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The most common source of entrapment and entanglement in most locales is the motor vehicle collision. Other potential sources include industrial accidents and agricultural incidents. It is imperative that medical providers have a standardized approach to these situations, have basic familiarity with safety issues and extrication concepts, and understand that the medical approach to these situations is unique.
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Describe motor vehicle, industrial, and agricultural-related causes of entrapment and entanglement.
List key nonmedical personnel and bystanders who are present on the scene, and may serve as a vital asset during these operations.
Describe the initial approach to the entrapped and/or entangled victim.
Provide a basic description of tools utilized by fire/rescue personnel during extrication operations.
Describe the dangers associated with medical operations within a motor vehicle during extrication operations.
Discuss unique challenges to airway management in a motor vehicle.
Discuss management of hypotension and hemorrhage in the entrapped and/or entangled victim.
Discuss the criteria associated with the consideration of field amputation.
List other resources and personnel that may be helpful during this unique type of call.
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INITIAL APPROACH TO THE ENTRAPPED OR ENTANGLED PATIENT
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The initial approach to any scene should always be the same but special attention is necessary when arriving first. Scene safety begins with the call going out/dispatch notification. Activate all possible resources early; it is always better to turn away resources when they are not needed than to need them and be delayed because they are not on scene. Access point and direction should be considered for any potential hazardous materials involvement. Likewise, flow of traffic and positioning of vehicles should be considered during the initial approach. Medical vehicles should generally be close to the patient without jeopardizing contamination or damage to the ambulance. Positioning of medical vehicles should be in such a way as to be protected by larger vehicles such as fire apparatus. The path to and from the vehicle should be out of traffic—in many extended operations there will be multiple trips to and from the vehicle for equipment or supplies; the more trips through or close to passing traffic, the more likely there is to be a secondary incident. Vehicles should be parked so as not to impede the loading of a patient into the ambulance and so as not to block the ambulance in at the scene. Upon arrival, there should be a visual scan for any downed lines or electrocution hazard.
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If you are the first rescuer on scene an appropriate size-up should be made and conveyed to the communication center and other responders via radio in most cases. Basic information includes number and general acuity of patients and whether additional or fewer resources are needed and the response mode required on other incoming providers. Advise other responders of hazards to expect. In the common situation of an MVC with reported entrapment ...