BY LARRY COLLINS
On November 15, 1999, a crane overturned onto a restaurant on the historic Malibu Pier while transporting a 3,000-pound piece of hardware for a pile-driving operation to renovate the pier’s storm-damaged understructure. As the heavily laden boom crashed through the roof of landmark Alice’s Restaurant, the driver’s cage was crushed against a concrete wall separating a parking lot from the pier structure, pinching the 19-year-old operator between the wall and the body of the crane.
Firefighters from the County of Los Angeles (CA) Fire Department (LACFD) spent several hours using cranes, rescue air bags, extensive shoring and cribbing, cutting and breaching, and other tactics to free the operator while attempting to prevent serious crush syndrome-related consequences.
This accident was yet another reminder that unsafe construction practices can create unique rescue challenges for firefighters. The successful rescue of the crane operator demonstrated why fire departments benefit from maintaining an awareness of local construction activities and hazards. And, it showed the continuing value of modern fire department-based urban search and rescue (USAR) programs.
At 9 a.m., as surfers plied “head-high” waves on nearby Surf Rider Beach, a construction crew was hard at work repairing the underpinnings of Malibu Pier. The pier and several restaurants that shared its pilings had been closed since the deadly storms of 1992 and 1993, when heavy surf threatened a major collapse. Traffic was heavy along the Pacific Coast Highway as residents and visitors struggled past construction on a stretch of coast that’s been the site of no fewer than four state and federal disasters in the past eight years.
The day’s job included a pile-driving operation to reinforce the underpinnings of the pier and associated structures. According to eyewitnesses, a crane had “picked” a large steel pile-driving device from the back of a flatbed truck in a parking lot that separated the Coast Highway from the beach and pier. Several onlookers later recalled their surprise when they saw the crane begin to slowly drive across the parking lot-parallel with traffic on the highway-with the 3,000-pound load suspended from the end of its boom. They reported that the 19-year-old operator not only failed to extend and lock the crane’s outriggers but was attempting to deliver the pile-driving equipment by driving across the parking lot with the heavily-loaded boom at nearly full extension.
If true, this maneuver was inexplicable. The parking lot consisted of relatively thin asphalt pavement and concrete laid over a pier system anchored in sandy soil. No fewer than a dozen vehicles were within the boom’s “fall zone” should it totter toward the Coast Highway. Even to casual observers, it seemed an unnecessarily dangerous maneuver, considering the potential for workers and innocent motorists to be crushed should a mishap occur.
As the crane neared the pier, the load began to “pendulum.” There were reports that one of the wheels (obviously unsupported by any outriggers) sank into the asphalt, which, in turn, started a dangerous oscillation. Witnesses reported that the operator slowed the crane to a stop and attempted to counteract the pendulum effect by moving the crane boom “against the swing.” He succeeded in damping the movement of the load for a fleeting moment, but then the load began swaying side to side ever more violently. Within seconds, the entire crane was tilting from side to side. The load was swinging out over two lanes of bumper-to-bumper traffic on the Pacific Coast Highway and then back toward the ocean-directly over the roof of Alice’s Restaurant on the pier.
NARROW ESCAPE FOR SOME
Several construction workers, whose eyes had been drawn to the crane boom’s unusual motion, scrambled to get out of the way as the load went toward the pier. Their escape was the first lucky break of the day. Now (as the saying goes) the pendulum swung the other way. People seated in cars stuck in traffic had mere seconds to react as the boom and its load rushed toward them and swung overhead. If the crane had gone over toward the highway, many would have been crushed or trapped. This was the second fortunate break of the day. But it wasn’t over yet; now the load was swinging back toward the pier.
Just outside Alice’s Restaurant, a G.T.E. employee repairing a pay phone glanced up just in time to see a heavy metal object flying at him like a demolition ball on a pendulum arc. It was at this point that the crane finally tipped over, flinging the load toward Alice’s. The body of the crane fell onto the separation wall on which the telephone was mounted.
The repairman, standing between the crane and the wall, dived away at the last moment, literally saving himself by a fraction of a second and several inches. The telephone and the separation wall were instantly crushed by tons of flying metal and steel. According to witnesses, any hesitation on the repairman’s part would almost certainly have been instantly fatal. His was the third stroke of luck for the day. But, as is often the case in situations like this, someone else was about to run out of luck.
The only person left in the fall zone was the crane operator (who, according to witnesses, seemed torn between jumping out to save his life and staying in the cab to make a last-ditch attempt to prevent a disaster). Whether through choice or simply his inability to get out of the cage, the operator remained inside as the crane went over. The operator’s cage was crushed directly against the separation wall, reducing the top three courses of concrete block to their original state.
