Table 1 Definitive roadside rescue skills scale
Item rating | 0 | 1 | 2 | N.A | ||
|---|---|---|---|---|---|---|
Individual protection for each responder | High-visibility vest with each responder's role marked on the back | |||||
Safety shoes | ||||||
Long sleeves | ||||||
Safety helmet | ||||||
Blue gloves for trauma patients | ||||||
Site security | Approach marking by the ambulance driver | |||||
Positioning of the SMUR vehicle according to traffic direction (upstream if accident is in the traffic direction and downstream if in the opposite direction) | ||||||
SMUR vehicle parked with wheels turned outward from the road axis | ||||||
Prohibition of walking in the safety area called the “buffer zone” upstream of the accident | ||||||
Flashing lights and hazard lights turned on | ||||||
Facing traffic when moving on the road | ||||||
Consideration of threatening environmental factors (electric poles, fires, etc.) and complex situations (cut cables, energy leaks, battery damage) | ||||||
Communication of threatening environmental factors and complex situations to the rest of the SMUR team and firefighters | ||||||
Adapting safety measures to the identified threats and complex situations without compromising the rescue of victims | ||||||
SMUR team stays back as soon as a dangerous situation is identified | ||||||
Engine of the crashed vehicle turned off if safety conditions allow | ||||||
Primary stabilization performed if safety conditions and the situation allow | ||||||
Parking brake of the crashed vehicle engaged if safety conditions allow | ||||||
Vehicle security | “P” position selected on the gear lever of an automatic/electric vehicle if safety conditions allow | |||||
Smart key kept at least 5 m away from the crashed vehicle if safety conditions allow and if easily accessible | ||||||
No unnecessary manipulation of the crashed vehicle | ||||||
Person rescue | Approach | Searching for access points for rescuers to reach the patient | ||||
First visual contact made facing the patient to maintain head-neck-torso alignment | ||||||
Head immobilization performed in the safest and most comfortable way | ||||||
Face-to-face visual contact interrupted only when head immobilization is performed | ||||||
Emergency evacuation (in case of cardiac arrest, respiratory arrest, uncontrolled active hemorrhage, etc.) | ||||||
Victim prioritization | ||||||
Prioritizing actions for care | ||||||
Inter-service Communication | Clarifying the role of each responder during various actions to avoid unnecessary crowding around the victim and the vehicle | |||||
Consultation between emergency physician leader and the COS | ||||||
The emergency physician leader and the COS define a medical access point | ||||||
Immobilization technique before extraction discussed based on the planned maneuver and the patient's clinical condition | ||||||
A rapid extraction axis is defined if an emergency evacuation is necessary | ||||||
The improved extraction axis is defined | ||||||
Estimated extraction time for improved extraction | ||||||
The doctor/paramedic leader and the COS define a maximum extraction time not to be exceeded | ||||||
Regular reassessment and communication on the situation | ||||||
Systematic anticipation of an emergency evacuation | ||||||
Emergency evacuation remains a possibility, and the organization of the ideal or rapid exit should not prevent this possibility | ||||||
Situation report given to the SAMU to anticipate available and necessary hospital resources for victim care | ||||||
Protective cover used during the cutting phase | ||||||
Vigilance around cut areas and placement of protective shields | ||||||
FFP2 masks for responders and victims during glass cutting | ||||||
Helmet and safety goggles for responders near cutting areas | ||||||
Continuity of care | Regularly reassess the autonomy of the oxygen bottle | |||||
Regularly reassess the battery of the ventilator throughout the intervention | ||||||
Monitor always visible in the safe zone | ||||||
Organizing equipment for good ergonomics | ||||||
Note the time of tourniquet application in case of uncontrollable hemorrhage | ||||||
Patient extraction | Patient prepared for extraction (stretcher ready, vacuum mattress in place) | |||||
Ambulance heated in winter | ||||||
Blanket available | ||||||
Patient covered as soon as possible | ||||||
Secure vascular access before patient mobilization | ||||||
IV lines clamped before patient mobilization | ||||||
Agreement of all actors involved in patient mobilization obtained before extracting the patient | ||||||
Head-neck-torso alignment preserved | ||||||
Intubation tube secured by the emergency physician during transfer | ||||||
Remove unnecessary medical equipment and ensure that the rest of the equipment follows the patient during extraction | ||||||
Check vascular access patency after vehicle extraction | ||||||