Rescue Report
By Eric L. Kirk, FF, EMT-P
Photos by Jim Hoffler, BC, EMT-P

A technical rescue involving a critically injured man in a tree reaffirms how training, innovation and calm, creative problem-solving can overcome a critical incident.

On Oct. 10, 2009, at 1138 HRS, firefighters were just getting lunch on the stove when Engine 1, Ladder 1 and Medic 4 were dispatched to a 911 call for a male subject who was bleeding from the head from a chainsaw accident. The patient was in a tree, hanging upside down and unable to move. Rescue 1, a technical rescue team, and a battalion chief were also placed on the call.

Medic 4 was the first unit to arrive at 1144 HRS and reported that there was in fact a man bleeding from the head and upside-down in a tree. The man was not moving, and it was unclear if he was conscious or not. All other responding apparatus were on scene by 1146 HRS.

The scene was located in a suburban neighborhood. The patient was 12 feet up in a full-grown ash tree that he had been cutting down with a chainsaw. He was then struck in the back of the head by a tree limb, flipping him forward. His T-shirt caught a branch, leaving him bent forward and suspended in the air. His torso lay over another limb that had a smaller, upward-oriented branch that had been cut to a point. His legs partially straddled a fork at the top of the trunk, and his left leg was entangled in a ground ladder.

Two civilians climbed each of the two ladders that were already propped against the tree. They used clothes in an attempt to control a freely flowing head bleed. To make matters worse, the ladder the patient’s leg was entangled in was unstable with only one footpad contacting the ground.

The patient’s physical condition was poor and deteriorating. The firefighter-paramedic from Medic 4 climbed the ladder the patient was caught in, which was footed by a firefighter, to make contact with the patient. He reported that the 48-year-old male was conscious and alert but in significant respiratory distress. The patient was unable to breathe in fully, as he was rounded prone over a tree limb with a pointed branch poking into the right side of his chest wall. The patient’s skin was pale, he was diaphoretic, and he was becoming cyanotic. He was only able to speak one-word sentences at a whisper. Essentially, he was slowly suffocating, and rescuers suspected pneumothorax (a collapsed lung). Nearly as troubling: The patient was unable to feel or move his arms and legs. He complained of severe neck pain and indicated that he thought his neck was broken. Meanwhile, he was bleeding heavily from a scalp laceration to the occipital area; blood from the laceration had soaked through three trauma dressings and could not be controlled. There was a pool of blood at the base of the tree.

The firefighter-paramedic treated the patient immediately with 15 liters of oxygen with a non-rebreather facemask. A cervical collar was placed while Rescue 1’s Tech Team assembled their equipment, and Ladder 1’s aerial platform (a reserve piece) was maneuvered into position and hoisted. The firefighter-paramedic put the patient’s arm around his shoulder and stepped up a rung on the ladder, straightening out the patient’s thorax, which allowed his volume of breath to increase. The firefighter-paramedic then used his structural firefighting gloves and his hand to provide some relief by padding the sharp, pointed branch. At this point, the patient’s condition began to slowly improve.

Rescue 1’s Lt. Andy Creekmore placed a department roof ladder at the back of the tree and climbed up, assuming a good vantage point above the patient. From there he devised an extrication plan, calling for an LSP device and straps for lifting. Note: An LSP device is the amped-up rope-rescue version of a simple KED, with built-in lifting points and padding. LSPs are versatile, short-body immobilizers that are generally designed for vertical lifting with ropes through confined spaces, like man holes or ship hatches, for patients with spinal injuries. It was an optimal tool for this situation, readily available and well-known by the rescuers.

Meanwhile, on the ground, Lt. Mathew Wells coordinated the overall operation and worked with Battalion Chief Jim Hoffler 1 when he arrived.

Ladder 1 positioned their platform adjacent to the rescuers in the tree. Once the patient was secured in the LSP, the firefighter-paramedics in the bucket extended a backboard to the tree limb, toward the pointed branch. With the lieutenant lifting above, the patient was slid prone onto the backboard toward the ladder crew. He was in significant pain during this transfer. His left leg was worked through the rungs of the ladder and lifted up. The patient was then rotated to a supine position and secured to the board for spinal immobilization.

The 105' Pierce tower allows for the securing of backboards and basket litters to the bucket, so the ladder was rotated to the rear and lowered to a negative incline where the platform was brought down onto the street. Unstrapped, the platform was level to the ambulance’s stretcher, making the transfer straightforward.

Once removed to the ambulance, the firefighter-paramedic and AEMT/firefighters began their trauma assessment and treatment. The patient was stripped, straightened on the LSP, repackaged, and his head wound was redressed. Vital signs were acquired via a LifePack 12 while a large-bore IV was started in his right anticubital vein. EKG and pulse oximeter monitors were also applied.

Medic 4 left the scene for a nearby Level 1 regional trauma center at 1230 HRS. Time en route to the trauma center was 17 minutes.

The patient improved greatly once removed from his upside-down, above-ground entrapment. En route he regained all sensory functions and his respiratory issues resolved, ruling out a gross pneumothorax. Fortunately, the sharp branch that pressed into his chest and made his aerial extrication so difficult only contused him. He became hemodynamically stable, and the bleeding from his scalp slowed somewhat.

The rescue units returned to service after washing down the base of the tree and decontaminating their gear and equipment.

Lessons Learned/Lessons Reinforced:
This call went very well; however, the smoothest calls are often the ones we can learn the most from.

Thirteen responders, each certified as an Enhanced Level EMT or above, arrived on scene within 5 minutes of dispatch and 7 minutes of the 911 call.

Though physically exerting at times, the rescue was notably calm and reasonably paced. The victim was also fortunate to have the streets clear of cars so the ladder truck could extend its stabilizers and aerial platform. Thankfully, there were few wires or other overhead obstacles to deal with.

Following the incident, some points arose that we will consider for future incidents. The ladders that the patient had placed were good, commercial-grade ladders, but they weren’t tested or NFPA-approved. Perhaps the one ladder the patient’s leg was not mixed up in could have been replaced by a trusted department ladder. Also, safety ropes could have been used to secure the steeply positioned ladder tops to the tree. Although firefighters footed the ladders throughout the incident, at one time three rescuers were standing on the entangled ladder, which couldn’t be replaced or repositioned. There was no choice but to use it, but it could have been used in a smarter way.

Critical to the success of the incident: staying collected during a crisis, training, knowledge of their equipment and creativity. But sometimes, even in the fire-rescue universe, “imagination is more important than knowledge.” – Albert Einstein

Eric L. Kirk currently serves as a firefighter-paramedic and rescue diver on Quint 3 and Fire Boat 1 in Portsmouth, Va., and he also works as a Neonatal and Pediatric Transport Paramedic in Norfolk, Va. He began his fire/EMS career in the Hudson Valley Region of New York in 1986, and has been a paramedic since 1990. Kirk has published EMS- and fire-based fiction; his latest novel, “Flashover, a Firefighter Consumed,” is available at all major online booksellers.

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