RESCUE REPORT
Alabama Responders Complete Challenging Auger Rescue
By Tom Vines

Rescues involving auger entrapment can be extremely daunting and intimidating calls.

(Note: A typical auger consists of a continuous corkscrew blade on a long metal shaft surrounded by a round metal tube. Augers are often used to move material such as shelled corn or grain from a lower end where the product is placed, to a higher end where it is discharged. Augers vary in size, from a few inches to several feet in diameter. They are found in industry, construction and agriculture. In some rural areas, they are a common cause of traumatic amputations to children working on family farms. Auger injuries usually result from the auger screw’s high-speed cutting actions. These injuries can be traumatic amputations, severe avulsions, fractures and lacerations, and are often contaminated with dust, soil and other matter.)

On June 8, the Ashford (Ala.) Volunteer Fire Department and Ashford EMS were called to respond to a man trapped in a mechanical device at a local pallet factory. When they arrived on scene, they were faced with a horrific entrapment—one that would require not only a team of skilled technical rescuers but a full surgical team as well.

A 15-year-old boy had fallen feet first into the upper end of a large commercial double auger/mulching machine about 2 feet in width. Both of his legs were entrapped to his knees and wrapped in opposite directions around the two auger blades.

Emergency medical technicians with the Ashford Rescue Squad immediately began conducting a primary and secondary assessment and considering potential rescue strategies. The Ashford responders quickly recognized they had a situation that would require advanced rescue capabilities. So, through the mutual-aid channel, Ashford requested technical rescue response assistance from the Dothan (Ala.) Fire Department (DFD), located approximately 10 miles to the west.

At 1420 HRS, the DFD dispatched Engine 5 (Dothan’s first-due paramedic engine), Engine 9, Heavy Rescue 4, Battalion 1 and an EMS support officer. After receiving a report from Ashford Command, responding units requested that the Southeast Alabama Medical Center in Dothan place a trauma/surgical team on standby. It appeared from the teen’s injuries and severe entrapment that amputation might be the only option.

The Dothan Fire Department arrived on scene at 1425 HRS. The rescuers’ primary goal was to disassemble the machinery from around the patient without causing further injury. However, it quickly became apparent that it would not be possible to extricate the patient by disassembling the equipment. Just removing the bolts to disassemble the structure would not solve the problem. The only possible option for removing the patient: using cutting torches and saws.

The surgical team was called to respond to the scene immediately, not only for possible amputations, but in case the victim’s medical condition deteriorated during the prolonged extrication.

Dothan Fire personnel and the Houston County Sheriff’s Department dispatched vehicles to transport the surgical support team from the medical center. The team consisted of the director of emergency services, an orthopedic surgeon, an anesthesiologist and a vascular surgeon.

A unified command was established to include Ashford Fire, Dothan Fire, the Ashford Police Department and the Houston County Sheriff’s Department. The command system included a medical group to treat the patient and keep him stable throughout the extrication; a rescue group to remove the casing from around the victim, cut the auger blades and hoist the victim out of the auger; and, due to the hot weather, a rehab group. The heat and difficult work required work/rest cycles for all responders at the scene.

Rescuers placed padding around the patient in an effort to relieve pressure on his legs. They also set up a morphine IV to help with the pain.

As rescuers cut the auger blades, the metal around the patient began to heat, so rescuers used ice found on site to cool the immediate area around him. Fire paramedics hung multiple IVs on local equipment. When the trauma team arrived, they began giving the patient universal donor blood to prevent shock while rescuers continued their extrication. By carefully monitoring the patient’s vitals, they could adjust IV flow. The medical team’s efforts resulted in the patient being hemodynaically stable and conscious the whole time.

Once the metal around the auger was cut, rescuers used block and tackle to raise the auger blades. They were then finally able to carefully unwrap his legs from the auger.

The patient was completely immobilized in a Miller Half Back. The crew then performed a rapid extrication, and after two and a half hours, the boy was completely freed from entrapment. With a surgeon aboard, AirHeart helicopter transported him to Southeast Alabama Medical Center in Dothan, where he was immediately taken into surgery. After a stay in the ICU and a little more than a week in the hospital, he was discharged in good condition. He did not need amputation.

