The Team Approach - Stability and Initial Access
Stability is literally the foundation of any successful casualty centred rescue. Preventing vehicle movement is vital for the following reasons;
- Prevents any further injury to the occupants (spinal/pelvic injuries etc)
- Provides a solid base for medical intervention
- Prevents any further structural deformation of the vehicle during the rescue process
Once safety on scene is established, stability can begin. Entry into a vehicle should only be made once stability is completed (unless a casualty is at immediate risk, due to a compromised airway) and the process should be safe, rapid and easy, allowing casualty care to begin immediately. If the process of stability is delayed, safety is compromised, as is casualty care, and the technical rescue cannot progress. All of this adds to your on scene time and delays extrication.
Worldwide, statistics differ, but we know that the majority of extrications are performed on vehicles that are still on their wheels where blocks and wedges are adequate.
However, a proportion of vehicles will be on their roof or on their side following a collision and the mechanism of injury means that effective stabilisation is critical and additional equipment will be required. Often the final position of the vehicle may be off road, on uneven surfaces and on soft ground, so the equipment you choose must be able to cope with this type of environment.
Stability Phases
We can look at stability in 3 phases;
Phase 1 - Manual stabilisation
If it is identified that a casualty is at immediate risk, then manual stabilisation should be considered. This is where crew members get their hands on the vehicle to restrict movement while a medic gains access to perform a life saving intervention (e.g. open an airway)
An example of this, where a car is on its wheels, crew members can brace the vehicle on the wheel arches, this stops the vehicle dropping on its suspension.
This should only be a consideration where there is an immediate risk to life, and should be done a s a result of all risks being assessed
Phase 2 - Chocks and Blocks
In most cases there is no need for manual stabilisation, so the use of chocks and blocks will usually be your first approach.
TIP - Never hammer of kick blocks/wedges into place. This is unnecessary and can cause pain and discomfort for the casualty(s) in the vehicle.
Phase 3 - Additional Equipment
There are occasions where the position of the vehicle means that additional equipment is required. For example the V strut or Powershore, as in the pictures below.
The Holmatro V-Strut makes stability of vehicles in such positions, safe, rapid and easy meaning that casualty access can be gained as soon as possible. Its intelligent design means that the strut can be extended in a single action to precisely the required length (due to small intervals) and auto locks, saving time. Its serrated multipurpose head means that it ‘bites’ into the vehicle construction, with no need to find an edge to hold against. Its tilting foot means that the strut can be inserted at any angle, allowing use off road. Its design and construction means it is ergonomic, perfectly balanced and extremely light weight, all of which reduces the burden to the rescuer during use.
Rechecking Stability
During the rescue process, stability must be constantly monitored and as weight is removed from the vehicle (or added by rescue personnel getting inside) your chocks, blocks and additional equipment should be adjusted.
Remember - Stability is not just about the casualty, but allows you to work safely and more efficiently.