BY MARK VAN DER FEYST
Conducting a confined space rescue is a risky endeavor that requires great skill and patience. Many times, numerous rescue attempts have failed because of rescue personnel’s lack of patience and skill. In technical rescue operations training, we teach students how to avoid rescue failure by recognizing the presence of certain conditions in a rescue operation that contribute to the overall situation. Outlined in the acronym FAILURE, these items are as follows:
- Failure to understand the environment.
- Additional medical implications overlooked—e.g., dust, crush syndrome.
- Inadequate preparation.
- Lack of teamwork and training.
- Underestimating the logistical needs.
- Rescue vs. recovery.
- Equipment not mastered.
Failure to Understand the Environment
This encompasses a few perspectives on how the environment can lend to the overall failure. The first important environment consideration is the atmosphere inside and around the confined space. Responding personnel sometimes overlook monitoring the atmosphere and end up becoming victims themselves. The basic four-gas monitor will be a benefit since it detects the percentages of oxygen, carbon monoxide, and hydrogen sulfide gas and lower explosive limits (LEL). Ideally, conditions should be zero percent for hydrogen sulfide, zero percent for carbon monoxide, zero percent for LEL, and 21 percent for oxygen. An increase/decrease of only one percent in any category is equivalent to a concentration of 10,000 parts per million (ppm) of a contaminant in the ambient air. Even though there is just a one percent difference between normal and acceptable limits doesn’t mean that it is safe to enter. For example, with hydrogen sulfide at a concentration of less than 0.001 percent, after one or more breaths, death may be immediate.
Monitoring the space around the outside of the confined space is as vital as monitoring the inside. Take outside readings at the space’s opening, at the top of the space, at the middle, and at the bottom. If the space is horizontal, monitor at incremental distances usually about every 20 feet leading in. Conduct the readings at regular intervals to monitor any changes in the environment. To compensate for the presence of an atmospheric contaminant, ventilate the space (photo 1), which will provide an exchange of fresh air coming in for the bad air coming out. Monitoring the space over time as it is ventilated will determine whether the ventilation has been effective. Ventilation also helps by cooling off the interior environment and providing fresh air for any victims present.
|(1) Photos by Randy Padfield unless otherwise noted.|
Consider temperature extremes since they can produce heat or cold thermal injuries in personnel as they conduct a confined space rescue. Heat stress is a common injury many rescuers sustain; it may result from the sun shining directly on them; the ambient heat conditions; and heat generated by equipment, from bodies inside the space, and by processes. Most confined spaces will be hot and humid since there is very little air flow, if any. The rise in temperature inside the space as well as the temperature outside the space has a significant impact on the rescue team.
Outdoor confined spaces may also have the sun’s heat directly affecting the heat already generated inside the space. Body heat can also account for the ambient heat conditions. Rescue personnel wearing chemical protective clothing will be more vulnerable to heat stress since they are totally encapsulated in a plastic shell that increases the rescuer’s metabolic heat factor and limits that person’s time in operation. Carefully monitor the amount of time a rescuer spends inside the confined space and ensure that personnel receive sufficient time to rehabilitate so you can cycle rescue personnel through the operation.
Heat extremes can also come from processes and equipment that generate large volumes of heat. You must identify and control them to mitigate the hazard’s contribution to the heat stress factor. Sometimes, this cannot be eliminated because of other technical/industrial reasons. If this is the case, then you will need to manage the heat exposure.
Some confined spaces are damp, wet, and very cold and can result in hypothermic states (photo 2). This will be especially dangerous for the victim inside the confined space. For the rescuers, exposure to extreme cold limits their endurance and dexterity and, hence, their performance. Fortunately, in a cold environment, you can introduce warmth if needed to assist in the rescue or recovery of the victim.
Failing to understand the topography of the land or the work surfaces present is another environmental issue. Confined space rescues occurring indoors or inside a building will have work surfaces that vary in type, size, and height. These differences will present a challenge, and failing to understand or identify these differences may lead to overall failure. Surfaces may be slippery because they have dust on the floor, are wet from water or other liquids, are cluttered with debris, or are restricted in height or size.
Obstacles around the work site are another issue. Many industrial work sites will have process pipes, electrical conduit trays, steam lines, water lines, conveyor lines, and so forth all around that may prohibit rescuers from engaging effectively.
