Winston Churchill Memorial Trust

To study rapid extrication techniques

and moving vehicles with patient’s in- situ

Firefighter Peter Kirwan

Technical Rescue Instructor
Fire & Rescue New South Wales
 Rapid Extrication Techniques

THE WINSTON CHURCHILL MEMORIAL TRUST OF

AUSTRALIA

Report by - PETER KIRWAN – 2013 Churchill Fellow

THE NRMA – ACT ROAD SAFETY TRUST CHURCHILL FELLOWSHIP to study rapid
extrication techniques and moving vehicles with patient’s in-situ

I understand that the Churchill Trust may publish this Report, either in hard copy or on the
internet, or both, and consent to such publication.

I indemnify the Churchill Trust against any loss, costs or damages it may suffer arising out
of any claim or proceedings made against the Trust in respect of or arising out of the
publication of any report submitted to the Trust and which the Trust places on a website for
access over the internet.

I also warrant that my final Report is original and does not infringe the copyright of any
person, or contain anything which is, or the incorporation of which into the Final Report is,
actionable for defamation, a breach of any privacy law or obligation, breach of confidence,
contempt of court, passing-off or contravention of any other private right or of any law.

Signed: Peter Kirwan Dated: 5th September 2014

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 Rapid Extrication Techniques

Index:
4 Acknowledgements
5 Introduction
6 Executive Summary
7 Program
8 Background
11 Moving Vehicles
20 The Norwegian Rapid Extrication Technique
27 Conclusion
28 Recommendations
29 References

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 Rapid Extrication Techniques

Acknowledgements:
I would like to begin by acknowledging and thanking the Winston Churchill Memorial Trust
for the opportunity they have provided to me to research rapid motor vehicle rescue
techniques.
I greatly appreciate the support provided to me by Ms Linda Cooke and the NRMA – ACT
Road Safety Trust in sponsoring my Churchill Fellowship.
I would also like to acknowledge the following people and organisations for their support of
my research:
Ms Gail Wykes, Director of Education, Fire & Rescue NSW (Professional Referee)
Dr Ken Harrison, Director of Education and Training, CareFlight (Project Referee)
Mr Greg Mullins AFSM, Commissioner, Fire & Rescue NSW
Mr Jan Einar Andersen, Project Leader – TAS, Norwegian Air Ambulance Foundation
Mr Les Baker, Engineer, City of Charleston (S.C.) Fire Department
Mr Garry Nielsen, Station Officer, New Zealand Fire Service
Dr Samantha Bendall, Assistant Director Education and Training, CareFlight
Norwegian Air Ambulance Foundation
Charleston Fire Department
New Zealand Fire Service
Finally, I would like to thank my wife Kim and my two children, Joshua and Sophie, for
supporting my day to day work and Fellowship.

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 Rapid Extrication Techniques

Introduction:
As a firefighter for over 20 years I have attended countless motor vehicle crashes.
In 2009 I became a Rescue Instructor, teaching all aspects of rescue, but particularly
motor vehicle crash extrication. In this role I have taught hundreds of firefighter’s
techniques to assist them to successfully rescue casualties from vehicle crashes.
In striving for continuous improvement, it became apparent that there is virtually no
evidence based research evaluating techniques for rescuing casualties from a motor
vehicle crash. There is, however, significant research on other aspects of road safety. This
includes vehicle design and construction, road design, pre-hospital trauma care and in-
hospital medical systems to promote best outcome recovery.
In 2011, the Australian Transport Council published the National Road Safety Strategy
2011-2020. This strategy is framed by the guiding vision that ‘no person should be killed or
injured on Australia’s roads’. The target for the next 10 years is to reduce the numbers of
both deaths and serious injuries by at least 30% (Australian Transport Council, 2011).
Whilst rescue crews are unable to reduce the injury rate, they may be able to reduce the
fatality rate and improve the casualty’s chance of a better outcome with new and faster
techniques.
This may be achieved through changing the current paradigm in relation to moving
vehicles with patients in them and the adoption of other rapid extrication techniques.

