Necessity is the Mother of Improvisation

Off-Shore, In-Water Triage

By Mario Vittone  

 

 

The Coast Guardís 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 EMTís, 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 ďneedles poking his spineĒ, 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 EMTís 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 isnít one of the objectives on the National Registry of EMTís 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-EMTís 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 EMTís everywhere:  The critically needed ankle strap only looks like it floats.)

Thiessen realized it didnít when it was 10 feet below him. After a very brief argument with himself about weather or not he could fabricate a new one given his environment and resources, he gave chase and finally caught the rogue at 20 feet.)

Ö. Retrieving the ankle strap, Thiessen darted for the surface, completely ignored the looks of ďhow did you get way over thereĒ from the boat crews, swam back to the patient and got back to work.  He got the leg immobilized (under ten minutes, thanks) and the boat crew lifted the patient on board. 

While all this is going on, Mida was swimming circles, loading his patient into the litter. When he finished the task his patient was hoisted to the 6522. Mida opted to stay behind and assist with the other victims and the crew agreed and departed scene. Many EMTís reading this will shout ďabandonmentĒ but this was a smart call given the severity of the other injuries and the proximity (15 min flight) to the nearest hospital. Mida knew his patient was secure, alert and oriented with no immediate life threatening injuries, there were six other patients for the other two EMTís,  Thiessen was busy with one and the other EMT was focused on the patient with respiratory problems. Mida had to stay to help with the other four patients. These are just the kind of tough decisions you have to make when working in the marine environment. 

The rest of the mission went like you would expect when victims outnumber resources. Thiessen got to a place where he could pull traction on that leg (you didnít think that was going to happen underwater too, did you?), some patients were transported to the recently arrived Sheriffs boat, other were transferred to a Coast Guard 41í and they all began the 30 minute transport to Port Fouchon where local ambulance crews had established a triage station. The 6522 had developed problems and was unable to return to the scene but managed to make it to Port Fouchon to pick up Mida and Thiessen.

Their innovation and level headedness during this one puts them on my own personal list of EMTís I would most want to come get me.

Bravo Zulu to AST2 Mida and AST3 Thiessen for keeping their head about them when most wouldnít have.

 

AST2 Mario Vittone is a Helicopter Rescue Swimmer and the unofficial storyteller of the New Orleans survival shop.

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