It was one of those horrible accident scenes where everyone knew the outcome wasn't going to be good no matter how careful the rescuers were.
It was 6:06 p.m. on Dec. 7 when Colleton County Fire-Rescue crews were dispatched to the scene of a one-car crash on Sidneys Road in Walterboro, S.C. They found a 2007 Cadillac DTS four-door sedan on its side with its roof crushed against a tree.
The sole occupant, a 78-year-old male driver who was the local funeral home director, was severely entrapped with critical injuries. Three hours later he succumbed despite valiant efforts from members of the rescue team.
During the extrication, an airbag deployed, injuring a firefighter/paramedic who was in the car working on the victim and who had to be hospitalized.
"It was a mess," said Colleton County Fire-Rescue Executive Director Barry McRoy. "It was a very challenging extrication to say the least."
The outcome might have been different if the team had access to technical information sold by two leading manufacturers of hydraulic rescue tools - The Rescuer's Guide To Vehicle Safety Systems from Holmatro Rescue Equipment or the Moditech Crash Recovery System from Hurst Jaws of Life.
Leaders of both companies believe rescuers should know what dangers lurk in the twisted metal confronting them before they touch a vehicle with a tool, and their publications contain detailed information on hundreds of vehicles.
On that dark evening in Walterboro, McRoy said the airbag in the steering wheel of the Cadillac was the one that deployed and hit the firefighter.
"We couldn't even see the steering wheel due to the damage," he said. "It was somewhere down around the floor in the wreckage, near the center of the car, but somehow the airbag found its way out… It sounded like a gun going off."
The firefighter suffered some major contusions, swelling and deformity of one of his arms, but no breaks. After an overnight hospital stay, he had three weeks of therapy and two weeks of light duty before he was fully recovered.
Rescuers subject themselves to hazards that have only gotten more complicated - and dangerous - as motor vehicles have evolved. Today, they face a myriad of airbags that can come at them from nearly any direction, seat belt pretensioners, roll-over protection that deploys roll bars, gas struts that can explode with deadly projectiles and even pyrotechnic airbags on the outside of vehicles to protect pedestrians.
The number of injuries to firefighters and rescuers that occur during extrications is difficult to pin down. Cuts and scrapes are countless. Injuries from airbag deployments and safety system activations are terrifying, but thankfully appear to be rare.
Occasionally rescuers find clues as to what they are about to confront, such as manufacturer warning labels and experiential wisdom, but the lack of vital information and knowledge can lead to catastrophic harm to patients, as well as those trying to help.
Holmatro released its 2008 sixth edition of The Rescuer's Guide in January. Unfortunately, Colleton County rescuers didn't have that information on Dec. 7, a situation that has since been remedied with the acquisition of the guide.
"We now know from The Rescuer's Guide that an air bag sensor is located in the area they were cutting," McRoy said.
Users of the guide say it can take as little as 60 seconds to find technical data on most vehicles. Both the Holmatro and Hurst systems can be used on computers to speed access to extrication information when time is critical and patients are trapped.
Damage to the Cadillac was extensive, according to McRoy, who said the car went out of control at a high rate of speed and started to roll before slamming, roof first, against a tree, snapping it off at its base.
The Cadillac hit the tree at the A post, crushing the sidewall, dash and roof down on the driver. "The driver's lower body was pinned between the dash and the floor, and his head was trapped between the driver's top door frame and the B post, with the tree just inches from his head," McRoy said.
Rescuers knew the battery was still connected, and the occupant protection systems still active, but the battery was not accessible.
Locating The Battery
The DTS Cadillac is the only 2007 model with the battery under the rear seat, a fact that was not immediately known until a mechanic on the scene suggested rescuers look there to disconnect the battery and render the airbags and protection systems harmless.
Holmatro's and Hurst's guides would have told rescuers the location of the battery as well as the airbags and, more importantly, the sensors and charges used for deployment.
Because of the extent of the damage to the car, McRoy said it wasn't immediately possible to disconnect the battery, so the rescuers pressed on.
The roof was removed with an Ajax tool, and rescuers attempted to displace the driver's seat by cutting the rear support, but the front supports were not accessible. They decided to use the Ajax tool to cut the floor pan in an attempt to reach the front bolts holding the seat.
"It was a very slow process due to several floor layers," McRoy said. "At about the 1 hour and 40 minute mark, we assume the crew working on the floor side struck something which set off the steering wheel air bag."
The injured firefighter was transported by the squad's Medic 9 to the Colleton Medical Center, and when the extrication was completed, it was too late.
"We worked for 2 hours and 45 minutes to get [the victim] out of the car only to have him die shortly after being placed in the ambulance," said a frustrated McRoy.
Holmatro's guide shows that 2007 Cadillacs have the safety systems control module under the driver's seat. The airbag deployment could have been triggered by cutting the floor pan, especially with the battery still connected, or by the airbag capacitors still having a charge. Even disturbing the wires controlling the airbag system could have caused it.
