Editing Vehicle extrication

{{Short description|Process of removing a person trapped in a vehicle}}
[[File:Car crash 1 (cropped).jpg|thumb|294x294px|Crashed car]]
'''Vehicle extrication''' is the process of removing a patient from a vehicle which has been involved in a motor vehicle collision.<ref name=":3">{{Citation |last1=Greaves |first1=Ian |title=Patient rescue and transportation |date=November 2020 |work=Oxford Handbook of Pre-hospital Care |pages=699–722 |url=https://doi.org/10.1093/med/9780198734949.003.0013 |access-date=2024-03-06 |publisher=Oxford University Press |doi=10.1093/med/9780198734949.003.0013 |last2=Porter |first2=Keith|isbn=978-0-19-873494-9 |url-access=subscription }}</ref> Patients who have not already exited a crashed vehicle may be medically (cannot exit a vehicle due to their injuries) or physically trapped,<ref>{{Cite journal |last1=Fenwick |first1=Rob |last2=Nutbeam |first2=Tim |date=2018-04-02 |title=Medical vs. true physical traffic collision entrapment |url=http://www.magonlinelibrary.com/doi/10.12968/jpar.2018.10.4.158 |journal=Journal of Paramedic Practice |language=en |volume=10 |issue=4 |pages=158–162 |doi=10.12968/jpar.2018.10.4.158 |issn=1759-1376|url-access=subscription }}</ref> and may be pinned by wreckage, or unable to exit the vehicle because a door will not open, sometimes the patient can be dead

== Operations ==
Once an incident scene is protected, extrication can commence.  Vehicle extrication can be considered in six phases. These phases are:<ref name=":4">{{Cite journal |last1=Nutbeam |first1=Tim |last2=Fenwick |first2=Rob |last3=Hobson |first3=Charles |last4=Holland |first4=Vikki |last5=Palmer |first5=Michael |date=December 2014 |title=The stages of extrication: a prospective study |url=https://emj.bmj.com/lookup/doi/10.1136/emermed-2013-202668 |journal=Emergency Medicine Journal |language=en |volume=31 |issue=12 |pages=1006–1008 |doi=10.1136/emermed-2013-202668 |pmid=24005643 |s2cid=31692082 |issn=1472-0205|url-access=subscription }}</ref><ref>{{Cite web |title=Team Approach |url=https://www.holmatro.com/en/rescue/blog/team-approach}}</ref><ref name=":3" />

# Safety and Scene Assessment
# Stabilisation and Initial Access
# Glass Management
# Space Creation
# Full Access
# Immobilisation and Extrication
[[File:SV-RTL In Action (16500296669).jpg|thumb|A team of firefighters and rescue technicians secure vehicles during a training operation.|288x288px]]
[[File:Extrication_exercise_by_firefighters_from_Paris_2024_(20).jpg|thumb|Extrication demonstration in Paris]]

=== Safety and Scene Assessment ===
Once a scene is protected, for example from other moving traffic, the fire service commander will complete a rapid assessment to identify any significant hazards<ref>{{Cite web |title=Six stages of extrication |url=https://ukro.academy/wp-content/uploads/2018/09/CC-Six-Stages-of-Extrication.pdf}}</ref> that may present immediate risks to emergency service workers, members of the public or the patient or patients. This may include fire, hazardous substances, the risk of falling from a height, or being electrocuted or injured by falling masonry from a damaged building. Steps are then taken to mitigate these risks.

=== Stabilisation and Initial Access ===
==== Stabilisation can be thought of as three phases. ====
[[File:Crashed Renault Kangoo (3).jpg|thumb|A crashed car being stabilised]]
'''Phase 1''' is rapid stabilisation, these are simple methods to improve vehicle stability:

*Applying a parking brake
*Applying a wheel chock
*Applying a winch wire
*Deflating tyres (this may compromise subsequent rescue efforts and forensic investigations)
*Electrically isolating the vehicle
*Using personnel to brace the vehicle

'''Phase 2''' is stabilisation achieved using chocks and wedges under and around the vehicle.

