Stepping Up

Salt Lake City’s new technical rescue team performs difficult confined-space rescue.

By Martha Ellis

For years trench rescue has not topped the list of most fire department’s training schedules. Many underestimated the potential for disaster that a trench rescue presents, so time and funding were usually designated to other areas of need. Today, however, the urgency of not only having a well trained technical rescue team in place, but also a group of highly trained individuals to act as a rapid intervention team, has become apparent.

In the fall of 2002 the decision was made to develop and support a formal technical rescue team in Salt Lake City. “Up to that point we had many highly skilled and motivated people on the job,” explains Captain Mark Carson, the captain assigned to head up developing the project. “The problem was they were unable to respond effectively. They were not stationed together and there wasn’t any coordinated training on technical rescue in place.”

After a multi stage testing process, a team of seven Captains, nine Paramedics, six Engineers and three firefighters was selected. The team received 50 hours of initial training prior to being put into service. Performance based skills development is on going, requiring roughly 100monthly hours of continued training.

Into the Breach

On January 28^th, the value of a well-trained team was realized, as a 43-year-old construction worker lay trapped at the bottom of a14-foot foundation excavation. He was pinned beneath hundreds of pounds of loosened debris, in a space approximately 3 feet wide. He was in shock, hypothermic and suffering from back pain.

Approximately 3 hours earlier the victim had been sent into the “trench” to clear debris from the base of the foundation to allow for the application of a weather proofing material.

The “trench” was 14 feet deep; one side being concrete while the other side was an unsupported excavation wall comprised of “Type C –Un-cohesive/Saturated” soil and boulders. Setting on top of the unsupported wall was another 14-foot foundation.

OSHA classifies soil stability according to its strength and cohesiveness. Stable Rock (rated type A) is considered the most secure, while Type-C is considered the least stable and thus most likely to collapse and entrap. The soil’s cohesiveness rating reflects its bonding ability, and the saturation rating measures the moisture content. All of these ratings allow rescuers to assess the potential for further complications when developing a plan for securing and entering atrench environment.

Size up

When crews were dispatched to the scene at 1418 hours, the initial report was of a structure collapse with a trapped victim. After going in route, details revealed a different scenario and additional resources would be needed. Salt Lake City Fire Department has an8-member heavy rescue team in service 24-7, responding on Rescue Engine 5 and Truck 5. On this particular afternoon Rescue 5 was manned by Captain Ron Fife, Engineer Nick Glagola, a Paramedics Matt Taylor and A.J. Quirantes. Quirantes was swung in to Station 5 for the day and was not a certified heavy rescue team member. Captain Steve Crandall, Engineer Joel Christopherson, and Firefighters Darrin Whitaker, and Calvin Christiansen manned Truck 5.

After receiving up-dated information en route, Captain Crandall called for the five-member technical rescue team from Salt Lake County Fire Department. (The two teams had trained together and the understanding of mutual aid had all ready been established.) The county team consisted of Engineer Bryan Case, acting in charge, Paramedics Mike Bohling and Matt Hambleton, and Firefighters Ken Aldridge and Matt Weygandt manning Heavy Rescue 10.

Salt Lake City’s Rescue 4 (Captain Marty Peterson, Engineer Richard Snow, and Paramedics Tom James and Terry Jameson) was the first arriving unit. After establishing command they did a quick verbal assessment of the patient and established that he was conscious but unable to move. He was bent over at the waist with his lower extremities and left arm pinned under debris and his head wedged under a large boulder.

Upon the arrival of Company 5, Captain Crandall assumed the role of Rescue Operations Officer (RO). A quick assessment of the trench, soil, patient position and condition were made. Captain Fife, who was initially assigned to Safety Officer, established a “hot zone”. “In order to facilitate the safety of all the crew members, I needed to prohibit anybody from getting into the area and creating undue congestion which could impede the rescue operation. Too many people in the hot zone could also lead to secondary collapse,” explains Fife. Secondary collapse is always a strong possibility in situations like this. Excessive activity too close to the trench can create enough vibration to trigger such a collapse.