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Executive Summary
Peter Kirwan - Technical Rescue Instructor
Fire & Rescue New South Wales
189 Wyndham St
Alexandria, NSW 2015

peter.kirwan@fire.nsw.gov.au
The NRMA-ACT Road Safety Trust Churchill Fellowship to study rapid extrication
techniques and moving vehicles with patient’s in-situ.

Norway – Mr Jan Einar Andersen, Norwegian Air Ambulance Foundation

United States – Mr Les Baker, Charleston Fire Department
New Zealand – Mr Garry Nielsen, New Zealand Fire Service

Every year, approximately 1,400 people are killed and 32,000 are seriously injured on
Australian roads (Australian Transport Council, 2011). This poses a significant cost to the
community, both in financial and social terms. The reduction of the road toll is a national
priority, and in 2011 the National Road Safety Strategy was released.
The target of the National Road Safety Strategy is a reduction in fatalities and serious
injuries of 30% by 2021.
Rescue services, whilst not specifically mentioned, have an opportunity to contribute in this
vital endeavour.
Adoption of techniques that give rescue operators more options can simplify and speed up
the rescue. This will assist in achieving the ‘golden hour’, reducing rescue time between
the traumatic injury and definitive care of the patient (NSW Department of Health, 2009).
Due to limited scientific research into the effect that rescue services have on patient
outcome, Australia now has an opportunity to become a world leader in this field.
I intend to conduct demonstrations and presentations to the Australasian Fire and
Emergency Service Authorities Council members and other organisations who are
stakeholders in pre-hospital trauma response.
Through a focus on multi-agency training and awareness, rescue agencies have the
opportunity to reduce extrication times for people trapped as a result of a car crash.
With the combined focus of rescue, medical and research organisations, I hope to ensure
modern extrication techniques are implemented, supported and adequately resourced
across a National platform to assist in achieving the National Road Safety Strategy target.

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Program:

Norway
22nd May 2014 – 6th June 2014
Norsk Luftambulanse (Norwegian Air Ambulance)
Drammensregionens Brannvesen (Drammen Region Fire Department)

TAS 3 Course in Kåfjord, Troms

United States
6th June 2014 – 19th June 2014
Charleston Fire Department
South Carolina State Association of Fire Chiefs Conference
Speed, Simplicity, Boldness Training

New Zealand
21st June 2014 – 2nd July 2014
New Zealand Fire Service (Mt Wellington, Papatoetoe, Napier, Hastings, Masterton
and Lower Hutt)

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Background

Rescue or extrication training is generally not based on scientific research. Rather, it is the
collective experience of instructors and practitioners that has been built upon over the
years to form a cohort of key concepts and skills. Perceptions of expected injuries, actual
injuries, as well as patterns of vehicle deformation have generally led to formulation of the
extrication plan for each motor vehicle crash.
It is often taught that the vehicle must be stabilised to prevent further injury to the patient
during the extrication process. This stabilisation process generally refers to packing timber
or plastic blocks between the underside of the vehicle and the ground to prevent any
movement, which results in the vehicle remaining in the position in which it is found by the
responding crews.
As an example, if a vehicle has impacted a tree on the driver’s door, and the driver is
trapped, the vehicle would be stabilised in-situ with the extrication being conducted around
the tree. This process limits access for the concurrent tasks of the medical and rescue
crews as well as to a part of the vehicle that is the most likely cause of the entrapment.

Rescue scenes can become congested by

obstructions and personnel.

Private collection

Skills acquisition and skills maintenance for rescue personnel is generally conducted in
isolation of medical personnel and their associated equipment. Also, training for the
medical stabilisation and treatment of the casualties of a motor vehicle crash rarely include
rescue personnel and their associated equipment. By conducting motor vehicle rescue
training in isolation, it fails to replicate real world conditions.
Other issues also arise at the scene of a motor vehicle crash. These include protection of
forensic evidence for any subsequent investigation and limitation of the effect of the
incident on traffic flow. Whilst these issues should always take second place to saving life,
they may impact on the rescue crew’s plan.
In discussing rescue incidents, most, if not all, rescue operators can recall incidents where
if they had simply moved the vehicle away from an obstruction the extrication would have
been much easier and/or quicker. It is years of training, accepted practice and a belief that
moving the vehicle will worsen a casualty’s condition that prevents them from doing so.

