1) The document outlines guidelines for safely extracting patients from vehicles following accidents to minimize spinal cord injury and further injuries. 2) It stresses maintaining spinal alignment and minimizing twisting of the patient's body. 3) Rescuers should fully assess the patient's condition, provide oxygen, and address any life threats before beginning the extraction process.

1. Vehicle Extrication Wairarapa Ambulance Service Heidi Whitman, Intensive Care Paramedic

2. Maintain spinal alignment To minimize spinal cord injury and paralysis. Minimize body twisting To reduce further injuries and reduce fracture movement and pain. Two Basic Principles

3. Patient Condition A rescuer undertakes a full assessment of the patient before extraction …Unless rapid extrication is required for the time critical patient. This includes: Check safety, scene, and situation.

4. Approaching the Patient First rule out dangers to the rescuers. Initially approach the vehicle from the front so as to avoid the patient twisting their head.

5. Alignment If the patient is slumped over, use two rescuers to bring the patient’s body into neutral alignment.

6. A second rescuer brings the head into neutral in-line position and performs manual in-line stabilization. The second rescuer performs airway maneuvers as necessary. C-spine

7. Airway Maneuver If the patient’s airway is compromised by blood, vomit, or tongue, etc. then the second rescuer also performs a jaw-thrust airway maneuver in addition to maintaining in-line stabilization.

8. High Flow Oxygen Patients with potentially severe injuries need high flow oxygen via a non-rebreather mask. Set the oxygen flow rate at 10-25 lpm. If the patient’s breathing is inadequate, then assist breathing with BVM ventilations. This will require another rescuer.

9. Initial Assessment: A-B-C’s Any life-threats to the ABC’s need to be addressed immediately! Rapid Trauma Assessment A rapid head to toe assessment that should take no longer than a minute to complete. This assessment searches out the trauma specific life threats to a patient. Patient Assessment

10. Vehicle cutting to allow for accessing and the removal of the patient is part of the overall patient care and should be done simultaneously with the assessment and treatment of the patient. Ambulance officers should not stop vehicle cutting unless it directly affects patient care. Unneccessary halting of cutting will increase onscene times and affect the golden hour concept. Vehicle Cutting

11. Minimize spinal movement When moving the patient onto a longboard, use multiple rescuers guiding the torso and legs to minimize twisting and maintain neutral positioning.

12. Sometimes vehicle damage or positioning requires non-traditional patient extraction, such as on their side or on their stomach. If this is necessary, then use multiple rescuers to maintain neutral positioning as best as possible. Extract the patient onto a board, then carry them to a safe location where they can be logrolled into a supine position. Prone or Side Extraction

13. Above All, Safety First! To Rescuers, Bystanders, and Patient