Multi Tasking Exercises

Driving Rescue Forward -

By Len Watson

Experienced Fire Rescue crews need to be tasked with ground breaking exercises. Existing training methods no longer cut it and seasoned rescuers are crying out for more advantageous training. Of course the cost in setting up such exercises is both time hungry and expensive and to go ahead with such training, would really mean getting the most and best from it. Such training really needs to address the multi-vehicle crash involving cars, trucks and vans as a mass casualty exercise containing at least several entrapments. Pre-planning is essential and exercise detail directed to ensure that all objectives of the exercise are met.
Pie in the sky has no part in all of this. Enabling objectives are critical in planning such an exercise, otherwise your department will be pouring money down the drain. For example, It is pointless capsizing a truck onto a car if the car’s roof remains intact or the truck has no cargo. An under-ride is another example, where damage to the vehicle is in-appropriate. Risk-assessment is also vitally important. Hazards must be analysed beforehand and a safe method of work mapped out before the exercise is signed off. Of course all of this presumes that those that set-up the exercise know enough in the first place and are capable of safely directing and monitoring it. Audit is best done with snapshots, as in my experience the nitty-gritty points that need to be raised are somewhere lost in the hours of video footage. Editing, scripting, voiceovers and production can only be as good as the exercise planning and performance of crews, warts and all. Exercise Objectives
Ideally, setting out exercise objectives should be rationalised to the type of rescue commitments that your departments is required to carry out from time to time. In the absence of data collection, this is best done by a collective consensus of the more experienced within your department. Otherwise you may need to seek advice from another department or recognised experts in the field of heavy rescue. An example of some multi tasking objectives could read as follows – To achieve the object of the exercise students must be able to – Conduct large-scale scene assessment Identify resource requirements Secure and stabilise the scene Task and direct rescue teams Continual assessments and work detail redeployment Keep a logistical account of operations Participate in an enquiry Collate information, conduct a debrief and giving evidence Scene assessment – this will need to include q Risk recognition q Risk and scene assessment, control and mitigation Identifying resource requirements – Of course the exercise can only encompass the equipment within your fire department and any other service or agency taking part. Securing and stabilising the scene – This will depend on how the exercise is laid out and the resource of all those taking part. It is pointless setting up an exercise that cannot be safely and satisfactorily achieved. Consider this will involve q Scene stabilisation q Casualty and heavy rescue Triage and extrication q Safety management Extrication and casualty care Tasking – The actual performance of the exercise will necessitate the following - q Sectoring and zoning q Assigning work directives q Scene control and safety officers briefings q Reassessment and work detail redeployment q Logistics Investigation and enquiry – In reality rescue operations of this nature usually takes many lives and, have a high concentration of seriously injured. During extrication evidence can be destroyed or depleted and, crash deformity relocated or cut away making it difficult to piece it all back together. Mass death and injury could possibly lead to a judicial enquiry, making it very difficult for a fire department, especially where they have a ‘no data collection’ policy, to give an exacting account of events. Collating, debriefing and giving evidence – The collection and cataloguing of information is essential, if only for a worthwhile debrief, let alone for giving in evidence. From what goes on in the developed world at present, one would imagine that extrication is an unknown science and beyond the boundaries of accountability. All these areas can be addressed by a well orchestrated exercise or not as the case may be, if the exercise is half baked. Being positive, a thought-out, rationalised well conducted exercise offers an excellent platform for learning and experience.
Illustration - A multi tasking exercise with yellow rings depicting the various scenarios.
Mapping out the exercise
This is best done by first carrying out a fact finding mission to establish what’s necessary. Appoint a working group and then lay it out on paper. The multi-tasking extrication exercise must be developed on a solid, realistic foundation. If the parameters and criteria is misconceived, then it becomes an exercise for exercise sake. To make it work you will need to set parameters and criteria for the exercise - Parameters and criteria Set the size - The emergency services and agencies that are necessary to take part Number of crews Number and type of vehicles Mannequins and/or live casualties Type and number of scenarios Directing the exercise Safety and Adjudication Debrief
Building the various scenarios
Creating a multi tasking exercise is really a matter of collecting a series of crash types and building them into a single scenario. A good basis to begin with is to gain a good under-standing of the various crash types that can exist within a multiple accident.
