BY DAVE DALRYMPLE
In previous columns, I have discussed the concepts of space making (Fire Engineering, March 2005) and strategic cutting (Fire Engineering, January and March 2006). We need to study today’s vehicles-what they are made of and how they are put together. With this information, let’s look at the crashes to which we respond and the patients we treat.
Vehicles today have the inherent ability to absorb crash energy and redistribute it throughout the vehicle (photo 1). The vehicle compresses to absorb that energy in engineered locations called “crumple zones.” When the crash energy exceeds the crumple zone’s ability to absorb it, that energy is transferred into the passenger compartment. The vehicle deforms and is displaced into the passenger compartment more readily in today’s vehicles than in those built a decade ago or earlier (photo 2). To see this illustrated, visit the Insurance Institute for Highway Safety’s Web site (www.iihs.org) and look at the photos and video clips of the vehicles involved in the various crash tests.
 Photos courtesy of author. |
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Although this type of construction helps save lives, it also restricts and confines victims, thus limiting our ability to access, care for, and ultimately remove them from the wrecked vehicle. Although we may be well-versed in the various tool evolutions used to displace vehicle components, how often have we tried or practiced tool evolutions to create more interior space to allow us to work more effectively and safely? Let’s look at interior space-making techniques.
ROOF CONSIDERATIONS
Often, we confront a motor vehicle accident with roof “impingement” (resulting from a vehicle rollover or a severe impact) in which the roof distorts and crushes around the victim. Usually, the goal is to remove or displace the roof, but often the roof is in close proximity to the victim (photo 3). The tools used may cause vibration or even movement that might move that roof even closer to the victim. Using a spreader is one way to provide space quickly. The approach is similar to the one used to displace a door by placing the spreader in the window; our intent here is to lift the roof away from the victim instead of displacing the door outward (photo 4).
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Although the evolution above provides some space, what if we need more or if our victim is not close to a window opening? How about a ram? We have focused primarily on using the ram to displace a dash using the dash roll evolution-what about using it for other applications? The telescoping ram is an excellent tool to assist in our spacemaking quest. Simply place the ram vertically inside the vehicle and extend the ram to lift the roof.
With both evolutions, we need to remember a few things. Place hard protection between the tools, the victim, and the interior rescuer. When displacing the roof, don’t omit glass management. Often, the glass will be broken in the crash; if it is not, consider what the glass will do when the roof is lifted (photo 5). In addition to the glass being “loaded” from the crash’s energy and damage, consider what forces the spreader or ram will exert. Also, look at what the ram will be pushing against. The ends of the ram have a fairly small contact area; we might want to increase that surface to spread the force more evenly.
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CROSS-RAMMING
One of the most effective methods to maximize interior space is the cross-ramming evolution (photo 6) in which the hydraulic ram is placed into the vehicle and then extended from one vehicle component to another. A key point in this evolution is to maximize the ram’s surface contact area with cribbing at each end and thus spread the force of the ram over a larger area. If we are pushing against an object that is intruding into the vehicle itself, we must place cribbing between the ram end (photo 7) and that object and the vehicle to maximize our ramming efforts.
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Depending on the vehicle damage and intrusion, we may also consider removing the roof, which will enhance our ramming efforts by weakening the vehicle’s structural integrity.
Also, think about what we are pushing against. Cross-ramming may be an option when the vehicle’s B-post is intruding into the occupant’s cell. Strip the interior trim to check for safety system components such as seat belt pretensioners or gas generator cylinders for side-curtain air bag systems. With the size of some of the small telescoping rams currently available, we can effectively cross-ram space even in footwell areas. As with any controlled displacement, we need to effectively monitor the vehicle as it is displaced, manage that displacement by cribbing it, and monitor the victim to facilitate disentanglement and note any change in victim status as our extrication progresses.
STEERING COLUMN
Another possibility for maximizing interior space is the steering column. In most vehicles, the steering column will tilt up to make more space; in some vehicles, the column can move or telescope as well. We should look for and use these features to our advantage.
SEATS
Seat movement is another option. Although manually adjusting seats can facilitate increasing the victim space quickly, more vehicles now have power seats. At an extrication incident, we should cut off the vehicle’s power quickly. However, before doing so, during size-up consider whether seats need to be moved before shutting down the vehicle’s power.
Take a good look at seating configurations in minivans and SUVs (photos 8, 9). Certain seats may be removable or even stowable to maximize cargo space. However, many of these seats may work differently from vehicle to vehicle. If the vehicle is damaged in the crash, will the seat mechanisms still work so that the seats can be removed?
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If possible, remove headrests, consoles, and armrests to get them out of your way.
Although in extrication we focus much of our attention on displacing the exterior of the vehicle, we should revisit working the interior. Current vehicle construction involves crash energy absorption and cab-forward design, with a downsized exterior and maximized interior space. Vehicles today may have “dissimilar” seating configurations and a structure that readily crushes inward, making extrication, already complicated by new technology, even more so by reducing the space available to facilitate victim care. We need to employ aggressive extrication techniques to increase the victim’s chances of survival.
DAVE DALRYMPLE is a career EMS provider for Robert Wood Johnson University Hospital/St. Peter’s University Hospital Emergency Services in New Brunswick, New Jersey. He is also a firefighter/EMT/rescue technician and former rescue services captain of the Clinton (NJ) Rescue Squad. Dalrymple is the education chair of the Transportation Emergency Rescue Committee-US and serves on the Expert Technical Advisory Board of the International Emergency Technical Rescue Institute as the road traffic accident advisor.
