1. #1
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    Question Doors or Roof First?

    I am sure that this has been discussed in some detail but I am new to these forums. Which should generally be considered the first to go?
    Door or Roof?

    I know that each extrication has to be looked at individually.

    I personally think that the doors need to go first if possible.
    Chime in and give me your opinions. Thanks

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    Default Re: Doors or Roof First?

    Originally posted by lumpy39
    I know that each extrication has to be looked at individually.
    That pretty much says it all. I really have no preference, it depends on which is easier/faster to remove depending on vehicle position, damage, & patient condition. Personally, I think taking the roof is faster, but I take it case by case.
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    TEKRSQ quote:
    --------------------------------------------------------------------------------
    Originally posted by lumpy39
    I know that each extrication has to be looked at individually.

    --------------------------------------------------------------------------------



    That pretty much says it all. I really have no preference, it depends on which is easier/faster to remove depending on vehicle position, damage, & patient condition. Personally, I think taking the roof is faster, but I take it case by case.
    Sounds about right to me.
    Shawn M. Cecula
    Firefighter
    IACOJ Division of Fire and EMS

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    If the only access we have to a vehicle is through a window, we will force doors first so that care can be initiated. Even if there are some opening doors, we typically will remove doors first just to get them out of the way.

    If you have an unstable trauma patient and the only thing trapping him is a door, I'd say it would be a waste of time to mess around with a roof when you could rapidly extricate him.

    On the other hand, if the patient had a possible spine injury with neurologic compromise and was somewhat stable, I'd say it would make more sense to take your time and take the doors and roof simultaneously.

    All depends on the situation, like everyone said. But this is how we've typically done it in the past.
    Last edited by Resq14; 12-12-2002 at 04:44 PM.

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    I'm guessing that your talking about a real involved extrication since most of our pin ins only involve popping a door. Even if the extrication is more involved I feel that the door is the correct place to start.

    If you have enough tools to work at the same time then fine, but the door may be all that you need.

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    Just spent 45 minutes last night working on getting a victim out of Toyota Rav 4 that got T-boned on the drivers side.

    When I got there, the passenger's side door was popped open, an EMT inside and the other vehicle jambed up tight against her.

    First was the passenger's door, just to allow a little more room for the EMS folks, then the roof. We took what was left of the driver's door off her after we pulled the vehicles apart.

    Every accident is different; everyone usually has a different idea of how to go about getting the victim out.

    Generally I have a good idea of how we're going to go, but my guys are good... they will tell me right away if we need to change plans, if they see something's not right, they stop and fix it. That's the nature of the beast in extrication.

    One thing that we always try to do afterwards is brainstorm and discuss the "why’s" and "how to do it differently" before the tow trucks take everything away. (Last night’s top comment : "Let’s put ‘em together any try it again")

    Looking back over the years, I would say that it seems like the door is first to go, especially if you can't get to the victim. We are also firm believers of taking the roof, and bringing the patient up and back to get them out.
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    JJ has it right on. We usually pop the doors for access to the casualty then remove the roof to bring them out, unless the medics want otherwise.
    A hot debief on scene is one of the best ways to learn. When the pressure is off and the clock has stopped we can all look at what each of us has done and why, and talk it through. How many times have you looked a job and thought "why did I do it that way", or "that is obvious how come I missed it". If you talk the job through with the rest of the crew you all can be taught something (even the crusties) and in the end Joe Public gets the benefits.
    On a couple of occasions after the casualty had been taken away and no one else was around we have tried a different technique out on a car to see if it would have worked, (I can't recommend it but we got away with it.

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    We are also firm believers of taking the roof, and bringing the patient up and back to get them out.
    I have seen this comment in many different extrication threads. I brought it up at my last EMTB refresher for discussion and the instructor thought I was nuts. "Why the hell would you lift someone up and straight out the back when you can simply rotate them out the door?" Up and straight back is not a method that is taught anywhere in my area in EMT classes. Guess some people in NJ need to get up with the times and do what's best for the patient.
    "This thread is being closed as it is off-topic and not related to the fire industry." - Isn't that what the Off Duty forum was for?

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    Maybe this doesn't answer the question, but ...

    If you have a set of spreaders, then I would think that it would be a safe guess that you have a set of cutters, too. At which point, both the doors and roof should be worked at the same time.

    If you only have one tool (combi), or if your setup can only run one tool at at time, then get the sawzall out and start taking the roof.

    There's gotta be a way to do both at the same time.

    We have a policy that we just keep working until the patient is out. If EMS says take the door, we start on the door and the roof until the patient is out. If the door is off, we start on the roof until the patient is out. That way, we avoid having the door off, then EMS saying they need the roof, too. This way, the roof is already started.

    Bones ... straight lifting vs. rotating? Do the other EMT's want their spinal cords rotated instead of lifted? I know I don't, and I'm sure you don't either.

