Extrication training: Practice how you play
What does that mean? When sports teams practice, do they leave protective gear in the locker room? Do they omit rules just because there are no judges watching? No, they practice as if it’s a real game. Why do we often omit fundamental steps when we practice extrications?
The Drill
The common scenario is that we have a junked vehicle in a salvage yard, or if we are lucky, that has been towed to our station. Most often the batteries are long removed as are the hazardous fluids and any dangerous cargo they may be carrying. I have seen many crews execute great techniques in extrication training, reacting to fictional rescue scenes designed to polish their skills. All too often though, no scene assessment, no safety checks and no hazard mitigation are factored in. We jump in and go right to work because everything is ‘safe’.
We have talked before about practicing until you never make mistakes. How can this be done if we do not practice every step? If crews don’t perform all of the proper procedures, every time, mistakes and injuries can happen when it counts.
Consider extrication competitions; every step must be checked off to receive a good score. All of these steps are preplanned. Motorsports Safety Teams assign duties to each crew member and follow standard procedures every time to ensure safety and success. Crew assignments are crucial. They should be discussed while en route. They can be assigned at that time, or pre-assigned by seating position in the apparatus, as a standard guideline.
What do we have?
No matter how we plan it, this assessment is the responsibility of the first arriving crew.
First; overall scene size up: What do we see when we arrive? How many vehicles? External hazards; are there power lines, natural gas lines, or fires present? Is it safe for crews to approach? What kind of vehicles are involved; passenger cars, cargo vehicles? If the latter, what is inside? All this needs to be assessed and communicated to the crew present and all later arriving teams. Once we deem that approach is safe, phase two begins.
The target vehicles
What are the stability concerns? Is a vehicle going to roll down a hill or out into traffic? Is it dangling precariously? Will two simple blocks in front of and behind a wheel ensure safety? Does a vehicle need to be further anchored before crews begin to work?
Where is the vehicle positioned? Is it on a rail track? Is it a safe enough distance from active traffic lanes for responders to work? Are the engines running or fluids leaking that could cause dangers? Practice removing and securing the keys or electronic ignition devices (fobs). Some of these need to be up to 20 feet (6.5m) from the vehicle. Before doing so we need to install the airbag protection cover on the steering wheel in order be able to retrieve the keys safely and create a safe working environment for the medic.
Now we need to access and disconnect the battery. While doing this someone should be assessing the patients. All the while the crew and especially the team leaders need to be informed that these benchmark tasks have been completed. Many of these tasks are done simultaneously, practicing them makes it smooth. We have to practice doing them every time though, so it becomes natural, never forgotten.
Tool position
Tool position and the body position of the rescuer should be monitored closely during hydraulic tool use in training scenarios. It is easy to take shortcuts during practice that would not be possible on a live scene. Avoid practicing techniques that you know you can’t do when the patient is there. Remember to formulate and practice plan B also. Consider that the medical condition of the patient may change. You should have and be able to execute both rapid and controlled extrication plans.
Environmental conditions during extrication training
Environmental conditions need to be addressed as well in extrication training sessions. What type of weather might you encounter? In some areas of the world, much like my home state of Texas, we can experience three seasons on the same week. Freezing weather, pouring rain and temperatures nearing 85f (29C), all in five days’ time. Do we have the necessary provisions on our apparatus to deal with these? Practice working in the heat, setting up hydration operations and crew rotations. The same needs to be done with cold weather scenarios and rain. Hypothermia can quickly set in. Protecting patients in inclement weather is also crucial. Seasonal training is very important. Getting crews out, into the bad weather to practice only makes us better when the time comes to perform for real.
How are your scene lighting abilities? Apparatus lights are only effective in a small area around the vehicle. What if the crashed vehicle is too far off the roadway or traffic does not permit us to park closely? Do you carry adequate portable lights? Your hydraulic tools should be equipped with work lights, are the batteries fresh? Night drills can shed a whole new light on your crews’ readiness.
Last but certainly not least, let’s talk PPE
If I only had one board for every person I have seen wearing incomplete PPE because ‘it’s just training’, I could build a mansion. Only wearing a coat or just gloves and a helmet is asking for catastrophe. Being complacent is one of the leading causes of injury. Many times PPE is restrictive, hot and can be uncomfortable. Why practice in conditions that are not real? The goal of practice is to hone skills. Part of those skills are overcoming obstacles and learning how to work with what you have. Wearing complete PPE during extrication training should be the only option. Not only for safety reasons, but also for learning purposes.
The bottom line is, train how you play. Do not accept nor seek out shortcuts that will leave you unprepared for real rescue scenes.
As always, I welcome your comments and look forward to discussions on all blog topics.
Jason Bell
Product Marketing Manager
Holmatro Inc