Vehicle extrication

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Crashed car Car crash 1 (cropped).jpg
Crashed car

Vehicle extrication is the process of removing a patient from a vehicle who has been involved in a motor vehicle collision. [1] Patients who have not already exited a crashed vehicle may be medically (cannot exit a vehicle due to their injuries) or physically trapped [2] and may be pinned by wreckage or simply unable to exit a vehicle (ie because a door won't open).

Contents

Operations

Once an incident scene is protected, extrication can commence. Vehicle extrication can be considered in six phases. These phases are: [3] [4] [1]

  1. Safety and Scene Assessment
  2. Stabilisation and Initial Access
  3. Glass Management
  4. Space Creation
  5. Full Access
  6. Immobilisation and Extrication
A team of firefighters and rescue technicians secure vehicles during a training operation. SV-RTL In Action (16500296669).jpg
A team of firefighters and rescue technicians secure vehicles during a training operation.

Safety and Scene Assessment

Once a scene is protected, for example from other moving traffic, the fire service commander will complete a rapid assessment to identify any significant hazards [5] that may present immediate risks to emergency service workers, members of the public or the patient or patients. This may include fire, hazardous substances or risks such as the possibility of falling from a height being electrocuted or falling masonry from an involved building. Steps are then taken to mitigate these risks.

Stabilisation and Initial Access

Stabilisation can be thought of as three phases:

Phase 1 is rapid stabilisation, these are simple methods to improve vehicle stability:

·      Applying a parking brake

·      Applying a wheel chock

·      Applying a winch wire

·      Deflating tyres (this may compromise subsequent rescue efforts and forensic investigations)

·      Electrically isolate the vehicle

·      Using personnel to brace the vehicle

A crashed car being stabilised Crashed Renault Kangoo (3).jpg
A crashed car being stabilised

Phase 2 is stabilisation achieved using chocks and wedges under and around the vehicle.

Phase 3 is stabilisation utilising additional equipment to stabilise a vehicle, this may be more complex and include:

·      Hydraulic/pneumatic stability equipment

·      Lifting bags

·      Struts

Glass Management

Glass management involved controlling the risk posed by the windows of the vehicle. [6] This is far more however than just the removal of the vehicle’s windows. It must also include the control of any glass fragments which may pose a risk to the patient, attending emergency service personnel or which could damage equipment especially hydraulic hoses.[ citation needed ]

Space Creation

The space creation step starts with a structural assessment of the involved vehicle to determine which vehicle components could be simply opened, moved, or manipulated by utilising a vehicle’s natural design features. [3] This would include opening doors, windows or sunroofs and moving/removing seats or headrests. Beyond that, an extrication plan will be formulated which details which vehicle body parts will need to be removed, displaced or reformed to allow access to the patient or patients. [7] A number of specific techniques can be utilised and these are discussed later.

Consideration should also be given to moving the vehicle involved in the incident if that will aid space creation. [8] [9] Moving vehicles with patients still inside is permissible if deemed safe. Relocation of crashed vehicles may:

Full Access

Full access aims to ensure that you have enough space to meet and exceed a patient's clinical requirements and to meet the needs of emergency service personnel. [1] Space creation should allow access for medical trained responders to reach the patient. They can assess the patient and if required undertake medical interventions for the casualty for example; stopping bleeding, opening obstructed airways, providing medications such as oxygen or tranexamic acid.[ citation needed ]

Immobilisation and Extrication

Classic dogma was that individuals involved in road traffic collisions needed extremely careful handling, including the utilisation of cervical spine collars and spinal immobilisation boards.  This is not however supported by the available evidence base. [10] [11] Patients should be encouraged or assisted to self-extricate from the crashed vehicle as a first-line extrication plan unless: [12] [13]

