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 considerations: site assessment, including review of any existing permits
• Resource organization and accountability (IMS)
• Control issues: perimeters and control zones, hazard evaluation and control (including energy control), and a comprehensive risk/benefit analysis that evaluates the viability of the victim
• Equipment needed: personal protective equipment, chemical protective clothing, specialized rescue equipment
• Rescue/recovery objectives: on-scene work assignments, communications procedures, emergency decontamination procedures for the victim
• Decontamination procedures for rescuers
• On-scene safety and health procedures, including personnel health monitoring, on-scene rehabilitation, emergency medical care procedures, and the designation of a safety officer
• Scene termination procedures

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.
 

Allocated resources must be organized and accounted for using an incident management system.  As the incident commander, you need to know what resources are allocated and determine whether these resources will be sufficient to mitigate the situation.  A properly utilized incident management system will also help the IC maintain an appropriate span of control and will aid in locating units operating on the scene.  Control zones must be identified and issues of defining the zones addressed.  The primary hazard isolation zone, known as the “Hot” Zone, should at least incorporate the area where the hazard is immediately dangerous to life or health, plus some.  The “Warm” Zone is where operations will be conducted.  The “Cold” Zone is where your command post and the civilians will be located.  Everyone else should be outside of those defined areas.  A more thorough hazard evaluation must follow that and after that, a comprehensive risk/benefit analysis evaluating victim viability is required.  The only pressing reason that a team should be considering an entry under any circumstance is to rescue a viable victim.  In the case of a body recovery, all efforts should be directed toward mitigating hazards prior to entry; injuring or killing rescue personnel during a recovery is completely unacceptable.

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. 
 

One of the most necessary parts of the action plan is the requirement to consider the safety and health of everyone on the scene, especially of responders.  Incident commanders should consider the use of pre-established checklists to avoid missing any critical safety issues.  The assignment of a safety officer to look over those issues will help the incident commander to insure that identified hazards are evaluated and that accountability procedures are in place.  The action plan needs to address the establishment of a rapid intervention team (RIT) to back up the entry team.  The safety officer is responsible, if assigned, to develop a plan for that crew in case they should have to go into service to assist the entrants.

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.
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Capt. Michael “Mick” Mayers has served the resort community of Hilton Head Island, South Carolina as a firefighter and paramedic since 1982. His career began as a volunteer with Bridgeport (PA) Fire Company #1 in 1980. Capt. Mayers is the US&R/Heavy Rescue Advisor for Hilton Head Island (SC) Fire and Rescue Department and the Deputy Director of the South Carolina Emergency Response Task Force (SC-TF1) Urban Search and Rescue Program.  He is the Secretary of NFPA 1006, Professional Qualifications for Rescue Technicians and serves as an adjunct instructor and rescue curriculum committee member for the South Carolina Fire Academy.  Capt. Mayers holds a degree in Fire Science Technology from Savannah Technical Institute and holds professional certifications as a fire officer and instructor, as well as EMACS Hazardous Materials Technician and National Registry Paramedic certifications.  Hilton Head Island Fire & Rescue serves the second largest barrier island on the Atlantic Coast, a world-renowned golf, tennis, and beach community with over 35,000 permanent residents and over 2,500,000 visitors a year. The 137 employees of the Fire/Rescue Department cover 54 square miles (including 13 miles of beachfront) with seven engine/medic companies, one truck/technical rescue company, and a Battalion Chief. The department in 2002 handled over 6,000 calls for service.  Capt. Mayers is a native of Montgomery County, PA and lives on Hilton Head Island with his wife, Kathleen, and daughter Emma. He is a fourth generation firefighter; his father is the current fire marshal for Towamencin Township, PA  and his brother is a career fire officer in Anne Arundel County, MD. His articles on technical rescue and special operations can be found on the e-magazines Firehouse.com, WithTheCommand.com, and SCONFIRE.com.