BY DAVID DALRYMPLE
We need to reexamine our extrication tools and evolutions in light of the construction and materials used in today’s vehicles (e.g., high-strength metal alloys, hybrid components, and crush-and-crumple zones). Using a mix of old techniques, current evolutions, and new concepts will enable us to disentangle our patients safely and rapidly to produce better patient outcomes. The more options you have in your mental toolbox, the better for you and your patients.
There is no easy solution to these extrication issues. Just make sure you have the most powerful hydraulic cutter; a reciprocating saw equipped with good rescue blades; and a good rescue air chisel with long, sharp bits. Your hydraulic spreader and rams will come in handy in ways you might not have thought of before.
Remember, as with any extrication evolution, protect the patient. Place hard protection between the patient and your tool work, manage any glass, cover any sharp edges, and observe how the evolution’s progress is affecting the patient.
ROOF STRIP OR TRENCH
This evolution has actually been around for quite awhile, as has the roof flap evolution. But the roof flap really doesn’t give you the space you need (except on SUVs, minivans, and station wagons), and you still need to cut roof posts for it to work. The roof strip or trench removes the center of the roof from between the roof rails from front to back. This enables you to quickly remove most of the roof with a lot less weight to manage.
However, with today’s vehicles, this evolution enables you to avoid cutting the areas where most side curtain supplementary restraint system (SRS) inflation modules are placed. You still need to pull edge trim prior to cutting, but except for the Jaguar S-type and Volkswagen Golf, Rabbit, and Jetta models, the vehicle should be free of these devices. Although you might still encounter higher-strength roof rail reinforcements, they should not be as strong as the roof posts.
Using the hydraulic cutter, make a relief cut inboard of both roof rails at the front and the back. Then take a reciprocating saw or a rescue air chisel and make a cut connecting the relief cuts on both sides. Although you can use the reciprocating saw or rescue air chisel for the entire process, the hydraulic cutter will make short work of any higher-strength reinforcements on the roof edges.
Use caution in making cuts since the blades or bits will extend into the vehicle’s occupant space. Use hard protection and good visual referencing as you work. After removing the roof section, cover the sharp edges on each side, since these cuts will be very sharp and jagged. Although this evolution will not remove the entire roof, it will facilitate removing patients up and rearward vertically (photos 1-3).
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ROOF SECTIONING
On larger vehicles such as SUVs, minivans, and even station wagons, the roof structure is fairly large. Flapping the roof by folding it in a certain direction can create a decent amount of space to aid in patient management and disentanglement. However, these vehicles also permit another option, sectioning the roof. If you need to remove the roof around only the driver of a minivan, why spend the time, effort, and personnel to remove the entire roof or even flap the roof when you could just remove the section above the front occupants, or even just immediately above the patient?
As with roof trenching, you must use good hard protection, good visual positioning, and eventually good sharp edge protection. However, roof sectioning facilitates quick roof access above the patient; if correctly sized, it also allows you to remove the patient vertically. As you cut into the roof edge and posts, you must pull edge trim and manage glass as needed (photo 4).
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ROOF TENTING
What about the vehicle that has “uncuttable” reinforced roof posts? Maybe do a roof trench? But what if the patient’s condition is time critical and he needs to be disentangled right away? Going through the vehicle’s side using a door displacement doesn’t always provide enough room and is not quick either.
Ideally, you also strive to remove patients with “head, belly, and toes” in line. As vehicles have evolved, the average window opening has gotten larger. These factors point to a roof tent evolution. Basically, you will widen the rear window opening, recline the patient’s seat, and slide the patient up a long spine board for packaging and removal.
To widen the window opening, you have to manage the rear window glass first. The easiest and quickest way to widen the opening is to place the hydraulic spreader into the window opening and open the spreader. After removing the edge trim, place one arm of the spreader on the vehicle’s package deck and the other arm against the roof edge. For the arm that is against the package deck, first place cribbing on the deck to spread the load of the tool’s force over a greater area. As the spreader opens, you create space by tenting the roof.
Now you can improve on this tent by either extending the tent with a hydraulic ram or jack or by making a partial roof trench and using the ram or jack to push the roof piece even farther up. Although your disentanglement space is smaller than usual, the roof tent provides some quick useable space if your patient’s condition is time critical (photos 5-7).
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TRUNK TUNNELING
Many of you have seen trunk tunneling evolutions before. Usually you think of this maneuver when you encounter an underride or override incident. Although this evolution can be time consuming, tunneling also offers you an option for creating space to move the patient though the vehicle’s rear inline. This evolution can be time consuming if the rescuer lacks practice and has made a poor tool choice. Using the hydraulic cutter and the reciprocating saw together and according to each tool’s strength, you can complete this tunneling evolution fairly quickly.
First, manage the rear window glass. Then, force open the trunk or hatch. Cut the trunk/hatch off its hinges and get it out of your way (photo 8).
