VEHICLE EXTRICATION BASICS
BY RICHARD A. MARINUCCI AND LEE A. PANOUSHEK
Removal of automobile-accident victims is a critical function of fire and rescue departments. Like structure fires, automobile extrication can be quite simple or extremely complicated. As a critical function, it requires individual proficiency in conjunction with teamwork. Good performance during an auto extrication–which is necessary to ensure safe, proper, and rapid removal of the patient or patients–is dependent on preparation and training.
Proper preparation makes operations run smoother and ensures quality care to the patient. There are four components to the preparation phase:
Develop a procedure. The procedure must be flexible enough to address a variety of extrication scenarios while establishing consistent guidelines that can be used regardless of the severity of the incident. The procedure must be consistent with the abilities of the personnel and equipment available. For example, hy-draulic power tools can have a wide variety of optional equipment (such as cutters, spreaders, and rams of various sizes with accessories). Because of cost, not all departments can carry all this equipment. Consider this factor when developing the procedure.
Acquire the necessary tools and equipment. To perform extrication, you need the tools to do the job. As mentioned above, a wide variety of options is available when selecting appropriate tools and equipment. First, you must figure out how much you can afford. After the budget is established, ask your members their opinion on the equipment needed. A committee is not a bad option and can provide good direction. Consider homemade devices in addition to commercially available equipment. The ingenuity of firefighters is renowned. Many “commercial” tools originated as firefighter inventions. Mutual-aid companies also can be a good source of specialized equipment.
Train in all the proper techniques. The training function must be consistent with departmental procedures and available tools. Because of time constraints, extrication training does not always get the consideration it deserves. Since time is valuable, make sure you are prepared. Training must include the command, planning, and coordinating aspects as well as skill development and patient care. Members must be trained to work with specific tools. Hands-on applications can be practiced with vehicles from a local junkyard. These opportunities give firefighters a chance to learn skills with the available extrication tools and to function as part of a team. Use these opportunities to hone skills and experiment with different techniques. Find out what works and what doesn`t. You may find that many situations require only hand tools. Creativity and common sense are great assets. Do not forget to include patient-care skills in your training program.
Continually practice both individual and team skills. Actual training programs begin the learning process for firefighters but do not allow sufficient time to pursue adequate skill development. Individuals must make the effort to practice skills so that operation of tools and equipment is second nature; accident scenes rarely offer ideal conditions in which to learn. Incompetence compromises patient care and can be very embarrassing, so make sure all individuals accept the responsibility to become competent with your equipment. Extrication, regardless of how complex, should consider all functions–from arrival to termination.
KEEP A CHECKLIST
Size-up. Gathering of all pertinent information with respect to the incident begins when the alarm is received. Where is the location, and what facts are available from the dispatch center? On arrival, survey the scene. Look for hazards, quickly assess the patient, and rapidly evaluate the extrication needs.
Personnel safety. Like all fire department operations, safety of the rescuers must take priority. This involves arriving safely and properly placing the apparatus to protect the firefighters while allowing easy access to required tools and equipment. Using size-up information, consider the possibility of circumstances in which the incident might deteriorate. Is it safe to approach the vehicle? Potential hazards such as downed power lines or leaking fuel require special considerations. Protective clothing must be worn. Volunteers responding directly to the scene must have proper safety equipment (including turnouts, medical gloves, and protective goggles or glasses). If the potential for a fire exists, suppression units must be ready and operational during the entire extrication.
Apparatus placement. Like successful fire scene operations, extrications require proper placement of apparatus. Use the vehicles to protect rescuers. Leave space for subsequent arriving apparatus, especially those that carry heavy equipment. Volunteers arriving in personal vehicles should be ranked so as not to interfere with the operation.
Traffic control. In some situations, fire department personnel arrive before police officers. If so, traffic can be a problem. Initial actions may be directed to basic traffic control to help protect the scene from further problems.
Incident commander. Establish command and begin developing a strategy for the extrication. Begin patient care while preparing for the extrication, if possible. If not, develop your plan with strong emphasis on expediting the operation. Depending on the number of patients, the complexity of the extrication, and the number of firefighters needed, you may need to establish sectors. Regardless, the incident commander must coordinate all activities, giving consideration to the safest, fastest, and easiest way to remove the patient or patients. The plan of attack must be communicated to all rescuers. While the operation is in progress, begin developing contingency plans.
