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Dear Reader - Our free download study documents have had very positive feedback on relative subject matter over the last few issues, which has helped greatly in our research.  So much so we now intend to revisit pertinent topics with a view to broadening these study documents. From the feedback we received when we looked at the UK's new law on Corporate Manslaughter and Corporate Homicide and how it may affect the UK fire service, we were left with no illusion as to the shortcomings in training and fire/rescue performance that exists within certain training regimes. When I anecdotally said "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 was staggered to learn that out of all the replies not one could relate any form of structured analysis or collection of data for extrication rescue.  That only goes to reinforce my experience that audit plays no part in service delivery particularly  in MVC/RTC extrication rescue. It appears that the vast majority of the RESCUE News Letter readership wants an airing on the topic of Training restructuring and reform, and a foundation for a standard that is based on the real world.          l -  Len Watson editor -  [ FEEDBACK ] - 

FIREFIGHTER - Protocols for Life Threatening Situations

'Building Extrication Standards & Training', an informative report for discussion and study posted on our web site [ CLICK ], we had hoped for more detailed feedback but in all we were surprised by the overwhelming response from those firefighters / rescuers seeking to improve their skills and better their training, delivery and response. So much so, it has inspired us to reexamine this topic, paying more attention to what is not being done by training departments, its effect on stress levels and of course casualty outcomes.

For those new readers joining us for the first time, or if you need your mind refreshed, the article that has sparked this re-visit can be downloaded by clicking above. Another document pertinent to the arguments we will raise here - 'New Style Training' - can be accessed [ HERE ].

The State of the Art of Extrication in Developed Countries - Making do with an ineffectual, number crunching training policy, with no audit or review has become a major scandal of our time: an insult to human decency and one, were if it accountable, could quite easily be considered culpable manslaughter or homicide. Are these terms too strong for your palate? Well then, lets look at it another way. Poor ineffectual training will reflect in a teams performance, subtract from efficiency and best practice and, in some cases, cause / hasten injury deterioration, which could result in permanent incapacity and/or death. 

Which ever way it is viewed it is inescapable and unacceptable, yet it is allowed to continue year in year out. More poignantly, some emergency services make political levy, giving the impression of 'best value' when in fact, viewed by the experienced eye, their motives are very questionable and undignified. 

Having made this statement it is now necessary for me to offer up the evidence so that you, the reader, can be judge and jury and draw your own conclusions. 

The Current Status of Training -  For those readers on the outside, related to extrication rescue by family, friends, business or politics, it will be necessary for me to offer up a more detailed, reader friendly account.

Today most fire departments offer anywhere between 16 Hours to 40 Hours Basic extrication training for new students. They also run infrequent refresher courses which offer much of the same old same old training. Extrication training encompasses classroom delivered theory sessions and 'hands-on' practical sessions.

Classroom instruction and theory gives  foundation information on a department's standard operating procedures (SOP's); a very basic understanding of vehicle construction, and a theory session on new vehicle technology where the subject matter is pretty much glossed over. 

Established over a long period of time, in general rescue department SOP's cover motorway, freeway or highway procedures, which in some ways differ from police procedures and certainly do not cater for all situations. 

With vehicle extrication it is essential that rescuers have a fundamental knowledge of vehicle construction, steels and composites used in construction, and the location of relevant component parts that have an associated risk. While some fire departments have taken the initiative and created suitable information and promotional material, the vast majority are sadly lacking, leaving a gaping hole in their commitment and Health and Safety policy.

Crash damaged vehicles take on a very different dimension but, so far in my travels, I have not seen any input as to how this affects a vehicle in terms of extrication. In viewing this we must appreciate all the different vehicles that actually exist; the difference between car, 4x4 and truck etc and their relation to the various techniques and evolution involved in dismantling the crash damaged vehicle.

Again, in our fast moving world, developments in vehicles (design and components) leave Rescuers in its wake, forever playing catch-up trying to contend with these new challenges that are created year on year.  Outside the limited publications underwritten by private resource and the 'Extrication Challenges', which are competition driven and only run in some countries, when solutions are found there is no working facility in place to disseminate and share this information between the emergency services.  In the UK we have a national computerised 'Finds' facility but all I ever see on that system is "does anyone out there know anything about ...." syndrome. 

