Vehicle Extrication Overview

April 24, 2008

Click here to see the Handout

Objectives for tonight

Concentrate on the Basics
Anatomy of a Vehicle Safety Considerations Our Extrication Tools On Scene Operation

Review Common Extrication Techniques Practice Operating Tools

Objectives for the next drill

As much hands on practice as possible We should have 3-4 vehicles Extra Tools provided by Gary Conahan Concentrate on basic extrication

techniques Thursday, May 8 starting early at 6:30 pm

A-POST The front support post of a vehicle where the roof is supported by extension of the body.

C-POST The post supporting the rear portion of the vehicles roof.

B-POST The center post between the front (A-Post) and rear (C-Post) of a vehicle.

ROCKER PANEL Term used to describe the bottom portion of the door frame in a vehicle.

NADER PIN Part of the door latch assembly in vehicles designed to keep the doors closed during a vehicle crash. Also referred to as the striker bolt

Door Hinges can be cut or spread apart to detach a door. Wiring in doors may be difficult to cut with hydraulic tools.

Engine Compartment

Passenger Compartment

Cargo Compartment (a.k.a. Trunk)

 The engine compartment and the cargo

compartment are designed to absorb an impact so that the passenger compartment remains intact. Keep in mind that the cargo compartment and engine compartment may be reversed on some vehicles (i.e. old VW Bug).

 Where does a vehicle get its strength?

Older Cars? Modern Cars? Space Framed Vehicles?

 Where does a vehicle get its strength?

Older Cars? Modern Cars? Space Framed Vehicles?

 Where does a vehicle get its strength?

Older Cars? Full Framed two steel rails that support the floor
and are the support for the vehicles construction. They are heavier and move in more predictable ways during extrication. Removing one part has little or no effect on another Dash Lifts work well when pushing down on the frame rail.

 Where does a vehicle get its strength?

Older Cars? Modern Cars? Space Framed Vehicles?

 Where does a vehicle get its strength?

Modern Cars? There is no central foundation of steel. Bends and creases of the sheet metal provide the

strength. Sheet metal is lighter and easier to cut. Operations may cause the passenger compartment to bend downward or lift upward. Working on one side of the vehicle may affect the other side. Solution = Relief Cuts & Stabilization.

 Where does a vehicle get its strength?

Older Cars? Modern Cars? Space Framed Vehicles?

 Where does a vehicle get its strength?

Space Framed Vehicles? Common in full size cargo vans. Built like a bird cage. The frame is self supporting. The body is put

together with a series of panels attached to the framework. The Body parts can be removed to expose the frame. Cut / spread the frame to extricate the patient.

 Windows
Laminated Glass Windshield Tempered Glass Side windows Back window Cut with Sawzall or Z Tool Break with Center Punch

Passive Restraint System

 There are too many options for airbags in

vehicles now. Airbags not deployed in an accident can be disabled by disconnecting the battery. The charge in the firing capacitors will dissipate over time from 30 seconds to 10 minutes depending on the vehicle (Corvettes may take up to 20 minutes).

 If possible, look before you cut or spread.

Airbags are supposed to be marked. Take care not to put yourself or tools in front of the steering wheel or other airbags. Other suggestions?

 Personal Safety
Full protective clothing including eye protection, helmet, gloves. Be aware of and anticipate the movement of tools and metal. When sawing glass HOLD YOUR BREATH laminated glass turns into powder when sawn.

 Hazard Control
Electrical hazards
Wires down on vehicle Electrical system of vehicle

Fluid spills Hazardous cargo

 Traffic Control
Beware of oncoming traffic. Dont hesitate to shut down the entire roadway. Turn it over to law enforcement as soon as possible but dont let them restore traffic flow too soon COMMUNICATE.

 Crowd Control
Keep bystanders back away from the scene. Keep rescuers back away from the scene unless they have a job to do.

