Vehicle Extrication with Downed Primary Wires
At 14:05 you respond to a two-vehicle collision on a four-lane road. A compact sedan has struck a utility pole on the driver's side and is resting on its wheels. The pole is cracked and primary wires are down across the hood, arcing intermittently. The driver is conscious, pinned by the dashboard at the knees, with a deformed steering wheel and a deployed airbag. The driver's door is jammed. A bystander is trying to open the passenger door. Traffic is passing in the adjacent lane at 55 mph. You are the officer on the first-arriving engine; the rescue squad is eight minutes out.
1. What are your first three priorities, and what do you do about the bystander and the passing traffic?
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First, scene safety and electrical hazard control. The downed primary wires are treated as energized; I establish an exclusion zone around the vehicle and pole, keep everyone out, and request the utility and law enforcement. I do not let anyone touch the car or the wires. Second, traffic control: I position the engine to block the incident lane and request police to close the road; 55 mph traffic next to a rescue scene is a second emergency waiting to happen. Third, patient access and stabilization from a safe direction, if it can be done without entering the electrical zone.
The bystander is told firmly to stop and move away; if he does not, a crew member escorts him back. He is not being helpful by opening a door into an energized vehicle. I keep the patient calm from a distance until the utility confirms the lines are de-energized.
2. How do you stabilize and gain access, and what changes if the vehicle is a hybrid or electric?
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Once the utility confirms the lines are de-energized or the vehicle is isolated, I stabilize: chock the wheels, crib the vehicle, and set parking brake or secure the ignition. I do not move the car while the patient is pinned. Access starts with the least invasive route: try the doors, then glass management on a side window away from the patient, then door displacement.
On a hybrid or electric vehicle, I treat the high-voltage system as live until proven otherwise. I look for orange cabling and the high-voltage battery, avoid cutting or displacing into those areas, shut off the ignition and disconnect the 12-volt battery if accessible, and use the manufacturer's rescue information if available. I do not assume the car is dead because it is quiet. The extrication plan changes to avoid the battery and cable paths, and I may wait for the rescue squad or tow service rather than cut blindly.
3. What is your patient care and extrication sequence?
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Patient care runs in parallel with extrication, not after it. I assign someone to maintain manual stabilization of the head and neck, assess airway, breathing, and circulation, control bleeding, and treat for shock. I keep the patient informed and avoid unnecessary movement. Pain and anxiety are managed within protocol.
Sequence: stabilize the vehicle, manage glass, open or displace the door, then create space at the dashboard with a ram or dash roll, working from the side away from the patient. I extricate only after the patient is packaged and the path is clear, then move to the cot and transport. The rescue squad may take over the tools, but the medical plan and the electrical hazard control stay with the incident. I do not let the extrication timeline outrun the patient's condition.