Extrication Safety

We are somewhat limited because time is still of the essence when we consider that if the victim is injured severely enough, he or she belongs in the hands of the skilled professionals in the nearest trauma unit; we can stabilize but if the injuries are extensive, the victim belongs under the care of professionals who have the resources at their command. Careful planning will serve to lessen the time that the overall operation takes place and we will still have the victim to the hospital within the "golden hour."

Photo by Melissa Martz The Pleasant Gap, PA, Fire Company responded on Jan. 21, 1997, to a report of a motor vehicle with entrapment. The first chief to reach the scene was told a car was under a 30-ton truck loaded with 50 tons of stone. The driver's-side door of the car had to be removed and the dash rolled back to free the victim.

Photo by Melissa Martz After being freed from the car, the victim was taken to a local hospital in satisfactory condition.

Let's look at some of the problems and some of the related solutions. I am not going to make recommendations on the type of tools that will be employed rather, we will deal with the mechanics of each situation:

• When a vehicle is on its roof, extrication of the victim should be through the doors.

If need be, we have the technology and ability to "make a third door" on a two-door automobile in order to simplify the operation. We can even remove the roof in conjunction with the use of our high-pressure lifting bags and any number of cutting devices in order to remove a crushed roof. Stabilization of the car is going to play an important role in the safe extrication of the victim(s).

• When a vehicle on its side, we may find it easier to go through the roof.

In this situation, the importance of an air chisel cannot be overemphasized; when cutting the roof, operators are reminded to insure that the steel inner bracing under the "skin" of the roof and the headliner are cut and removed to make for a more efficient operation. We should make our opening as large as possible since, in all likelihood, we will be removing the victim on a backboard and we want to make the opening large enough so that we may operate "like ladies and gentlemen." Why make our operation more difficult?

Keep the following suggestions in mind when developing our plan of extricating our victim from his or her predicament.

If only one door can be opened, extricate the closest victim first, even if that person is not the most seriously injured. This seems almost elementary but if we try to work "around" a victim who can be removed more easily first, it is going to serve to make the later removal more difficult. We should attempt to remove those who can move under their own power first for the same reason it is going to give us better access to the more complicated victim and, in all likelihood, make the entire operation a lot smoother.

Here are a few suggestions in logical sequence that are going to simplify the removal of the person trapped in the front seat but especially the driver:

1. Force the door which is going to provide best access for the longboard/shortboard; it does not necessarily have to be the door where the victim is trapped. When utilizing a hydraulic rescue tool, great care should be taken not to "tear" the door from the Nader pin; if the door begins to tear, try attacking from a different vantage point. We want to avoid wasting time and energy "ripping" the door apart. Reposition the tool until we get the best point of attack and we attain the results we have set out to do that is, "popping" the door from the Nader pin.
2. With several members, apply steady, even pressure to the door in order to enlarge the door opening. The last thing we want to do here is jar the victim. Keep unnecessary movement to an absolute minimum.
3. Push the front seat back; we may even choose to lower the back down on the newer automobiles in order to provide more room to work and swing the patient into position.

We should mention the problems encountered with electrically powered seats as part of our size-up, we should consider the "pull the battery cable syndrome." If the battery is not causing a sparking hazard, consideration should be given to the fact that we may utilize the power seat controls to achieve what we need. This will be an important part of our assessment of the fuel spill hazard.

If we need even more room, we can slide the seat back by means of our hydraulic rescue tool. The spreaders are useful in this situation but practice is required to get this procedure right. The tip placed against the door opening where the firewall is located should be at a slightly higher elevation than the tip placed against the front of the seat. Place the tip of the spreader against the face of the seat we want to push and not to go down too low and place the tip of the spreader against the channel rail of the seat. If done improperly, the seat rail will be ripped from the floor, the seat can lift in an undesired direction (up against the steering wheel) and we could do further harm to the victim. An electric seat is very difficult to push in the first place and we put the victim at greater risk of further injury if we do not plan accordingly.

If it is necessary to displace the steering wheel, the hydraulic rescue tool chains should be used as a last resort; in my opinion, the risk of making a mistake and injuring the victim is greatly enhanced by using the chains. I am not condemning them; I believe there are many ways to accomplish the same task without using the time-consuming procedure of placing the chains in operation. And with the ever-increasing use of plastics in automobiles today, again, we may achieve little more than breaking the plastic because the hydraulic rescue tool is so powerful.

The psychological first-aid in this phase of the operation cannot be overemphasized. Attempt to keep the victim informed of the noises, fumes, etc., so that he or she will maintain confidence in us, the rescuers. It would be easy to lose this confidence if we say the wrong thing for instance, "this isn't going to hurt." Let victims know if it is going hurt when they are being moved onto a longboard or their heads are being taped for better immobilization.

With the power tools and hand tools that we have at our access, there is little we can't do should it become necessary we have the strength to literally disassemble an entire automobile if we go about in a logical sequence. As long as we keep in mind the idea that what we want to do is to remove the structural integrity of the area we are working on, there is little that we can't achieve. If we plan properly, we are certain to have that victim to the hospital well within the "golden hour."