Search Operations and Victim Management

Objectives (1 of 4) Discuss the use of search tactics during search and rescue operations. Describe emergency medical response system levels of service. List general hazards that may be present during victim management at a technical rescue event.

Objectives (2 of 4) Describe victim access considerations and procedures. Describe victim stabilization. Identify the need for triage at a technical rescue incident.

Objectives (3 of 4) List common victim injury patterns related to technical rescue events. Describe types of patient packaging devices and their use. Explain the safety procedures for working around helicopters.

Objectives (4 of 4) Describe response planning and incident management requirements related to victim management at a technical rescue event.

Victim Management (1 of 2) Identifying hazards to which a victim may be exposed Accessing victim or victims Performing triage for multiple patients

Victim Management (2 of 2) Assessing and stabilizing patient injuries Interacting with victims Moving and transferring victims requiring technical rescue assistance

Awareness Level Responders Identify the location of rescue victims upon first arrival. Gain access to the victims’ location. Assist more qualified rescuers with patient movement and transfer.

Search Phase (1 of 2) Time during which patients are located Location may be clear or unknown Entrapment makes more complex Can be prolonged and require many resources depending on situation

Search Phase (2 of 2) Search operations involve combination of: Detective work Analysis work Speculation Use of search tools, equipment, tactics

Search Environment Determines Difficulty of search operations Amount of required resources Tactics utilized

Examples of Environments Water Wilderness Structural collapse

Search Tactics Methods depend on type of rescue, drives decisions regarding tools or techniques Reconnaissance to gather information regarding type, size, complexity of situation Witness interviews to obtain information Includes victim’s last known location

Factors That Determine Urgency Time elapsed Victim profile, including experience and available survival equipment Environmental conditions Terrain/hazards History of incidents in area/site

Search Plan Based On Urgency of search Available resources Existing hazards to responders Known information about victim or victims

Define Search Area Search grid: Segmentation: Identifies, prioritizes, documents search area Starts search in specific area Segmentation: Allows for search of large area Establishes specific search area boundaries

Primary and Secondary Searches Primary search: “Hasty” search Deployment of resources to initiate rapid search of area thought to contain survivors Secondary search: Slower, methodical search to ensure no victims overlooked

Search Resources (1 of 2) Determined by type, complexity of problem Might include specialized personnel resources, such as: Incident management personnel Trained or specialized searchers EMS Search dog handlers

Search Resources (2 of 2) Specialized vehicles, such as: Helicopters Off-road vehicles Horses Watercraft Require plan ahead of time

Basic Life Support (BLS) (1 of 2) Medical first responders or EMT-Basics Limited set of emergency medical skills Can perform cardiac defibrillation using AED Cannot administer medications beyond: Assisting patient with prescription medications Administration of IV fluids

Basic Life Support (BLS) (2 of 2) Courtesy of Yellowstone National Park/NPS

Advanced Life Support (ALS) (1 of 3) Extensive training required; greater investment in equipment and personnel training than BLS Operate as extension of physician, using standing orders, protocols, radio direction

Advanced Life Support (ALS) (2 of 3) May require more personnel at emergency Training levels include: EMT-Paramedics EMT-Intermediate includes limited ALS skills

Advanced Life Support (ALS) (3 of 3)

Primary Hazard May be larger event, such as a natural disaster Specific type of technical rescue may be secondary factor or cascade event created by larger event Can create other hazards for rescuers, such as flooding, electrical wires, debris Rescuers may also create hazards at rescue site.

Hazard and Risk Assessment Identifies Hazards rescuers will be exposed to Hazards victims must be protected from Level of personal protection equipment (PPE) required Necessary safety procedures

Hazard and Risk Assessment © Dennis Wetherhold, Jr.

Vehicle Accident Hazards Include Fuel spills Jagged metal, broken glass Uncontrolled traffic flow Unstable vehicles Air bag systems and hydraulic systems Possibly hazardous cargo

Trench Collapse Hazards Include Potential for secondary collapse that may entrap rescuers Atmospheric hazards Exposure to broken utility lines

Confined-Space Hazards Include Exposure to oxygen-deficient, explosive, toxic atmospheres Engulfment potential from flowing products Uncontrolled energy sources Reduced visibility Slippery surfaces

Needs Identified by Hazard and Risk Assessment Special technical rescue protective gear Placing and staffing of protective hose lines for fire hazard Controlling broken utilities or uncontrolled energy sources Obtaining flotation device Additional or specialized resources

Perform Hazard Evaluation Before Initiating Patient Care Critical to rescue Patient care shifts focus away from environmental hazards. Hazards may worsen, especially in dynamic situations. One crew member should be disconnected from patient care, continuously evaluating the environment.

