Vehicle Extrication - Operations

Operations

The basic extrication process consists of, but is not limited to, six steps:

• the protection of the accident scene, to avoid a risk of another collision (marking out the scene with cones or flares (not advisable if gasoline is leaking), lighting) and of fire (e.g. switching off the ignition, putting vehicle in park, disconnecting the battery, placing absorbing powder on oil and gasoline pools, fire extinguisher and fire hose ready to use);
• patient triage and initial medical assessment of the patient by a qualified medical rescuer;
• securing the vehicle (see cribbing), to prevent the unexpected movement (e.g. falling in a ditch), and the movements of the suspension, either of which could cause an unstable trauma wound or cause injury to the rescuers; a vehicle should never be moved, it should always be secured.
• the opening of the vehicle and the deformation of the structure (such as removing a window) to allow the intervention of a first responder, of a paramedic or of a physician inside the vehicle to better assess the patient and begin care and also to release a possible pressure on the casualty;
• removal of a section of the vehicle (usually the roof or door) to allow for safe removal of the accident victim, especially respecting the head-neck-back axis (rectitude of the spine);
• removal of the person from the vehicle

In less complicated cases, it is possible to extricate the casualty without actually cutting the vehicle, such as removing a person from the side door or another part of the vehicle.

As soon as possible, best before beginning the mechanical operation, a medically trained person enters the cabin to perform first aid on the casualty: mid-level assessment, stopping the bleeding, putting a cervical collar on the patient (extrication operations are likely to provoke vibrations), providing oxygen first aid. In France, this rescuer is called the "squirrel" (écureuil). NFPA regulation 1006 and 1670 state that all "rescuers" must have medical training to perform any technical rescue operation, including cutting the vehicle itself. Therefore, in almost all rescue environments, whether it is an EMS Department or Fire Department that runs the rescue, the actual rescuers who cut the vehicle and run the extrication scene are Medical First Responders, Emergency Medical Technicians, or Paramedics, as a motor vehicle accident has a patient involved.

After the vehicle has been secured and access gained to the patient, the EMS team then enters to perform more detailed medical care. Continued protection of the patient from extrication itself, using hard and soft protection, should be done at all times. The deformation of the structure and the section of the roof take several minutes; this pre-extrication time can be used for medical or paramedical acts such as intubation or placing an intravenous drip. When the casualty is in cardiac arrest, cardiopulmonary resuscitation can be performed during the freeing, the casualty being seated. The use of this incompressible duration is sometimes called play and run, as a compromise between scoop and run (fast evacuation to a trauma center) and stay and play (maximum medical care onsite).

The last step is usually performed with a long spine board: the casualty is pulled up on it. An extrication splint (KED) can help to immobilise the spine during this operation.

Extrication, as defined by NFPA must be done by medically certified individuals, and as such, many Rescue teams are run by standalone Emergency medical services departments. In major cities, where fire departments have firefighting/Emergency medical technicians, fire departments can run rescue. In NYC, the police department handles some aspects of rescue. In many rural areas, and specifically in New Jersey, usually volunteer First Aid Squads handle rescue. In the midwest, there are dedicated Rescue Departments that run neither fire trucks nor ambulances and strictly focus on rescue. There are some departments that are a combination of Fire/EMS, Police/EMS or Rescue/EMS, but the concept is that most organizations that run Rescue have some sort of EMS division or EMT training. As such, Extrications are handled in many ways. Some are by run completely by one organization, such as strictly by an EMS department. Some are a run by a combination department that runs ambulances and fire trucks. Some are run as an inter-agency joint effort. Some are backups to others. And some departments run just a heavy rescue truck. Some departments also might only handle light rescue and door pops, leaving the more complicated rescue and heavy rescue dedicated to a heavy rescue unit.

Extrication includes patient assessment, treatment and removal of the patient from vehicle. Some departments only carry with them minimal tools such as one set of jaws of life and are only capable of simply "popping" a door off and then must step away to allow the medical rescuers in or to allow a more dedicated heavy rescue team in who has more equipment. Extrication units are supposed to not only have many different kinds of extrication tools, but medical equipment, oxygen, and backboards as well. Extrication is the entire process from fire protection, power unit disengagement, vehicle security, patient security and treatment, removal of vehicle from patient, removal of patient, and transfer to ambulance. Extrication is not just simply popping a door off.