A Vehicle Rescue System
In some parts of the country, it isn’t uncommon to find that 30 percent or more of a fire department’s alarms are related to automobile accidents. In many of those incidents, an officer or even an entire department will make the mistake of thinking that the response begins with the dispatch. In actuality, it begins far in advance of that, with planning, classroom instruction, and practical, hands-on experience in a controlled environment where the skills learned in the classroom can be practiced and perfected.
My purpose here isn’t to provide a lesson in extrication, but to emphasize the point that extrication is just one phase of a total system—a vehicle rescue system.
What follows is a step-by-step breakdown of the 11 activities involved in answering a typical motor vehicle accident dispatch. Notice that of the 11 steps, only 8 happen at the scene. Two occur prior to the incident, and one occurs after it’s over.
- Readiness. The firefighters must be properly trained—familiar with the types of equipment available to them, proficient in the use of these tools, and aware of where they’re stored on the apparatus. Command officers must know what specialized equipment is owned by neighboring districts and available under mutual aid.
- Response. How quickly is the system put into effect? The district should have been thoroughly covered with a phone sticker program so rapid, accurate dispatches are possible.
- Assessment. Upon first reaching the incident site, make a complete survey of the scene. Pay particular attention to the number and types of vehicles involved and the damage the vehicles have sustained. Consider the types of problems that might arise because of the condition of these vehicles.
- Hazard control. Before starting to extricate the victim, you must address the hazards identified in your assessment to preserve the safety of the rescue team. Whenever time and other circumstances permit, get the help of various experts (such as utility company crews for downed wires, hazardous materials teams for dangerous cargo, and so on). All vehicles involved in the accident must be fully stabilized to be safely worked in and around. Depending on the situation, stabilization could be as simple as wheel chocks, or it could be as complicated as using air bags, ropes, or cribbing.
- Support operations. Now that the safety of the scene has been assured, the actual extrication can begin. In conjunction with it, support operations should be carried out. These operations are things that make the extrication team more effective. Such operations would include scene lighting and traffic and scene control.
- Gaining access to the patient. The next step in removing your victim from the vehicle involves getting a trained first aider, emergency medical technician, or paramedic into the vehicle. That person’s mission will be to provide an initial assessment of the patient’s medical condition and to begin whatever treatment is possible under the circumstances. At the very least, cervical traction should be applied and maintained (a rigid cervical collar should be applied at the earliest possible time), and the patient should be informed of both what’s expected of him and what will be happening around him. As time and work space permit, wounds should be dressed, splints applied, and so on.
- Emergency care. Firefighters responding to the scene should be completely trained in basic lifesaving techniques, because the ambulance crew may not be readily available. In areas where the ambulance corps covers several fire districts, the engine company may well be the first on the scene. Standard first aid skills and the
- Disentanglement. There are basically two ways a patient can be removed from a vehicle: disentangling the victim from the wreckage and disentangling the wreckage from the victim. The earlier physical assessment of the victim is critical in deciding which approach to take.
- Removal and transfer. Once the patient has been extricated, the person must be removed from the vehicle and transferred to the ambulance. Removal should be accomplished with the aid of a short board or similar device used in conjunction with a full backboard, and any other devices or procedures necessitated by the nature of the patient’s injuries. Once removed onto the long board, the patient can be transferred to the ambulance stretcher; but make sure first that the patient is totally secured to the board. Use three responders on each side to carry the patient, and have people leading the way as needed to clear obstacles, provide lighting, and so on.
- Termination of the call. Now that all the excitement is over, some crews believe all that remains is to throw the gear back on the apparatus and head home. This attitude will result in disaster on the next run. Cleaning up at the scene doesn’t only mean replacing equipment on the apparatus; it also has to include a complete check of the equipment.
- Critique. The final step is to conduct a thorough review of the incident and discuss the portions of the evolution that weren’t handled with the utmost proficiency. The goal here should not be to blame or criticize anyone, but to discuss alternatives.