Victim Access (1 of 3) Complexity varies depending on the entrapment type. Type of technical rescue determines difficulty. Victim location precipitated during the search phase. Requires control or reduction of hazards that may affect rescuer

Victim Access (2 of 3) Procedures, access equipment, and access techniques vary widely. Rescuers should continuously look for new hazards. Major goal to secure, stabilize victim and protect from further harm Rescuers must identify escape route prior to entry.

Victim Access (3 of 3) Courtesy of Robert Rhea

Victim Assessment (1 of 2) First priority following assessment Identifies patient injuries and adverse medical conditions Determines resources to extricate, package, transport patients

Victim Assessment (2 of 2) Based on medical protocols established by AHJ and applicable local, state, federal laws: Ensure protection from bloodborne via PPE Adherence to written protocols related to BSI

Victim Stabilization per BLS Establishing and maintaining adequate airway Providing respiratory ventilation to maintain air flow Controlling severe bleeding Maintaining circulatory system Spinal immobilization or shock treatment, if necessary

Triage (1 of 2) Sorts patients based on severity of injuries or medical conditions Essential in mass-casualty incidents where increased number of patients strains resources Review mass-casualty triage process. Follow local medical protocols to determine patients with highest priority.

Triage (2 of 2) © Scott Downs/Dreamstime.com

Common Injury Patterns Rescuers should be familiar with common injury patterns related to specific rescue scenarios. Review injury patterns for: Vehicle accident entrapment Confined-space Trench and structural collapse Wilderness Water

Victim Packaging, Movement, and Transfer (1 of 4) Performed after victim access, assessment, initial treatment Often uses long spine board or similar device Rescuers choose the appropriate packaging device for the environment. Goal is completing process safely, efficiently, limiting further injury

Victim Packaging, Movement, and Transfer (2 of 4) Special equipment may be necessary. Ends with patient transfer, or handing-off patient to EMS responders for transport to medical facility

Victim Packaging, Movement, and Transfer (3 of 4)

Victim Packaging, Movement, and Transfer (4 of 4) Courtesy of Ferno Washington, Inc. Courtesy of Junkin Safety b. c. Courtesy of Ferno Washington, Inc. d. Courtesy of Ferno Washington, Inc. Courtesy of Ferno Washington, Inc. Courtesy of Ferno Washington, Inc.

Resource Requirements Emergency medical services resources: Can be significant, depending on situation and environment Specialized victim packaging and transfer equipment: May need to fit in small, space-limited areas Must allow for proper victim management, stabilization, movement Multiple patients requires multiple patient packaging devices

Transport Vehicle Options (1 of 3) Ambulances Mass-care vehicle, like a medical bus used for numerous patients Commercial or school buses Aircraft for serious injuries

Transport Vehicle Options (2 of 3)

Transport Vehicle Options (3 of 3) Courtesy of the Prince George’s County Fire/EMS Department

Helicopter Usage (1 of 2) Initial reconnaissance and large-area search operations Transport rescue teams over long distances and in isolated areas that are difficult to access by ground Flood and swiftwater rescue Serious medical emergencies

Helicopter Usage (2 of 2) © Fred L. Isom/ShutterStock, Inc.

Helicopter Resources Agency supplying helicopter determines helicopter needed for particular rescue Identify locations and response times of helicopter resources during response planning. Rescue response agencies should have SOGs related to helicopter assistance.

Helicopter Safety and Landing Zone Management (1 of 2) Be aware of hazards directly related to approach, landing, and takeoff. Be aware of procedures for identifying, procuring, and securing landing zones. Be aware of safety guidelines for working around a helicopter.

Helicopter Safety and Landing Zone Management (2 of 2)

Incident Management Requirements Use ICS to achieve strategic objectives. ICS staffing and positions are determined by scope of event. ICS management personnel are responsible for strategic and tactical management.

Response Planning (1 of 2) Perform regular needs assessments to determine vulnerability to various technical rescue events. Identify capability of agency personnel in advance, including level of performance at which agency personnel are trained.

Response Planning (2 of 2) Understand location, capabilities, and response times for regional, state, federal search and rescue teams and medical teams.

Summary (1 of 2) Victim management includes identifying hazards, accessing victims, performing triage, assessing patient injuries, stabilizing victim injuries, interacting with victims, and moving and transferring victims. Resource requirements vary, depending on entrapment problem and number of victims.

Summary (2 of 2) Effective planning incorporates risk assessment, resource assessment, and development of written procedures. Rescuers must understand types of common injury patterns. ICS may be necessary to control the emergency.