Trapped Extremities

Tips for dealing with upper- & lower-extremity entrapments

If you’ve taken an extrication class in your career, somewhere along the line, you ran into someone who knew all the tricks. I may not be that guy, but I do know some proven methods to extricate a patient with a trapped extremity. And I’m not talking about that basic scenario where you can fit a hydraulic spreader to free the patient’s extremity; I’m talking about the scenario that is so tight on space that it doesn’t allow you to get a tool into the area involved.

Upper Extremities
There are a few key places where hands and arms get trapped, especially in rollover crashes and t-bone collisions: 1) between the seatback and the door and 2) between the seatback and the center console. The issue with this type of entrapment is that the rescuer must get close to the patient to free them. This takes coordination between the medic caring for the patient, the incident commander coordinating the rescue and the crew performing the rescue. The medic (who is inside the car with the patient) plays a huge role by assessing exactly how the patient is pinned. The medic relays this information to the incident commander so he or she can determine the best course of action.

There are several tools you can use to help free a victim. The small hydraulic spreader that’s used for forcing entry of residential and commercial doors is a good first choice when access is limited. The scissor jack, which you probably throw away after extrication training, will get you the “McGuiver Award” if you actually pull it from someone’s trunk to use for this type of incident. Another option: You can use a hammer to drive simple wedges in the area. Lift Bags are perfect for this application but you must have the correct size for the operation. Remember: Lift bags require constant training to stay on your game.

Lower Extremities
Lower-extremity entrapment is not as common as upper-extremity entrapment; when we do face lower-extremity entrapments, they are often the result of a frontal offset crash. This type of entrapment was very common in the 90s. Car manufacturers have combated this by adding the boron steel bar down the A-Post and reinforcing the rocker panel. This creates a double-edged sword for us now. It allows the dash to stay intact but, it is also strong, making it difficult to move.

Most cars have center consoles. They are tied into the boron rod that runs though the dash and provides protection to the passengers. The easiest way to push the dash off of someone’s lap is to pull the plastic off the center console and find what looks like a 1" strip of metal with holes in it. If you cut that, you’ll be able to push the dash up with a small hydraulic ram or the spreaders. This is where finding the boron rod will help with moving the dash.

You have some options for isolated foot entrapments. First, establish that it’s not a shoe entrapment. Take some trauma shears and cut the shoe laces or the shoe. This will allow you to hopefully point their toes and pull toward the person. Rope or webbing can also be used to pull the brake pedal. I’ve used small hydraulic cutters to cut the pedals. It has been my experience that if you can have a rescuer physically touch the patient’s feet, than they are not as trapped as you think.

Stay Safe       
These are a few proven methods to rescue an entrapped patient. Like all things, there are more than a few ways to skin a cat. Remember: work smarter, not harder.

Brad Havrilla is a 20-year veteran with Palm Beach County Fire Rescue, where he is currently assigned to the training division. Havrilla is an international extrication judge and the past vice-chairman of the IAFC Transportation Emergency Rescue Committee. He was the recipient of the Harvey Grant Excellence in Rescue Award in 2004.