As it was, low flying news helicopters trying to capture the scene did cause a small secondary collapse about 10 feet to the west of the working area. Fortunately, the protective panels that were already in place by that time safely protected all HRT members and the patient.

A dry erase board was mounted to the foundation within the hot zone. A diagram of the trench was drawn, indicating patient location, wall composition, and trench shape. The trench was an “L” shape, indicating that special care would be needed to secure the corner.

“Complicating the situation was the fact that he was right at the corner of two walls/”trenches” that formed an “L”. Consequently, he was exposed to two vertical walls of unstable soil at right angels to each other. Statistically, there is a 75% chance of a secondary collapse in “disturbed”-previously excavated-soil. Also, the most common trench/excavation configuration involved in collapse, secondary or otherwise, is an intersecting “L”,” states Crandall.

Combine that with the fact that they were dealing with very unstable soil there was an extremely high likelihood of secondary collapse. A plan was established including safety considerations, primary medical considerations, how to secure the trench, and how to establish the high point hoisting system.

Anchor Points

In most trench operations ground pads can be placed along side the trench, allowing worker to simply carry equipment to the trench edge. This scenario presented a whole new set of challenges. “Each panel, pneumatic shore, bucket of soil, piece of medical equipment, etc. had to be hauled up ground ladders then lowered into place from the top of the wall with ropes,” recalls Crandall. This was going to require even greater organization, communication and equipment management to orchestrate.

Because this was not your standard trench operation, special consideration also had to be given to safety. Team members operating on the top of the foundation needed to be secured with harnesses and tag lines. Multiple lines need to be secured on the up-hill side of the scene. Firefighter Whittaker was assigned to the Rigging Sector. It was his responsibility to secure the tag lines. “There were no anchor points close to the trench. I went about100’ up the hill to the next house. I used the support columns on that home to set 2 anchor points,” he states.

Working within a construction zone presents its own inherent risks. Special consideration was given to assure there were no other obvious hazards present such as unprotected utilities and untenable air quality inside the trench. SLCFD Hazardous Materials Team (Jack Tidrow, Chris Bluth, Davin Halverson, Dan Mortensen) was assigned to do a walk around of the entire site and prepare for air monitoring and management within the trench.

Providing for the patients safety was also a key consideration. He was slowly being buried by soil and rocks raveling (breaking free) from the unsupported side of the trench were slowly burying him. Protecting his head prior to entering the trench was the primary objective. Because he was unable to move or help himself in any way, a helmet was lowered down on a rope, then using pike poles much like chopsticks, rescuers were able to place the helmet on his head.

Medical Considerations

Trench rescues not only provide their share of technical challenges, but unique medical conditions need to be considered early in the operation as well. Typically, a trench rescue is not a rapid event. Most can take 3 to 4 hours depending on the complexity o the situation.

In addition to assuring the ABC’s, spinal and any acute injuries requiring immediate attention have been addressed, rescuers need to be keenly aware of the hazards of Crush Syndrome (CS). This insidious culprit can often be overlooked in the heat of managing a rescue. If not addressed early in the operation all your efforts could go to waste if the patient goes into acute renal failure or cardiac arrest after you free them.

CS develops when a large mass of skeletal muscle is crushed until cell membranes begin to leak allowing for chemical imbalances both inside and outside of the cell. If this occurs, dangerously high quantities of potassium combined with myoglobin and other toxins can be released into the victim’s blood stream upon the release of the pressure. Pre-treating is critical even when symptoms are not present.

In a crush situation, the muscle tissue is also being forced to function with little to no oxygen supply, and this anaerobic condition can produce excessive amounts of lactic acid over prolonged periods of time. In addition to breaking down the affected muscle tissue, and exacerbating complications with blood toxicity levels, this can also lead to metabolic acidosis.

