opposite window extraction
from A Seat

 

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

The procedure is also excellent as a rapid extraction technique when no cutting tools are available,  and a rear window extraction is not an option (such as in a utility vehicle).

 

 

 

 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 window, the following general principles should be applied whenever feasible:

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

  • Rescue equipment staging area should be setup at the side opposite to the extraction 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 the front of the vehicle so as not to interfere with the Ambulance or 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 of the patient’s head 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

 

If Rescue is available, removal of the steering wheel  will  create additional space for the extraction of the driver, and prevent legs & feet getting caught during the roll out.

  

To allow for the removal of a patient through a side window, additional space can be made by performing a vertical spread in the window, although this is often not required.

Opening the door whilst creating additional space, will however cause the angle of the Board to be lowered and increase lateral bending of the spine.

A forward roof flap or full roof removal will also provide additional head space,  when access to the patient from the sides is limited, or the dash has been crushed in on the patient.

Again if there is no clear benefit, a forward roof flap or full roof removal should be avoided due to added scene time.

 

 

  INSERT THE LONG SPINE BOARD

 

Place a blanket over the 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 window opening and onto the seat the patient is sitting on.

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

 

 

 

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

 

 

 

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

 

Begin the slide out of the vehicle on the LSB 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.

Officers 3, 4 & 5  are positioned on the outside of the vehicle in the direction the patient will be extracted and will assist in sliding the patient out of the vehicle.

 

Rotate the patient onto their side 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 patient’s spinal column.

 

Slide the patient up the Board in 30 cm movements using the rope.  Officer 1 should remain at the patient’s feet if possible to assist the slide, and to  ensure the patient’s pelvis and legs stay aligned with the torso.

As the patient is being slid up the LSB, slowly rotate the patient onto their back.

The patient is slid up the LSB until the patient’s  shoulders are level with the shoulder markings on LSB in preparation for immobilisation.

 

Raise the foot end of the LSB until the LSB is horizontal.

 

 

 

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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