Billy Leach Jr.: S – I – M – P – L – E Approach to a Motor Vehicle Collision

By Billy Leach Jr.

With vehicle technology constantly changing, it is virtually impossible for responders to keep abreast of every change. Therefore, we should strive to create a s-i-m-p-l-e procedure that is applicable to all vehicles. In doing so, we will create a safer rescue operating environment.

Step 1: Secure the Vehicle from Movement.

With the number of hybrid vehicles ever increasing, notwithstanding that they look strikingly like their ordinary counterparts, responders may indeed endanger themselves by following commonly taught procedures. You arrive to find a driver slumped across the steering wheel; he appears unconscious. You approach the vehicle, attempting to make patient contact. The patient awakens, subsequently moving his foot from the brake and striking the accelerator. Suddenly, the vehicle moves forward, striking and injuring a responder. The vehicle was a hybrid in the “sleep” mode. These vehicles can travel at speeds up to 25 miles per hour (mph) on almost silent electric power. Generally, you can identify hybrids only on close inspection.

Old habits are difficult to change. Typically, responders have made rapid approaches to the patient without regard for potential vehicle movement. Consider placing two tire/wheel chocks near the initial response gear to serve as an obvious reminder that you must secure the vehicle.

Step 2: Isolate the Hazards.

Most of today’s vehicles are equipped with six supplemental restraint system (SRS) air bags--quite possibly more. Two of the common SRS air bags installed are window curtain units that deploy downward from the roofline.

Responders typically approach the vehicle and lean into the window to begin their assessment. This places them in the direct deployment path of the window curtain SRS. Simply opening a door to begin assessment places them in the deployment path of a window curtain SRS or a door- or seat-mounted SRS air bag, posing the potential for serious injury.

Immediately after arriving at the scene, deenergize the vehicle’s electrical system by switching the vehicle off, removing (and maintaining) the key a minimum of 50 feet away, disconnecting the battery, or simply “double cutting” the battery cables. Batteries may be found in a multitude of places within vehicles; they are not limited to the engine compartment. Actively look for all of them. Don’t forget to disconnect or “double-cut” the 12-volt accessory cable, usually found connected to the positive battery terminal. If batteries aren’t accessible, remove all fuses. Capacitors are installed in the SRS circuit to provide an alternate source of energy to deploy the SRS. Generally, once the vehicle’s electrical system is deenergized, these capacitors will begin decaying, thus losing their stored electrical energy. De-energizing a vehicle’s electrical system will isolate a hybrid’s high-voltage system.

Cut the seat belts promptly after gaining interior access. Simply leaning into a vehicle to unbuckle a seat belt places you into an SRS airbag-deployment patch. Fully extend the seat belt from its retracting mechanism, and cut it.

As soon as possible, check for a potential reverse-fed electrical sources--i.e., items inserted into the power outlet receptacle. If anything is plugged into these receptacles, remove it immediately. Modern vehicles may have more than one power outlet receptacle, perhaps there is one in the rear of the vehicle.

Remain aware of the “5-10-20” SRS deployment path’ during medical rescue operations—five inches away from door-mounted SRS, 10 inches away from steering wheel-mounted SRS, and 20 inches away from the passenger frontal (dashboard) SRS.

Step 3: Manage the Scene.

With ever-changing technology and increasing hazards, even seemingly minor incidents can escalate quickly. It is imperative to establish and provide incident management at every scene. The incident manager (IM) must make everyone aware of the potential dangers that exist on scene. Likewise, every responder should inform the IM of any hazards immediately.

Approaching traffic is a serious hazard at any scene. Each responder has a responsibility to protect himself, and the IM is responsible for protecting responders from this hazard through effective parking and traffic control.

Step 4: Protect everyone from fire.

Fire is likely one of the foremost hazards at a collision scene. Everyone at the scene must be protected. Many today’s vehicles are equipped with polyurethane plastic fuel tanks and pressurized fuel transport lines. The fuel transport lines are under constant pressure ranging from 15 to 95 pounds per square inch (psi). Should a transport line rupture, fuel will instantly be sprayed on sources of ignition, resulting in a rapidly spreading fire. If the ensuing fire isn’t immediately extinguished, the plastic fuel tank will quickly melt and spill its contents.

Not all vehicles are powered by conventional fuels. You must identify the fuel and mitigate the hazard. This may include reducing vapor release by closing a valve or dissipating a vapor cloud. Responders must determine the vehicle’s fuel source and reduce its associated hazards.

Once a fire develops, the heat will envelop the compressed gas hood support strut, greatly heat them, and likely cause them to dislodge and be propelled for great distances. Responders have been injured by these projectiles.

Obviously, patients must be protected while being treated and extricated. Use a covering that is fire resistant and offers excellent flash fire protection.

Place a charged fire hose capable of flowing 100 gpm in position between the greatest fire hazard and the responders/patient. Staff the hoseline with a minimum of two firefighters who are wearing full protective personal equipment with self-contained breathing apparatus (mask in place).

Step 5: Look Before Spreading or Cutting Anything.

Many vehicles are equipped with various SRS components that could become dangerous projectiles if physically damaged, heated, or severed. For example, compressed-gas inflators for window curtain SRS are pressurized to 3,000 to 4,000 psi. Possible locations for these inflators are the A, C, or D posts, lower dashboard area, the roofline above the rear window, and the roofline parallel with the vehicle. SUVs may have two compressed-gas inflators on the same side, one for the normal curtain SRS air bag and one for third-row seating.

Pyrotechnic seat belt pretensioners are commonplace in today’s vehicles; they are usually found in the mid to low B-post area. Avoid cutting into them.

Without fail, use the “Peek and Pry Technique”: In every circumstance, peel away the interior trim components to expose potential hazards that must be avoided during spreading/cutting operations.

Step 6: Extricate; Do Not Extract.

To meet today’s economic and safety demands, manufacturers are creating smaller vehicles on the exterior while maintaining larger interior compartments for passenger comfort. This places the patient nearer the B-post area, likely beside it. “In the day,” we rotated the packaged patient in the seat and lowered him onto a long spine board. This worked well with vehicles having large doors, which generally is not the case today. This creates the opportunity for greater spinal manipulation, causing additional injury. Remember the basic mantra of extrication: Remove the metal from the patient! Axial spine alignment is imperative; thus, responders should extricate, not extract!