Extrication from an overturned vehicle

A vehicle overturned on its roof is not an everyday situation in vehicle extrication, forcing rescuers to decide, based on the patient’s condition, whether to perform a safe extrication along the patient’s long body axis or to conduct an immediate extrication through the opened door.

The decision must be made quickly as the patient has generally been suspended upside down in the seat belt for 10-15 minutes at this point. Time is of the essence not only because of the patient’s orientation, so all unnecessary activities should be avoided and the individual rescue modules should be worked through purposefully and in parallel. Righting an overturned vehicle would be inadvisable due to the high risk of further injury to the vehicle’s occupants.

Securing the vehicle includes securing the accident site, assessing the situation, fire safety and securing the vehicle with a sturdy support.

Due to the weight of its engine, an overturned vehicle will often come to rest with its rear end pointing slightly upward. A quick initial stabilisation with wedges positioned in the area of the rear corners of the roof allows the ‘inside rescuer’ to make a rapid assessment of the patient’s condition after establishing initial contact. Initial contact can be achieved through a window broken during the accident or through a window, removed at a safe distance from the patient, during glass management. Immediately afterwards, a decision about the rescue method must be made to decide whether to adopt patient-friendly safe extrication or immediate extrication. Regardless of the selected method, during the rescue activities the patient should be supported from the back by an additional rescuer in the vehicle.

Access through the rear end can be expanded for safe extrication by removing the rear door or window and removing the rear seat backrests or the complete back seats. At the same time, open the door next to the patient for emergency access.

If the patient’s condition deteriorates, this door can be used to quickly perform an immediate extrication after freeing the patient. However, rescue via a door involves a risk of further injuries.

Particularly while creating the rescue opening (so-called tunnelling), every action needs to be scrutinised and assessed in terms of the time involved – could there be a faster and simpler approach?

Battery management must also be considered carefully for this kind of accident. Even if the battery is accessible it should not necessarily be disconnected – many modern cars have battery- operated seats and without the battery power it may not be possible to adjust their position to facilitate the extrication.

As part of a safe extrication, in addition to partial or complete removal of the back seat bench, the vehicle can be hinged open like a clamshell if needed in order to make more room for the patient. Make cuts on the C (D) and B pillars and the edges of the roof in front of the vehicle’s support points. When cutting the B pillars, ensure that the cut is positioned between the roof and the seat belt shoulder bracket. However, before starting work, consider whether the extrication can also be performed without the clamshell approach and expanded tunnelling, or which benefits compensate for the additional time required.

To free the legs, a spreader or rescue ram can be used to enlarge the footwell under the dashboard. Shortening the vehicle’s steering wheel spokes at this stage can make the rescue easier at the later stage.

The transfer to the ambulance or the actual extrication from the vehicle calls for good coordination among the rescuers. The patient should be pressed upwards into the seat by two rescuers so that the spinal column is guided by the rearward movement of the seat back. At the same time, insert a spineboard or scoop stretcher into the footwell between the patient’s thighs and the dashboard. Match the upward movement of the seat by slowly pushing the stretcher upwards. The movement of the seat back must be slow and smooth so that the patient cannot lose contact with the seat. When the separation between the pelvis and the spineboard or scoop stretcher is small enough, cut the belt and extricate the patient from the vehicle face-down and in the direction of the long axis of the body.

An experienced team can perform the extrication from an overturned vehicle in around 12 minutes if the patient is not trapped. If it is necessary to free a trapped patient, the rescue can last up to 45 minutes.