Unfamiliarity breeds challenges, especially for rescuers faced with an incident that they haven't seen often enough to know what to do immediately. Training should take care of that problem, but when was the last time you trained to rescue a farmer trapped in agricultural machinery?

The potential difficulties in farm rescue are numerous, but there's one that no amount of training can alleviate: remote locations. Farm rescues can be in fields and wooded areas miles from decent roads and over hard-to-cross creeks. Heavy rains or snowfall can make these remote locations even more inaccessible, severely hindering the delivery of personnel and rescue equipment to the emergency scene. Rescue trucks that can't leave paved areas will be a problem, and fields may be traversable only by four-wheel — drive pickup trucks or tractors. Equipment may even have to be carried into fields or wood lots.

A lack of familiarity with farm machinery is another difficulty. Unlike automobiles, farm machinery is built to last for decades, not years, and this inherent strength can be surprising to rescuers. The heavy-rescue equipment used in automobile extrication is sometimes no match for farm machinery.

This fact forces rescuers to be more resourceful and to rely on tools and techniques that typically aren't used in automobile rescues, such as disassembly with heavy tool sets, heavy metal cutting with high-performance torches and using unfamiliar tools. Rescuers also need to practice extricating mannequins from farm machines, much like they do in automobile extrication practice. Only then will they experience the limitations of their current training, vehicles, equipment and tools.

Preparedness basics

The best predictor of rescuer performance is how they've done during training and on previous rescues. Fire service leaders need to ensure that their personnel, vehicles, equipment and tools are prepared for farm rescues, which can be subject to more obstacles than the typical rescue call.

For example, rescue trucks may not be able to transport personnel and equipment to an off-road farm accident. Rescuers may have to use alternative methods of transport such as four-wheel — drive trucks or even tractor-pulled wagons. Vehicle-mounted features that rescuers rely on, such as a lighting system, also may be unavailable if the vehicle itself can't get to the scene. Likewise, vehicle-mounted electric generators and compressed-air units used to power rescue tools will be unavailable.

A regular program to ensure equipment performance is a must. Rescue equipment in rural areas can sit idle for long periods of time. Batteries weaken, gasoline engine performance falters when fuel ages or spark plugs foul, compressed-gas cylinders leak down, and hydraulic and pneumatic hoses and seals can deteriorate. Any of these problems can lead to equipment failure, which could cause a prolonged extrication and even patient or rescuer injury or death.

Preparation also includes familiarity with the response area. District pre-plan books need to be located in each emergency vehicle to ensure a timely response. Some farmers have numbered their fields or even use Global Positioning System coordinates to manage their farms. These maps and coordinates can be added easily to district pre-plans.

The sooner responding officers can gather information regarding the rescue, the sooner they can formulate and implement a plan while en route. For example, a call for a farmer trapped in a corn-picker should trigger the need for high-pressure air bags to be brought to the scene. A report of a farmer trapped in a silo unloader should activate the nearest high-angle rope team and/or aerial apparatus.

Scene evaluation

The first few minutes of a rescue often set the stage for the entire event. A calm but deliberate scene evaluation, an interview of co-workers or family members, and an assessment of hazards will go a long way toward conducting an effective response.

Most initially arriving officers find it valuable to secure a 360° view of the incident to ensure that important aspects of the rescue are identified. The first-arriving rescue unit must decide whether an offensive or defensive rescue can begin. An offensive approach describes a scene where rescuers can approach the patient with confidence that the risks they are taking are commensurate with the benefits to be gained.

For example, consider an older tractor that has overturned and is very unstable. First-arriving rescuers who lack proper equipment to stabilize the tractor would need to take a more defensive approach in caring for the trapped farmer. Once the tractor is properly stabilized, a more offensive approach can be taken.

Many extrications will benefit from the establishment of inner and outer perimeters. The inner perimeter surrounds the immediate area where hazards can injure unprotected rescuers, and the outer perimeter identifies where bystanders need to keep out to ensure their safety and to protect rescuers from unneeded hazards and distractions.

Those bystanders are most likely family members and co-workers, who may be quite distraught. If possible, command should assign a liaison to keep them abreast of the rescue and collect valuable information on the patient. Co-workers may have witnessed the emergency and be able to relay the events leading up to the incident. They may also know the kinematics involved in the injury.

It's not uncommon for co-workers or family members to have attempted a rescue before the arrival of emergency units. This can cause a dilemma because while these bystanders are understandably charged up, they're unlikely to have rescue or EMS expertise.

