TREATING VICTIMS
THE RESCUE COMPANY
(Photo by Tom McCarthy.)
When we think of treating victims, we usually think of a seriously bleeding victim of a vehicle or construction accident, industrial mishap, or stabbing or shooting. We tend to associate cervical collars, blood pressure cuffs, various dressings, gauze pads, bandages, splints, and resuscitators with these types of incidents.
In rescue operations, however, the first treatment a victim will probably receive is psychological treatment from the rescuer. During complex rescue operations this type of treatment generally w ill be of longer duration than that which normally is rendered to victims of vehicle accidents, shootings, and stabbings.
PSYCHOLOGICAL TREATMENT
Just how important is psychological treatment? Extremely important. Victims who are seriously injured and are conscious generally have two major concerns: How serious are my injuries and am I going to live? and How long will it take to free me? (The latter question usually is asked during vehicle accidents and major building collapses alike.)
Some victims who are unresponsive during a rescue operation later report hearing the rescuers but being unable to respond. I remember most vividly a young woman who tried to end her life by jumping from the fifth floor of a rehabilitation center. 1’he building had a five-foot-high picket fence around the entire complex, and when she jumped she became impaled on the fence. The pickets penetrated her body in three locations: the thigh, the buttock, and the side just above the hip. The first rescuers at the scene were amazed to not only find her alive but conscious and pleading for help. As rescuers set up a backboard and provided stabilization shoring for the board, which became a temporary means of support for the duration of the rescue operation, the officer in charge began communicating with the victim. Psychological treatment was put to the extreme test in this incident. Here we had a young woman who was impaled on a picket fence, supported on a backboard at a height of five feet from ground level, and aware that the pickets went through her body. Her thoughts: Would she live through this ordeal (her original intentions were to do away with life)? I low would the rescuers free her from this most unusual position?
We began by reassuring her that yes, she would be freed; time didn’t seem important at that moment. As the rescue operation began, we again reassured her that she was in good hands–those of rescuers who had previous experience with this unusual type of incident. The rescue unit involved in this operation had responded to five impalement incidents in the past 13 months.
As rescuers used cutting torches to begin cutting the picket fence in two different areas (this would expedite the operations), a protective fire blanket covered the victim to protect her from sparks from the torches. The officer explained the entire scenario to her step by step and the reasons for each action. He emphasized that it was important for her to remain as still as possible to prevent the possibility of additional injuries. Keeping up a conversation with the victim, the officer was able to take attention away from her injuries and focus instead on how they were rescuing her.
By this time EMS personnel had arrived on the scene, but because of the victim’s position on the fence, they were unable initially to perform a patient survey or assessment. Additional EMS personnel arrived and helped ready the necessary equipment so that as soon as the victim was free and lowered to street level, they could start treating her without delay. They needed two stretchers side by side to support both the victim and the separated section of picket fence that had been cut but was still imbedded in the victim.
Ideally, cross-training between fire and EMS personnel will make it much easier to understand each other’s problems and needs in situations like this. At this incident, because of the victim’s position on the fence, rescuers had to free the victim and lower her before EMS could begin treatment. EMS saved valuable time by preparing their equipment and being ready to start treatment as soon as the victim was lowered.
Rescuers helped EMS personnel remove the victim to an ambulance to ensure that the cut section of fence would be moved as gently as possible to prevent further injuries. The ambulance had to be stripped so both stretchers and personnel could accompany the victim to the hospital.
The incident commander ordered another officer to proceed to the hospital before the ambulance transporting the victim left the scene. This served a twofold purpose: to ensure that the entrance used to bring the victim into the hospital would be clear and large enough to accommodate two stretchers side by side, and to prep the emergency room staff as to what had occurred and how the victim was impaled and tell them to set up a working area away from other patients. Because of the small size of the emergency room, this would involve shifting both patients and personnel.
The officer suggested that all nonmedical personnel, including hospital volunteers, be removed from the area in which the victim would have to pass through and be treated. An older, seasoned veteran of emergency room treatment objected to being told what to do by a firefighter. The officer tried to explain that because of the victim’s appearance and condition, any unnecessary personnel might cause unnecessary disruptions.
