'Crash' course in life-saving
Published: 01 September, 2006
UK: Dave Armstrong Lead Training Facilitator for Dorset Fire and Rescue Service
Dave Armstrong is Lead RTC training instructor for the Dorset Fire and Rescue Service; he sees safety as being of prime importance during the extrication process. Dorset F&R spends many hours training on RTC scenarios.
“On commencement of the watch or en-route to an RTC, in line with a casualty centred team approach, everyone will be designated a specific task. We usually have five people in a team, sometimes six. The team consists of an incident commander, a driver / pump operator, two tool operators, a casualty carer and if available another person that functions as a runner picking up whatever tasks are left to do. ” Dave explains.
The first stage of the RTC is the assessment. Dave calls it a slow approach where the pump operator will take a fend-off position to maintain the safety of the scene. Every member of the team gets off on the safe side, while the pump operator rolls out a hose and provides an extinguisher as a precaution in case of fire.
An area is then designated for equipment - where it gets laid out - the so-called ‘equipment dump.’
The incident commander will formulate a plan of action by assessing any potential life-risk, damage to any vehicles involved paying due regard to the safety of their crew and other services involved in the rescue.
The casualty carer will make an initial contact with anyone in need of medical intervention, triage and deliver first aid.
“We always try to approach from the front so the patient doesn’t move his or her head. The casualty carer carries oxygen therapy, resuscitation and other first aid equipment.
As well as acting on their findings the carer reports the results to the officer in charge and rest of the team,” he continues.
The tool operators will deal with stabilisation of the vehicle, followed by glass management. Only then will the process of extrication begin.
When the car is safe to enter the casualty carer gains access to attend to the patient; whilst they are doing this they should also look for hazards like undeployed airbags, roll-over protection systems and seat belt pre-tensioners, etc. “Basically, all the bits in the car which have a ‘potential to bite’ need to be taken care of as a precaution. Once identified, disconnection of the battery is a good first move to making things safer.
By using hard and soft protective shielding all casualties are protected during extrication operations. One of the first things we do to promote recovery is to create space for the casualty. For instance, if there were any metal impingement we would force it away from the casualty. Usually the removal of the door helps a fair amount.”
Dave explains that he teaches his students to go for ‘total simultaneous activities’ during the process. Survival rates increase significantly if RTC casualties get transported to hospital within an hour of the actual event. This is known as the ‘Golden Hour’.
“We formulate two plans A and B. A is about definitive care and the best way to remove the patient from the wreck. Plan B is formulated for situations when the condition of the patient deteriorates. Often for Plan B we cut the retaining straps on the doors, force them forward and tie them to the front bumper so that they are out the way. Should they need to come out in a hurry then they can. Plan A is for definitive care and may well consist of a roof flap or removal. We make the hole fit the casualty not the casualty fit the hole,” he comments.
Prior to any cutting operations the team will strip out any plastic finishes from inside the car to expose and eliminate any potential dangers that may be encountered.
Following space creation the casualty carer then assists the paramedic crew, if in attendance, to administer neck supports and secure the casualty to the longboard (spineboard). Under the paramedic’s strict guidance firefighters then help transfer the patient to the awaiting ambulance.
“We always try to have a HOT debrief, quickly evaluating how things went. We do this to aid any investigation and to if necessary improve for the future. If carried out while still at the scene your memory is much clearer. We are more often than not are unable to do this onsite with the paramedics, as they are on route to hospital with any casualties. However we usually catch up with them later. Once the scene is safe it then gets handed over to the police,” he concludes.
