BY TOM SITZ
On November 13, 2006, at 0611 hOUrs, Painesville Township (OH) Fire Department Station 1 was dispatched for a report of a “man with his clothes trapped in a machine” at Dyson and Sons, 55 Freedom Road. The responding firefighters received no other dispatch information or updates. Dyson and Sons is a heavy industrial complex that specializes in working with and forging large specialty steel appliances. A lieutenant and four firefighters staff Station 1. Because of the mysterious nature of the call and the time of day, the station officer in charge (OIC) augmented the normal equipment response for this type of call (an engine and medic unit) with a technical rescue vehicle. Weather did not affect the response, and the duty crew was briefly delayed at a train crossing for about one minute.
SIZE-UP
On arrival, we saw numerous employees running around, pointing to the warehouse where the victim was located, the first indication that this was something more than just “clothes trapped in a machine.” We walked through the warehouse to the victim’s location, approximately 75 feet from our entrance point. We observed a 37-year-old male who was standing; what appeared to be his coat and sweatshirt were very tightly wrapped around a steel rod. The victim was partially hunched over the rod; a coworker was supporting him.
As we got closer, we could see blood on the floor; he was clearly in distress and was moaning, but he was alert and oriented. In response to our query, he said he thought the rod had penetrated more than just his skin. We were unable to see the rod’s entry point because the clothing blocked our view.
Firefighter/paramedics began patient care while others began to set up to extricate the patient, holding him up to keep him standing. We also began cutting away the victim’s jacket and sweatshirt with trauma scissors to confirm whether the rod actually penetrated the victim. We cut away just enough of the clothing to determine that the rod had indeed penetrated the victim in his upper left abdominal quadrant. As soon as we confirmed the impalement, we stopped cutting away the clothing, believing that it would help to hold the rod in place during the extrication. We also requested a medical helicopter to meet us at the hospital for immediate air evacuation to a trauma center. From this point, we decided to remove only the clothing necessary to expedite patient care; we removed the coat’s sleeves to provide IV access.
The patient, a machine operator, was working with a 20-foot-long, one-inch threaded steel rod that was spinning in a lathe as he was working (photos 1, 2). It appeared that he had walked around to the spinning end of the rod to check its threads as it worked its way through the lathe. At this point, the spinning end of the rod caught his coat and sweatshirt. The clothing quickly became wrapped around the spinning rod, tightening it around him and pulling him toward the rod and impaling him (photo 3). The victim continued to be pulled into the rod until a coworker heard his cries for help and shut down the machine.
 (1) Photos by author. |
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INITIAL ACTIONS
The patient was standing with about six to seven feet of rod between him and the lathe. The other 13 to 14 feet of rod was secured in the lathe. Patient care was administered as we were setting up to cut the rod. Members established IV access and assessed the patient’s vital signs, after which he received morphine. Bleeding was very minor; the entangled clothing may have helped apply direct pressure as it was wrapped around the rod. All advanced life support (ALS) equipment was set up and in position before we started any extrication attempt.
There was about six to seven feet of rod between the patient and the lathe, so we decided to cut the rod at a point about three feet from the patient. We felt this would be far enough away from the patient that heat transfer from cutting would not be an issue. However, this decision would come back to haunt us later.
Before cutting, we cribbed the rod, which was about 4½ feet from the floor, to avoid transferring any downward cutting pressure into the patient’s abdomen. We cribbed the rod on both sides of the planned cut using two pallets turned on their ends, atop each of which we placed one 4 × 4 cribbing piece and one wedge. We did not crib the rod too firmly to avoid transferring any upward force into the patient’s abdomen. With the wedges lightly contacting the rod, we used our hands to hold the rod against the cribbing so members could immediately adjust the wedges as needed to maintain the rod’s stability. As soon as we had cribbed the rod, completed all initial patient care, and had all ALS equipment in place, we started to cut.
CUTTING
Initially, we selected the reciprocating saw, figuring that it would reduce spark production and heat transference to the patient. We also placed wet towels on the rod to dissipate any heat produced from the operation. Initial scene assessment revealed that we would be working above what appeared to a 100-gallon hydraulic oil tank that supplied the lathe machine; a small amount of oil had leaked from it on the floor. Although a concern, the possibility of ignition with this type of oil from cutting sparks was pretty minor, and a large dry chemical extinguisher was kept ready during the cutting operation.
As we cut, when the reciprocating saw was about halfway through the rod, it started to bind, causing the rod to vibrate; the patient voiced his discomfort. We quickly readjusted the saw’s position and attempted to finish the cut. But as soon as the cut was started, the bar began to vibrate; the cutting operation was suspended. I believe that the saw blade was binding on the retraction phase of its cutting cycle, causing the vibration, possibly because the depth of the cut was deeper than the height of the blade.
At this point we switched to a rotary saw (photo 4) to cut the rod since we felt that other tools, such as hydraulic cutters, would cause up/down movement on the rod. This would cause the patient discomfort and possibly make his injuries worse. The rotary saw with the aluminum oxide steel-cutting blade cut through the remaining bar in about five seconds. The patient never complained during this cut; from my perspective, the bar never vibrated. Members supporting the rod during the cut said that they felt no heat transfer into the rod. The patient was placed on a backboard and cot and transferred to the medic unit. Total time for the extrication from arrival on-scene to the patient’s transfer into the medic unit was 25 minutes.
