shotsJ | Hot
Rigs | Live
Issues | Hazmat
| EMS/Rescue |
Arson | Deaths | Across the US | WMD/Terrorism| Media | Site Search | Web Search | Email us
|February 6, 2004
Developing action plans for technical rescue
By Capt. Michael “Mick” Mayers
Hilton Head Island Fire & Rescue
Faced with a technical rescue emergency, the potential incident commander should, after scene size-up and assumption of command, develop an incident action plan. An incident action plan (IAP) should be developed for any emergency you plan to manage, but the complexity of technical rescue is even more deserving of a plan to be developed and implemented.
The first arriving officer needs to establish scene control and exercise command options appropriate for the emergency scene. This officer has an immediate decision to make; either assume or pass command. Just as in any fire or medical incident, the rule is: unless you can take an immediate action that is going to make an immediate positive difference in the scene outcome, the first arriving officer should establish a strong, visible, centralized command. Technical rescue emergencies are often much too complicated to try to manage them "on the move".
Development of an IAP should be consistent with the organization’s standard operating guidelines for technical rescue. The IAP should identify the problems at hand and include strategies for dealing with those problems. Components of a typical action plan might include the following:
Size-up requires a comprehensive site assessment
to determine the hazards at hand. Site preplans lend valuable information
to the decision-making process, but they certainly don’t replace reconnaissance
of the scene. Conditions often change from the time the original
preplan survey was conducted until the time the incident occurred.
Therefore, information gathered in the initial size-up is crucial to the
development of the plan.
So what tactics will you employ to mitigate the incident? Is your team going to perform an entry? Physical or environmental hazards need to be managed prior to entry. Can this situation be handled without entering the hazard exclusion zone? Surface victims or lightly entrapped victims are relatively easy to remove from the area by telling them to get up and move or by assigning some of your “Operations” level personnel to assist them out of the scene. In confined space situations, non-entry retrieval may be the quickest and the easiest way to get the victim out, if they were equipped with a haul line. If entry into a hazard zone is required, determine whether or not you have the equipment needed: i.e.; personal protective equipment, chemical protective clothing, and/or specialized rescue equipment. If your discussion revolves around entering a confined space with Level "A" PPE, have you considered whether the victim is even likely to be a viable patient? Often taken for granted, ventilation is something that can be performed easily from the outside, is good for improving patient viability, and it makes the scene safer.
The core of the IAP addresses the rescue/recovery objectives. Getting down to the task level requires some hard and fast decisions regarding on-scene work assignments, communications procedures, and emergency decontamination of the victim. Set the tone for the incident by establishing your goals- life safety, property conservation, and incident stabilization. What objectives must be accomplished to meet these goals?
Depending upon the incident, the incident
commander must consider the need for decontamination and assign resources
to facilitate that endeavor. Obviously, decontamination will be indicated
by the type of material present or suspected to be present in the space
or surrounding environment. A high percentage of technical rescues
do not require decontamination, but the only way to know that for sure
is to assign resources to monitor the hot zone before and during the entry.
The RIT should be using the same or greater level of respiratory protection and should be wearing the same or greater chemical protective clothing. This team should have also have tools necessary to remove the entrants, including stokes or litters. Safety considerations should be addressed and communicated in the pre-entry briefing. Particularly in technical rescue, some that should be discussed are signs and symptoms of chemical exposure, hypo- and hyperthermia, and stress. Rescuers should be directed to look for this symptomatology in themselves and in other personnel, and know the procedures for emergency evacuation.
In addition to the potential exposure to hazardous atmospheres, technical rescue is stressful. Performing pre-entry monitoring provides the team with the ability to tell if there is a change in the mental or physical status of a team member. Monitoring of vital signs should be established in your protocols and performed prior to entry. Again, this procedure can be outlined ahead of time in a checklist format.
When the Entry Team does exit the Hot Zone, they should undergo post-entry medical monitoring to compare vital signs to baselines. Subsequent rehabilitation of personnel is paramount. Although I haven't seen a study to back it up, a hazardous materials guru once told me that the fire service injures many more people in hazardous materials incidents by way of temperature stress in fully-encapsulated chemical gear than we do by way of chemical exposure. In my experience I would tend to believe him. Although heat stress is not something you tend to associate with many technical rescue incidents, it really depends upon the environment, the duration of exposure, and the protective equipment required for making an entry. Exterior supporting crews also need to be monitored for exposure, especially on particularly hot or cold days.
Although OSHA 1910.146 calls for all confined space rescuers to be trained in first aid, conventional wisdom leads you to believe that they should be at least EMTs in this day and age. Medical providers for the responders should be at least at the level of EMT-Basic, but I recommend that you require Advanced Life Support (Paramedic) provision. Some of the things that affect responders (crush syndrome, electrocution, chemical exposure, etc.) will require more advanced techniques (cardiac monitoring and dysrhythmia management, pharmacological intervention, and advanced airway maneuvers) than an EMT can deliver. Emergency medical care procedures should be established ahead of time. In technical rescues hypothermia, crush syndrome, electrocution, asphyxia, exposure to carbon monoxide or methane, burns, or chemical inhalation can be planned for in advance. Treatment protocols would definitely be indicated. Have the items you need to aggressively manage these on hand.
Finally, the plan should address scene termination. Considerations need to be made for removal of the victim to treatment and transport personnel. Once the victims have been transferred, resources will have to be allocated to secure the scene. You don't want more people entering out of curiosity, or even more importantly, to tamper with evidence. Technical rescue incidents are often workplace related; the occupational safety authority (OSHA) is going to want to investigate the scene. Keep unauthorized people out of the space and plan to turn the scene over to law enforcement if necessary.
As we mentioned at the beginning of the
article, planning is important to the success of the rescue. As has
been said many times before, "People who fail to plan, plan to fail".
Be proactive, take a deep breath and manage the scene like a professional-
don’t let it manage you.