Moving the vehicle during an auto-extrication

[NYMedic828]

I volunteer as a fireman on the side and last night we did an extrication drill in which I taught a junior guy to punch a hole in the side of a car to put a support jack into.

He said to me "Isn't it bad to move the car by hitting a hole into because of spinal injuries"

My answer to him was that it really is not that important as everyone thinks and they teach in EMT schools in the past. Studies have began to show that very few of our patients ever have a true spinal injury, and when they do we often end up doing them more harm with our pre-hospital "spinal precautions" such an imperfectly applied color and an uncomfortable flat board for their naturally curved spine.

I then explained to him that absolutely we should use our best judgement in doing our best not to agitate the vehicle and the patient(s) inside it. If they have injuries then any significant movement is absolutely going to cause them more pain and discomfort. Ultimately we should be doing what we need to do, moving what we need to move to get them out in a safe and a efficient manor that caters to their comfort as much as possible.

Was I wrong in basically telling him that its ok to cause movement of the vehicle from time to time? I just wanna make sure I had my info correct. Im pretty sure thats what my recent PHTLS coarse advocated as far as spinal injuries and measures to splint them go.

O

 

[mycrofft]

I'd say, done good.

Can't extricate from an unstable vehicle. Done that, not optimal. Move it as needed but use sense and not force when able.

Teaching how to use tools is good and fun. Teaching to think and use minimal force (say, cribbing auto in place instead of dragging to a flat spot) is harder but can save time and risk.

(reference: my frequent story about partner cutting carpet around entrapped foot, causing FD to put saw, winch and Jaws away).

 

[Veneficus]

"To free from entrapment or imprisonment"

My favorite definition of Rescue.

Here is the deal.

A patient cannot sit in the car with a stabilized spine forever. They have to be moved.

Before patient care comes rescuer safety.

Now I have been at this game a while and I know there is no such thing as a completely safe rescue, but you do have to take reasonable precautions.

The vehicle must be stabilized, dangers like airbags, running engines, flamable liquid spills, etc must be mitigated.

Back in my fire days we used to use wooden cribbing and high pressure airbags for stabilization. It was cheap, simple, and didn't require holes punched etc.

After you deal with rescuer hazard, you must gain access. Enough access to work and remove the patient. (rescue is all about the patient)

Medical care during a rescue is secondary. If the rescue is prolonged, simultaneous medical care must be undertaken. But in most cases you do not start on scene care that will prolong the rescue. (defeats the purpose actually)

In a perfect world, you would be able to completely eliminate all movement when you were rescuing somebody.

But if we lived in a perfect world, nobody would need rescued.

Nobody in a cemetary has a spinal cord injury.

Some movement is inevitable. Nature of the beast.

You are correct though, the incidence of primary and secondary spinal in jury is much less than advertized in EMS training.

Much of the research is showing that delayed cord injury is from ischemia (which is worsened by immobilization devices)

The delayed injury is not the same as a secondary injury from movement.

Life over limb over property.

Make prudent decisions based on your individual patient and circumstances of the environment.

 

[Aidey]

I have yet to participate in an extrication during which the car does not move at all. Some movement is inevitable. If the vibration from the extrication tools is enough to give your patient a spinal injury, your patient was screwed from the get go.

 

[DesertMedic66]

Punching a hole in the side of a car for support (we use the rescue 42 system) isn't going to cause that much movement to the patient. Unless your like the hulk.

 

[mycrofft]

Use air chisel? Then they need ear plugs

 

[ffemt8978]

I have yet to participate in an extrication during which the car does not move at all. Some movement is inevitable. If the vibration from the extrication tools is enough to give your patient a spinal injury, your patient was screwed from the get go.

Especially when you consider the minimal movement during rescue compared to the movement they went through during the actual accident. (Note: this does not apply if you are flipping the car over to extricate the patient.)

 

[NYMedic828]

Punching a hole in the side of a car for support (we use the rescue 42 system) isn't going to cause that much movement to the patient. Unless your like the hulk.

Basically same as what we use.

we use "rescue jack"

the little peg on the head is what the hole was for. I punched it with ease with a halligan in the hollow rear panel.

 

[NJN]

I agree with what you told your new guy. Punching a hole in a hollow panel isn't going to cause enough movement to be significant to the patient as using the tools can cause more potential danger to the patient (sharp metal, uncontrolled movement). Stabilizing a vehicle in place is going to cause some movement whether you are punching a hole for your struts or using the chains under the vehicle and then raising to create a stable vehicle. Even using traditional cribbing causes movement if you deflate the tires (with a vehicle on it's wheels) in order lower it onto the cribbing.

 

[mycrofft]

Wish they'd stabilized that one car on its side in the mud....

 

[DrParasite]

the theory is to move the vehicle as little as possible.

the reality is, you want to move the vehicle as little as possible.

the definition of "as little as possible" is where the question is.

we crib the vehicle to prevent rocking using step chocks. and on more complicated extrications, use more to prevent excessive movement.

but considering how much we overstress C-spine and crap, I don't think a little movement is gonna kill someone.

but a lot of movement probably won't be a good thing