When the Uncomplicated Becomes Complicated

By Michael N. Ciampo

When school is dis-missed for the summer, the number of incidents involving children seems to rise. Unfortunately, many of the incidents that involve children can be very serious and often can result in a fatality. They can also leave us wondering how in the world the children got themselves into this predicament and how we, the rescuers, are going to get them out of it.

Responding to a report of a child trapped in a bicycle seemed to us a simple and routine call. Most of us thought it would be a basic extrication: to free the rider, reverse the bike’s pedals and the pants would come undone from the chain and sprocket assembly, or cut the pants with a scissors. As we approached the scene, we noticed a trail of blood leading up to the bike and one child holding the rider up on his side. Seeing the blood reinforced our policy to bring the first-aid kit as a necessary initial action when responding to such incidents.

As we approached the scene, what we thought was a simple extrication was turning into a complicated rescue. A quick size-up revealed that a child had been riding his bike barefoot and his foot was wedged between the bike’s frame. The child was crying and trying to be brave, but the scope of his injuries—a broken ankle and bare toes wrapped around and impaled between the sprocket and chain—had him in shock. Quickly, one of the members took over to physically support the child and talked to him to take his mind off of his predicament and to gain his trust. As we began the extrication size-up, we requested a medic unit (to possibly administer a digital nerve block) and a heavy rescue company (with more specialized tools). Remember, it’s easier to call for additional help and not need it than to need it and have to wait for it.

Luckily, we keep a tool kit on the apparatus for smaller extrications such as this. The kit includes small hand tools such as assorted screwdrivers, pliers, cutters, hacksaws, wrenches, a hammer, a pry bar, and a small bolt cutter.

The members donned medical gloves because of the bleeding and wrapped the child’s toes with gauze pads. Even if you’re going to use regular work gloves, you should still put on a pair of medical gloves underneath for added protection. Blood and bodily fluids can easily penetrate the work gloves, exposing you to unneeded risks.

The first plan of attack was to release the chain and attempt to take some of the pressure off the child’s toes. Most times the chain is a simple device to remove: There are two elongated slide clips on one of the links that you can pry or slide off with a screwdriver and needle-nose pliers. However, in this situation, with the bike on its side and because of the location of these links, it was quicker to cut the chain with a large bolt cutter. When cutting any object with the bolt cutter, try to get the material deep into the cutter’s jaws. Placing the material at the tip can cause it to slip out of the jaws when you cut. Also, when cutting chains, it may be necessary to keep the chain taunt so that it doesn’t twist while you apply pressure during the cut.

Once we cut and gently removed the chain, we relieved a lot of pressure off the child’s toes. His simple sigh of relief let us know step one was a success.

Often, it is easier to unbolt the rear wheel and slide the tire forward in the frame to release tension on the chain. However, because of the child’s body position and the bike acting like a support, we could not perform this tactic.

Our next step was to remove the child’s bent foot and impaled toes from around the sprocket and in between the frame rails (holding the rear wheel assembly to the bike). Initially, we felt removing the rear wheel with wrenches and pressing in one side of the frame would give us enough clearance to slide the toes. Again, this tactic wasn’t an option because of the bike’s position and how it was supporting the rider. Our next option was to use the reciprocating saw, but because of the size of the saw and blade; the narrow working area; and the fact that the saw cuts in a push/pull motion, which can create a lot of vibration and shifting of the material being cut, we opted instead for the whizzer saw (an air-powered circular disc cutter, commonly used in muffler removals). Although it makes a peculiar, high-pitched noise while it cuts (which you may need to let the victim know about), it allowed us easier access to the tight area around the child’s foot.

As we cut, we checked the metal frame often for heat buildup. One member had a pressurized water extinguisher ready to cool the metal if needed. Once we completed the cut of the frame just behind the sprocket, we bent it inward and carefully removed the child’s foot. We slid the bike out from between his legs and gave him appropriate medical aid. On completion of the rescue, we all agreed it was a learning experience in that what may seem like a simple extrication may involve some finesse, time, and the use of smaller hand tools. When dealing with children, keep in mind their emotional needs, and look at things from their perspective so they will gain trust in you as their rescuer.

MICHAEL N. CIAMPO is a 24-year veteran of the fire service and a lieutenant in the Fire Department of New York. Previously, he served with the District of Columbia Fire Department. He has a bachelor’s degree in fire science from John Jay College of Criminal Justice in New York City. He is the lead instructor for the FDIC “Truck Company: Essentials” H.O.T. program. He wrote the Ladder chapter and co-authored the Ventilation chapter for Fire Engineering’s Handbook for Firefighter I and II (Fire Engineering, 2009) and is featured in “Training Minutes” truck company videos on www.FireEngineering.com.

 

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