By Larry Collins
Industrial accidents take many forms, but L.A. County firefighters were confronted with an unusual dilemma on February 11, 2004, when a worker’s leg became trapped in the chain that pulls vehicles through an automated car wash. The ensuing operation required hydraulic rescue tools, a rescue saw, a new gasoline- and oxygen-based cutting torch, and imaginative rescuers who were compelled to administer an unusually high dose of morphine to the victim, who screamed in agony through much of the rescue.
The Incident and Response
At 1209 hours, L.A. County Fire Department (LACoFD) Engine and Squad 154 were dispatched to a traumatic injury at a car wash in the city of Covina, with no initial report of entrapment. Upon arrival, Engine 154 captain Leonard Fontes could see the victim being supported in a semi-standing position by other people. The man’s right foot appeared to be trapped in the chain mechanism that pulls automobiles through the automated washing system. The victim’s screaming could be heard from the street, an indication of the high degree of pain he experienced from the crushing forces being applied to his foot.
Fontes’ made his size-up report and requested that the closest truck company and battalion chief respond. Quint 153 (which carries extrication equipment including hydraulic rescue tools) and Battalion Chief 16, Gary Aalbertsm, were dispatched. The response was upgraded to a person trapped, and USAR Task Force 1031 was also dispatched.
Fontes first directed a member of his crew to perform “lock-out, tag-out” operations to ensure that all mechanical power to the system was eliminated. He directed the others to begin freeing the victim with the tools they had on the engine and squad while he gathered additional information from the manager about how the chain-driven system operated, looking for possible solutions.
Initial Rescue Operations
The man was still experiencing severe pain and clamored for something or someone to help him. Fontes and his crew began working to free the man and help manage his pain. The man’s foot had become trapped in the chain and was now being crushed between the chain and structural members of the car wash’s vehicle propulsion system. Fontes directed his personnel to begin working with hand tools and the hydraulic rescue system carried on Squad 154 (a paramedic unit staffed by two firefighter/paramedics).
While personnel retrieved various tools, Fontes continued to develop a plan of action, and two firefighter/paramedics assessed the man’s injuries. They determined he was a candidate for the immediate pain medication administration. His vitals were stable and the injury appeared limited to the crushing of the right foot and ankle. While the radio man contacted the base station, the patient man established an I.V. and prepared to administer morphine, anticipating an order from the base station. The base station concurred with their assessment and treatment request, and ordered up to 10 milligrams of morphine sulfate, titrated to effect (e.g. pain relief). In short order, the morphine was going on board, but it didn’t seem to lessen the man’s pain sufficiently. He was still screaming, even as his rescuers worked out a plan to get him out. Trying to extract someone who’s in so much pain can be extremely stressful (especially when bystanders are multiplying the natural sympathetic reaction). This was one of those situations.
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The continuity of technical rescue operations at this incident was designed into the LACoFD’s urban search and rescue system from the beginning, and it shows why most technical rescues in the LACoFD’s jurisdiction are completed by first responders on engine and truck companies and paramedic squads, all of whom have been trained to the USAR/technical rescue “awareness” level. Many of these responders have also completed a variety of other USAR/technical rescue and swiftwater rescue courses offered by the LACoFD. That was always part of the plan: providing first responders with the knowledge, skills, abilities, and tools to accurately assess rescue problems, begin stabilization, and conduct technical search and rescue operations using tools carried on their units, with backup and safety support provided by the secondary responders on USAR Task Forces, on the department’s helicopters, and the department’s haz-mat task forces for confined space, structure collapse, tunnel rescue, trench and excavation rescue, and terrorist attacks. |
Engine 154’s crew began working to gain access to the victim’s foot, while the firefighter/paramedics from Squad 154 continued treating him and assisting with the extrication. Meanwhile the man’s coworkers continued to physically support the man, who had become trapped in a very unnatural position and needed to be propped up to avoid falling forward (and possibly snapping his leg at the shin, which would simply complicate the crushing injuries and increase his agony). The coworkers were doing a good job of helping their colleague remain in the position of best comfort, and the firefighters worked around their legs trying to get at the main problem.
The hardened chain was housed below the vehicle path, in a sort of channel or sheath, protected by metal plating. It was accessible only by a narrow slot where the vehicles are pulled along the vehicle travel route. Somehow the man had managed to step into the one place where the slot’s opening was large enough for an adult foot. The chain must have grabbed his pant leg and shoe and dragged him backward until it wedged and began crushing his foot until another employee struck the emergency stop button.
