"Block Training" Extrication Training Page

         Valparaiso Fire Department 
   Vehicle Extrication Training (2012)



Welcome to this months "Block Training"At the end of May Todd Hoffman from Scene of the Accident.com will bring his Ultimate Vehicle Rescue training to our department.

This 1-day classroom/hands on course is designed to prepare you for 2012 and beyond. New Steels, New Designs, Alternative Fuels, Advance Restraint Systems, High Voltages and High Pressure Devices are all covered in detail. You will also learn the new techniques and procedures required to safely and efficiently extricate patients from these newer more hi-tech vehicles.
The link below is connected to his Bio and a 7min clip of a different class Todd offers (Vehicle Extrication for the New Millennium). Check out his web site as well it has great video's and training material.

Vehicle Extrication Definition From Wikipedia

(Section 1)

Vehicle extrication is the process of removing a vehicle from around a person who has been involved in a motor vehicle accident, when conventional means of exit are impossible or unadvisable. A delicate approach is needed to minimize injury to the victim during the extrication. This operation is typically accomplished by utilizing chocks and bracing for stabilization and hydraulic tools, including the Jaws of Life. Standards and regulations can be found in NFPA 1670 and 1006. 
Basic extrication process consists of, but is not limited to, six steps:

1 - The protection of the accident scene, to avoid a risk of another collision (marking out the scene with cones or flares (not advisable if gasoline is leaking), lighting) and of fire (e.g. switching off the ignition, putting vehicle in park, disconnecting the battery, placing absorbing powder on oil and gasoline pools, fire extinguisher and fire hose ready to use) ;

2 - Patient triage and initial medical assessment of the patient by qualified medical rescuer;
3 - Securing the vehicle (see cribbing), to prevent the unexpected movement (e.g. falling in a ditch), and the movements of the suspension, either of which could cause an unstable trauma wound or cause injury to the rescuers); A vehicle should never be moved, it should always be secured.

4 - The opening of the vehicle and the deformation of the structure (such as removing a window) to allow the intervention of a first responder, of a paramedic or of a physician inside the vehicle to better assess the patient and begin care and also to release a possible pressure on the casualty;

5 - Removal of a section of the vehicle (usually the roof or door) to allow for safe removal of the accident victim, especially respecting the head-neck-back axis (rectitude of the spine);

6 - Removal of the person from the vehicle
As soon as possible, best before beginning the mechanical operation, a medically trained person enters the cabin to perform the first aid to the casualty: mid-level assessment, stopping the bleeding, putting a cervical collar on the patient (extrication operations are likely to provoke vibrations), providing oxygen first aid. NFPA regulation 1006 and 1670 state that all "rescuers" must have medical training to perform any technical rescue operation, including cutting the vehicle itself. Therefore, in almost all rescue environments, whether it is an EMS Department or Fire Department that runs the rescue, the actual rescuers who cut the vehicle and run the extrication scene are Medical First Responders, Emergency Medical Technicians, or Paramedics, as a motor vehicle accident has a patient involved.
After the vehicle has been secured and access gained to the patient, the EMS team then enters to perform more detailed medical care. Continued protection of the patient from extrication itself, using hard and soft protection, should be done at all times.

Additional risks with new technologies

Active systems such as airbags make cutting into a vehicle more complicated: when they are not set off during the accident (e.g. in a vehicle struck from the rear or a rollover), extrication operations may set them off. This can cause additional trauma to the accident victim or to the rescuers. Airbags can remain active anywhere from 5 seconds to 20 minutes after being disconnected from the car's battery. This is one of the reasons rescuers disconnect the vehicle's battery and wait before cutting into a vehicle.

New hybrid technologies also include additional high voltage batteries, or batteries located in unusual places. These can expose occupants and rescuers to shock, acid or fire hazards if not dealt with correctly.
Automakers are using Ultra High-Strength Steel (UHSS) to achieve the 5-Star Government Crash rating. Vehicles have UHSS areas of the body structure like the A-Pillar, B-Pillar, rockers, side impact beams, and roof beams. This steel is difficult to cut with the standard extrication tools used by rescue personnel.

