2Introduction Rescue has many meanings Actions that trained firefighters perform to remove someone from imminent dangerExtricate people if they are already entrappedFirefighters must be aware of existing dangers and minimize the risksConsistent training required to keep up to dateThis chapter only touches the surface
3Hazards Associated with Rescue Operations Hazards associated with every type of rescue operationTunnel vision: focusing on a particular problem without considering alternatives/consequencesRisk/benefit analysis performed each time personnel committed to rescue operationsReassess continually throughout operationEstablish exit points and safe havens
4Safe HavensSafe 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 conditionFirefighter should identify safe havens and employ basic survival techniques that will allow them to escape the situation
5Safe Haven Characteristics Characteristics are basically the same for all emergency incidentsTemporary safe areaAway from the hazardTenable environmentIdentifiable by rescuersAllows for self rescueSafe havens are identified to provide temporary safety during a dangerous situation
6Safety and SurvivalUpon entry of a safe haven, firefighters should employ safety and survival techniquesInitiate MaydayMaintain constant communication with Incident CommanderStay calm and conserve airMaintain constant contact with crew membersPosition yourself away from hazard but next to wall or window to allow rescuers to find
7Safety 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 tappingFirefighters should be prepared to use all of the skills necessary for self survival and rescue7
8Figure 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.
9Search of Burning Structures Two-in/two-out:Work in teams of two or moreTwo firefighters standing by immediately outsidePerform rescue profile before enteringOccupancy type/time of dayFire/smoke conditionsActivity cluesMaintain awareness of position within a buildingTeam members stay togetherLeave a light at the entry point
10Figure 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.
11(A)(B)Figure 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.
12Primary Search Search for both life and fire Conducted prior to fire being controlledOne of the most dangerous activitiesSearch areas most likely to have victimsWhen searching fire floor, go to fire area and search backward toward entry pointAbove the fire floor, work toward fireVisibility often obscured by smoke and darknessPause occasionally to listen for victims
13Secondary Search Conducted when fire is out or under control Much more thorough since no immediate fire dangerSearch through debrisSearch building exterior for victims who have jumped or escaped and are injuredRecommended that different crew perform secondary searchSecondary search must be thoroughMany victims have been missed on search efforts and their bodies discovered after firefighters leave
14Thermal Imaging Cameras and Search Thermal imaging cameras (TICs) aid in search efforts and identifying potential hazardsInfrared energy has three types of emitters:Passive emittersActive emittersDirect source emittersDrawbacks and limitations:Expensive; do not replace basic search techniquesDo not see through glass or water
15Figure 16-11 Infrared energy is not visible but is part of the electromagnetic spectrum. Figure Visual representation on a TIC screen.
16Figure Visualizing convected heat currents on the TIC can help firefighters determine the location and extent of a fire.
17Large Area or Rope-Assisted Team Search Rope anchored to stationary point outside hazardous environmentFirefighters lead out the search lineTeam crawls into the structure following the lineFive to seven firefighters requiredTeam leaderControl/Entry supervisorRemaining firefighters
18Figure 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.
19Figure Firefighters should work from a search rope bag that can be shouldered while controlling the rope as it is deployed from the bag.
20Figure 16-18 Semicircular main line search pattern.
21Rapid Intervention Teams Average of 12 firefighters to remove one downed firefightersAs many as 20 percent become victims themselvesFive goals:Locate firefighterAssess condition and environmentProvide emergency air supplyCall for additional teams and resourcesAttempt to remove firefighter
22Victim Removal, Drags, and Carries Victims removed carefully and expeditiouslyDo not cause any further injuryRescue situations sometimes prevent rescuer from using all the care a person would likeAll carries and drags place additional stress on rescuer’s musculoskeletal systemTighten core muscles around hips, back, torsoKeep spine in neutral positionUse legs and buttocks for leverage and lifting power
23Carries Extremity carry: Seat carry: Conscious and unconscious patientsRequires two rescuersSeat carry:Conscious patients
24Drags Blanket drag Lift and drag Push and pull drag Uses blanket or salvage coverRequires one rescuerLift and dragConditions must allow standing upPush and pull dragWorks well for removing unconscious firefighterRequires two rescuers
25Figure 16-20 Webbing and pre-manufactured slings can be valuable for dragging a victim.
