Providing Care After a Farming Accident

The call came in around 4 p.m. on September 26 to the Northwestern Joint Fire District, headquartered in Raymond, Ohio about 35 miles northwest of Columbus. A woman’s leg had been impaled in a farming implement accident. 

“As we’re getting into the fall, the farmers are getting their heads – which is what cuts the crop from the product – ready to harvest their crops,” notes Tim Merrick, fire chief for the Northwestern Joint Fire District, located in a rural area of about 6,000 people and covering 116 square miles. 

One experienced multigenerational farmer there had purchased a lifting device at an auction last year to pick up his corn heads and bean heads with his tractor instead of combining and moving them around the farm to work on them.   

“He had never owned or used one before the day of the incident,” says Merrick. “It didn't come with an owner's manual. He's guessing what he's supposed to do.” 

The farmer and his female partner picked up the head to the three points on the tractor. The pins were not put into place to lock the head to the lifting device. 

The farmer made a homemade slam hammer using a 25-pound lifting plate to beat out high spots in the pan where the grain is collected.  

“This is a lot of movement and force to an item not secured,” notes Merrick. “Resting the cutter head on the cement blocks may have caused the head to slip off easier. He basically made a semi-stable lift very unstable, because he took the weight off of it and then was shaking it when he was hammering, trying to get that high spot out of it, and ended up pulling it off of the tractor.”  

It rolled forward about three feet.  

“We assumed when we got there by the way his female partner was sitting in everything that she was working with changing the teeth on the cutter head and she wasn't,” says Merrick. “She was actually in there holding things in place that take this high spot out.  

“He was underneath the head pulling on this thing when it came off and grazed off his back, sliding forward down the concrete blocks. This had the potential to entrap both of them underneath it. It slid off of him, falling forward and dropping on her and impaling her.” 

The farmer – whose phone could not get cell service – located his partner’s phone and called for help. 

The rescue entailed 10 rescue workers in two rescue vehicles and a helicopter – six rescue workers from the Northwestern Joint Fire District and four from the Marysville Division of Fire, including Battalion Chief Jim Strayton, who assisted with coordinating. Merrick was in command. 

“We’re a volunteer part-time base,” notes Merrick. “We have some full-timers who were dispatched with our engine and medic immediately for a farm implement accident and started mutual aid with Marysville.” 

Both rescues used both sets of airbags to lift the head off of the woman.   

“One from the front and one from the back, because it's designed to flex,” says Merrick. “The purpose of an airbag is to fill a void space and lift an object. When that void space continues to exist because it's flexing but it's attached to somebody, you have to have the importance of cribbing as you go, obviously, but we actually had to attack and lift it from both sides at the same time to keep it from flexing so we could get it parallel to pull her off of it. 

“In EMT school, you’re taught that you don't remove an impaled object. We have a 30-foot head that's impaled in this lady's leg. They normally teach us to cut around and leave it in place because we don't want to cause more damage, which is factual. But sometimes you have to do things that you don't want to or that are not normal to benefit somebody.” 

Upon arrival, Lieutenant Barrett climbed into the head to get next to the woman to see what was happening.  

“We realized that the cutter bar had two to three knives in her and at least one guard was inside her leg,” says Merrick.  

The plan of action is to start with the least aggressive approach and end with the most aggressive way to extricate somebody, he adds. 

“We have to assess how stable she is. Do we have time to evaluate and do things in a slow, methodical fashion? Or do we need to move her quickly because she nick her femoral artery and is bleeding out? We don’t have 10 minutes to stabilize to do more than the minimum because she's not going to be alive anyhow.  

“We were fortunate she didn't have any of those life-threatening situations. She was just in a bad situation. We slowed down. We got an IV on her so we could give pain control. We identified it wasn't necessarily a crushing injury because her leg was not underneath the head – it was underneath her. The blocks were supporting some of the weight of the head.” 

Lieutenant Luke Streng from Marysville climbed in on the other side of the woman and started placing bags.  

“We had our firefighters placing bags on the backside, and then coordinated a lift with Lieutenant Barrett,” says Merrick. “Before we started moving the head, we gave her pain control, because obviously it's going to hurt.” 

The six paramedics on the scene discussed the level of pain control within the protocol that would be used. 

Lieutenant Barrett – who ultimately was the one responsible for the patient care – opted to go with a lower dose of Ketamine instead of a medium-level dose for pain control. 

“It was a good call,” notes Merrick. “While it took the pain and the edge off and made her loopy, it didn't make the situation worse by her suddenly being in a catatonic state with a pain med. 

“We waited for the pain meds to take effect and then started lifting the airbags to get the head. They got to elevate it enough to where they could get her leg out from underneath of it. We cut the tines on the head to slide her out of it.” 

She was airlifted to a nearby hospital, treated, and released at about 1 a.m. the next day. 

“This was the best-case scenario for a bad situation, having lots of large muscle tissue damage from the knives and the head going into her, the guard going into her,” says Merrick. “But it never hit an artery and didn't hit a tendon.  

“I grew up working on a dairy farm, so I get it. It’s not the first farming accident we've had as a department. But it's definitely the most successful one we've had.” 

Merrick notes his department has a “great working relationship with all of our mutual aid companies around us. Because we are a rural area, we rely on each other. We’re not like big cities with many hospitals in a five-mile area. We have to be able to be self-sufficient for 15 to 20 minutes.” 

His department works on four boxes of training: frequent occurrence, high hazard; frequent occurrence, low hazard; rarely occurs with high hazard, and rarely occurs with low hazards.  

“Identifying the scenario, it’s bad,” he says of the incident. “We’ve got a rarely occurring situation that has a high potential of injury – not only to the patient but to the crews. Most of the crew didn't grow up working on a farm, so this is a completely foreign object to them that they're trying to work in.” 

Merrick cautions others to not get elevated with anxiety in their actions. 

“Act like a duck,” he says. “A duck looks perfectly smooth on top, but underneath his feet are moving like there's no tomorrow.  

“It’s important to make sure you have your command structure set up and that individual is not afraid to be the bad guy and say, ‘Stop – we need to bring this anxiety level back down to a controlled event.” 

In such a situation as this, Merrick notes that one wants to stay professional, but there’s a lot of ‘angst and anxiety’ when one knows the individual. 

“It’s not just working on some farmer who had a bad day – it’s working on someone you know who's having a bad day,” he adds.   

“You’ve got the farmer who wants to hook a long chain to this thing and lift it because his partner is underneath this device. In their mind, the simplest way is just to get it off of them, not realizing the fact that one of these blades can then rip her femoral artery and kill her. That’s where we have to come in and be professional and methodical in what we do.  

“If there’s one takeaway, it’s about command and control and don't make the situation worse. It can escalate really easily really fast if you don't have a plan.”