'''Phase 3''' is the use of additional equipment to stabilise a vehicle. This may be more complex and include:
*Hydraulic/pneumatic stability equipment
*Lifting bags
*Struts

=== Glass Management ===
Glass management involves controlling the risk posed by the windows of the vehicle.<ref>{{Cite web |title=Glass management is more than breaking glass |url=https://www.holmatro.com/en/rescue/blog/glass-management-more-breaking-glass}}</ref> This is not just the removal of the vehicle’s windows: it must also include the control of any glass fragments which may pose a risk to the patient and attending emergency service personnel, or which could damage equipment, especially hydraulic hoses.{{Cn|date=March 2024}}

=== Space Creation ===
The space creation step starts with a structural assessment of the involved vehicle to determine which vehicle components could be simply opened, moved, or manipulated by utilising a vehicle’s natural design features.<ref name=":4" />  This would include opening doors, windows or sunroofs and moving/removing seats or headrests.  Beyond that, an extrication plan will be formulated which details which vehicle body parts will need to be removed, displaced or reformed to allow access to the patient or patients.<ref name=":5">{{Cite web |title=Space Creation |url=https://ukro.academy/space-creation/ |access-date=2024-03-06 |website=UKRO |language=en-GB}}</ref> A number of specific techniques can be utilised and these are discussed later.

Consideration should also be given to moving the vehicle involved in the incident if that will aid space creation.<ref>{{Cite web |title=Vehicle relocation at RTCs |url=https://www.linkedin.com/pulse/vehicle-relocation-rtcs-james-coomber |access-date=2024-03-06 |website=www.linkedin.com |language=en}}</ref><ref>{{Citation |title=Vehicle Relocation with casualty & HEMS medic in situ. |url=https://www.youtube.com/watch?v=iywzdNHKPEY |access-date=2024-03-06 |language=en}}</ref> Moving vehicles with patients still inside is permissible if deemed safe. Relocation of crashed vehicles may:

* Improve safety
* Reduce rescue times
* Provide better access to the casualty

=== Full Access ===
Full access aims to ensure that there is enough space to meet and exceed a patient's clinical requirements and to meet the needs of emergency service personnel.<ref name=":3" /> Space creation should allow access for medically trained responders to reach the patient. They can assess the patient and if required undertake medical interventions: for example, stopping bleeding, opening obstructed airways, providing medications such as [[Oxygen therapy|oxygen]] or [[tranexamic acid]].{{Cn|date=March 2024}}

=== Immobilisation and Extrication ===
It used to be thought that individuals involved in road traffic collisions needed extremely careful handling, including the use of cervical spine collars and spinal immobilisation boards. This is not however supported by the available evidence base.<ref>{{Cite news |last1=Geddes |first1=Linda |last2=correspondent |first2=Linda Geddes Science |date=2022-07-06 |title=Doctors to overhaul car wreck rescue techniques amid new evidence |url=https://www.theguardian.com/uk-news/2022/jul/06/doctors-to-overhaul-car-wreck-rescue-techniques-amid-new-evidence |access-date=2024-03-06 |work=The Guardian |language=en-GB |issn=0261-3077}}</ref><ref>{{Cite journal |last1=Nutbeam |first1=Tim |last2=Fenwick |first2=Rob |last3=May |first3=Barbara |last4=Stassen |first4=Willem |last5=Smith |first5=Jason E. |last6=Bowdler |first6=Jono |last7=Wallis |first7=Lee |last8=Shippen |first8=James |date=2022-01-15 |title=Assessing spinal movement during four extrication methods: a biomechanical study using healthy volunteers |journal=Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |volume=30 |issue=1 |pages=7 |doi=10.1186/s13049-022-00996-5 |doi-access=free |issn=1757-7241 |pmc=8760816 |pmid=35033160}}</ref> Patients should be encouraged or assisted to self-extricate from the crashed vehicle as a first-line extrication plan, unless:<ref>{{Cite web |title=Control measure - Casualty-centred rescue from a mode of transport: Initial actions |url=https://nfcc.org.uk/control-measure/control-measure-casualty-centred-rescue-from-a-mode-of-transport-initial-actions/ |access-date=2024-03-06 |website=NFCC |language=en-GB}}</ref><ref>{{Cite web |title=Self-extrication in road traffic collisions: do we really need to cut the roof off? |url=https://www.paramedicpractice.com/features/article/self-extrication-in-road-traffic-collisions-do-we-really-need-to-cut-the-roof-off |access-date=2024-03-06 |website=Journal Of Paramedic Practice |language=en}}</ref>

