BY JOE VANDER PLAAT
On August 25, 2005, at 12:40 p.m., the Wyckoff (NJ) Fire Department was dispatched to assist at the scene of a serious motor vehicle accident on Route 208 North in Wyckoff, New Jersey. Route 208 is a four-lane highway with two lanes in each direction and grass shoulders separated by a concrete Jersey barrier on the center median.
The initial response was to set up a landing zone for a medevac helicopter on a field one mile from the accident scene. Prior to the arrival of initial fire units, paramedics operating at the scene requested that a fire department rescue company respond to the scene to assist with victim extrication.
 1. Photos by L. Murphy. |
In response, a Wyckoff rescue company was dispatched to the scene along with an engine company; two additional engine companies were dispatched to secure the landing zone.
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On arrival, Wyckoff rescue command was established and located a one-car motor vehicle accident on the right-hand shoulder of the northbound lanes. The male driver was sitting on the shoulder in shock and was transported by ambulance to a nearby hospital for evaluation. The female passenger was sitting in the front passenger seat.
The driver reported that he possibly fell asleep and drifted off the roadway. After leaving the pavement, the vehicle proceeded parallel to the highway until it struck a 100-foot-long wood stockade fence (photo 1). When the vehicle struck the fence, an upper cross member of the fence, with dimensions similar to that of a 2 × 4, went over the vehicle’s hood, penetrating the windshield on the passenger side. The fence member continued into the passenger compartment, impaling the female passenger. The piece entered and passed through the victim’s neck and came out through her shoulder. The cross member snapped, and a section approximately three to four feet long extended out from the victim’s neck and lodged under the vehicle’s dashboard and seat (photo 2, arrow).
Wyckoff rescue command immediately met with the paramedics and determined that the rear door and “B” pillar of the 2000 Toyota Avalon needed to be removed to allow sufficient room to safely extricate the victim.
In accordance with fire department standard operating guidelines, crews cut the car’s battery cables before cutting or operating in or around the vehicle. This removed power from the air bag modules to minimize the possibility of air bag deployment and potential injury to the rescuers and victim. It also prevented the possibility of any sparking during the operation.
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However, after the rescue crew removed the passenger side “B” pillar (photo 3), the paramedics asked rescue personnel to recline the seat. Since the seat was electric and the battery power had been disconnected, this presented a problem. As an alternative, rescue personnel considered cutting and shortening the wooden piece that had impaled the patient. Because of the close quarters inside the vehicle, cutting and possibly causing more injury to the patient during such an operation was a major concern.
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Rescue members decided to attempt removal of the victim from the vehicle without cutting the wood. By that point, the paramedics had intubated her, started an IV, administered oxygen, and connected a heart monitor. They also were greatly concerned that the board had possibly penetrated into the jugular vein or was dangerously close to it. Keeping the fence piece immobile, allowing as little movement as possible, was imperative and the main goal of the operating firefighters.
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As the paramedics continued to work on the victim, a fellow crew member and I evaluated several options for cutting the wooden fence member impaling the victim. Initially, we thought that the O-cutter or a brake pedal cutter would be the easiest. We tested these tools’ effectiveness by cutting a piece of wood found lying at the scene. However, during the cut, a piece of the wood broke off and shot two feet away; we quickly ruled out this alternative. We then tested a reciprocating saw, but the resulting vibration made us rule it out as well.
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Finally, we tried a circular saw, which provided superior results and thus was our tool of choice. However, we did not cut the lumber before victim removal as originally planned. By this time, paramedics had stabilized the victim’s condition, and she was ready for removal from the vehicle onto a long board and then onto a stretcher.
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Several crew members were in place for the removal: one stabilized the victim, one stabilized her head, one immobilized the piece of wood, one held the IV bag, and another held the oxygen. We slowly moved the victim and reclined her onto the long board.
By this time, the medevac helicopter had landed on the southbound lanes of the highway. The flight medic arrived at the scene, spoke to the paramedics, and determined that the victim could not fit into the helicopter with the four-foot piece of wood protruding from her shoulder; now it definitely had to be cut. With one member performing head stabilization and two members holding the fence piece, we covered the victim with an aluminum blanket to protect her and her wound and to protect the rescue crew from flying debris.
Preparing to cut, I preset the saw depth so as not to expose more of the blade than was necessary. One member recommended that I hold the blade guard back so that when I went to make the cut it would not present any problems. I got myself into a comfortable position, resting on another firefighter to stabilize myself and permit good control of the saw. I made my cut and stood back. The cut was successful; it was clean and smooth and caused no further injury to the victim and no injuries to others at the scene.
After the cut, everyone stood back to evaluate the length of the piece of the fence. At this point, the flight medic requested that another foot of wood be removed for easier transport. Since the board was much shorter, this meant that several crew members initially stabilizing the board could no longer do so; only those under the blanket with the victim could access and stabilize the piece. The second cut went as smoothly as the first.
We stabilized the wooden piece using towels, tape, and cravats and rolled the victim on a stretcher down the highway to the waiting helicopter. The tremendous team effort ensured the successful outcome. The victim fully recovered.
SECOND INCIDENT
Two weeks after the initial impalement incident occurred, the Wyckoff Fire Department was again dispatched to Route 208 North; a truck was reported off the road and possibly on fire. On arrival, the first-due engine located a pickup truck well off the roadway and into a wooded area (photos 4, 5). The vehicle had driven through another section of the stockade fence and came to rest after hitting a tree.
Although there was no visible fire, what appeared to be smoke was coming from the engine compartment, but it was actually steam from the damaged radiator.
A hoseline was stretched to protect members initiating a search for any entrapped victims. The vehicle was resting in an area of dry brush, and it was feared that the hot catalytic converter could ignite dry debris under it. The firefighters deenergized the vehicle. An ambulance crew had arrived before the fire department and was performing first aid on the lone victim, who had suffered a deep laceration to the arm when a section of the fence penetrated the front windshield and just missed impaling him into the seat. Fortunately, no extrication was required (photos 6, 7).
LESSONS LEARNED
• Cutting the battery. Prior to cutting the battery, rescue crews should weigh the pros and cons. If the vehicle has electric seats, do they have to be adjusted to expedite the extrication? This is not the first time we have run into this problem. Currently, our department is reevaluating our policy regarding this situation and battery cable cuts. I still suggest cutting the battery as soon as possible, especially prior to cutting or spreading doors.
• Be prepared for the worst. Listen to the radio transmissions en route to the scene for any updates. Since extrication was not initially mentioned, the rescue crew and I never thought that hydraulic tools would be needed; the rescue truck had to be repositioned for us to use the tools at the scene.
• Traffic safety. Safety and traffic patterns should always be set up and taken into account when working on the highway. Shut down the highway if necessary.
• Cutting. Measure or mark the object so you have to cut it only once. Whenever possible at the scene, practice cutting the material you’re planning to cut first. What seems like a good idea at first may not work.
Responding within two weeks to two accidents involving the same fence and section of highway and presenting possible impalements proved to be a real learning experience. Since these incidents, our department has surveyed the numerous types of fences in the community. They are constructed from a multitude of materials: plastic, metal, aluminum, wood, and more. The department is exploring all of its tool options and procedures to use in case of another vehicle run-in with a fence. The department is also considering adding an impaled victim in an auto scenario as part of its rescue vehicle extrication training. These operations also remind us that if an incident occurs once, it can happen again. ■
■ JOE VANDER PLAAT is a 10-year veteran of the Wyckoff (NJ) Fire Department, where he serves as an apparatus training officer and instructor for the department.
