BY DAVID DALRYMPLE
We all seek that gadget that gives us an edge: an extrication tool, a new evolution, or a new methodology that will help us to see things in a different way or make patients more at ease while caring for them. One venue for seeing many of these gadgets is an extrication challenge. Many of the teams competing constantly strive to shorten time, speed material displacement, and provide better patient management; they are constantly looking for that added edge. However, mainstream rescuers do not get to see many of these gadgets, which is unfortunate because there are some fantastic tools available. This article presents some of these cool gadgets I have seen at recent regional, national, and international challenges and educational programs held around North America.
VEHICLE BACKGROUND INFORMATION
This is an area that is becoming more and more important to us. Although your eyes remain the primary way to spot on-scene hazards, be it for an extrication, a vehicle fire, or a roadside medical emergency, there are many more hidden hazards today. Holmatro has produced an excellent reference book and accompanying CD on vehicle safety systems for rescuers (photo 1); the newest version can access information directly from an entered vehicle identification number (VIN). A software package, “Crash Recovery System,” produced by Moditech, Inc., is a graphic database of vehicles with hazards clearly marked in a glass cutaway format, including high-strength reinforcements in the vehicle’s structure. Depending on the software version, you can scan in the VIN with a handheld device, type it in manually, or search visually to bring up the correct vehicle (photos 2, 3). Vehicle manufacturers produce emergency response guides (ERGs) for hybrids and alternative-fueled vehicles, as well as complete rescue manuals for their entire vehicle lines (photo 4). You can find rescue manuals and ERGs online and download them. In North America, Mercedes Benz, Volvo, and Honda produce rescue manuals for their entire line of vehicles.
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STABILIZATION
In the past few years, we have seen a tremendous growth in stabilization devices; most of these devices are built around tension buttress cribbing principles. Tension-buttress systems take a diagonal brace and “tension” it to the vehicle by a strap from the base of the diagonal brace. However, a new device, called a “Stab Fast,” puts a new twist on these devices; it is adjustable, self-contained (with strap, strut, base, and attachment points), and simple to use and apply. The ratchet strap used to “tension” the device is attached in such a way that it doesn’t allow too much belt into the ratchet, where it can twist and jam the mechanism. The strap has a traveling hook that can attach to the vehicle base and adjust to the situation. A version of this device being sold in the United States also has a windlass built in to adjust and tension the strut (photos 5, 6).
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Besides strut devices, consider other cribbing options for vehicles on their wheels. Many of us regularly use step chocks, wedges, and tire deflation for these upright vehicles, but we must remember how today’s vehicles can be found, heightwise, between the ground and the bottom of the vehicle (photo 7). Cribbing upright vehicles is not always as straightforward as it used to be. In fact, how effective are step chocks today? With “run flat” tires becoming more and more common than tire deflation, how effective will that be down the road? With these changes, we must take another look at other cribbing options for upright vehicles (photo 8). Step chocks are still a good choice but are not quite as effective heightwise or widthwise (six inches) as in the past. Marry these wedges to the step chock with an industrial self-closing fastener to allow for quicker and easier carrying and application (photo 9).
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Quick chock-style cribbing, which allows for greater flexibility and height and keeps everything under the vehicle, is also an option. A quick chock is a platform of 4 × 4 cribbing, approximately 16 inches long, topped off with a ½-inch sheet of plywood, glued and screwed into place. Use a 6 × 6 (or 4 × 4) wedge, the length of the top of the platform, to tighten (photo 10).
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PATIENT MANAGEMENT
How do you keep hard protection with your tools? We all know it is important to place a shatter-resistant barrier between our tool evolutions, the patient, and the EMS provider. However, it can be difficult to get that hard protection in place and in use. One department places a piece of hard protection under a staged tool so the tool operator can pick up the hard protection as well as the tool, thus reinforcing its use and need (photo 11). With that barrier, would using short boards or cut-down wooden backboards be necessary? A better choice for our tool operations, especially when cutting, is a shatter-resistant yet flexible shield, such as one made of Lexan® (photo 12). A teardrop shape with cut-in handles works extremely well.
