It’s not uncommon to read stories about motor vehicle collisions in poor weather conditions that involve multiple vehicles-sometimes 50 vehicles or more. In these situations, initial arriving responders may be quickly overwhelmed by the lack of equipment available to perform disentanglement procedures. Responders may have to become inventive with tools that aren’t typically the first choice for certain operations. In some jurisdictions, as few as two entrapped patients may create situations where resources are overburdened and responders have to rely on uncommon uses of certain equipment.
In the past year, this column has addressed several lift bag concepts such as the physics of lifting, the ejection path and proper storage and weight classification marking. Many responders view lift bags as a one-dimensional tool with little application for tactics other than lift operations. However, in times of need, they may provide sufficient force and spreading distance to serve other functions.
Displace Seat Back
Front seat tactics are exceedingly important these days given the number of vehicles with power seats and the emphasis on an inline path of egress. The rescue group should first determine if the seat location is appropriate-it may provide an unsafe situation for the patient, a poor setting for interior rescue work or an ineffective opening for patient movement. The front seat area could be especially unsafe if the patient is in contact with roof or side damage, which can transmit reaction from disentanglement procedures. When front seat manipulation is determined appropriate, rescuers must be prepared to move the seat quickly and safely, with minimal stress on the patient.
A patient’s extremities may get trapped between the seat back and Bravo post. One method of freeing the entrapment is to displace the Bravo post outward using a ram from the interior, but this method takes longer than displacing the seatback itself. Also, in scenarios where the side of the vehicle is against an immovable object, it may be impossible to displace the side. Instead, a small, high-pressure lift bag can be inserted between the post and seat back and then inflated. In this situation, two to three inches of movement should suffice to free an extremity.
Steering Column Displacement
Many years ago, responders trained extensively on the process of displacing steering columns with the use of chains and hydraulic tools. With the development of dash displacements, the technique of using chains has all but disappeared. However, in situations where hydraulics are committed elsewhere, this technique may be appropriate. Even in some larger vehicles such as school buses and tractor-trailer cabs, it may be easier and quicker to displace a steering column instead of the entire dash.
The damage to the vehicle may have already created an opening in the windshield, but if not, create a hole to slide the chain through at the base of the front windshield in line with the steering column. Secure one end of the chain to the steering column and the other end to a structural member on the undercarriage at the front end. Center a lift bag under the chain and above the fire wall. Utilize cribbing as necessary to distribute the weight under the lift bag. Because there is a limited distance of travel, it may be advantageous to use a ratchet chain binder to remove any slack out of the chain prior to inflating the bag. Inflate the lift bag while monitoring the movement of the bag and column closely. Displace the steering column just enough to extricate the patient.
Patient Vehicle Movement
In our June extrication article we discussed moving the patient vehicle as a necessary and reliable tactic in certain situations. Some of the key points included:
- When initial plans fail to provide a suitable path of egress, responders may have to depend on less-frequently-used secondary plans.
- The potential advantages of patient vehicle movement include improved access for EMS personnel, an improved path of egress and decreased extrication time.
- When moving a patient-occupied vehicle, we must maintain patient stabilization.
- Movement of the patient vehicle typically requires a high level of skill and a well-established incident command structure.
Lift bags may be used to move the vehicle off immovable objects, especially when space is limited. In some cases, they may be capable of providing up to twenty inches of movement. One advantage they may have over other tools is their ability to be slowly inflated, making the movement process smoother. As long as the appropriate precautions are taken, this method is applicable regardless of whether the patient vehicle is wheel-, roof- or side-resting.
In another patient vehicle movement tactic, lift bags may provide the opposing force to struts in a one-sided controlled roll. A controlled roll may be utilized to mitigate a side-resting vehicle with a patient entrapped on the low side or path of egress concerns when the roof of a side-resting vehicle is against an immovable object.
Lift bags have traditionally been associated with lift operations, yet they have the greater potential to be used in a variety of other situations, especially when presented with unique conditions or when equipment options are limited. Responders should understand the potential uses of all types of equipment and be prepared to creatively deploy them during uncommon disentanglement procedures.