Volunteer Fire Brigade Training Module 5 rescue and emergency medical operations

RESCUE AND EMERGENCY MEDICAL OPERATIONS

Fire Brigade Mandatory Training – Version 1.0 August 2012 Training Course provided by the Pre-Fire Planning, Training and Community Relations Section (PFPT-CRS), Zamboanga City Fire District (ZCFD), Bureau of Fire Protection – 9 (BFP-9) Page 1 of 32

MODULE 5


Trainee Guide



Introduction Welcome, in this module we will discuss about the principles in search and rescue and basic life support. Knowing the different basic principles in search and rescue and giving the necessary life support techniques will enable a responder to save lives of victims successfully.

Purpose: The purpose of this module is to provide you basic information on the fundamental in search and rescue and basic life support.

Scope: This module has two main subjects with a six-hour and a two-hour duration respectively; basic rescue and emergency medical operations.

Objectives: By the end of this module, you will:

1. Know about the basic search and rescue principle. 2. Practice rescue methods and techniques. 3. Know and practice ropes and knots techniques. 4. Know how to give basic life support.

Conditions: The instructions you receive in this module is intended for fire brigade members, both old and new ones, with the assumption that you already have knowledge about fire suppression and control. Instructions will take place in a classroom environment. Pictures, slideshows and actual rescue and medical emergency equipment and/or demonstrations will be used when necessary and upon availability.



Basic Search and Rescue Principle Tactical Considerations

Phase I : Assessment on arrival

Phase II : Pre-rescue operations

Phase III : Rescue operations

Phase IV : Termination

Phase I: Assessment on Arrival

Primary Assessment

Secondary Assessment

Primary Assessment

Information Gathering

The ff. questions must be answered:

Have all occupants been accounted for?

How many victims are there?

Is their exact location known?

Are they injured or merely trapped/stranded?

Are they conscious, and if so, can they communicate?

Decision making

Answers to these questions help the rescuer make the critical decision.

Can the units on scene or en route handle the situation?

Do additional units need to be called?

If more resources are needed they must be requested immediately to get them on scene ASAP.



Secondary Assessment

Involves some reconnaissance of the scene or detailed information about the type of elevation differences involved, its physical characteristics, and the problems to be anticipated.

Types of Elevation Differences

The type of elevation differences involve can indicate some of the problems that must be dealt with.

HAZMAT

High voltage power lines

Toxic atmosphere in below grade spaces

Steep slopes, poor footing, sheer cliffs

Increase the number for ambulances for MCI

The number of trained personnel and how much and what type of specialized equipment will be needed to handle the situation safely and efficiently

Hazards Assessments

Downed power lines

Leaking/spilled HAZMAT

Potential for fire spread or explosions

Lack of adequate anchor points, loose debris, of rock that may fall, sharp edges and abrasive surfaces

Mode of Operation

Finally, all of the info gathered will confirm the nature and extent of the rescue problem and will allow the IC to make an important decision whether it is a rescue operation or retrieval operation.

Phase II : Pre-rescue Operation

Should last for a few minutes and all the necessary things to make the rescue operation as safe as possible must be done.

Finalize the incident action plan



Gathering the necessary resources

Monitoring and managing the atmosphere

Making the scene safe for the rescuers to work in

Ensuring an adequate communication capability

Incident Action Plan

Need not be in writing for simple rescue operations but must be in writing for larger and complex rescue operations

Construction of Plan A and Plan B

Change the plan as situation significantly changes

In extreme cases, plan of operations to rescue rescuers should be ready also

Gathering Resources

If there are too few rescue personnel or if the personnel are insufficiently trained to perform as needed, the best equipment in the world will not get the job done and vice versa.

If the IC is initially unsure about the type and or amount of equipment that will actually be needed, he or she should call for everything that might be needed.

Personnel

Depending upon the nature and extent of rescue problem, the number of rescue personnel needed varies. However, even the rescue of one victim from the top of a water tower can involve at least ten rescuers with safety officers, IC, and support personnel excluding EMS personnel.

