Vehicle on Roof
Rear Window Extraction

The following technique offers an option for a vehicle on it's roof with the patient still strapped in their seatbelt.  The advantages of this method are the removal from the seatbelt can be achieve rapidly compared to other methods, spinal alignment 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 and perform Manual In-Line Stabilisation of the patient’s head.

 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, but a clear benefit is needed to justify the extra time.² 

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

Officers are positioned at the following places:

Officers 1 & 2 are positioned on either side of the patient’s torso - Officer 1 outside the vehicle and Officer 2 inside the vehicle.

Officer 3 & 4 are positioned on either side of the patient’s pelvis - Officer 3 outside the vehicle and Officer 4 inside the vehicle.

Officer 5 is positioned at the rear of the vehicle and  controls the insertion of the LSB under the patient.

Officer 3 positioned at the patient’s pelvis rotates the back of the seat rewards as far at it will go as it is providing no support for the patient.

Officer 1 & 2 positioned at the patients torso then insert a jacket style Cervical Extrication Device (CED) under the patient. Using the CED as a torso splint, rotate the patients torso upwards towards the back of the seat. It may be of benefit if time persists to attach the chest straps for improved stability.

It will be necessary for the patients head to be carefully rotated to the side by Officer 5 for application of the CED. 

Officer 5 positioned at the rear of the vehicle places a blanket over the broken glass of the rear window 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. Officer 5 then inserts the LSB through the rear window and into the steering wheel for stability, and for reduced dropping height of the patient when released from the seatbelt.

Officer 3 positioned at the patient’s pelvis assists  Officer 5 ensuring the LSB is inserted into the steering wheel.

Officer 4  cuts the patient’s seatbelt.

Officers 3 & 4 positioned at the patient’s pelvis uses the seatbelt to lower the patient onto the LSB, and ensure the patient’s legs rotate either side of the steering wheel.

Officers 1 & 2 positioned at the patient’s torso, at the same time, support the patient in the horizontal position with the CED, slowly lowering the patient onto the LSB in conjunction with Officers 3 & 4.

  SLIDE PATIENT ONTO THE LONG SPINE BOARD

Begin the slide out of the vehicle on the LSB by:

Officers 1 & 2  positioned on the either side of the patient's torso assist in the sliding of the patient onto the LSB by grasping handles on the CED.

Officers 3 & 4  positioned on the either side of the patient's pelvis assist in the sliding of the patient onto the LSB by grasping the patients clothes at the pelvis.

Officer 5  continues to support the LSB to prevent the LSB from slipping out of the steering wheel.

The patient is slid up the LSB in 30 cm movements until the patients shoulders are level with the shoulder markings on LSB.

Once the patient is correctly positioned of the LSB, slide the LSB carefully out of the steering wheel and out of the vehicle, placing it on the ground.

IMMOBILISE PATIENT TO THE LONG SPINE BOARD

With the patient extracted prone (on their stomach) carry the patient to a safe place and log roll the patient using the 180º 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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