The Golden, CO, Fire Department (GFD) is a combination of a small paid administrative staff, three paid operations officers, and approximately 85 volunteers. The department does have a specialized Technical Rescue Team, and firefighters are trained in basic technical rescue as part of their probationary year. Of course, one of the challenges with being a mostly volunteer department is never knowing who will be available to respond, particularly to complex rescues like the one we experienced in April.
Unique series of events
On April 4, 2017, the City of Golden received approximately 10 inches of heavy, wet snow with freezing temperatures overnight. This set the stage for a unique series of events. April 5 was a sunny 64-degree day, which quickly melted the snow where the sunlight hit. Shaded areas saw little change in snowpack.
At 12:35 p.m., GFD was dispatched to North Table Mountain for a report of a hiker who had fallen and sustained injuries. Engine 21 (E21) was “on-air” (not at the station) and responded with two personnel, direct to the scene. Radio traffic indicated three firefighters were responding to Station 21 and would staff the Heavy Rescue (R21). Chief 21 (C21) also responded.
Dispatch advised crews that the hiker was at the base of the climbing cliffs, trapped by a rock. The hiker was said to be bleeding heavily, unconscious with gurgling breaths.
E21 arrived on scene shortly after members of the Golden Police Department (GPD) at 12:41, and established command. Command realized it was a large-scale event and moved the incident to a tactical channel.
GPD briefed fire personnel and advised that a huge boulder had the hiker trapped. Police pointed out the location from the parking lot. The hiker was supposed to be approximately 0.4 miles up with an estimated 400-foot elevation gain.
AMR Medic 31 (M31) arrived at the same time as Chief 21, who took over Command functions. M31 and one member from E21 formed a recon group. The equipment carried up included a drug box, backboard, immobilization kit, medical jump kit from E21 and M31, and a New York Hook in the hopes that members could pry the rock off the hiker (Plan A).
The trail used was on the south side of North Table Mountain. The snow had melted and saturated the ground, which had transformed the dirt trail into deep and slippery mud. It was hard for members to maintain footing on level ground.
About half way up the trail, the recon team met with a group of outdoor education students who indicated that they knew where the hiker was located and offered to help. They also said there were two paramedics with her.
Initial assessment
Arriving at the location of the hiker, GFD personnel found two off-duty paramedics from a nearby fire department and one bystander. One paramedic was holding C-spine, and the other was attempting to obtain baseline vital signs. The bystander was holding the patient’s right hand. He identified himself as her friend.
He said the patient was from out of town and they had planned on rock climbing that day. The two stopped to set their packs down and take a break, but never got the chance to sit. They heard a loud crack, then the patient was struck by a dislodged boulder. She was laying with her legs bent under her back, trapped by a boulder on top of her left foot, ankle and about one-third of her shin. Another boulder was to her right side, and she was laying on top of another rock. Her back extended past the rock below, hyper-extending it.
The paramedic holding her head was using his knee to assist in keeping her in a more anatomical position. She had an obvious, open crush injury to her left leg/calf area. She was unconscious at the time of crewmembers’ arrival, but breathing with stable vital signs. Radial pulses were found to be thready but present. Further assessment by the M31 paramedic revealed bilateral tibia/fibula fractures, an open head wound and a fractured right radius. Medications were given per protocol, and contact to medical direction was accomplished by personal cell phone.
Facing the boulder
Assessment of the scene by an E21 crewmember revealed a boulder approximately 6 feet long with a triangular shape of 2½feet on all three sides had dislodged from approximately 30 feet above. These rough measurements were called into Command to get an estimate of the boulder’s weight.
Command consulted with the Colorado School of Mines Mine Rescue Team and estimated the boulder could weigh as much as 1,500 pounds. Due to weight and the orientation of the rocks to the patient, Plan A—using the hook to pry the boulder off the patient—was abandoned.
A request for heavy rescue equipment was made. Additionally, Command was notified that a chopper-go would be pertinent, and due to trail conditions, it would be easier to go up to the top of the mesa, rather than down. A roughly 75 foot by 75 foot mostly flat clearing sat just below the trail. This clearing had some smaller boulders scattered, but was hopefully a good enough landing zone for the helicopter (Plan B).
Command had dispatch patch the helicopter radio channel to a separate tactical channel so crewmembers had easy communications with the 800-MHz radios. However, members’ immediate concern was more rocks coming loose and hitting rescuers. As such, two safety officers were set up to watch the rocks above for any movement. The rock face was still dripping water from the cracks. Escape routes were identified for all rescuers on scene.
Command requested additional resources via mutual aid. A total of eight more agencies responded, bringing in 17 additional apparatus. These ranged from full career fire departments to volunteer departments to specialized rescue teams. Command also requested Flight for Life out of Denver, and Army National Guard from Aurora for a long-line vertical extrication (Plan C). The additional ground resources were mostly directed to the north side of North Table Mountain’s access road. This road is typically dirt, but on this day, it was covered in snow from the previous storm. City plow trucks were used to help clear snow on the dirt road. Additionally, county park service sent a small fleet of pickup trucks to assist in the transportation of equipment and personnel. The snow created a huge access challenge, but was still the best option.
