Extrication techniques: Vehicle in ice
Follow a prescribed rescue sequence and prepare immediately upon arrival for a go rescue when a vehicle is in icy water
Victims immersed (head above water) in cold water colder than 70 degrees F will develop cold shock within 2 minutes. This involves immediate gasping, hyperventilation, inability to hold one's breath, tachycardia and hypertension.
Disability or loss of motor function and mental status occur within 15 minutes. This results in disorientation, inability to verbalize and process information, and inability to control movement. Hypothermia occurs within 30 minutes and affects every organ much like a multi-system trauma. This ultimately culminates in cardiac arrest.
That gives us a 30-minute window to pull off a rescue sequence, if we are lucky.
However, there are unique resuscitation outcomes involving hypothermic patients. In general, the recognized data for cold-water resuscitations suggests that these victims may still be viable as long as 60 minutes after submersion or drowning.
This pushes the envelope even further because we must be willing to take greater risks for a longer period of time because the victim's survivability profile has increased. Additionally, we must be willing to move with greater aggression initially because the victim's ability to avoid drowning is decreased dramatically. As always, follow a systematic progression.
Last week we had a passenger vehicle lose control, proceed over an embankment and drop approximately 10 feet below grade into a large retention pond that had about 8 inches of ice on the surface. The car broke through the surface of the ice and sank nose down to the point that the rear deck lid and roof were the only portions above water.
Our heavy rescue arrived on scene to find the driver had extricated himself through the sunroof and was standing on the roof of the car. The crew used a reaching technique and an extension ladder to create a bridge between the bank and the vehicle. One rescuer crawled out to the vehicle and brought the driver safely back to shore.
This resulted in an uneventful rescue sequence, but the "what ifs" should always be addressed to develop effective action plans. What if the vehicle had been significantly damaged or was not equipped with a sunroof? Then you are dealing with an entrapped victim that requires extrication.
What if the victim was incapacitated and could not participant in the rescue? That presents packaging, removal and EMS-care challenges. What if the victim had slipped off of the vehicle and fallen through the ice? Now you are probably facing a go rescue sequence.
All of these scenarios up the ante. The systematic progression helps crews quickly identify the required action and apply the appropriate technique and tactic.
The standard rescue sequence for all water-based rescues is self-rescue, reach, throw, row and go.
For self rescue, coach the victim to place his forearms on the ice and perform a series of powerful leg kicks to create buoyancy and propel his body up onto the ice. Once on the ice, have him roll toward more stable ice.
If the ice breaks away, continue the coaching sequence because it is bringing the victim closer to shore. This requires a victim that is active, responds to verbal commands and has strong motor function. This also has a limited period of effectiveness. The more the victim moves, the faster he loses body heat.
For reach, use a long-handled tool such as a pike pole or ladder to reach the victim and coach him to grab and hold it. Then either pull him to shore or articulate the ladder to swing him into shore. This requires a moderately active victim who shows moderate motor function and responds to initial verbal commands.
For throw, deploy throw bags to the victim declaring "rope" when you throw. Once the victim has the rope, coach him to hold on and position his body and rope such that extraction from the ice hole is optimal. Pull him to shore. This requires a moderately active victim that shows moderate motor function and responds to verbal commands.
Reaching and throwing techniques can be combined by attaching a throw line to a reaching device with a simple clove-hitch and overhand-safety knot. Slide the device across the ice and then use the attached line to pull the victim to shore. This may help disperse the victim's load on the ice edge and extend your reaching device.
For row, use a lightweight, buoyant platform such as an inflatable boat or ice sled. Attach retrieval lines to the inflatable platform and progress across the ice. If extrication efforts are required, these platforms serve as a floating tool tray for extrication tools.
Go rescues involve individuals progressing across the ice without a floating platform. Typically, these rescuers are tended with a line attached to the break away ring on their floatation device or body harness. Tend lines should never be hard linked to a rescuer without a break away element when moving water is flowing under the ice. This is the highest-risk application but a much more predominant rescue technique in ice than moving water applications.
The first thing to address is our own safety. Proper PPE is a must. We use an annual dexterity test to impress upon members the dangers of hypothermia and improper PPE.
The test involves screwing together nuts and bolts with your hands and forearms immersed in a large bucket of ice water. This is also a good tool for members to experience the various physiological effects of cold water. Some experience headaches, intense hand and arm discomfort; all members experience a rapid decline in fine motor skills.
Everyone approaching the edge of the water must have a Coast Guard approved PFD and ideally an exposure coat. Turnout gear is always a no-no near water, but you commonly see that ignored because it is cold and turnout gear is warm.
As soon as possible primary and secondary rescue and back up personnel should don cold-water suits or standard dry suits complemented with appropriate thermal layering and accessories. Water helmets are also essential on the ice.
Assuming the first-arriving companies consist of at least three people, one should don a PFD and exposure coat if available. The subsequent members should don cold-water suits and be prepared to make a go rescue. This allows rescue actions to occur immediately upon arrival while simultaneous preparing for more invasive rescue actions.
The next arriving company should split PPE in the same fashion to augment shore-based personnel and provide back up rescuers to the primary and secondary rescuers. If boat-based operations are required, then the first arriving company should immediately communicate that to incoming crews.
If the victim is on top of the vehicle, then remove the vehicle from the equation by simply categorizing it as a platform. Evaluate the depth of the water and whether the water is static (retention pond) or dynamic (river).
Also, evaluate the stability of the ice; vehicle stabilization is the first priority. A vehicle that has broken through the ice can be somewhat stabilized by rescuers attaching a chain or winch to a structural component of the vehicle.
The necessity for this depends on the water assessment and whether or not the vehicle has stabilized itself on the water body floor and ice. Using a tow rig cluster with multiple hook options is a great addition to the chain segment to provide adaptable attachment points to the vehicle.
It is also important to secure the chain well and tension it with a come-a-long or by applying tension to the mechanical winch. This action essentially requires rescuers to progress directly to a row or go sequence. If the vehicle is stable, initiate the rescue sequence: self rescue, reach, throw, row, go.
If the water line is at the doors of the vehicle, the victim will have to be coached to self extricate through a window, sunroof or hatchback. Once the victim is out, apply reaching techniques with ground ladders.
If the victim is on the ice, attach a PDF to a throw bag and throw them to him. Instruct him to don the PDF and hold the rope while progressing across the ice. Coach the victim through appropriate weight distribution techniques.
Always avoid coaching a victim onto the ice if the vehicle platform is stable. The outcome will always be better if we keep the victim from being immersed in cold water.
When these initial options are not viable because of the victim or vehicle presentation, progress to row and go techniques. Extrication will typically be limited to roof flap or removal techniques to prevent water intrusion into the vehicle.
Battery operated reciprocating saws and hydraulic tools are ideal in this application to eliminate hydraulic hoses and electric cords. If water intrusion is unavoidable or the vehicle is already submerged, then have a well-planned extrication sequence that involves a rapid-removal technique prior to initiating the intrusion.
Rescuing victims from icy water can be difficult and dangerous, especially given the short window for execution. But proper technique and PPE will boost the odds for a successful rescue.