If extrication is required, patients should not be transported on a rigid extrication (spinal) board, [14] as this can cause pressure injuries, and false positives on later examination of the back. [15] [16] [17] Cervical collars do not adequately protect the neck, [18] raise intracranial pressure, [19] [20] impedes airway management [21] and cause pressure ulcers, [22] [23] [24] and their routine use is not advised in the developed world, [25] [26] and if used they should be loosened at the earliest opportunity. [27]

Extrication tools and equipment

U.S. Air Force Kaylee Goodwin, a Civil Engineer Squadron firefighter, stands with a spreader, at Eielson Air Force Base, Alaska. The spreader is a hydraulic vehicle extrication tool designed to free crash victims from automobile wreckage and other rescues from small spaces. Iceman in action 150306-F-YW474-181.jpg
U.S. Air Force Kaylee Goodwin, a Civil Engineer Squadron firefighter, stands with a spreader, at Eielson Air Force Base, Alaska. The spreader is a hydraulic vehicle extrication tool designed to free crash victims from automobile wreckage and other rescues from small spaces.

Rescue personnel may use a number of powered rescue tools to extricate victims. There are three main types of powered rescue tools including:

Stabilization tools include:

Other equipment that can be used during a vehicle extrication include but are not limited to:

Vehicular Technical Rescue Techniques

Roof removal being demonstrated Extrication exercise (1).jpg
Roof removal being demonstrated

These include: [7]

A roof flap can be undertaken forwards, backwards or sideways. The technique is similar for all three, but the direct the roof is "folded" differs. The steps to perform this technique (forwards) would include: [32]

  1. Remove the glass from all side and rear windows
  2. Cut all seatbelts
  3. Strip trim around cutting points
  4. Cut all roof pillars except front A-pillars
  5. Cut “hinge” cuts in roof rail at windshield at the front of the car
  6. Flap roof forward and secure in position
  7. Cover sharps

Removal of the B-post or B-Pillar of a vehicle to allow improved access. The B-pillar is located between a vehicle's front and rear side glass, where it serves as a structural support of its roof, its removal leaves the side of a car wide open.[ citation needed ]

Third door creation (or conversion) provides additional access to patients in 2 door cars. [33]

The dashboard and steering column can intrude into the passenger compartment and crush a patient or restrict their movement. A dash roll, or dash relocation aims to create space by moving the dashboard away from the patient. [34]

Additional risks

Airbags

Paramedics successfully extract the victim of a crash in Toronto Paramedics extract a patient in a car accident.jpg
Paramedics successfully extract the victim of a crash in Toronto

Active systems such as airbags make cutting into a vehicle more complicated: when they are not set off during the crash (e.g. in a vehicle struck from the rear or a rollover), extrication operations may set them off. This can cause additional trauma to the victim or to the rescuers.[ citation needed ] Airbags can remain active anywhere from 5 seconds to 20 minutes after being disconnected from the car's battery.[ citation needed ] This is one of the reasons rescuers disconnect the vehicle's battery and wait before cutting into a vehicle.[ citation needed ]

Hood Hinge Struts

Hood hinge struts can pose a great amount of danger to rescuers who are extricating a victim from a car that had any significant heat in the engine compartment. According to the strut manufacturers, these sealed and pressurized struts are designed to operate at temperatures ranging from 40 degrees Fahrenheit to 284 degrees Fahrenheit.[ citation needed ] No manufacturer could provide any evidence that any testing at temperatures above 284 degrees Fahrenheit had ever been conducted. During a vehicle fire, especially an engine compartment fire, the two hood hinge struts will be exposed to high heat levels. Since there is no pressure relief "valve" on any of these sealed and pressurized struts, the units can fail violently when overheated.[ citation needed ] Unfortunately for firefighters, this failure can actually "launch" the entire strut or just one part of the unit a significant distance off the vehicle like an unguided missile. It is the launching of the heated strut that in several incidents across the United States, has caused serious injury to firefighters. [35]