    Stay Safe

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    Default VERTICAL VS TWISTING

    Bones...
    You & I know that the majority of the Medic's who teach in our area are barely strong in their BLS skills nevermind trauma. They primarily sevice the Retirement Villages.
    For those unaware, Ocean County has more seinor developments than Florida or Arizona (as per 2001) Primary calls c/p & SOB.
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    There's gotta be a way to do both at the same time.
    We have an Amkus system that can run both the cutters and spreaders at the same time... we know it's true...it happens all the time

    DON'T FORGET HANDTOOLS : Just because the power cutters are working on the "A" post, doesn't mean the sawzall can't be working on the "B" post. A high lift jack will open a door while the spreaders are working on another. One thing that seems to happen alot is once a department gets a set of jaws (no matter what brand..another whole discussion thread upon itself) They seem to forget the basics. We try to train occasionally without the power tool just to keep up the skills with the basic tools.

    We have a policy that we just keep working until the patient is out.
    AMEN BROTHER !!
    I've seen way too many times where EMS says OK, you can stop now. 5 minutes later we have to start up the tool again and finish the roof or door.

    Think of it this way :If the vehcile is damaged to the point where you need tools to open the door, the damage is done, you ain't going to hurt the car any more by taking the roof or the other doors. The more metal removed = eaiser to move the victim
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    When I ask rescue crews what is THE most common job they do at a vehicle crash, they always say "opening a jammed door". That is by far the most frequently performed vehicle rescue task. Roof removal doesn't even come close in number of times it is performed compared to the door job.

    You know what they should say? They should answer that the most common vehicle rescue task they perform is 'vehicle stabilization'. It has to be considered at ALL incidents regardless of whether the doors need to be worked on or the roof has to go.
    Ron Moore, Forum Moderator
    www.universityofextrication.com

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    That is not true here. We almost always take the roof.

    The only problem with that is if you need to pop the
    doors after the roof is gone it is difficult, not impossible
    but difficult, no structural integrity (big word) left.

    I feel the best idea is to do both, best to have 2 plans working
    instead of one.

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    Although there may be circumstances where removing the roof first is necessary, this should usually be avoided. By removing the roof you lose alot of your purchase points to remove the doors. It makes a vertical crush impossible as well. It should not take much longer to remove the doors beforehand if you have your crew working efficiently.
    THE ABOVE REFLECTS MY OPINIONS AND IN NO WAY REFLECTS THOSE OF MY DEPARTMENT.

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    I might as well throw in my two cents....

    Each job will be different, so you cannot have a stead-fast rule on this. What you do need to keep in mind are your priorities:

    #1 - Scene safety
    #2 - Patient access for EMS
    #3 - Removal of wreckage from the patient
    #4 - Removal of patient from the scene

    When I approach a crash scene, the best option to getting the patient out is dictated by which one fits those priorities the best.
    Richard Nester
    Orrville (OH) Fire Dept.

    "People don't care what you know... until they know that you care." - Scott Bolleter

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    The problem with taking the roof first is the lack of structural support to the B-post. Once the roof is gone, pushing against the B-post, most times, causes it to move into the patient compartment making it difficult to pop both the front door pin and rear door hinges. As pointed out in a previous post, taking the roof first takes away the option of a vertical spread which may be necessary in a broadside accident. Any extrication in which you think the front door pin and the rear door hinges need to be attacked, strongly consider attacking them before roof removal. The added structural integrity the roof provides to the B-post makes it considerably easier attacking these pins and hinges; especially if your cutters don't cut them.
    Think about doors first, then the roof. Biggest thing - THINK and PRACTICE
    Be Safe

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    Whenever we do an extrication we take out all the glass, (except the windshield), and then begin to pop the doors. And when popping doors I always try to pop the hinge side first. I find doing it this way helps prevent the door from digging into the ground as you peel it from the car. The nader bolt holds the door in place while you pop it from the hinges, after you've freed the hinged side it's just a matter of a light nudge with the spreaders and the door pops free of the nader bolt.
    As far as removing roofs, we rarely do it. Most of the scenes we face don't require it. but when we do need to, we use a recip saw. It's much faster then the cutters. Once the doors are clear of the vehicle, with a good recip saw and blade you can have a roof off a car in less then a minute.

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    I think Chief Bator & Res14cue said it best in this discussion about doors or roof. When it comes down to both jobs remember if your popping the door & that fails your 2nd plan could be a vertical crush. If you take the roof then you lose the ablity to do a vertical crush.

    I do agree every M.V.A. is different but you should be thinking of plan B & if you use plan B then you should have plan C.

    Remember basic Hand Tools.

    Ron also made a statement that is true. Stabilation should be the most frequent job we do at M.V.A.'s.

    Stay SAFE

    Jim
    Last edited by thesnowman; 02-12-2003 at 09:36 PM.

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    I think Chief Bator & Res14cue said it best in this discussion about doors or roof. When it comes down to both jobs remember if your popping the door & that fails your 2nd plan could be a vertical crush. If you take the door then you lose the ablity to do a vertical crush.

    I do agree every M.V.A. is different but you should be thinking of plan B & if you use plan B then you should have plan C.

    Remember basic Hand Tools.

    Ron also made a statement that is true. Stabilation should be the most frequent job we do at M.V.A.'s.

    Stay SAFE

    Jim

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    we are in the doors first .......roof second club.......crib crib crib !
    IACOJ both divisions and PROUD OF IT !
    Pardon me sir.. .....but I believe we are all over here !
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