Extrication Education: back to basics

Guatemala trip
The trip to Guatemala was pretty awesome and we had a great time teaching their folks some basic rescue techniques. They were eager to learn and we plan on returning July 2010 to continue their training and hopefully get some more equipment donated. Read my full trip details at carolinafirejournal. com.

Vehicle crashes
Last issue we looked at how we approach vehicle crashes, remembering that we must make the scene safe and stable before we start our extrication procedures. The battery should be disconnected to disable the frontal bag and help to eliminate any sparks or electrical arching. Next, the vehicles should be stabilized using cribbing, rescue jacks, or both. Then, do a quick check for the SRS markings that indicate side bags, curtain bags, or seatbelt pre-tensioners. Cutting into a 5000 PSI nitrogen cylinder could definitely be hazardous to your health.

Now we need to determine if the patient(s) are trapped or pinned. If the patient is trapped, then nothing is physically holding the patient in the vehicle, but there is no clear way for them to exit or be extricated from the vehicle. If the patient(s) are pinned, then they are being physically held in the vehicle by the vehicle. Trapped victims need to have an exit created to access, then properly stabilize and remove them. If the victim is pinned, then not only do you have to create an access but you will have to remove whatever materials that may be holding them in the vehicle. You have to remove the vehicle from the victim rather than remove the victim from the vehicle. Determining whether the patient is trapped or pinned determines your next step in the extrication process.

Regardless of the situation, you will have to gain access to the patients so they can be stabilized and emergency medical procedures can be administered. Once the patient is stabilized then they will have to be removed. When trapped, usually the easiest way to remove them is to displace the door. This will give you an opening large enough to pass a backboard through. If this opening is not large enough, you can consider removing the “B” post and do a double door removal. Removing the roof can be an option if the doors can’t be removed in a timely manner, or other obstacles prohibit you using the doors as an exit for the patient. These extrications are usually done pretty fast.

What if the patient is pinned in their vehicle after a crash. Now, we have to remove the material that is pinning the patient in there, usually metal and plastic. Simply removing the doors or roof will not allow you to extricate the victim. You now have to negotiate what is holding them and move it. You also have to gain access and stabilize the victim before this is done.

Now we put our plan together as to how we are going to remove our patient. This may require pushing, spreading, or cutting metals and plastics off and away from the patient. One important thing to remember is that when we cut and spread we are transferring energy from our power tools to the vehicle. Once this energy is applied to the vehicle we need to consider how this might impact our victims. The energy we apply is not destroyed, so make sure it does not affect the very folks we are trying to rescue.

Next issue we will look at some of the basic techniques we can use to extricate these folks utilizing hand tools and power tools. As always, train to be the best you can be, and stay safe.