If your department does not have CS protocols address it with your licensing physician. This is a very real problem, which does not just apply to trench rescue- it’s also common in disasters such as earthquakes, building collapse, industrial accidents and motor vehicle accidents as well.

Paramedic Matt Taylor was the first medic assigned to advanced medical care of the patient. While the trench was being secured for entry he contacted medical control at the closest trauma facility. “I wanted to discuss the possibility of crush syndrome and start taking preventative measures against it by getting advanced orders for IV treatment,” states Taylor. There would be more than enough to keep him busy once patient contact was established. Getting advanced orders would allow him to treat immediately based on what he found, saving valuable time.

“There was some confusion on the part of the hospital because they couldn’t figure out how bicarb would be administered without a line established,” he recalls. This can be unfamiliar territory for the medical staff in your ER. “Hospitals need to be educated on the nature of these types of calls to allow for addressing potential medical complication prior to even getting to the patient,” recommends Taylor.

Orders were received for IV sodium bicarbonate to combat the acidosis and insulin and glucose to prevent potential cardiac problems due to excessive potassium levels. Orders for morphine were also obtained for pain management. The hospital sent a trauma physicians assistant to the scene to test blood samples as they could be obtained from the trapped victim.

Securing the Trench.

Once the patients head was protected and rescuers had appropriate fall protection in place the arduous task of securing the trench ensued. The first panel was hoisted up the ladder and lowered into the trench to the left of the patient. It was an8’x4’ panel with a 2”x12”x 12-foot strong back, referred to as a ShorForm panel. Placement was difficult due to the precarious working conditions and the large boulders at the foot of the trench. Once in the optimum location, the Paratech pneumatic air shore was lowered in using ropes and the air hose that connected it to the pressurizing system, and the shore was shot.

Because of the uneven surface on the unsupported side of the trench, it was necessary to “back fill” the voids behind the trench panels with high-pressure airbags. This provided for more contact against the unstable wall and a more effective shoring system.

One side of the trench was concrete and it was debated whether or not t simply place the base of the shore directly against it. Due to the fact there were concrete ties protruding into the trench from the wall, full size panels would not have worked. The decision was made to place just the 2”x 12”x12’ strong backs on the concrete side to facilitate nailing the shores into place. Capturing the corner required placing thrust blocks with45degree angle cuts on their ends just inside the corner edge of the concrete wall. This created a flat surface for strut placement, providing an apposing force to drive the panels into the corner of the “L”. Using the lumber on the concrete side allowed for securing those necessary thrust blocks, as well.

Five panels total were utilized to provide a safe working environment for the rescue team to administer medical care and work on excavating the patient.

Command, Organization & Communications

Although the majority of the scene control was in the hands of the RO (Crandall), an effective incident command system existed. Battalion Chief Dan Andrus was the Incident Commander (IC) and quickly recognize that establishing a planning and logistics Divisions in an extended operation such as this would be crucial to the overall success of the operation. Battalion Chiefs Kris Garcia and Dennis Goudy not only oversaw the successful implementation of both divisions, they also kept a close accounting of all crews on scene.

Scott Freitag acted as the Public Information Officer and Liaison to media personnel. This proved invaluable when quick action needed to be taken against the low flying helicopter. Due to the danger the helicopters were presenting, IC requested the airspace over the scene was closed.

As the RO, Crandall had the responsibility of choreographing all activities inside and out of the trench. Perched on the concrete foundation he was able to relay crucial information to all members on scene.

There is no latitude for ineffective communication on a scene of this nature. Working in a small workspace with pneumatic equipment demands concentration and definitive commands. All communications were funneled through Crandall. “Using the 800 MHz radios allowed us to set up a ground channel for radio to radio communications on scene, although most communications were conducted face to face,” states Crandall.

Every medical up-date, request for medical supplies, reading off the CO monitor, or command to shoot a strut or inflate and airbag was filtered through Crandall.

