HURRICANE ISABEL PROMPTS TECHNICAL RESCUE RESPONSE

BY DANIEL BINGHAM

Hurricane Isabel, a Category 2 hurricane, made landfall during the early afternoon of September 18, 2003, between Cape Lookout and Okacroke Island, North Carolina. It moved northwest at 20 miles per hour across eastern North Carolina before it was downgraded to a tropical storm. It continued to move up the coast and affected the Mid-Atlantic area, including the Washington, D.C., metropolitan area. In preparation for the ensuing storm, the federal and local governments and schools were closed; public transportation in the area was suspended.

Isabel left hundreds of thousands without power, streets were submerged by flooding, sustained winds reached 60 miles per hour, and thousands of trees were toppled before the storm finally broke up over Southern Canada.

On September 19, 2003, as a result of the storm, the Arlington County (VA) Fire Department (ACFD) was overwhelmed with responses for wires arcing and down, trees into houses, and other hurricane-related problems. After an extremely busy day and night, units were dispatched at 0047 hours to a tree into a house with a report of a person pinned. The initial assignment consisted of one engine, one medic unit, the technical rescue team, a battalion chief, and an EMS supervisor. This response was less than a normal technical rescue response because of the high call volume.

The ACFD consists of 10 stations with 10 engines, two trucks, two heavy rescues (technical rescue and haz-mat), and seven advanced life support (ALS) units within two battalions covering 22 square miles. Engines are staffed with four firefighters, trucks and rescues with three.

The technical rescue team consists of a quint, a rescue, and a medic unit, stationed together with a satellite station that has an additional engine and a support trailer. Minimum staffing is five on-duty trained personnel.

Because of the anticipated call volume, departmentwide staffing was increased to four on the trucks and rescues. Additionally, three support units staffed with two were strategically placed in service to run minor storm-related calls. The technical rescue support trailer, staffed with two, and two reserve medic units were placed in service. Typically, response times are four minutes or less; however, in this case, it was 18 minutes until the first units arrived on the scene because of the extensive damage Hurricane Isabel had caused—the most direct response routes were blocked by downed trees and power lines.

Arriving units were greeted by an occupant of the house who told them a large tree had fallen and crashed through the second floor, pinning her husband in his bed. Tree branches were seen extending from the roof area from side A (front), but the extent of the damage and the anticipated type of operation that would be needed were deceiving.

(1) Initial size-up.

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(2) View of the master bedroom from the doorway. (Photos courtesy of author.)

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SIZE-UP

The first-arriving engine and rescue arrived simultaneously and began size-up. They were faced with a surreal scene: A mammoth oak tree approximately three feet in diameter had fallen from side C (rear). The tree had crashed through the roof, the bearing wall, and a large window on side C; the trunk had pinned a man who was sleeping in his bed. The tree destroyed the roof assembly; these materials were compacted between the victim and the tree trunk. To further complicate matters, the tree was situated so that a large limb was vertically in the air and moving as a result of the high wind, causing the man pain.

Initial victim assessment revealed that the man was conscious and alert; he had pain in his chest area and lower extremities. Paramedics quickly began ALS and treatment for crush syndrome (a situation in which circulation is cut off from large areas or the extremities and return of circulation can prove fatal). This was a paramount consideration when extricating the victim.

ACTION PLAN

After the initial size-up, the following action plan was developed and communicated:

• Assess the victim and administer initial treatment.
• Selectively clear the area of debris and furniture to better access the victim.
• Calculate the approximate weight of the tree (the battalion aide). Command needed this information before requesting a crane, to ensure the correct size crane would be acquired.
• Stage equipment on the second floor.
• Initiate a high-lift jack. Because there was an area of only four inches between the bed and the rear exterior bearing wall, a high-lift jack was initially placed on a base of 4 2 4 cribbing, as close as possible to the bearing wall to limit the tree’s downward movement. This jack, although generally a very unstable method of shoring, worked well as a temporary measure since the tree was cradled by a window frame and was being supported laterally. Additionally, controlling the tree’s downward movement and the strength of the floor assembly were major concerns because of the load the jack would transfer to it.
• Capture our progress with 4 2 4 cribbing.
• Place the quint’s aerial ladder over the area so that we could assess the situation from above and possibly cut away some of the limbs to reduce the weight.
• Attempt to initially stabilize the tree and possibly slide the victim out from beneath it once it was shored and cribbed and debris was selectively removed. This would be complicated because of the tree’s irregular shape and the fact that it was supported only by the jack and the heavily damaged wood-frame house structure.
• Secure utilities.
• Call for the technical rescue support trailer for larger dimensional lumber for shoring (cross-staffed by a technical rescue engine company).

