Vehicle extrication

thumb|294x294px|Crashed car in [[Copenhagen.]]

Vehicle extrication is the process of removing a patient from a vehicle which has been involved in a motor vehicle collision. Patients who have not already exited a crashed vehicle may be medically (cannot exit a vehicle due to their injuries) or physically trapped, or unable to exit the vehicle because a door will not open.

Operations

Once an incident scene is protected, extrication can commence. Vehicle extrication can be considered in six phases. These phases are: 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.

Stabilisation and Initial Access

Stabilisation can be thought of as three phases.

thumb|A crashed car being stabilised

Phase 1 is rapid stabilisation, these are simple methods to improve vehicle stability:

Applying a parking brake
Applying a wheel chock
Applying a winch wire
Deflating tyres (this may compromise subsequent rescue efforts and forensic investigations)
Electrically isolating the vehicle
Using personnel to brace the vehicle

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:

Hydraulic/pneumatic stability equipment
Lifting bags
Struts

Glass Management

Glass management involves controlling the risk posed by the windows of the vehicle. 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.

Space Creation

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. 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. Moving vehicles with patients still inside is permissible if deemed safe. Relocation of crashed vehicles may:

Improve safety
Reduce rescue times
Provide better access to the casualty

Full Access

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. Patients should be encouraged or assisted to self-extricate from the crashed vehicle as a first-line extrication plan, unless:

the patient cannot understand or follow instructions, or
the patient is unable to stand (or it is suspected that they would be unable to stand) on at least one leg, due either to injury or to another condition, for example:
Impalement
Suspected pelvic fracture
Suspected or confirmed bilateral leg fractures
Signs of head injury (significant dizziness or confusion)

If extrication is required, patients should not be transported on a rigid extrication (spinal) board, as this can cause pressure injuries, and false positives on later examination of the back. Cervical collars do not adequately protect the neck, but they raise intracranial pressure, impede airway management and cause pressure ulcers, and their routine use is not advised in the developed world, and if used they should be loosened at the earliest opportunity.

Extrication tools and equipment

thumb|397x397px|U.S. Air Force Civil Engineer Squadron firefighter, holding a spreader, a hydraulic vehicle extrication tool designed to free crash victims from automobile wreckage and other rescues from small spaces.

Rescue personnel may use a number of powered rescue tools to extricate victims. There are three main types of powered rescue tools including:

Hydraulic rescue tools – Rescue tools powered by a hydraulic pump. The pump may be powered by hand, an electric motor or a gasoline engine. They may be portable or mounted to a vehicle. There are 4 basic types of hydraulic rescue tools:
Spreaders,
Shears (Often referred to as the Jaws of Life),
Combination spreader/shears,
Extrication extension rams.
Pneumatic rescue tools – Rescue tools that are powered by pressurized air. The pressurized air is sourced from SCBA cylinders, vehicle mounted cascade systems or air compressors. Saws, Air bags, air shores and air chisels are examples of pneumatically powered rescue tools.
Pneumatic lifting bag – Pneumatic lifting bags are air-pressurized devices that lift objects. They come in three basic types: high-pressure, medium-pressure and low-pressure. They are usually made with a rubber exterior reinforced with steel wire or Kevlar. When deflated they are about one inch thick.
Winch<nowiki/>es – Winches are usually vehicle mounted. They are used in conjunction with chains or cables.

Other equipment that can be used during a vehicle extrication include but are not limited to:

Gasoline rotary saw – A well-maintained gasoline rotary saw can be fitted with various blades: carbide toothed blades, abrasive blades, and diamond blades are among the common blade choices for rescue operations.
Pliers, adjustable wrenches, screwdrivers, etc. – Tools such as these can be used to disconnect the 12-volt battery system; remove interior trim at all push, pull and cut locations; disassemble vehicle components, etc.

Remove the glass from all side and rear windows
Cut all seatbelts
Strip trim around cutting points
Cut all roof pillars except front A-pillars
Cut “hinge” cuts in roof rail at windshield at the front of the car
Flap roof forward and secure in position
Cover sharps

Pedal displacement
B-post rip

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.

Third Door creation

Third door creation (or conversion) provides additional access to patients in 2 door cars.

Dash roll

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.

Additional risks

Airbags

thumb|Paramedics successfully extract the victim of a crash in [[Toronto]]

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. Airbags can remain active anywhere from 5 seconds to 20 minutes after being disconnected from the car's battery. This is one of the reasons rescuers disconnect the vehicle's battery and wait before cutting into a vehicle.

Hood Hinge Struts

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. 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. 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.

Hybrid Cars

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.

Liquid Petroleum Gas

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.

Specific extrication challenges

Car manufacturers are increasingly using ultra-high-strength steel (UHSS) to increase 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.

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.

References

External links

Vehicle Extrication: Levels I & II: Principles And Practice [Paperback<nowiki></nowiki>]
Bumper to Bumper Extrication: Extrication from inside the Auto Industry [Paperback/ebook<nowiki></nowiki>]
Ron Moore's University of Extrication on Firehouse.com
Extrication information on Vehicle Body Structures
Vehicle Extrication Training and Training videos
iRescue: App for iPhone/iPad to help the emergencie professionals to get information about a car in rescue situations
Vehicle extraction technics (PDF file, 70p, 4.9 Mb)