DOCUMENT RESUME ED 330 875 TITLE Rescue Manual.

PREFACEThe Ohio State University Instructional Materials Laboratory has played a major role in the training ofpublic safety personnel through the development of text materials for many years. Due to the advances inthe rescue techniques, it became apparent that the existing text was obsolete. Upon the advice of manyknowlegeable people in the rescue service, the Instructional Materials Laboratory initiated the developmentof a new text that would be easily updated, and address the needs of the rescuer. To this end, an editorialreview board representing a broad spectrum of individuals in the various phases of the research professionwas convened to determine what topics this text should address. The culmination of this effort is the RescueManual. It is hoped that this text ran be useful to not only the new rescuer but will serve as a referencesource for the experienced rescuer.Ronald SlaneTechnical ConsultantCollege of EducationThe Ohio State UnivereityJoyce LeimbachCurriculum ConsultantCollege of EducationThe Ohio State University9vi

MODULE 1TABLE OF CONTENTSIntroduct ion1Occupational Stresses in Rescue Operations3Size-upCritique711Reporting and RecordkeepingTools and Equipment for Rescue OperationsPlanning for Emergency OperationsIncident Command SystemDealing With Natural Disasters1723253337MODULE CONTENTSThe 1989 Rescue Manual has been grouped into ten modules in accordance with the recommendationsfrom the Rescue Editorial Board.Module 1Module 5IntroductionOccupational Stresses in Rescue OperationsHazardous MaterialsSize-upCritiqueModule 6Industrial RescueRescue From a Confined SpaceExtrication From Heavy EquipmentRescue Operations Involving ElevatorsReporting and RecordkeepingTools and Equipment for Rescue OperationsPlanning for Emergency OperationsIncident Command SystemDealing with Natural DisastersModule 7Extrication From VehiclesModule 2Module 8Patient Care and Handling TechniquesRenue Carries and DragsTrench RescueShoring and Tunneling TechniquesFarm Accident RescueWilderness Search and RescueAircraft RescueHelicopter InformationEraergency Vehicle OperationSelf-Contained Breathing ApparatusProtective ClothingModule 3Forcible EntryStructure Search and RescueRescue Operations Involving ElectricityCutting TorchesModule 9Ice CharacteristicsRiver Characteristics and Tactics for RescueWater Rescue TechniquesWater Rescue/Recovery OperationsDive OperationsWater Rescue EquipmentWater Rescue Safety TipsModule 4Construction and Characteristics of Rescue RopeKnots, Bends, and HitchesCritical AnglesRaising SystemsRiggingModule 10Using the Brake-Bar Rack for Rope RescueRope Rescue TechniquesAerial Ladder and Aerial Platform RescueGlossary'AppendixPUBLIC SAFETY SERVICES PUBLICATIONS AVAILABLEFor ordering and pricing information contact:Instructional Materials LaboratoryThe Ohio State University842 West Goodale BoulevardColumbus, Ohio 43212Phone (614) 221-4950vii10

MODULE 1ACKNOWLEDGMENTAcknowledgment is extended to the following persons for their willingness to share their knowledge andexpertise and for authoring information presented in this module:IntroductionDan Hoffman, Paramedic-Firefighter, Liberty Twp. Fire Department, Powell, OhioOccupational Stress in Rescue OperationsDouglas Rund, M.D., FACEP, Associate Professor and Director, The Ohio State University, Divisionof Emergency Medicine, Columbus, OhioSize-up, Critique, and Reporting and RecordkeepingGlenn Alexander, Chief, City of Dayton Fire Department, Dayton, OhioTools and Equipment for Rescue OperationsMike Warner, Firefighter-Paramedic, Medina Fire Department Life Support Team, Medina, OhioPlanning for Emergency Operations and Dealing with Natural DisastersBob Pettit, Assistant Chief of Staff for Planning, Ohio Emergency Management Agency, Columbus,OhioIncident Command SystemGary Fellows, Fire Protection Engineer, Wheeling Pittsburgh Steel Co., Wheeling, West Virginia11viii

