Casualty-centred rescue from a mode of transport: Initial actions

Control Measure Knowledge

Rescuing a casualty from a mode of transport will require the adoption of a team approach, to ensure the actions taken consider the safety of all emergency responders and the casualty, including their clinical needs.

Fire and rescue services should ensure policy and training considers evidence-based principles for the extrication of casualties. They should consider aligning to:

Planning

An initial casualty-centred plan should be based on situational awareness, of the casualty and the mode of transport. The plan should be communicated to the team, and feedback from the team should also be considered. The plan will determine the appropriate approach, considering glass management, space creation and full access, through to what is necessary for the safe and timely rescue of the casualty.

All responding agencies should work together to develop a bespoke casualty-centred extrication plan, with the primary focus of minimising entrapment time.

Independent of actual or suspected injuries, casualties should be handled gently and dignity maintained where possible. A focus on absolute movement minimisation is not justified, and should be balanced against the speed of access based on medical advice.  Due to concerns relating to time- critical injuries, removing entrapments and enabling rapid extrication should be prioritised over full access. Medical responders should determine when and how extrication should be performed.  This should be based on a shared understanding of risk considering the cause of entrapments, the vehicle and surroundings, and should consider the advice of fire and rescue service advice regarding possible mechanisms of extrication.

Self-extrication or minimally assisted extrication should be the standard ‘first line’ extrication, unless one or more of the following contraindications are present:

  • An inability for the casualty to understand or follow instructions
  • The casualty is unable to stand, or it suspected they would be unable to stand, either due to injury or another condition, for example:
    • Suspected pelvic fracture
    • Impalement
    • Suspected or confirmed Leg fractures
    • Signs of dizziness or confusion

The removal of any physical entrapment should be prioritised, to ensure the casualty can be removed from the mode of transport if their medical condition rapidly deteriorates.

Personnel should be aware that the decision to perform a rapid rescue of a casualty, as determined by their medical condition or external factors, could be made at any stage of the rescue.

Casualty-focused extrication:

There should be a focus on the casualty during their extrication, with the following principles applied if possible:

  • Communicate with casualties using their name if known, to:
    • Explain what is happening during the extrication
    • Reassure them about their own well-being
    • If appropriate, reassure them about the well-being and safety of others, including companion animals
  • Provide an ‘extrication buddy’; this is a member of the emergency services team who is dedicated to communication, reassurance and explanation to the trapped casualty
  • Allow the casualty to communicate with family or friends if safe to do so

Requesting additional resources

Requesting additional resources at the earliest opportunity should lead to reduced rescue and on-scene times. Resources could include:

  • Additional or specialist medical assistance
  • Heavy lifting equipment
  • Additional or specialist rescue equipment

Consideration of these requirements should be given while en route to the incident, based on information obtained by other responders already on-scene, or information gathered by the fire control room.

Consider mode of transport relocation

Consideration should be given to relocating a mode of transport; this could be either the one containing the casualty or another one involved in the incident. The mode of transport may need to be moved away from another object, obstruction or hazard. Carrying out this may:

  • Improve safety
  • Reduce rescue times
  • Provide better access to the casualty

However, this action may not be required, or may not be possible. If the mode of transport is to be relocated, this approach should be used in conjunction with advice and monitoring from medical responders. The decision also needs to be based on the time it will take to relocate the mode of transport, as part of the overall time to rescue the casualty.

Initial access

Initial access to the mode of transport may be required to provide stabilisation; this may include applying its parking brake (also referred to as a handbrake), isolating its engine or using other methods to reduce the risk of it moving. Initial access may also be required to provide urgent medical assistance to a casualty, which may be achieved by opening a door or rear hatch, or breaking a window or sunroof. For further information refer to Transport – Using tools to access modes of transport.

For incidents involving a large goods vehicle (LGV) or heavy goods vehicle (HGV), a clear working area should be established around it to allow the use of mobile platforms, from which personnel can work. A platform should allow for personnel to work at the same level as the casualty, without having to encroach on the minimal space available within the driver’s compartment. For further information refer to Transport – Accessing large modes of transport.

If platforms are used, personnel should be managed to ensure that the limited space is used effectively, and the number of personnel should be kept to the minimum required to carry out the rescue.

Stabilisation

The mode of transport may need to be stabilised, using the most appropriate method for the safety of the casualty and emergency responders. Based on the requirements of the incident, a staged approach to stabilisation may be applied, using all or some of the stages:

  • Phase 1 – Rapid stabilisation, for example to provide the casualty with medical assistance, may be performed manually using methods such as:
    • Applying a parking brake (handbrake)
    • Isolate vehicle to prevent it restarting or re-energising
    • Applying a wheel chock
    • Applying a winch wire
    • Using personnel to brace the mode of transport
  • Phase 2 – Stabilisation can be achieved using chocks and wedges
  • Phase 3 – Stabilisation uses additional equipment to stabilise a mode of transport such as:
    • Struts
    • Hydraulic or pneumatic stability equipment
    • High or low-pressure lifting bags

Strategic Actions

Tactical Actions