Vehicle extrication begins with leadership

There are specific things the first-arriving officer can do to improve a vehicle extrication's outcome


The tone drops for a multi-vehicle crash with injuries. When the rescue crew roles, the officer has a distinct set of responsibilities.

When first arriving on scene, the officer must conduct a good size up and paint a picture of the scene. This allows incoming companies to start game planning en route.

To do this accurately, the officer needs to avoid tunnel vision. Start big and get small. That means surveying the general scene and then zooming in to the vehicles and patients themselves. This may involve two different size ups.

The first radio transmission may go something like this:

"Rescue 3 is on scene. I have two upright cars involved, moderate to heavy front-end damage to both vehicles, bystanders are around the vehicles, no additional hazards on the scene. Rescue 3 will have mobile command and accountability and will be investigating.

"P.D. has all southbound traffic blocked and Rescue 3 has all northbound traffic blocked. All incoming companies proceed through the medians."

The second transmission will then go something like this:

"All patients are out of the blue car. We have two patients trapped in the red car. Make this a working extrication (add any additional resource requests and assignments). Dispatch, we need two ambulances. Rescue 2, when you arrive, begin extrication. Rescue 3 will assume initial patient care."

Three Ms

When making the initial survey, remember to look for any additional hazards to the crew first and to the victims second. This includes line downs, traffic flows, fuel leaks, etc…

Quickly apply the three Ms — mitigate, manage and monitor. Narrow your vision down from the scene to the vehicles. Identify position, damage and any additional hazards related to the vehicles themselves.

Unstable vehicles through position of rest or hazards (hybrids, fuel leaks, fire) should be identified and the three Ms applied as well. This is like peeling an onion. Continually dissect the scene in layers until you get to the core.

To get to the core and the secondary assessment, the officer must get off the rig and engage the core. I am not a fan of the remote or fixed command concept for the initial company. This takes an essential set of hands and leadership out of the most needed areas and confines it to a command vehicle.

I am a huge fan of passing incident command to the appropriate incoming officer and establishing operational command. The officer has to be fluid in her approach to this and keep her eyes on the prize.

Approach with caution

You must maintain an accurate awareness of where you are most needed. When the officer gets off the rig and approaches the vehicles to investigate, having tools is a must. Those include a halligan, window punch, cable cutters, pliers and a battery powered combination tool — if you don't have one get one; they are game changers in speed and efficiency.

Think of the secondary assessment as a 360 for a residential structure fire. Move quickly and look for the things to key in on. As you work around the vehicle(s), develop an understanding of the mechanism of injury, the access areas to the victims and the vehicle engineering and attack points.

Approach the vehicle with caution as it may be in gear, ignition on and fuel running. If you identify victims in the vehicle, immediately inform the crew so that they can initiate their response.

Just like many officers shut off the gas in their residential 360s, so should the officers address needed actions at the vehicle 360. These should include victim access and hazards.

To reach a victim, try before you pry. Attempt to open doors. If doors are not viable access points, look to glass.

If the glass is intact, break a pane, ideally directly behind the patient. This allows medics access to the victim in a relatively safe zone and keeps the majority of the shattering glass off of the victim.

Reaching through the driver and front passenger compartments opens rescuers up to impact zones from the dual-stage front airbags. These two airbags have the largest impact zones.

Make the purchase

Once personnel have gotten into the back of the vehicle, a more detailed patient assessment can be performed, the keys can be removed from the ignition, the vehicle can be placed in park, and the victim can be covered with an extrication blanket.

While this can all be done from the rear through the middle of the vehicle, thus avoiding the airbags, it is not always necessary or appropriate. Sometimes, we must reach through the front compartments to access ignition, transmission, hood latches, etc… The key is to do so intelligently and only risk a lot to save a lot.

To mitigate and manage hazards, create purchase points with the halligan at one of the hood hinges. Rescuers often get tunnel vision and attack the objective directly.

In auto extrication, an indirect attack is often far more effective. That's because modern vehicles have two segments of thin sheet metal for body panels to create inner and outer panels. The panels are glued together with automotive adhesives.

The connections such as latches and pins are getting stronger. Taking a tool to the edge of any modern body panel will almost certainly separate the two panels. This decreases the structural integrity and resistance of the panel, and result in a mess of metal that does not do anything to expose or pop the connection.

With a hood assembly, attacking the hinges by popping them or spreading then cutting them allows the hood to be folded forward. This gains free access to both the battery (if it's under the hood) and the latch assembly. This is a much more reliable and efficient hood-access process than traditional hand tools or hydraulic tools at the latch.

This is also where having a battery-powered combination tool makes a huge difference. This will significantly speed up the overall extrication time.

Communicate

If appropriate based on scene resources and timing, de-energize the vehicle and it put it into a safe working condition. If the supplemental crew is arriving on scene, delegate, but this must be the priority before extrication begins.

Now you're ready to go to work. You need a plan of attack and you need to be a good communicator. 

The officer must develop a primary and secondary action plan. The crew should know the verbiage and extrication techniques the officer will use and expects.

The officer should communicate the desired outcome to the crew and let them go to work. Do not micro manage. If you have been diligent in training your crew, they will overcome obstacles and think through the scenario on their own.

Give them a slightly unrealistic timetable to push the pace aggressively but ooze calmness onto the scene.

Be hands off

A secondary action plan should already be forming in your mind. Coordinate with EMS and support personnel and put everyone to work on the same page.

Officers become less effective at implementing the action plan if they have tools in their hands. This is not always possible due to manpower or expertise constraints.

If you find yourself with a tool in your hand, keep your head on a swivel and know that you are responsible for far more than the task you are about to perform.

Extrications often unravel when rescuers start rushing and stop progressing with their spreads and cuts in an organized fashion. There should always be a sense of urgency, but there should never be a sense of chaos.

Keep two tools working at all times and keep the scene clean. Get nonessential rescuers out of the way. If the action plan is not manifesting the way you expect, know when to intervene and either give technical guidance, leadership or redirection to the secondary action plan.

Good officers can always hone their team skills through training and street experience. It is important not to duplicate bad habits or failures. Always critique your own efforts as well as the crews and always walk away from it with things to improve upon.

There is no such thing as a perfect event and every event is different. Create a culture within your crew of embracing that truth, but always striving for perfection. 

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