Vehicle on Roof
Rear Window Extraction

The following technique offers an option for a vehicle on it's roof when the patient has been released from their seatbelt and fallen onto the roof of the vehicle with their head and torso pointing towards the rear of the vehicle.  The advantages of this method are spinal alignment (to protect the spinal cord) is maintained, and body twisting (which can further aggravate fractures and other injuries) is minimised as compared to other techniques available.

 SCENE SETUP

  PREPARE THE PATIENT

Once the vehicle has been stabilised, Officers can enter the vehicle a perform Manual In-Line Stabilisation of the patient’s head. 

If the patient is in the prone position (lying on their front)  as depicted here, a Cervical Collar cannot be applied.

The use of a jacket style Cervical Extrication Device (CED) is very limited in these cases unless the patient is found in an upright sitting position in the vehicle.

 MAKING AN OPENING

To allow for the removal of a patient through a rear window, an opening needs to be made.  Generally removal of, or the faster process of breaking the rear window will be adequate.

To allow for access to the patient, the doors of the vehicle will need to be opened.

In rare cases full side removal will be required for adequate access to the patient. 

Please Note: In this scenario, a full side removal has been undertaken to allow improved viewing of the extraction technique.

  INSERT THE LONG SPINE BOARD

Place a blanket over the broken glass to allow the LSB to easily slide in and out of the vehicle. Failure to do this may result in severe LSB vibration during extraction.  

The patient will usually be found on their stomach or side, however LSB insertion is similar in either   situation. To insert the LSB under the patient, the  patient will need to be lifted using a modified  Side Straddle Lift  technique:

Officer 1 places the LSB at the patient’s head.

Officer 2 positions at the patients head and stabilises the patient's head for the LSB’s insertion.

Officers 3 & 4 are positioned on either side of the patient at the patient’s torso, each placing one hand under the patient’s shoulders and the other hand under the pelvis.

When ready, Officers 2, 3 & 4 raise the patient 3-5 cm whilst Officer 1 slides the Board under the patient until it stops (usually about the patients waist level).

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

Begin the slide out of the vehicle by:

Officer 1  continues to support the LSB.

Officer 2 continues to stabilise the patent’s head  during the slide out of the vehicle onto the LSB.

Officers 3 & 4  positioned on the either side of the Board assist in the sliding of the patient onto the Board by grasping clothes at the shoulders and waist.

The patient is slid up the LSB in 30 cm movements until the patient’s shoulders are level with the     shoulder markings on LSB in preparation for          immobilisation.

Once the patient is correctly positioned of the LSB, slide the LSB out of the vehicle and place it on the ground.

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

If the patient was extracted supine (on their back), immobilise the patient to the LSB.¹

However if the patient was extracted on their side or stomach (as depicted here),  carry the patient to a safe place and log roll the patient using the log-roll 5 person prone 180º technique to get the patient supine, then immobilise.¹

The patient can now be safely carried to the Ambulance stretcher.

• The photos presented above are staged with pre-prepared vehicles.  Protective coverings have been left off the patient for photographic purposes so as to clearly demonstrate the techniques being used.

• All Ambulance, Rescue and Fire staff are referred to as 'Officers' in this presentation.

• In all road accidents, Officers should undertake scene protection from oncoming traffic, perform outer & inner circle checks, control hazards including fuel leaks, establish fire protection of the scene, ensure vehicle stabilisation before entry of the vehicle or any cutting, disconnect batteries, be aware of the dangers of undeployed airbags & ROPS,  maintaining a safe working distances from the deployment path as recommended by your agency.

• Officers should wear Personal Protection Equipment (PPE) as recommended by your agency.

• Officers work gloves should be removed when in direct contact with the patient's skin due to fuel and other contaminants that may have impregnated the gloves.  Only personal protective barrier gloves should be allowed to come in contact with the patient.

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