16 May Multi agency approach to extrication
“Coming together is a beginning. Keeping together is progress. Working together is success.”
The above quote is attributed to Henry Ford who, as most readers will know, became quite successful in the motor industry during the 20th century. He knew a thing or two about bringing people together to achieve a common goal. Although he did not actually invent the ‘production line’, he was instrumental in its development. With the result, increased production efficiency enabled ‘the common man’ to afford an automobile. The processes involved in the manufacturing of a new vehicle back then (as now) relied upon the combination of people with differing skills all working closely together to produce the final product. So can we draw any parallels asks Ian Dunbar, Rescue Consultant at Holmatro?
There are very few places in the world where extrication is carried out by a single agency that is responsible for all of the tasks that need to be completed on scene. In fact, I cannot think of a single location where I have witnessed this arrangement. Of course there are parts of the world where the technical and medical aspects of the rescue are performed by the same department (some parts of the USA for example), but there will usually be other agencies on scene taking care of other issues such as:
■ medical assistance – paramedic/doctor
■ crowd/scene control – police or law enforcement
■ isolating services such as water, gas or electricity – utility companies
■ accident investigation – police or law enforcement
■ patient transfer – air ambulance
■ heavy lifting – specialist heavy lifting/hauling company
■ hazardous material management – Hazmat teams
So, for the vast majority of rescues, there will not be just one agency to work autonomously on scene. There will nearly always be a need to establish contact and maintain communication for the duration of the incident. It will be necessary to discuss the priorities, capabilities and limitations of each agency to allow the incident commander to make an effective plan; a plan that is safe for everyone on scene and is most effective for the entrapped victim.
Of course, the reason that we potentially have multiple agencies on scene, is because the processes involved in extrication are rarely simple. It takes a combination of skills, attributes and equipment to make the incident run safe and smooth and allow it to come to a successful conclusion. When all of these people arrive on scene, they should be part of a well-trained and well-disciplined team that works safely and with maximum efficiency. Each having an excellent understanding of the role of others. There are clearly two relationships that must work effectively here; one being a working relationship and the other, more critical in my view, a preplanning or training relationship.
Coming together – the beginning
I believe there is a need to establish a multi-agency relationship before you actually respond to the incident. The side of the road is not the place to learn about the other agencies. An environment must be created, where all the stakeholders who attend the scene of an extrication can come together and discuss, train and pre plan for the event. Where and how do you initiate this?
Well quite simply, think about all of the extrications you have attended; who else was there? Make a list and start to make some calls. The most difficult part is establishing initial contact and opening the lines of communication.
Start a dialogue and explain that you are interested in what they can offer and how they can help you during an operational incident. Remember, these people will be very busy, so have a clear idea of what information would really assist you, for example:
■ What is their priority on scene?
■ What equipment do they use?
■ What is the full range of their capabilities?
■ What are their limitations i.e. what can’t they do?
Having this full understanding of these abilities and limitations allows a rescuer to make an informed decision about what resources will be useful during future operational incidents. Remember, this is a two way thing. The other agencies will benefit from knowing what your role is at the scene of an extrication. Educate them on your priorities, planning, process and considerations. This may have an impact on how they operate in the future. The mutual understanding of each other’s role is key to working safely and efficiently.
Keeping together – the progress
Once multi-agency communication is established, it is important to sustain and develop this relationship; make it part of your training and preplanning for future incidents. Training in isolation (i.e. as a single agency) is immensely valuable, as it allows you to focus and develop core skills and standard operating procedures that are required for safe and timely extrication from your point of view. However, this should be supplemented with frequent multi agency training, which is well structured and has predetermined aims and objectives (both for individual agencies and for the group as a whole).
A huge benefit to all agencies here, is that during a training exercise they will be present for the whole event and will play a key part in the debrief or evaluation. At the roadside, my experience tells me that many agencies may have left the scene prior to the conclusion of the incident, meaning they miss valuable feedback (as well as not having the ability to give their own findings).
Working together – the success
In the event of a multi-agency response to the scene of an extrication, the preplanning and training relationship that has already been developed, will greatly assist in the formation of a strategic plan. The incident commander now has a greater insight into what each agency can do and also what they require. They can, for example, immediately appreciate what access a paramedic will need; access can be gained and space created accordingly, without the need for prolonged discussion. Likewise, a doctor on scene will be more aware of what is involved in the removal of a vehicle roof. With this information they can make a more realistic clinical decision based on time.
As well as assisting strategically, preplanning with other agencies promotes personal working relationships. Have you ever been on a scene where you know the first name of the doctor, paramedic or police officer? It may sound trivial, but I can guarantee it creates a much easier working environment for all concerned.
For many years, I was satisfied by a good working relationship with other agencies on scene. We would get the job done safely, successfully and in good time. However, I did often find myself leaving an incident and asking myself ‘Why did they do that?’ or ‘I wonder why they didn’t consider this?’. More critically, as an incident commander, members of my crew would often ask similar questions, and sometimes I just didn’t have the answers. This meant that there was a clear lack of mutual understanding in some areas. This is not a recipe for development. It was clear to me that there was a need to further develop the training relationship. So, I picked up the phone and volunteered my time to train ambulance / paramedic crews in the issues surrounding technical rescue. This not only allowed me to pass on some knowledge, but allowed me to learn a vast amount of information regarding my local ambulance service. All of which, I have no doubt, assisted with the resolution of subsequent incidents. We must think wider than the technical and medical aspects of rescue, and even consider incorporating some agencies we may not readily expect to see at every scene. This will ensure that we are sharing and receiving the widest range of knowledge.
Every agency is busy doing what they do, and very often time to get together may be limited. However I do think that the sharing of knowledge should not be confined to your department or service, but should cross the boundary into other disciplines.