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Look under the package deck for the torsion bar for the trunk lid. This is made of spring steel and is difficult to cut well. It is usually held in with a clip. You can displace it fairly easily with a halligan or a forcible entry tool much more easily than by cutting it (photos 9-10).
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With the hydraulic cutter, make a deep relief cut into each edge of the package deck. Using the reciprocating saw, extend the relief cuts toward the rear seat. Finish the cuts by removing the package shelf (photo 11).
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Now take a look at the rear seat back. Many rear seats have split folding seat backs, so take advantage of that. Otherwise, look at the base of the rear seat back. Typically, the seat back is bolted in only two locations. Use a handlight to get a good look at the attachment; use your hydraulic cutter to shear the seat back attachment. Maneuver the rear seat back out; you can usually easily remove the rear seat bottom cushion too, if needed (photo 12).
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This brings you up to the front seat now with nothing to hinder you behind (photo 13). When tunneling with today’s vehicles, remember battery locations. In many contemporary vehicles, the primary battery is in the trunk, as are the high-voltage and 12-volt primary batteries in hybrids.
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Use caution! In the Honda Accord, Ford Fusion, Mercury Milan, and first- and second-generation Honda Civic hybrids, the high-voltage battery is in the rear seat back, so a tunneling evolution is not advisable. As always, use good hard protection and address sharp edges as you work, since the space will be very confined.
CREATIVE RAMMING
Creative ramming involves using the hydraulic ram for more than just dash displacement in the dash roll technique. The ram can push a greater distance than the spreader and, when extended, can pull back that same distance. It comes in a variety of sizes; telescoping models can extend an even greater range of distances. Remember, never sideload this tool, since it can damage the cylinder.
The hydraulic ram can assist in displacing and reproportioning the vehicle’s components and the entire interior. Creating space is the name of the game; quickly making the disentanglement pathway is important.
Remember the following when employing creative ramming:
- Ensure your ram ends are securely supported and anchored on the vehicle.
- Do not sideload the ram; it can damage the cylinder.
- Observe how the vehicle reacts to creative ramming. You may need to put additional stabilization in place.
Cross-ramming including roof displacement. Today’s smaller vehicles are designed to crumple and crush to absorb crash energy to protect the occupants (photos 14, 15). But consider the useable space needed to manage patients and eventually disentangle them. The day of the door “pop” and laying a long spine board on the vehicle’s bench seat to remove a patient is pretty much over.
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Observe where occupants sit in vehicles today; most frontal occupants sit alongside or behind the vehicle’s B post. Consider a significant side impact with intrusion into the occupant cell, or an offset frontal crash. The area available for you to manage the patient rapidly shrinks. Smaller vehicles such as the Honda Fit and the Scion IQ (photo 16) offer even less space to maneuver in, which may hinder even basic patient care and increase the patient’s entrapment.
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In extrication, the essential concept for all cars in general, but especially for smaller cars like the Fit and the IQ, is “just push the inside apart” to provide more space. The hydraulic ram is well suited for this. Consider where you will place the ends of the ram; how the damaged vehicle will react as you stretch it back into a wider position; how this will affect vehicle stabilization; and, most importantly, how this will affect the patient. You need to find strong sections of the vehicle structure to support the ram; otherwise the ends of the ram might punch through the vehicle. Even when using these strong points, remember that they have been compromised; you might need to crib where you place the ram ends also.
Removing the roof structure will assist in the cross-ramming evolution by weakening the vehicle’s structure even more, making reproportioning the vehicle easier (photo 17). However, the vehicle might collapse further as you remove the roof. In this case, before removing the roof, position the ram in the vehicle first and extend it to make contact with the areas you wish to widen. Depending on what you need to widen and what rams are available, you can cross-ram many areas of the vehicle (photo 18).
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We have discussed cross-ramming horizontally, but you can also cross-ram vertically. Think about a vehicle that has rolled over and now is back on its wheels but its roof is crushed. Wouldn’t it be much easier to work around the patient and facilitate patient care if the roof was removed and away from the patient’s head? You can quickly facilitate this as follows:
Place the hydraulic spreader in the window opening, and force the roof upward. You can extend this farther and make a greater opening by placing the ram vertically and pushing the roof up and away. As with all tool operations, ensure that you have placed hard protection between the patient and the work you are doing, pull interior trim, and cover sharp edges (photo 19).
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You can also use the ram to displace the retractible hardtop roof in convertibles. In most convertibles today, the A posts and windshield headers include ultra-high-strength reinforcements. So these A posts will be a difficult cut; if the retractable roof is up, the entire roof will necessitate a difficult effort all around. You can force the roof apart at the A post by “popping” the latch with the hydraulic ram. Place the ram vertically with one end against the roof latch and the other against the floor. Extend the ram to break the latch and pop the roof from the windshield header.