 Protect the Patient

Cover when breaking glass. Protect the patient from metal movement (use a backboard). Maintain the patient during extrication.
Airway Management Spinal Immobilization Bleeding Control

 Protect yourself
Always wear gloves when handling the patient. Broken glass can get imbedded in clothing, car seats and other unsuspecting locations.

 Other safety considerations? ? ? ? ?

What extrication tools do we carry on our vehicles and where are they kept?

What other extrication tools do we have in our arsenal?

TNT Hydraulic Tools

Power Unit Spreader Cutter Ram

Halligan Tool Flat Head and Pick Head Axes Pry Bar Sledge Hammer Bolt Cutter Sawzall

Step Chocks Cribbing (4x4; 4x6) Wedges Angle Bracket Special Door Pulling Rope Hand Tools Wire Cutters Bolt Cutters High Lift Jack Various Old Pneumatic Tools Hack Saw

I probably forgot some . . . ? . . . Anyone? . . . Bueller? . . . Bergen? . . . Bobby Brown? . . . Whitney?

On Scene Operations
Assess the scene as you approach Establish Incident Command Size Up
Is it safe to leave your vehicle? Is it safe for other incoming units? # of vehicles involved? # of Patients? Additional Resources? Etc

On Scene Operations
Circle Surveys
Outer Circle Inner Circle
Lower Level Survey Upper Level Survey

On Scene Operations
Circle Surveys
Outer Circle
Walk 360 around the vehicle looking away from the scene (be mindful of hazards) Check for patients that have been ejected from the vehicle Check for any hazards or possible threats

On Scene Operations
Circle Surveys
Inner Circle
Walk 360 around the vehicle looking towards the scene (be mindful of hazards) Lower Level Survey look around and under
Is the vehicle on anything (power box, power lines, etc.)? What condition is the ground in with regard to cribbing (soft, hard, wet, dry)? Is the vehicle leaking anything (gas, oil, coolant, etc.)?

On Scene Operations
Circle Surveys
Inner Circle
Walk around the vehicle looking towards the scene (be mindful of hazards) Upper Level Survey look inside
# of patients? Is the vehicle auto/manual in park or neutral? Ignition on/off? Airbag? Have they deployed? Doors Locked? Power Locks? Power Seats?

On Scene Operations
Stabilization
Cribbing
Step Chocks (AKA Stair Step Cribbing) Box Cribbing Wedges Air Rescue Bags Post Cribbing (Rescue 42 Bar)

On Scene Operations
Stabilization
Cribbing
4 Point Cribbing 6 Point Cribbing

Place the cribbing then deflate the tires to stabilize the vehicle
Pull the valve stem with a pliers or channel lock Pierce the sidewall with a halligan tool or pry bar

Post Cribbing

Four Point Cribbing

Six Point Cribbing

On Scene Operations
Tool Staging We have a designated tarp on Engine 2 marked with silhouettes of commonly used extrication tools that we carry on our apparatus. The special tarp keeps tools organized. Obtain a tool from the tarp. Once the assigned task is complete return the tool to the tarp.

On Scene Operations
Action Circle = an area 10 to 15 feet wide around the vehicle
Larger if needed Tool staging area is just outside of the action circle First aid equipment, stretchers and backboards should remain out of the action circle until needed

On Scene Operations
Action Circle Keep it clear of:
Non-essential personnel Tools not in use Bystanders Parts of the vehicle after they have been displaced

Always have a charged hose line available just outside the action circle

On Scene Operations
Team Approach Line up style
Firefighters line up behind each other just outside the Action Circle. Firefighter(s) receive an assignment. Firefighter(s) complete the assignment. Firefighter(s) report the assignment complete then get back in line behind the other Firefighters.

On Scene Operations
Miscellaneous Stuff
Golden Hour Time to surgery That includes responding to the scene, extrication, immobilization, transport, stabilization at the ER, etc. Platinum 10 The goal is to reduce extrication time to 10 minutes so there is as much time as possible to get everything else done within the Golden Hour.

