Just as a child is not a small adult from an emergency medical perspective, a truck is not just a big automobile. Accidents involving trucks have their own essential aspects that make them a special challenge.
Usually a truck is considerably heavier than a car. In a rear-end collision with another truck, much larger amounts of kinetic energy are involved, resulting in much higher deformation energy than for cars. Given this, it is no surprise that trucks are designed with reinforced front ends that pose serious problems for fire brigades. Here the required relief cuts call for rescue cutters that not only deliver outstanding cutting power but also an effective cutting geometry with pull effect.
Besides the reinforced passenger safety cell, the patient is of course also at a much higher working position, making it more difficult for rescuers to gain access for initial contact and later extrication. Here the Lukas rescue platform makes a big difference.
Truck accidents (one truck rear-ending another) take up a lot of space. If such an accident happens on the motorway, it may be a good idea to keep space free for a crane when organising the work area at the accident scene. In special cases, a fire brigade crane can be a decisive aid for technical rescue when a vehicle needs to be lifted or towed. But as far as the use of rescue tools is concerned, it can also result in long paths from the fire engines to the accident scene. Carrying rescue tools, hydraulic power units and assorted safety equipment takes time. This is exactly where rescue tools that do not need for heavy hydraulic power units come into their own. In addition, it is easier to work inside the vehicle with these “hoseless” tools.
With the aid of a mnemonic scheme that has proven effective in accident rescues for automobiles, the tasks in such an accident can be worked through methodically and nothing gets forgotten.
SIBORFA (from the German SEBTEF) includes the following modules: Secure; Initial contact; Battery management, Open door; Roof removal; Free legs; Ambulance. These modules can be combined at the scene in accordance with the situation.
The following will highlight only peculiarities that distinguish truck accidents from car accidents.
The Secure module includes a range of activities such as securing the accident area, assessing the overall situation, fire safety, securing and supporting the vehicle, glass management, removal of interior trim, and marking planned cuts. A complete assessment of the situation is particularly important. After finding ways to gain access to the patient and looking for leaking fluids, checking the load is crucial. If hazardous materials are leaking, it can have fatal consequences for the rescuers.
The vehicle can be kept from rolling away by chocking the wheels or securing it with a winch. In this situation, winches should be used with special care; an 80kN winch will not be able to adequately secure a 40-ton truck on a slope. The passenger safety cell can be secured against unwanted movement with a truck securing set (tension belts and endless slings).
After securing the site, try to get a rescuer to the patient as quickly as possible so that vital parameters can be checked and decision about necessary speed of the rescue can be made. The quickest way that comes to mind to achieve this is of course a door that can still be opened. An alternative is the removal of the front windscreen as part of glass management. Sabre saws can provide a decisive advantage here as a truck’s windscreen is much larger than that of a car. Initial contact with the patient is much easier when the rescue platform has already been set up.
In Battery management it is very important to ensure that the battery is not disconnected until the seat has been blocked in position. Disconnecting the battery, switching off the ignition or pressing the emergency stop button on a hazardous materials vehicle can lead to sudden lowering of the pneumatically adjustable driver’s seat. This can reduce the pressure on trapped extremities, causing blood to accumulate in the legs. Lack of blood in circulation can result in shock. So if there is a pneumatic seat, never disconnect the battery or switch off the ignition if the seat has not been blocked in place.
When Opening the door for enhanced patient access, keep in mind that it can weigh as much as 80kg to 100kg. Before detaching the door in the hinge area, secure it from the other side of the vehicle with a rope.
Removing the roof of a vehicle that is lying on its side can be a very useful enhancement for rescue extrication; here sabre saws and angle grinders have proven effective.
For Freeing the legs, use the two-cylinder method.
Insert the first cylinder parallel to the rocker panel at the level of the door lock after making a relief cut parallel to the rocker panel in the A-pillar. The cut in the A-pillar should be made along the markings, downward towards the patient. The first rescue-ram pushes the front end forwards, releasing the trapped patient. The use of telescopic cylinders that have double strength in their first stage is especially effective for trucks. If this does not release the patient, relief cuts at the front of the vehicle to decouple it from the affected side of the vehicle are effective. Then position a second rescue-ram between the edge of the roof and the front edge of the dashboard or the A-pillar to stabilise the front end in the current position. The first rescue ram can now be removed to allow access to the patient.
For transfer to the Ambulance, that is extrication of the patient from the vehicle, a scoop stretcher or spine board can be used, or a KED in combination with a scoop stretcher or spine board. For extra support, the KED can be pulled on with a pulley on a turntable ladder. Then the patient slides onto the scoop stretcher more easily. To do this, space to set up the ladder must be kept available in the work area, which is not always so simple.
As described, there are certainly peculiarities to consider in truck rescues. Such operations, which are not exactly everyday activities, pose special challenges that fire brigades must be prepared to meet. To do that, an illustrated set of guidelines, such as the new poster about truck rescues produced by Lukas in association with the Nuremberg Fire Brigade in Germany, can help.
Axel Topp is Chief Fire Inspector for Nueremberg Fire Brigade