1. #1
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    Cool "Extrication Epinion#1"

    I have attached a photo of a recent MVA our department had.

    I will give more details on my next thread. I just wanted some Extrication Epinions on the photo.

    Size-up/Scene safety
    Stabilization
    Seeing, evaluating, and entering with the victim
    Systematic disentanglement
    Separating and Securing the patient
    Attached Images Attached Images  
    Last edited by NB87JW; 06-29-2002 at 09:17 PM.
    "Making Sense with Common Sense"
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    Cool More Details for This incident

    The Motor vehicle accident (MVA) was a recent wreck our department responded to. A teenaged male "lost control" of his vehicle when a deer said to have run out in front of him. He rolled the truck on to the drivers side and slid off the road in to a 20 inch power pole. The pole hit both "A"-pillars just below the roof-line. The pole then hit and pressed the steering wheel downward against his lap. The poll missed his chest/neck and head by 2-3 inches. The extrication took three companies more than an hour to extricate the lad. They had three power unit and tools. I review all of our Complex Extrication Evolutions and I have an Idea of what I might have done to safely expedite the extrication evoltion but I wanted to solicit a discussion and get "Extrication Epinions".
    "Making Sense with Common Sense"
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    Bit hard with just the one photo, but here goes....

    * Stabilise the vehicle using wedges around all sides. Also use a ratchet strap and secure the car to the pole. The pole won't be going anywhere in a hurry, let's use it to assist us!

    * Remove as much glass as possible.

    * Using cutters, flap the roof to the front of the car. Cut both C pillars, both B pillars and flap it in front of the pole. Secure the roof to the front of the car to stop it coming back at us.

    * Using a pedal cutter or similar, cut the steering wheel rim and spokes. Without seing inside, I'm assuming that would be enough to free the actual entrapment. (Cutting the wheel away will generally give us approx 6 inches of room.)

    * Lay the seat back.

    * Slide the seat back on its tracks.

    * Remove casualty.

    Would this have worked JW?
    Luke

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    I'll go controversial on this one just to stimulate a controversy.Put a Ked and collar on the lad,hook a twin line hyd tow truck to the truck and gently lower it back onto it's wheels,procede with the extrication in the usual fashion.You should be able to accomplish this slowly and with no harm to your patient.I've done these in place like this one and there is little room to work around the pole.Far easier in this scenario to remove the vehicle from the pole.T.C.

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    I don't find it all that controversial 101. After staring at the photo for a few minutes, I also asked myself..."How can I move this car off the pole with the patient in it?" I like your idea of trying to get it down on all 4 wheels, just like when they roll completely over and the victim is either still strapped or pinned in, its a bitch to keep them from shifting (or falling) with gravity.

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    The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of.

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    ALS,I'll bet we draw some dissenters.I liked your response to my gusset theory.The reason I mentioned it was a nearby town had a fire in their unfinished new fire station and one factor that had them going immediately defensive was falling gusset plates.This vehicle would "stand"back up very smoothly and easily using the equipment described.I've done a worse version of this where we removed the patient thru the floor but it's a lot of work.T.C.

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    I also like Rescue 101's idea, but I plan on getting very controversial, lets say that there were no wreckers available for an extended amount of time, and the patient was a priority one that had to be out yesterday, I would hook a chain too the top frame rail of the truck, and wrap it around the pole and then hook it back onto itself. Next I would place our heavy duty resqjack against the same frame rail, and then hook the straps to the bottom frame, next I would cut a two foot section out of the top frame rail to the side of the buttress system, next hook a chain to the front of the top frame rail, and also one to the rear of the top frame rail, then have these chains connect to the winch on our rescue pumper, slowly rewind the winch cable and pull the two ends of the truck away from the pole.

    Of course I would have cut the steering ring and column first, if that was possible.

    I would also have personnel holding c-spine and to scan for any possibilities of crushing injuries from the movement of the truck.

    As I said, this would be in an extreme case of do or die, but then if it got that bad I just might take my ventmaster saw and cut the back of the truck away, and remove the patient.

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    Default Controlled Rollovers

    A controlled rollover would work, but food for thought- with that sort of impact, would the rood of the car be wrapped around the pole, which would hinder the ability to roll back onto its roof?

    We tried it a while ago with a fatality into a tree, just like this, and it wasn't too succesful due to the roof trying to hold the car in place....

    How would you feel, being the casualty in the car?

    How would you fit a KED PROPERLY when a vehicle is on its side?
    Luke

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    Lutan,I don't think this particular patient was probably at the top of his game at this point.The only sensation he'd probably be cognisant of is the fact his world just leveled out.I'm still waiting on that flying pig you promised me,The grill's fired and ready.Hehe T.C.

