Vehicle extrication is the process of removing a vehicle from around a person who has been involved in a motor vehicle accident, when conventional means of exit are impossible or inadvisable. A delicate approach is needed to minimize injury to the victim during the extrication. This operation is typically accomplished by using chocks and bracing for stabilization and hydraulic tools, including the Jaws of Life.
The basic extrication process consists of, but is not limited to, six steps:
- the protection of the accident scene, to avoid a risk of another collision (marking out the scene with cones or flares (not advisable if gasoline is leaking), lighting) and of fire (e.g. switching off the ignition, putting vehicle in park, disconnecting the battery, placing absorbing powder on oil and gasoline pools, fire extinguisher and fire hose ready to use);
- patient triage and initial medical assessment of the patient by a qualified medical rescuer;
- securing the vehicle to prevent the unexpected movement (e.g. falling in a ditch), and the movements of the suspension, either of which could cause an unstable trauma wound or cause injury to the rescuers; a vehicle should never be moved, it should always be secured.
- the opening of the vehicle and the deformation of the structure (such as removing a window) to allow the intervention of a first responder, of a paramedic or of a physician inside the vehicle to better assess the patient and begin care and also to release a possible pressure on the casualty;
- removal of a section of the vehicle (usually the roof or door) to allow for safe removal of the accident victim, especially respecting the head-neck-back axis (rectitude of the spine);
- removal of the person from the vehicle
In less complicated cases, it is possible to extricate the casualty without actually cutting the vehicle, such as removing a person from the side door or another part of the vehicle.
As soon as possible, best before beginning the mechanical operation, a medically trained person enters the cabin to perform first aid on the casualty: mid-level assessment, stopping the bleeding, putting a cervical collar on the patient (extrication operations are likely to provoke vibrations), providing oxygen first aid. In France, this rescuer is called the "squirrel" (écureuil). NFPA regulation 1006 and 1670 state that all "rescuers" must have medical training to perform any technical rescue operation, including cutting the vehicle itself. Therefore, in almost all rescue environments, whether it is an EMS Department or Fire Department that runs the rescue, the actual rescuers who cut the vehicle and run the extrication scene are Medical First Responders, Emergency Medical Technicians, or Paramedics, as a motor vehicle accident has a patient involved.
After the vehicle has been secured and access gained to the patient, the EMS team then enters to perform more detailed medical care. Continued protection of the patient from extrication itself, using hard and soft protection, should be done at all times. The deformation of the structure and the section of the roof take several minutes; this pre-extrication time can be used for medical or paramedical acts such as intubation or placing an intravenous drip. When the casualty is in cardiac arrest, cardiopulmonary resuscitation can be performed during the freeing, the casualty being seated. The use of this incompressible duration is sometimes called play and run, as a compromise between scoop and run (fast evacuation to a trauma center) and stay and play (maximum medical care onsite).
The last step is usually performed with a long spine board: the casualty is pulled up on it. An extrication splint (KED) can help to immobilise the spine during this operation.