dont rip me too bad

[firemanpat29]

Im 2nd guessing myself over an extrication last night
2 vehical t bone highway speeds, small car uturns infront
of small bus (15 or 20 passenger size). Luckily bus had
no passengers. Bus on/in small car drivers side..Driver
critical, Ems in car with driver. only way in is move
the bus. Here is where Im 2nd guessing my self.
(Im highest rank FF present and also the best with extrication.
Sounds conceited but Im not like that Have had several EMTs
ask for me by name at major wrecks.)There was no wrecker
and no winch (and 101 was too far away) so after cribbing
the car. I decided that instead of letting a pickup truck
with a chain pull the bus,(wich is what was about to be done on my arrival) I would start it up and back
it out/off of the car. I was in eye and verbal contact
with the FF Emt in the car with patient. and I had a charged
1.5 ready. but afterwards I got to wondering if I should
have taken the risk of starting the bus. Damage was not very
bad on the front of bus and it worked fine no movement
of car at all. I dont know how the Very young Female
driver made out it didnot look promising. What ideas
do you have. What might I have done differently.

[fireguy919]

How far was the bus on top of the car? And how far was bus into the passanger compartment?

[fftrainer]

I'm not criticizing... I hate monday morning quarterbacking! I'm just looking for a little more info.

You stated only way in was moving the bus... Why? What prohibited passenger side access? What prohibited coming in through the trunk? Was it simply a time constraint based on patient condition?

Again, just trying to paint a better picture in my head to help you out and also file the info away in my little bean in case the same thing happens to me one day.

Given the basics that I know, my personal preference would be to avoid starting the bus. Granted if its the last resort so be it. You took the precautions of a charged handline, cribbing, etc.

Some people might disagree, but we don't always do the ideal when it comes to a real job in the field. The only time I ever find the ideal situation working out is on a staged incident on the training ground. Too many variables in the real world. Bottom line is do the best you can with what you have and make sure everyone goes home!

[vehext]

I have to ask... why did you not want to pull the bus away using a chain? I'm thinking it's the same as a winch, but I may be wrong. I'm not second-guessing, just curious.

Other than removing bus, I don't know what else you could do. Patient is critical - you do what you have to do. Bottom line... it worked.

JEB

[EFD840]

First off, don't stress too much. Good idea or not your plan (made in the heat of the moment) clearly worked and you're here rehashing it to see if there's a better way for the next time.

Now, as to your question, I'm with FFTrainer. A little more detail would help greatly. What about the situation made in necessary to move the bus at all? How was the patient entrapped? How did the EMT gain access? What resources (personnel and hardware) were on-scene?

Just thinking out loud, why not take the roof and remove the patient vertically?

[firenresq77]

Need more info. Do you have any pics, by chance?

[MetalMedic]

As said many times before, don't beat yourself up too bad. Your patient was extricated and everyone went home, so to me that is a "win" as far as the call went.

I often talk about having options and to me, the key to being good at extrication is having more than one way to do the job available to you. Sometimes plan "A" is the obvious choice, and sometimes plan "B" and "C" look better at the moment, but may not be so appealing once the problem is resolved. It doesn't necessarily mean you did it wrong, you just made a choice and got the job done.

I too would like to know more about the overall scene. The picture I have in my mind that worries me about re-starting a vehicle that has its front end buried into a drivers door is what condition the radiator and other engine components are in. Will re-starting it potentially expose your patient and the EMT to radiator fluid being pumped our or battery acid being thrown about by a cooling fan? I assume you have cleared those possibilities, but it was the first thing that came to my mind.

[firedog7]

Excellent point Metalmedic, also what kind of damage is possible when backing out, is there entangled metal that will catch and cause more damage to the patient? starting the bus may also create an ignition source,you may want to consider quickly laying down a blanket of foam under the engine area before you start it to catch any sparks, It is a an option I would have to carefully weight out, but with all things considered and carefully excecuted removing the bus could solve a whole lot of problems right away to gain access to the damaged drivers side if you feel that is the most safe and easyiest way to remove the patient once the bus is out of the way.
I've found the blowing out the B-pillar evolution the most effective and fastest way to remove patients involved in T-Bone collisions, which will not result in the doors or b-pillar going any further into the interior compartment.

[firemanpat29]

First thanks to all this is the one thread on here
that has the least bashing and offers the most help.
Sorry no pics, The front of bus was 12 to 18 inches
into drive side. Height difference made front bumper
area aprox 6 in over rocker panel. Door pushed in and
down onto driver,that is the main reason the lead paramedic
and I decided to go in from drive side. The way we work together
with the various med guys is Ask what they need done and
give other options if we have any. They are in charge of patient
we run the tools. I had the same conserns about starting the
bus, but there was no easy plce to hook chains and did not
have the time to waste hooking pulling, rehooking, and was not
sure the F150 they had backed up to it would have pulled
it smoothly. the car was (I think) a new taurus with
the little teardrop window in the rear between rear door
and back glass, there was no easy way to get roof off
without getting bus out of the way. front of bus had
sone damgage but radiator area did not seem smashed.
I dont honestly know if I would do the same thing again
but that is what makes it interesting, never the same thing
twice. Just got off the phone with my Mom, Patient lived
across the street from her and Pops,just moved in a month
or so ago, I had seen the girl once or twice out in the
yard when Id go see my parents. She did not make it, heard the
brain stem was broken..... She had a faint pulse when
we put her on the helo but didnt make it to the hosp...
sorry didnt realise I was rambling on thanks again for the
imput Patrick

[rualfire]

Tough loss.

Her fate was already determined before you were even dispatched. Nothing more you could have done to improve her chances.

I agree with the others. You addressed the risks appropriately and did what was required to accelerate the extrication to give your patient the quickest access to advanced care.


We had a similar event last week. Was Semi vs 1/2 ton. Being able to remove the semi from the passenger side would have been a tremendous asset.

As it was, the passenger was stable (really). It took us longer to free his feet than it would have if we had access from the passenger side. (we pushed off the drivers A post with rams to unfold the floor pan)

I'm confident that the engine of that semi would have started, but I think backing this one up would have created significant movement in the pickup.

When the wrecker finally pulled the pickup off the semi, there was a significant tangle.

[firedog7]

Rualfire, with all the fireman around the patient you can't see very well so I'm curious as to what stabilization methods you used on the pick-up truck?

[MetalMedic]

I see an ungloved hand in picture #3... must have been one of them silly cops!

[rualfire]

I wish I could say otherwise, but no stabilization was done on the pickup.

It was supported on the passenger side by the front of the semi, and the front drivers suspension was completely compressed.

It was a retty solid platform. Should have been fully blocked though. I will use these pics to re-enforce that mantra at our next practice.