In an opening page of the Holmatro guide, company President William "Gif" Swayne writes: "The need for this guide became clear to everyone at Holmatro after we began teaching our vehicle anatomy programs at the fire departments and training centers around North America… Everywhere we've done the program, the reaction has been the same, 'Wow, there is a lot we didn't know about the potential hazards in cars today.' The same question was always asked, 'How can we tell what safety systems a particular car has and where are they located?' Until now that question has not had a good answer."
Hurst Jaws of Life has a similar take on the need for information to keep rescuers safe.
"New technologies make it more difficult for the rescue worker to access and extricate victims from the wrecked vehicle," Hurst says in a product brochure. "Many safety restraint components turn into a potential hazard for the rescue worker and the victim after an accident… Determining the locations and deactivation procedure of these components is extremely important during the extrication process."
Fran Dunigan, the marketing manager for Holmatro, said his company began publishing information to help rescuers in 1998 with a "white paper" on the topic of airbags. That was followed up by the first edition of The Rescuer's Guide in 2000. Dunigan was instrumental in that effort.
"The company has made a commitment to keep rescuers safe with a product at a price point they can afford," he said.
Preceding the safety systems guide, he said Holmatro published a firefighters rescue guide, which is still in print, and distributed more than half a million copies. The object was to teach firefighters the basics of rescue techniques.
When it came time to go a little further, and describe the hazards firefighters face, Holmatro contracted with Mitchell International, a leading provider of information about vehicles for collision repair and insurance companies based in San Diego, Calif.
Mitchell collects information about autos to help body shops give estimates for repairs, and Holmatro tapped into that resource.
"We have the most reliable and complete information available on vehicles on the road in North America," Dunigan said. "And we update it on a regular basis." The sixth edition has a feature that allows users to go on-line and pick up information about mid-year changes auto manufacturers often make.
Reference Book Or CD
Holmatro's product includes a three-inch thick reference book and a compact disc with the same information for easy access from computers. Many fire and rescue apparatus are equipped with mobile data terminals (MDTs), laptop computers mounted in the cabs or command centers of apparatus.
Holmatro sells the book and CD for $199, and that price allows for one on-line update.
Hurst's extrication guide, The Moditech Crash Recovery System (CRS) is an interactive Windows-based software program. It's a newcomer to the market, having been available for two years.
The product is licensed to fire departments and rescue squads for $575 per year. Secondary licenses to the same purchasing agency are available for $75. The price is renewed annually because information the system provides is updated continuously.
A CRS user pays an annual fee for use of the software and database for the duration of time desired, according to Moditech, and when that period has ended, the software automatically stops functioning and access to the database is no longer possible.
Hurst also offers an upgraded version that allows rescuers to look up vehicles by their Vehicle Identification Numbers (VINs).
Aaron Guenther, the director of marketing for Hurst Jaws of Life, said the system can be upgraded with an optional bar code scanner to be used in conjunction with a laptop or the VINs can be entered manually. The upgrade cost is $495.
"The program allows a fire department or rescuer access to detailed information on a specific vehicle prior to placing a tool on it," Guenther said. "The CRS could also be used in classroom training for new types of vehicles on their associated construction and components."
Some information in the CRS program includes color-coding to identify hazards. A yellow color, for instance means a high voltage area in a hybrid vehicle.
"The idea is that the rescuer sees the danger area prior to cutting and chooses another location or gains information on eliminating the threat directly on scene prior to cutting that area," Guenther said.
As manufacturers improve vehicle construction with new materials and designs, extrication tools might become less effective on certain areas, Guenther said. For example, he said the A and C posts may have additional thicknesses or be reinforced with stronger material. The CRS program will indicate the specific tensile strength to give rescuers information on what tools will be most effective to cut or spread the material.
"Even lighter and more economical vehicles can contain additional reinforcement," Guenther said. "I'd encourage the rescue service and fire departments to be cautious with assumptions on both the size and price of vehicles."
An Extrication Pre-Plan
Moditech, based in The Netherlands, is an information technology company that specializes in the design and implementation of mobile information systems for emergency aid and rescue teams. Hurst is the sole U.S. distributor of its system, which is built on more than 10 years of experience in data acquisition and software development in the auto body repair industry.
While Holmatro and Hurst are the leaders in extrication guides, at least one other enterprise, called airbagdata.com, had tried to develop an Internet based guide. Its system, which was available from 2001 to 2003, was based on a personal data assistant, like a Palm Pilot, and relied on engineers and emergency workers to contribute, update and review data in a "community repository" system.
McRoy, the Colleton County Fire-Rescue director, said his department plans to use the Holmatro guide as a primary tool on all future extrications. "With the complicated systems and new materials on today's vehicles, extrications are going to have to be treated similar to fires," he said. "The rescuer's guide will serve as the auto extrication pre-plan."
He said he intends to buy additional copies and place them all the other rescue vehicles in the county.
"I believe if we possessed a copy of the guide prior to the [Cadillac DTS] accident and used it as we plan to in the future, we could have avoided this incident," he said.