Extricating Ego’s

Photo: © 2013 MHarris“How long is it going to take to cut the patient out of this car wreck?” Ask this question of any fire fighter at the scene of a motor vehicle collision and it could be taken as a direct challenge. It’s the ambulance services’ way of throwing down the gauntlet and asking fire, “how good do you think you are?”. However long they might say, my experience has always been to add on a few minutes. As much as I think the challenge is helping me spur the fire crews into action, getting an unrealistic estimate does little for my patient treatment plan and gives me an unrealistic expectation. Being the paramedic I need to know where in the vehicle extrication we will hit a delay or where could I expect a lull to settle over the scene. Knowing how long an extrication will take comes with years of experience, being stood at the side of a rain soaked motorway or sat crunched into the back of a mangled car wreck with a patient.

To settle any uncertainty in how long it should take to extricate an entrapped patient, the fire service undertook an audit into the times various phases of an extrication took at certain motor vehicle accident scenarios.

Here is the journal article I spotted with some more background information.
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“The stages of extrication: a prospective study”
Tim Nutbeam. et al.
Emerg Med J doi:10.1136/emermed-2013-202668AbstractBackground: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication.

Objective: To report the time taken for the various stages of extrication.

Methods: A prospective, observational study carried out in the West Midland Fire Service’s metropolitan area. Time points related to extrication were collected ‘live’ by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive.

Results: During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24–38 min.

Conclusions: In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.

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