On November 7th, 1996, the department responded to a trench rescue call. What follows is a series of accounts from key players in the incident, who detail their involvement in the dramatic 9-hour rescue of two construction workers trapped in a trench after a boulder the size of a small pick-up truck came crashing down on them.
EMS Magazine would like to thank all of the contributing authors for their involvement in this project.
The first arriving firefighters followed their instincts-they climbed into the hole to free the two men. However, it didn't take long to figure out that we had more work than available manpower. I immediately called for mutual aid to respond, which included a technical rescue team (TRT) and air rescue team to transport the victims. At this point, Margate Fire Rescue's role in the operation changed from extrication to medical treatment and support.
There is a saying that position is everything in life. If this is true, then the location of the incident helped save the lives of these two men. With the arrival of technical rescue teams from both Broward County Fire Rescue and Ft. Lauderdale Fire Rescue, requests for items like plywood, 4 x 4 lumber and shovels were being made. Fortunately, there was a Home Depot within half a mile of the site. This aided us in getting the necessary supplies quickly to the incident scene.
The rescue of the first victim, which took about 3 hours, eventually reached a point where the victim was pinned by one leg. A decision had to be made to lose the leg or lose the victim. Because the nursing home sits directly behind a hospital, we managed to locate an orthopedic surgeon to direct the paramedics if it became necessary to amputate the victim's leg. Fortunately, the leg was freed by a firefighter who hung upside down and chipped away at the rock with an air chisel.
Next we extricated the second victim, who had suffered extensive injuries and was in need of a blood transfusion. Once again, location played an important part. The hospital provided an emergency physician, who directed the paramedics to get a blood sample for testing, matching and administering. One of the paramedics, who was also a registered nurse, gave the patient a blood transfusion.
On arrival at the scene, I reported to incident commander Captain Wohlitka, who had a list of supplies that had been requested by the Technical Rescue Teams while en route to the scene. Joined by a Broward County medic, I went to a Home Depot located half a mile from the scene, grabbed a manager and several store employees, and, in 10 minutes, had a truckload of shoring supplies. The Technical Rescue Teams and our supplies arrived on scene at the same time, so there was no delay in the operation.
The hospital directly adjacent to the call site provided unbelievable support: whole blood, test results, two orthopedic surgeons (in case amputations became necessary), an anesthesiologist, food and drinks, and a management team to provide us with anything that we needed. After the incident, the hospital staff admitted that they had no idea how complicated a rescue like this could be, or how important and effective our command structure was.
This call could have happened in any small town. Training and mutual-aid-type drills make all the difference in preparing for the unknown.
Upon arrival, the TRT met with Margate Fire Rescue incident command to conduct a preliminary size-up of the rescue operation. Rescue considerations included: site conditions, such as soil type, ground water and established dewatering systems; tension cracks upon the lip of the trench; the stability and location of the spoil pile; and compromised, damaged or exposed utilities.
The trench was approximately 40' long by 12' deep. It was a type C soil cave-in with three workers trapped, one of which was a fatality. Margate firefighter/paramedics had gained access to the trench, established ALS care and were working to free the patients. Hazmat personnel were providing atmospheric monitoring in the trench for potential hazards.
The TRT's next priority was to establish scene control by creating a secured 100' radius around the trench and shutting down any equipment or machinery not essential for the operation to prevent further ground vibrations that could lead to a secondary collapse. Ground pads were placed around the trench lip. Ventilation fans were set up to ventilate the trench, and additional dewatering systems were put into operation to supplement the contractor's dewatering system.
At this point, we acquired additional manpower from the City of Ft. Lauderdale's Technical Rescue Team. Both teams started constructing a shoring system using finn-form sheeting with Paratech pneumatic rescue struts to provide stabilization of the trench in case of secondary collapse. This would protect both patients and rescue personnel who were working in the trench. A means of egress was established at both ends of the trench using two ladders placed approximately 30' apart.
Rescue personnel began rotating work periods in the trench. While the TRT Safety Officer evaluated rescue operations, other technical rescue personnel started to access the trapped men working from the safe area of their established shoring system. It became apparent that the victims were not only trapped by soil, but also by a large piece of coral rock, approximately the size of a pickup truck, that had caved in from one side of the trench, pinning the construction workers against the other side.
At this point, water was accumulating in the bottom of the trench. The patients were trapped in a kneeling position, and paramedics started treatment for crush syndrome, as the technical rescue personnel knew they were not yet able to lift the rock off the construction workers to gain access to them.
Our first plan was to place a high-pressure airbag in a small pocket beneath the rock next to the patients on a 4 x 4 wooden cribbing bed and then try to lift the rock in small increments. This proved futile as the airbags just pushed the wooden cribbing bed into the silty sand under the rock. The second plan was to use a hydraulic ram to move the rock upward. This also failed in the same manner as the airbags. The third plan, which proved successful, was to cut away small pieces of the rock that was pinning the patients using a high-pressure air chisel. Working on one patient at a time, due to limited access, the rock was removed.
