Fire IQ: April 2012
By Peter Hunt
By Peter Hunt
Motor-vehicle collisions (MVCs) are one of the most common calls to which firefighters respond.
Motor-vehicle collisions (MVCs) are one of the most common calls to which firefighters respond. However, an MVC can present major challenges and even life-threatening situations for victims and rescuers.
Each year, many firefighters are injured and some are killed due to secondary collisions. As with fire fighting, a disciplined approach to handling an MVC helps to ensure a successful outcome when faced with a serious extrication, chaotic conditions at the scene and/or a critically injured patient.
Applying the basic principles of incident scene management, creating a manageable span of control and establishing key sectors are the main elements associated with an organized and effective operation.
Preparation for an MVC begins with clearly defining the roles and responsibilities of pump and rescue crews, pre-planning best routes and traffic patterns, developing good working relationships with police and EMS, understanding new vehicle technology, and constantly training in the most realistic conditions possible. In this regard, a good relationship with the local wrecking yard provides the opportunity to train with multiple vehicles and to create challenging crash scenarios. Some fire departments have had success obtaining cars in exchange for a tax receipt, then offering the wreck to the local tow truck operator, who in turn, gets the scrap value of the vehicle.
While it may seem obvious, the importance of buckling up and driving within the limitations of the road and weather conditions when responding to an MVC cannot be overstated.
Once on scene, the chaos of an MVC can be viewed in smaller, more manageable units and the following steps serve as a guide for the incident commander: stabilize the scene, stabilize the vehicle(s), stabilize the patient(s). Likewise, crew roles and responsibilities should be strictly enforced to ensure against duplication of some and neglect of other critical functions.
The single best initial step to stabilize the scene is the appropriate placement of the apparatus. Typically, this involves angling the pump and heavy rescue in such a way as to protect the rescuers and vehicles involved from the flow of traffic. Operators should not hesitate to take all the lanes they anticipate needing. Often, however, tow trucks, traffic jams, other emergency-service vehicles and the general chaos of the emerging rescue make this a challenge (not to mention the difficulty often experienced getting the heavy rescue close enough to place extrication tools quickly into operation). Sometimes a not-so-polite reminder to non-essential people to get their vehicles out of the way might be required.
Also worth mentioning at this point in the MVC is the importance of calling additional resources as early as possible (especially in remote locations) and similarly, not cancelling apparatuses until you have determined exactly what is required. On more than one occasion, I have cancelled a heavy rescue only to find that a door needs to be forced or a roof must be removed – not a good situation when the patient can’t afford a delay in extrication and treatment. A quick but thorough scene survey by the first due company officer is the best way to decide what resources are required.
At the earliest point in an MVC, when the need for extrication is known or suspected, or the condition of the scene and vehicles poses any kind of risk to victims or firefighters, the following sectors should be established and adequately staffed by command: vehicle stabilization, extrication, fire control and medical.
When faced with a serious collision involving multiple vehicles, certain required tasks may pose a challenge to crews, including ensuring proper stabilization (including four points of cribbing), keys out of ignitions, parking brakes applied, batteries disconnected, fluids contained and a charged hose line stretched by a member in full PPE/SCBA. Skipping these important steps can have catastrophic effects later in the rescue, and knowing this should give you the discipline to complete necessary tasks first before aiding the victim.
To reduce chaos at difficult extrications, I have always found it helpful to assign crews to very specific roles. For example, in the case of multiple vehicles, a crew is assigned to deal with only one vehicle. In the event of a single-vehicle extrication, one crew gets the driver side and a second crew gets the passenger side.
In a perfect scenario, EMS is on location to stabilize and treat the patient(s). If that is the case, an exchange of information should take place to ensure that both agencies understand the immediate needs of the other, such as the extent of extrication required to effectively remove trapped victims. One of the greatest challenges facing a fire crew at a serious MVC comes when EMS personnel are either delayed or overwhelmed with victims, thus requiring that we carry out patient treatment in addition to our many other responsibilities. If the latter is the case, while it may seem obvious, do not allow heavy-rescue crew members to get involved with patient treatment. They must be available to set up and operate the tools required for the extrication. Assign members from a pump to patient care and leave the rescue guys to their extrication obligations. Once the doors are forced and the roof removed, the heavy-rescue crew can assist in patient packaging and subsequent removal to the stretcher and ambulance.
It takes a lot of discipline and training to organize the chaos of an MVC. But it can be accomplished through strict application of the principles of the command system and by creating smaller, more manageable roles for responders.
Peter Hunt, a 32-year veteran of the fire service, is a captain in the Ottawa Fire Department’s suppression division. He can be reached at email@example.com