Land topography is an important factor when dealing with a confined space rescue outdoors. The slope of the land will affect how and whether the equipment can be used at full or only partial capacity. The land or soil content around the confined space may be solid, loose, saturated with water, or muddy; this will affect the operation as a whole. You may have to adapt rescue equipment to compensate for the surface conditions.
Other considerations are differing elevations and access to the confined space. Some confined spaces are not easily accessible and will present a multitude of access issues. With restricted access, it will be difficult to set up specialized equipment and stage personnel for the rescue operation. Differing elevations—e.g., the difference in height between the confined space and the catwalk or access points—will contribute to the challenge. Transporting equipment up the required elevation may be the biggest obstacle. Transporting the victim after extrication from the space will be the next obstacle.
In photo 3, a variety of confined spaces are on top of a grain elevator. The elevation difference between the confined spaces and the ground is about 50 to 60 feet. The access to the confined space is limited by narrow catwalks accessible from inside the elevator. No direct access is feasible from the inside. Staging equipment will be difficult, as will removing the victim from the space and lowering him to the ground.
|(3) Photos by author.|
Photo 4 shows the exterior of the grain elevator. Notice the elevation difference and the obstacles above the confined spaces. The access points are limited by narrow catwalks, which are entered by the main building.
|(4) Photos by author.|
The confined space in photo 5 is between the gray solid wall and the pipes. The only access point is from above, where the yellow step ladder is positioned. The access point is congested with many overhead and ground level obstructions. Notice the wet surface of the floor around the confined space.
|(5) Photos by author.|
You must evaluate and understand the environment for rescue operations to succeed. Not taking the time to understand the facts presented during the size-up phase of the rescue operations will certainly lead to the overall FAILURE of the operation.
Additional medical implications overlooked
They include possible medical issues arising subsequent to the initial entrapment—falls, traumas, and cardiac arrest. Most confined space rescues involve a person who is overcome by a toxic environment or a lack of oxygen within the space. In very few incidents are medical reasons the catalyst for the rescue. However, when a confined space rescue operation is initiated, you must consider and address these factors. A person may be trapped within a confined space with no medical injuries or conditions. On the other hand, the victim may be trapped because of a medical condition. Determining the mechanism of injury is essential.
Certain confined spaces will have mechanical devices inside them that can entrap a worker. This may involve the worker’s limbs, which necessitate that you consider the medical implications.
Crush syndrome is a life-threatening condition that you need to consider at an incident whenever a body part is being impinged on or trapped under or by a piece of machinery or even by the confined space itself. In crush syndrome, muscles crushed with a heavy weight release toxins into the bloodstream—myoglobin, phosphorus, and potassium—once the pressure on the affected area is released. These toxins lead to eventual renal failure as well as cardiac arrhythmias. If not recognized, this syndrome can lead to the death of the trapped worker.
Dust is another medical issue to consider. Where fine dust is present in large quantities within the confined space, the worker will suffocate, so the critical function is to remove the worker from the space as quickly as possible. This would be a grab-and-go operation.
If a fall or other injury is involved, you must conduct a quick size-up of the medical implications. Make verbal contact with the worker inside; if that individual can respond and communicate, you can ask questions to determine the medical implications present. If you can establish no communication, observing the environment is the only way to determine this.
Not preparing for the worst that can happen can lead to a failed confined space rescue. Many rescue workers enter a confined space thinking that it is only another routine day; they do not prepare for the actual rescue of the victim. Entering a confined space is easy; getting the entrant out when something goes wrong can be hard. You must be adequately prepared to answer the question, “How do we get the entrant out?” before the entrant goes in. Photo 6 shows a well-prepared team during a training exercise that went well.
Regulations offer a great tool in preparing for a rescue and will dictate what must be done prior to entering a confined space. They will also dictate what must be present on site before any confined space entry. You can create checklist forms to ensure that you have made adequate preparation.
Entry always requires a completed permit. The permit should include a detailed rescue plan describing the type of rescue to be initiated, who will be the rescuer, whether the equipment needed is on site and at the location ready to go, whom to contact for additional help, who will be the backup rescuer, and what personal protective equipment is needed.