On Scene Operations
Miscellaneous Stuff
An accident severe enough to require extrication is severe enough to cause a spinal injury.
A rescuer climbing into a car can move it enough to move and injure the patient Stabilize first! Approach from the front. Gain eye contact and advise them not to move. Approaching from the side may prompt the patient to turn their head causing further injury.

On Scene Operations
Miscellaneous Stuff
Seat belt supports are typically located near the B-Post. Avoid them if possible. They are usually located 6 in front of or 6 behind the end of the post. Cut the battery as soon as possible. Take into account electric door locks, windows and seats. Airbags will be disabled after the battery is disengaged.

On Scene Operations
Miscellaneous Stuff
Remove all glass before spreading or cutting. Intact glass can shatter when using tools dispersing pieces all over the place. Often the best way to take the glass is to roll the window down leaving about a showing. Use a window punch or halligan to break the glass. The shattered glass will fall inside the door frame.

On Scene Operations
Miscellaneous Stuff
Push on the interior portion of doors. It is more structurally sound than the sheet metal skin. Never try to cut the Nader Pin. When swinging a tool look behind you first and announce loudly swinging tool. Avoid potentially loaded bumpers.

On Scene Operations
Miscellaneous Stuff
Terminology:
Freeze = Emergency stop of all activities on scene (usually to prevent unsafe operation) Thumbs Up = Turn on the power unit or engage the hydraulic tool Thumbs Down = Turn off the power unit or disengage the hydraulic tool

Common Extrication Techniques

Taking the Glass Simple Door Removal Fifth Door Conversion Third Door Conversion Dash Lift Roof Removal

Common Extrication Techniques

Taking the Glass = Break all the tempered glass safely before cutting or spreading.
Roll down windows/break in door frame Center punch Tape first (remove window in one piece) Plastic Collapsible Spanner Wrench Tip of an antenna PROTECT THE PATIENT

Common Extrication Techniques

Center Punch

Common Extrication Techniques

Tape window and remove as one piece

Common Extrication Techniques

Tape window and remove as one piece

Common Extrication Techniques

Use a spanner or other object

Common Extrication Techniques

Use a spanner or other object

Common Extrication Techniques

Disconnect the battery / accessing the engine compartment
Cut the negative battery cable To disable the airbags To disable the ignition Stabilize the vehicle first Try before you pry If all else fails, bend up the corner of the hood to access the battery

Common Extrication Techniques

Bending up the corner of the hood

Common Extrication Techniques

Dont stand in front of the bumper

Common Extrication Techniques

You must overcome the factory bends in the hood

Common Extrication Techniques

Scratch out a line on the hood and beat the metal into a crease

Common Extrication Techniques

Pierce the hood with a halligan and bend the corner up

Common Extrication Techniques

Common Extrication Techniques

Common Extrication Techniques

Common Extrication Techniques

Common Extrication Techniques

Common Extrication Techniques

Common Extrication Techniques

Simple Door Removal
Does it need to be removed or just pulled out of the way? We have a specially designed rope that provides a mechanical advantage to pull back and stabilize a door (click here to see the handout). Always stabilize the vehicle first.

Common Extrication Techniques

Simple Door Removal (i.e. drivers door)
Create a purchase point Spread the door latch assembly apart Open the door to expose the hinges Spread or cut the hinges Work from top down Be careful not to push tools or metal into the patient Someone should stabilize the door to prevent it springing open - bent knees

Common Extrication Techniques

Purchase Point - An opening made that allows room for the insertion of rescue tools for the purpose of moving metal, plastic and debris. Push down and pull up to create an opening.

