Attending Incidents PDF

Attending Incidents Learning outcomes By the end of this chapter you should: Understand the importance of personal protective equipment. Understand the irriportance of scene preservation at serious or fatal road traffic accidents. Know how to approac...

Attending Incidents Learning outcomes By the end of this chapter you should: Understand the importance of personal protective equipment. Understand the irriportance of scene preservation at serious or fatal road traffic accidents. Know how to approach motorway or dual carriageway incidents when traffic is moving slowly or is stationary. Know the precautions that must be taken when driving on the hard shoulder. Know howto approach motorway or dual carriageway incidents when the carriageway is blocked or closed. Understand why travelling in convoy should be avoided and the precautions that must be taken when it is unavoidable. Know the safest position in which to park when attending incidents on the motorway or dual carriageway. Understand the importance of regular situation reports to ambulance control. Know the best practice procedures for leaving a scene. Know what to do if you come across an incident when driving a non-emergency vehicle for your trust. Know the circumstances in which a police escort may be required and the procedure to follow. [  Emergency Ambulance Response Driver's Handbook A consistent, uniform approach to attending incidents on multi-lane carriageways (motorways/dual carriageways) and other roads by the emergency services is essential. This chapter outlines the best practice procedures described in Guidance for Ambulance Service Response to Incidents on the Motorway Network (Including Smart Motorways), produced in association with the National Ambulance Resilience Unit and Highways England. Topics covered include strategies to be used when approaching, parking at and leaving incidents on multi-lane carriageways and smaller roads, as well as specific procedures to be followed when you are the first emergency vehicle on scene, travelling in convoy or are accompaniedby a police escort. Dual carriageways may have many of the same characteristics as a motorway, such as hard shoulders, central reservations and speed limits. While their designations are different, the principles applied to motorways should equally be applied to dual carriageways. The term ‘fast road' defines any road with a speed limitgreaterthan40 mph. m Personal protective equipment Personal protective equipment (PPE) - including a fastened high-visibility jacket and hard helmet - should be worn at every incident, no matter how minor it may seem. This is especiallytrue when attending an incident on a multi-lane carriageway motorway/dual carriageway or any other class of road. Serious head injuries can be - and have been - sustained by members of the emergency services who have been struck by objects thrown up by vehicles passing at high speeds. Staff should decide whether any further protection is required when carrying out their risk assessment of the incident. Scene preservation It is important to remember that the scene of any serious or fatal road traffic accident is considered a crime scene by the police. Although it should not interfere with the care and treatment of patients, which is paramount, you should be mindful, when on scene, to minimise unnecessary disturbance to potential evidence. no  Attending Incidents I Motorway and multi-lane carriageway approach The high volume of vehicles on multi-lane carriageway motorways and dual carriageways, and the speeds at which they travel, present ambulance staff with unique problems. Minor incidents can rapidly expand to involve a large number of vehicles, while any incident may lead to a large build-up of traffic, causing difficulties for approaching emergency response vehicles. Different methods of approaching incidents on multi-lane carriageways have been devised depending on the traffic conditions, ► Flowing traffic: ambulances should approach using the main carriageway whenever possible, usually in lanes two or three (see Figure 13.1). This allows other road users to react in a normal manner, moving left when seeing an approaching ambulance or hearing sirens. Do not use Lane 1 - this could cause drivers to move onto the hard shoulder where other vehicles may have stopped. ► Traffic on the main carriageway is moving slowly: approach on the hard shoulder with visual warning equipment activated (blue lights and flashing headlights). The use of sirens has been known to cause drivers to pull onto the hard shoulder, into the path of emergency response vehicles, so consider their use carefully. Remember: you can use your normal road horn to indicate your presence if required. ► Traffic on the main carriageway is stationary: approach on the hard shoulder with all EWE activated - blue flashing lights and sirens. However, you must be aware of the danger of members of the public being on the hard shoulder - people sometimes get out of their vehicles to see what's going on or to stretch their legs if they have been in stationary traffic for some time. Layout of a multi-lane carriageway The police may also direct you to approach or leave an incident in the wrong direction if the carriageway is blocked or closed. In these circumstances the same procedure applies: ► Drive on the left ► Use visual warning equipment (blue lights and flashing headlights) ► Keep your speed down ► Be aware that other emergency response vehicles may be travelling towards you on the same carriageway. 