A few months ago, I had an opportunity to speak at length with a farm employee who had a harrowing experience last fall. Since reviewing that incident and providing training to rescuers from various agencies, I found that 10 common steps affect the outcome of every rescue incident.
Grain Bin Rescue
He and his employer were working together to “get corn grain to flow better” inside his 30,000 bushel bin. His job was to walk along the inside edge of the bin on top of the grain. This walking pushed the grain down toward the center unloading auger. The corn was a little out of condition and was sticking together. This walking around the inside of the bin was something they had to do on occasion. His employer was outside the bin at the top access door in visual contact with him. Suddenly, a large amount of grain released beneath him and he was quickly entrapped to his waist. His employer immediately ran down to turn off the unloading auger, but by the time he returned to the top of the bin, the employee was shoulder deep in corn. He did manage to keep his arms free and his employer lowered a rope to him with the other end of the rope tied off to the interior ladder of the bin. The employer called 911 and then returned back to the bin. While waiting for help to arrive, he lowered in a four-foot long section of 6”x6” timber that they laid in front of the employee to give him something relatively secure to lean on. He also tried to pull up on the rope that was earlier lowered and was by now wrapped around his armpits, but this proved unsuccessful so now they could only wait.
At one point during the 5 1/2-hour ordeal, the employee counted 25 people inside the bin, attempting to do something. Luckily for this individual, he previously worked in excavating and had taken a training program on crush injuries so he knew enough to keep his toes and feet moving throughout this ordeal. This action was important to keep his blood flowing into his extremities that were being constricted by the pressure of the grain. This could have saved his life.
Rescue Raises Concerns
Aside from the more than five hours of being trapped, some other notable concerns about this rescue effort were:
- About an hour into the incident, two employees from a neighboring grain elevator responded to the scene with grain rescue equipment to offer their assistance, but these individuals were not allowed past the fire-police perimeter.
- The local fire chief and the commander of the regional technical rescue squad spent several minutes debating about who was in charge of this operation.
- At one point, there were six firefighters standing on the platform at the top of the bin before someone with some basic knowledge suggested to the incident commander that the platform was only rated for 600 pounds.
- The farm employer who was with the employee throughout and who had left the bin when rescuers began to arrive was never allowed back to the bin to offer technical advice and much needed practical assistance.
- After five hours of no progress, a sheriff’s deputy demanded that the farmers and agri-business people be allowed to take control of the scene, where the rescue was completed.
Training For Grain Bin Rescues
Unfortunately, this story is not too uncommon. There are many entities offering training programs geared at helping emergency responders be in a better position to respond to and manage grain bin entrapments. The variety of training programs range from a few hours to several days in length.
The question often gets asked, what is the right training for grain bin rescue? This article will try to get at this answer, but I’m sure will raise more thoughts and questions than definite answers. Hopefully it will stimulate a dialogue among interested parties.
I drafted several outlines in preparing for this article all of which I wanted to be sure used the following terms: awareness, operations, technical, competence, teamwork, NFPA and/or ANSI approved, and ending with the thought that you needed to assure any worthwhile training was tested or aligned with some set of consensus standards such as those found in NFPA or the National Board of Fire Service Professional Qualifications (Pro Board). But as I was teaching a basic farm confined space class the other day, it struck me. Any successful rescue has 10 steps that must be achieved and an unsuccessful rescue will lack one or more of these 10 steps. A training program is just a tool to help a rescue crew fulfill the 10 steps. So let’s review these 10 steps and see if doing so can define what an adequate trained rescue unit needs to do.
Step 1: Preparation – This is without question the most important step in rescue. This phase involves understanding the environment you are about to work in or prepare for. In grain bin rescue this involves gaining an understanding of the problem: why do people go into bins? How do people become trapped? What are the hazards to those people that go into bins and what are the hazards to us as rescue people? How many grain storage bins are in my region and how likely will there be an emergency?
Basically, this is a pretty thorough understanding of the environment. I tell responders to open their eyes when they drive around the neighborhood, see what’s out there. Ask yourself if someone’s in that bin, how would you get in and get them out? By raising these questions I would hope and expect that they would do some of their own research for the answers. There are numerous articles related to this subject and any training program out there dealing with grain bin emergencies covers this critical information without a huge investment in time or tuition. Without this basic understanding, none of the following steps will succeed.
