By Author(s): Les Baker 
Published Thursday, September 30, 2010
| From the October 2010  Issue of FireRescue 
In recent years, the fire service has placed increased emphasis on the ability of hydraulic cutters to sever the advanced steels being built into the structural components of vehicles. These construction designs increase crashworthiness and protect occupants in a variety of collisions; however, they also pose new challenges to rescuers.
Responders may arrive at a motor-vehicle collision where a patient is entrapped almost entirely within a roll cage. Additionally, rescue tools may not be able to make a substantial opening in the immediate area of the patient. Typical evolutions such as Bravo post removals and roof removals may be virtually impossible with the hydraulic, electrical and pneumatic tools that have been sufficient for many years.
Some departments’ answer to advanced steel: purchasing new-age cutters that boast cutting forces in excess of 200,000 lbs. Unfortunately, many departments can’t afford newer cutters or systems given other priorities and budget constraints. Although tools purchased just 2 or 3 years ago may not be able to meet the demands posed by high-strength steel, many department administrations simply can’t justify the redundant expenditure. Some departments may have to rely on outlying companies that utilize combination tools until a more dedicated rescue vehicle can arrive on scene. A review of various manufacturers’ combination tools, however, shows a maximum cutting force of 120,000 lbs.—far less than the forces required to handle high-strength steel.
So what should departments do to combat this problem?
An alternative to dealing with advanced steel: Develop strategies and tactics that work around these reinforced areas. Several methods for dealing with this problem have been identified (i.e., ripping off the roof line of the Bravo post, creating a sunroof). A less aggressive or time-consuming method to consider is a form of tunneling through existing openings.
When developing extrication strategies, determine the location of the patients and potential paths of egress. Paths could include existing openings, such as doors that are still operable, the front windshield opening, rear window opening, rear hatches and, in limited situations, the side window openings. These openings should be fairly obvious and easy to recognize during the survey of the vehicle. The openings can then be prioritized by practicality based on collision damage, exterior obstructions, ease of operation, etc.
In short, rescuers can locate the patient, locate the most suitable opening and determine the tactics necessary to clear a path between the two. Rescuers should be well versed in this process as it’s typically used to gain patient access. In certain situations, the same opening used for gaining access will be the path of egress.
Let’s look at an example. The Volvo SUV pictured below was involved in a frontal collision. This type of vehicle suggests the potential for advanced steels and, based on post-incident analysis, advanced steel does exist in the roofline, Bravo post and rocker panel. Rescuers completing surveys should easily spot the existing openings that could be used for patient removal while avoiding tactics that would involve cutting the advanced steel.
Specifically, the front windshield area can provide a 4' by 2 ½' opening. The front and rear door area separately can provide a 3' by 2 ½' opening if completely removed, or a 2' by 1½' opening for just the glass area. The side glass area can provide a 2' by 1 ½' opening. The rear hatch area can provide a 4' by 3' opening if completely removed, or a 4' by 1 ½' opening for just the glass area. Lastly, the front and rear doors as well as the side glass are mirrored on the passenger side of the vehicle. Although these measurements don’t hold true for all makes and models of vehicles, this should give a good indication as to the worthiness of this tactic.
Unfortunately, rescuers may not discover the presence of advanced steel until they’ve already committed time and resources to the initial tactic. In these cases, the utilization of pre-existing openings may not be as complicated as starting a secondary path of egress. In fact, if the age and type of car suggest the potential for advanced steel, using existing openings may be the most suitable alternative plan.
This method is similar to bus extrication tactics, where an existing opening is used and/or enlarged. Combined with clearing any interior obstructions, this method allows for an effective path of egress for multiple patients. It’s also similar to tactics commonly used on roof-resting vehicles, where patients are lying inside the vehicle and doors are operable. Rescuers find an opening, remove or displace seatbacks to clear and enlarge the path of egress, then transfer the patient to a long spine board. Even in older-model vehicles without advanced steel, similar techniques may be advantageous when there’s significant damage close to the patient, and they’re in need of rapid extrication.
What You Need to Know
To accomplish tunneling, rescuers must have an in-depth knowledge of seat tactics, including headrest removal, lowering seatback, displacing seatback, removing seatback, displacing a seat and removing a seat. Some of these tactics may have to be accomplished with the patient still in the seat. With that in mind, ensure patient and rescuer safety by properly positioning hard and soft protection, observing safe tool techniques and covering any cut or sharp edges during and after maneuvers.
