Chapter 16 Rescue Procedures. Introduction Rescue has many meanings –Actions that trained firefighters perform to remove someone from imminent danger.

Chapter 16

Rescue Procedures

Introduction• Rescue has many meanings

– Actions that trained firefighters perform to remove someone from imminent danger

– Extricate people if they are already entrapped

• Firefighters must be aware of existing dangers and minimize the risks

• Consistent training required to keep up to date

• This chapter only touches the surface

16.2

Hazards Associatedwith Rescue Operations

• Hazards associated with every type of rescue operation– Tunnel vision: focusing on a particular problem

without considering alternatives/consequences– Risk/benefit analysis performed each time

personnel committed to rescue operations• Reassess continually throughout operation• Establish exit points and safe havens

16.3

Safe Havens • Safe havens are areas of refuge that can

be utilized while waiting to be rescued or until you are able to escape the hazardous condition.– Utilized when firefighters can no longer exit in the

same manner in which they entered due to a dangerous condition

• Firefighter should identify safe havens and employ basic survival techniques that will allow them to escape the situation

16.4

Safe Haven Characteristics • Characteristics are basically the same

for all emergency incidents– Temporary safe area– Away from the hazard– Tenable environment– Identifiable by rescuers– Allows for self rescue

• Safe havens are identified to provide temporary safety during a dangerous situation

16.5

Safety and Survival • Upon entry of a safe haven, firefighters

should employ safety and survival techniques– Initiate Mayday– Maintain constant communication with

Incident Commander– Stay calm and conserve air– Maintain constant contact with crew

members – Position yourself away from hazard but next

to wall or window to allow rescuers to find 16.6

Safety and Survival (cont’d.)• Upon entry of a safe haven,

firefighters should employ safety and survival techniques (cont’d.)– Lay horizontal with PASS device

positioned effectively and create audible sounds such as tapping

• Firefighters should be prepared to use all of the skills necessary for self survival and rescue

16.7

16.8

Figure 16-3 Well-equipped interior structural firefighting/search and rescue crews need a minimum of full PPE, SCBA, PASS, forcible entry tool, flashlight, portable radio, and thermal imaging camera.

Search of Burning Structures• Two-in/two-out:

– Work in teams of two or more– Two firefighters standing by immediately outside

• Perform rescue profile before entering– Occupancy type/time of day– Fire/smoke conditions– Activity clues

• Maintain awareness of position within a building– Team members stay together– Leave a light at the entry point

16.9

16.10

Figure 16-4 During an interior search, firefighters should stay in contact with a wall. If visibility is hampered, firefighters can reach into the center of the room using a tool or a “human chain” technique.

16.11

Figure 16-7 Crawling, holding on to one another in a straight line (A) is not very productive when searching. Extending off one another toward the center of an area being searched (B) will allow more area to be covered in a quick manner.

(A)

(B)

Primary Search• Search for both life and fire

– Conducted prior to fire being controlled

• One of the most dangerous activities– Search areas most likely to have victims

• When searching fire floor, go to fire area and search backward toward entry point– Above the fire floor, work toward fire

• Visibility often obscured by smoke and darkness

• Pause occasionally to listen for victims

16.12

Secondary Search• Conducted when fire is out or under control

– Much more thorough since no immediate fire danger

• Search through debris• Search building exterior for victims who

have jumped or escaped and are injured• Recommended that different crew perform

secondary search• Secondary search must be thorough

– Many victims have been missed on search efforts and their bodies discovered after firefighters leave

16.13

Thermal Imaging Camerasand Search

• Thermal imaging cameras (TICs) aid in search efforts and identifying potential hazards

• Infrared energy has three types of emitters:– Passive emitters– Active emitters– Direct source emitters

• Drawbacks and limitations:– Expensive; do not replace basic search

techniques– Do not see through glass or water

16.14

16.15

Figure 16-11 Infrared energy is not visible but is part of the electromagnetic spectrum.

