MOVING LARGE VICTIMS: NO SMALL TASK
BY BRIAN K. JOHNSON, SR.
My platoon had just completed updating pertinent information and general concerns as we reported for duty at 1730 on a November evening when our deputy chief approached us with the details of our call. It was to the home of a 63-year-old, diabetic man (who will be referred to as “Jack”) who resides two blocks from the fire station. Jack is essentially bedridden and weighs more than 500 pounds.
Fire department, police, and volunteer ambulance personnel had responded to Jack`s home to provide lifting assistance on numerous occasions. It ap- peared that Jack would roll to his right while on his queen-size bed and be unable to bring himself back up–or, for that matter, to move himself much at all. He would be wedged between his bed and the various items he had accumulated and stored in and around the room over the years. His elderly aunt, who resided with him and was responsible for his care, rejected our suggestions to rearrange the room, eliminate the bed frame, and move the mattress to the floor.
Over the past 24 hours, we had responded along with the police department to three incidents involving returning Jack to his bed. Given this frequency of calls, it was deemed necessary to remove Jack from his home and to transport him to the local hospital for evaluation.
Long-standing factors contributed to this decision. The first was Jack`s diabetic condition. He would often skip his self-administered insulin and be on the verge of disorientation and delusion. His aunt, unable to manage him in this condition, would ask us to persuade him to take his dosage before he grew worse. Second, we had determined in the past that it would be impossible to remove Jack expeditiously under fire conditions. We shared these concerns with Jack; after roughly 20 minutes of debate, he reluctantly gave his permission to proceed with his removal.
THE LAYOUT
Jack`s home, a two-story Victorian built in 1910, has only one bathroom–on the second floor. The three bedrooms are also on that level. All four rooms face a common hall at the top of the stairs, which measures approximately eight feet square. The inverted T staircase is accessible from the main foyer and the dining room. At the approach from the foyer, a large oak railing ascends up the stairs to the left. To the right is a wall that is common to the foyer and dining room. At the perpendicular point of the staircase is a common landing, approximately 312 by 212 feet, which is roughly six feet higher than the first floor. It is another six feet vertically from the landing to the second floor. There are no rails at the dining room approach; instead, the wall to the right of the steps forms a right angle at the landing leading up to the second level. The stairs are 30 inches wide.
Jack`s sleeping area is on the second floor because that`s where the bathroom is. His room, the first on the left at the top of the stairs, has one window that faces the front of the house.
PLAN A
Initially, we believed that our only option was to cinch Jack up tightly in a Reeves or Skedt stretcher with a backboard for additional support. We would then maneuver him out of the bed and into the common hall. Considering the narrowness of the staircase, we would then rope and lower Jack by gliding him down the stairs to the landing. Once there, we`d bring him vertical, take a quarter turn to the left, tilt him back, and proceed down the dining room side of the steps. The dining room, though farther from the entrance, was more advantageous in terms of space and configuration; it provided a large enough area in which to position carriers to remove him from the home. Both the dining room and foyer were filled with antiques and other items that needed to be cleared.
As we gathered our equipment, we continued to reassess the evolution we were about to perform. We were anxious and apprehensive about Jack`s safety and that of the rescue personnel. While several firefighters, patrolmen, and ambulance crew members cleared our path of egress on the first floor, the police, fire officers, and veteran rescue technicians were upstairs discussing an alternative plan.
At first, Jack`s dimensions and weight were believed to be too much for our new stokes rescue basket. A past incident in-volving a woman of comparable weight and stature had precipitated our concern, for she had compromised the integrity of our “original” stokes basket by altering its webbing and board forms. Second, the window in Jack`s bedroom (as well as others on that level) were too small to facilitate an aerial rescue evolution. In addition, Jack`s aunt would not allow the window or staircase to be altered.
PLAN B
We rethought the situation and selected a window rescue. Confident that the stokes rescue basket would properly support Jack (with proper support modifications), we turned our attention to the window and the area outside the house to check for obstacles that might inhibit the evolution. Our rescue efforts were divided into interior and exterior operations.
INTERIOR OPERATIONS
The first order of business inside was to clear the window for egress. The windows were the original double-hung sets that came with the house. Jack`s was 56 inches by 39 inches; the sill was 20 inches off the floor. An early-model air conditioner made of two parts–a compressor and a support case–was positioned in the sill. Using the handle attached, we removed the compressor unit by sliding it out of its case support cover. Then, we removed the several screws that held the case in place. Next, we removed the inner and outer window jambs and the window cases, since the storm windows were screwed to the outside trim. Now it was time to prepare Jack.
