BY MICHAEL BRICAULT
After performing a diligent, rapid, and safe primary search, firefighters have located a victim needing rescue. Should they carry or drag the victim to safety? That depends on some variables.
Is the victim conscious and able to assist in his own evacuation from the immediately dangerous to life and health (IDLH) environment? If so, it could be as simple as the firefighters’ shepherding the victim toward the safest exit from the IDLH area.
If the victim is conscious and can do so, he can assist himself by following simple firefighter instructions that detail how he is to exit the window and mount the ladder positioned there, where a waiting firefighter will receive and guide him down to safety.
In these cases, this is not a true rescue but rather, as the late Chief Tom Brennan, former Fire Engineering editor in chief and technical editor, would describe it, “a victim removal.”
Obviously, a conscious victim will be easier to manage than an unconscious one, unless the conscious victim is completely hysterical. There is a difference between people on-scene who are excited or scared and those who are hysterical. Such victims are so agitated that their emotions have completely overtaken them, they are no longer in control of themselves, and they are unable to help themselves during a residential fire emergency. This emotional condition of civilians on-scene is one of the variable victim factors that very few firefighters are prepared to deal with.
The fire service trains personnel to assist and direct conscious victims we assume will follow our directions and to carry, drag, or otherwise remove unconscious victims. But what do you do with the overly excited people whose emotions are overriding their ability to think clearly?
Unfortunately for operating companies, attending to these hysterical victims can be time- and personnel-intensive and sometimes even dangerous. More than one firefighter has been pushed away or even attacked by a hysterical victim during a rescue attempt. Also, hysteria can be very contagious to anyone around these people, including the firefighters themselves. Operating forces must be on guard against this contagious condition and keep absolute control of themselves and their emotions. At times, this will be easier said than done.
Imagine trying to bring an hysterical victim down an aerial ladder from the fifth floor of an apartment building with a working fire. Other people are trapped, the fire is out of control, and there are lots of loud distractions such as blaring radios and sirens from incoming apparatus. Many firefighters must yell just to communicate with each other. The image of fully geared firefighters pouring into a home in the middle of the night may not be as welcome a sight to an occupant just roused from his sleep as you might like to think. Just because you know what you’re doing there in the middle of the night doesn’t mean the occupant does.
These removals require extra time and effort for firefighters to complete as well as a great deal of patience, control of the victims, and professionalism. Firefighters must remain very close to the victim and, many times, in direct physical contact. The human touch has the ability to transmit the firefighter’s confidence and may have a calming effect on the excited people on-scene.
Many times, you must hold these victims’ hands, sometimes literally, and move them to a safe area where additional personnel can supervise them. In some instances, extremely excited people may even require a little more than this. Whatever the case, these people must follow the firefighters’ directions and be removed from the IDLH environment and away from the action area where suppression and rescue efforts are ongoing. Finally, personnel must prevent these hysterical people from attempting to reenter the residence, where they will hinder firefighters and possibly become victims all over again.
Remember that you don’t simply remove or evacuate victims from a residence; you evacuate and remove them from one specific area to another. You do not just throw people out onto the street to let them fend for themselves. Once you have civilians in your care, you must turn them over to another firefighter’s charge until the incident is under control or until you can evacuate them from the scene altogetherfor example, send them to the hospital.
CONSCIOUS VS. UNCONSCIOUS VICTIMS
As stated earlier, those victims who are conscious and have become trapped or had their exit cut off by the fire may be able to assist firefighters with their own removal, provided they are not hysterical. Barring unusual circumstances, the removal should go rather smoothly, provided that the victim follows directions. You must project confidence when you interact with these people; give them very clear directions with an authoritative tone of voice. Above all, maintain control of the scene.
By comparison, an unconscious victim is going to be a real gut check. There is no nice way to say it. Many firefighters who have performed rescues of unconscious victims have said that it was without a doubt the most difficult thing they have ever done in their career. Considering the physical condition of many burn victims, it is easy to understand why many firefighters have described the rescue of a burned, unconscious victim as a grotesque experience. This description is not added for dramatic effect; this is reality. If a firefighter has responded to more than just a few fires, he already knows that there is enough drama involved in the incident itself.
Physically demanding, extraordinarily difficult, grotesque, mentally exhaustingthese are the words firefighters who have performed rescues use to describe the experience. These are the realities of firefighting that involve conducting residential search and rescue operations. They don’t say it is unrewarding, something they wouldn’t want to do again, or not challenging but rather that it’s incredibly difficult. Also, unless the victim you locate is right on the other side of the front door, this is what you should expect.
By mentally preparing for adversity, you have taken the first step to overcome these difficulties. A firefighter who is mentally prepared for the realities of performing a rescue will not be shocked or surprised at the unpleasantness and will not hesitate in a rescue operation.
CARRY OR DRAG
In the old days, firefighters were taught to carry victims. Many of us are familiar with the old fireman’s carry: place the victim up and over the shoulder. This technique may have worked well for our predecessors. However, today, with firefighters wearing SCBA and fully encapsulating bunker gear, it is more advantageous for firefighters to drag victims to safety. But before we rule out the option of carrying a victim altogether, let’s consider when a victim carry would be advantageous.
