(1) Failing to provide large openings puts firefighters in difficult positions
and hinders our ability to provide victims with a proper standard of care.
(Photos courtesy of East Pierce Fire and Rescue, Bonney Lake, Washington.)
( 2) Large openings allow us to get “plenty of hands” on victims. It also
allows us to stabilize, treat, and remove victims safely and efficiently.
Extrication: The Art of
BY SHAWN WAGNER
EX TRICATION IS THE ART OF MAKING space. One of the many challenges of extrication is getting more space
to free entrapped victims. One thing you’ll
never hear anyone say on the scene of an
extrication is, “Thanks, but you gave me a
little too much room to work.”
Approach extrication with the thought
of maximizing available openings. Too
often in our haste, we create an opening
just big enough to remove the victim.
Patient care suffers with this “just big
enough” approach. When we don’t have
enough room to take the victim out
“inline” on a backboard, we may be ma-
nipulating and unnecessarily twisting or
torqueing the victim during the extrica-
tion. This is obviously dangerous to some-
one with a compromised spine, but even
less injured victims can suffer additional
trauma. Allowing proper stabilization of
any fracture or injury prior to removing
the victim allows for a smoother, quicker
extrication and better patient outcome.
If the damage has caused intrusion
into the patient compartment and is in
contact with the victim, the victim often
will not be able to tolerate our working in
that area. Any metal movement or vibra-
tion will be transferred to the victim. In
this instance, we must work farther away
and “peel” the vehicle away.
A single open door doesn’t create the
room we need to work safely. If all we
do is remove a single door to extricate a
victim, we allow room for only two firefighters standing sideways on either side
of a backboard. Those two firefighters
are limited to awkward lifting positions
and poor body mechanics, which is the
reason most of us are seeing doctors
for on-the-job injuries. Although it may
seem that having just enough space to
remove a victim trapped in a vehicle
would be quicker, in truth, anticipating
and allowing for rescuers to have room to
work saves time when time is critical.
Maximize Space with a Maxi-Door
In rookie school or your first extrication
class, you learned how to “pop” doors.
This is a fairly easy skill that doesn’t
take much effort to become proficient.
(maxi-door), however, needs additional coaching and practice. Without the
proper instruction, it will appear slow
and cumbersome. But done correctly, the
maxi-door technique can create a large
working space in minutes.
For this to work, we use the strongest parts of the vehicle—hinges and
Nader pins—to our advantage. During
an accident and the subsequent damage
that occurs, the vehicle’s welds become
weakened and unpredictable. I’ve even
seen where attacking the damaged
part of the vehicle resulted in the metal
peeling away. This makes getting a purchase point difficult and frustrating. The
damaged door has lost its integrity to the
point that it can’t be used to force or fail
a Nader pin. The trick is to think globally:
Consider starting away from the damage
in an area where the vehicle is more predictable. Most of our training occurs on
undamaged vehicles. Use that knowledge
and predictability to your advantage.
Hinges and Nader pins are usually intact,
even after significant wrecks. Use this to