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Auto Extrication Combines Many Challenging Elements

Issue 2 and Volume 13.

hydraulic spreader
A hydraulic spreader is one of the basic tools for auto extrication. It is well suited for “popping” auto doors to provide access to trapped patients.
hydraulic "O" cutter
A group of rescuers polled about which tools should be included in auto extrication arsenals concluded a hydraulic “O” cutter was mandatory. Cutters can perform a variety of extrication procedures, including cutting door hinges.
Rescue personnel
Rescue personnel need to be ready for anything when they arrive on the scene. Los Angeles (City) Fire Department crews were confronted with two fatalities and two critical injured patients, one of whom later died as a result of the injuries received. The driver of the Toyota pickup truck was carrying an engine in its cargo area, which slammed through the cab on impact, severely injuring it’s driver. All three high school students in the red Camaro were killed as a result of the crash. (Fire Apparatus Photo by Mark Saxelby)

One of the most challenging tasks rescue crews face is vehicle accident extrication because it combines many challenging elements in a single scenario.

Possible dangers include multiple patients, poor visibility, fire, hazardous materials, traffic and small and confined work areas, as well as inherent hazards with the vehicle.

Moths To The Flame

On-scene rescuers work up close and personal with victims when they are trapped, in pain and unable to care for themselves. That’s what motivates all emergency response personnel – helping people in need.

As a consequence, vehicle extrication can result in a “moth-to-the-flame” situation as too many rescuers can take up workspace, hindering operational areas and in many cases lengthening the rescue time.

To make effective extrications with positive outcomes, certain basic equipment and command and rescue approaches are required.

There’s a plethora of tools available for rescue operations. Some are simple, but most are complex. What departments really need are sound foundation tools, good training and some imagination.

That is not to say specialized tools do not have a place, but let’s be realistic. Most agencies do not have the staffing, budget or space to keep a dedicated “heavy rescue” apparatus loaded with the multitude of high-tech equipment for specialized rescue operations. In fact, most organizations accomplish rescues with what is carried on a standard engine or truck company.

Recently, I had the opportunity to sit on a focus group of rescue specialists from throughout the country – from large cities to small rural towns – to evaluate hydraulic rescue tool systems.

It took little time for the 20-member group to determine the basic hydraulic rescue tools and associated equipment for a wide variety of rescue scenarios, including vehicle extrications was:

  • A hydraulic power unit (high pressure, dual outlet).
  • Hydraulic spreaders.
  • Hydraulic curved blade cutters (“O” cutters).
  • Hydraulic rams (1 short and 1 long, telescopic preferred).
  • Chains and shackles (for pulling).
  • One hose for each tool, plus a spare (25- 30-foot length).

This hydraulic tool selection allows rescuers to push/spread, pull, and cut in an extremely wide variety of rescue scenarios – among them rolling dashes, popping doors, rolling roofs, pulling steering wheels or moving seats.

 

A Basic Approach

The selection was considered the base kit of equipment, which is beyond the basic tools carried on an engine or truck company. That would mean a special purchase outside of normal day-to-day use tools, such as chocks and cribbing, reciprocating saws, pry bars and the like.

There are many good articles on specialized rescue procedures by very good authors. It’s my intent to communicate a basic approach in a manner that’s understandable and retainable so it can be applied under the stress of the rescue scenario.

That basic approach to vehicle extrication covers the following points: sizing up the scene; evaluating the patient(s); evaluating the vehicle; assigning tasks; developing an extrication plan; extricating the patient(s); critiquing post incident; and demobilizing.

During the size-up phase of the extrication, rescuers will need to comprehend the overall situation and quickly try to figure out what caused the incident. Rescuers need to determine whether the vehicle is in a static situation or dynamic. Hazards to the patients and rescuers must be immediately identified as well as hazards that might become problems during the extrication operation.

A determination as to whether there are sufficient resources on the scene, or in-route, to handle the situation must be made. All of this must be done within moments of arrival.

Assessing Injuries

Next, patients must be evaluated and the number must be determined. An assessment of their injuries must be completed to determine whether they have minor injuries, critical injuries, or even if they’ve already perished. A evaluation of the best immediate medical intervention must be done and a determination made as to what hazards, if any, will the intervention create. For example, high-flow oxygen might increase the risk of fire.

The extent of entrapment of the patients is high on the list of assessment. It’s important to know soon whether a patient is pinned by a crushed dash, or whether the door is jammed and just needs to be popped. The extent of entrapment will determine the level of protection the patient needs from hazards created by the rescue operations.

As the patients are being evaluated, the vehicle needs to be evaluated as well. The position of the vehicle and its stability will factor greatly into the methods used for extrication, as will the manufacturer, model and type.

Identifying Dangers

Before any extrication can begin, the dangers need to be identified, particularly fuel leaks and ignition sources, restraint systems and airbags, gas shocks and other dynamic devices. Given the particulars of the rescue, there may be special or unique hazards that need consideration.

After size-up and patient and vehicle assessment, the incident commander will need to assign tasks. As staffing permits, extrication scenes should have perimeter control, a safety officer, scene safety personnel and a medical group responsible for communications, triage, treatment and transportation. A rescue or extrication group is also required, and they’ll usually be the ones to develop the extrication plan.