The first patient was placed in a halfback extrication harness attached to a tag line/haul line and pulled free. He was transferred to a backboard and stokes basket, then removed from the trench to a staging area to be airlifted to a trauma center. The same techniques were used on the second patient, with the extrication accomplished in 30 minutes.
At this point, we were able to locate the fatality. As the operation turned from rescue to recovery, a safety officer removed all rescue personnel from the trench for rehabilitation and debriefing, and a plan for recovering the victim was put into effect.
The recovery operation was conducted at a much slower pace, as the safety of rescue personnel was now our main concern. Due to the victim's location and access difficulties, a water vacuum truck requested from the Utilities Department was used by rescue personnel to remove water, soil and debris from around the victim so they could extract the body.
One of our most difficult decisions in this operation was which patient to save first. Both patients had extensive injuries and diminishing levels of consciousness, and both seemed to be giving up. In addition, there was a language barrier with one patient. Fortunately, a Margate firefighter/paramedic spoke Spanish and was able to communicate with the man, who would only say that he'd lost the feeling in his legs and "just wanted to die." As it turned out, we were successful in saving both patients, but without our specialized equipment and training, I seriously doubt that we could have saved either of the men.
Fire departments should be prepared for this type of operation, as every city, town and community has ongoing trench projects. By identifying resources now and training with them, your department can be better prepared should you be called to a trench rescue operation. Remember, your personnel will only perform in the manner in which they have been trained.
The sector was approximately 20' south of the command post and 200' east of the trench. I issued my first press release within the first 20 minutes of the call, with updates promised every 30 minutes.
As it became apparent that the rescue would not be completed quickly, the television media sent for mobile units in order to go on the air live at 5:00 p.m. I established a parking area for these units and located an area north of the site where the media could store their cameras and sound equipment.
Three television crews and approximately 10 newspaper reporters were present at the scene. Media reps were very respectful of the established perimeters as long as I continued to supply them with new information. I also prevented personnel who were not involved in the rescue from blocking their camera shots.
Three problems occurred during this call. First, heavy helicopter traffic overhead made it difficult for rescue workers to hear each other, so I asked the television reporters to contact their respective air units and have them clear the area.
The second problem occurred when a police officer, acting on orders from his supervisor, began filming the scene from the nursing home roof. The media felt this individual had an unfair vantage point; however, after I explained that the cameraman was a police officer and that I would attempt to provide them with a copy of the tape, they seemed satisfied.
The last challenge occurred during recovery of the fatality. I had to strike a balance between providing the media with the coverage to which they were entitled while continuing to provide proper respect for the victim. A disposable blanket hung from the shoring jacks left a view of the trench but blocked the view of the actual recovery.
We became aware of the call's severity when a second call from the site stated that three workers were trapped in the trench and one was presumed dead. The first paramedics in the trench were Rob Davis, Rob Ruel and I. When the other rescue unit arrived, Todd Kroupa and Adam Sitman joined us. The fatality was pronounced at 4:07 p.m.; the other two victims were trapped chest-deep in the trench and were not doing well. The initial firefighters who had jumped in were using anything they could to dig these men out, including their hands, an army shovel and a pick that was taken off the job site.
The victim we decided to free first was more alert than the other trapped worker, but his legs were entangled with those of the deceased victim under the boulder. Todd Kroupa and I tended to the second victim-a young Hispanic male who did not speak any English. Since I speak Spanish, I was able to communicate with him. His legs were pinned underneath the soil and boulder. Within the first 15 minutes, we realized that additional resources would be needed to handle the scene, so a call was made to the Broward County Technical Rescue Team to assist us in freeing the men.
Medically, the first victim had facial and head injuries, with suspected chest and abdominal trauma, and his left ankle was broken. The second victim was thought to be in more serious condition, due to his diminishing level of consciousness. He had facial and head injuries, along with internal injuries and a possible broken left leg. Since the patients were going to be in the trench for a while, Margate paramedics began ALS procedures. Both patients were given oxygen via high-flow mask and IVs of Ringer's lactate with large bore IVs. Due to the confined area, access to the patients was difficult. While we waited for the trench team to be ready, we attempted to shore the walls of the trench with anything we could find-backboards from our rescue trucks, pieces of plywood from the job site and cribbing of the engine-to prevent further collapse. While rendering aid, a second collapse did occur and paramedic Reul was injured, though not seriously.
Within the first hour of mobilizing the Technical Rescue Team, we had approximately 60 to 70 firefighters working to save these two individuals. To alleviate exhaustion, two teams rotated in the trench every 30 minutes. After three hours, at 6:58 p.m., the first victim was freed. By then, the second victim was a little more alert, due to the ALS care administered by the Margate paramedics. The medical sector officer, Ty Vassil, who was in radio communication with the trauma hospital, asked about giving the second victim whole blood and treating for crushing syndrome, which happens when a part of the body is trapped and immobile with no circulation for long periods of time. The blood in those limbs becomes full of deadly toxins that, when freed, can throw the victim into cardiac arrest. The hospital suggested we hang two units of blood and give him an amp of sodium bicarbonate, which would lower his metabolic acidosis. Paramedics are not allowed to give whole blood in the field, but, as a registered nurse, I was able to hang the blood and infuse the patient with no complications. After one hour of extrication, he was also free.
