For the officers and firefighters assigned to Clayton County, GA, Fire Department Station 5, Sept. 24, 2003, was going to get real busy, real soon. Just three hours into the crew’s shift, Engine 5 and Medic 5, an advanced life support (ALS) ambulance, were dispatched to a “vehicle accident...
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Firefighter/EMT Janice Koch-evar of Medic 5 crawled inside the crushed SUV to access the injured driver. She determined the driver was trapped against the center console by the roof, steering wheel, and driver’s door. The 43-year-old female driver complained of crushing pain to both lower extremities. Kochevar palpated the woman’s right femur and suspected it was fractured. Oxygen, large-bore IVs and EKG monitoring was initiated. The patient’s vital signs were stable, so medical control authorized the administration of Morphine for pain relief given the difficult and lengthy extrication. Paramedic Sergeant Dennis Callahan administered morphine via the IV line.
The challenge for extricating the SUV driver was how to remove the loaded cement truck to gain enough access to remove the driver. It was not going to be possible to attempt removal from the passenger’s side of the car because her legs were trapped in the driver’s floorboard and the center console was another challenge. The cement truck was going to have to be removed to gain access to free the driver’s legs.
The county police department had requested that a wrecker contractor dispatch a standard rollback wrecker and its largest tractor wrecker. The wrecker drivers didn’t realize when they arrived on scene that they were quickly going to be integrated into the fire department’s incident command system.
The extrication officer, Sergeant Lou Padovani, had initially used a 35-ton airbag to generate eight inches of lift to gain some access to the patient. He then directed the tractor wrecker to be used as a crane to secure the cement truck so it could not place any more weight on the SUV. The tractor wrecker’s boom is rated for 40 tons of lift. The rollback wrecker was positioned to attach its cable to the front of the SUV. Once the tractor wrecker secured the cement truck, the other wrecker slowly pulled the SUV away from the suspended cement truck. The SUV had to be moved only about 20 feet to allow access with the extrication tool to start cutting away the driver’s door. The decision to employ the wreckers resulted in a much faster extrication of the injured SUV driver. Nevertheless, it still took 52 minutes from Company 5’s arrival until the driver was removed.
The incident commander had already requested a helicopter respond to transport the SUV driver to one of Atlanta’s trauma centers. Rescue Air 1 had landed at a nearby middle school, and the police department had transported the medical crew the short distance to the incident scene. This was helpful because the helicopter medical crew was able to participate in the treatment of the patient during the extrication process. Consequently, once the patient was freed from the wreckage, no time was lost to communicate patient information from the fire department paramedics. The patient was driven to the landing zone and loaded into the helicopter without incident. She was hospitalized for several days and is expected to make a full and completed recovery.
The Clayton County Fire Department is a fully integrated fire-EMS agency, and all personnel are dual-certified by the State of Georgia in EMS and firefighting. Many of the department’s 300 personnel are nationally certified as well. Consequently, the first-arriving engine and medic units were able to provide the initial care for both patients and begin establishing the necessary action steps to be taken.
The department’s officers frequently participate in structured incident command training to ensure smooth coordination and communication with resources. Additionally, incident command training frequently involves other public safety agencies. The lesson for other fire and EMS agencies is they are encouraged to ensure personnel are trained in and utilize incident command.
The department maintains excellent and collaborative relations with the county’s police officers and sheriff’s deputies. Consequently, the requests for traffic control, crowd control, securing a helicopter landing zone and transportation of the helicopter’s medical crew were handled well. Additionally, the county police chief was on the scene ensuring that maximum cooperation was provided. While most fire and EMS departments maintain excellent relationships with local law enforcement, training together and strengthening two-way communication are critical when extra effort and assistance is needed for resolving incidents quickly and professionally.