Rescue at Night
Remember the last time you did some practical extrication training? It was in nice weather, not raining and not too cold. I also bet it was during the day. Of course it was, it makes sense. It’s a safer, warmer environment, everyone can see and things are generally a whole lot easier for all concerned, especially the person who volunteered to be your casualty. But the very reasons you chose to do your extrication training during the day in fine weather, is the precise reason you need to think seriously about how you prepare for extrications that you attend in the middle of the night when the elements are not so desirable.
There are many factors that make the process of rescue at night more challenging, but let’s consider just two:
- Reduced Visibility
- Reduced Temperature
Reduced Visibility
This fundamental difference will greatly affect your ability to operate at the same pace and still retain the level of safety required on scene. Reduced visibility makes your initial assessment more difficult and therefore more time consuming. Recognizing and managing risk is far more difficult when your ability to see is diminished. Identifying the fuel type of the vehicle and locating casualties will prove more problematic, as will stabilization due to the structural parts of the damaged vehicle being harder to establish. Managing glass will not be a straight forward task. During daylight glass fragments can easily be seen and dealt with, reducing risk to all on scene, but in the case of no daylight, this will be more difficult.
Identifying and treating the injuries sustained by your casualty is also far more difficult at night.
Reduced Temperature
In general night time brings reduced air temperature. The issue here, however, is not really the temperature differential between the two parts of the day, but the rapid exposure to a reduced temperature for both the rescue team and, more importantly, the casualty. Before the impact the occupant would have been warm and comfortable inside the passenger compartment, where the environment is temperature controlled. Immediately following the impact, however, the occupant is now faced with exposure to the outside environment and faces rapid loss of body heat. Due to the loss of glass from the windows during the collision, the cabin will no longer be temperature controlled and, more critically, the casualty is not suitably dressed for being outside.
From a medical point of view, exposure to cold (and in particular hypothermia) coupled with trauma is not a good mix, especially when your casualty is suffering from an internal or external bleeding.
So what can you do?
Keep things simple. Body temperature in this situation is affected by two major factors: Exposure and time. Your efforts must concentrate on keeping both to a minimum, whilst still extricating in a safe manner.
Can we reduce the casualty’s exposure to the environment?
The extrication process by definition will mean we are exposing the casualty to the elements, so we must think smarter:
- Vehicle Positioning – Can this reduce wind exposure (without affecting crew safety)?
- Multiple use of thermal protection, blankets etc.
When you start to formulate your plan, keep in mind the issue of exposure. For example, if your final extrication plan is a roof removal, consider making this a roof flap. Your cuts can be put in place and the roof flapped at the very last moment, just before the physical extrication takes place. This limits exposure to the elements.
Preparation
A theoretical discussion is a good place to start. You cannot deviate from your standard, well-rehearsed approach, but you must be prepared for each phase to be a little more complex, challenging, and as a consequence, more time consuming and with a differing risk dynamic. The proper rescue tools can help you to recoup some of this lost time.
Training
Once you have the theory and tools in place, arrange a training session at night. Remember that the fundamental principle that applies to any training event is safety, so walk through each phase of the extrication process and see what practical problems arise, then discuss and work out solutions.
Rescue at night increases risk and extends time on scene. Realistic training will reduce these.
Conclusion
Realistic training is nothing new. Sometimes we miss the fundamental elements and subtle differences that make it realistic. Rescue at night has a very different dynamic. You must work smarter, practice simultaneous activity and make the most of intelligently designed tools that allow for quick and easy operation. The most important point is to acknowledge that extrication at night increases risk and extends time on scene. Preparation and training will reduce these risks and allow you to focus on the process of rescue; after all that’s why you are there.
As usual I welcome your thoughts!
Ian Dunbar