Side Door extraction
from A Front Seat

The following technique should be used as a last resort for when the patient is found sitting normally in the front or back seats of a vehicle, but the patient cannot be extracted out the rear window. 

This method causes significant spinal and body twisting (which can further aggravate spinal cord function, fractures and other injuries), and is an increased OH&S risk to Officers undertaking the extraction as compared to other techniques offered.

 SCENE SETUP

  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

Removal of the steering wheel  will  create additional space for the removal of the driver and prevent feet getting caught during the twist out.

To allow for the removal of a patient through a side door, an opening needs to be made. 

Open the door and push it forward to provide an adequate opening.

An alternative to the above is full door removal, but as this takes additional time, a clear benefit is needed to justify this added scene time (such as the requirement for a dash roll due to the legs being trapped under the dashboard).

The height of a patient sitting in a seat, is often higher than the roof line of the door.  This requires the patient to be quashed down or tilted sideways to get out of the vehicle,  If the seat cannot be lowered adequately to clear the patients head, consider flapping the side of the roof.

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

Position Officers at:

Officer 1 is placed behind the patient to assist in the rotation of the patient during the extraction.

Officer 2 is placed on the inside of the vehicle and grasps the handle of the CED to lift the patient for LSB insertion under the patient.

Officer 3 is placed on the outside of the vehicle and grasps the handle of the CED to lift the patient for LSB insertion under the patient.

Officer 4 is placed on the outside of the vehicle and inserts the LSB under the patient’s bottom when Officers 2 & 3 lift the patient.

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

Begin the slide out of the vehicle by keeping the patient in a sitting position and:

Officer 1  from behind supports the patient’s head in the initial movement.

Officer 2 inside the vehicle assists in the rotation of the patient’s legs the extraction.

Officer 3 grasps the inner side handle of the CED as soon as it can be reached.

Officer 4 holds the outer side handle of the CED at the beginning of the slide and will assist in the rotation & control of the torso of the patient during the extraction.

Officer 5 & 6 support the end of the LSB.

The patient is slid slowly in 30 cm movements along the LSB and slowly rotated ensuring the patient’s pelvis and legs are kept in alignment to the torso.

Once the patient is 1/2 way along the LSB, the patient is laid down onto the LSB.

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

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.⁹

The patient can now be safely carried away from the vehicle to the Ambulance stretcher. 

• 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.