Necessity is the Mother of Improvisation
Off-Shore, In-Water Triage
By Mario Vittone
The
Coast Guard’s EMT School in Petaluma California is arguably one of the best
EMT-Basic schools in the world. As
good as they are, they simply cannot prepare their students for everything. There are so many variables in the world of water rescue. Unimaginable
scenarios and obstacles seem to be commonplace for Coast Guard EMT’s, but on
June 16th, Air Station New Orleans based rescue swimmers AST2 Max
Mida and AST3 Matt Thiessen handled a situation so far from anything they were
formally prepared for that their story deserves a retelling and explanation
beyond that of the basic ALCOAST Message Format.
On
that sunny Sunday afternoon Mida and Thiessen responded with, LT Michael
Brandhuber, LT Harper Phillips and AMT3 Alan Campbell as flight members of
Rescue 6522 to a call for help approximately seven miles offshore. The initial report was of a person in the water with back pain, hanging
on to an oilrig and another victim with a broken leg. Given the proximity to land and the obvious difficulty with in-water
spinal immobilization, the Aircraft Commander (Brandhuber) opted to take both
swimmers. As is often the case,
the difference between what you expect and what you get can be enormous.
The
crew arrived on scene to find a partially submerged sport fishing boat, which
had obviously collided with the rig. On
board at the time of impact were twelve people. Five people had been removed
from the water. Seven of the
twelve were injured. Four of them
were still in the water. There
was another EMT along with another boat crew in an RHI (Rigid Hull Inflatable
boat) from Coast Guard Station, Grand Isle. They had retrieved from the water a woman with a compound ankle
fracture who was also suffering from respiratory problems and chest pain as
well as two survivors with shoulder injuries (one broken clavicle and a broken
scapula).
In
the water was a 54 year-old man complaining of a hurt back and “needles
poking his spine”, assisting him was a civilian from another boat. 1 AST2
Mida was lowered into the water, followed by a rescue litter. Mida then began the very delicate and difficult task of immobilizing a
patient in the water.
AST3
Thiessen was lowered from the helo soon after Mida to assist two other victims.
He swam towards them and noticed one of them was in obvious
pain as his leg, fractured at mid femur, swayed back and forth with the
passing swells (find THAT in your protocols.) His upper thigh was swollen.
There was obvious internal bleeding and Thiessen knew that further movement
would aggravate the injury and the bone could tear the femoral artery (in the
top ten for bad things to happen.) Thiessen
knew he had to immobilize that leg fast, but how? The litters were all in use, there were three EMT’s for seven victims
and he was in the water! There
was another victim helping hold the man up (both in lifejackets,) but the
fractures to his face made him a poor choice for an assistant. He had problems of his own.
AST3
Thiessen was well trained, but in-water immobilization of a femur fracture
simply isn’t one of the objectives on the National Registry of EMT’s list
of things to learn. So Thiessen
did the only thing he could do. He improvised. He towed the two victims over to the RHI, had someone from
the boat crew help the victims hold on to the boat and asked for a (get this)
traction splint.
For
you non-EMT’s out there, that is a device used to pull traction on a broken
leg. This particular brand Thiessen had on hand (The Kendrick
Traction Device) looks like a piece of collapsible tent pole with attaching
straps, buckles and Velcro that can intimidate all but the most mechanically
inclined. When you first see one
it looks more like something you just broke, not something you just bought. It comes in about six pieces and comes out of its container like
springs come out of a cheap watch. Putting the thing on a mock patient in the
classroom environment with all the air you care to breath is tricky enough,
this EMT can only imagine the challenge of applying one to a screaming victim
while underwater and the only thing to stabilize the patient against is a
moving boat. But with a deep
breath, Thiessen submerged and went to work.
(Note to EMT’s everywhere: The critically needed ankle strap only looks like it floats.)