111  Emergency Ambulance Response Driver's Handbook i " Mark^^s’t's I Gantry sign j ETB. A I o j.' 33 cc a> tu I194.7I o J3 E V c if- o o E o o o E so o o Os b POLICE POLICE SLOW SLOW T POLICE POLICE ACCIDENT ACCIDENT T POLICE POLICE ACCIDENT ACCIDENT Fi 'ure 13.2 Parking in a coned-off area. 114  Attending Incidents I Ambulance as first emergency vehicle on scene Incidents confined to the hard shoulder The following parking procedure should be followed when you are the first emergency vehicle arriving at an unprotected scene on the hard shoulder: ► Stop 50 metres before the incident in a straight line with the carriageway. ► If there is no physical barrier or other obstruction, such as a bridge support, turn the front wheels towards the nearside; if there is a barrier, turn the front wheels outwards towards the carriageway. If the vehicle is subsequently struck from behind, it will then be steered away from you rather than pushed straight towards the incident you are attending, ► Switch off forward-facingblue lights and flashing headlights, but keep your rear-facing blue or red lights on (or both if fitted), as well as sidelights and hazard lights. Keeping the rear doors closed when possible will ensure that their reflective, high-visibility markings can be seen. ► If possible, stay behind the barrier when walking towards the incident. If this is not possible, stay as far away from the live carriageway as you can. Keep a lookout for approaching traffic. Incidents on the main carriageway If you are first on scene at an incident on the main carriageway you may need to place your vehicle in a fend-off. fend-in or in-line position - refer to your local ambulance service's procedures, These extremely hazardous positions involve using the vehicle to block one or more lanes, and should be performed with the utmost caution. h In-line vehicle positioning With in-line positioning, the vehicle is parallel to the running lanes on the carriageway This I maximises rear-facing lighting and rear vehicle markings. Figure 13.3a In-line vehicle positioning. 115  Emergency Ambulance Response Driver's Handbook Figure 13.3b Fend-in vehicle positioning. Figure 13.3c Fend-off vehicle positioning. Fend-in vehicle positioning For fend-in positioning, the vehicie is angied, pointing front end towards the nearside in the direction the traffic shouid pass. This method fiiis the lane that is to be ciosed and acts as a visual reinforcement of the cone taper. Fend-off vehicie positioning For fend-off positioning, the vehicle is angled, pointing front end towards the carriageway in the direction the trafhc should pass, This method fills the lane that is going to be closed, and also acts as a visual reinforcement of the cone taper. It appears stationary to the approaching trafftc. V p >* i" > I w Figure 13.4 Incorrect fend-off vehicle positioning for multi-lane carriageways. 116  Attending Incidents On multi-lane carriageways on no account should the incident scene and responders form an island with traffic passing on both sides. General guidelines In all cases stop 50 metres before the incident, turning the front wheels in a safe direction to reduce the risk of the vehicle being pushed into the incident if it is struck. You should also stop in a position that affords maximum visibility of rear visual devices and reflective or high-visibility markings; all rear-facing visual warnings - blue lights, rear-flashing red lights, sidelights, fog lights and hazard lights - should be activated. Position as detailed below, depending upon which lane the incident is in; ► Lane 1: position in Lane 1, do not intrude into Lane 2 ► Lane 2 (three or more lanes): position in Lanes 1 and 2, normally at an angle (fend-off/in); do not intrude into Lane 3 ► Lane 3: position in Lane 3 but do not intrude into Lane 2 ► Lanes 2 and 3: position in Lane 2 and 3; do not intrude into Lane 1. The police will permit you to block as many lanes as required to ensure your own safety and that of your patients. No one should return to the ambulance once it is parked in a fend-off position unless absolutely necessary. Keep your eye on passing traffic; you must never assume it is safe. Research has shown that a significant proportion of drivers are unable to distinguish a stationary vehicle from a moving one on a motorway or dual carriageway. See Appendix 1 for details on Patient Transport and unmarked vehicles attending incidents on motorways and dual carriageways. Leaving the scene Re-joining moving traffic when leaving the incident scene is also extremely hazardous - other road users may be too busy 'rubbernecking'to notice that you are moving. If there is a clear path in front of you, you should proceed in a straight line in that lane or on the hard shoulder. You can change lanes when you have built up enough speed to match the traffic conditions around you. Your rear blue lights should remain activated until you have re-joined the normal traffic flow; you can then turn them off if not conveying patients to hospital as an emergency. 