Seven Steps Define an Approach to Emergency Extrication Operations
As the fire service becomes increasingly involved in the field of accident victim extrication, the fire officer must become more aware of his responsibilities and duties in these emergency situations.
Planning is a time-proven method of coping with fireground problems, and it is my suggestion that extrications, as well as all other nonfire emergencies, can greatly benefit from the application of such foresight. By using the acronym RESPECT to signify the following steps—respond, evaluate, stabilize, protect, extricate, coordinate and transport—we can define the areas of concern and chart our approach.
Response is the first direct action taken and therefore should be closely examined. Operations which get off to a bad start tend to stay bad. Of immediate concern is the location of the accident. Is it on a limited access highway? Will traffic be blocked, making an alternate response route more appropriate? Do the prevailing weather conditions also suggest another route in order to avoid slippery hills or flooded areas? These questions should be answered before leaving quarters.
Will units respond from more than one station, and if so, can you anticipate crossing their response route or those of other emergency vehicles on the way to the scene? Are you being special-called or responding on mutual aid outside of your normal district? If so, is the driver sure as to the best way to get there?
Volunteer or on-call departments must also be concerned about the response of members to the scene in their private autos. This practice should be discouraged as much as possible, because it usually serves to increase confusion and add to traffic congestion.
The planning involved in response should also cover specific duties to be carried out upon arrival. In departments that run with both engine and rescue companies, these duties will be clearly defined. But for smaller towns or in volunteer departments, such planning may consist of a tailboard discussion of who will do what, based largely upon the manpower at hand. In any event, the officer should not overlook the importance of an organized response.
The proper positioning of the apparatus must be considered as an integral part of response. Poorly placed apparatus can block access to other emergency vehicles and have a generally adverse effect upon the entire operation. Apparatus should be parked uphill if the scene is on a grade, and always located at a safe distance.
Consideration should be given, at all times, to the safety of fire fighting personnel. If the road is to remain open, rigs should be parked well off the pavement, so that members will not be stepping off into traffic. Warning signals should be used only as needed, and floodlighting carefully positioned so it does not shine directly into the eyes of oncoming drivers.
The second area of concern is the evaluation of the incident. Just as an officer must correctly size up a fire upon arrival, so too must he determine what will be required at an accident scene. If your department does not provide ambulance service, has one been notified? Will one be sufficient? Will any specialized tools or equipment have to be called? Will outside agencies such as utilities be needed? Are any of the vehicles involved carrying hazardous materials, or are they mass transports such as buses? If so, more manpower and equipment will certainly be required.
Stabilization refers both to the vehicles and the victims. It is good practice to chock the wheels of any car involved in an accident. Wooden cribbing, jacks or airbags can be used to steady an otherwise unsafe auto. For vehicles over embankments or through guardrails, a safety line should be run from a winch or a towtruck to prevent further movement.
Stabilization of the victims consists of removing any life-threatening emergency. Patients should be immediately examined for pulse and respiration, symptoms of shock, and for severe bleeding. Since automobile accidents are the leading cause of fractures, these should also be suspected. Remember, too, that spinal injuries may be present and that the mishandling of such injuries can cause paralysis and even death. For these reasons, it is strongly recommended that all departments involved in vehicle extrications provide their fire fighters with some form of certified emergency medical training.
Protection against further injury or fire must also be supplied. If the vehicle engine is still running, shut it off. If not, disconnecting the ground side of the battery may eliminate one potential source of ignition. Where hazardous atmospheres may already exist, the removal or cutting of the battery cable and the related dangers must be weighed against the problems caused by a live electrical system.
Leaking fuel is still another hazard faced at accident scenes. Small leaks can be stopped with wooden or rubber plugs, plumber’s putty, or specially made sealing compounds. Fuel lines may be crimped with pliers. The type of fuel and the weather will have a bearing on what further action will be necessary. The use of water to wash down diesel oil or other flammable spills in subfreezing temperatures may create an ice hazard more serious than the spills themselves. In these cases consider the use of sand or gravel to reduce the dangers.
Overturned vehicles should never be righted while they are still occupied. Doing so subjects the passengers to further injury, while increasing the chances of fire.
