By Jeff Pugh
We have all been through tactical classes and training where we have heard that when arriving at the scene of structure fire your actions, communications, rig positioning, and initial tactical decisions in the first five minutes can dictate the next five hours. Well, the same holds true for auto accidents where mechanical extrication is required. This is obviously compounded when the accident involves multiple vehicles or transit vehicles carrying multiple passengers. These multiple casualty incidents (MCIs) or multiple patient incidents (MPIs) can be extremely challenging, but you can set up your scene for success with proper command and control as well as communications.
The Transportation Emergency Rescue Committee (TERC) and the World Rescue Organization (WRO) recognize 20-minute extrication timelines for basic life support trapped victims and 10 minutes for advanced life support “Rapid” extrication patients. These goals can be obtained depending on tool knowledge, training, extrication plans, and communications between crews as well as the degree of entrapment. When there are multiple vehicles, there should be multiple extrication leaders. The goal is to reduce the time for extricating victims from a motor vehicle accident (MVA).
Whatever your department policies involving MVAs are, where mechanical extrication is required, the goal should be to respond with enough personnel and equipment to get the job done. The responding personnel should have their roles established before they step off their rigs. Yet, we are still seeing chaos at MVAs with crews arriving without tying in with the incident commander or extrication leader prior to going to work. There is still obvious “committee” work and “freelancing.” These sorts of behaviors need to be modified through training and education, or we will continue to see firefighter near miss or National Institute for Occupational Safety and Health reports of firefighter injuries and deaths while operating at MVAs. With the proper command and control in place, we can improve our extrication time lines and reduce firefighter injuries and deaths in this high-frequency / high-risk discipline.
As with any emergency response, the clock starts at dispatch when it comes to mitigating the emergency. This holds true for motor vehicle accidents when mechanical extrication is required.
Responding units need to consider things such as; the best approach/route to the MVA, adding resources, and the all-important size-up. This is a critical element and one that will set the stage for reducing time. The size-up or painting the picture, as I like to call it, needs to be clear and informative as well as cover such things as
· Confirmed location
· Best access for incoming units
· Number and type of vehicles involved
· Solid, brief description of what you see/have. Paint the picture during your size-up.
· Adding resources
· Setting up command
Aside from getting the crew safely to the scene, the driver/engineer also needs to focus on defensive parking and creating a safe working/operational zone, coordinating with the fire officer. This has become a hot topic over the years with fire and police working together at MVAs. The police have an obligation to keep traffic moving while the firefighters need to operate in a safe work zone. So how do we come to a common goal of working together? Through open communications as well as training between these agencies. Without a decent working relationship with law enforcement, the scene can turn chaotic and even get into legal issues involving firefighters. We have all heard about or watched the videos of fire officers and engineers being arrested for blocking the highway or not following police orders. Neither agency needs this sort of “bad press”; we are both there for the same reasons.
(1) Photos by author.
The incoming units need to visualize what you see through your on-scene report / size-up; paint the picture. They also must make contact with the first-arriving officer or IC a few minutes out, letting them know they are “two minutes out,” and ask for instructions. This affords the IC the opportunity to consider the next-in resource and how it can be used. This communication is critical in the first few steps of the situation to help reduce time. If the next-in rig cannot raise the IC on the radio at the “two-minutes-out” mark, it should make another attempt at “one minute out.” If there is still no response because the IC is too busy or possibly on the wrong frequency, the responding companies should still have an idea of what to bring to the scene based on the size-up and the units already on scene. These crews should not just park defensively or at a tactical advantage. These incoming crews need to bring the appropriate equipment to the scene based on the size-up and what the other crews on scene do not have or need.
Along with solid communications and common extrication terms, specific roles need to exist as well. Depending on staffing, these positions should be assigned or assumed on arrival at the scene: IC, extrication leader, and interior stabilizer.
Depending on staffing, the IC and extrication leader may be the same person. The IC orchestrates the overall scene, is ultimately in charge of the incident and may also serve as the safety officer. This position works closely with the extrication leader(s) as well as the key positions such as Medical, Treatment, and Transport when involved with an MPI or MCI. Another function of the IC is resource management; this is a critical element in creating a safe and effective extrication scene.
Extrication leader(s) command and control the extrication. Typically, they are not involved with the actual hands-on, but they take a leadership role managing three to seven firefighters in the extrication. There may be more than one extrication leader when there are multiple vehicles and patients requiring extricating. This position is a key element in meeting the goal of reducing the time it takes for the extrication and safe removal of the patient. The extrication leader sets the pace, helps establish the extrication plans, assigns positions, and establishes a personnel pool. This position does not necessarily need to be an officer; however, it should be the person with the most extrication experience and who has a strong command presence. We all understand that officers are in charge of their crews and the scene, but we should also agree that the officer needs to recognize the strengths of his or her crew and may become a hands-on individual for the extrication vs. the person in charge. The extrication leader answers directly to the IC.