* the patient cannot understand or follow instructions, or
* the patient is unable to stand (or it is suspected that they would be unable to stand) on at least one leg, due either to injury or to another condition, for example:
** Impalement
** Suspected pelvic fracture
** Suspected or confirmed bilateral leg fractures
** Signs of head injury (significant dizziness or confusion)

If extrication is required, patients should not be transported on a rigid extrication (spinal) board,<ref>{{Cite web |title=Are cervical collars effective and safe in prehospital spinal cord injury management? |url=https://www.paramedicpractice.com/other/article/are-cervical-collars-effective-and-safe-in-prehospital-spinal-cord-injury-management |access-date=2024-03-06 |website=Journal Of Paramedic Practice |language=en}}</ref> as this can cause pressure injuries, and false positives on later examination of the back.<ref>{{Cite journal |last1=Oomens |first1=C.W.J. |last2=Zenhorst |first2=W. |last3=Broek |first3=M. |last4=Hemmes |first4=B. |last5=Poeze |first5=M. |last6=Brink |first6=P.R.G. |last7=Bader |first7=D.L. |date=August 2013 |title=A numerical study to analyse the risk for pressure ulcer development on a spine board |url=https://doi.org/10.1016/j.clinbiomech.2013.07.005 |journal=Clinical Biomechanics |volume=28 |issue=7 |pages=736–742 |doi=10.1016/j.clinbiomech.2013.07.005 |pmid=23953331 |issn=0268-0033|url-access=subscription }}</ref><ref>{{Cite journal |last1=March |first1=Juan A. |last2=Ausband |first2=Stephen C. |last3=Brown |first3=Lawrence H. |date=January 2002 |title=C Hanges in P Hysical e Xamination C Aused by U Se of S Pinal I Mmobilization |url=http://www.tandfonline.com/doi/full/10.1080/10903120290938067 |journal=Prehospital Emergency Care |language=en |volume=6 |issue=4 |pages=421–424 |doi=10.1080/10903120290938067 |pmid=12385610 |s2cid=23309499 |issn=1090-3127|url-access=subscription }}</ref><ref>{{Cite journal |last1=Ham |first1=Wietske |last2=Schoonhoven |first2=Lisette |last3=Schuurmans |first3=Marieke J. |last4=Leenen |first4=Luke P.H. |date=April 2014 |title=Pressure ulcers from spinal immobilization in trauma patients: A systematic review |url=https://journals.lww.com/01586154-201404000-00033 |journal=Journal of Trauma and Acute Care Surgery |language=en |volume=76 |issue=4 |pages=1131–1141 |doi=10.1097/TA.0000000000000153 |pmid=24662882 |s2cid=23746350 |issn=2163-0755|url-access=subscription }}</ref> Cervical collars do not adequately protect the neck,<ref>{{Cite journal |last1=Horodyski |first1=MaryBeth |last2=DiPaola |first2=Christian P. |last3=Conrad |first3=Bryan P. |last4=Rechtine |first4=Glenn R. |date=November 2011 |title=Cervical Collars are Insufficient for Immobilizing an Unstable Cervical Spine Injury |url=https://doi.org/10.1016/j.jemermed.2011.02.001 |journal=The Journal of Emergency Medicine |volume=41 |issue=5 |pages=513–519 |doi=10.1016/j.jemermed.2011.02.001 |pmid=21397431 |issn=0736-4679|url-access=subscription }}</ref> but they raise intracranial pressure,<ref>{{Cite journal |last1=Kolb |first1=James C |last2=Summers |first2=Richard L |last3=Galli |first3=Robert L |date=1999-03-01 |title=Cervical collar-induced changes in intracranial pressure |url=https://www.sciencedirect.com/science/article/pii/S073567579990044X |journal=The American Journal of Emergency Medicine |volume=17 |issue=2 |pages=135–137 |doi=10.1016/S0735-6757(99)90044-X |pmid=10102310 |issn=0735-6757|url-access=subscription }}</ref><ref>{{Cite journal |last1=Raphael |first1=J. H. |last2=Chotai |first2=R. |date=May 1994 |title=Effects of the cervical collar on cerebrospinal fluid pressure |url=https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1994.tb03482.x |journal=Anaesthesia |language=en |volume=49 |issue=5 |pages=437–439 |doi=10.1111/j.1365-2044.1994.tb03482.x |pmid=8209990 |issn=0003-2409}}</ref> impede airway management<ref>{{Cite journal |last1=Yuk |first1=Moonsu |last2=Yeo |first2=Woonhyung |last3=Lee |first3=Kangeui |last4=Ko |first4=Jungin |last5=Park |first5=Taejin |date=2018-03-30 |title=Cervical collar makes difficult airway: a simulation study using the LEMON criteria |journal=Clinical and Experimental Emergency Medicine |language=English |volume=5 |issue=1 |pages=22–28 |doi=10.15441/ceem.16.185 |issn=2383-4625 |pmc=5891742 |pmid=29618189}}</ref> and cause pressure ulcers,<ref>{{Cite journal |last=Powers |first=Jan |date=October 1997 |title=A Multidisciplinary Approach to Occipital Pressure Ulcers Related to Cervical Collars |url=https://journals.lww.com/jncqjournal/Abstract/1997/10000/A_Multidisciplinary_Approach_to_Occipital_Pressure.8 |journal=Journal of Nursing Care Quality |language=en-US |volume=12 |issue=1 |pages=46–52 |doi=10.1097/00001786-199710000-00008 |pmid=9309916 |issn=1057-3631|url-access=subscription }}</ref><ref>{{Cite journal |last=Walker |first=J. |date=July 2012 |title=Pressure ulcers in cervical spine immobilisation: a retrospective analysis |url=http://www.magonlinelibrary.com/doi/10.12968/jowc.2012.21.7.323 |journal=Journal of Wound Care |language=en |volume=21 |issue=7 |pages=323–326 |doi=10.12968/jowc.2012.21.7.323 |pmid=22886331 |issn=0969-0700|url-access=subscription }}</ref><ref>{{Cite journal |last1=Tafti |first1=Abbas Abdoli |last2=Sajadi |first2=Sanaz |last3=Rafiei |first3=Hossein |date=October 2015 |title=Pressure ulcer stage IV caused by cervical collar in patients with multiple trauma in intensive care unit |journal=International Wound Journal |language=en |volume=12 |issue=5 |pages=606–607 |doi=10.1111/iwj.12158 |issn=1742-4801 |pmc=7950713 |pmid=24102782}}</ref> and their routine use is not advised in the developed world,<ref>{{Cite journal |last1=Sundstrøm |first1=Terje |last2=Asbjørnsen |first2=Helge |last3=Habiba |first3=Samer |last4=Sunde |first4=Geir Arne |last5=Wester |first5=Knut |date=2014-03-15 |title=Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review |journal=Journal of Neurotrauma |volume=31 |issue=6 |pages=531–540 |doi=10.1089/neu.2013.3094 |issn=0897-7151 |pmc=3949434 |pmid=23962031}}</ref><ref>{{Cite web |date=2019 |title=INTERNATIONAL TRAUMA LIFE SUPPORT: THE USE OF CERVICAL COLLARS IN SPINAL MOTION RESTRICTION |url=https://www.itrauma.org/wp-content/uploads/2019/05/Current-Thinking-Cervical-Collar-Use-in-SMR-May-2019.pdf |website=International Trauma Life Support}}</ref> and if used they should be loosened at the earliest opportunity.<ref>{{Cite web |title=Prehospital spinal immobilisation |url=https://fphc.rcsed.ac.uk/media/1764/pre-hospital-spinal-immobilisation.pdf |website=Royal College of Surgeons of Edinburgh}}</ref>

