Four challenges to extrication in a tunnel rescue
Resource management is key to overcoming access, patient transportation and ventilation challenges in a tunnel rescue
Two New Jersey Transit buses recently collided in the Manhattan-bound tube of the Lincoln Tunnel. Firefighters and EMS faced Friday morning commuter traffic to assess and treat more than 30 injured in the crash.
When responding to these types of emergencies, rescuers will face four key challenges that will significantly increase the degree of difficulty:
1. Patient access
Access begins with establishing the size-up. In many instances, the crash itself will not be accessible from the initial staging point. Gridlock may have occurred due to restricted lanes coming into the tunnel, making the scene itself remote and removed from view.
Directing dispatch to gain as much information as possible from the caller will help make appropriate decisions regarding personnel and resources that will be required for the rescue operation.
Pre-plan responses to the tunnels and restricted areas in your response area so you can identify alternative means of access if available. Place resources at optimal access points to ensure you can support the operation and be initially versatile in your approach. Putting all of your eggs in one basket by establishing a singular staging point may backfire if the dispatch information doesn’t line up with the actual event.
2. Resource management
Resource management will have a profound impact on the success of any tunnel rescue operation. Before you can determine what equipment you need, you need to verify the nature and magnitude of the event.
It may be advisable to deploy two different crews. The initial crew can be deployed as a fast attack recon team with a secondary crew in stand-by until they identify additional resources that may be needed. If you don’t have the personnel to support this concept, then go in loaded for the worst-case scenario so that you are not shuttling personnel back and forth between the staging point and the actual scene.
Utilizing equipment with high degrees of portability and sustainability for a restricted access rescue is essential. For extrication tools, battery-powered platforms are ideal. Battery-powered tools will eliminate the need for gas-powered power plants and hoses, and allow the initial crew to gain access and begin working much more efficiently. For sustainability, bringing additional batteries and a single lightweight generator for a 110 adaptor is a much easier approach than lugging the gas-powered hydraulic power plant and all of the hoses.
Most battery-powered tools are also equipped with integrated LED lighting. This potentially eliminates the initial need to bring in scene lighting and allows the rescuers to operate more safely and effectively. The scene will most likely be chaotic, and extremely congested and confining regarding obstructions and limited access. Managing hydraulic hoses would be challenging.
Fire control may be an additional challenge in stretching lines. Go small and lightweight, and seriously consider pro packs or foam-based applications. If hybrid vehicles are involved or commercial vehicles with greater fire loads, then the focal point of this facet will require more thought and resources to manage. Extinguishers may be your best bet with the initial size-up or recon crew if no fire indicators are present on the initial dispatch message or external size-up.
Lifting and or stabilization efforts will also have to be considered. Struts that offer lifting capabilities and large step chocks will be optimal initially. Both of these are versatile pieces of equipment that are relatively lightweight and do not require additional operating sustenance, such as an air source with air bags.
3. Adequate ventilation
Rescuers need to remember that they will be operating in a somewhat contained environment that may not adequately ventilate all of the potential CO buildup. While making your way to the scene, rescuers should be encouraging by-standing motorists to shut off their vehicles.
Reducing combustion engine byproducts by going battery powered will also help eliminate the need to establish additional ventilation and atmospheric monitoring.
4. Egress/patient transport
Once the patients are accessed, identify medical treatment requirements quickly and request appropriate resources. Develop an egress plan and establish your landing zones or pickup points for EMS.
Getting the patients to the points may be challenging depending upon the configuration of the tunnel, distance to travel and obstructions within the tunnel.
For example, access coming into the tunnel may be extremely congested if accessing from the incoming side with traffic flow. However, the traffic flow outlet side of the tunnel may be completely free, allowing secondary access coming in against the designed flow of traffic. If accessing the tunnel from the outlet side, ensure that proper safety measures are in place through law enforcement or ancillary personnel to manage traffic and any other potential hazards.