However, these eyewitnesses understand the farm machinery better than rescuers ever will, and their expertise should be taken into consideration. They can also help rescuers identify hazards that may not be obvious. For example, the toxic pesticides that caused the farmer to collapse next to the tractor still may be present, or the electric line the farmer contacted still may be energized.

Command post setup

Following the reconnaissance of the incident scene and contact with bystanders, the first-arriving unit needs to call in its radio report, establish a command post and begin following proper incident command practices.

The initial radio report serves an important role by providing the 911 dispatch center and all other rescuers insight into the event. This insight allows for better decisions on how to respond and enables each rescue unit to formulate its own plans. For example, if the responders are aware that the patient is trapped under a tractor, they can think through the steps they'll take on arrival.

The initial report can also set the emotional tone for the entire rescue. A hurried, unclear and panic-filled radio report can heighten the emotional levels of later-arriving responders. On the other hand, a clear and concise report often serves to calm other responders.

The use of the incident command system is important for farm machinery extrications, and its flexibility makes it appropriate for any size incident. A smaller, less-complicated incident means each officer is responsible for more roles, and the reverse holds true.

Soon after the initial rescue unit arrives, a command post must be created in a location appropriate for the incident and staffed by the necessary agency representatives. In an incident involving a farmer trapped in an agricultural machine, for example, the command post likely will be staffed by fire, rescue, EMS and law enforcement representatives. Larger, more encompassing incidents, such as a fire in a storage building, will require additional command post representatives.

In a farm machinery entrapment, the command post sectors could include extrication, medical, safety and staging. If there's a threat of fire, a suppression sector would be needed, and if the incident is especially long or the weather is extreme, a rescuer rehab sector would be needed.

Time-saving tactics

Rescuers must be able to quickly formulate plans to manage the incident. The extrication should follow a plan that has been created for and then communicated to the appropriate rescue sector.

For example, in a power take-off disentanglement, Plan A may be to disassemble the PTO shaft that has entangled the farmer. Plan B may be to cut the PTO shaft on either side of the farmer, and Plan C may be to unwrap the broken extremity from around the shaft.

It's critical that these plans be developed and prepared for. As the disassembly of Plan A is under way, rescuers need to prepare for Plan B by securing and testing the equipment to cut the PTO shaft. Still others may be contacting a medical control physician for advice on unwrapping the broken extremity from the shaft for Plan C. By layering these preparations, much of the delay that comes with a lengthy extrication will be eliminated.

Delays also can be trimmed by requesting additional rescuers to the scene before they're needed. Because the response times to many of these incidents are, by nature, lengthy, requesting outside assistance early is important.

A mutual aid agency or specialized team need not respond directly to the scene. In fact, a staging location away from the scene keeps these team members from getting involved in the rescue prematurely while still negating much of the time delay and giving them an opportunity to prepare. A representative could be brought into the command post to help develop rescue plans and explain the abilities and limitations of the nearby resource.

Safety of rescuers and patients

Rescuer safety is paramount in our business. Ensuring rescuer safety at farm extrications begins before the rescuers arrive and ends once the incident is completed and everyone is back at the station.

There is never a need for a rescuer to drive unsafely. Accidents involving emergency vehicles and volunteers responding in their personal vehicles continue to injure and kill. It's the responsibility of first-arriving rescuers to advise other responders to slow down if the patient's condition warrants.

At the scene, the number of rescuers in the inner perimeter needs to be controlled. For example, if only two rescuers are needed to stabilize an overturned tractor, it's important to keep others out of the inner perimeter. Rescuer freelancing at the scene also must be controlled, and any rescuer inside the inner perimeter needs to be able to retreat quickly.

Rescuers must wear the protective equipment commensurate for the rescue. This protection will differ depending on the extrication being conducted. Interior firefighting gear, if worn properly, can provide a good level of protection against many hazards encountered at farm machinery extrications. Other departments wear flame-retardant jumpsuits or coveralls for extrication work. Heavy gloves, helmets with approved eye and face protection, and steel-toe boots are needed for these rescues.

The safe use of rescue tools is critical. Rescue tools may be called on to perform tasks that extrication tool manufacturers did not envision because most were designed for use in automobile extrications. Some farm machinery is built stronger than the rescue tools responders carry. The stronger the machinery, the stronger the extrication forces that must be applied. These higher forces increase the likelihood of rescue tool failure and slippage, as well as the fracturing of both machinery and/or rescue tool. The failure, slippage or fracturing of metal can be disastrous to a patient, rescuer or bystander.

