While working a trade on Tower 15 (the slowest tower company in a wealthy part of Orlando), our firefighters had an opportunity to put their training to work and truly make a difference in a young lady’s life. The city was extremely busy that night. The engine and rescue company (fire-based transport unit) housed at the same fire station (Engine 15 and Rescue 15) had just gotten toned out for a medical run. Shortly after, we were dispatched to a vehicle crash less than a mile from our firehouse as a single-unit response. This usually signifies that the motor vehicle accident (MVA) is minor. The notes on our computer said, “Vehicle flipped.”
I updated the crew with the information; another set of notes populated with the following: “Entrapped, with flames.” As I raised our dispatch to upgrade the alarm to a full extrication assignment (one engine, one tower, one heavy rescue, one rescue, and one district chief), we could see the smoke and the glow from the vehicle. The alarm was upgraded as we pulled on scene.
We quickly donned our self-contained breathing apparatus (SCBA); there was so much smoke in the area that we had to stop and spot the truck short, a little farther away than we wanted to. We could barely see the vehicle itself and didn’t want to run over any debris or, worse, a potential ejected victim (photo 1).
On arrival, we found a single vehicle rolled over on its roof with heavy damage, leaning against a tree. The car was on fire and we had a visual of one person trapped inside. Since we are a tower company, we do not carry a large amount of water (only 300 gallons) and very rarely stretch lines. Our fireground functions typically consist of vehicle extrication, search and rescue, forcible entry, aerial operations, technical rescue, and so forth, but, in this case, we had no choice. We didn’t have time to wait for a suppression unit (engine company) to arrive, especially since they were dispatched just as we pulled up to the scene and would be delayed. I gave the scene report and advised the District 5 chief (D5) that we would be stretching a line and operating in rapid rescue mode.
In the Orlando (FL) Fire Department, our seat assignments (predetermined tool assignments and job functions based on where you are riding on the apparatus) would typically allow us to start working right away without needing to communicate or come up with a game plan. This practice works great for 99 percent of our calls, but in this specific case we had to deviate from those assignments.
Before exiting the rig, I directed one firefighter to grab the water extinguisher to keep the fire in check while the engineer and a second firefighter stretched the line. I performed a quick 360° survey around the vehicle and could see the victim from the rear window. She was lying supine, wedged in between the roof and the mangled headrest of the backseat. We had an engine compartment fire that was rapidly extending into the passenger area of the crushed upside-down vehicle. A lot of smoke was pushing out from the inside compartment where the victim was entrapped.
We could hear the victim screaming from the partially broken glass of the rear window. She was coughing and begging for help, “Please, get me out,” “Don’t let me die,” “My legs are burning,” “I can’t breathe, please help me.”
In my 18 years of service as a firefighter, I’ve been directly involved in the rescue and removal of four unconscious civilian victims from structure fires. Though hectic and nerve-racking, the tension I felt didn’t come close to what I was experiencing on this car fire. I attribute the increased level of stress to the victim being conscious and talking. Her desperate cries for help added an unbelievable level of mental stress to an already time-sensitive, chaotic situation.
I removed and cleared the rear window with my halligan and made patient contact as smoke and steam were billowing out of the opening. “Is there anyone else in the vehicle?” I asked while assessing the patient’s injuries and damage to the vehicle. “No, please get me out! I can’t breathe! I’m the only one in here!” she frantically screamed.
Plan A, dirty-dragging (i.e., a simple grab and go) her out the rear, wasn’t going to work; the opening was too small and the entrapment too severe. We needed to create space to extract her from the mangled mess.
Since the flames were producing so much smoke, my main concern was protecting her airway. She didn’t have much time. Most civilian fire fatalities result from smoke inhalation, not thermal burns.
At that moment, I decided to take off my face piece and SCBA, cracked the bypass open, then applied my mask to the victim’s face to buy us time while we extricated her under fire conditions. “Keep this mask on your face and try to slow your breathing down. I promise: We will get you out of here,” I told her.
After discharging the water extinguisher and knocking the fire down, one firefighter transitioned to setting up the extrication tools (hydraulic cutters and spreader). The second firefighter applied water from the now-charged 1¾-inch line. We had a hard time putting the fire out, as it kept reigniting because the fuel tank was compromised. We needed foam.
Simultaneously, the engineer and I worked on stabilizing the vehicle with rescue struts and cutting the open trunk out of the way with a cordless reciprocating saw to maximize access to the rear window opening.
The first firefighter had to extend the hydraulic lines of our extrication tools because they were too short to reach the scene. Our tools are on a 75-foot hydraulic reel system with an option for a 30-foot extension bundle.
Plan B was to put the fire out, lift the vehicle with the rescue struts, and perform a roof removal/slide-out (an extrication technique that we’ve done many times and that has worked great for us in the past). But since we were not able to extinguish the fire completely, we had to extend the hydraulic lines, the victim’s SCBA was running low on air, and no other units were yet on scene, it was time for Plan C.
Tower 15 ran out of water as Engine 16 (E16) and D5 arrived on the scene. Because of road construction, debris, and police cars in the way, both E16 and D5 had to park some distance from the scene. E16 stretched their own line and began foam operations while simultaneously establishing their own water supply from a nearby hydrant. D5 established command and requested a patient count, which was given as follows: “T15 to Command, we have one patient, still entrapped.”
The fire was still pushing a lot of smoke toward the victim, so we decided to forgo lifting the vehicle and instead began cutting the C-post with the reciprocating saw until the hydraulic lines for the cutters were extended and in operation. We weren’t going to just sit there and wait. Any progress is better than no progress at all, especially since the SCBA (applied to the victim) was running low on air and we were out of water. A request was made for E16 to bring an additional SCBA from their unit in case the patient ran out of air prior to being extricated.
