Replies to This Discussion

Permalink Reply by william on February 3, 2008 at 12:08pm

ok responce would be 2 ALS medic units, rescue, 2 engines one for fire and one asst. the police with traffic control , and squad for extra man power.. and a air taxi put on standby...and if need be for a landing zone if the PT can not be taken by ambulance to a trama center have a engine dispatched for the LZ ...ok hazards..there are a ton on this one glass, possible fluids.. and most of all AIR BAGS being that this looks to be a newer car there could be side air bags as well as the side curtains and they do not look to be deployed and neither do the driver or passenger front bags !!!! well first i would start with the power to the car...cut it completely.. bend some of the hood where the battery is and cut the cables less chance of the air bags having a delayed fire or anything heating up... once the power is cut... start cribbing the car and containing fluid at the same time...as for cribbing..i would start with a set of rescue struts. 1 on the trunk or near the quater panel of each side of the car. after they are in place i would have a step chock behind each front tire and also 2 step chocks placed at the hood of the car.. and the cribbing/stabilization is complete...from there i would remove any glass away from the rear of the car because that is where im bringing the PT out..after that was complete i would start on extraction of the PT... well being that the PT is pinned near the stearing wheel of the car i would start with a dash roll to be sure that there is enough space to work on the PT and room for the medics to move around and also being thats where the PT is pinned... and if needed wich most of the time not i would cut the roof away from the C post and push the roof flat to the ground...after the PT was tend to by the medics and borded and collared you can do this either one of 2 ways either pull the pt out by grabbing each side of the board and lifting and sending it out the back strait to the strecher...or the way i perfer tie 2 nylon ropes to the board and drag it out the rear and then where there is more space....lift the board to the awaiting strecher and strap up and go...and transport to the awaitng LZ if it was needed...or to the Trama center.. thats how i would go about with this one

Permalink Reply by Ric Smith on February 3, 2008 at 2:29pm

Sounds good to me but with a couple of variations. First, I would let my internal guy (medic) do the electrical isolations by turning off the ignition & placing vehicle in park (if possible)... the battery my not be were you think it is. Then, let him/her finish the internal survey by identifing the status of pt. (ALS/BLS), airbags, best route for extrication, and any entrapment issues THIS WILL SET THE TONE FOR YOUR EXTRICATION. Per the picture provided: For a BLS pt (ie: we have time to play) my plan "A" would be to chock the front & strut the rear (both sides), then conduct a trunk tunnel as well as cutting the "B" & "C" posts to flap down the entire roof and create a HUGE hole to allow for a safe & deliberate extrication. REMEMBER: if the pt is stable (BLS), we want to take as many precautions as possible to prevent any futher injury. Now if the pt is ALS: I would chock the front, chain saddle the rear, cut "B" & "C" posts, lay back driver seat and go.... That's if I didn't have to intubate, start IV's or both of course. I do however understand that there're soooo many variables to take into consideration and that each incident is different as well as how an agency thinks & does things. Well, thats my 2 cents.....Thanks, Ric

Permalink Reply by lutan1 on February 3, 2008 at 2:41pm

Hey! Don't chnage terminology on me- I thought it was an "Air Bus", not an air taxi!!!!

Permalink Reply by Ric Smith on February 3, 2008 at 2:48pm

In the Seattle area we call it "AIRLIFT". The company name is: Airlift Northwest. In SoCal we call it "Life Flight". Again, company name.

