“AWARE”: A LIFE-SAVING PLAN FOR RESCUING TRAPPED FIREFIGHTERS

“AWARE”: A LIFE-SAVING PLAN FOR RESCUING TRAPPED FIREFIGHTERS

BY JAY B. OLSON

Your company is fighting a routine apartment fire when you hear a familiar voice on the radio. It`s a member of your company. “I need some help.” There`s a twinge of desperation. “The first floor collapsed, and I`m stuck under the debris in the basement.” You can hear his low air alarm in the background.

As you remain in contact with the trapped firefighter, you notify the incident commander (IC) of the firefighter`s approximate location for the rapid intervention team (RIT) team dispatch. You know the RIT will do exactly what it has been trained to do–embark on a quick “grab-and-go” rescue.

Unfortunately, rescuers run out of air before they can free the trapped victim. They`re forced to leave the firefighter behind while they replenish their air, delaying the rescue attempt for a critical period of time.

The prevailing practice of deploying civilian rescue techniques for extricating trapped firefighters too often results in tragedy. Let`s face it. When we get lost, trapped, or pinned and are not able to help ourselves, our rescue usually is going to be far more difficult than that of typical civilians. There are several reasons for this:

A firefighter`s fall through a floor into a tangled, cluttered, constricted mess involves much more than rescuing an unconscious civilian from a bed, a closet, or the living room floor.

Extricating fire personnel is made all the more difficult by our 50 to 70 pounds of gear.

From primary search through overhaul, we may be required to remain in a burning or fire-weakened structure for hours. Because we naturally work more closely to the seat of the fire and in fire-weakened areas for long periods of time, we`re more vulnerable to collapses, fall-throughs, and similar hazards that can pose difficult rescue challenges.

On the other hand, we`ve got an independent air supply, protective gear, training, and experience. These tools give us a better chance of surviving a catastrophic event–at least for some finite period. But realize that time is of the essence.

If your department fails to acknowledge these realities, it probably lacks any plan for addressing them. And if it hasn`t planned and trained for firefighter rescue, it could be jeopardizing one of your own member`s–or your–chances for survival.

Fire service history is replete with examples of firefighter fatalities in which the rescuers` first reaction was to attempt a civilian-style grab-and-go rescue. When that failed, human nature kicked in. They then focused on what was trapping or pinning the firefighter by attempting to remove the encumbrance. Both the grab-and-go and the initial extrication attempt are necessary and proper. The trouble is that when we fixate on the encumbrance, we burn up the rescue`s “window of opportunity.” Tragedy strikes when the rescue gets interrupted or air supplies run out.

Grab-and-go and removal of the encumbrance are entirely proper, even critical at the onset, but if they don`t work within minutes, it`s time to switch to a plan better designed to buy time and preserve life. That`s where AWARE comes in.

THE “AWARE” RESCUE PLAN: A NEW MINDSET

The trapped firefighter`s hopes for survival depend on four crucial ingredients: Air, Water, A Radio, and Extrication. Together, these items form the acronym AWARE–an effective ready-made plan that could someday spell survival in a situation you might encounter.

Although each of the AWARE ingredients is important, the first two–air and water–are preeminent. Whether those provisions are made simultaneously or in tandem will depend on the situation. The proper AWARE approach dictates that we first provide the victim with a redundant (primary and backup) air supply. We then create a defendable space with water protection using hoselines, distributors, or piercing nozzles. These two factors alone could buy several additional hours of extrication time. In the case of a firefighter`s fall-through into the basement, for example, that additional time could be used to cut a larger hole in the floor, feed a ladder down, and disentangle the victim. More air for the victim also buys needed time. Water protection creates a defendable space. Together, air and water can, in many cases, make the environment survivable, providing more time to extricate the victim. This becomes particularly important when special tools are needed to remove the firefighter from an especially difficult entrapment, such as when a metal object must be cut using the appropriate saw stored on the apparatus. And should a firefighter become entrapped in a hard-to-access confined space, making sure the victim has air can buy time for rescuers to devise and execute a viable extrication plan.

