Confined Space Suicide? Case Study
Many years ago I responded, as part of my fire department’s technical rescue team, to a confined space incident. The call was dispatched around noon on a Monday. I was a fire fighter, and one of the Technical Rescue Technicians on the responding crew. Our Fire Department is comprised of both full and paid on call staff and covers a response area of 318 square kilometers. This call was attended to by our full time crews.
The initial response to the incident consisted of a four-person Engine company (their district), a battalion chief and the technical rescue team (consisting of an Engine + Technical Rescue Truck, six more personnel) and the duty Chief. In total we had 12 staff on scene, six of whom were technical rescue qualified.
Upon arrival, the initial information relayed to the crews from onsite staff was that a worker had entered the space in an attempted suicide. The space was a concrete, underground electrical vault approximately 20’ x 25’ with a hatch approx. 4’ x 4’. A permanent ladder provided access and the space had approx. 6’ of head room. There was a concrete dividing wall which essentially created a confined space within the main space. This space was accessed by an opening approximately 4’ x 4’.
As part of the first in Technical Rescue (TR) apparatus, the initial request we had on scene was for documentation on the confined space (hazard assessment, entry procedures, etc). At this point we knew the worker had entered the site (verified by proximity entry card swipe) on Saturday approx. 36 hours prior. When the patient’s co-workers showed up on site for work on Monday, they found the patient’s personal effects on the their desk and a cryptic note alluding to the patient hurting themselves. The co-workers had initiated the 911 response.
Out in the facility yard, there was a hatch to the confined space propped open. When we asked the co-workers who found the note and personal effects about what had occurred to this point, they indicated that one of them put a fan into the hole and made entry into the space. The entrant noticed that the entry points into one of the interior spaces (confined space within a confined space) was covered by a sheet of plywood from the inside and appeared to be caulked or sealed shut. At that point the co-worker then left the space. The co-worker reentered the space with a second worker and a sledge hammer to ‘force’ their way into the interior confined space. When they finally broke thorough, the plywood ‘hatch’ fell inward and partially covered a compressed air cylinder of Nitrogen (to be determined later). From this point they are both unclear about what occurred. One worker indicated they immediately vacated the space. The other worker indicated he could ‘see’ the missing worker 20’ away in the space laying on the ground, meaning he had entered the inner space. He did not say he approached the patient however said the worker was ‘dead’.
Topside, some decisions had to be made and a rift began between responding agencies.
One group of responders took the stand that the worker had been in the space for over 36 hours and with the presence of the Nitrogen cylinder, they assumed a successful suicide attempt. They were of the opinion that it was an unsalvageable situation and therefore until HAZMAT team confirmed the atmosphere was safe, they would standby and consider it a ‘recovery operation’.
The Technical Rescue Team (TRT) took the stand that a subject isn’t ‘unsalvageable and dead’ until they are in the hospital ER, warm and confirmed dead. In the interim the TRT received the nod to get the rescue team dressed and ready to access the space and set up the associated rigging. The entry team of 2 responders dressed in full FR PPE and SCBA (the entrance to space was 4’ x 4’, ladder access and 6’ ceiling as ascertained by blueprints and confirmed the previous workers who entered). In the after action report, a concern about not using SAR and hardline communications was brought up. The TRT felt we had adequate PPE for the operation and that there was no need to set up SAR as the access point was large enough to allow for SCBA.
Law enforcement (LE) arrived on scene and considered it a crime scene. Police insisted on entering to document and collect evidence. Upon discussions however it was determined that neither LE or BCAS (British Columbia Ambulance Service Paramedics) staff are trained in confined space entry which prohibited either agency from entering the space.
It was finally decided to let the confined space rescue team into the space under the auspices that they document by digital camera every angle and item in the space. The entry team was equipped with FD issue radios and after confirming no atmospheric changes (the space had remained clean respirable air since our first monitor went into the space), we sent the team in. The team was told to progress slowly and methodically, then focus on gathering evidence via camera versus rescue. After a few minutes I looked down into the space to find a team member trying to get my attention (the radios had failed to transmit out of the concrete vault). The rescuer indicated that they had a ‘living patient’. This was repeated to all those around the site and the team continued to set rigging in place to extricate our ‘dead’, now ‘live’ patient. The team went from “recovery/evidence gathering mode” to ‘rescue mode”. Once the patient was extricated to the space opening, the patient was attached to a 4:1 mechanical advantage and extricated from the space. The patient was quite disoriented and lethargic and patient care was turned over to the paramedics.
The entry team confirmed that the patient had set up a small bed including foam mattress and 5 gallon bucket as a commode in the space. The patient had several prescription drug wrappers around the bed and a caulking gun. The nitrogen cylinder valve was closed and had not been discharged into the space.
What appeared to have occurred, was the patient had intended to seal themselves into the space, take a high dose of the medication, plug in their iPod earbuds and open the cylinder in order to displace all the oxygen in the space. It appears however that the medications either rendered the patient unable to operate the valve or unconscious.
Lessons learned from this event.
At a rescue event, the trained and equipped Rescue Team needs to be utilized in the planning phase and their expertise considered.
Never assume a recovery vs rescue.