Rescue

FO1 Louise Mark U Cirunay, EMT-B, BFP

Special Rescue Unit
Introduction

 Rescue = “Act of delivering from danger or

imprisonment”
 In EMS, Rescue = Extricating or disentangling
victims who will become your patients
Paramedic Rescue Roles

 Vary from area to area

 All RESCUERS need “rescue awareness”
– Ability to recognize hazards
– Knowledge of specialized capabilities and when to
call for them
 Rescue awareness necessary to avoid
injury/death of paramedics/patients
Rescue Roles
Some systems
require RESCUER
training in rescue
beyond awareness
level
Rescue Roles
 All rescuers should have training and
equipment to allow them to:
– Assess hazards associated with various
environments
– Establish incident command
– Access patients
– Provide assessment/initial care
– Provide medical balance to the skills of the technical
rescuers
Topics
 Rescuer Roles
 Personal Protective Equipment
 Phases of Rescue Operations
 Types and Processes of Rescues
– Surface Water
– Hazardous Atmospheres (Confined Space, Trench)
– Highway Operations
– Hazardous Terrains
Rescuer PPE

 Helmets  Flame protection

 Eye protection  Personal flotation
 Hearing protection  Lighting
 Respiratory protection  HAZMAT suits/SCBA
 Gloves  Wilderness protection
 Foot protection
Helmets

 Four-point, non-elastic suspension

 No non-removable “duck bills” in back
 Needs vary with situations
– Vehicle/Structural: NFPA firefighting helmet
– Confined Space/Vertical: Climbing helmet
– Water: Padded rafting or kayaking helmet
Eye Protection

 ANSI approved, vented goggles or industrial

safety glasses
 Do NOT rely on fire helmet face shields
Hearing Protection

 Choice depends on practicability, convenience,

environmental considerations
 Options
– High quality earmuff protectors
– Multi-baffled rubber earplugs
– Sponge-like disposable earplugs
Respiratory Protection

 Surgical masks
 Commercial dust masks
Gloves

 Leather gloves for cut/puncture protection

 Surgical gloves (latex and non-latex) for body
fluid protection
Foot Protection

 High-top, steel-toed boot with coarse lug soles

 Laced boots are preferable to pull-on types
 In colder environments boots should be
insulated
Flash/Flame Protection

 Turnout gear, coveralls, jump suits

 Nomex ®, PBI ®, flame retardant cotton
 Bright colors with reflective trim and symbols
 Insulation in cold environments
Personal Flotation Devices

 Should be worn when operating on/around

water
 Coast Guard-approved
 Type III PFD approved for rescue work
 Should have attached knife, strobe light, and
whistle
Lighting

 Flashlight
 Headlamp attachable to helmet
HAZMAT Suits/SCBA

 Level A, B, C, D
 Level selected depends on nature of product,
area of incident in which personnel are
operating, personnel responsibilities
 Requires proper training to use
 EMS personnel should know how to remove
Backcountry/Wilderness Protection

 PPE for inclement weather

 Water purification supplies (iodine, filters)
 Snacks (energy gels or bars)
 Temporary shelter (tents, tarps, bivouac sacks)
 Butane lighter
 Extra flashlight, batteries
Patient PPE

 Helmets
 Eye protection
 Hearing, respiratory protection
 Protective blankets
 Protective shielding
Helmets

 Two-point suspension construction-style

helmets appropriate for most circumstances
 Rescuer-quality helmets may be required in
caving, climbing situations
Eye Protection

 Vented goggles with elastic band

 Workshop face shields
Hearing/Respiratory Protection

 Disposable earplugs
 Surgical mask or industrial dust mask
Protective Blankets

 Water, weather, most debris: Vinyl blankets

 Fire, heat, glass dust: Aluminized blankets
 Cold: Commercially-available wool blankets or
55-gallon trash drum liners
Protective Shielding

 Backboards
 Specially-designed basket stretcher shields

Better shielding of patients =

Difficulty in patient care access
Safety Procedures

 Steps in curbing “heroics” and maintaining

optimum safety include:
– Rescue SOPs
– Crew assignments
– Preplanning
– Training exercises
Rescue SOPs

 Include sections on all anticipated rescue types

 For each rescue type list
– Required safety equipment
– Required actions
– Prohibited actions
– Specific assignment modifications
 Always provide for a Safety Officer
Crew Assignments

 Physical screening
 Psychological screening
PrePlanning

 Identify potential rescue locations, structures,

activities
 Evaluate specific training, equipment to
manage potential rescues
PrePlanning

 Provide for personnel maintenance, rotation

 Protected “stand-by” sites
 Hydration (diluted sports drinks)
 Food (complex carbohydrates
Training Exercises

 Base scenarios on likely events

 Include all agencies likely to respond
 Integrate IMS, technical rescue, patient care
 Use exercise results to modify plans,
procedures
Rescue Operations
Rescue Operations