The First Ten Minutes: A Best Practices Approach to Motor Vehicle Collisions

(Section 2)

Even though firefighters respond to more motor vehicle collisions (MVCs, photo 1) than any other emergency (except medical emergencies), consider all the things we need to evaluate, assess, and begin to mitigate on scene. Although the scene hazards really have not changed much over time, our response and the hazards we encounter have changed. The vehicle is the dynamic hazard in the equation these days. Supplemental restraint systems (SRS) systems, batteries and their subsequent locations, motive power, and vehicle glazing are all items that we need to factor in. On top of these considerations, we need to do this size-up quickly and completely to ensure an effective plan of action.
First Minute…
We need to ensure our safety before we even step off the rig, so we must position our apparatus in a “fend off” manner. This vehicle positioning helps to protect us and our patients by placing the apparatus between the incident and traffic. We must then begin to evaluate the incident. Scan the area for scene hazards and perform our initial “windshield” size-up.
As you approach the vehicle(s), take into account how the vehicle appears. How is it oriented: upright, on its side, or overturned? What kind of stabilization should you consider? How is the vehicle damaged? How much “crush” or damage do you observe? This information should clue you in to potential entrapment and possible injuries. Do you see any deployed SRS systems? We should strive to approach the front arc of the vehicle so you can make visual then verbal contact with the patient(s). Once you find the patient and establish contact, maintain it throughout the incident. You have assessed the scene and located and begun to mitigate the hazards. When you are assured that the scene is safe, stabilize the vehicle to minimize or prevent vehicle movement. This ensures a stable foundation for space-making evolutions and minimizes movement of the patient.
Third Minute…
Once the vehicle is stabilized, make access and begin hands-on patient management: Ensure his airway isn’t obstructured, that he’s breathing, and evaluate his circulation; engage in manual C-spine management; put on a C-collar; and administer O2, as indicated. Take a good look at the vehicle’s interior. Where are the SRS systems? Are they deployed or undeployed? Is there damage to the interior? Is the patient physically entrapped? Next, secure the vehicle’s power.
Ensure the vehicle is shut off, and remove the vehicle’s keys. Remember, today’s vehicles can have proximity keys (photo 2) that need to be more than 15 feet from the vehicle to ensure that it can’t be accidentally started. Then disconnect the 12v battery…But can you find the battery (or batteries, depending on the vehicle)? In a substantial percentage of vehicles today, the battery is not in the engine compartment. But even if it is there, it might be hidden.

You need to ensure that the vehicle’s power is secured for two important reasons. First, by shutting down the power, you start the process of draining the energy storage component of the SRS system computer. This helps ensure responder safety with regard to SRS systems (photo 3). Second, this will also shut down the high-voltage drive power in a hybrid vehicle. However, you also need to see what power accessories, such as windows and power seats, are in the vehicle before power is removed. The officer in charge should document when power was shut down and also the items discussed above.
Five Minutes …
How is the patient? What are the presented or potential injuries? Is the patient medically entrapped? Remember, you might need to make space to disentangle the patient, even if he is not physically pinned. Vehicle rescue is a patient-driven skill, and the patient’s injuries, real or potential, will drive your creation of a disentanglement pathway.
The officer in charge of the rescue effort must devise a tactical plan of action (photo 4) based on the information presented at the crash. Although the incident commander (IC) knows the strategic goals at a MVC is the life safety of personnel and care of the injured, the IC must rapidly develop a tactical plan of action. Various versions of this plan must be created to take into account the many variables that could be present—many more than existed in the past. And this must be done many times faster than in the past, as well.
Although some you of might think this is a lot to be accomplished in five minutes (others will think it can be done faster), consider some the MVC responses you have been on in the recent past. There is more to deal with in today’s vehicle than meets the eye. Power isolation is critical for both responder and patient safety, yet we need to temper that concern with the need to use some of the vehicle’s power accessories at times. Also, the need to develop and process a tactical plan of action on scene is critical, especially considering the numerous hazards we encounter on scene. Although motive power is a big concern, I believe the ability to create space and produce a viable pathway to disentangle a patient will be a larger issue with today’s vehicles and the rescue tools we use.
Six Minutes
At this point, the rescue/operations officer’s tactical extrication plan for creating a disentanglement pathway for the patient is well underway. The engine has a line stretched, charged, and staffed with self-contained breathing apparatus (SCBA) in place and is in the process of locating the 12v battery or batteries and disabling their power. Even they cannot access the batteries--either because of damage, access, or both--all personnel on scene are aware that the vehicle still has power in place even if the key is secured and back in the apparatus and ignition is off. In this case, we still need to continue our disentanglement process; however, we will need to work with caution. Initial stabilization would have been completed prior to emergency medical services (EMS) access to the patient, since most of our MVCs end upright on their wheels. However, even if the vehicle is not in this position, our stabilization will be in the process of wrapping up; the various strut systems we have access to today make short work of many of the situations we run into on the streets.

