Multiple Vehicle Accidents

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Multiple Vehicle Accidents
Naval Station Rota, Spain (Feb. 12, 2003) -- A firefighter uses the “Jaws of Life” to cut open a car door during a mass casualty drill that simulated a multi-vehicle accident. U.S. Navy photo by Journalist 1st Class Ralph Radford.

By John Morse

The incident command system for structure fires has evolved into a very sophisticated system.  There are sectors, divisions, and safety officers, to monitor the progress on the interior, roof and sometimes each level of the structure.  Unfortunately there isn’t any well used incident command structure for vehicle extrications.  With no well used system there are a few important things we need to remember.

It seems like we totally lose our organizational structure when it comes time to perform an extrication.  Everyone has a specific role at a structure fire but at an extrication everyone has a different idea of what to do and how to get those patients out of the vehicle. Company officers and incident commanders need to work extra hard to take control and get everyone focused on the same process.

In large multi vehicle accidents with multiple patients it is a good idea to divide the accident into different sections, much like the tasks at a structure fire are divided.  The sections can be named for the vehicles designated with a number or letter.  A company officer and crews are then assigned to each accident.  For some reason everyone feels the need to direct the person using the Jaws of Life.  The job of directing is the responsibility of the company officer and not the rest of the firefighters.  Unfortunately I witnessed someone who was not in a position to give orders point a finger to show the firefighter where to place the jaws. The person handling the jaws was in agreement with that placement and was actually in the process of moving the tool to that spot and ended up closing the jaws on that pointing finger.  A shrill scream was followed by re-constructive surgery and 3 months off work.  Keep your hands to yourself at an extrication, and follow the orders you are given.

Accidents involving semi-trucks pose a few unique problems.  It is surprising when you walk up to a semi to check the driver and find that he is sitting at about the same level as your head. That will make things very difficult if that driver needs to be immobilized and taken out on a back board.  Make sure you get a couple folding ladders and have plenty of people to help move that patient safely.  Most truck cab body parts are fiberglass and prying tools won’t do much good.  A saws-all will quickly remove those fiberglass panels.

A well organized extrication without a lot of chatter will give the patient more confidence in the efforts to free them from the vehicle.  That trapped and injured person can hear everything the crew is saying and won’t get much comfort from a crew that is verbally disagreeing on the process.  It is a good idea to assign someone to communicate with the patient and explain what is being done to get them safely out of the vehicle.

At a structure fire a firefighter’s physical effort is measured by SCBA use.  After emptying an air bottle firefighters are sent to rehab and given a break.  Extrication is very heavy work and incident commanders need to make sure crews are rotated and rested.  I have seen some pretty worn out firefighters following an extrication.  You will need at least five people to open a door and remove some one from a vehicle.

If everyone does their part your extrication will be a success. If you are a firefighter do the job you were given.  If you are a company officer take charge.  If you are an incident commander make sure you have enough resources on the scene or on the way.

 

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