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  • extrication advice.

    I work at an ambulance service that provides all of the extrication in our area. We carry a full set of jaws on one ambulance and a motor and omni tool on the other four. The fire dpts. in our area do not do the extrication, it is up to EMS. This routinely creates resorce problems as it is highly possible for one paramedic and one emt to be responsible for patient care, command and extrication. At time we may have first responders or fire show up, but there is no garentee as they are all vol. Could I please here you comments on this system. I would like to know if any other systems are set up this way, pros, cons. Wha is the ideal # on an extrication team? Any input would be welcomed. Thanks

  • #2
    An ambulance crew doing extrications is totally foreign to me. Is it common in your area? In my area the FDs do the extrication. Are you at least training with the FDs in your response area so they can assist you? Have you tried to get them to take over this duty?

    Even on a basic door pop I like to have at least four trained people on scene.

    Apparently you guys are used to this system but I don't know how you do it.

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    • #3
      No we don't train with the fire dpts. The ambulance does all of the extrication. There has been no attempt to get the fire dpts. to take this duty over. Generally on a mva a typical responce will be two ambulances, however we do a lot of long distance transfers and that only leaves 1 ambulance (1 medic, 1 emt) to do all facids of extrication, pt. care, and command. I'm sure you can see the frustration in this. I dont believe it is a very good system. What I'm looking for is any information on any place else doing this. Does anyone have any EVIDENCE that this is not a good way to do extrication? Thanks

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      • #4
        I once worked for an ambulance service in Mississippi that did the extrication. We were a hospital based service and the local Fire Department didn't want to do it becasue the chief said it was "too expensive".

        Back then, (were talking in the 70's) we only had manual portapowers and a couple of other hand tools.

        We developed a protocol, that if we had an accident response that involved extrication we automatically requested the Fire Department, (He thought it was too expensive to do extrication, and we thought it was too expensive to put a tank, pump, and hose line on our ambulances)and we had our disptcher send a second ambulance.

        This way we were able to have one start the extrication, one stay with the patient, and when the calvary arrived, the Fire Department was our manpower pool, and the back up unit assumed all patient care once they were on scene.

        We didn't have Incident Comand back then, but the first unit in did the extrication, and then cleaned up the mess, and the second unit in took the patient to the hospital. Things would get hairy when we had 2 or 3 or more patients.

        I wasn't the best way to do things, but it was all we had, so we made the best of it. for all I know now this service may not do the extrication, and the new Fire Chief or Chiefs may have taken the role of extrication from the hospital EMS.

        This may not be of any help, but the concept of EMS doing extrication is rare but not totally unheard of. There are a couple of volunteer First Aid and Rescue Squads in New Jersey that do the extrication as well. I wish you luck.

        Ed Brando


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        • #5
          If you are looking for evidence point out the number of jobs that need doing and that four people for extrication, stabilization, suppression, medical, etc. are simply not enough. I may be wrong but isn't it NFPA standard to have a charged hose line during extrication? Can you call for mutual aid to get the fire crews to assist? Could you call for a Mass Casualty Incident (MCI) since a standard MVA could easily overwhelm your capabilities? At any rate start training with the fire departments. Who knows, they may even want to start doing it. If nothing else you will at least work better together when you have to. Within our system the ambulance is run by the hospital with fire handling the extrication, we are simultaneously dispatched. We have four crews that are on call on a rotating basis (one week on, three off). Our county also has a mutual aid association. As an association they get more accomplished and we all work together quite well. They have established criteria for automatic dispatching, more than one entity may be dispatched automatically based on the call. Best of luck.

          ------------------
          Train like you want to fight.

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          • #6
            In the NJ county my agency operates in, just about all of the EMS agencies do rescue. Some FD's are just getting into it but it creates a duplication of services which, in my mind, is a waste of township funds which could go towards more neccessary things. Most of the Rescue Squads have their seperate Rescue Companies and Heavy or Medium Rescues. Sometimes we can come up a little short on personnel so we do some joint training with the local FD's, who are automatically dispatched on MVA's, on basic scene stabilization and assisting us. We also outfitted all of their engines with cribbing in case they are first to arrive.
            With EMS doing rescue, there is more emphasis on pt care. I remember pulling up to an MVA only about a year ago and witnessing the FD, untrained in any extrication or pt care, prying and pulling the doors open with a halligan bar with no stabilization! Our system has been proven to work for many years.

            JH

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            • #7
              jhaney, While it may or may not be true that it is better as far as pt. care with ems doing extrication, I'm talking about resorces. It sounds like you guys have rescue trucks and people to man them. My county has no rescue truck at all. All extrication gear is carried on the ambulances. If only one ambulance is available, the ems crew is responsible for all facids of the operation except law enforcment and fire supression. We must: Do scene size up, evaluate pt. perform pt. care, establish and run incident command, evaluate extrication tactic, remove and set up tools, perform extrication, remove patient, continue caring for patient, load up tools and transport patient. All of this is done by two people, a medic and an emt, and in full turnout gear. I'm sure you can see the resorce problem. I dont disagree that ems should or shouldnt do extrication but if we are going to, it would be nice to have a rescue truck and personel to man it.