Equipment

The amount and types of equipment needed also vary with the nature and extent of the rescue problem.

Rescue unit

Aerial unit

Engine company

Command vehicle



Ambulance

During complex incidents, we may need specialized units such as:

• Lighting units • Air units • Communication units • HAZMAT unit • Confined space unit

Preparing the Scene

Lighting – during night rescue operation

Mitigating hazards – identifying primary and secondary hazards

Fire protection – charged hose lines

Shoring – additional support for secondary collapse

Communication

• Voice communication • Hardwired phones • Portable radios • Lifeline

o 1 tug – Ok o 2 tugs – Advance o 3 tugs – Take up (eliminate slack) o 4 tugs – Help

Rescue Team Composition

• Team Leader • Rescue Squad • Break tender (belayer) • Back team • Hauling team



Phase III : Rescue Operation

The phase of the operation obviously involves rescuers entering a relatively uncontrolled environment and that necessitates the use of a personnel accounting system. May involve searching treating and packaging the victims prior to moving them to safety.

Personnel Accountability System

1. Minimum accountability Only one of two rescuers work in hot zone with only names, time of entry, and exit are recorded with constant visual and verbal contact of the team leader and without the use of breathing apparatus.

2. Maximum accountability More than two rescuers work with use of the breathing apparatus or when they must work out of sight of the team leader. The names, time of entry and exit of each rescuer as well as the gauge readings are recorded.

Reaching the Victim

In order to assist a trapped victim to safety, one or more rescuers must first reach the victim. This may be the most difficult and time consuming part of the operation. Victims are most certainly injured or unconscious, or both, thus putting them in a situation to be rescued. Rescuers need to bring trauma kit, spine boards, stretchers, etc. with them.

Search Patterns

Search in pairs

Exit from same place entered

Enter and exit in the same direction if you are to continue the search. eg. Enter right, exit right

Enter and exit in opposite direction if you are to abort the search. eg. Enter right, exit left

Mark rooms searched with chalk marks, markers etc.

Guide right or guide left

Thoroughly search all areas, including behind furniture and inside closets and bathrooms.



Entry Precautions

1. Always approach the scene as if it is dangerous. 2. Only authorized personnel are allowed to operate or enter the scene. 3. Observe the correct procedures needed for the rescue operation. 4. Rope rescue should only be done as a last resort where other means cannot. 5. Proper PPE must be donned for full-bodied protection. 6. Cordon the area. 7. Conduct risks assessment before commencement to determine the;

a. Hazards involved b. Emergency and rescue procedures required.

Safe Work Procedures

• Rescuers to standby • Maintain communication with all teams making entry • All entry personnel shall don safety harness and safety lines • Ensure no one smoke in the vicinity of the confined area • Ensure proper insulation and isolation of electrical wires and appliances to prevent possible

electrocution or fires occurring • Remember to undertake precautions for hot works like standing by water hose line or other

extinguishers

Emergency Response Precautions

Don’t rush in

Don’t try alone

Call back-up

Have standby team ready to assist

Rescue tools must be in working order, inspect and maintain them regularly, and counter check before use

Follow correct procedures given or as instructed

Always stay alert and get ready to get out quickly when you notice any worrying signs.



Stabilizing/Treatment

Internal lashing

External lashing

Harness

Ambulatory and uninjured victims can be assisted to ground level by being placed in a Class II or Class III harness, depending on the level of security required for safety and the level of assistance needed.

Raising and Lowering Victims

• Low Angle Rescue • High Angle Rescue • Below Grade Rescue

Phase IV : Termination

Termination phase of a rope rescue involve the obvious element of retrieving pieces of equipment used in the operation and some less obvious elements such as:

Investigation

Release of Control

Critical Incident Stress Debriefing (CISD)

Equipment Retrieval

• Identifying/Collection o The process of identifying and collecting equipment assigned to the various pieces of

apparatus on scene can be made much easier if each piece of equipment is clearly marked; however, nothing should be engraved or stamped onto the surface of the rope rescue equipment.

