F.A.I.L.U.R.E.s of Technical Rescues
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Last month I wrote about the last time your team practiced a scenario involving the command level of a technical rescue evolution. I hope you have taken the opportunity to do exactly that. If it has been a while, you may have run into a problem with one or more areas of the evolution. If your team met with a failure, hopefully a F.A.I.L.U.R.E. acronym will help identify the area where problems occurred — and assist in reducing the possibility of problems in the future. This acronym can be found in Buddy Martinette's book, "Trench Rescue Awareness, Operations, Technician."
All of the above reasons can have a significant impact on the survivability of a viable patient and can increase the chances of a fellow firefighter being injured.
Failure to understand or underestimating the environment
This is one of the primary reasons for a rescuer or victim fatality. Not understanding the hydraulic forces exerted on the open walls of a trench can lead some to treat this environment as every other area they have worked in. The idea that, "it can’t happen to me," may be the same complacency that buried the excavator we were called to rescue. Knowing the hazards of the confined space environment will assist in developing an Incident Action Plan to ensure all possible hazards have been considered.
Additional medical implications not considered
Knowing the significant weight load from the dirt in a trench collapse can drive medical personnel to consider the possibility of compression syndrome. They will also know that once that weight is removed, the compressive forces of the soil that impeded blood flow will now allow toxins from an anaerobic metabolism to be released into the body. An informed, experienced pre-hospital provider will already have an EKG monitor attached and ALS medications ready for intervention. Being ahead of the treatment game in this type of patient is the only way to improve the chances of survival for the victim.
Inadequate rescue skills
This statement should not be misconstrued to insult those individuals who do their best with the knowledge they have. But if your department has the technical rescue equipment, shouldn't you know how to properly use it? A good example would be confined space air management equipment. A large number of companies posses the "air cart" as part of their equipment, but can you run two separate entrance teams, a victim air line and also a low pressure air tool off of the same piece of equipment? This critical piece of survival equipment should only be managed by someone who is familiar and practiced with this device.
Lack of teamwork and experience
Emergency situations are the worst possible time to find out that your Airshore equipment may not necessarily mate with the Paratech equipment carried by your neighboring automatic aid rescue companies. Do you carry Hansen, Foster or Paratech air line fittings? Do you carry adapters to deal with this problem? Or have your regional teams already agreed upon a singular fitting to be used on all air systems? Do you all use the same confined space escape packs by the same manufacturer? Do you know what your neighbors' skill level is and have you trained with them? Have you worked together on trench, confined space, collapse, water rescue and extrication scenarios? Do your crews feel comfortable with each other and do they feel comfortable with each other? When is your next drill scheduled with your neighbors?
Underestimating logistical needs
Unless your department is one of the very few large (lucky!) departments that is capable of carrying all the technical rescue equipment necessary to deal with a progressive trench collapse, you will need more equipment and personnel to complete a complicated tech evolution.
A simple trench collapse where two pairs of panels and shores are placed will take about eight persons per pair of panels. This does not take into account the command team or medical specialists. If you wish to place successive series of panels, you will need both more toys and more personnel. Do you know where to get it from and are you lucky enough to have them dispatched at the same time as your resources?
Rescue versus recovery not considered
Like cars and drugs, speed kills! Not considering the impacts of the evolution may lead a crew to take unnecessary risks for a body recovery. Here's an example: An individual in a confined space is engulfed in a flammable liquid-based product. It takes on average a minute to collect a 911 caller's information and to dispatch initial resources. If the first on-scene unit does not get there until four minutes later, the victim has most likely expired, based on the total extent of burial. Then, build on the time required to assemble the required confined space equipment, suit out, flush the flammable liquid out of the space, ventilate and ready a team. This will take about 10-15 minutes for a well-practiced team. By this time, we should anticipate that we are performing a body recovery. Now this is an extreme but realistic scenario; the Incident Commander should always be collecting information and projecting the survivability of an event for a victim. If all the facts show a drastically reduced possibility of survival, build the command structure and advise the rescuers this is a recovery and pace yourselves accordingly. This is a very difficult call to make as an IC, but it can save one of our own.
Equipment not mastered
The best intentions will not defeat lack of ability. Individuals must take the time to familiarize themselves with the equipment being carried. You must know a manufacturer's recommendations for operations and any other "informal" operational methods that can be learned from others. Know also how to clean and maintain this same equipment. Who is your contact for preventive maintenance and who is it sent to for repairs? Knowing your equipment better will give you more options for utilization.
In addition to the F.A.I.L.U.R.E. acronym, remember that we are action-oriented individuals. We are fire service/EMS professionals because deep inside we are control- oriented people. We thrive on the ability to change chaos and create order. Technical rescue specialists are even more driven to find a solution to solve complex problems. However, technical rescue is also when time should be taken to collect all possible information to design a safe operational plan. We cannot substitute speed for brains!
Remember, we can train out ignorance with practice— but we can't fix stupid!
Please remember to take the time to become a master of your trade. Firefighting requires a significant amount of time and effort to be competent. It takes a driven individual to invest the time and training required to be a practiced Technical Rescue Specialist.