The threat of a fire or explosion at the scene of an extrication is real. Farm machinery is often covered in combustible dry plant material or flammable petroleum products such as lubricants or fuels. Rescue tools that can produce a spark or flame, such as high-temperature cutting torches, are especially hazardous.

These hazards are even more dangerous to entrapped patients because they can't retreat, don't have protective clothing and already have been injured. They also may suffer from environmental problems like hypo- or hyperthermia. In each case rescuers will need to assess and treat these complicating environmental issues.

Stabilizing the incident is critical to reducing the chance of further injury to the patient. Turning off the machinery, controlling fuel and other fluid leaks, and stabilizing the machinery in place with cribbing are crucial. Rescuers also need to protect the patient by shielding him or her from the hazard with barriers. This shielding can take several different forms. If fire is a threat, then turnout gear may be an appropriate barrier to place over the patient. If power tools are being used, then an EMS backboard will protect the patient from fracturing metal.

Extrication and medical teamwork

Both the extrication and medical sectors of a farm machinery extrication must work in concert. The patient's life and the safety of the rescuers depend on these two sectors working collaboratively. The sector leaders need to be side-by-side near the inner perimeter, directly monitoring the extrication. They need to be close enough to monitor the extrication, but not so close as to be drawn in to provide hands-on work.

The extrication and medical sectors will be formulating and carrying out the series of layered plans required to remove the patient from the machinery. These sectors, along with the safety officer, also will be responsible for the safety of both the patient and all rescuers inside the inner perimeter. The medical sector will be constantly monitoring the patient's condition and advising the extrication sector on the need for a rapid or more controlled extrication.

Because extrications can be lengthy and are often located in hard-to-reach areas, MedEvac services should be considered for unstable trauma patients. Once the patient is extricated, it's common for rescuers to relax and let down their guard by removing protective clothing or demonstrating a less-safe attitude.

However, the hazards that were present prior to the patient's extrication still are present. The threat of fire is still real. The tractor may be just as unstable as when the patient was removed. The removal of rescue tools needs to be as planned as the extrication. Used equipment and tools then must be inspected thoroughly, especially if they were used in a high-force application or an unusual manner.

The remoteness of typical farm rescues, the inherent strength of agricultural machinery and the unfamiliarity that rescuers have with those machines make these extrications challenging. However, if rescuers are prepared with good pre-plans and manage the extrication properly, extrications can be accomplished more quickly and efficiently. An organized incident command structure that accounts for everyone's safety, a layered extrication plan and good knowledge of rescue tools are all required for a successful extrication.

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Ted Halpin is an extension support specialist for Cornell University in Ithaca, N.Y, and the co-founder of the university's FARMEDIC program, which has been training rural fire-rescue personnel in farm emergencies since 1981. Halpin grew up on his family's farm and John Deere dealership and has 24 years of volunteer and career fire, rescue and EMS experience. He holds undergraduate degrees in agriculture and fire protection and a master's degree in public administration. The next FARMEDIC course will be held Oct. 17-19; visit www.farmedic.com for more information.

To stabilize scene, turn off engine and plug fuel leaks

An important step in any extrication is to quickly stabilize the incident. For incidents involving farm machinery, shutting off the engine, controlling fuel and other fluid leaks, and cribbing the machinery in place goes a long way toward reducing the likelihood of further injury to the patient and rescuer.

Most modern farm machinery use diesel engines. Some of these engines, and all gasoline engines, will shut down by simply turning off the ignition key. Many diesel engines, however, require the pulling or pushing of a knob or lever to shut them off. A red-colored knob next to the ignition key is typical on most late-model tractors. These knobs may have the universal fuel shut-off sign of a fuel pump with a circle and slash over it. On older-model diesel tractors, the engine throttle handle may have to move to a certain position to shut the engine off. Rescuers need to familiarize themselves with these fuel shut-off controls.

Fuel leaks may develop when farm machinery turns over. As fuel leaves its tank and flows onto a hot engine or meets sparks created by the extrication, fire is a real threat. A charged attack hose line must be used to protect the patient and rescuers. Large farm tractors can hold up to 100 gallons of fuel, thereby posing a considerable risk. Rapidly controlling a gasoline fuel leak is critical and may be performed using basic hazmat leak devices.

Other liquids can also pose a hazard. Hot engine coolant, transmission or hydraulic fluids can burn the patient and rescuer and make the rescue more difficult. In addition, battery acid may leak and cause obvious caustic injuries to the patient and rescuer. Battery acid also can cause a rescue air bag to fail by its corrosive nature.