Pre-Planning Elevator Rescues, Part 2/2

Elevators are incredibly complex machinery systems, and they are also one of the more common causes of machinery rescue incidents in urban and suburban areas.  One strategy for improving your agency’s response to elevator rescue incidents is to get out and start pre-planning the elevators in your community.  In this post, we are going to finish up discussing some of the information that can be included in an elevator rescue pre-plan.

Type of Elevator System(s)

The two broad categories of elevators are hydraulic (buildings < 6 stories) and traction elevators (buildings > 6 stories).  Within each of these broad categories there are many variations.  It is important for first responders to understand the basic differences and hazards associated with each elevator type.  Knowing the elevator type may also help you locate the elevator machine room.  Which leads us into our next piece of information.

IMG_1021

Location of the Elevator Machine Room(s)

Securing the power to the elevator is one of the most important steps to take when performing an elevator rescue.  Unfortunately, there are still many first responders skipping this step.  Pre-plan the location of the elevator machine rooms in your buildings, so that you can quickly and efficiently secure the power when called upon to perform a rescue in an emergency situation.  Keep in mind, some elevators are being built now as machine room less (MRL) systems.  These elevators may not have a traditional elevator machine room.

Location and Type of Elevator Keys

There are two types of keys first responders should be concerned about: the fire service key and hoistway door key.  The fire service key will allow first responders to recall the elevators to a designated landing (typically the lobby) using the Phase 1 recall.  Some departments will have possession of these keys, while others will have to rely on retrieving them from the facility at the time of the incident.  The other keys first responders should be familiar with are hoistway door keys.  Hoistway door keys allow first responders to open the door leading into the elevator from the floor.

Do you include any other information in your elevator rescue pre-plans?

We include a section discussing elevator types and hazards in our Machinery Rescue Awareness (3 hours) class.  For more in-depth information related to elevator emergencies, check out Dragon Rescue Management, Inc.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC

Pre-Planning Elevator Rescues, Part 1/2

Elevators are incredibly complex machinery systems, and they are also one of the more common causes of machinery rescue incidents in urban and suburban areas.  One strategy for improving your agency’s response to elevator rescue incidents is to get out and start pre-planning the elevators in your community.  In our next two posts, we will talk about some of the different sections you may want to include in your elevator rescue pre-plan.

Elevator Maintenance Company

This is one of the most important pieces of information to pre-plan.  Ideally, removal of occupants from a stalled elevator should be performed by the elevator maintenance company.  Even when an emergency situation exists and first responders must perform the rescue, it is still important to ensure the elevator company has been called.  At the very least, the elevator company will need to make any necessary repairs and place the elevator back in service.

Location of the Elevator(s)

Facilities may have multiple elevators located in different parts of the building.  These different elevators may each serve different floors and/or may even be different types of elevators.  If a 911 caller says that they are experiencing a heart attack in elevator three, do you know where elevator three is in that building?

IMG_4431

The pictures above show elevators 1 – 3 in an office building.  The elevators, mainline disconnects, and car light switches are all labeled accordingly.  However, it is also important to realize that this building has three additional elevators labeled 4 – 6.  Those elevators are on the other end of the building and have their own elevator machine room.  Pre-planning the locations of these elevators can help save time when someone is trapped in the elevator and experiencing a medical emergency.

Next week we will discuss some additional pieces of information that should be included in an elevator rescue pre-plan.

We include a section discussing elevator types and hazards in our Machinery Rescue Awareness (3 hours) class.  For more in-depth information related to elevator emergencies, check out Dragon Rescue Management, Inc.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC

Tips for the Vehicle Rescue Officer

Vehicle rescues are probably the most common type of technical rescue incident we encounter as first responders.  However, we still have to stay on top of our games.  In this blog post, we will discuss some tips and tricks that you can implement as an officer at your next extrication.

763439

Performing a scene size-up is key.  The officer should do a 360 degree walk around the accident scene, if possible.  Identifying and mitigating scene hazards is obviously important, but for the purposes of this post we are going to focus on the rescue size-up.  The rescue size-up focuses on how we are going to safely and efficiently stabilize the vehicle, access, disentangle, and extricate the patient.  It is imperative that the officer mentally begins to develop multiple plans of attack for each of these tasks.