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    We had a very similar accident with two entrapments (both deceased) recently and obviously we have had several discussions on how we would remove the patients in a hurry if they had still been viable. Our car impacted sideways at an estimated 85 MPS and had more bend around the tree. Rolling the car back onto its wheels would not be an option as the car would not be anywhere near stable (it is now a U shaped car).

    Some of the obvious solutions include removing the pole/tree. Then again a utility pole would not be easy or safe to manage with the wires attached. Removing the roof would not be possible with the utility pole in the way and the patient proximity below the roof. Which basically puts you back to rolling the car or going from the bottom. A bottom extrication in our case with two patients would be very dificult as the major cutting required could contact hidden patient extremities.

    Anyway I dont have a solution that would be quick and prevent further patient injury.

    I looked forward to the future replies.

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    Talking Fantasy Island or Ransom?!

    The pig! The pig!

    It's on it's way, 101! Hang on, not until I get a second option/Plan B for truck vs car! hehehe If you want to see your pig alive, I want $1,000,000 delivered by noon today to the bin outside the post office. Don't bring anyone, don't tell the Police. This threat is real....


    To Apatrol, how did you get your guys out of the car in the end?
    Luke

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    How about tunneling through the back of the cab? My tool of choice is the air-gun. Starting at the front corners of the box, cut downward at each corner. Then lay the bulkhead of the box down onto the floor of the truck box. Move to the back window of the cab of the truck. From the bottom corners of the window, cut downward toward the floor of the cab. Then lay the back section of the cab down onto the floor of the truck box also. Recline the seat back to its fullest extent. Board the patient - keeping nose, toes, and belly button in line. The patient is now ready for safe removal.

    (It is assumed that the patient was properly stabilized and immobilized prior to beginning this process.)

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    Absolutely 101,

    We've done this several times with the use of wreckers or using a winch, snatch blocks, slings, etc and it works great. The only thing(s) that alter the operation is the extent of entrappment/ entanglement and how far is the vehicle wrapped.

    We had one where the vehicle impacted a tree as shown the above picture, only 3' between the front and rear of vehicle.

    Used the winch to separate the vehicle and then rolled it over, gently onto the ground, again using the winch and related eqip and then completed the extrication.

    Your only limited by your imagination and your willingness sometimes to realize that the extrication may require the use of outside resources.
    These views/ opinions are my own and not those of my employer/ department.

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    Just a thought if the car is wrapped around the pole, the pole is cracked, etc.

    Our power company (PG&E) always has pole trucks available to install a new power pole if one breaks, burns, etc. They have a boom and clamp which lifts and positions poles with ease. I'm willing to bet there's one in your town.

    I worked a major storm a few years ago where a pole carrying high voltage lines had snapped and was hanging from the wires. PG&E simply drove up, clamped and raised the pole, and parked the rig holding the pole and wires until they had time to install the new pole.

    So... Call 'em and have them clamp the pole above the wreck. Chainsaw the pole above and below the car. Now you can roll it if you wish and use cutters, etc.

    Just another option.

    Tim
    www.rescue42.com

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    Jeez Timmy.I hate to tell you this but I actually like that idea.We don't have any pole claws here,they're still doing it the hard way,but it's a great idea.T.C.

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    Alright, at the risk of upsetting some people, here goes. I don't believe in moving the vehicle more than it is when we get there. The 1st basic step in vehicle extrication is cribbing and stabilizing the vehicle. Why break the 1st cardinal rule? Next, in order to asses the pt, begin even the most basic of pt care and determine level of entrappment and method of extrication, you need to be able to evaluate the pt and have one of YOUR people in the car. There is no SAFE way to right the vehicle and still maintain 100% control and ABSOLUTE safety for the pt and your person in the car. I say work it as it sits. We know the roof is down because both "A" posts are down and the sterring wheel is down on the pt. I will also surmise that the dash is down on the pt since the steering wheel is. Long crib the frame side of the truck and tension it back to the vehicle frame. Long crib and tension the opposite side as well. All tension anchors should be as low as possible so as to ensure maximum support and are as out of the way as possible to rescuers. Have a Plan "A", "B" and "C" formulated and ongoing simultaniously if they don't interfere with each other. I mean a 3 pronged survey/attack from the rear, the bottom and the top. It is a pick up truck and it should be relatively easy to pierce the back wall of the cab. The removal of the roof from the exterior and also from the rear should be relatively smooth and not to difficult. After making access to the pt and beginning pt care, determine level of entrappment. In this case the steering wheel and dash is down on the pt and we need to move it. The exterior crew working on the bottom of the vehicle can make your very large relief cut at the base of the "A" post on the drivers side (The elevated side in this case). A simple reverse displacement can then be done to remove the car from the pt. Instead of lifting the dash off the pt as is normal, you move the bottom of the car from the pt and the pole all the while cribbing the "gap" as you go. Here I would use the wrecker but ONLY to stabilze the DISPLACED portion of the vehicle in addition to cribbing the gap. That way nothing goes flying back were it started suddenly. A quick removal of the pt on a back board and into the waiting helicopter. Just my thoughts.
    Last edited by STATION2; 07-09-2002 at 06:59 AM.
    Stay low and move it in.

