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"They're trapped...what are you talking about?"

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  • "They're trapped...what are you talking about?"

    For all you technical 'purists', here's a question from a central NY State fire officer that makes you think.

    "Ron,

    I just want to pick your brain for a couple minutes. Recently at the station a few of us were discussing what extrication really means. Here are my thoughts. In our County, many departments would refer to using hydraulic tools to remove a door as extrication instead of disentanglement.

    The definition of "disentanglement" in Mosby's Paramedic Textbook, Second Edition, defines it as a "systematic removal of a vehicle or structure around a victim". In simple terms, "cutting the car away from the victim, creating a pathway through the wreckage".

    We all know what patient packaging is. Collar, board, possibly even a KED.

    Now move to extrication. Disentanglement is complete. The patients vitals are stable and injuries non life threatening. The patient meets all of the protocols for having a KED placed on them. With the collar already applied and head stabilization in place, the KED is applied and the board is resting on the seat, you start to EXTRICATE the patient out of the vehicle using the pathway that was created during DISENTANGLEMENT.

    See where I am getting at. Why do so many relate to the grabbing the tool as extrication instead of disentanglement? How did that word get lost?

    You could have an auto accident with the door to the patient already open and technically, wouldn't we still have a patient to extricate? Disentanglement wouldn't be required, but the extrication of the patient from within the vehicle is still necessary.

    What are your thoughts?"

    My Reply:
    If you want to talk 'technically', then we have to go with the definitions of extrication and disentanglement found in the textbooks. They are there in print but they don't reflect the reality of what we commonly call the things that we do.

    An accident with injuries, where the victim is longboarded out an operable door is 'technically' extrication, but if you call that extrication, you'd be laughed at. If you had a serious crash scene and said we needed to "disentangle" somebody, your crew would look at you like you're nuts! "They're trapped...what are you talking about?", they'd say.

    The reality of our rescue world is that someone long before us decided to call the ripping and tearing work we do "extrication" and that has stuck ever since. Nobody routinely uses the term disentanglement; we use "people trapped" instead.

    I don't make a big deal out of this; working tools to tear a vehicle apart is "extrication" and everybody seems to know what that means, so I just go with it.

    This is a case where being technically right, isn't really right.
    Ron Moore, Forum Moderator
    www.universityofextrication.com

  • #2
    There's lies, damn lies, and statistics...oh wait, we're talking about English...

    There's lies, damn lies, and definitions...
    IACOJ Canine Officer
    20/50

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    • #3
      We run into a similar problem with definitions, namely 'entrapment.' Often, our dispatchers will only send an ambulance to an MVA because it is 'without entrapment;' their definition of entrapment seems to be that the car is completely wrecked and needs to be torn apart by heavy hydraulics. Even if the dispatcher knows that the patient has neck and back pain and it in the vehicle, they still won't send rescue initially. Usually the ambulance crew has to request rescue to assist with KED-ing & removing the patient, and possibly assisting with crowd control (troopers are few and far between).

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      • #4
        I agree with Ron, extrication is distangeling someone from a car, and then we remove them. So another question would be, How minimal of work does someone have to do to have it considered an extrication? Is breaking a window so we can unlock a door and open it considered extrication? Or do we have to actually "use force" to get into the vehicle to have it considered as extrication?

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        • #5
          Is breaking a window so we can unlock a door and open it considered extrication? Or do we have to actually "use force" to get into the vehicle to have it considered as extrication?

          Seems to me that breaking a window is using force.


          Tanker
          I.A.C.O.J. Firefighter/EMT-B

          "I'm gonna drill a hole in your skull and pump out all the stupidity"
          Gunny Ermey


          "Never underestimate the Power of Stupid People in Large Groups"


          Humpty Dumpty was pushed

          Polishing the Chrome on all the IACOJ "apparati"

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          • #6
            Alright Tanker, lets give this another try.

            When would you consider that extrication has started. Poping a window, forcing a door, or even just opening a door via the door handle to assist in getting someone out?

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            • #7
              When I was responding for rescue's we considered the casualty to be "positionally trapped" if all we had to do was pop a door, break a window, etc. ie: they were not physically pinned by the vehicle components.

              "Trapped" was when they were pinned in the car by components. ie: dashboard, floor-pan, etc.
              Luke

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              • #8
                Popping/Breaking a window could be considered gaining access to the interior, and the systematic disentanglement phase (moving metal & plastics) from around a "trapped" victim and removing the victim is the Extrication. Likewise the entire evolution could be considered an Extrication Evolution, whether it is simple or complex.

                Luke, good to see ya posting again. How's the baby and bride?

                Be safe bro's

                fraternally, Jordan
                "Making Sense with Common Sense"
                Motor Vehicle Rescue Consultants
                ( [email protected]) Jordan Sr.

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