You Make the Call #10

[rmoore]

A Posting from Forum Moderator Ron Moore

I am surprised at some of the decisions being made in the newest "You Make the Call" scenario.

If you haven't worked through the case study yet, here's an overview. The incident involves a 4-door struck broadside with a trapped passenger. The decision points allow you to focus on your department's procedures for extricating when the entire side of the car is crushed in.

The one decision point that surprises me is the large number of crews deciding to use their power spreader rather than their cutter to remove the door at the hinges.

Work through the scenario and see how your choices compare to over 500 hundred others who have already worked through the crash and made their decision.

You Make the Call #0010
http://www.firehouse.com/cgi-bin/for...?ubb=forum&f=5

Ron Moore

[firefighter26]

Hey Ron, good point. However, I have to admit that I was one of the firefighters that chose to use the spreaders to "pop" the door off its hinges. I actually had a number of reasons for my desicion. First off, my department runs strictly combie tools, so tactics with cutters is unfamilar territory. However, popping the door is my departments protocal, which is what I was going on.

Secondly, taking the entire side of the vehicle is one of our tired and tested scenarios, both in "the pit" and on the street.

Use the combie tool to pop the drivers door hinges, and the rear door latching pin. Use the combie tool to cut the B post up high and you can fold the entire side down, or with another cut (either combie tool or sawsall), you can walk the entire side away, (which is what we do a lot of).

Like always, every department is different. These tactics work wonders for us.

Just some background, my FD's district covers a very heavily traveled section of highway, seeing, on average, 38 000 vehicles a day. The highway narrows from 2 lanes a side, to 2 lanes total, on a mountain, which includes some not so forgiving curves. Our call make-up is about 65-70 percent Motor vehicles accidents.

[[email protected]]

After completing the you make the call section I have a question. Trying not to sound like the arm chair IC because I wasnt their, why didn't they remove the entire b pillar? During a training class I attended the instructor demonstrated a technique to remove the entire side wall with minimal amount of cuts or spreads. It involved starting at the rear of the vehicle first by opening the rear door latch, cutting the b pillar high then making a cut where the b pillar meets the rocker pannel, using the spreaders to break the b pillar from the rocker pannel, then cut the door hinges for total removal. I like this technique because you have no uneven surfaces to walk on. I know that thier are a few ways to skin a cat, and maybe inhind sight the crew knowing that the doors wouldnt lie completely flat might have done it differently. One other point, the car wasnt the victim, and as long as they got the patient out as quickly as possible with out futher harm then the call was completed correctly. Just might be something to consider on the next one.

Mike D.

[rmoore]

Spreading to break a hinge is good and so is knowing how to cut the door off with a different tool. Power cutters are an acceptable way to remove the door at the hinges but I agree, it may not work unless you have a dedicated cutter, not the combination unit as you mentioned.

Do you practice other ways to take off a hinge? I recommend you try out the "Kwik Cut" air chisel tool. It is really impressive for this task.

If you didn't have your 'combi' available, how else would your crew remove a door? What's your Plan B?

[rmoore]

Mike:

"Blowing out the B-pillar" is the evolution you described. It will be the feature of the December 2001 Univ of X article in Firehouse.

The reason it wasn't possible in this incident was that the T-bone hit drove the bottom of the door in so deep that the rocker channel even rolled almost 180 degrees onto itself. As it was pushed in, the door dropped down to almost contact the rocker.

With the entire sidewall bent inward like this, the side wouldn't even budge when the top of the B-pillar was cut.

To gain access to the inside bottom of the B-pillar, we needed to remove the rear door. it wouldn't open far enough manually. The bottom hinge was buried too near the patient so we went with the "lay down' evolution instead.

Primarily because of the low hit on the side of the car and the position of this patient, it was quickest to lay the sidewall down a bit and longboard the woman out over all that metal.

Although in the You Make the Call drill, we analyze it step-by-step, the total time was just a few minutes.

[firefighter26]

We were actually looking at getting a dedicated cutter for those exact reasons, Ron. We have practiced with other departments and used their cutters to take out hinges (much to their frowning because they don't cut hinges with them, strictly posts).

As for a Plan B, for doing the entire sidewall we would use our air chisel, as you mentioned. We have a really cool bit that works great for taking out hinges. Not sure what it is called or who made it, but it works wonders. If that is not working, Plan C (which could be tried first) is the every trusty Hooligan tool and pry bar combination. More times then I can count we have been told the Combie unit is "broken" during our practice scenarios, so we all have become used to having to use our hand tools. Of course, if the hydraulics are not available and we need to cut a post we turn to our sawzalls, (actually, 50% of the time the Sawzall is our first choice).

About two months ago we did a call where a Dodge Shadow served to avoid rear ending a vehicle making an illegal left turn across the highway in front of them. The Shadow made the wrong choice and went into on-coming traffic and head on into an Isuzu Trooper. The passenger of the shadow was removed quickly. The passenger door was opened and hyper-extended to allow for the spine board to be placed under them. EHS did spinal and slid him up the board and out, then down flat and lifted him onto the stretcher. EHS did initial spinal from the window, then took over from the back seat while we did the door. As for the driver, it was decided to take the entire side wall out because that side received the most damage, and the driver was rather tall and had her seat back all the way. Our interior was in the back seat doing spinal while we popped the hinges on the driver's door. The rear door could open (not much) so we didn't have to worry about that. Once the front hinges where taken, the combie tool went to work up high on the B post. Once done, we folded the side wall down and used our sawzall to cut the bottom of the exposed B post and walked the sidewall away. The driver was taken out with the same technique as the passenger.

