By Todd D. Meyer
Published Wednesday, March 31, 2010
| From the April 2010 Issue of FireRescue
Winfred Man Loses Leg in Farm Accident
“Local emergency response officials report that a rural Winfred man was seriously injured late Thursday afternoon in a farming accident. The patient had a leg severed below the knee by a corn silage chopper in a neighbor’s cornfield, according to first responders. Members of Lake County Search & Rescue assisted in having the patient transported by a Sanford Health helicopter ambulance to a Sioux Falls medical facility. The Madison Ambulance Service and Lake County Sheriff’s Department also responded to the emergency call.” (Excerpted from the Madison Daily Leader, Sept. 18, 2009.)
Before you stop reading and turn to the next article, keep an open mind. As you drive to work each day, you likely pass potential entanglement situations—everything from hay fields to construction sites to logging operations to golf courses to industrial manufacturing centers. Each entanglement situation has the potential to stretch your talents and resources. In this article, I’ll focus on farm machinery; however, the information applies to all of the above-mentioned situations. So continue reading, even if you don’t have corn fields in your response area.
A variety of equipment and techniques will be necessary to stabilize a situation involving farm machinery. You may need to bring in heavy equipment (i.e., a tractor with loader) to assist. The situation may require the use of air bags, struts or large amounts of cribbing. Even simple bottle jacks can be a great asset to have on your rig.
One often-overlooked problem with stabilization is how to support the entrapped patient. You certainly don’t want to cause more harm. You may need to apply a Kendrick Extrication Device (KED) or secure a high point and put the patient in a harness or LSP Half Back. If this isn’t possible, rescuers may need to physically hold the patient to prop them up.
A couple additional notes about stabilization:
- If the implement is already connected to a tractor, use the tractor as an anchor.
- You must use lock out/tag out procedures.
There are four techniques for disentangling a patient from a piece of machinery. The one you select will depend on the available resources.
Cut/Spread: Will the tools on your engine or rescue unit be effective on the machinery? Can your hydraulic cutter cut the materials that surround the patient? As firefighters, we sometimes want to go for the big push or cut and immediately pull the victim out. Instead, we may have to peel away layers just to evaluate what plan will work. What other tools do you have on your rescue unit? Is a cutting torch an option? Are circular saws or reciprocating saws available?
Backing Out: Manipulate the machinery either forward or backward. This motion must be controlled, and you may need to get assistance from technical resources (e.g., a local service tech, owner’s manual). If it’s spring-loaded, will releasing it make matters worse? Remember when you were testing for a fire job and you were faced with those stupid gear questions on the mechanical aptitude test? This is where they come into play.
Unbolt: You’ll need large sockets and wrenches, WD40, large electric or air-supplied impact wrenches as well as sufficient air supply and electrical power—no battery-operated stuff here.
The Kitchen Sink: You may need to do a coordinated combination of all of the above.
An effective incident commander (IC) will request resources early and continuously forecast their resource needs throughout the event.
If you’re the IC, you’ll need to establish an Extrication Group Supervisor to work through the incident action plan (IAP). The Extrication Group Supervisor will need to work closely with the Medical Group Supervisor, making sure no effort is wasted or duplicated. The situation may also require a Transport Group to work out transportation details. Establishing these groups will give you the opportunity to really evaluate the situation, develop resources for plans B and C and handle additional needs of the incident.
A final note about command: It’s critical that you (the IC) remain detached from the emotions of the alarm. If you cannot remain detached, find a replacement.
Develop relationships with your local tractor dealer, implement dealer and commercial tire dealer. Any of them could have useful resources. Invite them out to the firehouse, and pre-plan their resources. Have the companies’ phone numbers on your resource list. Do their service trucks have a crane and a large air compressor? If plan A calls for the use of air chisels, you may be able to run off of their truck. This will be better than swapping out SCBA bottles all day. Additionally, consider the time of day. If nighttime is fast approaching, you’ll need to forecast your lighting needs. Don’t wait until sundown to start calling.
Do you have the appropriate resources to access the patient and then transport them back to the pavement? Time of year may dictate how you do this. If the accident occurred in a field, the field itself will present different challenges during planting (spring) and harvest (fall).
Additionally, is it July when the temperature can top out at 100 degrees F and shade is a half-mile away, or is it November and a storm front is coming in? Are heaters or cooling equipment necessary?
If you don’t have corn fields in your response area, the question may be whether you can get to the 14th hole at the Country Club in the middle of winter. Can your medic unit maneuver on cart paths to access the patient?
How long will the extrication take? One, 2, 6, 12 hours? Be prepared to develop your resources for the long haul. Write down and frequently revisit your IAP. Keeping track of total incident or operational time may aid you in evaluating your IAP.
Think about rehab and swapping out crews. When will they need rest?
Additionally, your resources may need to be evaluated and changed if the incident goes from a rescue to a body recovery.
Some important questions to ask about EMS: Is field amputation plan B? If so, is a physician part of your plan to deal with this possibility? Does the victim have crush injuries? If helicopter transport is an option, are they on the ground yet? Call and update your trauma center so they can prepare.
After we take care of the patient, the event may not be over. We may need to continue the rescue to retrieve the amputated limb. If so, you’ll need to deal with packaging and transporting the limb. Don’t wait until you’re three-fourths of mile out in a corn field to figure this out.
Dealing with Family
Incidents involving serious injury are traumatic events that will affect you, your crews and your community. The family will be devastated and may need long-term support.
Consider this scenario: Dad runs to town for parts. His 16-year-old son is baling hay. Dad returns and finds his son entrapped in the baler.
Law enforcement may need to respond to hold dad back. However, dad may be the only technical expert on scene so he may need to be engaged. As the IC, you’ll need to assign resources (i.e., a chaplain) to meet the needs of the family. If you’re the one dealing with the family, you won’t be able to effectively run this incident.
The first time you think about machinery entanglement should not be when the tones go off for a “man injured in a silage chopper entrapment” incident. How you pre-plan and prepare for these events will dictate your success and whether you run the incident or the incident runs you.
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