I am going to take a break from the series I have been writing on rope rescue to discuss operations at the recent collapse of a building under renovation in midtown Manhattan. We will focus on the operations of Rescue Company 1 (R1) as witnessed by me to learn what lessons can be applied to emergency training.

On October 30th I was working the R1 day tour in Manhattan. We had just finished a multi-car accident involving injuries and were returning to quarters when a radio call redirected us to a reported ceiling collapse. Initially designated as a minor incident, the incident was soon upgraded with two victims reported. One was DOA and the other was trapped and in serious condition. Upon arrival we were directed by NYPD to the front of the building. While the company gathered their gear I reported to the chief in charge. The chief confirmed the radio reports and was assigned to extricate the survivor.

Proceeding to the collapse area, I conducted a rapid structural assessment. The collapse had pinned the victim under structural elements as well as several floors of debris, compromising the immediate surrounding area.1 The complex collapse pattern consisted of a V-shaped collapse with multiple structural members forming supported and unsupported lean-tos that together created a funnel with several collapsed floors of debris, much of it loose brick, poured into it.2 The wide part of the funnel started from the upper floors. It narrowed to a point above the center of the victim’s back. The victim lay prone, pinned by debris and structural elements up to the armpits.

The collapse zone and the surrounding area would require a variety of shoring to support ongoing operations. On the positive side, the victim was warm, verbally responsive and had a strong grip. His chief complaint was back pain. Of immediate concern were signs of respiratory distress. I assured him that we would get him out. A rapid initial assessment of the structure and the victim indicated that extrication had to start immediately. It would take extensive tunneling operations involving selected debris removal, shoring and cutting structural members. This would be time consuming with the victim’s condition expected to deteriorate. As manpower and equipment became available, safing operations would have to be done simultaneously with extrication – despite the danger. Lifting debris off the victim’s back and away from his sides was initiated to ease his breathing and allow for a further assessment of the situation. As anticipated, this meant a localized secondary collapse, the first of many that would prove unavoidable. Working with a member of Rescue 1 I began tunneling operations at the upper left side of the victim.

Meanwhile, the R1 chauffeur and another R1 member established control of operations in the street. The chauffeur put in a call for Collapse 1, one of five special units primarily used in support of Rescue 1 with specialized collapse equipment and lumber for shoring. The chauffeur gave C1 directions on optimal placement. He had the ambulance on scene moved, then backed in after C1 was in position. This gave the collapse unit optimal access to the area of operations and allowed the ambulance a clear path of egress. The chauffeur also coordinated setting up the cutting station to fabricate shoring components. It also provided room for the large amount of equipment necessary to begin initial tunneling and extrication.

The two remaining R1 firefighters conducted a quick structural assessment of the surrounding area and reported to the victim’s location. One joined me in the tunneling operation, moving to where he could tunnel into a waist level position on the victim’s right to begin extrication. The other R1 firefighter teamed with another member and began shoring the access to the front of the victim. After initiating these shoring operations, the member then joined extrication operations on the victim’s right. Two parallel operations worked directly on victim removal. These consisted of void expansion, cutting, shoring, selected debris removal and some lifting. I called for the shutdown of utilities. When a rescue medic arrived, one rescuer backed out to provide access. Rescue medics are trained to operate with Special Operations units in rescues. After consulting with me and assessing the victim, the medic started an IV in anticipation of crush injury syndrome, common among collapse victims. When a victim is freed from a collapse, the release of pressure allows potentially lethal toxins built up in the crushed body parts to enter the main circulatory system. The medic also provided oxygen by means of a non-rebreather mask.

A large variety of specialize tools were used during collapse operations. These operations were performed slowly and methodically. I remained positioned within the collapse area where, with minimal movement, I could oversee both parallel operations. In some cases I was able to visually and tactilely follow pieces of the rubble through the debris pile to assess how operations on one side would affect the other.

By this time numerous other special operations units had arrived. Rescue 4 began supporting operations on the victim’s right and Squad 18 the victim’s left. The chief of the rescue battalion, also known as the special operations chief, oversaw work by the special operations units.

An FDNY doctor made his way to the patient. FDNY has doctors trained to operate in situations such as collpses. This doctor had extensive experience with our FEMA USAR team NYTF1. After withdrawing members to provide access I reported on the victim’s condition. I had been able to periodically reestablish contact with him, holding his hand and talking to him to assess his current status. His grip had weakened and grown colder. He was talking a lot less. The victim was still pinned by the left hip portion of his torso, not just a limb. Amputation, discussed as a last resort, would not be viable if his condition continued to deteriorate.

Nearing the final stage, operations continued using a twoprong approach. Multiple stages of simultaneous lifts, together with debris removal and cutting operations, continued. Much of the cutting done now was to place the various lifting equipment. During these operations I remained positioned to supervise and coordinate both operations. Other work stopped during each lift so members could watch and listen for unintended consequences.

