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At 2:37 P.M. on Feb. 13, 2004, the Bel Air Volunteer Fire Company in Harford County, MD, was alerted for a vehicle accident with entrapment on Thomas Run Road near Ruff’s Mill Road. Paramedic 391 and Rescue 351 responded at 2:38. While enroute, the units were advised that the Harford County Sheriff’s Office was on location confirming rescue and that only a “door pop” would be needed to extricate the patient. The incident commander, Deputy Chief Bill Snyder, riding Rescue 351, had the rescue assignment of an additional engine continue.
The 140-member company protects a population of 70,000 in an 80-square-mile first-due area, answering over 7,000 calls a year from two stations. Apparatus includes six engines, one heavy rescue, two trucks, one air unit, two brush trucks, three advanced life support (ALS) ambulances and two paramedic chase cars.
Photo By Jennifer Kerr
“Go-Team” members and other emergency responders attend to the patient at the scene of the accident.
Upon arrival, Snyder and EMS Assistant Chief John Blake quickly assessed the scene and determined that aviation was required due to severe trauma to the lower extremities of the belted passenger. Approximately seven feet of guardrail had penetrated the passenger compartment of the vehicle at the passenger door, coming to rest in the area of the steering column. The patient’s legs were pinned from the knees down between the door skin, guardrail and steering column. In addition, one ankle was pinned under one end of the guardrail. It was determined that additional resources were needed to complete the extrication.
Within minutes of the aviation request, Blake called for the Shock Trauma “Go-Team.” Based at the University of Maryland Shock Trauma Center, the Go-Team is comprised of trauma surgeons, nurse anesthetists and support staff. This team can perform a wide variety of hospital-based skills that are outside the protocols of field-based paramedics, such as amputations, sedation, and whole blood or other blood product transfusions. The Go-Team was requested for two reasons. First, due to the position of the patient’s leg versus the position of the guardrail, it was virtually impossible to determine whether the foot or leg was impaled on the guardrail and would need a field amputation. Second, in the position the patient was found, any movement of the vehicle or guardrail would cause excruciating pain in his lower extremities. The Go-Team could sedate him to complete the extrication.
Harford County Emergency Operations/Communications advised command that the Maryland State Police Med-Evac would arrive in about 10 minutes and the Go-Team in 20 to 30 minutes. Snyder then directed personnel to immediately remove the roof. This gave EMS personnel better access to the patient and gave firefighters a better view of what they had to work with. Firefighters were assigned the following tasks:
2. Remove the passenger door, which was situated on top of the patient.
3. Staff a charged hoseline.
4. Remove the remaining guardrail and a street sign that was blocking rescue workers from getting to the passenger side of the car.
5. Roll the dash forward.
At this point, the extrication efforts became difficult. Firefighters pushing, pulling or lifting in one direction caused the opposite reaction at other end. Because the guardrail had penetrated the fire wall, pushing the dash forward caused the guardrail to be pressed down on the patient, causing extreme pain. The rescuers tried to lift the guardrail from numerous positions, but this only caused the dash to roll forward toward the patient’s feet. Firefighters then attempted to use a high- pressure air saw to remove small pieces of the door to get better access to the patient’s lower legs, but this was time consuming.