BY BILL LOWE, JEFF HOOD, AND JERRY RUSSELL
December 15, 2002, WAS A BUSY 24-hour shift for the officers and firefighters of Clayton County (GA) Fire Department’s Station Three B-shift: training evolutions; routine maintenance; and responding to numerous EMS, fire, and service alarms. Station Three is staffed with one battalion chief and 11 officers and firefighters who operate one engine, one heavy rescue squad, and one advanced life support (ALS) ambulance.
ASSESSMENT
Station Three’s location in the center of the county makes it a hub of activity, since it backs up many of the department’s 11 other county fire stations. The crew had retired to the bunkroom for a night’s sleep. But at 0224 hours, the station was toned out for a “vehicle accident with injuries and possible entrapment” at 7090 Jonesboro Road (about one mile from the station). Arriving three minutes later, the company found that a passenger car had left the roadway and struck a two-rail metal fence surrounding a car lot (see photo 1). Lieutenant Jerry Russell, the officer in charge, established Jonesboro Road Command. His size-up found the accident involved one vehicle occupied by only the driver. There were no fuel spills or scene hazards such as electrical line involvement.
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MEDICAL SECTOR
Sergeant Scott Olney, EMT-P, was the paramedic in charge of patient care. His initial patient assessment found the following: Two 11/2-inch-diameter steel fence pipes approximately 20 feet long had entered the front of the vehicle and passed through the radiator, over the engine, through the dashboard, and into the passenger compartment. One of the pipes was deflected down through the floorboard between the driver’s legs, but the other pipe passed through the steering wheel and through the air bag, entered the driver’s torso, exited his back, pinned the patient to the driver’s seat, and finally lodged in the trunk.
The victim was a male teenager. The pipe had entered his upper left chest at the clavicle line and exited through the left shoulder blade. Remarkably, his vital signs were stable throughout the extrication process, and he had full and clear bilateral breath sounds with no tracheal deviation. There was little blood visible despite the fact that approximately six feet of the pipe had traveled through his body.
Personnel initiated the following medical care for managing an impaled patient, and Olney remained inside the vehicle to evaluate, treat, and calm the patient during the extrication process:
- Enhanced airway with nonrebreathing mask at 15 lpm, since this type of mask is the preferred means of delivering high-oxygen concentrations to a spontaneously breathing patient.
- Established two large-bore IVs with 16-gauge catheters for fluid replacement.
- Stabilized the object in place with bulky dressings applied to the patient’s chest and back wounds.
- Administered morphine, with Medical Control’s approval, for pain relief since victim maintained static and stable vital signs.
EXTRICATION SECTOR
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The extrication sector easily determined the pipe had to be cut to remove the patient from the vehicle. Members opened the driver’s door using a hydraulic spreader to pop the door and access the interior. A pneumatic saw—because of its extremely high rpms, short stroke, and low-vibration characteristics—was selected to cut the heavy-gauge steel pipe.
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Because the saw would generate heat while cutting, wet towels were wrapped around the pipe and placed between the patient and the saw cut location (see photos 2, 3). The cutting surface was lubricated to reduce the cutting time and to provide an additional cooling agent. The frontal cut was made between the steering wheel and the patient’s chest; the posterior cut was made between the patient’s back and the driver’s seat (see photo 4).
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VICTIM REMOVAL AND TRANSPORT
During the cutting process, the patient remained conscious and alert. He told the paramedic he could feel the cutting saw vibration in his chest. The total patient stabilization and extrication time was only 33 minutes from equipment arrival to patient removal (see photo 5, 6). The patient was transported to Southern Regional Medical Center and promptly taken to the trauma surgery unit. Remarkably, the patient was released from the hospital after only three days and is expected to make a full recovery.
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- The fact that the department’s personnel are all dual-role, with fire suppression and EMS certifications, was a significant advantage in establishing sectors and assigning tasks. All personnel were in turnout gear, thus increasing scene safety.
- Heavy-rescue expertise and equipment were vital. The Clayton County heavy rescue squad concept was developed more than 10 years ago and has been expanded annually since. It possesses a full spectrum of rescue equipment including extrication, trench, confined space, and high angle. All departments are strongly encouraged to acquire such expertise/equipment or identify local resources if a similar incident occurs in their jurisdictions.
- Dropping and staffing a charged 13/4-inch cover line was necessary, given the potential fire hazard from the badly damaged engine compartment.
- The time of the event (0224 hours) was also an advantage, since Jonesboro Road is one of the most congested roads in the Atlanta region. The accident would have required law enforcement cooperation to reroute traffic if it had occurred during commuter hours.
- The fire department’s long-standing and collaborative relationship with our medical control, Southern Regional Medical Center, was vital. The paramedic talked directly with the physician by cellular telephone, ensuring accurate communication of information. A secure telephone line allows far more candor than a radio frequency.
- If the patient had been unstable, it may have been necessary to transport a physician to the scene if the extrication were lengthy. Requesting a medical helicopter was another alternative.
LESSONS LEARNED
Photos by Warren Bond.
BILL LOWE, EMT-P, is a captain and shift supervisor with the Clayton County (GA) Fire Department, where he has worked for 24 years. He has a doctorate in human resource management and a post doctorate in marketing management and is a university professor of public administration. Lowe is pursuing the National Fire Academy’s Executive Fire Officer program.
JEFF HOOD, EMT-P, is a deputy chief and supervises all fire suppression and EMS operations for the Clayton County (GA) Fire Department, where he has worked for 24 years. He is a Georgia EMT/paramedic instructor, was awarded a Georgia Governor’s Valor Proclamation for rescuing a police officer shot during a hostage standoff, and is a National Fire Service Staff and Command School graduate.
JERRY RUSSELL, EMT, is a lieutenant and a squad officer with the Clayton County (GA) Fire Department, where he has worked for 20 years. Russell is certified in numerous technical rescue areas including trench, confined space, high angle, and extrication and is a public safety diver. He was Clayton County’s 1999 Firefighter of the Year and received a departmental valor award in 1989.