Interior Stabilizer
The interior stabilizer is the individual inside the vehicle performing critical steps to help meet the goal of reducing time. In a perfect world, this position would be filled with a fire/medic in the proper PPE since many ALS functions can be performed inside the vehicle if required to save a life. The interior stabilizer works for the extrication leader, who does not necessarily need to be an officer. This position should be filled by the firefighter with the most experience and training in auto extrication.
Of course, you can have all the positions/boxes on the status board filled, but if the responding crews do not have the proper tools and training to get the job done, the outcome may not be favorable.
As you can see, An MVA, especially one that involves extrication, needs a modified command. Obviously, this would expand for larger incidents. Just as with any other emergency call we respond to, there needs to be firefighter accountability.
Whatever your department policies are involving motor vehicle accidents where extrication is imminent, the goal should be to respond with enough personnel and equipment to get the job done safely. The responding personnel should have their roles established before they step off their rigs.
Two-Minute First-Due Exercise
Initial Actions: First-Due Engine Company at an MVA
Performance Objective: While operating under the direction of the company officer, the 1st arriving crew quickly and efficiently achieves the following benchmarks: safe positioning of the apparatus, scene lighting, initial size-up and scene survey, hazard detection and fire protection, patient contact, initial vehicle stabilization, equipment staging.
Conditions: Given a staged vehicle accident with an assigned crew and the equipment normally carried, the following is a recommended method.
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Objectives |
Officer- in- charge Initials |
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1. |
The driver positions the engine in an angled position to protect the work area. He starts cab procedures. |
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2. |
The officer gives an initial “windshield survey” over the radio. |
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3. |
The driver places the engine in pump and chocks the rig’s wheel. He then extends the light mast and places cones and/or flares to divert traffic. The driver pulls a protection line and places it near the crashed vehicle. The driver stages any additional equipment as needed. The driver stages cribbing bag and step chocks at the crash area. The driver contacts the officer for reassignment. He performs inner circle if it is a two-person engine/truck company. |
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4. |
3rd firefighter (or driver) takes a dry chemical extinguisher and does a rapid 360 survey of crash scene (inner circle survey). |
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5. |
3rd FF (or Driver) performs inner circle survey, chocking wheels (or wedges key points for car on side or top) of involved vehicles to prevent movement. 3rd FF checks for number of patients and hazards. |
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6.
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Officer performs an outer 360 survey; consider thermal imaging camera and flashlight. The officer provides update to dispatch and instructions to arriving units. |
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7. |
Additional assignments: Refer to SHADE* acronym. See attached. |
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8. |
After completion of inner and outer 360 surveys- A “Rapid” and extrication plans “A” & “B” needs to be identified to all involved in the extrication. |
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Recommended benchmark time for steps 1-6 is two minutes or less. |
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References: National Fire Protection Association 1006, Standard for Technical Rescuer Professional Qualifications, and NFPA1670, Standard on Operations and Training for Technical Search and Rescue Incidents: Meeting awareness/operations-levels objectives.
* SHADE:
S= Scene Safety, Size-up and Survey. Inner and outer survey for (1) hazards and patients, (2) stabilization and fire control, and (3) triage/med-ops needed?
H= Hazard location/Hoseline placement; Hybrid/alternative fuel badging?
A= Access patients; Immediate Aid and Airway
D= Disconnect batteries/Disentanglement
E= Extricate and remove from vehicle
BIO
Jeff Pugh has been involved in auto and heavy extrication for more than 21 years as a professional firefighter/instructor with 13 years as a company officer for Central Pierce Fire & Rescue in Washington State. He has competed in and helped organize auto extrication challenges regionally, nationally, and worldwide for the past 15 years. He was the chairperson as well as an active member/instructor of his county’s Special Operations Team. Pugh is a rescues squad leader for FEMA WA-TF1; he has training in several rescue disciplines. He has been involved in numerous educational extrication videos, including the 10-disc series for Action Training Systems. He is co-owner of Rescue Innovations and created the First Responder Jack for the Hi-Lift Company. He is president of and lead instructor for the Puyallup Extrication Team (aka PXT), which he helped to establish more than 15 years ago, and his department. He was a tester and evaluator for the manufactured prototype and current models of extrication personal protective equipment and tools such as the First Responder Jack.
