By TOM SITZ
The Painesville Township (OH) Fire Department (PTFD) and the Concord Township (OH) Fire Department (CTFD) have an excellent working relationship and conduct multiple company training evolutions several times a month from spring until winter. The departments also review and use each other’s equipment. In addition, we review the CTFD’s engines in case one of our chauffeurs needs to act as a fill-in on one of their engines if needed for an emergency. On July 22, 2009, at 1218 hours, the PTFD assisted the CTFD in a rather unusual extrication incident.
A Concord, Ohio, resident had been playing with a set of steel handcuffs at his home when one side of the cuffs locked tightly around his left wrist. Unfortunately, he did not have a key to remove the cuffs (photo 1). The Lake County (OH) Sheriff’s Department (LCSD) was dispatched on the initial 911 call to unlock the cuffs with its handcuff keys. After several attempts and broken keys, the LCSD requested the CTFD. After the CTFD arrived on scene, members assessed the patient and started patient care. During the assessment, they eliminated from consideration several tools, including the saw (because of the vibrations), for fear of injuring the patient. The cuffs were applied so tightly and were biting into the patient’s wrist so that his skin was over the lower portion of the cuff, making removal of the cuff similar to a surgical operation. The CTFD was able to remove the free-hanging side of the cuffs using a hacksaw for better access to the wrist cuff.
|1 Photos by Sean Roeheaver|
On arrival, the CTFD officer in charge (OIC) suggested to the PTFD OIC that the best piece of equipment to use to remove the cuffs without causing patient injury was a three-inch whizzer saw (photo 2), which we carried on our engine for such an extrication; the PTFD OIC agreed. The patient’s arm was protected on each side of the cuff with a damp towel and duct tape (photos 3, 4), giving the saw operator about a half-inch of space before the saw would strike the patient. The duct tape served the following three purposes:
- 1 It compressed the towel so we could get multiple wraps (layers of protection) around the arm.
- 2 It would indicate the saw’s cutting depth. If the saw nicked the tape, we would put another piece of tape over the original tape so we did not keep cutting into the same groove, which would have made it harder to judge the depth of the cut.
- 3 It prevented the towel from binding up the saw if it had nicked the tape/towel.
|photo 2 by author.|
After the patient was prepared for the procedure, the OICs conferred to make sure everything was in place and on site. This included numerous bottles of sterile water to cool the cuffs during cutting, a medic unit, and all necessary medical equipment should the patient suffer a severe cut or emotional stress. Once everything was prestaged, we placed a pair of safety glasses on the patient and laid a towel on the left side of his head to protect him from sparks and to keep his eyes focused on his family, who were on his right side. Several other fire and police officers on scene were examining the other pair of handcuffs from the set, looking for areas of weakness that we could attack.
The cutting operation commenced; we started with two small relief cuts, about one inch apart, to see how the cuffs reacted. The cuffs were under a lot of tension because of how tightly they were placed on the patient’s wrist. We hoped the relief cuts would loosen the cuffs to allow the saw operator more working room around the patient’s arm (photo 5). Unfortunately, the relief cuts had no effect on the cuffs and provided no additional working room.
By examining the other set of cuffs, the officers determined that the pin holding the internal tumblers in place kept the cuffs locked together. We would cut out this pin and, hopefully, loosen the tumblers enough so that we could manipulate the cuffs. This took several cuts, as the pin was set fairly deep into the cuff’s body. Note that when making several deep angled cuts, you should notch out the area being cut as you go to prevent the saw from binding (photos 6-8). If more than 50 percent of the saw blade goes into an angled cut, the saw most likely will bind and cause vibrations, which can cause discomfort to the patient and make the saw difficult to extract from the object for repositioning.
Unfortunately, cutting out the pin did not free the tumblers enough to remove the cuffs; we determined that we would have to continue cutting to expose the tumblers visually (photo 9). This worked; once the tumblers were exposed, members manipulated them with a flathead screwdriver and released the cuffs with no injury to the patient (photo 10). In discussing the operation, we realized that we had just performed a “through-the-lock entry” on a pair of handcuffs.
Prestage all equipment in the immediate work area. This greatly increases the speed and efficacy of an operation. For this procedure, we prestaged medical equipment, numerous air bottles, a whizzer saw, and several toolboxes. We also used 1½ air bottles to complete this operation.
Manage time properly, and double-check everything. This was not a time compressed operation. Although the patient was in pain because of the tightness of the cuffs, CTFD medics determined that the color of the patient’s skin was good and he was not in danger of losing his hand any time soon. (Good color and perfusion told us we had some time to double-check everything.)
Use towels and tape to protect the patient and to give the saw operator a margin for error. We completely protected the patient’s left arm and side from injury, giving the saw operator confidence should the saw kick or move.
Pour water on the steel and the towels to protect the patient between cuts. When making an extended cut, the saw operator must stop at least every 15 to 20 seconds to allow the cutting area to be cooled. Several times during this operation, the water applied to the cuffs after a long cut turned to steam. In this scenario, we had a responsive patient who could tell us when things were getting warm, alerting us to stop cutting and cool the area. However, when dealing with an unresponsive patient, the saw operator must monitor the heat and cool the area as needed so as not to injure the patient.
Wear the appropriate level of personal protective equipment (PPE). The saw operator determined that tinted safety glasses and extrication gloves were sufficient PPE for this operation. He ruled out wearing a helmet because it would not allow him to get his eyes close enough to the patient and the cut area as needed. A bulky structural firefighting coat would have limited and impeded his movements. Bunker coat sleeves could potentially become caught in the saw, sucking the saw operator’s arm into the saw. We were operating in a completely controlled environment; a different environment may have mandated more PPE for the operator. If the operator was wearing his turnout coat, I would have duct taped his sleeves to make sure that they would have stayed out of his way.
Train together! The CFTD knew that we had the proper saw for this type of extrication, and we knew that the CFTD had several types of auto extrication stabilization equipment that we did not carry. Because we train together, we know and, more importantly, trust each other.
Joint training takes work; you have to leave the station and sweat to have a productive drill. Watching a video or computer simulation will not produce an effective engine company; that will only help you for operations in extreme weather or temperature conditions. Last time I checked, we work in the rain.
If you operate with other organizations on a mutual-aid basis, meet with them before the emergency. Learn and know their capabilities, skill level, and personnel, and build a relationship of trust. If we are expected to fight together, we need to train together. Work out the communication problems ahead of time, understand how everyone operates, and learn what is expected of you when you arrive on the scene of their operations.
It is wonderful to watch the first- and second-due engine companies work together on the fireground. When you cannot tell the difference between two engines from different communities because of how they interact, someone from both organizations has been doing their job. In the end, the citizens we serve are the winners.
TOM SITZ is a lieutenant and 27-year veteran of the Painesville Township (OH) Fire Department. He is an instructor for Lakeland (OH) Community College in its fire science program and has developed several of its online classes. He also teaches for Auburn Career Center in its firefighter certification programs.