Station 154’s personnel first used a rescue saw to cut open the steel plates to expose the chain and the man’s leg. They used hydraulic spreader tips to bend and peel back additional steel. Then they used hydraulic cutters to snip away some of the offending steel. With some of the plating removed to expose the man’s foot, the firefighters were better able to determine how he was trapped. They decided to try to reverse the process that had trapped him, by pulling the car wash chain in the opposite direction, hopefully freeing his foot.
To do this, they had to begin dismantling the chain after making sure it was not under tension, which could cause an elastic rebound or some other unwanted reaction. With various hand tools, the engine and squad crews managed to pull pins and basically sever the chain, just as Quint 153 and Battalion 16 arrived, with Chief Aalberts assuming incident command.
Dismantling this link in the chain provided firefighters with an exposed pin around which they could hook a rescue chain. They set up the rescue chain and a hydraulic spreader just as they would do for a “closing” maneuver (similar to a modified steering wheel pull). One firefighter observed and touched the victim’s and ankle to call for an all stop if there was any unwanted movement or more pressure exerted on the victim. Unfortunately, the car wash chain refused to budge more than a few millimeters in the opposite direction. Personnel theorized that sort of stop mechanism might be preventing the chain from moving backwards or that chain propulsion system was designed for one-way operation only.
Joined now by Quint 153, which carries the standard extrication tool inventory for LACoFD truck companies (including hydraulic rescue tools, rescue air bags, reciprocating saws, etc), Station 154’s crew worked to remove more plating with the rescue saw and hydraulic tools to expose more of the chain and the victim’s foot. They were also looking for other extrication options.
Meanwhile, Squad 154 found that the man’s pain had not been sufficiently reduced by the morphine. He had to constantly be held up by firefighters and bystanders in a sort of forward-leaning stoop, and his continuing agony was plainly evident. The paramedics reported this to the base station, which ordered a additional 5 milligrams of morphine. However, even with nearly 15 milligrams of morphine on board, the man’s suffering was not alleviated to an acceptable degree. The definitive treatment here was primarily to free the man’s foot, stabilize the leg, make sure the victim’s vitals remained stable, continue treating him for pain, and get him to the emergency room. So efforts concentrated on freeing victim’s foot.
Time for the Petrogen
After a few minutes, Station 154 and Quint 153 managed to expose a section of the chain and had made progress getting to the man’s foot. They worked to pry and peel back more metal, attempting to reach the vertical metal post that helped form the framework of the platform, and which was pinching the man’s foot and ankle. However, it was becoming evident that the hydraulic rescue tools could not reach into the gap to cut or move the critical metal framework elements that were crushing the man’s foot between the sheath and the chain. Something smaller, more maneuverable, and more precise was required. Captain Fontes radioed USAR Task Force 103 that they were in need of a torch or some other tool that could reach into the gap to make the cuts.
Task Force 103 was less than a mile away, and personnel had already discussed the tools required to get the job done based on reports from Captain Fontes and Chief Aalberts.
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L.A. County firefighters were first exposed to the Petrogen at the World Trade Center collapse after the 9-11 attacks. The Washington State FEMA US&R Task Force arrived with several of them. It proved so successful at cutting a variety of types and thicknesses of metal and steel at the WTC collapse, that more were ordered on the spot, and other agencies began adopting this tool for daily use and for FEMA urban search and rescue operations.
The LACoFD had recently purchased a Petrogen for USAR Task Force 103. It had already been used successfully in a number of extrication rescues, including an incident involving a runaway freight train that derailed into an East L.A. neighborhood in July 2003 (see Fire Engineering [month to be researched]), prompting members of USAR Task Force 103 to use it for a variety of metal burning operations. And it proved fortuitous for the victim in the car wash rescue.
USAR103’s captain had already directed the USAR firefighters to pull the Petrogen cutting torch off the Rescue Tender2 to place it in service for an immediate metal burning job once they arrived, with the ArcAir exothermic torch, a pneumatic “whizzer” saw, and other tools ready for backup.
USAR TF Arrives
Task Force 103 arrived at 12:48 hours. Battalion 16 and Captain Fontes met Task Force 103’s captain and pointed out the pieces of steel that needed to be cut to free the man’s foot.
By the time USAR103 arrived, personnel on location had exposed the chain, especially the area where the man’s foot was trapped, attempted to reverse the process of entrapment, administered 15 milligrams of morphine, and were in discussion with the base station about other options if the extrication were to be prolonged much further. They had attempted to cut away the pieces trapping the victim using rescue saws and hydraulic tools. When they came to an impasse with those tools, the first responders recognized the need for a torch to get at the remaining pieces that required cutting. Prior to the USAR team’s arrival, they had pulled a protector line to support the metal burning operation (e.g. keeping the man’s foot cooled and taking precautions against a fire erupting in the confined area in which the rescue was being conducted), making for a smooth transition from first responder to integrated secondary responder operations in support of the first-due personnel.