Jack was too large to lay supine in the basket. Our best bet was to get him on his side and to secure him laterally. We lined the stokes with heavy blankets and then tilted him enough to expose most of his back to the face of the basket. We then pulled him and the basket as a unit. Excess lengths of blanket draped over the stokes protected him from the cold and cushioned him from the securing ropes.
To secure Jack to the basket, we first tied his hands together with a short section of one-inch-wide tubular webbing (rated at 4,000 pounds). Then, using one-half-inch static kernmantle ropes throughout (rated at 9,200 pounds), we threaded the basket in a standard crisscross pattern and tied off with double clove hitches and safeties. To reinforce the stokes basket, three two-inch-wide adjustable straps with D-rings at each end (rated at 9,000 pounds) were wrapped around the stokes at Jack`s shoulders, just below his waist and at his feet. Each one was brought together with a large locking carabiner (rated at 9,000 pounds). Rope was threaded through all three carabiners, which were centered directly above Jack and knotted with an MR-8. A carabiner was attached to that to establish one of two vertical lift systems.
The second system was comprised of a three-inch steel O-ring pivoting a four-legged, two-inch tubular webbing unit (rated at 18,000 pounds). The legs of the unit were connected to the extremity points of the basket`s frame (two at the shoulder and two at the knee). Each end contained sewn-in, spring-loaded clamp locks. Two guide lines were then established–one at the feet and the other to one side of the basket. One carabiner was attached to the metal frame at each of these points. The ends of the two separate ropes were then tied with double-eight knots and locked to the carabiners.
EXTERIOR OPERATIONS
Outside of Jack`s window was a slightly pitched and very well-supported porch roof that extended across the full width of the house. Two good-sized oak trees situated on either side had branches that extended to the roof and overlapped extensively, blocking any direct path to the street. The truck engineer positioned the nose of the ladder truck to face the house from the road, approximately 30 feet from the front door. He staged the piece roughly 20 degrees left of a direct path to the window and angled the ladder course between a telephone pole at one side and electric wires overhead. The ladder was a four-section, 106-foot steel telescopic rear mount aerial. With chainsaw in hand, a firefighter scaled the ladder and began removing the obstructing branches until the ladder tip reached the house. The tip was then extended and locked at a point suspended above and parallel to the pitch of the second-story roof, which is directly over Jack`s window. This position brought the end of the second fly to a point over the porch roof. A two-inch-wide adjustable strap was wrapped around the last two rungs and connected by a carabiner. A two-inch single pulley (rated at 6,000 pounds) was added to the carabiner–the standing support point. The end of the rescue rope was tied off with an MR-8 knot and connected with a carabiner to the vertical lifting systems. The rope was reeved from that position through the standing pulley and (following the ladder) down toward the front of the truck, establishing the fall line. The rope was then reeved through the lead pulley which, with another strap and carabiner, was anchored to the truck`s front axle (rated at 18,000 pounds) and led away 20 feet to the lifting force area. For halting ease only, a Gibb`s ascender (rated at 1,000 pounds) was positioned at a point near the standing support pulley.
Jack was brought to the window when all preparations were complete. We were able to situate him on the porch roof parallel to the house. The tag line at his feet was manned at ground level. Three personnel positioned inside Jack`s bedroom held secure the line that tagged the side (in case of any additional swaying or rocking). Three persons were on the porch roof with Jack; they made sure that his departure from the roof was smooth, kept him informed, and ensured his well-being along the way.
Eight fairly large police and fire personnel were enlisted to lower Jack. They gently pulled up once to lift him from the roof, then lowered him down the one flight to the ground. Finally, as many ground-level personnel were managing him into the ambulance, other workers returned Jack`s home back to its original state.
LESSONS LEARNED
Training is the ongoing education and fine-tuning of professionals that im-proves performance. Training is paramount in the fire service. Although many situations we encounter may not surface often, it is our responsibility to be ready for them.
In a small municipality such as ours, circumstances such as those above occur infrequently. However, our operation proved successful because of our overall knowledge and the teamwork among our crew and the other entities involved. To that extent, we were prepared. Being prepared in the fundamentals of any given evolution may allow for an intelligent modification of accepted procedures.
We acknowledge, however, that there is always room for improvement. And we continue with renewed zeal to train toward that end.
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BRIAN K. JOHNSON, SR., is a captain, an EMT-D, and a 12-year veteran of the Pleasantville (NJ) Fire Department. He has a bachelor`s degree from Franklin & Marshall College in Lancaster, Pennsylvania, and is a New Jersey state-certified fire instructor and fire prevention official.
