Rear window extraction
from A back Seat

 

The following technique has been found through extensive trials, to be the best method for patient extraction when the patient is found sitting normally in the back seat of a car.  The advantages of this method are spinal alignment is maintained, and body twisting (which can further aggravate fractures and other injuries) is minimised as compared to extraction through a side near door.  

 

 

 

 SCENE SETUP

 

Overcrowding and poor placement of equipment at the scene of an accident by Rescue and Ambulance Officers can cause delays in the extraction, scene cluttering & trip hazards requiring multiple movements of equipment. 

With the patient in this scenario being extracted out the rear window the following general principles should be applied whenever feasible:

  • Ambulance equipment staging area should be setup at the rear of the vehicle on the 5 m outer circle.

  • Rescue equipment staging area should be setup at the front of the vehicle on the 5 m outer circle..

  • Fire protection with a live hose is again placed on the 5 m outer circle at 45º to the front of the vehicle so as not to interfere with the Rescue staging area.

 

 

  PREPARE THE PATIENT

 

Perform manual in-line head stabilisation and apply a cervical collar.

Apply groin straps on each leg using triangular bandages.

The groin straps must be placed in the gluteal fold to obtain proper stability for the extraction.

The use of a Cervical Extrication Device (CED) is of very limited value in this scenario and is generally not required.

 

 

 MAKING AN OPENING

 

To allow for the removal of a patient through a rear window, an opening needs to be made.  Generally removal of, or the faster process of breaking the rear window will be adequate.
   

Alternatively a forward roof flap will provide additional space when access to the patient from the sides is limited.

Rear roof flaps should be avoided as they will block the exit for the patient. 

The current practice of door removal will in many cases not provide any assistance in the extraction of the patient unless the legs are trapped, but will simply increase scene time and should be avoided if there is no clear benefit.

 

 

  INSERT THE LONG SPINE BOARD

 

Place a blanket over the window edge and boot to allow the board to easily slide in and out of the vehicle. Failure to do this may result in severe Board vibration during extraction.  

The option of pre-strapping the Board with each strap attached at one end will speed up and ease securing patient to board once the patient has been extracted.

 

 

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

 

Officers should be positioned in the following way:

Officer 1 stands at the back of the vehicle, places one foot on the boot of the vehicle and the other foot on the bumper of the vehicle.  Officer 1 hands should hold the top handles of the Board.

Officer 2 & 3  are positioned either side of the patient, kneeling on the boot of the vehicle.  Officer 2 & 3 lean in through the rear window and hold the groin straps with their arms closest to the Board.  Officer 2 & 3 outer arms cross over and hold the Board, locking their inner arm to the Board so that during the extraction, the patient's position is maintained on the Board.

Officer 4 & 5  are positioned inside the vehicle on either side of the patient.  Officer 4 & 5 place one hand under each knee to control the knees during the Boards rotation to ensure the patients knees remain in the bent position.  Officer 4 & 5 place their other hand on the patients ankles to prevent the feet getting caught under the seats in front.

 

Begin the slide out of the vehicle by:

Officer 1 pushes himself off the boot and whilst doing this, lifts the board 30 cm upwards (to allow the patients feet to clear the front seats) and then pivots the head of the Board down until the board is horizontal and resting on the boot of the car.  This complete step should take no more than 3 seconds.

Officer 2 & 3  ensure they continue locking their arms to the Board during the Board's movement so the patient does not slip down on the Board.

Officer 4 & 5 ensure the patients knees remain in the bent position during the maneuver so as no pressure is placed on the spine.  Once the Board is in the horizontal position, the patients knees should almost be touching the roof.

 

 

 

 

Once the Board is stable on the boot of the vehicle, begin to slide the patient up the Board in 30 cm movements, slowly straightening the knees, until the patient's shoulders are level with shoulder marking on the Board.

 

 

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

 

 

Now immobilise the patient to the Board.

The patient can now be safely carried away from the vehicle to the Ambulance stretcher.

 

 
Additional Notes:

  • The photos presented above are staged with pre-prepared vehicles.  Protective coverings have been left off the patient for photographic purposes so as to clearly demonstrate the techniques being used.

  • All Ambulance, Rescue and Fire staff are referred to as 'Officers' in this presentation.

  • In all road accidents, Officers should undertake scene protection from oncoming traffic, perform outer & inner circle checks, control hazards including fuel leaks, establish fire protection of the scene, ensure vehicle stabilisation before entry of the vehicle or any cutting, disconnect batteries, be aware of the dangers of undeployed airbags & ROPS  maintaining a safe working distances from the deployment path as recommended by your agency.

  • Officers should wear Personal Protection Equipment (PPE) as recommended by your agency.

  • Officers work gloves should be removed when in direct contact with the patient's skin due to fuel and other contaminants that may have impregnated the gloves.  Only personal protective barrier gloves should be allowed to come in contact with the patient.

 

 

This training manual has been produced with the assistance of

 

Ford Australia Pty Ltd

Holmatro Rescue Equipment

NEANN Emergency Products