Vehicle Extrication — Access and Disentanglement

Vehicle Extrication — Access and Disentanglement

Vehicle extrication is the process of safely removing a trapped patient from a damaged vehicle. Your goal is to move the vehicle away from the patient — not the patient through a small opening. Every action you take must protect the patient from additional injury and protect the crew from the hazards a damaged vehicle presents.

Scene Size-Up and Stabilization

Before any tool touches the vehicle, stabilize it completely. An unstable vehicle can shift and crush a trapped patient or a rescuer. Place step chocks or cribbing at all four wheels and consider deflating the tires on a vehicle that is upright. Confirm the ignition is off. Disconnect or have the utility company address any downed power lines in the hazard zone. If airbags have not deployed, treat them as live hazards — avoid placing yourself in the deployment path and do not cut through airbag inflator modules.

Assign a safety officer for every extrication evolution. That person has the authority to call an immediate stop to all tool operations.

Personal Protective Equipment

All personnel in the work zone wear full structural firefighting PPE, including helmet with face shield lowered, gloves rated for cut resistance, and eye protection. Patient and victim role players (mannequins in training) are covered with a protective blanket before glass operations begin. Remove or cover all sharp edges created by cuts before patient contact.

Emergency vs. Standard Access

Emergency access is used when the patient's medical condition demands immediate contact — typically a door handle that still works or a spring-loaded punch to break tempered glass. Break tempered glass at a lower corner away from the patient; it shatters into small cubes. Laminated windshield glass must be cut with a glass saw or reciprocating saw; it does not shatter the same way.

Standard access involves systematic removal of vehicle components — doors, roof, or dashboard — to create a large, unobstructed working space. This is the approach for most extrication scenarios.

Door Removal

A modern vehicle door is held by two hinges and a latch that engages the Nader pin (a metal post on the B-post). To remove a door:

1. Nader-pin relief: Place the tips of the hydraulic spreader in the door gap near the latch and spread to defeat the latch. This is often called "popping the door."

2. Hinge cuts: Once the latch is defeated, cut both hinges with the hydraulic cutter, starting with the lower hinge. Keep the cutter blades perpendicular to the hinge to prevent blade damage.

3. Remove the door and carry it completely clear of the work zone.

Always call out each tool movement and confirm the patient is clear before activating hydraulic tools.

Roof Removal

Roof removal gives rescuers full vertical access and is the standard approach when spinal packaging is needed.

1. A-post cuts: Cut each A-post (windshield pillar) as low as practical, angling the blade away from the patient.

2. B-post cuts (if present): Cut the B-post at a mid-height location to control the fold direction.

3. C-post cuts: Cut each C-post at the roofline level.

4. Fold the roof: Roll or fold the roof backward onto the trunk. Immediately cover or fold back all cut edges to eliminate sharp steel hazards.

5. Confirm no sharp edges are exposed before packaging and removing the patient on a long backboard with cervical collar applied.

Dash Roll and Dash Displacement

Frontal collisions often drive the firewall and dashboard rearward, trapping the patient's lower extremities. A hydraulic ram pushes the dash forward and upward, relieving that entrapment.

1. Cut or remove the A-post to eliminate structural resistance.

2. Place the ram in the door opening, base against the B-post and tip against the dash or rocker panel reinforcement point.

3. Extend the ram in small increments, calling out pressure or extension distance aloud at each step (e.g., "Ram extending — 2 inches").

4. After each increment, confirm patient clearance — ask the medical crew inside whether the entrapment has been relieved.

5. Place cribbing under the raised dash at each increment so the load is never held by hydraulics alone. This follows the same principle as cribbing under any raised load.

Tool Sequence and Coordination

One tool operator, one spotter, one safety officer — that is the minimum crew for powered tool operations. The operator does not activate tools until the spotter confirms patient and crew clearance and gives a verbal go. Keep all hoses and cords routed away from the work zone floor to prevent tripping.

If a hydraulic unit loses pressure during an evolution, do not attempt to restart with a load on the tool. Crib the load first, then troubleshoot the unit.

Skill Sheet and Evaluation

Your performance is evaluated against an NFPA 1006-based skill sheet. All critical tasks — tool placement, patient protection, edge covering, cribbing maintenance, and verbal coordination — must be checked off. Missing a single critical task is a failure of that evolution. Practice each evolution until the sequence is automatic.