戴夫·达利姆普（Dave Dalrymple）
Photo courtesy the Indianapolis Fire Department
Many of the ideals and methods firefighters retain about vehicle extrication as a subject matter have been handed down over the past 50 years or so ago. Let’s think about that for a moment. We’ve had automobiles for more than 100 years. But we’ve not had “modern” rescue tools since the 1960s. The 1970s saw the emergence of two important parts of the response equation: power hydraulic rescue tools and EMS. The 1980s saw the emergence of a key point of vehicle extrication, namely training materials. Harvey Grant wrote his first book on vehicle rescue in the early ‘80s, and in the latter part of the decade saw the introduction of the first video-structured training program that had supporting written documentation in the format of instructor guides. This program was called “The Carbusters,” and was authored by Steve Kidd and John Czakowski. Part of the Carbusters series was a video tape by Ron Moore, who was an early pioneer in realm of school bus extrication. The early ‘90s saw books emerge from Ron Moore, a second edition ofVehicle Rescueby Harvey Grant and Jim Gargan. On the training grounds, we had Dwight Clark, OB Streeter, Al Sergio Sr., Don Gardner, Ken Jones. These are just a few of the many that took some of the lessons and added their own life knowledge and skills to the discipline, advancing vehicle extrication so that we might add our own contributions. Vehicle rescue instructors today are truly standing on the shoulders of giants.
The Patient Is the Priority
但是，我们对过去的教训过多吗？作为下一代教师，我们有什么“新”思想，概念，方法论，技术？可以肯定的是，我们采取了工具的发展并沿进化量表进行了进步，使进化更快，更顺畅，更安全。我们对它们进行了改进，甚至创建了新的，以使旧的旧工作再次起作用。
But what about methodology? What about the bigger picture? Well, the two biggest items at a motor vehicle crash are patient care and safety. Safety is always paramount. There are fantastic gear options nowadays, including Hi-Viz vests. We have traffic incident management training, and we protect scenes today with apparatus. We even have on-scene hazard information available via smartphone or tablet apps. At every training class we attend, patient care is mentioned. Yet in the practical skill sessions, how often do we see some sort of “patient representation” in our training vehicles? Some train this way, but many do not.
有关的：PATIENT CARE AT MOTOR VEHICLE ACCIDENTS|病人和救援考虑|救援Real Estate: Simultaneous Operations at a MVC
当培训中没有一个人时，我们如何期望我们的学生在各个层面上与患者互动？这使我们能够执行“垃圾场”工具的演变，例如42英寸的破折号升降机，坐在驾驶员的腿部位置。您可能会问为什么患者管理如此重要？有人可能会说，我们有一辆救护车在车站外面，或者另一家机构将其提供给我们。它对该患者非常有价值，以至于您可以从内部和内部看到破坏的车辆的视觉线索。救援人员可以进行快速的患者评估，以评估他们正在处理的患者类型的类型，并确定他们是否有时间进行适当的解释。我们可能有95％的时间进行这样的评估，但是剩下的时间呢？那时候事情变得热，您必须忙碌起来，现在就有一个大洞！
If you don’t have those patient management skills, you might have a situation that involves rapid status changes in the car. Have you ever seen an incident where there is a dynamic shift or change that no one expects? There are usually negative consequences, and sometimes the patient expires in the vehicle. To return to our previous point, If the EMS providers arrive at the same time as you or before you, that’s great. But how many times do you arrive first on scene, or there are multiple patients to be managed? Firefighters do not need to be doctors or even paramedics, but they must have the fundamental ability to read visual clues and determine who is sick and who is not.
一个点上的术语。让我们使用des的短语cribe the full “circle of life” in our workspace, the vehicles. People enter the vehicle as “occupants.” When they have crashed, they become “casualties.” When we intervene and start care, they are “patients.” Finally, when all is said and done, they become “survivors” or “fatalities,” depending on the outcome. While we are speaking about vehicle extrication, all forms of rescue ARE patient care driven! Why else would we be there? What other metric of success should we as rescuers use? Along with that, after ensuring we go home safely, our aim must be to provide for a better patient outcome. Extrication is a medical intervention. Trauma is the disease of time.
Put those two declarations together and you get a powerful message that dovetails nicely with our priority: Making sure of a better patient outcome. Once again:
- Extrication is a medical intervention
- Trauma is the disease of time
- 努力确保更好的患者结果
Although spacemaking is a technical (mechanical) skill, its roots are firmly based in our patient outcome. Rescue is a patient-care driven skill.
To convert this mindset into a practical skill set along with spacemaking, we developed the concept of “Rescue Real Estate.” A group of instructors came up with this idea when we were trying to come up with a way to coordinate operations so that everyone who arrives on scene can work and not be in each other’s way. This idea developed into a concept over time and through trial and error at classes. It comes down to who does what job or role they play AND where that is in or on the vehicle. First off, hazard control, including power isolation, is handled usually by the engine. Since 97 percent of vehicles the 12V battery is either in the front or rear of the vehicle they “own” those areas. Second, since we have a patient involved in this motor vehicle crash and we need to begin patient management, EMS needs to access the interior of the vehicle, so EMS “owns” that space. Finally, our rescue team “owns” the exterior of the vehicle specifically, the sides between the front and rear wheels. If you think about it, pretty much all your tool evolutions are performed in that area on the vehicle. Try implementing this concept, and you will likely find it works surprisingly well.
Part 2: The Mindset and The Technique
DAVID DALRYMPLE,Aietecri，是克林顿（NJ）EMS/Rescue的消防员/EMT/救援技术员。他已经积极参与紧急服务已有34年了，教授运输救援主题已有22年以上。他是Lowwayrescue LLC的执行教育者，这是一个动态的运输救援培训团队。He has taught at FDIC since 2003, and was team captain when Clinton’s team won the world vehicle rescue challenge in 1998. He is certified as an International level extrication assessor and has taught and assessed in North America, Europe, the UK, and South Africa. In 2007, he received the coveted Harvey Grant award for excellence in rescue education. Dave is also a member of the Society of Automotive Engineers (SAE) task force on hybrids and electric vehicles for first and second responders. He volunteers as a fire/rescue technician for the Sports Car Club of America-Northern New Jersey region and is actively involved in emergency response at performance rally events with American Rally Association. He is a member of the International Council on Motorsport Science and his ESRS rally rescue program holds SFI accreditation. Besides writing for fire rescue publications, he is a contributing author for the PennWell消防员I＆II教科书，并在宾夕法尼亚州的车辆救援系列中有特色188金宝搏是正规吗消防工程。他还是三个季节的训练分钟视频的主持人。188金宝慱官网历史
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