The First Five Minutes: A Best Practices Approach to Motor Vehicle Collisions

 

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Even though firefighters respond to more motor vehicle collisions (MVCs, photo 1) than any other emergency (except medical emergencies), consider all the things we need to evaluate, assess, and begin to mitigate on scene. Although the scene hazards really have not changed much over time, our response and the hazards we encounter have changed. The vehicle is the dynamic hazard in the equation these days. Supplemental restraint systems (SRS) systems, batteries and their subsequent locations, motive power, and vehicle glazing are all items that we need to factor in. On top of these considerations, we need to do this size-up quickly and completely to ensure an effective plan of action. 

 

We need to ensure our safety before we even step off the rig, so we must position our apparatus in a “fend off” manner. This vehicle positioning helps to protect us and our patients by placing the apparatus between the incident and traffic. We must then begin to evaluate the incident. Scan the area for scene hazards and perform our initial “windshield” size-up.

 

As you approach the vehicle(s), take into account how the vehicle appears. How is it oriented: upright, on its side, or overturned? What kind of stabilization should you consider? How is the vehicle damaged? How much “crush” or damage do you observe? This information should clue you in to potential entrapment and possible injuries. Do you see any deployed SRS systems? We should strive to approach the front arc of the vehicle so you can make visual then verbal contact with the patient(s). Once you find the patient and establish contact, maintain it throughout the incident. You have assessed the scene and located and begun to mitigate the hazards. When you are assured that the scene is safe, stabilize the vehicle to minimize or prevent vehicle movement. This ensures a stable foundation for space-making evolutions and minimizes movement of the patient.

 

 

Once the vehicle is stabilized, make access and begin hands-on patient management: Ensure his airway isn’t obstructured, that he’s breathing, and evaluate his circulation; engage in manual C-spine management; put on a C-collar; and administer O2, as indicated. Take a good look at the vehicle’s interior. Where are the SRS systems? Are they deployed or undeployed? Is there damage to the interior? Is the patient physically entrapped? Next, secure the vehicle’s power.

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Ensure the vehicle is shut off, and remove the vehicle’s keys. Remember, today’s vehicles can have proximity keys (photo 2) that need to be more than 15 feet from the vehicle to ensure that it can’t be accidentally started. Then disconnect the 12v battery…But can you find the battery (or batteries, depending on the vehicle)? In a substantial percentage of vehicles today, the battery is not in the engine compartment. But even if it is there, it might be hidden.

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You need to ensure that the vehicle’s power is secured for two important reasons. First, by shutting down the power, you start the process of draining the energy storage component of the SRS system computer. This helps ensure responder safety with regard to SRS systems (photo 3). Second, this will also shut down the high-voltage drive power in a hybrid vehicle. However, you also need to see what power accessories, such as windows and power seats, are in the vehicle before power is removed. The officer in charge should document when power was shut down and also the items discussed above.

 

Five Minutes … 

How is the patient? What are the presented or potential injuries? Is the patient medically entrapped? Remember, you might need to make space to disentangle the patient, even if he is not physically pinned. Vehicle rescue is a patient-driven skill, and the patient’s injuries, real or potential, will drive your creation of a disentanglement pathway.

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The officer in charge of the rescue effort must devise a tactical plan of action (photo 4) based on the information presented at the crash. Although the incident commander (IC) knows the strategic goals at a MVC is the life safety of personnel and care of the injured, the IC must rapidly develop a tactical plan of action. Various versions of this plan must be created to take into account the many variables that could be present—many more than existed in the past. And this must be done many times faster than in the past, as well.  

Although some you of might think this is a lot to be accomplished in five minutes (others will think it can be done faster), consider some the MVC responses you have been on in the recent past. There is more to deal with in today’s vehicle than meets the eye. Power isolation is critical for both responder and patient safety, yet we need to temper that concern with the need to use some of the vehicle’s power accessories at times. Also, the need to develop and process a tactical plan of action on scene is critical, especially considering the numerous hazards we encounter on scene. Although motive power is a big concern, I believe the ability to create space and produce a viable pathway to disentangle a patient will be a larger issue with today’s vehicles and the rescue tools we use.