Car accidents with trapped victims can be incredibly frustrating. There is often very little one can do until the rescue services achieve extrication. Sometimes, because of limited patient access, all you can achieve during extrication is some very basic airway management, pain relief through a crap IV and ‘neck stabilisation’ while waiting for the firemen to fully extricate. Everyone on scene knows how every minute counts, and it feels like it is taking forever. A British study in EMJ looks at how long the various stages of extrication takes.
The authors define some necessary steps that need to be performed in order to achieve extrication.
1. Scene assessment and safety: Rescuers assess scene safety. Other traffic needs to be controlled, airbags secured, chemical spills managed etc.
2. Stabilisation: The car is stabilised so it wont move during extrication. Air is released from tires, pneumatic stabilisers applied ect.
3. Glass management: Glass from windshields must be managed. A windshield under stress may explode and shower the victim with fragments causing cuts or even inhalational injury. Often an anti-shatter film is applied before the windshield is lifted out.
4. Initial access: The phase where ambulance or firemen have limited access to the patient and can make a rough assessment of what medical management is required. If the victim is in a critical condition the clincians can call for a rapid extrication without immobilising the victim.
5. Full access: Enough internal and external space has been created so that rescuers can provide somewhat effective treatment. The victim is ready to be extricated.
6. Final extrication: the victim is extricated, often immobilised on a spineboard, to an prepared area where full medical stabilisation happens.
The authors calculate the average time each step takes after identifying 158 incidents with trapped victims requiring fire crew extrication. Time-points were collected by listening to emergency services’ two-way radio.
Stabilisation and glass management took on average 4 minutes each, meaning initial access was achieved after 8 minutes. Achieving full access required another 12 minutes. Finally, extrication took on average 7 minutes. Median time to full extrication, after which full medical management can begin, was 30 minutes.
On average it takes 30 minutes to achieve full extrication. After setting up the stretcher, setting up for intubation, for immobilisation and what not, it seems to take an eternity for the firemen to extricate. Often, all you can do is just watch. Still, im often surprised when I see the actual timings after delivering the patient to the hospitals. Most of the time, extrication happens a lot quicker than I expected. I guess it’s the intensity of car crash scenes that’s screwing up my perception of time.
Study lives here:
Emerg Med J. 2014 Dec;31(12):1006-8. doi: 10.1136/emermed-2013-202668. Epub 2013 Sep 4. The stages of extrication: a prospective study.Nutbeam T1, Fenwick R2, Hobson C3, Holland V4, Palmer M5.
Also, I found an excellent, but a bit dated, review describing some of the basic principles of extrication:
Emerg Med J. 2005 Nov;22(11):817-21. Extrication of the seriously injured road crash victim. Calland.