Permalink Reply by lutan1 on February 3, 2008 at 3:07pm

Here's a few links of interest-
CarBusters (Including some on line tests) http://www3.us.elsevierhealth.com/MERLIN/Carbusters/

Contemporary Vehicle Extrication Techniques (Brendan Morris) http://www.fireengineering.com/articles/article_display.html?id=234926

Permalink Reply by Michael Bates on February 5, 2008 at 7:57pm

I would agree with flapping the roof down, using my struts i would chain saddle the rear as said. one thing no one has really mentioned is cutting the steering wheel. someone stated they would do a dash roll but being inverted like that, will make it difficult . it's probably quicker to get in their with a cutter, porta power, or brake pedal cutter...even a sawzall would work . this would also save the need to switch which tools are connected

Permalink Reply by Ric Smith on February 5, 2008 at 9:40pm

I agree, but only if needed. My internal guy (medic) is the one to make that call. With all the roleover's I've been on, I've yet to have a need to cut the steering wheel. Dashrolls, pedal & steering wheel cutting have all been the result of some type of front-end or front-end/side damage. Something else to keep in mind..... (in regaurds to a dashroll) If you start cutting the frame on a roleover (especially a "uni-body" design), you run the risk of losing structural integerity and collapsing the vehicle on your patient.

Permalink Reply by Stacy Banderinko on February 10, 2008 at 12:48am

alright, here's my thinking. we must do extrications totally different from some of you guys, but here it goes. stabilization happens before any rescuer goes inside the car. if the back window is tiny, there's no need for it, and i would do a box crib smack in the middle of the trunk (that's if the window is too small to do anything out of it). if not, one JYD (Junk Yard Dog) or air shore on either side of the window to allow for access and egress. the car is top heavy, so the front isn't going to move anywhere, just fill the void spaces with step chocks. of course cut the power once the inside rescuer gets to it, cause you're not getting to it from the outside. you would risk moving the car by trying to get to it from the hood. i agree with the fact that the inside guy sets the pace for the extrication process. nothing gets done unless the inside guy says okay. (i've had that happen to me before. i was on medic crew at a rollover, and the FD caused our patient a huge head lac cause they cut his seatbelt without the inside rescuer knowing...he fell onto glass head first.) so, in our area, no way would we flatten the roof to get out the back...too much risk of losing stabilization (i've actually never heard of that or scene it used). try to open the doors...sometimes they can still open to give you enough room. if not, i believe we would cut the B post of the car. as far as the steering wheel, get some cutters in there and cut the darn thing. make sure you have something to catch the guy (again, previously stated problem), or make sure his seatbelt will catch him. once that happens, again, this is for side access, stick a board inside through the door as far as it can go, maneuver the patient onto it, and drag and go. as far as response units, it depends on the area for us. if it's in our district, it's one or two rescue pumpers (depending on which part of town or what highway, we have two) and one ALS unit per patient. if it's in a neighboring district, it's two rescues and an engine (we would be one of the two rescues), and again one ALS unit per patient. all accidents get ALS units, no matter the severity. we also make sure that at least one of our EMTs and/or Medics gets on the truck...our ambulances can be slow sometimes. oh, up here we have two flight companies, LifeFlight (Allegheny/West Penn Health System), and STATMedEvac (UPMC Health System). we take whichever has the fastest ETA. we use the full name for LifeFlight and STAT for the other. no air bus, air taxi. etc. and we would not call for either of the two until command gets an initial update from crews. we can usually decide within the first 30 seconds of arrival whether or not we need flight. we are only 5 minutes tops from the nearest trauma center, and our Chief just happens to be a Flight Medic for one of the companies.

Permalink Reply by Ric Smith on February 11, 2008 at 2:55am

Ok, here are a couple of pics to show you what I was referring to. Now, these are without the trunk tunnel. Also, notice the maxi-door removal as well....LOTS & LOTS of room. By the way, that car isn't going ANYWHERE.......

Permalink Reply by lutan1 on February 12, 2008 at 1:56am

WOW! I've never used these struts and have certianly never seen scenarios like this one- pretty impressive!!!

Permalink Reply by Ric Smith on February 12, 2008 at 2:03am

Ok, these pic show exactly what I was talking about. We did this while prep'n for one of our competitions.

Permalink Reply by Stacy Banderinko on February 14, 2008 at 10:58pm

i've never seen that either. i'll have to ask to try that next month when we do BVR during our training nights, because that looks awesome. about how long does it take to do everything?

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