In looking over the past 30-odd years I have been involved withvehiclerescue, I noticed the tool evolutions and methodologies for空间制造to extricate injured vehicle occupants haven’t changed all that much. They have evolved along with tools and vehicle technologies, but sometimes we are behind the curve in both tools and vehicle technology. Trauma is a disease of time;vehicle extricationis a medical intervention.
NEXUS Study
Our need to rapidly access the injured occupants, safely create space or make a pathway to disengage them from the vehicle, and transport them to the appropriate medical facility has remained constant. However, even this has changed in the light of the NEXUS study1,2that has brought about the widespread use of selective spine clearance in the prehospital environment. This allows us to board and collar only those injured vehicle occupants requiring such treatment according to our patient assessments. Common sense coupled with focused patient assessment wins. Sadly, as a result, manyemergency medical services (EMS)供应商已经变得自满和宽松的。而than allow rescue personnel to create a proper safe space to disentangle patients, these EMS providers choose to drag patients across vehicle center consoles and other obstacles; they can point to the NEXUS study that says the percentage of the chance of further injuries is nil. But how professional are these actions truly? Would you want them to do this to your family members?
(1)拔出车辆的相反或乘客侧。(作者照片。)
(2)A patient is moved on a long spine board out the rear of the vehicle.
相关的消防员培训
Movement and Packaging
您用什么移动和包装患者？尽管可调节的C犯罪分子很好且合理，但长长的脊柱板被皱眉 - 为什么？如果您的评估证明了它们的使用合理，请使用它们。您仍然可以将它们用作传输或移动设备；此类应用没有错。但是，选择性脊柱清除程序不希望您使用长脊柱板transport适当医疗设施的患者。
What about other movement devices to assist you with disengaging your patients from the vehicle? The Kendrick Extrication Device® (KED) comes to mind for most rescuers. The KED has been around since the 1970s. It was designed for the vehicles of that time, in which the front driver’s seat had a large amount of space; large door openings; and a bench seat, the prevalent seating of the era. Many rescuers today do not even know what a bench seat is. Most vehicles today have four smaller doors, front bucket seats designed to keep you planted in the seat with a center console between the driver and front passenger, and much less interior space than ever, yet we still use a device unimproved for at least 45 years to do the same thing it was designed to do in the 1970s. If we put it on any patients in a vehicle today, it would physically entrap them if they weren’t already.
Better Movement Devices
There are much bettermovementdevices on the market today. The key word ismovement。短或半尺寸的板和勺子板是替代方案。长脊椎板的替代方案包括塑料外观勺板和真空床垫。尽管真空床垫的使用有些尴尬，但您需要训练和练习。
(3)车辆的侧面暗恋。
（4）一些战略方向的空间创造。
（5）全面拆卸用公羊推动。
在北美没有脱离的另一个运动装置，但绝对是要尝试的东西是救援BOA。它的工作方式很大，因为无尽的织带循环可以为拖动或医院的毯子滚动起电梯，但效果比任何一种设备都好得多。
Techniques vs. Vehicles Today
尽管我在上面指出，为什么EMS提供商必须与患者一起在车内动手实践，但我们需要改善对抗创伤的现场时间。病人没有时间在他身边，我们也没有。车辆的解脱是医疗干预。
但是，我们今天使用的许多工具演变都是过去30或40年使用的相同演变，随着时间的流逝，它已调整为车辆。救援技术人员必须明确适应当今的车辆，以便在患者的创伤时钟获得时间。可悲的是，在这一领域，我们作为救援人员或响应者甚至不随意进行任何研究。我们只有在让新车辆进行练习或对涉及它们的事件做出回应时，我们才能了解新车辆的挑战。
Today’s vehicles absorb crash energy two different ways. Front and rear vehicles will readily absorb crash energy and crush easily. The front end includes the driveline; even that will absorb crash energy and, to a certain extent, will drop onto the ground, which will transfer the crash energy to the ground, even flattening the tires in the process.
