School Bus Extrication - Part 3: Time to Stabilize
David Pease, Carolina Fire/Rescue/EMS Journal
I hope this finds everyone well and the winter was not too bad. Sometimes it is a slight disadvantage when I write an article or column and it doesn’t reach everyone until several months later. I attended the Piedmont Fire Seminar in Winston Salem and had a chance to talk with a lot fireman. The seminar looked like it went well. I always enjoy going to the conferences, meeting folks and hearing your comments. I was also honored to be the guest speaker and assist with the installation of the new officers for the Wilson County Rescue Squad in January. My hat is off to all their hard work and dedication.
In the last two columns we have looked at how buses are constructed and how they operate. This is always a consideration when trying to gain access into the bus. We are now going to look at stabilization of the bus so we can safely gain access and remove our victims. One thing that needs to be considered, it is rare that you will ever have someone pinned in a bus. Passengers will get thrown around, sustain traumatic injuries, along with cervical injuries, but rarely will they be pinned in the bus. Your primary mission will be to gain access, survey your patients, stabilize them and then remove them from the bus.
Before we get into some of the techniques of stabilizing the bus, we need to look at the scene and command actions that need to take place. The term “IAP” refers to the Incident Action Plan, something that needs to be considered and used at any major or minor incident. Most departments don’t preplan for a bus emergency, but maybe we should. Having been involved in several bus crash responses, things can get rather chaotic real fast. It is amazing how parents can find out their child has been involved in a bus wreck, show up on scene, and you are still working the wreck. Not only do you have to consider the rescue / extrication aspect of the incident, but how many medic units you will need, can the local hospitals handle the number of patients you will be sending, and soon the media will be knocking at your door. Some years back, I responded to a bus wreck with approximately 20 children onboard. All had sustained minor injuries, but I felt in my best judgment that they all needed to be checked out at the hospital. One of those CYA things, you know!
Well to transport over 20 children to the hospital was going to tie up quite a few medic units, so I made the decision to transport all of them on one unit! I am sure you are wondering how I stuffed 20 kids in a medic unit, and somewhere along the way I must have lost my mind. Well, since all the patients had only minor injuries, I kept them all on the bus and that became my transport unit. I had the ambulance follow me, the bus driver, and all the kids to the hospital. I had my medical gear onboard and assessed all the patients, along with taking their vital signs. I did call the hospital ahead of time and make sure we could transport them all to that one facility, instead of taking them to several different facilities. This is thinking out of the box, but it worked quite well.
You could very easily have 20 children, and they all have to be transported by ambulances. You may have to send them to different hospitals and require a multitude of medic units. This is where your IC and IAP come into play. Not only will you be dealing with the injured patients, there will be many “wanting to help” bystanders, the media, and probably some of the family of these children. Trying to maintain control and get the job done can be quite taxing. Having a bus extrication class and drill can help you prepare for this type of incident.
Now, the first thing we need to do is assess all the hazards. This includes, but not limited to, fuel spills, electric lines, traffic conditions, bystanders, and the stability of the vehicles involved. Before entry can be made, the bus will need to be made stable. This could be a rather simple process of chocking the wheels, or could involve extensive cribbing. Each situation can, and will be different. The good thing is we know that buses are extremely well built and stable. This will help us in our ability to safely stabilize the bus and other vehicles that may be involved.
A point to remember when stabilizing any vehicle is that you should always try to obtain at least four points of contact. Now, the fact that the bus may be on all four wheels does not necessarily constitute four good points of contact. Remember, that the bus can still move side to side from its center axis. The bus’s mere height may allow it to move and shift, so you may have to crib it regardless. Cribbing and stabilizing a bus can take a large amount of cribbing, so you should have plenty on hand or look at other stabilization options, such as rescue jacks or struts. These can save you time and cribbing.
If the bus is on all fours, you should consider cribbing the four corners to prevent any shifting or rolling from side to side. High lift jacks would be another option for the corners. Also make sure you chock at least two tires and chock them on both sides. If the bus has flipped on its side, it could be relatively stable if it is on level ground. Placing wedges or step cribs under the outer perimeter of the bus will help keep it from sliding and shifting. If the bus is on an incline, it becomes a whole new problem. Consider putting straps or cables to the upper side and attaching to a good solid anchor. If you have rescue type jacks or struts, they can be placed on the lower side, once the upper side has been secured. This should keep the bus from shifting or sliding. Remember that you can use good solid trees, guard rails, your rescue of fire apparatus, and even a properly set picket system. If you use the one of your apparatus, make sure the wheels are chocked and the vehicle can’t or won’t be moved.
If the bus is resting on another vehicle, then four points of stabilization should be established. When using 4” x 4” cribbing, a block crib technique should be used. When using a crib block system, you can only stack the cribbing twice the length. So, if your cribbing is 24” long, then you can only stack 4ft. If you are using 3ft cribbing, then you could stack 6ft high. You can quickly see that having enough cribbing for this type of stabilization can be quite a task in itself. The stabilization jacks or struts are a good compliment for large vehicle stabilization and extrication. Also remember, you can use straps, chains, or cables to help secure the bus, or a combination thereof.
Be sure and survey the angles and weights of the bus so you can determine which way the bus could shift or slide. If you are going to work in the bus to remove patients, you must stabilize the bus so no movement will take place. Good stabilization is something that should not be overlooked in your IAP. The SAFETY of your rescuers is always your number one consideration.
I realize that it is hard sometimes for departments to acquire a bus for extrication training. One approach you might want to consider is asking to use the bus for training, but that you will not cut the bus up or destroy it in anyway. See if the salvage yard will let you practice cribbing and stabilization on the bus. Let them know that you will not be cutting on the bus, but only practicing your stabilization techniques. Perhaps you can even get them to turn the bus on its side or another vehicle. You get to practice your techniques and they still have a bus they can use for salvage.
Remember to always train hard and to your best, because the life you save one day, may be your own. Stay safe and feel free to email or contact me anytime.