Vehicle on its Side: Extrication Options

Fewer Options, but More Control

With a vehicle on its wheels, we typically have many choices: various doors or windows for access, multiple ways to create space, or even completely relocating the roof. 

However, when a vehicle is on its side, the options are limited. This may seem like a disadvantage at first, but in practice, it can actually provide more control and faster decision-making. Fewer choices often mean a clearer strategy.

Points of Consideration

Injury Pattern

A vehicle on its side may have rolled multiple times. This increases the risk of serious injury to occupants, especially if they have been unbelted. Rapid access is essential in these situations to enable time-critical medical procedures (such as airway management).  

Stability

Stability is often severely compromised, especially on uneven terrain. The vehicle must be stabilized in such a way that it does not impede access and does not pose risks during extrication. Use, for example, props or straps to prevent movement. 

Safety and Risks

A vehicle on its side increases the risk of fuel, coolant, or oil leaks. The catalytic converter can also become exposed and radiate heat. 

• Be aware of the fire hazard and use protective equipment if possible. 
• Remain alert for leaking fluids and have fire extinguishers on standby. 
• Work as much as possible outside the fall and leak zones of the vehicle. 

Access and Roof Flaps

Access to the vehicle is usually through the rear (tailgate or rear window). The most common method for full access is to fold down the roof by cutting through all A, B, and C pillars (and, if present, the D pillars as well). The photo accompanying this blog shows how rescuers work with a car whose underside is against an obstacle. The advantage of this is that the roof is completely exposed and therefore easily accessible for rescue equipment. 

Avoiding Glass Management 

If the doors remain closed, the glass in the doors should be managed (taped and/or broken). The risk is that glass will fall from above into the interior, potentially onto the victim or medical personnel. 

Opening the doors before cutting the pillars largely eliminates the need for glass management. The door can be held open with a strap or by a team member. After cutting, the door can be closed again. This saves time and protects both the victim and the rescuers. 

Alternative Scenarios 

Not every vehicle is ideally positioned on its side. 

• With the underside against an obstacle (as in the photo): a roof flap is often the fastest and safest option. 
• With the roof against an obstacle: a roof flap is not possible. In that case, tunneling through the tailgate can be a solution, with seats being removed or pushed aside to access the victim. 
• Returning the vehicle to its wheels: Increasingly, after consultation with medical personnel, the decision is made to return the vehicle to its wheels in a controlled manner. This can significantly simplify extrication, provided it is done safely and in a controlled manner. 

Increased Emphasis on Patient Care

Working in a vehicle on its side is already challenging for firefighters. If medical personnel also need to be inside the vehicle to stabilize the victim, the complexity increases even further. 

Therefore, the victim’s condition remains paramount: it determines how much time is available and which extrication technique is most appropriate. Sometimes the medical urgency requires rapid, direct access; in other cases, there is time to choose a controlled and less risky approach. 

Practical Example 

In an accident where a vehicle came to rest on its side against a tree, a roof flap was chosen. The vehicle was first stabilized with shoring. Because the victim was unresponsive and had difficulty breathing, access had to be obtained quickly. By lowering the roof, medical personnel were able to quickly access the victim and clear the airway. Thanks to the clear division of labor between the fire department and paramedics, the victim was quickly extricated and transferred to the ambulance. 

Conclusion 

A vehicle on its side presents unique challenges, but also opportunities for a clear and efficient approach. Stability, safety, and the victim’s medical well-being are the factors that determine the strategy. 

Have you ever witnessed an accident involving a vehicle on its side? We would love to hear your comments and practical experiences. 

Checklist: Team-Oriented Approach to a Vehicle on Its Side 

1. Safety and Situation Assessment
   • Assess risks (fire, fluid leak, traffic, catalytic converter). 
   • Cordon off the area and ensure a safe workspace. 
   • Develop an action plan with clear team roles.
2. Consider Vehicle Movement
   • Can the operation be made easier or safer by moving the vehicle in a controlled manner or placing it on its wheels? 
   • Only carry out after consultation with medical personnel and provided it is 100% safe.
3. Stabilization 
   • Stabilize the vehicle with supports, straps, or wedges. 
   • Ensure that stabilization does not obstruct access or clearance.
4. Initial Access & Medical Assessment
   • Create an initial access point as quickly as possible (preferably through the tailgate or window). 
   • Allow medical personnel to assess the victim and initiate life-saving measures. 
5. Glass Management 
   • Prevent falling glass above the patient and rescuers.  
   • If possible: open doors before cutting, so glass management can be skipped. 
6. Creating Space & Increasing Access 
   • Choose a strategy: lower the roof, tunnel through the rear, or perform a controlled straightening. 
   • Consider the victim’s position and medical priorities. 
7. Immobilization and Extrication 
   • Stabilize the victim (neck/back/limbs). 
   • Perform extrication in a coordinated manner with continuous medical care. 
8. Evaluation 
   • Assess the victim’s condition after extrication. 
   • Evaluate the response with the team: what went well, what could be improved? 

Marinus Verweijen
Holmatro Rescue Consultant