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Dear Reader - In this issue we continue with our serialisation of 'Working With Live SRS' and 'Hydrogen On-Board Vehicles'. We have had very positive feedback on these subjects and it has helped greatly in our research.  We intend to incorporate some of the information into future articles. Also in this issue we take a look at the UK's new laws on Corporate Manslaughter and Corporate Homicide and how it may affect the UK fire service. It would be very interesting to know how world fire services measure their MVC/RTC performance and the 'duty of care' they afford their public. I have been to many fire services and from my experience, audit plays no part in service delivery particularly  in MVC/RTC extrication rescue. Perhaps this is an area we should look into in future issues - let me know if you would like the news letter to move in this direction.   l -  Len Watson editor -  [ FEEDBACK ] - 

Hydrogen On Board .../..

In Last month's issue we discussed 'inverted side removal' on a 4dr  car that has come to rest on its roof, where the vehicle has intact undeployed SIPS, which included head protection systems (air curtains). In this issue we continue and look at the critical risk  issues that can be associated with vehicle extrication rescue.

As always we would advise all new readers that this article is one in a series and, to gain a complete understanding, it is necessary to begin by reading ISSUE 10 – 17  ‘Rescue with live undeployed SRS systems’ before continuing to read this issue – Click [HERE] to begin.

Before we move on to the critical risks involved in this extrication, to refresh your memory I would ask you to read the history of the incident again -

History - Single vehicle crash - front 1/4 oblique impact - The 4dr car has had a 40% front off centre pointed impact with a tree and has ended up on its roof, nose down on roadway. The front road wheel and suspension have been shoved backwards into the front footwell restricting the available space where the casualty's lower limbs and feet are located. The casualty is suspended up-side-down held by the seatbelt.

The steering wheel airbag and the driver's pretensioner have deployed - The front passenger airbag and all SIPS (front seat mounted airbags, air curtains) and all the remaining pretensioners remain undeployed - The vehicle's battery is under the bonnet/hood and cannot be accessed - The driver is trapped in situ.

In the extrication detail in ISSUE17 we discussed the variations in inverted side removal dependant on the positioning of the SIP modules. We are now going to discuss the likely risk critical areas that may arise and the reasons why certain risk control measures are adopted.

As a pre-note to this study I would draw your attention to the relevance of 'Duty of Care' and its bearing on other members of the rescue team. This is particularly prevalent in the UK. For more information read: UK - Corporate Manslaughter & Corporate Homicide Act 2007 - How it affects the UK Fire Service.

INVERTED SIDE REMOVAL - Working with live SIPS

• 6"/150mm   - Door/seat mounted airbag cushioning depth

• 20"/500mm - Door/seat Thoracic and Window airbags will deploy downwards

• 20"/500mm - IC and HPS will deploy upwards

Liberation of propellant: The most likely incident of propellant leak will be experienced where the seatbelt pretensioner is cut through. Sodium Nitrate may detonate whereas Sodium Azide will present a serious chemical hazard. Instigate and observe safety procedures in force within your department.

The CLAM

One of the known areas of severe entrapment in the overturned vehicle, that often ends in casualty demise, can be identified where the roof pillars suffer partial or complete collapse. In witnessing the many extrication competitions, this is one area I see the participating teams, when given this scenario, fall down. Here I see teams performing side removal and ramming between the sill and the roof’s side channel or burrowing in via the hatchback to gain sufficient space to release and remove the casualty. Hardly conducive to spinal care and immobilisation.

Due to their keenness to take part in competition in the first place, it seems reasonable to presume that these teams represent the best within their service. My operational and training experiences have led me to the same understanding. It must be stated here that the value of making space has long been seen as the best way to perform a controlled release, enabling the team to stabilise and remove the casualty with the minimum of unwanted spinal movement. This is particularly relevant in overturned vehicles as spinal injury can be seen to be more prevalent. It is from this perspective I advocate the following life saving procedure, as it is easy to learn, safe to perform and can with practice be performed in around 15 minutes. 

The CLAM evolution entails the side of the car being removed, rams being placed strategically in position, a strategic cut made to the roof's 1/4 post and the rams extended to open the interior of the vehicle up. This evolution has been around for a long time. It can be performed with one ram, but in the interest of convincing sceptics, it is advisable to incorporate two rams until the evolution gains acceptance. 