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Ideally, the extrication plan should be developed between the medical team and the
rescue team. Both teams need a realistic understanding of what is required and possible
to achieve the best patient outcome. In order to manage the dynamic environment, both
teams need to communicate their plans quickly and succinctly using a common language
to deal with the multiple demands on site.
The concept of the ‘golden hour’, where the victim of a traumatic injury is at definitive
health care within one hour from the time of injury is widely accepted as the benchmark for
trauma care. The NSW Trauma Services Plan makes reference to the golden hour and
further elaborates on it by identifying, as target criteria, 20 minutes scene treatment time
as one of the three components of the hour (NSW Department of Health, 2009). The NSW
Trauma Services Plan does not mention the extrication of the casualty in the 20 minute
scene treatment time nor includes rescue services as an integral component of a trauma
system. This is not isolated to NSW.
Often the golden hour takes second place to concerns surrounding the perceived condition
of the casualty’s spine. Whilst these concerns appear valid, they may not be warranted;
the spinal immobilisation applied may not be effective and may delay the rescue when
other medical issues may be more pressing.
Hauswald, Ong, Tandberg and Omar (1998), in their study on out-of-hospital spinal
immobilisation, found a greater rate of neurologic injury in patients that had received pre-
hospital spinal immobilisation than those who had received no immobilisation. Additionally,
Grayson and Gandy (2013) reviewed a number of studies that demonstrate that
demonstrate that pre-hospital spinal immobilisation is either ineffective or detrimental for
the patient (Grayson & Gandy, 2013). Grayson and Gandy (2013) indeed postulate that
routine spinal immobilisation provides no benefit to the majority of patients.
Whilst the purpose of this report is not to enter into the discussion on pre-hospital spinal
immobilisation, it is central to the argument regarding moving vehicles with patient in-situ.
It is not uncommon, as a result of a motor vehicle crash, for the casualty to have multi-
system trauma. Injuries other than spinal injuries may be the most pressing medical
emergency for that person.
In Australia every year there are approximately 1,400 deaths and 32,500 serious injuries
due to road crashes (Australian Transport Council, 2011). Paraquad, the Paraplegic &
Quadriplegic Association of NSW, details that there are 350 to 400 new cases of spinal
cord injury in Australia each year, and of those, 52% (approximately 200) are the result of
transport-related accidents both on and off road (ParaQuad, n.d.).
Given these statistics the concern regarding vehicle stabilisation may be over-emphasised
and there are certainly times where moving the vehicle is warranted.
Other situations where the vehicle may need to be moved, excluding medical priorities
include:

path of egress concerns

secondary entrapment
under-rides
side resting vehicle with the patient trapped on the lower side
vehicle in the water

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The risks of moving the vehicle must be considered against the short and long term
outcome of the casualty (Baker, 2011). We identify that preventing spinal injury is very
important. There are life threatening circumstances that may cause spinal precautions to
take second place. There real issue here is that rescue agencies and medical teams in
Australia do not normally train for or practice these techniques together.