Seven Minutes
EMS has started hands-on care already: the primary survey is done; the C-collar is in place, if practical and possible; and high-flow O2 in place. The patient condition has been passed along to the rescue crew and officer, and thus to the incident commander (IC). Depending on what damage is found and what sort of pathway our tactical plan of action is calling for, glass management is underway. Depending on the vehicle involved, we might need to cut out the glass in our way; in general, our old friend, the center punch, will soon be less useful than ever before. Our patient is covered with soft protection during the glass management phase and, depending upon where the glass is removed, even hard protection or even some of the new glass management materials are being used. Tools are being prepped--power hydraulics tools, recip saws, air chisels, and hand tools.

Depending our patient’s condition, we might create space to improve our room to work on the patient. Or if we are dealing with a time-critical patient, we might be widening existing spaces to facilitate a rapid extrication. The rescue officer is in constant contact with the IC to ensure that the IC is on top of the incident mitigation and facilitating the right resources needed for the incident.

Eight Minutes ….
Recheck stabilization as our tools go to work. Remember, after every major action on scene--such as a vehicle component displacement or removal, glass management, or such--we should always recheck our stabilization, even if it is simply tapping the wedges or cribbing to ensure they stay tight. Unibody vehicles lose strength and move as you act on them. Stabilization keeps them solid and locked to the ground as best as we can by maximizing ground contact.

Our tactical plan should be to make a maximum space the first time around. Most times and in trying to keep our patient “head, belly, toes” in line, we will consider removing or displacing the roof structure. However, most of today’s vehicles give us another option which, if done on the same side of the patient, provides almost the same amount of room as a roof removal: a total side removal. Most modern vehicles, be it a car, SUV, or even a pickup truck, are four doors so that if we facilitate both doors and the B post, we have obtained a pathway without obstruction, and this has been secured much faster than a simple door displacement or “pop.” Regardless of the pathway we are creating, strive to multitask tool actions and ensure that you are using hard protection between your tool work and the patient and the EMS provider inside the vehicle. Also, remove interior trim wherever you are cutting, prying, or spreading into the vehicle’s interior.

Nine Minutes ...
The EMS provider is keeping the patient in touch with what is going on around them. Have you ever been entrapped in a vehicle? Even if you know what is going to happen, it can be pretty scary (I know!), so imagine someone who is injured and has no idea of what all the noises are and such. It is important to keep that hands-on care for many reasons besides the obvious. If we have a patient status change we ALL need to know immediately. Our tactical plan needs to shift dramatically, resources need to be shifted, and the whole incident mitigation process needs to jump into a higher gear. At this point, examine two separate scenarios: one involving a time-critical patient and the other nontime-critical one (I’m not saying that a nontime-critical patient is less important; however, we have time on our side, to a certain extent, for our efforts on scene.)
Time-Critical Patient:
EMS has signaled that our patient needs to be rapidly extricated. Although there is no physical entrapment, the patient is medically entrapped because of vehicle damage and potential injuries to the patient. Since we have access to the rear of the vehicle, the rescue/operations officer directs the rescue team to facilitate a “roof tent” evolution by making two small relief cuts inboard of the rear-most roof pillars. Then the rescue team places some cribbing onto the package shelf of the vehicle and places a power hydraulic spreader or a mini power hydraulic ram and extends or spreads the roof upward. This hyperextends the roof upward at least eight to 12 inches. As the tool evolution is operating, the rescue team places hard protection between the EMS provider and the tool work. As that is occurring, one of the rescue team members is facilitating the patient’s seatback in a slightly reclined position and stays in position with the patient and the seatback.
Nontime-Critical Patient:
The rescue team has split into two teams to work simultainously on both sides of the roof. Besides multitasking with tools, the teams are also matching tools to optimize tool use to the posts they are cutting. After displacing the interior trim prior to cuts, cutting any wiring with hand tools and placing hard protection between the tool evolution and the patient and interior EMS provider, the power hydraulic cutters focus on the A and B posts while the reciprocating saws tackle the wider C posts.