The officer must be willing to receive input from other first responders on-scene, but ultimately the incident will progress the smoothest if there is an officer with strong leadership skills that can make decisions on the tactics employed.  I have been at many vehicle rescue incidents where there seemed to be multiple individuals making decisions, and it always resulted in confusion, frustration, and ultimately a slowed rescue operation.

One of the most important individuals you must receive input from at a vehicle rescue incident is the EMS provider-in-charge.  A lot of times we think that there are only two modes of operation at a rescue scene – rescue and recovery.  However, the reality is that included in that “rescue” mode are several different variables.  Whether the patient is stable or unstable is one of them.  If the EMS provider on-scene tells you the patient is unstable, then it is time to pick up the pace and extricate as quickly as possible.  If they are stable, then you may have time to perform all the disentanglement techniques and create as much space as possible.  The only way you can make the best decisions for the patient is to have strong communications with EMS.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC

Prehospital Treatment of Crush Syndrome

You and your partner are dispatched as the first due responding ALS unit for an industrial rescue. The dispatch notes indicate that one worker is trapped after an accident, but no other workers are injured. You see that you have a heavy rescue, a rescue-engine and ladder company responding with a chief officer. Enroute, you and your partner start discussing how you will approach the extrication and the medical treatments that may be necessary.

The scenario described above falls into the category of low frequency, high impact. Simply stated, they don’t happen all that often, but when they do, they are time and resource intensive. You may only have an annual refresher on technical rescue and the medical treatment of these types of patients. Lastly, with the low frequency of these events, we are not able to refine our skills through repetition on the job. With any technical rescue, the first consideration should be, “Is the scene safe?” You will need to consider what other resources you may need on scene such as a second or third ALS unit for other victims and the rescuers.

2-37Typical High-Pressure Air Bag Kit. Source: IFSTA

Arriving on scene you are directed to a staging area that will allow suitable egress from the incident. You find the victim conscious, alert and oriented with a patent airway. There is a large concrete pipe laying across the patient’s right femur. His chief complaint is leg pain, and he denies any other injuries. You attach your cardiac monitor and see that other than a slightly elevated normal sinus rhythm heart rate, all other vital signs are within normal limits. You establish two large bore IVs and follow your protocol for pain control with analgesia. By now the rescue company has determined that the best way to extricate the victim will be by using air bags to lift the pipe. The patient’s right leg has been pinned by the concrete pipe for 45 minutes. The rescue company say that they are ready to lift and are waiting for you to give the go ahead. Coordinated extrication is key in the removal of any victim, but with crush syndrome it is paramount due to the type of injury.

Crush injuries differ from other types of blunt force trauma. After as little as thirty minutes, the damage to large muscle groups will have a profound effect on your patient. When cells are crushed the cell membrane is compromised, and everything inside the cell is suddenly let out. The inflicting object, in this case a concrete pipe, prevents the spilling out of these harmful contents until it is removed or lifted from the muscle. You will be most concerned about the sudden release of potassium into the patient’s blood stream. Continuous ECG monitoring is key as you will be watching for ECG changes to determine the presence of excess potassium, known as hyperkalemia. The progression of changes during hyperkalemia will go from peaked T waves, to ST depression / prolonged PR intervals and eventually to a wide QRS / V-tach which is life threatening.

IMG_3684Sodium bicarbonate is a key medication used for treating crush syndrome. Calcium chloride and albuterol are other medications used.

We treat hyperkalemia with an array of medicines each carrying out a separate task. The first is by introducing a chemical buffer to offset the impending acidosis. This is achieved by pushing sodium bicarbonate. The timing of this administration is key. It must be done when the object is lifted and the sudden release of potassium hits the bloodstream. Secondly, we want to protect the myocardium which is especially sensitive to potassium by administering calcium chloride. This will precipitate if mixed with sodium bicarbonate, so use your second IV to accomplish this. Lastly, an albuterol treatment can be applied as it will help to drive potassium out of the bloodstream and back into uninjured cells. As soon as the victim is extricated be prepared to open your IV fluids wide open to obtain a systolic blood pressure greater than 100 and to give additional sodium bicarbonate and calcium chloride if ECG changes are observed. The patient should be promptly packaged and transferred to the nearest trauma center.

