The Team Approach - Full Access
The art of space creation and achieving full access during vehicle extrication has come a long way in the twenty years since I became a firefighter. The early 1990's saw the introduction of the Team Approach, but in my formative years we still very often didn't make as much final extrication space as we could have done.
Thankfully, our much improved understanding of traumatic injury, more advanced techniques and equipment, means we are now better prepared to create ultimate space, ensuring we are fully sympathetic to the casualty. Having said that, my job takes me to places where preservation of the vehicle is a major consideration because it is the victims personal property. Taking the roof off the vehicle in order to extricate in some cases, can ruin the livelihood of the victim, so alternatives have to be found.
Let's face it, we mostly consider full access to be the roof relocation, no matter what orientation the vehicle is in (i.e. on its wheels, side or roof). However we must consider other options if the casualty's condition does not allow sufficient time to relocate the roof. One option is a side removal. If the casualty is in the 'normal' seated position, this will involve some degree of rotation, but if time is not on your side then there has to be (usually) some compromise.
Of course, the gold standard is to extricate the casualty 'in line' therefore protecting any possible spinal injury. We should be aiming for 20 minutes for this kind of extrication, and this can be achieved by adopting as much simultaneous activity as possible, allowing each phase of the rescue to flow seemlessly into the next.
Roof off or Roof Flap?
It is important that as a rescuer, you have options on scene. Full removal of the roof is of course one option, but there are advanatages to flapping the roof. Firstly you can flap the roof either to the side or to the front, depending on the location of the vehicle and the access you have.
The forward roof flap has 2 clear advantages;
- To complete the forward roof flap, you must cut the C and B posts on both sides, then make a relief cut into the roof apporximately 10cm from the top of the A pillar. This means there is no need to cut the laminated windscreen, thus creating no dust.
- Once the cuts are made, the roof can be left in position until the casualty is ready to be extricated. In extreme weather, this means that their exposure to the environment is limited. Of course, both options work well, and should be practiced, but like any other technique, the more options you have on scene, the more effective you are.
It is important to remember that the creation of full access is not just for the benefit of the casualty. Maximum space allows rescuers to work safely and more efficiently during the final extrication phase, allowing the maximum number of personnel to assist with the physical removal of the casualty.
Once full access has been created, there needs to be a full reappraisal of safety on the scene. This includes checking the vehicle stability, covering all sharp materials created by the cutting process and the removal of any vehicle debris and tools that will cause a hazard in the immediate working area.
We have now arrived at a stage where our casualty is ready to be removed from the vehicle. The immobilisation and extrication phase is something we will cover in my next blog.
As always I welcome your feedback.
Ian