Aggressive Extrication

[acfire]

Several days ago we had a van over and embankment (20 feet, laying partially on its side, unstable) and the driver was pinned in the wreckage. He also was inpaled with a metal bar through his leg. The extrication took one hour and forty minutes.
He was removed and airlifted to Harborview in Seattle and is making good progress. The patient was alert and oriented throughout the whole process.

We are taking some heat because of the time involved in safely removing the patient. We keep getting the "Golden Hour" thrown at us.

As the command officer I have reviewed the operation with the extrication crews and medics. All agree it was one of the most difficult extrication tasks they had ever worked. The one sentence we hear is that the crews were "not aggressive enough."

My feeling is we had an alert patient, literally pinned and a slow and cautious was the right approach. In talking to the crews they all stated if the patient was not alert and oriented and/or in resp. distress or worse they would have found a way to yank him
even if required a scaple.

Any comments or items of discussion would be appreciated.

[Adze]

In situations like yours, it may take a long time to extricate a patient when you are trying to prevent further injury to the patient and keep the FF's and Med's safe...among other things.

Let me guess...the people who are giving you heat are people that don't know jack squat about extrication, right? Of if they are familiar with extrication, then they have never faced that situation so they are probably talking out of their a**.

Without seeing the extrication first hand, if your crew and meds think you did a good job then you probably did.

Do you feel that if you worked any faster you would have comprimised the safety of the patient or any personnel on the scene? If so, they you did a good job. Remember, safety first.

[Rescuespike]

I have been in similar situtations. There have been times that extrications have taken extended periods of time. If the patient is stable, do not risk further harm by trying to speed up the extrication. Think of what you are cutting, where pressures are being applied and where metal and debris is going. It is not worth the risk to save TIME unless you need to save a LIFE.

If the medics are giving you a hard time ask them why they put KEDs on patients. This is time consuming. They could use a rapid extrication move to remove the patient instead. (I realize the significance of a KED, this can be used to prove a point)

In my opinion I think that you did everything correct.

Chris Schultz
Mountain Ambulance www.rescue70.org

[This message has been edited by Rescuespike (edited October 29, 2000).]

[MetalMedic]

Been there.. done that myself. Ours was a tractor/trailer rig with the cab hanging about 20 foot up in the air off of a bridge. We had about 1 hr. 30 min. in extrication... and to make matters worse, we were not aware we had an aputated leg involved. The victim was alert and kept telling us he could feel his leg (the "leg" was trapped below the knee, with the victim upside down). The leg was found submerged in the creek below us about 10 minutes before we freed the victim. The OIC did not let the extrication team know this, for fear the victim would hear it and freak out on us. Now, imagine my surprise when we got him free only to find the leg we were trying to save was just a stub!

Remember, it isn't "your" emergency. Safety is always the #1 concern, and YOUR safety is more important than the victim's. Since the victim is making progress, it sounds to me like you did a fine job. The "golden hour" applies to getting a "major" trauma patient into a Level 1 trauma center. If your patient was alert and oriented, we can assume he was stable enough to take your time to do it right and not to take any unnecessary risks.

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Richard Nester
Orrville (OH) Fire Dept.


[This message has been edited by MetalMedic (edited October 29, 2000).]

[Ron Shaw]

How long does it take to perform an extrication? If you can answer that question with a simple 10, 15, 20 minutes you are a better instructor than most of us. No two accidents are the same, what may take 5 - 10 minutes today may take as long as your's the next.

There is nothing worse than to beat a fellow member down, especially when they are already hurting inside for taking so long. Especially when it there may have been no other way. When I here there was an extremely long extrication, I don't attack the crew that did the work, I just thank God that I didn't have to go that night.

I did a demo with a 32-A when they first came out in front of our town's people that came out to see this new wonder tool that will cut time and save lifes. It was imbaressing, it took 40 minutes to pop a damn door. Talk about being embarressed, I learnt then that you don't lock up the Nadar pins during a demo with the public and press near by.

I agree it is important to get the patient to the hospital as soon as possible. However, this is not always possible. There are several factors which come in to play. Some may be out of our control.

"As stated before, we all have been there done that." While it is easy to point fingers after the fact, let those that judge remember some day the shoe may be on the other foot and they may be judge themselves. While history does not repeat it's self, it does travel in full circles.

Here are a few suggestions that may help reduce some time in the future for you:

1. I teach that if a door can be repositioned to 90 or better, leave it on and go to the next task.

2. As soon as possible, remove the roof when there are no side impact curtains mounted along the roof rails. This makes life much easier for the EMS people or those inside the vehicle.

3. Stabilize, power disconnect ASAP, using the electrical supply to your advantage first.

4. Scan (Ron Moore term) for all hazards, around, under and inside the vehicle prior to touching the vehilce.

5. If the vehicle is equppied with EPG, you may beable to roll it down, leave it in place or remove as required using a Glasmaster, Sawzall or similar tool for laminated glass removal.

6. Do not restrain or cut into any airbag system.

7. Not the damage to the vehicle to relate to your patient injuries.

8. When your first plan of attack doesn't work, use the secondary plan that you have been formulating as the work was going on.