Hybrid Cars

New hybrid technologies also include additional high voltage batteries, or batteries located in unusual places. These can expose occupants and rescuers to shock, acid or fire hazards if not dealt with correctly.[ citation needed ]

Liquid Petroleum Gas

Some vehicles have an additional autogas (LPG) tank. As the system was not built in, there is a risk of damaging the pipe which is often under the car, releasing the pressurized fuel. The risk of this is minimized by locating the line in a protected position during installation. Modern installations also have a shutoff solenoid at the tank so that rupture will only release the fuel in the line rather than allowing fuel to come out of the tank.[ citation needed ]

Specific Extrication Challenges

Car manufacturers are increasingly using ultra-high-strength steel (UHSS) to the crash safety ratings of their vehicles. UHSS is used in areas of the vehicle such as the A-pillar, B-pillar, rockers, side impact beams, and roof beams. This steel is difficult to cut with the standard extrication tools.[ citation needed ]

Carbon fibre poses unique challenges when used to manufacture vehicles. It is light and strong and can be difficult to cut. In addition cutting this material can produce particulates which are harmful to health, and breathing protection is required for rescuers and the casualty. [36]

See also

Related Research Articles

<span class="mw-page-title-main">Tetraplegia</span> Paralysis of all four limbs and torso

Tetraplegia, also known as quadriplegia, is defined as the dysfunction or loss of motor and/or sensory function in the cervical area of the spinal cord. A loss of motor function can present as either weakness or paralysis leading to partial or total loss of function in the arms, legs, trunk, and pelvis; paraplegia is similar but affects the thoracic, lumbar, and sacral segments of the spinal cord and arm function is retained. The paralysis may be flaccid or spastic. A loss of sensory function can present as an impairment or complete inability to sense light touch, pressure, heat, pinprick/pain, and proprioception. In these types of spinal cord injury, it is common to have a loss of both sensation and motor control.

<span class="mw-page-title-main">Hydraulic rescue tool</span> Tool used by emergency rescue personnel to assist vehicle extrication of crash victims

Hydraulic rescue tools, also known as jaws of life, are used by emergency rescue personnel to assist in the extrication of victims involved in vehicle accidents, as well as other rescues in small spaces. These tools include cutters, spreaders, and rams. Such devices were first used in 1963 as a tool to free race car drivers from their vehicles after crash.

<span class="mw-page-title-main">Rescue</span> Operations for life saving, or in response to injuries after an accident

Rescue comprises responsive operations that usually involve the saving of life, or the urgent treatment of injuries after an accident or a dangerous situation.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

<span class="mw-page-title-main">Major trauma</span> Injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

<span class="mw-page-title-main">Clearing the cervical spine</span> Process of determining the existence of a cervical spine injury

Clearing the cervical spine is the process by which medical professionals determine whether cervical spine injuries exist, mainly regarding cervical fracture. It is generally performed in cases of major trauma. This process can take place in the emergency department or in the field by appropriately trained EMS personnel.

<span class="mw-page-title-main">Spinal board</span> Device used in pre-hospital trauma care

A spinal board, is a patient handling device used primarily in pre-hospital trauma care. It is designed to provide rigid support during movement of a person with suspected spinal or limb injuries. They are most commonly used by ambulance staff, as well as lifeguards and ski patrollers. Historically, backboards were also used in an attempt to "improve the posture" of young people, especially girls.

<span class="mw-page-title-main">Vacuum mattress</span> Device used for patient immobilisation

A vacuum mattress, or vacmat, is a medical device used for the immobilisation of patients, especially in case of a vertebra, pelvis or limb trauma. It is also used for manual transportation of patients for short distances. It was invented by Loed and Haederlé, who called it "shell" mattress.

<span class="mw-page-title-main">Spinal cord injury</span> Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of the spinal cord and can be complete, with a total loss of sensation and muscle function at lower sacral segments, or incomplete, meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis, including bowel or bladder incontinence. Long term outcomes also range widely, from full recovery to permanent tetraplegia or paraplegia. Complications can include muscle atrophy, loss of voluntary motor control, spasticity, pressure sores, infections, and breathing problems.

