Extrication

[Medic26]

My fire department does rescue, my EMS agency also does rescue for 5 fire districts for which we cover.

Personally I have seen good and not so good extrications from both. The advantage to my EMS agency doing rescue is that we have a pool of 5 fire companies to pull from for manpower.......the result is a well rounded, experienced and thinks outside the box as a team group of people who have proved they can get the job done. Its great having people from different companies who can share knowledge. Anyway, I just think you have to look at each situation differently........what works for us will most likely not work for you. EMS or FIRE..........who cares as long as it gets the job done!!

[EMT001]

Extrication in my locale is handled by the fire department, however complete scene control is given to EMS incident command. A typical extrication scene will follow this sequence of events:

1) EMS determines the extent of patient injury to the best extent possible given the access limitations. This is to determine the neccesity of additional resources and if EMS is going to need to set-up in the car prior to the initiation of extrication. IF the pt.'s condition is so severe that immediate interventions are required, EMS personnel will enter the vehicle. If the only intervention required at the time is C-spine stabilization, a firefighter will enter, apply C-collar, and maintain stabilization. At all times during extrication, a safety officer is designated to watch the responder in the vehicle. If the responder signals for extrication to stop it is stopped immediately.

2) As this is occuring the FD extrication team-leader is determining the fastest and safest way to remove the patient from the vehicle (or, if your on a call similar to mine last night, remove the vehicle from the patient.) This is done in conjunction with EMS incident command. Once the extrication plan as been approved by EMS and FD command, it is initiated. All of this does not take as long as you might be imagining.

3) Extrication is complete.

Works great, we never have safety or staff issues.

All extrication assignments get an ALS crew, BLS crew, FD engine company, and FD rescue company.

[Coach Hohman]

Our fire departments (three small volunteer departments) do all the cutting and also help with extraction if needed. We have some great firemen who keep the patients best interest in mind...and then we have "redneck Joe" who just loves to fire up his Jaws of Life and start cutting things without thinking. There are onlya few "redneck Joe's" in our area...but the only conflict we ever have with the departments is sabout "those guys" not using common sense. If I have a 4 y/o patient stuck in a car that's already scared of all the noise...I want cut INTO that care. Cut a door off or something and get me int here, because I'm great with kids and that kid is going to go into a panic by him/herself. Most firemen respect that request...some of them think I'm a moron and go right at the frame without thinking...now I have a 4 y/o patient with whatever injury that sees nothing but flashing lights, screaming and loud noises...I think if the firemen (and in a lot of cases EMTs) in our area used their heads, sometimes things would run a lot smoother..but for the most part, we get along. They're there when we need them (Medical calls, minor MVAs) and we're out on structure fires handing out water, cooling them down, running radio traffic...ext..

[emsmnguy]

Where I cam from, for example, a MVA, the Sheriff/State Partol took care of the traffic. The Rescue Squad handled the extrication, and helped with treatment and the Fire Department made sure our scene was kept safe for us to work in. Sure, there was sometimes cross role's being done. But the main thing was the safety of us and the patient(s).

We came to this great relationship by getting together and having cross training. Regularly! And another way is to do joint community events with all agencies. ea: community bbq's..community health and safety day. Have members of the different departments dig in your rig and play with your stuff. One day, or one night at 3am, someone on the other department might remember where you kept that short backboard when you need it because your holding your patiens cervical collar and your *ss is stuck in the smelly wreak.

Its all about communicating and sorting differences...at the station..not the field.

rock on!

[kyle308]

our FD does the extrication, but most of our EMTs are certified.

we work in close communication durring the whole deal and if possible have the medic in the vehicle with the patient.

[cowboy_medic]

extrication here is handled by our Rescue Crew who also do rope rescues. The rescue crew is a fourteen member crew who train extensively with the ambulance service since 3/4's of the rescue crew are EMT's they know what needs to be done to insure pt. safety. If a Fire Department is on scene they refer to the transporting unit, but the nice thing is that all the local fire departments train with us so communication is high

[firedoc5]

I know this is old topic, but...

In the past I've done vol. ambulance, paid ambulance, vol. fire, paid fire, etc. For the most part we all just jumped in and worked together, not matter the agency. Luckily around here we've all worked well together. It helps that everyone more or less gets the same extrication instruction. Most of us are ERT certified.

One thing I will stress is that in primarily rural settings, farm implement and heavy machinery extrication should be taught. Extricating cars and trucks are one thing but tractors, combines, even grain silos are another matter. It also helps with semi's and tanker trucks. If you don't have that kind of program you need to look into it. IMHO

[MedicAsh]

This is a huge issue here. We have county fire, and city fire. This is confusing so brace yourself.

MM 190 to mm 245 interstate (east to west) North and south if city is paged then it stays the same - city fire primary extrication county fire, fire suppression on the 1st out call. Should the need arise that there is a call while the 1st out crews are out then it changes to county extrication and city fire suppression.

EMS does NO extrication at all.

Did I confuse you all?

[firedoc5]

This is a huge issue here. We have county fire, and city fire. This is confusing so brace yourself.

MM 190 to mm 245 interstate (east to west) North and south if city is paged then it stays the same - city fire primary extrication county fire, fire suppression on the 1st out call. Should the need arise that there is a call while the 1st out crews are out then it changes to county extrication and city fire suppression.

EMS does NO extrication at all.

Did I confuse you all?

Not at all. I know of depts. that are really hung up on what their function is, and only that one function. We really never had the argument of who was going to do what. Whoever was there and knew what to be done, they just did it. If more than one dept. or agency was there, it was not uncommon to have someone from county fire handling a hose off a city pumper. Or city personnel running the district's Hurst tool.

I was visiting my folks one day when my dad was coordinator of the local volunteer amb. service. Had a van roll off a "s" curve into a ravine. I went ahead and rode out with them. We got there first. I was inside stabilizing the patient when the volunteer fire/rescue showed up. They pulled off their booster line and stood at the road. I hollered to them to have someone come down and cut the battery cable. You thought I'd asked them to perform brain surgery or something. They weren't going to take an order from some EMT. Later on I mentioned to one of their Lt.'s that wasn't there. He hit the roof. But I don't think anything else was said or done about. Typical for a small town.

All in all, everyone has to do whatever it takes to get it done.

[englishemt28]

The fire companies for the most part but there is a special rescue company the does just the extracation for some fire comp. who don't have the tools