Unique Case Study in EMS Special Ops Presented at Firehouse Expo

Participants in the new EMS Special Ops program at Firehouse Expo came together Wednesday to hear from a panel of rescuers involved in a ground breaking industrial rescue in Pennsylvania in March 2006.

Rather than giving away the details of the incident in an overview, the speakers walked listeners through the event as if they were there. By the end, it was revealed that the incident, in which an employee was trapped in a 35,000 pound press, may be the first known case involving a bilateral field amputation with patient survival.

The presentation was facilitated by Dr. David Jaslow of the Albert Einstein Center for Special Operations in Philadelphia, who responded to this incident as Medical Director for the Buck's County Rescue Squad. Jaslow is also a consultant for EMS Magazine and a columnist for EMSResponder.com.

The room quickly hushed as Jaslow played the 911 call and rescue assignment communications.

Jaslow then gave the scene size-up: the patient's arms had been pulled through two massive sets of rollers, and he was caught dangling 18 to 24 inches off the ground. His face was pressed against the rollers, and some facial skin had been pulled in. He was awake and talking.

The lead rescuers described the "oh shit" factor and described the challenges of the scene: the patient was only partially accessible; the space around him was confined; the area was hot, noisy and filthy; and the machine had to remain live, because turning it off would set it back to its start position.

Parts of the machine were dismantled to secure it, but the press could not be sufficiently dismantled to remove the patient in any reasonable amount of time.

The rescuers described their limited options, their limited time to work as the patient's condition deteriorated, and what eventually did and did not work in terms of medical logistics and extrication.

As each rescue plan failed, the situation became more strained. Rescuers resorted to breaking some rules, such as using a cutting tool while oxygen was being administered, (with fire suppression personnel on standby.)

The presenters also described the emotional challenges of the incident, as this was the first time they had ever encountered an extrication they could not complete.

"As a rescuer that is very hard," said Chief Ed Wimmersberger of Newportville Fire Company #1. "It goes against everything you've learned and everything you've done all your life."

The panel of rescuers also included Chief Scott Bahner and Deputy Chief Joseph Barbagallo of the Buck's County Rescue Squad, Chief Kevin Flanagan, Sr. of the Edgely Fire Company, Deputy Chief John Ribarchik of America Hose, Hook and Ladder Company #2, and Chief Herb Slack of the Bristol Borough Fire Department. They also presented input on behalf of Peter Faight of the Bristol Borough Police Department, who was unable to attend.

The rescuers eventually came to the difficult but unanimous decision to amputate. Jaslow described the process of getting the equipment and performing the procedure, and the critical care provided to the patient en route to the hospital.

In order to recover the patient's limbs afterward, the rescuers had to complete sending them through the rollers. Reattachment was attempted at the hospital against Jaslow's advice, and failed.

Despite the failed to attempt to extricate the patient intact, the rescue was a success, Jaslow said, as unified command and NIMS saved the patient's life. The patient has since recovered rapidly, is in high spirits, and is in the process of getting prosthetic arms, Jaslow said.

One of the final messages of the panel was that it is impossible to train for every circumstance - rescue personnel need to check their egos and work together.

Jaslow, who designed the EMS Special Ops program for Firehouse Expo 2006, said the program was off to a good start and he hopes to grow and continue the program in future years.

Jaslow will also be presenting at EMS Expo in Las Vegas this September.