Prior to the modern rapid intervention team (RIT), the fire service was taught that if you were in a fire and your partner went down you simply would drag them to safety. After incidents such as the deaths of Denver Firefighter Mark Langvardt in 1992 and Phoenix Firefighter Bret Tarver in 2001, the world of RIT changed dramatically. Rapid intervention teams all over the country started taking time to evaluate, and even treat their patient, prior to extrication from the fire building. Unfortunately, the concept of just grab and go is still alive and well in technical rescue. In the world of tech rescue, it has somehow become perfectly acceptable to take everything we know about EMS and throw it out the door.
In many incidents, “time” is used as the excuse. Think back to rope rescues, trench rescues or ice rescues that you have read about or witnessed. Video after video can be found showing emergency responders “grabbing and going” with their patient. The technical rescuers in today’s fire service need to stop and focus on their patient’s EMS needs, instead of using the grab-and-go method.
This article will discuss how to develop a technical rescue response program that properly utilizes the EMS elements you have in your community. In upcoming articles, scenarios will be used to illustrate further usage of the formula described above and I will outline specific EMS skills that play a large role in rescue operations. Resource usage, on-going evaluations and timeline estimation will be discussed thoroughly.
As emergency responders, it is not only our duty to respond to the calls for service, but to also provide the customer with the highest standard of care to which we are trained. Technical rescue responses should be no different. Obviously, variables such as size of department, call volume, training budget, target hazards and number of personnel are all going to play a role. We should not allow the standards of medical/EMS care to become a variable as well. The focus of this article will be to lay out a formula that can be implemented in your community to help the incident commander decide how to best utilize EMS during technical rescue responses.
Understanding Your EMS Capabilities
The first element of the formula has to be the level of EMS that your service provides to the community. A fire department that utilizes firefighter/paramedics who are cross-trained technical rescuers is going to respond and render care much differently than a smaller service that employs first responder level personnel with very little technical rescue training. Medical treatment at a trench rescue involving crush injuries is going to be very different than treatment at a Low Angle Response where the patient twisted their ankle.
Look at your response area and its needs. Do you have rescue target hazards in your communities that generate runs? If the answer is yes, then your medical response has to be a big part of your rescue planning. First responders, EMTs and paramedics all have a place at the rescue; the key is where they fit, and how they fit together. Having an entire department of Urban Search and Rescue (USAR)/paramedics would be ideal, but such an asset is rare and unrealistic. In the real world, most organizations have various levels of medical training throughout their ranks.
Take a look at your organization’s highest level of care and decide how they can and will be used during a response. If your organization doesn’t provide primary EMS care in your area, and this element of the response is provided by a private or secondary service, these folks need to be included in your planning. There needs to be a very honest conversation between your organization and theirs about the laws, risks and skills associated with tech rescue. For example, the patient packaging used in a confined-space incident may be a piece of equipment that a paramedic from a private organization has never seen before. A paramedic from a private service climbing into a confined space to render care could result in a fine from OSHA. What this gets down to is putting the right people into the right spots.
Anticipating The Rescue Hazards
The next element is evaluating the type of rescues that you are likely to run into in your community and those around you. This process is not much different than standard target hazard identification, and it can be utilized to identify your organization’s training needs.
- If low-angle rescues are identified as your most likely and/or highest risk incident, patient stabilization and back boarding are going to play a big role in any rescue.
- High-angle rescues are a different game. If your patient is suspended by a harness from a window washing rig, back boarding is going to be secondary concern.
- Trench rescues provide lots of built-in time to evaluate how your patient is responding to any injuries or their response to any treatments delivered.
- Ice rescue is usually about getting the patient out of the immediate danger and then treating them appropriately.
In all of these examples, the events leading up to what has occurred is very important. A patient who fell through the ice is very different than one who struck the ice as he fell off his snowmobile breaking through the ice at 40 mph. As an officer on scene, you need to evaluate the type of rescue and the amount of time required to successfully complete it.
Another element in the formula is the technical training level of your personnel. If your organization has 50 members and five of them have specialized rescue training, you better hope that one of those five are on duty every day. If you work in an area that is prone to earthquakes, you should train as many of your personnel as possible in USAR procedures. If there is a large power plant in your community, your organization should look at some solid confined-space rescue courses.
Technical rescue training in your organization can be made to fit the needs of the community you serve. Focus your efforts and your budget on the skills your personnel have the best chance of using.
The next step is to really be good at those skills; drill often enough so your people are truly comfortable with your organization’s chosen disciplines. Train with your service partners as well. The medical response element associated within your organization needs to know and be proficient at their role. Realize that there is a limited amount of responders who can act as rescuers. This isn’t like a structure fire, where additional alarms will continue to supply the incident commander (IC) with endless amounts of firefighters. At a significant technical rescue event, the IC will have a limited number and possibly run out of technical rescuers. Again, use the right people in the right spots.
Putting The Pieces Together
The final step of the formula is to add in all the elements and see what comes out the other side. Analyze the incident in front of you; don’t rush into a technical rescue incident like a structure fire, balance the problem and the available resources to create an appropriate strategy. How many possible patients are involved, and what kind of time period are you looking at before you gain access? Factors such as weather and time of day make every rescue scene unique. It's a safe bet to plan at least two hours ahead of what’s in front of you. Start calculating the number of resources you have at hand for the incident.
Is there a need to call in a USAR or technical rescue team from a state or federal agency? Depending on the incident, additional alarms or mutual aid from a neighboring community may give you the resources needed. A USAR Rescue Specialist/Paramedic and a two-year firefighter/first responder are different types of resources, so it’s very important not to lose track of how many you have of each. Put all of the information into the mix, and then pull another brain into the pool. Locate someone on scene that can be your medical point of view, and have that individual work the worst-case scenario for the patient care element.
Now, using the patient care plan provided to you, add everything together taking into account what your estimated incident time might be. Mix in the proper personnel and the proper amount of resources and you should be close to a solid incident action plan.
Experience is going to play a big role in telling you what will work and what won’t. The most important thing is to slow down and plan for the next step of the rescue before it happens. As a professional rescuer, it is our job to slow things down and ensure the incident is being handled as safely as possible. Patient care cannot be overlooked for speed or any other reason.
DEREK PETERSON has been in the fire service since 1991. He is currently a captain and paramedic with the Saint Paul, MN, Fire Department. Peterson has been a certified fire instructor with various technical colleges and training institutions for the last 18 years. He acts as the lead instructor for the St. Paul Fire Department's technical rescue program and has assisted with the department’s training academy since 2005. He has developed courses on apparatus operation, rapid intervention, company operations, incident command for technical rescue, advanced strategies and tactics, and crew integrity. He is a medical specialist and trainer with the regional Urban Search and Rescue Team, Minnesota Task Force 1. Prior to joining St. Paul, he served as a firefighter and trainer for the cities of Coon Rapids and Eden Prairie, MN.
