Vehicle ExtricationWairarapa Ambulance Service

Heidi Whitman, Intensive Care Paramedic

Maintain spinal alignment ◦To minimize spinal cord injury and

paralysis.

Minimize body twisting◦To reduce further injuries and reduce

fracture movement and pain.

Two Basic Principles

Patient Condition A rescuer undertakes a full assessment of

the patient before extraction◦ …Unless rapid extrication is required for the time

critical patient.

This includes: ◦ Check safety, scene, and situation.

Approaching the PatientFirst rule out dangers to the rescuers.

Initially approach the vehicle from the front so as to avoid the patient twisting their head.

AlignmentIf the patient is slumped over, use two rescuers to bring

the patient’s body into neutral alignment.

A second rescuer brings the head into neutral in-line position and performs manual in-line stabilization.

The second rescuer performs airway maneuvers as necessary.

C-spine

Airway ManeuverIf the patient’s airway is compromised by blood, vomit, or tongue,

etc. then the second rescuer also performs a jaw-thrust airway maneuver in addition to maintaining in-line stabilization.

High Flow OxygenPatients with potentially severe injuries need high flow oxygen via a non-rebreather

mask. Set the oxygen flow rate at 10-25 lpm.If the patient’s breathing is inadequate, then assist breathing with BVM ventilations.

This will require another rescuer.

Initial Assessment: A-B-C’s◦ Any life-threats to the ABC’s need to be addressed

immediately!

Rapid Trauma Assessment◦ A rapid head to toe assessment that should take

no longer than a minute to complete.◦ This assessment searches out the trauma specific

life threats to a patient.

Patient Assessment

Vehicle cutting to allow for accessing and the removal of the patient is part of the overall patient care and should be done simultaneously with the assessment and treatment of the patient.

Ambulance officers should not stop vehicle cutting unless it directly affects patient care.◦ Unneccessary halting of cutting will increase

onscene times and affect the golden hour concept.

Vehicle Cutting

Minimize spinal movementWhen moving the patient onto a longboard, use multiple rescuers guiding the torso and legs to minimize twisting

and maintain neutral positioning.

Sometimes vehicle damage or positioning requires non-traditional patient extraction, such as on their side or on their stomach.

If this is necessary, then use multiple rescuers to maintain neutral positioning as best as possible.

Extract the patient onto a board, then carry them to a safe location where they can be logrolled into a supine position.

Prone or Side Extraction

Above All, Safety First!

To Rescuers, Bystanders, and Patient