The collection and sharing of information seems destined to fall forever on deaf ears. Everyone seems preoccupied in borrowing what they can, claiming ownership and building their own empires - hence the current state of extrication rescue !!! 

Don't get me wrong, there are those wonderful people out there, movers and shakers that have busied themselves and have become the world recognised peers of extrication rescue. Even here we see knowledge being held close to chest. Of all that goes on in rescue, these people really do have a gripe. They have the most to offer and most to lose as they are the innovators who have their work stolen and abused by unscrupulous pretenders, especially those in larger departments; the services that can most afford to buy in this experteese.

Well, who has ever heard of large departments buying in consultancy and experteese without ripping off those that have worked tirelessly to innovate and create rescue doctrines. True many are happy to give without receiving but study and research, and the development of new risk assessed techniques and evolutions requires funding. 

As one that is totally bitched off, let me tell all those trainers out there - to steal another's vocational work without permission or acknowledgement, you are subtracting from the future development of rescue. Moreover, superiors who condone or overlook this theft, blight the noble traditions of their service and shame those gone before. These departments should be named and shamed - but that's too much to wish for.

Now let's get down to the meat -  All rescuers love 'Hands-on' extrication training. Generally rescuers do far more training than actual extrication involvement at the roadside - well I certainly hope so. If not you are going to have very poor results in terms of end outcomes.

It is with the scrapped/discarded or junk  vehicle that all rescuers begin training with and continue with in training. The best that can be hoped for is four wheels and a full interior. These end-of-life vehicles are between 10 and 13 years old, rusted and are very distant cousins to the latest model, which sport all the latest innovations, high strength steels and components.

Techniques and evolutions -  If you have read the 'discussion documents' already suggested, the uninitiated will begin to understand the science of extrication and the extrication evolutions that need to be practiced for a rescuer to become anyway proficient in the art of extrication rescue. Where this criteria isn't met, any extrication outside those practiced, will meet with unforeseen problems, be less effectual and carry a much higher risk for rescuers and casualties alike. 

This situation ranges from stabilisation to tool usage to evolution performance.  More poignant, competence in performing a world recognised evolution may not be there, and even more poignantly the actual extrication performed may not be beneficial to the casualty's condition - hey but who really knows? Who cares? And to put you on the spot - do you know? I am pretty certain that you wouldn't be reading this if you were not a driving force in rescue with a lot to offer.

It is with you, the rescuer, that it all begins with and ends with. If you don't care who's around that gives a ____?

If you feel I am being your conscience - well you're right. My whole service life was beleaguered by this attitude - that and professional jealousy. If you are experiencing the same road, dig your heels in and never give up.

I have recently been an expert witness in a court case between a firefighter and his employer. The firefighter injured himself using a dated straight blade combi tool to cut HSLA steel on the side channel on a car's roof structure. Without going into too much detail, the circumstances were somewhat estranged, but anyway, the end result was the firefighter received an incapacitating back injury. 

The judgment was awarded to the firefighter on the grounds of old/outdated equipment, other tools that were more adequate and training competency.

In the current climate this situation can only repeat itself. Loosely described, the proficiency and concurrent competency in extrication rescue preparedness has not been underwritten or met by training departments as a whole. 

Students and continuation training must encompass tool usage in all aspects; in technique and overall performance, and when used in foreseeable cases in extenuating circumstances, competency and safe working practices must be underwritten.  Where a judgment call is made on the grounds of ongoing dynamic risk assessment, the person calling the shots is in fact accepting responsibility. What a poor state of affairs if training departments don't encompassed such parameters.

Evolution Analysis/risk assessment - To begin with, I would ask you this question - What would you consider to be the prime reason for developing rescue? Next I would ask "what do you conceive to be the main performance criteria? I believe that these are two very vital questions that every rescuer should be able to answer. 

Just cause and just motivation stems from the answers. The answers - 1.) To reduce life loss and morbidity, and 2.) To perform  extrication appropriate to casualty survivability initiatives.