In 1999, the Norwegian Air Ambulance Foundation began a training program under the
title of TAS (tverrfaglig auttmedisinsk samarbeid), the English translation being
Interdisciplinary Emergency Medical Cooperation. The TAS program is based on the
model of all attending agencies working together to achieve the best outcome for the
patient.
Training sessions are facilitated by instructors from the Police, Ambulance and Fire
Service with participants attending from each agency. This leads to all responders being
aware of the requirements and key communication points of other agencies at an incident.
TAS 1 Course covered trauma care, CPR and major incidents.
TAS 2 Course was launched in 2003 and focused on the rapid extrication of a victim
involved in a frontal or frontal offset motor vehicle crash. TAS 2 is based on the theory that
too much time was being spent at the scene and that issues such as uncontrolled
haemorrhage and hypothermia were a significant risk to the patient. The premise behind
the rapid extrication technique trained in this module is to reverse the forces of the original
impact and attempt to return the occupant cell of the vehicle to its original shape to speed
up patient extrication.
In 2004, Wik, Hansen, Kjensli and Steen published a paper in the medical journal “Injury’
on Rapid Extrication from a Car Wreck. Wik et al (2004) reviewed and tested the
Norwegian technique and compared it to more traditional dash displacement techniques.
Whilst the sample size was small, the results showed that by using the Norwegian
technique, the time to patient release was halved (Wik, et al., 2004).
Calland (2005) reviewed the extrication of seriously injured victims from motor vehicle
crashes and identified that every incident is unique and moving the vehicle to gain access
to the damaged areas should be considered as an option. Moving the vehicle clear of
obstructions allows rescuers more access to the damaged vehicle and that action alone
can reduce extrication time. The Norwegian technique described above for frontal and
frontal offset collisions may require the vehicle with the entrapped patient to be moved to a
better position to allow the technique to be applied. Calland (2005) proceeded to comment
that subsequent to the Wik et al report, the rapid extrication technique continued to be
taught widely in Norway.
In his conclusion, Calland (2005) highlights the need for medical and rescue crews to be
cognisant of the others needs and that this can occur through joint training.
In 2007, Senior Firefighter (SF) Darren Crawford of the New Zealand Fire Service was
awarded a Firefighters Scholarship, travelled to Norway and investigated the rapid
extrication technique. SF Crawford (2007) identified that the technique would be
“controversial” and to overcome the controversy, firefighters would need to be educated,
not only on the technique, but on the medical and injury aspects of a motor vehicle crash
(Crawford, 2007). SF Crawford’s report saw an operational pilot of the technique
commence at selected rescue tender stations in New Zealand.

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In 2010, Station Officer (SO) Garry Nielsen of the New Zealand Fire Service reported on
the operational pilot. SO Nielsen’s report included debriefs with attending crews following
incidents where rapid extrication techniques were applied. SO Nielsen also conducted
demonstrations of the technique for Police and St John Ambulance personnel where the
technique was received positively. In his conclusion, SO Nielsen identified that that the
technique “has a place as a quick alternative to traditional techniques…” (Nielsen, 2010).
The New Zealand Fire Service also renamed the technique Time Critical Extrication as
they believed that it better reflects the nature of the patient’s status rather than the
extrication itself. Anecdotally, this has added to the acceptance of the technique within the
Fire Service.
The Norwegian Air Ambulance Foundation has completed over 270 TAS2 courses since
2003 and this technique has therefore been used operationally since that time. There have
been no reported increases in injury to the patient or the rescuers since it came into use.

Moving Vehicles

Vehicle position prior to moving it to facilitate Vehicle position at the conclusion of the
the rescue of the entrapped patient. rescue of the entrapped patient.

Private collection Private collection

Prior to moving a vehicle involved in a motor vehicle crash, attempts should be made to
prevent the loss of any evidence that may be required by crash investigators at a later
time. However, if there is an immediate threat to life, all reasonable steps must be taken to
protect the casualty first and foremost.
There are a number of options available to attending emergency services to document any
physical evidence present at the scene of a motor vehicle crash. The first and most
versatile method would be photography and videography. These can both be undertaken
with a smart phone or other recording device.
Multiple angles should be photographed to provide a series of photos for police.
Emergency services personnel should be aware of any relevant agency or government
policy on recording of images at an incident and that the images may become the property
of the police.

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Whilst there may be some benefit in images being kept for training purposes, privacy laws
must be considered. Images that directly identify the casualty or the vehicle should be
deleted, de-identified or consent sought for their use.
Another method of recording vehicle placement is to physically mark the location of the
vehicles prior to moving them. This can be performed with spot or line marking paint,
commonly carried on fire appliances to mark fire hydrants.
A number of different marking styles are in use. One is to mark the location of the corners
of the vehicle on the roadway.

Marking the vehicle corners for later

reference.

Private collection

An alternative, and more popular method is to spray a vertical line down the wheel,
through the wheel centre, and then across the ground out from the wheel. Finally, spray a
line along the ground and parallel to the wheel. This should be performed on all wheels
where possible. This is the method preferred by the New Zealand Police Serious Crash
Investigation Unit.

