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Negligent Box Cribbing?

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  • #31
    Hey I totally agree but it doesn't matter on how many times you train or with what equipment you train with or have in your rescue, there will be a time that you come across an incident that you are unprepared and do not have the proper equipment and with this you might have to improvise which may mean going against SOG's to save a person's life.
    Last edited by chavoman; 09-05-2006, 07:44 PM.

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    • #32
      Crib

      Great comments, the testing done in VT was very informative. Let me throw this out there and give me a little feedback.

      First I believe that cribbing is neccessary;
      1. So the pt will not move when the car is rocked by someone gaining access to the pt. They could have a spinal injury and this perhaps could paralyze them. For this reason crib before medics enter vehicle!
      2. So when we are using the tools the metal will have a solid base underneath it, as in pushing a dash etc.. which if we didnt do this it would perhaps move the vehicle and move the pt., or rip the metal and not give us the lift we want..etc.
      3. So the vehicle wont move.

      My theory which I don't practice cause of SOP's is that once the Pt(s) is being stabilized by a medic(s) and or C-collared with manual stabilization, after that cribbing is useless unless it used for the tools.

      Reason - how could this possible be for the pt when the seats they are sitting in have about 4inches of foam with springs underneath. When moving a pt that is over 150 (maybe less) you have to get a backboard/KED under there butt or lift them, we are moving them. The way that is usually the best way to get a pt out that is in a seat in a seating position is a vertical lift onto a backboard - maintaining C-spine, meaning roof has to come off. This seems to be the method of choice these days.

      Also doing a Rapid Extrication - you know pt is circling the drain.
      Do you always crib?
      Only if you have the personnel?
      Go right to the tools needed?

      Whats your thoughts?
      Burn
      Burn<br />LT/EMT/Inst />Central Mat-Su FD<br />Wasilla Alaska

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      • #33
        This thing says my post is to short add at least 10 characters so here they are.

        Originally posted by BurnCMSFD
        Great comments, the testing done in VT was very informative. Let me throw this out there and give me a little feedback.

        First I believe that cribbing is necessary;
        1. So the pt will not move when the car is rocked by someone gaining access to the pt. They could have a spinal injury and this perhaps could paralyze them. For this reason crib before medics enter vehicle!
        2. So when we are using the tools the metal will have a solid base underneath it, as in pushing a dash etc.. which if we didn't do this it would perhaps move the vehicle and move the pt., or rip the metal and not give us the lift we want..etc.
        3. So the vehicle wont move.
        1,2,and 3 I agree on, though I would add some things to that list.

        My theory which I don't practice cause of SOP's is that once the Pt(s) is being stabilized by a medic(s) and or C-collared with manual stabilization, after that cribbing is useless unless it used for the tools.
        You have heard the old firehouse phrase Don't get tunnel vision, will I think this is were you started to enter the tunnel. In line 1, and 2 your concern was not moving the patient. in this line your main concern was not moving the patient. Now in the line below line you are just about to answer your own question, how could this possible be for the pt? Do you begin to see a pattern All eyes are on not moving the patient.

        Reason - how could this possible be for the pt when the seats they are sitting in have about 4inches of foam with springs underneath. When moving a pt that is over 150 (maybe less) you have to get a backboard/KED under there butt or lift them, we are moving them.

        Now step back from the tunnel and look at the whole picture. What is our first concern on any scene? US and our crew! as bad as it sounds we did not put that person in there. Our job is to TRY our best to help them. We are going to be pushing and pulling on that car.
        1. vehicle on 4 wheels: Is there any incline? Do you know it is in park and the brake set, probably not being the patient is in bad enough shape to need you.
        It is in park; do you know the transmission was not damaged in the crash?
        You mentioned supporting the rocker to do a dash roll, one of the biggest problems in stabilization is side to side movement, when you crib under where you are working is it going to slide sideways because you didn't crib the other side?
        2. Side resting:Without stabilization when you jump up on top to open the door, is it going to roll on over and throw you under it, or on one of your men standing there?
        3. Roof resting: most of the time you will be going through the back glass, when you are about half way in, is the roof going to collapse and crush you.
        We can go on and on, but I think you can get the picture. Cribbing is about less movement of the patient but it is also about protecting us.


