In our previous article for a first responder basic life support firefighter (May 1997), we gave you considerations at a vehicle accident involving fire. You learned you must effectively implement an incident management system, which includes treatment of patients. We will continue that process in this column concerning a building collapse.
Photo by Jack Jordan Your first instinct to finding somebody trapped in a building collapse is to rush in and get that person out. Be aware. You don't want members of your crew to become victims as well, and poor planning could further endanger your patient.
It sounded like a sonic boom. A few minutes later, you and your Engine Company 5 are dispatched to a building collapse at 1600 E. Thomas along with Engine Company 9, Ladder Company 9 and Battalion Chief 2. Your rig rounds the corner, laying a dry supply line as you go and is first on the scene. You size it up.
"Dispatch, this is Engine 5."
"Go ahead, Engine 5."
"We are on the scene of a small two-story office building with a structural collapse on the southeast corner of the building. Engine 5 will be Thomas Command with additional report to follow." (See chart on page 16.)
Photo by Jack Jordan
Witnesses start filling you in. Remodelers were taking out a structural support of the building when the roof collapsed. You can hear somebody crying in there. Another man is standing in the parking lot. His arm has been severed from the elbow down and he has a strange look in his eyes.
As the first responder you should be committed to one thing saving lives. That includes the lives of the rescuers. Now break that down in incident management system fashion.
You have a Level I patient that guy with the severed arm. If he doesn't get help very soon, he could die from blood loss. Get a firefighter helping that patient immediately. The firefighter replaces her work gloves with latex exam gloves and puts on her splash protection glasses. She yells at the man to lie down on his back and extend his severed arm in the air. An injury above the heart helps abate blood loss. Yelling at him brings him out of his shocked daze. Plus, part of the primary survey is taken care of. He is obviously conscious, alert and able to move.
She applies direct pressure with sterile "four by fours" (four-inch-by-four-inch gauze pads) to the stump end and directs the patient to hold them in place as she affixes the pads by tightly wrapping "kling" (gauze strips) to hold them in place. She is getting him involved in his own survival and not allowing him to become lethargic.
Another man stumbles out of the building. He is holding his head and one of your firefighters checks him over quickly. He was hit on the head by a board but that is all. He is alert. And somebody is still crying for help. This is triage. Accessing the patients and deciding who needs help the most first. The patient with the bump on his head can wait. Somebody inside needs help.
You make the radio report. Your alarm room now has a heads-up as to what kind of patients you have and can start making the arrangements with hospitals, ambulances, air evacuation, etc.
Every fiber of your being screams to go in that building and save whoever is crying for help. You, as the on-scene commander, must remember the safety of your crew members. What is the integrity of the building? Is there leaking gas? Is there fire? You assign your engineer to cut the utilities on the exterior of the building. You and one firefighter pull a handline to the collapsed portion of the building. You look in. There is a man about 20 feet inside the building. A portion of flooring from the second story has trapped his left leg from the knee down. He is coughing up blood, crying and looking directly at you with that "thank God the firefighters are here to save me" expression on his face.
Safety. Are you ready to go in there with your crew if there is a possibility that more materials from above can collapse down on you? Are you ready to create more victims for the rescuers?
Make your radio report. You probably need heavy equipment. You have another patient. Engine 9 shows up on the scene. You assign them to be Treatment Sector. Your firefighter needs help with the severed arm injury. Somebody should take a closer look at that guy with the head injury. Ladder 9 is also now on the scene. You order them to report to you for rescue operations.
You now have a judgment call. Do things look safe for rescuers to approach the trapped victim? Assuming all looks OK, you and your firefighters approach. While the crew from Ladder 9 assesses the best way to get that guy out of there, you and your firefighter start getting vitals on the victim pulse, respiration, blood pressure, temperature, skin temperature, level of consciousness, pupil size and reactivity. The vitals are normal.
It really doesn't take long. Your Rescue Sector team has removed the construction material that pinned your patient's left leg. For a brief second, you remember that not so many years ago you were concerned only with getting him out of there and turning him over to the medical guys. Things have changed, You are now expected to take care of basic life support responsibilities.
You direct them as they put a full backboard under him. A C-collar goes on and the patient is secured to the board (tape, straps, bandage) to insure c-spine protection. You take vital signs again. They are normal. His coughing has stopped.
Regardless, you take a pessimistic attitude and put oxygen on the patient by nasal cannula at 15 liters and assume the patient sustained a possible blunt trauma injury to the abdominal and/or chest area that may account for the coughing up of blood.
Once this victim has been taken to the Treatment Sector, make sure his vitals are checked every five minutes. Remove his clothing and do an extensive secondary survey, which includes checking for breathing sounds such as crackling, gurgling or a decrease in breaths that might indicate lung injury. Feel for deformities in his body. You'll have to treat for flail chest, fractured bones and bleeding.
Both the battalion chief and the ambulances have arrived on the scene. You can turn command over to the chief. And you have a solid report to give to the medics. You have met your basic life support responsibilities by removing the patients from danger, stabilizing them and gathering vitals to turn over to the medics.
Decker Williams, a Firehouse® contributing editor, is a 27-year veteran of the Phoenix Fire Department currently serving as a battalion chief. One of Arizona's original paramedics, he teaches the incident management system at medical incidents for firefighter safety and is a staunch supporter of the dual role of fire service first responders. Tim Simmons has been with the Phoenix Fire Department for 12 years and currently is assigned to the Division of Corporate Communications. He is also a volunteer captain in the Nogales, Mexico, Fire Department.