Let`s look at each of AWARE`s elements more closely.

Air Needs

Each department has its own resources. Here are some of the sources we use at the Portland Fire Bureau:

The driver/pump operator`s SCBA off a pumping engine. It is usually available.

If not being used, a command vehicle or chief`s car will usually have an SCBA.

An air compressor or air unit. In Portland, each air unit has six spares.

An SCBA off a firefighter`s back. If a firefighter is not using his SCBA, rescue has priority.

A remote air compressor and a 300-foot air hose. The air hose plugs directly into the victim`s regulator. (Note: This can be very time consuming. Resort to this only after you have supplied the victim with air backed up by a redundant supply of SCBAs. Keep in mind that a hose is vulnerable to being cut, burned, or kinked and that it`s just as hard to protect 300 feet of airway.)

There are two kinds of victims: those who are out of air and those who will soon be out of air. That`s why your RIT`s most important piece of equipment is a victim`s portable air supply. In this respect, be sure you have a complete SCBA with regulator and face piece. If your victim has fallen through a floor or has undergone some similar traumatic event, he may have broken or lost his mask or regulator.

Water Protection

Typically, we all do a good job of protecting downed firefighters with protective hose streams. There are, however, more tools and techniques at our disposal than just standard hoses and nozzles. We should be looking to incorporate distributors and piercing nozzles into our overall arsenal by applying water directly on the victim. The aim is to first create a defendable space around the victim and then to fortify that space by working outward. Note the new mindset here. Make sure, however, that water doesn`t collect in the space and create a drowning hazard.

A Radio

One helpful tactic is to dedicate an emergency channel for a trapped firefighter`s exclusive use so he doesn`t have to compete for air time. In situations where the trapped firefighter cannot be removed as soon as he is discovered by rescuers–if equipment is needed to extricate him or if the rescuers are low in air supply, for example–we preset a radio to the dedicated emergency channel, give it to him, and then monitor. This approach has several advantages:

It`s quick and easy.

The victim`s level of consciousness (LOC) and needs can be constantly monitored.

You`ll know immediately if the victim self-rescues.

The victim isn`t competing for radio time. Naturally, providing a radio will not be possible in every circumstance, and maintaining rescuer-victim voice contact still is a priority, but a dedicated radio may offer a critical contingency in a life-and-death situation within a loud, confusing environment.

Encumbrances

It is impossible to exhaustively cover every potential encumbrance. The key is to remember that if you`ve built the survivable environment described above, you`ll have more time to acquire the necessary equipment, remove the encumbrance, and save your firefighter.

THE PORTLAND DRILL

The key to improving your department`s effectiveness will depend in good part on learning from past tragedies and close calls from the entire fire service–not just personal mistakes or those of your department. “War gaming” and hands-on drilling in realistic scenarios are also crucial. Don`t let the first time you attempt to rescue a firefighter be the real thing.

We recently conducted a realistic drill in Portland, which we believe will vastly improve our department`s effectiveness at firefighter rescues. The drill was a joint training effort between our department and that of Vancouver, Washington. Nearly 700 firefighters participated in a drill spanning three weeks.

To build realism into the exercise, we obtained permission to use a three-story ordinary construction apartment building that had recently sustained a fifth-alarm fire. We then arranged three separate rescue scenarios. In each instance, we simulated smoke and fire with mechanical smoke and red lighting; visibility was zero.

The Basement Window Rescue

In our first drill, a crew heard a firefighter shout for help as it was headed for rehab with tanks having only 500 psi. Crew members found the firefighter trapped in a basement behind deeply recessed window bars. He had fallen through the first floor, was completely out of air, and had lost his face mask. He was conscious and ambulatory, but his egress was cut off by fire–the barred window was his only way out.

