PPE for the Technical Rescue Victim

Recently, I have seen a couple of fairly risky technical rescues being performed where the patient/victim was not provided any personal protection equipment (PPE). Without identifying the agencies involved or when exactly they occurred, I will just say that the two rescue scenarios involved a swiftwater rescue and a rope rescue. In both scenarios, the victims appeared relatively uninjured.

Swiftwater Rescue

When gaining access to a victim in the swiftwater rescue environment, the initial rescuer should always take, at a minimum, a personal flotation device (PFD) for the victim. A swiftwater rescue helmet is also highly recommended. Even if the victim is uninjured, they could easily be swept away downstream or struck in the head by an object during the rescue. Swiftwater victims may also be hypothermic and/or physically exhausted from hanging on to an object for dear life. We must protect them to the best of our abilities during the rescue.

Rope Rescue

During a rope rescue, it is standard operating procedure for any rescuers going on rope to be wearing a helmet. If the victim is going to be brought up (or down) on the rope, they should also be provided with a helmet. Safety glasses and gloves may also be appropriate. Even something as simple as a rescuer accidentally dropping a carabiner from above could result in the victim suffering a significant head injury if they are not wearing a helmet.

Remember, life safety is our number one concern at these incidents. OUR life safety, but also THEIR life safety! Stay safe out there.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC

Fracture Management in Technical Rescue

Traumatic musculoskeletal injuries in the technical rescue field are commonplace.  Unfortunately, fracture management is generally breezed over in training with a “you already know how to do this” attitude that leads to excessive verbalization and incomplete skill development.  Training scars are formed when training is incomplete, verbalized, or the right supplies are not made available for the scenario.

Everything is perishable and skills need to be practiced and completed accurately to build muscle memory. This completed training also develops the ability to adequately manage the injury in atypical situations through the application of concepts. By building adequate concept understanding you reduce the possibility of additional injury, such as internal bleeding, possible nerve damage, and additional fragment displacement. 

By practicing your skills in the training environment, you will be better prepared to utilize them in atypical or austere conditions.

Splints should meet the following three requirements:

1. Splints need to provide circumferential COMPRESSION.

2. They need to be COMFORTABLE.

3. They need to be COMPLETE. 

Now let’s discuss construction. Think about a cast. Casts are the end state for many fractures. The first layer of the cast is gauze that is pulled tight around the injury and shrinks a little to create the internal compression needed to provide support and reduce swelling. The second layer is padding to make the cast comfortable, and the outer layer is hard to provide rigid support and protect the injury from further damage.

Our field splints need to be similar but are generally built in a slightly different order. We start by selecting our rigid support materials. These can be sticks, SAM splints, trekking poles, etc. We size up the rigid support to be able to hold up the injury and place it where gravity will pull down on the injury. Then we need to apply our padding on top of our rigid support; and no, the padding on SAM splints and padded board splints are not adequate! Your padding should be 1-3 inches thick and be 360 degrees around the injury to adequately fill void spaces and provide the necessary support. Then we use our elastic wrap to compress all the soft material into a solid object.

As we sit and contemplate Newton’s Laws, we must remind ourselves of the 3rd law that discusses “equal and opposite reactions.” This law is very pertinent to our construction. The rigid support, placed where gravity is pulling down, allows for support and pushes back up. The padding placed on top provides more support and comfort. Lastly, the compressive wrapping pushes back down against the injury, compressing the tissues and materials, so that when movement occurs the bones and fragments stay put. This leads to comfort. Finally, if the splint is “complete,” it contains all the materials used so that the splint looks relatively presentable and holds together during the rescue.

Applying these concepts to any fracture will enable you to better manage your patient. You will need to be far less aggressive in your pain management, which in turn makes for a less needy patient so you can focus on the rescue. The tradeoff is that we need to take the time to do this correctly. Which means we may have a longer on scene time. Take that time! Fractures are just one of the situations where if we don’t follow these concepts, we can potentially increase the damage and negative long-term outcomes for our patients. A poorly constructed splint is the same as no splint at all! Do your patients a favor and take the time to practice correctly and apply these concepts. I promise they will thank you later!

Jason Tartalone, NRP, FAWM, WEMT-P, TP-C, EMPF
Sergeant Rescue Training & Consulting

NFPA 1006, 2021 Updates

Earlier this week, the 2021 update to NFPA 1006 Standard for Technical Rescue Personnel Professional Qualifications was released. I have been tracking the changes coming for quite some time and have been tweaking my curriculum accordingly. Here are some of my thoughts on some of the changes.

Rope Rescue Operations is a pre-requisite for…

If you remember, the 2017 update did away with the “General Requirements” chapter and moved most of those job performance requirements (JPRs) to the Rope Rescue Awareness and Operations chapters. Naturally, Rope Rescue Operations then became a pre-requisite for many of the other disciplines.

In the 2021 update, Rope Rescue Operations was removed as a pre-requisite for many of the major disciplines. It is still required for certain disciplines that require a lot of rope skills, such as Tower Rescue, Confined Space Rescue, and Swiftwater Rescue. However, it was removed from many others such as Structural Collapse Rescue Technician, which was surprising to me and something I do not totally agree with.