117  Emergency Ambulance Response Driver’s Handbook I Other urban and rural roads Attending the scene of an incident on any road, including those in residential areas, presents a degree of risk. Emergency response crews should not become complacent and should be especially aware of the risks associated with 'red mist' - paying too much attention to what may be presented at the scene before arriving at it can allow intrusive thoughts to influence your decision making process, Regardless of the medical competencies or skills the clinician may have, these hold no value until they have safely arrived at the scene. As with motorways and dual carriageways, stopping on any high-speed road - or indeed anywhere where other vehicular activity is present - is potentially high risk, especially for covert vehicles that may be attending these incidents. Non-emergency vehicles at scenes other vehicles that operate within organisations, for example PTS vehicles, may periodically come across incidents on highways and may not be fitted with the appropriate emergency warning equipment, In these instances, the driver should perform a dynamic risk assessment and consider whether it may be safer to park away from the incident and provide control with a situation report {see opposite) rather than to stop at the scene. This can be very difficult, but you must not be tempted to put yourself in danger. See Appendix 1 for further information on non-emergency vehicles attending motorway or dual carriageway incidents. Stopping and parking at the scene When parking at the scene of any emergency, crew and vehicle safety must be paramount. Parking should, where possible, take place in an area that facilitates safe egress for staff, minimising the danger caused by passing vehicles. Consideration should be given to the likelihood of patient loading, which would entail sufficient clearance required for ramps and tail lifts. If the vehicle is parked partly on the pavement, this may mean that the ramp or tail lift may not deploy correctly due to the kerb impeding its operation. The use of warning lights should be appropriate for the density of hazards present or potentially present. In residential areas, the use of hazard warning lights alone may be sufficient, whereas other rural or urban roads may require the full use of emergency warning lighting. 118  Attending incidents When parking at night ensure that, as a minimum, the vehicle sidelights are illuminated, particularly if you have to park facing oncoming traffic, Solo responders need to consider the most appropriate parking positions carefully, particularly in residential areas. Parking directly outside a private dwelling to attend to a patient may inconvenience any following back-up vehicle when they need to park and load a patient. Consider: ► Initial mobile reconnaissance or dynamic risk assessment. Which parking option offers the maximum protection? Is there a safer alternative? Review regularly. ► PPE must always be put on prior to leaving the vehicle, ► Unseen or unheard vehicle activity that may be hidden in the blind spot of the vehicle on the side from which you are exiting. ► What warning equipment is htted to your vehicle that could provide greater protection? ► The activation of rear red flashing lights is very effective due to their primary colour attraction; however, in the presence of mist or fog this can be distracting for other vehicles, which may not see you initially. Look, listen and be extremely vigilant about the potential of developing hazards as yet unseen. Remember While attending any incident, staff must consider the parking location carefully, not only for patient and crew access but, more Importantly, whether it offers the maximum protection to other road users. Is there a safer alternative? Your personal safety is paramount, it is vital that the correct use of PPE is adopted and that maximum visual warning is activated on the responding vehicle. I Situation reports If you are the first emergency vehicle on scene you should provide control with a situation report (SITREP) as soon as possible. A SITREP is a situation report provided to control, detailing your exact location, direction of travel, the number and types of vehicles involved in the incident, the number of casualties 119  Emergency Ambulance Response Driver's Handbook and whether further assistance is required. It should contain the following information: ► Your location - the nearest marker post (see Figure 13,5) will confirm your location to within 100 metres ^ A driver location sign (see Figure 13.6) will give your position on motorways and some A roads (see below) V Your direction of travel, for example northbound/southbound ► The number and types of vehicles involved in the incident ► Which lanes of the carriageway are involved ► Whether any hazardous loads are involved. 