BY JOE MANCOS, NR-EMTP, AND TOMMY McNEILL, CCEMTP
Farm accidents claim many lives each year throughout our country and can be a tremendous challenge to emergency responders for many reasons. The accident may not be discovered and reported immediately, and the farm may be remotely located and have poor access for emergency services. The resulting delayed response times may mean a poor victim outcome. All of these factors eat away at our precious “Golden Hour”; many times we arrive to find that the “Golden Hour” was several hours ago.
Farm machinery incidents make up a large part of the farm-related injuries and may result from the equipment’s age, lack of maintenance or missing safety equipment; the operator’s inadequate training; failure to read the operator’s manual; ignoring safety warnings; or failure to follow safety rules. Any of these factors can result in entanglement or injury.
Farm machinery’s construction differs from that of highway vehicles from which we are accustomed to extricating victims. Farm equipment is heavier and has a different center of gravity; the metal used in its construction may be stronger than that in our rescue tools. Responders must be trained in specific rescue procedures designed for these types of incidences. Agriculture rescue or “farmedic®” programs are an excellent way to learn or brush up on decision making, stabilization, and machinery extrication skills. Visiting a local farm equipment dealer is one good way to learn about the different types of machinery used in farming; the dealer is a valuable resource for your agriculture rescue resource list.
Power take-off (PTO) accidents can be very serious, resulting in life-threatening injuries and even death. A PTO is used to transfer power from the tractor to a variety of implements through a shaft. The stub is the part to which PTO-powered implements are attached on the tractor; typically, the number of splines on the stub will indicate the PTO’s speed; usually the more splines, the faster the PTO. The human body is no match for the impressive power of a PTO, which can have speeds of between 540 and 1,000 rpm (photo 1).
(1) Typical 540-rpm PTO stub.
The shaft from the implement is usually connected to the stub by a spring-loaded push pin or spring-loaded collar. On older implements, you may even find a hole designed for a pin to fit into, but normally the pin was lost long ago and something else has been substituted for it (photo 2).
(2) PTO shaft without safety guard. Notice the pin in the collar near the universal joint. (Photos by Joe Mancos.)
The PTO shafts will usually be of solid or tubular shaft construction. If cutting the shaft is the most feasible option in an incident, look for the weakest point to make your cut. Exothermic torches are great tools for cutting shafts. The down side is they produce sparks.
Not all tractor or PTO incidents happen on a farm. Look around your response area; farm-type machinery has many applications in urban and industrial settings. Streets and maintenance departments and construction crews may use tractors with front-end loaders, backhoes, scrape blades, and many hydraulic or PTO-driven implements such as spreaders and mowers. Also, golf courses and city parks use agricultural-type machinery in everyday operations. It is essential that we know how to handle these types of emergencies regardless of whether we work in an agriculture area or at a downtown city station.
Before we consider the case study, let’s review a few important safety steps.
Stabilize the scene. Remove any hazards to protect the rescuers as well as the victim; look for stored energy. Stored energy can be electrical batteries, leaking fuel or fluids, or simply energy resulting from someone or something being entangled or wrapped or suspended in machinery. A sudden release of this energy could possibly harm rescuers.
Stabilize the tractor. Shut it off, and chock the wheels. Look at the implement-how does it need to be stabilized? Keep in mind that not all tractors shut off with a key; on some diesel tractors you must locate the fuel shutoff to shut it down.
Also, just throwing a 4 × 4 under the rear wheels won’t be adequate because of the size of the tires. Using truck chock blocks may be sufficient. Typically, you will need to build the cribbing up at an angle to make it steep enough to prevent the tractor wheels from rolling. Take one 4 × 4 and place it about 10 inches in front of the wheel pointing side to side, then place two or three 4 × 4s in line with the tire/wheel, one end resting on the first 4 × 4 you placed and the other end butted against the wheel, then take a final 4 × 4 and place it side to side on top of your last 4 × 4s, and butt it against the tire tread. Both rear wheels should be chocked front and rear. Once the tractor and any attached implements are stabilized, you can then stabilize the patient.
On December 24, 2005, at 1721 hours near the small town of Vass, in Moore County, North Carolina, the Circle V Fire Department and Vass Volunteer Rescue Squad were dispatched along with Moore County EMS to a traumatic injury: male patient caught in an auger-type wood splitter. The fire department responded with two engines and one equipment/command truck. The Vass Rescue Squad responded with a medium rescue truck and a basic life support quick response vehicle. Moore County EMS responded with an ambulance staffed with two paramedics and one EMS operations truck with the on-duty shift captain/paramedic. The University of North Carolina’s Air Care’s Tar Heel 1 was dispatched early for medical air transport to UNC Chapel Hill Medical Center, the closest Level 1 trauma center.
The first-arriving fire and rescue crews found James McKay, 83 years old, with his left arm entangled in the PTO-driven shaft of an auger-type wood splitter (photo 3). The tractor was not running, and the victim was unresponsive. A witness stated that the tractor “choked down” when the victim became entangled.
