Roadways are getting more and more crowded, people are driving faster and, thanks to cell phones, multi-tasking behind the wheel seems to be the norm for some people–not a good situation for emergency personnel on roadways. We’ve all felt the sudden breeze from a vehicle speeding past the accident scene, and we’ve all seen traffic congestion build as people slow or even stop to get a look at the scene, sometimes causing a secondary accident. By stabilizing the scene, we may gain the critical space to perform our work without peril.
By the Numbers
Statistics on firefighter injuries or deaths at vehicle accidents used to be hard to find; this statistic was somehow grouped into the “other” category instead of a category of its own. Fortunately, the Web sites www.firefighterclosecalls.com and www.firefighternearmiss.com, as well as other agencies, have started tracking roadside incidents. And with this documentation has come changes to our standard operating guidelines and procedures related to roadside operations.
The State of Florida may give us some greater insight into the number of incidents involving emergency vehicles stuck at accident scenes. Florida officials have maintained a record-keeping system for “struck-by” incidents involving law enforcement agencies. According to www.ResponderSafety.com, between 1996 and 2000, the Florida State Highway Patrol reported a startling 1,793 incidents in which stopped law enforcement vehicles were struck, resulting in five deaths and 419 injuries.
Incident statistics indicate that this trend most likely isn’t limited to Florida. EMT Rick Seiner was struck and killed while working an accident scene near Humansville, Mo., on Sept. 2, 2005. Chicago Fire Lieutenant Scott Gillen was struck and killed while working an accident scene on Dec. 23, 2000. More recently, in December 2008, Delaware City firefighter Michelle Smith died from injuries received when she was struck by a hit-and-run driver while assisting an injured motorcyclist.
Accounts of emergency responders being injured or killed on roadways seem endless; however, these statistics are dwarfed by the number of “near hits.” Stories of near-hits could be told by most, if not all, emergency responders. A matter of inches has been the difference between life and death on too many occasions.
Considering the number of close calls on roadways, many states have adopted “move over/slow down” legislation. This legislation states that when drivers see an emergency vehicle with warning lights, they must merge over at least one lane or, if traffic doesn’t permit this, slow down to a reasonable speed. It wasn’t easy to convince some states to adopt this legislation.
One example: On Jan. 28, 1994, Paramedic James Garcia was struck and seriously injured in the line of duty while tending to a victim of an accident scene in South Carolina. The laws protecting emergency responders at accident scenes were so poor in South Carolina that Garcia was actually found at fault for being in the roadway when he was struck. Garcia has since worked hard to promote the move over/slow down law in South Carolina. In 1996, his efforts paid off when a new law was passed.
Although the move over/slow down laws have helped, emergency responders are still in serious danger if proper safety guidelines aren’t followed. With this in mind, I’ll address the three forms of stabilization at vehicle accidents: stabilization of the scene, vehicle and patient.
Scene Stabilization
Scene stabilization not only protects us but it also protects our patients. Begin scene evaluation upon your arrival, scanning the entire area from the outside in. Check for all possible hazards: fire, utilities, loads/cargo, fuel leakage, hazardous material, debris, crowds, weather and downed power lines, to name a few. Ask yourself, “What do I need to deal with first?” and “Are we dealing with a mass-casualty incident?” We must remain wary of tunnel vision. As first responders, we have a tendency to rush to the patient(s) without sizing up the entire scene. Slow down and look around so you don’t discover additional hazards after it’s too late.
One key to protecting emergency responders is proper apparatus positioning. Apparatus should be located between the incident and traffic to “fend off” oncoming vehicles. The preferred apparatus for this task is an engine or ladder truck. Rescue vehicles or ambulances should be positioned in front of the accident scene, protected by the larger units. This creates a safer area for loading the patients. Another tactic being employed by some departments: placing extrication and medical equipment in compartments on the same side of the truck. This way, the driver can position the apparatus so emergency responders have access to everything they need within the safe area.
