Vehicle extrication is the process of removing a patient from a vehicle which has been involved in a motor vehicle collision.[1] Patients who have not already exited a crashed vehicle may be medically (cannot exit a vehicle due to their injuries) or physically trapped,[2] and may be pinned by wreckage, or unable to exit the vehicle because a door will not open, sometimes the patient can be dead
Once an incident scene is protected, extrication can commence. Vehicle extrication can be considered in six phases. These phases are:[3][4][1]
Once a scene is protected, for example from other moving traffic, the fire service commander will complete a rapid assessment to identify any significant hazards[5] that may present immediate risks to emergency service workers, members of the public or the patient or patients. This may include fire, hazardous substances, the risk of falling from a height, or being electrocuted or injured by falling masonry from a damaged building. Steps are then taken to mitigate these risks.
Phase 1 is rapid stabilisation, these are simple methods to improve vehicle stability:
Phase 2 is stabilisation achieved using chocks and wedges under and around the vehicle.
Phase 3 is the use of additional equipment to stabilise a vehicle. This may be more complex and include:
Glass management involves controlling the risk posed by the windows of the vehicle.[6] This is not just the removal of the vehicle’s windows: it must also include the control of any glass fragments which may pose a risk to the patient and attending emergency service personnel, or which could damage equipment, especially hydraulic hoses.[citation needed]
The space creation step starts with a structural assessment of the involved vehicle to determine which vehicle components could be simply opened, moved, or manipulated by utilising a vehicle’s natural design features.[3] This would include opening doors, windows or sunroofs and moving/removing seats or headrests. Beyond that, an extrication plan will be formulated which details which vehicle body parts will need to be removed, displaced or reformed to allow access to the patient or patients.[7] A number of specific techniques can be utilised and these are discussed later.
Consideration should also be given to moving the vehicle involved in the incident if that will aid space creation.[8][9] Moving vehicles with patients still inside is permissible if deemed safe. Relocation of crashed vehicles may:
Full access aims to ensure that there is enough space to meet and exceed a patient's clinical requirements and to meet the needs of emergency service personnel.[1] Space creation should allow access for medically trained responders to reach the patient. They can assess the patient and if required undertake medical interventions: for example, stopping bleeding, opening obstructed airways, providing medications such as oxygen or tranexamic acid.[citation needed]
It used to be thought that individuals involved in road traffic collisions needed extremely careful handling, including the use of cervical spine collars and spinal immobilisation boards. This is not however supported by the available evidence base.[10][11] Patients should be encouraged or assisted to self-extricate from the crashed vehicle as a first-line extrication plan, unless:[12][13]
If extrication is required, patients should not be transported on a rigid extrication (spinal) board,[14] as this can cause pressure injuries, and false positives on later examination of the back.[15][16][17] Cervical collars do not adequately protect the neck,[18] but they raise intracranial pressure,[19][20] impede airway management[21] and cause pressure ulcers,[22][23][24] and their routine use is not advised in the developed world,[25][26] and if used they should be loosened at the earliest opportunity.[27]
Rescue personnel may use a number of powered rescue tools to extricate victims. There are three main types of powered rescue tools including:
Stabilization tools include:
Other equipment that can be used during a vehicle extrication include but are not limited to:
These include:[7]
A roof flap can be undertaken forwards, backwards or sideways. The technique is similar for all three, but the direct the roof is "folded" differs. The steps to perform this technique (forwards) would include:[32]
Removal of the B-post or B-Pillar of a vehicle to allow improved access. The B-pillar is located between a vehicle's front and rear side glass, where it serves as a structural support of its roof, its removal leaves the side of a car wide open.[citation needed]
Third door creation (or conversion) provides additional access to patients in 2 door cars.[33]
The dashboard and steering column can intrude into the passenger compartment and crush a patient or restrict their movement. A dash roll, or dash relocation aims to create space by moving the dashboard away from the patient.[34]
Active systems such as airbags make cutting into a vehicle more complicated: when they are not set off during the crash (e.g. in a vehicle struck from the rear or a rollover), extrication operations may set them off. This can cause additional trauma to the victim or to the rescuers.[citation needed] Airbags can remain active anywhere from 5 seconds to 20 minutes after being disconnected from the car's battery.[citation needed] This is one of the reasons rescuers disconnect the vehicle's battery and wait before cutting into a vehicle.[citation needed]
Hood hinge struts can pose a great amount of danger to rescuers who are extricating a victim from a car that had any significant heat in the engine compartment. According to the strut manufacturers, these sealed and pressurized struts are designed to operate at temperatures ranging from 40 degrees Fahrenheit to 284 degrees Fahrenheit.[citation needed] No manufacturer could provide any evidence that any testing at temperatures above 284 degrees Fahrenheit had ever been conducted. During a vehicle fire, especially an engine compartment fire, the two hood hinge struts will be exposed to high heat levels. Since there is no pressure relief "valve" on any of these sealed and pressurized struts, the units can fail violently when overheated.[citation needed] Unfortunately for firefighters, this failure can actually "launch" the entire strut or just one part of the unit a significant distance off the vehicle like an unguided missile. It is the launching of the heated strut that in several incidents across the United States, has caused serious injury to firefighters.[35]
New hybrid technologies also include additional high voltage batteries, or batteries located in unusual places. These can expose occupants and rescuers to shock, acid or fire hazards if not dealt with correctly.[citation needed]
Some vehicles have an additional autogas (LPG) tank. As the system was not built in, there is a risk of damaging the pipe which is often under the car, releasing the pressurized fuel. The risk of this is minimized by locating the line in a protected position during installation. Modern installations also have a shutoff solenoid at the tank so that rupture will only release the fuel in the line rather than allowing fuel to come out of the tank.[citation needed]
Car manufacturers are increasingly using ultra-high-strength steel (UHSS) to the crash safety ratings of their vehicles. UHSS is used in areas of the vehicle such as the A-pillar, B-pillar, rockers, side impact beams, and roof beams. This steel is difficult to cut with the standard extrication tools.[citation needed]
Carbon fibre poses unique challenges when used to manufacture vehicles. It is light and strong and can be difficult to cut. In addition cutting this material can produce particulates which are harmful to health, and breathing protection is required for rescuers and the casualty.[36]
{{cite news}}
|last2=