Figure 16-12 Visual representation on a TIC screen.

16.16

Figure 16-13 Visualizing convected heat currents on the TIC can help firefighters determine the location and extent of a fire.

Large Area or Rope-AssistedTeam Search

• Rope anchored to stationary point outside hazardous environment

• Firefighters lead out the search line– Team crawls into the structure following

the line

• Five to seven firefighters required– Team leader– Control/Entry supervisor– Remaining firefighters

16.17

16.18

Figure 16-15 Large area occupancies generally have not only large open spaces but may also incorporate obstructions (shelf units, machines, displays, etc.) at various and random locations within the open spaces.

16.19

Figure 16-17 Firefighters should work from a search rope bag that can be shouldered while controlling the rope as it is deployed from the bag.

16.20

Figure 16-18 Semicircular main line search pattern.

Rapid Intervention Teams• Average of 12 firefighters to remove

one downed firefighters– As many as 20 percent become victims

themselves

• Five goals:– Locate firefighter– Assess condition and environment– Provide emergency air supply– Call for additional teams and resources– Attempt to remove firefighter

16.21

Victim Removal, Drags,and Carries

• Victims removed carefully and expeditiously– Do not cause any further injury

• Rescue situations sometimes prevent rescuer from using all the care a person would like

• All carries and drags place additional stress on rescuer’s musculoskeletal system– Tighten core muscles around hips, back, torso– Keep spine in neutral position– Use legs and buttocks for leverage and lifting

power

16.22

Carries• Extremity carry:

– Conscious and unconscious patients– Requires two rescuers

• Seat carry:– Conscious patients– Requires two rescuers

16.23

Drags• Blanket drag

– Uses blanket or salvage cover– Requires one rescuer

• Lift and drag– Conditions must allow standing up– Requires one rescuer

• Push and pull drag– Works well for removing unconscious

firefighter– Requires two rescuers

16.24

16.25

Figure 16-20 Webbing and pre-manufactured slings can be valuable for dragging a victim.

Ladder Removals• Bringing a victim down a ground ladder

requires four to six team members– Rescuers on the inside get victim over windowsill– Exterior team gets victim down safely

• Communication between teams very important

• May present the victim head- or feetfirst, facing toward or away from the rescuer

• If rescuer feels loss of control, leaning into ladder will stop the victim from moving

16.26

Backboard, Stretcher,and Litter Uses

• Preferable to use a backboard, stretcher, or litter– Designed to provide protection, immobilization,

safety• Backboards provide spinal immobilization

– Rescuer at patient’s head maintains traction and directs effort

• Patient placed on stretcher by extremity carry, utilizing backboard, or having patient lie directly

• Patient must be secured as soon as possible

16.27

Extrication from Motor Vehicles• Extrication more difficult in larger vehicles

– Heavier structural components and crash severity

• Follow pre-determined sequence of events:– Scene assessment– Establishment of work areas– Vehicle stabilization– Patient access and stabilization– Disentanglement– Patient removal– Scene stabilization

16.28

Tools and Equipment• Firefighter’s most valuable tool is

knowledge• Power hydraulic tools

– Hydraulic pump supplies pressure to operate spreaders, cutters, and rams

• Air bags can lift heavy loads a considerable distance

• Air chisels and reciprocating electric saws have evolved

16.29

16.30

Figure 16-21 Gasoline engine-powered hydraulic pump for extrication equipment.

16.31

Figure 16-22 Power hydraulic spreaders.

Figure 16-23 Power hydraulic cutters.

16.32

Figure 16-24 Power hydraulic rams.

Figure 16-25 Power hydraulic combination tool.

16.33

Figure 16-26 (A) A typical high-pressure air bag set. (B) A typical low-pressure air bag set. (Courtesy of Rick Michalo)

(A) (B)

16.34

Figure 16-28 A high-pressure air chisel kit. (Courtesy of Rick Michalo)

Figure 16-29 A battery-powered reciprocating saw.

