Article and photos by Dan Fuller
Shortly after 11pm on November 8, 2009, a Minot, North Dakota, homeowner awoke to a loud crash inside his home followed by the alarm of the home’s smoke detector, which activated. When he went to the main floor of the house, he found two strangers trying to leave the residence through the front door, which was locked. He opened the door to get them out of the house and went into the basement, where he found a vehicle that had crashed through the front of the house and landed on his 15-year-old daughter, who was asleep in her bed. Minot Central Dispatch received his 911 call, and an immediate full first-alarm response of two engines, a ladder, and a rescue was toned.
(1) The scene from the interior.
(2) A view of the vehicle from the rear where it crashed into the basement.
Engine 1 and Ladder 2 arrived on scene and staged to the west of the scene. As the incident progressed, a rescue plan was formulated. The vehicle obviously needed to be lifted off the patient. The issue was how to lift the vehicle off the patient while ensuring it remained level. If the vehicle were to dip to one side or the other, it could impinge the patient’s legs or head, causing more injuries. Three teams were set up: a medical team, an interior team, and an exterior team. The medical team was set up in the adjacent room and prepped all of its equipment to make a rapid transport once the patient was freed. The interior team was responsible for setting up cribbing and the air bags. The exterior team was responsible for securing the vehicle so that it did not pitch forward or move from side to side. The vehicle was a Cadillac SRX, a type of SUV-sedan “crossover.” It was secured to Rescue 2 with a 16,000-pound winch that was mounted on the rear of the truck using the tow hitch receiver. This setup allowed us to have more immediate access to our hydraulic tools, since they are mounted with reels in the rear compartment of the truck (the truck was ordered this way from the manufacturer). Minot Central Dispatch, at the request of the Minot Police, notified a wrecker service just after the initial dispatch. It arrived on scene and tied off on the front of the rescue in case it was needed. A metal chain was looped around the vehicle’s rear axle and secured to the rescue as a safety measure as well.
(3) The cribbing and air bag setup.
(4) Another view of the vehicle on the interior.
The vehicle was lifted off the patient using cribbing and air bags. The cribbing was 24-inch long 4 × 4 lumber. Two separate box cribs were made from the concrete floor to the inside of each wheel assembly. A three-foot-square piece of plywood was then added to give the air bags some stability. The decision was then made to attempt to lift the vehicle off the patient because of her serious condition. The Technical Rescue Trailer and Special Operations Rescue would have necessitated a call-back crew to staff , and it was on the other end of town, meaning it would take at least 20 minutes to respond. The patient became combative and began to lose consciousness. We slowly and alternately lifted the air bags and winched the vehicle. Once the car was approximately a half inch off her chest, the patient’s mental status, breathing rate, quality, and color improved.
Once the vehicle was off the patient’s chest, we conducted manual C-spine immobilization while she was slid over to the wall. This created enough space to apply a C-collar. It was determined at this point that the vehicle could not be lifted enough to completely slide the girl out. Command decided that the bed posts be cut to drop the end of the bed enough to slide her out and onto a backboard. The bed posts were made of tubular steel approximately three inches in diameter. Hydraulic cutters were used to cut each post at the point in which the bed frame attached horizontally. The legs were removed, and the bed dropped eight inches, creating the space needed to remove the patient. During this process, the areas of the patient that were under the car were rapidly assessed for injury and major bleeding. Nothing was noted. She was slid out onto the backboard and secured. Removal from the entrapment took less than 20 minutes from arrival, and the patient was at a Level 2 trauma center within 26 minutes from dispatch.
The Advanced Life Support ambulance service for the city, which is hospital owned, does not train its personnel in extrication or equip them with the proper safety gear for incidents such as this. Gloves, helmet, and eye protection would have helped, but because of the location of the car and the debris around the patient, uniform pants and the issued light three-season jacket did not offer any protection against cuts and abrasions. Having a cross-trained firefighter-paramedic offered a quick solution to the problem, but it is not a permanent fix.
The dual-location winch was used in the rear of the truck for this incident. The design gives operators the flexibility to use the winch no matter which way the truck is pointing. In this case, backing the truck into the scene enabled us to have the hydraulic tools closer to the incident where they were used.
The speed of the rescue was correctly determined by the condition of the patient. Her mental status, respiratory effort including rate and depth of inspirations, and skin color/temperature /condition were all signs of a hypoxic patient and of impending cardiogenic shock. Once it was determined the situation required immediate removal of the patient from the entrapment, a rescue was planned, executed, and reevaluated as the incident progressed. Once the patient was removed from the scene, a firefighter/paramedic from R2 rode with the ambulance to the hospital. Engine 1’s captain drove the girl’s parents to the hospital in their private vehicle so that they could have transportation once at the hospital and so they were not driving in an excited state. The hole in the house was secured with plywood, and all units went back in service. Driving the parents to the hospital and boarding the hole in the building weren’t necessary, but they did improve overall customer service. The girl was admitted with a hip fracture and was released the next day. She was back on the basketball court within four months. Good use of the incident command system, familiarity with the tools that were used, and cool heads led to a successful rescue.
Dan Fuller is a firefighter for the Minot (ND) Fire Department. He is also an NREMT-certified paramedic, a fire service Instructor, and a tester for the North Dakota Firefighters Association. Prior to starting his fire service career, he was a staff sergeant in the United States Air Force, where he served for eight years.
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