I have instructed crews for many years on dealing with incidents where there is Restricted Access to Rescue Scenes. Changing the dynamics of an approach will affect the thinking of incident commanders and introduce an element of uncertainty. Difficult access is where your ability to get to the extrication site is compromised, meaning that the method of getting personnel and equipment to where they are needed is made more difficult and often, less safe.
Scenario & Important Factors
One of my favourite training scenarios is to place a car at the bottom of an embankment (about 10m down a 60 degree slope) then instruct crews to access from the top. It is interesting to watch incident commanders process the information and contrive a plan. In my opinion the decision on how to overcome the hazard (or slope, in this case) should depend on the following factors:
– Is the person trapped in the car responsive? If they are shouting/responding this means they are breathing, they have a patent airway and are oxygenating blood.
– Are they unresponsive? Perhaps they are slumped forward, which possibly compromises their airway.
– How will you control the risk? What equipment do you have? A simple line/rope or full height safety/rescue equipment and trained personnel? Extending a ladder on the ground will provide a safer access for personnel.
Risk versus Benefit
There are other considerations of course and the way you gain access depends on your equipment and training, however this increased risk must be balanced by the potential benefit. What I mean here is that an unconscious, unresponsive casualty with a potentially compromised airway is (usually) a higher priority than a patient who is in the car but awake and communicative and your decision making must reflect this. The question you must ask yourself is simple: Is the level of risk proportionate to the potential benefit? You will have a number of ways of controlling this risk and each option will take time and resources. The key is to choose the appropriate option that provides the highest possible degree of safety whilst bringing the most benefit.
A real incident from early 2014 in Waterford, Republic of Ireland. Photo courtesy of Waterford Fire & Rescue.
Once access has been gained to the incident how do you then manage the logistics of moving the necessary equipment in a safe manner? Finally, what is the best location for the incident commander? Do they stay at the top where they can see everything or do they go down? Such an incident is perfect for ‘Sectorization’. That is where the incident ground is split into sectors and an incident commander is nominated for each area therefore ensuring command and control for the whole scene.
It’s only a hill, but it causes so many problems!
By Ian Dunbar
Rescue Consultant, Holmatro