The whole evolution, including vehicle assessment, stabilisation and risk control measures can be realistically performed in under 15 minutes.  Of course this requires practice, both to gain the skill level and the confidence to perform it for real when it matters.

For the firefighter or paramedic without sufficient medical know how or understanding, there is no easy way to evaluate the importance this evolution holds for the entrapped casualty. Suffice it to say that experience will eventually guide you this way.

In the next issue I will detail the various scenarios, the procedure, include all the risk control measures and SIPS safety information so that the reader can appreciate what is involved, and the real value that the CLAM holds.

Useful sites:

Continued from previous ISSUE

So far in this series on hydrogen on board vehicles and fuel cel vehicles (FCV's) we have discussed the following:

This hopefully has opened the mind of the reader and given some idea of the hazards and risks that firefighters / rescuers may have to face in the not too distant future. To offer a more in-depth insight we will attempt to capture the imagination by offering up some likely operational scenarios and invite, you the reader, to consider what actions you would take to combat the situation.

In this issue, in the name of discussion and learning, we are going to speculate on some hypothetical situations that no doubt will arise. In an effort to prepare for this eventuality we are asking you the reader to become actively involved. Hopefully with our collective minds we will enter a new learning curve to share with all rescuers.

The Road Traffic Collision - Your fire department has been called to a motor vehicle collision where a truck has rear ended a car, trapping the rear occupants in the rear seats.  On arrival on scene you initiate scene assessment and quickly realise that all is not what it seems to be. A high pitched hissing noise is emanating from the ‘entrapment’ vehicle and an audible alarm is sounding.

On investigation you rule out the vehicle’s tyres and radiator as the source of the noise.  There is no abnormal smell and any give-away indication, and motif or badge has been obscured by the impact damage. 

Now taking account of the information imparted in this series so far what else can we now consider?. I would like to ask you the reader how would you risk assess this situation and how would you control the risk and manage the extrication? 

To submit your thesis click on the following link – [ RTC ]

Domestic Garage – Hydrogen release - On a hot summer’s day you are called to a hydrogen release form a vehicle parked in a domestic garage integral to the house.  On arrival you are met by the occupant who explains that the vehicle’s hydrogen alarm is sounding.  What actions would you take to risk assess the situation and subsequently make the incident safe?

To submit your thesis click on the following link – [ H release 1 ]

Hydrogen Vehicle fire - You are called out to a H alarm sounding by the owner of the vehicle. It’s a hot summers day without a cloud in the sky and you notice frosting around the hydrogen vent, and you attention is brought to a heat shimmer above the roof of the car. What risks must be considered and how would recognise or assess the risks?

To submit your thesis click on the following link – [ H fire ]

Fire in underground car park - You are mobilised to a vehicle fire in a relatively small basement car park. On arrival the fire alarm is sounding and you are faced with smoke logging that impairs visibility above waist height.  On scene assessment it appears that only one vehicle is alight and is directly threatening vehicles on either side. On tackling the fire with a hose line the whole basement is blanketed in smoke. As the fire is controlled it is reported back to you that the H alarm on a fuel cell vehicle is actuating. On investigating you realise that around the pressure release vent the vehicles paintwork has been scorched and assume that the venting hydrogen had been alight and extinguished with the water spray.

What actions must now be taken – 

To submit your thesis click on the following link – [ H Fire/release ]

Hydrogen release in an underground car park - On arrival to a H release on the middle level of an underground car park servicing a multi storey department store, you are faced with an executive car that has had its H alarm sounding for approx. 10 minutes.  A quick reckoning indicates that each floor parks approximately 100 vehicles with a continuous stream of customers in and out.

Take us through the likely risk assessment and your immediate actions to –

To submit your thesis click on the following link – [ H release underground ]

One more area I would like you to consider from the fire angle is the significance that the batteries play, particularly when they contain Potassium Hydroxide (You may access information at  [ CLICK ].  On familiarising yourself you will begin to see the significance that the run off can have as the fire is extinguished, especially as FCV’s have a sizeable bank of batteries. We will discuss this in a later issue of the news letter.

I am sure you will agree that the hypothetical situations outlined here are not far fetched and realistically simulate real situations that are likely to arise in the future as fuel cell vehicles become common place.  Managing the risks that these vehicles will undoubtedly bring with them must be given early recognition and, to be prudent, to speculate on what can possibly go wrong opens the mind of not only firefighters but designers and planners. That cannot be a bad thing!

