The evolution of automobile design and technology, including safety devices, has affected patient injuries and treatment for first responders significantly. The newest construction techniques have positive and negative effects on injuries that are inflicted in a collision and on the treatment that’s given by EMS.
As many know, a substantial portion of motor vehicle accidents only have ambulances dispatched to them unless the incident is upgraded by someone. This means that EMS can arrive prior to arrival of fire/rescue. Therefore, the basics of automobile design are important to EMS, because EMS providers should try to gain access while they wait for rescue to get on scene. If EMS waits, those people delay patient care, which, by the way, is a case for gross negligence.
Unfortunately, EMS doesn’t get more than 3–4 hours of extrication training in EMT or paramedic training, unless these people are cross-trained. EMS must have more information, particularly in regard to newer automobiles. For example, getting a heavier patient out of a newer-designed seat isn’t an extrication problem; it’s a package and removal issue for EMS. However, a bad mindset that proliferates is that it must be fire/rescue personnel who remove entrapped patients. Not so. Fire/rescue and EMS must work together for better patient safety (e.g., patient entanglement), victim packaging and patient treatment before removal. It only is a matter of time before such a circumstance ends up in court. EMS providers must understand the extrication process, and rescue teams must remember the EMS goal of not harming a patient further.
New complexities
The construction of the newest automobiles can pose challenges. First responders must deal with complex and potentially unfamiliar systems, such as electric and hybrid powertrains, air bags, seat design and seat belts. These systems might pose hazards, such as electrocution, fire and explosion, and might require special tools and techniques to extricate victims safely. Additionally, new automobile construction might affect the types and severity of injuries that EMS encounters, because injuries that are inflicted by newer automobiles can differ from those that are caused by older automobiles. For example, some studies suggest that the construction of the newest automobiles might increase the risk of lower extremity injuries, such as fractures and amputations, because of the increased stiffness and intrusion of the vehicle structure.
Improved safety systems
The newest automobiles have enhanced safety features, such as crumple zones, more and new types of air bags, and reinforced frames and structures. These features can reduce the severity of injuries in a crash, potentially leading to fewer critical patients for first responders to treat. Over the past several years, I observed that when occupants wore a three-point restraint system correctly, in crashes that occurred at a speed of slower than 45 mph, many walked away from the collision. On the other hand, in crashes that occurred at faster speeds, new automobiles’ encapsulated designs made extrication and removal more difficult.
Prior to the enaction of 2015 federal safety updates, automobiles contained soft metals. Today, high-strength steel and alloy metals are more the rule than the exception. Support systems make side impacts less destructive by channeling the force of the impact into automobiles’ posts. Dashboard support systems increase protection of the passenger cabin, too. The 2024 Tesla Cybertruck has an exoskeletal support system. In other words, the vehicle is reinforced from the outside instead of internally (endoskeleton). In the future, who knows how this type of design will change injury patterns and extrication techniques.
Harm to first responders
As of 2024, automobiles might have as many as 19 air bags inside of them. The air bags can be located in more than 30 places.
Undeployed air bags pose significant safety risks for first responders and trapped victims at accident scenes. Being hit by an air bag can be fatal.
Never forget that air bags only are deployed when someone sits in that seat. So, if you find an air bag deployed without a victim in that seat, the victim was ejected, and you must find that individual.
When an automobile still has lights on, its low-voltage battery or another power source, such as a stereo capacitor, is intact. In these cases, the automobile is considered “hot.” Air bags that aren’t deployed can deploy without warning, including as a result of pressure switches being activated and extrication processes.
An inert gas deploys most air bags in a fraction of a second. The air bag quickly deflates after the impact. Side curtain air bag systems are the only air bags that inflate speedily but remain intact (for 10–15 minutes). First responders might arrive at an incident quickly, and side curtain air bags remain inflated. They can be cut easily with a knife or scissors to access the side of the automobile.
Safety glass
The design and construction of automobile windows change continually, which makes access to the interior of an automobile more challenging.
In older automobiles, the front window usually was the only one that was made of safety glass: two pieces of glass that have a piece of plastic between them. Most other windows were tempered glass, which can break easily and shatter into many small pieces. In the newest automobiles, more and more windows are safety glass, and some automobile manufacturers now have Gorilla Glass, which is significantly stronger than others. These reinforced windows are more difficult to break and remove.
Seat design
Several elements of newer seat design can make patient packing and removal more difficult. Consoles that are between seats mean the seats now are compartmentalized, which makes removing a victim across seats extremely complicated. This design increases the time to package and remove all patients.
Furthermore, seats have everything integrated, including seat belts, cooling and heating systems, and wings to help to keep passengers more secure.
Some of the integrated wings move when the automobile rounds a corner. When such an automobile is involved in a crash, you must lift and move a patient forward to remove the individual. Suppose that you have a heavier patient who has multiple long bone fractures. In that case, secure the patient to the seat with additional straps, block up and cut the seat posts, and remove the patient and seat all as one “piece.”
Seats, including rear seats, can be designed in a reclined position. This can cause difficulties with patient removal. A patient’s head will be behind an automobile’s post instead of in front of it. This requires removal of the post or roof to assist in removing a victim.
Changing care & extrication
With new technologies and automobile designs, there’s greater emphasis on training first responders to effectively use their skills to understand the dynamics of patient care. Automobile construction changes continually, which makes it more difficult for first responders to gain access to, extricate, package, treat and remove victims who are involved in a motor vehicle accident.
When rescue companies train in vehicle extrication, they should involve EMS. It’s one thing to rip apart an automobile, but having an entrapped victim changes everything. EMS must participate in the care and removal of every victim.
Protect all responders with the proper protective gear, and shield victims from getting injured during the extrication and removal. Covering victims with a blanket doesn’t protect them. Protect them from the vehicle and extrication process using something rigid and flexible, such as a KED device. Remember to crib and stabilize all vehicles before gaining access and starting extrication.