• Abandonment o In some cases, the rescue environment is too hazardous to justify sending rescue

personnel back to retrieve pieces of equipment even expensive ones.



Investigation

All rope rescues should be investigated at some level at the very minimum, a departmental investigation should be conducted for purposes of reviewing and critiquing the operation.

Release of Control

Once rescuers respond to the scene of a rope rescue they assume control of the scene and the immediate surrounding area. With certain limits, they can deny access to the scene to anyone, including the property owner. However, the process of releasing control of the scene back to the owner or other responsible party is sometimes not as straightforward as it might seem. The property owner should be given an explanation of any remaining hazards.

CISD

• Injuries suffered by victims can sometimes be extremely gruesome and horrific and that are likely to produce psychological or emotional stress for rescuers involved.

• The process should actually start before rescuers enter the scene. • Briefing process is done wherein the rescuers who are about to enter the scene are told what to expect

so that they can prepare themselves. • Debriefing process is done within 72 hours of completing their work on the incident.

4 Components of a Successful Rescue Operation

1. Knowledge of the techniques available 2. Skills necessary to perform the techniques 3. Physical fitness needed to apply the skills 4. Judgment to decide which technique is to be applied



Rescue Methods and Techniques Types of Rescue

• Trench Rescue • Rope rescue • Vehicular Accident Rescue • Special Rescues

o Electricity o Natural gas/liquefied petroleum gas o Cave o Mine o Silo/grain vessel

Rope Rescue

When victims are located above or below grade in rescue situations, the most efficient and sometimes the only means of reaching and getting them to ground level may be by the use of ropes and rope systems.

○ EX.

Confined spaces

Rock edge

Upper floors of buildings

Traversing above a hazardous area

Rescue rope, webbing, and appropriate hardware and softwares are used to protect rescuers and victims as they move and work in elevated locations where a fall could cause injury or death.



Types of Rope Rescue

Low Angle Rescue

Are those where the angle of the slope is such that rescuers do not need to be supported by a lifeline to avoid falling down the slope.

High Angle Rescue

Are those in which the rescuers must be supported by a lifeline to keep from falling.

Below Grade Rescue

Rescuers from below grade are most often in some sort of confined space. This adds the problem of testing, managing and monitoring the atmosphere within the space. This usually involves the use of a rescue tripod to lower rescuers and equipment into the space and to raise them and the victim out.

Equipment used

Personal Protective Equipment

• Helmet

• Eye protection

• Outerwear

• Gloves

• Footwear

Software

• Rope

• Accessory cord

• Webbing

• Harness

Class I, II, III



Hardware

• Load bearing

Carabiners

Swivels

Anchor plates

• Ascending devices

Handheld ascenders

Cams

• Hardware

Descending devices

Figure of 8 plates

Rappel racks

Belay Plate

• Pulleys

Single-sheave

Double-sheave

Triple-sheave

Edge rollers

Anchor System

The variety of ways anchor system can be configured is limited only by the situation, the equipment, available, and the imagination of the rigger (anchorman). However, all anchor systems fulfill the same function: to provide a safe and dependable means of securing the rescuer to a bombproof anchor point.

Anchor systems may also provide redundancy in case of systems failure, and/or they may spread the load among two or more less-than-bombproof anchor points.



Single point and multipoint anchor systems are commonly used and in the absence of an anchor points, a series of picket can be used for a man-made system.

CAUTION

Regardless of what kind of anchor is selected rescuers must be aware that virtually any anchor can be overloaded and fail if enough pull is applied.

Anchor Points

Natural anchors o The most commonly used natural anchors are trees and rocks around which webbing of rope

can be wrapped. However, both of these have a potential for failure. Before using them as anchors, you should examine trees for potential rot. But even trees with sound wood may not be good anchors if their root systems are shallow or thin or if they are in wet soil. Boulders weighing tons can be pulled over by the stresses of an anchor system.

