[Shock Trauma. Baltimore, Maryland.]

A Car Can Kill You At Zero Miles Per Hour

or, Rescuer safety and well-being (and the patient, too!)

(Transcriber's note: I first received a copy of this document when I took my first course in automobile extrication some years ago. Since then, I've come back to it time and time again as a teaching aide for both myself and for students. At times funny, it describes most of the hazards encountered on-scene at most MVAs. Read it, think about it, and beware. Remember, "if someone must die from on-scene hazards, it should be the patient, not you." Stay safe.)

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There are many hazards that can cause death or injury to rescuers in the performance of their job. In addition to these dangers, the loss of a rescue team member due to death or injury at the scene can further complicate a situation. These events can cause a team to lose its composure and concentration, compromising patient care; therefore, it is important that all rescuers be taught to recognize the problems and dangers that they face during rescue activities.

The following is an attempt to stimulate rescuers to think on their own. Rescuers should always be aware that the same dangers that put them to work can also take them out of action and make them a victim.

The readers must realize that all of the situations they will encounter as rescuers cannot be expressed in this article; however, many of the potential problem areas are mentioned.


Automobile glass is designed for visibility, safety, beauty and, in some cases, as part of the structural integrity of the car. Glass in cars that are driven in the United States must be one of two types: windshield and tempered. Plate glass is also used.
Windshield Glass
Automobile windshields consist of two pieces of glass that are laminated with a special plastic. The plastic holds the glass together when it is penetrated to help keep lacerations to a minimum. Windshields, when broken or penetrated, can cause cuts to the rescuers and patients.

A new type of windshield is now found on some cars. This glass has a plastic liner on the passenger side of the glass to help prevent penetration from the inside of the car.

Tempered Glass
The glass on the rear and side windows of vehicles is made from a special tempered glass that shatters into thousands of small pieces when broken. The common belief that this glass is not dangerous is untrue. The small "crumbs" of glass created when tempered glass shatters can cause the rescuer and patient much grief. Each piece has many cutting edges. These pieces are often found embedded in rescuers and victims by doctors who must probe deep into their flesh to remove the glass.

Plate Glass
An "after-market" glass that does not meet the above criteria is also in existence. Many pick-up trucks have sliding back windows that are made from plate glass. In addition, this glass is sometimes found on custom vans. This type of glass is very dangerous; when it breaks, it produces shards that can cause serious laceration and puncture wounds. There have been many instances of this type of glass penetrating minimum standard protective gear.

Wear protective gear, and protect the patient.


If there were no such thing as fuel, there would be very few auto accidents. All cars must have some form of fuel to use for power. Most fuel can burn, causing thermal burns, and is explosive, causing blast injuries. Fuel can also cause chemical burns.

The most common fuels are:

Gasoline: Ignites at 800+ degrees F; vapors are heavier than air. Gasoline can be ignited by open flames, catalytic converters, cigarettes, electrical sparks, etc.
Propane: Ignites at 850+ degrees F; is 1.6 times as heavy as air - a real ground hugger. Propane will ignite much the same as gasoline.
Alcohol: Has much the same properties as gasoline, and is also heavier than air. Alcohol requires "alcohol foam" for suppression.
Diesel: Has a much higher ignition temperature, and is the most "forgiving" fuel. Diesel vapors are heavier than air.

For these dangers we must remove the fuel, and/or remove the oxygen, and/or prevent ignition. The rescuers must also protect the patient, wear protective gear, and have ample fire suppression apparatus on hand, manned and ready to fight fire.

Electricity is a fairly new source of power on the automotive scene, and probably offers fewer hazards than all of the others; however, this is not to say that electric cars will be without fuel problems. The power sources may have acid or caustic mediums, hydrogen and oxygen gas, and, even if the car uses solar power, there are the dangers of electric shock and ignition of flammable materials and gases.

For the dangers of electric cars, we must protect the patient, wear protective gear, turn off the power, and neutralize the battery medium.

Hydrogen has been used as a vehicle fuel in some isolated cases. This is a very dangerous fuel. The ignition temperature is fairly high at 1085 degrees F, but its flammable range is from 4 to 75%. A good point about hydrogen is that its vapor density to air is 0.1, so it dissipates quickly on release.

Wear protective gear. Be prepared to fight fire and contend with the battery medium.