The key to the successful treatment of crush syndrome involves the coordination of all parties involved. You should not hesitate to call for additional resources such as another ALS unit or for a physician response team that may carry additional medication outside of your ALS protocol. As with any incident, scene safety and communication is key. Let your patient know what you’re doing and when you’ll be doing it. While time is of the essence, don’t rush through the extrication as not coordinating the administration of medication with the rescue company can have life-threatening effects. A rescue like this may be a once-in-a-career event, but your patient will be depending on your expertise to save them.

Author’s note: Always refer to your medical director and local protocols for clinical guidelines in your jurisdiction.

Larry Durland, BSN, RN, PHRN, CFRN, CEN
Instructor
Elder Technical Rescue Services, LLC

Mention this blog post when contacting us to set up a Medical Aspects of Technical Rescue (3 hrs) class for your agency and receive a 10% discount!

Picking Things Up with Cribbing and Air Bags

Heavy lifting drills can be an absolute blast for rescue professionals.  There is something extremely satisfying about lifting an object of considerable weight with the simple press of a button.  However, there is a lot of knowledge, skill, and attention to detail that goes into these evolutions.

photo_may_07__10_07_18_am

Box Cribbing

Do you know how much weight your box cribbing can safely carry?  Typical 4″ x 4″ cribbing made of softwoods (i.e., Douglas Fir) will provide you 6,000 lbs. of carrying capacity per contact point.  That means, when you stack two pieces of cribbing per layer, you have a total of four contact points for 24,000 lbs. of carrying capacity.  The maximum height of a crib stack is relative to the length of the pieces of cribbing, but the recommended maximum height of a crib stack made of 4″ x 4″ cribbing is 4 feet.

It is critical that all layers of the crib stack are aligned perfectly.  The transfer of weight through the crib stack is dependent on all of the connection points being in line.  If one of the layers of the crib stack is off centered, the entire operation can be compromised.  It is also important to maintain at least 4″ of overhang on the edges of the crib stack.  Finally, when lifting with high pressure air bags on top of a crib stack, the top layer of cribbing has to be a solid layer or else inflating the air bags will cause the entire stack to fail.

High Pressure Air Bags

The high pressure air bags pictured here are operated at 118 psi, but you have to be familiar with the correct operating pressure of your bags.  Some newer models operate at higher pressures.  Try to use the biggest air bag you have for your lifting evolutions to ensure you get maximum lift height and capacity.  Remember, as the bag inflates, its lifting capacity decreases due to the bag’s shape becoming rounder.

A maximum of two bags can be stacked (again, this can differ between makes and models), and when that is done the lifting capacity is equal to that of the weakest air bag.  We recommend always stacking two bags if you have the space, even if you don’t think you will need to use both of them.  It slows the whole rescue scene down when you realize one air bag isn’t giving you enough lift height and you have to scramble to add a second bag in after the fact.

Scene Management

It is important to remember that stabilizing and lifting are two different operations.  The priority is stabilizing the object to prevent the load from shifting and making the situation worse.  Then, we can set up our lifting operation.  When we lift, we always follow the object up with our stabilization system.  We refer to this concept as, “lift an inch, crib an inch.”

Assign a supervisor to oversee both the stabilization and lifting operations to ensure they are on the same page and coordinating their efforts.  The supervisor should also give all lifting commands.  A safety officer is also an important position to fill during these evolutions.  Keep the number of personnel near the object during the lifting operation to the bare minimum (typically just those adjusting the stabilization system).  For those who must remain close to the object during the lift, ensure they are wearing appropriate PPE and always have an “exit strategy” should they need to remove themselves from a dangerous situation.

Lastly, you must coordinate the lifting operation with EMS!  Crush syndrome treatment has to begin before the lift and its imperative EMS is ready to provide follow-up treatment as soon as the patient is extricated.  We’ll talk about this more in our next blog post.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC