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3 May 2024
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Featured FRI Magazine article: Bus accident rescue strategies by Colin Deiner, chief director, Disaster management and Fire Brigade Services, Western Cape Government (FRI Vol 2 no 2)

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A tour bus might present the problem of foreigners who might not be able to speak the same language as the responders
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A vehicle on its wheels will require a fair amount of timber to reach the base of the body
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Fire fighters receive training in school bus roll-over and pinning
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Arlington Fire Department, Texas: crews learning how to get people out in the event that all of the exits were blocked
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Uvalde, Texas, first responders treat students at the scene of the rollover accident involving a school bus
​https://www.frimedia.org/uploads/1/2/2/7/122743954/fri_vol2no2_lr.pdf

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This week’s featured Fire and Rescue International magazine article is: Bus accident rescue strategies written by Colin Deiner, chief director, Disaster management and Fire Brigade Services, Western Cape Government (FRI Vol 2 no 2). We will be sharing more technical/research/tactical articles from Fire and Rescue International magazine on a weekly basis with our readers to assist in technology transfer. This will hopefully create an increased awareness, providing you with hands-on advice and guidance. All our magazines are available free of charge in PDF format on our website and online at ISSUU. We also provide all technical articles as a free download in our article archive on our website.
 
Bus accident rescue strategies
By Colin Deiner, chief director, Disaster management and Fire Brigade Services, Western Cape Government
 
The huge reliance of the majority of South Africans to use public transport (often over long distances) carries the potential risk of accidents with large numbers of casualties. The structure of many of the busses used, as well as the lack of passive restraint systems and the kinds of protection systems found in new cars, generally worsens the situation and presents rescue and medical responders with a range of extrication challenges that are not always that easy to prepare for.
 
The successful management of any major accident with multiple casualties is built on five main pillars:
  1. Adequate response preplanning.
  2. Sufficient equipment and medical rescue supplies.
  3. Staff trained for bus-rescue.
  4. Effective medical response capacity.
  5. Effective incident command.
 
First responders
First arriving units will be confronted by a myriad of challenges and must give priority to an effective early size-up of the situation before zeroing in on the screaming, bleeding patients (of which there will be many). The initial size-up must be done as comprehensively as possible as it will set the focus for the rest of the operation. If it is done haphazardly at this point, it will take a long time to get control and focus efforts where they are needed the most.
 
The areas on which the first arriving commanders should focus include the following:
 
Incident command
The first task should be to establish a strong and visible command. There will be a number of responding agencies who each have their own priorities. It will be difficult to try to establish a command structure and get everyone to work within the structure if it is being done for the first time on the scene. Response preplanning must include all responders including private ambulance services, traffic control services and police. It will probably not be an easy meeting and I don’t wish to enter into a discussion on who is responsible for what here suffice to say that it must be agreed to and adhered to before the incident. Secondly, once a standard operating procedure is developed, every single responder must understand where they fit into the structure and what is expected of them. This should allow everyone to seamlessly augment one another and create a relatively painless establishment of command.
 
Hazards
Prior to approaching the accident scene, efforts must be focussed on identifying and securing all visible and perceived hazards. This includes fires, downed electrical lines, fuel/oil spillages and unstable vehicles. The instability of a heavy vehicle such as a bus, could override all activities in certain circumstances. An overturned bus with all its roof pillars collapsed is probably the biggest nightmare (second to a submerged vehicle) any rescue team could face. Stabilisation should not be as big a problem initially but will start to become more prominent as the rescue efforts increase. Cutting holes into the sides of the bus could cause severe instability and it will be important to check vehicle stability at regular intervals.
 
Weight and height are instant challenges to rescuers when working with busses. Understanding weight is important to properly stabilise the vehicle.
 
The windows are generally fitted with laminated glass and are typically held in place by a gasket. It can be removed by pulling the centre bead of the gasket with a pair of pliers or small pry tool which will then allow the windshield to be removed as one piece. This reduces the small shards of glass typically produced when using a reciprocating saw or standard window saw.
 
Fuel tanks are typically held in place by metal bands attached to the frame and could possibly be damaged during the crash. The size of the vehicle and attached fuel tank could cause a large fuel spill that must be addressed immediately.  During size-up, rescuers must pay close attention to the tank, as hydraulic oil can also be stored in side-mounted tanks that can be mistaken for fuel tanks. The hydraulic tank is typically smaller than a fuel tank and there will also be a hydraulic line that does not run to the vehicle motor.
 
Number of casualties
There are likely to be many casualties with a wide range of traumatic injuries. Depending on the type of transporter and demographics of the occupants, this could offer a different set of challenges. A school bus accident will obviously present a large number of injured children while a tour bus might present the problem of foreigners who might not be able to speak the same language as the responders.
 
The absence of a passive restraint system could cause people to be thrown free of the bus and, depending on the type and mechanism of the accident, leave them spread over a large area. Some victims may not be immediately visible and it is important that the area is searched to ensure that all passengers are accounted for.
 
We have spoken about how easily an incident with many casualties can overwhelm responding agency. The solution is to call for sufficient help early. The many ways that we communicate in the modern world would generally mean that a mass of responders will descend upon the scene very early on. Ensure that a primary and secondary staging area is identified very early on and that all incoming units are directed to stage where they can be most effectively utilised.
 
Primary staging is the area where first arriving units will gather. They will generally be placed in the most advantageous spot for their specific type of operations. Secondary staging refers to the area where all second response units are placed and called in when and where necessary. This practice provides the incident commander with an organised system to identify all units on scene and allows the movement in and out of the accident scene in an orderly manner. It will be necessary to assign someone to manage the staging areas. This person needs to record the arrival (and capability) of each arriving unit and relay this information to incident command. As and when it is required, command will request a specific unit which will then be released by the staging officer.
 
There are few situations more confusing than EMS crews transporting patients to any number of hospitals without informing incident command of their activities. A strong control must be in place for this eventuality and record must be kept of all ambulances and helicopters leaving the scene.
 
Contact should also be made with the receiving hospitals that should be advised to activate their mass casualty plans if they are to receive the bulk of the patients. Information on specific injuries or situations such as exposure to hazardous materials should also be provided to the hospital emergency unit.
 
Incident command
An incident commander will have more than just the accident scene to deal with. Uninjured passengers, media, relatives and friends who learned of the accident and onlookers will quickly overwhelm the scene and it is vital that law enforcement units on scene be deployed immediately to deal with this.
 
You will need to appoint a communications officer to keep relatives, the public and media updated on events and to take the pressure of you. It would be best to consider a point fairly distant from the scene itself and to direct everyone there. This might be difficult due to anxious relatives and inquisitive media but necessary and must be given some priority.
 
The next important step would be to establish a triage area to deal with all patients. A fair number of patients will be walking wounded and will be able to free themselves from the wreck. They will however, have to be accounted for and they should also be directed to the triage area where they can be assessed and registered.
 
The medical officer must keep record of each patient’s injuries, treatment and to which medical facility they are transported (more of this later).
 
Equipment
A rescue evolution on a bus might require a slightly different approach to equipment than a standard light motor vehicle rescue and will require tools that can be moved into and operated in more confined spaces than standard heavy hydraulics. A lot of the cutting work will be done with reciprocating saws which are lightweight and the tool of choice for cutting through composite panels which normally constitute the side of a bus. Certain important issues must be noted when working with reciprocating saws:
  • Always anticipate the blade path. An uncontrolled cut can lead to serious injuries. Ensure that you have enough hard protection to place between the blade and any persons in the immediate vicinity.
  • Use the right blade and make sure that you have sufficient spare blades as you are likely to run through a number of them during a single cut.
  • Although battery powered reciprocating saws have easier manoeuvrability than electric saws, it does tend to run out of battery power relatively fast. Either ensure that you take along enough replacement batteries or revert to the electric model.
 
The use of exothermic cutting equipment should be avoided due to the proximity of flammable materials and possible fuel spills. If this is the only option, ensure that the area is adequately protected on all sides before commencing with the cutting work.
 
The rescue rated air chisel is still the best tool for cutting through panels as there is no exothermic reaction and a much closer control can be achieved.
 
A wide range of additional prying and lifting tools will be needed in this multi-faceted operation and should be placed in a well-managed and easily accessible tool staging area. Any tools removed from the staging area should be returned immediately after use as a number of rescue evolutions will be happening at the same time with the same equipment. Don’t tie a piece of equipment up in an area when it may be needed somewhere else.
 
Stabilisation
As in light motor vehicle rescues no one should enter or touch the bus until it is adequately stabilised. Busses are large vehicles generally weighing in excess of 12 tons and require stabilisation over a larger surface. Due to their design and construction busses also have mainly flat surfaces which will allow for a fair amount of “natural” stabilisation.
 
A vehicle on its wheels will require a fair amount of timber to reach the base of the body and services having access to a trench collapse unit or heavy rescue squad should consider carrying more 150mm x 150mm (6”x 6”) blocks in place of the more common 100mm x 100mm (4”x 4”) blocks. The larger and more stable 6x6 cribs should overcome the problem if the vehicle is on a level surface.
 
Vehicles perched on top of other vehicles or road barriers will offer a different challenge and could require the application of a crane truck to take up the open space which has been created by this incident. If rescuers are required to work under a heavy vehicle an on-going cribbing operation should be put in place to protect the rescue team.
 