26Ladder RemovalsBringing a victim down a ground ladder requires four to six team membersRescuers on the inside get victim over windowsillExterior team gets victim down safelyCommunication between teams very importantMay present the victim head- or feetfirst, facing toward or away from the rescuerIf rescuer feels loss of control, leaning into ladder will stop the victim from moving
27Backboard, Stretcher, and Litter Uses Preferable to use a backboard, stretcher, or litterDesigned to provide protection, immobilization, safetyBackboards provide spinal immobilizationRescuer at patient’s head maintains traction and directs effortPatient placed on stretcher by extremity carry, utilizing backboard, or having patient lie directlyPatient must be secured as soon as possible
28Extrication from Motor Vehicles Extrication more difficult in larger vehiclesHeavier structural components and crash severityFollow pre-determined sequence of events:Scene assessmentEstablishment of work areasVehicle stabilizationPatient access and stabilizationDisentanglementPatient removalScene stabilization
29Tools and Equipment Firefighter’s most valuable tool is knowledge Power hydraulic toolsHydraulic pump supplies pressure to operate spreaders, cutters, and ramsAir bags can lift heavy loads a considerable distanceAir chisels and reciprocating electric saws have evolved
30Figure 16-21 Gasoline engine-powered hydraulic pump for extrication equipment.
31Figure 16-22 Power hydraulic spreaders. Figure Power hydraulic cutters.
32Figure 16-24 Power hydraulic rams. Figure Power hydraulic combination tool.
33(A)(B)Figure (A) A typical high-pressure air bag set. (B) A typical low-pressure air bag set. (Courtesy of Rick Michalo)
34Figure 16-28 A high-pressure air chisel kit. (Courtesy of Rick Michalo) Figure A battery-powered reciprocating saw.
35Scene Assessment (Size-Up) Predetermined sequence of steps or actionsCarried out by the officerScene safety considerations:TrafficNumber and type of vehicles involvedPotential number and extent of injuriesHazardous conditionsDegree of entrapmentAssessment determines need for additional resources
36Establishment of Work Areas Ideally, all traffic in and around area of vehicle incident should be shut downCongestion creates secondary hazardsTraffic barrierLarge fire apparatus can form initial barrierPark at a slight angleTraffic calming:Warn approaching traffic of upcoming hazardHazards zoning
37Figure 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.
38Vehicle Stabilization Required on all accidentsPut transmission in gear and chocking a wheelCribbing, air bags, ropes, etc.If vehicle has injured person inside, take the weight off the suspension systemCribbingDeflate tiresMore complex situations require more complex tools
39Patient AccessProvide a pathway for the rescuer to evaluate and care for the patientRemove or fold back the roofThrough a window that can be broken or removedOnce access is gained:Patient evaluated; life support activities initiatedPatient’s position evaluatedPatient protected from further injuriesPackaging initiated
40Figure 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)
41Removing Glass Glass used in vehicles is laminated Tempered glass removed by striking with point of a toolPenetrates the passenger compartment if rescuer loses controlSpring-loaded center punch applied to corner of the glass breaks it in more controlled mannerWindshield removal performed with removal of roofSignificant time savings
42DisentanglementRescuer advises the incident commander as to the extent of injuries and mechanical entrapmentBest pathway determinedDisentanglement methods:DisassemblyDistortionDisplacementSeverance
43Patient RemovalWhen pathway created and made as safe as possible packaged patient removedGoal to minimize aggravation of existing injuriesRemoval should be made only with direct supervision of certified EMS responderOften patient removal and movement to ambulance takes rescuers out of work areaSpotters watch for traffic during patient movementEscape routes planned
44Scene StabilizationAfter patient removal, firefighters secure incident sceneHazard assessment continualVehicle recoveryTow operator must be advised of vehicle hazardsFluid/parts cleanupDry absorbent used for oils, engine coolant, diesel fuelGasoline best absorbed with fuel padsUse gloves that can be decontaminated
45Specialized Rescue Situations and Tools Specialized rescue calls are more dangerousMany times rescuer fatalities outnumber initial victims of the accidentElements imperative in specialized rescue:Continual hazard assessment, risk/benefit analysisOperating guidelines and proceduresScene controlIncident management and accountability
46Rope RescueVictim either above or below normal ground level and beyond practical means of rescueVertical or high-angle rescue entails the victim and rescuer relying on rope for supportHazards in addition to falling hazard:Bad or slippery footingFalling objectsHazardous atmosphereEquipment misuseUtilitiesTrip hazards
47Figure Vertical or high angle rescue entails the weight of the victim and rescuer relying solely on rope for support. (Courtesy of James Pelliterri)
48Water Rescue Water rescue is very dangerous for rescuers Methods and procedures:ReachThrowRowGoSwift-water rescue a specialized fieldRescue workers working at an ice rescue should have thermal rescue suits
49Figure 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 A firefighter using the throw method to rescue a victim in the water. Note the PFD and the underhand throwing technique.