Artificial Anchors o These are special types of hardware specifically designed for creating anchors. Many artificial

anchors such as nuts, chocks, and cams, are used but these are usually not as secure as good natural anchors.

Strength of an Anchor

Anchors must be able to sustain the greatest anticipated force on the high angle system as calculated through the safety factors.

Anchors that are so strong they can withstand any force of the high angle system are said to be bombproof.

Mechanical Advantage Systems

A force created through mechanical means including, but not limited to, a system of levers, gearing, or ropes and pulleys usually creating an output force greater than the input force and expressed in terms of a ratio of output force to input force.

Synonymous with…

Raising system

Pulley system

Hauling system



M. A. amplifies the pulling force of the haul team.

Things to consider in constructing M. A.

Length of available rope

Distance of the rescuers to the victim

Number of haulers

Categories

Simple systems

o Simple mechanical systems are used mainly for low angle rescuers. These systems typically provide a range of mechanical advantage from 2:1 to 3:1.

Compound systems

o These systems are used when the lift needed is beyond what is provided by a simple system. Compound systems are those in which one simple system is attached to and pulled on another simple system to multiply the mechanical advantage gained. Compound systems typically provide a range of mechanical advantage from 4:1 to 9:1.



Fundamentals of High Angle Rescue Techniques

3 Fundamental Tools in Rope Rescue

Gravity o Defined as the force between two objects with mass o Mass is attractive – the greater the mass, the greater the force of attraction o Gravity is our finest & most important tool o It is the engine in rope rescue system

Friction o Defined as the resistance to relative motion between 2 bodies in contact o Good friction balances the effects of gravity o Absorb heat and dissipate to surrounding o Bad friction disintegrates knots o Cuts and burns

Human Factors o Must have the knowledge and skills o Use teamwork o Must control anxieties

Correlation

To accomplish rope rescue tasks, we must have cooperative relationship with all tools Ancillary tools are simply connections for the primary tools Gravity, friction and human factors must be in harmony in order to routinely effect safe, high level

rescues Rope rescue should be considered only after all other means of accomplishing the task have been

rejected.

Always remember to:

Back it up o Main system backed up by another system o Double roping or belayed system

Check and double check o Buddy system – working in pairs or with separate safety officer o Touch system – touch each part when checking set-up



Ropes and Knots Rescue Knots and Lines

• The knot itself is usually thought of as the intertwining of the ends of the line in such a way as to be secured and suitable for any one of a variety of designed purposes.

• To be suitable for use in rescue, a knot must be easy to tie and untie, be secure under load, and reduce the rope’s strength as little as possible.

• A rope’s strength is reduced whenever it is bent. The tighter the bend, the more strength is lost. Some knots create tighter bends than others and thereby reducing the rope’s strength to a greater degree.

• All knots should be dressed after they are tied; that is, they should be tightened until snug and all slack are removed.

Kernmantle rope - A rope constructed with its interior core (the kern) protected with a woven exterior sheath (mantle) that is designed to optimize strength, durability, and flexibility. The core fibers provide the tensile strength of the rope, while the sheath protects the core from abrasion during use. The name is derived from German Kernmantel... which means coat protected core.

Types of Ropes

Dynamic rope – this design of rope is purposely made to be stretchy ( usually around 30% or more elongation at failure). It is designed to absorb the impact of the climber’s fall, minimizing the shock to his body, equipment, victim and preventing injury.

Static rope – with a very low stretch of up to 6% and is weaker than dynamic ropes but may be advantageous to certain raising and lowering situations. It is not designed to absorb the impact of a climber’s fall, as in a shock load.

Rope Management

Criteria for reuse:

Rope has not been visibly damaged.

Rope has not been exposed to heat, direct flame impingement, or abrasion.

Rope has not been subjected to any impact load.

Rope has not been exposed to liquids, solids, gases, mists, or vapors of any chemical or other material that can deteriorate rope.



Standard of Safety

NFPA standard 1983 specified the strength of a life support line to be 15 times the load.

