Extrication Basics: Vehicle Entry for Victim Removal

Last month we spent some time talking about some of the actions taken before the extrication, or disentanglement, can begin to take place. This month we will focus on gaining access to perform patient contact and treatment, efficient tool usage and operation, and we will highlight some simple procedures to perform on the emergency scene.

At this point in the incident, the on-scene surveys have been completed, hazards have been secured or abated, and vehicles have been stabilized horizontally, vertically, and internally. It is imperative to get medically trained personnel into the vehicle to begin to stabilize the patient while the disentanglement takes place. The quickest method to achieve this is to remove the glass, from a location furthest from the victim, so that any broken glass is kept far from the patient. Once the glass is compromised, all glass should be placed under the vehicle, when applicable. To do this, it is paramount to identify what type of glass is in the vehicle:

Tempered Glass is found most frequently in side and rear windows. It is single layer, but stressed on the outer surface. This glass will shatter into small pieces when broken, so it is advisable to cover the glass with duct tape, spray adhesive or sheets of adhesive paper so the glass can be collected and removed without exposing the victims to sharp edges (photo 1). Rescue teams carry spring-loaded center punches to break this type of glass, but the point of a Halligan tool or any other pointed tool can work as well.

Laminated Glass is found most commonly in front windshields. This type of glass is constructed of polyvinyl butyral plastic sandwiched between two layers of glass. When this glass is broken, it will remain together as a unit but will crack and tear. This type of material can be removed with a variety of tools, such as an axe, a reciprocating saw, a pneumatic windshield saw, and even a hand saw (photo 2).

Enhanced Protective Glass (EPG) is a newer class of laminated glass, located in side- and rear-window assemblies. These glass panels will react in a similar fashion as laminated windshields, as the construction methods are very similar. Most rescuers will attempt to attack the side- and rear-window panels as if they are constructed of tempered material, but two or three attempts with a center punch on these panels will yield little more than a few small marks in the window. Furthermore, these panels will usually be marked in the lower corner of the window where the word “laminated” or “EPG” may be present. Once the presence of EPG is found, removal can be performed with the same tools used for laminated glass panels.

While patient care is being performed, crews can begin to make purchase points, spaces in the vehicle where the spreaders can be placed to displace the vehicle’s materials. One method of setting purchase points is with the use of the Halligan tool and the Flat Head Axe, or the “irons”. The Halligan tool is set into place with the Adze end of the tool into the gap, usually between the door and the post. The tool is driven into place with the Flat Head Axe or other suitable tool, and the shaft of the tool is then lifted up and down, in order to create a larger “point” for the spreader tips to be placed (photo 3).

Another method to gain a purchase point is by using the hydraulic spreaders. In one method, the tips of the spreaders are placed between the top of the door skin and the “A” post, the rear of the hydraulic tool is angled upward, and the spreaders are then opened. This vertical crush action will begin to displace the door outward, providing a point for the spreader tips to begin to attack the hinges on the doors. Another technique that is successful is by opening the spreaders as wide as possible, and using the tool’s arms to compress the metal together. The spreader arms can be placed on a front fender, in a location just behind the center of the front wheel, and by squeezing the fender together, a purchase point can be made to access the hinges (photo 4). To access the pin side of the door, the spreaders are opened and placed diagonally onto the door assembly, with the tip side of the tool pointed closely to the approximate pin location. By squeezing the door assembly, the metal will deflect and expose the striker pin and Nader Safety Latch on the door-post assembly. No matter what technique is employed, keep in mind that the “golden hour” and the “platinum ten” clocks are still ticking away; use a technique that can be deployed quickly and efficiently.

Now that purchase points have been made, it is time to displace some metal. A few safety points to consider when deploying hydraulic extrication tools:

1. Do not position yourself between the tool and the vehicle. When the tool begins to displace metal, the tool can react and shift towards the vehicle. Once it pins the rescuer against the vehicle, serious injury can result.

2. Full PPE is a must. There will be flying glass dust, shards and splinters of metal, plastic and other materials reacting violently on the scene, and a rescuer can get injured quickly. There will also be the potential of exposure to bloodborne pathogens and body fluids; protect yourself against any potential injury and exposure.

3. Be aware of your surroundings. There will be plenty of activity around the rescue scene, and some actions will produce reactions that will have to be addressed (i.e., loose cribbing materials, tool proximity to patient, etc…).