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Blankets also protect the patient from broken glass and the elements. However, patients, as well as responders, can find blankets constrictive and hot. To allow for less constriction and heat, one team cut out a section for the patient’s head, sewed a layer of material in place that allowed light and air through (but not particles), then sewed the section back on and attached a self-closing fastener to it for rapid access (photo 13). The manfacturer of Kovenex® is now working with that team to produce a commercially made product. However, it will be fire-rated and retroreflective (photo 14).
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Another item to assist in comforting a patient is a personal battery-powered fan that moves air around the patient to create a slight cooling breeze (photo 15). It is just enough to keep the air around the patient moving. Think about how that might help on a hot day.
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TOOLS AND USAGE
I’ve mentioned some stabilization devices, but what if you need to move a traffic-blocking vehicle off of the highway? Would you use a wrecker or floor jack? Another option would be GO jacks (photo 16), which are used in the towing and automotive industry to facilitate the moving of a vehicle. A GO jack is a hydraulic jack with castor wheels that fits snugly around and raises the tire. It is placed on all four wheels or two (on the same side); once the jack has raised the tire, the castor wheels enable easy movement of the vehicle.
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A high lift, or tractor jack (photo 17), is also used to lift and stabilize vehicles. However, in its normal configuration, this might be a difficult tool for spreading and lifting. In one instance, one team added to this toolcreating a multifaceted rescue toola widened base plate, securely locking the small base of the jack, and a U-bracket, which allowed the jack to slip firmly over a door or vehicle body piece. A third add-on piece was a lengthened attachment over the jack’s tongue to facilitate lifting, spreading, and security.
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The scissor jack (photo 18) is basically the same jack anyone might have in the trunk of a vehicle but modified for rescue service. Teams use this jack as a lifting tool or to assist in stabilization. You can weld a large base plate onto the bottom of the jack to improve stability. You can weld a second plate onto the top of the jack to increase the point of contact. You can use a speed wrench on the lifting mechanism to facilitate movement and placement under a vehicle.
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Let’s look at a tool to facilitate dash/column displacement. Most times, we use power hydraulics to perform a roll or lift to displace the dashboard. What happens when you don’t have them available? One option is to displace the steering column, but you must be sure to do it safely (lift the column, do not pull it). There are commercially made devices for this task. However, one team devised and built a simple solution to this problem, called the “Boomerang” (photo 19). The boomerang-shaped device has a base plate at the apex of the wings; the side toward the steering column uses an anchor sling to make a girth hitch around the column. The other end of the boomerang connects to a pulling device, such as a come-along.
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For those of you still using duct tape and fire hose for sharp-end protection, there are several other choices to consider. Simple, inexpensive items for sharp-end protection are pool noodles and roll-cage padding (photo 20). Slice the pool noodle lengthwise, or open the roll-cage padding farther than normal, and open these items up to slide over a sharp end; use a bright color for increased visibility.
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Another inexpensive idea is simple PVC pipe cut into very short rings, with a small section cut out to allow the ring to be spread (photo 21). These rings make excellent clamps when a blanket or hose end is used to cover a sharp edge, keeping the cover in place.
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One final piece of gear to mention is the Kevlar®-lined sharps cover from Speedings Ltd. (photo 22). These blankets come in a variety of sizes; post covers come in two sizes. These covers are excellent for their adjustability and flexibility and have a series of magnets sewn into the edges. Post covers use a flexible self-closing fastener strap to “wrap and strap.” Both use bright colors to facilitate visibility of hazards and are Kevlar®-lined for enhanced sharp-edge protection.
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We are all on a quest for that time-saving device to make our job go more safely and more smoothly and to ensure a better patient outcome. The extrication scene with its challenges has been a birthplace of ingenuity in vehicle rescue. Many of these gadgets are indeed homebrewed, but much thought and effort go into trying to resolve the issues involved.
David Dalrymple is a career EMS provider for Robert Wood Johnson University Hospital/St. Peter’s University Hospital Emergency Services in New Brunswick, New Jersey. He is also a firefighter/EMT/rescue technician and former rescue services captain of the Clinton (NJ) Rescue Squad. Dalrymple is the education chair of the Transportation Emergency Rescue Committee-US and serves as the road traffic accident advisor on the Expert Technical Advisory Board of the International Emergency Technical Rescue Institute.
