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RTC extrication
#1
A question for my Fire and Rescue colleagues.  Or anybody else who is in the know. 

Can you do a dash roll with out taking the roof off? In a '' standard '' dash roll what as the min cuts?  

Cheers 
Steve
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#2
I can't see any reason why you would want to, to be honest. It only takes a few minutes to get the roof off anyway.
You could just do a roof flap instead of a removal, but if you tried to roll the dash with the A posts still attached you're just going to pull the roof down lower onto your patient and compromise space around him.
willcork, joined Emergency Services Forum in Feb 2010.
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#3
(21-01-2016, 10:34 AM)willcork Wrote: I can't see any reason why you would want to, to be honest. It only takes a few minutes to get the roof off anyway.
You could just do a roof flap instead of a removal, but if you tried to roll the dash with the A posts still attached you're just going to pull the roof down lower onto your patient and compromise space around him.

Fair enough...  Just going on recent experience took a lot longer than a few minutes to take the roof off... For it to add no value as the pt had to come out side anyway.  It's more to build my experience/knowledge for future.  Ie how do you assess the car and decide what comes off..  Or is it a case of convertable is the default.  I understand you are guided by us as to the priority of the patient but after that we are left to yere ways and means....  Which is grand as ye are the experts,  but I'd like to get a better understanding of the process.
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#4
For a full dash roll the quickest way to do it takes 6 cuts.

Cut both A posts.

2 relief cuts on the roof in front of the B post and flap the front of the roof back and secure it.

2 more relief cuts on the panels below the a posts as close to the floor as you can and insert the ram to roll the dash.

Wedge the relief cuts open to ensure they don't close.

Not the recommended way to do it but it can be done that way.

The recommended way takes two more cuts, instead of the relief cuts in the roof you cut the B posts and the C posts making sure your last cut is the post closest to the casualty. Just remember before we cut the plastics inside the pillars must be removed so we can see that we are not cutting wires or seatbelt tensioners etc etc etc, that can actually take longer than the cuts themselves depending on the vehicle involved.
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#5
Quote: took a lot longer than a few minutes to take the roof off... For it to add no value as the pt had to come out side anyway

Taking the roof off usually has the benefit of creating much better space for everyone to work in when it comes to moving the patient. Unless time is not available I'd usually see it as worth it - for manual handling alone even.

If it was a time critical situation and you just needed a relatively small displacement to free the patient (and the car isn't something built like a tank) you could consider partial relief cut to bottom of A post, ram in place off B post and last cut high up on A post, which will give a reasonable amount of room, but mightn't work in all situations. I also like the Dashboard lift for those situations as you're not left with a ram across the likely extrication path.

The full dashboard roll as described above means you need to manage the roof in some way - 
http://tkolb.net/tra_sch/VehicleExtra.pdf

Then there's always Hurtigfrigjøring.
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#6
Don't see why bringing the pt out the side after a roof removal would be in any way unusual? That would generally be the norm .
Not sure to be honest why the roof wouldn't come off if the patient is trapped, no roof means easy assessment and access for all, reduces the manual handling issue and generally creates a better outcome, that is assuming of course there is an entrapment or at least a reason for a fire service intervention.
In fact to be honest, if I didn't see roof off, I'd be wondering what were the circumstances that were such that it wasn't required.
A dash roll is difficult to achieve without the roof being removed but in circumstances where a roof can't be taken off, say an under run where a car has gone under a truck trailer , a dash lift is really effective, but accurate cuts to weaken the structure are pretty vital.
As for how do you decide, well Im always guided by the medic, if they feel they can't remove the patient without further injury then that's where we'll step in.
And deciding what particular technique is usually fairly straight forward but dependent on how and where the pt is trapped.
Extrications can be incredibly easy or horribly complex, having the knowledge, experience and equipment the same as any job resolves that.
I've seen a massive difference in RTCs in the last twenty years. Car design has improved enormously and true entrapment are very rare now. The vast majority of extrications are to prevent further injury rather that releasing a pt from "entanglement".
Ten or fifteen years ago it was all lower limb or chest entrapments. You were constantly doing dash rolls, now those injuries are very rare and the passenger cell of the vehicle is rarely intruded upon. The damage to people's legs was incredible but very rare today
We used to need a huge array of different sized hydraulic Rams to gain space , they just gather dust now and rarely needed.
Have a look at the Holmayro website, there's a huge amount of videos and explanatory techniques on that.
The problem with the world is that the intelligent people are filled with doubts while the stupid people are full of confidence...
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#7
The improvements in vehicle construction definitely aren't given enough credit in our improving road fatality trends. Like Brigade says, getting the ram out is a rarity now, even heavy frontal impacts on modern cars aren't resulting in significant displacement of the firewall and dash as a general rule.
I drive a fairly old car, and it's something I'm very conscious of - I'm not going to fair out too well in a head on collision.
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#8
(21-01-2016, 03:05 PM)Brigade Wrote: Don't see why bringing the pt out the side after a roof removal would be in any way unusual? That would generally be the norm .
Not sure to be honest why the roof wouldn't come off if the patient is trapped, no roof means easy assessment and access for all, reduces the manual handling issue and generally creates a better outcome, that is assuming of course there is an entrapment or at least a reason for a fire service intervention.
In fact to be honest, if I didn't see roof off, I'd be wondering what were the circumstances that were such that it wasn't required.
A dash roll is difficult to achieve without the roof being removed but in circumstances where a roof can't be taken off, say an under run where a car has gone under a truck trailer , a dash lift is really effective, but accurate cuts to weaken the structure are pretty vital.
As for how do you decide, well Im always guided by the medic, if they feel they can't remove the patient without further injury then that's where we'll step in.
And deciding what particular technique is usually fairly straight forward but dependent on how and where the pt is trapped.
Extrications can be incredibly easy or horribly complex, having the knowledge, experience and equipment the same as any job resolves that.
I've seen a massive difference in RTCs in the last twenty years. Car design has improved enormously and true entrapment are very rare now. The vast majority of extrications are to prevent further injury rather that releasing a pt from "entanglement".
Ten or fifteen years ago it was all lower limb or chest entrapments. You were constantly doing dash rolls, now those injuries are very rare and the passenger cell of the vehicle is rarely intruded upon. The damage to people's legs was incredible but very rare today
We used to need a huge array of different sized hydraulic Rams to gain space , they just gather dust now and rarely needed.
Have a look at the Holmayro website, there's a huge amount of videos and explanatory techniques on that.

Cheers for the comprehensive replies lads.  His feet were trapped by the pedals after an intrusion by the driver side wheel arch into the foot well.... But it didn't become apparent until after the roof was off and the driver door too.  My thinking in relation to roof off would always be to immobilise in line of the spine...  Lots of torsion and pulling and lifting if going out the side. It was a good hour plus of extrication in the end.  Definitely food for thought if we had to do a rapid extrication. Must try and organise a session with the local brigade some day.
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#9
I suppose every one is different. I think you can have a roof off and total side removal down very quick. Allows you to get the board in easily enough without having to haul the pt up onto the board and out the back.
The problem with the world is that the intelligent people are filled with doubts while the stupid people are full of confidence...
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