Importance of Stabilization

[BigJohnson]

We have just taken over the extrication duties from the sheriffs Department and have formed a team from 3 neighboring departments. We formed a SOP team and wrote that vehicle stabilization must occur before rescue team members enter the vehicle. We haven't tried the SOP's on a scene yet and one of the departments captain is challenging the fact that stabilization is not nescessary before rescuer entry into the vehicle. I'm looking for support or evidence to bring to our 35 member team on if he is more right than wrong. We are all part-paid. Thanks, FF Steve.

[ALSfirefighter]

Steve,

I applaud the fact that you stress the importance of stabilization. It is one skill that I have witnessed recently that sometimes seems to go to the wayside. As far as the situation you raised, I would say that it would have to fall underneath, the common sense, and the OIC's size up. While having SOG's is very important. The one thing everyone has to keep in mind is that they are a "guide." Its not the law. If the vehicle is sitting on all 4 tires, I would, and would let me crew members enter to begin treatment. I've also entered cars that are on their sides on the street, but only after ensuring that the vehicle was stable. I arrived first and the ENG and ambulance was some time away and I needed to begin treatment. Risk vs. Benefit. The basic question of all incidents. However, regardless of whether or not something happens, always stabilize!!
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The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of.

[HVFDFC]

Our SOG states that we will always stabilize. However, none of our SOG's are carved in stone. But if we say always, then every one going to the scene is on the same page until a circumstance arises that stabilization may not be required, and we can make adjustments.

But we like to keep it simple. At every MVA, we will always expect to stabilize, disconnect the battery, or pull a hose for protection until the situation allows us to alter the plan.

A good example of this was a call we did last night where a Neon hit a moose. On route (15-minute drive) we were clarifying everyone’s rolls when we got to the scene. One of the rolls was to pull the step cribs and get ready to stabilize once the scene survey was completed. During the survey it was noted that the passenger was not breathing and had no pulse. The decision was made that stabilizing would not be an efficient use of time, and we proceeded to extricate the patient.

Although our attempts were a lost cause, it shows how on the scene you make the adjustments to fit the situation.

Don’t let there be any guesswork in your SOG where personnel have to remember what rules apply in certain situations.

[pokeyfd12]

Steve, one of the most important jobs at the scene of an MVA is to make sure the vehicle is stabilized. This can be done at the same time as the primary survey of the scene.
Remember, stabilizing he vehicle does not only mean making sure the vehicle doesn't move. Stabilizing the vehicle also includes making sure there aren't any leaking flammable liquids, toxic chemicals, downed power lines or if the vehicle is on fire.
The easiest thing to do to stabilize a vehicle is to throw a wheel chock from the fire apparatus under one of the wheels or put step chocks under the frame. The tires can also be flatted so the vehicle doesn't roll. Something people tend to forget after they have been in an accident is to put the vehicle in park or put it in neutral with the parking brake on if it's a standard shift. I've responded plenty of times with the ambulance and arrived on scene as the vehicle slowly rolls because it's still in drive. There is a good possibility that the transmission or driveline is damaged so that even putting the vehicle in park won't keep it from rolling.
It's a common sense maneuver. Also remember that the safety of your crew is your primary responsibility. I sometimes picture a FF detailed to disconnect the battery getting run over because the vehicle suddenly started rolling down the hill. That's not a safety minded crew.
If I had a dime for every FF that started extrication on a vehicle without checking for downed wires or leaking fuel. I'd probably have about 50 cents but I think you get my point.

Stay safe

Rescue Lt. Kevin C. (aka Pokey)

[skip61rupert]

Steve, great start. Stabilization is a very important part of the extrication. If you need some additional "ammo" as to why it is important, a good resouce is the emergency room doctor who will treat the patient with a c4 or c5 fracture and got bounced around while the crew "rips and tears". The doctors are a great resource. Use them. You will like what you hear.

[roadwayrsq]

Steve-Good & prudent choice!
Stabilization lays the foundation for all your operations with the vehicle(s) involved and ensures no unwanted movement which in turn makes for better patient outcomes!
Be safe,
Dave D

[kbud]

Steve, here's a link to a great article by Steve Kid (Carbusters) discussing how unibody vehicles may react stabilized or unstabilized to your extrication evolutions. Hope this helps... http://www.jems.com/firerescue/e0104a.html

Kevin

[Dalmatian90]

I'll bet we're having more of a difference in definition of "stabilization" and "access" than opinion.

