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 with injuries – cement truck overturned on an SUV at Georgia Highway 138 at Walt Stephens Road.” The intersection was one mile from the station and the units arrived in less than three minutes.
As the officer of Engine 5, Lieutenant Terry Ivey, approached the scene, he immediately determined this call was going to demand many additional resources. A fully loaded cement truck weighing 34 tons had flipped over and landed on top of a sport utility vehicle. The SUV driver was pinned, since the entire driver’s side of her vehicle was crushed due to the cement truck’s enormous weight. Additionally, the cement truck driver was trapped in the wreckage as well.
Scene Assessment
Initially, crowd control was a concern because of the large number of bystanders who sought to aid the victims. The severity of the crash and the cement truck’s heavy structural strength greatly increased the complexity of the extrication efforts. One fortunate aspect of the accident was that there were only two patients – the drivers from both vehicles; there were no passengers in either vehicle.
Ivey established “138 Command” and requested the following additional resources: a ladder truck, a heavy rescue squad, an additional ALS ambulance, one EMS shift supervisor and one fire shift supervisor. While waiting for reinforcements to arrive, Ivey directed the EMS crew to treat the SUV driver, and tasked his engine EMT to start treatment on the cement truck driver. Additionally, police officers and sheriff deputies rerouted traffic and established a police line to keep bystanders away from the large and complex emergency scene.
Ivey quickly determined that two separate vehicle extrications had to be performed at the same time. He followed the department’s five-step vehicle extrication standard operating procedure to ensure premier patient care was delivered, and the maximum coordination/utilization of resources:
The accident caused the cement truck to flip over, landing on the driver’s side, so the driver was slammed hard as the truck impacted the road. The 44-year-old driver was found semiconscious with head and chest injuries. An additional complication was that the driver was trapped inside the cab by a collapsed steering wheel. Rescuers punched out the windshield and a firefighter/EMT entered the cab to begin assessing and treating the driver.
Another hazard to scene safety was a diesel fuel spill from the cement truck’s saddle tanks and approximately 25 gallons of hydraulic fluid leaking from the tumbler. As a countermeasure, a hydrocarbon emulsifier was sprayed on the fuel to reduce its flammability, and a charged attack line was manned to confront the fuel spill threat. A hydraulic rescue tool was used to cut the corner posts of the cement truck and the roof was lifted to increase access for patient care and spinal immobilization. The patient was placed on a long backboard with cervical collar, oxygen and EKG monitoring. He was transported by an ALS ambulance to the hospital without incident.
Complicated Rescue
The SUV’s driver entrapment was quite profound given that the driver’s side of the SUV was collapsed to the center of the vehicle. The roof was collapsed to the level of the hood. Ivey directed that the wheels of the SUV be chocked to ensure the vehicle could not move. The concern was that the SUV was still running with the transmission in drive, and the weigh of cement truck was keeping the SUV from moving. The rescuers could not access the key to turn the vehicle off because of the extensive damage, so the engine compartment was pried opened and the battery cables were cut to kill the engine.
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.
Lessons Learned
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.
Training between flight crews and the department’s EMS personnel is conducted frequently. Additionally, Clayton County is directly adjacent to the Atlanta city limits, providing close access to Atlanta’s nationally recognized trauma centers. Clayton County paramedics frequently use helicopters for major trauma calls, so the familiarity between flight crews and medics is high, and several of the department’s paramedics work part time as flight medics.
Jeff Hood, EMT-P, is a deputy chief and supervises all fire suppression and EMS operations with the Clayton County, GA, Fire Department, where he has worked for 25 years. He is a Georgia EMT/Paramedic Instructor, was awarded a Georgia Governor’s Valor Proclamation for rescuing a police officer shot during a hostage standoff, and is a National Fire Service Staff and Command School Graduate. Bill Lowe, EMT-P, Ph.D., is a captain and shift supervisor with the Clayton County Fire Department, where he has worked for 25 years. He has a doctorate in human resource management, and is pursuing the National Fire Academy’s Executive Fire Officer Program. Earl Watson is a battalion chief and shift supervisor with the Clayton County Fire Department, where he has worked for 30 years. He has extensive experience with company and battalion level line operations, and has served as an elected board member of the department’s largest employee organization for over 15 years.