25 Distance along motorway in km. Lower number shows tenths of kilometre 4^ Pointer to nearest emergency telephone A 194.7 1 Figure 13.6 Example of a driver location sign. Figure 13.5 Example of a marker post. Marker posts are a distance In kilometres from a defined point and will give your location within 100 metres. The example post shown in Figure 13,5 is 25.3 km from the defined point. This information will be passed on to the police or Highways England control - they will activate the matrix signs, if available, to warn approaching motorists. Driver location signs are small and blue. You will find them at the side of motorways, positioned every 500 metres, and on some major A roads. Providing the details on the sign nearest to the incident will make it quicker for other agencies to find you. 120  Attending incidents ► The top line shows which road you are on ► The letter on the second line - A or B - gives the direction in which you are travelling ► The bottom line tells you how far you are from a given location. Remember! You must use the terms lane 1', lane 2' and lane 3', not the 'slow lane’, 'middle lane' or 'fast lane’. You must keep control regularly informed, Subsequent SITREPs should include; The number of casualties ► The types of injuries sustained ► Requests for further vehicles if required ► Requests for air ambulance, if required ► Whether assistance is required from other agencies, for example the fire and rescue service ► Notifying hospitals, Police escorts Occasionally circumstances may dictate that an ambulance requires a police escort on its journey, for example If it is vital that the journey to hospital is a slow, uninterrupted and smooth one, or that the journey time is reduced. This request must usually be approved by ambulance control (refer to your local service's procedures}. The police will provide an escort if they are in agreement that one will indeed cut the journey time or make it slower and safer, and if police resources are available. The following procedure for escorts given by police motorcycles or other police vehicles has been offered by members ofthe Police Driver Standards Group; > One motorcycle is positioned at the front of the ambulance, and it is its role to maintain a safe and constant speed. ► Another is positioned on the offside of the ambulance, visible in the ambulance’s offside wing mirror. ► The final motorcycle is positioned to block off traffic at the next major hazard, such as a junction or a roundabout. ► As the ambulance goes through the hazard, the bike controlling the hazard takes up a position on the offside of the ambulance. The bike that was previously In this position moves up to control the next hazard. 121  Emergency Ambulance Response Driver's Handbook Alternative procedures are in operation around the country, and it is in the interests of all services to work across boundaries and within written local / policies and procedures. There is no exemption available for the driver of an ambulance vehicle to claim exemption when escorting another vehicle to hospital. This is a specialised function and must only be completed by the police who do hold exemptions to do this. B KNOWLEDGE RECAP 1 Explain why personal protective equipment is essential when attending incidents on a multi-lane carriageway. 2 What is 'scene preservation’ and why is it important? 3 Which lanes should be used when approaching an incident on a motorway or dual carriageway in flowing traffic? 4 What precautions should be taken when approaching an incident on a motorway or dual carriageway by driving on the hard shoulder? 5 Explain the dangers of using sirens when responding in slow moving traffic on the hard shoulder of a motorway? 6 Why should a number of emergency vehicles responding to a single incident avoid travelling in a convoy? 7 Where is the correct place to park at an incident on a motorway or dual carriageway that is already being attended by another emergency service? 8 What are 'fend-off, 'fend-in' and 'in-line' parking positions and when would you use them? 9 What information should be relayed to control in a SITREP? 10 What information should be relayed to control in subsequent SITREPs? 11 Describe the procedure for leaving the scene of an incident on a motorway or dual carriageway, if the path ahead of you is clear, 12 What procedure should you follow if you come across an incident while driving a vehicle that is not fitted with emergency warning equipment? 13 In what circumstances might you request a police escort? 14 Can an ambulance solo responder provide an escort for another emergency ambulance vehicle in some circumstances? l|22