Negligent Box Cribbing?

[LeeJunkins]

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.

[BurnCMSFD]

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.

[LeeJunkins]

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

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

[BurnCMSFD]

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

[chavoman]

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.

[LeeJunkins]

chavoman,
I say take the chance and do what you have to do
No offence bro. but I highly disagree. This attitude is what puts us in that situation.
Are we just going to let someone die because "ITS AGAINST WHAT WE'VE BEEN TAUGHT"
No with this attitude we are going to let one of our people and a patient die, because as you said "ITS AGAINST WHAT WE'VE BEEN TAUGHT" and we did not prepare the equipment we were taught we would need. That is what this thread is all about, finding out what we need and training our people to use it properly so that we are not caught in that situation.

or are we going to take that chance ? Hey I am just as guilty as anyone and everyone on here has stated the same, but is the next chance the BIG one, or are we going to train and prepare to do the next one right?

Every situation is different and you do what you have to do. Are we just going to let someone die because "ITS AGAINST WHAT WE'VE BEEN TAUGHT" or are we going to take that chance ?
This is a twisted version of an old old fire department saying, Chief Confusses says " we alllllways done it that way and it alllllways worked"

[chavoman]

doesn't it all come down to the type of situation you are in? What if you don't have any other means of stabilization and the patient is red and the only way that you can work safely is to go over the height limit. Is it safe? Is it negligence. Every situation is different and you do what you have to do. Are we just going to let someone die because "ITS AGAINST WHAT WE'VE BEEN TAUGHT" or are we going to take that chance ? I say take the chance and do what you have to do.

[Rescue101]

Once again my well educated friend, you read too far thru the post.It's virtually impossible to catch you napping as was my point.If you think however,that I won't stop trying: THINK AGAIN! I WAS napping when I responded to your original post and didn't catch the amended version with the 18" clause.That being said there is a local church being refurbed in town and it's sitting on timber cribs I GUARANTEE are higher than 15 inches(yes,the blocks are bigger than 4x4)But I KNOW the footprint is smaller than the Fema/Usace recommends.Again,does that make it right? NOPE, but there are crews working in there everyday and the occasional Osha inspector.As far as classes on cribbing,it would be my opinion that either Tim or Billy would put on a class if the price and timing were right.And you would wind up with a bunch of people wondering why they ever did what they have in the past.Myself,I'm a winching specialist:in cribbing a mere student but ALWAYS willing to learn.The one sure thing I know about cribbing is you NEVER have enough with you.We need to have cribbing in pill form like those little Martians on the bugs bunny show.Just add a drop of water; POOF! you've got a 6x6.If life could only be so easy. T.C.

[TimatRescue42]

Nap? I don't nap!

Naps are for saps and other undesirable chaps.

I like Frank's study on cribbing for his analysis on hardwood vs. softwood. Go Doug Fir!

Note there is nothing on Frank's site concerning crib height. Back to FEMA/USACE, which to my knowledge is the only standard available.

R101, you're smart with your longer cribbing. Unfortunately, most of what I see is still 18", and the crews don't know ANY cribbing rules or standards. 10 feet tall? Sure, why not!



Nap. Harumph...

Tim

[LeeJunkins]

Just call me the referee I am keeping track of this thread, it is some thing that we all are failing to teach enough of. I didn't realize how dumb I was to it until I set in on one of Big Rigs classes last year. I would really like to get a class just on this subject in our school we are planning.

[Rescue101]

Hehe Lee,I was skimming right thru, saw the cribpac,didn't notice the test part.On this particular subject no harm in a double posting.I kinda like stirring Tim up once in awhile,He's got a lot of great products and is a good source of information for debate.Trying to catch him napping however,...... T.C.

[LeeJunkins]

Frank Maltese has done extensive research on cribbing and has made up some very nice sets.He's experimented with various types of wood in a 100 ton plus press.I would regard him as an authority on the subject of type vs load.And I believe he has some findings you would find interesting

TC I just posted it in the post above you.

[Rescue101]

My point was apparently misunderstood Tim.I'm NOT suggesting you work outside the safety limits of your equipment,ANY of it.And I don't think I've got an 18" stick on my rig anywhere unless it's a wedge stick.But cribbing is an interesting subject.Frank Maltese has done extensive research on cribbing and has made up some very nice sets.He's experimented with various types of wood in a 100 ton plus press.I would regard him as an authority on the subject of type vs load.And I believe he has some findings you would find interesting.But looking at this matter from an abstract point of view: Every day the fire service does things that are not "book correct"and saves lives doing it.The same applies to cribbing. Is it right? Not my place to judge.I believe in offering the best training that you can get. Learn the principles and practice them.But I DO NOT believe there is an experienced,active extricator that can say with any honesty that they haven't pushed the edge somewhere in their career,myself included. Cribbing probably isn't the best place to do this but I've seen my share of horror stories with it.But thanks for keeping me honest,T.C.

[TimatRescue42]

Rescue 101,

If you check you'll see that I didn't say that a 4X4 box crib was limited to 15". What I said is that a 4X4 box crib of 18" long 4X4's with 2 corners of the box under the load is limited to 15", and that is true per the FEMA/USACE standards (the only ones I know of).

The only way you could ever build a 4X4 box crib over 30" high is with longer cribbing and more corners under the load. The max height of a box made with 18" 4X4's with all 4 corners under the load is 30", but not more. See the math above or check the FEMA/USACE spec.

I'm not picking on you, but I think you represent the point we're discussing. You are a very experienced Firefighter and a Training & Safety division Chief, and you make a good point that 15" in a TT underride won't get you far, but (I think) you are then suggesting we knowingly violate the limits of safe cribbing height to get the job done, and I disagree with that. I assume any certified BRR class would teach the FEMA/USACE cribbing standards.

I agree about the widespread misconceptions of correct cribbing rules. If you check ADSNWFLD's post, you'll see that this discussion is doing some good in correcting some misconceptions.

Tim

[LeeJunkins]

I found this the other day, Every one may be interested in it. Be sure to click were it says next page at the bottom, and Chart of compression results at the bottom of the second page.
http://www.cribpac.com/cribtest.html