BY BILL CLARKE
“Service assignment” is a designation the Camden County (NJ) Communications Center applies to mostly nonemergency incidents requiring fire department personnel and equipment. The Haddon Heights (NJ) Fire Department (HHFD) responded to two such incidents within three days that proved unusual and most challenging.
At 1622 hours on a Thursday, the Haddon Heights Ambulance Corps’ Squad 2, Medic 4 (based at Virtua Hospital System), and local police were dispatched to a 9-1-1 call for a cardiac arrest. The first-arriving police officer advised the communications center that he would need help because of the patient’s size. He and another officer initiated CPR. At 1627 hours, the HHFD was dispatched for a “Service assignment—assist EMS” call and responded with an engine and a crew consisting of a captain and five firefighters.
En route, the captain was informed the incident involved a cardiac arrest patient whose estimated weight was more than 700 pounds. On arrival, advanced life support (ALS) and basic life support (BLS) units continued CPR and initiated ALS. Squad 2’s captain advised HHFD personnel that they needed assistance in packaging and moving the patient to the ambulance as soon as possible. It was clear that available staffing on scene was inadequate to package, move, and transport a patient of this size, and additional personnel and special equipment were requested. The patient was in a ground-floor bedroom and had been moved to the floor from his bed by EMS and police.
 1. Photo by author. |
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Four additional firefighters responded from the HHFD with confined space equipment, which it was felt would aid in the packaging and moving of a patient who could not fit on a stand-ard stretcher. The Runnemede Fire Department (RFD) responded with units that brought the “Runnemede Ramp,” an adjust-able ramp assembly consisting of several hinged metal panels and four scissor jacks. A local citizen, whose wife has major medical problems requiring frequent ambulance transport, designed and owns the ramp. The citizen allows the fire department to use the device whenever needed. The ramp was designed to go over the top of steps to enable a stretcher to be rolled down a flight of steps to the floor level of an ambulance without requiring lifting. This device has been used throughout the county over the years and has definitely proved to be a back saver (see photo 1).
The engine crew moved furniture and removed doors to facilitate movement of the patient and assessed other steps that would be needed to get the patient into the ambulance. Members removed several tree limbs in the front of the house to enable the ambulance to back up to the house’s front steps, removed the vehicle’s rear-door stop pins so the doors could open fully, and removed the stretcher hold-down and lock assembly so the patient could fit inside the ambulance. At the same time, members of the RFD set up the ramp on the front steps.
Using the skid and webbing from the confined space equipment container to package the patient, rescuers moved the patient from the bedroom, through the house, out the front door, and down the ramp.
Before the patient could be loaded into the ambulance, a doctor at the hospital, communicating by cell phone and telemetry with paramedics, pronounced the patient dead. The medics made themselves available for service. Although the incident was no longer urgent, it was far from over. Help was still needed to move the now-dead patient.
The police contacted the county medical examiner, who, after consulting the family doctor, authorized the body’s removal to a funeral home. When the funeral director was informed of the situation, he requested that the fire department remain on scene to assist with the body’s removal. On arrival, he agreed with the department’s plan to leave the body on the skid and use the ramp to move the body into the ambulance. He also asked that the department assist with moving the body when the ambulance arrived at the funeral home.
The ambulance transported the body at 1741 hours, and all units relocated at the funeral home. The ambulance was positioned at the home’s receiving door; the body was moved onto a casket carriage onto which a 3/4-inch-thick piece of plywood had been secured. The carriage was moved onto a hydraulic lift that descended to the basement embalming room (see Figure 1). There, the body had to be moved onto the embalming table, which was not wide enough to hold the deceased. A funeral home stretcher was raised to the level of the table and lashed to it to accommodate the body. The funeral home portable hydraulic lift (similar to an engine lift) was positioned to raise the body onto the table (see Figure 2). However, the straps normally used were not long enough to go around the body, so webbing and carabiners were used. Four firefighters stood on the lift to counterbalance the weight of the deceased. The body was finally placed on the embalming table.
 Fig 1 |
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 Fig 2 |
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All companies involved then returned to service. It had been more than two hours since the first units were dispatched.
Back at the station, members agreed that although this was an unusual incident, it was not unheard of. Although not extremely difficult, it was very challenging. The number of steps required to complete the assignment surprised everyone involved. The knowledge of the special equipment available through mutual aid was very valuable in that the Runnemede adjustable ramp greatly facilitated moving the body.
But the incident did not end there. Two days later at 1005 hours, the HHFD received another “service call—public assist” for the funeral home. Eleven firefighters responded with an engine and a utility vehicle. The funeral director told arriving members that the hydraulic lift used to raise the deceased to the first floor would not operate. The body was lying on a plywood sheet atop a casket carriage, had been prepared for the funeral, and needed to be raised to the first floor.