Central ram push. For dash displacement, in addition to the dash roll evolution using the ram and the dash lift using the hydraulic spreader, there is the central ram push. This evolution uses a very large hydraulic ram and parts of the vehicle structure. Used extensively in Sweden, where it originated, the central ram push evolution pushes the dash forward horizontally in the direction of the vehicle’s crush zone. Goran Valentin, an instructor from the National Swedish Rescue Agency, demonstrated this evolution at the 2008 Fire Department Instructors Conference. He successfully used the technique on 2008 vehicles such as the Ford Focus and the Ford F-250 maxi cab pickup truck.
In this evolution, first remove the vehicle’s roof or at least six inches of each A post. Next, displace or remove the door closest to the patient so you can observe your displacement efforts in relation to the patient. Taking your largest ram, place an extension on one end with a claw or C-foot ram end attachment (photo 20).
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On the other ram end, place a purpose-made support, or use your ram support bracket. Place the ram end with the ram support bracket on the rear seat in the middle and the other end of the ram against the dash, aiming toward the radio between the vehicle’s front seats. Extend the ram, allowing the end against the dash to break through it and continue until that end is against the vehicle’s dash reinforcement bar (photo 21).
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Once the ram end is against the bar, you can continue to ram forward; you can also make a relief cut into the base of each A post at the footwell to assist your ramming. By placing the force of the ram against the dash reinforcement bar, the force is spread across the entire bar and moves the entire dash area forward horizontally. With this evolution, you must closely monitor the ram end against the rear seat, the ram end as it crushes the dash, and the movement of the dash in relation to the patient. As always, put hard protection between your tool work and the patient.
An option to add to this evolution, especially if you have footwell entrapment, is to add a small ram into the door area to ram the footwell forward as your central ram push progresses. This evolution works especially well on today’s vehicles because of the dash reinforcement bar, the vehicle’s inherent construction, and energy absorption design. It doesn’t work so well on older vehicles.
Upper rail roll.In the upper rail roll evolution, you displace the dash upward and forward without pushing the engine compartment down. In many ways, it works like the dash roll and the dash lift.
First, you need to add a stabilization point under where you will place the ram support (photo 22). Next, place the ram with one end on the ram support and the other against the upper door hinge or the lower A post. After extending the ram and placing it in slight tension, make a horizontal relief cut at the base of the A post by the footwell. Place the ram first to prevent the dash from dropping as you make relief cuts. Next, make two cuts about six inches apart in the A post, and remove that piece.
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Following that, access the crumple zone area and make a deep, wide cut into the crush zone. To do this, remove or displace the front fender to expose the upper rail behind it. Once you have cut the upper rail (photo 23), begin operating the ram. As the ram extends, the dash and upper rail will displace upward and forward, hinging on the relief cut made in the vehicle’s crush zone in the upper rail. As with a traditional dash roll, monitor the stabilization, and adjust as needed; watch how dash displacement occurs in relation to your patient. A downside of this evolution is that the ram is usually in your patient disentanglement pathway if you are removing the patient to the side.
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Using the ram instead of a spreader.One new idea is to use the ram in place of or with the spreader to displace or tear vehicle components. I have tried this in performing a B post tear evolution. On newer vehicles, the type and amount of reinforcement in the B post can make it difficult to displace the base of the B post off and away from the rocker panel. It also can be difficult because of the vehicle’s construction, where the entire vehicle side is an extrusion. I have used a ram instead of the spreader for displacement with some success. It usually works best with a small telescoping ram and a good solid base for the ram to push from (photo 24).
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Another technique is to tear the top of the B post from the roof structure to aid in roof removal. You would use the ram against the roof edge near the B post and push the roof up vertically. Using the ram’s ability to push in a straight line allows the roof material to separate or tear from the reinforcements in the top of the B post. You still need to sever the rest of the roof posts, but this technique should be explored further. The only limitations are safety considerations and your imagination (photo 25, 26).
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David Dalrymple will present the classroom session “Alternative Tool Evolutions for Today’s Vehicles” at FDIC 2011 on Wednesday, March 23, 2011, 1:30 p.m. – 3:15 p.m., in Indianapolis.
DAVID DALRYMPLE is a career EMS provider for the RWJUH Emergency Medical Services in New Brunswick, New Jersey, and a volunteer firefighter/EMT/rescue technician for Clinton (NJ) EMS/Rescue. He has been actively involved with emergency services for 27 years. He is the education chair of the Transportation Emergency Rescue Committee-US (TERC), is a certified international level extrication assessor, and serves on the Expert Technical Advisory Board of the IETRI as its road traffic accident advisor. Certified as a NJ fire service instructor, he has been teaching transportation rescue topics for more than 16 years. He is the executive educator for Roadway Rescue LLC, an educational team for transportation rescue training. He is an ICET (Netherlands) certified registered International SAVER instructor. He contributed to Fire Engineering’s Handbook for Firefighter I and II (2009). He received the 2007 Harvey Grant award for excellence in rescue education. He is featured in “Training Minutes” on vehicle extrication on fireengineering.com. Dalrymple’s new three-DVD vehicle extrication series (Fire Engineering, 2011) will be introduced at FDIC 2011.
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