Scene Assessment (Size-Up)• Predetermined sequence of steps or actions• Carried out by the officer• Scene safety considerations:

– Traffic– Number and type of vehicles involved– Potential number and extent of injuries– Hazardous conditions– Degree of entrapment

• Assessment determines need for additional resources

16.35

Establishment of Work Areas• Ideally, all traffic in and around area of

vehicle incident should be shut down• Congestion creates secondary hazards• Traffic barrier

– Large fire apparatus can form initial barrier• Park at a slight angle

• Traffic calming:– Warn approaching traffic of upcoming hazard

• Hazards zoning

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16.37

Figure 16-30 The first-arriving large fire apparatus should be positioned to create a traffic barrier and work zone. Cones and a spotter/flagger can help re-route traffic.

Vehicle Stabilization• Required on all accidents

– Put transmission in gear and chocking a wheel– Cribbing, air bags, ropes, etc.

• If vehicle has injured person inside, take the weight off the suspension system– Cribbing– Deflate tires

• More complex situations require more complex tools

16.38

Patient Access• Provide a pathway for the rescuer to

evaluate and care for the patient– Remove or fold back the roof– Through a window that can be broken

or removed

• Once access is gained:– Patient evaluated; life support activities

initiated– Patient’s position evaluated– Patient protected from further injuries– Packaging initiated

16.39

16.40

Figure 16-35 Many times access to the patient can be made by removing the rear window. Note that the vehicle is properly cribbed, and the glass edges the patient attendant has to crawl over are covered. (Courtesy of Rick Michalo)

Removing Glass• Glass used in vehicles is laminated • Tempered glass removed by striking with

point of a tool– Penetrates the passenger compartment if rescuer

loses control– Spring-loaded center punch applied to corner of

the glass breaks it in more controlled manner

• Windshield removal performed with removal of roof– Significant time savings

16.41

Disentanglement• Rescuer advises the incident

commander as to the extent of injuries and mechanical entrapment

• Best pathway determined • Disentanglement methods:

– Disassembly– Distortion– Displacement– Severance

16.42

Patient Removal• When pathway created and made as safe

as possible packaged patient removed– Goal to minimize aggravation of existing injuries

• Removal should be made only with direct supervision of certified EMS responder

• Often patient removal and movement to ambulance takes rescuers out of work area – Spotters watch for traffic during patient

movement– Escape routes planned

16.43

Scene Stabilization• After patient removal, firefighters

secure incident scene– Hazard assessment continual

• Vehicle recovery– Tow operator must be advised of vehicle

hazards

• Fluid/parts cleanup– Dry absorbent used for oils, engine

coolant, diesel fuel– Gasoline best absorbed with fuel pads

• Use gloves that can be decontaminated16.44

Specialized RescueSituations and Tools

• Specialized rescue calls are more dangerous– Many times rescuer fatalities outnumber initial

victims of the accident

• Elements imperative in specialized rescue:– Continual hazard assessment, risk/benefit

analysis– Operating guidelines and procedures– Scene control– Incident management and accountability

16.45

Rope Rescue• Victim either above or below normal ground

level and beyond practical means of rescue• Vertical or high-angle rescue entails the

victim and rescuer relying on rope for support

• Hazards in addition to falling hazard:– Bad or slippery footing– Falling objects– Hazardous atmosphere– Equipment misuse– Utilities– Trip hazards

16.46

16.47

Figure 16-39 Vertical or high angle rescue entails the weight of the victim and rescuer relying solely on rope for support. (Courtesy of James Pelliterri)

Water Rescue• Water rescue is very dangerous for

rescuers• Methods and procedures:

– Reach– Throw– Row– Go

• Swift-water rescue a specialized field• Rescue workers working at an ice rescue

should have thermal rescue suits

16.48

16.49

Figure 16-40 A firefighter using the reach method to rescue a victim in the water. Note the PFD and the use of a pole to extend the firefighter’s reach.

