In the last three articles we have looked at how school buses are designed and constructed. The types of steel they are made from as well as how they are fabricated. We talked about the emergency exits located in the rear and in the roofs of all new buses. We also discussed some scene hazards and how to deal with multiple patients and bystanders, how to run the scene and how to stabilize the bus for extrication. Now it is time to look at the extrication phase of our operation.
First, I want you to think about all the school bus wrecks you have ever been on, or seen on the news or read about. How many ever involved someone pinned in the bus? Most rescuers have never come across anyone who was pinned in a bus. Now, for definition purposes, pinned refers to when the bus, or vehicle, is physically holding the patient in. “Trapped” would be when they can not exit the vehicle until an opening can be made. There has been, and will be, the rare occasion when someone can be pinned in the bus. It can happen.
We have now made our scene safe to work around and controlled all the hazards. We have Incident Command in place and our scene is under control. At least as much as it can be. You have stabilized the bus and we are now ready to go to work. Our first action would be to gain entry into the bus, so we can triage and evaluate just what we have. Our access only has to be large enough for our rescuers to enter. Our first entry choice would be the windows. The front window is large and can be easily removed. That would be your first choice if available. The side windows are another good choice, as a rescuer can fit through the window opening once the window has been removed. If for some reason the windows are not an option, and the bus is on its side, you can cut through the roof. If the bus is new, then it will already have roof exits that can be utilized. Remember, if you are going to cut through the roof, make your cut between the roof supports.
Gaining entry is the easy part. Now you need to make your openings large enough to get your patients out. These patients will probably need to be on long spine boards and completely immobilized. If the bus turned over, or rolled, these children have been tossed around like dice in a “Yatzee” cup. You could have a lot of kids, with a lot of injuries. Again, if the front window is a viable option, remove the center support and use it for the patients near the front of the bus. New buses have one big front window and there is no center post to remove.
For your patients in the middle, either use a side entry technique, or enlarge the opening cut through the roof. If you are using the side entry, cut out the post between two of the windows. This can be done with a hydraulic cutter or reciprocating saw. Then at the base of the window on both sides, make cuts to the floor. These cuts should be right beside the side support beams. Remember, that the seat will be attached to the side, so it will also have to be cut loose from the wall. Then cut across at floor level from one side cut to the other. Remove the side piece and pad or tape the edges if needed. Again, these cuts are better made with a reciprocating saw using good quality rescue blades. You now have an opening large enough to remove boarded patients.
From the rear, you can cut out the back framing and exit door. This will give you a large opening to remove patients. If that is not enough space, you can make cuts down both sides, from the base of each back window. Cut close to the corner supports, then make cuts across the floor. Afterwards, you need to cut the two window posts and the entire back of the bus will peel down. Again, most cuts can be made with a reciprocating saw, along with cutting the post with your cutters. This maneuver is harder than I just made it sound, but it can be done in a relatively timely manner.
The floor of the bus is extremely strong with heavy support beams and channels. This would be a last resort for accessing and removing patients. The rest of the bus is not as strong, and all attempts should be made to enter and extricate through the sides and roof. Keep in mind that the bus is constructed of galvanized steel and cordless reciprocating saws will not last. Air chisels can also be used for cutting and skinning sheet metal. Remember, you have a large cache of equipment that can be used, don’t get tunnel vision when planning your access and extrication.
Nothing replaces good “ole” training and practice. I realize that buses can be hard to come by, so when a class on bus extrication comes along, jump at the chance to take it. Always keep an open mind and keep safety in the forefront.