Front ¼ oblique impact (Front off-centre)
The most common of all entrapment crashes, the front ¼ oblique impact (front off-centre) where converging vehicles meet, usually when overtaking, sees the vehicles rotate before coming to rest. Impacts occasioning footwell entrapments will rotate in excess of 90o and the rebound factor can place them at least several meters (15–20 feet apart) apart. This type of crash damage is not often seem on motorways (highways) unless a vehicle enters the carriageway going in the wrong direction.
Front ¼ oblique impact (Pole impact)
Knowing the realistic types of real live crashes is a real bonus when setting up a multi tasking exercise. Another is finding crash damaged vehicles appropriate to the crash type. One of the most common types is the front ¼ oblique (front off-set), especially one consistent with a pole or tree impact. This can be ideal for an off-road situation, in a ditch or on uneven ground. This will also help to critique stabilisation and safe working practices when working off-road.
Side-on impact
The side-on impact with a tree is also a fairly common event. Again this is likely to see the vehicle off-road and even wrapped around the tree. Again it will help greatly to acquire a crash damaged vehicle with consistent damage. It is all very well and good using ‘end-of-life’ vehicles for basic training but, in all honesty, what realistic learning curve can be achieved. Older, crash damaged write-offs are readily available and a benefactor should be sought.
Vehicle-on-its-side
When after a collision a vehicle ends up on its side, for the purpose of any exercise, injuries must be consistent with the collision type. As the purpose of any exercise is to frequent Rescuers with expectant real-life situations, to adapt, perform and overcome, it is essential that, from the onset, exercise planning sets a realistic learning curve where outcomes can be measured and debriefed. This type of scenario can easily be made more complicated by having the car boxed in by other vehicles.
Vehicle on-its-roof
The overturned vehicle that comes to rest on its roof always offers a unique learning curve. Rarely mastered in a proficient manner, this type of incident per entrapment situation, carries the highest percentage of road-kill. Where roof pillars have suffered a high degree of collapse the problems become even more pronounced and the learning curve steeper. Again, to balance a vehicle on the kerbstone and stabilisation becomes an
issue particularly for first due paramedics. Getting clever with the exercise set-up, fluid can be introduced to simulate a fuel spill and a cosmetic smoke canister used to spice the situation up. Where the exercise has been cursed with inclement weather, cosmetics can still be used. The wet roadway can be treated with an immiscible liquid to denote a fuel spill and knowing that ‘end-of-life’ vehicles are usually impregnated with the smell of petrol we are pretty much halfway.
Why stop there, if there is a pond or ditch about it can be used to position the vehicle. Of course this raises environmental issues but a properly prepared car with fuel, oil, fluids etc., removed could really temper an exercise. With a reasonable quality ‘end-of-life’ car with intact windows, excellent door seals and no rotting to the floorpan (a VW Golf is usually an excellent choice) and can offer a unique realistic learning opportunity of a life and death situation enough to stir the imagination. Although the submerged car is a low frequency involvement, it does happen and will be encountered by many rescuers’ over the years.
When considering crash-types suitable for a multi-tasking exercise we should realise that in a multi-vehicle accident, vehicles are likely to be compacted where rebound is prevented by other vehicles cascading into them. Although this makes the mechanisms of injury easier to identify it can be used to make the actual extrication much more difficult. Rescuers will benefit due to the rarity of this situation.
The Team Approach Exercises are absolutely pointless unless they subscribe to a high level of cross-platform interaction between the relevant services and, where involved, outside agencies. Employing the Casualty Union or introducing live casualties in appropriate scenarios is essential. Also the pertinent use and positioning of medi-train simulation mannequins is a must if the most benefit is to be drawn from the exercise. After all the planning, time, money and resource ploughed into such an exercise, what a waste if all is lost for the want of a ‘nail’.