Triage. Assessment of the patient or patients is crucial to prioritize treatment and transport. The severity of the injuries will dictate the patient care and extrication techniques. Life-threatening injuries may cause rescuers to compromise patient care in order to readily extricate the patient for transport to a trauma center. If the patient is stable, allow the rescuers to take extra care and precautions.
Continual scene assessment. Your assessment information will be used to establish the extrication techniques and tools to be used. Assign duties with relatively specific directions. Rescuers must provide feedback as to the effectiveness of the plan and the tools.
Resources. Determine the resources needed. This will depend on the severity of damage and necessary patient treatment. Tools basic to all necessary operations and possibly special equipment will be needed.
Stabilization of vehicle. Stabilize the vehicle. Wheel chocks, shoring blocks, and other basic equipment can be used. In more complex cases, winches, tow trucks, or heavy equipment may be needed.
Access to patient(s). Rescuers must get to the patients to assess and begin treatment. Some work may be needed to get rescuers to the patient and to remain with the patient during the operation. Traction may be needed immediately and continually while splints and backboards are applied.
Patient(s) care/documentation. In most cases, extrication operations will include patient care. Thus, bedside manner is extremely important. Hearing the loud power tools and glass breaking and being surrounded by firefighters can be very frightening. Let the patient know what will be happening, and explain the procedures to be used. Also protect the patient from potential harm, such as broken glass or sharp metal, which could be the result of the accident or the use of the tools. Blankets and long backboards will work in most cases. Stabilize the patient, apply the necessary splints and/or traction, and provide advanced life support if necessary and available. Record important information necessary to complete required reports.
Extrication/tool drop area. Set up an area in which to place all tools, close enough to be practical but away from the action so as not to cause a hazard. Keeping equipment close and available saves time. Know what is needed and consolidate in a central area.
Extrication team. Assign members to work as an extrication team. They generally will be separate from those treating the patient. They must operate as a team with a designated leader. The leader will coordinate activities with the team and the incident commander.
Extrication power tool application. Train and practice with your power tools. Know ahead of time the intricacies of your equipment. Bear in mind all safety considerations. Protective clothing is needed for all those who are operating tools and those in the immediate area. Keep members who are not using tools far enough away. Use the tools to make space for rescuers and to remove patients.
Extrication. Extrication scenes can change, and circumstances may warrant adjustments in the strategy. Information must constantly be gathered and processed.
Transport of patient(s). Once removed from the accident, secure the patient to a stretcher. Continue care and ensure that the level of treatment corresponds to the injuries.
Return apparatus to service. After completing the extrication, begin restoring equipment and apparatus in preparation for the next alarm. Cleanup must include provisions for compliance with all safety regulations and procedures, including bloodborne pathogens.
Reports. The incident must be properly documented to include patient care and the elements of extrication. The officer-in-charge has the responsibility to ensure this is done properly and in a timely fashion. All pertinent facts must be recorded.
Incident critique. Depending on the severity of the incident, a post-incident critique is very beneficial to the organization to continue planning for future incidents.
No matter what the severity of the extrication incident, simple principles must be applied as they are with structure fires–strong strategy and tactics are needed. Extrication can be accomplished with logical, well-planned-out steps that ensure the patient will receive proper treatment and be removed as quickly as possible. n
EXTRICATION CHECKLIST
Size-up
Personnel safety
Apparatus placement
Traffic control
Incident commander
Triage
Continual scene assessment
Resources
Stabilization of vehicle
Access to patient(s)
Patient(s) care/documentation
Extrication/tool drop area
Extrication team
Extrication power tool application
Extrication
Transport of patient(s)
Return apparatus to service
Reports (documentation)
Incident critique (CISD)
RICHARD A. MARINUCCI is chief of the Farmington Hills (MI) Fire Department. He has bachelor`s degrees in secondary education, fire science, and fire administration and is an editorial advisory board member of Fire Engineering.
LEE A. PANOUSHEK, a 10-year veteran of the Farmington Hills (MI) Fire Department, serves as the department`s EMS coordinator. He has bachelor`s degrees in biology and chemistry.
