By Dave Dalrymple
Photo above courtesy Ashley Lopez, Ocala (FL) Fire-Rescue
Responders must remember that the mindset of vehicle rescue is a medical intervention. Although our focus must indeed be upon our patient, we cannot bring the crushed Hyundai to the ED with patient in it. As technical experts in the discipline of extrication, we need to disentangle our patient and hand over to EMS to continue prehospital care en route to the appropriate medical facility.
It is vital we create a pathway to remove our patient from the vehicle to be transported by EMS. This is called “spacemaking,” or making/creating space. We might need space initially to access the patient, then different space to disentangle the patient from the vehicle. The days of performing a door pop or displacement as your access and removal space are gone. With smaller vehicle size and the fact that today’s vehicle absorb energy, small vehicle become even smaller, thereby makes our space creation more difficult and decreasing our time parameter. Remember, too, that today’s vehicle structures are tougher to cut and break. Responders must think outside of the box to get time back on our side of the patient’s “Golden Hour”! Power hydraulic rescue tools have become smaller yet faster. These tools are lighter in weight and more ergonomic—the type of equipment we only dreamed of 10 years ago. The biggest strides have come from the battery-powered, self-contained hydraulic rescue tools. Yes, newer tools will help us keep up with vehicles on the street, but new mindset and methodology is needed.
The Heart of Vehicle Rescue
A new or even a renewed mindset and methodology is called for in today’s motor vehicle crashes (MVCs). I have broken down some of the various facets of the discipline, but together they form the foundation of that “new” mindset and methodology–coordinated stages of vehicle rescue. While it is vital to have the focus of patient management into our vehicle rescue evolutions, these same evolutions need to be practiced well and be done by skilled tool operators. We need correct tool choices, focused tool evolutions, and timely tool-created space or pathways to disentangle our patients. All of this is done to provide a better patient outcome every time.
Take the “Golden Hour” concept of surgical intervention for a trauma patient and go one better: Make our on-scene time a true “Platinum Ten,” a 10- to 15-minute period on scene time from our arrival until our patient is disentangled and moving to definitive care. Remember, trauma is the disease of time! We can achieve this on a regular basis if we train that way, work that way, think that way, and move that way. This is no rocket science, but rather applied common sense: team tasking fused with good BLS patient care and management welded to straightforward tool skills.
This new or renewed mindset and methodology comprise the “Pillars of Vehicle Rescue.” Each of the “pillars” represent a cornerstone of both your vehicle rescue operational practices and educational direction.
- Mindset and methodology
- Stages of coordinated vehicle rescue
- Rescue real estate
- Occupant “Circle of Life”
These are only simple to write down, but difficult to apply every day. It takes purpose to perform power isolation and stabilization on every injury-producing motor vehicle collision in which someone is in the vehicle.
On the technical side, vehicle power is not your friend; if you cannot find the battery at least shut the ignition off and remove the keys to your apparatus. Remember proximity keys and if you have a family in the vehicle there might be more than one key. Move with a purpose, and care for the patient while the rescue team goes to work prepping the vehicle. The engine crew should secure the keys, shut off the vehicle, and find the 12V battery now cutting both cables with a double cut. Finally, EMS takes charge of patient management and advises what is needed in terms of resources and spacemaking.
Back to BASICS
Finally, let’s revisit some of our current methodology. Everybody in every discipline seems to be doing “back to basics” evolutions. What are the basics of vehicle rescue today? No two instructors will give the same answer, and the basics of five years ago are different today. In keeping with the word “BASICS,” here’s what I believe truly are the “basics” for vehicle rescue today:
B – Battery gone/ignition off/keys out (power isolation)
A – Alterative mindset and methodology
S – Stabilization of the incident and the vehicle
I – Information of hazards on scene
C – Creation of a patient pathway
S – Strategic cutting/severing
Today’s “BASICS” are a combination of mindset, methodology, operational tasks, technical gear, and tempo that needs to occur at every injury producing motor vehicle crash. It does not mean you will need to check every box off on every incident, but the mental methodology needs to be addressed every time.
“B” stands for power isolation, which includes taking safety systems/supplemental restraint system (SRS) off line and takes into account taking alterative drivetrains, hybrids, and electrics off line, as well. Given the spread of alternative-fueled vehicles, this identification grows more difficult and important, and is why 12V power isolation becomes critical.
“A” is for alternative mindset and methodology. Some of our existing mindset and methodology going back a decade or so may need to be upgraded. We must account for the technology of vehicles today and rise to the occasion.
“S” stands for stabilization of both the hazards found on scene and with the vehicle. Hazards on scene have not changed much, but hazards with and in vehicles have! This also includes the actual stabilization of the vehicle, as unwanted vehicle movement is a hazard.