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              • #8
                LT334

                Interesting that you are in the predicament that you are in! I'll tell you a short story about what happened in our area.

                F.D. is volunteer and the Ambulance service is private non-profit volunteer.

                At first, the medical training required of personnel was minimal. Remember the old "Load-n-Go" technique? Then of course, as time went on, we now have very intricate and time consumming training as well as continuing education to keep certifications.

                Initially the ambulance squad purchased the 1st "Jaws" through a revenue sharing program that the state of VT. had. (It no longer exists of course) they were 100% responsible for their operation as well as the medical care.

                As time went on, the "Medical" personnel who were putting in a tremendous amount of time to be "Medical", didn't have time to do extrications.

                Hence the F.D. now does 100% of the extrications and our ambulance does 100% medical service.

                Point to ponder: If you have a trained EMT and a Medic who are medically incapacitated because of the lack of manpower and the fact that there is much too do then, how good is the patient care?!

                These people have put, and I am sure, continue to put in a tremendous amount of time to maintain their medical certs. Why should these people be put in a situation that does not allow them to use their medical expertise?

                I would suggest that you approach the area F.D. and perhaps work out some sort of deal where they will provide the extrication and your guys can provide the medial care.

                Please let us know what you come up with for a solution. We were fortunate to be able to work it out very quickly and both parties were, and still remain very satisfied.

                Good luck!!

                Bill spirka, Captain

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                • #9
                  Problem is the administration of the ambulance service does not want to give up extrication, he enjoys the fact that we are the "only" ambulance district to do our own extrication. All of the rual fire dpts. are volunteer and there is no guaranteed responce from them. We have a city fire dpt. that could do it, however they dont want to. Uless the county went to a differant fire dpt. setup, there are only three options, 1) try to force the city fire dpt. to do it. 2) get an outside agency to do it. or 3) continue to do extrication ourselves. #3 is probably the best option, but in my opinion there needs to be a differant setup than handling extrication from ambulances. The ambulance service doing it and getting a rescue and the personel to man it is probably the best option. However the administration, either for financial reasons, pride, or ignorance doesn't consider this an option. What I would like is PROOF that the way we do it is not the best for patient care. Then I can present it to the correct people and answer all of tier arguments against it. Thanks

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                  • #10
                    Lt334
                    It sounds like you're the lone ranger on this issue and if the higher powers are dead set against giving up extrication you're going to have a hard time convincing them to change.

                    The only "proof" I can think of is when a patient dies because of an extended extrication and insufficent medical care during the removal. It sounds like you guys have done extrication forever and somehow you make it work.

                    IMHO your services' best option is to reach out to the VFDs in your territory and ask for their help. If you've always done it and haven't asked for their help in the past they are not going to offer. You'll have to approach them. You've got the tools and the training, they've got the people (or at least more than you do). Even if you keep the tools they can assist with extrication when they arrive and they should be there on an MVA anyway.

                    As far as there being no guaranteed response from the VFDs....where the hell is mutual aid?

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                    • #11
                      We have six smaller vol. fire dpts. Since they are so small, there are a lot of times when we dont get a responce from a fire dpt. in a resonable time to do extrication.

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                      • #12
                        Three words for you Lt334,THE GOLDEN HOUR. Tell your administrator that you are compromising the patients time of survival and it would greatly affect the out come of the patient if you could transport them faster. The other option as you stated is to purchase a "RESCUE VEHICLE" designated for the purpose of extrication. A small utility body would do the job in most cases if all you are going to be used for is extrication.
                        I would also talk with the FD's in your area and try to schedule some type of training in the field of vehicle extrication. Lets face it, how many fireman don't like to cut up a perfectly good car or truck? I never miss the opportunity . I wish you luck it sounds like you have a real manpower problem that could do real harm to someone real fast.

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                        • #13
                          LT334,

                          Several opinions that I have. The first is that the reason that your higher ups may not want to give up the extrication is that they may be "charging" the patients for these services. Money talks.

                          The second is that you may need to revamp the way that you perform extrications. If you are worried about the time it takes you to take out, set up, and then put away equipment, there may be faster ways. Retractable or electric hose reels may be an option for the hydraulics and slide out trays for the power head. I have thought of this same idea for a type III, it would work pretty well. Another idea is to equip your rigs with reciprocating saws. They are quick, light, and can cut a lot of metal fast.

                          My department covers an area that is served by 4 fire departments. We do all of the extrication (not to mention most all other rescues). We have a rescue truck that carries all of the equipment. And special personnel to man the truck. Most of our people are crosstrained in all areas (ems, rescue, fire). Our philosophy is that the extrication MUST be patient orientated. If the fire departments do not want to be trained in EMS or train with us on extrication, they will not be involved. They perform fire protection and traffic control.

                          Just some of my opinions and ideas. Hope they help.

                          Chris Schultz
                          Mountain Ambulance Service www.rescue70.org

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