Strategic-Level Approach to Extrication Incidents

Strategies and decision-making techniques for extrication incidents

By Les Baker
Published Monday, December 10, 2012 | From the February 2013 Issue of FireRescue

There are more than 6 million motor vehicle collisions (MVCs) annually in the United States, and most require some form of response and mitigation by emergency service organizations. Regardless of the degree of vehicle damage and resulting level of entrapment, responders must establish command, properly size up the incident, and make the decisions that will lead to the appropriate tactics. And as with any other type of emergency incident, a safe, focused and practical set of strategies should define the overall tempo and guide personnel through incident operations. With this in mind, let’s review the strategic-level management involved in extrication operations.

Establish Command
First-arriving units must establish incident command in accordance with local procedures. Although these guidelines are presented in the context of a department that has staffed apparatus, there are some common philosophies that exist and are applicable to almost any setting.

The first-arriving company officer establishing command has a choice of modes and degrees of involvement in the tactical activities, but continues to be fully responsible for command functions and the development of strategies. The officer must determine which type of command mode of operation—Investigative, Fast Attack or Command—will fit the needs of the incident, and their initiative and judgment in this situation is critical. Most responders are familiar with the three modes, but may not have considered their application at MVCs. Note: These modes only apply to company-level operations; when a chief officer arrives, that person should establish a stationary command post and assume command through proper transfer procedures.

Investigative Mode: This is for situations that generally require investigation by the initial-arriving company while other companies stage, pending assignment. A large percentage of the MVCs we respond to need little to no action from responding units. This is often obvious from the windshield view of the first-arriving unit, but the scene should still be investigated further to confirm that this is the case. The officer should accompany the crew to investigate the incident and determine what actions will be needed. If they determine that there are further needs, then they can assume one of the other modes and take the appropriate actions.

Fast Attack Mode: This is appropriate for situations that need immediate action and require the company officer’s direct involvement. In these situations, the company officer accompanies the crew to the scene to provide the appropriate level of supervision and assistance. These incidents include critical life safety situations, firefighter safety concerns and/or situations where immediate action is needed to stabilize the incident. This mode of operation is slightly less complicated at an MVC than a structure fire incident because there are typically fewer resources on the initial dispatch, allowing for better span of control and management.

Command responsibilities cannot be neglected when fast intervention is critical, and the company officer gets involved in the tactics. Fast Attack Mode should not last more than a few minutes, and should end when the situation is stabilized, when it cannot be stabilized or when command is transferred to a higher-ranking officer.

Note: Don’t assume that just because there’s a significant mechanism of injury that there is also an immediate life hazard, warranting the Fast Attack Mode. The decision to get involved tactically due to patient condition should be determined from a quick assessment of the patient.

Command Mode: This is appropriate with incidents that involve hazardous materials, mass casualties and serious hazards. Because of their size, complexity or potential for rapid expansion, they require immediate and strong command. In such cases, the company officer will initially establish an effective command position until relieved by a higher-ranking officer.

Strategy Development
An extrication incident has a much more defined set of strategies than we are commonly accustomed to with structure fire incidents. Each structure fire presents a unique set of circumstances, such as unknown building contents, varying floor plans, questionable structural integrity, changing fire conditions, etc., which can partially (if not completely) alter the strategies from incident to incident.

The following set of strategies can broadly apply to an overwhelming majority of MVCs that require disentanglement:

  • Ensure the safety of personnel and bystanders
  • Determine hazards and initiate appropriate control measures
  • Gain access and provide emergency care
  • Conduct required disentanglement tactics
  • Transfer patient and terminate incident

These strategies should guide the overall incident action plan. This plan should be disseminated using the incident structure and communications, notifying resources of the overall direction and placing them in the most advantageous positions. If your department currently uses time checks for structure fires, incorporate those into MVCs as well. This reinforces accountability as well as trending strategies and tactics.

Decision-Making
During the process of establishing command and initiating size-up, we instinctively begin to process the information through recognition, pattern-matching and mental simulation. This serves as the basis for naturalistic decision-making, which involves recognition of constraints such as limited time, high stress and incomplete knowledge—all key characteristics of real-world, complex environments.

We cannot create a responder knowledge base that covers each and every type of incident, including MVCs. As such, the IC and disentanglement officer should rely on crew resource management (CRM) principles to guide them through the decision-making process. (Note: CRM is a supervisory enhancement tool that significantly reduces injuries and mishaps by focusing on improving performance in several critical areas: communication, decision-making, teamwork, task allocation and situational awareness—factors that have been found to be critical in improving a leader’s performance and a crew’s safety.) They should also refer to previous experiences and rely on other crewmembers for similar input and ideas for possible solutions.

