Tech Rescue

The Use of Uncommon Tactics at MVCs

Issue 6 and Volume 9.

Each year the Darlington County (S.C.) Extri- cation Team, in conjunction with Florence Darlington Technical College, hosts the Southeastern Extrication School. This school focuses on extrication-related disciplines and provides training to 300 participants from more than 70 departments and eight states. In an effort to provide the best training possible, we summon some of the best known names in the industry. A day after our most recent session ended, we received a call from a participating department saying they had applied several tactics they learned to a recent motor vehicle collision (MVC). Due to the unique decision-making process and the uncommon tactics employed, their event provides some key learning points that all responders can benefit from.

The Event & Response
The driver of a four-door passenger vehicle suffered life-threatening injuries in an MVC just north of Pageland, S.C. Responders from Pageland Rescue Squad, High Point Fire District and First Health EMS arrived to find that the passenger vehicle had been struck on the driver’s side by a full-size truck. The impact had collapsed the driver’s side door and Bravo post onto the driver, trapping him in the vehicle. Both vehicles ran off the road, stopping parallel to each other with the driver’s side of the passenger vehicle against the side of the truck.

Rescuers used the winch on their crash truck to pull the passenger vehicle away from the truck. The hood of the passenger vehicle was then pried open so the battery cables could be cut and the car was stabilized with cribbing. Rescuers used cross ramming to push the Bravo post and door away from the driver. Once accomplished, they used hydraulic tools to remove both doors and the Bravo post on the driver’s side, freeing the driver for treatment by First Health Paramedics and transport to Carolinas Medical Center in Charlotte, N.C.

Patient Vehicle Movement
Responders must be proactive in their development of initial and secondary disentanglement plans during an extrication incident. The development of these plans should begin with the dispatch information and continue throughout the incident. Most incidents can be mitigated with common initial plans, but when those initial plans fail to provide a suitable path of egress, additional and sometimes atypical plans should be put into action.

Occasionally responders must rely on advanced tactics, such as this case which required movement of the patient vehicle. It is important for responders to be open-minded to the effectiveness of tactics like these under the right conditions. The key to a successful operation is having an understanding of the resources available and your personnel having the training and skills necessary to complete the movement in a controlled manner. There are several scenarios where moving the patient vehicle should be considered, including path of egress concerns, secondary entrapment and safety issues.

In this particular case the secondary entrapment of the Bravo post and the subsequent path of egress were a major concern. The obvious tactic, without considering the secondary entrapment, may have been some version of roof removal. Although this tactic would have created a large opening to remove the patient, it was ineffective as a path of egress due to the intrusion of the Bravo post. To relieve the secondary entrapment and perform full extrication would have required undue manipulation of the patient. Cross ramming was the most appropriate clearance tactic, but would have been practically impossible without moving one of the vehicles.

The passenger vehicle did not pose much of a challenge for the crash truck because the truck was equipped with a large-capacity winch. However, responders needing to move vehicles should evaluate the vehicle to determine how much resistance it presents and whether the equipment on scene is capable of overcoming that resistance. This is determined by factoring the overall vehicle weight with surface conditions, rolling resistance and degree of slope.

Ram Operations
Simply put, the reason someone becomes trapped in a vehicle is because the vehicle has been deformed to an extent that does not allow for exit under normal means. Understanding that concept, if we can manipulate and/or remove damaged parts to place the vehicle back in shape and possibly enlarge those existing openings, we can remove the patient. Sometimes this process is complicated by exterior obstacles, limited tools and/or personnel, vehicle position, etc. But placing the vehicle back in its engineered position can make normal extrication tactics easier by reducing the amount of tension and/or compression on the vehicle parts.

After moving the patient vehicle, cross ramming was possible and served several functions: It relieved a secondary entrapment of the patient’s left side; it placed the vehicle in its original position to assist with further tactics; and it relieved a certain amount of mental stress on the patient by creating distance between them and operations.

Multi-Agency Coordination
That every agency should work closely together and understand each other’s role sounds good in theory, but even agencies that train together frequently experience some issues with multi-agency coordination.

There were three agencies involved in this incident, not including law enforcement and the recovery companies. One of the supervisors at the incident indicated that EMS was closely consulted on the potential options prior to moving the patient vehicle. After a quick discussion it was determined that moving the vehicle was the best option, and responders closely worked with EMS personnel to ensure the vehicle was moved in a controlled manner.

Summary
This incident proves that consistent, realistic and diverse training does pay off. Responders at this incident coordinated their efforts with other agencies and utilized a combination of uncommon and common tactics to successfully mitigate the incident.

A special thanks to Pageland Rescue Squad.