得到教训: Rescue from Vehicle-House Crash

经过

文章和照片由Dan Fuller

晚上11点后不久2009年11月8日，北达科他州的迈诺塔，房主在家里醒来时醒来后，随后是家居烟雾探测器的报警，激活。当他去房子的主楼时，他发现两个陌生人试图通过前门离开居住，锁定。他打开了门把它们走出了房子，进入了地下室，在那里他找到了一辆已经撞到了房子前面的车辆，并降落在他的15岁的女儿，他在床上睡着了。Minot Central Smaratch收到了他的911呼叫，并立即进行两种发动机，梯子和救援的完整第一警报响应。

（1）来自内部的场景。

（2）从后部撞到地下室的车辆的视图。

发动机3首先到达场景，并建议所有传入单元继续热响应。规模-up from the curb revealed that a large sedan-type vehicle had crashed though the wall of a two-story, wood-frame, split-level house. Engine 3’s captain established command and found the patient pinned beneath the front bumper of the car and a futon-type bed. She was lying supine; the front bumper was resting on her chest from the midline over to her left shoulder. The rear wheels were caught on what was left of the A side wall and was resting at a 45° angle. The patient’s mental status was appropriate; she was alert and oriented to person; place, time, and event. Her skin was pale, cool, and moist to the touch. Her chief complaint at this time was difficulty breathing. A firefighter/paramedic from R2 took over patient care from the ambulance crew. The ambulance company did not provide their crews with any personal protective equipment for such an event, and it was obvious a provider needed to be with her during the rescue. A large-bore intravenous (IV) was established in the right forearm. CMS was present bilaterally, and the patient’s pupils were constricted and sluggish. Her blood pressure was 80/50, and the patient reported no pain on initial assessment. She became combative as the救援进展，尖叫并试图摆脱车辆。她的生命体征在整个过程中监测救援.

发动机1和梯子2到达场景and staged to the west of the scene. As the incident progressed, a rescue plan was formulated. The vehicle obviously needed to be lifted off the patient. The issue was how to lift the vehicle off the patient while ensuring it remained level. If the vehicle were to dip to one side or the other, it could impinge the patient’s legs or head, causing more injuries. Three teams were set up: a medical team, an interior team, and an exterior team. The medical team was set up in the adjacent room and prepped all of its equipment to make a rapid transport once the patient was freed. The interior team was responsible for setting up cribbing and the air bags. The exterior team was responsible for securing the vehicle so that it did not pitch forward or move from side to side. The vehicle was a Cadillac SRX, a type of SUV-sedan “crossover.” It was secured to Rescue 2 with a 16,000-pound winch that was mounted on the rear of the truck using the tow hitch receiver. This setup allowed us to have more immediate access to our hydraulic tools, since they are mounted with reels in the rear compartment of the truck (the truck was ordered this way from the manufacturer). Minot Central Dispatch, at the request of the Minot Police, notified a wrecker service just after the initial dispatch. It arrived on scene and tied off on the front of the rescue in case it was needed. A metal chain was looped around the vehicle’s rear axle and secured to the rescue as a safety measure as well.

（3）褶皱和气囊设置。

（4）内部车辆的另一个视图。

使用婴儿床和患者抬起患者气囊。该击打是24英寸长4×4木材。两个单独的盒子婴儿床由混凝土地板制成到每个轮组件的内部。然后加入了一块三英尺平方的胶合板，以使气囊一些稳定性。然后，决定试图因为她的严重状况而试图将车辆从患者身上抬起。这技术救援拖车和特殊运营救援将需要一个呼叫船员到员工，它在镇的另一端，这意味着至少需要20分钟才能回应。病人变得良好，开始失去意识。我们慢慢地抬起气囊并绞掉车辆。一旦汽车距离胸部大约半英寸，患者的精神状态，呼吸速度，质量和颜色都会有所改善。

Once the vehicle was off the patient’s chest,我们进行了手动C脊柱固定，同时她滑到墙上。这创造了足够的空间来应用C-onlar。在这一点上确定了车辆不能抬起足以完全滑出女孩。命令决定切割床柱子放下床的末端足以将她拉出来并进入篮板。床柱的直径约为三英寸的管状钢制成。液压切割器用于切割每个柱，在床架水平附加的点。腿被移除，床掉下了八英寸，创造了去除患者所需的空间。在此过程中，迅速评估患者的患者的面积损伤和重大出血。什么都没有注意到。她滑到了篮板上并担保。 Removal from the entrapment took less than 20 minutes from arrival, and the patient was at a Level 2 trauma center within 26 minutes from dispatch.

得到教训

为城市的高级寿命支持救护车服务，即医院所有，不培训its personnel inextr或者用适当的安全装置用适当的安全齿轮，如此。手套，头盔和眼睛保护会有所帮助，但由于汽车的位置和患者周围的碎片，均匀的裤子和发出的轻型三季夹克没有提供任何防止切割和擦伤的保护。拥有交叉训练的消防员 - 护理人员提供了一种快速解决问题的解决方案，但这不是永久性修复。

救援2携带两英尺-square crates of 4 x 4 cribbing onboard with 18 pieces of 4 × 4 cribbing total, and every piece was needed to make up for the height needed to reach the front axle of the vehicle. More room is available on the truck, but the need for more cribbing was never identified until this incident. Recommendations for “light rescue” certification for the state is eight 2 × 4 × 18-inch blocks and eight 4 × 4 × 18-inch blocks. “Heavy rescue” is eight 2 × 4 × 18-inch blocks and 16 4 × 4 × 180-inch blocks. Although the Minot Fire Department meets the heavy rescue certification by the state, this incident illustrates the need for more resources than those required by the state.

双重-location winch was used in the rear of the truck for this incident. The design gives operators the flexibility to use the winch no matter which way the truck is pointing. In this case, backing the truck into the scene enabled us to have the hydraulic tools closer to the incident where they were used.

冗余，虽然“低-Tech，“将链条围绕后轴的安全措施很好。然而，使用轭类型的系统将轴的每一侧连锁每一侧更适合，我们在现场没有拥有。它将更安全，阻止车辆向前倾斜，同时防止它向左滑动。

通过患者的状况正确地确定救援的速度。她的精神状态，包括灵感率和深度的呼吸努力以及皮肤颜色/温度/条件都是缺氧患者的迹象和即将致力的血管休克。一旦确定所需的情况，就必须立即从夹带中移除患者，计划，执行并重新评估救援，因为事件进行了进展。一旦患者从现场移除，一旦从R2骑行的消防员/护理人员都与救护车到了医院。引擎1的船长将这个女孩的父母推到了私人车辆的医院，以便他们在医院有一次运输，因此他们不会以兴奋的状态开车。房子里的洞用胶合板固定，所有单位都返回服务。将父母驾驶到医院并在建筑物中登上洞并不必要，但他们确实改善了整体客户服务。这个女孩患有臀部骨折，并在第二天发布。她在四个月内回到了篮球场。良好使用事件命令系统，熟悉所使用的工具，冷却头导致成功救援。

丹富勒是Minot的消防员（ND）消防部门。他还是NREMT认证的护理人员，消防服务教练和北达科他州消防员协会的测试仪。在开始起火事业之前，他是美国空军中军士的一名员工，在那里他服务于八年。

相关链接

相关文章更多来自作者

没有帖子显示