Les Baker: Extrication Zone: Principles of Extrication

BY LES BAKER

There are more than six million motor vehicle collisions (MVCs) annually in the United States, and most require some form of response and mitigation by emergency service organizations. Regardless of the degree of vehicle damage and resulting level of entrapment, responders must establish command, properly size up the incident, and make the decisions that will lead to the appropriate tactics. And as with any other type of emergency incident, a safe, focused, and practical set of strategies should define the overall tempo and guide personnel through incident operations.

ESTABLISH COMMAND

First-arriving units must establish incident command in accordance with local procedures. Although these guidelines are presented in the context of a department that has staffed apparatus, there are some common philosophies that exist and are applicable to almost any setting.

The first-arriving company officer establishing command has a choice of modes and degrees of involvement in the tactical activities, but he continues to be fully responsible for command functions and the development of strategies. The officer must determine which type of command and mode of operation—investigative, fast attack, or command—will fit the needs of the incident. Initiative and judgment in this situation are critical. Most responders are familiar with the three modes but may not have considered their application at MVCs. Note: These modes only apply to company-level operations; when a chief officer arrives, that person should establish a stationary command post and assume command through proper transfer procedures.

Investigative Mode: This is for situations that generally require investigation by the initial-arriving company while other companies stage, pending assignment. A large percentage of the MVCs we respond to need little to no action from responding units. This is often obvious from the windshield view of the first-arriving unit, but the scene should still be investigated further to confirm that this is the case. The officer should accompany the crew to investigate the incident and determine what actions will be needed. If they determine that there are further needs, then they can assume one of the other modes and take the appropriate actions.

Fast Attack Mode: This is appropriate for situations that need immediate action and require the company officer’s direct involvement. In these situations, the company officer accompanies the crew to the scene to provide the appropriate level of supervision and assistance. These incidents include critical life safety situations, firefighter safety concerns or situations where immediate action is needed to stabilize the incident. This mode of operation is less complicated at an MVC because there are typically fewer resources on the initial dispatch, allowing for better span of control and management.

Command responsibilities cannot be neglected when fast intervention is critical, and the company officer gets involved in the tactics. Fast Attack Mode should not last more than a few minutes and should end when the situation is stabilized. When it cannot be stabilized or when command is transferred to a higher-ranking officer, don’t assume that just because there’s a significant mechanism of injury that there is also an immediate life hazard, warranting the fast attack mode. The decision to get involved tactically because of a patient’s condition should be determined from a quick assessment of the patient.

Command Mode: This is appropriate with incidents that involve hazardous materials, mass casualties, and serious hazards. Because of their size, complexity, or potential for rapid expansion, they require immediate and strong command. In such cases, the company officer will initially establish an effective command position until relieved by a higher-ranking officer.

STRATEGY DEVELOPMENT

An extrication incident has a much more defined set of strategies than we are commonly accustomed to with structure fire incidents. Each structure fire presents a unique set of circumstances, such as unknown building contents, varying floor plans, questionable structural integrity,  and changing fire conditions, which can partially (if not completely) alter the strategies from incident to incident.

The following set of strategies can broadly apply to an overwhelming majority of MVCs that require disentanglement:

·         Ensure the safety of personnel and bystanders.

·         Determine the hazards, and initiate appropriate the control measures.

·         Gain access, and provide emergency care.

·         Conduct the required disentanglement tactics.

·         Transfer the patient, and terminate the incident.

These strategies should guide the overall incident action plan. This plan should be disseminated using the incident structure and communications, notifying resources of the overall direction and placing them in the most advantageous positions. If your department uses time checks for structure fires, incorporate them into MVCs as well. This reinforces accountability as well as trending strategies and tactics.

DECISION MAKING

During the process of establishing command and initiating size-up, we instinctively begin to process the information through recognition, pattern-matching, and mental simulation. This serves as the basis for naturalistic decision making, which involves recognition of constraints such as limited time, high stress, and incomplete knowledge—all key characteristics of real-world, complex environments.

We cannot create a responder knowledge base that covers every type of incident, including MVCs. As such, the IC and disentanglement officer should rely on crew resource management (CRM) principles to guide them through the decision-making process. (Note: CRM is a supervisory enhancement tool that significantly reduces injuries and mishaps by focusing on improving performance in several critical areas: communication, decision making, teamwork, task allocation, and situational awareness—factors that have been found to be critical in improving a leader’s performance and a crew’s safety.) They should also refer to previous experiences and rely on other crewmembers for similar input and ideas for possible solutions.

The IC should establish the strategies during the initial size-up of the incident to provide overall direction. Because any emergency scene is dynamic and subject to change in seconds, it may become necessary to adjust the initial strategy to meet any new demands recognized during the evolution of the incident.

