Note how the Toyota’s rear door has a purchase point already provided by the impact. The front door hinges are also exposed due to the inward crushing of the doors.

Almost any time a patient is trapped, rescue crews have to work with some portion of the side of the vehicle. If a four-door vehicle is involved in a collision, especially a T-bone collision, occupants can be trapped by jammed front and rear doors and by the inward crushing of the B-pillar.

Collision damage to this four-door Toyota resulted from an intersection crash. The impact proved fatal to the front-seat passenger who was extricated out an open driver’s front door. But what if occupants were trapped upon your arrival and these two doors had to be opened? What procedures does your department use when confronted with this rescue challenge?

The seatbelt pre-tensioner is visible at the base of the B-pillar on this Volkswagen Passat. The brown plastic trim is the inside molding of the B-pillar. The outer edge of the driver’s seat displays an airbag ID for the seat-mounted side-impact airbags.

There are four different evolutions that could be used to remove the entire sidewall of this vehicle. This column will discuss the “Blowing Out the B-Pillar” evolution, a procedure that is very effective in real-world scenarios.

Maximum Efficiency A close look at this T-bone collision damage to the Toyota reveals that as the initial impact pushes the B-pillar and doors inward, the front door hinges become visible. In addition, the latch end of the rear door moves inward enough to actually create a purchase point for a power spreader tool. Window glass may or may not be broken. “Blowing Out the B-Pillar” takes advantage of these crash-generated purchase points to save time and maximize rescue crew efficiency.

A close-up view of the loaded pre-tensioner shows the triangle with an exclamation point, the universal sign for the presence of a “warning” or “hazard.”

As with all jammed-door evolutions, total sidewall removal cannot be effective unless the vehicle is first stabilized and the electrical system shut down. Rescue crews used the “Blowing Out the B-Pillar” evolution on a Volkswagen Passat that had been struck on the driver’s side. The sidewall has been maneuvered back into place to help explain the action steps that were accomplished at this scene. Confronted with both driver’s side front and rear doors jammed, patient access was gained from the passenger’s side. The trapped VW driver was stabilized and protected. The sidewall evolution begins by forcing the rear door open at the latch.

The first spreader push is made at the points indicated by the rearmost red line. The second spread is made with the tips moved forward to the points indicated by the forward red line.

After the rear door opens, the B-pillar trim is peeled away and the seatbelt cut through. In this real-world incident, stripping the B-pillar trim away exposed the seatbelt pre-tensioner unit on this 2001 model year vehicle. Since the front airbags had not deployed, the pre-tensioner remained loaded. With the rear door open, a horizontal cut, parallel to the rocker panel, is made with the power spreader. This cut severs the back side of the B-pillar, below the bottom rear door hinge. The intent at this point is not to have to cut completely through the base of the B-pillar. One good, deep cut into this back side will weaken it enough that the power spreader can tear it off the vehicle.

The end result of “Blowing Out the B-Pillar” is that both doors and the B-pillar move outward on the front door’s hinges. It the sidewall can be widened enough that the patient is readily removable, the evolution is complete.

With the B-pillar cut completed, a power spreader is then used to “blow out” the bottom of the B-pillar. The tool operator stands in the rear door opening. The right arm of the spreader is placed against the outer edge of the rocker channel several inches behind the base of the B-pillar. The tip of the left arm pushes against the forward corner of the rear door. As the spreader opens, the door will move outward and the cut in the B-pillar will begin to tear. The spreader is then repositioned for a second push. This time, the right tip is moved forward to a point at the stub of the B-pillar. The left tip can continue to push against the rear door or can now be placed to push against the B-pillar or the bottom rear door hinge. As the spreader opens, it forces the B-pillar outward until it tears from the rocker channel, allowing the entire sidewall to move away from the vehicle. The top of the B-pillar is then cut free, allowing the front door, rear door and B-pillar to pivot forward on the front door’s hinges. Brute force is used to widen the front door beyond its normal opening range.

Total sidewall removal can complete the evolution by breaking or cutting both front door hinges of this Honda Accord. “Sharps” protection must be put in place at all hazard areas.

The front door and the entire sidewall can be totally removed. In an incident involving a 2000 model year Honda Accord, both front door hinges were cut with a power spreader. “Sharps” protection at the end of the task requires covering of any jagged exposed metal created during the evolution. Sharps hazard areas include the top and bottom of the B-pillar at the roofline and rocker channel, the rear door latch if metal has torn and the front door hinges if the sidewall is completely removed.

Removing both doors and the center B-pillar in this manner allows maximum patient access on that side of the vehicle. With practice, your team will be able to accomplish this within an impressively short time. “Above Average” benchmark time is two minutes and 30 seconds or less from start to finish. “Acceptable” benchmark time is three minutes and 30 seconds or less.

Required Tactics The “Blowing Out the B-Pillar” evolution tactics must include: A. Vehicle stabilization. B. Patient sharps protection and safety. C. Removal of side window glass. D. Cut/remove seatbelts. E. Remove interior trim panel from B-pillar. F. Open rear door at latch. G. Cut B-pillar below bottom rear door hinge. H. Blow out B-pillar with spreader at rocker channel. I. Cut top of B-pillar at roofline. J. Widen sidewall on front door hinges. K. Remove total sidewall at front door hinges (optional). L. Apply sharps protection to cover exposed metal.