How to manage a chain-reaction vehicle crash

The number of victims, the distance they are spread across and the natural hazards make these extremely tough incidents to bring order to

Whether global warming or just bad luck, fire departments across the country are dealing with a marked increase in multi-vehicle crashes.

These scenes are not just a few cars end to end, but hundreds of vehicles ranging from tractor-trailers to passenger vehicles and yes, emergency vehicles as well — all packed and stacked in a Rubik's cube of twisted metal and panicked civilians.

The expected culprits of such crashes are bad weather, deteriorating road conditions, distracted drivers and the chain reaction that occurs when traffic is suddenly halted. But anything can trigger these devastating pileups from a drunk driver to someone dropping a snack or texting a friend.

Regardless of what or who is at fault, the same dangers exist for first responders as those caught in the crash sequence.

Historically, firefighter deaths related to response and roadway incidents are the second leading cause of firefighter fatalities. Not becoming another highway statistic is a major response consideration in this type of emergency and should never be discounted by the first-arriving officer and crew.

Multi-vehicle crashes can span a mile or more, and command of the scene will take increased time and resources before absolute control is established. This is a critical strategic element when calling for additional aid such as rescue teams, ambulances and additional law enforcement.

Staging resources away from the incident as well as waiting for traffic control and salt or sand in wintery conditions may be the expedient action to take in such large-scale situations. As the incident unfolds responders need to have a clear size-up, an accurate staging and an overall triage.

Here's a closer look at the six phases of establishing order on these scenes.

Initial response
In the initial response phase, determine the size and location of the incident in highway sections or miles, as well as any related information. Initial triage includes vehicles as well as victims.

Establish coordinated response with incoming medical responders, and identify the types of vehicles involved, especially hazmat, tractor-trailers, buses and livestock carriers.

Verify reports of civilians trapped, wandering or leaving the scene. Continue receiving updates on weather (precipitation, temperature, visibility) and road conditions, especially control and closure status.

Secondary response
In this phase of the response, it is important to establish on-scene unified command with separate operations. Confirm dispatch operational channels and responding agencies, which includes staging information and equipment status.

Direct crews to the injured and uninjured victims. This involves providing medical care, extrication and removal from scene. Patient transport options include ambulances or civilian transport such as busses. The best option may be to protect in place by stabilizing passengers and the vehicles.

Begin accountability both internally for first responders and externally for civilians. And plan for extended operational periods that may include night operations, rehab and crew replacement.

On-scene cooperation
This phase involves working with other agencies such as law enforcement, state highway departments, utilities companies, local public works and private tow response. Coordinate first responder priorities such as hazard, vehicle and victim stabilization with law enforcement responsibilities like accident investigation, fatalities, vehicle removal and highway stabilization.

Formalize command and control operations, locations and responsibilities with law enforcement. Verify law enforcement and state highway radio channels. And control private company response with a law or fire representative.

Having law enforcement agencies well versed in emergency response will be a great advantage as they will most likely be first on scene. Size-up training geared toward fire and EMS response will be worth the politics and pre-incident planning involved with police and sheriff's departments.

On the flip side, police officers will appreciate help with scene control as civilians are removed and hazards have been reduced.

Command response
As important as emergency services are in these types of incidents, public works, state highway and law enforcement agencies, not to mention wrecker and bus companies, can be critical to scene stabilization, equipment supply and civilian evacuation. Placing them in a unified command position or under its control, expedites their assistance in all secondary response areas.

As different responding agencies, companies and services begin to arrive, on-scene unified command will become the most efficient form of moving forward. While it is difficult to give up one person per group, communication to coordinate response capabilities will become critical as the event progresses.

On a large incident accountability will consist of identifying each division, branch and team leader. They, in turn, will be responsible for their individual crew members. This gives incident command more time for assignments — leaving accountability to expand sensibly as additional resources arrive.

Rescue tasks
Initial vehicle positioning is critical. In most incidences, the apparatus will be the primary staging area until something better can be declared. Initial duties will include protecting crews, initiating suppression activities and providing a tool area. This location may expand into accountability, rapid intervention and rehab, but it is more than likely that these designations will move.

In the case of massive wreckage, ladders can be used to cross over stable vehicles — laddering to areas unimagined in a book. Sliding extrication gear and medical bags using backboards across ladders increases efficiency and lessens energy expenditure. Such task solutions are not often discussed in critiques but are important to learn.

Reaching victims is just the beginning, however. Twisted metal is packed with stored, dangerous energy. A bumper's coil strength when released is enough to break a leg. Weakened roofs, flimsy or bank-vault doors, unstable fluids, electricity and passenger protection devices are just some of the vehicular landmines encountered.

As you gain access to patients there will be multiple, simultaneous evaluations. These must be done in strict coordination with hazard management.

Victims need to be treated, extricated, packaged, graded and transported accordingly. This process requires absolute coordination and cooperation with medical authorities on scene and is yet another reason for interagency pre-planning.

Hazards suppression  
Coordinating fire suppression, hazmat potentials, exposures and rescues in addition to patient care, puts additional stress on already stretched resources. If crews are split, equipment must be allocated accordingly.

You may have to divide medical and extrication gear to double your effectiveness, especially as workloads increase with distance. 

Tractor-trailers require great care and precision. For large incidents, they tend to become location markers for hazardous environments, containers and loads included. Crew members must identify local surroundings and begin vehicle and victim assessment — in that order. 

Watch for utilities both geographically and situationally. Given an ungrounded power line by the side of the road or an exposed wire on a tanker, there is substantial risk of ignition and electrocution. An overstretched hydraulic line or crumpled saddle tank can be deadly when damaged.

A protect-in-place protocol becomes a significant strategy during large-scale incidents involving passenger cars. There will be an entire response crew ordered to contact every unaffected vehicle.

Personal contact and some snacks and water while conducting an informal assessment go a long way in stabilizing the scene and extending civilian patience. This simple act of reassurance can be a critical component for complete command and control of the scene.

Emergency vehicle response and roadway scene safety are two of the most dangerous areas for both firefighters and law enforcement responders. As tired as firefighting crews are, concluding an emergency by remaining on scene and assisting with traffic control, clearing driving lanes, retrieving evidence and reopening the highway should be part of every fire department SOP.

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