Man's Grave or Man-hole?

We respond to a call for breathing difficulty to find a lady who is lonely and breathing just fine. She denies having any chest pain shortness of breath, abdominal pain or a head ache. Her vital signs are within normal range. The primary and secondary exam is unremarkable. As the Company Officer I am monitoring radio traffic and hear a call being dispatched in our response district for a man unconscious in a man hole. I advise the paramedics on the ambulance that the engine is going to clear and respond to the next call. They can stay on this scene until they call the hospital and get a release from the emergency room doctor.

My engineer driver and I quickly clear the scene and respond to the call along with another ambulance from the downtown station. We arrive first to find the supervisor pulled the man out of the man hole and he is now on the ground still unconscious. We quickly assess the patient and find he has a pulse and is breathing. He only responds to painful stimuli and the supervisor advises us he was in the man hole using a gas powered saw. The only fresh air he had was supplied through a 1/4 inch air hose from an air compressor on the truck. He further advises us that he (the supervisor) went into the man hole to pull the other worker out. Both individuals are assessed using a sensor that reads blood CO levels through a finger probe. The unconscious patient has readings of 38-40% and the supervisor has readings of 12-18%.Supplemental oxygen is given to both patients with a non-rebreather mask at 15 letters per minute.

We now have two patients, patient A is unconscious and patient B has also been exposed to high levels of CO. As part of the scene survey we get a quick CO reading in the man hole, we stick a small tube into one of the small hole of the man hole cover and get a CO reading of 300-350ppm. A very dangerous place to be working with insufficient fresh air. As discussed in an earlier post, CO binds to the blood hemoglobin and takes the place where O2 molecules normally adhere. This means the blood cannot deliver needed oxygen to cells throughout the body including the critical areas of the brain, heart and lungs.

Patient A starts to regain consciousness but he is combative and uncooperative. After his supervisor explains he will lose his job if he refuses to go to the hospital he reluctantly agrees to go. He and his supervisor are loaded into the ambulance where oxygen therapy is continued and an IV is established for patient A. After arrival in the emergency department the doctor performs a quick assessment and sends patient A for hyperbaric treatment. This will speed the process of releasing the CO from the blood hemoglobin and allow the oxygen its rightful place. A close call that could have ended in a tragedy. A related post.

No Time, Under Where?

2230 hours should be time to wind down the day. A day full of training and business inspections. I'm in the shower and just got soaped up suddenly the strobe on the wall starts flashing and the station tones sound. Its a vehicle rollover on a curvy canyon road. Hurry! Hurry! rinse off as much soap as possible grab the towel and dry off while I'm running to grab my coveralls. No time for the normally essential clothing, zip up the coveralls and quickly pull on some socks over wet feet. Now I'm running to the vehicle where my partner waits. After pulling on my bunker paints, we're en route with very little delay.
The dispatcher's voice comes over the radio and declares there is a patient trapped in a pick up truck and extrication will be needed. We arrive to find the pick up truck with its driver side on the ground. After a quick and careful scene assessment I kneel down to find the driver's arm coming through the door window and moving. I start talking to the the man who declares his side hurts and his arm is pined under the truck. I continue my assessment by asking questions because I can not see the man yet. The ambulance arrives and one of the paramedics takes over patient care as my crew prepares for the extrication.
We quickly develop a plan and start by using stabilizer struts on the underside of the truck which now faces the canyon wall and another set on the top of the vehicle, which faces the river. This will prevent vehicle from falling over onto its top or back onto its wheels while we move the victim to safety, protecting the responders and the patient.
 

The next tool used are air bags specifically designed for lifting heavy objects at emergency scenes.  We stack two of these under the side at the "C" post (back corner) of the truck cab. Here is an example of how these bags work to lift.

 After the vehicle was stabilized one of the medics climbed into the top of the cab through the passenger window to gain access to the patient. This is an important part of helping the patient remain calm and assisted with the extrication from the inside. We slowly lifted the truck and the medics gently slid the the victim out and onto a backboard. The patient's neck was protected with a c-collar while he was strapped to the backboard and then moved onto the cot. On the way to the hospital the medics performed a detailed assessment, started IVs and oxygen treatment. With a mechanism of injury like this, the patient may have fractures in his arms, skull, chest, legs or internal injuries of the chest or abdomen. In this case, the patient was fortunate and only sustained rib fractures and minor head lacerations. A few stitches and some time in the emergency room for observation and he goes home, me, I return to quarters for a rinse and the clothing i didn't have time for earlier.