In submitting your ideas on this subject we would appreciate ‘right of reply’ and your permission to discuss your input on an open platform so all readers can benefit and partake in the forum. We would appreciate an early response so that we can begin discussing further these scenarios in the next issue of the news letter.  _________________________________________

UK - Corporate Manslaughter & Corporate Homicide Act 2007 - How it affects the UK Fire Service -

A brief introductory article on the Corporate Manslaughter & Corporate Homicide Act 2007 can be read at www.resqmed.com/Corporate.htm

The Home Secretary has made it clear that he intends to enforce the law to make it easier to identify and convict those responsible for corporate killing but what does this new Act mean for the Fire Service?

The Act can be accessed at this site - The Corporate Manslaughter and Corporate Homicide Act 2007. The Act in prescribing relevant 'Duty of Care’ makes, amongst others, managers personably responsible for their actions and/or lack of action.  Within the Act the relevance of ‘Duty of care’ plays a crucial part in understanding the Act.

Meaning of relevant 'duty of care'

‘Duty of Care’ is further defined in section 8 of the Act where it is broken down into bite sized sections so that a jury can consider blame pinpointing relevant areas.

Factors for the jury - Section 8 of the Act applies where—

2 - The jury must consider whether the evidence shows that the organisation failed to comply with any health and safety legislation that relates to the alleged breach, and if so—

The jury may also—

In section 3 the jury has been unleashed to examine procedures and accepted practises and today this is more and more going to be influenced by expert witnesses. Existing standard operating procedures that have been tolerated for years will be scrutinised and the Act does not prevent the jury from having regard to any other matters they consider relevant.

In lieu of outmoded SOP’s it would appear that the fire service as a whole is under ‘starter’s orders’ and leaves no illusion that fire service management personally hold a degree of responsibility for firefighters while at the workplace and in pursuance of their duties. Many examples where the fire service could be found wanton immediately spring to mind.

Examples -

Guide lines - have been in use in the UK fire service for as long as I can remember (over 50 Years) and in that time they have remained virtually unused. Except for drills I can recall only three fire in my service career where they were used and then at one of these fires (Gallender Street, East London), they were primarily responsible for two firefighter deaths.  At the Coroners court the London Fire Brigade received an ‘improvement’ notice which necessitated a rewrite of their Operational Procedure 91 note. Certain points were raised during the proceedings but were never realistically acted on. The OP was rehashed and accepted but the warts still remain.  Why, because nobody knows any better and still no review and audit is in place to measure performance. 

SCBA Duration times - What a nonsense this has been over the years. The principle of having a stage procedure for booking firefighters into a smoke logged building where the duration time of their air set is estimated, the equivalent of an adult walking at 4mph (6kph), is ludicrous as in reality it can be as much as 50% out of kilter. The equation takes no account of hard working, severe stress and differential in personal air consumption. Moreover, emergency procedures for colleagues in trouble is based on this flawed concept and there is no realistic awareness training in place to address this very significant finding. Consider - firefighters can be low or out of air before entry control sends in the emergency team. 

Fire fighting techniques - A London firefighter, Paul Grimwood, wrote ‘Fog Attack’, a well researched manual offering, amoungst other things, a safe means of firefighting that has been adopted by many fire departments all over the world; but not all.  

Why? Is it because it’s flawed or not everyone agrees with the principle? Since the launch of this book most firefighter I know and many firefighter I meet, know about and make use of pulse water spray firefighting (The act of pulsing water spray overhead to lower ceiling temperature and to  ascertain whether it is boiled off or it returns as droplets indicating that it is safe to proceed). Does it prevent flashovers?  Has your fire department trialled the technique in the flash-over simulator?  Surely, one would think, common sense must prevail and, after evaluating this technique, it would have been embraced and adopted on a wider scale.

The use of high pressure atomised water and chemical suppression additives is held back in the same way positive pressure ventilation was. Wonderful claims are made by manufacturers and distributors of these systems. Have you ever looked at how these systems are trialled by the fire service and by whom? 

What’s new in the fire service? Thermal imaging, new radios (Shame about radio procedures and the ability to work underground), new fire gear, new fire appliances; all of these have been there for a long time and upgrades do much of the same thing.  Think new ideas and trialling new procedures – now ask what’s new!