The rescuer’s skill level is another detail. The assigned rescuer must be properly trained in confined space rescue and regularly practice to ensure mastery of the needed skills. This person will have the hardest job when things go wrong, since he will need to react in a fashion that is parallel to the incident. Having qualified personnel on site or responding to the incident is vital to success. Personnel trained and certified to local, state, or nationally recognized standards will be the key ingredient to success of the rescue operation.
Lack of teamwork
During a confined space rescue incident, there needs to be one person in charge—the incident commander (IC). This person will make the final decisions on how to effect the rescue, who will do what tasks, and who will oversee the whole operation from start to finish. When emotions overtake certain team members, they will want to control the operation and start to ignore the IC and implement what they think is best. At this point, communication breaks down, and mistakes occur. Mistakes made in ignorance can be very deadly for the rescuer and the person to be rescued.
The same is true when team members are working together for the first time. They will not know how the other members operate or think in this regard and the “island building” begins. Rescue crews need to train together regularly so they are familiar with each other’s patterns, thinking, and strengths/weaknesses and know who will be in charge every time.
Controlling your emotions also helps in compensating for the lack of teamwork. Rescuers who get excited very easily should not be the ones effecting the rescue; they will only contribute to the hysteria. Only rescuers who are calm and collected and who can think and act under stress should make up the team.
Underestimating logistical needs
It is wise to expect the worst and prepare for it rather than to expect the best and be unprepared. Many times, rescue crews responding to a call are not prepared for what they will face. In a confined space rescue incident, the crews responding must expect the worst. They will thus be prepared on arrival and ready to act immediately.
Preplanning is one way to prepare. If rescue crews can go to known confined spaces within their response district ahead of time and preplan the response to that particular space, they will be much further ahead and better prepared. Preplanning considerations include the following:
- Site accessibility.
- Type of space.
- Interior configuration hazards.
- Hazards outside of and surrounding the confined space.
- Lock-out/tag-out areas.
- Confined space function.
- Staging areas for equipment and resources.
- Confined space work frequency.
- Average number of workers entering the space.
- Training level of on-site rescuers.
- Special rescue equipment.
The list above is a generic preplanning list for any confined space. Once you have made an initial visit, more questions may arise for on-site personnel to answer.
Another aspect of preparation is having the necessary rescue equipment on site at the confined space location. Many times during a confined space entry, the rescue team will be on site at the incident location, but the equipment is not on site but on an apparatus at the fire station or available through mutual aid from another municipality. If a fire company responds to a confined space rescue call and does not have the proper equipment on its apparatus, it must request additional units equipped with the proper equipment to respond.
Rescue vs. recovery
Establishing the mode of operation at the outset of the effort is vital to its success (photo 7). The IC needs to determine right away whether the operation is a rescue or a recovery. Such a determination sets the pace of the operation and must be communicated to everyone on site very clearly. A size-up of the situation will aid the IC in making this decision. Rescuers need to realize that sometimes you cannot save everyone. This is where the team needs to keep its emotions in check as it confronts the possibility of recovering a body instead of rescuing a live person. Would-be rescuers soon become victims when toxic atmospheres within the space overcome them. According to National Institute for Occupational Safety and Health statistics, would-be rescuers make up 60 percent of confined space fatalities.
Equipment not mastered
Confined space rescue teams use lots of different equipment in their operations; all who are expected to use the equipment must master its use. This only occurs through regular training and practicing with the equipment. The time to learn how to use a piece of equipment is on the training ground, not at the confined space incident. Knowing how to use a piece of equipment is not enough—you need to understand how and why it works and know its limitations. Only when you fully understand these aspects can you say you have mastered it.
Mastery also involves using equipment in the way it was designed to be used. Too many times, someone in the fire service will adapt equipment to fit a current need, and the adaptation now becomes a failure point. Technical rescue equipment is specific and designed for a standard method of operation. It is not designed to be adapted for an unauthorized use.
MARK VAN DER FEYST is a 13-year veteran of the fire service and a member of the Woodstock (Ontario, Canada) Fire Department. He is an international instructor teaching in Canada, the United States, and India; a local level suppression instructor for the Pennsylvania State Fire Academy; and an instructor for the Justice Institute of British Columbia.