All the proper equipment should be sent on the initial dispatch. It’s still common to see departments send an ambulance manned by a crew of three or four people with the understanding that if they need an engine company or an extrication unit, they’ll call for it. Calling for extra equipment causes a delay in getting the victim to medical care, cutting ever deeper into the “golden hour” for trauma patients.
The safety of the ambulance crew must be considered, too. Picture a critically injured victim at a car accident. The ambulance crew arrives at the scene and immediately sees the need for an engine and extrication tools. The proper requests are made, but this help is four to five minutes away. The ambulance crew knows the patient needs immediate care, so its members enter an unsafe accident scene. While they’re inside the car attending to the patient, the car bursts into flame, and suddenly you have multiple casualties instead of just the initial one.
Any apparatus sent on an initial dispatch that won’t be needed at the scene can always be returned by the first officer at the scene, after that person has assessed the situation. This type of initial dispatch might include (but isn’t limited to) a fully equipped ambulance; an engine or minipumper set up for the application of water or foam; the proper hand tools to begin the extrication process; and mechanical or hydraulic tools for more involved extrication evolutions.
If the rescue squad or ambulance hasn’t yet arrived, also determine how many patients will require transport to the hospital. This will enable you to get mutual aid ambulances dispatched more quickly, should they be needed. Again, this is in the interest of getting the patients to the hospital as fast as possible. Few other things are worse than having the patient completely extricated from the wreckage and then having to sit and wait for a mutual aid ambulance.
One of most critical assessments that you will make is of the hazards at the scene. This determination is of paramount importance—your safety and your crew’s has to be the primary concern at all times. Look for downed electrical wires, dangerous cargo on the accident vehicles, unsafe traffic conditions, water hazards, and any dangerous conditions involving the vehicles, whether it be explosion or fire possibilities, unstable vehicles, or something else.
Remember, scene control includes not only civilian bystanders, but also firefighters not included in the operation at hand, tow trucks drivers waiting to do their jobs, and overeager members of the press. Scene control should be approached with the intention of keeping the fewest people possible in a danger zone at the scene.
Another consideration is the protection of the patient from any by-products of the extrication. For example, if glass has to be removed, the responders inside the car will be needed to help protect the patient by draping a fire blanket or a turnout coat.
If at all possible, this step shouldn’t involve any elaborate procedures. All that’s needed is to quickly create an opening somewhere in the car that will allow’ access to the patient inside. This could be through a side or rear window or any other opening easily created. It’s here that the knowledge of hand tools comes into play. Avoid waiting for power tools at this step. The time to be fancy is after someone has had access to the patient and stabilized the person. Time is of the essence here, and you can’t wait for power tools at this phase.
When gaining access, time is of the essence; you can’t wait for power tools, so it’s here that knowledge of hand tools comes into play.
knowledge of cervical traction are usually all that’s required at the scene before the ambulance arrives.
Disentangling the victim from the wreckage should be avoided with a critically injured, multitrauma patient and in any situation in which the patient’s condition can’t be ascertained with certainty. However, if the patient’s condition allows, the person can be maneuvered toward a more readily accessible means of egress, assuming, of course, that the victim has been properly immobilized prior to any movement. For example, a patient involved in a two-car accident in which the driver’s door has taken the brunt of the collision could much more easily be removed through the passenger’s door than through the driver’s door, w’hich would have to be forced open.
Disentangling the wreckage from the victim could involve such things as removing a door or roof, pulling the steering column, displacing the pedals or dash, and so on. Again, the protection of the patient and rescuers inside the vehicle must be stressed.
Look for such things as worn or frayed ropes and extension cords, damaged tools, and the like. Refill the fuel tank on your hydraulic tool’s power plant, or, if you use a pneumatic tool, check the status of the air bank. Remember that you might be sent on another response before you get back to the station—don’t just say, “We can finish this later at the firehouse.”
In addition, give any members involved at the scene the opportunity to discuss problems they have in regard to what’s just transpired. This is a necessary step in helping the team members deal with the stress of the situation; and in the long run, it will help the effectiveness of both individual members and the unit as a whole.
The need for planning and standard operating procedures can’t be stressed heavily enough, for it’s through planning and practice that mistakes and confusion at a motor vehicle accident scene can be avoided.