Other tips for stabilizing the scene: Ensure emergency cones and flares are placed accordingly, set up necessary vehicle emergency lighting and wear high-visibility protective gear.
Although I’m sure everyone on the scene is concerned with safety, different public safety agencies have different priorities. Law enforcement, for example, is generally concerned with closing off lanes. So make sure you maintain good communications with law enforcement. Inform law enforcement personnel about how long you estimate the extrication or rescue will take; this will help them to make better decisions about traffic flow. Determine if you can allow traffic flow around your scene. There will definitely be times when you’ll need to close all lanes around your accident scene. But remember: Closing all lanes makes it difficult for additional units to reach the scene.
The next phase of scene stabilization is the “outer circle,” a term coined by Steve Kidd and John Czajkowski, the producers of the “Carbusters” series. The outer circle refers to the 360-degree area around the vehicle. The area can be 25, 50 or more than 100 feet in diameter, depending on your scene. Complete a size-up of the outer circle before the inner circle (discussed below). Remember, we’re working from the outside in.
You may find a variety of hazards in the outer circle, such as electrical hazards and fuel spillage. And you must take note of ejected victims or walking wounded. This is also a good time to identify the make or model of the vehicles, and whether the vehicle is a hybrid. Carefully analyzing the outer circle will give you an overview of the scene and help you determine a proper action plan. Note: This should take no more than 30 seconds.
Vehicle Stabilization
The next phase of scene safety is the “inner circle”: the 5—15 foot area surrounding the vehicle. Look for the same hazards as in the outer circle, and check both the underside and interior of the vehicle.
Tip: Pay close attention to the vehicle’s interior when an impending storm is forecast or has hit the area (i.e., hurricane, tornado, heavy snow/ice). People often transport large quantities of gasoline and liquefied petroleum (LP) during times of emergency.
Other important inner-circle observations: deployment of airbag systems, entrapment, the number of patients involved, and securing possible vehicle movement by turning off the ignition.
Patient Stabilization
Vehicle stabilization is a top priority and must be accomplished without delay; only when this is complete can you begin patient stabilization.
You must do everything in your power to gain access to the patient without further injuring them by moving the vehicle or removing glass and metal.
Start with the basics: Open the airway and check for breathing and circulation (ABCs), and use and maintain cervical-spine immobilization. Then begin a secondary survey: a head-to-toe check, looking for additional injuries and possible extremity entrapment. Follow your department’s medical protocols for further trauma treatment.
If you can access the patient via an open window, a rescuer on the outside of the vehicle can begin the process of patient protection and evaluation. Cover the patient with soft protection (i.e., a blanket) to prevent any falling or flying debris from injuring the patient or contaminating any wounds.
Although soft protection works well for protecting the patient from flying debris, it does not offer much protection from mechanical injury that could result from improper use of hydraulic equipment, reciprocating saws, air chisels or other extrication devices. So, when using these devices in close proximity to the patient, you must protect the patient with hard protection such as a short spine board, plexiglass or plywood.
Additionally, when you’re ready to remove the patient from the vehicle, don’t forget to cover any sharp metal created by the extrication process. In our rush to remove the patient, we often overlook this simple and quick practice. You can use blankets, old hose, floor mats, duct tape–anything you can think of or have at hand–to ensure the safety of the patient during their removal from the vehicle.
Final Thoughts
The danger faced by emergency responders on the highways and roadways across our country has increased dramatically. We know the reasons: faster driving, cell phone use while driving, and distractions caused by navigators, DVDs and so on. People seem to be doing a lot more than just driving and watching out for me and you.
That’s why it’s important we do our jobs and do them right. Since some drivers are not watching out for us, we must guard against them. Check for hazards on the scene. Stabilize the scene from the outside/inside. Protect the patient before, during and after the extrication.
The bottom line: Protect the patient and protect yourself, and we’ll all go home safely.