Following the AWARE procedure, the rescuing crew members immediately removed their SCBAs and handed the firefighter a face mask through the bars. The rescuers protected the victim and created a defendable space using a 212-inch line. The crew also fed a 134-inch line to the victim for his use, along with a radio that was preset to a dedicated and monitored channel.

Meanwhile, the crew officer contacted Command and requested the RIT to dislodge the bars. The method to be employed and the choice of tools were left to each individual team. Overall, we forced 25 sets of window bars. Crews that didn`t participate observed.

The time the crews consumed varied with the chosen methods and tools–they ranged from eight and one-half minutes minimum to 23 minutes maximum, depending on the crew and the type of the window bars. For example, wood-cutting blades on our circular saw had to be changed to metal cutting blades. But because we were implementing our firefighter rescue plan and had created a survivable environment–and because the victim was conscious, able to move, and relatively close to the window–those delays were not factors. To further expedite such a rescue, it is recommended that the RIT team–as well as the ladder company–carry as regular equipment two saws: one all ready to cut wood and the other to cut metal. It is preferable to have the ladder crew perform cutting operations so as to allow the RIT to focus more fully on its primary mission; however, be prepared for all possibilities and situations.

The First-Floor Collapse

The second scenario was a classic first-floor collapse into the basement. Crews were informed that a firefighter had fallen through the first floor into the basement, mid-building, east end.

In this scenario, we created daunting circumstances for the trapped firefighter. He was pinned under three feet of assorted debris and entangled in wiring. He was allowed one-third of a bottle of air. His right arm was dislocated and broken. Both legs were crushed by a 10- 2 10-inch timber that had to be hand-sawed. He could only be extricated up through an existing 24- 2 30-inch hole in the first floor.

Each crew member was deprived of half his normal air supply. Rescuers were told that those who hadn`t started to evacuate within one minute of their low air bell alarm would be considered victims. As victims, they would have to remain in place until a subsequent team rescued them. We also insisted that participating rescue teams transmit regular progress updates, reporting their locations, needs, and conditions.

The following teams were used: a rescue team, assigned to the victim in the basement; a support team, assigned to the first floor; and an equipment shuttle team. Backup teams would replace teams as they ran out of air. Every crew had to rotate through the basement, and only one crew was permitted in the basement at a time. Several proctors were placed in the basement to monitor performance and ensure compliance.

The basement was itself a confusing maze, rife with obstructions and partially involved in simulated fire. When the first team arrived in the basement, it heard low-air and PASS alarms.

Here again, we found that the most successful rescue teams utilized AWARE rescue plan strategies:

Air. A redundant supply of SCBAs, with constant monitoring of level of consciousness, bought time.

Water protection. Distributors placed through the first floor created a defendable space, allowing rescuers to leave their handlines and rotate with fresh crew replacements.

Victim`s radio. As expected, the victim`s air, level of consciousness, and emotional needs were more effectively monitored.

The encumbrances. The smoke, clutter, entanglement, confused layout, and limited egress all proved to be enormously time-consuming but were less relevant with adequate air sustaining the victim.

The Roof Collapse

During the course of the basement rescue operation described above, Division 3 broke in with emergency radio traffic, disclosing secondhand information that there had been a partial roof collapse onto the third floor, trapping our firefighter victim beneath. His exact location was unknown. The building is a 150- 2 60-foot three-story filled with smoke and zero visibility.

In this exercise, the RIT was launched to the third floor to conduct a search with other crews assisting. For drill purposes, we stipulated that these crews share the same fire channel as the basement rescue effort, purposefully increasing radio traffic to step up confusion and frustration.

After a systematic search, a team located the victim pinned under the fallen roof in the extreme southwest corner. Fire was immediately impinging, and his air had just run out. His back and arm were burned, and he suffered rib injuries.

