IN EXTRICATION, WHEN ACCESS to a car’s both sides and the roof is limited, we use a trunk-tunneling evolution to access the passenger compartment. But what if it’s a pickup truck? We have even less space within which to work. Why can’t we use the same type of tool evolution on a pickup truck as we do with a car, using trunk tunneling?
Let’s consider a pickup truck lying on the driver’s side with a driver entrapped. At this scene, we have already completed the first-due tasks-hazard control, vehicle stabilization, and the start of patient management. We have removed the roof to obtain better access for the patient and for the EMS provider. Just like in a car, remove interior trim to check for supplemental restraint systems (SRS) (photo 1). However, we find that our patient is still pinned by the dashboard and steering column. Since the patient is seated upright, it is difficult to remove him through the roof. Let’s get rid of what’s behind the patient and take him out more in line with his spine. We have removed the roof and managed and removed the rear glass, so let’s look at what else needs to be displaced.
 1. Photos by author. |
First, we have to remove the rear wall of the truck’s bed, then the rear wall of the cab, and finally the rear of the truck’s seat. Sounds pretty simple and straightforward, but is it?
Truck bed. Our first task is to displace the sheet metal of the vertical panel of the truck bed that abuts the rear of the cab. Use a power hydraulic cutter to make an initial access cut at a 90° angle to the lip that runs along the top of the truck bed (photo 2).
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Continue the vertical cut with a reciprocating saw or an air chisel down to the floor of the bed. If using a reciprocating saw, use a short blade, or keep the saw at a steep angle to avoid hitting the rear of the truck cab. Repeat this same cut on the other side of this panel of the truck’s bed. These two cuts are joined by a third horizontal cut along the floor of the truck’s bed. Before making the third cut, if using a reciprocating saw, you can first bend or fold the sheet metal between the two vertical cuts down to the floor of the bed, which will give you more space to cut and make the third cut easier (photo 3).
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Cab. Although the rear cab panel is also primarily sheet metal, you might encounter layers of materials such as steel, plastic trim, and foam insulation. The rear of the cab is cut in the same way as the end of the truck bed.
Make a vertical cut on each side of the rear cab panel down to the floor of the truck cab. As with the rear truck bed panel, the third horizontal cut along the floor of the bed joining the two vertical cuts can be facilitated by bending or folding the cab’s rear section (photos 4, 5).
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 5. |
Seat back. Before removing the seat back, you might want to package the patient in a Kendrick extrication device (KED) or have a backboard in place.A pickup truck might have a bucket seat or a bench seat. Can it be folded or moved? A bench seat usually has only two brackets holding the seat back in place; you can cut them with a power hydraulic cutter fairly easily (photo 6). Remember, however, you will be working in close proximity to the patient, so good patient protection is a must. Also, you might need to “fish” the seat belt ends back through to facilitate moving the bench seat back.
 6. |
Bucket seats may be easier to work with, since many recline. If they do, and the recline mechanism still works, you can recline the seat backward to assist in disentangling the patient. If it does not recline, no problem! Cut the seat-back bracket on each side of the bucket seat. Be careful when doing this, because of the bracket’s flat, angular shape and the types of material that might be present. The bracket might contain boron, and the bracket’s shape can gouge cutter blades.
Although the power hydraulic cutter is a good choice here, be aware that the tool might react as you cut this bracket-again, because of its shape or material. Also look for the presence of side-impact SRS in this area. Once you have finished making your cuts, remove the seat back.
You can now begin to disentangle the patient. First, cover up the many sharp edges on the bed, cab, and seat (photo 7). The key point here is that you might have to manage the patient’s body position as you package him, since you have removed the seat back that might have been supporting him. However, with the seat back out of the way, you can get more “hands” on the patient to assist with moving and packaging, and the removal can be more in line with the patient’s spine.
 7. |
Even though this is a simple basic tool evolution, it shows the need for continuing to look for new methods of making space. We need to find new, creative ways to find that space, since vehicles have become more and more complex and smaller in size.
DAVE DALRYMPLE is a career EMS provider for Robert Wood Johnson University Hospital/St. Peter’s University Hospital Emergency Services in New Brunswick, New Jersey. He is also a firefighter/EMT/rescue technician and former rescue services captain of the Clinton (NJ) Rescue Squad. Dalrymple is the education chair of the Transportation Emergency Rescue Committee-US and serves as the road traffic accident advisor on the Expert Technical Advisory Board of the International Emergency Technical Rescue Institute.