Marking the wheel position for later reference.

Photo courtesy of the New Zealand Fire Service

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When the decision to move the vehicle has been made, the team leader of the rescue unit
should determine the best method of moving the vehicle.
Moving the vehicle may be performed by methods such as the use of common rescue
tools through to attaching chains or cables between the vehicle to be moved and the
rescue vehicle.
Where the vehicle is within close proximity to a solid object, hydraulic rescue tools or
airbags can be used. By spreading or pushing between the solid object and a strong point
on the vehicle, the vehicle can be moved clear of the obstruction. This may be undertaken
by hydraulic tools such as spreaders and rams or other rescue equipment such as high or
low pressure airbags.

Moving a vehicle away from a solid object using hydraulic

spreaders.

Private collection

Moving a vehicle away from a solid object using

hydraulic spreaders.

Photo courtesy of Mr Les Baker

Consideration should be given to the surface the vehicle is to be moved across as the
vehicle may dig in and subsequently skip or jump.
The distance the vehicle can be moved is limited by the spread of the rescue tool.

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An alternative method to move a vehicle utilising a spreader is to push between the vehicle
and the ground. This technique can be used when greater clearance is required as a
number of ‘steps’ can be taken.

Moving a vehicle by spreading between the

ground and the vehicle.

Private collection

If less friction between the ground and the vehicle is required or the ground is soft or
uneven, a rescue or spine board can be used as a ski or sled.
The leading wheel in the direction of travel is raised and the board is placed underneath.
The vehicle can then be moved with hydraulic tools as previously described or pulled with
a winch.

Utilising a spine/rescue board as a ski to

facilitate moving a vehicle.

Photo courtesy of Mr Les Baker

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 Rapid Extrication Techniques

Utilising a spine/rescue board as a ski to facilitate moving a

vehicle.

Private collection

This technique will also work where a wheel has been removed from the vehicle as a
result of the crash.
To lift the vehicle, spreaders or airbags may be used either from an end or a side.
To reduce the amount of lift required to overcome the suspension sag in order to place the
board under the wheel, the wheel can be strapped up and over the boot/bonnet to the
other side with a ratchet strap or chains. Alternatively, the strap or chain can be wrapped
around the nearest pillar.

Lifting a vehicle to place a spine/rescue board

under a wheel.

Private collection

Winches can also be used to pull a vehicle clear of obstructions. Winches may either be
vehicle mounted or portable. Chains are attached to the vehicle to be moved as low as
possible and, where possible, higher on the towing vehicle to provide some lift.

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Vehicle mounted winch used for rapid extrication fitted to a

Norwegian fire truck.

Private collection

Tirfor hand winch Come-a-long hand winch

Private collection Private collection

Another option is to use the rescue vehicle to relocate the vehicle. The New Zealand Fire
Service highlights that utilising a rescue vehicle to relocate a crash vehicle is a special skill
that needs to be practiced (New Zealand Fire Service, 2014). Utilising a rescue vehicle to
relocate the crashed vehicle can be undertaken in a controlled manner that does not
overly shake the vehicle. Attachment points on the rescue vehicle need to be rated
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sufficiently to cope with the expected load. A rescuer or paramedic should remain with the
casualty whilst the vehicle is being moved and a guide should be provided for the rescue
truck.

Moving a vehicle by dragging with a fire truck.

Photo courtesy of the Norwegian Air Ambulance Foundation

The chains provided by the Norwegian Air Ambulance Foundation as part of the TAS2
rapid extrication course are a 2 leg chain attached to a common ring. Also on the ring are
two shortening hooks to enable each chain leg to be adjusted individually. The ring can be
attached directly to the rescue vehicle or by a cable or chain as appropriate. The other
ends of the chains have a hook that has the ability to be side loaded, allowing the chains
to be ‘choked’ on to an object.

Chains provided by the Norwegian Air Ambulance Foundation for

rapid extrication.

Private collection

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 Rapid Extrication Techniques

Hooks attached to chains provided by the

Norwegian Air Ambulance Foundation.