50Figure 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 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.
51Structural Collapse Rescue Five stages:Reconnaissance and rescue of surface victimsVoid searchSelected debris removalGeneral debris removalDebriefingThree types of collapse:Pancake collapseLean-to collapseV-type collapse
52Figure 16-47 A pancake collapse Figure A pancake collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.
53Figure 16-48 A lean-to collapse Figure A lean-to collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.
54Figure 16-49 A V-type collapse Figure A V-type collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.54
55Reconnaissance and Rescue of Surface Victims Initial size-up uses a six-sided approachHazards handled in four ways:Avoid hazard areaRemove the hazardShore or support the hazardMonitor the hazard for deteriorationHailing system for victims who can respondBasic knowledge of cribbing, shoring, tunneling
56Trench and Below-Grade Rescue Trench: excavation deeper than it is wideMaximum width 15 feetIn trench collapse:Uncover victims head and chestSupplement respiration with oxygenUse ground pads to distribute weightFissures in soil or sides of trench indicate additional collapseThrow victim a rope in case of secondary collapse
57Figure Rescuers entering a trench must have the necessary training and equipment put into place prior to entry. (Courtesy of James Pelliterri)
58Confined Space Rescue Confined space: Large enough to be entered for workingLimited entry and exit pointsNot designed for continuous occupancyIsolate hazards through lock out/tag out procedureCommon hazard is oxygen-deficient atmosphereHazardous or toxic vaporsSample the atmosphere before entering
59Rescue from Electrical Situations Assume electrical hazards are energizedVictims in contact with electrical wire also energizedNo protective clothing is designed to protect from electrical currentIn vehicle accident, vehicle may be energized and passengers are safe unless they exitGround gradient: tingling sensation in bootsBack away with a shuffle foot motionReel coil: wire will spring away from point at which it was cut
60Industrial Entrapment Rescue Usually a complex processProcedure for vehicle extrication applies with minor changesStabilization of entrapping machinery begins with shutting down the powerRelease stored energy in the machine if this will not cause further movementCrib or block entrapping partWhen possible, operate the machine through rest of its normal cycle, or back out
61Elevator and Escalator Rescue Immediately request the dispatcher to confirm the service company has been calledUnless there is a compelling medical emergency, await arrival of service technicianEscalator usually involve passengers getting caught in landing plate or hand railMost escalators have emergency shutoff switches at bottom landingLanding plate can be removed by removing screwsHandrail loosened by wheel that drives handrail
62Figure Elevator cars may have top emergency access panels, side emergency access panels, or both.
63Farm Equipment RescueRescue of victims injured by farm equipment very challengingEquipment usually must be disassembledEvents located far from paved roadsSpecialized training should be provided to firefightersLocal equipment dealer an excellent source of information
64Lessons LearnedMuch greater variety of real-life rescue situations than covered in this chapterRescue situations are low-frequency eventsHigh risk to firefightersRisk/benefit analysis must be ongoingFirefighter should not be put in hazardous situation to save something already lostStay aware of “big picture” to stay safe and avoid tunnel vision