To create the victim`s defendable space, crews drove a piercing nozzle through the fallen roof and simultaneously provided him with a complete fresh SCBA. With a rope bag, they hoisted up a 10-ton hydraulic jack, lifted the fallen roof, and extricated the victim. Having done so, however, they were then informed by radio that the stairway had collapsed, their hoseline had burned, and heavy fire had overtaken the hallway. This forced the crew to request that a ladder company be positioned on the building`s south side. Having identified their location by marking a window with luminescent lights, they egressed the building via the positioned ladder.

Once again, the AWARE techniques came through. Air bought time so that the jack could be hoisted and positioned; a piercing nozzle protected the victim`s space, and the jack was effective as an extrication device. (The victim already had a radio.)

LESSONS LEARNED AND REINFORCED

The challenge and realism built into the Portland drills made it possible for participants to come away with a number of valuable lessons, including the following:

Staying with the victim. We found that the most efficient way to execute the rescue and ensure the victim`s survival is to leave at least one rescuer with the victim from start to finish. The rescuer monitors the victim`s air supply and can report to fresh crews where equipment is located, the rescue`s progress, and other valuable data. To do this, you`ll have to keep two people supplied with air at the extrication site.

The face-to-face. As crews rotate out, it`s important that they pass on to the rescue division information that is too unwieldy for simple radio contact–such as the victim`s exact location, points of access, the location of spare air supplies, and potential dangers. Drawing a diagram helps a lot.

Marking the victim. In a smoky and cluttered environment, a hoseline is your best choice for marking the victim`s location. Relocating the victim on each rotation makes no sense. If a hoseline isn`t viable, use a rope bag with luminescent lights. Remember: If you`ve deactivated the victim`s PASS device to protect communications, be sure to reactivate it when rotating out.

Discipline is crucial. Ignoring depleted air supplies was one of the rescuers` biggest mistakes. Given the zero visibility, obstacles, and bottle-necking of our conditions, rescuers who ignored their low air alarms and waited too long sometimes got lost. In real life, they would have died. Have the discipline to respect your own limitations.

Don`t stray from your lifelines. In the chaos of zero visibility and obstructions, don`t stray too far from your hoseline or rope bag. In a 150- 2 60-foot structure, for example, you can easily get lost and run out of air.

Marking tools and equipment. In some drills, the victim ran out of air and died just because crews couldn`t find the full SCBAs that were only a few feet away. We also couldn`t locate saws, the base of a ladder, and even our 10-ton jack. Our solution would be to have your equipment shuttle teams mark all tools and full SCBAs by duct-taping them with luminescent lights. But remember to remove luminescent lights off the air bottles once they become depleted.

Avoid overcrowding. The rescue site is often cluttered and restricted. Many times it is so crowded that you can`t tell whose low air bell is going off. The PASS alarm and smoke detectors add to the confusion. Don`t exacerbate the problem by overcrowding the rescue site.

Practice makes perfect. Practice switching over to a fresh air supply without changing the air bottle or the victim removing his mask. SCBAs vary, so determine how this best works for you. A trapped victim should not be expected to hold his breath more than five seconds while his air supply is being switched. In some instances, we have gotten it down to two seconds.

RIT proactivity. The RIT should be proactive–not reactive. Proactivity means sizing up the building; marshaling sufficient equipment; selecting hoses that will reach all points of a structure; tailoring rescue tools to fit the building`s construction type; determining the building`s configuration; identifying points of ingress; locating hallways, stairways, and fire escapes; locating standpipes, pumpers, and other water sources; and constantly monitoring the fire frequency to get a feel for the incident.

RIT designations. When there are multiple RIT teams operating or on standby, RIT designations (“RIT1” or “RIT2”) can become confusing. When the RIT is preparing for its mission, it is a “RIT.” But consider–for the sake of communications, scene control, and accountability–designating the RIT by company name (“Engine 26”) once it leaves its launching point and begins its mission. We found in our drills that this prevents confusion.

Thermal imaging cameras. As a new technology device, they have their place, but acknowledge their limitations. They don`t work that well, for example, in finding victims buried in three feet of debris consisting of chairs, wood, electrical cords, and other items that might entrap a firefighter. In one instance, a crew using a helmet-mounted camera lost a trapped victim when the victim was no longer able to wave his arm above the debris.

