BY DAVID SWEET
Since my first article in Fire Engineering in November 1999, I have seen the use of my Side-Out Technique spread to many parts of the world. However, the technique has been altered over the years and is being presented incorrectly in some venues.
The Side-Out Technique’s main design purpose is speed and efficiency in gaining access to a patient involved in a side-impact collision of a four-door vehicle. Many magazine articles, training DVDs from experts in the field, and tool manufacturers have altered my original design and added or deleted some main steps that make the technique less effective. This is serious; lives depend on this technique’s working properly the first time without critical failures or added frustration for rescue personnel.
The mechanical science of a vehicle crash and what happens to the metal and framing material from the impact are facts all fire rescue personnel must understand. When a collision or an impact occurs to a vehicle, depending on the severity, there will be structural or framing damage. The original design in the metal’s yield and tensile strength will be altered with the force direction now moving inward.
For example, take your index finger and poke the side of an aluminum can really hard, creating a good dent. The original design in the yield and tensile strength (smooth round flowing surface) of that aluminum can has been altered, and the force direction is now moving inward. Now, if you try to remove the dent by squeezing the side of the can around the dent, you will increase the size of the original dent because you are actually applying an inward force in the same direction the aluminum wants to continue to travel. The correct action would be for you to put your finger or a stick inside the can’s opening and push the dent out from the inside, opposing the inward force of the aluminum. The dent will, for the most part, smooth out.
This example is simplified, but it does a good job of replicating the process of the side impact of a vehicle. The force of the impact causes the stress of the collapsed metal to now move inward, and any applied force from a hydraulic tool that is not positioned correctly will cause the metal to continue moving inward toward the patient instead of moving outward—away from the patient—which is our goal.
The first part of the technique requires gaining access to the rear door. Most instructors have demonstrated that you have to attack the area of the rear door closest to the Nader pin/latching mechanism, releasing it by creating a purchase point access and spreading sections of metal/framing away until the door either breaks away or the latching mechanism is separated. This can cause many problems with the metal tearing away and breaking down its structural integrity as well as the initial force direction of the metal from the impact (it wants to move inward, the direction of the impact). Applying force in this area only accentuates the metal’s inward movement. A better approach is to force the metal outward or opposite the force direction of the impact. The door’s window frame (or D-ring) plays a vital role.
Step 1. Using the vertical spread technique, place the hydraulic spreader closest to the latching mechanism near the far end of the door in a vertical position through the door window. The bottom arm will be positioned at the bottom of the window opening, and the top arm will be positioned on the roof rail (photo 1). Open the tool, and watch as the arms force the metal outward, causing the window frame/D-ring to buckle out, creating a small purchase point for the next step in the technique. You will know how far to continue opening the tool when you feel the force of the tool start to pull you and the tool inward inside the vehicle.
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| Photos by author. |
Step 2. Take the spreader out of the window and place the tips in the purchase point opening of the window frame. Open the arms and spread the window frame out and away from you; this spreading action will force the area where the door and window frame meet to open up and peel down and outward, exposing the latching mechanism (or Nader pin) (photo 2).
Step 3. Adjust the tool and work the metal outward and away, continuing the action until the Nader pin/latching mechanism can be exposed enough to be rolled off (or until the latching mechanism can be cut with a hydraulic cutter rated to cut through this type of hardened metal) (photo 3). The trick is to continue to spread the window frame out as far as you can without tearing it off. A common mistake most rescuers make here is to stop spreading the window frame down and out as far as they can and then drop the spreader tips lower in an attempt to attack the latching mechanism too soon. This will only cause the window frame to fall back over and block any access of a cutter to the latching mechanism. Remember to operate the tool as a trained technician: Use the spreader as a surgical instrument, meticulously spreading away all of the metal blocking access to the pin.
Step 4. Once you have released the rear door from the latching mechanism, make a relief cut on the bottom of the B post just above the rocker panel and just below the bottom hinge. This relief cut is a small cut (as deep as the blade will cut) into the bottom of the B post; it is virtually impossible to make one cut all the way through the post; a small cut is all you need to create the tearing effect that occurs when a hydraulic spreader is set in a position to push. A common mistake is to attempt to make a pie or section cut instead of a simple relief cut into the bottom of the B post. Making a pie or section cut into the bottom B post frame is not only extremely difficult because of the lack of space and awkward angle, but it will also cause a critical delay in time and is not necessary (photo 4).
After you make the initial relief cut, begin spreading and tearing away some more metal. However, let the relief cut do what it is designed to do, which is to tear away. Sometimes, additional cutting may be necessary after the initial spreading motion because of hardened steel plates added to the bottom of the B post in the form of advanced high-strength steel (AHSS) such as boron or anchoring plates for the seat belt mechanism. These steel additions will hold the bottom post together and stop the tearing action of a relief cut dead in its tracks, so thoroughly examine the spreading action and determine whether you need more cuts. Another common mistake is to stop the spreading action prematurely—when the door required only one more extended push of the spreader. Do not get ahead of yourself; you must accomplish a few more steps before you can attempt to spread the B post and door section off of the vehicle frame.