Back-up teams are always a good idea too.

The extrication plan must consider how a patient is trapped and what needs to be done to free him or her. The sequence of events to effect the extrication needs to be mapped out. It’s also important to forecast what effects the rescue effort will have on the patient’s well being, and whether all the tools and personnel are on the scene to perform the rescue.

Alternate plans should be developed in case the first plan is not successful.

Once the plan has been developed, make sure personnel keep to their assigned tasks. If the plan doesn’t work, try it again one more time and then shift to the back-up plan.

Stop, Look and Critique

Once the patient has been extricated, stop for a moment and critique what just happened, while you are still on the scene. Learn what worked and what did not. Take the time to think about how you’d do it the next time and take the opportunity to recognize and praise good work and creativity. It’s probably not the best time to be too critical, as everyone is beat and stressed from the extrication itself.

Then, there’s always the cleanup and demobilization. Rescuers will need to release and return tools and resources to their home units or districts. Hazards, like spilled fuel and downed power lines, need to be neutralized or made safe before leaving the scene. All personnel and equipment must be accounted for, and information for incident reports should be documented. Once those tasks have been completed, it’s time to release the scene to the appropriate authorities. In most cases that’s the police.

An often overlooked, but essential, part of vehicle extrication is the command and control element. Assignment of essential tasks and coordination of efforts results in a timely, safe and successful outcome.

It’s important to maintain sight of the big picture. From the start, the person in charge must assume command and size up the scene. As the extrication evolves, it’s the incident commander’s job to make sure adequate resources are assigned and dispatch is updated often.

The commander must also establish a staging area for additional or excess resources as they arrive and then assign those resources to duties based on the needs of the incident. He or she is required to act as the liaison with other agencies at the scene and be the point person for the post-incident critique.

Here are some pointers for commanders. Upon arrival, pick a spot to have a good overall view of the scene, not just the extrication operation. Evaluate everything, including wires down, traffic and anything that could affect the rescue operations. Let everyone know you are on the scene by announcing yourself on the radio and identifying the incident by naming it, such as freeway incident command.

Incident Command

The key to signal to all responding that you are on the scene and managing it is prescribed under the incident command system (ICS).

In many cases, the incident commander is not the first person on the scene, and it’s important for the incident commander to communicate with personnel already there to help get a full picture of what’s happening and what’s needed.

Take a moment to match what you think your resource needs are with what you have on-scene or in-route. Have something in your “hip pocket” for issues that may pop up.

Update the dispatch center with a brief description of the incident, the location of the incident command post (ICP) and the staging area. It’s also a good time to request any additional resource needs that have been identified in the initial scene assessment.

As mentioned earlier, there’s a natural tendency for the “moth-to-the-flame” movement of rescuers, and that’s why a staging area is critically important for excess resources.

Staging areas are often overlooked, but they serve an important function, preventing resources from piling in, as well as giving the incident commander time to place resources based on need.

The incident commander also has the responsibility to assign duties under the ICS. One of the basic assignments is a scene safety officer. A practical approach would be to assign the officer of the first engine to the position of incident safety officer and the staffing of that engine to establish a perimeter with a protection line in place. It’s important to provide for safety first.

A fire company fits the bill for the medical group in charge of managing the medical component of the extrication. The officer of that company can coordinate patient care and ensure the communications, triage, treatment and transportation functions of the extrication are performed. This approach also provides leadership for expansion in an escalating incident.

The natural assignment for the extrication group is the first-in truck company. All functions related to the extrication could, and should, be coordinated by the truck officer, including activities related to vehicle stabilization, extrication and coordination. That person will be responsible for all activities occurring in or around the vehicle.

By assigning personnel to functional groups under ICS, members know what their job is and for whom they work, eliminating freelancing and confusion.

The Big Picture

With key people in place, the incident commander needs to stay focused on the big picture. Ride herd on excess personnel and prevent them from crowding around the extrication scene. They might think they’re helping, but they’re not.

As the incident develops, other supporting agencies will arrive on the scene, including the power company, the police and possibly the coroner. All will need guidance and direction. That’s a responsibility of incident command, but as the incident commander, you’re too busy managing the scene. Therefore, assign one of your officers to serve as the liaison officer to relieve you of those duties.

Under no circumstances should you leave personnel and agencies to their own devices as they will become part of your big picture problem. Learn to control the outside agencies that arrive on the scene for the same reason you’re there – to help out.

A Simple Approach

The incident commander best handles incident critique, and the best time to evaluate your actions is on the scene. The players involved can look at the actual vehicle, discuss what went right and the alternatives to what went wrong or didn’t work. Take advantage of this critical training opportunity. Don’t be afraid to ask your subordinates what you could have done to better support them in their tasks. If you don’t ask, how can you expect to improve?

Vehicle extrications, by nature, can be overwhelming, but a simple approach to what can be a complex job keeps confusion to a minimum and provides the highest level of success.

Editor’s Note: Mark Saxelby is a battalion chief with the Los Angeles City Fire Department. In 1990 he started the department’s first Urban Search and Rescue (USAR) team and has been its logistics manager since its inception. He teaches disaster logistics throughout the country and has conducted numerous command, logistics and rescue training classes.

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