However, the sides of the vehicle are a totally different matter. The side of the vehicle is designed torepelcrash energy ordeflectany intrusion into the passenger area. Therefore, you should suspect an occupant injury if there is a six- or 12-inch intrusion into the side of the vehicle.
So, we must find a better way to create space in vehicles to disentangle patients. Today’s vehicles today are smaller; in many crashes, they will crush up even smaller. We need to use the vehicle toassistus in space creation and be more strategic.
通过战略工具的演变，我们可以从车辆中的事件中释放出存储的崩溃能量，从而逐渐削弱车辆结构，或者通过我们的工具演变和动作使其故意失败。
Controlled Vehicle Relocation
Controlled vehicle relocation is not new; it involves moving the vehicle to a better location or reorienting it to facilitate space creation. This has a new life because of the selective spine clearance from the NEXUS study. This tool operation has been used for some time in the motorsports field and around the world. In some incidents with some vehicles and orientations, you have no other choice but to move the vehicle to facilitate driver removal. Under the safety officer’s supervision, it uses simple tool operations with simple cribbing or stabilization while EMS is treating the patient. Once the vehicle is moved into its new position, rescuers stabilize it and begin making space.
Strategic Tool Operations
在此中，我们寻找削弱车辆结构，释放车辆结构吸收的“陷阱”的碰撞能量的方法，并使车辆结构为我们提供帮助，以帮助创造空间的访问空间和患者分离。一种方法是挡泥板“ raus”或带状/去除的演变。拆除了患者一侧的挡泥板，但是完成后是关键。它是在稳定完成后立即完成的，而玻璃管理处于进度，EMS与患者一起进行。第一个工具演变，它暴露了门铰链，压碎区以及对车轮内部的损坏。这将使您可以轻松地卸下门，并观察患者的脚和下肢受伤和陷阱。
Other examples include the dash lift and the whole process of cross-ramming the vehicle structure. Today, rams, especially telescopic rams, are fantastic, dynamic tools for the process of reforming the vehicle’s interior back to its original size or to a size we require for patient disentanglement.
Total Side Removal
门位移或“弹出”是常规的工具演变；这需要改变。过去，车门更大，还有更多的两门车辆。门位移成为患者进入和患者分解的最常见工具操作。这是有道理的 - 令人愉悦的访问，易于拆除 - 但今天不行。
Most vehicles (cars, SUVs, and pickup trucks) now have four doors. Although they are smaller and the outside materials are thin, flimsy, and weak, they are backed up by very strong advanced steel alloys and other materials. Simple door pops are gone, along with the easy access.
Now we must consider a total side removal, also called the B post tear or rip, the butterfly evolution, Noah’s Ark, and so forth. Look at the side of the vehicle and consider it as a single door or one large side opening—just another structural component to be displaced or removed.
Remember, we can create space in a variety of ways. Removal/relocation of vehicle components and stretching the vehicle structure are the primary ways to create space for access to disentangle patients from vehicles.
（6）Sharp edge protection of various types.
(7)紧急响应信息。
Today’s vehicle construction methodology using advanced steels and alloys in structural reinforcement adds a tool to our space creation process. In addition to being very strong, these materials have high tensile strength. High tensile strength alloys, if bent, will stay bent in the direction in which they were bent. This means that, using a power hydraulic rescue tool ram, rescuers can stretch and bend certain vehicle components (e.g., roofs) and even stretch them farther away by severing a roof post (e.g., an A post). This is also why a dash lift works well; since you are putting force under the dash reinforcement bar, you basically are making it into a class 1 lever. So instead of removing four doors and a roof and displacing a dash, you can today perform a fender raus or a total side removal, stretch/displace the vehicle roof upward, and lift the dash in much less time while using the vehicle structure to assist instead of resist.