Figure 16-41 A firefighter using the throw method to rescue a victim in the water. Note the PFD and the underhand throwing technique.

16.50

Figure 16-42 A firefighter using the row method in a small boat to rescue a victim in the water. Note the extra PFD in the boat for the victim. Do not attempt to lift the victim into a small boat; instead have the victim hold on to the side.

Figure 16-43 A firefighter using the go method to rescue a victim in the water. Note that the firefighter is carrying an extra PFD for the victim.

Structural Collapse Rescue• Five stages:

– Reconnaissance and rescue of surface victims– Void search– Selected debris removal– General debris removal– Debriefing

• Three types of collapse:– Pancake collapse– Lean-to collapse– V-type collapse

16.51

16.52

Figure 16-47 A pancake collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.

16.53

Figure 16-48 A lean-to collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.

16.54

Figure 16-49 A V-type collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.

Reconnaissance and Rescueof Surface Victims

• Initial size-up uses a six-sided approach• Hazards handled in four ways:

– Avoid hazard area– Remove the hazard– Shore or support the hazard– Monitor the hazard for deterioration

• Hailing system for victims who can respond

• Basic knowledge of cribbing, shoring, tunneling

16.55

Trench and Below-GradeRescue

• Trench: excavation deeper than it is wide– Maximum width 15 feet

• In trench collapse:– Uncover victims head and chest– Supplement respiration with oxygen

• Use ground pads to distribute weight• Fissures in soil or sides of trench indicate

additional collapse• Throw victim a rope in case of secondary

collapse16.56

16.57

Figure 16-53 Rescuers entering a trench must have the necessary training and equipment put into place prior to entry. (Courtesy of James Pelliterri)

Confined Space Rescue• Confined space:

– Large enough to be entered for working– Limited entry and exit points– Not designed for continuous occupancy

• Isolate hazards through lock out/tag out procedure

• Common hazard is oxygen-deficient atmosphere– Hazardous or toxic vapors

• Sample the atmosphere before entering

16.58

Rescue from Electrical Situations

• Assume electrical hazards are energized– Victims in contact with electrical wire also

energized

• No protective clothing is designed to protect from electrical current

• In vehicle accident, vehicle may be energized and passengers are safe unless they exit

• Ground gradient: tingling sensation in boots– Back away with a shuffle foot motion

• Reel coil: wire will spring away from point at which it was cut 16.59

Industrial Entrapment Rescue• Usually a complex process

– Procedure for vehicle extrication applies with minor changes

• Stabilization of entrapping machinery begins with shutting down the power– Release stored energy in the machine if this will

not cause further movement– Crib or block entrapping part

• When possible, operate the machine through rest of its normal cycle, or back out

16.60

Elevator and Escalator Rescue• Immediately request the dispatcher to

confirm the service company has been called

• Unless there is a compelling medical emergency, await arrival of service technician

• Escalator usually involve passengers getting caught in landing plate or hand rail

• Most escalators have emergency shutoff switches at bottom landing– Landing plate can be removed by removing

screws– Handrail loosened by wheel that drives handrail

16.61

16.62

Figure 16-60 Elevator cars may have top emergency access panels, side emergency access panels, or both.

Farm Equipment Rescue• Rescue of victims injured by farm

equipment very challenging• Equipment usually must be

disassembled• Events located far from paved roads• Specialized training should be

provided to firefighters• Local equipment dealer an excellent

source of information16.63

Lessons Learned• Much greater variety of real-life rescue

situations than covered in this chapter• Rescue situations are low-frequency events

– High risk to firefighters

• Risk/benefit analysis must be ongoing• Firefighter should not be put in hazardous

situation to save something already lost• Stay aware of “big picture” to stay safe and

avoid tunnel vision

16.64