Amid the chaos and excitement of any rescue operation, there are often important aspects of incident that can be overlooked. Sometimes, the sequencing of tasks becomes disjointed. Though the outcome we all seek is the same, the way we get there can vary between rescue teams.
The key to success is to create a systematic approach to perform functions that ensures that they will occur in proper sequence and in a timely manner. For example, we use the acronym P.A.S.S. when we use portable fire extinguishers. It stands for Pull – Aim – Squeeze – Sweep. These four steps must be performed in a certain sequence to be successful.
In EMS, we use a variety of acronyms from ABC [Airway – Breathing – Circulation] to the SAMPLE history [Signs/Symptoms – Allergies – Medications – Previous history – Last intake – Events preceding]. Search and rescue teams have used L.A.S.T. [Locate – Access – Stabilize – Transport] for many years. In our technical rescue training programs at the Hennepin Technical College, we have been using the acronym R.E.S.C.U.E.D.
R.E.S.C.U.E.D. encompasses all the requirements found within National Fire Protection Association [NFPA] 1006: Standard for Technical Rescue Personnel Professional Qualifications and the NFPA 1670: Standard on Operations and Training for Technical Search and Rescue Incidents.
The first action in any rescue is to respond to the call for help. During this stage, we gather information to determine the correct level of response. We need to know the location of the incident to determine the most effective response route. We need to know the nature of the incident to determine what rescue resource will be needed.
Upon arrival, the team leader conducts an evaluation of the incident, often referred to as a size-up. The team leader must locate the victim(s); identify any immediate hazards that threaten the victim(s) as well as the responders; and determine the condition of any victims to identify the needs for EMS and extrication.
Paramount to any rescue operation must be the safety of the response team and the victims. The need to protect against known or suspected hazards must be the team leader’s highest priority. Those hazards that were identified during the evaluation must either be eliminated or controlled. In situations where hazards will still exist, the team leader must ensure that all responders follow proper operating procedures while wearing all appropriate personal protective equipment [PPE]. This would also include providing PPE for the victims.
The care of the victims must be at the core of every rescue. Patient care begins with the first contact, whether visually or by voice. Assessing the patients’ condition determines the immediacy of the rescue, and confirms if this will be a rescue or recovery operation. This would also be referred to as triage.
Patient care continues as the rescuers make access to the victims and initiate hands-on EMS. From basic first aid to advanced life support, the care of the patient continues until the patient is transferred to another provider.
Utilize the Incident Command System
The incident command system has proven itself an effective and efficient method of managing resources in virtually any emergency. From fires and floods to earthquakes and epidemics, the ICS continues to give the incident commander the means to organize resources into functioning units while maintaining communications and accountability at all levels.
The five branches of ICS are present in technical rescue. Command and operations are the two most obvious components that are utilized, but the need for logistics to support the operations is critical. Without planning, there can be no logical path to completion of the rescue. Finance/Administration, though rarely seen, is always present as command documents the use of resources and accounts for all personnel and equipment.
The most obvious element in any emergency rescue is the extrication of victims. From high-angle pickoffs to confined space and machinery extrications, this is the most hazardous aspect of the rescue operation. It is also the most technically challenging. There are three stages identified during the extrication.
The first stage is to gain access to the victims. This will range from walking to climbing to crawling or being lowered. Typically, one rescuer is assigned to get to the victims to complete the patient evaluation and to stabilize the patient to prevent further injuries. The first rescuer will initiate any immediate lifesaving actions while assessing the needs for extrication.
In the second stage, the means of egress will be established. In most cases, it will be necessary to remove the victims by the same route that rescuers used to gain access. Rescuers who are lowered to the victim level will generally require a hauling system for retrieval. However, when a safer, more efficient or effective route of egress can be identified it should be utilized.
The third stage involves the release of any person trapped by engulfment, entanglement, or by the configuration of a space that restricts their movement. This stage can become the longest, and most technically challenging. It may require the use of special tools, knowledge, or techniques to safely and efficiently allow rescuers to remove the patient.
The final action of any rescue will be the delivery of the patients to the most appropriate medical care facility by way of the most efficient delivery system. It might be as simple as walking them to an aid station, or carrying them to an ambulance. This would include the establishment and safe operation of a helicopter landing zone at the scene of a rescue operation.
By training and practicing R.E.S.C.U.E.D., we have created a standard method for systematically conducting rescue operations, regardless of their nature or complexity. It fits well into the incident command system as a planning tool for command to establish tactical priorities. Best of all, our students can easily transition from rope rescue to confined space or other courses using the same concepts in all our technical rescue training programs.
John Lindstrom II is a retired Battalion Chief from the St. Louis Park (MN) Fire Department with 42 years of experience in firefighting, rescue, and EMS. John is currently an Adjunct Instructor at the Hennepin Technical College (MN) developing and providing customized training services to municipal and industrial emergency responders.