EXTRICATION is a removal of the victim from a difficult situation or position; or

Removal of a patient from a wrecked car or other place of entrapment

1. When to Perform Extrication

● Automobile & motorcycle accidents.

● Train derailment.

● Collapse building.

● Unconscious injured victim.

● Emergency situations:

Cave-in – Farm machine injuries.

Fire – Gunshot wounds.

Water accident. – Fall from height.Classification of Rescue Operation

● Basic Rescue with minimum equipment involved rescue operation

2. Classification of Rescue Operation

● Basic Rescue with minimum equipment involved rescue operation

Medium Rescue- involves specialized equipment normally found in rescue vehicle

Heavy Rescue - complicated rigging, patient handling under extremely difficult or

Adverse conditions, breaching or wall disimpactation of vehicles and all types of rescue

FYI The Fire Department or the Military Rescue Groups usually do medium and heavy rescue.

3. Elements of Rescue

In Work Phase follows:

L - Locate

A - Access

S - Stabilize

T - Transport
Because extrication of some may be quite difficult, consume much time and require specialized
equipment, the priorities of assessment, stabilization and transport may need to be adjusted for certain
victims/patients.

4.Problems in Rescue Situation

• Several medical and rescue units.

• Lack of identifiable leadership.
• Disorganized provision of care.

It is therefore, essential for one person to be in charge of the overall rescue operation. This person must
be medically trained and qualified to judge the priorities of patient care. This person has to assume
responsibility for the overall management of the extrication process as well as the details of patient
care. It is best to reach an agreement on the protocol of assigning this responsibility in advance through
the development of an incident command system or as a part of the local disaster plan.

5. Principles of extrication

• Evaluation (size up) the situation. See Photos/Images above.

• Locate all victims.
• Provide for the safety of rescue personnel and the patient.
• Secure the scene.
• Gain access of the patient.
• Provide emergency medical care (stabilize the patient)
• Disentangle the patient.
• Prepare the patient for transfer.
• Transfer the patient.
SPINAL INJURY MANAGEMENT

1. when Spinal Injuries occur

• Violent impact to the head, neck, torso or pelvis.

• Sudden acceleration or deceleration accidents.
• Falls from a significant height with the patient/victim landing on the head or feet.
• Gunshot wounds to the neck or trunk.
• All shallow water diving accidents.
• All unrestrained victim of a vehicle crash.

2.Signs and Symptoms of Spinal Injuries

• Pain in the head, neck or back.

• Numbness, tingling or weakness.
• Pain when in motion.
• Deformity.
• Tenderness.
• Laceration or contusion.
• Paralysis.

3.Examination of Spinal Injury

All injured patients caused by any of the above mechanism must be evaluated for the possibility of a
spinal injury. In conscious patient, you take the following steps to determine the presence of a possible
spinal injury:

• Ask the victim/patient or witness about the nature of the accident.

• Ask the victim carefully about areas of pain, numbness or weakness.
 • Look for contusion, laceration and abrasion about the face, head, or trunk and look for any
deformity of the spine.
• Feel for any irregularity, deformity or point of tenderness along the spinous process posteriorly.
Check arms and legs for decreased sensation.
• Check for weakness or paralysis by asking the patient to wiggle his/her fingers and toes.

4.Care for Spinal Injury (First Aid)

Proper emergency care for spinal injury may prevent the need for extensive medical care and
permanent disability. You have the opportunity to prevent paralysis and death; failure to examine a
possible spinal injury or ineffective splinting of the unstable spine might cause significant, long-term
problem. See Photos/Images above.

• Maintain the victim’s/patient’s breathing and ensure adequate ventilation. Perform C-S
Emergency pine control and or Jaw thrust maneuver.
• Control serious bleeding using local pressure dressing.
• Most importantly, immobilize the victim before you move him/her.

5.Helmet Removal

• Many patients with neck injury are motorcyclists or football players who may be wearing
protective helmet.
• Four circumstances in which part or the entire helmet should be removed.
• When the facemask or visor interferes with adequate ventilation or with your ability to restore
an adequate airway.
• When the helmet is so loose that securing it to the spinal immobilization device will not provide
adequate immobilization of the victim’s head.
• When life-threatening hemorrhage under the helmet can only be controlled by its removal.
• When because of the size of the helmet, using it as a part of the spinal immobilization will cause
extreme flexion of the neck (this situation usually occurs in children).

STEP 1
The first rescuer removes the chinstrap while the second rescuer holds the head in line with the
body.

STEP 2
While the first rescuer supports the head, the second rescuer spreads the sides of the helmet.
STEP 3
The second rescuer slides the helmet off the victim.
STEP 4
Once the helmet is removed, the second rescuer applies in-line stabilization.

6.Immobilization of Spinal Injury

  Immediately begin stabilization by holding the head firmly with two hands. Gently lift the head
to the position where the victim’s eyes are looking straight ahead and the head and torso are in-
line (neutral in-line position).