9. If your current tool isn't doing the job, use another. I have seen some of the most powerfull spreaders fail to do what you might think was a simple job. While the hydraulic tool manufactures or reps, may disagree with me, we are forgetting to use hand tools. The service as a whole has had a tendency to forget handtools. While some may be slower, cutting with a proper demolishion/rescue blade and a Sawzall may be your best backup. They will cut hinges, pins, sheet metal and yes EPG/laminated glass.

10. Try the Modified Dash Roll if your in a hurry, it will avoid cutting impact curtains, inflators (when mounted in the rear pillar) and pretensioners. It doesn't open the roof up, but it will shave minutes of the total extrication time.

11. Drill, Drill, Drill... So many times I have here people tell me, I don't need to drill I have been on the the department for XX years. Come show time, and it can be an ugly site!

12. Use your resources, plan ahead, don't be affraid or ashamed to call for help. If you wait until you need it, it may aready be too late.

13. Take command, and use the Incident Command System to your advantage to help you through the incident. An IC that try's to micro manage an incident is not helping, especially in a large scale accident.

14. The wreck may look worse than it is, the beast may only look difficult don't be intimidated be for you start. And try before you pry!

15. Pull a handline for your protection as well as the patient. If you get in the habit of doing it, when it is really needed it will naturally.

16. Up date your training, if your using training material that is two years old, you've been smoked by those of use that keep up on things.

17. Read trade periodicals such as Moore's articles to keep up to date on the latest information available.

18. Visit the dealerships and inspect the vehicles, knowing car design will help you shave some seconds off as well.

19. Go to some competions and learn new methods, don't get tunnel vission: We have been doing it this way for 20 years! Well times have changed and so have the vehicles.

20. Check your equipment out, with the new federal grant money having been approved, now is your chance to get some badly needed equipment that you haven't been able to procure.

21. Is your equipment in a state of readiness?

22. Preconnected lines save time.

23. Have multi company drills so those not on an piece with the rescue tools, know how to use them. I happen to see the O.T. slip the other day on the computer at the station, there was 3 privates out at the station with the rescue. That meant one or more O.T. FF was going to operate equipment that they may not be familar with. With a truck running out of district with two FF this is important.

24. Get a hold of one of the books like Holmatro and Sally Straight offer, look it over and see where battery locations are as well as some other hazards. There is plenty of good reading.

25. Wear dust mask when cutting glass.

26. PPE, so it's only a car accident... Well it can catch fire!

27. When was the last time you checked and changed fuel/oil in your power unit?

28. Check your hydraulic lines for excessive cuts (contact your rep for acceptable depths).

29. Ask questions the foolish one is the one that did get asked.

30. Take a car and tell your personnel to do a dash roll with hand tools. The power unit just died... you can have then perform all the other techniques as well with hand tools. If they hear it, see it and do it, the learning process will work much better.

31. Moore is coming out with a new extrication manual, pick up a copy and this should help as well. To my knowledge this is the latest extrication text book to be published.

This will give you a few thoughts to help improve overall time. I am sure some of the other readers can add to the list to help you out.

One of the things that I highly recommend is CIS training, especially for the officers to recogize signs and symptoms. "AC" don't let the other people beat you down, especially those that weren't on scene.

You might think about getting everyone there together as post incident analysis. Develop someting positive out of the incident. Start off by telling everyone how you feel they acted professional and did a good job even under the extreme conditions. Then work your way into how they felt things went and how WE could improve the extrication if it were to happen again.

Regards,
Ron Shaw

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Ron Shaw
http://www.extrication.com

[Carl Avery]

Lotsa Good Words from Lotsa good people. SO I will try to keep it short for a change. 20 minutes or Less should always be our goal. The Golden HOUR is real. Now do not shoot me! I said goal Any Goal or objective MUST be tempered with REALITY and the Scenario you are faced with. To take a Note from RON SHAW's post, If it aint working move on to something that will work! that goes for tools and / or plans. If your plan is working and REAL progress is being accomplished while EVERYONES Safety is Kept in mind, then keep it going ( making sure you are honestly evaluating your progress). Go for it if it takes longer than 20 minutes, so be it! Remembering the Old saying "Some Puppies can't be F_ _Ked". Do what it takes to do the Job in an Safe and Efficent Manor, no matter how long it takes. Let me also say Evaluating the Patient does have an impact on HOW AGGRESIVE you should be, BUT NEVER at the Expense of the SAFETY of your personnel or the entraped persons.

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Carl D. Avery

[MetalMedic]

#1 - Ron Moore is coming out with a new book??? OH GOODY!!! I hope he let's us know when it becomes available. Barns & Noble and Amazon only have the 1990 version currently

#2 - Who is Sally Straight and where can I find that book at???

#3 - Secondary Plan - To me, that is the KEY to getting the job done. I have had better success by planning ahead, thinking about what I will try if what I am doing doesn't work. Often time, that option ends up as a logical "next step" in the evolution of the extrication.

Excellent post Mr. Shaw!!

