Best Practices for Vehicle Rescue Today 

We often highlight technology issues and concerns with vehicles however how often do we hit upon operational concerns and their impact at a vehicle related incident or emergency? Be it concerns around supplementary restraint systems (SRS) or tool evolutions; we need information in the mitigation of such incidents at a motor vehicle crash or a vehicle fire.

Beside this information, our operational functions have changed to interact with the dynamic hazards of the vehicles on the street today while many of the topics relate directly to technology concerns, let’s take these issues and fuse them to real world solutions.

Many of the operational facets of these emergencies have changed, especially in the recent past. This can be in the form of command and control, tool operations and even patient care. We need to be aware of many of the technological issues with vehicles today to improve the outcomes of the patients we come in contact with. In fact all responders, be it on the rescue tool, manning the protective hose line, performing patient care or the officer in charge, play a key role in providing a better patient outcome and they all need to understand the impact of vehicle technology in their role and responsibilities. So let’s take a good look at each of these operational facets individually.

Command and Control
The buck stops here people – the officer on the apparatus is responsible for the crew and their safety. Whoever performs the scene survey needs to identify hazards, patient concerns and any new vehicle technology (NVT) concerns and issues. In turn, these issues need to be communicated to the crew by the officer to ensure all personnel are aware of hazard. The officer should document NVT concerns and also have access to information on vehicle hazards available on scene. This information source can be vehicle emergency response guides (ERG), text such as Holmatro’s ‘Rescuer guide to vehicle safety systems’ or software such as Moditech’s ‘Crash recovery system’.

Safety
All personnel, especially those performing size up and evaluation must inspect vehicles completely for NVT concerns / hazards. Such hazards when identified are communicated to the officer in charge as well as the rest of the crew. Even though there is a need to perform our size up quickly, it must more thorough and complete than ever before. Scene hazards are a given but we need to read the wreck effectively to capture clues for potential injuries, entrapment and hazards directly related to the vehicle’s technology such as motive power, safety systems etc.

All personnel need to take appropriate caution and defensive measures when a vehicle technology hazard is identified. A critical action today is isolating the vehicle’s power which is a two step process, first the vehicle ignition is shut down and keys are removed from the vehicle which is especially important today due to proximity ignition. Then we would isolate the battery from the vehicle by disconnecting or severing the wiring and then removing from the vehicle if possible / practical. Such power isolation should then be documented. Think of the ramifications of power isolation – we need to find power accessories such as power seats as part of our size up and there will be times when we cannot perform such power isolation due to crash damage and / or battery locations we are unable to locate. Remember that in over 40% of today’s vehicles the battery is outside of the engine compartment and in those instances we will need to work with more caution than in the past.

Next there is a need for the interior trims need to be displaced to evaluate if potential NVT hazards / concerns are present – if such hazards are present then the entire crew needs to be made aware of the identification and location. Think about what that might be – first off, we need to look for side curtain inflation cylinders as these devices can be found in either the roof posts or roof edges. Second, we can sometimes see reinforcements or structural components in the roof post and edges which is also important depending upon the tools we are using.

Whenever using tools in the area of the passenger cell an appropriate barrier(s) is placed between the patient(s) and the crew members. This barrier can take the form of either soft or hard protection. Soft protection is for use when performing glass management and keeping a clean work area around our patient(s), being a tarp, blanket or a soft cover. When using cutting or spreading tools inside the occupant compartment, the use of a good cutting shield is indicated. A cutting shield is an example of hard protection – today’s hard protection needs to be a flexible shatter proof shield since we will need to get into close confines and we will sever hardened materials that can produce small fragments that can fly and have energy.

Finally, debris with potential SRS devices must be identified to the wrecker / recovery personnel as well as all emergency personnel. Care must be given to these objects especially how they are placed after being removed from the vehicle. A few years ago this would never have been a consideration. Today we must think about the amount of vehicles that have side impact and side curtain airbags which have become almost standard items on most vehicles, be it a car, SUV, minivan or pick-up. This forces us to deal with ‘live’ and ‘loaded’ SRS in debris that we might displace or remove in the process of the rescue. When these vehicle components are removed we need to ensure they placed with the sheet metal side down and the interior facing upwards.

