Effective Extrication Is A Systematic Process

Since I have been in the fire service (and I suspect long before that) fire departments have been responding to wrecks to free people who have been trapped. This happened before there were “Fire/Rescue” departments and paramedic services.

Like so much that has changed, extrication has gotten so much better – becoming much more efficient and effective. The fire service knows that faster and safer extrications translate into more lives saved, shorter hospital stays, and less time in rehabilitation. People who would have died or been seriously injured are now back to normal much quicker, in part due to these improvements.

We must also mention that vehicle safety has improved over time. Seatbelts and airbags do work. Crashes that used to have a horrible outcome now may result in no injuries or just minor scrapes.

Improvements to extrication did not happen magically. There has been a lot of work done to improve the tools and techniques. The commitment of many in the fire service to hone their skills has also been a contributing factor.

Incident Frequency Low

Responses to crashes requiring extrication remain a challenge mostly because the frequency of incidents is not great in almost all departments. Hence the challenge remains to continually maintain and improve capabilities – always with the goal of faster and safer extrication and proper patient care.

Successful extrications are the product of the right tools, good procedures and regular practice and training (with a little help from command and leadership). Of course these components are part of any successful fire department operation. Departments are challenged to maintain their competence in the face of infrequent events, limited time to practice and shrinking resources. The solution lies in dedication and commitment to the task and creative thinking to get what you need.

Basic fire department forcible entry tools were used to pry vehicles apart. Later, hydraulic tools were developed that could spread and cut, making it somewhat easier and faster to tear a car apart. Little concern was given to vehicle stabilization. Firefighters used whatever means they could to get old vehicles from the local junkyard. They received some basic instruction from the tool manufacturer and “played” with the tool to learn the best way to be effective.

Today, the hydraulic tool is not the only game in town, and even it has expanded its capabilities. There are so many more options regarding tools to consider. Some are specifically made for emergency extrication while others have been adapted from more conventional tools. These provide not only choices, but often a more cost-effective way to accomplish the goal.

There are many common tools that are being used with great results. Reciprocating saws, various prying tools, glass cutters, and hi-lift jacks are just some that get regular use during auto extrications. Their use has come from firefighters experimenting and looking for ways to improve. They also have been looking for other means that may not be as costly. Training programs and journals have documented the successful use of many hand tools for extrication. Other items can be developed based upon your needs and available funds.

Lumber For Cribbing

For example, lumber can be used for vehicle stabilization if you are unable to purchase some of the more commercial cribbing available. Turn the creative juices of your members loose and also talk to neighboring departments. Read and research. There is much that can be accomplished. Remember, extrication is no longer just about the use of hydraulic tools.

Sound procedures are needed. While there can be many variations on crashes and methods, there will always be some fundamental practices that are essential to the successful outcome.

Develop A Plan

There was a time that upon arrival, a firefighter entered the vehicle to treat the patient (usually stabilize the spine) and the rest of the crew figured a way to rip as much of the vehicle away from the patient as they could until the patient could be removed. Now there needs to be a systematic process.

It should include:

  • Scene safety – make sure the rescuers and any other bystanders are protected from further harm, including parking vehicles to protecting rescuers.
  • Develop a plan – this is part of the incident commander’s role, but it must be communicated to all.
  • Stabilize the vehicle – make sure it won’t move while you are working on it.
  • Assign the tasks – assuming you have trained on the tools and methods available to you, turn your crew loose.
  • Take care of the patient – to be done safely and in the best interest of the patient, including starting ALS treatment.
  • De-escalate the incident and make sure everything is returned to normal
Each of the above bullet points provides guidelines, but do not restrict the critical thinking needed to make proper choices. The procedure needs to recognize the commonalities of all incidents.

All of this is pulled together through quality training. The challenges to train for extrications are similar to the challenges for most emergency operations. First, you need to find the time.

As the fire service world gets more complex and more demanding, the time needed to adequately train in all areas is harder to schedule. But that comes with the territory and must be found. As a low frequency event, training on extrication becomes more critical.

Another challenge is finding the necessary props – vehicles on which to practice. In many cases, fire departments are relegated to use whatever vehicles can be donated from a junk yard. These typically are older and may be manufactured differently than the cars on the road today.

Personnel must be aware of the differences among cars and must study to learn the best ways to deal with them. If there are opportunities to practice on later-model cars, these should be pursued. Something that is common in today’s vehicles – like airbags – are not found in the typical cars used to practice techniques. Make sure that the training includes discussions and possible simulations when the real thing is not available.

Vehicle extrication has improved greatly over the years. Groups such as the Transportation Emergency Rescue Committee (TERC) – check the Web site, www.terc.us – do their best to stay up on the latest developments.

The bottom line is that the goal is to minimize extrication time to get the patient to the hospital as quickly and safely as possible. The shorter the time, the better the outcome. Though it is not a high-frequency event, the consequences are great. You owe it to your community to be the best that you can be.

Editor’s Note: Richard Marinucci is chief of the Northville Township (Mich.) Fire Department. He retired as chief of the Farmington Hills (Mich.) Fire Department in 2008, a position he had held since 1984. He is a past president of the International Association of Fire Chiefs (IAFC) and past chairman of the Commission on Chief Fire Officer Designation. In 1999 he served as acting chief operating officer of the U.S. Fire Administration for seven months. He holds three bachelor’s degrees in fire science and administration and has taught extensively.

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