For the safety of all concerned, the extrication crew should have an appropriate extinguisher at its disposal, and this should be backed up with at least one charged line of l‘/2-inch or larger hose. Prior to beginning the actual extrication, victims should be shielded with a fire-retardant blanket to protect them from broken glass and debris. Or a turnout coat may be used. Remember to periodically check any covered victims for changes in physical condition.
To begin the extrication process, one member should be assigned to open up possible points of entry by widening gaps between the body and doors with a Halligan or pry bar. This should be done after the doors have been tried to see if they are already free. Prying with a hand tool may exert sufficient force to open them. If not, the taps created in the sheet metal will provide good starting points for hydraulic spreaders.
Initial entry may involve the accidental or intentional breakage of glass.
Choose a side window away from the victims if possible, because pieces of broken glass can become dangerous projectiles. Never shatter a windshield or rear window. Auto glass can be easily broken with a spring-loaded punch, or by a crisp blow with a pointed tool. Placing a sheet of adhesive contact paper over the window to be broken will do much in reducing flying glass.
Windshields set in rubber may be removed by cutting the gasket, but a different technique is required for those windshields set in mastic. Cutting along the edge with an ax or using a specially designed windshield removal tool will work best. If it is not necessary to remove the entire windshield, it may be advisable to punch a section out from the interior of the vehicle, as when chains or a come-along are used to raise a steering wheel.
Hydraulic tools may also be used to push back seats, but first check to see if the track is operational. If it is, check to see that the seat is extended to its rear limit. Moving the seat may eliminate the need for any further action.
Where steering columns must be pulled to free a trapped victim, be sure that the steering wheel and steering column are properly secured. Energyabsorbing columns can kick back, causing further injury. If it becomes necessary to remove or open the roof of a vehicle, the air chisel and other mechanichal tools are suggested. If a complete removal is in order, be sure to have personnel ready to hold the roof when the supports have been cut.
Whenever large quantities of material must be cut, the use of power saws and acetylene torches may be considered. The benefits of these methods, however, must be carefully weighed against potential injury to the victims and the presence of flammable or explosive atmospheres.
Two final points should be mentioned concerning the extrication process. The first is to avoid the pitfall of directing your efforts against the damaged side of the vehicle. While many times this will prove to be the correct approach, I have watched many departments waste valuable time prying and cutting when the injured could have been more easily removed from the undamaged side of the auto.
The second point is to consider the needs of the victim, both physical and mental. Rocking the vehicle or sudden jerky motions can aggravate injuries. Avoid them when possible. Remember, too, that automobile accidents are not a daily happening for most people and that they will be understandably apprehensive—especially when you arrive and start cutting and bending what is left of their car. Make a point of reassuring victims that you are taking actions to help them and that some of these actions will make noise.
Coordination, the sixth concern, refers to the coordination of actions and services. It is more difficult to fight a fire when hose crews and ventilation teams do not work together. It should come as no surprise that the various actions such as jacking, shoring, cutting and stabilizing required to carry out a successful vehicle rescue also require coordination.
It is the responsibility of the fire officer to provide direction and leadership to fire fighters and to ensure the proper completion of the task. Examine the relationship between all actions being taken, and do not hesitate to make adjustments when required.
In addition to the coordination of rescue efforts, coordination between emergency services is also needed. The fire officer will be the liaison between the fire department and other agencies assisting at the scene. Responsibilities of each must be understood by all concerned. Anything to lessen on-site confusion will be a positive step.
Transportation, the final consideration, may mean different things to different departments, according to whether they run an ambulance. In any event, first-aid training should include the use of cervical collars, short boards, long boards and other extrication devices.
In communities with fire department ambulance service, transportation will also include the notification of the appropriate medical facility, selection of the delivery route and the monitoring of vital signs while en route to the hospital.
No matter what the case, care and forethought must be given to this final phase of the extrication procedure. Carelessness here can negate all the good done before.
It should be mentioned that many of the basic concerns, such as the importance of wearing turnout gear and the awareness of electrical wires and other hazards, have not been discussed. These points must be reinforced on a company level.
Neither has there been an attempt to offer a step-by-step guide on how to cope with every extrication problem. Practical experience and referral to any of the more detailed manuals on the subject will provide these answers.
However, if officers remember the acronym RESPECT when dealing with vehicle extrications, they will not only direct a well-organized operation but may gain a different type of respect for themselves and their department.