As the final lifts were conducted webbing was attached to the victim to maneuver him through the restricted area of egress. When he was clear of entanglements a backboard was called for and the victim was maneuvered out of the rubble. He was then packaged and handed off to the waiting ambulance while members remained at the collapse site to breakdown operations.

The duration of operations until the under control signal was transmitted was three hours and 47 minutes.

The support operations for this rescue were extensive. Squad 288 conducted operations in the basement shoring underneath the collapse. Rescue 3 and Squad 1 operated in a reserve capacity in case a major secondary collapse trapped the operating units. After the primary operations concluded, Rescue 3 and Squad 1 removed the fatality victim who was standing pinned by the head by a single floor joist.

Lessons Learned

Patient Care - In a training environment focusing on specific skills, aspects of patient care can be overlooked. When learning technical skills the patient mannequin is often treated as a load to be moved from point A to point B. In addition to assessing the patient’s condition and providing appropriate physical care, psychological first aid should be applied through communication. This allows the patient’s condition to be monitored during prolonged operations. Incorporate this into training. In a training environment the patient’s initial condition and changes to their condition should be expected to stimulate a specific response. In a confined space scenario the patient’s condition could decide what manner of patient packaging should be applied. In this scenario the patient’s condition combined with a rapid assessment of the structure and the level of entrapment prompted the initial reaction of immediately beginning extraction. The patient’s deteriorating condition led to consideration of amputation as an option for extrication.

Realism – Training is often conducted in a relatively sterile environment. This is the appropriate in a building block approach to learning. But, eventually, variables should be added. One example is in auto extrication. You will see personnel using hydraulic tools to perform extrication techniques on a vehicle that may not be damaged. If the vehicle is damaged the object -- tree, building, another vehicle --that supposedly caused the simulated damage is not included in the scenario. It is simple to remove the door from an undamaged vehicle as compared to removing the same door smashed around a tree trunk. Some of the most notable variables encountered during the aforementioned collapse occurred during shoring and lifting operations. Often when training with various lifting tools -- hand pump spreaders, jacks (strut, pencil, hockey puck, bottle), duck bill spreaders, air bags and clam shell spreaders -- we lift solid objects with little thought as to the full scenario in which this would be required. To simulate a real world application try lifting several floors of loose debris consisting largely of loose bricks using just a bottle jack. I touch on this further in the next section.

Tool Selection – Obviously, we should master the “go to” we depend on daily. However, we should not neglect the tools that are rarely if ever used. When conducting training on obscure tools I have often heard the following -- “I will never use that.” For the majority of the highly specialized gear that is probably correct. But for some critical piece of equipment that statement will be wrong. The problem is nobody knows in advance what equipment is safe to disregard.

The lifting conducted during the October operation involved many unique challenges that required highly specialized, rarely utilized equipment. In many cases the tool had to have an extremely low profile to do the job. Generally, the FDNY tool of choice for a low profile lifting device is the air bag. In this case they were not viable for two reasons. One, air bags would not have been low profile enough to gain a purchase on the material being lifted. And, two, the required footprint to place an air bag was too large to be able to position it and would have made access and egress for the victim difficult. Cutting also posed special challenges such as a large variety of material-- metal, wood, concrete, brick and cable -- all requiring different tools. There is also the need to minimize vibrations, the potential fire hazards produced by tools such as torches, the excessive sparks many saws produce and gas powered tools that produce a toxic atmosphere within a confined area of operations. Three of the FDNY’s main cutting tools were either not an option or were of only limited use. Hydraulic spreaders and cutters often associated with auto extrication were much too big. Also, they twist objects as they cut. The cut off saw in particular is big, gas powered and produces sparks. Reciprocating saws cause excessive vibrations. A small sample of the tools utilized included:

● Shoring

● Lumber

● Struts

● Cribbing

● Cutting Tools

● Mini-Band Saw (Cordless)

● 6 ¼” Circular Saw (Cordless)

● Reciprocating Saw (Cordless)

● Rebar Cutters

● Lifting Tools

● Hydraulic Spreaders (Hand Pumped)

● Numerous Low Profile Hydraulic Jacks i.e. hockey puck

● Strut Jacks

● Duck Bill Spreaders

● Clam Shell Spreaders

● Pencil Jacks

● Bottle Jacks

The operations at this collapse were highly technical and multifaceted, requiring teamwork and cooperation between the members of Rescue 1. Their coordinated efforts were made possible through their extensive and ongoing training.

1 In the Summer 2013 issue I wrote of the five stages of a collapse rescue. In this case since all of the construction personnel were accounted for and a viable victim was previously identified there was no need for Rescue 1 (as the first Special Operations Company on scene) to address several of the steps. 2 In the Spring 2014 issue I wrote of collapse patterns. The victim in this case was exactly where you would expect to find him – at the base of the V.

James Kiesling is a Captain with the Fire Department, City of New York’s Special Operations Command. He holds a bachelor of arts in fire and emergency services from John Jay College of Criminal Justice and an associates degree in occupational studies in fire protection technology from Corning Community College