Popping the door?

[RyWfd]

Our EMS service routinely requests extrication to gain access to patients by just "popping the door". What types of vehicle stabalization do others use for these minor incidents? We often chalk the wheels of the vehicles, front and back. Unless the vehicle is off the street, rarely do we do anything else.

[e33]

You bring up an interesting point. Most Fire and Rescue agencies work without stabilizing vehicles every day, not only is detrimental to patients, it isnt very safe for us either. Think of the forces involved with a simple door pop. The car will certainly be jostled when using tools. A better point to consider is that by stabilizing cars, you are now working on a solid platform. You should be stabilizing every vehicle in an MVA, regardless of noted damaged. What do you pop doors for anyway....or why do you cut roofs?? Most places do it due to the components being pinned and jammed..referred to often as entrappment. But entrapment can be viewed different than pinned. If you cannot get a pt out of a vehicle without difficulty, even if the vehicle is not badly damaged, they are entrapped...no?? In most cases a simple removal of the b-post from roof level to rocker panel level is sufficient, as it allows to lay seats back etc. Pts that are pinned, are actually stuck between vehicle components, such as the dash and steering wheel. If you are taking a pt in a KED out a passenger side door over a console.....you are not providing the service that is expected. Remember that extrication is a pt. care skill too. Look at what is presented to you, size it up. Notice the vehicle, damage, airbag equipped or not, number of pts, etc. I see the "wiggle" being done an awful lot. Pts that are not rapid extrication candidates should be getting KED's, few exceptions...and bad weather isnt one. ALL vehicles in which rescuers work should be stabilized (4 points) and wheels chocked. Put trans in neutral and parking brakes on in vehicles. 90% of the time step chocks and wedges will handle the task, p/u and suv may require box cribs. Deflation of tires is unnescessary if you properly stabilize, and makes it harder for wreckers to pick them up. The "lift and Tuck" method may be perferred for inserting step chocks as wedges sometimes work their way out. Also, many times when a door pop is done, the door isnt what is really in the way...its usually the roof or b post.....look at what is happening...remember the old WYSIWYG (what you see is what you get). If the components are inyour way, get rid of them. Dont compromise the patient. Hope this helps.

[RyWfd]

Thanks for your insights e33!

[Halligan84]

As a minimum, we safe the car. Disconnect batteries, 2 wheel chocks and stabilize with 4 step blocks. The thing im always worried about is when the "routine" door pop becomes more and we don't have the basics taken care of.

[RoadwayRescue]

Stabilization is a must any time tools are being used on a vehicle. Also, anytime that occupants that are still in the vehicle but access is not in question you should still stabilize the vehicle. Think about C-spine! Even EMS providers getting in and out of the vehicle will cause movement. So we should stabilize each and every time we have occupants that are injured in the vehicle, trapped or not. And in today's vehicles, even having access does not ensure a path to move that patient correctly and safely. How many times do we have to make space to effectively work on a patient? I would say more times than actual "trapped" patients.
As to how, at least 4 point stabilization and chock the tires. I still prefer tire deflation to lifting the vehicle. Lifting the vehicle runs the risk of back injuries, overzealous lifting too much moves the vehicle & patient and still does not take the vehicle suspension & tire movement completely out of the picture. Stabilization needs to be checked and updated during the rescue process, it's not a one shot deal. As evolutions proceed and metal/materials are displaced or removed the vehicle can & will shift depending upon it's construction.

[BC White]

I have my people follow a basic rule:
"If the tools come off (the rescue truck), the lumber goes under".
Even if we just pop a door, no less than a three point crib for a minor door pop.
Hand tool or powered hydraulic, there is no difference.
I have seen countless departments do extrication with little or no cribbing, and if that's how they do it, that's fine with me. Everyone looks at things differently.

If it's my scene, the lumber comes out before we go to work.

[KenNFD]

I have my crew go one step farther. We stabilize the vehicle anytime a patient is to be removed, even if it is a convetable with the doors open.

My FD is dispatched to any MVA with injuries. We often arrive before EMS. I like to give them a stable vehicle in which to treat the patient.

[EML089]

Just remember no call is ever typical, always keep you and the patient safe. regardless of what needs to be done at the scene you dont wont to find out later you should have stabalized.