Brought to you by: Captain Edwards

It should be stressed at this time that this is not a lecture about inter service co operation at RTAs. There are other lectures which deal with this subject. Simultaneous Activity at Road Traffic Accidents deals with a strategy for improving the efficiency of what the Fire Service strives for at RTAs - The Saving of Life.

“Has anyone heard of the “Golden Hour”? Oh you have; can you Define it for me please” The Golden Hour is a term coined by the Emergency Services and Medical professions to describe the “Perfect Maximum” amount of time that will pass from impact at a survivable* RTA through arrival of the various agencies; initial actions; Extrication in this example by the Fire Service; until the Casualty is in hospital under the care of a trauma team. * In this case survivable means a person with injuries that will not kill in this first hour so long as proper immediate care is applied; AND they are satisfactorily “delivered to the Hospital”.

Time Zero; The RTA occurs.

Hopefully within ten minutes the first Emergency Service personnel attend; in this case, like so many it is the Police and Ambulance. This is usually because the general public don’t think of the Fire Service when they see an accident. Quite quickly the Paramedics or Police realize that the person(s) are seriously entrapped and require the attendance of specialist extrication - The Fire Service

Twenty minutes into the incident the Fire Service attend and the Extrication proper begins.

If the casualty (s) are lucky it may well take only minutes for us to release them. Unfortunately it sometimes may well take over the limit of the hour. In the above case the Extrication is a relatively easy one; only 30 minutes.

To continue with this “perfect” scenario the released casualties are evacuated to hospital within the allocated sixty minutes of the hour.

Re-Iterate

Many of you will have heard of or practiced the team approach. Ask if anyone can define it then show the definition “This is the definition”. (Read out Loud) We pre plan for fire from day one of recruit training on the drill yard; all positions are numbered; all crew members know their tasks and places. This carries on to the fire ground where many of the tasks required at an incident are instinctive. Is it not therefore possible to pre plan for RTAs in the same way? RTA Training on a Recruits Course covers a minimum time on the syllabus.

For a Fire - Re iterate the crew positions and tasks, perhaps you could question the audience about the “Title” of each crew position e.g., “what does No 1 do?” then flash up the answer; and so on. Show the audience that they all know what one to fives duties are without thinking. Stress that this is instinctive.

The Officer in Charge In many ways the OiC has all the same responsibilities as at a Fire. Crew Safety. Initial Situation Appraisal. Command and Control. Supervision. Tasking. Liaison with Police; Ambulance; Doctors. Initiation and Discipline of the Two Metre Zone.

The Glass Manager / Assistant One of the primary tasks when gaining access to the Casualty is Glass Management. This does not mean that all other Crew Members “Ignore” this job; For instance the Stabilizer can assist once he’s free. It’s not unusual for the whole Crew less the Medic and OiC to take care of this phase

The Medic The most important job at an incident - preserving the life of the Casualty and not worsening their condition. The Medics only task is casualty care. This can involve collaring*, to protect the Cervical Spine; Survey, to find and treat external life threatening bleeds; and Airway Management - inclusive of Oxygen Therapy.** *Don’t forget that the head has to be supported in the “Neutral” Position even if a collar has been fitted. **Oxygen Therapy should consist of at least 15 litres per minute through a therapy mask, the idea being to flood all tissues with as much oxygen as possible, given that the blood supply (the oxygen's “transport” system) may be limited due to blood loss through wounds sustained.

Tool Operator (1) / Stabilizer As the name suggests this crew member starts the incident by providing stabilization to the vehicle. This can involve stepped chocks, blocks, wedges and even sections of short extension ladder. No one is to mount the vehicle until it is stabilized.* Once the vehicle is safe then full casualty care and extrication can begin. The Stabilizer then reverts to tool operator. *Be aware that other Emergency services may already be on the vehicle. Don’t be frightened to chase them off; be firm, polite and insistent.

Tool Operator (2) This crew member can assist in stabilization initially; and once the vehicle is safe can be preparing and operating separate tools to the first Tool Operator.

The Incident must run in set stages: Scene Safety; Extinguishing Media to Vehicle (and tested); Stabilization; Casualty Care; Battery Disconnect. The above ensure that the Vehicle is “Made Safe” and the situation cannot worsen. The next phases are: Glass Management; Equipment Dump; Begin Extrication.

There is no reason why a well trained Crew cannot achieve several tasks at once during Extrication as well as during the first stages of the incident.

This is the Scenario: The vehicle shown has been involved in a side impact and there is one Trapped Casualty; The Driver. By this stage the vehicle has been made safe, the Medic is with the casualty the Glass has been managed and the Extrication begins. Slide Build: The Assistant provides the Casualty Shield to protect the trapped person from the cutting tool; Tool Operator (1) provides the Hydraulic Cutting Tool to use adjacent to the Casualty. This tool is easily controllable, safe and quiet enough to use close to an injured person. Cuts - Driver Side “A” and “B” Posts; At the same time Tool Operator (2) can be getting the Electrical Saw to work. Though not Casualty Shielded the Saw is far enough away from the trapped person to allow safe use. Cuts - Passenger Side “A”, “B”,“C” and Driver Side “C” Posts; By this stage Tool Operator (1) will have finished with the Hydraulic Cutters and can begin Door Removal with the Hydraulic Spreading tool, again shielded by the Assistant. A further Crew will have arrived by now to lend support.

THANK YOU And And STAY SAFE STAY SAFE