==Extrication tools and equipment==
[[File:Iceman in action 150306-F-YW474-181.jpg|thumb|397x397px|U.S. Air Force Civil Engineer Squadron firefighter, holding a spreader, a hydraulic vehicle extrication tool designed to free crash victims from automobile wreckage and other rescues from small spaces.]]
Rescue personnel may use a number of powered rescue tools to extricate victims. There are three main types of powered rescue tools including:
* [[Hydraulic Rescue Tools|Hydraulic rescue tools]] – Rescue tools powered by a hydraulic pump. The pump may be powered by hand, an electric motor or a gasoline engine. They may be portable or mounted to a vehicle. There are 4 basic types of hydraulic rescue tools: 
** Spreaders, 
** Shears (Often referred to as the [[Hydraulic rescue tool|Jaws of Life]]), 
** Combination spreader/shears, 
** Extrication extension rams.<ref name=":0">{{Cite news|url=https://www.firerescue1.com/fire-products/Extrication-Tools-Cutters-and-Spreaders/articles/2196040-Rescue-tools-Pros-and-cons-of-3-power-sources/|title=Rescue tools: Pros and cons of 3 power sources|website=FireRescue1|language=en|access-date=2019-02-26}}</ref>
* [[Pneumatic]] rescue tools – Rescue tools that are powered by pressurized air. The pressurized air is sourced from [[Self-contained breathing apparatus|SCBA cylinders]], vehicle mounted cascade systems or air compressors. Saws, Air bags, air shores and air chisels are examples of pneumatically powered rescue tools.<ref name=":0" />
*[[Electric power|Electric]] rescue tools – Rescue tools that are powered by electrical power. Powered through power cords linked to electricity generators and through batteries. Reciprocating saws, spreaders, shears, extension rams, and spreader/shears can all be electrically powered.<ref name=":0" />
 
