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Harness Induced Pathology

Harness Induced Pathology is a silent killer in High Angle Rope Rescue, it can also be known as Harness hanging syndrome, Suspension Trauma, Suspension Induced Shock, and Etc. Whatever the title may be, it still poses a problem for rescuers and patients. We will be covering the problems associated, sign/symptoms, and recovery of Harness Induced Pathology.

Harness Induced Pathology occurs when a rescuer or victim is suspended in their harnesses for long periods of time. When the harness is under tension around the body it can constrict around the major arteries and blood vessels thorough out the body, thus not allowing the proper blood flow to the heart, brain, and muscle tissues. When the proper blood flow is interrupted it can cause hypoxia to the brain, causing the rescuer/victim to become unconscious, and in some cases even death. Another problem associated with Harness Induced Pathology is the pooling of blood in extremities. When the harness constricts around the body it can act as a tourniquet cutting off the much needed oxygen to vital organs.  During normal bodily functions, the legs do not pool larger amounts of blood due to the large amounts of muscle tissue surrounding the arteries, thus allowing the heart to pump normally while the leg muscle provides assistants in allowing the blood the travel "uphill". When this process is interrupted by constricting of the harnesses around the legs, the muscle and blood vessels in the legs tend to relax. This can cause the heart to drop in blood pressure when the constriction or tourniquet is released, thus not allowing enough blood to reach the brain. One other problem with pooling blood is septicemia. When blood pools for longs periods of time it can build harmful toxicants. When these toxicants are released, they travel to vital organs causing shock and even cardiac arrest at times. If rescuers understand the sign and symptoms, they can treat and even prevent this from happening to themselves and victims.

 

Signs and Symptoms

Faintness, nausea, hot flushes, sweats, breathlessness, feeling of panic or uneasy, change in pulse rate (suddenly slowing or becoming rapid), cramping of muscles, and or sudden fatigue

 

Preventing Harness Induced Pathology:

Rescuers:

  • Take adequate fluids
  • Keep warm but avoid excess sweating and heat exhaustion
  • Recover before a long assents  or other vigorous exertion
  • Do not push yourself to the point of exhaustion  
  • Avoid prolonged stationary suspension in a harness – take turns at the job, consider a boson’s chair or alternative belay position.
  • If it is necessary to hang in your harness, change position as necessary to keep comfortable and try to regularly tense your calves to maintain circulation
  • Always wear a chest harness so that you can lean back without risk of turning inverted or falling from your harness if consciousness is reduced or lost for any reason
  • When wearing a class two or three harness, make sure your waist strap is tight, but do not over tighten the thigh and buttocks straps. Leave room for adjustment during rescue of training operations
  • If you feel at all faint or unwell at any time, let others know, tense your legs repetitively and try to lower your head and raise your legs.

Treating Harness Induced Pathology:

  • Stabilize the patient as well as possible before a lift
  • Ensure cold patients are adequately insulated with dry and waterproof clothing or a plastic bag and blankets or hypothermia bag if in a stretcher – do not forget to insulate the head.
  • Rehydrate if possible – oral water or sports drinks if conscious, IV fluids if medical or paramedic assistance enables this.
  • If exhausted, provide some easily digestible energy source – glucose sweets etc.
  • Treat any cold or exhausted person as a patient and ensure they are closely monitored and, if possible, hoisted horizontally in a stretcher rather than allowed to climb or be hoisted in a harness only.
  • If a horizontal stretcher hoist is not feasible, consider an under knees strap to hold the patient more horizontally.
  • When vertical hoist is unavoidable, minimize hanging time
  • Accompany patients during raises and lowers wherever possible
  • Monitor vital signs
  • Ask conscious patients to do leg contractions to assist circulation
  • Get the patient horizontal as soon as possible, consistent with safety for rescuers
  • If collapse occurs mid hoist and intervention is not possible on the rope, complete hoist or lower patient rapidly – whichever will get the patient to a stable position with at least one rescuer to provide care.