Tragically this goal seems as distant now as it was in 1991 when I first embarked upon the HEMS study - Vehicle Extrication Rescue and Pre-Hospital Trauma Care - free download [ CLICK ]. The driving force behind interactive, cross-platform training is forever being stifled and even discouraged.  How can evolutions be analysed without taking medical intervention into account?

Evolution analysis and risk assessment can only be achieved on a national basis. Whether in Europe, USA, Canada, Russia etc., to realistically achieve such a goal requires government intervention. The real purpose behind this can only be measured in the cold light of gross national loss and insurance underwrite. Without such favored involvement, fire departments can only pay lip service to Health and Safety especially where casualty outcomes are concerned. 

Who else can influence the motor industry to furnish the emergency services with the real-world risk assessed information that the emergency services require to work efficiently, safely with life retrieval solutions.

We have seen a placated half-hearted attempt by the motor industry offering 'rescuer guidelines' publications as a way to underwrite their 'duty of care'. They have even involved fire departments in maturing these productions. The results are cheap and inept, not just the end product but their lack of understanding and foresight; their misinterpretation of what is actually needed, budget constraints and real life-saving initiatives.

It certainly isn't all their fault. The myopia of the individual fire service input is usually puerile, their experience too fragmented with no collection of worthwhile data and analysis influencing their decision making. As is the insurance implication where their business profile is built on the status quo. Insurance premiums underwrite insurance claims and of course all running costs and profits. Working on the premise - If it isn't broke why fix it - Insurance companies are guilty of profiteering at the motorists misery.  

Road kill, morbidity and suffering are all part of the equation.  Although insurance companies have experienced several downturns in losses at some point or other over the last 25 years, which admittedly has helped to stabilise premiums and increase profitability, they have had no government encouragement whatsoever with a view to helping the rescue effort. It seems almost malevolent that the more successful rescue becomes, insurance companies rub their hands together.

Insurance companies' have a vital role to play in the development of rescue extrication preparedness. Thousands and thousands of vehicles are crash damaged each year and are subsequently written off. Some are sold back as salvage, where they are rebuilt or parts reclaimed.  Many rebuilds that end up back on our roads are often highlighted in subsequent road kill. 

As discussed, old end-of-life vehicles offer little value in terms of extrication training. How much better to train with newer vehicles that have sustain crash damage making them uneconomical to repair. Even better, vehicles that are branded 'total losses' with limited reclaim value would be ideal. 

Catchment pounds for crash investigation already exist at designated Police stations and Pounds. These could be sited at designated fire stations and, after examination, released for Extrication training. 

Of course this notion is far too simple and impractical, and it would need a change in policy and current strangle holds to be relinquished; and of course everyone's blessing

If you wish to comment on this article or feel you have something to add -  have your say, please contact me at - lenwatson@resqmed.com 

Useful sites:

Continual risk assessment and emergency standard operational procedures and their pitfalls - a document for discussion.

Introduction - The first of the two photographs above depicts immanent collapse as the roof structure caves in and walls are forced outwards and secondly, the split second before the brick structure fails and falls to the ground. Fires of this nature can take life including that of firefighters. and continual risk assessment plays the major part in operational safety.

FRA’s Fire Risk Assessments

In the UK the assumption that each building has a Fire Risk Assessment Policy in place with all remedial action taken, with each building conforming to building regs and are compliant with current fire legislation is so much poppycock. With self regulating ‘Fire Risk Assessment’ superseding ‘Fire Certification by the Local Fire Authority, we have now reached a point where blame will be determined after the event. Moreover the advice of inspecting officers will no longer be heard and enforcement cut back on as services prune costs.

Fires such as the Penhallow Hotel in Newquay, Cornwall which literally burned to the ground as a result of cutbacks, had to be demolished to a pile of bricks before the fire investigating team could enter. The remains left little evidence to be collected and everything relevant to the building's FRA was destroyed.

The fatal fire that ripped through the four-storey Penhallow Hotel leaving behind a gutted shell.