        The way that is usually the best way to get a pt out that is in a seat in a seating position is a vertical lift onto a backboard - maintaining C-spine, meaning roof has to come off. This seems to be the method of choice these days.
        I wrote on another thread about this not long age. For a few years now we have got into rapid extrication, Pop the door, C spine, C collar, spin them around and put them on a back board. We have gotten so used to this that most never even think about our true mission. TOTAL SPIN ALIGNMENT. So yes you do have the not moving the patient right, but look at the rest of the picture also.

        Also doing a Rapid Extrication - you know pt is circling the drain.
        Do you always crib? YES!!! A rescuer should be just like a medic, a medic jumps off the truck and grabs his bag on the way to the car, a rescuer should jump off the truck and grab some step chocks on the way to the car.
        Sound stupid, It may until you walk in front of a hybrid just as the patient lets off the brake.

        Only if you have the personnel?
        Go right to the tools needed? Just a note about using tools and stabilizing most anyone 100 lbs. or more can actually push a car down the road. 100 lbs. now look at our tools 150,000 lbs. can it move the car?

        I can't believe this forum would not post this because it was to short 5 times, love computers.
        Whats your thoughts?
        Burn
        Last edited by LeeJunkins; 09-07-2006, 09:05 PM.
        http://www.midsouthrescue.org
        Is it time to change our training yet ?

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        • #34
          Excellent

          Lee did I hit a nerve... I think you read a little to far into the post on some of your replys, but thats cool.
          With 41 years in the emergency services I am honored that you are still going at it and keeping us young bucks in line.

          1,2,and 3 I agree on, though I would add some things to that list.
          Please add on to nuture our minds, or wake them up.

          . Side resting:Without stabilization when you jump up on top to open the door, is it going to roll on over and throw you under it, or on one of your men standing there?
          3. Roof resting: most of the time you will be going through the back glass, when you are about half way in, is the roof going to collapse and crush you.
          We can go on and on, but I think you can get the picture. Cribbing is about less movement of the patient but it is also about protecting us.
          I was referring to a upright vehicle which is probably 70% of wrecks, I should have stated that. I assumed it was obvious what I was talking about... sorry

          For a few years now we have got into rapid extrication, Pop the door, C spine, C collar, spin them around and put them on a back board. We have gotten so used to this that most never even think about our true mission. TOTAL SPIN ALIGNMENT.
          So what you are saying is instead of cutting the roof off and doing it correctly you compormised the pt's spine... but hey you cribbed the vehicle.

          Do you always crib? YES!!! A rescuer should be just like a medic, a medic jumps off the truck and grabs his bag on the way to the car, a rescuer should jump off the truck and grab some step chocks on the way to the car.
          Sound stupid, It may until you walk in front of a hybrid just as the patient lets off the brake.
          Comparing us with Medic's...the gall ( im a medic also) This I believe is somewhat debateable depending on the scene, obviously on the intial size up we would hope someone would see hybrid, pull keys do all the good stuff so incoming units can play nicely with pt, if we need chaulks we need them. But its not like that everywhere. By the way we chaulk all vehicles.

          Just a note about using tools and stabilizing most anyone 100 lbs. or more can actually push a car down the road. 100 lbs. now look at our tools 150,000 lbs. can it move the car?

          Opinions are great to stir conversation, I believe we should start a petition to make people sit on wooden seats so they slide out easier.
          Burn<br />LT/EMT/Inst />Central Mat-Su FD<br />Wasilla Alaska

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          • #35
            BurnCMSFD
            I didn't mean to make it quit that strong of reaction, I am just one that deals with a whole lot of new people and I stress stabilization for their safety, you and I may know all of these things but you will be surprised how many are out there doing extrication and have no clue of the dangers.
            I mentioned the Hybrid, I set in one of the largest extrication classes in the state a few weeks ago and heard the instructor tell the class that Toyota was the only ERG out and it just covered how to shut it down. Do they know about sleep modes, I don't think so. So you can see why I am so strong about it.
            Hey! you didn't hit the nerve he did you just got in the middle

            Wasilla, Alaska, I was at NFA with a lot of people from up there beautiful country, they have sent me a lot of pictures.
            Last edited by LeeJunkins; 09-07-2006, 10:44 PM.
            http://www.midsouthrescue.org
            Is it time to change our training yet ?

            Comment

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