1. #1
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    Default A You Make the Call for Commanders

    Side-resting SUV on residential street

    PD officer on scene

    FD personnel just arriving at rear of vehicle

    What would you do?
    Attached Images Attached Images  
    Ron Moore, Forum Moderator
    www.universityofextrication.com

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    Well start at the top....

    Stabilize the vehicle, crib at the "A" & "B" posts

    Scene Safety, Get Hose line in-service (Looks alittle wet under the Pass. side door could be water could be gasoline)

    Patient access, fastest way would be thru the rear window (It appears that the driver is conscious) C-Spine stabilization.





    Robert B.
    Haddon Fire Co. #1
    Haddonfield EMS

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    Ron, I'm assumming 1 patient in vehicle:

    1. Quick outer circle scan - power lines, etc. Hose line charged
    2. Stabilization - basic 3-point Res-Q-Jack setup
    3. Disconnect Battery
    3. Glass removal
    4. Patient access through windshield
    5. Remove roof while leaving high side B-post/seat belt intact to support patient.
    6. Support and package patient.
    7. Check surroundings for ejected occupants or injured pedestrians if unconfirmed.
    8. Wait around for the wrecker.

    I'd handle it the same way this Mass. fire dept handled this scene:

    A Walpole couple was involved in a two car motor vehicle accident at the intersection of Route 1 and Route 27 resulting in the rollover of their pickup truck. Both occupants were held in place by their seatbelts, greatly reducing their injuries.

    "Res-Q-Jackô" were used to stabilize the truck while Firefighters operated the "Jaws of Life" to remove the roof. The occupants were transported to the Caritas Norwood Hospital, treated and released.

    Photo Credit Neponset Valley Daily News intern Devin Ulrey



    www.res-q-jack.com

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    Very good decisions based on what you have been shown in this one image.

    Yes, there were some fluid spills.

    Yes, the electrical system was still intact upon FD arrival.

    Yes, there is only one patient inside the vehicle; the driver that you see hanging by the seatbelt.

    Access to any patient involves both "initial access" and "sustained" access. For the initial first contact with this patient, you would not want to cut into the windshield. The mention of the rear glass access is a better choice.

    Yes, the additional image posted of a different crash offers a good solution to this type of patient entrapment.

    Do you believe that this patient could be extricated without ever opening any doors?
    Ron Moore, Forum Moderator
    www.universityofextrication.com

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    Originally posted by rmoore
    Do you believe that this patient could be extricated without ever opening any doors?
    Yup. The roof could be flapped to the back (like in the 2nd picture shown) or to the side so that it lays on the ground. I don't see why you would want to mess with doors at all. For an initial means of access, it's also possible to make entry through a top passenger window.

    Tensionned buttress stabilization and a winch/come-along to secure the vehicle to the system would be my preferred method of stabilization. I know it's not always possible, but I'd prefer to place the stabilizers/struts on the underside side of the vehicle and then pull the vehicle into the stabilizers with a little tension on a winch cable. This keeps the working side of the inner circle free from big obstructions and reduces the chance of stabilization interfering with roof removal.
    Last edited by Resq14; 08-15-2002 at 08:59 AM.

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    Due to the location of the patient wouldn't it be best to extricate through the door?
    How do you plan on popping the door? One is under the side resting vehicle and one is now in the air at the top of the vehicle. Would you ladder the side of the vehicle and put additional weight against the side of the vehicle and bust your ***** to operate the tools? I wouldn't.

    Now suppose you did do all of this and your concern has been shown to be in-line stabilization. How is having the door off at the top helping to maintain in-line stab.? The patient is "c-shaped' by nature of hanging by the seat belt. if you straighten them and board them then your talking about a straight up lift to get the board and patient up and out of the vehicle.

    My plan would be one of two things. Plan A would be flap the roof down. Since this is an SUV Plan B is through the cargo area and get the back of the seat off, board the patient and go.