Ascending and descending rope is now technician level

The 2021 update has moved the skills of ascending and descending rope to the technician level. This also includes being able to self-rescue from a jammed or malfunctioning descent control device. I think this was a good move to make. Operations level personnel are still required to get on rope while being lowered and raised by their teammates, but most of the operations level skills now are boots-on-the-ground rigging skills. The technician level includes all of the more challenging on-rope skills and advanced rigging systems such as horizontal rope rescue systems.

Vehicle Rescue has been changed, AGAIN!

In the 2013 edition, vehicle rescue was still combined with machinery rescue. In 2017, vehicle and machinery rescue were split into two separate disciplines. Vehicle rescues involving passenger vehicles were considered operations level and rescues involving heavy vehicles were technician level.

In the 2021 update, the committee has separated vehicle rescue into two different disciplines. We now have Common Passenger Vehicle Rescue and Heavy Vehicle Rescue, each with their own set of awareness, operations, and technician level JPRs. The rough break down is that if the vehicle is resting on all four-wheels or as it is intended to be used, it is operations level. If the vehicle is any other position it is technician level.

I like the way the new standard breaks down vehicle rescue into two different disciplines. Unfortunately, some places still have not finished updating their curriculum to meet the 2017 revision, and this 2021 update will likely cause even more confusion at the local level.

There were obviously other changes made to the standard, but these were the three biggest updates that I noticed. Elder Technical Rescue Services, LLC will be using the updated standard in all our programs immediately. Contact us to discuss setting up training for your agency.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC

Floodwater Rescue Considerations

Water rescue incidents that occur in suburban and urban communities present challenges that may not always be present when responding to incidents on rivers and other large bodies of water. In this post, we will discuss some special considerations when responding to floodwater incidents.

Differential Pressures

This is the hazard that scares me the most because first responders have been killed and injured by it before. Differential pressure occurs whenever two bodies of water are equalizing. I have written about differential pressure numerous times before by analyzing various LODD case studies. Take a few minutes and read about them at the links below.

Floodwater LODD: Lessons Learned

Lessons Learned from a Water Rescue LODD

Contamination

Floodwater that ravages our communities will bring hazardous materials along with it. Think about the fuels and pesticides that people have in their sheds and garages. Bulk chemical storage systems at can be compromised during storm events. Sewer systems can also become inundated and spew large quantities of sewage out into the floodwater. These are just a few examples of how floodwater becomes contaminated.

The best protection from hazardous materials contamination is by avoiding it. If that is not possible, wear proper water rescue PPE which includes dry suits. Dry suits help keep the water away from your body, minimizing your potential exposure to hazardous materials. Just remember, dry suits are not actually certified chemical protective clothing and it is still possible to become contaminated even in the water rescue environment.

Widespread Effects

Typically, when there is flooding in one jurisdiction, it is likely also happening in a nearby jurisdiction due to storm activity. Normal mutual aid resources may not be available, so your agency may have to wait longer than usual for assistance or you may be working with a water rescue team that you have never met or trained with before.

Additionally, since flooding events can be so widespread, it may present itself in different ways. Some agencies will primarily respond to flooded intersections inundated by surface water (non-moving water). Other agencies will have areas of swift water (moving water) that develop with victims trapped or pinned by the power of the moving water.

If you are interested in learning more about floodwater response, we offer Flood Rescue Awareness (3 hours) and Flood Rescue Skills Development (12 hours) programs. Contact us to set up a class for your agency.

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC

Oxygen Displacement Calculations for Confined Space Rescue

In a previous post, I discussed atmospheric hazards related to oxygen deficient and enriched environments. One of the ways that an atmosphere can become oxygen deficient is from another gas being introduced into the area and pushing all the oxygen out. We refer to this process as oxygen displacement. But just how much of that other gas is present? That is the answer we are going to answer today.

Let’s do the math

In order for our oxygen concentration to decrease 1% (I.E., from 20.8% to 19.8%), there needs to be five times that amount, or 5% of another gas pushing it out. The reason for that is because oxygen is only 1/5 of the normal atmosphere. Let’s remember that we can also express percent of atmosphere in terms of parts per million (PPM), with 1% equaling 10,000 PPM.

Calculations:

Step 1 – Subtract your current oxygen percentage from 20.8 to determine how much it decreased.

Step 2 – Multiply that number by 10,000 to convert it to PPM.

Step 3 – Multiply that number by 5 to account for the fact that oxygen is only 1/5 of normal atmosphere.

Practical application

Observe the readings on the detector and calculate how much of another gas is present in the confined space.

Step 1 – 20.8% – 19.1% = 1.7%

Step 2 – 1.7% x 10,000 = 17,000 PPM

Step 3 – 17,000 PPM x 5 = 85,000 PPM

That is A LOT of another gas! It could easily be well above the immediately dangerous to life and health (IDLH) level for that gas. If your detector does not have a sensor capable of detecting the displacing gas, you may have no indication that it is present other than your oxygen percentage decreasing. The moral of the story is that any drop in your oxygen percentage may indicate something bad is present!

Bill Elder
Owner / Lead Instructor
Elder Technical Rescue Services, LLC