    Be safe.


    Larry

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    Station 2,I will disagree with one part of your response.A COMPETENT tow operator can remove that vehicle from the pole with 100% control and predictability.I have done a similar event the process taking 30-45 seconds after rigging.There was NO patient or rescuer compromise.No saying it's what I'd do every time,but it's what I'd do on this scenerio given the information we recieved.T.C.

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    Rescue 101, I agree that a compentent wrecker driver, tow operator, etc. can be invaluable on a scene like this. But, it is outside our control (Atleast in my part of the country), to be guaranteed a proficient operator every time who can do this type of surgical level vehicle movement. As we all know, Murphy will raise his ugly head at the most inopportune time and it can create chaos. I believe in not putting faith and trust in anything outside of my control. I can trust my equipment because I maintain it, check it and operate it daily. I can trust my co-workers by working with them day in and day out on scenes and training with them to learn each others strehgths and weaknesses. I cannot however, control the actions of someone who does not fit any of the above. If push comes to shove and it is necessary, then you always have to look at options and that would be one. But definetly the last one for me.
    Stay low and move it in.

    Be safe.


    Larry

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    Hi Larry,

    I agree that I would only use a wrecker as a last resort and the ones that we do have all have top notch operators.

    We have used the winches mounted on our rescues and other rescues to lower or move the vehicle when we have vehicles wrapped around trees/ poles or other positions that you can not peform an extrication. We use several snatch blocks, slings, straps and have NEVER had any negative issues with it.

    The bottom line is, that we need to train and be prepared for every possible scenario and be prepared to do what is needed to remove the pt in whatever manner is dictated by the severity of the entrappment/ entanglement.
    These views/ opinions are my own and not those of my employer/ department.

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    Larry,I can't speak for your area but here I can have any company or operator for a life safety issue on my request.By no means would I suggest to you to violate your Dept. SOG BUT I WOULD strongly suggest if you have a couple good towing companies in your area that you involve them in your training program and utilize them as a listed resource.Bill Jackson of Fla. has started a core group of experienced operators that will respond to a LIFE SAFETY emergency at NO CHARGE!I would suggest you look around your area and involve companies interested in the heavy rescue end of the business.You might be surprised.Do what you gotta do,but in place is Waaay too much unnecessary work for me.Keep the thoughts coming,I learn every time I log on.T.C.

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    Default What they did not do on this MVA

    The replies to this thread have been well thought out. I will say that the IC and Companies did not utilize a tow truck. Personally I think having them at the scene during the operation would have been prudent (just in case), but they did not. I have used tow trucks several times on calls before (a few as times as a last resort). If we do use them at all make sure you know the driver(s)on a first name basis. (Meaning you really know each drivers capabilities) I think someone already mentioned this.

    When we train in the "junk yards" we involve the drivers (mostly observation and some scenarios include their cables) Try it! I have made the habit of requesting the tow vehicles VERY early (en-route). Occasionally you may need to specify which "Class" (A,B,C) of tow truck you need. Class-C being the HUGE Kenworth sized truck (in the US)One incident last year we needed two simultaneously to help lower a Suburban from a BIG Fir tree with two fatalities and One "sick" patient trapped under one of the victims. This particular call could NOT have been done without the tow-vehicles.

    I am sorry about not having clearer photos for this incident thread. A few of you mentioned going in through the back (front bed wall, and rear cab wall) You would more than likely need to cut the L-brackets on the seat in order pull him out the back. Obviously too the roof would have to be gone already. In my opinion, for this incident it would have been the easiest route OUT. The IC chose a different route (using the pole, relief cuts, spreaders). Any more Extrication Epinions for this? I WILL share them all with the companies who were there.

    Just so all of you know the Patient is home already and doing fine. (long bone injuries only, nothing life threatening.) Good thing I guess his "Golden Hour" was toast.

    JW
    Last edited by NB87JW; 07-10-2002 at 12:29 PM.
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