Private collection

The New Zealand Fire Service has adopted a three leg chain setup. All three legs of the
chains have shortening hooks fitted to the end. To allow the chains to be choked around
an object, a full round turn is required to allow the chain to bite in to the object. The chain
set was developed in consultation with their supplier to ensure the required working load
limit was achieved.

Chains provided by the New Zealand Fire service for rapid extrication.

Private collection
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 Rapid Extrication Techniques

Other equipment that may assist rescue crews attaching chains to vehicles to move them
include ‘J’ hooks, with and without chain or shortening hooks attached and a ‘cluster’ of
different hook types to enable rescue personnel to pick the best type for a given situation.
These hooks may also be found on tow trucks and other recovery vehicles.

A ‘J’ hook and ‘cluster’ of hooks to assist crews attaching chains to a vehicle.

Private collection

To assist in moving vehicles at the scene of a crash, some American fire departments are
equipping rescue trucks with trolley jacks and vehicle skates.

Vehicle recovery skates and trolley jacks are

options to move vehicles at crashes.

Photo courtesy of Mr Les Baker

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The Norwegian Rapid Extrication Technique

Image courtesy of the Norwegian Air Ambulance Foundation

The Norwegian rapid extrication technique is a multi-step approach for the release of a
casualty trapped in a frontal, or frontal offset, crash. It is an extension of the reverse dash
winch technique commonly performed on forward control vehicles involved in frontal
collisions.
It is based on the concept of reversing the crash forces and that the blunt force trauma of
the patient is the most pressing element of the crash.
The technique encourages concurrent rescue activity and leaves the passenger
compartment free for medical personnel to treat the patient. Medical personnel can remain
with the casualty throughout the extrication as the rescue personnel work outside the
vehicle. The technique allows for pause points as directed by the medical personnel,
however once the vehicle is being ‘pulled open’ the time to completion is relatively short.
The technique provides an alternative method of displacing a dashboard that has
entrapped the casualty. It does not require a ramming point, intact sill or ‘B’ pillar to push
from and leaves the door openings free from tools remaining in place to hold the dash up.
It should be noted that the Norwegian technique does not replace existing, traditional
techniques. Instructors and firefighters referred to the technique as ‘another tool in the
toolbox’. Situation and scene factors may delay the set up and the advantages of the rapid
extrication technique may be lost. In these situations, traditional techniques would need to
be applied.
The Norwegian technique can also be applied to heavy vehicles. Where the technique is
applied to a cab-over truck, the cab needs to be anchored to ensure the cab does not tilt
forward. This can be achieved with chains or straps from the cab rearward to the chassis
or wheels.

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Heavy vehicle cabs may need to be secured

to prevent the entire cab tilting.

Photo courtesy of the Norwegian Air

Ambulance Foundation

Not only is the Norwegian rapid extrication technique used in Norway and New Zealand, it
is also used in parts of Finland, Denmark, Sweden and Russia.
A number of key positions exist when applying the technique. These positions need to be
across the technique and be able to communicate clearly. The positions are:

Interior rescuer(may be a paramedic)

Rescue commander
Vehicle driver or winch operator
Communication between these positions may be undertaken by voice or with hand signals.
Application of the rapid extrication technique requires the crashed vehicle to be in a clear
area with up to 30 metres either end to allow space for the pulling vehicles/anchor and
chains.
Once the vehicle is in a suitable location, the vehicle is anchored front and rear. One
anchorage, either front or rear, can be a fixed, immovable object. The other anchorage
needs to be able to apply tension to the crashed vehicle. This may be undertaken with
either a winch or the rescue vehicle itself.
The anchors should be in line with the vehicle to prevent any sideways movement when
tension is applied.
Ideally, the crew should be split into two teams, one for each side of the vehicle. This
reduces the likelihood of personnel crossing tensioned chains.
Note: The following instructions should not be considered ‘training’ in the technique and
agencies should seek further clarification where required.
The following steps are then performed. Where possible, activities should be undertaken
concurrently.

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1. Manage the glass on the vehicle. This includes the removal of the windscreen.

