Many courses instruct students on general extrication tactics such as side-outs, dash displacement, roof removal and tunneling; however, these tactics by themselves may not provide an appropriate work environment on the interior of the vehicle or a suitable patient path of egress.
An often overlooked part of the vehicle extrication process is the front seat tactic. Front seat manipulation is more important now than ever given the number of vehicles with power seats. Front seat techniques are most commonly needed when:
- The collision has damaged the electrical system at the battery or along the path of the wiring, making any powered seat inoperable;
- Personnel have disabled the battery prior to attempting to operate seat controls; or
- The manual or electrical controls still work but the damage from the collision will not allow the seat or seatback to move along its intended path.
In these cases, knowing how to manipulate the seat is key. The rescue group should first determine if the seat location provides an unsafe situation for the patient, a poor setting for interior rescue work or an ineffective opening for patient movement. Situations that can make the front seat area unsafe include deployment of airbags and roof or side damage that contact the patient, which can transmit reaction from disentanglement procedures.
If seat manipulation is determined appropriate, rescuers must be prepared to move the seat quickly and safely, with minimal stress on the patient. In this article, I’ll share tactics and tools appropriate for manipulating the seat in several different situations.
Seat adjustments range from simple mechanical systems to electrically operated systems that may have as many as eight different directions of movement. Rescuers must have sufficient knowledge of seat construction, operating mechanisms and potential hazards. Although seat construction may vary according to manufacturers, the basic concepts are the same.
The front seat, whether driver’s side or passenger side, features four main components:
- Headrest, including the headrest frame, guides that lock the headrest in different height positions and hold it in place on the seatback frame, and the cushion and covering.
- Seatback frame assembly, including the seatback frame and the cushion and covering. Depending on the type of vehicle, it may include lumbar adjustments and supports, heating components and an airbag located in the outer side.
- Seat pan, connected to the seatback frame by means of an adjustable hinge. The hinge is typically permanently mounted to the seat pan and bolted to the seatback, although some models are welded to the seatback as well. The adjustable hinge may be controlled by a manual lever or electric motor on the side of the seat. This control, as well as others located on the outer portion of the seat pan, is covered by a plastic shield.
- Leg assembly and tracks, which are attached to the floor pan. The tracks allow the seat to be adjusted forward or rear.
The headrest is sometimes used for assisting with stabilization of the head and spine during the extrication process. However, some headrests have a forward position that does not allow for easy backboard positioning, such as when laying the seatback for patient egress following roof removal.
Therefore, removing the headrest can provide advantages for rescuer access and patient removal. In a tunnel situation, for example, removing the headrest may allow the seatback to lower past the rear seat and/or raised floorboard area. This increases the clearance between the patient and rear roofline during patient removal.
Always try to remove the headrest using the mechanism. If that method does not work, simply clip the headrest guides with bolt cutters or a confined space cutter and push the remaining stub back into the seat.
Another option: Remove the headrest on the seat opposite the patient. It provides a considerable amount of extra room for interior rescuers to work, especially if there is roof intrusion.
In collisions with roof impingement, such as major rollovers or under-rides, it’s important to establish separation between the roof and the patient to prevent the patient from being injured further from vibration and/or shock during disentanglement tasks. Lowering the seatback will move the patient away from the roofline and place them in a better position for the medic to provide care.
A lower seatback also helps with patient removal when the roof must be removed, providing a better angle to transfer the patient to a long spinal board. A lower angle means rescuers don’t have to lift the weight of the patient straight up and over the seatback. If the situation requires the side to be removed, lowering the seatback allows for a more inline transfer to a long spinal board (Figure 2).
Rescuers can use hydraulic tools to lower the seatback, but this should be a second option. First, try the simpler and easier method: using the controls. If the release is manual, first move the seat forward slightly to relieve the pressure off the mechanism.
Note: The techniques described from this point forward will require disarming the side-impact airbag if the vehicle is so equipped. Never use any tools, even manual tools, near the sensor unit before disarming the side impact protection system (SIPS). Disarming the SIPS can be done by ensuring the key is off and removed from the ignition, and the battery is disconnected. Even once the SIPS is disarmed, you should avoid crossing the deployment path.
Whether the seat is powered or manual, if the mechanism doesn’t release the seatback, expose the outer hinge with a cutting device such as a carpet knife (Figure 1). This will allow you to examine the easiest way to defeat it and possibly avoid unnecessary cuts.
The first option: Find the bolts on the hinge that connect it to the seatback. Remove the bolts with an air ratchet with a short socket. This works best because it’s quick and the small profile allows the ratchet to get to the bolts even in situations where the B-post is still intact.
If the hinge is welded to the frame or the bolt heads are inaccessible, cut the hinge with an air chisel with a hard metal pressure setting or a hydraulic cutter. Tip: When using the cutter from the side, be sure to keep the cutter perpendicular to the hinge so the cutter doesn’t violently twist or torque the blades.