 

If unable to provide IV therapy from height, wait until to victim is a few feet from the ground, give appropriate fluids and treatment before the patients harness releases tension from the victim’s body. Remember, when working from rope always try and reposition ones self to avoid Harness Induced Pathology.

Information on this article is from Fire and Rescue Concepts Tower Rescue Program and some reference material of DR. Ian Millar, MFESB Medical Officer

DISCLAIMER: This post is for informational purposes only. If Departments wish more training on Rope Access or Tower Rescue Training contact us at estroud@fireandrescueconcepts.com

Posted in Confined Space Training, ems-health-safety, ems-topics, fire-rescue-topics, major-incidents, patient-management, rescues, special-operations, training-development, training-fire-rescue-topics, Uncategorized

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Hooks and Hoses, Let’s Work Together

Capt. Trey Smith

So you want to be a truckie, or even a nozzleman? Assuming these roles takes tremendous knowledge of the responsibilities and expectations to be performed which should not be taken lightly. These positions will make or break a good offensive fire attack.

These positions are the workhouses of the fireground and one does not perform or work efficiently without the other. For the moment, let's try to put aside our egos and focus upon the task at hand of getting the wet stuff on the red stuff. Following two large scale incidents in my first due area in recent months, I have had time to reflect upon some of our successes and our shortcomings of two identical fires involving mutli-family occupancies or large scale residences.

I started out my career assigned to several active engine companies and had some great officers and firefighters I have worked with throughout my tenure. I became a truckie after making Captain and enjoy the challenges of truck & rescue work. But in my 30+ years within the fire service, I have grown frustrated at the reality of having lots of nozzlemen and hose jockeys but few ceiling pullers and the lack of coordination between the two functions.

While true, chief and line officers are expected to direct the symphony of crews working to contain a rapidly progressing fire, many firefighters are under the fallacy tactics training is solely for white & gold shields and doesn't apply to the tailboard firefighter. But the reality is, these positions (nozzleman and celing pullers) will work without direct supervision of the line officer. This results in the IC relying upon the decisions of a firefighter to decide upon the appropriate hoseline and to accurately select the placement of a critical position to defend areas of non-fire involvement. During particularly large scale fires where the fire is "running the attic", several key tactics must occur in a timely fashion or our brothers & sisters will inevitably be overrun and will be losing the battle to stop the forward progression of a rapidly developing fire.

To understand fire travel is to fully grasp the concept of fluid travel and smoke reading. Fire is a fluid that will always follow the path of least resistance. Therefore, as the saying goes…" where there is smoke there is fire", and if gone unchecked or reversed the fire will eventually show itself sometimes more than we expect. So, our hooks and hoses must possess the ability to predict the stage of the fire, the level of heat production, and where it is headed based upon reading the color of smoke, the intensity, and the rate it is leaving the structure will impact the success of our attack.

Let's face it… we have all been there during the heat of the engagement… lots of screaming. noise, confusion, darkness, heat, stress… you name it. We open up the ceiling to get the nozzle into to position within the cock-loft or attic only to see the distinguishable signs of heavy fire rolling across the structural members (truss) above our heads. What should this indicate to the nozzleman and truck crews? And what immediate actions should be taken when these cues are indicated?

1. Observe the direction of the fire. Where is coming from and where is it going? Look at the amount of fire, heavy, moderate, or light?

2. Radio back to IC/Command the fire has passed your attack team. The IC continually needs this feedback in order to re-assess his strategy/tactics, his situation and resource status. He/she may prioritize the incident needs based upon your feedback or request/re-direct additional resources.

3. You are standing in a potential collapse area! Get out from underneath such areas! Because the fire is continually attacking the structural members, we lose valuable seconds of integrity trying to breach walls and ceiling only for them to come crashing down on our personnel. Lightweight wood and steel bar joist floors and roofs don't wait for you. They are coming down whether you are ready or not.