Of course we can blame IRMP (Integrated Risk Management Planning) as having an adverse impact, yes appliances were off the run and manning levels were inadequate. This only becomes a concern where the service fails to –

• Optimise the deployment of emergency personnel and resources on the risk profile of the community served.
• and minimise the destructive and harmful effects of emergency incidents to life, environment, property, heritage and the economy

Presumably systematic, risk based reviews of emergency response and standards with a view to improving flexibility, effectiveness and efficiency has all come about through audit, review and trial. I, personally am at a loss to understand how the strategy aim ‘to intervene effectively’ is underwritten. To my knowledge there is no worthwhile structured collection of information; of actual firefighting or rescue performance indicators that are linked to any real measurable outcomes. What can be seen are annual indicators such as breakdown of incidents attended and cost to the economy calculated from national statistics provided by the Government. Well, if IRMP can see through these murky waters to gain a clear picture from these statistics to act on, I know where you are coming from, but I cannot excuse where you are going.

Moreover, it can be seen openly where the development of fire service training is, that is for anyone who knows how to view it.  As a whole, current firefighter training is still enforcing the myths and some of the worst procedures of the past, with little new on the horizon.

Unfortunately, all the resource redirected toward community services, new dimensions and other groups have added to the firefighters workload and significantly watered down existing preparedness training. Not to mention the long standing heritage of ‘make-do’, number crunching and the ‘out of step training that prevails, the UK fire service is in danger of significant ground-loss that may take several years to reflect in the annual indicators. Watch out for the increase in fire fatalities and other consequential injuries - RTC fatalities and other special sevices.

The Wealth Of False Fire Service Doctrine - After a long eventful life in the London Fire Service I can report that I have only ever witnessed changes after long drawn out arguments; also as a result of catastrophic failures and improvement notices, and even then they invariably failed to address the real issues. Preparedness training has always suffered and has always been guided by a lack of understanding of real-time operational involvement. This is overly reflected in the published manuals and directives available to the British fire service, and are there for anyone with a degree savvy to see. Let us be more direct and discuss some of the elements that prevail. Let us begin with ‘stair procedure’ which is thought to every firefighter in the British fire service.

Article drawn from ‘FireNet Forums’ - I recently came across this question posted on FireNet forums which directly relates to fire service policy on manoeuvring on stairs - “Sweep first few stairs with back of hand to clear debris and check for holes, then check soundness of first stair with foot.  If stair is sound then step up and continue hand sweep/foot check for each stair as you move up. Whilst moving up the stairs you should be stood upright between each step to help with balance, not crawl up the stairs on all-fours, but you can check with your hand as many stairs as you can reach, then carry on with foot check as you move up”

God save us from inexperience and the blind leading the blind!  For the non-initiated, the raw recruit and the inexperienced the passage above will seem to be acceptable but ‘good practice’.  Well let me pull it to bits, analyse it and rewrite as a ‘real-world’, ‘hands-on’ action plan.  

The issue arising - There are many types of staircases and a multiplicity of fire scenarios that positively ridicule the above procedure.

Types of stairs and staircases –

• Interior enclosed stairs
• Interior open plan stairs
• Interior open plan, open-thread
• Interior open stairwell 2+ floors
• Escalators
• Exterior enclosed thread staircase
• Exterior open fire escape

Stair construction:

• Wooden 
• Stone step 
• Concrete  
• Cast iron
• Metal stairs/escalators
• Stairwell with smoke lobbies off
• Open stairwell with automatic smoke ventilation system
• Pressurised staircase

Can any firefighter in their right mind say that the stair procedure outlined above in the FireNet forum and taught by UK fire departments is in anyway in tune with firefighter needs !!!  Lets continue and measure the procedure further against the backdrop of some fire scenarios.

Stair condition, fire intensity and fire spread - A small fire is not really representative as to the necessity for a ‘stair procedure’ unless the fire is immediately under the stairs or the stairs is actually enveloped in fire.  A small fire is quickly put out and as such, damage will be clearly seen and the risk minimal. 

However where the fire has gained a substantial foothold, especially where all occupants are not immediately accounted for and an upper floor need to be searched, moving up a damaged staircase and then renegotiating it with a casualty that needs to be brought down, is untenable as the risk assessment now entails the weight distribution of up-to three persons. This becomes totally unacceptable when the staircase has not been risk assessed for the following –

• where the casualty is unconscious, weighty and requires two firefighters to carry them down the stairs.

