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Extrication principles from an elevated incident scene
Here are the important things to keep in mind to prepare and practice for this type of response
Not every extrication call you respond to will take place on a level roadway. You may encounter many different challenges upon arrival at these incidents which require rescuers and equipment to be raised or lowered to reach the vehicle and victims. Some of the situations that arise include:
- A vehicle over the embankment on an interstate ramp
- A truck found over the edge on a winding country road
- A van in the branches of a tree after rolling down a hill
Unique situations which require the first responders to work from above the accident site are a challenge as it is not a typical incident response; getting equipment and systems in place is time consuming and critical details can be overlooked. Here are the important things to keep in mind to prepare and practice for, as well as respond to, this type of response.
Preplanning and training
As a part of your preplanning for these incidents you should take a look at your agency’s capabilities in the area of rope rescue operations. If you are trained and equipped for these types of calls, your staffing will be your next item to review. Mutual aid should be considered if the demands of the rope rescue and extrication component is beyond the personnel power available at a call of this nature. Responder safety and victim care should not be compromised due to insufficient staffing on scene.
Part of your department’s training program for vehicle stabilization and extrication should include getting together with your local towing company to become familiar with their equipment, capabilities and limitations. Towing professionals also possess a vast knowledge related to securing vehicles in unique situations as they have most likely experienced many more of these situations than most emergency responders. Once you have the working relationship with these specialists, it makes reaching out to them at an incident for assistance much easier.
Scene safety and control
Scene safety is always our number one priority. Establishing safe working areas will minimize the potential for responders falling over a drop off. Barrier tape and control lines work well as a visual hazard reminder. Properly equipping rescuers working near the edge with rope rescue harnesses and tethering to safety lines is a good practice for anyone working in the hot zone above the accident.
Stabilizing the vehicle prior to attempting to make entry may be much more challenging. Many of the traditional methods for vehicle stabilization utilize the solid surfaces that the vehicle rests upon.
You may have structures or trees to strap the vehicle to in order to stabilize it during the rescue operations. Other times, you may have to lower cables down to the vehicle to provide the stabilization needed.
Always be familiar with your agency’s equipment and the equipment from others. Tow truck cables, wire rope from a grip hoist system or other rated systems can be used from above to help secure the vehicles.
Extrication equipment practices
The extrication equipment you are accustomed to operating will react much differently when you are working suspended onto or next to a vehicle. With the expansion of battery powered tools in the extrication industry, this task has become much more manageable. However, not every agency carries these types of tools, so make sure you train with the equipment available to you.
The traditional hose-feed hydraulic units will accomplish the same tasks as the newer self-contained power supplied tools. The expanded challenge with using these tools, however, is their additional weight and the need for hose line management when put into operation from above the vehicle. Extra caution should be taken to secure and protect the couplings on the hoses and tools to ensure that they are not damaged or disconnected during the operation.
Utilizing a prusik cord to secure the hose and attach it to a control rope will help with this process. Once this task is over, inspect the prusik cords thoroughly. If any hydraulic fluids or other contaminants have been in contact with a prusik cord, take it out of service for life safety operations.
Retaining and or suspending equipment is critical to an efficient operation. This is not a difficult task, however it is something that should not be overlooked.
All tools are heavy enough to fatigue a rescuer trying to hold them in place without some form of assistance from above. This assistance can be as simple as having a tag line attached to the tool with another responder controlling it from above. If the situation is more challenging, it may be of value to place the rope in a device to control the lowering phase as well as to secure the tool's location once in position.
A variety of methods can be used for controlling the equipment from simply lowering by hand and tying off the line once in position to using a Munter hitch, rescue 8 and a Petzl ID. The best thing to do is practice with these methods and other options you have available to you and see what fits your needs best.
Having a tail on the tag line for the tool has worked well in many situations. The tail allows the operator to tether the end of the tag line to a structure or part of the vehicle to provide a pivot point for the tool once in position.
Accessing and removing the victim
Focus on using the simplest methods to remove the victims from the vehicle to minimize the time working in the hazard zone. If you can pop a door and free the victim without any other maneuvers, stick with that approach.
However, if you must remove doors or roll roofs, plan on how you will control these items once they are cut free from the vehicle. You may need to have additional ropes lowered to your location to attach to items being removed so when they are cut free they don’t fall in a manner which will injure others in the area of the incident. The larger the pieces that you remove, the more potential for the vehicle to shift if not properly stabilized prior to the process taking place.
Using a work positioning line for the responder is also beneficial. When the responder is suspended on their safety line, obtaining leverage can be challenging, due to the pendulum effect it creates. Using a short section of rope or a set of fours will provide the tieback for the leverage that is required when trying to maneuver a tool against the vehicle.
Operational safety concerns
Hot spots on the vehicle add another safety concern during this type of rescue operation. Extra caution should be taken when working near mufflers, exhaust pipes, catalytic converters, break cylinders and any other vehicle parts that produce excessive heat.
If the vehicle is overturned, many of these hazards are exposed to the responder and the equipment being utilized for the rescue. Contact with these hot surfaces could burn the responder, melt life safety ropes or damage other equipment.
Leaking fluids should also be identified and avoided if at all possible. Having your life safety rope covered in gas, oils, hydraulic fluids or any of the other caustic products from the vehicle can create a negative situation if left unchecked. A thorough inspection of life safety ropes and equipment must take place immediately after the incident. Any items identified as damaged must be taken out of service until they are properly maintained or retired if the damage is not correctable.
Victim care and handling
If the patient has been suspended in their vehicle restraint system for a long period of time, additional medical challenges can take place. Breathing can be compromised due to the victim’s abdomen being compressed as they hang over their seatbelt and blood flow can be affected with the potential of suspension trauma from the event.
Victim handling provides additional challenges to the responders. Gravity always wins if you do not properly secure your victim. Make sure you have a plan in place and equipment available to secure the victim prior to opening up the vehicle and releasing any restraint systems which may be holding the victim within the vehicle.
This aspect of the rescue can be more complex if there is any entrapment of body parts within the vehicle that have to be overcome before you can remove the victim. Hand tools may be your best option when space is limited and access is compromised.
Using a tool bucket to lower tools to the responders working below helps keep your equipment in one place and readily available when needed. Do not rely on the wire handles on a plastic bucket to hold up. Instead use a short section of cordage or rope to make a secure handle for this raising and lowering operation.
Practice and training essential to becoming proficient
When you respond to these complex incidents, planning is your greatest tool for success. Practicing the skills in non-traditional manners is the only way you will become proficient at working in environments where rescuers and equipment need to be raised or lower to reach the incident.
Our goal is to remove and hand our victims over to advanced medical care as quickly as possible. This can only be accomplished with proper training for these unique incidents.