1. #1
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    Default Removing the roof at all extrications?

    Hey all, I was speaking to a senior guy on my squad, and he told me that Newark EMS/Rescue (I think that was the organization he mentioned) removes the roof on ALL extrications. the reasons were as follows:

    1) if you are cutting the car, it's almost always totalled, so it's not like you are costing the patient more in repairs
    2) it gives you a lot more room to work, from a patient care standpoint
    3) you can remove the patient easier, because you don't have to worry about the roof, C or B posts
    4) it allows you a much better view of the interior of the car (ie, what is trapping the patient).

    anyone else have an opinion on this?
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  2. #2
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    Always take the roof? That's a little extreme and I don't think it's representative of the wide variety of collisions we respond to.

    Do we take the roof on a critical patient when all we need to do is pop a door to get them out? Nope. Are we ready to in case we run into problems getting the door open? Yup.

    I think you have to take into consideration:
    - damage done to the vehicle from the collision
    - condition of the patient(s)
    - position of the vehicle, obstacles to extrication
    - Backup plans
    - Are you going to cause more damage to the vehicle regardless? i.e. cutting doors, posts, etc...
    - the big picture

    When you think like this "always" and "never" aren't really applicable.

    Remember that "totaled" is a very relative term. You can "total" a vehicle and not have a lot of damage to it. And on the flipside, you can have a lot of damage to a vehicle and have it still not be "totaled." My department has had issues with the latter with a newer minivan that we felt was totaled. Haha, NOPE.

    The bottom line I guess is that you do what needs to be done on a per call basis, and be ready to go to plans B, C, etc.
    Last edited by Resq14; 08-10-2004 at 01:27 PM.
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    Well see,there you go again 14.Take the roof and it removes all doubt. Totalled;(N);vehicle has repairable damage that will cost 75-80%of it's current market value to properly repair.Variables:What's your market and what's your vehicle? Known "totalling" factors,Bent uni-body,lateral bends in roofline rear of B post,bent frame,any combination of the above with deployed air bags,your friend is the adjuster, left front tire under right rear passengers seat(still attached to car)car has travelled down 500' of QUALITY Maine stone wall.And there's others.Seriously a lot of folks think that procedure can be carved in stone.I haven't found that to be so,and rely heavily on training and instinct to make correct decisions.Sometimes it goes and sometimes it stays.And SOMETIMES you hope someone else will show up to help.(G) T.C.

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    Never say always......... Bottom line is you do what you have to do to remove the vehicle from around the patient..........

  5. #5
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    Yes, like I said, "totaled" is merely one factor (the least important, imho). Ron had a good article about this a while back... dunno if there's a link to it online.
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    Isn't it tough to remove the roof if, say, the vehicle is upside down?

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    Not if you have the right equipment,struts,etc.T.C.

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    True.
    The image I had in mind was more along the lines of, oh how can I put this, yes!, squashed down flat!

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    I have one word to add:
    SIDE AIR BAGS

    Don't forget they might be there before you remove the roof. If you haven't been able to locate and/or disconnect the battery you could be in for real trouble when you cut one of the posts.
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  10. #10
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    There are never any absolutes in extrication, departments can have set SOG's but to say you have to do steps 1 thru 10 on every call isn't practical.
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    Nothing like being a bit slow to respond to some of the topics here, , but I struggle with the thought of always removing the roof. Whilst it creates loads of room, etc., it can also be very time consuming (Dependant on many factors such as crew experience, equipment used, shape of car after accident, etc) and unnecessary for the succesful extrication of many casualties.
    Luke

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    I think, as it seems most do here, it's situational. On one dept we actually had our SOG's and Medical Protocol's cover this. If a rapid extrication is needed, pop and door and get them out. This was the one that an insurance company had an issue with, If a c-spine injury was found with positive neurological deficit(numbness, tingling, or actual paralysis) was found no matter the condition of the vehicle(granted not upside down) the roof came off and a vertical removal was done to keep C-spine inline at all times.
    If I can find the pictures of the car we cut,it was a new Lexus that was all decked out. Honestly there was minor damage to the vehicle but we had numbness and tingling into all extremities and a burning sensation in the pt's neck. The medic ordered the roof removed. The chief questioned it for a second but was reminded of protocols and went with it. It was a minor rear end accident but caused several cervical fractures. The lady is fine after some rehab and about 9 months in one of those halo devices. Her insurance company actually wanted to sue the FD over the extrication but was thrown out at the first disposition by the judge and reprimanded the attorney and insurance company for a frivalous lawsuit.
    This is the only time I could think of we had to remove a roof for what appeared overkill at first, but after proper sizeup we decided it the best course of action. So I don't believe in removing the roof all the time but it may surprise sometimes when you do.
    Later, Keep it safe.

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    There is one interesting side story to total roof removal that we haven't discussed here. "Timing".

    Let's say there is in fact a Rescue Squad (in New Jersey or any place else) that really does try to remove the roof at their extrication scenes. My question is "When do you do it?" What's your timing of that task?

    If you remove the roof early, how does that impact any jammed door work that you might have to do yet? In most cases, it is easier to open and remove a jammed door when there is an intact structure all around it. Removing the roof makes the car into a convertible. Is that what you wanted to do? The doors and sidewall get spongy and that could be a bad thing.

    If you first open the doors, tear down the entire sidewall of a vehicle, and then remove the roof as your final job, was it really necessary or effective for that matter? Could the patient have been removed laterally instead of vertically?

    If you're going to move the dash and firewall off your patient (jacking the dash or rolling the dash) do you need the roof totally removed or could you get by with just cutting a chunk out of the A-pillar and then moving the dash?

    I am an advocate of total roof removal. The point is, timing of all your rescue tasks is everything. There's nothing wrong with always "anticipating" total roof removal, or thinking about taking it off... I just wouldn't say always!
    Ron Moore, Forum Moderator
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    The thing to remember in ANY extrication is quick, and safe removal and packaging of a patient involved in the incident, If you can remove the patient with a simple door pop and sliding a backboard in then that is the easiest way to do it. Roof Removal does give you more space and more of an opening but it can also be time consuming and sometimes you just don't have the time... Think Smart and use your head to make the judgement.
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    There is one interesting side story to total roof removal that we haven't discussed here. "Timing".

    Let's say there is in fact a Rescue Squad (in New Jersey or any place else) that really does try to remove the roof at their extrication scenes. My question is "When do you do it?" What's your timing of that task?
    When I first read Rons post, I immediately thought he was talking about timing the evolutions, but then I re-read it. Ron is spot on. Remove the roof too early and it can create bigger issues later on in the rescue.
    Luke

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    Not contradicting anything anybody has said, but is time a real big factor. I know it is time consuming, but with right equipment you could have the roof off by the time the door is popped. We practiced about a week or so ago It was a 4dr cougar I think, anyways we had alot of trouble on the back door. We we tried popping hte door, the skin was just coming off. May have been a stubborn car. But I think that time isnt a really big issue with the proper training. Now Dont get me wrong. When I say proper training I am meaning practice makes perfect. Just remember #1 while doing anything.


    Auk

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