Knowing the tools of the trade. Sometimes you`re limited to the equipment at the scene. However, be aware of the specialty equipment available within your own department, your municipality, and even the private sector. And of course, even the best equipment is useless unless, through advance arrangements, you`re able to reliably access and deploy it at any hour of the day or night.

Safety with piercing nozzle. Be careful not to hit a trapped firefighter when pushing the nozzle through a space to him. Also, make sure that its use will not cause him to drown or interfere with his air supply.

Complex Civilian Rescue Situations

AWARE principles sometimes have positive transfer to many complex civilian rescues. For example, in one true-life tragedy, a 450-pound victim was trapped in an upper-floor room. Even with assistance, she was physically incapable of or unwilling to climb over a windowsill onto the waiting ladder. By creating a survivable environment long enough to perform a window cut, we might have saved her.

Command Responsibility and Planning

Command`s rescue plan should be well established and practiced before the crisis hits. Absent those preparations, firefighters will naturally devise their own on-the-spot solutions. The last thing you want is 30 firefighters converging into a cluttered basement, simultaneously running out of air, scrambling out, and being forced to leave a trapped victim behind. Organization and control are critical.

Let`s use our first-floor collapse example to illustrate how effective planning can work. A firefighter has fallen through the first floor into the basement of a three-story apartment building. Here`s a plan you might consider:

Immediately launch the RIT to the victim`s suspected location. Locating the downed firefighter is paramount and in certain circumstances more difficult than you might think.

Be sure to apprise and continually update the RIT of newly acquired information–obstacles, hazards, locations, numbers of victims, and so on.

Call for additional alarms immediately. Downed firefighter rescues are invariably manpower-intensive. In the Portland drills, we required a minimum of two greater alarms.

Create a rescue branch, and assign it a radio channel separate from the main incident. Station a rescue branch director at the command post to relay communications from rescue personnel and victim directly to the IC. If you`ve ever been to a fire when a firefighter is in trouble, you know that excessive radio traffic makes communications nearly impossible. Training must take into account radio discipline.

Assign sufficient personnel to back up and support the RIT. If your base is depleted and you can`t wait for greater alarm companies, think about drawing your help from other working divisions or companies who have completed their primary search.

Once the initial rescue effort is staffed and self-supporting–with enough crews to rotate in and out without interrupting the rescue effort–always implement a second effort from an alternative point of entry. This increases your trapped firefighter`s chances for survival.

As an industry and profession, we have assumed that the methods we use to rescue civilians will work just as well for rescuing trapped firefighters. We haven`t devoted enough attention to rescuing ourselves, and too often the results have been tragic. The strategy presented here will buy valuable time that will allow rescuers to take all the measures they need to extricate and save the firefighter victim. n

(Top) The Portland drill. The victim`s air and water needs are first priorities in an AWARE rescue. Note the redundant air supply. (Photo by Craig Callicotte.) (Middle) Using utility straps, firefighters work together to lift the victim through a 25- by 30-inch hole. (Photo by Fabian Jackson.) (Bottom) This firefighter, pinned under a collapsed roof, would be very difficult to locate in zero visibility. (Photo by William Bench.)

A RIT enters the building using items from Portland`s list of special RIT equipment needs, including extra SCBA. Some items are cached at entry point. (Photo by Craig Callicotte).

(Left) A rescuer practices switching to a fresh SCBA bottle. (Photo by Craig Callicotte.) (Right) Distributors kick out a lot of water–570 gpm. They have a 30-foot diameter and can be left unmanned. (Photo by author.)

EQUIPMENT

Each situation is different and requires its own combination of tools and equipment. However, the equipment needs of most rescues will meet some basic parameters. At the early stages, equipment will generally be low-tech, familiar, portable, quickly deployable, immersible, and operable in a zero-visibility, oxygen-deficient atmosphere.