Stabilization tools include:
* [[Jack (device)|Hydraulic and nonhydraulic jacks]] – Designed to lift the vehicle.
* Buttress Tension System – A buttress tension system is used to stabilize a vehicle resting on its side or top. It may consist of a minimum of three 4 x 4 inch posts wedged between the vehicle and the ground, or it may be a system composed of metal rods and straps. The exact placement varies by the condition and weight of the vehicle as well as what the vehicle is resting on.
* [[Wheel chock]] – Wheel chocks are used to stabilize vehicles resting on their wheels. They are commonly constructed of aluminum, hard rubber, wood, or urethane plastic.{{Cn|date=March 2024}}
* [[Box crib|Cribbing]] – Cribbing consist of wood or plastic blocks that are made in a variety of shapes and sizes.<ref name=":1">{{Cite news|url=https://www.fireengineering.com/articles/print/volume-169/issue-9/departments/the-rescue-company/maximizing-your-tool-cache.html|title=Login|newspaper=Fire Engineering: Firefighter Training and Fire Service News, Rescue|date=September 2016|access-date=2019-02-26}}</ref>
* Pneumatic lifting bag – Pneumatic lifting bags are air-pressurized devices that lift objects. They come in three basic types: high-pressure, medium-pressure and low-pressure. They are usually made with a rubber exterior reinforced with steel wire or Kevlar. When deflated they are about one inch thick.{{Cn|date=March 2024}}
* [[Winch]]<nowiki/>es – Winches are usually vehicle mounted. They are used in conjunction with chains or cables.<ref name="IFSTA 6th Edition Essentials of Fire Fighting">{{cite book|title=Essentials of Fire Fighting|publisher=Fire Protections Publications Oklahoma State University|pages=479–549|edition=6th}}</ref>

Other equipment that can be used during a vehicle extrication include but are not limited to:

* [[Rotary saw|Gasoline rotary saw]] – A well-maintained gasoline rotary saw can be fitted with various blades: carbide toothed blades, abrasive blades, and diamond blades are among the common blade choices for rescue operations.<ref name=":1" />
* [[Reciprocating saw]] – This is a versatile tool, the blades for reciprocating saws have undergone recent changes in composition. High-end carbide-tipped blades have had proven results in the fire service and can cut boron.<ref name=":1" />
* [[Angle grinder]]s<ref name=":1" />
* [[Impact wrench]]/[[air ratchet]] – when paired with the right sockets, will speed up disassembly tasks. Air chisels are also ideal for rescue work. Depending on the tool size, capabilities may range from sheet metal to plate steel. Larger style air chisels are also effective on concrete.<ref name=":1" />
* [[Oxy-fuel welding and cutting|Oxy-fuel cutting torches]]  may be oxygen gasoline, oxygen, acetylene, or exothermic type torches. Space limitations on the rig often determine the size of the cylinders and, therefore, the torch capabilities.<ref name=":1" />
* [[Tempered glass|Tempered]] and [[Laminated glass|laminated]] [[Glass breaker|glass removal tools]] – Tools designed specifically for glass removal are more appropriate than traditional forcible-entry tools. They create less shock to the vehicle and limit patient compartment intrusion.<ref name=":2">{{Cite web|url=https://www.firerescuemagazine.com/articles/print/volume-8/issue-9/extrication/5-essential-extrication-tools.html|title=5 Essential Extrication Tools|website=www.firerescuemagazine.com|access-date=2019-02-26}}</ref>
* [[Pliers]], [[Adjustable spanner|adjustable wrench]]es, [[screwdriver]]s, etc. – Tools such as these can be used to disconnect the 12-volt battery system; remove interior trim at all push, pull and cut locations; disassemble vehicle components, etc.<ref name=":2" />
* [[Wire cutter]]s and [[seatbelt cutter]]s – Almost any disentanglement tactic requires wires and/or seatbelts to be severed for the complete removal of components. Having easy, quick tools readily available makes quick work of these tedious tasks.<ref name=":2" />
* [[Utility knife|Razor knife]] – A sharp blade can be used to expose upholstered areas during operations.<ref name=":2" />