Wire Boot Hole
Let’s reconsider the wire boot hole through which the wiring harness goes through from the dash to the door for two reasons. First, it’s an already-made hole, so we just have to push the harness and the boot out of the way. Second, this hole is prime real estate for a deep relief cut for a dash evolution. Insert one of your cutter blades on each cut in both directions—i.e., toward the occupant cell and away from it. Cutting toward the occupant cell is a simple snip, but the cut going toward the firewall/wheel well allows you to open the cutter wide and the other blade to grab into the wheel well.
Another option is to use your spreader to perform a “no-relief cut” dash lift in two ways. One way is to insert your spreader tips into the wire boot hole and open the tool vertically, “ripping” the hole open as the arms open. Adjust the tool as the spreader lifts the dash; you might need to grab more of the dash or of the lower A post. The second “no-relief cut” dash lift is to capture the inner end of the underside of the dash with one spreader tip/arm; the other tip/arm goes against the footwell. As the tool opens up and lifts, it stretches the dash. The dash reinforcement bar acts like a class 1 lever as simple mechanical advantage in both cases.
Safety
Remember the key safety items that are still important. Strip/pull trim whenever cutting roof posts and roof edges. It’s a good practice not to blindly cut into a vehicle structure without looking at what we are cutting into. Use hard protection between tool evolutions and the patient and the interior rescuer. It’s more important than before because the advanced steels/alloys used in vehicles tend to create small pieces of debris when fractured during severing. Using soft protection to cover patients and the interior rescuers is equally important.
Power Isolation and Keys
Power isolation is critical. Remember to chock the wheels and set the parking brake. Shut the vehicle off and gather upall按键。找到12伏电池和双切割bothcables, the negative first then the positive, and document it. Keys today are almost always wireless fobs, but they are now trending toward a card and a smartphone app.
Keep keys 50 feet away from the vehicle, which is much farther than before. However, you can use a Faraday bag to block the key’s radio frequency identification signal to the vehicle.
如今，超过50％的12伏电池都在发动机舱外；下一个最可能的位置是车辆的后部。在检查12伏电池时，请考虑车辆损坏等。
车辆危险信息
Last but becoming extremely important is on-scene vehicle hazard information. Alternative-fueled vehicles have had emergency response guides from day one, but even if we hadallthese forallthe vehicles on the street, even as an electronic PDF, it would be next to impossible to look up the relevant information in a timely manner. Fortunately, there are smartphone apps, and automotive manufacturers have installed QR code stickers on their vehicles to assist us on scene. They give us background information on vehicle hazards and concerns—e.g., how to shut down an alternative-fueled vehicle in various ways, firefighting tactics, and more.
These are just some of the concerns today’s vehicle rescue professional must consider; vehicle technology is changing so dynamically. Other emergency service segments are more proactive in researching the methods, issues, and concerns of their responders. Vehicle rescue and extrication should likewise research the who, what, where, when, and why of what we do on scene. To keep ahead of the trauma clock, we need to investigate new methodology and tools for space creation; better educational programs to facilitate patient care and rescue skills; and operational planning skills that blend patient management, rescue activities, and overall scene mitigation activities as a whole.
Endnotes
1. Hoffman JR, Wolfson AB, Todd K, Mower WR. “Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS).”Ann Emerg Med。1998 Oct;32(4):461-9. doi: 10.1016/s0196-0644(98)70176-3. PMID: 9774931.
2.霍夫曼，杰罗姆。“ C-Spine成像的Nexus标准。”https://www.mdcalc.com/nexus-criteria-c-spine-imaging。
DAVID DALRYMPLEhas been involved with emergency services for 38 years. He has been teaching vehicle rescue for the past 27 years, educating on vehicle technology issues and concerns. He is involved with the Society of Automotive Engineers Task Force on electric, hybrid, and alternative-fueled vehicles for first and second responders. Dalrymple is the educator/rescue consultant for RoadwayRescue LLC and has taught at FDIC International since 2003.
