Advanced Training Cuts Car Crash Extrication Time

Researchers at the Medical College of Wisconsin continue to explore ways to improve outcomes for victims of automobile crashes. Using a full-scale vehicle crash laboratory and facilities dedicated to the study of impact biomechanics, they are working to enhance the team skills of emergency responders and reduce the time it takes to get people to trauma centers, as well as improving how they deal with serious injuries.

One test conducted in 2005 showed that advanced training enabled a team of firefighters to significantly reduce the time it took to extricate two dummies from a mock car crash. Working in collaboration with SAFE (Safe & Fast Extrication, Inc.), the researchers set up a drill scenario of a T-bone crash (in which one car hits the other in the side) with two cars colliding at 40 miles per hour. The firefighters took 57 minutes to complete the extrication before the training. After the training, the same firefighters did the job in less than 20 minutes.

"There are two aspects to the extrication that we deal with," said Frank A. Pintar, PhD, Medical College Professor of Neurosurgery. "The SAFE organization actually trains the firefighters to improve their extrication methods. By extrication I mean moving metal in the vehicle to free an occupant so that they can be taken to a Level One trauma center. Dealing with the car issues and getting the person out of the car is the first aspect.

"The other aspect is the way severe injuries are dealt with. What do you do with a spinal cord injury patient? What do you do with a person who has a collapsed lung? Those issues are more medical and we've just scratched the surface on how we could actually improve those immediate first-responder methods when applied to the victim of the crash.

"So, in spinal cord injury the first step we've taken is to see how the stabilization procedures currently in use affect the movement of the head-neck complex of an injured occupant. We do that we with sophisticated monitoring equipment, something no one else seems to be doing right now."

The "Incident Commander" Approach
Firefighter training and certification in Wisconsin is defined in levels: level one is sufficient to work as a firefighter but does not include crash extrication; level two includes extrication but is not required by the state. The advanced training used in the research goes beyond the current levels and indicators to date show that it will save lives, said Dr. Pintar.

"We were actually quite surprised at how that extrication time could improve so dramatically," said Dr. Pintar of the staged field test. "But watching several firefighting teams do this in different circumstances helps our understanding. That's the reason why our crash lab has a consistent scenario for them to work on, so we can actually measure the differences.

"The advanced method has a team approach with a single 'incident commander' who calls out signals and looks at the operation from the whole perspective. The commander is an experienced responder who assesses the situation and is barking out orders. The rest of the team is following those orders and all of them have roles, so everything is happening at once. We've seen that the teams without an incident commander extricate more slowly. Having someone in charge who is not otherwise distracted, keeping things organized, seems to be a very critical part of reducing time."

"Cross Training" and the Golden Hour
Another aspect of the advanced approach could be called "cross training," being sure that several individuals on a responding team are able to use all of the available tools. "With everyone trained in multiple tools, the incident commander can say 'remove the windshield glass' or 'stabilize the car' and they'll pick up the appropriate tool to do the job," Dr. Pintar notes.

"If all of the individuals are trained on multiple tools to accomplish the same thing in different ways, that saves time. For example, you don't want to have just one person that can use Jaws of Life (a device that can literally pull a car apart). We've seen incidents where one person in a unit was trained on Jaws of Life by the manufacturer, so nobody else will even touch that equipment if that person doesn't show up.

Dr. Pintar noted that current training conducted at state technical colleges shows firefighters how to work with the tools and how to perform specific procedures such as removing car roofs, but it does not give the team approach training at the advanced level. While a few departments are now using advanced training, he said, it will not be widely available without changes in state requirements and a modest dedicated funding source. Funding to train additional units at the advanced level is being applied for, said Dr. Pintar.

"Teams perform vehicle crashes more often than they fight fires," said Dr. Pintar. "The more units that we can get out there with advanced training, the higher your chances of surviving these crashes. Period. Imagine going from 60 minutes down to 20 minutes for extrication, and getting to the hospital in time. That means there's a chance of not bleeding to death, a chance of stabilizing an otherwise un-survivable crash.

"It's the 'golden hour' principle," Dr. Pintar notes, referring to the belief that getting a victim to the hospital within an hour greatly increases the chance of survival. "That's the goal of SAFE. They strongly believe that in every crash, no matter how challenging, the people should be out within twenty minutes or less. A rollover, in a ditch, up against a wall, whatever, they believe that if it's a properly trained unit they will know what to do to get the job done safely and quickly."

Dan Ullrich
HealthLink Contributing Writer

Funding for this research was provided partly by the CDC Injury Research Center at the Medical College of Wisconsin, the Department of Veterans Affairs Medical Research, the National Spinal Cord Injury Association, and the Department of Neurosurgery at the Medical College of Wisconsin.

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