1. Chapter 16
Rescue Procedures

2. Introduction Rescue has many meanings
Actions that trained firefighters perform to remove someone from imminent danger
Extricate people if they are already entrapped
Firefighters must be aware of existing dangers and minimize the risks
Consistent training required to keep up to date
This chapter only touches the surface

3. Hazards Associated with Rescue Operations
Hazards associated with every type of rescue operation
Tunnel vision: focusing on a particular problem without considering alternatives/consequences
Risk/benefit analysis performed each time personnel committed to rescue operations
Reassess continually throughout operation
Establish exit points and safe havens

4. Safe Havens
Safe havens are areas of refuge that can be utilized while waiting to be rescued or until you are able to escape the hazardous condition.
Utilized when firefighters can no longer exit in the same manner in which they entered due to a dangerous condition
Firefighter should identify safe havens and employ basic survival techniques that will allow them to escape the situation

5. Safe Haven Characteristics
Characteristics are basically the same for all emergency incidents
Temporary safe area
Away from the hazard
Tenable environment
Identifiable by rescuers
Allows for self rescue
Safe havens are identified to provide temporary safety during a dangerous situation

6. Safety and Survival
Upon entry of a safe haven, firefighters should employ safety and survival techniques
Initiate Mayday
Maintain constant communication with Incident Commander
Stay calm and conserve air
Maintain constant contact with crew members
Position yourself away from hazard but next to wall or window to allow rescuers to find

7. Safety and Survival (cont’d.)
Upon entry of a safe haven, firefighters should employ safety and survival techniques (cont’d.)
Lay horizontal with PASS device positioned effectively and create audible sounds such as tapping
Firefighters should be prepared to use all of the skills necessary for self survival and rescue 7

8. Figure Well-equipped interior structural firefighting/search and rescue crews need a minimum of full PPE, SCBA, PASS, forcible entry tool, flashlight, portable radio, and thermal imaging camera.

9. Search of Burning Structures
Two-in/two-out:
Work in teams of two or more
Two firefighters standing by immediately outside
Perform rescue profile before entering
Occupancy type/time of day
Fire/smoke conditions
Activity clues
Maintain awareness of position within a building
Team members stay together
Leave a light at the entry point

10. Figure During an interior search, firefighters should stay in contact with a wall. If visibility is hampered, firefighters can reach into the center of the room using a tool or a “human chain” technique.

11. (A)
(B)
Figure Crawling, holding on to one another in a straight line (A) is not very productive when searching. Extending off one another toward the center of an area being searched (B) will allow more area to be covered in a quick manner.

12. Primary Search Search for both life and fire
Conducted prior to fire being controlled
One of the most dangerous activities
Search areas most likely to have victims
When searching fire floor, go to fire area and search backward toward entry point
Above the fire floor, work toward fire
Visibility often obscured by smoke and darkness
Pause occasionally to listen for victims

13. Secondary Search Conducted when fire is out or under control
Much more thorough since no immediate fire danger
Search through debris
Search building exterior for victims who have jumped or escaped and are injured
Recommended that different crew perform secondary search
Secondary search must be thorough
Many victims have been missed on search efforts and their bodies discovered after firefighters leave

14. Thermal Imaging Cameras and Search
Thermal imaging cameras (TICs) aid in search efforts and identifying potential hazards
Infrared energy has three types of emitters:
Passive emitters
Active emitters
Direct source emitters
Drawbacks and limitations:
Expensive; do not replace basic search techniques
Do not see through glass or water

15. Figure 16-11 Infrared energy is not visible but is part of the electromagnetic spectrum.
Figure Visual representation on a TIC screen.

16. Figure Visualizing convected heat currents on the TIC can help firefighters determine the location and extent of a fire.

17. Large Area or Rope-Assisted Team Search
Rope anchored to stationary point outside hazardous environment
Firefighters lead out the search line
Team crawls into the structure following the line
Five to seven firefighters required
Team leader
Control/Entry supervisor
Remaining firefighters

18. Figure Large area occupancies generally have not only large open spaces but may also incorporate obstructions (shelf units, machines, displays, etc.) at various and random locations within the open spaces.

19. Figure Firefighters should work from a search rope bag that can be shouldered while controlling the rope as it is deployed from the bag.