Meanwhile, the boom and its load swung out over the roof of Alice’s and then crashed through it. The crane would have turned completely onto its side except for two things. First, as the length of the boom drove through the roof in a downward arc, its momentum was interrupted by the bearing walls, which stopped the boom just below the level of the headers. Second, the body of the crane wedged itself against the separation wall bordering the parking lot.
The chassis and body of the crane mashed against the wall, its motion accelerated by the pendulum momentum of the extended boom and its load. The heavily reinforced metal structure of the cage was crushed and deformed between the separation wall and the body of the crane. The operator was pinched between opposing walls of steel as the seat was shoved upward by deformation. The effect was not unlike a child’s creasing the bottom of a cereal box upward (inward) and then crushing the sides together to form a slightly elongated and off-kilter rectangle; however, instead of completely flattening the box of the operator’s cage, the bearing walls and the separation wall stopped the process with inches to spare. Only a few inches more, and the operator’s head would have been crushed between the wall and the cage.
The operator’s pelvic girdle was pinched between the heavy metal of one side of the cage and the metal box that housed the boom control levers (later it would be discovered that his pelvis was severely fractured); the hydraulic pistons that infringed on the cage complicated the situation. He also had other injuries, and the specter of crush syndrome or death by hemorrhage during a prolonged extrication loomed.
The operator had been shoved tightly into whatever space was left after the metal stopped deforming against the wall; he was basically entombed in metal. As often happens in accidents of this nature, he was lucky to have escaped instant death, but he was also unlucky in that he was about to suffer through several hours of excruciating pain as rescuers struggled to free him. Worse, the operator’s cage was resting directly on what remained of the separation wall, a fact that would delay the extrication.
EMERGENCY RESPONSE WITH HELICOPTER ASSIST
After receiving a 9-1-1 call from passersby, the LACFD dispatched a first alarm “person trapped” response, which included Engines 88 and 70, Quint 125, Paramedic Squad 88, Air Squad 17 (a Bell 412 helicopter staffed with a pilot and two USAR-trained firefighter/paramedics), USAR-1 (the department’s central rescue company), and Battalion 5 Chief Erik Ekeberg.
To expedite shoring, stabilization, and lifting operations, the captain of USAR-1 flew from 40 miles away on Air Squad 17 with selected search and lifting equipment, including a snake eye remote camera, a search cam, air bags, and other tools. Air Operations Section Captain Dan Gordon, another USAR-trained member, accompanied them for technical support. For a decade, helicopter transportation has been a common tactic for USAR-1, a rescue company that responds to all technical rescues within the LACFD’s 2,000-square-mile jurisdiction, including more than 60 cities, the San Gabriel Mountains, and Catalina Island.1 In this case, the captain of USAR-1 (and the crew of Air Squad 17) arrived on-scene no longer than 20 minutes after the other first-alarm units. The USAR-1 apparatus arrived 30 minutes later.
SIZE-UP AND REQUEST FOR ADDITIONAL RESOURCES
On arrival, Engine 88 Captain John Dishaw reported a large crane on its side with the operator trapped in the cage and the crane’s boom through the roof of Alice’s Restaurant. He requested LACFD dispatch to notify Malibu’s Building and Safety representative to provide technical assistance. On Battalion 5 Chief Ekeberg’s arrival, Dishaw transferred command to him. Ekeberg then assigned Dishaw as the Rescue Group leader.
In rapid succession, Ekeberg gave a follow-up report, confirming that this was a major entrapment of unknown duration (triggering move-up assignments to cover vacant fire stations) and requested another paramedic squad, an additional engine company, a Cal/OSHA investigator, and one Camp Crew (an LACFD wildland fire hand crew supervised by an LACFD firefighter/specialist) as a workforce to help move equipment and shoring materials. Camp Crew 13-1, consisting of female inmates based at one of two LACFD fire camps in Malibu, was dispatched because it was closest to the incident.
Through the crane company involved in the accident, Ekeberg arranged for the response of a 100-ton crane (Crane 2) to assist with stabilization and lifting operations. And, based on a suggestion from USAR-1, he requested Heavy Rescue 56 (a heavy wrecker with a remote-control boom) from the City of Los Angeles Fire Department (LAFD) and one LACFD USAR trailer, towed by Utility 5 from nearby Fire Station 70.
