Best Practices for Vehicle Rescue

by David Dalrymple

From the 2008 vehicle extrication e-Newsletter, sponsored by

We highlight technology issues and concerns with vehicles, but how often do we hit upon operational concerns and their impact at a vehicle-related incident or emergency? (photo 1) Be it supplemental restraint system (SRS) concerns or tool evolutions, (photo 2) we need information in the mitigation of such incidents at a motor vehicle crash or a vehicle fire. In addition to information, our operational functions have changed to interact with the dynamic hazards of the vehicles on the street today. Although many of the topics relate directly to technology concerns, let’s take these issues and find real-world solutions. Many operational facets of these emergencies have changed, especially in the recent past. These changes can be in the forms of command and control, tool operations, and even patient care. We need to be aware of many of the technological issues with contemporary vehicles to improve the outcomes of our patients.. In fact, all responders–be they staffing the rescue or the protective hoseline, performing patient care, or taking charge of the scene–play a key role in providing a better patient outcome. Everyone needs to understand the impact of vehicle technology in their roles and responsibilities. So let’s examine each of these operational facets.


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COMMAND AND CONTROL

The buck stops here. (photo 3) The officer on the apparatus, bottom line, is responsible for the crew and their safety. Whoever performs the scene survey must identify hazards, patient concerns, and any new vehicle technology (NVT) concerns/issues. In turn, these issues need to be communicated to the crew. The officer ensures all personnel are aware of hazards. The officer should document NVT concerns and also have access to information on vehicle hazards available on-scene. This information source can be vehicle Emergency Response Guides (ERGs),, texts such as Holmatro’s “Rescuer Guide to Vehicle Safety Systems,” or software such as Moditech’s “Crash Recovery System.” (photos 4,5,6)


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SAFETY

All personnel, especially those performing size-up and evaluation, must inspect vehicles completely for NVT concerns/hazards. When such hazards are identified, report them to the officer in charge and the rest of the crew. Even though we need to perform our size-up quickly, it must be more thorough and complete than ever before. Scene hazards are a given, but we need to read the wreck effectively to capture clues for potential injuries, entrapment, and hazards directly related to the vehicle’s technology, such as motive power, safety systems, and so forth. All personnel need to take appropriate caution and defensive measures when a vehicle technology hazard is identified.

A critical action in today’s incidents is isolating the vehicle’s power.(photo 7) This is a two-step process: Shut down the vehicle ignition, and remove the keys from the vehicle. This is especially important because of proximity ignition in modern vehicles. (photos 8, 9) Isolate the battery from the vehicle by disconnecting it or severing the connectors, thereby containing it from the vehicle if possible.(photo 10) Such power isolation is documented. Think of the ramifications of power isolation–you need to find power accessories such as power seats as part of our size-up. And there will be times when you cannot perform such power isolation because of crash damage or inability to locate the batteries.. Remember, in more than 40 percent of vehicles today, the battery is outside of the engine compartment.(photo 11) In those instances, you will have to work with more caution than in the past, plus you need to deal with the high-voltage (HV) drivetrain power in a hybrid vehicle. This power-isolation process not only takes power away from the various safety systems in the vehicle but also secures the HV drivetrain power from the HV battery forward. Remember, stay away from the bright orange and bright blue cables (HV-wise) (photos 12, 13)


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Next, interior trim(s) need to be displaced to evaluate if potential NVT hazards/concerns are present (photo 14). If such hazards are present, they must be identified for the entire crew. Think about what this entails. First off, you need to look for side curtain inflation cylinders; these devices can be found in the roof posts or the roof edges. Second, you can sometimes see reinforcements or structural components in the roof post and edges. This is also important, depending on the tools you are using.


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Whenever using tools in the area of the passenger cell, place an appropriate barrier(s) between the patient(s) and the crew members. This barrier can be soft or hard protection. Soft protection, for use when performing glass management and keeping a clean work area around the patient(s), consists of tarps, blankets, or a soft cover (photo 15). In terms of hard protection, a cutting shield is needed when using cutting or spreading tools inside the occupant compartment (photo 16). Today’s hard protection needs to be a flexible, shatterproof shield, since you must get into close confines and you will sever hardened materials that can produce small fragments that can fly, and have energy.


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Finally, identify debris with potential SRS devices for wrecker/recovery personnel as well as all emergency personnel (photo 17). Carefully observe these objects, especially how they are placed after being removed from the vehicle. A few years ago, this would never have been a consideration, but numerous vehicles on the road today have side-impact and side-curtain air bags. Side SRS systems have become almost standard items on most vehicles, whether they are cars, SUVs, minivans, or pick-ups. This forces us to deal with live, “loaded” SRS in debris that we might displace or remove during the rescue process. When these vehicle components are removed, we need to ensure they are placed with the sheet metal side down and that the interiors are facing upwards.


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TOOL USE/EVOLUTIONS

Although these practices also can fall under safety, the following observations are intended specifically for tool operations. First, the tool operator must observe a “safe” area in reference to observed NVT hazards/concerns. This is especially important if you cannot isolate the vehicle’s power. For the interior rescuer today, that observance of “space” from SRS is pretty difficult at best (photo 18). With the average of six to eight SRS devices in contemporary vehicles, barring a roof removal, we have run out of “safe” space.


