The October 2013 edition of FireRescue’s In-Depth Extrication column discussed situations that call for the movement of the patient’s vehicle. Responders must be proactive when developing initial and secondary disentanglement plans during an extrication incident, and 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, including some form of a side, roof, or tunnel tactic. When those initial plans fail to provide a suitable path of egress, however, additional and sometimes less frequently used plans should be put into action. Occasionally responders must rely on advanced tactics, and although moving the patient vehicle is seldom required, the tactic may prove to be invaluable when needed. There are several scenarios where moving the patient vehicle should be considered, including path of egress concerns, secondary entrapment, and safety issues.
In a fortunate sequence of events, the October 2013 article helped ignite a passion within a first responder halfway around the world to explore patient vehicle movement. Peter Kirwan had previous experiences with the tactic as a career firefighter in New South Wales, Australia, serving for over 20 years in a department comprised of more than 350 stations and 7,000 staff. With the last 10 of those years devoted to extrication instruction, Kirwan was always looking for new skills and techniques to pass on to the firefighters he trained. What he found missing was actual research on the effects of certain techniques on patient outcome. While the concept of the “golden hour” is widely accepted as a benchmark to aim for, there was limited evidence on how to achieve it from an extrication perspective.
When Kirwan undertook his initial extrication training, the prevailing attitude was that the patient vehicle must be stabilized before any extrication procedures commenced. This was based on the belief that the victim was subject to a high likelihood of spinal injury, and that any movement of the vehicle could lead to permanent disability. In reality, Australian statistics show the likelihood of permanent neurological deficit to be lower than what was projected. Australia has a road toll of approximately 1,400 deaths and 32,500 serious injuries every year1, with only approximately 200 cases of permanent spinal injury due to transport-related incidents.2
Kirwan was awarded a Churchill Fellowship to travel overseas and research rapid extrication techniques. This took him to Norway to study the rapid extrication technique that has been implemented throughout the country by the Norwegian Air Ambulance Foundation. From Norway it was on to Charleston, South Carolina, to study similar strategies in patient vehicle movement with Les Baker, and then finally onto New Zealand to visit the New Zealand Fire Service and witness how they have applied the Norwegian rapid extrication technique in their emergency responses.
The Norwegian Technique
In 2003, the Norwegian Air Ambulance Foundation began rolling out rapid extrication training throughout Norway. The technique is based on the premise that internal injuries and extreme cold had a negative impact on patient outcome and getting the patient to the hospital rapidly would result in a better outcome.
The Norwegian technique involves removing the windshield and rear window, opening both front doors and applying two sets of chains to the vehicle-one attaching a truck to the front pillars of the patient vehicle, while the other set of chains attaches from the rear pillars of the patient vehicle to another truck. The chains are slightly tensioned before weakening cuts are made deep into the bottom and top of both Alpha posts. Once these weakening cuts are made, the vehicle is pulled open by either moving one of the trucks away or by operation of a winch. Training of the technique in Norway is undertaken with an instructors from the fire service, police department and the ambulance service, and includes participants from all three services. This means all agencies work for the best patient outcome.
Since 2007, the New Zealand Fire Service has been conducting trials of the Norwegian technique, most recently with an expansion of the trial in 2014 to 20 of their busiest rescue/tender fire stations. While this technique has not proven popular in the United States, it should be looked at as a possible alternative when more traditional tactics do not work. It pays to be open minded to new ideas and research, while still exercising caution and restraint in instituting change too quickly or without due process.
After several weeks of traveling the world and training on this technique with various agencies, Kirwan developed the following recommendations. While it is vitally important to evaluate this list from your own agency’s perspective, these recommendations-though primarily developed for rescue agencies within Australia-are applicable to any agency in North America and around the world. They provide a reasonable basis for tactics that could potentially assist your agency at an incident where patient vehicle movement is a viable option.
- Rescue services and agencies should become stakeholders in their relevant state or territory trauma institute to facilitate the flow of current trauma care information.
- State health departments should include rescue agencies as part of the state trauma system to recognize the role that rescue agencies provide in pre-hospital trauma care.
- Rescue agencies should update manuals and procedures to allow rescue operators the option of moving vehicles to facilitate rescue.
- Rescue agencies should adopt the Norwegian rapid extrication technique as an additional option to current practices.
- Rescue agencies should review equipment to ensure that recommendations 3 and 4 are achievable.
- Fire services, police departments and ambulance services should co-develop and co-deliver motor vehicle rescue training to reinforce a team approach to trauma care and vehicle extrication.
Working with Kirwan showed how it doesn’t matter where a motor vehicle collision occurs or what type of vehicle it involves-if responders are skilled and knowledgeable they should be able to mitigate the situation. This level of skill and knowledge should also allow for the positive interaction of responders, regardless of the organizations and/or responsibilities.
Dedication to Service
Kirwan’s visit to South Carolina coincided with the South Carolina Firefighters Conference, where Mike Gagliano of the Seattle Fire Department delivered a quote that sums up the kind of dedication that fueled Kirwan’s research and travels: “The fire service is in need of men and women who will take their individual skillset, talent and gifts and share them with the rest of us in a way that is understandable and applicable. This typically is something that lights you up and fires your imagination to see the magnificent thing that is the fire service become even better. Your passion should be a humble, authentic dedication to never allow mediocrity to be acceptable, and always strive to ensure you are improving yourself and those around you.” Everyone who cares about the fire service should find their passion, just as Kirwan did, and make a difference for the citizens we serve.
The emergency service is continually changing and evolving. We see these changes through research, development of new tools and tactics, and the passion of responders around the world. As first responders and public service organizations, we owe it to the people we serve to evaluate and apply these changes appropriately while maintaining a solid foundation of basic skills and concepts.
A special thanks to Mike Gagliano
1. Australian Transport Council. National Road Safety Strategy 2011-2020. (2011). Canberra: Australian Transport Council.
2. ParaQuad. (n.d.). About Spinal Injury. Retrieved July 16, 2014, from paraquad.org.au/information-main/about-sci-facts/