Depending on the damage to the vehicle, you may need to conduct ram and/or spreader operations prior to remove the patient. If side or roof intrusion causes secondary entrapment of the patient or restricts the path of egress, the intruding material should be returned to its original position and in some cases hyper-extended. Interior ram operations can be used as long as close attention is paid to the contact points. Make sure each point is solid, and “peel and peek” as necessary.
For roof intrusion, also consider the use of a spreader placed vertically into window openings. The effectiveness of this tactic will depend on the orientation of the roof in relation to the push point. If the side is compressed toward the center line of the vehicle, the spreader will have a tendency to move inward as the arms spread apart.
Take steps to ensure that the opening is enlarged as much as possible using spreader operations and that all sharp edges are covered. These openings may not provide the largest path of egress, but in situations where doors aren’t accessible or patient condition doesn’t allow longer operations, this opening may be the most appropriate.
At times, this technique may require the transfer of the patient to the long spine board in a less-than-desirable angle. If the patient is unstable because of life-threatening injury, and they require immediate resuscitation, or if the time required to apply the device would jeopardize the patient’s life, the patient’s head and neck should be stabilized with manual, in-line support, and the patient should be moved as a unit to a long spine board. Otherwise, take the time to apply a short spine extrication device, such as a short spine board, Kendrick Extrication Device (KED) or Oregon Spine Splint II. These devices splint the cervical and thoracic spine when a patient is sitting or is in a confined space. After short spine board immobilization, the patient should be moved to a long spine board device for complete spinal immobilization.
Departments may not have the ability to effectively and efficiently mitigate advanced steel in vehicles; however, several innovative tactics have been developed to help departments overcome challenges involving advanced steel. Responders must depend on both traditional and non-traditional tactics to successfully extricate victims. Don’t underestimate the potential of developing a path of egress between patients and existing openings. Find an opening, push parts back into their original positions and clear the path. These tactics may be simple and less aggressive, but they can provide an effective means to remove a patient in a vehicle with advanced steel.
GM & OnStar Help First Responders Cut Through High-Strength Steel
Automobile manufacturers are increasingly implementing ultra-high-strength steels in vehicle structures to help protect occupants, meet government requirements and reduce vehicle weight. General Motors (GM) uses ultra-high-strength steels in specific sections of its vehicles beginning with the 2009 model year.
To help first responders plan crash extrication methods, GM provides identification of the vehicles, models, vehicle zones and specific parts that use ultra-high-strength steels through its training website at www.gmstc.com .
In light of new developments with high-strength steels and electric vehicle technology, Chevrolet and OnStar have joined with leading national organizations, such as the International Association of Fire Fighters (IAFF), the International Association of Fire Chiefs (IAFC) and the National Emergency Number Association (NENA), as well as EMS agencies, to host a series of training sessions to educate responders nationwide. The tour kicked off on Aug. 24 and will continue through the end of the year with stops in San Francisco, Los Angeles, Austin, Detroit, New York and Washington, D.C.
The training will feature a Chevrolet Volt and will review techniques to safely and expeditiously rescue crash victims. The training will include animation and illustrations of an electric vehicle, highlighting locations of high-strength steel, cut points for extrication, first-responder labeling, automatic and manual electrical shut-off and more. In select areas there will also be live extrication demonstrations.
Chevrolet and OnStar have collaborated with first responder representatives from national safety organizations in the development of educational materials to be shared with emergency communications personnel, the fire service, law enforcement and EMS agencies nationwide. Training materials for the tour include feedback from these organizations, and will be posted on www.onstar.com/publicsafety  for those departments unable to attend the training sessions. GM and OnStar will continue to work with the first responder communities to educate them about new vehicle technology.
Want More Extrication Tips From Les?
Tunneling is a tactic that we’re rarely required to perform at extrication incidents. However, it may become more common for responders in the future, with the increased number of sport utility vehicles and minivans on the road. In his online article, “10 Tips for Conducting Tunneling Operations at Extrication Scenes,” Les Baker covers just that, so check it out at http://tinyurl.com/tunnelingtips .
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