During my career, I participated in several lengthy extrication incidents and have witnessed or heard of countless extended extrication times. In many cases, once personnel evaluate the incident, they realize the amount of work is not reflective of the amount of time spent on scene. Questions may arise including: Why weren’t other tactics utilized, where did all the time go, and why didn’t we recognize those things? Regardless of the level of training and experience, resources such as command sheets, time notifications, and checklists provide even the most proficient personnel with assistance in highly stressful and dynamic conditions.
Several years ago, the Charleston (SC) Fire Department instituted time notifications on the belief they could enhance scene safety at all confirmed structure fires and any other emergency scene based on incident needs. Deputy Chief John Tippett described the importance of time notifications as follows, “Time is an elusive commodity on the incident scene. Incident commanders and crews at fires can become so engrossed in operations that they lose track of how long a victim may have been exposed to deadly heat and smoke, how long the fire has been burning, how long the building’s structural members have been under assault, or all three. The results can be disastrous. The use of predetermined ‘time on-scene’ notifications (10 minutes, 20 minutes, etc.) has proven to be an indispensable tool. The notifications keep fireground commanders aware of how time is advancing as they evaluate the effectiveness of the attack plan vs. the fire’s progress.”
This process begins once the first unit checks in on scene and continues in 10-minute intervals until the incident commander terminates the notifications. Although promoted at more regular intervals, personnel should use time notifications as a minimum time frame to check their self-contained breathing apparatus air level. Departments should consider the use of time notifications at extrication incidents.
Establishing command, sizing up the incident, and formulating a plan based on good strategies are necessary to proficiently and safely mitigate a motor vehicle crash and remain constant regardless of the severity of the entrapment and patient condition. During this period, the overall tempo and command mode are determined by the initial-arriving company officer.
Command must have an established relationship to entrust his group supervisors for viable input and making tactical decisions to accomplish the strategies. The disentanglement supervisor must be proactive in his development of initial and secondary disentanglement tactics to accomplish the strategies and provide constant feedback.
Because any emergency scene is constantly changing, it may become necessary to adjust the strategy and tactics to meet any new demands recognized during the evolution of the incident. As described in a previous article covering tactical decision making, there are numerous factors that may prohibit, or at least hinder the completion of, the primary plan and determine the need to switch to a secondary plan. Although it seems possible to determine these factors during size-up or the initial stages of tactics, many times responders have already committed to the primary plan before discovering issues including the following:
- Additional hazards such as hazardous materials.
- Pressurized cylinders, pretensioners, etc., from safety systems.
- Unique vehicle construction features.
- Advanced steels.
- Secondary patient entrapment.
- Unanticipated reactions from vehicle damage.
- Change in patient condition.
- Equipment failure.
Although these extenuating circumstances can seriously affect the operational flow of an incident, they also have an indirect impact on the responders specifically. As operations take unexpected turns and the initial excitement of the situation diminishes, many times responders show signs of frustration and lack of motivation. Responders may show an unwillingness to consider recommendations and potentially change tactics. This attitude typically results in decreased communication at the strategic and tactical level, lack of situational awareness, poor decision making, and reduced teamwork. In addition to these significant safety concerns, the patient has to endure extended extrication times and the associated mental stress and possible worsening medical condition.
Time Notification Advantages
The extrication process provides a framework for the incident strategies and lays out an incident action plan that can be applied to every incident. Following this plan helps ensure that we approach each incident in a logical manner and use the appropriate tactics. Time notifications can provide an additional means to monitor incident progress. By the first time notification, at 10 minutes, responders should be able to establish command, carefully survey the scene, initiate patient contact, request additional resources as necessary, control hazards, stabilize the vehicle in the position found, and begin disentanglement procedures.
By the second notification, at 20 minutes, an appropriate path of egress should be established. This timeline is presented as a minimum standard and, depending on the incident conditions and needs, may not always be applicable. That is something that the incident commander and disentanglement supervisor can evaluate at each time notification.
In addition to evaluating overall operations, command personnel and supervisors should use the time notifications, much like checking air consumption rates, to ensure they are properly managing the situation. They should consider the following:
- Rotating personnel as necessary and monitoring for safe work practices.
- Maintaining tempo and providing encouragement when needed.
- Making decisions in a timely and efficient manner.
- Positioning to monitor the major work area and personnel.
- Ensuring the primary plan is progressing and secondary plans are considered.
- Contacting medical personnel on the status of the patient.
- Not becoming task focused and assisting where and when appropriate.
Time notifications have been used for various emergency incidents, especially those that have a high risk or a unique set of needs. They have proven to be a valuable asset to incident commanders in tracking the effectiveness of operations and making timely decisions. The no-cost initiative should be integrated into extrication incidents given the potential life hazard and responder safety concerns.