Vertical Lift from A seat

 

The following technique is an option when the doors are jammed and will be difficult to open, the seat won’t recline backwards (such as in a utility vehicle), and roof removal provides the easiest egress for the patient.  It is adaptable to both front and rear seat patients.  This technique is however the most difficult of all the extraction techniques taught in this manual, and is easier to achieve if the patient is placed in a jacket-style Cervical Extrication Device (CED) with handles. 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 a side door extraction.  

 

 

 

 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 of the vehicle, 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 DeviceCED 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 of the patient’s head needs to be maintained until the patient is properly immobilised to a LSB.1-9 

 

 

 

 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 their feet getting caught during the vertical lift.

 

If access to the patient’s lower legs is difficult, side door removal can be undertaken. 

Door removal however is not essential for the manoeuvre to be successful. Therefore Officers must consider time vs. benefit.10-11

Folding the roof forward, or the less preferred option of complete roof removal will be required for the extraction of the patient from the vehicle.

Cutting of the front window for complete roof removal (required in new vehicles) creates significant amounts of glass dust and sharp hazards to the patient and Officers.

  

 

 

  INSERT THE LONG SPINE BOARD

 

Officers lean the patient slightly forward and slide the LSB into the seat from behind.

 

Once the LSB is inserted, lean the patient back onto the LSB.

 

 

 

  LIFT THE PATIENT ONTO THE LONG SPINE BOARD

 

Four Officers are required to perform the lift.

Begin the slide out of the vehicle on a LSB bypositioning Officers at:

Officers 1 & 2  at the patient’s head end hold the top half of the LSB with one hand, and hold the side  handles of the CED with their other hand.

Officer 3 & 4 at the patient’s pelvic end grab the  bottom edge of the CED with one hand, and support under the patient’s knees with their other hand.

 

 

 

The patient is slid up the LSB in one quick action.

When the patient is 3/4 of the way up the LSB, the LSB is rotated backwards to a horizontal position.

Continue sliding the patient up the LSB 30 cm   movements until the patient's shoulders are level with shoulder markings on the LSB.

 

 

Click here for front and side photos

 

 

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

 

Now immobilise the patient to the Board.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.

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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