A critical part of preparation for a grain bin rescue team is actually practicing rescuing someone from a grain bin under training conditions. This ideally would be done every year so the skills stay fresh. An ancient Chinese proverb says: You tell me and I will hear; you show me, and I will see; you have me do and I will understand. This is so true with training for any rescue incident.
Step 2: Dispatch/response – The best example to use with this is CPR training because so many people have taken a CPR class so they can relate to how this works. A CPR-trained person will begin to recite the CPR steps in their mind when they are summoned to a person that has collapsed. This is pretty instinctive. By the time they arrive on scene to assist, they have rehearsed in their minds the proper steps and in some cases have made other calls for assistance while they were responding. This is only possible because they know CPR, have had training and have practiced doing CPR so they understand how things are supposed to work…they are prepared (Step 1). A well-prepared team member will instinctively know what needs to happen when arriving on scene so they will summon additional help or at least acknowledge the proper resources are also alerted and on their way.
Step 3: Scene size-up and taking charge (Incident Command) – If one action sends the entire task down the drain, this one would be it. Many "first on the scene" people that attempt to "help" are then trapped, injured or even killed because they failed to understand the hazards to themselves or someone did not take charge of the scene to assure all potential hazards are acknowledged and a well thought out plan has been put into place.
In my training I use the term "3 S’s of stabilization": stabilize the scene by identifying and recognizing the hazards to the rescue crew; stabilize the machine, or in this case the grain bin (more in Step 4) and then stabilize the patient (more in Step 7). Unfortunately, this critical step is too often the weakest link on many rescue scenes and is the one step that really cannot be taught (only enhanced) in any training program. A good experienced incident commander will understand the task to be done, realize what resources are needed to achieve that task, get those resources in place and communicate the plan to all involved. Too often, we see incident commanders look at the task to be done, look at the resources he has on the scene (those who showed up that day) and then put them into action. Can you see the difference? You can have the best training in the world, but without that effective leadership, it’s often for naught. Ego plays too big of a role in many rescue scenarios. A good commander will acknowledge his/her team’s weaknesses and request help from people to fill their voids.
Step 4: Hazard recognition and control – The size-up identifies the initial hazards; this step is where actions are employed to control those hazards the team is trained to control. The scene must be made safe to affect a successful rescue. Knowing when the scene is safe to work in is part of the preparation phase, along with past experience. Not every hazard needs to be completely controlled, but they all need to be acknowledged and taken into account with the rescue plan.
Step 5: Support operations – Here’s an important step where a rescue operation can shine or fizzle, and it has everything to do with being properly prepared and pride. There is no rescue squad that can handle every rescue incident. It is perfectly okay for a rescue squad or fire company to arrive on the scene and say: “we don’t do this type of rescue,” but the next thing out of their mouth should be: “but we have requested the services of someone that specializes in this type of rescue.” This statement acknowledges that they made themselves prepared by understanding what needs to happen and pre-planning their response in the event this type of incident happens. Too often, “industry” folks are highly critical of emergency responders for not performing. A well-prepared fire company will be able to manage almost any incident thrown at them, not alone but by teaming up with proper support operations.
Step 6: Access – Gaining access to the victim is obviously important and the ability to do this safely is more important. A well-prepared rescuer will understand the environment inside the bin and will expect that if a person is entrapped or engulfed in grain that a logical reason is because the grain is out of condition, which could result in voids or cavities. With this understanding, rescuers will know how to keep themselves from falling into these “potential voids.” How can one be prepared for this? This will require the discipline to allow no more than two people inside and the comprehension of knowing how to secure those two entrants to a lifeline that will keep them from sinking. The scene that I described above wholeheartedly failed this step. Sure access was made, but 25 people could have been a disaster waiting to happen. This was testament that Steps 1-5 had failed setting up a domino effect that would continue. The time to learn how to enter a bin of potentially out-of-condition grain safely is definitely not the day you have to do your rescue. Being properly prepared means that the “team” has practiced bin entry procedures.