Remember some basics in regards to cutting roof posts. Always cut at a 90° angle to the post regardless of what tool you are using. If it’s a power hydraulic cutter, let the tool do the work; don’t fight the tool and allow the tool to run through its entire operational cycle. If the post defeats the tool, stop, reposition, and try your cut again. Many times, depending on where the roof reinforcements are, sometimes moving an inch or two is all you need to get to weaker material. Reciprocating saws let the saw do the work. The saw should stay at zero miles per hour with the shoe of the tool firmly pressed against what is being cut. The blade is doing the work! If you are using a battery-powered reciprocating saw, make sure you have a space battery handy.

When cutting the B post, remember to reach in and find the adjustable seat belt bracket and cut above it or below it. Also, those of you who like to make a ‘pie” cut into the top of the B post, remember that many side curtain supplemental restraint systems (SRS) place the inflation module in that location and it is inside the bag itself.

The last two steps before the roof can come off entail (1) making a last post cut, the one closest to the patient’s head, to make sure the roof doesn’t come down onto the patient and( 2) make sure the seat belts are cut prior to moving the roof. There is nothing more frustrating than to start to move the roof off and get snagged because the roof is still attached by the seat belts.
Ten Minutes
Time-Critical Patient:
As the rescue team members remove the power hydraulic tool and cribbing, they cover up the sharp edges created by the tool evolution and the upper roof edge to protect the patient during movement. The EMS crew outside the vehicle has brought up a long spineboard and CID and facilitated sliding it through the widened rear window onto the top of the patient’s seatback. The interior EMS provider has moved to the side, and the rescue team outside next to the patient assists moving the patient’s seatback into a reclining position and sliding the board forward. A long blanket roll is placed under the patient’s arm as well as the EMS provider, and the rescue team member slide the patient carefully up the board. As the patient moves farther up the board, the outside EMS crew slides the board carefully out of the vehicle onto the rear of the vehicle. They attach the CID and strap the patient to the board and secure the O2 unit onto the board, then move the patient onto an ambulance stretcher for movement. As the patient is moved to a transport vehicle, the rescue team assists the interior EMS provider in exiting the vehicle and begins to secure the working area.
Nontime-Critical Patient:
Now that the roof post is severed, lift and remove the roof in a controlled manner. As the team walks the roof away, it is placed in the warm zone in the part dump, “shiny” side down and fuzzy side up. Why? Think about it: Many times you are displacing and removing vehicle components like doors and roofs that have live undeployed SRS safety systems in them. Although the likelihood of an accidental deployment of side impact SRS systems is nil post-crash, they can be influenced by pressure, shock, and static charges--all of which can be triggered by your equipment. This hazard is something we really didn’t have to worry too much about a decade ago, but today’s vehicles are a different story. At least if the shiny or sheet metal side is against the ground, the undeployed SRS system is facing upward, not toward the ground.

The rescue team then secures the working area by covering up sharp edges and rechecking vehicle stabilization.

We have now reached our 10-minute mark after arrival on scene. Although I have tried to include most of the important things we will encounter, each MVC is different and the vehicle is the dynamic hazard out there. Time-critical patient rescuers need to strive for a 10-minute-or-less extrication time. With the knowledge, training, and tools available today, we can check that 10 to 15- minute benchmark box more often than not. How do we get there? We need to stay on top of today’s hazards, look at new methodology, and try new tool evolutions that push the envelope.


(Section 3)

Toyota used the image below to simply explain how an impact absorbing body and a high strength cabin protects occupants. Just remember, the toughest still will be in the cabin area but can extend into the impact absorbing area too. Never assume your cutters cannot cut any part of the vehicle, if your cutters stall, go to plan b. Plan B can be as simple as repositioning the tool.

