Ian Dunbar, Rescue Consultant at Holmatro Rescue Equipment, explains how officers in charge of extrications are the ‘maestros’ of their team
Even the world’s best orchestras are nothing without their conductor. The ‘maestro’ provides tempo, structure and guides sections of the orchestra in and out of the performance as required. He is the focal point, through whom all of the energy passes for the duration of the performance. The end is often met with great adulation for the maestro, but he always turns and acknowledges the performance of the musicians.
I have always thought that it is possible to draw a direct parallel between the role of a maestro and that of an officer in charge (OIC) at the scene of an extrication. A well-disciplined and experienced incident commander will make the process look effortless, ensuring a safe and timely extrication from their team. Of course knowledge and experience is not gained over night; so what are the elements needed for effective command and control on scene?
Safety on scene
So much of the role that the OIC performs is down to the understanding that safety on scene is always the priority and this should be instilled in the team during all training sessions whether they are theoretical or practical. On scene, no work can begin until the OIC has identified all hazards and communicated this information to the crew. The most effective way to do this is to complete a 360 degree survey of the scene. Once the inner survey (area immediately around the vehicle) and outer survey (the wider area depending upon the environment) are completed, then the OIC can instruct the crew what their initial priorities should be and the extrication process can begin. For the duration of the rescue the OIC must ensure that all persons on scene operate safely, wearing full personal protection equipment and adopting the correct position when using hydraulic rescue tools.
The need to maintain safety throughout the rescue should dictate the positioning of the OIC. A perfect distance is about 2-3 metres from the vehicle allowing a clear view of the full working area. It is sometimes tempting to get closer but this must be resisted: Being positioned too close to the vehicle means that you cannot see the full risk area. The only exception to this rule is when there is an issue requiring immediate attention, where safety is compromised or when there is a need for the OIC to get their hands on the casualty during the extrication process (for this reason the OIC should also wear medical gloves under their normal extrication gloves).
Ideally the OIC should position themselves so they can see every cut/spread/ram. The tool operators should be focussed on the critical area where they are working (e.g. the spreader tips or the cutter blades) while the OIC can see the wider area, ensuring complete safety. There are times too when, for whatever reason, the plan is just not going right and progress is slow. It is at this point where the OIC may be tempted to get more involved and even get their hands on the tools. This must never happen. If it does, effective command and control is lost. The best way to ensure that this never happens is to prepare and train in the most effective way. It’s fair to say that the distance an OIC stands from the car, is directly proportional to the success of his team.
The importance of communication
The extrication scene is a very dynamic place and the OIC must gather a lot of information in a very short amount of time so that an extrication plan can be devised. Information such as the condition of the casualty and their level of entrapment (from the medic) is necessary before this plan can be conceived. This information has to be communicated to the rest of the team and how this is achieved is critical. The OIC has essentially two options when it comes to communicating the plan. They can inform individual members of the team as they work (this is time consuming and means the OIC will be adopting an undesirable position) or they can call the team together and give a short but precise brief. Although the second method means a temporary cessation of work, it allows the OIC to ensure that the information has received all team members and is understood. Best practice is also to ask for feedback. All team members have experience and may have a more effective solution and be able to offer a viable alternative. The need to maintain communication throughout will also ensure that the OIC’s position is maintained. Regular updates from the medic and the technical team will inform the OIC of how the plan is developing, and allow them to adapt quickly to any unforeseen problems.
Of course communication with other agencies (paramedic/police) is an integral part of a successful rescue, but this must not compromise effective command and control of the scene. The OIC should consider nominating a deputy (where personnel permit) to deal with other agencies.
Motivation to achieve progression
Momentum is extremely important and the OIC has a crucial role to play here. Minimum time on scene means that your casualty can receive definitive medical care at the earliest possible time. Simply by motivating the team, the OIC will ensure that the team maintains momentum. Of course from a practical point of view, momentum can be achieved by the proactive management of resources. This means that the OIC has to be thinking at least one step ahead of the current task, and needs to ensure that whatever resources (people or equipment) are required next, are easily available. This ‘simultaneous activity’ reduces time on scene, ensures that an effective (but safe) pace is maintained and enables seamless progression.
Minimum on scene teaching & technique management
Your training regime should illuminate virtually all on scene coaching/teaching by the OIC. The ability to immediately react to the simplest and most concise instruction means that the team can work more efficiently. For example, if the OIC asks for the side to be taken out of the vehicle (removal of doors and B pillar) then the team should already know their preferred option, without the need for the OIC fully describing how the technique should be performed. Of course there will always be a scenario which is so far removed from your common approach that a short discussion must take place in order to arrive at a solution, but this should be the exception and not the rule. There will also be occasions where the chosen technique is not having the desired effect, despite the best effort of the crew. This is the point where the OIC must make a decision and change the approach. The management of techniques like this ensures that the crew can quickly adapt and refocus.
Handing over command and control
The OIC is ultimately responsible for the rescue process; however there comes a point where he/she should relinquish an element of control. When the final extrication space has been established and the casualty is ready to be extricated, the medic must take over and control this phase of the rescue. This is simply because they are in the optimal position to take charge. They have a full understanding of the casualty’s condition and are usually performing some kind of manual stabilisation (e.g. cervical spine management). The OIC is still responsible for overall safety and their position should not change, but all communication should now come from the medic. When the casualty is free from the vehicle and in a safe area, the OIC will reclaim overall command and control.
Debrief
The OIC must facilitate some form of evaluation following the extrication (or training event). This can take several forms:
1. Hot Debrief – This is normally carried out on scene immediately after the rescue (or training session) has been completed. This should be open to all persons on scene and even multiple agencies (Depending upon the type of incident, it may be more appropriate to perform this back at the fire department).
2. Cold Debrief – This is normally at a later date and again should, where possible, involve multiple agencies.
The information discussed in an operational debrief is extremely valuable and both positive and negative points should be considered. A debrief is also a time where OIC’s can ensure the wellbeing and welfare of their team. We must never forget that extrication can be a very stressful event, even for experienced rescuers. The importance of knowing your team on an emotional level is extremely important, especially at times like this, and the welfare of crew members is something an OIC needs to consider long after they have left the scene of an incident.
Conclusion
Command and control of extrication is not easy. It requires discipline and confidence which only comes from experience. How you gain such experience is crucial and should be a mixture of operational incidents and realistic training, both theoretical and practical. The safety of your crew must be your priority as this will form the majority of your actions on scene, both in terms of decision making and positioning. The ability to absorb information, process it and then deliver a fully viable extrication plan to your crew is a very difficult skill and not only takes immense communication skill and operational competence but a high degree of emotional intelligence too. A good OIC should expect to be challenged on scene and a knowledgeable and competent crew should be able to do this, if they believe there is a viable alternative to the original plan.
An OIC has to be a motivator and be able to produce the best from their team without the need for coaching. Finally they must be able to reflect upon the work that has been carried out, and in a group situation via a debrief, provide structured quality feedback that will allow the future development of skills, whilst at the same time rewarding industry and endeavour.
Maybe upon reflection, it might be easier to conduct an orchestra than to manage an extrication team. Whatever your view, as an OIC just make sure your team continues to hit the right notes, time after time, and remember; the baton is optional.
By Ian Dunbar, Rescue Consultant at Holmatro Rescue equipment. Before joining Holmatro, Ian was a Training Officer in the UK Fire & Rescue Service with a background in both technical as well as medical rescue. Ian provides Consultation & Training to emergency services departments around the world.
