Monday, August 4, 2014

Dumpster Diving

She has one more task left before she leaves work for a long weekend, and heads out to the dumpster to drop off a load of cardboard. As she tosses it in, she happens to glance down and sees a body half-buried in the cardboard at the bottom. Justifiably, she panics and runs back inside to call 911.

We arrive just behind the fire department and see several police officers leaning over the edge of the dumpster, laughing as they talk to somebody at the bottom. Pretty good clue that the guy's alive, most likely very drunk. When I peer over, that is exactly what I find. The round dumpster sticks out of the ground about 3 feet, but extends about 15 feet straight down. There is a half-naked (always the bottom half for some reason) man lying in the bottom on about 5 feet of cardboard and he slurs his name in response to my first question. Too drunk to stand and trapped by the perfectly vertical dumpster walls, he is relying on us to get him out. I just hope he's not injured so we can just help him up a ladder.

The FD lowers a ladder and a firefighter climbs down, asking him the questions I yell down. "Do you have any pain anywhere?", "All over.", "Any pain in your head, neck or back?", he winces and screams in pain as the firefighter palpates his neck and down his back. "Ow! That hurts!". Wonderful. Now I know I'm going down there, as this half-naked, drunk, incontinent man has to be immobilized, then lifted 10+ feet out of his cardboard prison.

Fortunately I rock-climb and have no issues with stuff like that, so after requesting a boost from the nearest firefighter (I think he was the Captain - oops), I swing onto the ladder and climb down carefully, as the base shifts on the mound of boxes beneath me. Once I land, my first priority is to clear out enough of the cardboard so we can work, and we begin to pass it up the the guys above us. Once I can actually see my patient, I begin a preliminary assessment of his vital signs as the fireman valiantly puts on his urine-soaked shorts. I establish that he has no life-threatening injuries, and we begin discussing how we're going to manage this extrication.

We decide (OK, I decide) that we will first strap him into the KED, a short spine board type immobilization device, then lower down the Stokes basket to get him out of the hole. Easier said than done, as the cardboard beneath him keeps shifting, the KED gets caught as we try to slip it underneath him, and there is barely enough room to work with the 3 of us down there. Let's just say we all got very cosy with one another. At least only one of us smelled!

Now that the KED is on, it becomes clear that it was actually the easy part of the extrication. We move him enough to allow the basket to be lowered down behind him, and it rests on a 45-degree angle. The next step is for the two of us - with barely enough room to stand shoulder to shoulder and an unstable base - is to lift 200 lbs of dead weight to shoulder height, hold him there with one arm, and strap him in with the other. Oh, all while maintaining c-spine immobilization. The firefighters from above lower down a strap that we slip under his arms and around his back in order for them to take some of his weight off us, and we manage to get him strapped into the basket. This is the reason I work out - and even being as strong as I am, it is the hardest I have ever worked on the job.

They pull up the basket and we give each other a sweaty high-five, ecstatic that we actually did it. Both of us are hot, filthy and soaked to the skin, but it feels great to have worked that hard and to have succeeded. The ladder gets lowered back down and I climb up to the top, getting off the dumpster by climbing down the nearest firefighter, and take back over patient care.