As we explore the topic of patient vehicle movement, tactics continue to be developed as responders become more open minded to the practice and inventive in the application of existing equipment. This column has discussed the movement of the patient vehicle and multiple ways to accomplish that based on the vehicle position, available equipment, and needs of the situation in the past. Recently, a tactic was introduced as a means to quickly and effectively move a side-resting vehicle with the use of struts and a pulling device such as a vehicle-mounted winch or come-along.
Some of the key points include the following:
- The movement of side-resting vehicles was limited to various forms of controlled rolls aimed at changing the angle of the vehicle in relation to the object that limited disentanglement tactics.
- The overwhelming consensus was that the vehicle could not be horizontally moved because of the high center of gravity in relation to the base of support.
- This tactic is easier and quicker to accomplish than a controlled roll; however, it does not expose the down side of the vehicle in the cases where a dash displacement may be necessary.
During the 2015 Southeastern Extrication School, an additional tactic was discovered by horizontally sliding one end of a side-resting vehicle using lifting struts and wheel dollies to move either the patient vehicle or a secondary vehicle. This tactic can be modified accordingly depending on the type of struts a department uses. Some advantages of the Southeastern Slide include the ability to move the vehicle a considerable distance in a shorter time frame, smoother movement overall, and less force needed because of the lack of friction on the vehicle side against the ground. However, the tactic does require consideration early in the stabilization process and the use of wheel dollies, which not all departments carry. Given the nature of the small wheels on dollies, this tactic requires a hard surface such as asphalt, concrete, or packed dirt.
Initially treat the incident as any other motor vehicle collision. Take the necessary steps to establish incident command, survey the scene carefully, call resources as needed, control hazards, and stabilize the vehicle in the position found with consideration to further movement. Then, take the following steps:
- 1. Place opposing struts on the undercarriage and passenger-compartment side of the front and rear of the vehicle similar to typical side resting stabilization.
- When placing the opposing struts, it is necessary to decide which end of the vehicle is going to be moved. The preferable choice would be to move the rear of the vehicle for two specific reasons: First, there is typically less weight at the rear of the vehicle, which decreases the load that needs to be lifted. This also keeps the majority of the vehicle weight stationary-the vehicle is less likely to have any gross movement during the operation. Second, movement of the rear more commonly opens up the path of egress. Patients are more likely to be removed inline toward the rear of the vehicle rather than the front. The ground conditions may limit options.
- Place the strut head as high as possible on a structurally sound part of the vehicle while placing the base of the strut on a wheel dolly.
- Connect the base to two separate points-much like older cam-strap systems or when there is not a direct point in line with the strut-which can be accomplished with a chain or a ratchet strap. In either case, the setup does not have to be completely tight if using lifting struts because struts can be extended for stabilization prior to lifting. When using other means to lift the vehicle and “follow” the load with the struts, use a chain binder or two separate ratchet straps to tighten.
- If a ratchet strap is run through the base, place a twist in the strap so the base cannot slide horizontally on the strap.
- Once the strut has been secured in position, use an additional strap or the integrated ratchet strap to secure the strut base to the dolly. Although tests have shown the vehicle is stable, placing a wedge under the dolly prevents any movement and simply holds the dolly stationary during the initial setup.
- Securing the base to the dolly is not as important with smooth surfaces, but it does make a difference with quick movements on rough surfaces or when debris such as glass coats the work area.
- Properly placing these struts for the slide also completes stabilization of the vehicle. At this point, the medic can gain access, assess the patient, and make preparations for vehicle movement.
- Put the lifting jacks in place and lift the load.
- From this point forward in the tactic, a coordinated effort should be conducted between the disentanglement group and supervisor, interior medic, and any established safety officers to ensure a smooth lift and move. The disentanglement group supervisor and safety officer, if appointed, should be positioned at the front or rear of the vehicle to monitor any safety concerns and directly see the responders completing the tactic.
- You only need to lift the vehicle enough to create a clearance between the ground and the car to move the vehicle several feet. If you exaggerate the vehicle movement more than 30 to 45 degrees, then you need to lift slightly more so the front tire, if functional, does not twist and stop movement.
- Remove the cribbing and position responders on the patient-compartment side of the vehicle for movement.
- Although it is not necessary, turning the dolly wheels in the direction of travel will make the initial movement slightly easier, especially on rough surfaces.
- If necessary, it may even be beneficial to quickly clear debris from the path of travel. This will make movement smoother, limit slip/trip hazards for the responders, and decrease the amount of effort needed to move the vehicle.
- The responders should be positioned in a manner where they can push the vehicle while monitoring both struts, including the attachment point, base, straps, and dollies.
- Move the vehicle the needed distance to create clearance to complete disentanglement procedures.
- Two responders can easily move the load, but depending on the vehicle’s weight, surface conditions, and topography, it may be reasonable to use an additional responder or a pulling device or walk it with a spreader.
- If the roof is wrapped around an object, cutting the posts first and securing the roof to the object will make the movement easier and smoother.
- Reinsert the cribbing and slightly lower the struts back onto the cribbing to prevent movement.
- Complete disentanglement tactics to create a sufficient path of egress.
With the creation of this tactic, responders now have several options to roll or slide a side-resting vehicle when trying to create space for a vehicle that has significant roof intrusion and is resting against an immovable object. Regardless of the tactic used, two groups of three or four rescuers working in coordination with each other should be able to establish an initial access, if necessary, and an appropriate path of egress in a timely manner. Train on these options and decide what works best for your organization based on your resources and comfort level.
Thanks to the Southeastern Extrication School, Victory Steel, Merrick Machine, and Beaver Lane Fire Rescue.