On Sept. 17, 1999, units from the Fairfax County, VA, Fire & Rescue Department were dispatched to fire box 2807 for a report of a person with a “hand caught in a mixer” at a bakery located in the 6100 block of Arlington Boulevard. A language barrier prevented dispatchers from obtaining enough information to determine the size of the mixer, the extent of the entanglement and the severity of the victim’s injury.
Because the first-due engine company was already assigned to a call, an engine company (Engine 410) from the second-due area and the first basic life support unit (Ambulance 428) from the Seven Corners Fire Station responded. Captain Stuart Smith monitored the initial dispatch and called the Public Safety Communication Center for an update on any information received. Dispatchers advised him that they were unable to obtain any more information from the bakery workers. Smith requested a heavy rescue company (Rescue 418) and a paramedic unit (Medic 410) to be dispatched and added himself (EMS404) to the call.
Ambulance 428 was the first-arriving unit and reported that the patient was a 30-year-old woman with what appeared to be traumatic partial amputation of her right arm. The remainder of her forearm and her hand was wrapped two times around the shaft of a large industrial bakery mixer. After hearing this situation report, a battalion chief (BC04) and a truck company (Truck 410) were added to the response. To compound the situation, the mixer’s heating element had heated the product being mixed to 160 degrees Fahrenheit.
Patient Assessment
Coworkers told rescuers the woman was wearing a bracelet while working with the mixer. The bracelet became snagged on the bolt that secures the mixing wand to the driveshaft. The patient’s arm was pulled around the driveshaft/ mixing wand, producing a mid-shaft compound fracture to the right ulna/radius and a de-gloving injury that exposed four inches of bone.
The mixer had been shut off, but it continued to turn, wrapping the rest of the patient’s forearm around the driveshaft two more times. The extremity below the break was gray and cool to the touch. There were no detectable capillary refill or distal pulses. When the patient’s right arm became entangled, she put her left hand down to brace herself – but that hand was immersed in the 160F batter, producing second-degree burns up to the wrist.
Rescue Considerations
After initial assessment, it was obvious that the limb was still attached, but that blood flow to the hand had been compromised. Removing the arm from the shaft quickly was of paramount importance if we were to have a chance of saving the limb.
Locking out the power to the mixer was the initial concern; this was accomplished quickly by disconnecting the electrical cord. The rescue company followed up by cutting power at the panel box and shutting off the gas supply at the valve. The inability to access the bolts that secured the mixing wand to the one-inch octagonal driveshaft was the second obstacle encountered when we started considering our options.
The patient’s forearm soft tissue was wrapped around the bolt assembly twice. A three-inch steel sleeve that houses the driveshaft was located immediately above the shaft and the patient’s arm. The size and composition of the collar precluded cutting the driveshaft there.
The gearing of the transmission in the mixer prevented rescuers from turning the wand and shaft backwards to “unwind” the patient’s arm and the mixer’s proximity to a wall kept them from moving the patient while unwinding her from the mixer. Further complicating the rescue was the tremendous amount of heat being produced by the mixer’s heating element. A coat was laid directly below the patient in an effort to deflect heat from the patient and rescuers.
At this point, 10 minutes into the incident, the patient was reassessed by EMS personnel. An IV line had been established by the paramedic assigned to Engine 410 and had so far maintained the patient’s blood pressure. Pain control was addressed and an order from medical control was obtained for 2-4 mg of morphine. She had been standing all this time with her right arm entangled and with second-degree burns to her left hand. If there was to be any chance of saving the patient’s arm, we would have to find another method of extricating it very soon.
Extrication
We requested assistance from an employee familiar with the operation of the mixer, but again the language barrier barred an exchange of information. Rescuers then examined a similar mixer in the same room in an attempt to figure out the best way to dismantle it. They found that a mechanism on the side of the mixer could be used to raise and lower the driveshaft and mixing wand. This assembly was similar to the mechanism used to raise and lower the chuck in a drill press. In its current position the shaft was in the fully retracted position. Rotating this mechanism clockwise would lower the mixing wand and driveshaft enough to give rescuers access to the shaft and distance the patient’s arm from the work area.
Unfortunately, the turning mechanism was lodged against the victim’s right shoulder by the rotation of the shaft and could not be turned. The rescue company decided to take out the entire assembly by removing a snap-ring keeper on the opposite end of the assembly and pulling it out and away from the patient. This also loosened the collar that covered the driveshaft, which allowed us to access it. The rescuers determined the shaft could be cut with a cordless reciprocating saw and a steel cutting blade. The shaft, the patient’s arm and the mixing wand were secured before any cuts were made.
Including two stops to change blades, the entire cut took just over five minutes to complete. Now, the mixing wand could be turned clockwise by hand and the patient’s arm unwound from the shaft and wand. The entire extrication had taken 45 minutes from the time of dispatch to patient transport. During the entire extrication process, the patient had made not a whimper!
To the surprise of all the rescuers, when the limb was straightened and splinted, the color and capillary refill returned to her hand. On arrival at the trauma center, the patient had movement and feeling in two fingers. After extensive reconstructive surgery, the patient regained use of all of her fingers and with physical therapy was expected to make a full recovery.
Entrapment scenarios always test a department’s personnel and resources. Ensure that adequate equipment and manpower are requested as soon as an accurate situation report can be obtained. Fire and EMS personnel can be overwhelmed by the complexity of such an event. The necessity for them to work and train together closely cannot be overemphasized.
Lessons Learned
- Don’t count on initial dispatch information for an accurate assessment of the situation. Accurate information is difficult to obtain by dispatchers when a language barrier exists.
- Ensure lockout procedures are followed before any action is initiated.
- Use onsite personnel who are familiar with the machinery involved for technical assistance.
- Assure advanced life support measures are initiated before extrication procedures begin.
- Contact medical control early in the incident with a patient situation and assessment. Reassess the patient frequently during the extrication and update medical control.