The casket carriage was rolled off the lift. Members examined the 15-year-old, 1,000-pound-capacity lift and found the hydraulic oil level adequate and the hydraulic pump electric power supply intact. The director estimated the deceased weighed between 700 and 750 pounds, although the body was never weighed. Apparently, the weight of the body was bending the hydraulic ram, preventing it from operating. It was decided the lift was the only way to raise the body to the first floor. The department called mutual aid for the air bags and cribbing necessary to accomplish this. A rescue and a utility company from the Barrington Volunteer Fire Department (BVFD) arrived with nine firefighters at 1031 hours.
BVFD personnel went to the basement to assess the situation. It was decided that since they were more familiar with this equipment, they would operate the air bags and deploy the cribbing. HHFD personnel were designated support and would move the equipment from various units to the members in the basement.
As the equipment was staged, personnel noted that the hydraulic lift shaft was considerably larger than the lift platform, which was raised to establish lifting points and to facilitate air bag insertion. Members improvised a ramp to permit rolling the casket carriage back onto the platform, using wooden cribbing wedges and excess plywood cut from the piece supporting the body on the carriage. Personnel used a reciprocating saw and cord reel for this task, since there was no electrical outlet near the lift.
The first lift was attempted at this point. Members inflated the air bags and activated the lift mechanism to prevent resistance or back-pressure from the hydraulic mechanism. When the air bags reached their maximum capacity, cribbing material was inserted under the platform to build a lifting platform for the next lift.
When the second lift was made, it seemed that the hydraulic lift was assisting in raising the platform. Metal stabilizing poles were inserted after the lift reached its maximum. It was decided to see if the hydraulic mechanism could now handle the job itself. Personnel stationed at each corner of the platform pushed up at the corners as the lift operated on its own. But when the platform rose beyond where the members could reach it, the mechanism slowed to a stop.
The stabilizing poles were again inserted under the platform and, using four-foot-long 4 2 4s, firefighters pushed on the underside of the platform until the lift reached the first floor. Stabilizing poles were again inserted, and the casket carriage was rolled off onto the first floor.
As personnel removed the equipment from the lift shaft, others assisted with placing the body in a casket, which required several attempts. They used the portable hydraulic lift previously used to place the body on the embalming table two days before. The last unit left the scene at 1214 hours—more than two hours after the first arrival.
These two special assignments illustrate the variety of skills, equipment, and knowledge needed to handle the diverse services we are called to provide to the community. Thus, many departments are changing their designation from “fire department” to “department of fire and emergency services.”
Although the initial “assist the squad” call was an actual life-and-death situation that, unfortunately, became a nonemergency, we still needed to remove doors, cut tree limbs, remove parts of the ambulance, and adapt equipment not normally used for this type of situation to complete the assignment.
LESSONS LEARNED
1. Find out what resources are available through mutual aid. It’s essential for today’s fire service to be aware of what special skills and equipment are available through mutual aid and other providers. We no longer just fight fires—we need more specialized tools and equipment to confront the wide range of incidents to which we respond more and more. Since limited funding restricts the equipment departments can obtain, we must share resources to get the job done. We may know that a company in our area has gotten a new piece of apparatus, but do we know what specialized tools it may have or if its SCBA bottles are compatible with ours? Does your communications center keep an up-to-date list of special equipment and apparatus available through mutual aid? If so, when was it updated?
2. Adapt skills and equipment to the situation. We must think out of the box to adapt tools and equipment normally used in a certain way or situation to meet the needs of the current incident.
3. Train with your mutual-aid companies. Training with mutual-aid companies is essential, especially with the specialized tools or equipment available. Not everyone needs to be fully proficient in the use of these items, but everyone needs to be trained in the basic operation and use of the tools.
4. Establish command and perform size-up at all types of incidents. This is the only way to develop and implement a plan. Good size-up allows us to determine, among other things, what resources we will need to accomplish our objective.
5. Make sure your equipment is where it should be when you need it. When checking out your apparatus, whether it’s done daily, weekly, or on training nights, do you open the boxes that hold some of the tools and equipment you carry, or do you check the item off just because the box is there? Are all of the tools that are supposed to be in the toolbox actually there? Remember, everything in a toolbox has legs. The same goes for the electrical adapter box. How do you know the thermal imaging camera or the gas detector operates properly? You have to open the box to find out. Periodically checking the checker is a good idea, too.
6. People are watching—and talking. We don’t work in a vacuum and are not the only ones who know what’s happening at an incident. Fire and rescue personnel arriving at a residence or funeral home attract attention. News about the situation does get around. The people watching have neighbors who have jobs and may be members of civic and social groups, and they talk. How the fire department behaved and performed in this situation, and the respect shown for the deceased, will become known to citizens of several communities. The departments involved can’t buy this type of public relations.
BILL CLARKE, a 43-year veteran of the fire service, has spent the past 32 years with the Haddon Heights (NJ) Fire Department, where he is a firefighter and a past assistant chief. A state-certified firefighter and fire instructor II, he is a part-time instructor at the Camden County (NJ) Fire Academy, where he also develops courses.