Once Battalion Chief Raleigh Bunch arrived on scene and assumed the role of scene Safety Officer. Captain Fife was reassigned to manage the “hot zone”. This involved a great deal of organization. There were two caches established: One for trench operations, and one for medical supplies. As one piece of equipment was being lowered into the “trench” the next required piece was being prepared.

Whether this meant securing panels to lowering ropes, assuring pneumatic devices were hooked into the pressurizing system, or preparing buckets full of medical supplies, it all had to be ready for use in the “trench” when needed.

There was a team of 4-5 individuals assigned to the panel team. Their job was to take the equipment up the ladders and hand it off to the team members standing on the foundation. “The hardest part of that assignment was not so much lifting the panels, but the pain in my feet from standing on the ladder rung for 30-40 minutes at a time,” explains Whittaker.

Rescue 4, who had been assigned to Medical Sector, over saw the medical cache and all medical documentation. Information coming out of the trench regarding patient condition, vitals, and time and quantity of medications administered was recorded both on a medical form and the white board mentioned earlier.

The trench operations cache was assembled by the team, but once all those members were committed to the actual panel, shoring and excavating teams, people retrieving equipment were typically line firefighters with little to no training in technical rescue.

“We’re working on a marking system for our equipment,” explains Fife. “Varying color bands for different length struts, and also a means to distinguish between swivel and stationary strut bases. That way if we have to send someone that is not familiar with the equipment to retrieve something, we can give them a simple description. These markings will be consistent with all mutual aid departments.”

Going in.

Firefighter Glagola was the first person to enter the trench after a safe box was established. The first order of business was to secure the helmet on the patient and provide him with eye protection. The second panel was placed to the right of the patient. “The second panel was a modified panel. It was a shorter panel in an effort to work around the boulders at the base of the trench,” recalls Glagola. Once the second panel was secured with the shores Glagola began excavating and Taylor was allowed into the trench to begin advanced medical care.

“One of the boulders was actually on his leg,” states Glagola “Initially we though we’d have to use cribbing and high pressure airbags to free him, but I was able to move it off of him manually.”

By this time they had covered the patient with a blanket and warm air was being pumped in with flexible ductwork off a propane heater. This helped immensely, however, the patients extremities were still vulnerable to the cold wetness of the soil. “After freeing his left hand I removed his wet glove and physically warmed his hand with mine. I then gave him my fire gloves to try to keep him as warm as possible,” states Glagola.

Remember, if warm air ventilation is going to be utilized in a winter environment the effect of that warming on the soil needs to be considered. Providing a generous safe box around the patient and working area prior to initiating the warming is recommended to avoid any further collapse as the soil is warmed.

Taylor was able to secure a c-collar, administer blow by O2 and establish two IV lines. Because of the extreme cold and the physical condition of the patient, microwaves of neighboring homes were used to warm the IV bags. “We used warming hand packs to keep them warm once back on scene,” states Taylor. Morphine and sodium bicarbonate were administered when the line was established.

“One thing I would have done differently if I had to do it again, would be to put the bicarb into the IV bag and let it drip in,” Taylor states. This would have eliminated having tojuggle another piece of equipment in such tight working conditions.

Timing in the Trench

Strict attention needed to be paid to the duration of time people were working in the trench. Ideally, rotating entry team members every 30 minutes is recommended. Resources being what they were, however, Crandall had a 45-60 minute rotation he stuck to.

“After setting 2 panels, stabilizing the patient and excavating at least2 dozen buckets of soil off him they called me out of the trench. It had been an hour from the time I’d gone in. It felt like about 20minutes,” recalls Glagola. “I felt bad having to get out of the trench,” he continues, “but we had 8 guys on the heavy rescue [that day], 7 of which were qualified to pick up where I left off.”

When individuals were pulled out of the trench they were sent directly to rehab. The Red Cross had been called in to assist with rehabilitation efforts due to the extended nature of this type of incident. In addition to hydrating and getting something to eat, members received a thorough medical evaluation. We all love being in the thick of things but, without proper rehab, we stand a great chance of becoming part of the problem as opposed to solving it.