Step 7: Patient assessment and care – It used to be that rescue involved getting the person out of their predicament without much regard to their potential injuries or underlying conditions. Much has been learned over the past decade about “potential” issues and consequences of patient care. This again is all part of the preparation stage – what types of conditions can occur to a person that is trapped in grain for five hours? How can this be evaluated and treated? When should treatment for these potential conditions be performed? All important questions that will really dictate how quickly or slowly actions should proceed to remove this victim. Once the victim is free, the rescuers must evaluate how this victim will be allowed to exit the bin. This is important to a successful “rescue.”
Training courses from years ago did not cover this topic and perhaps some don’t today, so how does one prepare to handle this issue? This is all part of continuing education – which is in that big step #1. How did we learn this stuff? We learned it by having some of our patients who were alert and oriented when we started our actions end up dead within minutes of our “rescue” actions. If we allowed ourselves to have an open mind and “understand” why this happened, this understanding made us better prepared for future incidents. Luckily for the victim in the above case, he had received training on crushing injuries from his previous employer in the excavating industry and he kept his blood circulating to his entrapped lower extremities by constantly wiggling his toes. This prevented blood from pooling in his lower extremities that could have led to serious consequences, possibly death. An important resource on this scene needs to be a person who understands how to assess and treat for some pretty significant medical conditions and these treatments may need to take place before you free this person.
Step 8: Disentanglement – Once it has been anticipated what might be going on with the trapped person and any immediate care issues have been addressed, procedures need to progress to get the victim free. This can be extremely complicated if dealing with stored energy such as machinery entanglement or a person caught under an unstable load such as a tractor. Freeing (disentangling) a person entrapped in grain does not have to be a complicated or lengthy process, but will require some tools. If the rescue crew understands the concept of flowing grain and the forces that are in play to keep that person entrapped, disentanglement activities are really the easiest step to employ in this life cycle. In our example above, had two entrants who understood how to employ a coffer dam around the victim, the disentanglement phase of that incident could have been completed in minutes versus hours. What might this have taken to be possible; two entrants who have practiced this skill by entering a bin with grain in it, while being tied off or secured with a managed lifeline.
Step 9: Extrication – Extrication means moving the person from the bad place to a good place. This needs to be done without causing any further harm to the person. In some situations, once a person is freed from the grain (disentangled) they will want to walk out under their own power and sometimes, this could be a fine strategy. However, there is at least one critical medical condition that might result from a lengthy entrapment that would make this a very grave decision. If rescuers need to secure the person to a basket or other device and raise that person to the top of the bin, then to outside the bin, then lower that person to the ground, that crew must be proficient in knots and rigging. Getting a person free is one thing, getting them to the ground is a totally different set of skills. If a rescue crew has the discipline to follow this life cycle, the crew to accomplish this task would have been called for during Step 5 for support operations and would be on scene by the time they are ready to do this. See how this can work to your benefit? Good for the person trapped and makes you look good at the same time!
Step 10: Termination – All too often, this step is neglected. After all, the rescue is over, everyone has done their jobs and there’s nothing you can do about that past. But this step is critical. You need to get all the equipment back in service so it’s ready for another emergency. And you need to spend some time to debrief or I like the term, “hot wash.” Review every step that was done, every action that was accomplished. What went right? What was good? What was not so good? Were you trained to do what you found that you needed to do? If not, can you find a qualified trainer to help you fill those gaps? Or do you know other people who have the training you now realize you need? Can they be employed to be part of your team for these kinds of events? If you pay attention to this step, haven’t you just made yourself better prepared for the next one? That’s why I like to show these steps in a circle…because the rescue evolution is a cycle.
It’s really not possible to define the perfect training program. To be prepared for any rescue; that rescue team must understand and practice the 10 steps above regularly on whatever cause their team is about. A team that pulls together for grain bin rescue should practice a grain bin rescue at different facilities at least annually if that same group of people work together on other matters throughout the year. If multiple agencies are forming teams, I think it makes sense to get together more frequently. Only a few of the steps above involve technical complicated skill learning. Many have to do with working together and effective leadership. That stuff can’t be taught well in a training program, it needs to be nurtured and grown over time…the more it’s practiced the better it becomes.
