Extrication Tips: Article One
Cross-ramming for severe side impact intrusion:
When dealing with severely trapped occupants from a side impact intrusion where the patient is wedged between the B-pillar (or post) and the seat, or their feet are trapped in the foot well, history has shown that most latch or hinge side front/rear door attacks usually result in the B-pillar being pushed farther into the patient. This is due to the metal being weakened which causes the B-pillar to follow the path of least resistance moving inward toward the patient. This will certainly cause more pain and suffering to our already distressed patient.
One option that has been proven successful for severe intrusion into the passenger compartment is cross-ramming. What this technique will do is push the impacted side of the vehicle back out to its near original position so the necessary requirements for patient removal can be done.
The procedures for using the cross-ramming technique are as follows:
First strip the trim off the B-pillar you are going force outward to ensure you will not be pushing against any seatbelt pretensioners when your ram is in place. Also ensure all glass is removed from the affected area.
Insert a long ram with extension attached and position the base of the ram against the opposing rear door near the latch side or rocker channel at a slight angle of the side of the vehicle you want to push out.
The most ideal position to place the base of the ram for strength is generally the rocker channel or bottom of the B-pillar, however, there may not be the space needed to insert it in these areas depending on the severity of the crash. You may have to position the ram base in less than desired areas.
Again ensure that you will not be pushing on or against undeployed side airbag systems especially on the non-impact side. (Strip before you rip!) It is quite possible that the ram will start to push out the non-impacted side first while extending; if this is the case you can distribute the force of the push over a larger area if you insert a 4×6" wedge or other type of cribbing between the ram base and the door. This should create more resistance on the ram base side.
If you choose this method, the tool operator must monitor the procedure very closely for any sign of potential failure of the wood or slipping of the ram.
Wrap a chain around the C-pillar, rear door and window frame to keep it from flying open from the force of the ram when extending.
You may now extend the ram. Push slowly until you have created enough room to make a cut at the top of the B-pillar you are pushing out. This cut may or may not be needed, but if left intact, the forcing of the B-pillar outward sometimes tends to pull the roof down very close to the patient’s head. (Always remember to use hard protection when making cuts near the patient). Once the cut has been made, continue to extend ram until the B-pillar is no longer in contact with the patient.
(Tip: If the vehicle is rear-wheel drive you can try to ram off the transmission hump in the middle of the floorboard by inserting the base of a short ram against the hump and the tip against the B-pillar. In using this method you may find it hard to get a good bite if the angle is too great, which may cause the tip to slip out when extending the ram.)
Once you are confident the side of the vehicle is pushed back out far enough, you may continue with common door removal tactics such as a “Total Side Wall Removal/Fifth Door Conversion” to create an egress for your patient.
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