4 Search Operations and Victim Management 4 Objectives

4 Search Operations and Victim Management

4 Objectives (1 of 4) • Discuss the use of search tactics during search and rescue operations. • Describe emergency medical response system levels of service. • List general hazards that may be present during victim management at a technical rescue event.

4 Objectives (2 of 4) • Describe victim access considerations and procedures. • Describe victim stabilization. • Identify the need for triage at a technical rescue incident.

4 Objectives (3 of 4) • List common victim injury patterns related to technical rescue events. • Describe types of patient packaging devices and their use. • Explain the safety procedures for working around helicopters.

4 Objectives (4 of 4) • Describe response planning and incident management requirements related to victim management at a technical rescue event.

4 Victim Management (1 of 2) • Identifying hazards to which a victim may be exposed • Accessing victim or victims • Performing triage for multiple patients

4 Victim Management (2 of 2) • Assessing and stabilizing patient injuries • Interacting with victims • Moving and transferring victims requiring technical rescue assistance

4 Awareness Level Responders • Identify the location of rescue victims upon first arrival. • Gain access to the victims’ location. • Assist more qualified rescuers with patient movement and transfer.

4 Search Phase (1 of 2) • • Time during which patients are located Location may be clear or unknown Entrapment makes more complex Can be prolonged and require many resources depending on situation

4 Search Phase (2 of 2) • Search operations involve combination of: – Detective work – Analysis work – Speculation – Use of search tools, equipment, tactics

4 Search Environment Determines • Difficulty of search operations • Amount of required resources • Tactics utilized

4 Examples of Environments • Water • Wilderness • Structural collapse

4 Search Tactics • Methods depend on type of rescue, drives decisions regarding tools or techniques • Reconnaissance to gather information regarding type, size, complexity of situation • Witness interviews to obtain information – Includes victim’s last known location

4 Factors That Determine Urgency • Time elapsed • Victim profile, including experience and available survival equipment • Environmental conditions • Terrain/hazards • History of incidents in area/site

4 Search Plan Based On • • Urgency of search Available resources Existing hazards to responders Known information about victim or victims

4 Define Search Area • Search grid: – Identifies, prioritizes, documents search area – Starts search in specific area • Segmentation: – Allows for search of large area – Establishes specific search area boundaries

4 Primary and Secondary Searches • Primary search: – “Hasty” search – Deployment of resources to initiate rapid search of area thought to contain survivors • Secondary search: – Slower, methodical search to ensure no victims overlooked

4 Search Resources (1 of 2) • Determined by type, complexity of problem • Might include specialized personnel resources, such as: – Incident management personnel – Trained or specialized searchers – EMS – Search dog handlers

4 Search Resources (2 of 2) • Specialized vehicles, such as: – Helicopters – Off-road vehicles – Horses – Watercraft • Require plan ahead of time

4 Basic Life Support (BLS) (1 of 2) • Medical first responders or EMT-Basics • Limited set of emergency medical skills • Can perform cardiac defibrillation using AED • Cannot administer medications beyond: – Assisting patient with prescription medications – Administration of IV fluids

4 Basic Life Support (BLS) (2 of 2) Courtesy of Yellowstone National Park/NPS

4 Advanced Life Support (ALS) (1 of 3) • Extensive training required; greater investment in equipment and personnel training than BLS • Operate as extension of physician, using standing orders, protocols, radio direction

4 Advanced Life Support (ALS) (2 of 3) • May require more personnel at emergency • Training levels include: – EMT-Paramedics – EMT-Intermediate includes limited ALS skills

4 Advanced Life Support (ALS) (3 of 3)

4 Primary Hazard • May be larger event, such as a natural disaster • Specific type of technical rescue may be secondary factor or cascade event created by larger event • Can create other hazards for rescuers, such as flooding, electrical wires, debris • Rescuers may also create hazards at rescue site.

4 Hazard and Risk Assessment Identifies • Hazards rescuers will be exposed to • Hazards victims must be protected from • Level of personal protection equipment (PPE) required • Necessary safety procedures

4 Hazard and Risk Assessment © Dennis Wetherhold, Jr.

4 Vehicle Accident Hazards Include • • • Fuel spills Jagged metal, broken glass Uncontrolled traffic flow Unstable vehicles Air bag systems and hydraulic systems Possibly hazardous cargo

4 Trench Collapse Hazards Include • Potential for secondary collapse that may entrap rescuers • Atmospheric hazards • Exposure to broken utility lines

4 Confined-Space Hazards Include • Exposure to oxygen-deficient, explosive, toxic atmospheres • Engulfment potential from flowing products • Uncontrolled energy sources • Reduced visibility • Slippery surfaces

4 Needs Identified by Hazard and Risk Assessment • Special technical rescue protective gear • Placing and staffing of protective hose lines for fire hazard • Controlling broken utilities or uncontrolled energy sources • Obtaining flotation device • Additional or specialized resources

4 Perform Hazard Evaluation Before Initiating Patient Care • Critical to rescue • Patient care shifts focus away from environmental hazards. • Hazards may worsen, especially in dynamic situations. • One crew member should be disconnected from patient care, continuously evaluating the environment.

