Freeing an Entrapped Patient is an integral part of freeing any entrapped (pinned) patient and is a process that, in my view, essentially has two distinct areas: external and internal space creation.
External space creation
External space creation is what we popularly think of when using the hydraulic tools. Examples of external space creation are:
- Fender crush/cut to expose hinges
- Door removal
- Side removal/B Post rip (blow out)
- Roof relocation
Internal space creation
Internal space creation refers to processes such as:
- Cross ramming
- Dash displacement (lift or roll)
Again, these make use of hydraulics.
Keep it simple
I would urge all rescuers to think about internal space creation (at least in the initial stages of a rescue) in much simpler terms and consider the possibility of creating space with nothing more complex than your gloved hand. This may sound like an obvious statement, but I continue to witness even seasoned operators missing the opportunity to use their hands at an opportune moment, which can lead to adding some considerable time to their extrication.
More motorised systems
I must point out here that the process of using your hand to manipulate the vehicles interior has changed considerably over the last decade. This is due to the fact that nowadays, even the most basic of vehicles make use of more motorised systems. When I started out I could move any part of the vehicle interior by winding a handle, turning a wheel or operating a lever. Those days are rapidly disappearing.
Prior to battery disconnection
With more motorised systems operating on the vehicles 12v system, it is vital to make use of these prior to the disconnection of the vehicle’s battery. This is one of the many reasons your extrication plan is so fundamental to your success. Disconnect the battery before you have, for example, lowered windows, moved steering wheels, reclined/slid back seats or even opened the rear hatch (as many locks are now electronically operated), then you are faced with a much more complex method of creating space. Sometimes you can reconnect the battery to make use of these systems, but not always, so think logically and ensure these tasks are completed before the juice is cut.
Use your hands… head
I often ask rescuers to create space by using no more than their hands (and of course, their head!) as it serves to show just how much internal space can be created in a very short time frame. The simple act of reclining seats and moving steering wheels can, in some cases, free an entrapment and it only takes seconds.
I have often said that rescue is overthought and doing the basics well will very often give good results. Let’s face it, you cannot get more basic than using your hands!