Chief Concerns
By Richard Marinucci
Fire Apparatus & Emergency Equipment Magazine

Rescue me. The words today probably make you think of the Denis Leary show on FX about the trials and tribulations of a fictitious member of FDNY. Of course if you are from Detroit, you might think of the Motown song. Regardless, members of the fire service all recognize the importance of rescue in this business. After minimizing risks to our personnel, it is the most important thing that we do. Yet, in most organizations it is not a frequent event, which makes preparation extremely important.

Firefighters can be called upon to perform rescues at structure fires, from vehicle crashes or special rescue scenarios such as ice, water, trench, high angle, confined space or collapse. Relative to the number of calls, particularly in those organizations that handle EMS in some form, the infrequency of rescue events creates a great challenge to make sure that every member is prepared. High performance will be required.

Rescue requires these elements — people, training, equipment, and decision making (i.e. selecting tactics and making assignments). Staffing is critical in most rescue situations. You need the right number of people for the circumstances. Any rescues involving moving of victims are labor intensive and very taxing on the rescuers. If further work is required after the rescue — for example there is still a fire to put out — you may not be able to rely on the personnel who may be spent from their efforts. This is but another reason that fit firefighters are essential.

A Core Skill

Training and repetition are needed to provide and maintain the skills needed to be successful in rescue situations. Appropriate training varies by the type of rescue — structure fire, vehicle accident or special rescue situations.

Training for rescues in structures must be considered a core skill in every fire department, and performance criteria must be established. There needs to be a game plan that establishes the core concepts to be used. As an example, what would be your expectations for assembling a team ready to perform a rescue? How long would it take? Once assembled, how would the rescue be handled? Would everyone know their role and would the team function as a team? Personnel must know the techniques to be used and must be drilled often so that their skills are sharp. The physical aspects of rescue must be second nature so that the firefighters can concentrate on the mental aspects in order to maintain continual awareness of the situation.

Rescues from vehicles require another skill set that needs to be practiced and honed. Also, the technology of modern vehicles is ever changing and creates a challenge to all rescuers to stay current with the latest techniques and tools. Treatment and safe extrication of the victim adds another component. Time is of the essence, and better-trained personnel will be faster and safer, which enables the victim to survive, spend less time in the hospital and less time in rehabilitation.

Special rescue situations are rare in most departments. Maintaining the training of personnel is very difficult in lieu of the other responsibilities of the job. In most circumstances organizations (mostly those that are not part of a large, metro department) should look to a regional approach. Combining the resources of multiple departments can be cost-effective and efficient. The core team can be prepared for the challenging calls that occur rarely. But even with a regional approach, the local department has responsibilities. Most likely the regional team will take time to assemble. The local department must be training to begin the operation and set the stage for the arrival of the more highly trained team.

Tools have become more significant in the advancement of rescue. Thermal imaging cameras have added a valuable tool to the toolbox. There are many varieties, from hand-held to helmet-mounts. There are also added features such as the ability to record and transmit. It is important to evaluate your needs and match your budget accordingly. Tools should be easily accessible and easy to use. Techniques for their use need to be drilled often.

Vital Tools

Hydraulic tools such as the "Jaws of Life" were once considered the single most vital tools for vehicular extrication. While they remain an important piece, other tools have become just as essential and valuable. This has been the result of addressing the challenges presented by the materials and assembly of the modern automobile. Unfortunately many departments do not have an opportunity to practice on newer models. Research is needed. Check the periodicals, trade shows and neighboring departments. Having the most appropriate tool for the job creates efficiency. The goal of the rescue is the safest method in the shortest amount of time. Consider ease of deployment, ease of use and effectiveness at meeting the goal.

Technical rescue situations require a variety of special tools. Each scenario has different needs. It should be up to your specialty team to determine the tools that will be required based upon an assessment of events most likely to occur. The team should also make recommendations as to what every department and company should carry to initiate rescue operations. These tools can help prepare the site for the arrival of more specialized tools and personnel.

Risk Assessment

Knowing what to do to best approach a rescue is probably the most critical component. The decisions are based upon the resources that you have available, both immediate and still to arrive, and the conditions that are presented. The decisions are based upon a valid risk assessment. One primary rule of engagement is to only risk a lot to save a lot. This is just the beginning because if you do not understand all the potential risks, you cannot make the correct risk assessment.

In structures, you need to consider the fire volume, location and potential to spread (how quickly and what direction). The construction type needs to be factored into the decision. Lightweight construction, whether wood, steel or other product, will shorten the time to safely complete a rescue. Decisions need to be evaluated based upon the likelihood of success. Only through continual study can one expect to learn as much as possible. Few, if any, fire personnel will gain enough actual experience through real events to learn everything that needs to be known. Study National Institute for Occupational Safety and Health (NIOSH) reports of their investigations and check out some of the great resources at the U.S. Fire Administration and the National Institute of Standards and Technology (NIST).

Knowledge of vehicle types, on-board hazards, and assemblies affect the tactics used for extrication. Other factors would include location, time of day, weather conditions, other safety hazards and the severity of the injured party. Based upon this information, an officer or firefighter can begin to formulate the right method to best extricate a patient and do so safely.

True expertise in the special rescue scenarios is challenging to obtain. Fire departments will rely on their specialists, whether internal to the department or part of a regional team, to gain insight so that the proper decisions are made prior to the arrival of any specialty team.

While rescues in some form occur relatively routinely, the more challenging events are less frequent and require significant effort to be successful. There needs to be adequate staffing, the right equipment, proper training and good direction with proper decision making for the outcome to be considered successful. Take a systems approach to your analysis of your capabilities and work toward shoring up the areas that need improvement. People expect the A-team to respond when they have an emergency, and you need to be prepared to deliver that level of service.

Editor's Note: Richard Marinucci is chief of the Northville Township, Mich., Fire Department. He retired as chief of the Farmington Hills, Mich., Fire Department in 2008, a position he had held since 1984. He is a past president of the International Association of Fire Chiefs (IAFC) and past chairman of the Commission on Chief Fire Officer Designation. In 1999 he served as acting chief operating officer of the U.S. Fire Administration for seven months. He holds three bachelor's degrees in fire science and administration and has taught extensively.