Packaging and Hauling

Soil on average weighs about 100pounds per cubic foot. In this case, given the soil saturation, it was more likely in the 120 to 130 pounds per square foot range. The victim was pinned under approximately five to seven square feet of soil and rock equaling anywhere from 650 to 1,000 pounds. Most of this was hauled out of the trench one 5-gallonbucket at a time and lowered down to waiting wheelbarrows to be hauled away.

Captain Carson was assigned to head up the rigging team. The tip of the aerial on Truck 5 was utilized to establish a high point. A 4:1 hauling system with an independent belay line was rigged. The truck was pulled into the garage area (Hot Zone) of the foundation when the patient was close to being ready to lift. There was only about a foot of clearance on either side of the outriggers, making for a perfect fit.

Once the patient was freed enough, and his over all condition had improved to allow him to sit up, an LSP 1/2 back was secured. (An LSP is similar to a KED, however it incorporates a safety harness and lifting bridle, as well.) Excavation continued until the patient could be slowly lifted to a suspended standing position.

“When lifting the patient initially, we wanted to move slowly, as all the toxins which had pooled in his legs were going to be released into his circulatory system,” explains Taylor. This was also the first opportunity they had to assess the patient’s lower extremities. Because the patient had no feeling in his legs they had no way of knowing their condition. No contusions or breaks were observed.

Once rescuers were confident the patient was stable he was quickly hauled up and over the 14-foot foundation wall and lowered down into the “Hot Zone”. He was then placed into awaiting stokes litter, loaded into the ambulance and transported to LDS Hospital. He was treated and released 8 days later.

Wrapping it up.

Once the patient was successfully removed from the trench he was placed in the care of Rescue 4 Paramedics James and Jameson. This was a relatively fresh crew and all HRT members, including the medics, were needed on hand to break down the shoring system.

Breaking down a trench operation is a lot like coming down off a mountain after a big climb. It is an easy place for people to let down their guard after the emotional crescendo of completing a task. However, as in mountain climbing, it is the time when HRT members need to remain equally or more focused than when there was a victim involved. The level of fatigue is high, while the scene intensity is low. Due to the dangerous nature of removing pressure from already unstable soil walls, the potential for secondary collapse is ever present. These factors need to be on all crewmembers’ minds as those shores and panels are being removed.

After a solid team rehab and debriefing, the crew, as a whole, systematically broke down the system, which had taken them 3 and 1/2 hours to build.

Conclusion

A successful ending to any incident can never come without lessons learned and room for improvement. The most precarious aspect of this operation was how quickly the qualified technical rescue personnel were committed.

“All the HR Team members on duty that day from Salt Lake City as well as Salt Lake County were engaged in actual hands on task tactical operations, “explains Crandall. “Our Rapid Intervention Team (RIT) was regular line firefighters, and we believe that is inappropriate for us.”

Continuing he adds, “We are looking at way to address how to get a higher level of training for our line firefighters to act as a RIT or back up team should something occur and HR Team members become pinned or trapped,”

There cannot be enough said about training when implementing a team of this caliber. Salt Lake City and County team members are constantly training, accumulating a minimum100 hours a month between the 3 shifts.

“Oddly enough, we were with the Battalion Chief and the rescue team watching trench rescue videos when the call came in,” recalls Crandall. “3days prior to the call we had completed 20 hours of joint training on operations level trench rescue with Salt Lake County,” he adds.

There were only a couple of moments when team members needed to be shuffled around, due to lack of familiarity with a component of the system. “We had common training when it came to trench collapse, placing panels and shooting struts. We did not have common training on the usage of rope systems and patient packaging devices,” explains Crandall.

When talking about technical rescue training, Crandall states, “You need common terms, common training, and common understanding. We believe, in the heavy rescue world, there is no such thing as common sense. Just common training.”