NFPA 1983 defined a person load to be 300lbs – best represent the average firefighter with all his gears

NFPA Safety Margin x 15

1-person load = 300lb x 15 = 4,500 lb

= 9mm

2-person load = 600lb x 15 = 9000 lb

= 12.74mm

Knot Classification and Usage

Stopper knots

Hitches

Loops

Bends

Harness

Stopper knots

Most often used to prevent the end of a rope from slipping through an eye or a hole. Stoppers could also be used to bind the end of a line so that it could not unravel.

Overhand knot



Figure of eight knot

Hitches

Knots used to secure a rope to a post, hook, ring or rail. Hitches do not keep their shape on their own.

Clove hitch

Timber hitch

Cow hitch

Italian hitch

Clove hitch

Timber hitch



Cow hitch Italian hitch

Loops

Made to be dropped over an object, unlike hitches, which are made directly around the object and follow its shape.

Overhand loop

Figure of eight loop

Bowline

Bowline on a bight

Triple Bowline

In line figure of eight

Overhand loop



Figure of eight loop

Bowline

Bowline on a Bight

Triple Bowline



In Line Figure of Eight

Bends

Knots used to join the ends of two lengths of a rope to form one longer piece. To ensure that the knot is secured, the two ropes that are to be joined should be of the same kind and have the same diameter.

Figure of eight bend

Square knot

Fisherman’s bend

Sheet bend

Figure of Eight Bend



Square Knot

Fisherman’s Bend

Sheet Bend

Harness

Seat harness

Emergency harness

Lifeline



Seat harness

Emergency harness

Lifeline



Other knots

Sheep shank – shortening

Prusik knot – self-locking knot

Butterfly knot – tensioning

Sheep shank

Prusik Knot

Butterfly knot



Emergency Medical Operations

Basic Life Support

Introduction to Basic Life Support

Kinds of Life Support

1. Basic Life Support (BLS)

An emergency procedure that consists of recognizing respiratory or cardiac arrest or both and the proper application of CPR to maintain life until a victim recovers or advanced life support is available.

2. Advanced Cardiac Life Support (ACLS)

The use of special equipment to maintain breathing and circulation for the victim of a cardiac emergency.

3. Prolonged Life Support (PLS)

For post resuscitative and long term resuscitation.

CHAIN OF SURVIVAL

Four Links



1. The First Link: EARLY ACCESS

It is the event initiated after the patient’s collapse until the arrival of Emergency Medical Services personnel prepared to provide care.

2. The Second Link: EARLY CPR

It is most effective when started immediately after the victim’s collapse. The probability of survival approximately doubles when it is initiated before the arrival of EMS.

3. The Third Link: EARLY DEFIBRILLATION

It is most likely to improve survival. It is the key intervention to increase the chances of survival of patients with “out-of-hospital” cardiac arrest.

4. The Fourth Link: EARLY ACLS

If provided by highly trained personnel like paramedics, provision of advanced care outside the hospital would be possible.

Breathing and Circulation

• Air that enters the lungs contains:

– 21% O2

– trace of CO2

• Air exhaled from the lungs contains:

– 16% O2

– 4% CO2

Clinical death (0 - 4 min. - brain damage not likely, 4 - 6 min. - damage probable).

Biological death (6 - 10 min. - brain damage probable; over 10 min. - brain damage is certain).

First Aid Management of Heart Attack

1. Recognized the signals of heart attack and take action.

2. Have patient stop what he or she is doing and sit or lie him/her down in a comfortable position. Do not let the patient move around.

3. Have someone call the physician or ambulance for help.



4. If patient is under medical care, assist him/her in taking his/her prescribed medicine/s.

Guidelines in Giving Emergency Care

Getting started

1. Plan of Action • Emergency plans should be established based on anticipated needs and available resources

2. Gathering of Needed Materials • The emergency response begins with the preparation of equipment and personnel before any

emergency occurs. 3. 3. Initial Response

• Ask for help. • Intervene • Do no further harm

4. 4. Instruction to Helper/s • Proper information and instruction to a helper/s would provide organized first aid care.