1INTRODUCTIONTo date there has been little rescue material available that addresses a multitude of rescue techniquesin one collective effort. The Instructional MaterialsLaboratory at The Ohio State University has developed instructional manuals and audiovisuals forpublic safety services for many years and continuesto address the needs seen in emergency efforts.This rescue manual represents an immense un-dertaking. It provides suggested procedures andtechniques that can be used in many emergencysituations. It was authored and reviewed by manymedical technician and water rescue procedures, firefighting procedures and hazardous materials handling, farm and trench rescue procedures, or othercombinations. Cross-training enables a rescuer toassist in more than one kind of emergency, and tofill in for othell. when necessary. It also allows optimum use of personnel. There is no way for oneperson to train for every type of rescue. Every rescueoperation is diffei ent, but most rescues have somecommonalities.subject-matter experts. Rescue operations often involve risk-taking procedures. Rescuers must alwaysTraining and actually performing rescue operations gives personnel experience in techniques andprocedures. Preplan and discuss potential "what if"remember safety first, that is, the safety of thescenarios. With this information, an emergency res-rescuers and bystanders, as well as that of the victimsinvolved.Throughout the development of this document, itwas readily evident that many emergency situationscritique.are unique, and there was no textbook to be consulted, nor is there time during an emergency toresearch techniques to be used to execute a rescue.Successful rescue operations often involve on-siteimprovisation. The ideal rescue situation seldom exists. It is necessary to be able to use the equipment,materials, and personnel that are readily available.Rescue personnel sometimes place their own livescue plan can be designed for potential incidents.Each completed rescue should be followed by aN o one group can handle every type of rescueemergency. It is often necessary to call on helpoutside the local departments for specific assistance.A list of current resources complete with names andphone numbers should be kept on file.Each community's public safety service agenciesshould develop a plan for interagency action in theevent of an unforseen disaster. This allows for agreater workforce, adequate backup for the localon the line. The degree of risk is high; however,team, and a contingency for any communitysharing of information and rescue techniques, alongwith training and practice, should reduce the risk.The concern for liability is also high; but the bottomline is that someone has to do the job.It is important for people involved in rescue operations to maintain as calm an attitude as possible.It is often necessary to work quickly, and clear, calmemergency.thinking usually produces the best results. Teamwork and communication between the rescuers areboth important to executing a safe rescue. Whensizing-up an emergency situation, procedures to beused should be discussed among the rescue teammembers. Successful rescues usually involve the co-operation and effort of the total team. It is alsoimportant for individual rescuers to be receptive toothers' suggestions and not feel rejected if someoneelse's idea is adopted.Training enables rescuers who are confronted withemergencies in the field to better provide adequatecare to victims. Trained safety service personnel areoften the best suited for emergency rescue work. Itis strongly recommended that rescuers be trained inmore than one rescue procedure, i.e., in emergencyIt is common for rescue personnel to be emotionally and physically exhausted once a rescue is com-pleted. The tension and stress encountered whenworking under adverse conditions is intense. Workingagainst the clock, along with the concern for humansafety, creates an extremely tense environment.Everyone reacts to stress differently. It is important for rescuers to acknowledge that everyone doesreact. Some people may become extremely chattyand need to talk, while others may withdraw andtry to block out the details, especially when involvedin an unpleasant situation.Following a rescue operation, all equipment, ma-terials and supplies must be cared for and main-tained in a condition ready to address a futureemergency. Review what happened, what procedureswere implemented, what worked and what did not,and actually critique the entire operation.Rescue operations are very important to humanlife. Procedures are often challenging and successfulrescues fire rtwarding. In a time of need rescuersare greatly appreciated.