Meanwhile, Ekeberg made the following assignments: Quint 125’s USAR-trained captain as safety officer, Squad 88 as Medical Group, USAR-1’s captain (on arrival by helicopter) as Shoring Group leader, and Engine 70 to assist with shoring and extrication.
THE RESCUE PROBLEM
Rescue Group Leader Dishaw surveyed the scene and found that the crane’s operator was being crushed at his pelvis and legs by a pinching action caused by deformation of the cage, which had crashed into the separation wall when the crane overturned. The operator’s head was nearly pinched between the deformed metal of the cage and the damaged separation wall. If the crane boom’s downward arc hadn’t been halted exactly where it was (by the bearing wall of Alice’s Restaurant), it’s likely that his head and upper body would have been crushed. Dishaw found that just a few more inches of movement might fatally injure the trapped operator.
Dishaw also found the crane’s outriggers in the “retracted” position, with the potential for additional movement (perhaps lethal to the pinned operator) if the separation wall were to be further crushed or if the bearing wall of Alice’s Restaurant were to experience additional failure. He determined that it would be necessary to stabilize the crane’s body and the boom, that the operator would have to be treated while the extrication proceeded, and that the extrication itself would require heavy cutting and spreading tools.
As the crews of Engine 88 and Quint 125 evaluated the task of dissecting the operator’s cage to extract him, they determined that they might be able to expedite the process by breaching part of the separation wall closest to the victim, thereby creating just enough room to slide him out of his seat, eliminating hours of cutting and spreading of heavy-gauge metal in a confined area. There was one problem, however: Part of the crane’s main body rested on the separation wall directly behind the operator, and breaching this part of the wall would cause the entire crane to shift. More stabilization was needed before any breaching could be done, so cutting into the operator’s cage was begun while Squad 88’s paramedics worked on the victim.
Recognizing this entrapment as a crush syndrome2 event, Firefighter/Paramedics Mark Rotondo and John Orduno from Squad 88 contacted the UCLA Medical Center base station and requested standard protocol treatment to limit the adverse effects of the crushing injury.
They also requested (through IC Ekeberg) the response of the department’s medical director, emergency room physician Frank Pratt, to oversee on-scene treatment during the prolonged extrication.3 Throughout the ensuing three-hour rescue operation, the trapped crane operator was the focus of fluid management through dual IVs, high-flow oxygen, close monitoring, and other treatment protocol to reduce the looming effects of crush syndrome. C-spine precautions were obvious considerations, as the operator was reporting that both his legs were numb; he was able to wiggle his toes and fingers.
Meanwhile, Squad 71 arrived and was assigned to treat the telephone repairman, who suffered minor injuries to his left arm and right knee when he dived away from the falling crane boom. After treating and sending the repairman to Santa Monica Hospital by private ambulance, Squad 71 (staffed on this day by two highly experienced USAR-trained firefighter/paramedics) was assigned to assist in extrication, prepare for rehab, and maintain readiness to treat rescuers who might become injured.
THE RESCUE PLAN
Air Squad 17 was five minutes out when LACFD Command and Control had just notified Ekeberg that LAFD Heavy Rescue 56 was unable to respond because of a mechanical problem.4 A construction foreman informed Dishaw that Crane 2 was still at least one hour away but that he had a five-ton forklift on hand for any task that might help the operation. After consulting with Quint 125 Captain Warren Chase, it was decided to position the forklift near the base of the crane boom (the only part of the boom it could reach) and use it to help support (not move!) the boom until the entire thing could be stabilized.
No one was under the illusion that the forklift could lift the crane boom (even if it could, lifting the boom was contraindicated until the shoring and cribbing operations were completed). The consensus of the on-scene firefighters5 was that any attempt to lift the boom at this point could result in the forklift mechanism’s failing catastrophically or the crane’s shifting, either of which might instantly kill the trapped operator and the firefighters attempting to free him because the “load” had not yet been fully secured.
On his arrival, the captain of USAR-1 was assigned as extrication officer, and Gordon was assigned as the shoring officer. Both met with Dishaw and Chase to finalize the rescue plan. They were soon met by the coordinator of LACFD’s FEMA USAR Task Force (California Task Force #2, also known as CATF-2), who had responded on USAR-1’s request.
It was clear that the actions first responders had taken prevented further injury to the trapped victim. Using sledgehammers and a rotary rescue saw with a dry-cut concrete blade, they had breached as much of the separation wall as they could (within safe limits), exposing parts of the operator’s torso. But they discovered that further breaching without stabilizing the crane boom might cause an uncontrolled shift in the crane’s position, which might fatally crush the operator. The first responders concentrated on cutting and spreading the cage away from the operator’s body but were now being stymied by the thick gauge of the metal and the confined area in which they were working.
