Many of the nation’s fire departments and rescue squads provide technical rescue services to their respective communities. One arena that is very common to many organizations is motor vehicle extrication. While newspapers and other media are constantly showing pictures of disentanglement actions, many do not realize the preparation and logistical work that goes into a successful extrication operation. We will look at some of these characteristics, discuss some of the more common extrication maneuvers, and then showcase some of the more ornate maneuvers for those times when we need to operate during extraordinary circumstances.
When we think extrication, we are really talking about disentanglement, the actual removal of the vehicle from around the victim (see Photo 1). Removal, or extrication of the victim, comes after the disentanglement work on the vehicle. That will vary greatly, depending on the severity of the impact, and the composition of both materials that have been involved in the accident.
So, what should the local service provider be bringing to the scene? First and foremost, trained, skilled personnel are the number one asset on any rescue scene, and extrication is not any different. Training will not only be focused on disentanglement skills; we will need people to perform stabilization, provide medical treatment to the victims, and control the threat of fires on these scenes. Additionally, depending on the vehicles involved, a response from the local Haz/Mat team may be in order. These skills will not become second nature without many hours of hands-on work with the tools and equipment associated with these techniques (see Photo 2). The extrication scene is a dynamic event; it is always changing, and has the potential to go bad quickly (see Photo 3). Therefore, I would be remiss not to emphasize the use of full personal protective equipment (PPE), including secondary eye protection above helmet shields, Body Substance Isolation (BSI) equipment, turnout gear, and crash gear for firefighters and EMTs, etc…. Any lack or disregard of the use of these basic protective ensemble components can lead to serious injury, and there is no permissible excuse for it.
Your department is dispatched to a reported vehicle accident with entrapments. This is the time to start your size-up, not at the accident scene. A lot of information can be gathered by the dispatch assignment. For example, the type of road (residential street, highway) can provide clues on the speed of impact you can expect. The location of the area may provide information about what hazards may be involved, such as type of vehicle, industrial equipment (forklifts and construction vehicles have accidents, too) and access to the scene issues (see Photo 4). One major point that should be considered in the size up is the “Golden Hour,” which is the time related to the onset of impact until the patient is receiving definitive, medical care at an approved medical facility. The problem with this is that the Golden Hour clock had started running before the responders had been dispatched; one can only estimate the amount of time elapsed, based on time of alarm, reflex time to respond, and traffic problems impeding access to the scene. Since this is difficult to ascertain with any degree of certainty, it is wise to focus the on-scene efforts towards the “Platinum Ten,” which is the optimum time frame when the responders arrive until the patient is disentangled and extricated from the vehicle. Keeping the total extrication time to less than ten minutes will help to keep operations closer to within the Golden Hour.
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