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Extrication Size-Up

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When I think of a size-up I always picture the structure fire where you walk around the building and gather information about the scenario.  During your 360 you check for a lot of things; windows, building layout, and the extent of the fire. 
 
You also can get a lot of information from occupants of the building, and witnesses.
 
When I think of an accident I think of a much smaller incident with less things to think about.  In reality an accident scene can have just as many things to evaluate.  Some things you evaluate are the same as a structure fire, but there are also a lot of differences.
 
One of the first things to be concerned with at an accident is keeping your crew safe from traffic hazards.  I can’t emphasis enough how important it is for someone to be responsible for keeping the crew safe from all the other cars and trucks on the road. 
 
I have been on a lot of incidents on the roadway where people looking at the scene we were working on weren’t paying attention to the traffic and either went off the road or rear-ended some one. Drivers don’t pay attention these days so we need to. 
 
Make sure your crew all parks properly and that the roadway is closed if necessary.  If you are the incident commander it is your job to decide how many lanes need to be closed, not the police. 
 
Incident commander is responsible for the safety of his crew, the police are concerned with keeping traffic moving.
 
Determining the number of patients can sometimes be difficult.  If there is no occupant of the vehicle able to communicate with you items in the car need to be investigated to see if there are additional people involved in the accident.  Car seats, lunch boxes, and clothing can all give clues regarding the number of possible victims. 
 
Sometimes the only way to ensure there are no additional victims is to search a large area around the accident.  I have been on incidents were we found additional seriously injured victims in bushes a surprisingly long distance from the accident. 
 
In a recent car vs. pedestrian accident the pedestrian was walking pushing a stroller.  I don’t think I have ever seen an empty stroller being pushed, but this time the lady was pushing an empty stroller to the store, I guess to carry her groceries home.  Not a normal situation, but I would have invested a lot into looking for that baby from that stroller.
 
We are all quick to call for extra manpower and equipment at a structure fire, but we are reluctant to call an extra alarm for an extrication.  Extrication work is very strenuous, especially in hot weather.  I have seen crews worked well beyond their limit on a hot expressway.  If an extended operation is expected make sure you get extra resources enroute. 
 
Crews working an extrication will never tell you that they need to be replaced, be sure and keep track of how long and hard crews are working and replace them when needed.
 
Different incidents have different priorities, but your job remains the same.  Assess the entire incident, keep your crew safe, and do your best to undo what has gone wrong.  No matter what the incident the incident commander’s job remains the same. 

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