As the engineer finished cutting one of the C posts, the second firefighter and I pried the roof down with a halligan, creating enough space to break the headrests off the back seat and pull the victim out through the rear window opening. We then dragged her out of harm’s way onto a backboard that was awaiting nearby and transferred care to the E16 paramedic. From our arrival to the victim’s extrication, 11 minutes elapsed, but it felt like an eternity (photos 2-3).
Some would argue that taking my SCBA off and putting it on the patient was a reckless and unsafe “cowboy maneuver.” Unsafe for whom? I believe that it would have been unsafe (for the victim) had I not done so.
We should never second-guess decisions in line with our organization’s mission: “To protect lives and property.” We should be putting the public first. My actions were based on split-second decisions, a reflection of our training. Our profession requires us to make critical decisions in high-risk scenarios. Since we “risk a lot to save a lot,” I stand by my decision of prioritizing the victim and her airway. Otherwise, this rescue would have turned into a recovery. Calculated risk is part of our job, and the public we serve expects it! We would all want our local firefighters to do the same for a member of our family.
Although the outcome was positive, as firefighters, we must always review, critique, analyze, and share our experiences. Many of us are hypercritical of ourselves, but that is what makes us better.
Personal protective equipment (PPE). Wear the appropriate PPE all the time, for every call! Use it for the call dispatched, and prepare for the worst-case scenario. If dispatched for a fire alarm activation, get dressed for a working fire; if it’s an MVA, get dressed for a pin-job (extrication) assignment. If we had just donned a reflective vest instead of our bunker gear prior to leaving the firehouse, we would’ve been not only physically behind the eight ball by wasting time but also psychologically, too. The added mental stressor resulting from seeing and hearing a person trapped under fire screaming for help and having bystanders videotaping and yelling, “Hurry, do something,” would cause you to freeze or, even worse, be “aggressive without intellect,” as my good friend Captain Rob Ramirez always says.
Apparatus. Parking the apparatus short of the smoked-filled scene because of visibility issues required extending the hydraulic lines, ultimately delaying the extrication. Although we made progress with the reciprocating saw and hand tools, a set of battery-operated hydraulic tools would have speeded up the rescue and eliminated timely logistics.
Size-up. When doing a 360o size-up of a vehicle crash, survey the immediate action area and its surroundings. I failed to properly size up the outer circle and missed a patient. The driver had somehow self-extricated and was sitting against a telephone pole approximately 50 feet past the vehicle. Tunnel vision or the pressing situation we had on our hands could account for this; regardless, the other patient was missed initially. Thankfully, his injuries were minor.
Locating the second patient earlier wouldn’t have changed any of our immediate actions but, from a command standpoint, that information was needed to request additional transport units. Use a thermal imaging camera to quickly scan the surrounding area for ejected victims, especially at night or in wooded areas. In the past, we’ve also requested the help of police helicopters to scan the area from the air for victims or bodies.
I had asked the victim trapped in the vehicle fire, “Are you the only one in the vehicle?” to which she replied, “Yes, I am.” I then confirmed, “Are you sure?” She frantically replied, “Yes, yes! Please get me out!”
Had I phrased my question differently, asking, “Were you the only person in the car before the accident?” or “How many others were with you in the car?” perhaps her answer would have clued me in to search further.
Rapid intervention team (RIT) pack. Securing the victim’s airway by giving up my SCBA and mask was a key factor in the success of this rescue. But if the situation presents itself again, we will bring and apply the RIT pack instead. RIT pack pros:
—It provides more air than the SCBA bottle (60 vs. 45 minutes).
—The RIT pack doesn’t have a personal alert safety system (PASS) alarm that sounds off every 20 seconds. An activated PASS alarm interferes with effective communication and increases stress levels on scene.
—I could have kept my SCBA on, which would’ve provided a more efficient and safer platform by protecting my airway and increasing my ability to see.
Fire suppression. If the hoseline isn’t stretched and charged prior to emptying the water extinguisher, you could use a dry chemical or carbon dioxide extinguisher. Once the line is in operation, using a fog pattern placed between the victim and the fire works great for protection, covers lots of surface area, introduces cooler air, and disperses vapors.
With about 600 deaths per year, vehicle fires are second only to family dwelling fires in terms of fire fatalities. They occur more often than we think. Just as with structure fires, expect victims every time, and have a plan. Time matters! Seconds count! Training pays off! The public expects us to put them first. We are obliged to uphold their trust and maximize their chance of survival.
That night, we had a mixed crew. Three firefighters from different truck companies and shifts were staffing Tower 15 and we had a roving district chief. Typically, a hodgepodge crew would throw off the team’s cohesiveness. But, in our case, it didn’t matter because we train to be mission driven rather than skill driven! We train to adapt and overcome stressful situations. The responding crew’s years of service ranged from 10 to 29 years (photo 4).
This call was even more special for us when we found out the next morning that the victim was one of our own, a dispatcher’s stepdaughter, Faith. You never know who you’re going to encounter on a response, so treat everyone as if they were your family.
We visited Faith at the hospital. She said that hearing the words, “We’re going to get you out of here, I promise,” made her feel so much better. The biggest takeaway after talking with her was to treat victims like human beings; they aren’t training mannequins! Talk to them, reassure them, and let them know what is going on and what is going to happen next. Faith will make a full recovery (photo 5).
This response was among the top five most critical calls of my career. There is no finish line—we are constantly learning and growing!
Bassel Ibrahim is an 18-year veteran of the fire service and a lieutenant with the Orlando (FL) Fire Department. He is a Florida Smoke Diver and a Georgia F.L.A.M.E.S. graduate and teaches truck company operations, vent-enter-search, and RIT operations across the country.