Do a quick internet search on vehicles vs. guardrails and your photo results will be endless. While guardrails are in place to protect vehicles/occupants from "dangerous" areas, many times they can add difficulty to an already challenging extrication. On occasion, guardrails will penetrate the occupant space and will need to be cut to facilitate patient removal. So the question is, what is the best way to cut guardrails?

Before we discuss cutting, we must first look at the most common guardrail type: the W-Beam. This rail is made of high-strength 10-12 gauge galvanized steel with a zinc coating to prevent rust. One thing we know about cutting galvanized material is the creation of zinc chloride/metal fume fever when using tools that cause high heat (torches, K12's, etc.) If this cutting is necessary it is recommended that it is done in a well ventilated area with respiratory protection. However, the method of cutting a guardrail will depend on how the rail is inhibiting extrication. Is the rail blocking the door, impaled in the patient, impaling the patient to the vehicle, or any trapping them by any other scenario?