[Canons on the ramparts at Ft. Louisberg. Louisberg, Nova


The metal on the outside of a car body is shaped to give a unique design and to provide for aerodynamics. Some metal in cars is designed specifically to give the car strength by forming it into columns. Examples are "A" posts, "B" posts, drive shaft tunnels, the inside foor panels, frames, and partial frams.

The main problem that metal poses for rescuers and patients is torn or cut edges. These edges can inflict severe lacerations to those on the scene. The metal is also a source of infection in these lacerations.

Metal is electrically conductive and can create real problems when electrically charged.

Metal can deliver or absorb great quantities of heat very quickly. Hot or cold metal can inflict painful injuries to bare skin.

Cover all sharp edges and all pointed "chrome" parts, protect the patient, and wear protective gear.


Plastic appears to be the material of the future for cars, and many cars already have plastic bodies. Plastic exterior panels can cause lacerations, but their biggest problem to rescuers and patients is the toxic smoke and fumes they give off in a fire.

A rescue involving a fire in a car should be approached with great caution. Modern cars are filled with plastics; from the dashboard to the back window, and from the headliner to the carpet, modern technology waits to kill you. Burning plastics generate many times of deadly toxic fumes, including hydrogen cyanide gas. The wiring insulation, seats, plastic dash, and all other plastic components in cars will give off these same toxic gases.

In case of entrapment, the first priority is for the rescuers; without their personal protection, they could also become victims. Fire and patient protection are the next priorities. The incident commander must decide whether to first handle the fire or patient protection, or whether to address both problems at the same time. Once these priorities are taken care of, the rescue can begin.

All present should be aware of the toxic gases, and must stay out of the smoke! Rescuers and fire fighters must wear protective breathing gear. Victims should be removed to a safe area if exposed, and oxygen administered as soon as safety allows.

[Knife in the head. Courtesy NYT Television and Jacksonville
 Medical Center.]


Back in the "good ol' days," bumpers were designed to protect cars from low velocity crashes and to push other cars that head dead batteries. Later, bumpers were incorporated into car designes to provide a smooth, flowing look. Next, bumpers began to lose their strength in favor of appearance. Today, bumpers are just for looks.

After a few years, insurance companies and the government recognized the dangers of vehicles without bumpers and the advantages of the return to a functional bumper (Ralph Nader at work), which lead to the advent of the hydraulic shock absorber bumper. One bumper system is designed to take a 2.5 mph crash, and the other at 5 mph crash. The front and rear bumbers have shock absorbers.

As usual, problems for the rescuers came with improvements to the bumpers. It is possible that a bumper can be left in a "loaded mode" after an accident. This is caused by uneven pressure on the shock absorber behind the bumper. In this position, the bumber may be released to its original position by pressure on the shock absorber, a change in temperature, or by being struck by an outside force. When the bumper recovers to its proper position, it may move two inches in a millisecond. If an unfortunate rescuer happens to be against that bumber when it recovers, he may experience a serious injury. All vehicles should be checked for "loaded bumpers" and, when found, they should be identified to all rescuers.

(I personally feel that efforts to neutralize a "loaded bumper" are dangerous, redundant activities.)

The shock absorber bumper offers a special hazard in a fire. The heat can cause the shock absorbers to explode, sending the bumper out as far as 150 feet. Look for loaded bumpers and mark them. In case of fire, the fire should be fought from such a position that no one is in danger if the bumper is blown out of the shock absorber. Wear protective gear.

Under the hood/deck lid and under the vehicle

Most of us forget what can happen when we raise a hood/deck lid to disconnect a batter or fight a fire, or when we crawl under a car for whatever the reason.

Lying in wait to hurt us are the shock absorbers, the fuel vapor containers, air conditioner gases, the radiator, the batteries, and burning plastics. Under the car is the exhaust system, consisting of the exhaust tubing and the catalytic converter. Let's not forget the fuel pumps located in the fuel tanks that deliver as much as 65 psi at the fuel induction system. Under the hood or deck lid, usually opposite the engine, may be a fuel tank, exposives, hazardous materials, etc.; any one of them might explode, causing injury from flying metal and plastics or a fire.

Most of the fuel systems on new cars are "closed" (not vented). In a fire, this could cause a pressure build-up in the fuel tank(s) and lines. A resulting explosion could give disasterous results, blowing blazing fuel all around the scene.