== Vehicular Technical Rescue Techniques ==
[[File:Extrication exercise (1).jpg|thumb|Roof removal being demonstrated]]
These include:<ref name=":5" />

* Roof removal
* Roof flap
A roof flap can be undertaken forwards, backwards or sideways. The technique is similar for all three, but the direct the roof is "folded" differs.  The steps to perform this technique (forwards) would include:<ref>{{Cite web |date=2012-02-01 |title=University of Extrication: Roof Removal Evolutions |url=https://www.firehouse.com/rescue/vehicle-extrication/article/10615842/university-of-extrication-roof-removal-evolutions |access-date=2024-03-06 |website=Firehouse}}</ref>

# Remove the glass from all side and rear windows
# Cut all seatbelts
# Strip trim around cutting points
# Cut all roof pillars except front A-pillars
# Cut “hinge” cuts in roof rail at windshield at the front of the car
# Flap roof forward and secure in position
# Cover sharps
* Pedal displacement
* B-post rip
Removal of the B-post or [[Pillar (car)|B-Pillar]] of a vehicle to allow improved access. The B-pillar is located between a vehicle's front and rear side glass, where it serves as a structural support of its roof, its removal leaves the side of a car wide open.{{Cn|date=March 2024}}
* Third Door creation
Third door creation (or conversion) provides additional access to patients in 2 door cars.<ref>{{Cite web |title=Extrication "Quick Tip" #53 (THE 3RD DOOR) – Fire Engineering Training Community |url=https://community.fireengineering.com/m/blogpost?id=1219672:BlogPost:626173 |access-date=2024-03-06 |website=community.fireengineering.com}}</ref>
* Dash roll
The dashboard and steering column can intrude into the passenger compartment and crush a patient or restrict their movement. A dash roll, or dash relocation aims to create space by moving the dashboard away from the patient.<ref>{{Cite web |last=Soda |first=Chris |date=2022-09-12 |title=Technical Rescue: Cut-Less Dash Displacement |url=https://www.firehouse.com/rescue/vehicle-extrication/article/21276132/removing-a-vehicle-dashboard-more-quickly-than-typically-can-increase-the-chances-of-saving-a-trapped-occupant |access-date=2024-03-06 |website=Firehouse}}</ref>

==Additional risks==

=== Airbags ===
[[File:Paramedics extract a patient in a car accident.jpg|thumb|Paramedics successfully extract the victim of a crash in [[Toronto]]]]
Active systems such as [[airbag]]s make cutting into a vehicle more complicated: when they are not set off during the crash (e.g. in a vehicle struck from the rear or a [[Vehicle rollover|rollover]]), extrication operations may set them off. This can cause additional [[Traumatic brain injury|trauma]] to the victim or to the rescuers.{{Cn|date=March 2024}} Airbags can remain active anywhere from 5 seconds to 20 minutes after being disconnected from the car's battery.{{Cn|date=March 2024}} This is one of the reasons rescuers disconnect the vehicle's battery and wait before cutting into a vehicle.{{Cn|date=March 2024}}