The first responders had placed small-dimension cribbing that was available in various places around the main body of the crane to begin stabilizing it, but the crane boom itself remained unsupported except for the five-ton forklift. In short: They had stabilized the scene to the limits of their equipment and training, and they were aggressively treating the trapped victim for crush syndrome and other injuries. Some of the required shoring/cutting/breaching/spreading materials and equipment were present, but other resources, including the secondary crane and the USAR-1 apparatus, had not yet arrived.
After reviewing these factors, the supervisors agreed to the following rescue plan:
- Continue simultaneous efforts to cut, push, and spread the cage and crane chassis away from the operator’s body while attempting to stabilize the crane’s body.
- Use Crane 2 (when it arrives) and large-dimension shoring to stabilize the fallen crane boom to make it safe so that the breaching operation at the separation wall could be completed (and perhaps create enough space to slide the operator out without dismantling the entire cage or the crane body).
- Reinforce efforts to cut the cage apart by applying heavier-duty tools carried on USAR-1.6
- Continue aggressive medical treatment for crush syndrome and other injuries.
- Coordinate with the California Highway Patrol and L.A. County Sheriff Department to shut down the Pacific Coast Highway to land Air Squad 17 for a medevac operation once it becomes clear that extraction of the patient was near.7
It’s customary during complicated rescues to develop alternate (or backup) rescue plans in case the initial tactics and strategy prove unsuccessful. In keeping with this principle, the Rescue Group officers developed alternate plans to be implemented if the crane operator’s condition suddenly deteriorated (requiring more drastic measures to extract him without delay) or if there were an unwanted shift of the crane or some other other unanticipated event.
One secondary plan (for a sudden decline in the patient’s status) involved lifting the fallen crane’s boom with Crane 2, air bags, a heavy wrecker, or other methods-and securing the boom and crane body with cribbing as the lift proceeded-to expose more of the victim and the cage for a rapid “down and dirty” extraction. Doing so would have been somewhat risky because of the fallen crane’s potential for uncontrolled movement. It would also require shutting down the highway and evacuating all nonessential personnel, bystanders, and media to a more distant location to limit exposure to the crane’s unexpected movement, snapping cables, or other hazards.
Shoring Officer Gordon coordinated with Camp Crew 13-1 Foreman Felipe Enriquez to move an on-site supply of large-dimension lumber to an equipment pool near the crane boom. Then he and Chase supervised the firefighters from Quint 125 and Engine 70 as they worked to shore up and stabilize the fallen boom.
They encountered problems when Chase investigated below the pier’s deck (consisting of creosote-encrusted, railroad tie-diameter lumber laid on a steel frame anchored through concrete pads to bedrock beneath the sand) and found the understructure badly compromised by the effects of the storms of 1992 through 1996. The deck was unreliable as the “foundation” for the shoring/cribbing system that would support the crane boom.
In keeping with standard protocol for situations involving the questionable integrity of “multiple decks” for shoring (conditions often encountered in earthquake-damaged multistory structures), Gordon and Chase decided on a vertical shoring system that would transfer the weight of the crane boom to the ground, directly through the existing deck. Similar systems are used to transfer building loads to the ground in damaged parking structures, mid-rise and high-rise buildings, and other multistory occupancies.
They started by instructing the firefighters to build a solid crib system of large-dimension lumber on a concrete pad anchored to bedrock below the pier (which happened to be directly in line with the crane boom). This system was built right up to the underside of the pier’s deck, a distance of about four feet. Wedges and shims were placed to establish direct contact between the crib system and the deck. This resulted in solid contact with the underside of the deck, right where the above-deck system would be placed.
Now, moving to the topside of the deck, the firefighters constructed a “box shore” system from the deck to the underside of the boom, a distance of about seven feet. The crane boom was then secured in place atop the box crib to prevent lateral movement. Now the boom was essentially locked in place. But, because of the total distance between the sand and the boom (approximately 13 feet, including the thickness of the deck), and the angle at which the boom was perched against the walls of Alice’s Restaurant, it was decided to await Crane 2 for additional stabilization before beginning further breaching of the concrete block separation wall.