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Richard Nester
Orrville (OH) Fire Dept.


[This message has been edited by MetalMedic (edited October 30, 2000).]

[Twostix]

acfire-
Your trapped motorist is in the hospital, alive and making progress. He has YOU to thank for that. Good job!! 'NUFF SAID!!!
Be Safe Get home! Twostix

[rmoore]

A Posting From Ron Moore, Forum Moderator

What does it take to be considered "not aggressive enough' at a crash scene? Elapsed scene time isn't the only measure of how we do our job. It isn't the only way to tell whether the crew is agressive or is one that looks like they are in over their heads every time they respond.

Here are just a few of the ways in which I spot the non-aggressive rescue team.

Your crew has no leader.

Your crew can't figure out what to do even with a leader; there is no overall strategy.

Your crew does only one job at a time and it's not the one that is needed to be done at that time.

Your crew has no Plan 'B' when what they are wasting their time doing fails anyway.

Your crew members all watch one guy work.

Your crew has no hustle and wouldn't know what to do with it if they had it.

Your crew tries to do everything with the power rescue tool.

Your crew only has a power rescue tool.

Your crew looks like amateurs and feels like it too.

Your patient dies from boredom not shock or trauma.

What's some other ways to spot the non-aggressive rescue team?


Ron Moore,
Fire Training Manager
Plano (TX) Fire Rescue
214-728-6776
<[email protected]>

[HYTHE FIRE DEPARTMENT]

You may be a non-aggressive crew if....

the crew discusses what they should do next over coffee and doughnuts.

if you decide to use hand tools for fear of scratching the paint on your Jaws.

if, (after popping one door) before you free the patient the team decides to pop the other three doors for much needed practice.

if you build a set of step cribbing at the scene.

if you pull out Ron Shaw's book and have a quick review session before you start.

if the patient gets fed up, opens the door and lets himself out.

if you bring a recovery unit and a canteen wagon to all of your MVA's.

All kidding aside, I think the only people you have to answer to are yourselves. We always do a "debriefing" after every incident with the members that were involved. The first thing we ask and discuss is what did we do well. From there, we go on to what we could improve. The areas that need improvement will be incorporated into the next training session. This is probably the best way to provide constructive criticism.

In most cases, I already know what we could have improved on at the scene. But when you let the members sort it out, they will get more out of the process than you telling them what they did wrong. It works wonders. It works so well, that we even do it after a training session using the same format.

[acfire]

Originally posted by rmoore:
A Posting From Ron Moore, Forum Moderator

What does it take to be considered "not aggressive enough' at a crash scene? Elapsed scene time isn't the only measure of how we do our job. It isn't the only way to tell whether the crew is agressive or is one that looks like they are in over their heads every time they respond.

Here are just a few of the ways in which I spot the non-aggressive rescue team.

Your crew has no leader.

Your crew can't figure out what to do even with a leader; there is no overall strategy.

Your crew does only one job at a time and it's not the one that is needed to be done at that time.

Your crew has no Plan 'B' when what they are wasting their time doing fails anyway.

Your crew members all watch one guy work.

Your crew has no hustle and wouldn't know what to do with it if they had it.

Your crew tries to do everything with the power rescue tool.

Your crew only has a power rescue tool.

Your crew looks like amateurs and feels like it too.

Your patient dies from boredom not shock or trauma.

What's some other ways to spot the non-aggressive rescue team?


Ron Moore,
Fire Training Manager
Plano (TX) Fire Rescue
214-728-6776
<[email protected]>

I can't thank all of those who replied enough. I have printed off all of the responses so that the personnel involved can review your comments. As I looked over all of the comments I could not help but think the extrication crews did a good, efficient job.

When we critiqued the incident back at the station we discussed many of the issues that you all have raised. Incident command was established, operations established, support established, air ops established and no one was injured. Yes we saw areas that needed improvement, we always do. As one person who replied to the posting put it, "Your trapped motorist is in the hospital, alive and making progress."

I can say for sure he would not have done it without us. He was not coming out of there by himself.


Thank You

Mike Snyder
Mason 5



[This message has been edited by acfire (edited October 31, 2000).]

[Carl Avery]

Now here is a post I have to second. a post incident CONSTUCTIVE Debriefing is vital to being good at your Job. Quality in Extrication is not a Destination but a Journey. Remember what your Vision of Good Job is, And what objectives you have to do to achieve that Goal. Temper that with Reality and your Rescue Team will always use the correct level of agression (yes there are Levels of agression and WE do need to be in control of our agression)

Originally posted by HYTHE FIRE DEPARTMENT:
All kidding aside, I think the only people you have to answer to are yourselves. We always do a "debriefing" after every incident with the members that were involved. The first thing we ask and discuss is what did we do well. From there, we go on to what we could improve. The areas that need improvement will be incorporated into the next training session. This is probably the best way to provide constructive criticism.

In most cases, I already know what we could have improved on at the scene. But when you let the members sort it out, they will get more out of the process than you telling them what they did wrong. It works wonders. It works so well, that we even do it after a training session using the same format.

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Carl D. Avery