• when a ladder could be pitched to the floor above and access and egress achieved through a window without the need for using the damaged staircase in the first place.

• where there is no credible evidence of a savable life to base a judgment call on, firefighters should not be committed unless there is a reasonable assessment of an achievable outcome and only then when an experienced firefighter calls the shots.

The assumption that conditions will not deteriorate and the staircase will not fail is wholly reliant on past experience and the team approach being successful. Where immediate fire suppression cannot be relied on, such assumptions should not be drawn.

So far we have only looked at one small area of firefighter commitment. Let us then consider other variations that alter our risk assessment and the urgency that can dictate  a snap decision between ‘benefit versus risk’.

Fire exposure - various scenarios:

• Heavily smoke logged premises

• Fast growing fire away from staircase with smoke logging.

• Fast growing fire in the vicinity of the staircase with a significant degree of smoke logging.

• Any of the above where rescues have been visually identified.

• Any of the above where persons have not been accounted for and are not visually identifiable.

• Now consider all the aforementioned where the fire is to be attacked as the search progresses.

Measure the situation where a person is hanging out of a window and the priority that is usually given to that rescue; and again measure that against ‘persons not yet accounted for’ and the degree of urgency to search the building that it conjured up in your mind. Considering the fire variations listed above and the fact that persons missing within the building are most in danger of suffocating, what stair procedure should be adopted? Is it really necessary to adopt a ‘one-for-all’ stair procedure, training firefighters to the point of indoctrination and to blindly follow, when it is so obviously flawed and subtracts from any notion of the efficiency required for a snatch rescue before the victim asphyxiates. Not convinced – read on and broaden the debate to include fires in all premises.

Premises types -

1.) Fires in domestic premises

• Average family house

• Large family house

• Fire in multi occupancy

• Fire in high rise dwellings

2.) Fires in commercial premises

• Two or more floors (factory)

• Two or more floors (warehouse)

• High rise offices

3.) Sub-surface fires (Basements and concourses)

• Basement - sub basement office

• Basement - sub basement store/ warehouse

• Underground train station

• Underground military base/store

As can now be realised from the premises list, types of stairs and staircases, and all the scenarios that could possibly be encountered, there is no easy measure, and certainly no ‘one-for-all’ stair procedure that should be adopted.  There can be no doubt that our firefighting culture is firmly anchored in the past.  To add to this dilemma, the assumptions that prevail in the fire service under the heading of experience, dynamic risk assessment, command and control are hopelessly flawed and leave a lot to be desired - To be continued .../..

No matter what safety innovations we put in vehicles, as long as vehicles travel on the roads there will always be fatal and morbid crashes. One of the biggest killers is weight differential, Truck versus car.

The horrendous crash pictured above happens many times every day on the roads all over our world. In the developed world, proven traffic management schemes control the potential for the daily carnage to some degree but in the emerging nations and the third world much has become normative with little hope and  little funding to develop suitable roads and quality traffic control.

If in the developed world we are plagued by what seems to be the inevitable, what chance have the rest of our world got.

When viewed prospectively, modern cars offer little added protection when measured against mass and weight differential. Supplemental restraint systems, high strength low alloy and boron steels, and additional crush resistant structures mean very little when truck meets car.

Mass differential: Vehicles of unequal weight

There is a popular misconception held by most Rescuers that when two vehicles meet at speed that the sum of these speeds produces the collision force. This does not represent what is taking place. Based on Newton’s law there are very relevant issues involved that paint a totally different picture. In the way of offering a brief explanation that opens the mind to the real relevance of impact forces the following equations will paint a very different picture to popular misconception –

The head-on crash

When this crash type is witnessed during crash test high-speed camera footage, bodywork deformity will be seen as very much the same in respect of impact at 40mph with a solid stationary object as compared with impact with another vehicle with a closing speed of 80mph at point of impact. This can be best expressed by the formulae below.

Sir  Isaac Newton – Law of Motion
E=0.5MV²  (E-energy, M-mass, V-velocity)

The differential in ratio in this truck versus car collision is 20 ~ 1: and we must appreciate that there other factors that will also reflect in the end outcome – e.g. The car design and the ground clearance of the truck leading to under-ride – Breaking impairment due to the front wheels of the truck lifting off the ground.

