Trapped in a Snow Blower

   In my almost 20 years in fire and EMS, I've always been amazed by the places people put their hands. The following call happened during a patch of cold and snowy weather.

   The West Webster (NY) Fire Department, which provides fire, rescue and basic EMS transport, was called for a 24-year-old male with his hand trapped in a snowplow. Even my eldest son knew that dispatch couldn't be accurate, and he guessed the person actually had their hand trapped in a snow blower. Though he is only 11, he guessed right.

   I live about as far away from this scene as possible in my district, and as it was cold and snowing, it took me a short while to get to the call. On my arrival, I found our rescue and one of our pumpers were on scene, with the ambulance close behind me. A paramedic from North East Quadrant Advanced Life Support was also just arriving. As I walked up, I saw a snow blower in the middle of a driveway. A man knelt in front of it, his right arm through the discharge chute and his right hand in the barrel. He was being attended by fire and EMS personnel.

The Scene

   The patient had tried to clear the discharge chute and, with a knit glove on, got his hand in too deep. The impellers moved, and he found the three middle fingers of his right hand trapped between the steel impeller blade and the housing, which is a very thick, sturdy steel cylinder.

   The patient was alert and oriented, covered in a blanket, kneeling on his left knee. His left hand was trying to feel the tips of his right fingers. His right hand was through the discharge chute, which was attached to the top of the impeller housing by a steel ring at the bottom of the chute. This resulted in him having to hold his right hand up at a very awkward angle, with about 5 pounds of steel hanging on it. Our firefighters had turned off the device and disconnected the spark plug cable. They had also disconnected the discharge chute from the machine so we could get better access to the patient's hand. The patient was in some pain when we tried to move the hand, but had good feeling everyplace except the tip of his index finger.

   As it was about 15°F outside with a steady wind and snow falling, it was important to get this patient out of this mess as quickly as possible. While he initially had feeling in two of the three trapped fingers, it was not clear how long that would last. Also, there was no bleeding, so there was concern that if we took too long, the patient's fingertips could become unsalvageable. On top of that, with the cold temperature and steady wind, the risk of the patient becoming hypothermic was very real.

   This is where good communication between fire, BLS and ALS is critical, as many things had to happen simultaneously to resolve this call positively. We are fortunate to have fire and BLS ambulance in one organization, and our ALS service works closely with our fire department, enabling open, clear communication and good understanding of everyone's roles.

The Extrication

   First, we needed to secure the machine and ensure the impeller blades would not advance as the obstructions were removed. It is hard to say with certainty if there is still tension on the shaft until you allow the shaft to spin, and in this case that could have cut off the patient's fingers, or possibly even mine, as I was trying to assess the patient's hand and pull his fingers loose when the time was right. This stabilization was done with some cribbing.

   Next we needed to figure out how to gain access to the impeller blades. These blades do not spin backward, but even if they could, the patient's fingers were wedged between the outside edge of the impeller and the steel barrel, so any movement could result in amputation. In this case we would have to find a way to stretch the steel cylinder of the discharge chute into an ellipse, enabling the fingers to be pulled out over top of the impeller blades.

   Finally, the most important order of business was patient care. It was cold and windy out, the patient was in shock, and his pants were getting wet from kneeling in the snowy driveway. The NEQ paramedic initiated an IV, our EMS folks covered the patient with several blankets, and we kept his trapped hand warm with my own hand and several heat packs.

   One might think extricating this patient would just be a matter of cutting the steel impeller barrel apart and freeing the hand. This was not the case since, just like in some car accidents, we had body parts to work around. The patient had limited mobility due to his arm being through the steel discharge chute and trapped deep inside the impeller housing. There was not enough room to get a saw in to cut the steel barrel, and even if there were, there was little room to maneuver, and if the saw slipped, it could injure the patient.

