Response to a MVA today can be a bewildering event. Although we respond to more MVAs than any other emergency except medical emergencies, think of what we need to evaluate, assess, and begin to mitigate on scene. Over time think of how our response and the hazards we encounter has changed. The vehicle is still the dynamic hazard in the equation however think of what we need to look for today – SRS systems, battery(s) and their locations whether they are in the engine compartment, vehicle interior, and trunk/cargo area, and so on; motive power ( gas, diesel fuel, CNG, or gas/electric Hybrid) and vehicle glass/glazing – are all items we need to consider.
These issues make it more difficult, though no less important, for first-due companies to perform a quick and complete size-up to ensure an effective plan of action. What follows is a collection of tasks first-due companies should complete based on their size-up.
Begin With Safety
Begin at the point of arrival. Before we do anything, we must ensure our safety. To that end, position the apparatus in a “fend off” manner by placing the vehicle between the incident and the traffic. This positioning helps protect responders and the patients. After apparatus placement is complete, evaluate the incident by scanning the area for scene hazards such as downed utilities, traffic, fire, etc.
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Check the orientation of the vehicle and stabilize it accordingly before beginning any extrication. |
As you approach the vehicle(s), observe the vehicle’s appearance. What is its orientation? Is it upright, on its side, or overturned? What kind of stabilization do
you need to consider? How is the vehicle damaged? How much “crush” do you observe? This information should indicate potential entrapment and possible injuries. Do you see any deployed SRS systems?
Many of today’s safety systems will not be deployed. Approach the front of the vehicle(s) to make visual then verbal contact with the patient(s). Once you determine their location, establish and maintain contact with the patient (s) throughout the incident. Having assessed the scene and taken the necessary steps to mitigate identified hazards, you can begin to work on the vehicle.
The Extrication
When you are assured that the scene is safe, begin vehicle stabilization. Stabilization ensures a stable foundation for space-making evolutions and minimizes movement to the patient.
Once you have stabilized the vehicle, make access and begin hands-on patient management. ABCs, manual C-spine management, C-collar and O2 as indicated. Take a good look at the vehicle’s interior. Are there any SRS systems deployed or even undeployed? Is there any damage to the interior? Is there physical entrapment to the patient?
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Once the vehicle is stabilized, begin hands-on patient management. |
While the above is occurring, another crew member can ensure the vehicle is shut off and remove the vehicle’s keys. Remember, today’s vehicles can have proximity keys that need to be more than 15 feet from vehicle to ensure it cant be accidentally started. These proximity keys are electronic and do not need to be in specific place in the vehicle for it to start. Next, secure the vehicle’s power. Only do so after you make sure the extrication crew doesn’t need to operate any windows or seats that may be 12-V powered.
Finding the battery can be difficult in today’s vehicles. Some have more than one batter. Remember, a substantial percentage of vehicles today have the battery elsewhere than the engine compartment. But even there it can be hidden. It can be found under the vehicle seats, in the cargo, or trunk area, or even in the vehicle’s fender.
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When securing power to the vehicle, remember batteries can be found in various locations. |
We need to secure the vehicle’s power for two important reasons:
- By shutting down the power we start the process of draining the energy storage component of the SRS system computer. This goes toward ensuring our safety with SRS systems.
- Securing the vehicle’s power will also shut down the high-voltage drive power in a hybrid vehicle. However, we also need to see what power accessories, such as windows & power seats, are in the vehicle before power is removed. The officer in charge should document when power was shut down and document the items hit upon above.
Keep checking the vitals of the patient and to assess injuries. Also determine if they are medically entrapped. Remember, you might need to make space to disentangle the patient, even if they are not physically pinned.
IC Ultimately Determines First Due Tactics
The officer in charge of the rescue effort must devise a tactical plan for first-due units to follow based on the information presented at the crash. Although the IC knows the strategic goals at an MVA are life safety of personnel and patient care of the injured, the tactical plan of action and various versions of it must take into account many variables, much more than in the past.
The ensuing tasks must be completed in less time than in the past as well. Protect your crew from traffic and evaluate scene hazards. Scan the vehicle looking at damage, potential entrapment and hazards. Find any patients and begin pre hospital care of them. Stabilize the vehicle and then secure the vehicle’s power. Evaluate the patient’s injuries. Make space to disentangle the patient. Remove the patient and send them to the appropriate medical facility. The crew checks the equipment, services it if required, and returns to service. So even if the MVA is a common emergency to which we respond regularly, how well is it managed today? Think about it.
Dave Dalrymple is a career EMS provider for Robert Wood Johnson University Hospital/S. Peters University Hospital Emergency Services in New Brunswick, New Jersey. He is also a firefighter/EMT/rescue technician and former rescue services captain of the Clinton (NJ) Rescue Squad. Dalrymple is the education chair of the Transportation Emergency Rescue Committee – US and serves on the Expert Technical Advisory Board of the International Emergency Technical Rescue Institute as the road traffic accident advisor.
