A ‘Small’ Incident That Needed a Major Response

By Joseph Manfredonia

Sometimes, what appears to be a relatively small accident can necessitate the use of multiple resources and involve overly complex operations. This was the case in the accident involving one vehicle that occurred on Saturday, July 30, 2016, in Ramsey, New Jersey. While traveling in the northbound direction, the vehicle veered off of Route 17 and struck head-on a tree within the grass divider separating Route 17 northbound travel lanes from the off ramp to the Franklin Turnpike. The patient’s vehicle spun off the tree and was found in the reverse direction approximately 40 to 50 feet away from the tree. The vehicle was a Volvo manufactured in the early 1990s.

Responders on Scene

Ramsey Rescue Deputy Chief (492) arrived first on scene at 5:30 a.m. to find a single motor vehicle with the driver, the sole occupant of the vehicle, heavily entrapped. The deputy chief assumed initial operational control of the extrication. Ramsey Rescue Chief (490) arrived shortly thereafter and assumed command. Ramsey Rescue Assistant Chief (491) assumed vehicle and equipment staging operations.

492 confirmed with the Ramsey Police Department patrol that the helicopter had been requested and was in flight. Ramsey Fire Chief (430) assumed control of the nearby helicopter landing zone.

The crew of Ramsey Rescue’s first-due Heavy Rescue Unit 423 stabilized the vehicle, chocking four locations (two along the driver’s side and two along the passenger’s side). They then removed the driver’s side front and rear doors and staged and set up rescue tools for continued extrication operations.

(1) Ramsey Rescue Squad-Heavy Rescue Unit #423 (arrow) and Heavy Rescue Unit #R-8 (arrow) conducted the extrication operations. <i>(Photos by author.)</i>
(1) Ramsey Rescue Squad-Heavy Rescue Unit #423 (arrow) and Heavy Rescue Unit #R-8 (arrow) conducted the extrication operations. (Photos by author.)

The crew of Ramsey Rescue’s second-due Heavy Rescue Unit R-8 arrived and assisted Rescue 423 with extrication operations. Ramsey Ambulance Unit 424 placed a c-collar on the patient’s neck as soon as the Rescue 423 crew removed the roof from the vehicle and provided access to the patient.

The patient’s legs were entrapped and pinned independently of each other because of the excessive amounts of vehicle structure, dashboard, and center console wreckage sustained and displaced by the impact of the tree.

Hydraulic ram operations involved using three hydraulic rams at the driver side and one at the passenger side, with a come-a-long set up at the front vehicle hood. The objective was to remove enough of the front-end wreckage to free the patient’s legs and his lower body so that he could be placed on and secured to a long board. This necessitated removing, in addition to the roof, the driver’s side front and rear doors and displacing the driver’s side front quarter panel, the driver’s side front wheel, and the entire dashboard from the driver’s and passenger’s sides. Seven hydraulic rescue tools (two cutters, one spreader, and four rams) were essentially working at the same time to free the driver.

(2) The side impact bar was lodged into and remained in the tree even after vehicle impact.
(2) The side impact bar was lodged into and remained in the tree even after vehicle impact.

The extrication was completed in a half hour. The patient, who had sustained numerous compound fractures, internal broken bones, and injuries throughout his body, was transported alive via Ramsey Ambulance Unit 424 to the awaiting helicopter.

Lessoned Learned

As a volunteer department, our members’ availability varies by the day of the week and the hour of the day. Since this incident occurred on a Saturday morning, we had many members on scene. If it had occurred during the workweek, we would have had to call in additional personnel from surrounding departments early in the incident through our county mutual-aid system, Northwest Bergen Mutual Aid Association, particularly to ensure that our crews were rotated out, especially to prevent heat exhaustion from working in the July heat.

Ramsey Rescue operates all of its emergency scenes under the Incident Command System structure. In this incident, that structure began with the first-arriving rescue chief, who was the command officer, down to the chauffeur of the first-due rescue, who was assigned as the overall tools, equipment, and vehicles staging officer.

((3) The force of the impact into the tree dislodged the entire engine, transmission/drivetrain completely from the engine compartment. Note the come-a-long setup at the front vehicle hood (arrows).
(3) The force of the impact into the tree dislodged the entire engine, transmission/drivetrain completely from the engine compartment. Note the come-a-long setup at the front vehicle hood (arrows).

The complexity of this extrication rescue operation made it obvious to the three chief officers early in this incident that patient rescue operations needed to be broken down into vehicle sectors because of the significant amount of patient entrapment.

The deputy chief continued his focus on the driver’s side vehicle entrapment and debris removal to free the patient’s left leg, which involved displacing the front wheel and axle (the front wheel of the vehicle was displaced significantly enough to pin the patient’s left leg from the knee down to his foot completely under the driver’s seat). Hydraulic rams were used to displace the left side of the vehicle and dashboard. A come-a-long was anchored to what was left of the front vehicle undercarriage to assist in vertically lifting the dashboard off the patient.

The chief focused on the passenger’s side vehicle entrapment, debris removal, and vertical displacement of the overall dashboard to free the patient’s right leg.

(4) Four hydraulic rams were used simultaneously to free the entrapped patient. One ram was removed before this photo was taken.
(4) Four hydraulic rams were used simultaneously to free the entrapped patient. One ram was removed before this photo was taken.

The assistant chief managed all tools and equipment in operation, setting up additional tools and equipment as requested and required on a minute-to-minute basis and directing and assigning squad members to complete the needed tasks.

Most importantly, had we not had both of our heavy rescues at this scene, we would not have had enough hydraulic rescue tools to save this patient’s life.

JOSEPH MANFREDONIA is a 30-year veteran member and past chief of the Ramsey (NJ) Heavy Rescue Squad. He is a heavy rescue extrication instructor, hazardous materials specialist, certified drill ground instructor, fire inspector, and fire official and a technician/specialist in rescue diving, high-angle rescue, confined-space rescue, trench-collapse rescue, and structural collapse rescue. Manfredonia has a B.A. degree in architecture from the New Jersey Institute of Technology and an M.S. degree in construction management from Stevens Institute of Technology. He has managed the construction of numerous ground-up, high-rise buildings in New York City throughout his 23-year career as a construction manager that included unusual construction projects such as a national award-winning renovation to the U.S.S. Intrepid Sea Air Space Museum and the first modular high-rise building in New York City.

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