Biomechanical study 3: Nutbeam, T. Fenwick R, May B, Stassen W, Smith JE, Bowdler J, Wallis L, Shippen J.
https://sjtrem.biomedcentral.com/articles/10.1186/s13049-022- 00996-5
Extrication studied:
Roof removal
The most commonly delivered extrication type in the UK. The A, B and C posts and the roof removed facilitating a vertical extrication technique.
Technique: The participant was provided with manual neck stabilisation throughout, the back support of the driver’s seat was reclined mechanically and the Long Spinal Board inserted to the seat base. The participant was then slid up the board until they were horizontally situated (securely) on the spinal board.
B-post rip
The B-post, driver’s and driver’s side rear door are removed to facilitate patient access and horizontal extrication.
Technique: The participant was provided with manual neck stabilisation throughout. The back support of the driver’s seat was reclined mechanically. The spinal board was inserted at an oblique angle (pointed towards front centre console) and inserted to the seat base. Participant was then slid up the spinal board until fully on the board at which point the spinal board is rotated 45 degrees and placed horizontally onto the floor, next to the vehicle.
Rapid
The driver’s door is opened and the casualty assisted with a lateral extrication technique. Technique: The driver’s door is opened. The participant was provided with manual neck stabilisation throughout. The spinal board was inserted under the right thigh and hip, through an open door on the driver’s side. Hereafter, the participant was then lifted up the spinal board in a lateral position until the feet are released from under the steering column, allowing rotation onto back and then finally, slid into position further up the spinal board.
Self-extrication
The casualty leaves the vehicle without assistance.
Technique: The participant is asked to get out of the vehicle and take one step away. The fire crew offered no instructions on how the participant should exit the vehicle.
What we found:
Mean excursion and confidence intervals for anterior- posterior movement at the cervical spine
Mean excusion and confidence intervals for anterior- posterior movement at the lumbar spine
Time taken and confidence intervals (s)
Note – times above do not include “cutting” time.
What we learnt:
Self-extrication is associated with the smallest patient spinal movement and the fastest time to complete extrication. Rapid, B-post rip and roof off extrication types are all associated with similar movements and time to extrication in preprepared vehicles. In patients who can self-extricate, this should be the preferred extrication method. In patients who can’t self-extricate, following disentanglement the most rapid method of extrication should be delivered.