    Not picking, just thinking out loud!

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    Big bucks.........? You're ahead of me, heck I'm lucky if I get paid the peanuts left over from the circus elephants.......... More often than not I am compensated in headaches and aggravation - but I'll always come back for more because I enjoy it too much!

    Stay Safe!

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    Not to throw a complete monkey wrench into this, but on a lighter side if I was assigned to this job as EMS and no other function, once I made contact with the patient, and confirmed 1) he/she was CAOx3, 2)had no LOC, 3)is apparantly not under the influence of any substances, I would ask a little about the accident and the patient. I would then more then likely gain access through the rear/window when my brothers took it out, and clear c-spine, and allow the patient to walk out of the vehicle. Especially if he wanted to RMA. There is actually a very low percentage of pertinent injury associated to victims of rollover when restrained.

    If the patient was complaining of severe (*severe) pain to any part of his spine, I would still assess him/her the same as I would to clear it and makes notes as to where I may have positive findings on assessment. The thing that is constant here, that regardless of what the patient condition is, you will not be able to completely support, nor immobilize the thoracic/lumbar part of the spine due to the vehicle is resting on its passenger side. Sooner of later that seatbelt will have to be cut and gravity will prevail. This is where protecting the c-spine is most important due to its vulnerability and lesser natural support system, and a big ol' head sitting on it.

    This is not a post intended on arguing the point of being allowed to clear c-spine, if you can't/don't want to, I understand. It is an option we have been trained to do and have been for 2 years without a single problem.
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    ALSfirefighter - We are not allowed to clear C-Spine. What would you think of a KED here? We actually use them very often and have very short application times. It would be on before we were done flapping the roof. Just wondering...

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    Size up, deploy line or fire extinguisher, stabilize.

    Initial patient access through the rear window.

    I vote for a roof flap, but I'd take it toward the front of the vehilce to keep it out of the way.

    I also think that this situation would be an excellent use of the KED. Roll the cot near the SUV with a backboard on in, and you can move the patient from the vehicle directly to the cot with spineboard ready.
    Last edited by SilverCity4; 08-16-2002 at 11:11 AM.
    Bryan Beall
    Silver City, Oklahoma USA

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    Fire Safety 1- Until access is made to the hood, deploy a Dry Chem extinguisher or charged line.

    Stabilisation- Place wedges and blocks all the way around vehicle. (A minimum of two on both sides. Nose the rescue up to the under carriage and connect the winch. Gently pull the vehcile back slightly onto the wedges at the rear. Push in the wedges at the front. (Before everyone jumps on the bandwagon of the possibility of the vehcile rolling over from the winch- go and try it. It takes a fair amount of pull to roll a vehicle back onto its wheels vs onto it roof!)

    Access- Acees the casualty via the rear window. Break or lower the windoes closest to the ground as they won't sustain the force of rescuers/medics walking on them inside the vehicle.

    Fire Safety 2- Once inside the vehicle, attempt to lower all windows if they're electric, before disconnecting battery. Open the hood using the release mechanism. It should open easily due to the apparant lack of damage to the front end. Disconnect battery (earthed lead first), do not cut the cables. Have absorbaent material placed over the spilled fluid. Re check stabilisation now that a medic/rescuer is in the vehcile and also the hood has been opened, changing the balance slightly.

    Casualty- Protect the casulty. The side windows in the air, lower them down into the door if manually operated. Remove the remainder of the side and rear glass. Have another rescuer attempt to remove the front windscreen. Clear C spine or treat as per your dept.'s protocol. Leave seat belt on as it is assisting the casualty.

    Rescue- Due to the rigid style of the roof I would call for the roof removal. (A roof flap to the front or rear could be awkward due to the structural ridges on the roof. Also, a flap down to the ground will only creat an unstable work platform and casue a trip hazard.) Quick and easy to do using hydraulic cutters from both the inside of the vehcile and the outside. Re check stabilisation as cuts are made as the strength and structural integrity of the vehcile has been changed by cutting pillars and removing the roof. Cover all sharps as per normal procedures.