Lack of forethought and planning - It is wasteful and wrong to spend public purse money, expect Doctors, Nurses, Paramedics, Police Officers, Tow Truck Operators etc., to give up their valuable time for a poorly conceived and contrived exercise that fails to meet or falls short of ‘life-saving’ expectations. Lets move on and consider what else can be done to improve and motivate the multi-tasking exercise.
Using Large Commercial Vehicles To incorporate heavy commercial vehicles offers an excellent and consistent dimension as long as it id kept within the bounds of reality. Such vehicles may be hard to come by, especially if you intend to cut them apart. However, if we consider using them as props, we can consider scenarios such as the rear under-ride. The end-of-life can be prepared to simulate under-ride damage and positioned under the robust under-ride bar.
Similarly, side under-ride bars can be temporally removed and the prepared vehicle placed into position. Where the truck is dysfunctional and the owner willing, the tandem suspension may allow the leading rear wheel to ride up on the car. Of course this will depend on how well the car is prepared. You could also approach your benevolent tow truck operator. This becomes much more achievable if you involve him in the exercise from the first.
Using trucks as prop vehicles usually means that they are still roadworthy and must not be damaged in any way. This drastically reduces the advantages that could be gained and limits how the exercise is set out. Where trucks are ready for salvage or depollution, they can then offer real scope to take the exercise to an altogether higher level.
Using end-of-life trucks as props allows this valuable scenario to be enacted. Unfortunately crash damage, where the car is crushed between two trucks, is hard to come by unless you have a friendly ‘depollution yard’ prepared to recreate the crash damage.
The value of practising extrication, medical intervention and trauma care here cannot be refuted. The least that can be achieved is the absolute preponderance such an opportunity presents. The least this merits is for a written paper to be produced for circulation. The sharing of such a valuable experience is too good to be missed by the many.
The ability to use a truck for a prop without causing any damage is quite feasible. The tow-truck operator can, using the heavy wrecker or rotator, achieve some very realistic results. The frontal under-ride is safely achievable. However the car requires careful preparation to achieve the desired results
Where the truck has reached its ‘end-of-life’ it then becomes much more useful. It can be capsized on top of the car. Where the trailer or cargo coachwork construction is weak, it will cave in around the car. It will also leave the truck in a precarious position, needing to be stabilised using a safe method of work.
Why stop there – The crushed car can be placed under the truck as shown here. Of course such a situation would need a controlled interactivity to accomplish the extrication. Beyond normal fire service capability it would necessitate the tow-truck operator working in full cooperation with the rescue team. The wealth of experience to be gained, or should I say experienced, is the vital value the tow-operator can play.
As a Medic or Doctor have you ever come across this? Consider a leaking fuel line and the fact that the truck is being supported by the car’s compromised roof pillars, would you be prepared to crawl into this wreckage to render humanitarian assistance? The team response can be measured and, where the resource is available, worked safely to achieved the desired objectives.
Finding a suitable venue has become a major event particularly as Health and Safety has dug it’s heels in. Protect the Rescuer at all costs, irrespective of cost to the customer, the misfortunate victim needing rescue from their predicament. Many fire departments would find this scenario to ‘riskay’. However, in the field of operations, they will let them loose irrespective of consequences to carry out a rescue. For this purpose they use the term ‘dynamic risk assessment’ and all is well – or at least we hope so.
Who in all of this is looking after the customers’ interest; the casualty, who for better or worse, always hold their rescuers in high esteem. Not Health and safety, not senior or middle management; so who then? It amazes me that individual firefighters are prepared to pay for themselves to attend advanced levels of training outside their fire departments: to go places to receive the appropriate instruction and further their knowledge and experience.
From my travels there appears to be a world-wide dilemma. From basic training that fails to encompass cross-platform interactivity, both within the fire service and ambulance service, where police officers never get a look in, to advanced levels of vehicle rescue. In the meantime road users are dying and suffering needlessly. The problem is nothing new and has existed from the beginning of crash rescue. Although extrication capability and pre-hospital intervention has grown tremendously, it in no way detracts from the situation that the left hand does not know what the right hand is doing. This is openly visible and is reflected in training, text books and manuals which deal separately with the respective subject matters and ‘never the twain shall meet’.