20. Figure 16-18 Semicircular main line search pattern.

21. Rapid Intervention Teams
Average of 12 firefighters to remove one downed firefighters
As many as 20 percent become victims themselves
Five goals:
Locate firefighter
Assess condition and environment
Provide emergency air supply
Call for additional teams and resources
Attempt to remove firefighter

22. Victim Removal, Drags, and Carries
Victims removed carefully and expeditiously
Do not cause any further injury
Rescue situations sometimes prevent rescuer from using all the care a person would like
All carries and drags place additional stress on rescuer’s musculoskeletal system
Tighten core muscles around hips, back, torso
Keep spine in neutral position
Use legs and buttocks for leverage and lifting power

23. Carries Extremity carry: Seat carry:
Conscious and unconscious patients
Requires two rescuers
Seat carry:
Conscious patients

24. Drags Blanket drag Lift and drag Push and pull drag
Uses blanket or salvage cover
Requires one rescuer
Lift and drag
Conditions must allow standing up
Push and pull drag
Works well for removing unconscious firefighter
Requires two rescuers

25. Figure 16-20 Webbing and pre-manufactured slings can be valuable for dragging a victim.

26. Ladder Removals
Bringing a victim down a ground ladder requires four to six team members
Rescuers on the inside get victim over windowsill
Exterior team gets victim down safely
Communication between teams very important
May present the victim head- or feetfirst, facing toward or away from the rescuer
If rescuer feels loss of control, leaning into ladder will stop the victim from moving

27. Backboard, Stretcher, and Litter Uses
Preferable to use a backboard, stretcher, or litter
Designed to provide protection, immobilization, safety
Backboards provide spinal immobilization
Rescuer at patient’s head maintains traction and directs effort
Patient placed on stretcher by extremity carry, utilizing backboard, or having patient lie directly
Patient must be secured as soon as possible

28. Extrication from Motor Vehicles
Extrication more difficult in larger vehicles
Heavier structural components and crash severity
Follow pre-determined sequence of events:
Scene assessment
Establishment of work areas
Vehicle stabilization
Patient access and stabilization
Disentanglement
Patient removal
Scene stabilization

29. Tools and Equipment Firefighter’s most valuable tool is knowledge
Power hydraulic tools
Hydraulic pump supplies pressure to operate spreaders, cutters, and rams
Air bags can lift heavy loads a considerable distance
Air chisels and reciprocating electric saws have evolved

30. Figure 16-21 Gasoline engine-powered hydraulic pump for extrication equipment.

31. Figure 16-22 Power hydraulic spreaders.
Figure Power hydraulic cutters.

32. Figure 16-24 Power hydraulic rams.
Figure Power hydraulic combination tool.

33. (A)
(B)
Figure (A) A typical high-pressure air bag set. (B) A typical low-pressure air bag set. (Courtesy of Rick Michalo)

34. Figure 16-28 A high-pressure air chisel kit. (Courtesy of Rick Michalo)
Figure A battery-powered reciprocating saw.

35. Scene Assessment (Size-Up)
Predetermined sequence of steps or actions
Carried out by the officer
Scene safety considerations:
Traffic
Number and type of vehicles involved
Potential number and extent of injuries
Hazardous conditions
Degree of entrapment
Assessment determines need for additional resources

36. Establishment of Work Areas
Ideally, all traffic in and around area of vehicle incident should be shut down
Congestion creates secondary hazards
Traffic barrier
Large fire apparatus can form initial barrier
Park at a slight angle
Traffic calming:
Warn approaching traffic of upcoming hazard
Hazards zoning

37. Figure The first-arriving large fire apparatus should be positioned to create a traffic barrier and work zone. Cones and a spotter/flagger can help re-route traffic.

38. Vehicle Stabilization
Required on all accidents
Put transmission in gear and chocking a wheel
Cribbing, air bags, ropes, etc.
If vehicle has injured person inside, take the weight off the suspension system
Cribbing
Deflate tires
More complex situations require more complex tools

39. Patient Access
Provide a pathway for the rescuer to evaluate and care for the patient
Remove or fold back the roof
Through a window that can be broken or removed
Once access is gained:
Patient evaluated; life support activities initiated
Patient’s position evaluated
Patient protected from further injuries
Packaging initiated

40. Figure Many times access to the patient can be made by removing the rear window. Note that the vehicle is properly cribbed, and the glass edges the patient attendant has to crawl over are covered. (Courtesy of Rick Michalo)

41. Removing Glass Glass used in vehicles is laminated
Tempered glass removed by striking with point of a tool
Penetrates the passenger compartment if rescuer loses control
Spring-loaded center punch applied to corner of the glass breaks it in more controlled manner
Windshield removal performed with removal of roof
Significant time savings

42. Disentanglement
Rescuer advises the incident commander as to the extent of injuries and mechanical entrapment
Best pathway determined
Disentanglement methods:
Disassembly
Distortion
Displacement
Severance

43. Patient Removal
When pathway created and made as safe as possible packaged patient removed
Goal to minimize aggravation of existing injuries
Removal should be made only with direct supervision of certified EMS responder
Often patient removal and movement to ambulance takes rescuers out of work area
Spotters watch for traffic during patient movement
Escape routes planned

44. Scene Stabilization
After patient removal, firefighters secure incident scene
Hazard assessment continual
Vehicle recovery
Tow operator must be advised of vehicle hazards
Fluid/parts cleanup
Dry absorbent used for oils, engine coolant, diesel fuel
Gasoline best absorbed with fuel pads
Use gloves that can be decontaminated

