EXTRICATION "QUICK TIP" #56 (CLEAN vs. DIRTY RESCUE)

We all understand that the extrication of trapped patients from serious vehicle accidents can take time. Commonly, there is confusion about the best rescue method for a particular patient. We all know that each incident will vary depending on the level of entrapment and the more importantly the patient’s condition. Many department/state standards warrant the use of a LSB or KED device to regulate spinal immobilization UNLESS the situation warrants a rapid extrication. I like to keep it simple by breaking my operating modes into two simple plans-CLEAN RESCUE vs. DIRTY RESCUE. Let me explain…

For example, you respond to a MVC with one elderly woman in the passenger seat of an upright vehicle. During your walk-around you find no apparent hazards and during patient assessment you find that her arm is trapped between the driver’s door and seat frame. Vitals are stable and she is complaining of nothing but left arm pain and neck pain. This is a fine example of a CLEAN RESCUE.

• Patient/vitals are stable

• Patients condition doesn’t warrant immediate movement

• Spinal immobilization is warranted

• Currently no scene hazards that put the patient/rescuers in serious danger

Now let’s change the tone. You respond to a vehicle on wrapped around a telephone pole with 2 patients heavily trapped. The vehicle’s engine compartment is on fire and both occupants are trapped by the dash/doors. The driver is screaming hysterically that her legs are burning and she is combative. During assessment, you find bilateral femur fractures and an open radius/ulna fracture. The occupant (passenger) against the pole is breathing but unresponsive and is fading quickly. Both patients meet Trauma Alert (Air Transport) criteria. This is a fine example of a DIRTY RESCUE. This rapid extrication technique is designed to move critical patients that are have extremely time sensitive treatments warranted.  

• The vehicle fire/scene conditions are critical

• Unstable patient conditions warranting immediate movement/transport

• Treatment is time sensitive

• Patient 1 is blocking rescuers from another, more serious patient

• Multiple indications for a rapid extrication

While you should look at and follow your state/departments various protocols and procedures for short/KED/long spine boards, rapid extrication is a critical movement and can save lives when warranted. Just remember, you must be able to warrant your actions on both scene types. So do the right thing...

ISAAC FRAZIER is a Special Operations Lieutenant with St. Johns County Florida’s Heavy Rescue “Squad 4”. First due to the deadliest stretch of roadway in the nation, Frazier teaches from personal street experience providing tried and true tactics. Frazier is the owner of Tactical Advantage Training and creator of the course Tactical Extrication. Frazier travels nationally sharing his passion teaching fire and extrication courses. Frazier is a FDIC lead HOT instructor, FDIC lecturer, Fire Engineering Contributor, Fire Officer II, FL Paramedic, Special Operations Officer, Florida State Instructor, FLUSAR Tech, Diver, and FL Hazmat Tech.  www.TrainTacticalAdvantage.com