Through The Windscreen : Stabilisation and Initial Access in Remote Vehicle Incident Management

Stabilisation and Initial Access in Remote Vehicle Incident Management

In our last blog, we explored the importance of taking a deliberate 360° scene assessment before committing to the incident. Once you’ve done that loop, identified hazards, and set your priorities, the natural question is: what next?

The next critical phase is stabilisation and initial access, creating a safe working environment around the casualty and gaining those first points of contact to deliver care.

For practitioners who operate in remote or austere environments, this step can feel intimidating. You might not have technical rescue tools, you may have limited resources, and you almost certainly won’t have a fire crew arriving to “make safe” before you begin. But you still need to act.

Why Stabilisation Matters

A vehicle at rest isn’t always stable. On a slope, in a ditch, or after a rollover, a car can rock, settle, or even slip further as you start working. The EXIT project has challenged the historic concept that we stabilise to restrict further injury to casualties C-Spine therfore stabilisation now concentrates on team and operator safety and making a better working environemnet. Without stabilisation movement may:

• Crush or further injure the casualty.

• Compromise your position as a rescuer, especially on loose ground.

• Distract you from clinical priorities.

• Create drop zones.

• Force us to operate in environments that are not ideal or not possible.

  
  

In a city environment, specialist crews would manage this with struts, blocks, and heavy equipment. In the bush, mountains, or desert, you become the stabilisation crew.

The aim isn’t to make the car “rescue-service safe.” It’s to make it predictable enough that you can work on your patient without introducing new risks.

Basic Stabilisation Techniques Without Tools

You don’t need complex gear to reduce the risk of unwanted movement. Small, simple interventions can make a huge difference:

• Handbrake and Gear Selection - Always check that the handbrake is on and the gearbox is engaged (P for automatic, first/reverse for manual). Vehicles often roll simply because this was missed.

• Ignition Off, Keys Out - Prevents accidental movement, reduces fire risk, and stops undeployed airbags from activating while you’re inside.

• Wheels and Steering - Turn wheels into a bank or natural stopper if on an incline. This can prevent rolling if the vehicle shifts.

• Chocking the Wheels - Improvise with rocks, logs, sandbags, kit bags, or even boots. A wedge under a wheel can make the difference between a stable car and one that rocks with every movement.

• Weight Awareness - Avoid leaning heavily on the vehicle or climbing inside until you’re sure it’s not going to shift. In unstable terrain, even your bodyweight can start movement.

• Deflating tyres - This can increase vehicle movemnt massively however could reduce your options in the long run if that vehicle forms part of a transportation plan to definitive care.

• Your own vehicle - Positioning your vehicle in a way that prevents movement of the effected vehicle can be a very quick and easy way of mitigating future risk. Especially if the vehicle is on its side as this can eliminate drop zones.

• Small tools and kit - Basic kit that you may already have with you for other purposes especially if on expeditions such as ratchet straps, car jacks and winches can secure vehicles very effectively whilst having dual purpose.

These actions may seem basic, but in a remote setting they create the “margin of safety” you need to focus on medicine.

The First Rule of Access: Simple Before Complex

With stabilisation done, the next step is initial access, getting to your casualty. And here’s where many medics make their first mistake: assuming access must be hard.

In reality, most vehicles are far more accessible than we think. Try the simplest options before reaching for tools. Initial access should be clinicaly lead with the mechnism of injury at the forefront of priortising the speed of access.

1. Check All Doors - Gently try each door. You’d be surprised how often one opens easily while another is jammed.

2. Boots, Hatchbacks, and Sunroofs - Secondary entry points are often overlooked. A rear hatch or boot may give you direct access to a patient with less risk than forcing a door.

3. Windows

   • Partially open? Use them.

   • Closed but intact? A spring-loaded window punch (tiny, cheap, fits in any medic bag) creates quick access with minimal effort.

   • Avoid smashing large areas of glass unless absolutely necessary, it creates hazards and rarely improves your working position. If needed, smash the window on the opposite side to the casualty to avoid furtehr injuries.

4. Communicative Access - Sometimes your first “access” isn’t physical, it’s verbal. Talking to the patient through glass or a small opening allows you to:

   • Gauge airway and breathing.

   • Encourage self-care (“apply pressure to your wound,” “tilt your head forward,” “keep still until I can get in”).

   • Reduce panic and keep them engaged while you prepare.

   
   

Medical Priorities During Initial Access

Here’s where your clinical hat must guide your rescue actions. Once you have a point of access, however small, ask:

• Airway: Can I see or hear signs of compromise? If needed, can I reach to open or maintain it?

• Breathing: Can I assess respiratory effort through observation, communication, or minimal contact?

• Catastrophic Haemorrhage: Can I visualise or control major bleeding? Can I pass in a tourniquet or dressing?

• Circulation & Shock: What’s their colour, responsiveness, and overall perfusion?

Remember: the EXIT Project changed how we think about trapped casualties. Minimising entrapment time takes precedence over immobilisation. If your patient can communicate, move, or even self-extricate safely with guidance, you may not need to spend time forcing entry.

Stabilisation and Access as Medical Enablers

Think of stabilisation and access not as “technical rescue” tasks, but as clinical enablers. They create the conditions for you to deliver interventions that matter:

• A wedged wheel buys you the safety to place a pelvic binder.

• A cracked window gives you the reach to apply a tourniquet.

• Talking through the glass may keep a patient alert long enough to manage their airway later.

Your aim isn’t to open the car. It’s to open the path to life-saving care.

Avoid the Trap of Over-Commitment

Remote responders often feel the pressure to “do it all.” But remember: your patient doesn’t need a perfect extrication right now. They need stability, access, and medicine.

Every minute spent fighting a jammed door is a minute airway compromise or internal bleeding goes untreated. If you can reach the patient clinically and keep them alive, you’re winning.

Final Thoughts

In remote vehicle incidents, stabilisation and initial access are the bridge between your 360° assessment and your first interventions. They are not technical luxuries, they are essential steps that enable medicine to happen in an unpredictable environment.

• Stabilise enough to be safe.

• Access enough to deliver care.

• Always let your clinical priorities guide your actions.

Your job is not to be a firefighter with no tools. Your job is to be the medic who adapts, keeps calm, and protects both casualty and rescuer in the hardest places to work.

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