Extrication Strikes Back: Returning to the Basics while Keeping Focused on the Future

Article and photos by David Dalrymple

Vehicle extrication and rescue is more than simple tool work these days. Yes, without a creating space we cannot disentangle our patients from the wreck, but we now have to mitigate many more hazards than we ever did before (photo 1). As always, we’re usually at the end of learning curve, since our problems are usually out on the street before we know about them, for the most part. Some of these hazards can hurt us or our patients (or both) if not managed properly. Although each motor vehicle collision (MVC) is different, they are common everyday emergencies. Today’s hazards make each incident more complex, and with that complexity comes a learning curve.

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Vehicle rescue is a patient care-driven skill. The patient drives the incident with regard to any rescue scenario, and is the focus of every injury-producing MVC. That will never change, even though our own safety is still and will always be number one.

In much of today’s vehicle rescue discussion, we talk about vehicle technology and its impact on us and our operations. These issues alone are dynamic and offer much to consider. Safety systems are now found in new locations, in greater abundance, and in all types of vehicles. We must think about vehicle construction and materials, how our tools work or do not work with them, and how this impacts our methodology. Our mindset has changed in terms of finding alternative ways to rapidly disentangle patients. The motive power of vehicles is rapidly changing. What exactly are we dealing with nowadays from our “windshield” assessment? Can we always tell from our scene survey what type of motive power is involved in the wreck? In addition, we also must have increased situational awareness because of the increased traffic volume on a roadway infrastructure that may no longer handle it. We must account for these tremendous concerns every day on every vehicle-related incident. We must look for, deal with, and mitigate hazards and potential hazards we had never even thought of 10 or 15 years ago.

The Technical Jedi

Nowadays in extrication, we are seeing an influx of the “technical Jedi” types. The presence of these instructors reminds me of the scene from the original Star Wars movie, where Obi-Wan Kenobi and Luke Skywalker are riding in their land speeder with the ‘droids R2D2 and C3PO in the back. When they run into a squad of storm troopers, Obi-Wan uses the “force” to convince the troopers that these are not the ‘droids they seek. The use of the “force” temporarily diverts the bad guys’ attention from the task at hand.

Now some of you are probably saying, “Dave, isn’t this a little harsh? The information being provided is important.” Yes, the material is important and it’s especially critical for instructor to grasp how the technology works, but does it need to be presented that in-depth? It’s great background material and a great resource for instructors. I respect the knowledge I am getting from skill-matter experts in their fields of expertise. I certainly do not have a degree in automotive engineering.

But for all the technical material presented, it still comes down to what I taught in my very first hybrid class in FDIC in 2003: Isolate the power, first by shutting the vehicle off and removing the key (there were no proximity ignition keys in production vehicles back then) and then locate the 12-volt battery and disable it, either by cutting a section of each cable or disconnecting it. Just like we were told to do when frontal supplemental restraint systems (SRS) became widespread in the early 1990s. Power isolation is our biggest protection from vehicle hazards today, regardless of what is powering the vehicle. Today, however, that simple operation is complicated by more batteries, found in a variety of locations, and the advent of proximity keys.

The bottom line: Showing me the inner workings of the electric motor does not help produce a better patient outcome, sorry to say. This is not a swipe at the “technical Jedis,” since I do feel they have their place in extrication. But many people have lost sight of the bottom line–producing a better patient outcome (photo 2), which is getting tougher to do every day, for many reasons, and not just motive power concerns. There is even a kit out now a major online store sells for about $600 for mitigating a hybrid vehicle emergency. This kit includes litmus paper to test for acids from the high-voltage (HV) battery and a jug with “neutralizing agent” (it’s filled with water) to negate the spill on the ground. Now, almost all of today’s HV batteries use a solid electrolyte or gel, not a liquid as in a 12-volt battery. Someone missed the background on that one, and this is basically a kit that disseminates a great deal of misinformation and ramps up responders’ fear for no good reason.

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It’s 2011 and the model year is half over. Hybrids have been in production in North America since 1999. A decade has passed without, to my knowledge, any responder injuries or fatalities resulting from a hybrid drive train. Yet responders have been injured, some seriously, from various vehicle components at a vehicle-related incident, whether an MVC or vehicle fire (photo 3). Also, how many of you have encountered a vehicle that your tools cannot cut or spread? (photo 4) Or when you have spread the vehicle’s material, it shatters or shreds like paper, leaving you nothing to push against? Here the “technical Jedi” fall silent.

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STAGES OF COORDINATED VEHICLE RESCUE

Although we indeed must stay on top of motive power concerns and issues, knowledge is power. Most of these and the SRS issues can be managed through simple commonsense practices. Power isolation is key as a primary hazard management task at any vehicle-related incident. This practice will take the drive train and SRS systems off-line. However, with the materials and vehicle construction of today’s vehicles, our tools’ inability to create space for disentanglement force us to become more creative and savvy and make us “think and work smart” on our feet at all times. We must focus on cutting back the “golden hour” and trying to meet the “platinum ten” benchmark more often.

How do we get there? Start with aggressive incident management. Use the on-scene hazard information. Mitigate the hazards by quickly stabilizing the vehicle and isolating the power. Get hands on the patient to assess him. If you need to, deploy tools to create maximum space the first time around. Provide proper patient care and protection as the rescue effort is taking place. Package and disentangle the patient and then send him to the appropriate medical facility. Clean up, account for equipment, get personnel accountability reports from your colleagues, and return to service. Although I have hit upon the big parts here and maybe squeaked by some of the little things, I have touched upon all the important benchmarks we need to meet as we go through the rescue.

 

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We need to return to basics while keeping current with what’s out on the street today. We must also peer around the corner to see what’s will be relevant to today’s and tomorrow’s vehicles (photo 5), including motive power, safety systems, vehicle construction and materials, and up-to-date tools and educational methodology. If you can do all that–the force will be with you always!

DAVID DALRYMPLE is a career EMS provider for the RWJUH Emergency Medical Services in New Brunswick, New Jersey, and a volunteer firefighter/EMT/rescue technician for Clinton (NJ) EMS/Rescue. He has been actively involved with emergency services for 27 years. He is the education chair of the Transportation Emergency Rescue Committee-US (TERC), is a certified international level extrication assessor, and serves on the Expert Technical Advisory Board of the IETRI as their road traffic accident advisor. Certified as a NJ fire service instructor, he has been teaching transportation rescue topics for more than 16 years. He is the executive educator for Roadway Rescue LLC, an educational team for transportation rescue training. He is an ICET (Netherlands) certified registered International SAVER instructor. He writes on “Extrication Tactics” for Fire Engineering and contributed to Fire Engineering’s Handbook for Firefighter I and II (2009). He received the 2007 Harvey Grant award for excellence in rescue education. He is featured in “Training Minutes” on vehicle extrication on fireengineering.com.

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