    Casualty Removal- Whilst casualty handling is being performed, clear access path from the vehicle to the waiting ambulance.
    Slide the spine board in between the centre console the casualties seat. Have 2x Rescuers/medics support the casualty whilst the seat belt is removed. Gently lower the casualty down to the board. Slide him along the board on hos side. Do not rotate him on the board until C spine has been cleared. Walk board and casualty out of the vehicle to the waiting ambulance.
    Last edited by lutan1; 08-16-2002 at 05:17 PM.
    Luke

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    Just another note on scene safety. Anytime the police have been there prior to our arrival, it's nice to be able to confirm with them(PD) whether the occupant is in his situation as the result of a pursuit, or if there are any weapons or other dangerous objects( used drug needles, boxed up meth labs)in the vehicles.
    In the original picture, it almost appears the driver is trying to get his license and registration from the glove box, or maybe a loaded .45 because he's a wanted felon and doesn't want to go back to the big house

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    Lutan,This roof on this vehicle isn't particularly slippery.Depending on injuries most of the solutions have merit.For ease of entry,cut a&c both ends,b on upper side and fold roof to ground.Yes that does leave you with a trip hazard but only one post if you stay in line with your ONE patient.So many solutions,so little time.Or you could >>>>> Do it my way! Hehe T.C.

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    101, at no time did I say it was slippery when you fold the roof down. I said it was a trip hazard and it creates an unstable work platform for the rescuers.

    Just like your truck vs car- I've done heaps of these exact same incidents. I know I'm right, there is no better way!!! (Two can play your game you mongrel!!!!!!!! )
    Luke

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    If you insist, you pestiferous lil' kangaroo chaser!But have you ever done one with the steering wheel on the correct side? T.C.

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    Bones, KED would be helpful to allow of few of us beefy guys to have a extra handle to hole the patient so he doesn't go crashing with gravity if any symptoms/conditions where present with assessment. Unless of course he is unconscious and then its rapid extrication , (load & go) to the trauma center.

    Lutan and 101, easy fellas!!

    Lutan, excellent post!!!
    101, thanks for the laugh brother!!!!
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    I was going to write a longer reply but Lutan basically stole the thunder. I see hardly any need to even use a door. There is easy access through the rear window after safety (De-energize, fire protection) and stabilization is taken care of. C-spine protection, wound care (als/bls) of the vicitm. Th roof could be flapped down 3/4's down from the top (leave passengers posts in-tact). Make sure to see if the patient can't just be taken out the back window somehow safely, (be sure to recheck stabilization) Board patient easily from cab with adequate personnel. Obviously other plans should be discussed (all along) if plan-a doesn't pan-out.

    JW
    "Making Sense with Common Sense"
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    I definetly think you could access (both initial and sustained) the patient and extricate the patient without actually having to cut anything. A possible option (based on the picture given) would be to -
    1. Access through the rear liftgate, strapped to ensure it will stay open.

    2. Most every SUV has fold down rear seats, so fold'em down.

    3. Make initial contact with patent and do a initial evaluation and spinal immobiization. KED would be a good choice.

    4. Get another member up front with the initial member and another member in the back seat are with a full size spine board.

    5. Stabilize patient while the drivers seat is reclined.

    6. Place driver on spine board and strap him down unless critical.

    7. Slide board out the back.

    This senario is based on a full scene assessment , electrical system shut down and proper vehicle stabilization already in place before anyone enters vehicle. We are not a fire departement, only a rescue squad so the best fire protection we can do is a fire extinguisher.

    I would prefer to remove the roof entirely and give lots of access to the patient. However I would suspect that I could probably have the patient out faster without making any cuts than if I cut the roof off.
    Sounds like a good experiment for the next training night.

    Shane

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