奇数：刺激事件

THE RESCUE COMPANY❘MARK GREGORY

这似乎是一个例行的一日游 - 全天一场奔跑，随后进行了一些新的钻探Man vs. Machinery成套工具。由于午餐即将供应，该公司因当地住房项目的后方的“未知创伤事件”而被调音。在回应期间，Dispatch建议男性从第二层窗户掉下来，并在锻铁栅栏上刺穿。

On arrival, the officer and ironsfirefighterperform a scene size-up.Emergency medical services (EMS)personnel are already tending to the patient, and advanced life support measures are in place. Police have secured the area around the patient. The male is conscious, with his left femur impaled on a wrought iron picket. He is currently being supported by bystanders and EMS personnel.

• Construction Concerns: Impalement Hazards
• IMPALEMENT EXTRICATION
• 强化反应考虑
• Training Minutes: The Effects of Different Tools During Impalement Rescue

确保患者

As the公司官员, the information you have processed so far as well as your prior experience with these incidents dictate your next course of action: securing the patient. There are several methods you can employ. You can establish a high-point anchor and you can support the patient with a webbing body harness (photo 1). The scoop stretcher is another option that members of your company have used in the past. The ability to “split the stretcher” around the fence pickets and cross beams can be beneficial to stabilizing your patient. Your tool of choice for this incident is a multipurpose ladder (photo 2). You can use it as a platform to stabilize the patient at various heights.

You order the members to place the multipurpose ladder parallel to the fence with a backboard resting on it to stabilize the patient in the supine (on his back) position. You position the multipurpose ladder and backboard slightly lower than the top of the fence to aid members with room to disentangle the patient. Backboard straps secure the patient to the board.

• 刺激测试部门新资源
• 工业刺激课程

Disentanglement: Tools of Choice

With the patient secured to a stable platform and medical interventions in place, it’s time to decide which tool to use for a successful extrication. The truck company officer working alongside you calls for one of his members to bring over the battery-operated cutter. You confer with the officer and advise him that the cutter is not the tool of choice for this incident. From prior experience, you know that the cutting/shearing of metal will cause this tool to torque (photo 3). This torquing motion can cause the patient further injury and pain. Instead, you choose the battery-powered band saw.

The battery-powered band saw has been a fantastic addition to the rescue world and comes in either a battery or an electric version (photo 4). The tool does not emit much noise as it operates, which is a plus for the patient psychologically during the disentanglement. Keeping the patient as calm as possible during these incidents will be a benefit to his care as well as to the environment in which your responders are operating.

乐队锯是一个受控的切割。与右角磨床，往复式锯或切断锯等工具不同，乐队锯会产生较小的振动。热量耗散也很少，因为我们没有使用刀片的一部分切割，而是使用束带的整个长度。从锯中切割的末端也将是一个平滑的切割，这对于创伤中心人员至关重要。右角磨和截止锯等工具可以在完成切割上留下尖端的边缘。往复式锯和液压/电池切割器将锯齿状的边缘留在切割中（照片5），这会给创伤中心人员带来潜在的撕裂和撕裂危险，从而造成额外的内部伤害。锯切的切割是光滑的，这将极大地帮助拆卸物体去除，而拆卸过程中几乎没有额外的伤害。

Having a second band saw ready to go is also a “heads up” move because the band can snap or wear during the operation. Having a second band saw and spare batteries, if using a cordless saw, will allow you to maintain a continuous operation with minimal downtime.

解开时间：削减时间

The team has methodically performed all the steps necessary to continue working toward a successful disentanglement. The patient is secured, medical interventions are in place, and the necessary tools to get the job done are on scene. Now, you must decide where to make the cuts to free the patient with the cordless band saw.

锻铁围栏（照片6）由横梁和纠察队组成。纠察队不支持围栏的重量 - 交叉成员可以。如果在纠察队之前切割交叉成员，也可能发生扭曲。围栏和患者的重量现在需要加强。这将涉及其他成员的协助，这可能会阻碍行动。因此，首先取下纠察队，然后是交叉成员。

Cutting operations commence. The tool operator is guided by your call. The decision has been made to cut a section of fencing that is slightly larger than the impaled area. This is because of access issues with the cross member and from working so close to the patient.

纠察队已成功切割。现在，是时候裁员了。您必须通过附着的患者解决围栏的重量。削减将很快，成员必须在患者/篮板上安全地握住，这也将由多功能梯子支撑。削减了，病人现在是免费的。围栏的切割部分与患者一起运输到创伤中心。

这项工作还不完整

病人已经脱离了栅栏,now being prepared for transport by the ambulance. As a seasoned boss in the extrication world, you know the job is not yet complete.

病人要除去的栅栏前,you delegated another officer to ensure that transport can be attained. The measurement of the cut section of fence must be addressed. The patient must have proper clearance to be transported on the stretcher from the side wall of the ambulance. If this is an issue, one option would be to transport the patient on the stretcher feet-first rather than headfirst or use the bench wall position for transport.

该患者已成功加载到救护车中，您的公司跟随HM到达创伤中心，以防您需要进一步服务。在受创伤医师检查的检查后，他确定可以在手术程序中安全去除围栏，而不会造成其他伤害。患者将完全康复。

后批评

Your crew members as well as the other companies involved (EMS included) performed admirably. Thus, it is a good idea to conduct a post-ops critique. Go over the entire operation. Why were certain procedures performed? What was the reasoning behind the tools used? Would other tools or techniques have been advantageous to use? Share the results of the post-ops critique with other shifts to provide them with the plan/ideas necessary to repeat a successful outcome.

Drilling is the key to success. Although these responses may be rare for your department, rescuers must be prepared to handle the variety of situations they may face. A simple tool familiarization drill will allow rescuers to understand the pros and cons of the various tools we carry.

另外，审查工具维护程序。如果需要，所有成员都应能够在现场对工具进行例行维护。乐队锯刀的更换是一个很棒的10分钟钻头。另一个伟大的演习是展示使用工具切割的正确方法。

Keep in mind that some members will be involved in the disentanglement process, some in safeguarding transport, and others in trauma center ops. All members should be familiar with all areas of the rescue to ensure the best patient care possible.

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MARK GREGORY是一名35年的消防人员，纽约消防局（FDNY）的31年老兵。他是梯子176的队长，此前曾在塔梯子142，第13和15号塔梯子上担任船长；塔梯子111中的中尉；以及救援2和梯子132中的消防员。格里高利（Gregory）在FDNY和萨福克郡消防学院（FDNY）和P.L.的首席讲师指导。瓦肯消防训练。