When Crane 2 arrived, its operator was given a brief “tour” of the rescue operation and was instructed on exactly what was needed in terms of stabilization. After slinging the fallen boom and connecting Crane 2’s “hook,” it would be an “inch-by-inch” operation to remove slack in the cables to support (but not to lift) the fallen boom, essentially transferring the weight of the fallen boom to Crane 2’s boom. The operator, who was obviously very experienced, reassured the rescuers that this was a relatively easy maneuver and should present no problem. By now, Captain Mike Saenz, the CATF-2 coordinator, had arrived. He was assigned as the crane ops liaison officer.8 His job was to remain with the operator of Crane 2 throughout the stabilization operation, to ensure clear and direct communications, and to help prevent the fallen crane’s moving. This is standard protocol for LACFD crane operations, derived in part from the department’s FEMA US&R training and experience.
Saenz secured a tactical radio to Crane 2’s cage so the operator could hear it clearly. Through the IC, he requested, and was granted, a separate tactical channel for crane operations (to eliminate interference from other tactical channel users). Saenz would remain on Crane 2 to ensure that the operator had clear verbal and visual communication. It was decided that the extrication officer9 would give the hand signals-the primary form of communication in most crane operations. He was strategically positioned so that he had visual contact with both the trapped victim and the operator of Crane 2. One paramedic from Squad 88 was assigned to the patient’s side, to monitor him for any adverse effects of the operation (additional pressure from movement of the crane’s body, for example). The trapped operator, who was lucid throughout the incident in spite of the intense pain of being crushed at the pelvis, was given brief instructions and reassurances on the operation about to take place. He was still wearing his hard hat as well as a set of safety goggles that firefighters had given him.
At this point, the safety officer halted other extrication operations at the operator’s cage and cleared all personnel except the single paramedic from a designated danger zone. In this case, the danger zone included an area around the cage where uncontrolled movement of the crane might trap or “pinch” a firefighter, the area where the ends of a snapped cable might travel, and around the fallen crane boom. Extrication tools were set aside (but were kept running for immediate use), IV tubing was suspended from high points to allow uninterrupted flow to the victim, and the firefighters moved back to a safe distance for the estimated two- to three-minute period it would take to transfer the rescue load to Crane 2.
When the safety officer was satisfied that everything was in order, he signaled to Crane 2’s operator to take up slack until the weight of the fallen boom was transferred. The middle of the fallen boom, which had been bowing downward very slightly along its length, came up level with the rest of the boom. At the point at which the boom’s tip (partially buried in the roof of Alice’s Restaurant) began the slightest hesitation upward, the operation was halted. Now, Crane 2 was supporting the load of the fallen boom. This transfer of weight took less than two minutes.
After Crane 2’s operator confirmed that the load was secured, the shoring team moved in to tighten up the box shore system that had been built beneath the fallen boom. Within three minutes, the box shore was fully secured to the crane boom, which was now held in place by a dual system of cribbing/shoring and Crane 2. The forklift was kept in place as yet another layer of redundancy. The safety officer now allowed the firefighters to resume the extrication.
MEDICAL CONCERNS CONTINUE
With the fallen boom secured at two points and the body of Crane 1 secured with cribbing and air bags, it was now safe to breach the remainder of the dividing wall on which the crane’s chassis and body rested. It had been nearly two hours since the accident, yet the trapped operator appeared to be tolerating his injuries relatively well. The extrication officer used a fiber optic device to view the operator’s legs, which were not visible from the surface because of all the metal and the wall. This helped to determine where to cut and breach without striking the victim’s legs.
The firefighters knew from experience and training that such appearances can be deceiving. A critical period was approaching because this was the stage of long-term rescue during which crushing injuries begin to exhibit their insidious effects. Although classic crush syndrome normally doesn’t occur until after about four hours of entrapment, there is always a danger of rapid hemorrhage or hypotension when the pressure of entrapment is released. This is one reason that the term “smiling death” has been coined for crushing injuries: The victim is frequently alert-and sometimes euphoric-as the time of his release nears, but his condition may deteriorate rapidly or slowly on a seemingly unstoppable spiral toward death following his release. In the case of massive hemorrhage following the release of pressure, profound hypovolemia and hypotension may quickly bring about a patient’s demise if precautions aren’t taken before the pressure is released. If the crushing mechanism continued for much longer, the initial stages of true crush syndrome might not be far behind.10
Effective treatment for crush injury includes proper intravenous administration of crystalloid fluids while monitoring to maintain a urinary pH >6.5 with timely infusions of sodium bicarbonate-DURING the extrication process, however long it may take (hours to days!). Obviously, the most effective treatment of all is to rescue trapped patients as quickly as possible (within reasonably safe limits as determined for each situation). The need for elaborate monitoring and medical judgment for crush injuries is one reason the LACFD’s medical director is requested to respond to many long-term extrication operations. It’s also the reason each of the nation’s 27 FEMA US&R Task Forces includes two specially trained emergency room physicians and at least four crush syndrome-trained paramedics.11
In this case, the medical director was responding from another part of the county and had not yet arrived, so the paramedics from Squad 88 kept the UCLA Medical Center Base Station apprised of the progress, and they received corresponding directions regarding fluid management and pH monitoring.
