As a chief officer or safety officer at an incident involving extrication, you must have a plan and this plan must be clearly communicated to, and understood, by all responding units. But in the chaos of a stressful incident, small details can be overlooked as we rush to respond to victims. Safety, however, is no small detail, and you are ultimately responsible for ensuring that your personnel are operating in as safe a manner as possible.
Note: Safety preparations begin prior to the call. As a chief or safety officer, you must be aware of all the potential resources available to you, including technical rescue teams, USAR, specialized auto extrication teams, specialized equipment, paramedic services, trauma centers and helicopter services. These teams typically have safety plans built into their operational plans that must be taken into consideration.
First In
Often when we arrive on scene, there’s more to be done than the first-in crews can initially handle. Sometimes, it’s enough for the first-due apparatus to render the scene safe for themselves and other incoming units. Proper blocking, coning, taping and initial apparatus positioning ensure the scene doesn’t become a bigger mess than it already is.
After the scene is rendered safe for responders and has been thoroughly sized up and these conditions have been communicated to all personnel, conduct an initial triage of vehicles and other hazards. Note: I said triage vehicles and hazards. If there are vehicles or other hazards that present immediate danger to responders, they must be stabilized before patients.
Once the vehicle(s), surroundings or equipment are stabilized, assign crews to initiate Simple Triage And Rapid Treatment (START) to obtain numbers and conditions of patients. If possible, an incident safety officer (ISO) should be appointed, but safety remains the responsibility of the IC until this role is delegated. It’s critical that neither the ISO nor the IC get caught up in the action; they must remain observant in their respective roles.
Establishing hot, warm and cold zones can assist in managing personnel. How many times have you seen 10 firefighters and paramedics standing alongside a vehicle but only two or three actually performing truly necessary evolutions? I remember wanting to get my probationary firefighter some experience–any experience! But we must rethink this. The bottom line: More people in the “hot zone” means more people in immediate danger. Stage support personnel in the “warm zone,” where they are ready to assist or rotate in as needed, but out of the immediate danger zone.
Dave Dodson, the father of the ISO concept, reminds us of this in the second edition of his book “Fire Department Incident Safety Officer.” He describes the three ways we can handle risk and hazards: 1) avoidance; 2) transfer; and 3) adaptation.
Adaptation is the tactic most often employed on the emergency scene and is designed to make the hazard less severe for the exposed firefighter. Command officers should incorporate these terms into their vocabulary to clarify the safety strategy.
The Extrication
It is critical to responder safety that command ensure that responders inside the car (or patient area) are as protected as those on the outside. Furthermore, those responding must understand this policy before the call, and it must be enforced on scene.
Often, medical personnel are allowed to dive right into the scene of the incident. Although there are times when this may seem to be warranted, the IC or ISO must ensure they’ve donned personal protective equipment (PPE) prior to doing so. Proper PPE will guard against sharp objects and reduce exposure to the fluids and materials personnel working inside the vehicle may come into contact with. Remember: If a firefighter suffers a laceration or abrasion as they work, they can be exposed to communicable disease and toxic substances.
Post Call
Important: When a teachable or change-agent moment occurs, take advantage of it. These rare moments provide an opportunity to educate our personnel about the importance of engineering safe work practices, enforcing standard operating guidelines and following other rules and regulations. After all, it’s for the sake of our firefighters that such rules are created.