Common Extrication Techniques

Creating a purchase set halligan with a sledge or flat head axe

Common Extrication Techniques

Creating a purchase pushing down and pulling up

Common Extrication Techniques

Place the tip of the spreader in the purchase point

Common Extrication Techniques

Spreading the door latch assembly

Common Extrication Techniques

Spreading or cutting hinges

Common Extrication Techniques

Spreading or cutting hinges

Common Extrication Techniques

Fifth Door Conversion
Gain access to the front and rear seats of a four door vehicle. Eliminates the B-Post which is typically the piece in the way during patient removal from the vehicle. Stabilize the vehicle first. Take the glass.

Common Extrication Techniques

Fifth Door Conversion
Create a purchase point near the hinges of the front door. Spread / cut the front door off of the hinges. Spread / pull the front door back exposing the B-Post.

Common Extrication Techniques

Fifth Door Conversion
Cut the B-Post at the top and bottom Spread / pull the rear door back as far as possible Spread the door latch assembly of the rear door apart Remove the doors from the Action Circle

Common Extrication Techniques

The vehicle is stabilized 4 point cribbing

Common Extrication Techniques

Spreading to front door off the hinges

Common Extrication Techniques

Bending the door back to expose the B-Post

Common Extrication Techniques

Cutting the B-Post high and low

Common Extrication Techniques

Bending the door back to access the passenger compartment

Common Extrication Techniques

Removing the doors completely (out of the Action Circle)

Common Extrication Techniques

Third Door Conversion

Common Extrication Techniques

Stabilize the vehicle

Common Extrication Techniques

Take the windows

Common Extrication Techniques

The windows have been taken

Common Extrication Techniques

Remove the door

Common Extrication Techniques

The door and windows have been removed

Common Extrication Techniques

Make a relief cut in the B-Post and near the C-post

Common Extrication Techniques

Spread the sheet metal away to access the back seat

Common Extrication Techniques

Sorry about the bad slides

Common Extrication Techniques

Dash Lift using the spreader
Stabilize the vehicle Remove the front door(s) Make a relief cut above the wheel well Consider using the spreader to flatten the quarter panel before cutting

Common Extrication Techniques

Dash Lift using the spreader
Make a relief cut high on the A-Post Make a cut above the lower hinge on the A-Post (widen this cut if possible) Place the spreader in the lower A-Post cut to lift the dashboard Only lift enough to remove the patient Stabilize the lift with cribbing in the cut

Common Extrication Techniques

Click here to see a free web video of a dash lift using the hydraulic cutter and spreader Courtesy of American Rescue Technology Incorporated

Common Extrication Techniques

Dash Lift using the ram
Stabilize the vehicle Remove the front door(s) Make the same relief cuts
Above Wheel well High on A-Post Above hinge on A-Post

Common Extrication Techniques

Dash Lift using the ram
Position Hydraulic Ram between the bottom of the B-Post and the bend in the A-Post near the windshield Cribbing support is needed under the BPost (consider using an angle bracket) Engage the ram to lift the dashboard Lift only enough to remove the patient A high lift jack may work in place of the hydraulic ram

Common Extrication Techniques

Removing the roof
Extra personnel are needed to support the roof as the posts are cut. Assuming the vehicle is stabilized and the windows have been taken. Start with the windshield.

Common Extrication Techniques

Removing the roof
The windshield continued
Use the cutter to make cuts in both the drivers side and passengers side A-Posts. Use a sawzall or Z Tool (or ax) to cut across the windshield. Keep your mouth closed when cutting glass It helps to have one person on each side of the car cutting the windshield, if possible.

Common Extrication Techniques

Removing the roof
After the windshield has been cut and is free, cut both of the B-Posts. Then cut both of the C-Posts. Supporting the roof throughout. Remove the roof completely (towards the front, if possible, to avoid lifting the windshield over the patient). Remove the roof from the Action Circle.

Common Extrication Techniques

Common Extrication Techniques

Windshield Cut

Common Extrication Techniques

Common Extrication Techniques

This is an overview of vehicle extrication basics only. Thanks to Bill Muehl for some of the photos. Material taken from previous extrication drills designed by Dan Williams, Ted Harris (Viroqua FD) and various Internet sources.