IMPALEMENT TESTS DEPARTMENT`S NEW RESOURCES
BY ERIC M. NORBERG
July 9, 1996, was a busy day for the West Warwick (RI) Fire Department. Between calls, members spent the morning readying the department`s new special hazards truck, which carries heavy rescue equipment, for service.
Just after 12:30 p.m., Engine 1 (my company) and Rescue 1 (an advanced life support unit) were directed to respond to a report of “a child fallen off a bike.” We arrived at the scene in less than a minute and a half and could see down the driveway of a residence what appeared to be a young girl impaled on a fence. Approaching the area, we confirmed that an eight-year-old girl had a 34-inch-thick wrought-iron fence shaft completely penetrating her upper forearm.
The girl told us that she was riding her bicycle and fell off onto the fence at a family friend`s house. The friend knew not to try to pull the child`s arm off the fence and called 9-1-1 instead. Friends and family members held the child to support her weight (because her arm was a little higher than the fence) until the fire department arrived.
Engine 1`s Captain Jerry Tellier assumed command of the incident. He immediately called for the new special hazards truck. After a quick size-up, he decided that members would have to cut the fence and transport the child as she was, still impaled on a section of fence.
Captain Tellier determined that the best tool for the job was the sawsall. However, he requested that the highway garage bring a cutting torch to the scene as an alternative, as the department did not have one but was in the process of ordering one. Members stretched a hoseline as a precaution for the cutting operation.
While Rescue 1 evaluated the girl`s medical condition, I constantly reassured her and told her exactly what we were going to do to help her. We placed a towel between the child and her injury to block the unpleasant sight.
The special hazards truck arrived within minutes, and members readied the sawsall and electrical reel. At the same time, an IV line was started and the Hasbro Children`s Hospital was notified of the situation and given our estimated time of arrival.
The fence involved was three feet high and ran the length of the driveway. It had a horizontal top and bottom rail, which held the vertical fence spikes in place.
Captain Tellier made four cuts: two on the top rail and two on the bottom rail. Each cut took approximately 45 seconds. The sawsall proved to be an excellent tool for this situation. Although it took a few minutes longer to cut than a torch would have, it did not create any sparks; had little heat transfer; was quiet, allowing for better communication while cutting; and kept the patient`s anxiety level to a minimum. Our only concern was the vibration the saw caused, which was minimized by cutting close to the vertical spikes and having several members hold each side of the cut.
The section of fence removed measured two feet by three feet and was carefully immobilized with the child to the stretcher with several head blocks on either side of the child to support the fence`s weight and sheets to secure it. The child`s arm was bandaged in place, and she was transported to the hospital.
The elapsed time from dispatch until the child`s arrival at the hospital was 44 minutes; it took 15 minutes to set up and cut the fence.
The hospital staff removed the section of fence from the girl`s arm in surgery. No further fire department assistance or equipment was needed. The girl did not sustain permanent damage to her arm.
LESSONS LEARNED
Learn about uncommon situations such as impalements from other departments and how they handled them. Our department has never had an impalement situation before. However, we knew what to do from reading about impalements in fire service magazines.
Develop a plan and have an alternative if the initial plan is unsuccessful. Although we did not have a cutting torch, we ordered one from another city resource to stand by in case the sawsall was not successful.
Know the capabilities and limitations of your equipment. We took precautions to minimize the vibrations that we knew were inevitable in using the sawsall.
Do not assume that any call is routine. We were told originally that a girl had fallen off her bike. Imagine our surprise on arrival to find out that the girl had fallen off her bike onto a fence!
Teamwork is key to a successful operation. Everybody had a job to do–often at the same time. Actions at such an incident must be coordinated and must complement–not hinder–each other.
Focus on keeping the patient calm. This makes working conditions less stressful, which enables rescuers to concentrate on the task at hand. I constantly reassured the girl during the entire incident.
Contact the hospital well in advance so it can prepare for your arrival.
Make sure the cut section of fence will fit in the back of your EMS or other hospital transport vehicle.
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ERIC M. NORBERG is a firefighter/EMT-cardiac with the West Warwick (RI) Fire Department, where he has been for almost two years.
