Extrication Survey - Rollover Complexity
Several weeks ago I invited readers to complete a very short and simple extrication survey. A huge thanks to the 500+ that did, and if you haven't yet completed it, shame on you; you can redeem yourself here!
The results are very interesting and will certainly assist me in my training and teaching in the coming months. There are no massive surprises in the answers to the questions, although it does confirm my suspicion that the world of extrication is filled with more information, misinformation and disinformation that has a tendency to put the rescuer on the back foot, rather than having an empowering effect.
For the purposes of this blog I would like to challenge the concept of complexity that was asked in question 9 of the survey:
Which type of extrication do you feel is generally more complex in nature?
94% of respondents feel that extrication from a vehicle on its side or roof is more complex
Rollover incidents account for only approximately 3% of vehicle collisions but result in nearly 35% of fatalities which of course will include ejections (therefore negating the need for extrication). Should it be the case that these kinds of incidents are more complex?
Medical perspective
Well, from a medical point of view, we could assume that such incidents require a higher index of suspicion in relation to the patient's injuries. This is due to the forces involved; so we may have less time in which to extricate, possibly adding to the the feeling of complexity. There may also be a need to manage the patient's positioning as it is possible that they will be retained, upside down, by the seatbelt; which in itself is a difficult manoeuvre.
Technical perspective
From a technical perspective, newer vehicles have much stronger roofs and rollover incidents (these days) rarely lead to full deformation of the structure. This means that the structural integrity is retained and we have more space in which to work and extricate. Final space creation options are limited in both vehicles on their roofs and vehicles on their sides. Often the removal of a tailgate and creating full side access is all that is required (in addition to relocating the seats which can be as easy as manually winding them 'up') for a vehicle on its roof. For a vehicle on its side the only real viable option is gain access through the rear and fold the roof down for a final extrication space. My point here is that having a limited amount of options must surely reduce the complexity of the task.
Training perspective
Another factor that may add to the percieved difficulty is how we train. Very often we tend to stick to a vehicle on its wheels as manoeuvring a car into another orientation can be difficult (or against local policy). For this reason we become very proficient and more confident in dealing with a vehicle on its wheels. It is a familiar position and one we are very comfortable with. Stabilization and glass management become almost second nature. Our options for gaining access are well considered and regularly practiced. Our final extrication route tends to be either out of the back or out of the side (as very often we place our patients in similar positions).
A car is a car
I have always taught rescuers to see a car as a car, regardless of orientation or position. Although dynamically the scene is different in terms of safety, stability and glass management, the vehicle retains the same areas of strength which we must overcome in order to gain access and extricate. So although the position of the car is unusual, our aim remains the same.
Exposure reduces complexity
The key to reducing complexity is simple: exposure. If we expose ourselves to these type of incidents in training (as often as we do a vehicle on its wheels) the graph above will start to change with the aim that all of the complexities are viewed with the same consideration. In essence we must achieve a position where whatever the final resting position of the vehicle when we arrive, we are never out of our comfort zone.
As ever I welcome your comments!
Ian Dunbar