3OCCUPATIONAL STRESSES IN RESCUE OPERATIONSINTRODUCTIONOccupational stress and its potential effects onhealth are of much concern to all workers. The term"occupational stress" describes a process wherebyindividual employees appraise and react to job con-ditions and demands. The amount of stress thatemployees experience is determined both by thenature of their jobs and the extent of each employee'scoping abilities. Employees in some occupations experience more stress than employees in others. Rescue seems to be one of the high stress occupations.This chapter describes the stressful aspects of rescueoperations, the adverse effects of stress on healthand job performance, and strategies for reducing theamount of stress experienced by rescue workers.Jobs in rescue operations and emergency medicalservices can be exciting, challenging, and deeplyrewarding. However, they can also be very stressful.The aspects of rescue jobs that are challenging andrewarding are also those that make the job stressful.When the rescue team is alerted, there is a highprobability that some serious human emergency hasoccurred. The salvage of human life or limb mayinvolve a precise series of life-saving steps conductedin exactly the correct order in a brief time. Timeseems to vanish while rescuers try to perform complex motor tasks under less than ideal conditions.The other important feature of stress generationis the inescapable demand to make a decision onthe basis of incomplete data. Life and death decisionmaking under such uncertain conditions can generateemendous stresses within rescue workers.The rewards of doing the job well, however, areimmensely satisfying. The salvage of human life andhealth has to be one of the greatest satisfactions forany professional health-care worker or rescue worker.SOURCES OF STRESSThe work schedule of rescue workers is a potentialsource of both pleasure and stress. Many workersenjoy working long (24-hour) shifts in order to havesubstantial stretches of time between shifts to spendin leisure-time activities and/or with their families.However, long shifts can also cause stress. The body'snatural biorhythms are not in harmony with such aschedule.Rescue work can be physically demanding, especially when rescuers re3pond to calls throughout mostof the work shift. The body's energy and resourcesare quickly depleted under these circumstances. Instead of spending days off pursuing hobbies or socializing, rescuers may devote time off to resting upfor the next shift. Some workers feel that insteadof allowing for more time with their family andfriends, the 24-hour shift schedule actually interfereswith their family life and social life.Rotating shifts and frequently working overtimeoften aggravates this situation. Research has demonstrated that employees who work nonstandardshifts are more at risk for illnesses. Again, the body'sability to resist disease is adversely affected by long,constantly-changing work hours.For some rescue workers, the critical incidents oftheir work days are not as stressful as the minor,daily hassles. Good teamwork and supportive supervision are essential for effective rescue teams. Acritical and punitive supervisor or an uncooperativecoworker can create much stress for the rescue worker.Bureaucratic battles and unending paperwork canalso cause frustration and tension. The small ailyhassles are particularly stress-involving because somuch of a rescue worker's energy has to be directedtoward dealing with the life-and-death situationsthat arise. Few resources remain to deal with theother, srna-er hassles of the job, and thus there islittle tolerance for them.The ups and downs of a routine shift can also betaxing. Rescue work is not characterized by an evenwork flow. Long periods of "down time" are punctuated by immediate calls to critical action. A rescueworker must have personality characteristics thatallow sufficient flexibility to accommodate this unevenness in the work day.Another aspect of rescue operations that can causestress for rescue workers is the lack of opportunitiesfor advancement. The system is relatively new andis still developing; however, at this time, surveys ofrescue workers suggest that they are frustrated bythe lack of a career ladder.Given all of the potentially stressful aspects ofrescue operations, it is normal for rescue workers tosuffer from stress-related symptoms. Some peopleare more vulnerable to stress than others. Researchshows that those who dwell on the negative aspects3