FINAL BREACHING EXPOSES MORE OF VICTIM
Using sledgehammers and a rescue saw with a dry-cut concrete blade, firefighters proceeded to cut away the remaining sections of concrete block wall separating them from Crane 1’s operator. They carefully tested the final piece on which the crane body had been resting earlier and found that Crane 2 was holding the entire load. This part of the wall came away with no crane movement. They now had access to the upper part of the victim’s legs and thighs. Paramedics found that the patient was able to move his toes, and he appeared to have distal pulses.
Working with various hand tools, cutting and spreading devices, and rams, the firefighters worked to widen the space around the victim’s pelvis, which was still tightly wedged. The absence of a block wall gave them newly found room to expand and cut the operator’s cage. As they were getting close to extraction, they notified the Medical Group leader, who moved the Litter Team into position for rapid packaging and evacuation.
The operator’s seat was then cut apart, giving the firefighters just enough room to free the operator’s pelvis and legs.
When it became evident that extraction was near, traffic on the Pacific Coast Highway was halted, and Air Squad 17 landed in the center lanes, 200 yards from the incident. As he set the Bell 412 helicopter down, Pilot Gary Lineberry was hemmed in on both sides by power lines and a cliff on the inland side, a common scenario for the LACFD’s Air Operations fleet.
As the Litter Team moved in to package the victim in a “half-back” extraction harness/C-spine system, Air Squad 17 was on the ground, blades spinning. Once the crane operator was removed from the wrecked crane, he was quickly packaged and carried to the waiting helicopter. After he was loaded and secured, Lineberry lifted off and headed toward the UCLA Medical Center, where a trauma team was awaiting the operator’s arrival.
WRAPPING IT UP
With the victim removed, efforts turned to documenting, securing the scene, and removing equipment. As in many operations of this nature, the entire scene-including much of the shoring and Crane 2-was left in place until all investigations had been completed. This caused dismay on the part of the contractor, who initially had ordered the operator of Crane 2 to upright the fallen crane and pull out.
The IC and the safety officer countermanded this order. They informed the contractor that the scene now fell under the jurisdiction of the Cal/OSHA inspector, whose job it was to determine why the accident happened (as well as whether the firefighters used rescue/shoring techniques according to worker safety regulations). The crane (with its retracted outriggers) and all the shoring stayed in place, and the fire and sheriff’s departments secured the scene until the Cal/OSHA investigator took photos and measurements.
Later, a third crane was brought in to assist in uprighting Crane 1. Crane 2 was used to lift the fallen boom, and Crane 3 was positioned to prevent Crane 1’s boom from “penduluming” toward the Pacific Coast Highway after reaching its apex. This process took several hours, tying up traffic. By that time, the fire department was long gone from the scene.
The crane operator survived and fully recovered.
- Patience sometimes pays. This rescue reinforced an important point about operations in which people are trapped: Although everyone agrees on the importance of timely extrication, there are times when patience and diligence are the victim’s best friends. In the case of relatively stable victims trapped in complex predicaments, hasty actions without proper stabilization can prove disastrous for patient and rescuers. True examples of this abound (backhoe operators attempting to “dig out” buried trench collapse victims, rescuers attempting heavy lifting operations without adequate cribbing, and victims’ being crushed in secondary collapses caused by their rescuers, for example).
In this particular instance, the decision was made to stick to Plan A because the patient’s condition and the circumstances of his entrapment seemed to warrant a methodical approach to ensure his extrication without causing a disastrous mishap. Despite several setbacks, the victim was progressively and methodically disentangled from the wreckage, and he survived to tell about it.
- It is important to coordinate multiple disciplinary resources. The incident commander was initially faced with a situation for which he lacked all the necessary resources to safely execute the rescue. He found that outside resources were needed, including LAFD Heavy Rescue 56 and a private crane company (to support the downed boom), the sheriff’s department (for crowd and traffic control), and so on. He also found that additional department resources (including the USAR trailer and extra basic life support and advanced life support units) were needed. After accurately evaluating the situation and needs, Ekeberg requested these resources in a timely manner and closely coordinated (and supported) their operations when they arrived.