If the plan were unsuccessful, plan B was to stabilize the tree trunk and cut off the legs of the steel bed frame to drop the mattress and box spring to the floor to release the victim. Ultimately, this was unnecessary because crews were able to lift the tree enough with the jack.

After the size-up was completed, the plan was instituted. The officer of the rescue was designated the Rescue Group leader and explained plan A to the crews operating on the floor. This was vital to the successful outcome of the incident because many of the personnel were not trained in technical rescue. As stated by the veteran captain of the first-arriving engine company: “The plan was simple, realistic, and easy to understand—safety and patient care were the priorities—something that would have been done before technical rescue days.”

RESCUE PLAN INITIATED

A high-lift jack was placed on top of a base of three-foot-wide 4 2 4 cribbing that was laid down on the floor assembly closest to the bearing wall on side C to distribute the load. While this was being done, the quint crew positioned the aerial over the damaged area to assess from above if the tree limbs being moved by the wind could be cut and removed. This proved not to be feasible because of the extent of damage to the structure and the way the tree was resting. The jack was put in place and operated to relieve the downward pressure of the tree trunk without lifting it. After the tree was initially stabilized, the situation was reassessed. The paramedics reassessed the victim, who was still stable, conscious, and alert. His only complaint was pressure on his chest and pain in his lower extremities, which were pinned by a piece of the roof’s sheathing and trusses. We began to remove and cut more of the debris loosened by the initial jacking, but the victim was still complaining of pressure on his legs. It was suggested that a small air bag be positioned in a void between the roofing materials so that inflation of the air bag would reduce some of the pressure. The suggestion was determined to be a viable option because it would not move the tree and would give relief to the victim. The air bag was set in place and inflated until the victim’s pain was relieved. The air bag was left in place and monitored while the tree trunk was further stabilized.

This was difficult because of the amount of debris crushed to the floor and the limited work area. Since the jack was placed at the bearing wall, there was no room to build box cribs; it was decided to secure and monitor the jack and build a small 6 2 6 vertical T-shore opposite the bearing wall to support the tree at one end, with the jack on the other end and the bed in the middle. The plan was to jack up the tree, set the shore, and capture the trunk by using 4 2 4 wedges around it. However, there were no guarantees, since the tree was fractured near the center of the room, over the victim.

STAGING EQUIPMENT

Staging of equipment was critical to the successful outcome. As part of our technical rescue standard operating procedure, the rescue company driver performs this task. Because of the large amount of cribbing anticipated and the equipment that would be needed, an additional firefighter was assigned to this task. All the needed equipment was staged in the second-floor hallway, just outside of the bedroom for easy access. In addition, the driver was at this location to take requests; the equipment was shuttled from the street to the second floor throughout the incident.

TECHNICAL RESCUE SUPPORT VEHICLE ARRIVES

The technical rescue support vehicle and engine arrived with an additional six people; four of them were directed to set up a cutting station outside to build the 6 2 6 vertical T-shore. They were also directed to begin cutting 36-inch 4 2 4s to be shuttled to the second floor as additional cribbing. The other crew of two served as a rapid intervention team.

(3) The tree trunk after limb removal.

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(4) View from sides C and B.

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(5) Removal of the tree, sides B and C.

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(6) Removal of the tree from side A.

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VICTIM’S CONDITION DETERIORATES

The victim’s condition began to decline as the entrapment period lengthened. He was now complaining of having trouble breathing; the paramedics were concerned with chest trauma and crush syndrome. They reevaluated him and determined that his condition was deteriorating—he had to be freed as quickly as possible.

The change in the victim’s condition made it necessary to alter the stabilization plan; time was of the essence. We began our lift with the jack to move the tree high enough so we could remove the debris pinning the victim. We had 4 2 4 cribbing available to capture the progress made with box cribs and shoring. The order was given to attempt a lift with the jack in place. The jack was rated only at 7,000 pounds; we knew the tree’s weight far exceeded this, but we needed to lift the tree trunk only a few inches to be able to remove the roofing materials between the tree and the victim. We were also able to free some debris by pushing down on the mattress. (The victim’s condition and the pain he was experiencing were directly related to the give created by the mattress and box spring.)

As we were altering our initial plan, we heard a loud crack. Everyone operating in the room was given the “stop” command. We evaluated the tree’s movement. After determining that it was safe to do so, we again attempted to lift the tree.

The jack was raised an inch, but we could not remove more debris. The order was given to lift again; the jack was raised another inch, which gave us enough room to remove the materials. We meticulously cut and removed the debris from on top of the victim, successfully extricating him. He was removed from the structure, treated, and transported one hour after our arrival.