Step 5. Before you set the hydraulic spreader in place, you must cut and totally separate the top of the B post from the roof rail, as opposed to the small relief cut you made at the bottom of the post. It would be a big mistake to not separate the top of the B post from the roof rail and leave the top of the B post intact as the spreader is used to attempt to spread the B post free. Not cutting through the top section of the B post and attempting to spread its bottom section off the frame will create an opposing force from the intact post, which will add additional resistance to the post’s bottom section and will prevent it from releasing. The hydraulic spreader loses half of its spreading force because the intact top section of the B post is resisting/opposing the force being applied to the bottom section.
So, to avoid any critical failures, make that cut through the top section of the B post before you attempt to spread at the bottom (photo 5). One adjustment I have made to this is that, instead of making one straight cut on the top of the B post, I make a cross cut; this eliminates the jagged metal stub that hangs down after you make a straight cut. A member of the Pompano Beach (FL) Fire Rescue Department made this suggestion.
Once you have thoroughly cut the top of the post, position the hydraulic spreader at the bottom of the B post at an approximately 45° angle, with the bottom arm of the spreader resting on the rocker panel and the top arm angled toward the bottom hinge of the rear door. You may have to adjust this angle throughout the spreading action to find the optimum spreading angle. Once you have placed the tool in position, open the arms slightly to forcefully set the tool.
Step 6. Now, step back and examine where the tip of the bottom arm is resting on the rocker panel. Thoroughly shore up the area under the rocker panel with cribbing to avoid a critical failure of the technique and rocker panel (photo 6). The rocker panel’s hollow design makes it inherently weak in structure, so any significant force applied with the spreader without support will ultimately cause this metal to fail. The force applied from the spreader arm and tip resting on the rocker panel will easily penetrate through the rocker panel’s thin, unsupported metal, causing that section to tear away, which in turn eliminates that area’s structural integrity. Once the metal’s integrity is gone, there is nothing solid from where you can push, and the rocker panel frame’s weaker section will tear away instead of the B post’s bottom section, causing a critical failure of the technique. You must make certain that there is ample cribbing support under the rocker panel and that this cribbing is positioned just behind the swing area of the rear door so the door and B post section will not get hung up on the cribbing when it is forced from the frame. Catching a section of cribbing with the door and B post section as you remove them can cause the entire car to lift up or forcefully project a section of cribbing airborne; watch for this.
Step 7. With the cribbing support in place and the hydraulic spreader ready to push, have another rescuer take some webbing and secure it around the rear door to direct it outward from a safe distance once you force the door and B post section (photo 7). If the seat belt on the B post has not been cut, cut it before you attempt the spread to avoid the belt strap from stopping the spreading action. The hydraulic spreader is now ready to go into action.
Step 8. Slowly open the spreader, and carefully watch the metal that tears away (photo 8). As stated earlier, because of AHSS or steel anchor plates, this section may get hung up and require more cutting with a hydraulic cutter. This work is easy; you can cut around the plates if you are concerned about the strength of the cutter blades. Most of the AHSS is set only in sections because of the high design cost.
(Note: A great Web site for new vehicle construction updates that covers in depth many newer steels is www.boronextrication.com.)
Once you have separated the B post and rear door from the rocker panel, walk the door out, if possible, using the natural swing of the front door hinges. Some rescuers like to spread or cut the front door off of the hinges, but this is absolutely not necessary and is a waste of valuable patient survival time. Making enough room to gain access to the patient requires only that the door be spread to a 90° angle to the vehicle; it does not have to be removed.
Step 9. You can use the hydraulic spreader at this time to perform a technique called a door-widening maneuver. Make the spreader’s arms horizontal and insert their tips into the area between the top and bottom hinges (there is normally a door swing bar here that will come off easily with the applied force of the spreader).
Once you insert the tool, position your back against the front door and grasp the hydraulic spreader like a leverage tool, pulling it back toward you as you use your body to forcefully push against the front door (photo 9). The swing bar, if there is one, will quickly break, and the entire door section will bend toward the front quarter panel. The key is to move your body and the tool in the same forceful backward motion as you open the tool. Don’t let the tool walk you inward toward the patient or rip through the firewall. Also remember to have the additional rescuer use the attached webbing to lift and help direct the door and section around, which keeps it from getting hung up on the ground as you spread.
Step 10. Remove the patient, and then cut the door off (if you want to assist a tow unit) once the patient is en route to the emergency room (photo 10). Remember, the Side-Out Technique was designed for speed and efficiency in gaining access for patient removal. Additional cutting or spreading may be good for training, but it can be detrimental to the patient at game time.
The Side-Out Technique is effective when a very skilled group of rescue personnel attack it using the sequence just described. It works best when completed in tandem with one rescuer working the spreader and the other working the cutter, seamlessly transitioning between cutting and spreading to completion.
DAVID SWEET is deputy chief for the North Lauderdale (FL) Fire Rescue Department. He has a bachelor’s degree in professional administration and is the author of Vehicle Extrication Levels I and II: Principles and Practice, which is endorsed by the National Fire Protection Association and the International Association of Fire Chiefs. Sweet has written several training articles for Fire Engineering and Carolina Fire Rescue Journal and is a Florida level 3 instructor, offering programs on basic to advanced skills in vehicle extrication and FL-USAR vehicle and machinery rescue programs. Sweet has coordinated several extrication competitions from local events to the 2005 International.
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