**Usually** (but certainly not always)Stabilization for the safety of the rescuer gaining patient access is less extensive than the amount of stabilization needed once you start cutting, pulling, and prying the car apart to remove the victim.

And sometimes all the stabilization needed before access, is, well none. We frequently have cars that are on all four wheels, off the road and onto the shoulder in such a way their not going to tip over or roll away -- the situation of the accident has stabilized them. Now, we may have to crib up the frame depending on what we're doing for extrication, but not for access.

[BigJohnson]

Thanks for all the input and opinions. I thought that I had a big picture but it appears that I was more tunneled than I thought. From what I gather we need to make sure to consider stabilization, but don't become a stickler and ignore the obvious tasks that may take prescedence and wait for official stabilization. My thoughts for pushing for the stabilization first was that was one task that would be basically done if the primary extrication plan or tactic failed. I'm sure as we get some runs under our belts and some practice time all of your points will become very clear. Thanks again,
FF. Steve.

[mikema]

Steve,i'm glad your dept reconizes the need for stabilization at all MVA's that require the need for extrication of the victim from a vehicle.whether the extrication requires the use of power equipment or not the need for the vehicle to be stable at the time of extrication is one of the utmost concerns next to scene safety.i've taught extrication for many years and every class i stress the need for vehicle stabilization at every MVA.Steve i dont want to get into the methods of vehicle stabilization techniques here but if you want to e mail me i can give you alot of good info,or if anyone needs some good advise on extrication in all areas you can get my e-mail addy from here and we can chat about it and exchange ideas also. good luck,mike m

[rmoore]

A Posting from Forum Moderator Ron Moore:

Regarding a Captain objecting to stabilization of a vehicle, refer to the Oct, Nov, Dec 2000 and Jan 2001 University of Extrication series on the "Phases of Rescue" NFPA 1670 drill. In Phase One of the drill (Oct 2000 article) you will see that the 360 degree survey, checking for hazards, airbag scanning, stabilization of a vehicle, patient access, patient protection, electrical system shutdown and determining the contents of the trunk can all be done by a trained crew in 1minute:30seconds or less. That's not too much time to ask for the value that is gained.

It's taking your Captain more time to bitch about it than it takes to accomplish the task!

Stabilization is listed as an Ops Level proficiency in NFPA 1670, Chapter 6. It is therefore a generally accepted standard that we will all be held to in a court of law.

[Rescue101]

Now for my bit.An important reason to stabilize is the fact that a majority of your cars today are Front wheel drive.Once hit in the front many times a front drive axle will pop out or be shattered.When this happens,regardless of gear selector position you are in for a very nasty surprise.We responded to an incident once in which an over eager responder climbed into the vehicle before it was stabilized.The vehicle started moving.Luckily the rescue officer had two cribs and was able to safely stop it.Needless to say when critiqued we had a very sheepish individual and a learning curve adjustment of why we follow SOG.ALWAYS STABILIZE.T.C.

[lutan1]

Don't get bogged down in "unbendable" SOP's in that you MUST do this and MUST do that.

Gointo every scene with an open mind, and assess requirements and priorities.

Stabilzation is important in most scenarios, but in others, its not necessary or may hinder life saving efforts.

Be flexible in your approach.

[MetalMedic]

I love this forum, everyone has such a good handle on how to do things. I too like to see a vehicle stabilized before I enter it, but that is seldom the case when I end up as the EMT inside the vehicle. I certainly want some stabalization before I go about tearing away the stuctural members of the vehicle.

When I think about stabilization in terms of patient care, I visualise a bowling ball on the end of a broom stick. That was the example my instructor used when we learned C-spine immobilization in my first Basic EMT class. If you picture that bowling ball on a stick rocking around when you climb on that car to gain patient access, you can get a feel for the need for stabilization. If that action is going to rock the patients that much, you should stabilize first. If you can get into the vehicle without a lot of rocking and jarring, you generally can stabilize after you climb in.

[ 07-25-2001: Message edited by: MetalMedic ]

[res7cue]

My dept has an SOG that also states every vehicle will be stabilized;
1. Immediate life safety issues.
2. Vehicle stabilization.
3. Patient access.

and so on.
I think that every incident must be evaluated as to the actual need for vehicle stabilization.

Does the pt's condition dictate a rapid extrication or do you stay and play ?

Is the vehicle on a grade, sittin on a curb, sign post, etc?

If you're gonna stay & play, I feel that you must perform some type of stabilization to keep jarring of the pt to a minimum. But if your doin' a rapid extrication, c-spine and GO !

Just to many variables to say that you SHALL stabilize on EVERY incident.