Private collection

2. The front doors of the crashed vehicle are opened to allow access to the ‘A’ pillars.
Although not necessary for the technique, removing the doors completely provides
greater room.

3. The chains are attached to the ‘A’ pillars with the chain leg on the damaged side set
shorter than the other side. Chains should be attached as low as possible on the
pillars.

Private collection

4. Chains are attached to the ‘C’ or rear-most pillars.

Private collection

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5. Attach the other end of the chains to the anchor, winch or rescue vehicle as
appropriate.

Private collection

6. Apply tension to the chains front and rear.

Image courtesy of the New Zealand Fire Service

7. Cut the top of the ‘A’ pillars.

Photo courtesy of the New Zealand Fire Service

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8. Cut through the base of the ‘A’ pillar (‘A’ – sill gusset) as deep as possible.

Private collection

9. At the direction of the interior rescuer, the rescue commander details the front of the
vehicle to be pulled away to open the passenger cell.

Private collection

10. Extricate the patient to a stretcher.

Note: Once tension is applied to the chains, rescuers should avoid crossing them or
working within the red zone identified below.

Personnel should avoid working in the red zones where

possible
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Image courtesy of the New Zealand Fire Service
 Rapid Extrication Techniques

Tools should be passed over the vehicle and returned to the tool dump when not required.
When interviewed, instructors and course participants of the Norwegian technique said
there is substantial benefit from the vehicles being pre-damaged with the appropriate
impact for the training. The Norwegian Air Ambulance Foundation damages vehicles for
training sessions to replicate a frontal offset accident. This is ideally performed using a
crane and dropping the vehicle, or if a crane is not available, through the use of
earthmoving equipment.
The vehicle should be prepared prior for deformation by removing all fluids and batteries to
prevent any environmental contamination.
When using a crane to create the damage, the vehicle is attached to a remote release
crane hook near the tail light on the passenger’s side rear. The vehicle hangs vertically,
front down, and is raised to a height of approximately 27m. This provides for an impact
speed of approximately 80km/h. Once released, the vehicle falls vertically and impacts the
ground replicating a frontal offset crash.

When using a crane to drop the vehicle, the

hook should be placed close to the rear
passenger tail light

Private collection

When using earthmoving equipment, a crush is applied downward between the driver’s
side suspension tower and the base of the windscreen. The earthmoving equipment is
then used to push the front of the vehicle back, towards the passenger cell at the height of
the headlight. This should cause the dashboard to roll back and down onto the driver’s
seat. Depending on style of earthmover, the vehicle may be crushed between the bucket
and the tracks or between the bucket and a substantial object.

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When using earthmoving equipment to damage the

vehicle, the first crush is behind the suspension
tower. The second crush is rearward at the
headlight height.

Private collection

A car damaged, ready for training.

Private collection

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Conclusion
Rescue crews are not generally recognised as part of a ‘trauma system’. Most
documentation refers to a trauma system in a purely medical context. This position is
acceptable in the case of the non-entrapped trauma patient. In the event that the patient is
trapped, no amount of specialist medical personnel and equipment in a major trauma
hospital will be of any benefit to the patient if they cannot be released. Even if a medical
team is bought to the incident, the patient will remain trapped without adequate rescue
services.
The lack of research regarding the effect that rescue services have on the long-term
outcome of motor vehicle accident trauma victims has led to procedures and guidelines
that may not be in the best interest of the patient.
The over-emphasis of the risk of permanent spinal injuries as a result of motor vehicle
related trauma has prevented the use of some techniques which may have the ability to
reduce the fatality rate through more rapid extrication, medical treatment and transport to
definitive care.
The concept of moving vehicles to aid in the extrication process is valid. Access to the
damaged components of the vehicle can speed up the extrication; provide additional
working room for attending agencies and aid in the general management of the casualty.
The Norwegian rapid extrication technique is an option that should be available to rescue
crews. It provides an alternative to traditional techniques for the displacement of the
dashboard without any identified increase in the risk to the casualty or rescuers. It has
been available to Norwegian rescue crews since 2003 with approximately 17,000
personnel trained.
If the Norwegian technique is applied by a portable hand winch, the concept of ‘rapid’ is
lost. The time to access, set up and operate the winch would be longer than utilising a
vehicle mounted winch or simply the rescue vehicle itself.
Damage to the vehicles for training is an important aspect of the rapid or time critical
extrication course and should not be considered an insignificant aspect of the teaching
tools available.
The TAS series of courses reinforces cooperation between agencies and promotes
teamwork. One of the key definitions of teamwork is that all team members are focussed
on the same goal. The interdisciplinary method of training used in the TAS courses helps
to focus all agencies on the overriding goal of extricating, treating and transporting the
patient, improve communication and allow them to use their core skills to work effectively
and rapidly together to achieve a good outcome. It works by having instructors and
participants from each agency at each course. Additional benefits of emergency services
training together are tangible. Through education, incident scenes are not blocked by
attending emergency vehicles, leaving access for rescuers to apply the rapid extrication
technique if required. Police are aware that vehicles may be moved to facilitate the
extrication and are able to take steps to preserve and record evidence. It is well
recognised that “train as you fight” is an important concept in getting it right in high
functioning teams. Damage to the vehicles for training is an important aspect of the rapid
or time critical extrication course and should not be considered an insignificant aspect of
the teaching tools available.