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TRANSPORT
When we initially decided where to cut the rod, we factored in the height of the medic squad’s interior ceiling. However, we did not factor in the four- to five-inch drop-down lip where the squad doors close. When we picked up the cot to place the victim inside the patient compartment, the bar sticking out of the patient’s abdomen was about an 1⁄8 inch too long to clear the doorway. We had to angle the patient so he could get through the vehicle’s door; once past the doorway, there was plenty of room in the patient compartment between the ceiling and the bar.
AT THE HOSPITAL
When we arrived at the hospital and wheeled the patient into a trauma room, the helicopter crew was inside waiting for us. As the emergency room doctor and the flight crew prepared the patient for the flight to the trauma center, I noticed the pilot and copilot looking concerned, conversing and taking measurements with their hands. I asked them what was up; they responded that did not think the patient with the rod in place would fit through the doors in the helicopter. Using a tape measure, the pilots measured the helicopter’s opening and the length of the bar projecting from the patient’s abdomen. They confirmed that no more than two feet of rod would fit through the helicopter doors. So we had to cut the bar again.
The rotary saw, which was still at the scene, was brought to the hospital. As the saw was en route, hospital maintenance personnel brought a four-inch electric wheel saw (whizzer saw) with a metal-cutting blade. With both saws on-scene, we selected the electric wheel saw, since it would produce fewer sparks in a room filled with oxygen and not fill the ER up with carbon monoxide (CO).
Although the wheel saw did not produce many sparks or CO, it did have two drawbacks: It took several minutes to complete the cutthe rotary saw would have taken less than a minute; and because of the extended cutting time, the saw transferred a substantial amount of heat to the rodyou could not put an ungloved hand on the rod close to the cut. However, we had wrapped the rod in several wet towels and had a supply of sterile water on hand; otherwise, this would have been a problem for the patient.
At the trauma center, X-rays revealed that the rod was close to penetrating the patient’s liver when the coworker shut down the lathe. There was no damage to any organs or other soft tissue except for where the rod entered his abdomen. Our extrication efforts did not make the patient’s injuries any worse. Surgeons removed the rod, and the patient was released the following day.
LESSONS LEARNED
;• Because of the phrasing of the initial dispatch, “clothes stuck in machine,” some members did not don their bunker gear. Thus, they were not prepared with proper personal protective equipment (PPE) when the call turned out to be a technical rescue. Remember, whenever a dispatch uses the words “stuck or trapped,” responders should put on their PPE. Several years before, we were dispatched for “a child’s foot stuck in a bike.” The OIC decided to send the engine with the medic unit because of the word “stuck.” The child’s foot was so swollen in this case that we needed the hydraulic cutters from the engine to free him. If you think you might need certain equipment, take it with you. It’s easier to have it at the scene and not need it than to delay extrication of a critical patient because you left the equipment at the station.
;• We used three different saws to cut this rod: a reciprocating saw, a rotary saw, and a wheel saw. The rotary saw with the aluminum oxide blade was by far the most effective. If we face a similar situation in the future and have adequate room in which to work with it, I would choose the rotary saw first.
;• In an impalement or other incident in which an object projects from the patient’s body, cut the object so it does not extend more than two feet to make moving the patient into the medic unit or helicopter easier. In deciding where to cut such an object, consider what space limitations you may face along the way in moving the patient from the extrication site to medical transport vehicle.
;• Bring whatever saw or cutting device that was used at the scene to the ER. I originally intended to bring the rotary saw to the ER with us, but when I saw how much room we had in the patient compartment once we cleared the doors, I decided not to waste time and delay patient transport to retrieve it.
;• The value of preassigned riding positions and tool assignments becomes crystal clear in these unusual incidents, reducing confusion and increasing effectiveness. Total time from initial dispatch to arrival at the hospital was 41 minutes. Several minutes of this time included transporting the needed equipment up to the patient before we could even begin to extricate him. We had to park our vehicle approximately 20 to 25 feet from our point of building entry and travel another 75 feet within the building to the patient. This meant a round trip of 200 feet to get additional equipment. Since everyone had preassigned assignments based on their riding positions, everyone knew what their responsibilities were so no one had to be told. If everyone was going for the saw or patient care, it would have greatly extended the operational time for this incident.
;• During the postincident critique, we identified a deficiency in our extrication tool inventory. When we discussed what we would have done if we had not had enough work space to use the rotary saw, we said that the two-inch wheel saw (whizzer saw) would have been the tool of choice for working in a confined space. Our department has since purchased two two-inch pneumatic wheel saws for each side of town for any type of special extrication scenarios (photo 5). We also discovered through training with the wheel saw that we were able to cut the post to a vehicle brake pedal in a car completely in half in about 90 seconds.
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This was a very usual incident for our department. We had never worked an impalement injury of this magnitude, let alone with a conscious patient. I believe we had a successful conclusion to this incident for the following reasons: preassigned riding and tool assignments (everyone knew their job and performed it with very little direction) and a good scene survey (all the critical factors were in play when we developed our incident action plan).
TOM SITZ is a lieutenant and 24-year veteran of the Painesville Township (OH) Fire Department. He is an instructor for Lakeland Community College in its Fire Science program and for the Auburn Career Center firefighter training programs.