Vehicle rescue struts can also be used to prevent horizontal movement of the vehicle on its side.
In passenger cars, it’s a common practice to stabilise the vehicle by deflating the tyres. But when stabilising a bus, this should not happen. Due to the height of the bus a movement of 30cm on one side may cause a drastic tilt, resulting in further injury of the occupants and for the bus to be moved or towed, it will need its tyres inflated.
 
Extrication
Due to the lack of passive restraint systems you will most likely be confronted with patients in every conceivable position. People could be trapped by seat backs following a roof collapse in the event of a rollover. You will have to ensure that when the initial access route is made, that no one who might be trapped on the other side of the panel (and is not visible) gets injured in the process.
 
Consider establishing an access route and separate egress route through which to move patients that have been freed. Flow is critical; victim removal will be slowed if rescuers rush into multiple openings without leaving an exit route. Clearly mark entry and exit points during rescue operations to maintain the flow of victim removal.
 
If the bus is on its side, the front window can serve as the entry point and the rear window as egress. Side windows can also be used if some sort of vertical rope system can be rigged above the openings. If the bus is on its roof, use the main entrance as the entry point and the rear window for egress. These openings will largely depend on the structural integrity and positioning of the bus, along with victim location.
 
Doors can be jammed or heavily damaged but if it is the best route, then a door displacement using hydraulic equipment should be the best option. Should this not be possible you could use reciprocating saws to remove the entire frame.
 
Remember the old rule: “try before you pry”. If the occupants can open emergency exit windows, doors and/or roof hatches or rescuers can access the interior through them, it will obviously make life much easier for all. Operating locking mechanisms from the inside must always be considered as a first option.
 
When major metal relocation is needed, teams must totally remove the structural members to eliminate the overhead hazard.
 
Medical management
The medical component of a major bus accident will generally be divided into the following sectors:
 
Triage sector
The purpose of triage is to categorise patients based on the severity of their injuries, prioritise their need for treatment and transportation and stabilise life-threatening injuries.
 
A senior medical officer should be placed in charge of the triage sector and this person will have the responsibility to ensure the accountability and prioritisation of every patient on scene. This will include:
  • The location, number and condition of patients.
  • Positioning of the triage area (in place or at the entrance to the treatment area).
  • Resources required.
  • Assignment and supervision of triage personnel.
  • Ensure the provision of life-saving emergency medical care as needed and that patients are accounted for and tagged appropriately.
  • Safety and accountability of all assigned personnel.
  • Frequent progress reports to command.
 
The triage officer must take care to ensure that resources are prioritised and do not focus on a specific patient while others are neglected. It is here where sometimes the hard decisions have to be made to sacrifice the life of a critical patient in order to save the lives of others who might have a better chance of survival. Certainly the choice that none of us wish to have to make but that we need to be prepared for.
 
Patients should be triaged and tagged before movement to a treatment area. High priority patients are moved first, followed by less serious patients. Should an imminent life safety hazard exist however, it might be required that triage be performed away from the hot zone.
 
In a large incident, it may be necessary to establish multiple triage locations. There should always be good communication between the extrication and treatment sector officers.
 
Once triage has been completed triage teams can be reassigned to the treatment sector as this will be the most personnel intensive sector.
 
Treatment sector
Responders allocated to this sector are responsible for the actual treatment and emergency care of the patients.
Their responsibilities will include:
  • Decide whether treatment will occur “in place” or in a designated treatment area.
  • Determine resources required.
  •  Identify and establish a treatment area. In the event of a major incident, establish separate sectors based on the priority of patient injuries. 
  • Ensure that all patients entering the treatment sector have been triaged, assessed and re-triaged as needed.
  • Priority treatment and packaging of patients.
  • Provide progress reports to incident command.
 
The decision to treat a patient “in place” will be dictated by issues such as the degree of entrapment or condition of the patient. This decision should be taken in collaboration with the extrication sector chief and the triage sector officer. As soon as the initial treatment and/or release have been achieved, the patient should be moved to the treatment area.
 
Transportation sector
The transportation sector will manage patient transportation from the scene to appropriate medical facilities. Their responsibilities will include:
  • Provide resources
  • Establish a helicopter landing site if required.
  • Determine hospital availability status.
  • Coordinate patient allocation and destination with treatment sector.
  • Supervise the movement of patients from the treatment area to the ambulance staging areas and helicopters.
  • Maintain an accounting system of all patients and their destinations.
  • Provide progress reports, allocations and estimated arrival times to receiving hospitals.
 
Finally
I have really only touched the surface of this complex issue. It is up to each potential responder to take the time to study the construction of the kinds of heavy vehicles that he/she may encounter and train to deal with them effectively and in a way that provides maximum survival potential for the victim. The need for some extra equipment such as reciprocating saws, air chisels etc must be considered. Don’t tie your entire rescue capability up into your hydraulics. As good as they can be, you might have to work in more than one site on a heavy vehicle and for that you need the right tools and enough of them.

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