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Whilst the cost of conducting the training may be deemed ‘expensive’, the cost of trauma
to the community is significantly greater. This cost is reflected in both financial and social
terms.
The National Road Safety Strategy aims to reduce the numbers of both fatalities and
injuries by 30% by 2021. The outcome of trapped patients with time-critical injuries, and
the number of fatalities that occur after the arrival of emergency services are areas that
rescue services can have a positive impact on.

Recommendations
1. Rescue services and agencies become stakeholders in their relevant state or territory
trauma institute to facilitate the flow of current trauma care information.

2. State health departments include rescue agencies as part of the state trauma system
to recognise the role that rescue agencies provide in pre-hospital trauma care.

3. Rescue agencies update manuals, procedures and guidelines to allow rescue

operators the option of moving vehicles to facilitate rescue.

4. Rescue agencies adopt the Norwegian rapid extrication technique as an additional

option to current practices.

5. Rescue agencies review equipment to ensure that recommendations 3 & 4 are

achievable.

6. Fire services, police departments and ambulance services co-develop and co-deliver
motor vehicle rescue training to reinforce the team approach to trauma care and motor
vehicle extrication.

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References

Australian Transport Council, 2011. National Road Safety Strategy 2011-2020.

Canberra(Australian Capital Territory): s.n.
Baker, L., 2011. Smooth Movement. FireRescue Magazine, October, pp. 42-47.
Calland, V., 2005. Extrication ot the seriously injured road crash victim. Emergency
Medicine Journal, pp. 817-821.
Crawford, D., 2007. Rapid Extrication, Masterton: Darren Crawford.
Grayson, S. & Gandy, W., 2013. Does Spinal Immobilisation Help Patients. [Online]
Available at: http://www.emsworld.com/article/10964291/prehospital-spinal-immobilizatio
[Accessed 16 July 2014].
Hauswald, M., Ong, G., Tandberg, D. & Omar, Z., 1998. Out-of-Hospital Spinal
Immobilization: Its Effect on Neurologic Injury. Academic Emergency Medicine, March.pp.
214-219.
New Zealand Fire Service, 2014. Motor Vehicle Accident Time Critical Extrication Study
Guide. Wellington: New Zealand Fire Service - Training.
Nielsen, G., 2010. Final Report - Operational Pilot of MVA Rapid Extrication Techniques,
Masterton: Garry Nielsen.
NSW Department of Health, 2009. NSW Trauma Services. Sydney(NSW): NSW
Government.
ParaQuad, n.d. About Spinal Cord Injury. [Online]
Available at: http://www.paraquad.org.au/information-main/about-sci-facts/
[Accessed 16 July 2014].
Wik, L., Hansen, T. B., Kjensli, K. & Steen, P. A., 2004. Rapid extrication from a car wreck.
Injury, pp. 739-745.

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