   Therefore, this project was divided into three sectors. One was assigned to patient care, ensuring the man remained warm, alert, as pain-free as possible and out of further harm's way. The second group was in charge of disassembling the unit as quickly as possible without harming the patient or any rescuers. The third team was dedicated to safety, making sure all equipment was used in a safe manner, the area around the patient and crews was free of unnecessary equipment and cords, and any gas-powered devices were far enough away to prevent hazards to the crew.

   Once the patient had an IV established and 5 mg of morphine on board, the disassembly began. We decided to cut apart the auger blades on one side to gain access to the impeller housing. After the right side of the auger was cut away, the housing was accessible. A piece of 4x4 cribbing was placed on the bottom of the impeller barrel. Using a set of hydraulic spreaders, we slowly spread the barrel open. This process took several attempts, as space was limited and the disassembly team was spreading slowly to ensure the spreaders didn't slip, the impellers were immobilized and the patient's fingers were out of the way.

   After a few minutes, the housing was spread enough to allow me to pull the patient's fingers from above the impeller blades. Once freed, the fingers were wrapped in gauze in a position of use and the patient was moved to the waiting ambulance for transport. We were relieved to find all three fingers were attached, though badly crushed and mangled between the first and second distal knuckles. A few seconds after removal from the machine, they began to bleed. The patient had feeling in all fingertips, giving us hope for a good prognosis.

Lessons Learned

   If you live in a place where people use snow blowers, take the time to learn about the machines. Just as with a person trapped in a motor vehicle or piece of heavy machinery, there is no standard way to remove someone entangled in a snow blower. Get familiar with any tools you have that can be used to take them apart, and simulate a few rescues. The more you know about these machines, the faster you'll be able to put a plan together to take them apart and free a patient.

   Make sure you have good communication on all scenes. This is no place for freelancing or acting independently, as people, including rescuers, can get hurt. Beyond the simple problem of being entangled in machinery, additional factors such as extreme cold or heat, the patient's age and other medical conditions may necessitate prompt removal, especially if you are trying to save fingers or a hand that is still attached.

   Proper training and good communications will ensure rapid, safe extrication of your patient.

A Guide to Snow Blowers

   Snow blowers come in two types: Single-stage snow throwers and double-stage snow blowers. Single-stage snow throwers are often smaller and used for clearing just a few inches of dry snow, and the same blades used to gather snow also throw the snow out a chute.

   Two-stage snow blowers are meant to move a lot more snow, and they demand respect. These machines are powered by gasoline engines varying from 5 to 12 HP and up. The front has a large opening to gather snow, known as a collector. The collector is occupied by a rotating auger with blades to pull the snow toward the impeller. The impeller is oriented perpendicularly to the collector and auger, and takes the snow from the front of the blower that is drawn in by the auger and, while spinning at a high rate of speed, throws the snow out through a discharge chute. Because these machines are meant to pull a lot of snow through and throw it a good distance, there is a tremendous amount of power, or torque, to maximize the throwing distance, especially of wet, heavy snow.

   When the snow is wet and heavy, or when the discharge chute is rusty or obstructed, snow can get trapped in it and clog the chute. When this happens, you should turn off the unit and either put the device somewhere warm to let the obstructing snow and ice melt, or use a long stick, like a broom handle, to push the snow back down the discharge chute toward the impeller. This is where, according to the Consumer Product Safety Commission, more than 5,700 people a year make a critical mistake: Rather than letting the ice melt or grabbing a sturdy stick to clear the chute, people use their hands. What these people don't realize but soon find out is that when they are leaning over the machine and getting close to the impeller, the freeing of the snow and ice jam can allow the impeller blades to advance, trapping (and, more often than not, severing) one or more fingers or parts of fingers.

   Syed Ahmed Mustafa has been active in fire and EMS for 20 years. He is the past chief paramedic of North East Quadrant Advanced Life Support and remains an active paramedic and member of the board of directors while also serving as a captain with the West Webster Fire Department. In 2001 he was awarded the New York State Liberty Award for his work at Ground Zero. Mustafa cofounded Team AED, an organization established to help make AEDs more accessible to PAD sites throughout the country. E-mail Ahmed_Mustafa@WestWebsterFD.org.