By Tom Vines
Published Wednesday, June 13, 2012
On March 17, Maryland firefighters teamed with a mobile hospital unit to extricate a worker in a prolonged and difficult rescue.
A 9-1-1 call to Prince George’s County (Md.) Public Safety Communications Center reported that a man had fallen into a machine at a mulch business and that both his legs were trapped.
At 1053 HRS, the Prince George’s County Fire/EMS Department dispatched a full technical rescue confined-space box call, including Rescue 849, Ambulance 849B, Medic 810, EMS Duty Officer, Battalion 886, Technical Rescue Company 806, Technical Rescue Support Company 814 and Air Unit 816. As soon as it was defined as a working incident, the call was upgraded with Technical Support Unit 847, Laurel Volunteer Fire Department 810, Technical Services Battalion Chief and a second battalion chief unit. The first units arrived on scene at 1103 HRS and were met by the company owner.
From the outside, the nearly 15-foot-tall machine resembled a large construction dumpster. The machine was used to inject dye into mulch to give it color. The machine had an access platform on one side, but rescuers needed an additional access point, which they created by placing ground ladders against the machine.
The rescuers immediately verified that there was someone trapped inside the machine. The worker, a man in his 50s, was conscious, alert and in extreme pain. He was positioned with his face against the front wall of the machine, and metal blades and compressed mulch were pressing against the back of his legs. A coworker was in the machine with him, trying to hold the patient upright.
The firefighters immediately instituted a lockout/tagout, and removed the worker from the machine. They monitored the air but could detect no hazards. They then inserted a crew that included two paramedics to assess the patient and identify ways to extricate him.
It became immediately apparent that this would be a prolonged extrication, so the incident commander (IC) requested the Baltimore Shock Trauma Center (BSTC) GO-TEAM. ICs may request a BSTC GO-TEAM response for patients with suspected life-threatening injuries when extrication times are estimated to exceed one hour. The team—which consists of an emergency room physician, an anesthesiologist and a medical technician—was transported to the site by Maryland State Police Trooper 6, a helicopter. The State Police also dispatched Trooper 2 to standby for patient transport. Once it had delivered the GO-TEAM, Trooper 6 left the area and was later replaced by another helo.
Through the middle of the machine was a large shaft that ran end to end. Running off that shaft were metal arms attached to paddles, which stirred the product in the dying process. Because of the pressure against his legs in the femur area, the patient was unable to hold himself upright and kept falling back over the machine’s paddles. But through hands-on stabilization, firefighters were able to hold him upright throughout the extrication.
The rescuers were also able to quickly unbolt the metal arms attached to the paddles. However, the mulch product was so compacted against the patient’s legs that every time they tried to move the shaft, the worker cried out with intense pain.
With the arrival of the GO-TEAM, the anesthesiologist sedated the patient via IV. The rescuers were then able to move the shaft and lock it out of the way, and maneuver the patient’s legs without causing him further injury.
To raise the patient, rescuers positioned a tower ladder over the machine. They had anchored two change-of-direction pulleys under the tower basket. One pulley would be for the haul line, the other for the belay. After running a haul rope through the pulley, rescuers rigged a 4:1 MA haul system constructed of pulleys and Prusiks and anchored it to the base of the tower ladder. They attached a plastic basket litter to the ends of both the haul line and the belay line, and attached a tag line to the litter. They then backboarded the patient and placed him in the basket litter.
Using the tag line, rescuers maneuvered the litter to the side and away from the machine, and lowered the patient to the ground. They then placed him on the helo gurney for transport.
At 1249 HRS, Maryland State Police Trooper 2 transported the patient to BSTC where he was admitted in critical condition. Although both legs were injured, he survived with both legs intact, but faces a lengthy recovery.
Sources: Prince George’s County Fire/EMS Department Assistant Fire Chief Adon Snyder and Battalion Chief Steven White provided information for this report. Some additional details were taken from an account of the incident in The Washington Post.
Lessons Learned/Lessons Reinforced:
Chief White provides the following observations:
- “As with any complex incident, communications are paramount. It is important to ensure that all division and group leaders operating are aware of the current status of the incident and the plan moving forward. This will help ensure that the incident flows smoothly and that all systems are in place and ready when they are needed.
- “All division and group leaders need to ensure that they don’t become engaged in the actual rescue. By becoming engaged in the actual rescue, these leaders will tend to lose their overall focus and become focused on the patient and the immediate rescue operation.
- “Calling for additional resources early is paramount. On this incident, initial- arriving units called for specialty teams that were coming from a distance (the GO- TEAM). This early call enabled the rescue to be made quicker than if we had waited to start this team. We can always place units in service so call for them early.”
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