=== Hood Hinge Struts ===
Hood hinge [[strut]]s can pose a great amount of danger to rescuers who are extricating a victim from a car that had any significant heat in the engine compartment. According to the strut manufacturers, these sealed and pressurized struts are designed to operate at temperatures ranging from 40 degrees [[Fahrenheit]] to 284 degrees Fahrenheit.{{Cn|date=March 2024}} No manufacturer could provide any evidence that any testing at temperatures above 284 degrees Fahrenheit had ever been conducted. During a vehicle fire, especially an engine compartment fire, the two hood hinge struts will be exposed to high heat levels. Since there is no pressure relief "valve" on any of these sealed and pressurized struts, the units can fail violently when overheated.{{Cn|date=March 2024}} Unfortunately for firefighters, this failure can actually "launch" the entire strut or just one part of the unit a significant distance off the vehicle like an unguided missile. It is the launching of the heated strut that in several incidents across the United States, has caused serious injury to firefighters.<ref>{{Cite web|url=https://www.firehouse.com/rescue/article/10502463/pressurized-vessels-on-vehicles-part-2-pressurized-strut-challenges|title=Pressurized Vessels On Vehicles: Part 2 Pressurized Strut Challenges|website=Firehouse|date=September 2005 |language=en|access-date=2019-02-26}}</ref>

=== Hybrid Cars ===
New [[Hybrid car|hybrid]] technologies also include additional high voltage batteries, or batteries located in unusual places. These can expose occupants and rescuers to shock, acid or fire hazards if not dealt with correctly.{{Cn|date=March 2024}}

=== Liquid Petroleum Gas ===
Some vehicles have an additional [[Autogas|autogas (LPG)]] tank. As the system was not built in, there is a risk of damaging the pipe which is often under the car, releasing the pressurized fuel. The risk of this is minimized by locating the line in a protected position during installation. Modern installations also have a shutoff solenoid at the tank so that rupture will only release the fuel in the line rather than allowing fuel to come out of the tank.{{Cn|date=March 2024}}

== Specific Extrication Challenges ==
Car manufacturers are increasingly using [[ultra-high-strength steel]] (UHSS) to the crash safety ratings of their vehicles. UHSS is used in areas of the vehicle such as the [[A-pillar]], [[B-pillar]], rockers, [[side impact beam]]s, and roof beams. This steel is difficult to cut with the standard extrication tools.{{Cn|date=March 2024}}

Carbon fibre poses unique challenges when used to manufacture vehicles.  It is light and strong and can be difficult to cut.  In addition cutting this material can produce particulates which are harmful to health, and breathing protection is required for rescuers and the casualty.<ref>{{Cite web |last=Moore |first=Ron |date=2015-08-01 |title=University of Extrication: Identifying Carbon Fiber in Vehicles—Part 3 |url=https://www.firehouse.com/rescue/vehicle-extrication/article/12084326/university-of-extrication-identifying-carbon-fiber-in-vehicles |access-date=2024-03-06 |website=Firehouse}}</ref>

==See also==
{{commonscat|Vehicle extrication}}
*[[Hydraulic rescue tools]]
*[[Traffic collision]] 
*[[Heavy rescue vehicle]]
*[[Rescue squad]]
*[[Tram accident]]
*[[Vehicle recovery]]
*[[Firefighting]]

==References==
{{Reflist}}

== External links ==
* [https://www.amazon.com/Vehicle-Extrication-Levels-Principles-Practice/dp/1449648827 Vehicle Extrication: Levels I & II: Principles And Practice [Paperback<nowiki>]</nowiki>]
* [https://www.amazon.com/Bumper-Extrication-inside-Auto-Industry/dp/B0BN277LWL Bumper to Bumper Extrication: Extrication from inside the Auto Industry [Paperback/ebook<nowiki>]</nowiki>]
* [https://web.archive.org/web/20110716143906/http://www.firehouse.com/university-of-extrication Ron Moore's University of Extrication on Firehouse.com]
*[http://www.boronextrication.com/   Extrication information on Vehicle Body Structures]
*[http://www.rescue-sim.com/   Vehicle Extrication Training and Training videos]
*[https://itunes.apple.com/app/irescue/id483566831?mt=8   iRescue: App for iPhone/iPad to help the emergencie professionals to get information about a car in rescue situations ]{{dead link|date=March 2025|bot=medic}}{{cbignore|bot=medic}}
*[https://web.archive.org/web/20050628094947/http://www.neann.com/vet.pdf Vehicle extraction technics] ([[PDF]] file, 70p, 4.9 Mb)

{{Road accidents}}

[[Category:Rescue]]
[[Category:Automotive safety]]
[[Category:Traffic collisions]]