4. Communicate! Noise, confusion and tension run rampant on-scene. A good method of communication during disentanglement incorporates hand signals. For example, teams of two are commonly assigned to disentanglement tasks. One rescuer operates the tools, while the second backs up the first rescuer, and places one hand on the operator’s shoulder. A common signal technique uses a series of shoulder taps:

• One Tap means Stop!

• Two Taps means continue to operate

• Three Taps means we need to get back now, and I will explain it to you later…

Door Removal

The rescuers begin the maneuver by setting purchase points in the most accessible area of the pin assembly. The tips are set into place, with the tool assembly just short of perpendicular to the door. This position will allow the outer spreader arm to displace the door in an outward fashion, fatiguing the striker-pin assembly and causing it to fail (photo 5).

Once the striker-pin assembly has failed, the tips are then placed between the post and the door to tear the door from the hinges. Placing the spreader tips inside the hinge itself can cause the large hinge pin to fail, spreading the hinge assembly to the point of failure of the large hinge pin. Once the door is displaced, it may be necessary to cut any wiring that runs from the passenger compartment assembly into the door for power window, door locks and mirrors. Note: This example starts the displacement at the pin side of the door, but the evolution could begin at the hinge side of the door, based on accessibility on the accident scene.

Roof Flap and Removal

It may become necessary to provide more space to work around the patient for removal. One method to gain more room is to “flap the roof.” This maneuver requires two rescue teams, one at each side of the roof assembly. Rescuers utilizing the cutters will cut the “A” posts as low to the dashboard area as possible. Once these posts are cut, it may be necessary to support the roof, so it does not drop down onto the patient. Horizontal relief cuts are then placed behind the patient, and in front of the “B” post of the vehicle. A rigid pipe or suitable tool (Pike pole, wrecking bar, pipe, etc…) is then placed across the roof at the relief cut location. Rescuers then lift up on the front of the roof and “flap” the roof backwards (photo 6).

While this is a rapid method of gaining more space, there are some drawbacks. First, when this maneuver is performed on a high-speed roadway, the winds of passage from vehicles traveling past the incident can cause the roof to fold back down on the victim and the rescuers. It is advisable to tie the roof down to the rear of the vehicle. Secondly, the “flap” may not be feasible due to roof damage from roll-over incidents; in this case, rescuers are best served by removing the entire roof assembly. In this scenario, “A” posts, “B” posts, and “C” posts (4-door vehicles) are all cut as low as possible, and the entire roof assembly is lifted completely off of the vehicle. While this will provide an enormous amount of room, more rescuers are needed to lift the assembly off of the vehicle. If the scene is short staffed on personnel, it may be safer to perform the roof “flap”.

Dashboard Push

During frontal collisions, it is possible that the front/dashboard area can become displaced on top of the victim in the vehicle. In this scenario, it will be necessary to “push” the dashboard off of the victim. Access to the vehicle’s rocker panel and “B” post assembly is a necessity. A hydraulic extension ram is placed between the “A” post and the “B” post in a diagonal position; the cylinder/base of the ram is placed at the bottom of the “B” post, while the traveling/extension end is placed on the “A” post, just below the top of the dashboard. If no “B” post is present, it may be possible to clamp the hydraulic spreaders to the rocker channel to use as a base for the ram (photo 7). It is more efficient to utilize two rams, one on each side of the vehicle, but if only one is available, then it should be placed on the side dictated by the medical needs of the victim.

At this point of the maneuver, an important question is raised: Is there a need for a relief cut in the bottom of the “A” post? The deciding factor is based on the needed travel of the dashboard assembly. If the front of the vehicle is displaced, and the victim can be removed by restoring the dashboard back to the original position, then the relief cut may not be needed. However, if the lower extremities of the victim are entangled in the pedal assemblies, then it will be necessary to displace the dashboard beyond its original location to access the pedal area. In the latter case, a relief cut would be needed to facilitate this space (photo 8).

Conclusion

The skills and techniques presented here are some of the more common maneuvers that rescuers have utilized in the successful disentanglements of many victims. They are also building blocks for more intricate maneuvers that may be required on-scene. Next month, we will discuss a few different techniques that can add speed, space and efficiency to your rescue teams’ operations.

Until next time, stay focused and stay safe.

• See Michael Daley Live! Michael P. Daley will be teaching "Firefighting Operations in Strip Malls and Taxpayers" at Firehouse World, in San Diego, on March 1, 2011.