4. Re-Position your attack.

Why try to hold an ineffective position when the the fire is burning behind you? Truckies…Make inspection holes along the ceiling until you see no fire in the attic before deciding where to take up your new posture. when you pull the ceiling and see heavy smoke banking down on you, note the color of the smoke. Heavy black smoke indicates "Black Fire" This means you have high heat and are close to the fire which will be in your area in a matter of seconds! Moderate smoke provides some time to open up large areas and allows time to get hoselines in place. Make sure the nozzleman has the tools he/she needs to mount the offensive. Nozzlemen and Hose Jockies…Bring the attic ladder for goodness sake, don't rely on the truck company to bring it, they enough to do already! After all that IS where the fire is located. Have the hooks open up large areas in multiple rooms and hallway where the nozzleman can hit the fire as it advances from the floor. This is critical if using a large caliber stream such as a 2 1/2". Ever tried manipulating a 2 1/2" in an smaller room or attic space? The larger sized lines will not make the turns in a residence and should anticipate working from the floor and in a hallway or open space.

5. Find the seat of the fire and extinguish it! Often times, we forget that while trying to cut the fire off it isn't going to go out until someone cut's the head off the dragon! Get a line on the seat /origin of the fire and things will improve dramatically.

6. Maintain your egress!!! While engaging the forward progression of the fire, we forget the fire we passed may actually be cutting off our ability to evacuate. Get a back-up line in place, knock-down any fire impinging upon your escape route, or order the evacuation of all crews of an impending collapse or flashover of the area. If you are operating in the hot zone always have two or more ways to escape.

7. Listen to the radio! If you hear things being said such as "flowing the aerial", "Master Stream", "Defensive", "Roof Sagging", "partial collapse"… Don't hesitate to get you and your personnel to the hell out of a potentially catastrophic event.

8. Practice "Pro-actionarism" Pro-Actionarism is the act of being pro-active, taking initiative, taking action. Recognize when situations are going bad and make the necessary steps to mitigate them or make the decision to abandon the effort.

Posted in command-leadership, fire-prevention-education, fire-rescue-topics, firefighter-safety-health, firefighting-operations, fires, major-incidents, news, rescues, special-operations, training-development, training-fire-rescue-topics, Uncategorized, vehicle-operations-apparatus

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Fundamentals of Timber Rigging (Part one)

We will be doing a four part blog series on the “Fundamentals of Timber Rigging” for rope access. Timber rigging can be utilized for High Angle Rescue, Confined Space Rescue, Trench Rescue, and Structural Collapse Rescue.

Timbers used for rescue rigging is nothing new. But with newer equipment and technology, training on how to rig timbers for rescue has greatly diminished. Newer equipment and technology has allowed us to have access to pre-fab anchors, portable anchors, quick deployable struts, and etc. But with new equipment comes cost. With a struggling economy, equipment and training are usually first to go in emergency services. Many smaller departments just don’t have the funding to buy the newest and greatest equipment associated with their job. For departments that can not afford to buy the newest and greatest equipment for rescue rigging, there is a alternative. By using what the Army Core of Engineers started during world war area, departments can still achieve a positive outcome while having minimum impact on their budget.

Using timbers for

Vol. Fire Department sets up a Timber A frame

rescue can be productive for high directional anchors such as, Timber tripod, Timber jib arm, and Timber A frame. Most departments have the necessary equipment needed to preform timber rigging. Timbers needed for this type of work and training can be acquired from your local hardware store. In the next three part blogs we will go over step by step instructions and pictures needed to set up each type of rigging system.

DISCLAIMER: Fire and Rescue Concepts suggest extensive hands on training be completed on Timber rigging before preforming these techniques out on the field. This four part series is for informational purposes only. If Departments wish more training on Timber Rigging please contact us at estroud@fireandrescueconcepts.com

Posted in Confined Space Training, fire-rescue-topics, firefighting-operations, funding-staffing, rescues, special-operations, training-development, training-fire-rescue-topics, Uncategorized

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