Step 1: Secure the vehicle(s) from movement
With the number of hybrid vehicles increasing, and looking strikingly similar to their ordinary counterparts, responders may endanger themselves by following commonly taught procedures; the outer circle survey. You arrive to find a driver slumped across the steering wheel appearing unconscious. Approach to the vehicle is made, attempting to make patient contact. The patient awakens after contact, subsequently moving their foot from the brake and striking the accelerator. Suddenly the vehicle moves forward, striking a responder and injuring them. Unknowingly the vehicle was a hybrid in the ‘sleep mode’; these vehicles have the ability to travel 25 mph on almost silent electric power. Generally, hybrids can be identified only after close inspection.
Consider placing two tire/wheel chocks near the initial response gear, serving as an obvious reminder to secure the vehicle.
Step 2: Isolate the hazards
A majority of today’s vehicles are equipped with six SRS airbags, quite possibly more. Two of the common SRS airbags installed are window curtain units that deploy downward from the roofline.
Responders typically approach the vehicle and lean into the window to begin their assessment. This places them in the direct deployment path of the window curtain SRS. Simply opening a door to begin assessment places them in the deployment path of a window curtain SRS, door or seat mounted SRS airbag; these actions risking serious injury.
Immediately after arriving at the scene responders must de-energize the vehicle’s electrical system, by switching the vehicle off, removing (and maintaining) the key a minimum of 50 feet away, disconnecting the battery, or simply “double cutting” the battery cables. Batteries may be found in a multitude of places within vehicles, not limited to the engine compartment. Actively LOOK for all of them. Don’t forget to disconnect or “double-cut” the 12V accessory cable, usually found connected to the positive battery terminal. If batteries aren’t accessible, remove all fuses. Capacitors are installed in the SRS circuit to provide an alternate source of energy to deploy the SRS. Generally, once the vehicle’s electrical system is de-energized, these capacitors will begin decaying thus losing their stored electrical energy. De-energizing a vehicle’s electrical system will isolate a hybrid’s high voltage system.
Responders should cut the seatbelts promptly after gaining interior access. Simply the act of leaning into a vehicle to unbuckle a seatbelt places them into an SRS airbag deployment patch. Fully extend the seatbelt from its retracting mechanism and cut it.
As soon as possible responders should check for a potential reverse-fed electrical source, i.e. items inserted into the power outlet receptacle. If anything is found plugged into these receptacles, it should be removed immediately. Modern vehicles may have more than one power outlet receptacle, perhaps in the rear of the vehicle.
Responders should remain aware of the 5-10-20 SRS deployment path during medical rescue operations; 5” away from door mounted SRS, 10” away from steering wheel mounted SRS, 20” away from passenger’s frontal (dashboard) SRS.
Approaching vehicle collisions is...
S – I – M – P – L – E
S - Secure the vehicle(s) from movement
I - Isolate the hazards
M - Manage the scene
P - Protect everyone from fire
L - Look before spreading or cutting anything
E - Extricate, not extract
Step 3: Manage the scene
With ever changing technology and increasing hazards even seemingly minor incidents can escalate quickly. It is imperative to establish and provide incident management at every scene. The Incident Manager (IM) must make everyone aware of potential dangers that exist on scene. Likewise, every responder should inform the IM of any hazards immediately.
A serious hazard that exists at any scene is that of approaching traffic. Each responder has a responsibility to protect themselves. Every IM has the responsibility to protect responders from this hazard with effective parking and traffic control.
Step 4: Protect everyone from fire
Likely one of the foremost hazards at a collision scene is that of fire. Everyone at the scene must be protected.
A majority of today’s vehicles are equipped with polyurethane plastic fuel tanks and pressurized fuel transport lines. The fuel transport lines are under constant pressure ranging from 15-95 psi. Should a transport line be ruptured, fuel is instantly sprayed onto sources of ignition resulting in a rapidly spreading fire. If the ensuing fire isn’t immediately extinguished, the plastic fuel tank will quickly melt and spill its contents.
Not all vehicles are powered from conventional fuels. This fact necessitates that responders ascertain the specific fuel being used and mitigate the hazard. This may include reducing vapor release by closing a valve or dissipating a vapor cloud. Responders must determine the vehicle’s fuel source, and reduce its associated hazard.
Once a fire develops the heat will envelop the compressed gas hood support struts greatly heating them. Likely they will dislodge, being propelled for great distances. Responders have already been injured by these projectiles.
Obviously patients must be protected while being treated and extricated. Responders should use a covering that is fire resistant, and offers excellent flash fire protection.
It is a fundamental task for responders to place a charged fire hose into position between the greatest fire hazard and responders/patient(s). This fire hose must be capable of flowing 100 gpm and be staffed with a minimum of two firefighters that are fully protected with PPE including SCBA (mask in place).
Step 5: Look before spreading or cutting anything
Many of today’s vehicles are equipped with various SRS components that could become dangerous projectiles if physically damaged, heated, or severed. For example, compressed gas inflators for window curtain SRS are pressurized to 3000-4000 psi. Possible locations for these inflators are the “A”, “C”, or “D” posts, lower dashboard area, the roofline above the rear window, and the roofline parallel the vehicle. SUV’s may potentially have two compressed gas inflators on the same side, one for the normal curtain SRS airbag and one for third row seating.
Pyrotechnic seatbelt pre-tensioners are commonplace in today’s vehicles, usually found in the mid to low “B” post area. Responders should avoid cutting into these as well.
Without fail, responders must perform the “Peek andPry Technique.” In every circumstance responders must peel away the interior trim components to expose potential hazards to avoid during spreading/cutting operations.
Step 6: Extricate, not extract
In an effort to meet today’s economic and safety conscious demands manufacturers are creating smaller vehicles on the exterior, while maintaining larger interior compartments for passenger comfort. This places the patient nearer the “B” post area, likely beside it. ‘In the day’ we rotated the packaged patient in the seat and lowered them onto a long spine board. This worked well with vehicles having large doors; generally not the case today. This creates the opportunity for greater spinal manipulation causing additional injury.
We must remember the basic mantra of extrication; Remove the metal from the patient! Axial spine alignment is imperative, thus responders should extricate, not extract!