By ERIC J. RICKENBACH
Most readers will probably attempt to answer the title’s question with one of the following three responses:
- The use of high-strength steels, which make cars more difficult to cut;
- alternative power-source (electric, hybrid, and so on) vehicles; or
- air bags and other supplemental restraint system (SRS) hazards.
The reason for thinking this is simple: These topics receive the most press coverage. Read any major fire rescue magazine or journal article or search the Internet on the topic of vehicle rescue and, inevitably, you will find readily discussions on one of these three points; this is the reason there is so much time focused on vehicle extrication training. If you respond to the question with one of these three answers, you are following the same thought process as most rescuers on the street today. As a vehicle rescue instructor, I find that even beginner students will answer the same way. But what is truly the biggest challenge in vehicle rescue that you face?
The dictionary definition of the word “challenge” includes the line “a stimulating task or problem,” which refers to most of what rescuers do. Rescue, in any form, is a thought-provoking process where responders routinely overcome tasks or problems. But again, what is the biggest challenge vehicle rescuers face? Is it one of the aforementioned topics, or is it something else?
Every rescuer has heard about the use of high-strength steels in vehicle construction. Perhaps you have heard about this when the local rescue tool salesperson showed up at the station with his newest and greatest cutters that are “boron capable,” designed to deal with “complex car construction,” or any other number of marketing statements. To their credit, manufacturers are working to develop tools and equipment to deal with these vehicle construction challenges. Likewise, rescuers and rescue instructors are working to develop techniques to work around these construction features if their normal bag of tricks/tools cannot deal with the high-strength steels. So, although new car body construction is a challenge, is it our biggest challenge? The answer is no.
Everyone has heard the stories about car fires in electric vehicles and, by now, you know to stay away from orange cables and other high-voltage components. Vehicle manufacturers are producing detailed emergency response guides for these alternative power-source vehicles. These guides, coupled with some simple rules of engagement when dealing with these vehicles, lessen the challenge. So again, alternative power-source vehicles can be a challenge, but are they the biggest challenge we face? Again, the answer is no.
When a minicompact car such as the Scion Q has 11 air bags, rescuers may feel challenged working around all of these potential problems. However, vehicle manufacturers label the various locations of SRSs so that rescuers can remember to look for certain things before starting evolutions. Also, there is computer software on the market today that details the exact locations of SRSs (along with high-strength steel locations and alternative power-source shutdown procedures). At a minimum, rescuers should employ the peel-and-peek method of assessing SRSs in vehicles. So, while assessing for and working around SRSs can be a challenge, is this the biggest challenge a rescuer faces? No.
So, if none of the three of the most notorious challenges in vehicle rescue is the biggest challenge, what is? What about the significant challenges posed to us by the patient? You may say to yourself, “Wait, the patient is NOT the biggest challenge.” However, I will disagree with you and tell you the reason the patient is your biggest challenge from a twofold perspective.
First, do you even remember why you are at the accident? It seems that today rescuers, in general, have become overly focused on strong metals, electric vehicles, and air bags; the patient and patient care seem to have become afterthoughts. Don’t believe me? Think about the vehicle rescue incidents you have responded to in the past year. Now, add up how many times you have heard at any scene the question, “How’s the patient?” or “What’s the patient assessment?” Was that question-and the answer-verbalized so everyone working at the vehicle heard it?
Also, are you assessing the patient as well as you are assessing the vehicle? When was the last time that you actually knew the patient’s condition and status before you cut or spread a part of the vehicle? Every rescuer on scene needs to know about the patient. Rescuers and rescue services seem to have a big problem remembering that they are actually there to rescue a patient, not the car. I agree that some of this (forgetting the patient) can be attributed to the problems presented to us by the vehicles. However, rescuers must not forget the reason they are working on the vehicle in the first place.
The second part of my explanation deals with what you cannot assess in your patient. Modern medical technology is great, but street rescuers still do not have the benefit of portable x-ray machines, CAT scanners, or any other number of advanced assessment and treatment tools. You are left with a minimal amount of tools to assess and make critical lifesaving decisions, and the most important tools for this job are not tangible ones; they are our senses and our experiences. Remember to look at your patient, listen to your patient, and be hands-on in your assessment of the patient. Next, take this information, couple it with your experience, and consider what may be wrong with your patient and provide the most appropriate patient treatment, packaging, and ongoing care. Unfortunately, not having access to a definitive diagnosis while on the street presents an enormous challenge to rescuers.
So, if the patient is the biggest overall challenge in vehicle extrication, how do you overcome that challenge? There is no easy or quick answer to this question. There are no emergency response guides for the patient, and there is no computer software that will pinpoint problems with the patient. You are left with the ultimate challenge of vehicle extrication: keeping the patient as the PRIMARY focus of all on-scene rescue activities. This begins with a good patient assessment, performing quick and efficient disentanglement and extrication techniques, and providing for timely transport to an appropriate healthcare facility.
Learning the best places to cut a car, knowing where and how to depower a vehicle, and keeping your patient out of air bag deployment zones are all a part of overcoming the “patient challenge.” The most important thing to remember is why you cut and depower a vehicle or learn about air bag locations-all of these things benefit the patient. Keeping the patient at the forefront will lead you to being a better overall rescuer.
ERIC J. RICKENBACH is a 30-year fire service veteran and a firefighter and emergency medical technician with the Keystone Fire Company in Rehrersburg, Pennsylvania. He has been an instructor for vehicle rescue for the Pennsylvania Department of Health since 1997 and for the Pennsylvania Fire Academy since 2000. Rickenbach is also an instructor with the Penn State University PAgricultural Rescue Training Program.