Then the ambulance with the victim arrived at the hospital. The entrance had been made ready and the two stretchers were wheeled into the emergency room.
The sight of a victim with a picket fence sticking out of three areas of her body can be upsetting even to rescuers who have experienced numerous similar incidents. Credit has to be given to all the rescuers involved in this incident, as they kept their cool, went about their business, and watched their tongues during the operation. This made it much easier for the officer in charge to render his psychological treatment.
The story had a happy ending. The pickets had not penetrated any vital organs, and the loss of blood was minimized due to the pickets’ location as they entered the body. Paramedics and EMS personnel were on the scene quickly and stabilized the victim prior to her removal to the hospital. What at first appeared to be a possibly tragic incident turned into a success: After three weeks of hospitalization, the victim was well enough to go home.
A NOT SO PATIENT “PATIENT”
In another incident rescuers, after 8½ hours of digging, located a woman who survived being trapped in the rubble of a collapsed building. Psychological treatment of this victim would take a different form than that for the impaled woman.
This victim began a dialogue with rescuers, blaming the city mayor for the building collapse and her predicament. She cited his record on crime issues, environmental and pollution concerns-everything from daycare centers to multimillion-dollar contracts with out-of-town vendors. While she expressed her opinions, rescuers had cleared enough debris to allow paramedics to make an initial patient survey. Rescue work was halted so that paramedics could start an intravenous line, which would begin her treatment for dehydration and shock.
At this point rescuers realized that the woman’s injuries were more serious than they appeared. Paramedics were able to stop her from talking about the mayor long enough to get information about her injuries. Paramedics then informed rescuers that the victim probably was suffering from crush injuries from the mounds of debris on top of her. Crush injuries can lead to crush syndrome, which is defined as shock and renal failure following a severe crushing injury that results in soft tissue trauma. It is reported that crush syndrome accounted for more than half of the thousands of hospitalizations that occurred after the Armenian earthquake. As rescuers continued their efforts to completely free the victim, they realized that she was employing her own psychological treatment by discussing every current issue continuously, while hiding the fact that she knew her injuries were serious.
During the last phase of the rescue operation and just prior to removing her from complete entrapment, one of the rescuers asked her if she was married. She answered that she wasn’t but had plans to marry in the near future, which would have to be put off for a while. The rescuers asked why she would want to put off such a happy occasion. Her answer was quick and direct: “1 want to dance at my wedding.”
It took 18 months after the building collapse and many hard hours of therapy before she walked down the aisle. She invited her rescuers to the wedding and danced with them.
PHYSICAL AND MENTAL CARE
Proper and prompt treatment of victims is essential to their survival. Thus it’s extremely important that rescuers follow some basic rules to help ensure the proper treatment and care of victims, especially those involved in complex rescue operations.
- Psychological treatment can be rendered by anyone. No certifications or degrees are necessary-just good old common sense and compassion.
- Ideally rescuers should be trained with the necessary skills to treat accident victims-administering CPR, treating for shock, controlling the bleeding, and completely packaging the victim, including splinting, bandaging, and backboarding.
- First responders who do not have EMT, AMT, or paramedic qualifications should understand the responsibilities of these personnel and work with them, not against them. This can be accomplished by cross-training between EMS and rescue personnel.
- Protect victims so they do not suffer additional injuries during the rescue operation.
- Always treat victims for possible spinal injuries: Don’t move them until qualified medical personnel have examined them and taken the proper steps to prevent further injury.
- Victims of prolonged entrapment such as those in building collapses and industrial accidents are prime candidates for crush syndrome. Having qualified medical personnel at these incidents is a must.
The incidents described in this article are some examples of the many interesting rescues that are made nationwide every day. Do you have a rescue story to tell? We’d like to hear from you. Please write to Ray Downey c/o Fire Engineering, Park 80 West, Plaza Two, 7th Floor, Saddle Brook, NJ 07662.