Emergency Action Principles

1. Survey the Scene

Once you recognize that an emergency has occurred and decide to act, you must make sure the scene of the emergency is safe for you, the victim/s, and any bystander/s.

Elements of the Survey the Scene

• Scene safety.

• Mechanism of injury or nature of illness.

• Determine the number of patients and additional resources.

2. Do a Primary Survey

In every emergency situation, you must first find out if there are conditions that are an immediate threat to the victim’s life.

• Check for Consciousness • Check for Airway



• Check for Breathing • Check for Circulation

3. Call for Medical Assistance and Transport Facility

In some emergency, you will have enough time to call for specific medical advice before administering first aid. But in some situations, you will need to attend to the victim first.

4. Do a Secondary Survey

It is a systematic method of gathering additional information about injuries or conditions that may need care.

• Interview the victim. • Check vital signs. • Perform head-to-toe examination.

Rescue Breathing

Respiratory Arrest

Is the condition in which breathing stops or inadequate.

Rescue Breathing

Is a technique of breathing air into a person’s lungs to supply him or her with the oxygen needed to survive.

Ways to ventilate the lungs

• Mouth-to-mouth • Mouth-to-nose • Mouth-to-mouth and nose • Mouth-to-stoma • Mouth-to-faceshield • Mouth-to-mask • Bag mask device



Foreign Body Airway Obstruction

Two Types of Obstruction

1. Anatomical Obstruction

It happens when the tongue drops back and obstruct the throat. Other causes are acute asthma, croup, diphtheria, swelling, and cough (whooping).

2. Mechanical Obstruction When foreign objects lodge in the pharynx or airways; fluids accumulate in the back of the throat.

Classification of Obstruction

1. Mild Obstruction - The victim is responsive and can cough forcefully, although frequently there is wheezing between coughs.

2. Severe Obstruction - The victim is unable to speak, breathe, or cough and may clutch the neck with the thumb and fingers. Movement of air is absent.

Heimlich Maneuver

Heimlich maneuver or abdominal thrusts is recommended for relieving foreign body airway obstruction.

Cardiac Arrest

Is the condition in which circulation ceases and vital organs are deprived of oxygen.

Cardiopulmonary Resuscitation (CPR)

This is a combination of chest compression and rescue breathing. This must be combined for effective resuscitation of the victim of cardiac arrest.

When to S.T.O.P. CPR

1. SPONTANEOUS signs of circulation are restored.

2. TURNED over to medical services or properly trained and authorized personnel.

3. OPERATOR is already exhausted and cannot continue CPR.

4. PHYSICIAN assumes responsibility (declares death, take over, etc.).



SEQUENCE IN PERFORMING CPR & RB

Survey the Scene.

“The Scene is Safe”.

“Activate Medical Assistance & Transfer Facility”.

Check Responsiveness,

“Hey Ma’am/Sir are you OK? Victim Unresponsive”.

Open Airway (Head-Tilt-Chin Lift) Check Airway

Check Breathing (Look, Listen & Feel) for 5 seconds.

“Victim is Breathless”.

Give 2 Initial Ventilatory Maneuver (2 breaths).

Check for Signs of Life for at least 10 seconds.

“Victim has no signs of Life I’ll perform CPR”.

“Victim has inadequate/no breathing but with Signs of Life I’ll

perform Rescue Breathing”.



Review and Closing Review: During this module, we have discussed about the following;

1. Basic principles in search and rescue. 2. The different rescue methods and techniques. 3. The different ropes and knots. 4. How to give a basic life support.

Closing: With all the modules complete for a basic training as a fire brigade member, you should be knowledgeable now how to properly utilize the different firefighting equipment, the different techniques on how to use them and also the different approach and principles behind a complete firefighting operation.

Government & Nonprofit

Volunteer Fire Brigade Training Module 5 rescue and emergency medical operations