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Use a proper cutting shield in conjunction with tool operations near a patient or crew personnel. This has become more and more important. You need to observe caution and show concern for cutting materials with possible NVT concerns, in particular when using power hydraulic cutters, reciprocating saws, and rescue air chisels. Hardened materials can be found everywhere in the vehicle, from structural reinforcements to various components (photo 19). Not only can fragments be produced, but sometimes these materials are stronger than the tools using to sever them, creating a greater potential for breakage. Stronger tools and better operational techniques are extremely important. In addition to hardened materials, the other reason we remove/displace interior trim prior to cutting the roof posts/structure is to ensure there is no damage to the SRS inflation device. Cutting through a live side curtain inflation module can produce fragments under high pressure, with upwards of 10,000 psi, in side-curtain inflation cylinders and possibly in more than one inflation cylinder, especially in vehicles with larger sides (SUVs, minivans, and station wagons, photo 20).


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Think about this next practice. Respiratory protection is worn during glass management–not breathing apparatus, but a simple dust mask. Why? Much of the vehicle glass encountered today is laminated glass. This type of glazing needs to be cut to be removed from the vehicle because of its laminated construction of layers of glass and plastic and because it is bonded onto the vehicle. We have become accustomed to this material in windshields, but many vehicles today have laminated glass in the side and rear windows for a variety of reasons, in particular for added structural strength. Think about that for a moment–a change in glazing material to add strength to a vehicle’s structure. Times have changed, fellow rescuers, and changes are going to keep occurring (photo 21).


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We’ve mentioned power isolation already. Along with power concerns, think about how this power is distributed to the various vehicle components, namely by extensive and ever more complex electrical circuitry, computers, and the ability to store power in capacitors. Even today, our tools can complicate this power issue. Although it’s unlikely, our power hydraulics can produce a static charge as they pass through plastics. What happens when we encounter a device such as a side-impact or side-curtain SRS module and we have to sever wiring to it as part of evolution? Err on the side of caution. Cut or sever any wiring you encounter with a hand tool, not a power hydraulic cutter. To be on the safe side, consider potential SRS reaction (photo 22).


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Let’s go back to debris again. Place debris from the vehicle, especially roof and doors, into an identified debris pile and consider its potential SRS reaction (i.e., doors are placed with exterior panels faced down, interior facing upwards). This is done for a number of reasons. I’ve already mentioned the issue of “loaded” SRS in the debris, but we also want to keep our work area clear of trip hazards by keeping debris all together. In addition, this is useful for documentation or for training/educational purposes, since we seldom get the opportunity to cut new vehicles. Many times we can inspect various pieces of debris and glean information about how a component is made; what it’s made of; and, more importantly, how our tools fared against it (photo 23).


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PATIENT MANAGEMENT

One of the biggest concerns today is how our patients interact, so to speak, with the vehicle, especially the vehicle’s structure after a crash. Those of you who have been on the job for a number of years should consider how motor vehicle crashes (MVCs) have changed, particularly the occupant space inside the vehicle. Back in the old days, a door displacement or “pop” gave us enough room to access the patients and remove them (photo 24). Nowadays, however, that door displacement gives us patient access, and that’s about it. Factor into this the vehicle’s ability to absorb crash energy readily (photo 25), allowing the vehicle to crumple up and dissipate that energy, especially from the front and rear. On top of all that, the interior is getting closer to the front-seat occupants, almost like a cockpit. Then think of how seats are configured today–contoured, racing-style seats are the norm. Is it any wonder most EMS providers now use a rapid removal technique even when it isn’t needed?


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Are the packaging devices we have become accustomed useful in this day and age? The packaging devices for a stable patient, many times, will entrap a patient because of a lack of space. Remember, head-belly-toes alignment is still a best practice for patient removal. That hasn’t changed. What we have to rethink is our disentanglement methodology.

And our tool-evolution options have increased to a certain extent. Door “pops” are great for access but not removal, but many vehicles today are configured as four doors. Why not just perform a total side removal, like a maxi-door or B post tear evolution? With the removal of both doors and the B post, you have created a space almost equal to a roof removal on the same side as the patient. The tried and true roof removal is another option.

The biggest part of the equation is this: We must aggressively assess, size up, create space, facilitate patient care, and disentangle the patient rapidly today, even when faced with all the additional and ever-changing hazards we face (photo 26).


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Many of these tactical considerations are commonsense, straightforward tasks, but if they are ignored or disregarded because “nothing bad will happen,” think again. Murphy runs rampant on-scene, and little things snowball quickly. Some of the vehicle hazards today can outright injure personnel. Complacency is a shadow that can loom over all of us, especially since MVCs are a common, everyday emergency to which we respond. MVCs and how we operate at them, regardless of task, deserve a better, fresh look (photo 27).


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David Dalrymple is a career EMS provider for Robert Wood Johnson University Hospital/St. Peter’s 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 as the road traffic accident advisor on the Expert Technical Advisory Board of the International Emergency Technical Rescue Institute.

More: www.roadwayrescue.com

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