# Extrication



## hpowell945 (Sep 25, 2008)

Alright, I've got a good one for anyone. My friend from another service had an ambulance drill the other day...

Single Car MVA on a main road. Patient was ejected and thrown into a tree, where she was in the crawling position about 1 meter off the ground. Assuming C-Spine what else would people do?


This wasn't an actual call, it was a drill.


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## Oregon (Sep 25, 2008)

Oh, wow, I think I'd go for airway before C-Spine, or am I wrong about this?


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## KEVD18 (Sep 25, 2008)

1) welcome to the nut house.

2) this really should be in the scenario section, but im sure one of our illustrious cl's will take care of that

3) i said this recently in another thread. textbooks and protocols cant possible cover every possible situation. if they did, they would be to large to even consider actually remembering. in cases not perfectly covered by text or protocols, it is up to the responding personnel to use their best judgement and do the best they can. this is the difference between a robot and a thinking medic. the ability to think outside the box.

as far as this specific call, id really have to be there or have pictures of it to be able to tell you what id do. i can imagine that it would involve as many hands as i could get a hold of and some creative rigging. on the other hand, it could be as simple as a tower, my partner and a couple of truckies to help me out.


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## flhtci01 (Sep 25, 2008)

KEVD18 said:


> as far as this specific call, id really have to be there or have pictures of it to be able to tell you what id do. i can imagine that it would involve as many hands as i could get a hold of and some creative rigging. on the other hand, it could be as simple as a tower, my partner and a couple of truckies to help me out.



I agree too many unknowns and variables.  What might work this time might not work next time and vice versa.


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## mycrofft (Sep 26, 2008)

*By "Into the tree", do you mean...*

..cradled amongst the foliage, as it were, or straight in like Robin Hood's arrow?

The motorcyclist we had like that (the latter mode) needed neither treatment. Broke his helmet and crammed the beer can into his maxillofacial area pretty darn well. DOA, estimated speed of impact eighty mph. Tree, a big red oak, doing fine last I saw.

Pulse and resp check=>Airway-CPR-spinal precautions as needed in that order, followed by extrication, if you have the luxury to do that _after_ the others and not _first_ so you can DO the others.

Look for impalements, listen to chest.


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## Flight-LP (Sep 26, 2008)

1 meter, about 3 feet up..........Have the firefighters on scene stabilize, maintain the best restriction they can on the spine, backboard, and leave. That is providing there is a pulse present, if not, no treatment required, it just became a corpse for the coroner....................


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## Jon (Sep 26, 2008)

KEVD18 said:


> 2) this really should be in the scenario section, but im sure one of our illustrious cl's will take care of that



I took care of it... but I wasn't able to find anything to merge it with - Sorry


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## KEVD18 (Sep 26, 2008)

illustrious work sir.


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## BossyCow (Sep 26, 2008)

Hmm so basically the driver is low hanging fruit? I see a number of issues to be addressed first and formost being the scene safety for those treating her. Stay out from underneath until the stability of the branch she's perched upon can be determined. I would probably attempt a KED as soon as I could figure out how to get up to her with it. Then possibly some high angle rescue gear to lower her down. Perhaps a pulley up above to lower her gradually. 

It would all depend of course on the vitals and general condition of the pt. Is this a life over limb thing or an extrication puzzle?


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## KEVD18 (Sep 26, 2008)

you're going to ked a person dangling from a tree limb? i believe id pay to see that train wreck.


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## BossyCow (Sep 26, 2008)

KEVD18 said:


> you're going to ked a person dangling from a tree limb? i believe id pay to see that train wreck.



LOL.. I was tossing out options.. I'm thinking that if the pt could be accessed from above, given the legs up bent at the waist positioning, it would at least stabilize the spine.. otherwise how are you stabilizing C-spine? You gonna get a backboard up there? Without seeing pictures of the actual positioning of the pt, its all a he said/she said scenario with nothing but the pictures in our heads.


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## mikie (Sep 26, 2008)

KEVD18 said:


> you're going to ked a person dangling from a tree limb? i believe id pay to see that train wreck.



like the good ol'e days when the FD got cats out of trees!  This is just a little bigger


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## KEVD18 (Sep 26, 2008)

every way i picture this in my head, theres really no way you're going to get c-spine accomplished, aside from a collar and as much manual stabalization as possible.

as a technical rescue instructor/specialist, i can think of a few different ways to do it, but none of them would be quick so the delay in care v. efficacy of the rescue would have to be weighed.

i personally like a tower/ladder for this scenario.


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## reaper (Sep 26, 2008)

Just shake the tree, till they fall out. Then you can maintain c-spine better!


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## Scout (Sep 26, 2008)

Are they not already extracted?? Seem to have done a good job of getting out of the car?

At 1m, stomach/lower chest, coller and slide a LSB along their back, strap and lift


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## EMT-P633 (Sep 26, 2008)

Is she stable or unstable?

If she is stable. I would bring the LSB up under her and the branch. have a couple FF's hold the board. and then trim the tree branch. all while maintaining c-spine. lower her to the ground, sandwich another board behind her. and log roll her over to supine.

Is she unstable needing rapid extrication? if so. manual c-spine, pick her up off the branch using as many helpers as safely possible and apply LSB. since she is only 1 meter (3 feet) off the ground.


Then wether she is stable or unstable treat/transport appropriatly. 

I was taught CABC's (C-spine, Airway, Breathing, Circulation). usually you can maintain both C-spine, and open Airway simutainiously. (modified jaw thrust).

Now if she is a DOA. take several photos (yes censor the face / identity) and use them for teaching aids for seat belt / safe driving shock material!


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## mycrofft (Sep 26, 2008)

*BossyCow, only you would caution us to watch our for "deadmen"*

(Hanging dead branches for the citydwellers).
I got that "life over limb" thing too!


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## Capt.Hook (Sep 26, 2008)

One could also consider a chainsaw on the tree limb(s) if possible.  The situation would need to be perfect, but with proper patient position and limb arrangement this could be an option to cut the tree out from the person.


(oops, just noticed a mention of trimming a couple posts ago!)


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