In my almost 20 years in fire and EMS, I've always been amazed by the places people put their hands. The following call happened during a patch of cold and snowy weather.
The West Webster (NY) Fire Department, which provides fire, rescue and basic EMS transport, was called for a 24-year-old male with his hand trapped in a snowplow. Even my eldest son knew that dispatch couldn't be accurate, and he guessed the person actually had their hand trapped in a snow blower. Though he is only 11, he guessed right.
I live about as far away from this scene as possible in my district, and as it was cold and snowing, it took me a short while to get to the call. On my arrival, I found our rescue and one of our pumpers were on scene, with the ambulance close behind me. A paramedic from North East Quadrant Advanced Life Support was also just arriving. As I walked up, I saw a snow blower in the middle of a driveway. A man knelt in front of it, his right arm through the discharge chute and his right hand in the barrel. He was being attended by fire and EMS personnel.
The patient had tried to clear the discharge chute and, with a knit glove on, got his hand in too deep. The impellers moved, and he found the three middle fingers of his right hand trapped between the steel impeller blade and the housing, which is a very thick, sturdy steel cylinder.
The patient was alert and oriented, covered in a blanket, kneeling on his left knee. His left hand was trying to feel the tips of his right fingers. His right hand was through the discharge chute, which was attached to the top of the impeller housing by a steel ring at the bottom of the chute. This resulted in him having to hold his right hand up at a very awkward angle, with about 5 pounds of steel hanging on it. Our firefighters had turned off the device and disconnected the spark plug cable. They had also disconnected the discharge chute from the machine so we could get better access to the patient's hand. The patient was in some pain when we tried to move the hand, but had good feeling everyplace except the tip of his index finger.
As it was about 15°F outside with a steady wind and snow falling, it was important to get this patient out of this mess as quickly as possible. While he initially had feeling in two of the three trapped fingers, it was not clear how long that would last. Also, there was no bleeding, so there was concern that if we took too long, the patient's fingertips could become unsalvageable. On top of that, with the cold temperature and steady wind, the risk of the patient becoming hypothermic was very real.
This is where good communication between fire, BLS and ALS is critical, as many things had to happen simultaneously to resolve this call positively. We are fortunate to have fire and BLS ambulance in one organization, and our ALS service works closely with our fire department, enabling open, clear communication and good understanding of everyone's roles.
First, we needed to secure the machine and ensure the impeller blades would not advance as the obstructions were removed. It is hard to say with certainty if there is still tension on the shaft until you allow the shaft to spin, and in this case that could have cut off the patient's fingers, or possibly even mine, as I was trying to assess the patient's hand and pull his fingers loose when the time was right. This stabilization was done with some cribbing.
Next we needed to figure out how to gain access to the impeller blades. These blades do not spin backward, but even if they could, the patient's fingers were wedged between the outside edge of the impeller and the steel barrel, so any movement could result in amputation. In this case we would have to find a way to stretch the steel cylinder of the discharge chute into an ellipse, enabling the fingers to be pulled out over top of the impeller blades.