4 Victim Access (1 of 3) • Complexity varies depending on the entrapment type. • Type of technical rescue determines difficulty. • Victim location precipitated during the search phase. • Requires control or reduction of hazards that may affect rescuer

4 Victim Access (2 of 3) • Procedures, access equipment, and access techniques vary widely. • Rescuers should continuously look for new hazards. • Major goal to secure, stabilize victim and protect from further harm • Rescuers must identify escape route prior to entry.

4 Victim Access (3 of 3) Courtesy of Robert Rhea

4 Victim Assessment (1 of 2) • First priority following assessment • Identifies patient injuries and adverse medical conditions • Determines resources to extricate, package, transport patients

4 Victim Assessment (2 of 2) • Based on medical protocols established by AHJ and applicable local, state, federal laws: – Ensure protection from bloodborne via PPE – Adherence to written protocols related to BSI

4 Victim Stabilization per BLS • Establishing and maintaining adequate airway • Providing respiratory ventilation to maintain air flow • Controlling severe bleeding • Maintaining circulatory system • Spinal immobilization or shock treatment, if necessary

4 Triage (1 of 2) • Sorts patients based on severity of injuries or medical conditions • Essential in mass-casualty incidents where increased number of patients strains resources • Review mass-casualty triage process. • Follow local medical protocols to determine patients with highest priority.

4 Triage (2 of 2) © Scott Downs/Dreamstime. com

4 Common Injury Patterns • Rescuers should be familiar with common injury patterns related to specific rescue scenarios. • Review injury patterns for: – Vehicle accident entrapment – Confined-space – Trench and structural collapse – Wilderness – Water

4 Victim Packaging, Movement, and Transfer (1 of 4) • Performed after victim access, assessment, initial treatment • Often uses long spine board or similar device • Rescuers choose the appropriate packaging device for the environment. • Goal is completing process safely, efficiently, limiting further injury

4 Victim Packaging, Movement, and Transfer (2 of 4) • Special equipment may be necessary. • Ends with patient transfer, or handing-off patient to EMS responders for transport to medical facility

4 Victim Packaging, Movement, and Transfer (3 of 4)

4 Victim Packaging, Movement, and Transfer (4 of 4) Courtesy of Junkin Safety Courtesy of Ferno Washington, Inc.

4 Resource Requirements • Emergency medical services resources: – Can be significant, depending on situation and environment • Specialized victim packaging and transfer equipment: – May need to fit in small, space-limited areas – Must allow for proper victim management, stabilization, movement – Multiple patients requires multiple patient packaging devices

4 Transport Vehicle Options (1 of 3) • Ambulances • Mass-care vehicle, like a medical bus used for numerous patients • Commercial or school buses • Aircraft for serious injuries

4 Transport Vehicle Options (2 of 3)

4 Transport Vehicle Options (3 of 3) Courtesy of the Prince George’s County Fire/EMS Department

4 Helicopter Usage (1 of 2) • Initial reconnaissance and large-area search operations • Transport rescue teams over long distances and in isolated areas that are difficult to access by ground • Flood and swiftwater rescue • Serious medical emergencies

4 Helicopter Usage (2 of 2) © Fred L. Isom/Shutter. Stock, Inc.

4 Helicopter Resources • Agency supplying helicopter determines helicopter needed for particular rescue • Identify locations and response times of helicopter resources during response planning. • Rescue response agencies should have SOGs related to helicopter assistance.

4 Helicopter Safety and Landing Zone Management (1 of 2) • Be aware of hazards directly related to approach, landing, and takeoff. • Be aware of procedures for identifying, procuring, and securing landing zones. • Be aware of safety guidelines for working around a helicopter.

4 Helicopter Safety and Landing Zone Management (2 of 2)

4 Incident Management Requirements • Use ICS to achieve strategic objectives. • ICS staffing and positions are determined by scope of event. • ICS management personnel are responsible for strategic and tactical management.

4 Response Planning (1 of 2) • Perform regular needs assessments to determine vulnerability to various technical rescue events. • Identify capability of agency personnel in advance, including level of performance at which agency personnel are trained.

4 Response Planning (2 of 2) • Understand location, capabilities, and response times for regional, state, federal search and rescue teams and medical teams.

4 Summary (1 of 2) • Victim management includes identifying hazards, accessing victims, performing triage, assessing patient injuries, stabilizing victim injuries, interacting with victims, and moving and transferring victims. • Resource requirements vary, depending on entrapment problem and number of victims.

4 Summary (2 of 2) • Effective planning incorporates risk assessment, resource assessment, and development of written procedures. • Rescuers must understand types of common injury patterns. • ICS may be necessary to control the emergency.