A carry technique is certainly appropriate for bringing an unconscious victim down a ladder; you cannot drag such victims. Aside from a ladder rescue, what if the victim is smaller than the firefighter? A carry would be indicated here as well, provided it is easy to carry the victim.
Establishing age cutoffs for carrying these smaller victims may not work because it is not always possible to accurately judge a victim’s age; some of these smaller victims may in fact be adults. Also, putting a weight restriction on a victim is not practical either, since there may not be a reliable way to gauge a victim’s weight. Finally, different firefighters may be able to carry different amounts of weight.
The most reliable parameters for deciding when to carry a smaller victim are whether the rescuing firefighter can easily carry and control the victim during the rescue. The exception to this rule is a ladder rescue in which you must carry an unconscious victim.
PROPER DRAG TECHNIQUE
There is a proper way to drag a victim; do not just grab victims indiscriminately and drag them across the floor haphazardly. For example, do not drag a victim who is facedown or unconscious by the legs; it may cause substantial head and face injuries and complicate the rescue.
Dragging a victim by the legs will not protect an unconscious victim’s head during the rescue. Moreover, if the victim’s arms are free, they will naturally spread away from the body and may catch on doorways, corners, and other obstacles along the route, turning a straightforward victim removal into a complicated and time-consuming effort.
Do not drag victims by the wrist; the human wrist will not bear the entire weight of the body for very long, and a wrist or other joint separation is inevitable.
For a victim rescue drag, the axiom is, “Do no harm.” You should be able to perform a rapid and safe rescue for the good of the victim and yourself.
To properly drag a victim, do the following:
- Position the victim on his back (supine).
- Position yourself at the victim’s head and sit him up.
- Place your hands underneath the victim’s arms, high up in the armpit area, and reach across the victim’s chest. If possible, grab the victim’s opposite forearm with your gloved hand. If this is not possible, try to lock your hands together over the victim’s chest to maintain control of the victim.
- Stand, and drag the victim to safety.
This is basically the drag technique with which most firefighters are familiar and may have seen used in the Firefighter Combat Challenge competition (photos 1, 2).
(1) Photos by author.
First, you must prepare the window you are using for rescuing any victim (conscious or unconscious). Remove all glass; merely opening the window is insufficient, since this provides only half of the potential opening you need for the removal/rescue. Also remove all sashes, curtains, and window blinds. The last thing you need is for you or the victim to get entangled in curtains or blinds. Curtains hanging on the window could cause you to slip and fall or to drop the victim while you attempt to free yourself.
Next, move any obstructions underneath the window out of the way, such as night tables, small bookcases, entertainment centers, electronics, and associated cords. Think of what’s underneath your bedroom window or your child’s bedroom window. How about all of the wires associated with some video games? It is not professional or safe to perform a rescue of an unconscious victim over and around these obstructions. Clear all obstructions around the window.
Do not throw these items about the room indiscriminately, and especially be careful to avoid inadvertently covering the very people for whom you are searching. You may not be able to see a victim through the smoke if you just accidentally threw a night table and curtains on top of him.
Ideally, rescuing a victim down a ladder will require three firefighters: one firefighter at the base to buck/hold/control the ladder (remaining in this position until the rescue is complete) and two firefighters to climb the ladder.
One firefighter climbs the ladder and assesses interior conditions. This firefighter will, if the ladder is positioned to a window, remove all the window glass, the window sash from the upper pane, and any window treatments (curtains, shades, or blinds). This firefighter will then assess the interior floor condition directly below the window and climb into the room to begin the search. Be careful when you probe the floor with your tool. A carelessly probing steel tool can seriously injure or even kill a victim who is below the window area.
If you place the ladder to a porch, balcony, or roof edge, it should be easier to assess the stability of the intended landing area, since these locations are outside of the structure and presumably have better lighting and visibility.
Once this firefighter has dismounted the ladder and has entered the room, the second ladder member (not the one bucking the ladder) will climb the ladder to the window and monitor conditions for the interior operating firefighter. Should a victim be located, this individual remaining on the ladder outside the window will be the one to bring the victim down the ladder.
If primary search uncovers any victims, the firefighter on the ladder preferably should broadcast an appropriate and complete radio report. Although the interior searching firefighter can do so if needed, it is more appropriate to have the remaining firefighter on the ladder make this radio transmission. (See “The Residential Rescue Sequence,” Fire Engineering, April 2007, 221-224). When you discover a victim, your radio transmission should include the following information: your name, your location, what you have found, what you are doing, and what you need.
In the Albuquerque (NM) Fire Department, this is called a Conditions, Actions, and Needs (CAN) report. A typical CAN report is as follows: “Ladder 5 to Command, one unconscious victim found second floor, rear bedroom. We’re bringing the victim down the ladder. We’ll need some hands.” Based on this three-second report, command and all operating companies will know what you have found, what you are doing, and what you need.
