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Keep your head on a swivel: High danger on low-visibility scenes

Snow, fog, smoke and dust: 4 tips for operating in dangerous roadway conditions


Photo/Acadian Ambulance

Acadian Ambulance was recently called to, not one, but two different multi-vehicle crashes on highways in Texas and Louisiana. The scenes at the end of October involved a dangerous mix of fog and smoke from nearby marsh fires creating “superfog” conditions. The Texas incident resulted in over 28 patients from multiple small crashes spread over about seven miles. The Louisiana incident covered a shorter stretch of highway but involved about 100 vehicles and 46 patients transported to local hospitals.

Scenes like this are not uncommon and can result from a variety of weather conditions.

  • In February 2019, a snowstorm with blizzard conditions caused a whiteout on the Interstate near Neenah, Wisconsin. One hundred and thirty-one vehicles piled into each other, leading to 71 injuries and one fatality.
  • Dry conditions in May 2020 lead to a dust storm near Stevens Point, Wisconsin, obscuring the Interstate for a short period time, resulting in three dozen cars, trucks and semis crashing into each other.
  • Smoke from grass fires in Jackson County, Arkansas, in the beginning of October 2023 created low visibility across a highway. Fifteen vehicles collided and two people were killed.

Whatever the cause, these low-visibility calls require special consideration and EMS providers should take extra steps to ensure safety while operating in these dangerous environments, including these 4 tips.

1. Stay visible

It is likely already policy that high-visibility, reflective clothing or vests are worn anytime public safety responders are working on roadways, but when called to one of these scenarios, we should check each other and make double sure that nobody steps out of the rig without it. While the smoke, fog, dust or snow may reduce long-range visibility, the vests will still provide some shorter-range protection and help identify you as responders.

2. Be aware of your surroundings

Placement of vehicles on scene will also provide some protection to personnel on foot at the scene. Some fire departments have specific large vehicles, including retired fire engines, that are designated as part of the traffic safety response. Keep in mind that these vehicles only provide protection if you keep them between you and the oncoming traffic. Once you move around the scene to treat other patients, you may not remain safe. Also recognize that oncoming vehicles in low-visibility crashes often veer from the highway to avoid stopped vehicles that suddenly appear in front of them. The shoulders and medians of the roadways are just as dangerous as the traffic lanes themselves.

Each time you move to a new vehicle or location to check for patients or provide care, take a quick look around the area and plan your escape route to be prepared if approaching vehicles create a threat. Identify where guard rails or concrete barriers are in case you need to hop over them to avoid being struck. Look over the barriers, though, to confirm that there is grass or some other solid surface on the other side. Unfortunately, responders have been up injured or killed falling from bridges and other elevated roadways.

Don’t forget that it may be safest to move toward the oncoming vehicle but also laterally away from its path. When the vehicle hits another stopped car, momentum will cause debris to fly forward in the same path of the striking vehicle. The same concept applies when responding to a vehicle stopped on railroad tracks and a train is coming.

3. Maintain strict triage discipline

In terms of patient care, low-visibility mass casualty incidents are handled with the same principles, although triage and communication with transport officers may be more critical due to challenges in getting patients to locations where they can be assigned to a transport unit. Maintain strict triage discipline to avoid simply putting the closest patients on the first available ambulances.

4. Implement incident command

At the leadership level, low-visibility scenes require the use of unified incident command, bringing all agency chief officers together to share information about rapidly changing weather conditions, patient locations and ongoing scene hazard mitigation. Each agency must know where responders are working so that resources can be directed to them as needed. Sharing information is also important to reduce duplication of efforts as vehicles are checked for occupants.

Incident commanders may use divisions to organize operational teams across widespread incidents or they may even break the event into separate incidents if the situation warrants based on size, access and resources.

Another important task for unified incident command will be to identify shelters or other safe locations uninjured vehicle occupants may be transported to. The sooner these folks can be removed from the hazardous scene, the better. It is likely that their vehicles won’t be going anywhere even if they are drivable, and they will need to be relocated to a place where they can be reunited with family or friends.

Exceptional situational awareness

Above all, low-visibility multi-vehicle crash scenes require responders to practice exceptional situation awareness. As a helicopter pilot I used to fly with liked to say, keep your heads on a swivel.

Stay safe out there.

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Michael Fraley has over 30 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College. When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.