This is the second in a three part series on rope rescue. The first part covered some of the basic training philosophies behind the FDNY’s Special Operations basic rope rescue curriculum and the curriculum of Gulf Coast Emergency Response Academy (GCERA). Part two continues to examine basic rope rescue training as students are given ever increasing autonomy along with scenarios of increasing difficulty and complexity. The final installment will cover advanced rope rescue curriculum as well as some specialized courses and training. Information in the first part was presented by examining the first two days of a four-day (40 hour) rope course. We will continue by examining the final two days.
In day three the lecture topics begin with a brief introduction to the physics of simple machines leading into the mechanical advantage of pulley systems and the construction of raising systems. This lecture also covers some of the forces that are placed on the system due to such variables as the angle of pull and friction. Next is choosing and applying specific patient packaging devices and specific rope rescue scenarios. Throughout the lectures, films are presented of actual mistakes made by rescue teams during actual incidents and as training. These are utilized to stress learning objectives. For example, a film entitled “Square Knot or Granny” precedes teaching about knots. In this film a rescue team practices rappelling off a high-rise roof. One member used the wrong knot to tie his harness and fell to the side walk below. This film is used to show the importance of correctly selecting and tying knots.
In patient packaging, the main training point to remember is not the application of the specific device -- although this is important -- but rather choosing the appropriate device. Some major points to consider are: the NOI (nature of injury), the victim’s location and the urgency of removal. I use an anecdote to illustrate the potentially conflicting requirements of the NOI versus the urgency of removal. In the first example given in the anecdote the victim has succumbed to an oxygen deficient atmosphere and has just gone into respiratory arrest. In the second example the victim, while in a safe atmosphere, has fallen. Although his vitals are stable, he complains of being unable to feel his legs. In the former case, if the rescuers take the time to apply an elaborate patient packaging device, they are likely to end up with a perfectly packaged corpse. In the latter case the rescuers should choose the packaging device and techniques that will provide the maximum amount of patient protection and spinal immobilization in order to avoid exacerbating the patient’s injuries. The inversely proportional nature of speed of removal versus patient protection is illustrated by the patient packaging hierarchy (see diagram). The other critical factor in choosing the patient packaging device is the location of the victim. The main consideration is that the chosen device fit into where the victim is located. A smaller device that provides less patient protection will often be used initially with the patient placed into a device providing better protection as soon as possible. The other issue when treating the victim is to provide appropriate patient care that meets the rescuer’s level of training. The potential rescuer’s level of medical training is something to consider when selecting personnel.
I break down the final topic, specialized rope rescue scenarios, into two categories. The first category is based on specific scenarios that the team is likely to encounter. For the FDNY, a scenario that fits this criterion is the rescue of workers from hanging scaffolding. Training on this topic begins with lectures on various types of scaffolding and the potential failures, following with hands-on scenarios involving workers and collapsed scaffolding. The other category is scenarios based more on specific techniques that rescuers can apply. An example of this is a lowering technique that is specific to stairways.
The final day is broken into two sections. The final section is administrative -- a necessary evil. Training must be documented, the students evaluated by written exam and skills testing, the course critiqued and, finally, the gear inventoried. Preceding this is where the course all comes together by conducting realistic scenarios. These progress as they are conducted throughout the course. Initially, when scenarios are given, the students’ response is instructor led. In this case the instructor tells the students what rescue system to build as well as where and how to build it. As the students progress, the instructors should allow them more freedom to come up with solution and make mistakes. This teaches them to think through the problem. However, at this point specific equipment and techniques may still be mandated. For one example, there are several different devices the FDNY uses on the safety line. At different stations different devices will be mandated to ensure that the students are exposed to the pros and cons of the various devices.
In another example, at one station a vertical stokes basket raise may be specified and at the next a horizontal. As the students’ progress to the final scenario the instructors give them the specifics and the victims condition, then let them solve the problem only operating as safety officers. They should only stop the scenario to prevent injury. Deciding on a course of action, making mistakes and correcting them and completing the scenario without instructor interference give the students confidence in their abilities. The main problem I encounter at this stage is preventing instructors from offering the students advice during the scenario that is best left to the critique. At this point it should generally be presented as another option, not as the only option.
This brings the students to the final scenario. It is preceded by a briefing and a chance to configure each team’s equipment. The students are organized into teams of the same,or as close as practical, size as they will operate in after graduation. Until this moment the teams have been required to build all of their systems from scratch on scene to develop their proficiency. However, this is generally not how we operate in the field. Our units utilize many prebuilt systems. An example is units having a prebuilt safety line complete with appropriate anchoring equipment. In our urban environment, with a prebuilt system, setting up the safety line is generally a simple operation such as placing the bag next to a column of structural steel, putting an anchor strap around it and attaching the system to it with a carabiner. This can be done in a few seconds. Another example is units setting up their Stokes basket with a backboard, vertical and horizontal bridles, and the appropriate lengths of webbing utilized in patient packaging. Many rope rescue gurus look down on prepackaged systems. They believe that a rope rescue professional should look at each individual scenario and decide what particular solution is best instead of using a one size fits all approach. We opt for speed and simplicity.
Prior to the final scenario the students are given a last briefing where any problems are brought up and any questions answered. Live victims and some medical equipment are now incorporated. It is stressed that this is a simulation of a rescue and must be addressed in a timely manner. Two principals are emphasized to accomplish this. The first is to stress simplicity and not to over engineer the system. A good system now is better than a perfect system later. As the French philosopher Voltaire said “perfect is the enemy of the good.” The other principal is to overlap as much of the rigging operations and patient care and packaging operations as possible. The idea is to get a rescuer or rescuers to the patient as soon as possible to provide potentially lifesaving care and begin patient packaging. During this time the system that will be used for extricating the victim can be improved until it is time to begin.
The final scenario is sometimes referred to as “the yellow brick road.” This is a multi-step scenario where the live victim is first accessed and then raised one level, followed by multiple horizontal and vertical moves to the final destination. For this scenario the students are separated into two groups and two identical mirrored scenarios are conducted. This methodology was initially implemented to combat the tendency of students at this stage to become excessively slow and methodical. Since each group can see exactly where the other group is within their evolution they become competitive and move at a more realistic pace for a rescue operation.
Due to the complexity and the multiple levels imposed by this scenario instructors are positioned throughout, including as the victims, to act as safety officers and also be available at the after action critique.
By initially ensuring a solid foundation of personal skills, providing multiple scenarios of increasing realism and complexity while increasing the student’s autonomy the end product will be a student that is proficient and confident in their abilities.
James Kiesling is a Captain with the Fire Department, City of New York’s Special Operations Command. He holds a bachelor of arts in fire and emergency services from John Jay College of Criminal Justice and an associates degree in occupational studies in fire protection technology from Corning Community College