- Departmentwide USAR training is an invaluable asset. Within the LACFD are no fewer than 1,000 firefighters trained in Rescue Systems I, River & Flood Rescue Technician/Swiftwater Rescue Technician I, and Emergency Trench Rescue. Hundreds more are trained in Rescue Systems II, Advanced Rope Rescue, Confined Space Rescue Entrant, and other technical rescue disciplines. All 3,000 members are trained as first responders in USAR, swiftwater rescue, and confined space.
This level of training continues to pay dividends during the “daily” technical rescues that occur across L.A. County’s coast, mountains, deserts, and valleys. The ability of the first responders to shore, crib, breach, and use specialized rescue tools certainly expedited this rescue. The heightened level of training and readiness for “first responder” firefighters is an important aspect of the LACFD’s earthquake and disaster plans, developed with the understanding that specialized units will be scarce resources during major disasters.
This particular crane accident in some ways was a demonstration of the effectiveness of that approach. The fact is, the first responders would eventually have extracted the fallen crane’s operator, even without the USAR resources that were dispatched. One of the purposes of the USAR units is to make these operations safer for the victims and rescuers-as well as more timely-through the use of advanced equipment, training, and experience.
- Strategic choices must fit the circumstances. Some observers might ask, “Why didn’t the firefighters just use Crane 2 to upright the overturned crane in the first place?” Certainly, this would have been physically possible once Crane 2 arrived. In fact, it was possible to lift the boom even without Crane 2, using rescue air bags supported by substantial cribbing.
But under the conditions at this particular incident, lifting the boom or otherwise moving the crane’s chassis was judged to be unduly risky until certain benchmarks could be achieved. The operator was in a precarious position with significant pressure being applied to his pelvis, his head was mere inches from being crushed, and it appeared that as little as a few inches of “wayward” movement of the crane boom (causing the body of the crane to move as well) might have worsened his injuries or even have caused his death.
Furthermore, the patient was relatively stable (considering his predicament), the extrication/stabilization operations were proceeding as planned, he was being effectively treated for possible crush syndrome effects, and a fire/rescue helicopter staffed with a pilot and two firefighter/paramedics was ready to fly him to a trauma center.
- Awareness of the potential for crush syndrome can be lifesaving. The crane operator was an obvious candidate for suffering the effects of crush syndrome. Without appropriate treatment (and especially if he had been trapped for a longer duration), the insidious effects of crush syndrome might have caused yet another preventable case of “smiling death.”
- Helicopter transportation for rescuers and victims expedites operations. This one is self-evident. In Los Angeles County, getting specially trained firefighters (and other rescuers) and their equipment to the scene quickly makes for more timely technical search, rescue, and extrication operations, whether the incident is on the Pacific Coast Highway or in the middle of the San Gabriel Mountains. The LACFD’s USAR resources are accustomed to working with the Air Operations Section to accomplish this goal, practically on a daily basis.
Getting patients away from the scene and quickly to trauma centers and other appropriate facilities is clearly another benefit of fire/rescue helicopters. In addition to hundreds of annual wildland fire responses, the LACFD’s firefighter/paramedic-staffed helicopters complete thousands of medevac and technical rescue missions every year. This incident was a good illustration of two important aspects of the fire-based helicopter mission.
- Qualified crane operators and liaisons are vital resources. It is common for the LACFD’s USAR resources to request at least one heavy equipment operator (or the supervisor) as a technical specialist when cranes are being used for local search and rescue operations. Even though the operation went fairly smoothly in the absence of LACFD heavy equipment operators, it might have been a different story if the rescue had been more complicated. In retrospect, the level of expertise provided by the LACFD operators would have been of benefit in either case.
- At the time of this incident, the LACFD was making final preparations to expand the USAR program by adding two dedicated USAR task forces (each consisting of one USAR company and one USAR-trained engine company housed in the same fire station located on either side of the San Gabriel Mountains), to provide more timely countywide coverage for technical rescue incidents and disasters. USAR Task Forces 103 and 134 are now in service. Not only does this reduce ground-based response times and increase the level of on-duty USAR-trained personnel, but it provides more flexibility for managing difficult USAR incidents.
