Rescue and Extrication
The extrication sequence
Vehicle extrication is a system, and questions are usually about sequence. Standard phases: arrival and scene size-up, vehicle stabilization, gaining access, patient disentanglement, removal, and transfer to EMS. Get the order wrong and you create a moving load, broken glass, or an unstable patient. Stabilization means wheel chocks, step chocks, and cribbing at contact points - box-crib stacked, hands never placed between layers.
Vehicle anatomy and hazards
Modern vehicles carry high-strength steel in pillars, rockers, and B-pillars, and cutting them can defeat hydraulic tools or compromise the patient compartment. Supplementary restraint systems - airbags, pretensioners, inflators, and pressurized struts - are treated as energized until proven otherwise. Hybrid and electric vehicles add high-voltage cables (typically orange), battery packs, and a shutdown procedure: power off, secure the key fob away from the vehicle, and disconnect the 12-volt system. Never cut an inflator, gas strut, or high-voltage cable.
Tools and patient care
Hydraulic spreaders, cutters, and rams do the heavy work; hand tools, pneumatic chisels, and lifting bags fill gaps. Glass management - remove tempered glass fully, control laminated windshields with a saw or cutter - precedes patient contact. Provide spinal motion restriction per protocol and keep the patient covered and reassured.
Traps
Distractors describe cutting first and stabilizing later, or treating an undeployed airbag as inert. Another swaps the order of disentanglement and removal.
Rule of thumb
Stabilize, then access, then disentangle, then remove - and plan each cut before making it.