What's your interpretation of a Rapid Intervention evolution or Rapid Extrication?
In a few other threads, there appears to be a bit of debate over what's rapid and what's not....
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Thread: Rapid Intervention/Extrication
08-11-2002, 06:58 AM #1
08-11-2002, 10:59 AM #2
- Join Date
- Oct 1999
- Why? It's not like you're going to visit me! But I'm near Waco, Texas
the way i was taught years ago was that rapid extrication was removing the patient from a dangerous situation with little or no patient care done beforehand. obviously if the car is on fire you will pull the patient out before applying bleeding control measures. most of the time it was one person holding c spine while the others move the patient onto a backboard and out of the vehicle. this was rapid and usually about 30-45 seconds to do. but since each state and country has different schools teaching then everyone usually learns something different. it's when everyone gets together like in here and throw ideas at each other that we learn what works better and what doesn't work. we are all doing this for the same reason, saving lives.NREMT-P\ Reserve Volunteer Firefighter\Reserve Police Officer
Experts built the Titanic, amateurs built the Ark.
08-11-2002, 05:16 PM #3
- Join Date
- Jul 1999
- Puyallup, Wa.
I think the conduct of a rapid extrication depends on whether it's called for due to circumstances or patient condition.
If fire is the reason and it's just a small incipient one under the hood, put it out with water or a dry chem. and continue with a normal extrication if the passenger compartment is safe. If someone is physically pinned, you may also have to shelter in place, put the fire out first and then you can work to free them.
If you arrive and have the engine compartment well involved and spreading, it may be best to have 1 ff attack with a hoseline or extinguisher while the others work to remove any occupants. If the patient can't get out under his own power and the doors are jammed, breaking a window and pulling them through the opening may be the best course of action. Yesterday on the 405 north of here, a small car stalled and got rear ended at high speed by an SUV.The car caught fire rapidly. Bystanders and a state trooper were able to pull the unconcious driver out, but the front passenger and 2 kids in back couldn't be removed in time. Rapid extrication needed? ya, get them out any way you can. I can't see anyone using a backboard, C-collar and 4 personnel in those circumstances.
If rapid removal is called for due to the patient's medical condition, yanking them out would not be appropriate. You still need to make things safe - stabilization and fire protection. Then consider if they're physically pinned as you determine the fastest, safest route out. If the choice is to take them out the side of the vehicle, my plan A is normally a Maxidoor. It's worked very well for me and if I need a Plan B, moving forward and cutting the front door hinges will let me lay the entire side down in a short amount of time.
If the call is to go out the back and the seat can be reclined, it may be quicker to slide them out the rear window opening. This technique is relatively new to us and has worked great in training, I personally haven't had the opportunity to use it on a call yet. If the roof needs to come off in a rapid manner, having multiple tools working is great, hydraulic cutter to the narrow posts while the recip saw attacks the wide, rear posts.
Trapped by the dash? Leave the roof on and do a 'modified dash roll or jack'. Windshield removed and section of A post removed on the side you want to displace.
Quick breakdown of rapid as opposed to controlled extrication. Rapid: Quick stabilization of the vehicle with dry chem. positioned at the front, battery disconnected only if there are undeployed SRS or you can access it quickly, manual C-spine with quick survey for life threatening conditions ,no KED, make a big hole if the crash dictates you use the tools( faster to make it big and remove with no obstructions than creating a small opening and manipulating patient out side door), aggressive attack with multiple tools, more noise created as a result. Clean, efficient removal to a transport unit and don't let the paramedics waste all the Golden Hour trying to start an IV at the scene.
Sorry for the rambling, keep getting interrupted by runs.
Last edited by kbud; 08-11-2002 at 05:19 PM.
08-11-2002, 10:22 PM #4
- Join Date
- Sep 2000
- Westchester Co., NY USA
Being I'm one of the guys going round and round with this one, I gotta post here also.
Rapid Extrication and/or Load & Go which it is also referred to, is based on the patient's condition. Life threatening injuries warrant rapid extrication, which means manual spinal immobilization, loading on a backboard, and transport, ideally within the platinum 10. Anything that is life threatening warrants rapid extrication from a vehicle or load & go on other scenes. Also, by NYS and National Registry standard, should be performed when any condition is found during the primary (Initial) exam that warrants treating such condition without going any further. I've stated my opinion based on my training from both NY and NR, and taking any amount of time, to place a KED, or not pulling a patient with a life threatening injury out of vehicle the moment he/she is free is wrong.
I.A.C.O.J. Bureau of EMS Chairman
08-12-2002, 10:18 AM #5
The following is my opinion based only on what I have been taught, read, seen, and used in the field.
I think too many people are getting hung up on trying to define rapid extrication as one specific removal technique. Just like the term "Fire Suppression", "Rapid Extrication" can vary greatly in procedure and application based on the conditions present. Therefore, I believe that Rapid Extrication should be thought of more as a range of procedures and techniques that are applied based on the varying degree of Life Threat present.
Just like you wouldn't use a Deck Gun on a 3 gallon waste basket fire - you don't grab an A&O Pt. in a stable environment by the arm and drag them out of the car just because you can.
Likewise you don't pull a booster reel on a 50' X 50' fully involved factory and you don't KED, Collar, and Board a Pt. in a burning car (or one who's medically unstable and un-treatable in their current position/location).
My Definition: Rapid Extrication is the removal of a Pt. from a hazardous environment or life threatening situation as quickly and safely as possible while using the greatest amount of packaging & stabilization the situation will allow.Take Care - Stay Safe - God Bless
08-13-2002, 11:28 AM #6
- Join Date
- Jul 2001
- Silver City, Oklahoma USA
That's a pretty good definition Stephen.
I think that the biggest problem we've been having with the term "rapid extrication" on these boards is that many think of extrication as cutting a car apart. In reality, we are "extricating" a patient from the car even if we don't break out the tools.
The fire scenario is a good example of when we skip many, if not all of the basic steps and get victims the heck out of the situation. It does zero good to protect a victims spine if they die from burns or smoke inhalation because we took too long getting then out of a car.
Likewise, a victim in a MVA that stops breathing before you get KED on doesn't need the KED--he needs to breath.
Life over limb, every time.Bryan Beall
Silver City, Oklahoma USA
08-13-2002, 12:06 PM #7
Two patients in cardiac arrest in a VW Bug -- FD wasn't alerted until 30 minutes or so after the collision, so shock more than trauma had created the arrests.
And more than a decade later both are alive and able to enjoy life. One made a near 100% recovery, and the other has done remarkably well for how long his brain was starved for oxygen.
I like very much N2Dfire & Silver City's comments.
08-14-2002, 12:34 AM #8
- Join Date
- Apr 2000
This past weekend an off-duty Cranston, RI firefighter "rapidly extricated" a man from a burning wreck with the help of a bystander. After removing the female passenger (who was not entrapped, unlike the male driver) the firefighter crawled inside the (burning) car to disentangle the patient's legs, after which a passerby pulled the man from the car.
The passenger survived, unfortunately the driver did not (pronounced onscene).
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