The trucks continued on the top of the mesa to a location 400 feet away (vertically and horizontally) from the patient. A battery-powered combination tool (typically used for automobile extrication) was hiked to the patient’s location. Additionally, small high-pressure airbags were sent with SCBA bottles and the required adapters. This spot was also used to set up a medium-angle rope up-haul system 400 feet in length (Plan D). The up-haul system was created due to concern of Flight for Life not being able to land in the clearing below the patient.
Efforts from the extrication team included constant vital sign monitoring. Shortly after initial vital signs, the patient regained consciousness and her pulse changed from thready to strong. She continued to go in and out of consciousness, and her pulses fluctuated between strong and thready. During times of consciousness, she became slightly combative, even moving her broken right arm as much as she could.
The airbag system was set up with two lines to operate airbags individually. The downhill airbag was going to be used to help secure the boulder from sliding or rolling into the patient. The uphill airbag was going to be inflated to the point that members could free her leg. A trauma tourniquet was placed, but not tightened. Her leg still had visible pulses to the exposed tissue. Saline-soaked gauze was used to cover the wound, and a blanket was placed over the area to help keep dirt from contaminating it further.
Prior to airbag inflation, specific assignments were given. The firefighter at her feet was assigned to watch the clearance of the boulder and call stop when he could free her leg. One firefighter at her head was instructed to watch the downhill airbag to make sure the boulder was not slipping or pivoting into the patient. A paramedic at her head was in charge of the backboard being placed on her left side. He was to instruct people on her right in order to get the backboard slid between the rock and her body. An additional person was used to man the battery-operated combination tool in case of airbag failure or rock pivot. Safeties were reminded to keep watch of the rocks above and due to all the additional personnel at the extrication site, escape routes were re-identified. All of our extrication efforts had to happen quickly.
Flight for Life had attempted to land in the clearing below with no success. They landed on top of the mesa, near the rope up-haul system.
The rope system was now complete and ready. “Quiet on the set” was called at the site. All persons reported ready. The trauma tourniquet was tightened; however, a second tourniquet was needed to control the bleeding. Date and time were noted for the ER. The downhill airbag was pressurized just to the point of maintaining position. The uphill airbag was then inflated slowly. It cleared her leg by about one-half inch. The firefighter at her feet called stop as instructed, and personnel rolled her to the right, freeing her legs and allowing the backboard to slide into place. Her foot and ankle were obviously crushed and the bone sticking out had been crushed to the consistency of rice.
There was a Stokes basket on the trail directly behind the patient. The patient was carefully moved to the Stokes basket and secured with webbing for the medium-angle embankment rescue. Rescuers carried the patient 400 feet down the trail and tied into the system. Haul personnel on top of the mesa pulled the attendants and patient up to safety. The patient was handed off to Flight for Life with a typical handoff report about two hours later. Army National Guard never made it to the scene.
After the call, we met for a typical curbside after-action review (AAR). The things that went well:
- There was a fast response time with initial crews, use of a recon group, establishing command on a tactical channel and calling in mutual aid early.
- Once on scene, the biggest things that helped were lack of ego and strong collaboration.
- Everyone on scene “played nicely.” Some agencies had trained together, others had not. Everyone offered suggestions when needed, and quick decisions were made. Having multiple agencies on scene provided a wide range of experience levels as well as access to necessary medications GFD typically wouldn’t have.
- It was a calm, cool, collected scene.
- Being able to transition from Plans A through D helped make all crews feel at ease.
There were also elements that could have gone better. This criticism is not intended to pass blame or judgment, but to learn from our mistakes.
- Communications: We need to keep our radio traffic concise and to the point so other crews can relay pertinent information.
- The use of personal cell phones is sometimes OK, but it is better to use the ambulance phone that has all resources stored.
- Departments that have iPads or similar should bring one to a scene in a remote location. Pictures can help the emergency department, as well as provide beneficial training to the rest of the departments that couldn’t be there.
- Tablets and the like also have great resources to double-check local medical protocols and ensure rope systems are set up correctly. They are even handy to pinpoint GPS coordinates for the helicopter pilot.
- Rescuers hiked in the complete airbag kit, along with two one-hour bottles. A more concise description of the system being set up could have lightened the load for the difficult hike in.
- Keep a marker in the medical kit to mark an “X” on known pulse locations, as this would have been helpful for the changes in pulse strength.
- Preplan training with Army National Guard.
In sum
Typically, fire departments will train for “standard” technical rescue situations, like car accidents, swiftwater, building or trench collapse, to name a few. Some departments don’t go beyond the typical scenarios when they train. It is worth consideration to build on the “standard” call, and provide an open forum of ideas where typical techniques could be utilized in different situations.
In Golden, we try to focus on two additional ideas: 1) knowing your response area and resources and 2) knowing what equipment you have in your immediate and surrounding areas. It is absolutely necessary to know how to properly and quickly use the equipment we own. Going a step further, knowing the limitations and intricacies of our equipment can help us excel.
Departments everywhere can benefit from this kind of training, partnered with a drive for outside-the-box thinking. Keeping our minds open and a constant thirst for knowledge will help us be the professionals we strive to become.
Sidebar: About Golden
The district consists of five major highways, an engineering college, a major brewery operation (Coors), 10 miles of high-angle canyon with swiftwater extending into town, multiple recreation trails and many rock-climbing cliffs, along with various commercial and residential areas. This is all contained in an approximate 9-square-mile area. Our medical calls are contracted to American Medical Response (AMR). GFD assists with life-threatening injuries and conditions.