- Crush syndrome, compartment syndrome, and other “rubble pile medicine” topics are taught in mandatory continuing education for all paramedics in Los Angeles County. This was prompted mostly by the push to prepare Los Angeles County fire/rescue agencies to manage the medical complications of hundreds (or perhaps thousands) of victims trapped in collapsed buildings following a devastating earthquake. But the enhanced awareness and standardization of prehospital treatment protocols for crushing injuries has benefited many victims of “daily” entrapment situations, as demonstrated during this rescue.
- The LACFD’s medical director is routinely dispatched to oversee patient treatment during complicated entrapment incidents where long-term extrication operations are anticipated. It’s not uncommon for the medical director to be requested to stand by in case field amputation or other advanced treatment becomes necessary.
- Heavy Rescue 56 would have been helpful in stabilizing the fallen crane to allow the firefighters to continue breaching the wall to gain better access to the trapped victim.
- All field personnel of the LACFD complete mandatory USAR First Responder training, which includes lifting and moving heavy objects, shoring and cribbing, rescue air bags, high-angle rescue, swiftwater rescue, confined space first responder awareness, and various other skills. The LACFD Recruit Academy includes Rescue Systems I, Emergency Trench Rescue, Swiftwater Rescue, and Confined Space First Responder.
- USAR-1’s “machinery extrication” equipment inventory includes, among other equipment, heavy-duty come-alongs, rescue air bags of various sizes and capacities up to 72 tons, a small-profile cutter/spreader for use in confined spaces, various hydraulic rams, an exothermic cutting system, several Sawz-allsT, a “wizzer” saw, and several pneumatic metal-cutting tools..
- At this point, Air Squad 17 had been staged on a nearby helispot, prepared to lift off for a medevac to UCLA Medical Center at the direction of the incident commander.
- During crane-related “heavy lift” operations on FEMA or California US&R missions of CATF-2, a heavy equipment and rigging specialist (an LACFD heavy equipment operator) is normally assigned as the liaison. But all members of CATF-2 and other personnel who have completed Rescue Systems (R.S.) II are trained to support crane operations (including load slinging and signaling). This included the CATF-2 coordinator, who is allowed by virtue of his R.S. II training to act as “crane liaison” during emergency operations.
- The LACFD has a full-time staff of heavy equipment operators who operate the department’s bulldozers at wildland fires and a range of other equipment for fire road construction and other tasks. They are the heavy equipment and rigging specialists of CATF-2. Normally, the captains of USAR-1 make it a practice to request one of these heavy equipment operators (or their supervisor) as a technical specialist when cranes are being used for local search and rescue operations. In this case, the duty captain of USAR-1 simply forgot to request the response of an LACFD heavy equipment operator, a potentially costly oversight that, fortunately, didn’t impede the progress or safety of this particular operation.
- Constant compression of a muscle mass in one or more extremities (resulting in continued arterial perfusion but poor venous return) robs the tissue of oxygen-carrying blood and raises the level of carbonic acid, followed by a shift to anaerobic metabolism. At a certain point, the pressurized muscle cells stretch to the point that myglobin begins leaking from their membranes. This, combined with heightening levels of potassium, calcium, albumin, and oxygen-free radicals, causes metabolic damage to the extremity. After several hours, the inside of the compressed extremity becomes a sort of high-pressure toxic soup trapped behind a dam. As the pressure is released, the “dam” ruptures, spilling the toxic soup into the central circulatory system, back toward the heart, lungs, brain, and other vital organs. These chemicals can bring on a variety of secondary maladies, including ventricular fibrillation (in minutes), pulmonary embolism (minutes to hours later), adult respiratory distress syndrome (in hours), renal failure from solidified myoglobin that clogs kidney tubules (hours to days later), traumatic rhabdomyolysis or myoglobin and albumin in the blood serum (hours to days), and opportunistic infections (days to weeks later). (Source: “Crush Syndrome,” William Raynovich, JEMS, Jan. 2000.)
- Considering the need for such elaborate monitoring and treatment of trapped patients, it’s clear that many local, state, and even national EMS systems are overwhelmed by earthquakes, explosions, and other disasters in which many people are trapped in collapsed buildings for hours or days.
LARRY COLLINS is a fire captain, paramedic, and 20-year member of the County of Los Angeles (CA) Fire Department (LACFD), assigned to Urban Search and Rescue Task Force Station 103 (USARTF-103). He is assigned as a search team manager of CATF-2, the LACFD’s FEMA US&R Task Force, as well as the department’s Terrorism Working Group. He was the duty captain of USAR Company 1 (USAR-1) during this rescue.