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hard job
Here is a wreck to work lets see what we can come up with . See the attachment.
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Permalink Reply by Ben Waller on
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Tim,
If you have this kind of cliff in your response area, then you need to "overburden" your department with rope rescue capability. There are going to be a lot of situations where you can't get a wrecker above the patient or the wreck, and there are going to be rescue situations where no vehicle - and hence, no wrecker - are going to be involved.
If you have rope rescue capability - even a basic two-rope system on an engine company - then it will take less time to get a rope on the vehicle occupany than it will to rig a wrecker to it. If the occupant isn't injured, then the best practice is to do a rope removal prior to moving the vehicle with a wrecker.
I don't care how good the wrecker operator is, if you don't get rescuer access to the occupant first, then there's a better-than-even chance that moving the vehicle will injure him. He's not secured to the vehicle in any way - moving the vehicle may result in a smooth vehicle recovery with the victim splattered a few hundred feet down.
You're focusing your rescue on the vehicle. I'm focusing my rescue on the person.
Wreckers have their place in working some wrecks, but this wreck isn't one of them. I'm not questioning your ability to hook the car up, but there's no doubt in my mind that it's not the best way to do it.
Extrication that focuses on the patient is the way to go. The definition of "extrication includes "with due regard for the patient, his injuries, and his safety". If we don't focus the extrication on the patient, then we're not doing "extrication", we're doing "recovery" or "demolition". I can do recovery with a wrecker and I can do demolition with a car crusher.
Bottom line - if you don't get rescuer access to the occupant and secure him prior to moving the vehicle, how are you going to prevent him from further injury or death? -
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Tim,
One other question - by any chance do you have a vested financial interest in teaching using wreckers to assist in extrication?
Just wondering...
Ben -
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It won't if there is any kind of rock flake, overhang, or other obstacle that will hook on the contact side of the truck. From the photo, you can't rule it out.
Moving wrecked vehicles with people in them is a last resort, and we aren't anywhere near a last resort situation here yet. -
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Sorry - left out the word "not" as in "not injure the patient further".
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Permalink Reply by Asst Chief Tim Cook on
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Not unless you consider showing firefighters another tool and the CORRECT way to use it a vested interest. Just as patient/Emt laws vary State to State. Where did you ever get the idea that I/we put patient safety SECOND to vehicle recovery? Certainly not because I suggested a LEGITIMATE second way to perform a rescue I hope. When did I EVER suggest NOT accessing the patient and securing him/her? What works in my area (geographically) MAY NOT work in yours. Before you throw out the baby with the bathwater you MAY want to query agencies/students/firefighters that work with me regularly. I am QUITE sure you find that I'm NOT a nut case,am very well versed and good at what I do and JUST may know a thing or two about extrication AND vehicle recovery. Maybe you could ask Randy Schmitz,we've "played"before?Oh,have i asked you to do any procedure WITHOUT practicing it first? Didn't think so.By the way Ben,I think I mentioned earlier we don't have the bluff cliffs you mentioned earlier.We DO have some similar areas to this one and I'm basing my commentary SOLELY on this ONE picture. Which CAN be easily done as I suggest.This is based ON THIS PICTURE and this scenerio/picture alone. I'm sure in your area there is a great need for rope work. We would use ropes very occasionally in our area.Neither method is wrong,it just appears you've never experienced a "patient in"rescue. Some places won't allow it. The Piney woods don't fall into that catagory and we've done similar jobs SAFELY with great outcomes.
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Tim,
You didn't answer the question.
I'll rephrase it...
Do you get paid for teaching the technique you are espousing here?
Ben -
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Tim,
I've done three "patient in" extrications in the more than three decades that I've been doing extrications and the more than two decades I've been teaching it. All three were on flat, level ground and involved single vehicle wrecks where the only way to get the patient out was blocked by the big obstacle that the car hit. All three were done as a last resort, and all three involved moving the car with a winch attached to a rescue vehicle.
I've also been in command of extrications where wreckers were used to lift heavy vehicles off of either pedestrians or smaller vehicles, so I know how to do that, too.
I've done more than a few rescues where vertical rope skills were necessary to complete the rescue and the extrication on the same call. All were done successfully, and none involved the use of a wrecker.
You can shout "LEGITIMATE" all you want, but that doesn't make it so. The bottom line is that moving vehicles with a patient still in them - especially given the vertical exposure in the scenario here - is a very poor choice compared to having a rope team prepared to do vertical rescue in the type of terrain shown.
You haven't bothered to tell me how you'd make this rescue if you can't position the wrecker above the vehicle - which is a common problem in this kind of terrain.
The bottom line in the scenario shown is that it is a very, very vad idea to move this vehicle with the patient still in it. If you can reach the vehicle to secure the patient, you can rescue the patient without moving the vehicle. Moving the vehicle with the patient still in it when you have another alternative is a bad choice. Ask any EMS certifying agency. -
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Getting away with a bad idea a few times doesn't make it a good idea.