VICTIM RESCUEof events and those who blame themselves for failures or negative occurrences on the job are moreprone to stress-related symptoms. Those with TypeA personalities are also more vulnerable to stressthan others. Type A personalities are characterizedby an impatient and aggressive approach to theirwork. They hate to wait, and experience feelings ofanger when their progress is delayed.Everyone experiences some degree of stress atone time or another. The worst thing that a personcan do is to try to deny the presence of stress orfeign invulnerability to stress. Uncontrolled, chronich;gh levels of stress can have dire results.RESPONSES TO STRESSRescue workers may experience several immediate,worker may be more likcly to exercise poor judge-ment during a call or may be slower to respondappropriately. Such a worker may begin to sufferfrom chronic tardiness or absenteeism. Often, highlyiressed workers turn to alcohol or some other sub-stance to alleviate stress-related symptoms. Alcoholism and substance abuse may develop, resultingin further impairment of job performance.Unrecognized and untreated stress will result indecreasos in job satisfaction and may lead to workersleaving their jobs and the field of rescue operationsaltogether. Rescue occupations have a high rate ofturnover, which is detrimental to the provision ofhigh-quality care.COPING WITH STRESSshort-term physiological responses to stress. TheDenying the presence of stress serves no one'sbody's response to stress includes a release of catecholamines such as epinephrine. This results in elevations in blood pressure and heart rate, increasedserum glucose levels, and decreased gastric movement. People may also experience cold hands andfeet and profuse sweating.Stress may also result in more enduring outcomes.Research has now documented many adverse healthneeds, and threatens rescue worker's personal mentaland physical health. The probable accompanying fallin job performance makes the job more difficult forcoworkers and puts victims more at risk.effects of high levels of stress. Highly stressed rescueworkers may suffer chronic exhaustion. Even afterlong periods of rest, they may not feel that theyhttve regained their energy and strength. Severalmental health effects of stress are evident. Depression, anxiety, tension, and extreme irritability canbe stress-related. Stress has been implicated as oneof the many causes of cardiovascular disease andcertain gastrointestinal disorders. There is also evidence that stress, through impairing immunity,weakens the body's defenses so that cancers canStress that is ignored impairs the vitality of therescue operations system as a whole. High turnoverand low morale erode the effectiveness of the systemand cause it to expend much energy on refilling theflagging ranks of workers by training new men andwomen rather than on improving the skills and abilities of current rescue workers.There is no need to be fatalistic about stress.Many strategies can be employed, both by the individual rescue worker and by the rescue operationssystem, to reduce stress and its negative consequences. The first step for both the worker andmanagement is to acknowledge the presence of stressand the need to deal with it.Each rescue worker has unique coping mechanismsmore easily develop. Finally, stress can lead to skininflammations, allergies, certain types of sexual dys-that work best for him or her. Some may attemptfunction, and headaches.Stress is not related to disease in the same directard disease-specific way as a bacteria or other dis-in the face of an unsuccessful rescue attempt, theymay consciously try to remember and celebrate suc-ease-causing agent. Rather, responses to stressfulsituations in the environment alter the body's en-to focus on the positive aspects of work. For example,cessful saves.Others succeed in coping with their stress by depersonalizing relations with their patients. This cop-physiochemical or microbiologic disease agents.ing strategy should be implemented cautiously.Depersonalization that is carried too far may be aTherefore, people manifest a wide variety of symp-symptom of uncontrolled stress, said can impair rathertoms and syndromes as a result of high levels ofthan enhance job performance.docrine balance, thus increasing the susceptibility tostress.Stress can also contribute to a deterioration of jobperformance. An exhausted and despondent rescueOthers cope by talking about their actions andfeelings with others. Open communication with coworkers and others facir g similar stresses may be14

OCCUPATIONAL STRESSES IN RE3CUE OPERATIONSinvaluable and should be encouraged in rescue systems. Coworkers, family members, and friends mayprovide much-needed support for dealing with adifficult incident or a string of daily hassles.Some workers may prefer to release stress throughphysical activity. This strategy actually serves twopurposesit releases the tension due to stress andalso enhances overall good health and resistance todisease.Some workers manage to control their stress responses by setting aside time to relax, preferablyaway from work. (Beware the rescue worker whospends much of his or her free time lounging aroundthe workplace.) Sometimes special procedures canbe used to help workers relax. Relaxation techniques,such as guided imagery and meditation, are a standard component of any stress-management training.5CONCLUSIONStress is inevitable in rescue work. The demandsof rescue work, both physical and emotional, areconsiderable. If ignored, the resulting stress can leadto ill health, substance abuse, depiessio

Emergency Medical Technician Medina, Ohio. Consultant. Dory le Oakes. Technical Consultant. Columbus, Ohio. Bob Pettit Assistant Chief of Staff for Planning Ohio Emergency Management. Agency Columbus, Ohio. Albert R. Pugh Professor Emeritus The Ohio State University. Columbus, Ohio Willis Tro