The IC should establish the strategies during the initial size-up of the incident to provide overall direction. Because any emergency scene is dynamic and subject to change in seconds, it may become necessary to adjust the initial strategy to meet any new demands recognized during the evolution of the incident. Example: the discovery of trunk contents during power-down procedures that were not identified during the initial size-up.

As discussed in my previous article, “Golden Hour vs. Golden Period,” once patient contact has been made, the interior rescuer can conduct a quick primary assessment. The entire assessment shouldn’t take longer than 10 to 15 seconds. Whether the IC is acting in the Fast Attack Mode or if command has been passed and the initial officer in charge is serving as the disentanglement supervisor, the IC must use the information garnered during the overall size-up and provided by the interior rescuer to determine the appropriate level of tactics, taking the timeframe into account. This should be communicated to everyone on scene as quickly as possible through face-to-face communication or radio transmissions.

In Sum
Establishing command, sizing up the incident and formulating a plan based on good strategies are necessary steps to safely and proficiently mitigating any emergency scene. This principle applies to MVCs regardless of the severity of the entrapment and/or patient condition. Command must trust their group supervisors to provide viable input and make tactical decisions to accomplish the proper strategies. The disentanglement supervisor must be proactive in their development of initial and secondary disentanglement tactics to accomplish the strategies and provide constant feedback.

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The broad set of command strategies can even be applied to an actual entrapment as seemingly complex as this one. This rental truck was traveling on an interstate when it left the roadway, went up an embankment and struck an overpass column. The vehicle received major frontal damage with significant patient compartment intrusion and was wedged between the bridge and the slope, with the rear suspended off the ground. Photo Les Baker
Two engines with four personnel responded to this MVC where a pick-up truck struck a four-door passenger vehicle head-on, resulting in major damage and significant entrapment of a 13-year-old child in the passenger seat. Upon arrival, the dash was restricting chest expansion of the youth, resulting in a decreased level of consciousness. With a life safety issue and limited staffing level, the company officer made the correct decision to engage in tactical operations and assist the crew. Once disentanglement was complete, he withdrew to a better position and transitioned to a Command Mode. Photo Les Baker
This collision provides a great example of the need for a Command Mode. There is very little the crew can accomplish until the power hazard has been mitigated by the electrical company. In this case, the first-arriving company officer should take a strong command position and control resources. Photo Les Baker
The Olanta (S.C.) Fire Department responded to this MVC where a four-door passenger vehicle ran off the roadway and literally up a tree. The vehicle was standing end-on-end with the undercarriage leaning against several trees. Given the uniqueness of this low-frequency event, it is unlikely that anyone responding could recall a similar experience. However, there is a possibility someone on the team had some form of relevant training that could be applied to the situation. Mitigation of the incident included marrying the vehicle to the tree, flapping the roof and utilizing a ladder slide to remove the patient. Photo Courtesy of Chief Coker


Strategic-Level Approach to Extrication Incidents

Strategies and decision-making techniques for extrication incidents
The broad set of command strategies can even be applied to an actual entrapment as seemingly complex as this one. This rental truck was traveling on an interstate when it left the roadway, went up an embankment and struck an overpass column. The vehicle received major frontal damage with significant patient compartment intrusion and was wedged between the bridge and the slope, with the rear suspended off the ground. Photo Les Baker


Two engines with four personnel responded to this MVC where a pick-up truck struck a four-door passenger vehicle head-on, resulting in major damage and significant entrapment of a 13-year-old child in the passenger seat. Upon arrival, the dash was restricting chest expansion of the youth, resulting in a decreased level of consciousness. With a life safety issue and limited staffing level, the company officer made the correct decision to engage in tactical operations and assist the crew. Once disentanglement was complete, he withdrew to a better position and transitioned to a Command Mode. Photo Les Baker


This collision provides a great example of the need for a Command Mode. There is very little the crew can accomplish until the power hazard has been mitigated by the electrical company. In this case, the first-arriving company officer should take a strong command position and control resources. Photo Les Baker


The Olanta (S.C.) Fire Department responded to this MVC where a four-door passenger vehicle ran off the roadway and literally up a tree. The vehicle was standing end-on-end with the undercarriage leaning against several trees. Given the uniqueness of this low-frequency event, it is unlikely that anyone responding could recall a similar experience. However, there is a possibility someone on the team had some form of relevant training that could be applied to the situation. Mitigation of the incident included marrying the vehicle to the tree, flapping the roof and utilizing a ladder slide to remove the patient. Photo Courtesy of Chief Coker

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