<span class="mw-page-title-main">Cervical collar</span> Medical device used to support a neck

A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, although they should not be routinely used in prehospital care. They can also be used to treat chronic medical conditions.

<span class="mw-page-title-main">Kendrick extrication device</span>

A Kendrick extrication device (KED) is a device used in extrication of victims of traffic collisions from motor vehicles. Commonly carried on ambulances, a KED is typically used by an emergency medical technician, paramedic, or another first responder. It was originally designed for extrication of race car drivers. Typically used in conjunction with a cervical collar, a KED is a semi-rigid brace that secures the head, neck and torso in an anatomically neutral position. Its use is claimed to reduce the possibility of additional injuries to these regions during extrication, although its value has been questioned, as there is a lack of evidence to support its use. The original KED was designed by Richard Kendrick in 1978.

<span class="mw-page-title-main">Cervical fracture</span> Medical condition

A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury, resulting in loss of sensation, paralysis, or usually death soon thereafter, primarily via compromising neurological supply to the respiratory muscles as well as innervation to the heart.

This is a glossary of firefighting equipment.

<span class="mw-page-title-main">Blunt trauma</span> Trauma to the body without penetration of the skin

Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an object pierces the skin, enters body tissue, and creates an open wound. Blunt trauma occurs due to direct physical trauma or impactful force to a body part. Such incidents often occur with road traffic collisions, assaults, sports-related injuries, and are notably common among the elderly who experience falls.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the intervertebral disc between two spinal vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including good posture.

Grady straps are a specific strapping configuration used in full body spinal immobilization.

<span class="mw-page-title-main">Helmet removal (sports)</span> Emergency medical procedure

In sports medicine, helmet removal is the practice of removing the helmet of someone who has just experienced a sports injury in order to better facilitate first aid. Obvious causes include head and neck injury, or both, with no immediate means of excluding neck injury in the athlete who may be unable to give a history.

<span class="mw-page-title-main">Spinal precautions</span> Efforts to prevent movement of the spine in those with a risk of a spine injury

Spinal precautions, also known as spinal immobilization and spinal motion restriction, are efforts to prevent movement of the spine in those with a risk of a spine injury. This is done as an effort to prevent injury to the spinal cord. It is estimated that 2% of people with blunt trauma will have a spine injury.

<span class="mw-page-title-main">Basic airway management</span>

Basic airway management is a concept and set of medical procedures performed in order to prevent and treat airway obstruction and allow for adequate ventilation to a patient's lungs. This is accomplished by clearing or preventing obstructions of airways. Airway obstructions can occur in both conscious and unconscious individuals. They can also be partial or complete. Airway obstruction is commonly caused by the tongue, the airways itself, foreign bodies or materials from the body itself, such as blood or vomit. Contrary to advanced airway management, basic airway management technique do not rely on the use of invasive medical equipment and can be performed with less training. Medical equipment commonly used includes oropharyngeal airway, nasopharyngeal airway, bag valve mask, and pocket mask. Airway management is a primary consideration in cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid.

<span class="mw-page-title-main">Cervicocranial syndrome</span> Medical condition

Cervicocranial syndrome or is a neurological illness. It is a combination of symptoms that are caused by an abnormality in the neck. The bones of the neck that are affected are cervical vertebrae (C1-C7). This syndrome can be identified by confirming cervical bone shifts, collapsed cervical bones or misalignment of the cervical bone leading to improper functioning of cervical spinal nerves. Cervicocranial syndrome is either congenital or acquired. Some examples of diseases that could result in cervicocranial syndrome are Chiari disease, Klippel-Feil malformation osteoarthritis, and trauma. Treatment options include neck braces, pain medication and surgery. The quality of life for individuals suffering from CCJ syndrome can improve through surgery.

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