Bread & Butter Operations

5 basic extrication maneuvers every rescuer should know

When we think about “bread-and-butter” operations, we usually think about fireground operations; however, we go to more car crashes than fires, so we should know some “bread-and-butter” techniques that we can perform comfortably at any extrication scene. With this in mind, here are some basic maneuvers that every rescuer should master:

Stabilization of the vehicle definitely takes practice. You need to know your equipment well to master any vehicle that isn’t on four tires. The most unstable vehicle is one on its side, and the potential collapse zone is hazardous and must be secured immediately. To do this, tie off the vehicle to a substantial object and place wedges on either side. Buttress stabilization is the industry standard and should be used if possible. Be cautious when placing your stabilization components. The days when cars had frames are pretty much gone. Unibody construction is typical, and dent-resistant panels are also an issue. We can’t just slide cribbing under a car and expect it to provide solid stabilization. We must be certain that what we’re placing under a car is going to support its weight, especially when we deflate the tires.

When it comes to glass management, we should attack the glass while simultaneously protecting the patient from our operations. It’s too easy to forget the “little” things—like not showering the victim with shards of glass.

Once the car is stable and the glass out, we only have a few options to remove the patient from the car. The most used, and usually easiest, method is to remove the entire roof. I’ve mentioned in previous articles that the preferred method for removing the roof is the C/A/B method. The tool of choice is the reciprocating saw with a demolition blade. Cut the C post first, but remember to look behind the molding before cutting. Then cut the A post. The last cut should be the B post over the patient.

Removing doors has changed as car construction improves. Basically, our job has gotten harder. Door removal was once as simple as popping the door from the nadir bolt. The past couple of years have seen an improvement in side-impact collision bars, which are made of boron steel. In a severe side-impact collision, the bar can become impaled in the rocker panel of the A and B posts. If this happens, it will be very difficult to spread the door using the conventional method; thus, the rescuer has three options, one of which we’ve already covered: roof removal.

The second option is to cross ram the door. This technique is not used as often as it should be. The rescuer operates a ram from the interior of the car (usually at the B post) and pushes off of a solid structure within the car, like the rocker panel, the opposite B post or, if at all possible, ram from behind the patient. The intent is to place the door back into its engineered position. When it moves back, it will make room for the patient and allow the rescuer to use conventional techniques to remove the door.

The third option: the systematic removal of both doors (on a four-door sedan) while keeping the B post intact. The technique goes by the terms “Side Out,” “Rip and Blitz” and “Two-Door Swing.” It’s fairly simple and, once practiced, it works very well. Start by opening the rear door at the nader bolt. Cut high on the B post and then make a pie cut low on the B post. Using the spreaders, spread or rip the B post away from the car. You may have to readjust your anchor point, but you’ll rip the tack welds from the bottom of the B post, and the door will swing on the front hinges and can be tied back or just cut at the hinges. This should provide access to the patient. To get a little bit more room, don’t forget to carefully and deliberately slide the seat back and tilt the steering wheel up.

Practice these techniques in the junkyard where the forklift operator can crush in the doors. Place a mannequin in the seat and operate as if you’re on a real call. Do it by the book and don’t cut corners. If we practice this way, we’ll operate this way. It builds the right muscle memory.
Work smart be safe.

Brad Havrilla is a 20-year veteran with Palm Beach County Fire Rescue, where he is currently assigned to the training division. Havrilla is an international extrication judge and the past vice-chairman of the IAFC Transportation Emergency Rescue Committee. He was the recipient of the Harvey Grant Excellence in Rescue Award in 2004.