45. Specialized Rescue Situations and Tools
Specialized rescue calls are more dangerous
Many times rescuer fatalities outnumber initial victims of the accident
Elements imperative in specialized rescue:
Continual hazard assessment, risk/benefit analysis
Operating guidelines and procedures
Scene control
Incident management and accountability

46. Rope Rescue
Victim either above or below normal ground level and beyond practical means of rescue
Vertical or high-angle rescue entails the victim and rescuer relying on rope for support
Hazards in addition to falling hazard:
Bad or slippery footing
Falling objects
Hazardous atmosphere
Equipment misuse
Utilities
Trip hazards

47. Figure Vertical or high angle rescue entails the weight of the victim and rescuer relying solely on rope for support. (Courtesy of James Pelliterri)

48. Water Rescue Water rescue is very dangerous for rescuers
Methods and procedures:
Reach
Throw
Row Go
Swift-water rescue a specialized field
Rescue workers working at an ice rescue should have thermal rescue suits

49. Figure A firefighter using the reach method to rescue a victim in the water. Note the PFD and the use of a pole to extend the firefighter’s reach.
Figure A firefighter using the throw method to rescue a victim in the water. Note the PFD and the underhand throwing technique.

50. Figure A firefighter using the row method in a small boat to rescue a victim in the water. Note the extra PFD in the boat for the victim. Do not attempt to lift the victim into a small boat; instead have the victim hold on to the side.
Figure A firefighter using the go method to rescue a victim in the water. Note that the firefighter is carrying an extra PFD for the victim.

51. Structural Collapse Rescue
Five stages:
Reconnaissance and rescue of surface victims
Void search
Selected debris removal
General debris removal
Debriefing
Three types of collapse:
Pancake collapse
Lean-to collapse
V-type collapse

52. Figure 16-47 A pancake collapse
Figure A pancake collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.

53. Figure 16-48 A lean-to collapse
Figure A lean-to collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse.

54. Figure 16-49 A V-type collapse
Figure A V-type collapse. Note voids, where survivors may be located, that have been created by debris during structural collapse. 54

55. Reconnaissance and Rescue of Surface Victims
Initial size-up uses a six-sided approach
Hazards handled in four ways:
Avoid hazard area
Remove the hazard
Shore or support the hazard
Monitor the hazard for deterioration
Hailing system for victims who can respond
Basic knowledge of cribbing, shoring, tunneling

56. Trench and Below-Grade Rescue
Trench: excavation deeper than it is wide
Maximum width 15 feet
In trench collapse:
Uncover victims head and chest
Supplement respiration with oxygen
Use ground pads to distribute weight
Fissures in soil or sides of trench indicate additional collapse
Throw victim a rope in case of secondary collapse

57. Figure Rescuers entering a trench must have the necessary training and equipment put into place prior to entry. (Courtesy of James Pelliterri)

58. Confined Space Rescue Confined space:
Large enough to be entered for working
Limited entry and exit points
Not designed for continuous occupancy
Isolate hazards through lock out/tag out procedure
Common hazard is oxygen-deficient atmosphere
Hazardous or toxic vapors
Sample the atmosphere before entering

59. Rescue from Electrical Situations
Assume electrical hazards are energized
Victims in contact with electrical wire also energized
No protective clothing is designed to protect from electrical current
In vehicle accident, vehicle may be energized and passengers are safe unless they exit
Ground gradient: tingling sensation in boots
Back away with a shuffle foot motion
Reel coil: wire will spring away from point at which it was cut

60. Industrial Entrapment Rescue
Usually a complex process
Procedure for vehicle extrication applies with minor changes
Stabilization of entrapping machinery begins with shutting down the power
Release stored energy in the machine if this will not cause further movement
Crib or block entrapping part
When possible, operate the machine through rest of its normal cycle, or back out

61. Elevator and Escalator Rescue
Immediately request the dispatcher to confirm the service company has been called
Unless there is a compelling medical emergency, await arrival of service technician
Escalator usually involve passengers getting caught in landing plate or hand rail
Most escalators have emergency shutoff switches at bottom landing
Landing plate can be removed by removing screws
Handrail loosened by wheel that drives handrail

62. Figure Elevator cars may have top emergency access panels, side emergency access panels, or both.

63. Farm Equipment Rescue
Rescue of victims injured by farm equipment very challenging
Equipment usually must be disassembled
Events located far from paved roads
Specialized training should be provided to firefighters
Local equipment dealer an excellent source of information

64. Lessons Learned
Much greater variety of real-life rescue situations than covered in this chapter
Rescue situations are low-frequency events
High risk to firefighters
Risk/benefit analysis must be ongoing
Firefighter should not be put in hazardous situation to save something already lost
Stay aware of “big picture” to stay safe and avoid tunnel vision