Medical care in vehicle extrication rescue
Published on 19 October 2009
After a vehicle collision of significant force - as in the case of high-speed impact - it is likely that the occupants of the car, particularly the driver and front seat passenger, will be entrapped. Brendon Morris, Holmatro Rescue Equipment's Consultation & Training Manager, and a rescue paramedic in South Africa for many years, discusses the need for an advanced level of care for entrapped patients in vehicle extrication rescue.
Entrapment in a vehicle accident can be physical, mechanical or both. In other words, the victim can be trapped by his or her physical injuries or by the fact that the vehicle has crumpled in such a way that it is not possible to get out of the wreckage (mechanical).
Regardless of whether there is a physical or mechanical entrapment, victims are very likely to suffer significant internal injuries after a high-speed impact.
It is these internal injuries that can be worsened due to inappropriate handling and lack of good medical care during the extrication rescue process.
Combining technical extrication skills & advanced medical care
The specialized discipline of extrication rescue is performed with varying degrees of efficiency across the globe. To reduce the negative effects of moving an entrapped victim (whose condition may worsen due to their already fragile state), specialized extrication tools and techniques are needed. With rescuers in more and more countries becoming aware of this, the overall demand for these tools and techniques has increased over the years. What makes the overall discipline of extrication rescue so successful is that it combines technical extrication skills with advanced medical care of the patient.
From the second a crash occurs the medical condition of a trapped patient will begin to worsen. Approximately 50% of road traffic deaths occur at the crash scene. As we all know, the need for patients to get to a hospital as soon as possible is essential in increasing the chance of survival.
To this end, we tend to invest much time and money developing well-run ambulance services that can carry the patient to a hospital safely and efficiently. What is often forgotten, however, is the importance of ensuring that we do not harm the patient any further when freeing him from his position in the vehicle.
Extrication rescue should not only be used when it is physically impossible to remove a patient. It should also be routinely used to make sure that the patient is not moved or handled in a way that could further compromise his or her already delicate medical condition. Techniques such as a side and roof removal help to ensure that the patient can be removed from the vehicle in an in-line movement to protect him against the aggravation of potentially dangerous spinal injuries. This technique is just one example of how simple procedures can significantly increase the possibility of full recovery from a motor vehicle collision.
Challenges with extrication rescue efforts
Research in the field of extrication rescue, as with pre-hospital care, is extremely limited due to ethical and practical issues. Extrication rescue efforts are even more problematic to prove. What has been shown is that, of the high percentage of deaths occurring in the pre-hospital stage, many can be avoided. Moreover, many complications resulting in disability in the pre-hospital phase could also be avoided.
Unfortunately, we can see a large difference between the likelihood of surviving the pre-hospital stage in more developed countries as opposed to low and middle income countries. Perhaps this can be attributed not only to the lack of emergency medical services in these countries, but also to the lack of expertise and equipment for the extrication of victims from their damaged vehicles.
Another important consideration is the advent of new stronger vehicle constructions on the roads today. To deal with these, rescue tool manufacturers constantly have to develop stronger tools (especially cutters). New Car Technology often introduces the paradox of safety vs. accessibility.
In other words, the very construction that makes it possible for a driver of a car to survive the impact may well be the reason why it is impossible for a rescuer to free the victim when working with old, out of date rescue tools.
Basic first-aid training is not enough
In low and middle-income countries, patient transport by ambulance from the crash scene is rare, with most patients being transported by commercial vehicles having been "rescued" by the general public. Some programs are being developed to provide basic first-aid training to those most likely to come across vehicle collisions. Hopefully this will decrease mortality rates.
It may also be worth further investigating whether providing more extrication skills to those responsible for the rescue of patients from their damaged vehicles may also decrease mortality rates. Providing only first aid skills may even prove to be harmful where there is no formal system in place to control the extrication process.
Teamwork is critical to extrication rescue success
The scene of a motor vehicle collision is not the controlled environment of an operating or consultation room. The rescue scene has many dangers and risks associated with it and these have to be controlled. Extrication rescue does not only provide knowledge to rescuers on how to safely extricate patients, it also equips them with the skills to ensure that they do not become injured themselves during the rescue.
Extrication rescue techniques also include the various activities that must be done to ensure that all personnel involved in the rescue scene are working in a safe environment. A perfect example of this is the importance of ensuring that the vehicle's battery is disconnected in order to remove the chance of an electrical short circuit starting a fire. In terms of safety, the other matter to consider is the fact that many different services have to work together on a rescue scene.
The only way to ensure safety for all involved is for the services to work together as one team: each knowing exactly what their responsibilities are.
Brendon Morris - Consultation & Training Manager, Holmatro Rescue Equipment
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