Finishing up our look at extrication, we will examine a few techniques that will add speed, space, and efficiency to the extrication operation. Working within the “Golden Hour” and the “Platinum Ten” arena requires our operations to be quick, deliberate and safe. These additional skills will aid in patient disentanglement while providing maximum space in a proficient amount of time.
Keep in mind as we discuss these skills, that many steps have already been completed prior to arriving at this point. Stabilization has been established and is on-going; the incident scene has been secured; power supply to the vehicles has been secured; necessary glass has been removed; and patient care has commenced. We will pick up each skill at this point in our discussion.
Two-door vehicles have limitations when it comes to rear-seat access. There are times when accessing a patient in the rear-seat area will require some unconventional thinking. Normal access for passengers to pass between the “B” post and the front seat when getting to the rear seat will not work when removing an injured patient. Therefore, we need to make another access point or “third door” in the vehicle.
The first step is to access the rear panel and “B” post area by removing the front door from the nader pin/door striker assembly. Once that is completed, the cutters are used to make four cuts in the panel area: rescuers cut the “B” post in two locations, one at the top of the post, and a parallel cut in the bottom of the post by the rocker channel (see Photo 1). The next cut is made on a 45-degree angle, at the bottom left corner of the rear glass area for the rear seat. The last cut is made in the wheel well, connecting to the third cut that runs from the rear-glass area (See Ohoto 2). Once these cuts are made, the hydraulic spreaders are placed onto the “B” post, on a 45-degree angle, a few inches above the door-latch area. Two rescuers clamp the spreaders onto the panel, and with an outward/downward motion, the panel is displaced to allow access to the rear-seat area (see Photo 3).
Full Side Removal
Four-door vehicles pose a stabilization problem for rescuers when it comes to patient care. Medical personnel may be required to manipulate cervical stabilization around a displaced “B” post in an accident. Furthermore, side-impact collisions may hinder access to center-door striker assemblies and hinge areas on sedans. With this in mind, it may be best to remove the entire side of the vehicle in one maneuver.
Rescuers begin at the nader pin/door striker assembly area for the rear door, and displace the door from the connection (see Photo 4). Next, the cutters are utilized to cut completely through the top of the “B” post, and to place a relief cut in the bottom of the “B” post, parallel to the rocker channel. Be sure to cut the seat belt so the belt does not hinder the removal of the post.
The next step requires the rescuers to place the spreader tips into the lower relief cut in the “B” post, and in an outward/upward direction, displace the “B” post from the vehicle (see Photo 5). It will be necessary to support the rocker channel below the post to avoid pushing the channel assembly downward, instead of displacing the post. There has continually been debates about which cut to make first on the “B” post, the top cut or displace the relief cut. It has been my experience that the post displacement works much better when the top of the post is cut prior to displacement. After the post is displaced from the vehicle, rescuers can spread or cut the front door hinges, removing the entire side panel assembly from the vehicle (see Photo 6). Be sure to have some wire cutters on hand to cut any wiring for power accessories that may be in the door assemblies.