Tool Usage / Evolutions
While these practices also can fall under safety, the following are orientated specifically toward tool operations. First off the tool operator observes a ‘safe’ area in reference to observed NVT hazard / concern(s) which is especially important if we cannot isolate the vehicle’s power. For the interior rescuer the observance of ‘space’ from SRS is pretty difficult to achieve at best. With the average of six to eight SRS devices in a modern vehicle barring a roof removal we have run out of ‘safe’ space and the use of a good proper cutting shield in conjunction with tool operations near a patient and / or crew personnel has become more and more important.

We need to observe caution and concern when cutting materials where possible NVT concerns are present and give consideration to the tool deployed especially with our power hydraulic cutters but also with reciprocating saws and rescue air chisels.

Hardened materials can be found everywhere in the vehicle, from structural reinforcements to various components. Not only can fragments be produced but sometimes these materials are stronger than the tools we are using to sever them so the potential for blade breakage is greater than ever. Stronger tools and better operational techniques are extremely important today and along with hardened materials the other reason we remove / displace interior trim prior to cutting of roof posts / structure is to ensure that no damage is possible SRS inflation devices. Cutting through a live side curtain inflation module can produce fragments under high pressure which can see upwards of 10,000 PSI in side curtain inflation cylinders today and the potential especially in vehicles with larger sides (SUV, Minivan, station wagons) of more than one inflation cylinder.

Think about this next practice – during the glass management phase only a simple dust mask is worn and not breathing apparatus – Why? Much of the vehicle glass we encounter today is laminated glass or potentially could be so. This type of glazing needs to cut in order for it to be removed from the vehicle since it is bonded onto the vehicle due to its laminated construction of layers of glass and plastic. We have become accustomed to this material in the windshield but many vehicles today have laminated glass in the side and rear windows for a variety of reasons but one reason in particular is for added structural strength. Think about that for a moment – a change in glazing material to facilitate additional strength in a vehicle’s structure, times have changed fellow rescuers and changes are going to keep occurring.

We’ve mentioned already about power isolation. Along with power concerns think about how this power gets distributed to the various vehicle components. Extensive and ever more complex electrical circuitry, computers and the ability to store power in capacitors and even today our tools can add to this power issue. Whilst unlikely, our power hydraulics can produce a static charge as they pass through plastics – what happens then when we encounter a device such as a side impact or side curtain SRS module and as part of evolution we have to sever wiring to it?

Again unlikely but to err on the side of caution any wiring we encounter should be cut / severed with a hand tool not a power hydraulic cutter and to be on the safe side due consideration must be given to potential SRS reaction.

Let’s go back to debris again. Debris from the vehicle, especially roof and doors, are placed into an identified debris pile and consideration must be given to potential SRS reaction (i.e. door(s) placed with exterior panels faced down-interior facing upwards). This is for a number of reasons – we’ve already mentioned the issue of ‘loaded’ SRS in the debris, another would be to keep our work area clear of trip hazards by keeping it all together.

We need to ensure that we keep careful documentation in relation to vehicle rescues for a number of reasons. This is an area that can be easily overlooked but is vitally important for training / educational purposes as we seldom get the opportunity to cut new vehicles during training. If we are able to inspect various pieces of debris and glean information about how it’s made, what it’s made of and more importantly how our tools faired against it will enable us to build up a knowledge and understanding of the way in which modern vehicles are constructed.

Patient Management
Alright, let us shift gears now. One of the biggest concerns today is how our patients interact with the vehicle – especially the vehicle’s structure post crash. For those of you that have been on the job for a number of years, think how motor vehicle construction has changed, in particular, the occupant space inside the vehicle. A door displacement or ‘pop’ not only gave us enough room to access the patient but also remove them however in most cases today that door displacement gives us patient access and that’s about it.

Add into this the vehicle’s ability to absorb crash energy readily which allows the vehicle, especially from the front and rear, to crumple up and dissipate that energy. Factor in the interior getting closer to the front seat occupants almost like a cockpit and then think of how seats are configured today. Contoured, racing styled seats are the norm for most vehicles today so is it a wonder most EMS providers today use a rapid removal technique even when it isn’t needed to done in that fashion? The packaging devices for a stable patient many times will entrap a patient due to lack of space. Remember head belly toes alignment still is a best practice for patient removal. That hasn’t changed.

For more information, go to www.roadwayrescue.com