Nursing school doesn't teach you how to get people out of cars safely (nurse and patient safety). I spend a lot of time in triage and pull a lot of people out of cars, and once I was off work for a week after I totally jacked up my back pulling a dead lady out of a car. I mention this incident because had I been trained and not just freaked out that I had a code not on a bed with a board under her and a crash cart nearby, I probably would have taken the time to get her out in a way that didn't hurt me. I wasn't going to hurt her any worse. What I did was pull her out of the car by myself and twist around to lay her on the sidewalk. This was a horrible idea in every way.
But in less dramatic ways, I often have to figure out how to get people out of cars, and I'm not very big. It's easy to get hurt, and by far the biggest population involved is drunk people on the floor of the back seat, slippery with urine and vomit. There's nothing to grab hold of.
So I was thrilled when my hospital offered a spinal immobilization class. Then made it mandatory for everyone in the ER. One of our paramedic nurses taught it, and he started from different types of accidents and mechanisms of injury and went all the way to different triage-type situations. I found it vital and wish something like this were part of TNCC. He helped me learn to think through, "Here's what happened. Here are the forces involved. Here are the probable injuries."
And the extrication part? Like cash money to anyone who regularly runs out to cars and has to think "how do I get this person out of the car?" They don't even need to be spinally injured for this issue to pop up. You can use the same principles to work smart, not hard. I nearly jumped for joy about this class. It was hands-on, too. We had a fake car made with a chair and folding tables to simulate having to crawl around in small spaces.
I loved it and learned a ton: I hope hospitals without such programs will consider starting them for all ER nurses, or at least those who triage.