Rear SIDE window extraction

from front seat

 

  
 

The following technique offers an alternative extraction method for when the patient is found sitting normally in the front seat of a car, but cannot be extracted out the rear window of a car. 

 

 

 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 side 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 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.

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

 

 

 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 prevent the common problem of feet getting caught during the extraction.

  

 

 

To allow for the removal of a patient through a rear side window, some additional space often needs to be made.  Generally removal of the back 1/4 window will be required.

 

 

  INSERT THE LONG SPINE BOARD

 

Keep the patient sitting upright and rotate the back of the drivers seat fully down.

The front passenger seat should be slid forward and then the back of the seat rotated forward as much as possible to create additional space for LSB insertion. 

Place a blanket over the rear passenger side window ledge 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 of the patient.  Place the LSB on top of the blanket and slide the LSB through the closed door and into the seat.

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

 

 

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

 

Begin the slide out of the vehicle by positioning     Officers at:

Officer 1  on the outside of the vehicle - drivers side, assists in the rotation of the patient’s pelvis & legs during the extraction.

Officer 2 from behind supports the patient’s head in the initial movement, and also assists in the rotation of the patient during the extraction.

Officer 3 from inside the vehicle passenger side assists in the rotation of the patient during the extraction.

Officers 4, 5 & 6  are positioned on the outside of the vehicle in the direction the patient will be extracted and will assist in the sliding of the patient out of the vehicle.

Rotate the patient onto their side and onto the LSB. 

It is essential the patient's pelvis and legs be rotated sideways as well during the side roll to prevent lateral bending of the spinal column.

Slowly slide the patient up the LSB in 30 cm movements using the rope to assist.  Officers should be placed on either side of the patient if possible to assist the slide, and to ensure the patient’s pelvis and legs stay aligned with their torso.

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

 

Raise the foot end of the LSB and slide the LSB out of the vehicle until it is sitting in a stable horizontal position on the window ledge 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 adequately1-7.  However body immobilisation for protection of the thoracic and lumbar spinal cord will still be necessary.

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

 

 

 

 

 
 

This training manual has been produced with the assistance of
 

Ford Australia Pty Ltd

Holmatro Rescue Equipment

NEANN Emergency Products
 

 

 

Click to return to Index page