BY LES BAKER
Creating a wider and more in-line path of egress for patient removal has resulted in a recent trend of total side removals at extrication incidents involving four-door vehicles. At a recent training session at the St. Andrews (SC) Fire Department, a student asked how that concept would apply to a two-door vehicle. It became obvious that rescuers seldom take the time to ensure the same path of egress when removing the patient from the driver or passenger side of a two-door vehicle. When rescuers remove only the door, personnel must turn the patient almost 90° to remove him onto a long backboard (photo 1).
(1) Photos by author.
Third-door conversions are typically used on two-door vehicles to create a path of egress for backseat passengers, especially when roof removal is not an option. The more common way to complete this tactic involves removing the door and then doing a third-door conversion. In similar situations in which side removal is the primary plan, rescuers should also consider using a third-door conversion to remove a front-seat patient.
Through several training sessions, we developed a third-door/side-out tactic and implemented it into our response capabilities. To complete it, rescuers need an air chisel or reciprocating saw to remove the outer body panel and facilitate cutting the structural supports with hydraulic tools (photo 2).
When you have removed the outer panel, determine which tool will more easily sever the internal supports. In certain cars, the inside panel may be a solid sheet metal piece similar to the outside panel. In this case, use the air chisel or reciprocating saw to make a curved cut along the same path as the rear and lower outer cut. This limits the amount of additional work needed to free the inside panel (photos 3, 4).
Once you have removed the outer panel and severed the inner components, make a complete cut through the beltline support (i.e., the horizontal structural member between the B and C posts at your beltline level, the reinforced area just below the window opening) and a relief cut on the bottom of the B post. Pay close attention and look for seat belt pretensioners in this area to avoid cutting into them. They should be easily identifiable with the outer panel removed, which allows a direct line of sight (photo 5).
Once you have made the cuts, spread the bottom of the B post out and away from the rocker panel until the post and panel are separated. Ensure that the spread is sufficient enough so there is complete separation between the post and the rocker panel. Depending on the third door’s width, you may need to place additional cribbing underneath the B post to support the vehicle and provide a solid push point (photo 6).
After stripping the roof trim to ensure there are no supplemental restraint system (SRS) components present, you can make the final cut at the top of the B post, releasing the door and permitting the side to be opened on the hinges. Making this cut last ensures that the reaction from spreading the bottom out and away will not cause the top of the post to intrude into the patient compartment. Put hard protection between the patient and the cut location (photo 7).
When completing a side removal, decide whether to just cut the hinges to completely remove the side from the vehicle or to simply swing it around on the front hinges and strap the side to the front of the car. This decision usually depends on your standard operating procedures, the degree of entrapment, the patient’s condition, the car’s construction, and so on. Remove any remaining interior trim, cover all sharp edges, and prepare for patient removal (photo 8).
Although the third-door/side-out tactic above is presented in the context of a frontseat patient, the tactic will work just as well with a backseat passenger. When completed proficiently for either a frontseat or a rearseat patient, this tactic provides the following advantages:
- It involves approximately the same number of steps as a side-out on a four-door vehicle. A proficient chisel operator can complete it more quickly because rescuers do not have to mitigate the rear door and work around it to complete the bottom B post relief cut.
- For a frontseat passenger in a two-door vehicle, it provides a wider and more inline path of egress.
- Removing the outer panel allows rescuers to see the internal components such as support beams, seat belt pretensioners, preexisting holes, and so forth. This alleviates the need to pull trim on the interior and allows for better hydraulic tool cuts.
- It completely removes the third door from the vehicle. With other techniques, it is simply displaced rearward.
LES BAKER, a 12-year veteran of the fire service, is an assistant engineer with the Charleston (SC) Fire Department and a volunteer for the Darlington County (SC) Fire District. He has an associate of fire science degree from Pikes Peak Community College in Colorado Springs, Colorado. Baker is an adjunct instructor with the South Carolina Fire Academy and a member of the Darlington County Extrication Team.
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