Non-medical pre-hospital equipment: DipIMC practice questions
PHEM curriculum unit 3.4 · Theme 3: Using Pre-hospital Equipment
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 3.4, Operate common non-medical pre-hospital equipment.
Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 5 questions on this unit.
Question 1 · Scene Safety & Extrication · Moderate
A front-seat passenger in a car resting on its wheels has both lower legs pinned by the intruded dashboard after a frontal impact. The roof has already been removed. Which fire service technique is used to free the legs?
AA B-post rip, removing the B-post with the rear door attached
BA roof fold-down, cutting the upper posts and laying the roof down
C'Making an oyster', opening the crushed side with hydraulic rams
DA dash-roll or dash-lift, moving the dashboard off the legs
EGlass management, removing the windscreen in a controlled way
Show answer
Answer: D
A dash-roll or dash-lift, moving the dashboard off the legs
The ABC's account of space-making explains that for a car on all four wheels the simplest plan is usually to take the whole roof off; once access is made into the passenger cell, further space-making may be needed, such as a dash-roll or dash-lift to move the impacted dashboard off the patient's legs. The Oxford Handbook describes the same manoeuvre, hydraulic removal of the dashboard from a trapped front-seat passenger (the dashboard roll), in its full access phase. The other techniques belong to other geometries: the roof fold-down is the standard A-plan approach for a vehicle on its side, the B-post rip is used for a vehicle on its roof, and 'making an oyster' opens up the side of a crushed, inverted vehicle with hydraulic rams. Glass management is carried out to allow space-making such as roof removal and to prevent uncontrolled breakage, not to release trapped limbs. The ABC also advises checking that space-making is really needed before committing to it: limbs sometimes appear more trapped than they are, may be freed once adequate analgesia is given, and removing the patient's shoes can sometimes free feet trapped in the footwell.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: dash-roll and dash-lift · p. 113“move the impacted dashboard off the patient’s legs”
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: vehicle on its side, roof fold-down · p. 113“The standard A-plan approach involves the ‘roof fold-down’ technique.”
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: vehicle on its roof, B-post rip and making an oyster · p. 113“When a vehicle is on its roof, there are a number of techniques”
Ch. 21 Trauma: Extrication of the Trapped Patient · Glass management · p. 113“The glass of a vehicle is ‘managed’ to allow space-making”
Ch. 21 Trauma: Extrication of the Trapped Patient · Tricks of the trade: limbs that appear trapped · p. 114“Sometimes limbs appear more trapped than they really are”
Ch. 21 Trauma: Extrication of the Trapped Patient · Tricks of the trade: shoes · p. 114“removing the patient’s shoes where feet appear to be trapped in the foot-well”
Oxford Handbook of Pre-Hospital Carepp. 700–702Ch. 13 Patient rescue and transportation · Conventional extrication: full access and the dashboard roll“hydraulic removal of the dashboard from a trapped front seat passenger (dashboard roll)”
You arrive at a rolled hatchback lying on its roof with the driver conscious inside. The fire officer outlines the space-making options. Which approach is described in the ABC of Prehospital Emergency Medicine for a vehicle on its roof?
ARear hatch access or a B-post rip, with hydraulic rams to open a crushed side
BA roof fold-down, cutting the upper posts and laying the roof on the ground
CA dash-roll to lift the dashboard off the legs before any other space-making
DFull roof removal once the fire service has stabilised the upturned vehicle
ERolling the vehicle back onto its wheels, then full roof removal as for an upright car
Show answer
Answer: A
Rear hatch access or a B-post rip, with hydraulic rams to open a crushed side
ABC of Prehospital Emergency Medicine matches the space-making plan to the position of the vehicle. For a car on all four wheels this usually means taking the whole roof off, with a dash-roll or dash-lift afterwards if the dashboard is on the legs. For a vehicle on its side, the standard A-plan approach is the roof fold-down, in which the upper supporting posts are cut and the roof laid down on the ground. When a vehicle is on its roof, access can often be made through the rear door of a rolled hatchback or by a B-post rip, in which the B-post is removed with the rear door by cutting it at the top and bottom; where the roof has been crushed, hydraulic rams are used to open up the side of the crushed vehicle, known as making an oyster. Rolling the vehicle back upright and tackling it as a car on its wheels is commonly used in some countries but rarely carried out in the UK. Shared terminology lets the clinician understand what the fire service can achieve, and how long it will take, when agreeing a plan A and a plan B.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: vehicle on its roof · p. 113“When a vehicle is on its roof, there are a number of techniques”
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: vehicle on its roof — making an oyster · p. 113“hydraulic rams to open up the side of the crushed”
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: vehicle on its side · p. 113“The standard A-plan approach involves the”
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: vehicle on its wheels · p. 113“wheels, this usually means taking the whole roof off”
Ch. 21 Trauma: Extrication of the Trapped Patient · Space-making: rolling the vehicle upright · p. 113“some countries but rarely carried out in the UK”
scene-080 · Scene Safety & Extrication · Extrication · Hard · v2