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Photo 2: The area after the victim’s foot was freed. |
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Photo 3: Petrogen tool being used during the burning operation. |
Rescue Completed
The final phase of this rescue took just a few minutes. After confirming that the chain drive system had been locked out and tagged out, USAR firefighters quickly assembled the Petrogen, pressurized the gasoline canister, and hooked up the oxygen supply. A firefighter fired up the torch and, with a hose line in service to keep the heat off the victim’s foot and prevent ignition of flammables, started the metal burning operation. Meanwhile the ArcAir was placed in service as a backup torch.
The Petrogen made quick work of the metal pieces, allowing firefighters to pull them away from the victim’s foot, finally releasing him to the arms of colleagues and firefighters, who lifted him onto a waiting guerney. Paramedics quickly reassessed his vitals (still stable) and the crushing injury, splinting and immobilizing it. They rolled the victim into the ambulance and departed for the emergency room.
Lessons Learned
- Adopt “Best Practices” from wherever you find them. In this case, hydraulic rescue tools and a rescue saw with hand tools provided a very good start to gaining access to the victim’s leg. However, a cutting torch was required to fully access the foot and then to free it. Rescuers should be knowledgeable about the full range of tools available to them, where to get them, who carries them, how they are used, their limitations, and their capabilities.
- Rescue tool “ensembles” like those used in this rescue are often the most effective way to effect complicated extrication operations.
- Continued research and development (including into new tools) is a necessity for progressive fire/rescue agencies to stay on top of their game.
- Time is of the essence when victims are trapped in life-threatening situations and/or when they are in excruciating pain. For the victim, every second can seem an eternity. Putting ourselves in the position of the victim emphasizes the importance of firefighters and other rescuers knowing their job, their tools, and where to get special capabilities quickly when needed.
- Pain management is a critical issue when dealing with trapped victims. Whenever possible, we want to alleviate severe pain if it doesn’t compromise other aspects of treatment and victim welfare. Plus, it can help reduce stress on rescuers (and also crowds of bystanders, who can complicate the situation in some cases if they are overly emotional at the scene) by reducing victim screaming and other effects of pain.
- When burning metal in confined areas with gasoline and oxygen torches, proper ventilation and other precautions are important. Proper use of the tool is important to prevent gasoline from flowing freely. Contingencies such as protector lines are necessary.
- Provide appropriate protection for victims when metal burning operations are occurring in close proximity. This can include draping body parts with turnouts and other flame-resistant material, providing cooling measures directly or indirectly to the trapped victim, etc.
- As in all entrapment situations involving machinery, lock-out and tag-out is a critical task that should be accomplished as soon as possible.
- When victims are reported trapped, it’s important for the jurisdiction fire/rescue agency to dispatch the appropriate physical rescue response to provide the full range of rescue tools and capabilities, and to reduce the entrapment time, thereby reducing suffering and physical damage or mortality for victims.
Footnotes1LACoFD’s two USAR Task Forces (103 and 134) are California Type I USAR Companies staffed by six personnel meeting NFPA 1670 standards. They operate as a 3-apparatus task force, including USAR103, a 54-foot long 5th wheel trailer apparatus, Engine 103, and Rescue Tender 103, a former paramedic squad converted to carry a wide variety of rescue equipment including extrication, rapid intervention, swiftwater rescue, and high angle rescue.
2Rescue Tender 103 carries specialized extrication tools, Rapid Intervention equipment, swiftwater and high angle rescue gear, and other specialized equipment, and responds with USAR103 whenever it is dispatched to technical rescues and major alarm fires.
Larry Collins is a 25 year member of the Los Angeles County Fire Department (LACoFD). He is a captain, USAR specialist, and paramedic assigned to the LACoFD’s central rescue company, which responds to technical rescues and greater alarm fires across the Department’s 2800 mile jurisdiction. He is a search team manager for the LACoFD’s FEMA/OFDA USAR Task Force for domestic and international disaster response, and a US&R specialist on the “Red” FEMA US&R Incident Support Team, with deployments to the Oklahoma City bombing, the Pentagon collapse on 9-11, the 2004 Florida hurricanes, and others. He is a frequent instructor at FDIC and FDIC West, and author of articles in Fire Engineering magazine and a three-volume textbook series titled Technical Rescue (Fire Engineering Books and Videos-PennWell Publishing, http://www.technicalrescueops.com)
