By Jarret Enriquez
On June 7, 2024, Miami-Dade (MDFR) units responded to a motor vehicle collision reported as a “garbage truck versus a tree.” The first MDFR unit arrived and found a front loader garbage truck that had struck three palm trees and one very large mahogany tree. The officer of the first-arriving company established command and, realizing this had the potential to be a prolonged rescue operation, called for a technical rescue response. This consisted of the closest technical rescue fire company, a technical rescue battalion chief, Squad 1, and the “Heavy” 1.
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Every MDFR fire company is equipped with and trained to operate hydraulic spreaders, cutters, rams, and an array of battery-powered cutting tools. Generally, first-arriving fire companies extricate patients before the arrival of technical rescue fire companies. Rescue fire companies are staffed by personnel who are trained and equipped to perform complex extrications and rope rescue operations. MDFR’s heaviest assets consist of Squad 1, a heavy rescue and “Heavy” 1, a 50/60-ton rotating wrecker.
The Scene and Operations
The result of the inner and outer surveys revealed a male driver unconscious and lightly trapped and a female passenger, conscious but pinned inside the vehicle. The driver was rapidly extricated and transported to the nearest trauma center.
Extricating the passenger would be no easy task. The garbage truck was in a precarious position because it was on a sidewalk that had a downhill slope to another sidewalk approximately six feet below. Using the cribbing available on scene, the first-arriving units did their best with what they had to stabilize this large vehicle. After stabilization, crews began to assess the level of entrapment.
The passenger was trapped by the dashboard, which had pinned her legs. Crews formulated a plan and began extrication operations. The initial plan was to use a ram from the passenger side B post to the dashboard to spread it away from the patient’s legs. Unfortunately, for every action there is a reaction. In this case, the plan was quickly abandoned when the action of the spreading led to the reaction of a portion of the dashboard being pushed further into one of the patient’s legs.
At this point, Squad 1 and “Heavy” 1 arrived and a new plan was formulated. First, vehicle stabilization was reevaluated and improved utilizing Heavy 1’s winches, directional pulleys, and lifting straps. This action was taken to ensure that the garbage truck did not slide down the previously mentioned elevation. Once the vehicle was stabilized, a change in plans for extrication was formulated, which included relief cuts along the dashboard to avoid it from pushing into the patient any further. This plan was successful, resulting in extricating the patient in 90 minutes.
Lessons Learned and Reinforced
- Be proactive. Call for additional resources early. The first-arriving company officer, who became the initial incident commander (I/C), realized there was the potential—not necessarily a certainty—for a protracted operation. As a result, he called for additional resources earlier on in the operation. This included one of MDFR’s Air-Rescue helicopters flying a trauma surgery team, were it to be medically necessary to perform a field amputation of the patient’s leg.
- The condition of the patient drives the extrication operation. In this case, technical rescue paramedics closely monitoring the patient stopped the initial efforts at spreading the dashboard because it had an adverse effect on the patient. Crews engaged in a difficult and lengthy extrication can become so focused on tool operations that they can lose their focus on the condition of the patient, which, in this case, was deteriorating during the prolonged extrication. That’s why it is critical to assign personnel whose sole focus is on the patient. Extrication efforts must be coordinated with patient care to ensure the operation adapts to the condition of the patient. Had the patient’s condition further deteriorated, it may have necessitated a field amputation of one of her legs by the trauma surgeons airlifted to the scene. Fortunately, this procedure did not have to be performed.
- Rotate personnel frequently, especially in hot weather. A fatigued tool operator is a dangerous tool operator who may injure himself, the patient, or other rescuers. Rotating personnel requires strong leadership. Seldom will rescuers involved in an intense operation, such as this one, ask for relief.
Jarret Enriquez is a lieutenant with Miami-Dade (FL) Fire Rescue. He is a department-certified technical rescue technician who participated in the extrication examined in this article. He instructs in driver/engineer, rope rescue, confined space, trench rescue, and vehicle/machinery extrication techniques.