Units cleared the scene at 1719 HRS.

Officials with the Occupational Safety and Health Administration have launched an investigation into whether any federal violations occurred in the accident.

Sources: Dothan Fire Department Fire Chief Larry H. Williams Jr. provided information for this report. Some additional details were taken from an account of the incident in The Dothan Eagle.

Lessons Reinforced:
(Provided by Chief Williams)
1. “Lock-Out/Tag-Out: The initial responders did an excellent job in recognizing the need to shut off all power at the scene and secure it from accidentally being activated.
2. “Command Structure and Teamwork: A strong command-and-control structure was developed early and helped coordinate all groups working at the scene. There were no turf battles, and every agency worked together to achieve the incident objectives.
3. “Knowledge, Skills and Abilities: Everyone at the incident competently carried out their required tasks in a professional manner and worked as a team to solve all problems encountered.
4. “Utilizing Resources (Mutual Aid): Any community can become overwhelmed and require assistance from other agencies at any time. Every community strives to develop a workforce and equip first responders with the training and equipment required to handle a variety of responses. However, no community can completely prepare for every incident that may eventually occur; therefore, mutual aid is vital, especially in rural areas. Taking care of neighbors and working together as one team is a necessity. This concept was reinforced during this response, and all agencies supported one another to meet the challenges required.”

Lessons Learned
(Provided by Chief Williams)
1. “Rehabilitation: All emergency workers are committed to their responsibilities and often these individuals are reluctant to take necessary breaks. Command must be aware of this and demand that everyone on the scene follow established work/rest cycles. A few of the responders at the scene had gotten into positions early in the incident to provide support for the victim. This created some problems with rehab of these members since it was almost impossible to rotate them into the Rehab Group while continuing to assist the patient. Decisions must be made as command is expanded on how to relieve all personnel involved in critical operations at an incident of long duration.
2. “Communications: With any difficult or large response, effective communications is always a challenge. Although the groups were communicating well, at times, group-to-group interaction was lacking. Not everyone has a radio with this type of response, and the group leaders must have regular face-to-face discussions in order to coordinate overall tactical objectives.
3. “Equipment and its Location on Apparatus: Any time a response involves various agencies, the type of equipment and what it is called will be different. Also, not all personnel know where the equipment is located on apparatus from different agencies. Agencies that have mutual-aid agreements (written or verbal) must have equipment/apparatus familiarization meetings. Exercises and interagency training are the best methods to assist with this problem, but at a minimum, agencies must be familiar with each other’s equipment and apparatus layouts.
4. “Heavy Rescue 4 Familiarization: The Dothan Fire Department must do a better job of taking the Rescue (and Hazmat) Regional unit out in our area to show capabilities and explain how the system is set up.
5. “Medical Community: Physicians who may be required to respond to pre-hospital incidents must have a basic understanding of our rescue and medical capabilities. Likewise, pre-hospital personnel must know what surgical/medical resources are available to respond to field-based operations and a plan should be developed explaining how to facilitate the response when required.
6. “Helicopter: Due to usual short transport times, we aren’t often required to dispatch an air transport into our city or neighboring communities. But any time (early into an incident) you’re aware of lengthy extrications, it’s a good idea to call for an air transport unit. Fortunately for us, there are two primary helicopter air medical transport agencies in our immediate area. We called early but forgot one major issue: Where are we? We did not have a GPS to advise the air transport of a good location to land. It is highly recommended for departments and/or units that make frequent responses into rural areas to purchase a GPS that has the ability to easily provide on-site coordinates. The latitude and longitude can easily be communicated to the pilots, and all that’s required after notifying the pilot is for ground crews (and area law enforcement) to establish a landing zone and safety perimeter for the helicopter.”

Rescue Editor Tom Vines is the co-author of “High Angle Rescue Techniques” and “Confined Space and Structural Rope Rescue.” He operates a rope-rescue consulting group in Red Lodge, Mont.