 All operations include 7 basic phases

 Use phases to form mental picture of how
operation will be carried out
Rescue Operations

 Phase One — Arrival and Size-Up

 Phase Two — Hazard Control
 Phase Three — Patient Access
 Phase Four — Medical Treatment
 Phase Five — Disentanglement
 Phase Six—Preparation for Removal
 Phase Seven—Removal
Phase 1: Size-Up
 Begins at moment of dispatch
 Continues throughout rescue
 In route:
– Think through the 7 steps
– Decide what you are going to do first
 When you arrive:
– Avoid being caught up in the situation
– Step back, survey scene
Phase 1: Size-Up

 Goals
– Establish medical command
– Rapid evaluate
 Hazards
 Nature of rescue situation
 Appropriate additional resources
Phase 1: Size-Up

 Specialized Resources
– Is additional assistance needed?
– If you need something, call for it!
– Stay ahead of incident!
– If you routinely work with other agencies, have plan
of operations worked out in advance
Phase 2: Hazard Control
 Are there potential hazards to you?
 Are there potential hazards to other
responders?
 Are bystanders at risk?
 Is the patient in danger?

Dead Rescuers Don’t Help

Anyone!
Phase 2: Hazard Control

 Goals
– Identify hazards
– Manage by:
 Correcting them
 Moving patient away from them
 Calling for specialized resources
Phase 2: Hazard Control

 Weather  Hazardous materials

 Unstable structures,  Infection risks
vehicles  Swift water
 Electrical hazards  Confined spaces
 Fire hazards  Heights
 Traffic
 Emotionally unstable
patients, bystanders,
rescuers
Phase 3: Patient Access

 First phase that requires application of

technical rescue skills
 IMS should be in place
 Access should be based on plan approved by
Incident Commander and Safety Officer
 All personnel should understand plan before it
is implemented
Phase 3: Gaining Access

 Goals
– Get to the patient safely
– Assess patient, begin care
 Formulate access plan based on
– Terrain
– Personnel knowledge
– Extent of patient injuries
– Technical rescue expertise
Phase 3: Gaining Access
 Formulate access plan  Try before you pry!
based on:  Work from simple to
– Safety considerations complex!
– Terrain  A different strategy or
– Extent of patient injuries
route may have to be
– Personal capabilities
used for patient removal.
– Technical rescue
expertise
Phase 4: Medical Treatment

 Goals
– Initiate assessment ASAP
– Identify, correct life-threats
– Maintain care during disentanglement
– Accompany patient during removal, transport
Phase 4: Medical Treatment

 Initial Assessment
– Rapidly evaluate patient’s condition
– Immediate threats are:
 Hypoxia
 Shock
– At this point, why patient isn’t oxygenating or
perfusing is irrelevant
Phase 4: Medical Treatment

 Life-Saving Care
– If ABCs compromised, correct problem!
– If you cannot correct problem:
 Support oxygenation, ventilation
 Work with technical rescue specialists to develop a rapid
extrication plan
 Rapidly extricate patient
 Evacuate
Phase 4: Medical Treatment

 On-going Assessment and Management

– Identify, care for existing problems
– Anticipate changing patient conditions during
prolonged operations
– Continually reevaluate risks to patient and rescuers
– Provide psychological support to patient during
prolonged operations
Phase 4: Medical Treatment
 Psychological Support
– Learn, use patient’s name
– Be sure other rescuers use patient’s name
– Be sure patient knows your name
– Avoid negative comments where patient can hear
– Explain delays to patient
– Explain technical aspects of rescue to patient
– Do NOT lie to patient
– Stay calm
Phase 5: Disentanglement

 Goal: To release patient from entrapment

 Most technical, time-consuming part of rescue
Phase 5: Disentanglement
 Patient-centered
 Keep someone with patient to:
– Monitor condition
– Ensure technical rescue procedures do not endanger patient
 Protect patient at all times
– Use appropriate PPE
– Talk to him
– Explain what is happening
Phase 5: Disentanglement

 Do NOT do anything unless you know

EXACTLY what result will be
 Evaluate risk vs. benefit in all decisions
Phase 6: Preparation for Removal

 Goal: Package patient so:

– All injuries stabilized
– Patient moves as single unit through route of egress
Phase 6: Preparation for Removal

 Packaging methods must consider

– Patient condition
– Safety issues
– Environmental issues
– Technical considerations in moving patient
Phase 7: Removal/Transport

 Goal: Remove packaged patient, transport to

appropriate care.
 Considerations
– Patient condition
– Environmental issues
– Air vs. Ground transport
Conclusion
 Successful rescues are based on planning,
practice.
 Know what community’s target hazards are.
 Have plan for managing them.
 Know who you will be working with; train with
them.
 Know what kinds of help are available.
 Do NOT be afraid to call for help if you need it!
Conclusion
The challenge is NOT to
be innovative in a crisis.
The challenge is to be
well-trained and well-
disciplined enough to
FOLLOW
THE RULES!