Vehicle on Roof
Side Extraction

 

The following technique offers an option for a vehicle on it's roof when the patient has been released from their seatbelt and fallen onto the roof of the vehicle with their head and torso pointing towards the side of the vehicle.  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 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 side of the vehicle, the following general principles should be applied whenever feasible:

  • Ambulance equipment staging area should be setup at the side of the vehicle the patient will be coming out, and on the 5 m outer circle.

  • Rescue equipment staging area should be setup at the opposite side of the vehicle the patient will be coming out, and on the 5 m outer circle.

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

 

 

  PREPARE THE PATIENT

 

Once the vehicle has been stabilised, Officers can enter the vehicle and perform Manual In-Line Stabilisation of the head.

If the patient is in the prone position (lying on their front) as depicted here, a Cervical Collar cannot be applied.

The use of a jacket style Cervical Extrication Device (CED) is very limited in these cases unless the patient is found in an upright sitting position in the vehicle.

 

 

 MAKING AN OPENING

 

To allow for the removal of a patient, the doors of the vehicle will need to be opened.

 

Full side removal will provide excellent access to the patient and ease the extraction. 

Please Note: In this scenario, a full side removal has been undertaken to allow improved viewing of the extraction technique.

 

 

Rotating the seat’s back support fully rearwards will also create additional space for the extraction.

 

 

 

  INSERT THE LONG SPINE BOARD

 

 

 

 

Place a blanket over the roof 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.  

The patient will usually be found on their stomach or side, however LSB insertion is similar in either    situation. To insert the LSB under the patient, the   patient will need to be lifted using a modified Side Straddle Lift technique:

Officers 1 & 2 are positioned on either side of the patient at the patient’s torso, each placing one hand  under the patient’s shoulders and the other hand    under the patient’s pelvis.

Officer 3 positioned at the patient’s head continues stabilising the patient's head for the LSB insertion.

Officer 4 places the LSB at the patient’s head.

When ready, Officers 1, 2 & 3 raise the patient 3-5 cm whilst Officer 4 slides the LSB under the patient until it stops (usually about the patients waist level).

 

 

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

 


Officers begin to slide the patient out of the vehicle on the LSB by:

Officer 4  continues to support the LSB.

Officer 3 continues to stabilise the patient’s head during the patient’s slide out of the vehicle onto the LSB.

Officers 1 & 2  positioned on the either side of the LSB assist in the sliding of the patient onto the LSB by grasping the patient’s clothes at the shoulders and waist.

The patient is slid up the LSB in 30 cm movements until the patients shoulders are level with the shoulder markings on LSB in preparation for immobilisation.

Once the patient is correctly positioned on the LSB, slide the LSB out of the vehicle and place it on the ground.

 

 

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

 

If the patient was extracted supine (on their back), immobilise the patient to the LSB.1

However if the patient was extracted on their side  or stomach (as depicted here),  carry the patient to a safe place and the patient using the standard log-roll or 180º log-roll 5 person prone180º technique to get the patient supine, then immobilise.1

The patient can now be safely carried 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.          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

 

 

 

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