By DAVID DALRYMPLE
The concept of coordinated vehicle rescue was recently put forward to the members of the World Rescue Organization as an evaluation tool for the various extrication challenges around the world. While rescuers worldwide are faced with a wide range of hazards, many of those hazards are increasingly similar, whether in Clinton, New Jersey; Cape Town, South Africa; London, England; or even Gothenburg, Sweden.
You are faced with managing ever-changing hazards, yet you can learn from other firefighters more so than ever before, at least with regard to vehicle rescue. The Stages of Coordinated Vehicle Rescue document (Figure 1) has gone through several iterations over the years.
 Figure 1. Stages of Coordinated Vehicle Rescue |
David Coldbeck from the Australasian Road Rescue Organization (ARRO) drafted its original version based on materials from the Netherlands’ International Center for Emergency Techniques. It has since undergone a number of iterative enhancements from both Coldbeck and Paul Jerome at different times. Most recently, some of the ARRO’s New Zealand members have also added their input.
The document was designed specifically to address some of the peculiarities of the Australasian rescue environment where it is the rule, not the exception, that rescue and prehospital care are provided by two separate organizationsthat is, paramedics generally come from an ambulance service and rescuers may come from a fire service, state emergency service (nonfire rescue service), or other service (e.g., mines rescue service). Therefore, it was imperative to show the partnership (or integration) between rescuer and paramedic activities in simple terms.
Think about this description. Is it all that much different here? Even if the same department provides EMS and rescue, how often is the operation well integrated?
A breakdown of the extrication process in the percentage of time allocated to each stage was added to the diagram initially. At one point, this may have been represented in suggested minutes, using the Golden Hour (the first 60 minutes after the occurrence of multisystem trauma) as an overall concept to provide guidance, although it was quickly abandoned, given the distance issues in the Australian context (e.g., there are some rescue units that have a turnout area within a five-hour radius).
In its most recent iteration, the distribution-of-time percentage was applied to assist in informing a reworking of the challenge assessment guidelines, and the resulting percentage was applied to the distribution of marks available. For example, it was argued that it was not best practice to give the same level of attention (i.e., time and, therefore, marks) to initial size-up as to glass management and technical tool application to relocate material during extrication. Refer in the diagram to size-up, vehicle prep, and disentanglement. Granted, this is looking at the assessment of an extrication challenge, but can’t you benefit from a self-assessment of your operational skills at a motor vehicle collision (MVC) in a training/educational environment?
STEP BY STEP
Let’s do a side-by-side comparison of both our patient management and technical (i.e., tool evolutions) activities. Break this process down step by step.
Arrival.Size up the incident, look for hazards and clues for injuries and entrapment, look for mechanism of injury, and begin the tactical action plan for the tasks you must perform. Manage scene hazards and implement incident management systems (IMS). Command ensures hazard identification to all personnel on-scene and applies the strategic incident goals (patient care and safety).
Patient access and vehicle preparation. Gain access to patients to facilitate care, begin patient management, and begin to factor patient considerations into your tactical action plan. The rescue crew prepares the vehicle; stabilization occurs, power is isolated, glass is managed, and interior trim is displaced. These actions occur simultaneously or together as closely as possible. The engine crew stretches a line for scene protection. Command documents power isolation and hazard mitigation, takes the incident goals, and develops a tactical action plan.
Medical treatment and making space.As the rescue team creates space on the vehicle to prepare a pathway to remove the patient, firefighters provide hands-on medical care to the patient. Both tactical action plan sections tick away and progress toward our goal of disentanglement. Reassess stabilization as each tool evolution finishes, protect the patient and the interior rescuer with hard and soft protection, and update Command on the patient’s progress. Again, perform these actions simultaneously or as closely together as possible. Also, secure hazardous debris appropriately.
Packaging, removal, and the final push.As the removal pathway is completed, the vehicle’s sharp edges are covered up and the disentanglement path is cleaned up and made safe. Package the patient appropriately for his injuries and disentangle him from the wrecked vehicle. As the patient is handed over for transport to the appropriate medical facility, begin the process of taking up, cleaning up, and preparing for the next incident. Command documents vehicle information and any hazardous debris, such as an undeployed supplemental restraint system (SRS).
The above isn’t an all-inclusive listing of all tasks, but it is a good representation of what “best practices” should occur or factor into the decision-making process on-scene. Consider alternative-fuel vehicles, such as hybrid, compressed natural gas (CNG), E85, biodiesel, or even hydrogen (H2). These vehicles have additional considerations to be factored in, but if responders can isolate the vehicle’s power, all vehicles, regardless of the situation, can be worked around safely.
Safety systems are present in all vehicles today, with an average of six to eight SRSs on each; the best ways to make these safe for firefighters on the street are observation and power isolation. Vehicle materials, components, and construction weigh in heavily and affect tool evolutions. To counteract these concerns and speed up your on-scene time, be more proactive and preplan on-scene operations.
Having a good, flexible, and comprehensive operations framework is increasingly important, but you must use, develop, and even refine it. Use this framework as an educational tool to develop your skills at a MVC and hone and sharpen them. It will make for better patient outcomes and a safer, smoother scene time.
DAVID DALRYMPLE is a career EMS provider for the Robert Woods Johnson University Hospital Emergency Medical Services in New Brunswick, New Jersey, and a volunteer firefighter/EMT/rescue technician for Clinton (NJ) EMS/Rescue. He is a 25-year emergency services veteran. He is the education chair of the Transportation Emergency Rescue Committee-US (TERC). Dalrymple is certified as an international level extrication assessor and serves on the Expert Technical Advisory Board of the IETRI as road traffic accident advisor. He is also a member of the IAFC Specialized Technical Rescue Committee. He received the 2007 Harvey Grant award for excellence in rescue.
