I am convinced that, if we put a number of Incident Commander’s (IC) from different fire and rescue services in to a room, we would come up with a fairly standardised answer. It is fair to say it would involve such items as health and safety of all involved, the communication between your team and other agencies, ensuring that the proposed tasks are being carried out. You are coach and/or mentor and you lead as required. Much has been written about leadership skills over the years and yes, they all come into play as well.
However in my opinion it is much much more than that. It begins way before you even get off the appliance. It starts back on the Fire Station in a classroom. It starts with you as the Crew or Watch Manager or an Extrication Team Leader having a passion for all things RTC and the desire to be the best you can possibly be to deliver the most efficient service to the public you will be rescuing. It’s about going onto YouTube or Twitter and looking at all the latest tools and techniques from all over the world and it’s about working and talking to companies that make extrication equipment. It’s about looking for new ways of working. It’s about finding new technical cuts you can make, new ways of working to get casualties out of the vehicle in a shorter time frame. It becomes a mind set and this must be passed on from the Incident Commander or the Team Leader to everybody involved at the incident.
Throughout this article, I will pass on some of techniques and skills I have used to train our operational crews and extrication team. These have led us to be far more efficient on the road in Berkshire and also led to us becoming World Champions for the last three years consecutively. Some of you may not be convinced and feel that Rescue Challenges are nothing like a real incident. However, after booking in attendance and ensuring crew safety on the road, the team approach taken from the national RTC manual still applies. That is what we use in an extrication challenge and on the road in Berkshire. We are fortunate to have one of our extrication team members in our Learning and Development Centre (L&D) and can therefore shape the way the organisation trains in line with best practice.
Now, you will all receive RTC training from your L&D centre. This may be in the form of a one or two day course and may be on a yearly cycle or otherwise. I have no doubt that it will be of a very good standard, but there is only so much that can be delivered in this time. Therefore, it comes back to the IC or Watch or Crew Manager to cover and deliver all the all the other skills and information available. I shouldn’t think many L&D centres have the time to allow all the tool operators to construct a pyramid of plastic cups full of water with the hydraulic spreaders, but it will greatly improve your dexterity, awareness and confidence with the tool!
As already mentioned, the Team Approach from the manual is your best guide. I would supplement this with the assessor sheets from the United Kingdom Rescue Organisation (UKRO) website as they are a great training aid. One main point is that it does not matter who is riding in what position, as everyone will be fully aware of their roles and responsibilities the minute they dismount the appliance and start thinking as one. A good way to practice this is to task someone to set scenarios for you and the team with a casualty in different positions and with different injuries each time. As the IC, form a plan and, if the team is as tuned in as you, then the plan should be similar, i.e. roof removal or side removal and the techniques you would use.
We all know that the team approach works, as this is the gold standard laid down in the manual and it is the most efficient and effective way of working. With this in mind, I will now cover the key issues that, for me, can make the biggest impact at an RTC and which I have seen a fair amount of on the road and at extrication challenges.
As the Incident Commander, when you first get off the appliance the key issue must be to ensure the scene is safe for all in attendance. This will involve you completing an outer 360° survey as quickly as possible, taking the casualty carer with you. Between the two of you, a decision can be made as to the most appropriate entry point into the vehicle in order to assist both the casualty and the developing rescue plan. After covering all the outer hazards, the IC must approach the vehicle from a safe position and carry out a quick internal survey. This will involve looking into the vehicle and checking for any hazards such as the supplementary restraint systems (SRS) and anything else visible. At this point you can brief your casualty carer to approach the vehicle.
As you return to the appliance you should have personnel ready with the appropriate stabilisation equipment for the task they face and waiting for your hazard briefing. A common situation that can occur is that the remaining crew are setting up a tool compound with every piece of RTC kit being taken off the appliance; meanwhile no one has made contact with the patient. This can take a considerable amount of time and is unnecessary work at this stage. Remember it is our role to carry out a casualty centred rescue involving basic life support.