Both victims were immediately handed over to Margate paramedics to assess and continue ALS procedures. The victims were taken to a landing zone, where a helicopter was standing by to fly them to North Broward Medical Center.
The third victim was freed at approximately 11:21 p.m. and turned over to the medical examiner's office. One of the most difficult aspects of the call involved talking to the family of the deceased and seeing the anguish in their faces.
Upon our arrival at the main entrance of Beverly Manor Nursing Home, I could see the enormous trench, approximately 40' long, 5' wide and 12' deep at its most southern point.
The terrain is best described as a trench with no shoring equipment evident on scene. The north end of the trench was approximately 3' below asphalt level, descending to its most southerly point approximately 12' in depth. Enormous mounds of earth, which had been excavated from the trench by a crane, surrounded the perimeter. The trench floor consisted of coral boulders and white, damp sugar sand, making the bottom terrain very irregular. It was difficult for the rescuers to maintain their balance and not come in contact with the unstable trench walls.
Upon entering the trench, we noticed several construction workers with shovels trying to help unearth their trapped co-workers. I immediately asked the men to stop digging and leave the area. They complied with no hesitation.
Luis Villar went to assist the first victim, while I proceeded to the southerly point of the trench where I encountered victim #2 and victim #3, who was D.O.A.
Our No. 1 priority was safety. Rob Ruel and I worked as a team, along with Luis Villar and Todd Kroupa who comprised the second team that was assisting victim #1. I remember constantly reminding Rob Ruel to watch my back while I attempted to assist and unearth our trapped victim. I could hear the safety officer assigned to both sides of the trench constantly reminding us of the instability of the walls. I personally felt reassured.
Another important factor was the current condition/instability of the walls surrounding us. They looked very uneven and appeared to widen as they descended downward, leaving what looked like cliffs with enormous mounds of earth on them just above us.
I recall victim #2 being very anxious, tired and somewhat short of breath, with anterior injuries. I had to constantly remind him to calm down and not to disturb the integrity of the walls he was pinned up against. The only thing that I could see supporting the walls on the western side of the trench was what appeared to be a 3" water main and another 2" line just below it-probably electrical cable. These two lines were acting as the only brace keeping the integrity of the wall. We had to move fast.
Victim #2 was buried chest-high, with his anterior body pinned against the western wall. He was conscious, alert and oriented x 3. There were obvious anterior facial injuries and what appeared to be a possible depressed orbital fracture. The victim's chief complaint was head pain, as he said, "It feels like my head is going to explode." I continued to dig with my hands until an army shovel I had requested arrived. The sand around the victim was soft, loose and easy to remove. Once I had dug all I could, the victim took the shovel and tried to unearth his lower extremities. I was confident that we could remove him, and I called for some rope to tie around his chest so we could pull him out of the trench. Once the patient was secured with the rope, Rob Ruel and I attempted to pull him upward. His right leg came free at that point, but his left leg was still trapped.
Shortly after, we heard the safety officer tell us that the wall was going to collapse. I immediately cleared myself from where I was digging and heard a wall crash to the floor behind me. I turned around and saw that the southeastern wall had collapsed where Ruel and I had been assisting victim #2. I didn't know it at the time, but Ruel injured one of his ankles when the wall gave way. We returned to pick up where we had left off.
The victim's left foot was pinned beneath a boulder that weighed at least a ton. I continued to dig around the bottom half of the boulder in an attempt to free his left ankle. From where I was digging, I had a difficult time reaching his ankle, so I repositioned myself deeper in the hole where I could reach it better.
Another problem was the deceased victim, who was just to the left of victim #2 and was trapping his left leg. I dug around victim #3, thinking I was freeing victim #2's left leg, when in fact I was digging out the dead man's legs. To explain the position of victim #2's leg, imagine you are standing up. Taking your left hand, grab your left ankle, then slowly raise your leg and rotate your left ankle outward, placing it under your buttocks. Your knee will be somewhat horizontal, parallel to the floor you are standing on. Now, imagine that you have a steel-like crowbar behind your popliteal artery (or posterior knee) with a one-ton boulder resting on your ankle. That's the situation I was facing.
I continued to dig around the victim's left boot, but every time I removed a handful of water and dirt, more would accumulate. I could see water coming in on both sides of the trench as I removed more earth. It was extremely tiring and frustrating.
During my digging efforts, I could hear saws buzzing, people talking, ladders being positioned and hammers hammering. I was then ordered out of the trench to allow a fresh team in. I was ordered to go rehabilitate, rest and replenish lost fluids. About an hour later, I was assigned with Luis Villar to assist Ft. Lauderdale and Broward County Fire Rescue with shoring up the trench.
That day, two lives were saved, thanks to the combined effort of all the resources utilized. I believe I learned more during this 4 1/2-hour rescue than I could ever grasp in a classroom environment. This particular call will always stand out as being one of the most challenging, demanding and hazardous I've ever encountered.
| This article was compiled by Captain Dave Foster, rescue supervisor for Margate Fire Rescue. His EMS career spans 30 years, with his first medical experience in Vietnam as a combat medic. |