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As we pulled out of the firehouse at 0300 hours, the dispatcher informed responding units that they were receiving numerous calls for a serious motor vehicle crash with multiple patients trapped. I relayed the information to the backseat to notify them that we would be going to work. From that point, each member begins to dig into his or her mental playbook in preparation for what awaits. We start to view the accident in our minds; will it be like the last? Will it be something we have not encountered before? Will this be a clean or dirty rescue? There are so many variables: (How many trapped, vehicle types, condition of patients, vehicle orientation, entrapment type, responding crews/units and hazards) that just scratch the surface of a never-ending tactical checklist.

This brings up a question, are you prepared for what awaits you on the modern extrication scene? In reality, this is a preview for a call type dispatched every couple of minutes nationwide.  From the smallest volunteer department to the largest career, are the patients in either area more important than the other? In my humble opinion, a human life is just that, a human life. While teaching I commonly hear, “We only run a couple accidents that require extrication a year and therefore don’t need to train on it as much.” This thought process could actually be no further from the truth. The Fire Service, be it firefighting, extrication, or ems is based off our ability to problem solve.  We must work under pressure, in challenging environments, with critical patients, and many times with limited manpower and equipment. Many times our training is restricted by the ability to acquire cars, provide resources, and obtain department support. Junkyards can be minefields of poor training, from undamaged vehicles to limited troubleshooting required. We must address realistic training while remember what training really is. Training is not “testing”. The training ground is the time to make mistakes. This allows us to look at our shortfalls as individuals and as a team so through positive feedback become better.  Let’s look at some interesting national statistics compiled that just further show the importance of quality extrication training.

Annual United States Road Crash Statistics

  • Over 37,000 people die in road crashes each year

  • An additional 2.35 million are injured or disabled

  • Over 1,600 children under 15 years of age die each year

  • Nearly 8,000 people are killed in crashes involving drivers ages 16-20

  • Road crashes are the single greatest annual cause of death of healthy U.S. citizens traveling abroad

Now that we have briefly looked at nationwide statistical data, there are three key points are extremely high on my training “importance” scale.

One is the ability to make the training as realistic as possible. What do I mean by that? Let’s say your department is staffed with three man engine companies and a three man heavy rescue. On the training ground do you approach staffing realistically, or use twenty-five firefighters working together to mitigate the scenario? If you use the latter of the two, there is no wonder the “flow” of the extrication scene is not there. We have to practice our trade with the staffing hand that we are dealt. If you have six members in the first eight minutes, then train as such! Realism also directly relates to tool selection for the assigned task. For example, if you are responding on an Engine Company that is outfitted with a combi-tool, does it benefit you in training to use the larger hydraulic tools from the Heavy Rescue every time or should you work on the proficiency with your assigned tools?  I think without question, you know my answer.

The second point is to find the best extrications methods for YOUR dept. Yes...extrication methods will vary by department. There are so many variables ranging from staffing all the way down to equipment. I see so many departments gravitate toward large department tactics instead of taking the time to find out what will work best for them. For example, if your department is staffing a 2-man rescue engine as your primary extrication rig, is a full roof removal your best "first" choice for access? Probably not.  

The third and final point is to initially focus and gain proficiency on high probability call types. I think many times training primarily focuses on the lower probability calls involving buses, heavy trucks, crazy orientations, etc.  While training on these calls types is incredibly important, we must first sharpen our skills on our “core” extrication calls that will happen without question. Much hands on experience is gained during the years of training is this type of system. As I have said before, practicing one task until it is nearly automatic allows us to devote more of our brainpower to other more complex tasks.  Practicing skills allows us to not only improve at a particular movement but more importantly helps us respond to a particular situation quickly, calmly and automatically.  This can be a life saving proposition in the fire service, particularly in emergencies involving entrapments.  

Now when we add these three concepts together we can focus on creating a quality-training program for your individual department. Practice makes perfect in sports, music and in the fire service. Through training, when the skill level of your members increases, increase the difficulty and challenge. As the extrication skills becomes more complex and more advanced tools are used, it is essential that firefighters are able to become proficient and able to complete the required interventions under pressure.  Critical decision making is a vital part of any extrication you encounter. The choices you make under pressure will be critical to your patients outcome.  We must constantly work to improve our ability to complete the skills and stay up to date on ever changing new vehicle technology.  Although practice may not always make us perfect, practice will make us better operators and ultimately help to obtain our overall goal. To improve patient outcomes. Now get out there, put your hands on the equipment, create department specific methods, and get ready for the next run.

ISAAC FRAZIER is a Special Operations Lieutenant with St. Johns County Florida’s Heavy Rescue “Squad 4”. First due to the deadliest stretch of roadway in the nation, Frazier teaches from personal street experience providing tried and true tactics. Frazier is the owner of Tactical Advantage Training and creator of the course Tactical Extrication. Frazier travels nationally sharing his passion teaching fire and extrication courses. Frazier is a FDIC lead HOT instructor, FDIC lecturer, Fire Engineering Contributor, Fire Officer II, FL Paramedic, Special Operations Officer, Florida State Instructor, FLUSAR Tech, Diver, and FL Hazmat Tech.

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