You will now inform them of all the hazards, any patient information available and task them to stabilise. Nothing more needs to be said as all your time pre planning will take over. In addition, I would expect those personnel to report back with any technical inner and outer issues they encounter. In my opinion, once the vehicle is stabilised and made safe, the key is to get your casualty carer into the vehicle as soon as possible.
You now have a couple of minutes thinking time to plan. You must liaise with the casualty carer to obtain an initial briefing on any injuries and obtain further technical information from those stabilising as to the damage and impact. It is crucial to obtain an assessment of the car seats. Will they move? Are there any other limitations? Again your pre-planning, training and experience will guide you to offer various plans to the casualty carer to confirm a route out.
Once they have stabilised its now to one of the key areas – your IC briefing. This is vital and will dictate all your efforts for the rest of the evolution. In my opinion, you should gather everyone together, except the casualty carer, to ensure they are all aware of your plan. At this point, you can obtain any further information that they may have, confirm with them the hazards, the casualty’s injuries and let them know what you require. As already discussed, if you are a well practised Watch or Team, there should be no surprises and the briefing should be straightforward.
I would advocate stating the ‘emergency plan’, ideally the exit nearest the casualty if possible, but remember it must be viable! I would state the A plan, i.e. ‘side removal’ with any additional issues such as body work relocation requiring the hydraulic ram and this would then be supplemented with the ‘B’ plan if circumstances change. If you are an experienced team or Watch and proficient with the team approach, no more is needed other than to take/ask for their suggestions and/or confirmation of the plan.
The reason I am not so prescriptive with regard to the technical team is that I allow them to judge what is best for them to achieve my plan. If I have asked for a side removal, I will expect them to tell me how they wish to technically carry this out, for example by either a rip or post out. They will know what is the most efficient; taking into consideration what doors will open by hand without the need for hydraulic equipment.
Once the plan is in play this is where your command and leadership skills come to the fore. If more appliances arrive, you can deal with them and brief accordingly. If an officer arrives to take over, again, he can deal with the outward facing issues with the other agencies present and you can concentrate on the technical rescue. Depending on the work required or vehicles and patients involved, it may be that you need to get two teams up and running or bring more casualty carers into play. If everybody is trained up to team approach, it should cause no issues and everybody should fit seamlessly into your plan, once you have briefed them.
Now you need to stand back and monitor all the tools, techniques and work taking place ensuring that technical teams are rested and rotated every three or four cuts. Again, this demonstrates your incident command skills and can prevent tunnel vision from tool operators and you can step in as required. You must remain conscious of all the health and safety aspects of the incident and continue to obtain regular updates from the all the team as to progress. You must ensure that appropriate information is passed on to the partner agencies in attendance.
Once all the space is created and it is time for casualty removal, it is imperative that as the IC, you continue to remain focussed and ensure that the spinal board work is as effective as all the rescue techniques you have employed so far. This is another area of work that must be practiced on a regular basis so that everyone knows their positions to ensure confidence and competence.
I have only really scratched the surface on what I see as the role of the Incident Commander at an RTC on either our road networks or at an extrication challenge. From what I see in my own FRS and in others, I would suggest that we all carry out most of the above on a regular basis however, as we move into a new age of vehicle manufacture, we will need new tools and techniques to cope with these changes. With the best will in the world, most L&D centres will not be able to keep up with all these changes in their annual RTC training plan. Subsequently the role of the IC will be more important than ever to ensure your team is as efficient as it should be.
Paul Maynard is an Area Manager with Royal Berkshire FRS and the current Response Manager. He is still active in the development of all RTC training and equipment within Royal Berkshire. He has been a member of the Royal Berkshire Extrication Team for nearly 20 years and team leader since 2007. He lead the team to three successive World Rescue Challenge titles from 2011 – 2013 and is now an Assessor for the United Kingdom Rescue Organisation (UKRO)
For further information, go to www.ukro.org