Search techniques – We still have the same old search techniques written into the fire service manuals which were in place before I joined the service way, way back.  Still relevant today?  I hardly think so! There are many building types - domestic, high rise, offices, factories; warehouses etc that far supersede building designs of the past. It’s almost laughable to read except it’s a criminal shame. Why? Because nobody takes responsibility and the knowledge has not been researched and improved upon.

After the Fire Precautions Act 1974 premises inspection were initiated and the rank and file where sent out, inspections were carried out and1(1)d plans drawn up for each building. Where are they now and what use were they ever put to? Today there is a new initiative, Operational Recognisance Index Cards (ORIC), not only designed to familiarise firefighters with premises but to be made available operationally. But why cards and not electronic storage? How do they intend to share this information?  All of this is going to take a very long time unless someone comes up with a practical solution. Perhaps it should have been written into Fire Order 2005 making owners and tenants responsible for this. I presume that the fire information box is meant to be the answer.

Training and elements of training – All fire services and managers hold a ‘duty of care’ to their employees. This is enforced both in civil and criminal law and today a civil action can impose unlimited fines and corporate homicide can carry life imprisonment.  Training must reflect the real issues encountered in the firefighters field of operations. The vast majority of a firefighter’s duties are a known quantity that can be broken down into their various elements. The mystique, or should I say myth, that ‘no two jobs are alike’ is unveiling fast. The role of the expert witness will see to that and also open up the cans of worms that will eat away the complacency and cover up of incompetent managers.

Consider at what point we are at. Who does what in training?  The individual firefighter is only ever monitored and assessed in basic training. When it becomes a team activity, it is the team that is assessed. This is prevalent in fire house training where it is difficult to monitor individual action during fire-house exercises in cosmetic smoke. It becomes even more prevalent when training in ‘confined space’ techniques and very obvious indeed in RTC training where training in the use of individual tools, employing the various techniques to perform all the different evolutions are not mastered.  And who keeps exact records of the relevant elements of training? It appears that superficial tick box training is all anybody ever does.

We have only broached upon the subject here but it takes on a new dimension when firefighters are called upon to do their duty. In the field of operations the fire service has introduced another mystique called ‘continuous dynamic risk assessment’.  Sounds wonderful, a life saver built on the fabrication that we all know what we are doing.  Knowledge is a wonderful thing but we must also appreciate that it highlights the flaws and all the cracks that have been papered over.

The only real risk assessment that can be undertaken at present is built on what we know. You have got to recognise a hazard before the risk can be assessed. Straight forward – well no, the hazard may be hidden. Moreover it may be unknown as we are ignorant of it. Consider here that ignorance is no excuse if the information is available, especially if it is in your face, in text books and manuals.

Risk control measures and critical risk information has grown up with Health and Safety.  A good example is the chemical industry where all elements and processes are risk assessed; where exacting assessments have lessened the incidence of catastrophe and injury. Using this as an example how does the fire service measure up.

Tick box training has become the fire services’ answer.  However this falls flat on its face as there is no operational audit. There is no realistic operational collection of information, audit and review in place within the UK fire service. The only saving grace in all of this is hindsight, where past history can be measured by those with a good memory. Even so this can escape managerial minds which leaves firefighters, that is only the ones who care, to persistently harass senior officers for improvements. When this relates to employee safety, management can no longer afford to sweep it under the carpet or act upon it at a later date.  If they do, it becomes their personal responsibility and as such accountable in a civil and/or criminal court of law.

But by what ‘Duty of Care’ do managers or firefighters, individually or as a whole, now hold for the people that are in need of their services? In section 6 of the Act we find certain opt out clauses relevant to the emergency services.

6 Emergencies

Does this then mean that fire services’ obligation to the public is thrown to the wind: that in the pursuance of their statutory duty, managers and firefighters cannot be held accountable? Certainly as far as ‘Duty of Care’ to the public is concerned it would appear to be the case. Within the fraternity of the fire and rescue service it has long been known that fire service commitment is far from perfect. But what can one expect, when there is no breakdown or audit in place, other than the watchful eye of senior management and the Inspectorate of Fire Services all working within the constraints of last centaury thinking and tight budgets.

NEWS & VIEWS

Q.)  Len, having read the news letters on working in and around un-deployed safety systems, what are your views on this scenario?