Although both tools will effectively cut the material, the air chisel is better suited for limited-access situations and offers more control of the cut. When making the cut in a vehicle upside down during a tunnel operation, the chisel is easier to maneuver and hold in position. You might think this creates a considerable amount of shock that’s transmitted to the patient, but it’s actually a surprisingly smooth technique when you support the patient with a short board or rescuer.
A patient’s extremities may get trapped between the seatback and B-post. One method of freeing the entrapment is to displace the B-post outward using a ram from the interior, but this method takes longer than displacing the seatback itself.
There are several ways to displace the seatback (Figure 3):
- Use a spreader to gently move the seat away from the post until the extremity is free.
- If hydraulic tools are committed elsewhere, a large ratchet strap anchored in the direction of pull needed will move the seatback several inches.
- If your department carries small, high-pressure lift bags, insert them between the post and seatback and inflate.
Remember: In this situation, you’re only looking for 2—3 inches of movement to free an extremity.
If time allows and the situation warrants, you can remove the seatback. This may be useful in situations where a backseat patient must be removed. Whether moving the patient vertically rearward or horizontally forward, removing the front seatback will provide increased space for rescuer access and patient egress. Another situation where removing the seatback is useful: an overturned vehicle. During a tunnel operation or side removal to access an entrapped patient, removing the seatback provides extra room to work inside the vehicle.
The initial steps are similar to displacing the seatback: Expose the outer hinge and remove the bolts that attach the seatback, or cut the hinge.
The next steps will depend on the type of connection that exists at the inner hinge. Some seats feature a pin system that will allow the rescuer to remove it from the vehicle at that point. Others may require disassembly or severance of the inner hinge using the same techniques discussed in defeating the outer hinge.
Moving a patient vertically or horizontally is easier if the patient is away from the dash area. This can be done by moving the seat to its most rearward position along the tracks. If the seat is manual, it will usually feature a lever in the front that releases the seat along the tracks. If the seat is power-operated, you may be able to move the seat before disconnecting the battery.
If the track system is bent or the mechanisms inoperable, use a spreader to slowly move the seat rearward (Figure 4). Use the bottom of the A-post close to the rocker panel as a push point and make sure the direction of spread is as rearward as possible. The angle of spread is critical and should be in line with the track system.
Tip: Anticipate movement of the opposite side of the seat forward and monitor the movement closely. It’s common to hear a popping sound and see a slight jerk as the seat moves rearward, caused by teeth on the track system being stripped.
Manual seats may be equipped with a spring that returns the seat to the forward-most position once the mechanism is activated and no rear pressure is placed on the seat. Locating the spring and disabling it is difficult. Instead, slowly close the spreader and if the seat begins to move forward, stop and leave the spreader in place.
Very few situations require a total seat removal, but it can be needed when dealing with a lower extremity entrapment of the backseat patient or a patient stuck in the floorboard between the seats.
Whether attempting to cut the frame from the vehicle or remove the bolts from the floor pan, removing the seat can prove very difficult due to limited access. The spreader may work to displace the frame; however, this causes a large amount of shock to the vehicle. Removing the seat by spreading the frame from the floor pan should be a last-resort tactic.
A second, less violent method, if the situation allows, is spreading the seat bottom from the tract system (Figure 5). To accomplish this, the seat must be slightly forward or rear of the seat frame to provide a push point for the spreader on the seat bottom. A slow push will expose the area underneath the seat, allowing rescuers more control of patient protection.
Regardless of which method you use, pay close attention to the opposite reaction of raising the seat pan. This action will cause the seatback to displace into the opposite side of the vehicle, which could interfere with operations on that side. If possible and time permits, remove the seatback to avoid this reaction.
Know Your Seats
As an officer at an extrication scene, don’t overlook the simple task of manipulating a seat to help with the extrication process. As a rescuer, if you’re tasked with manipulating a seat, determine the best applicable tactic and keep patient and rescuer safety a priority during its completion.
A wise rescuer at an extrication competition told me, “The team that understands seats and can effectively and efficiently mitigate seats has a greater chance of winning.” It’s no different at the emergency scene. Rescuers who can perform seat techniques have a better chance of quicker and safer extrication.
Front Seat Safety
As with any other tactic, when manipulating the front seat, the rescuer should begin with the quickest and easiest tactic and work toward the hardest and most time-consuming.
Ensure patient and rescuer safety by properly placing hard and soft protection, observing safe tool techniques and covering any cut or sharp edges during and after maneuvers.
In addition, before a seat can be manipulated, the patient should be properly packaged as dictated by their injuries. Communicate with the medic before beginning the tactic so they can mentally and physically support and monitor the patient.