Once patient contact has been made, the interior rescuer can conduct a quick primary assessment. The entire assessment shouldn’t take longer than 10 to 15 seconds. Whether the incident commander (IC) is acting in the fast attack mode or has passed on command and the initial officer in charge is serving as the disentanglement supervisor, the IC must use the information garnered during the overall size-up and provided by the interior rescuer to determine the appropriate level of tactics, taking the timeframe into account. This should be communicated to everyone on scene as quickly as possible through face-to-face communication or radio transmissions.

With the exception of the initial actions required during a fast attack mode of operation, command-level personnel don’t have the time or the ability to dictate decisions on the tactical level. Command may establish a strategy, such as “conduct required disentanglement tactics,” but commanders must trust their group supervisors to provide viable input and make tactical decisions to accomplish the broader strategies. With this in mind, following are several key points that will assist supervisors with tactical decision making.

Tactical Decision Making

Follow the process. The extrication process was established to guide responders on the most appropriate sequence of events for handling MVCs. This formal plan essentially serves as the basis for the incident strategies and lays out an incident action plan that can be applied to every incident. Following this plan helps ensure that we approach each incident in a logical manner and use the appropriate tactics.

Mitigate or avoid new vehicle technology. Motor vehicles, regardless of size, shape, color, or propulsion system, are constructed of various amounts of plastic, rubber, metal, and paper. These materials are shaped into various designs and configurations to give the car structure and functionality. At the local shredding company, they run these vehicles through a simple process that shreds and sorts the materials into a pile of metal chunks and fluff (nonmetallic materials that remain after the shredding process).

If we can remove the new technology from the vehicle by disconnecting the battery and avoiding or mitigating components, then, much like the shredding process, we are left with metal and fluff. Further, responders should be stripping applicable trim and identifying vehicle components prior to push, pull, or cut operations, as this increases the odds of completing the tactic without contacting these components or any other hazards. This process addresses even the most sophisticated vehicle systems and allows us to easily complete needed tactics.

Put the vehicle back in its original position. Vehicle openings form a “cage” that surrounds the occupant compartment. The only reason someone becomes trapped in a vehicle is that the vehicle has been deformed in such a manner that the occupant is unable to exit the vehicle through one of the usual openings. Understanding that concept, if we can manipulate or remove damaged parts to put the vehicle back in its original shape and then possibly enlarge those openings, the patient can be removed. Sometimes this is complicated by exterior obstacles, limited tools or personnel, or vehicle position; however, when we consider every option available at most MVCs, there should be at least one possibility that allows for a suitable, inline path of egress. This step of placing the vehicle back in its engineered position also makes normal extrication tactics easier by reducing a certain amount of tension or compression on the vehicle parts.

Have multiple plans, and be prepared to change. When we arrive at a motor vehicle collision that requires extrication, responders begin to formulate a plan to mitigate the entrapment. It is usually a plan that is apparent and provides the best option for responders. Numerous factors may prohibit, or at least hinder, the completion of the primary plan and necessitate switching to a secondary plan. Although we can often determine these factors during size-up or the initial stages of tactics, many times responders have already committed to the primary plan before discovering the following:

–additional hazards, such as hazardous materials;

–pressurized cylinders, pretensioners, and so on, from safety systems;

–unique vehicle construction features;

–advanced steels;

–secondary patient entrapment;

–unanticipated reactions from vehicle damage; and

–a change in the patient’s condition.

Understanding these potential factors furthers the need to develop secondary plans that may have to be used. If needed, the disentanglement supervisor should communicate to the group members that the change is taking place and use resources appropriately. In situations where personnel and resources are abundant, the disentanglement supervisor may elect to start these secondary plans while others are working the primary plan. Being able to understand and accomplish this transition shows the flexibility and adaptability of the supervisor to complete the assigned task.

Create an inline path of egress. When freeing a trapped patient, determine the tactics that will provide the most inline movement possible to a long spinal board. The primary plan should be the best option available, taking into account all conditions to ensure this inline movement. Although secondary plans should attempt to provide an inline path of egress, they may not be as suitable as the primary plan. Simple things like positioning tools with the handle away from the patient movement or making an additional post will allow rescuers to gain valuable inches. Harden the egress to reduce the risk of further injury to the patient or injury to responders.

Establishing command, sizing up the incident, and formulating a plan based on good strategies are necessary steps to proficiently and safely mitigating an emergency scene. This principle applies to MVCs regardless of the severity of the entrapment or patient condition. Command must trust its group supervisors to provide viable input and make tactical decisions to accomplish the proper strategies. The disentanglement supervisor must be proactive in developing initial and secondary disentanglement tactics to accomplish the strategies and provide constant feedback.

BIO

LES BAKER, a 16-year veteran of the fire service, is an engineer with the City of Charleston (SC) Fire Department. He has a B.S. degree in fire science from Columbia Southern University. He is an adjunct instructor with the South Carolina Fire Academy and a member of the Darlington County Extrication Team, and he speaks and instructs throughout the country. He writes a monthly column for FireRescue Magazine and manages an extrication site.

 

 

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