Response to Railway Incidents: Train Strikes and Extrication

(1, 2) Access was the main issue—the incident location was elevated 20 feet with steep slopes and water below, under a train in the dark with a critical patient and no help available. (Photo 1 courtesy of Google Earth; photo 2 by author.)

The Victim

The victim was a 20- to 30-year-old female. She had been missing from an adjacent town for two days. We later learned she struggled with mental illness and suicidal ideations. She was walking along the tracks when the locomotive made contact with her. The force of the impact pulled her underneath the train between the wheels (called trucks) but did not cause any amputation. Instead, the blunt impact of her head and face with the locomotive pushed her between the rails, where the train continued to roll over her until it was stopped three-quarters of a mile later.

The victim was beneath a flat car with two 53-foot containers stacked on top. She had moderate to severe head trauma, some blood in her airway, and a broken arm. As our first medics got to her, she was moaning and responsive to painful stimuli. External bleeding was relatively minimal, but there was still a great concern for internal bleeding and brain swelling. Shock and hypothermia were also on everyone’s mind.

The Rescue

With this rescue, access was the main issue. Being elevated 20 feet with steep slopes and water below, under a train, in the dark, with a critical patient, and no help available to reach you is likely a worst-case scenario and not one that we had ever practiced or considered. Although we have had train strikes and vehicle vs. train crashes, our access had never been this limited.

We created a staging area for heavy equipment in the nearby park to carry equipment in as necessary. Unfortunately, the path through the park to the railroad tracks was no better: Trees and brush made access nearly impossible. We considered using chain saws to cut through the brush, but we knew that this would take up more personnel and more time than the patient had.

We considered launching our inflatable watercraft (an inflatable rapid deployment craft with a self-contained breathing apparatus bottle carried on the rescue engines) to ferry equipment across the marsh and extricate the victim to an adjacent commercial property. This too proved impractical in terms of time and access as well as the skill involved in such a highly complicated procedure and the risk of losing equipment into the water.

We used the police department’s all-terrain vehicle (ATV) to move equipment from the apparatus to the victim. However, this was only partially successful because, for obvious reasons, the ATV can’t go around a parked train that is 1½ miles long. Also, the steep slopes of the rail line and loose rock made it impossible for the ATV to climb the slope to access the track.

The train itself was hauling mixed freight, and some hazmat components were onboard but not near the victim. Although there were multiple cars with high hazmat quantities, there were no leaks. The car on top of the victim had two large 53-foot conex containers stacked on it; coupled with the car height, the load was more than 20 feet tall.

The initial rescue plan was to lift and stabilize the train car, similar to how we would approach any victim pinned under an object. We also discussed having our trauma center send a physician to the scene for field amputation, if necessary. Because of weather conditions, helicopter emergency medical services flights would be problematic, if not impossible, so ground transport was the only option. The environment of where to land a helicopter, set up a landing zone, and then transport a physician to an already limited-access area would have created another logistical hurdle.

When we evaluated the capacity of the train car, the conductor and engineer advised that this particular car that was on the victim was less than 100 tons. We carry stabilization struts for highway wall stabilization and other uses, but even with eight struts we did not have the height or capacity for a 200,000-pound lift. We also didn’t have equipment to perform that type of lift or cribbing on the dark, cold, wet, uneven terrain.

The Save

Although we considered many factors, the most important one was life. We were able to work quickly with the railroad and, after confirming the victim was not entangled, we separated the cars and moved the train. We had placed providers underneath the train, providing the victim with oxygen, blankets for warmth, and bleeding control. A tourniquet was applied to her extremity and a c-collar was used for c-spine immobilization. We created a clear path to the patient by moving the car approximately 20 feet.

At that point, the extrication was complete. We just needed to package the patient. Crews used a collapsible stretcher and maintained spinal precautions as best as possible and carried her down the tracks to an awaiting medic unit. Personnel prepped the medic unit by heating the patient compartment, readied IV supplies, and notified the hospital of an incoming trauma.

The patient was transported to a local hospital. She had facial and skull fractures but no serious brain injury. Her extremities were splinted and repaired and she had several minor internal injuries. She will receive treatment for her mental illness.

After the incident, we conducted an after-action report. We called larger departments that deal with subway and train accidents but noted that subway cars are significantly lighter than the loads we faced on a 100-ton freight car in an isolated environment. Our railroad companies have equipment, including a 100-ton rotating crane, that can lift derailed cars of this size. Many railroad cranes can go up to 160 tons; however, these highly specialized pieces of equipment are coming from railyards in urban centers and, in many cases, are not prepped to rapidly deploy.

Lessons Learned

Lessons learned from this incident follow:

• Preplan routes of travel to railroads. Have apparatus on both sides of the train for equipment and prepare for them to operate independently within the incident command system.
• Basic care matters. As tempting as it is to bring a heart monitor, IV supplies, and every trauma dressing imaginable, it all must be packed in—and packed out.
• Stay light and fast. When scouting for victims, take the basics: oxygen cylinders, basic bleeding control, tourniquets, and blankets. Also, call for more resources, if needed.
• Be prepared for extended operations. This patient was extricated less than 90 minutes from impact, but it took 30 minutes to find her.
• Ensure your crews are prepared for cooler and wet environments.
• Develop a relationship with your trauma hospitals. Although we would have requested services for a field amputation immediately, fortunately there was no need, and there was no room for access. Down-and-dirty field care and then ALS care en route to more definitive treatments proved effective yet again.
• Stage equipment. Prepare to pack in the necessities, including additional oxygen. Also consider rescue tools for entanglement including grinders, torches, cutters, spreaders, and air bags. All of these resources require lots of personnel and consumables, so don’t forget batteries, gasoline, and lighting.
• Build relationships with the railroad. Ultimately, moving the train was the best and right option and saved the victim’s life.
• Know where cranes and specialty equipment are kept and the process to request them through your communication centers as well as estimated response times.

In the end, this was a relatively easy rescue in very tough conditions. Our crews performed exceptionally well on an incident for which they had never trained. We value life and preserving it, and this call proved it.

TREVOR FRODGE is a lieutenant with the West Chester (OH) Fire Department. He is also an NREMT-P and a fire/EMS instructor and serves as a company officer on one of two rescue engines. Additionally, Frodge is a rescue team manager for the Butler County (OH) Technical Rescue Team and serves as a hazmat specialist for Ohio Task Force 1 Urban Search and Rescue.