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.