The searching firefighter will direct a conscious victim toward the window if you cannot remove the victim safely through the structure. Remember, a ladder rescue is incredibly dangerous and time- and personnel-intensive, but you must perform one if needed.
Once at the window, the firefighters must instruct the victim how to safely climb through the window and mount the ladder. The firefighter on the ladder must watch the victim very closely.
Victims should climb through a window in the same manner as firefighters. First, the victim puts one leg through the window and straddles the sill, placing the foot on the ladder rung. Next, the victim’s hands grasp the ladder and windowsill while the head and torso pass through the window. Shifting his body weight to the outside foot on the ladder rung, the victim draws the remaining leg out onto the ladder. At this point, the ladder firefighter should be very close to the victim. A safe rule of thumb is for the firefighter’s arms to be above the level of the victim’s waist. The firefighter should place his hands on the beams of the ladder while the victim places his hands on the rungs.
Drag an unconscious victim as close to the window (or roof edge, balcony railing, or wherever the ladder is) as possible. Once the interior firefighter locates a victim who is lying on his back, he picks the victim up in a cradle position with one arm beneath the victim’s shoulders and the other under the victim’s legs near the knees. The firefighter passes the victim through the window, feet first and face up, to the waiting firefighter on the ladder.
As the ladder firefighter receives the victim, the victim’s legs should be positioned so that they hang outside the beams of the ladder. The ladder firefighter should be standing on two separate rungs so one foot is higher than the other. This way, as he receives the victim and positions the legs, the victim will naturally come to rest straddling the firefighter’s knee. The firefighter will then place his hands up under the victim’s arms, tight up into the armpit area, and grasp the ladder (photos 3, 4).
This is a position of absolute control over the victim and allows the firefighter to maintain three points of contact with the ladder at all times while bringing the victim to the ground. The position of the firefighter’s hands on the rungs will add an element of protection, preventing the victim’s head from coming in contact with the rungs.
Using this technique, the ladder will absorb about 60 percent of the victim’s body weightweight the firefighter won’t have to contend with. Additionally, the ladder will provide friction, preventing the victim from sliding down the ladder too quickly. Should there be any problem during the ladder rescue evolution, the firefighter should lean/pull himself into the ladder to secure the victim between his body and the ladder.
Caution: Some firefighters incorrectly believe that it is possible to rescue an unconscious victim from a room and carry him down a ladder alone. This romantic Hollywood rescue notion is all but impossible unless the victim is substantially smaller than the rescuer and the rescuer can easily carry him in one arm. A ladder rescue of an unconscious, average-sized adult requires at least two firefighters. Remember, a time-consuming rescue evolution means there will be a significant time delay in an unconscious victim’s receiving emergency medical attention. And just having two firefighters perform a ladder rescue will push these members to their limit.
AERIAL LADDERS AND TOWERS
Performing a rescue or removal onto a tower ladder is significantly easier. Using the tower ladder is like bringing an elevator to the window. However, like any other ladder, you must properly position the tower. Although a tower platform has a gate or door in the platform railing, position it so that the top rail of the bucket is at or below the bottom of the windowsill. If the gate on the bucket is positioned at the windowsill, it means that the firefighter and the victim would have to climb up from the room, through the window, and onto the tower platform floor. However, placing the top railing of the platform below the windowsill will allow for a much easier and safer exit from the window, since everyone will be climbing down from the window and onto the platform.
Aerial ladders are altogether different. Position the top rung at the bottom of the windowsill, just like a ground ladder, leaving as much room as possible within the window itself for firefighters and victims to travel through.
With the aerial ladder at an elevation of approximately 45° (plus or minus, depending on the situation), a climbing transition will occur. Below 45°, it is comfortable and appropriate for you to climb the aerial using the rails as handholds. At an elevation above 50°, it may be more comfortable and safer for firefighters to switch to using the rungs as a handhold. This will depend on circumstances, the individual, and his experience. Regardless, maintain the same close contact with a conscious victim, and keep your hands above the victim’s waist level.
For the unconscious victim on an aerial ladder, the technique will be the same as the ground ladder technique except that the victim’s legs will remain inside the ladder rails. Below 45° of elevation, it will actually be easier to drag the victim down the aerial using the standard dragging technique described above.
During a search, you may find several victims. In fact, more than 30 percent of all fire victims are discovered along with another personthere are multiple victims. Which victims do you move first, the conscious or unconscious ones? According to Chief Tom Brennan, as a general rule, rescue the conscious victim first because it is a live rescue and you can do it faster than you can remove an unconscious victim, and with fewer resources. Moreover, the conscious victim may become panicky, jump, or become unconscious and then die while the time-consuming rescue of the already unconscious victim is taking place. This is yet another of the extreme circumstances of residential search and rescue.
MICHAEL BRICAULT has been a firefighter for the Albuquerque (NM) Fire Department since 1993. A nationally certified fire service instructor, he speaks on residential search and rescue. He is an adjunct instructor at the nationally accredited Albuquerque Fire Department Training Academy and a faculty member of several community college fire science degree programs. He has written a firefighter’s training manual on residential search and rescue and has coauthored standard operating procedures for ladder company operations.