Side Door extraction
When Leaning On the Door

 

The following technique offers an option when the patient is sitting with their back leaning against a door.  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.

 

 

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

  • Ambulance equipment staging area should be setup on the side of the vehicle the patient is to be extracted out of, and placed on the 5 m outer circle.

  • Rescue equipment staging area should be setup on the opposite side of the vehicle the patient is to be extracted out of, and placed on the 5 m outer circle.

  • Fire protection with a live hose is again placed on the 5 m outer circle 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.

 

 

  INSERT THE LONG SPINE BOARD

 

Lean patient forward off the door and fully open     beyond the normal hinge position if possible.   Place the LSB in behind the patient and rest the LSB on the seat.  Lean the patient back onto the LSB.

Push the door forward out of the way for improved access for the extraction.

If the door is jammed closed, lean patient forward off the door, cut the doors window frame, slide the Board through the open window and rest the LSB on the seat. 

Lean the patient back onto LSB, but ensure the LSB is not resting on the door.

Forcefully open the door. 

Consider undertaking full door removal only if there is a time vs benefit of the additional space for the extraction of the patient.2-3

 

 

 

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

 

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

Officer 1 remains on the inside of the vehicle and will assist in the movement of the patient’s legs during the extraction.

Officer 2  remains on the outside of the vehicle and will insert the LSB, and will assist Officers 3 & 4 in the extraction of the patient.

Officer s3 & 4  place themselves on the outside of the vehicle, assisting  in the slide and extraction of the patient onto the LSB.

Rotate the LSB downwards into a horizontal position. 

Once the LSB is in the horizontal position, slide the patient along the LSB in 30 cm movements until the patient's shoulders are level with shoulder markings on the LSB.

 

 

 

 

 

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

 

Now immobilise the patient to the Board.1

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

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

 3.     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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