Rear window extraction
from front seat

 

The following technique has been found, through extensive trials, to be the preferred method for patient extraction when the patient is found sitting normally in the front seat of a vehicle.  The advantages of this method are spinal alignment (to protect the spinal cord) is maintained, and body twisting (which can further aggravate fractures and other injuries) is minimised as compared to other techniques available.

 

 

 

 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 Stabilisation of the patient’s head and apply a Cervical Collar.

 

Apply a Cervical Extrication Device CED if the patient is not time-critical, or the patient is time critical but the application of the CED will not delay the extraction The CED will immobilise the cervical spine, as well as provide handles to ease the lifting and sliding of the patient.1-7

If the patient is time critical and the CED will delay extraction, consider application of the CED as a lifting device (application of the chest and groin straps only) which takes less than 2 minutes to apply, if the benefit of preventing gross twisting of the spine, and the prevention of back injury to the Officers undertaking the extraction is justified.

If a CED is not applied, manual in-line stabilisation needs to be maintained until the patient is properly immobilised onto a LSB.1-9

Tie the patient's legs together as outward rotation of the legs will cause pelvic girdle movement and therefore movement of the spinal column.

 

 

 MAKING AN OPENING

 

Removal of the lower section of the steering wheel  is an option that will create additional space for the   removal of the driver, and prevents the common problem of feet getting caught during the extraction.

 

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.

If the rear window removal provides insufficient space for the patient to be extracted through,   spreading of the back window with the hydraulic spreaders, ram or high-lift jack will crush the rear seat down and push the roof up, making significant space for patient removal.

  

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.10-11

If the patients legs are trapped under the dash, additional cutting including the door removal and a dash roll may be necessary to free the patient.

If the seat will not rotate backward, cutting the seat's back support will allow the seat to lay backwards.

 

 

  INSERT THE LONG SPINE BOARD

 

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

Place the LSB on top of the blanket in readiness for insertion behind the patient once the patient’s seat is rotated back.

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

Place a rope through the back upper handle of the CED. This will be used to pull patient up the LSB.

Keep the patient sitting upright and lay the seat back fully. Do not allow the patient to rotate downward with the seat as the seat winding downward will cause jerking to the patient.

Slide the LSB into the seat.

 

 

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

 

Slide the patient up the LSB in slow 30 cm movements using the rope, as well as Officers on each side   of the patient to assist the slide, and to ensure the pelvis and legs stay aligned with the patient’s torso.

Slide the patient up the LSB until the patient's shoulders are level with shoulder markings on the LSB.

Slide the LSB onto the boot of the vehicle.

 

 

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

 

Now immobilise the patient to the LSB.9 

If a CED has been applied correctly, it is considered that further head immobilisation will generally not  be necessary as the CED is currently considered to have splinted the cervical spine adequately.1-7  However body immobilisation for protection of the thoracic and lumbar spinal cord will still be necessary.9

 

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.

 

 

Bibliography

1.         Cline
Journal Of Emergency Medicine  1990
Comparison Of Rigid Immobilisation Collars

2.         Cline
Journal Of Trauma  25:649-653  1985
A Comparison Of Methods Of C-Spine Immobilisation Used In Patient Extrication And Transport

3.         Graziano
Annals Of Emergency Medicine  October 1987
Radiological Comparison Of Prehospital Cervical Immobilisation Methods

4.         Howell
Annals Of Emergency Medicine  September 1989
Practical Radiographic Comparison Of The Short Spine Board And The Kendrick Extrication Device

5.         Heurta
Annals Of Emergency Medicine  October 1987
Cervical Spine Immobilisation In Paediatric Patients: Evaluation Of Current Techniques

6.         Manix
Eighth Annual Conference And Scientific Assembly Of The National Association Of EMS Physicians
A  Comparison Of Prehospital Cervical Immobilisation Devices

7.         Podolsky
Journal Of Trauma  No 6  1983
Efficacy Of Cervical Spine Immobilisation Methods

8.         Chandler
Annals Of Emergency Medicine  October  1992
Emergency Cervical Spine Immobilisation

9.         Victorian Ministerial Task Force on Trauma
Review Of Trauma And Emergency Services     Report 1999

10.       Trunkey
Sci Am 1983;249:28.
Trauma.

11.       Sampalis JS,
J Trauma 1993;34:252—61.
Impact of on-site care, prehospital time, and level of in hospital care on survival in severely injured patients.

 

 

 

 

 

This training manual has been produced with the assistance of

 

Ford Australia Pty Ltd

Holmatro Rescue Equipment

NEANN Emergency Products

 

 

 

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