Selecting the right tools is an art in itself. Here are some pointers:

Distributors. Nothing attacks a fire through a small hole better than a distributor. It delivers a ball of water instead of a nozzle`s “cone.” It can be inserted in holes anywhere from two to eight inches in diameter and more than doubles the water of a 212-inch hoseline. Once in place, a distributor can be left unstaffed.

Piercing nozzles. Their sharp points make them good for driving through roofing, walls, and so on. At normal pressures, they deliver about 50 gallons per minute.

Ladders. You can lay ladders across weakened floor areas. If they`re too long, cut them down to fit the situation.

Air supply. Useful for furnishing air in impossible-to-access situations (see “Air Needs” on page 54).

Air manifold. It can be as far as 300 feet from the vehicle and used to simultaneously refill up to four SCBAs.

Hand saws. Although often overlooked, they function in an oxygen-deficient atmosphere.

Rope bags. They can be used to hoist and retrace a path of entry, but they sometimes entangle rescuers.

Paramedic scissors. They`re superior to knives, dikes, and wire cutters for cutting nonenergized wiring and entanglement hazards such as fallen ceiling suspension assemblies.

Luminescent lights. Excellent for marking victims, hazards, and equipment in zero or low-visibility conditions.

Utility straps. You can make a quick hoisting harness out of these straps in as little as 20 seconds. They are also useful for holding hose and dragging victims. Every Portland firefighter carries one.

10-ton hydraulic jack. It is portable, powerful, and reliable.

Obviously, this list isn`t exhaustive, but you should be able to find any of these items at the emergency scene. During our drills, we used all of them as well as bolt cutters, circular saws, the hydraulic spreader, and a sawmill–to mention a few.

Remember: At larger fires, the first few pumpers may already be pumping to capacity or have been stripped of hose, so the RIT may need its own pumper and water supply. Keep in mind that if the rescue team puts three distributors in operation, they alone will max out a 1,500-gpm pumper.

When initiating the rescue, RIT personnel often wonder what will be the most useful equipment. The question is best answered by following our AWARE principles. Here`s a generic RIT equipment list:

victim air supply,

enough hose to reach the victim,

an ax and halligan tool,

a rope bag for hoisting and retracing,

a spare radio, and

a rubbish hook (if you`re going into weakened areas for sounding). n

(Left) Rescue air bag at the ready. It is mandatory equipment for the RIT team. Carrying this rescue air bag at the shoulder leaves both hands free. (Photo by Larry Pittman.) (Middle) Contents of the rescue air supply include one-hour bottle, regulator, fill hose with female ends, spare mask, and two adult airways. (Right) A spare face mask is carried in the rescue air supply. (Photo by Doug Dryer.) Sometimes a firefighter may have lost a face mask, or it may have malfunctioned. Two airways are carried for unconscious firefighters. (Photo by Craig Callicotte.)

(Left) Air manifold with carrying bag. The manifold is capable of simultaneously filling four SCBAs 300 feet away from a mobile air compressor. (Right) Four firefighters` SCBAs are simultaneously filled. Notice how the hose can be retracted on a reel. (Photos by Craig Callicotte.)

Here`s a useful technique for supplying air behind concrete tilt-ups and similar impossible-to-access situations. Use a power saw to cut the seam. Then attach some breathing air tubing to an air bottle, and slide the tubing through the crease to the victim. Have him slide the tube under his mask seal. That tubing will get to places an SCBA never could. An alternate method is to fit the wide end of a 60-cc syringe barrel over an SCBA regulator outlet. Attach your breathing air tubing line to the other end of the syringe. Now, you`re furnishing compressed air. n

n JAY B. OLSON is a 22-year veteran of and a lieutenant in the Portland (OR) Fire Bureau. A former trainer at the Portland Fire Academy, he has made a special study of the unique aspects of firefighter rescues. He has an associate`s degree in fire science technology.