(3) A victim entangled in a PTO shaft-driven auger type log splitter. (Photo by Frank Staples.)
The patient had been feeding a log to be split onto the auger when the sleeve of his coat became entangled, pulling him down to the shaft and wrapping his arm around it. After stabilizing the tractor and the implement, personnel attempted to manipulate the victim and the shaft to “unwind” the victim, but were unsuccessful. Basic life support began on arrival of EMS units. Patient assessment and advanced life support care began immediately with ventilation assistance using a bag valve mask and high-flow oxygen.
The manual traction of the cervical spine continued as paramedics started an IV in the victim’s external jugular vein, then applied a rigid cervical collar. Injuries sustained during the incident included fracture of the left scapula, multiple rib fractures, thoracic spinal fracture (T-8), gross dislocation of the left humerus, and a partial avulsion of the left ear.
After attempts to free the victim by manipulating the victim and disassembling the machinery were unsuccessful, a decision was made to cut the PTO shaft using a reciprocating saw with a bimetal cutting blade (photo 4). Once the victim was free and placed on a long spine board, he was taken to the EMS unit to await the arrival of Tar Heel 1. The landing zone was in a field adjacent to the farmhouse.
(4) A PTO shaft after the victim was extricated. Note where the cut was made. (Photo by Frank Staples.)
• Because of the remoteness of the incident location and the possibility of life-threatening injuries, the on-duty EMS shift captain and 911 dispatchers initiated a medical helicopter transport to transfer the patient to a Level 1 trauma center on the initial alarm. This can be vital to a favorable incident outcome with a viable victim trapped or injured in farm or agricultural type machinery.
• As fire and rescue personnel were attempting to disentangle the victim, medical care was initiated as soon as medical personnel arrived on-scene with a cervical collar, manual spinal traction, and assisted ventilation; an IV was begun. The helicopter crew completed advanced airway procedures because of the need for rapid sequence intubation (RSI), not available to the local EMS service.
• Using rapid and basic victim assessment skills with very little equipment, the initial primary and most of the secondary survey can be completed. What is the victim’s level of consciousness (LOC)? Does the victim have a pulse in all extremities? (Lack of a pulse is an indication of falling blood pressure.) What is the victim’s skin color/temp? Is the victim cool, clammy, pale? If you are able to obtain a blood pressure, is it <100 systolic? Is the pulse tachycardic, >100? All signs of shock are the body’s way of telling us something is very wrong and to take notice.
This basic assessment can be carried out by anyone from first responder level to paramedic while immobilizing the victim. ALS care such as IV therapy and advanced airway procedures can be done while the victim is being extricated from the machinery if safety precautions have been taken for all in the “hot zone.” Remember, the sooner we can get even the most basic medical care to the victim, the better the final outcome.
• Using their training and combined experience, responders on-scene decided to cut the implement to free the victim. To free an entangled victim from farm machinery, there are three options. The first is to manipulate the patient or shaft to “unwind” him. Because of the tension (stored energy) on the implement from the weight of the patient and the winding effect of the accident, this was not practical.
The second option is to disassemble the implement. For the above the reasons, this, too, was impossible. The last resort was to cut or destroy the implement. We did this using a reciprocating saw. This particular implement was a solid shaft and took a few minutes to cut. Be alert to any stored energy that may be waiting for the right moment to release, causing additional injury to the victim or rescuers.
• Placing the apparatus close to the incident provided personnel with access to all equipment. The extrication’s total time was around 15 minutes.
• Most important is that all the agencies involved worked well together, which contributed to a successful outcome.
Currently, the victim is recovering at home, working around his farm. In the interview, he said, “I really can’t remember anything at all about that Christmas Eve night, but I’m really glad those guys knew what they were doing.”
JOE MANCOS, NR-EMPT, has more than 15 years of experience with the emergency services, and is a shift captain/paramedic with Moore County (NC) EMS and the Moore County Special Operations Team. He is also a captain with Pinebluff Fire and a volunteer with Aberdeen Rescue. Mancos is a certified instructor, qualified in firefighter I and II, rescue technology, VMR, rope and confined space rescue, and a paramedic instructor. Mancos and co-author Tommy McNeill founded M&M Fire and Rescue Training Services.
TOMMY McNEILL, CCEMTP, has more than 20 years of experience in emergency services and is a paramedic/asisstant crew chief with Alamance County (NC) EMS. He is assistant chief of Ash-Rand Rescue Squad and EMS, a member of North Carolina USAR Task Force 7, a board member of the North Carolina Association of Rescue & EMS Chiefs, and vice commander of the North Carolina Association of Rescue & EMS. McNeill is a former Randolph County EMS paramedic and telecommunicator and served with Westside Fire Department. He is a certified EMS instructor, rescue technician, and farmedic instructor.