Laying out the exercise: When considering the layout of the exercise, try to follow a pattern that leads to a crash history – how the accident happened. This will help to set-up each scenario in a logical, sequential manner. Also consider how the exercise is going to be directed. How many teams are going to be involved? Are the participating crews going to be phased in and, on arrival, what instructions are they going to be given? It is imperative not to allow the exercise to become a ‘run away’.
A logical sequence is vital to get the most out of the exercise. For this to happen the whole event must be directed; that means, all decisions made and actions taken must be monitored and, where they fall outside the planned remit, they must be redirected. Signalling the start of the exercise: The days of setting a fire to start an exercise are over. Environmental lobbyists will not condone it and anyway, what purpose would
it serve. Everyone already knows that fire is given priority. Vehicle fires are so common that there is nothing to be gained other than to dispel the movie makers myth, that ‘vehicles on fire always blow up’. The exercise is best initiated using normal call out procedures. A staggered attendance to mimic real-time response is essential and will add to the authenticity of events. Ensure that this is reflected across all participating groups as the last thing you want is a service showing up on-block or outside its normal time parameter.
Risk assessing and signing off the exercise Each separate scenario must be risk assessed. Hazards must be identified and a safe method of work agreed with the appointed safety officers. Each scenario will have to be analysed and where one scenario encroaches on another, the changing emphasis on risk will have to be managed to remove or control any ensuing risk. Health and Safety demands that each scenario has a written risk-assessment and safe method of work pro-forma that is comprehensively completed and signed-off as safe. Additionally, in the interest of the smooth running of the exercise, ‘safe method of work plans’ should guarantee that the exercise unfolds as intended, without unduly undermining freedom in decision making. However, ‘freedom in decision making’ must not be allowed to compromise safety in anyway, shape or form. Hazards must be analysed beforehand and safe methods of work mapped out. It is here that the magic lies. Even when setting up the exercise there is a steep learning curve. As indeed there is when setting down the safe method of work for each scenario for plan A, B and, if appropriate, plan C. After all, how many realistic ways can there be to do the extrication safely? That limits the risk assessment and offers the ideal criteria to work to. When completed the risk-assessment for each scenario must be signed off by all relevant parties and appointed safety officers must adhere and enforce the laid down safety plan. Of course all of this presumes that those that set-up the exercise know enough in the first place and are capable of safely directing and monitoring it. Where this can easily break down is in the planning stage. Meaning the person/s drawing up the plans may not be competent to do so. This, in my experience, is the worst possible situation. Not only will it lead to a misconceived exercise but, could lead to dangerous or bad practise being accepted as the norm. So what hymn sheet are we all singing off; what standard are we working to? The truth is there is no standard, only text books and those people with a proven track record – Join our study document - http://www.resqmed.com/extrication,pdf
Directing the exercise Do not confuse the Incident Commander of the exercise with the person ‘directing the exercise’. The exercise director is the one responsible for planning, co-ordinating, implementing and controlling events. Control is essential to direct and unfold events in the laid down logical sequence intended to achieve best results. Also, to avoid any action that could conflict or compromise safety of a scenario, safety offers must be properly briefed and directed to enforce safety. On the other hand, the incident commander and participating officers must manage the exercise within the parameters of the direction given and within the boundaries of all safety plans. The director of a multi-tasking exercise can often find themselves in conflict with senior ranks. This anomaly has grown over the years where advances in technology, extrication and trauma care have diminished officer training and experience, in essence amplifying the dinosaur effect. To overcome any possible misconception or conflict, exercise planning must be sufficiently detailed so as to explain the desired objectives and outcomes fully. This is best done by first writing the aims and objectives for the exercise. Then set down safety policy and an adjudication pro-forma for both the incident and each individual scenario. Provisions should also be made for incident command and sector command – Incident command · Overall scene and safety assessment · Sectoring and zoning · Tasking of sector officers and crews · Resource management · Communications · Multi agency liaison · Overall command and control · Press liaison Sector command · Sector scene and safety assessment · Zoning · Tasking of crews · Resource management · Communications · Multi agency liaison Zone command · Dynamic risk assessment for plan A and B (optional C) · Risk removal, reduction and stabilisation · Strategy implementation · Interaction (Technical/medical) · Command and control · Communication · Overall effectiveness Of course with smaller fire departments and mutual aid schemes this all becomes pie in the sky
Safety and adjudication The duty of the safety officer/s is to assess the strategy offered by the teams working on the various scenarios that he is responsible for. He must also liase with any other safety officer whose team may alter the integrity of the scene. He must supervise and not let the extrication team/s work outside the safety parameters set for the particular scenario.
