Most suspended, confined-space rescue victims are working in some capacity and are using a fall-arrest system; here’s how to treat and reach those victims
In the world of confined space, most of our victims are going to be entrants who are performing work as an employee. This implies several things.
They are most likely going to be operating with some degree of compliance with industrial guidelines. These guidelines require workers at height to have Class III harnesses and fall-arrest equipment. They also are required to be rigged to a retrieval system such as a winch.
Therefore, it makes sense for rescuers to develop rescue skills that address this presentation. This can play out in two ways.
First, the victim is simply a worker at height who is attached to a fall-arrest system and falls into the confined space. The system operates properly and arrests the fall but results in a suspended victim who must be hauled out with a supplemental system.
Second, the victim is being lowered or climbing down into a confined space on a retrieval system and encounters an event (illness, injury or system malfunction) that strands him at mid height. This also requires the victim to be retrieved, but the existing winch system and high directional anchor may be inadequate to perform that task.
Treating the victim
In either of these scenarios, our first consideration is the hazards associated with the confined-space environment and the condition of the victim. We will leave hazard management for another discussion and focus on the condition of the victim.
Quickly establish a timeline and an initial assessment of the victim’s progression towards suspension trauma — a condition where the compression applied to the victim’s lower extremities by the harness causes circulatory compromise. The victim will develop toxins in their lower extremities and exhibit signs of confusion, syncope, heart palpitations and potentially cardiac arrest.
Most research suggests that this event is going to happen if the compression of the lower extremities is not relieved and the recirculation managed. However, the predictability of how fast the symptoms will progress is highly dependent upon individual body types and characteristics.
So, play it safe and assume it may progress quickly. Even if the victim is not presenting with signs and symptoms of suspension trauma, aggressively prevent it by relieving the compression. Conscious victims can be coached to relieve compression by changing their body position in the harness or stepping up with foot loops that may be a part of their harness or one lower to them.
Unconscious or incapacitated victims must be quickly retrieved. Once they are topside, gradually progress the victim from a fowlers position to a semi fowlers position over approximately a 15-minute period to prevent flooding their circulatory system with the toxins built up in their lower extremities. Laying them flat quickly may result in cardiac dysrhythmia and arrest.
Scenario one
In the first scenario, the victim was relatively close to the top side and accessible. These fall-arrest systems have limited play in them and typically don’t play out more than 24 inches once they are activated.
The most effective way to rescue these victims is to use an extension or reaching device that will allow rescuers to attach retrieval and belay lines without making entry or wasting time descending or being lowered to the victim. Victims can also help make these attachments if they are capable.
In these industrial settings, high-directional anchors, or HDAs, are almost a necessity. If structural anchors are not accessible, rescuers should have portable HDAs such as tripods, bi-pods, or mono-pods. Not developing an HDA will make the edge transition extremely challenging for the rescuers and victim.
Simple systems such as block and tackles (4:1/5:1) with integrated cams or progress capture devices are fast to deploy and very efficient in straight up and downs like this. Once the belay line and haul system are attached to the victim’s harness, the victim can be hauled up and treated.
The vast majority of industrial harnesses use dorsal or posterior rigging points. This helps in this application because the loaded arrest system pulls the rigging point up above the victim’s shoulders and leaves it readily exposed for rescuers.
Scenario two
The second scenario involves not just a fall-arrest system but a retrieval system as well. Industrial retrieval systems present decision-making challenges.
Most of them are not compliant with rescue standards. The safety factor and load design are typically under-engineered for our needs. Additionally, victims who are not packaged or tended can become hung up on stairwells or other obstructions in the confined space.
I strongly recommend taking the time to evaluate the safety of the retrieval system before using it as a rescue tool. I also strongly recommend avoiding blind retrievals.
If they are attached to a winch but you do not have line of sight on them to ensure they are not and will not get hung up, do not start cranking the winch. Winches will not give you the same alert if the system meets unexpected resistance as will a rope-based retrieval system. I always prefer buffers for my potential mistakes or factors that may impede the rescue.
Conversely, industrial retrieval systems may facilitate the rescue. If the system is commensurate with the loads you will apply to it and is in good working order, you can use it. If it is not already attached, the winch cable can be deployed and attached to the victim using the applications from the previous scenario, and the rescue can be performed.
Remember to let the victim’s survival profile and the safety of your crew drive your decisions. Risk a lot to save a lot, and when you make a high-risk decision, do it from an informed and fully aware perspective.