COMMAND

When the battalion chief arrived, Military Road Command was established. The following command considerations and actions were taken.

Considerations

• Safety of the crews, victim, and occupants.
• The potential change in the severe weather conditions, which would create additional hazards.
• Stability of the house.
• Victim care during the extrication and considering the best route to the hospital in view of the weather and road conditions.
• Equipment and personnel needs.
• Time delay for responding resources caused by road and weather conditions.
• Alternate plan(s) should the primary plans be unsuccessful.

Actions

• After the size-up, the rescue captain was designated the Rescue Group leader, the medic unit was assigned to patient care, and the first-arriving engine was assigned to provide lights inside and outside and to ladder side B (left side).
• As the rescue plan proceeded, a technical rescue engine and a support unit were requested.
• In preparation for the storm, Arlington County Public Works had tree removal crews work throughout the night. A supervisor was requested to assess the possibility of cutting and lifting a portion of the tree. On arrival, the supervisor and the crew said they were not equipped to do so.
• A RIT was established because of the hazardous situation.
• A second medic unit was requested to stand by for fire department personnel.
• The presence of the EMS supervisor was requested because of the prolonged extrication and the fact that the victim’s condition was worsening. Additionally, as the extrication efforts continued and the victim’s condition worsened, his spouse became more and more distraught. Although she was not injured, it seemed as though she might need to be transported to the hospital.
• After the victim was freed and removed from the structure, the house was secured and placarded as unsafe.

• Everyone needs to know the plan and the objectives; the Rescue Group leader communicated this very well.
• Keep it simple so that everyone knows what is going to happen. We often make technical rescues harder than they actually are.
• The paramedics’ initial treatment for crush syndrome and assessments were crucial to the operation. They held their composure when the victim’s condition deteriorated, advising the Rescue Group leader of the need for rapid removal and transport.
• Once the victim was extricated, he was moved to the hall area outside the bedroom. In situations like this where egress is limited to a small opening, consideration should be given to moving the victim far enough out of the work area to keep the primary egress and escape route clear.
• Officers must be open to suggestions for altering the plan to expedite the process. The more information and suggestions you receive, the easier it will be to make the right decisions.
• Everyone worked together as a team, as it should be.
• Large trees are abundant in most jurisdictions. We must be prepared to calculate the weight of these trees. We found this difficult to do on the scene. After the incident, we researched and found a useful tree weight calculator at www.shodor.org/succeedhi/succeedhi/weightree/teacher/activities.html/. We used the calculator and determined that the tree weighed 89,000 pounds. You will have to provide this information when calling for a crane.
• There were some problems with nonessential people stacking up in the second-floor hallway. Like fires, this is a common problem because of our nature; we want to be where the action is. Company officers and personnel must exercise discipline and learn to stage away from the operational scene when not needed.
• Personnel assigned to stage equipment were initially getting tool requests that did not go through the Rescue Group leader. All requests for tools, communications, and equipment should come through and from the Rescue Group leader.
• Hurricane Isabel did significant damage to our community, and we were responding to call after call prior to the incident. All crews were fatigued. It is important that company officers monitor their personnel to ensure they are operating safely.
• Consideration should be given to assigning a safety officer to oversee the rescue operation. Unfortunately, we realized the need for this after the incident.
• The jack was placed against the side C bearing wall on a cribbing base because of the limited space in the room for air bags and shoring. The best approach to fully shore a tree lying horizontally in a wood-frame structure is to carry the load with structural shoring from the tree to the floor and each floor below until it reaches the foundation, or at least two floors down. However, the victim’s condition did not allow this.
• Speak with and build relationships with tree-removal companies in your areas. They are experts in their fields, work with trees daily, and can provide valuable information.
• This incident was extremely stressful to all involved. Critical incident stress management was offered to all personnel through our Employee Assistance Program.
• Overall, the incident went very well with a few minor problems.

LESSONS LEARNED AND REINFORCED

All personnel involved did an outstanding job; the victim was transported to a trauma center, where he was treated for his injuries and released.

As a follow-up to the rescue, we returned to the scene on our next shift to survey the structure in the daylight. As we approached the structure, the victim’s spouse greeted us. After explaining the purpose of our visit, we asked her how her husband was doing. She explained that he miraculously was released from the hospital already. To our surprise, she asked if we would like to speak with him. He greeted us with overwhelming gratitude and appreciation. This was a fine conclusion to our efforts and, in retrospect, is what the job is all about.

DANIEL BINGHAM is a fire/EMS captain in the Operations and Emergency Service Division of the Arlington County (VA) Fire Department, assigned to the Technical Rescue Team.