Tech Rescue

At First Sight

Issue 9 and Volume 8.

The primary objective of any extrication is to safely and efficiently remove the damaged vehicle from around the patient, right? Obviously, this operation can be as simple as opening a jammed-up door by hand or as complex as using hard stabilization with struts, air bags for lifting, cribbing boxes for shoring, cutters and spreaders for prying and crushing, etc. But no matter how basic or in-depth the operation, one thing is certain: The initial vehicle contact power-down procedures must remain consistent. If we train thoroughly and are sequential in the process, we limit the number of surprises when we’re in the middle of an actual patient extrication.

How many of us have thought we had the 12-volt battery disconnected, only to find there was a second 12-volt battery in a different location that was still connected? What about the times when we assumed that the car was initially stabilized with step chocks or cribbing, only to hear someone say, “I thought you had that!”? Who has been on a call where, after all was said and done, someone remarked, “Wow, I didn’t realize that was a hybrid.” Clearly, that’s not good.

It’s sometimes easy to get so excited that tunnel vision sets in, but the bottom line is that little things add up to big mistakes, and big mistakes get people hurt. With that in mind, let’s address those initial vehicle contact power-down procedures in order to limit unnecessary—and potentially deadly—hazards.

The Inner/Outer Circle Scan
The inner/outer circle scan is crucial and MUST be done by a minimum of two firefighters upon arrival. It is during this process that we will initially identify potential hazards that can hurt us, as well as unknown factors (e.g., spilled or leaking fuel, down or compromised power lines, ejected patients, compromised trees or objects, hazmat situations). This is the time to look left, right, up and down. Be thorough and be methodical; it’s for your own safety!

Initial Stabilization
Every car gets initially stabilized with step chocks, cribbing, controlled deflation of tires or a combination of all mentioned. The last thing we need on the scene of an extrication is a car rolling away due to NO initial stabilization. This sounds like a no-brainer, but this step is overlooked or just plain ignored over and over again.

Initial Patient Communication
If the patient(s) are coherent, inform them of who you are, what you are doing and why. Most important, be comforting. For most involved, this is their first accident/emergency, and communication is key.

Vehicle Status
Assume that the vehicle is running, and check the status of the dash lights. Are they lit up? Is the car still in gear? Have the air bags deployed? Is ONSTAR present, activated and online? Here are the next steps:
•    Place the vehicle in park and set the emergency brake.
•    Communicate to all firefighters on scene if air bags have deployed and give their locations.
•    Use 12-volt power to gain the most access to the patient(s) as possible. Specifically, move/tilt seats, move the power steering wheel upward, move power gas and brake pedals downward, lower windows, etc.
•    Turn off the ignition, or if there’s a Smart Key, push the button to shut down.
•    Observe dash lights for no signs of vehicle status being in the on/running position.
•    Turn off headlights.
•    Turn on hazard lights/emergency flashers.

Battery Disconnect
Locate and disconnect the 12-volt battery at the negative terminal. I prefer to cut a 3–4″ piece out of the cable because battery cables seem to have what I like to call a “cable memory.” I’ve seen disconnected cables magically work their way back to the battery terminal area, re-energizing the vehicle. If a 3–4″ section is cut away, it drastically reduces any chance of this happening. Verify that the emergency flashers are not still flashing. If they are, then there’s another 12-volt battery present. Find it, disconnect it, and make certain that the vehicle has NO 12-volt power left. Once the power has been secured, you should continue to operate as if an air bag is active and charged.  Remember, some capacitors that support the air bag system can hold a charge well after the battery supply has been secured.

Patient Contact
At this point, the car should be chocked/stabilized and in in park with the batteries disconnected and no 12-volt power present. It is now safe to establish full patient contact, taking all necessary precautions needed: C-spine stabilization, glass protection, immobilization of extremities, etc. Once again, I can’t stress enough the communication that must take place between firefighter and patient(s). Take a few extra seconds to inform them if you are going to break glass, cut off the top of the vehicle, lift the dash, etc. This extra step helps calm the patient(s), and trust me, it is appreciated in the end. Another helpful hint: Assume that you’re being videotaped throughout this entire process—cameras and recording devices are everywhere. Watch what you say at all times and always be 100% professional.

Patient Extrication
Be certain to distinguish between a “cut-and-run” extrication, where you need to get the patient(s) out and to the hospital NOW and a “take-your-time extrication.” Like the saying goes, “Let the situation dictate the tactics.” If all that’s needed is a simple door pop, then don’t get fancy; keep it simple. On the flip side, if the job is going to take some time, be prepared and use anything and everything at your disposal.

In Sum
These are the procedures that I like to use with my crew—and a process I teach. This is by no means all-encompassing. I realize that there are many ways to complete the tasks above and still be safe and successful. But one thing that is a MUST is to have an initial power-down procedure. It’s also essential to ensure that everyone involved knows their responsibilities. Being sequential throughout your process helps eliminate hazards—an important concept because it ensures that, as it states on the side of every Denver fire engine or truck, “Everyone Comes Home.”

Train hard, work smart and be safe!