Where a scenario involves more than one teams it becomes necessary to have more than one safety officer, especially where vision is restricted. It can mean restricting or stopping operations on one side of the scenario while the other side is stabilised. Again, as operations progress, it may be necessary to intervene or stop work while another team re-stabilises. All in all, the ‘safe system of work’ plan must be sufficiently outlined as to ensure safety at all times throughout the exercise.	EXTRICATION.COM training exercise, Toronto
For example, where vehicles are perched in a precarious position, participating teams must be made fully aware that they are dealing with real-time risks and that it is essential that safe working practices learnt in training must be adhered to at all times. For the purpose of such an exercise, ‘risk versus benefit’ is not an option and must be outlawed in any decision making. All safety officers must be of sufficient calibre to make themselves heard and enforce safe methods of work. Safety officers can also act as observers and make notes on the team’s performance for adjudication and debrief. Digital photography offers a distinct advantage here. Moreover it can also be used to enforce good practise.
Invite observers as adjudicators Official observers should really be selected from personnel with a keen interest in the subject matter. Ideally, they should have some standing within your service, either hold rank or recognised for their expertise and skill level. Due to the enormous amount of organisation and expense, the effort must not be undermined by missing out on the finer points of adjudication. Representatives from the participating services are essential and why stop there, I am certain that observers from outside your service would be very interested.
It is essential that observers are given the same safety briefing as the team/s they are adjudicating. More importantly, they must have prior access to the planned ‘safe systems of work’ detailed for the specific areas they are going to observe and be part of the overall briefing given to the team. Better still, it would be ideal to involve them in the exercise planning in the first place; particularly ‘safe system of work’ for the stabilisation and extrication options for the particular scenario being adjudicated.
Making-up the exercise When the exercise has been completed the same attention to detail and safety must be observed. A ‘safe system of work’ must also be put in place when reclaiming equipment. Stabilisation must be maintained as free standing equipment is withdrawn and all cribbing/blocking and props removed in reverse order so that no-one is placed in a position of risk. Of course the safest method is to use the heavy wrecker to rotate vehicles and place them back on their wheels and redeem equipment after the scene/s have been made safe.
Debriefing Getting everyone together to conduct the exercise in the first place is a major task in itself. Regrouping all those that took part at a later time for debrief is quite another matter and one that can be largely dispensed with. How much better to hold the debrief after completing the exercise while it is still fresh in everyone’s mind. In the time it takes to make up the equipment after the exercise, the debrief can be put together.
To get the best results form a debrief it has to be constructive and a two way street. As a learning curve it must meet expectations or retrospectively return value that can be made use of again and again. The exercise should not stop short at just meeting the set objectives, it can be used in many other ways to inform, study, evaluate, research and even innovate new ideas and solutions. With today’s technology it’s no big deal to make a documentary of the exercise and open up debate, not only within the whole of your fire department but with all the other fractions involved in rescue within your community.
Final comment Of course, all fire department have limitations as to faculty, skill, knowledge, research and innovation. Although departments can put their Trainers through an outside course it must be respected that one course is not the beginning or end of it all. It takes years of involvement, sharing and research, burnished by operational experience to become a recognised guru and lets face it, there are few around with that sort of track record – see useful links
If you wish to comment on this paper, you may use the following link – mailto:lenwatson@resqmed.com?subject=Re: Multi-Tasking Exercises