“I” is information of hazards on scene. This is new for a great many of rescuers, but it also is accessible to a great many of us and available to every department in the world wherever they might be. With the amount and type of hazards and how to manage them, you need a database, literally, in the form of smartphone or tablet apps. Fortunately there are a few out there, and some are free: For dealing with alternative fueled vehicles there is QRG app, Extricate app, and NFPA has 1st responder app which has added information. The best app for vehicle rescue hands down is CRS or iCRS from Moditech.com. Their database goes back to 1989 and includes trucks and buses. The top level of the app allows you to type in the license plate number and it will display the correct vehicle in a glass cutaway view with all the hazards in a color-keyed format. If it is alternative fueled or has special properties it will list primary, secondary, and tertiary ways to make the system safe.
“C” stands for the creation of a patient pathway and we’ve discussed this in detail already.
“S” means strategic cutting and or severing. This refers to the construction methodology of today’s vehicles. Most vehicles are built around the premise that each piece relies on the other for total structural integrity. This is akin to a bowstring truss roof. If we can understand how the vehicle was assembled, we can weaken it to facilitate our spacemaking operations. I believe this will be a key for future tool evolutions as vehicles become ever stronger around the occupant cell.
Rescuers come to me many times and ask: “Dave, what is the biggest challenge out there in vehicle extrication?” People talk about safety systems SRS or airbags, and yes, they are a hazard undeployed. Others speak about alternative fuels, which really still boils down to hybrids and electrics; hydrogen is still really isolated to Southern California and use of propane and compressed natural gas is limited. When these initially appeared, the commentary was that “people would be hurt, maimed, and killed.” Thus far, no responder has died from either and we’ve had some minor injuries from responders cutting through side curtain cylinders worldwide people.
How to deal with these hazards? The best way of increasing safety for you and you crews is to be aware of surroundings and block the vehicle. Next is power isolation, cut both the cables to the 12V battery (or batteries). This will disarm the safety systems SRS of the vehicle and begin the depowering process of the high-voltage system (If the vehicle is alternative fueled). When cutting, always take a chunk out of the cable, so double cut both. Power isolation is the biggest protective step you can make to the vehicle to ensure your continued safety. It reduces the hazard of both SRS systems and alternative drivetrains. We must try to accomplish this on every MVC in which occupants are still in the vehicle. Sometimes, due to crash damage or inability to find the 12V battery, responders will need to go to work so as not to lose time but with added situational awareness. Along with this, although much more favored in Europe than here in North America, is the application of a SRS-securing device on the driver steering wheel SRS. First off, the vehicle manufacturer and the SRS manufacturer have always said no. They have never been 100-percent foolproof, and what about the other SRS systems in the vehicle? You need to get into the path of deployment to put any of the devices on. If it’s one of the hardened devices and fails, that’s the equivalent of firing a charge of grapeshot into the occupant cell of the vehicle.
The biggest challenge faced by rescuers in the realm of vehicle rescue is twofold. First off is dealing with the ever-increasing strength and the variety of combination of materials being used as vehicle structure reinforcements. Some can be cut, others not, and others can be torn by using a ram in a straight push. The solutions are not always straightforward or easy to accomplish. Any type of material that is a shaped device will be even harder to break. The second is education on vehicle rescue. We need good, timely, pertinent information. There is a lot of very good information on vehicle rescue, but there is also some junkyard voodoo nonsense, too. How do we know which is right and wrong, or what is timely or not? How do we know what is realistic operationally and what is just junkyard voodoo playtime? Trial and error. We all hear about different ideas, seeing things in magazines or social media. We want to try it out ourselves, put our own spin on it. That’s all good, but we also need to temper our enthusiasm. Try it, evaluate it realistically under real-world conditions, such as putting a patient representation in during evolutions. If we keep in mind the fundamentals of the discipline and the focus on favorable patient outcomes, the proper techniques will become clear.
DAVID DALRYMPLE, AIETecRI, is a firefighter/EMT/rescue technician for Clinton (NJ) EMS/Rescue. He has been actively involved with emergency services for 34 years, having taught transportation rescue topics for more than 22 years. He is the executive educator for RoadwayRescue LLC, a dynamic educational team for transportation rescue training. He has taught at FDIC since 2003, and was team captain when Clinton’s team won the world vehicle rescue challenge in 1998. He is certified as an International level extrication assessor and has taught and assessed in North America, Europe, the UK, and South Africa. In 2007, he received the coveted Harvey Grant award for excellence in rescue education. Dave is also a member of the Society of Automotive Engineers (SAE) task force on hybrids and electric vehicles for first and second responders. He volunteers as a fire/rescue technician for the Sports Car Club of America-Northern New Jersey region and is actively involved in emergency response at performance rally events with American Rally Association. He is a member of the International Council on Motorsport Science and his ESRS rally rescue program holds SFI accreditation. Besides writing for fire rescue publications, he is a contributing author for the PennWell Firefighter I & II textbook and is featured in a three-DVD educational series on vehicle rescue from PennWell/Fire Engineering. He is also the host of three seasons of extrication Training Minutes videos.