If the automatic emergency fuel shut-off doesn't activate in an accident, the fuel pumps will keep pumping fuel at as much as 65 psi. If a fuel line is ruptured, fuel will be everywhere waiting to be ignited.

The plastic fuel recovery containers in the engine compartment can cause an increase in the fire and a possible explosion.

The air conditioning system can release gases that may be dangerous to the respiratory tract.

The radiator houses hot water and steam that cause nasty burns.

The battery can cause chemical and thermal burns, and can ignite fuel.

Beneath the car, the exhaust pipes can cause burns to the unprotected skin, and the catalytic converter could start a fire. Wear protective gear and have fire suppression equipment at hand, manned, and ready to fight fire.

[Motor vehicle accident. Western Speedway, Victoria, British
 Columbia. 176CD attending]

The Scene

The incident site often causes grave concerns to those who must perform their duties there. The number and types of problems that may be encountered at an accident scene are vast and complex.

The weather plays a very important part in planning a rescue at the scene. Fog, rain, sleet, snow, ice, cold, and heat bear directly on the well-being of the rescuers and the victims alike. In addition to the weater, the terrain - hills, cliffs, tress, and remote areas - offer their own hazards.

Also of concern are the position of the vehicle on the roadway, concentration of traffic, bridges, tunnels, and overpasses.

Incidents in urban areas often require crowd control, while rural incidents will only host those who are involved in the rescue.

Downed power lines and broken gas mains are common dangers that rescuers face.

Fires, hazardous materials, drunk drivers that run through the barriers, the blood of AIDS victims, collapsing buildings, and numerous other items also cause scene problems.

Rescue Tools

Rescue devices used by today's rescuers range from trucks full of very complex and expensive tools to only what is found at the scene. Large, powerful rescue tools are now common in the arsenal of many rescue squads. Many of these squads don't know the danger to which they expose themselves when operating power tools. If not properly held, the spreader can be propelled rearward into the operator while it is being activated. These tools may weigh more than fifty pounds and can deliver a tremendous amount of energy to the rescuer's thigh, hip, chest, or abdomen.

The hydraulic cutters and rams, pneumatic bags, cutters, wrenches, and electrical saws and drills are all used as rescue tools. Whether the operator is well-trained or a novice, these tools can cause death and injury to the rescuer and the victim.

Almost any hand tool can be used as a rescue tool. As long as the tool is used within its limits, it will probably work well. However, there will come a time when, in the heat of the battle, the limits of the tool will be exceeded by the operator. The rescuer, victim, and tool will suffer from this mistake.

Be well trained. Know your equipment. Wear protective clothing.

The Interior

The inside of a vehicle usually reflects the onwer/driver's personal life: a stick shift, a powerful radio, a tool box, a baby seat, little fuzzy dice hanging from the mirror, and so on.

The items inside a vehicle can cause a rescuer problems. Burning plastics, the occupant's pets, a loaded gun, the occupant, rattle snakes, and things we can't even begin to imagine line in wait to create new chapters in the life and times of the rescuer.

Wear protective gear. Carry a light.

[Baltimore City Fire Department Medic. Baltimore, Maryland.]

The Incident Commander

This person should be our greatest ally in the defense against all dangers we might encounter at any scene. The incident commander's job is to size up the scene, develop a plan, make tool choices, make poersonnel choices, communicate with other agencies at the scene, monitor rescue progress, be prepared to make changes in the rescue plan and, most of all, make sure that the scene is as safe as possible to ensure the safety and well-being of all personnel on the incident. Because we place so much trust in incident commanders, they can also become our greatest danger. If they are talking to the media, or handling any distraction where they can no longer see the entire picture, a fuel spill, a haz mat situation, an unstable vehicle, or any of a number of other problems can occur, causing additional injury or death. Therefore, the most important person at the scene - the incident commander - can be our best ally or our greatest danger.

A car that is not moving can hurt you

Wear your protective gear, practice your skills, and know your job. A car or truck that is the object of an extrication can cause death and injury to all of those in its reach.

Rescuers must be prepared to face a myriad of situations. No matter how well-trained and prepared they are. something old or new will always be around the corner waiting to challenge them. Burns, cuts, fractures, poisons, and death are too often the reward of well-meaning rescuers and their patients.

There are an infinite number of situations that can be encountered by the rescuer at the scene of a vehicle accident. This is in no way a complete list of the problems the rescuer is likely to face. Rescuers must forever be on the defensive if they are to survive their job.

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