Following a road traffic collision (RTC) the most common initial access to the casualty to secure c-spine and airway is to reach in through the door window opening. Now if the vehicle has a door mounted airbag and head protection system HPS, we are putting ourselves at some risk by reaching in through the door window. One technique that our trauma trainer has taught us is, if the casualty is slumped forward, it involves leaning through the window opening (both head and torso) to move the casualty (torso, neck and head in-line) into the upright sitting position. This could lead to some major injuries if SIPS were to deploy

As this is the most common method to initially manage the casualty's airway, I can only assume that once all other safety measures have been put in place, then this is a risk we must take.  Is there a better solution to stabilise the casualty without leaning in through the window opening?  If this is the only way, then I would carry it out as long we are aware of the potential risks.

Len I would appreciate you views as always - John Curley - Firefighter

A.)  Leaning through side windows of a car equipped with door or seat mounted airbags should be evaluated where -

In relation to 1.) above, the extrication can be handled over a longer time period and the medic/s given longer access through window openings before respective cutting and spreading is carried out.

In terms of 2.) above, where a rapid extrication is necessary the medic will have to be more flexible. Where the battery/ies can be disconnected the problems will not arise and the extrication can be managed safely without fear of deploying SIPS.  However with undeployed energised SIPS, extrication must be performed with enforced risk control measures.

‘Continual dynamic risk assessment’ of an RTC vehicle extrication incident is dependant on risk recognition, risk assessment, risk control measures and risk critical information. The procedure becomes pointless if the risk is unknown, cannot be seen or understood. Similarly, risk critical information must be weighed as benefit versus risk as the operation unfolds.

Bearing this in mind, in answer to the more specific side of the question you put, forcing doors at the doorlock have, in the UK to date, no reported incidence of inadvertent deployment. Therefore a medic leaning through the front door window of a car subject to a frontal or rear impact, up to this present point in time, has not been at risk. Cutting and crushing poses an altogether different risk but one that can be managed safely. Even so, you should keep in mind that it is only during the brief act of actual cutting, crushing and disconnection / cutting SRS/SIPS wiring that any perceivable risk really exist. Therefore in terms of safety, the following procedure is advisable - make ready the task and position the tool, and then enforce the safe distance rule until the task is completed. Other than that the risk of tending to the casualty through the door window is so far not a problem.

Consider a medic can gain entry into the vast majority of crashed vehicles. This obviates the need for leaning through open windows for prolonged periods.  But we still have to consider and manage the undeployed SIP system mounted, not just in doors, but in seats and in the roof of the car - I trust this answers your question – Len Watson

Euro NCAP’s concerns were justified: both the Nissan Navara and the Isuzu D-MAX/Rodeo received poor scores in Euro NCAP’s adult occupant rating. This confirms Euro NCAP’s belief that car manufacturers need to boost their efforts in safety testing across their ranges before cars reach production. The Navara achieved an extremely poor. Nissan consequently has now announced a service campaign with the intention of improving the airbag software of every Navara on the road since the start of production.

Although Nissan is progressively recalling all Navaras to rectify late airbag deployment, amazingly the recall takes no account, what-so-ever, of the passenger compartment becoming unstable in the impact and unable to withstand greater loading.

EuroNCAP states that "The chassis rail collapsed on the impacted side, allowing a significant level of intrusion into the driver's footwell. As a result, the dummy readings indicated a high risk of injury to the left tibia. Structures in the dashboard presented a hazard to the knees and femurs of both the driver and the front passenger. Protection of the driver's chest was rated as weak owing to the extent to which the chest was compressed, combined with the threat posed by the unstable passenger compartment. The passenger's neck was bent rearwards in the impact, presenting a high risk of life-threatening injury".

This makes Nissan the latest motor manufacturer to leave a prescribed entrapment legacy to its customers and to the emergency services. Think on: this issue has been around since this vehicle was introduced. Go deeper and no doubt we will find that it has led to many cases of morbidity and even death. 

Who is going to address this issue and represent the families?  Only the emergency services ever see the carnage and only the Police take down the details that can be offered in evidence which, incidentally, never measures vehicle performance. The question begs - who is killing who?

COMING NEXT ISSUE  

15 years on: Fire 'Gallender Street, unlawful killing' - The extraordinary story of a  fire in a multi rise warehouse that claimed the lives of two fire-fighters and questioned certain procedures that still remain in force within the UK fire service.

www.resqmed.com/DailyNewsSheet.htm

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