Extrication

The aim of extrication when dealing with SCI is to extricate the patient without causing any further secondary injury to the spine. Depending on the scene and situation this may be simple or it may be very difficult. As a clinician, you will have to take account of multiple factors and utilise the support and equipment available to you in the extrication process:

• Where there is likely to be a difficult extrication of a patient in a trauma setting, hazards may present. It is important that you keep safety in mind and communicate between your colleagues and any other emergency services present on scene. Through good communication, you can mitigate and reduce any hazards or dangers present to yourselves and the patient, such as Firefighters securing a vehicle in an RTC.
• When looking at extrication from a difficult scene such as an RTC, additional personnel will be required so you can safely remove the patient. Use of further ambulance colleagues and other services such as the Police and Fire and Rescue Service (FRS) will aid in making the extrication safer for the patient and all involved. Use of FRS skills can make the extrication process easier such as cutting doors off cars, removing doors and windows off buildings, etc. Discuss with them what further actions they could do to make the situation easier.
• Consider if the scene is especially challenging or requires further specialist extrication devices. Request for specialist services such as HART or more specialised FRS resources which may help with the situation.
• Consider the time critical nature of the patient or if there are any immediate dangers posing risk to life. In these cases, a ‘clean’ extrication may have to be omitted to save the patients’ life, such as if there was airway compromise which you couldn’t manage in the position they were in, or if there was an immediate danger to the patient such as a fire in the RTC vehicle. Try if possible in these cases to maintain some degree of immobilisation and neutral alignment of the spine.
• If the patient isn’t displaying any obvious SCI, such as any pain down the spine, any distracting injuries or neurological deficit, they may be able to self-extricate from their current position. Having a stretcher with a scoop next to their location, the patient can place themselves on the scoop. From this position you can then further assess for spinal injury and deficits. Advise the patient that if at any point they develop any symptoms or pain during movement, they stop where they are and you will immobilise them from that position.
• If the patient is displaying SCI symptoms, consider and plan how you are going to extricate the patient. Ideally, you want to limit any twisting or movement down to a minimum. If the patient is in a relatively open area in a supine position, the scoop can be used to split and reconnect underneath them. Slight log rolling may be required to allow easier insertion of the scoop. If in a prone position, then the patient will need log rolling onto a scoop so that they are supine. If in a standing position, a rapid takedown technique can be used to get the patient supine on the scoop.
• In more difficult positions where some twisting may occur, extrication devices can be utilised to help minimise movement. These devices often offer rigid protection to the spine, neck and head, and help keep neutral alignment. The body section wraps around the patient and secures with straps. This can give some handling and manoeuvrability when placed on the patient.
• A long board can also be utilised for the extrication efforts. Flatter than a scoop, it can allow easier insertion under the patient, and then they can be slid along the board. It is important to note that following extrication, the patient should be moved to a scoop or vacuum mattress for full immobilisation.