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...

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”.