One area of the fire and rescue service where responders can have a profound effect involves the extrication of patients from vehicles after a crash.
Arguably, these opportunities are more frequent for most departments than cases of trapped individuals in burning structures. But they are not daily events, so competence must be maintained and methods of improvement pursued. Getting victims out of a vehicle as quickly and safely as possible leads not only to the potential to save a life but also shorter hospital stays, less time in rehab, and less pain and suffering.
In the time since the pandemic first started, there has been an ironic twist in the vehicular crash statistics. The numbers indicate a reduction in the total number of crashes. No doubt this is because of the quarantine and other restrictions that affected car travel. But even with fewer accidents, there were more fatalities. The incidents were more serious, and it is suspected that people were traveling at a higher rate of speed since traffic was lower. For many departments, this meant fewer responses to accident scenes, but when they were called out, the severity was greater. It would be reasonable to assume that more of these crashes would require extrication. Complicating things more, departments probably were restricted in their ability to maintain skills, as the pandemic delayed some training. This is a possible perfect storm—an increase in events that require top-shelf performance and circumstances that limit “practice time” to maintain a high level of competence.
Regardless of a pandemic or other shutdown, extrication remains an important part of a fire/rescue department’s responsibilities. As stated above, this is an opportunity to really make a difference and produce a positive outcome from an unfortunate event. There are two primary components for those pursuing excellence in this area—practice and study. The practice part is what the fire service calls training. It involves learning techniques and then repeating them enough to reach a high level of performance. The study is done to learn the “work environment”—i.e., the makeup of the vehicles and the tools needed to accomplish the goals.
The evolution of the contents of automobiles is based on performance and safety. There are also changes related to the search for more energy efficient cars, with improved mileage when gasoline is used, electric vehicles, and alternative fuels. There is a need to make vehicles lighter and stronger—lighter to improve mileage and stronger to meet safety standards. The materials used do just that but continue to challenge rescuers. When all systems work as designed, responders often find those involved in the crash with no injuries or those minor in nature. But when the crash is severe enough, the victims can be trapped, requiring extrication. The components of the vehicle used to improve safety then become more of a challenge to peel off the occupants. Continual study of the coming challenges is imperative for those organizations that wish to stay on top of their game.
There is the old joke, “How do you get to Carnegie Hall? Practice, practice, practice.” If a rescue company wants to become great at extrication, members must practice a lot. Years ago, the department I was involved with entered some extrication competitions. That greatly improved their performance—not only those who competed but the rest of the department, as the bar had been raised. The events were good for a couple of reasons. They introduced new techniques. They also created a challenge. The competitive nature of the firefighters served as motivation. They did not want to be embarrassed in front their peers and family. They also wanted to come in first place. The result was a great reduction in scene time and a palpable improvement in confidence.
I do not hear much about competitions today. Departments need to develop their own motivation methods to generate the training and practice time needed to continually improve. Those that do also must make the practice meaningful and applicable. This can be challenging, as getting access to newer model vehicles may not be possible. Departments do their best and will use whatever is available. If programs using newer models are available in your area, find out how to take advantage of these opportunities. Look to your neighbors and mutual-aid partners to see if they have a line on some vehicles. If you rely on towing companies and salvage yards, try to look for newer models that have been involved in wrecks. Maximize the use of the vehicle, and practice on every square inch. Practice from start to finish—scene size-up and stabilization to deescalation. Use all the tools you have available, and experiment to see what works best in various situations.
There is no one tool that will work in all situations. There have been improvements made to the old standbys that enhance capabilities. The change from gasoline power to more battery usage has been helpful in reducing bulkiness and taken some obstacles, like hydraulic hoses, out of the way. Batteries are getting better all the time, generating more power and lasting longer. If you have not recently looked at what is the current state of the art, it is time to do some research. Find the tools that will make you more efficient and effective. There is always the challenge of finding funding, but these are incidents where high performance will make a huge difference. The more you know about the topic and the advantages, the better you will be at making your case for funding.
The objective of automobile extrication remains to remove the patient as quickly and safely as possible. Everyone should know the importance of short scene times with respect to positive patient outcomes. The advances in tools and improvements to vehicles have been a big factor in better endings. This will continue to prove to be the case but only if firefighters monitor the changes in vehicle manufacturing, look for better and more efficient tools, and continue to train. It is not a secret that those who practice more with the right tools will see much better performance. This is true in everything. And being really good at something as important as extrication will produce results that save lives, reduce pain and suffering, and instill a feeling that your efforts made a huge difference.
Whether your responses are infrequent or regular to calls for extrication, this is an area where true professionals shine and those unfortunate enough to have a really bad day—the victims—are fortunate to have responders who were prepared to the maximum.
RICHARD MARINUCCI is the executive director of the Fire Department Safety Officers Association (FDSOA) and chief (ret.) of the White Lake Township (MI) Fire Department. He retired as chief of the Farmington Hills (MI) Fire Department in 2008, a position he had held since 1984. He is a Fire Apparatus & Emergency Equipment and Fire Engineering Editorial Advisory Board member, a past president of the International Association of Fire Chiefs (IAFC), and past chairman of the Commission on Chief Fire Officer Designation. In 1999, he served as acting chief operating officer of the U.S. Fire Administration for seven months. He has a master’s degree and three bachelor’s degrees in fire science and administration and has taught extensively.