Ask extrication pioneers like Morris Simpson, Steve Kidd, Tom Carr, or Ron Moore. -
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Ben,I guess we'll agree to disagree.I have the same reservations on rope rescue that you have with the hydraulic recovery theory. I believe I did answer your question in that I ask for/recieve no pay for the cross training we do. Is that now a requirement?Yes,I did mention that in many of the Scenerios you mentioned(bluffs,overhangs)my tactics would change.This particular scene isn't one of them. Circumstances dictate the best/safest way to complete a rescue and that needs to be kept in mind. They didn't used tow trucks to rescue in Stock cars either a few years ago until they were shown a better way in the controlled roll. And No,i'm not going to get into a extended argument with you on that one. But thank you for a opposing view,I really do use critiques to further improve operations,
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Tim,
Thanks for the answer, but rope is better and safer for the patient in most situations.
Stock car racing is a much different world than production autos over a cliff, in terms of both the vehicle and the environment.
You still haven't explained how you are going to secure the patient in the vehicle in the above scenario prior to the wrecker lifting the vehicle. If you can access the patient and secure the patient, then you can rescue the patient.
We also have not ruled out an overhanging flake or small ledge behind the vehicle that can't be seen in the photo. Assuming that there isn't one isn't a safe assumption in this scenario.
There's no mystery in rope rescue. Like wrecker booms and cables, it's a simple application of physics. I stand by my statement that if you have the type of terrain shown in the scenario, you need a well-trained and well-equipped rope rescue team. The rope rescue team will be useful in situations where a wrecker can't even be positioned at the scene. The difference is that you don't need a clear roadway above the wreck to use a rope rescue technique, and when you lower a rope rescuer, you know that the patient, as well as the vehicle, will be properly secured prior to movement.
As for your reservations regarding rope rescue at wrecks, there has never been a documented case of a rope rescue at an extrication causing additional injury or death to a patient. Moving vehicles with patients trapped in them, on the other hand has caused additional injury and even death. That's why state EMS systems and rescue agencies teach moving the vehicle away from the patient, not moving the vehicle with the patient still in it.
As a last resort, I'd move the vehicle, but this situation is a long way from a last resort. Being able to do something is a long, long way from proving it as a best practice. -
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Ben,I don't think we're in substantial disagreement. I made a couple slips in earlier posts in regarding to using a straight chain.That won't be effective due to the lack of verticle control. You've beat me up pretty bad with some pretty big names(by the way,I've got most of their writings)Here's a few more: Billy Leach Jr.,Bill Jackson,Erik Stewart,Mark Anderson,The late Donnie Cruse and his Brother Ken and son Justin. All great innovators and Instructors. And I'm not advocating "victim in"recovery on every job,far from it.We've discussed at length SOME differences in your operational area as opposed to mine.You are highly skilled in rope work and a recognized authority in your Disipline and operational area. I don't depend on luck and bad ideas to accomplish life safety work.The Expert instructors you've mentioned didn't fall to Earth one day blessed with all the knowledge they have. They started with a platform and trained and experimented on the TRAINING ground until they could endorse or reject a procedure. My point with the Stock car is that just like modern firefighting methods,the rules can and do,change. Same with Medical protocols,they are quite different that they were 5 or ten years ago.Ten years ago, Tow truck operators and Fire units working together was a rarity. Not so much today as many realize the power and efficiency of working together.I'm SURE you realize that the how I'm going to secure the patient in the vehicle IS NOT a carved in stone one sentence answer. Just like with a rope rescue there will be MANY factors to take into consideration. Wish I could make it cut and dried for you but I can't. And last but not least: You're not alone in "time in"in extrication. In brief,I've been operating a tow truck since I was 10 yrs old or about 45 years. Back before extrication was a popular term,in the 70's,my Towing service was the only game in town.We had Portopowers and some hand tools,no one around had modern Hydraulic tools. We did that for ten years before the FD took it over. But we continued to train,read everything we could on the subject and worked closely with the FD which continued to today. I've learned alot,STILL learning but I've also pioneered a few tricks along the way."cip saws being one. We were using them long before you saw magazines touting their use. Thought it was just a local thing at the time. So now that you have a little of my background,I hope you won't think badly of me. Just remember there is always more than one way to a successful rescue.
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Tim,
I've used sawzalls, porta-powers, and even hacksaws for extrication since 1975.
I worked in the Chattanooga area for 16 years, which included being 1st due at the Century Wrecker factory in Ooltewah and running downtown where the Towing and Recovery Hall of Fame is located. When I volunteered with the county rescue squad, one of our members owned a major towing and recovery business. He routinely ran a twin-boom monster wrecker to our Interstate highway big rig wrecks. One of the guys I work with now has around 20 years as a heavy wrecker/recovery operator and has helped us move multi-ton props at our training area with it.
My points above were simply that no tool is the right tool every time. If you have many tools in the toolbox, are well-trained in ALL of them, and know situationally when to pull the BEST one out, then that will be the best for the patient. A vehicle wreck over a cliff is not just an extrication - it's an extrication, it's a vertical rescue, it's a trauma patient call, and it could also be a hazmat incident. If we go into this scene with only a hammer in our tool box, we'll try to make every problem look like a nail. Maybe a wrecker could do this job OK, but it's a little like driving a deck screw with a framing hammer. You can do it, and it might work, but a screwdriver would probably do the job better.
Once again, I have nothing against wreckers, and I'm fully aware of their capabilities. I'm also very aware of their limitations, and the limitations of some of their operators. If I'm in Command of this wreck, I know that I can control the actions of my rope rescue/extrication team. I may or may not be able to say the same for the wrecker operator. -
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