In order to help reduce the impact on the occupants during a collision and reduce cabin deformation, crumple zones at the front and rear of the vehicle absorb the impact with high efficiency. The cabin uses a body structure that is strong and does not deform easily. To help protect occupants during side collisions, where little crumple zone is available, a high-strength body frame, including the center pillar and the floor cross member, absorbs the impact with decreased deformation.
Scan through the attached link it's awesome it provides a variety of vehicle inner workings and vehicle body structures. The details and graphics are very detailed!       http://boronextrication.com/


(Section 4) 

Vehicle extrication and response video's to watch during Company Op's. Pick and choose. Reviewed a lot of video's the one's chosen below contain basic maneuvers and important training aspects.
The best video for learning basic and advanced extrication is from Hurst and Holmatro. The two links alone shows just about every conceivable maneuver that we need to learn to quickly and safely remove patients.

         http://www.holmatro.com/rescue/en/m1572/training-videos.aspx Variety of maneuvers from Holmatro
         http://www.jawsoflife.com/videos/default.aspx Variety of maneuvers from Hurst


Myths on E85 Fires

http://www.youtube.com/watch?v=4HESUmU7StQ  Responding to Vehicle Extrication Scenes
http://www.youtube.com/watch?v=WCDUQ-k9KYg&feature=player_embedded  Close Call Bumper Explodes
http://www.youtube.com/watch?v=NPajWzThRy4&feature=player_embedded  Bumper Shock Explosion
http://www.youtube.com/watch?v=b1Qj75pbl8o&feature=player_embedded  Airbag Explodes on Fireman
http://youtu.be/nrWtV9gUQGc  Funny Video
http://youtu.be/Y40h66mH75o  Roof Removal
http://youtu.be/mAPZhWObc1I  Paratech Strut Animation
http://youtu.be/9JGVqfofwx0  Extrication Hazard Control
http://youtu.be/P5SSw8TOmXE  New Car Dangers
http://youtu.be/NiBMBE_DhkU  Third Door Maneuver
http://youtu.be/gfEkZA8tDwU  Dash Lift Maneuver
http://youtu.be/xIZG2uzL9MM  Verticle Crush Maneuver
http://youtu.be/CTRSRpMM9dw  Open locked with a Core Drill
http://youtu.be/scQxj8brcj8  San Diego Responds to Fire 
http://www.youtube.com/watch?v=6lH08XldI_s&feature=player_embedded#!  Ripping the B-post
http://www.youtube.com/watch?v=OQKXKDB_IoM&feature=player_embedded  Gas Strut Removal


Fire Engineering Extrication Zone

(Section 5)

This site offers a huge library of extrication video's and articles from nationally known subject matter experts.
The site will provide plenty of material for Company Op's prior to the hands on with Todd Hoffman.

Extrication Grand Round Questions

(Section 6)

The Training Grand Round questions largely pertains to our equipment. Prior to the hands on training the questions must be completed and turned in to the Battalion Chiefs.

Extrication Grand Round Questions

"Houston we have a problem!"

I have become aware of a problem involved with the Extrication Grand Rounds.
The intent of the questions was to create a system that involved all three stations learning each others extrication tools. The end result would be familiarization of equipment throughout the department.

The problem we are running into is that each station is training at different speeds which is how it should be but in regards to relying on a different station to provide answers its not working.

As a result the answers provided below will eliminate the need to call each station for answers.

#10.  120 ft lbs & At the end of each exercise in which a cut has been made.
#11.  20'
#12.  2 tools the Torque Wrench and a Crescent Wrench
#13.  1 1/2" socket
#14.  15" tip to tip
#15.  29" and 10" extension
#16.  Check for live wire
#17.  It adjusts blade depth
#18.  Push down listen for click lift up to make sure its secure.
#19.  36" & 59",   cutters 7"
#20.  30 ft
#21.  Hurst Blue Oil
#22.  Wear PPE, Stay clear of moving parts, Trained personnel only, Follow operating
#23.  2.2 hp / Honda
#24.  Cutter, Lg Ram, Sm Ram, Spreader, Multi-Block, Power Unit
#25.  120 ft lbs
#26.  D
#27.  False
#28.  False
#29.  C-100 ft
#30.  B - 5w 30
#31.  36" tip to tip
#32.  False (same as #27)
#33.  False (same as #28)
#34.  Clockwise

In the future the questions will be drawn from the Blocked Training Material provided on our intranet exactly like the EMS Grand Round questions.. 
Thank you for the input and I always welcome it.


BONUS:  Bus Extrication

(Section 7)

Prior to leaving Todd Hoffman heard that our next training secession related to school bus emergencies. As a gift he burned his power point presentation on school bus extrication. A lot of good ideas. Check it out.

Bus Extrication Presentation