The Trooper was in way better condition and did require any Jaws work. The driver's door was hyper extended for the driver, but the passenger and rear occupant were removed without any extrication work.

Two vehicles and 5 patients we were on our way back to the station in just under 30 minutes, which includes taking some time to wait for the cops to get their act together and organize traffic (we shut the entire highway down) and vehicle removal (they look after that). Traffic analyst report says both vehicles where doing about 85-90 km/h (I guess 55-60 mph). All 5 patients survived.

A little bit different scenario, but the sidewall removal demos our typical evolution.

[J Hicks]

My primary concern is that there seems to be no stabilization in place from the pictures. My company SOP state that no Pt access is made until the car is made stable with cribbing. After the stabilization is in place I like the idea of cutting the hinges with the hydraulic cutters and the going down the line and removing the entire side of the car. Give yourself as much room as possible to work.

[firefighter26]

For us, no one goes in and nothing gets cut until the vehicle is stabilzed, unless it is the life over limb/grab and go scenario.

[Aaron Meland]

I agree with the comment on stabilization, the car should have been fully stabilized before extrication was attempted. Also mike was right about the easy way to do a side-out, going from back to front is a lot easier. As for Departments running just Combi tools, they would be doing themselves a big favor by getting a hydraulic cutter. They can cut a lot of things that a combi tool can't. A sawzall is no substitute as they are too noisy for patient comfort, and they are less reliable.

[mauzy]

Two questions for the group.
1) For those of you choosing to use cutters on the hings - Why? In some vehicles that could be a lot of steel. Why not use the spreaders to break the hinge?
2) Why not use an air wrench to remove the bolts at the front hinge? Granted the hinge may also be tack welded, you can have one crew working the rear door with the spreaders and another crew working the front with the air wrench.

Just another one of those "when the HRT fails can you still take a door off?"

[todd nelson]

I answered with the majority, I am wondering why not remove the roof as well. The bigger the hole the better the access, better treatment and also keeping the patient in line and not manipalating the patient. In extricating, need to be multi functional,have door removal going on as well as roof removal. This can be done in no time, if you know what you are doing.

I'm not real sure of the rules of this game...but I would not attack the door at all. I have found that removing the roof in this situation to work the best. Once the roof is off then you I would open the rear door then poss cut the B post. Another option after removing the roof is to use the Rams and push out the intruding B post and door from inside the car. If we had to open the front door first...I would use the Sreaders to squeeze the frnder to open up the area by the front hinge area then cut the hinges with the O cutter.
There sure is more than one way to skin this cat but I would not start at the front door.

[firefighter26]

Aaron, my department is the one in question using strictly combie tools. We are, however, going to deversify and get a cutter in the new year. (your from the province, ever hear of the Malahat on Vancouver Island?)

Mauzy, to answer you questions, 1) we use our combie tool to break the hinges all the time. 2) we have an air chizel, but we don't use it often. More likely we would utilize the combie tool for what it is, a combination tool. Cutter and spreader. Pop the door and take the post.

On average, we cut up 3-4 vehicles a month for practice. Two years ago we entered our first Automobile Extrication Team. We practiced for 6 months prior, increasing the number of cars we "played with" to about 5+ a month. Long story short, we did some time trials (because of the 20 minute time limit in the compitition) and that our four person team, (not including the IC) using just a single combie tool (and some other hand tools), could do our scene size up (inner and outer circles), staging area set up, cribbing, breaking glass, sending in an Interior responder, PT assesment, and finially removing the side wall in, on average, around the 10 minute mark. (take into account it was a 2 vehicle scenario and we did some work on the other one in there as well)

I am not saying what we are doing is the best, but it is what we do, and we have gotten pretty good at it. What I like about these forums is getting to know the different ways of doing things, that's what it is all about, right?

Ron, any comments? (and when does the next "you make the call" come out?)

[ 11-16-2001: Message edited by: firefighter26 ]

[D Wisner]

"A firefighter without equipment, is nothing more than a bystander." I believe that many readers are missing the point of "You Make the Call". Would you fight a structure fire with your 1" hose reel? Then why would you attempt an extrication without the equipment to do the job? Beg, borrow or steal the funds if you have to. (fund raisers, donations, federal or state grants, etc.). But please don't post a response filled with excuses.

[Dalmatian90]

Not quite sure what post/comment this was intended at
Would you fight a structure fire with your 1" hose reel? Then why would you attempt an extrication without the equipment to do the job?

But it's probably not the best example for the point being made.

Would I fight a structure fire with a 1" hose reel? Sure. If it's all I had, and that answer doesn't mean I'd use the same tactics as if I had a 1.75" available. For that matter, there is a hell of a lot of fires fought every year with an 1.75" where that line is grossly inadequate.

It does mean you need to work with what you have until you have obtained the funds you need to do it better.