• At no time should the head or neck be twisted or excessively flexed or extended. Manual
support must continue until the patient is completely secured to the spinal immobilization
device.
• In certain circumstances movement of the head to the neutral in-line position should not be
pursued. You should not force the head into this positon if:

˗ Neck muscle spasm occurs.

˗ Pain increases.

˗ Numbness, tingling or weakness develops.

˗ The airway or ventilation becomes compromised. In this circumstances stop and immobilize the
victim in the deformed position.

7. Full spinal immobilization

The general rule for management of spinal injury is to support and immobilize the spine, the head, the
torso, and the pelvis. Your goal is to end up with a patient who is properly immobilized on a long spine
board. It is best to over-treat than to risk further injury.

STEP 1

Prepare the needed materials.

STEP 2

The first aiders (three) will position on the victim and another one will do the C-Spine control

STEP 3

Team leader will give the command to kneel and will also instruct the person who do the C-spine control
to take over the command. First aiders on the side will hold the body of the victim and prepare to roll.

STEP 4

C-spine controller will give the command to roll the victim to one side.

STEP 5

The middle first aider will reach on the spine board and insert this to victim’s body. (Must be on a 45
angle)

STEP 6

The C-spine controller will give the command to load the victim, then instruct a push and pull movement
toward the head.
STEP 7

The C-spine controller will instruct to secure the victim with a triangular bandage starting from the
chest, hips, tights, legs, foot.

STEP 8

Place a head support from both side or use a blanket roll following the contour of the head and put a
triangular bandage to secure. Recheck Pulse, Motor, Sensory (PMS) then patient is ready to transport.

FYI Reminders on Spinal immobilization:

· Maintain and support an adequate airway and ventilation at all times.

· Ensure and maintain in-line support of the entire spine throughout the entire splinting
process.
· Apply property a correct cervical extrication collar as described earlier.
· Secure the victim’s torso to the spinal extrication device before securing the head.
· Avoid hyperextension or hyperflexion of the neck when you secure the head. In most
adults, the neutral in-line position will create a space between the head and the spinal
immobilization device.
· Adequate padding should be placed between the head and the device. In contrast, small
children will need padding placed between the shoulder and the device to prevent
hyperflexion of the neck when secured to the device.

Secure all straps snugly to minimize motion. However they should not restrict chest expansion or
circulation to the limb.

· Be certain that the patient’s mouth can be opened to clear the airway.

·Secure the victim well to spinal immobilization device (long spine/back board) with the head, torso and
pelvis aligned so that no motion will occur between any of these parts during movement and transport.
The patient should be so well secured that the entire body can be turned to one side to facilitate airway
management or vertical extrication if necessary.

8. Rescue form Automobile

It is usually not necessary to move a victim from a automobile before a professional/trained resource
arrives; automobiles do not often explode after accidents. If you can do so without moving the victim,
turn off the ignition and set the parking brake. If you must remove the victim from an automobile
because he/she is in immediate danger, first immobilize the neck and back with a short backboard. If
you have no board, you will have to weigh the urgency of moving the victim without a board against
waiting for a professional help with proper equipment.

SKILLS :Application of Bandaging and Body Splints Step1-24

STEP 1 Ensure that the Body Splint contents are shown.

STEP 2 Properly immobilize the patient with the correct size cervical collar. With manual traction still
being applied, gently move the patient forward by grabbing clothing in one hand and support back with
the collar.

STEP 3 Place the Body Splint behind the patient at 45° angle with the buckle on the outside.

SPTEP 4 Free the body splints leg straps by pulling the straps outward and down next to the patient’s
legs. Be sure that the straps are not tangled. Rotate the splint upright and center on the patient’s spine.

STEP 5 Ease the patient back onto the body splint and position the wings snugly under the patient’s
axilla.

STEP 6 In the application of the body wings, exercise care when applying pressure to the ribs to prevent
further injury to the axilla. Gently pull the wings together across the chest while maintaining tension on
the wings. Extend the bottom support strap from the splint, connect buckles together and tighten.

STEP 7 Pass a leg strap under one leg using a seesaw motion. Pull the end up between the legs and
couple it to the receiver on the opposite side of the device. Repeat for the other leg. Tighten both leg
straps. For a suspected groin injury. Pass restraint around leg and couple on the same side.

STEP 8 Position head panels around patient’s head. Apply forehead restraint strap to the body splint by
centering the foam pad on the upper portion of the forehead. Wrap the remainder of the strap around
the wings of the splint with gentle pressure. The chinstrap is applied in the same manner as long as the
airway is not compromised.

STEP 9 Extend the top chest strap across the patient fasten the buckles and tighten.

STEP 10 Position the patient for extrication with one person maintaining traction on the patient, swivel
patient to where rescuers can obtain hold of the lifting handles. Gently lay patient on transporting
device and remove.

STEP 11 Once the patient has been removed, loosen the top chest strap to ease breathing and loosen leg
straps so legs can be straightened.

STEP 12 Patient is ready for transport.