[Surgicalcric]

Methods of gaining access to patients can vary greatly depending on vehicle, accessability to vehicle, location of patient within vehicle, position of vehicle, and structural integrity of and intrusion into the patient compartment. I am not going to go into all the what if’s and how to's involved with gaining access to the patient, as we could very well be here all day with me throwing out scenarios, circumstances, and talking about all the cool can opener tools I have at my disposal to destroy a vehicle.

On this vehicle access to the patient would be easiest gained thru one of the doors since there is no structural intrusion into patient compartment. The passenger front door would be opened and removed from hinges if possible. If not it would be pushedas far open as it possibly could be.

The medic would direct another soldier to gain access from the rear door-passenger side and educate him on taking C-spine control if not already familiar, while he removes the patient's kevlar. (This is done by opening the hands wide griping the patients head/neck, being sure not to cover the ears so patient’s hearing is not impaired, and hold the head securely and firmly.) Any equipment removal should only be performed after C-spine control is initiated. A Collar should be fitted and placed around the patient’s neck if available. If a Collar is not available a rolled towel in the shape of a yoke can be used as a field expedient collar.

Another assistant would place one end of a folding stretcher(handles), LSB here in the civilian world, on the edge of the patient’s seat and hold the other end securely placing enough pressure inward on the stretcher to keep it from sliding off the seat edge as the patient is moved. The medic, taking hold of the patient’s BDU pants at the front pockets, will lift his butt up. (This is going to cause some discomfort to the patient, but the level of discomfort can be minimized with smooth movements instead of choppy, abrupt ones. The patient should also be advised of any movements prior to making them and to keep their hands and arms across their chest and not try to help.) As the patient is lifted, the stretcher is pushed underneath the patient’s butt. The patient is then lowered onto the stretcher as the body, in whole, is turned facing out the doorway. This should be done in one motion as to minimize stress on the back with twisting and discomfort in the injured extremity.

He would then be slid out and onto the stretcher, while laying him supine, in as smooth a movement as possible. Once onto the stretcher sandbags should be placed on each side of his head to provide immobilization of the cervical spine during movement and transport. The patient's body should be secured to the stretcher with 100 mph tape at the shoulders, hips, and ankles. The head is then taped down. One wrap of tape over the forehead and around the sides of the stretcher should suffice. The head is ALWAYS taped last and once taped down manual C-spine can be released. After patient is immobilized he can then be moved onto the ground or into an Ambulance, or Bird.

The person holding C-spine is in total control of all patient movements prior to immobilization. All movements will be on a three count/command. Movements are made so as the C-spine remains inline with the rest of the spine as a whole and any bending would be done at the hips and not at a point anywhere on the spine. This is easier said than done in the field. If there is not 3 people available the oerson holding C-spine can be omitted but know a Collar is not enough to secure the cervical spine inline whike extricating a patient from a vehiclepatient movement

I am aware it seems time consuming, as I would presume anything would while under fire. It takes much less time to perform than it sounds like though. From first contact to having patient secured onto the stretcher should take no more than 4 minutes. If under fire many of these steps will be omitted, but for discussion and training I think it is important to note all the steps.

HTH