You pull up on scene of a two-vehicle crash with reports of victims trapped. One car is on its side and the other car is buried windshield-deep into a live power pole. The night sky is black, and cold, stinging rain is hitting your face. As you give your initial size-up, you hear those dreaded words from your crew: “What’s the plan, captain? What do you want us to do?”
Does this sound familiar? At some point in our careers, we responded to an incident where we weren’t quite as prepared as we should have been. Fortunately, there are ways to avoid such moments. For starters, having a descriptive job function is paramount in these types of emergent calls. Although it’s recommended that everyone has a riding position and assigned functions/tools, you need more than this; you need a plan–a plan that everyone knows, rehearses and trains on, and that must be communicated to all players involved.
Sample Game Plan
Although there are many, many ways to safely extricate a victim from a motor vehicle accident (MVA), your crew needs a solid plan if you expect to accomplish the task in the safest and most efficient way possible. With this in mind, following is just one example of a “Game Plan”–in the easy-to-remember acronym IS-SAVED:
- I: Incident Command
- S: Size-up
- S: Safety
- A: Action Plan
- V: Victim/Patient Removal
- E: Extrication
- D: Debrief/Education
Let’s review each part of the plan in detail.
Incident Command
This is the foundation of the game plan. The incident commander (IC) is the one and only person in charge of the incident, so it is their plan that’s put into action. This is where communication is crucial. Everyone on scene must know the goals and objectives of the incident, as well as how they fit into the plan. The IC is a “hands-off” position; they should not be involved in the victim/patient-removal tasks unless there simply isn’t enough staffing to facilitate the extrication functions. It is preferable that the IC stand back and safely direct the tasks at hand.
Size-up
Size-up is our first objective. If we know other units are responding, the size-up paints a picture that helps those later-arriving crews put their plan of action into motion and prepare to assist the IC. Here’s a sample size-up for the situation presented in the introduction to this article: “Tower 1 is on scene and in command of a two-car MVA. We are Southbound I-25 at mile marker 123. We have one four-door sedan on its side with at least one victim trapped inside. We have one vehicle head-on into a live power pole with intrusion into the driver and passenger compartments–and at least one additional victim trapped. We need two ambulances for patient transport, the power company for electrical wires down, one heavy-rescue, one engine company and police units for traffic control. Tower 1 is stabilization for vehicle #1, which is located on its side. Rescue 1, you have vehicle #2, which is into the power pole. Engine 1 is water supply and fire protection. Over!”
Safety, Safety & Safety!
Safety is crucial for everyone involved at the accident–victims and especially firefighters. Traffic control is paramount. “Looky-loos” are looking at the wreck–not at the firefighter crossing the street and carrying extrication tools. This is where everyone involved becomes each other’s safety concern: We must keep our heads on a swivel at all times!
There are many questions to ask ourselves:
- Is everyone on scene following NFPA 1500: Standard on Fire Department Occupational Safety and Health Program, and wearing an approved safety vest and eye protection?
- Are fluids leaking and, if so, what are they?
- Have all airbags deployed?
- Have the batteries been located and the power been disconnected?
- Are we dealing with a hybrid vehicle or an alternative fuel vehicle and, if so, is the vehicle properly chocked and secured?
- Are live wires present?
- Are train or high-speed mass-transit tracks involved?
- Is a commercial vehicle involved and, if so, are there any hazmat concerns?
- Will our high-pressure airbags safely lift the vehicle, or do we need a heavy wrecker or tow operator?
I could go on and on, but I think you get the idea: Ask questions as they pertain to safety!
Action Plan
The action plan helps you establish what is needed to accomplish the tasks of assisting and freeing the patients. This is where training and practice pay off. Hopefully you had a chance to read my last article “Extrication: Thinking INSIDE the Box”, which addressed why it’s imperative to know what tools are inside the box–your apparatus–and how to use them properly on the extrication scene.
To establish a solid action plan, you need to ensure that your crews know your rigs, their tools and their locations, and the tool capabilities (strengths and weaknesses). Have they trained at your local “crusher”? Are they confident in their skills and know their job functions inside and out? Do they know who will perform the inner- and outer-circle scans? Are they all proficient in performing airbag scans and at disconnecting batteries? Are they masters of vehicle stabilization?
There are many, many more topics to master. The bottom line: Crews need to have a mastery of their job functions and know who is tasked with what on the extrication scene.
Victim/Patient Removal
Once again, there are a variety of questions to ask yourself when determining the best way to remove the patient: Can we simply remove a patient from a working door, or do we need to remove the roof and both doors, and lift the dash to free them? Are there high-strength steels in the A, B or C post? Do we have immediate life safety concerns? Is this going to be a 20-minute or less BLS extrication or is it a 10-minute ALS rapid extrication?
Have a plan A, plan B and maybe even a plan C. Things will go wrong: The power unit for your spreaders could go kaput, extreme weather conditions could hamper efforts, high-strength steel could complicate matters, you could have a lack of personnel, etc. Have many plans and remember to be professional at all times; you’re probably being recorded, video-taped or both!
Extrication
This is the heart of the operation and can be as simple as a common “door pop” or as intricate as a full-blown “bat-wing/B-post blow out and dash jack/lift.” Whatever the extent of the operation and the amount of work involved, there are a few rules that always apply: Remove the vehicle from around the patient(s). This is where training pays off so we can cut and manipulate the vehicle away from the victim like a surgeon. “Slow is smooth and smooth is fast!” This is a quote that a Denver firefighter always uses, and it couldn’t be any truer.
Debrief/Education
This is a crucial, yet often-overlooked, aspect of vehicle extrication. We need to figure out what went right and what went wrong at each incident. Every call we respond to–and especially a difficult extrication–becomes a great opportunity to learn something. The firefighters we admire the most and look up to are constantly learning and sharing their knowledge. This is how we grow as firefighters and as extrication professionals.
Final Thoughts
Whether you work for a small, rural, volunteer department or a large, paid, metropolitan department, the probability of responding to a chaotic MVA with victims trapped is not just a likelihood–it’s a certainty–so you need an action plan. There’s a saying that “It’s better to be lucky than good.” I prefer the saying, “You make your own luck.”