There are many factors in vehicle crashes that have a bearing on the collision forces and injury outcomes of the occupants. Two of the most important are vehicle velocity and mass. Velocity change on impact is widely recognised as the most important measure of impact severity both in the automotive industry and in crash analysis. Although this is most prevalent in truck versus car collisions we must not forget that other considerations are equally important depending on the circumstances.

The car design itself may be low and sleek and, as such, lends itself to under-ride, or the truck may have a high level of ground clearance, or a façade bumper/fender that is incapable of mitigating ride-up. In any case we must appreciate that the ride-down factor of in-build crumple zones will afford little comfort as the velocity change due to mass differential will overwhelm any built in protection particularly when measured against the structural rigidity of the truck.

Even at relatively low speed, collision forces can exact considerable bodywork deformity. The shear weight momentum of the moving truck can quite simply run-over the car. Trailers not equipped with or with flimsy under-ride bars are inescapable for the inattentive driver as indeed, the truck driver that swerves in too soon after overtaking can draw a car in under the rear wheels of the trailer.

Fire Rescue perspective

From the Rescuers point of view it is important to understand and be able to relate the significance that these type of incidence hold, not only to the community but to the post traumatic stress that builds inside the self. The shear bodily insult and degradation to the human soul these crashes present, live forever within the mind; particularly the futility of being called professionally to a no-hope situation.  The firefighter inevitably does the clearing up at scene and the remains are passed on to the pathologist at the morgue.

The importance of dignity, the way the situation is handled, is an area that has become procedural in the UK but still needs to be addressed in the emerging nations.  The clinical aspect of body recovery from vehicle entrapment and biocide clean-up of the wreckage and surrounding area is essential in terms of health and safety and in easing the strain of just plain coping with the horror in a civilized community - To be continued.../..

July-2008 UK - 6 fatal on A 607 - read more { CLICK ]

NEWS & VIEWS

SWEDEN: Volvo targets no-crash car - Volvo's vision for 2020 is to make cars that do not crash and cause no occupant deaths or injuries. Read more -http://www.just-auto.com/article.aspx?id=95420 

Some Chrysler airbags recalibrated to ’turn off’
Detroit Free Press - United States
Katz’s lawyers also contended that because of a design flaw the crash destroyed the minivan’s front airbag deployment sensors before they could signal the ...
See all stories on this topic

How to Determine If Your Air Bag Performed Properly
By Greate Way(Greate Way)
In a late deployment case, the air bag deploys later than it should, allowing a person to move toward the air bag (sometimes called "out-of-position"). The extreme force from an air bag at close range can cause catastrophic injuries. ...
Legal: Personal Injury - http://legal-personal-injury-gw.blogspot.com/

The effects of airbag deployment on severe upper extremity injuries in frontal automobile crashes - M.Virginia Jernigan MS^a and Stefan M. Duma PhD^a From Virginia Tech, Impact Biomechanics Laboratory, Blacksburg, Virginia.

Abstract - The purpose of this study was to investigate severe upper extremity injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 25,464 individual cases that occurred in the United States. An analysis of the cases indicated that occupants exposed to an airbag deployment were statistically more likely to sustain a severe upper extremity injury (2.7%) than those occupants not exposed to an airbag deployment (1.6%) (P = .01). In particular, 0.7% of occupants exposed to an airbag deployment sustained a severe upper extremity injury specifically from the airbag. In addition, when in crashes with an airbag deployment, older occupants were at a higher risk for severe upper extremity injury, as well as occupants in crashes with higher changes in velocity. (Am J Emerg Med 2003;21:100-105. Link to full study [ CLICK ]

Traumatic Simultaneous Asymmetric Hip Dislocations and Motor Vehicle Accidents

COMING NEXT ISSUE  

In the next issue we will discuss further the Firefighter Protocols for Life Threatening Situations - the 'continual dynamic risk assessment' - and the assumption culture of so-called 'experience' that undermines the professionalism and progression of the service.

If you wish to comment on any of the articles in this issue, we would welcome anything you have to say and wherever possible we will endeavour to answer you.

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