Patient Packaging for Rope Rescue Operations

By TOM DONNELLY

Patient packaging for rope rescue operations is a skill that all rescue company members must possess. Rapid, professional packaging will play a significant role in the entire rescue operation. Members must be able to provide prehospital emergency care to a victim while determining the appropriate packaging device for victim removal.

When discussing patient packaging devices, rope rescue operations personnel must have medical training as per their regional protocols, as well as be able to select the proper packaging device based on patient assessment. Some rescue operations have been drawn out because of patient packaging issues. Rescuers must be confident in the use of all devices they carry.

The following factors will dictate the type of packaging device you may use:

1 Mechanism of injury—does the patient require spinal immobilization?
2 Severity of injury—does the patient require rapid extrication?
3 Access to the patient—can the rescuer access the patient easily?
4 Is more than one rescuer required? Any quality spinal immobilization requires two rescuers.
5 Is the victim injured? Scaffold workers frequently hang from safety lines after a scaffold failure, but they are not injured.
6 Is the victim wearing a harness? Some patients can assist in their rescue.

Based on some of these factors, let’s look at some patient packaging options available for a rope rescue operation. These options are not all-inclusive or listed in order of use. Regardless of what devices you use, always consult the manufacturer’s guide for recommendations, and follow them to the letter.

ONE-INCH TUBULAR WEBBING

Most rescue company firefighters carry a 24-foot length of one-inch tubular webbing at all times with their personal protective equipment (PPE). This provides the rescuer with an emergency tie harness, if necessary (photo 1). Members must practice tying this harness until it becomes second nature; a rescue company firefighter in a rope rescue operation cannot waste time. Performing these skills is essential to success. This improvised diaper harness obviously is not very efficient in encapsulating the victim and provides no spinal protection.


1. Photos by author.

This harness could be used under the following conditions:

1 Rapid extrication is required (cardiac arrest, respiratory arrest, life-threatening injuries).
2 Victims need to be lifted short distances.
3 Civilian victims or downed firefighters need to be removed.

Another type of diaper harness made by various rope rescue manufacturers is simply called a “diaper harness.” The concept behind this is to encapsulate the victim. This device (photo 2) is fitted, as its name implies, like a child’s diaper, allowing the harness to come through the victim’s crotch area and connect with a carabiner to a hauling/lowering system.


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This device, regardless of the manufacturer, is safe and user friendly. The ability to adjust and apply this harness makes it a preferred choice for victim removal. The diaper’s major drawback is that it does not provide any spinal immobilization; thus, avoid using it if you suspect spinal injuries.

THE HALFBACK DEVICE

This is a versatile short body immobilization board designed for suspected cervical/spinal injuries during a confined space rescue operation (storage tanks, ships, etc.). The halfback comes complete with a full-head harness (photos 3, 4) and lends itself to a confined-space environment; the victim can be packaged for spinal injury, and it has the appropriate attachments to connect to a retrieval system. When dealing with victims suspected of cervical/spinal injury, personnel must conform to appropriate regional medical protocols. In some cases, you will find the victim in an extremely precarious position that will prevent immediate application of a full-sized backboard; the halfback device compensates and allows some cervical spinal immobilization until you can extricate the victim to an area where you can fully immobilize him.


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If you are lashing a victim to a backboard for a stokes or collapsible stretcher removal, use the backboard if you suspect the victim has cervical- or spinal-related injuries. Make sure backboards at a technical rope operation are equipped with straps and in good condition (photo 5, 6). When using the backboard for a patient with suspected injuries, tie a seat harness to allow the attachment of an additional safety line. You must secure this harness to the backboard and the injured patient to prevent manipulation of the spine should the safety line be tensioned. A 24-foot length of one-inch tubular webbing allows you to make a harness for lashing the victim to the board and for the use of an additional safety line.


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THE STOKES BASKET

This stainless steel tubular-framed device is often used because it is designed to tolerate the stresses of rope rescue. Once you have lashed the victim to a backboard, place him in the stokes basket.

When using the stokes basket, do the following:

1 Diamond lash the victim (to be discussed later) inside the stokes.
2 Use at least one 30-foot length of webbing.
3 Make sure the lashing is securely tightened.
4 Do not lash the webbing horizontally near the chest.

Let’s review a basic lashing operation. Once you place the backboard into the basket, secure the victim in the stokes with a 30- or 35-foot piece of webbing by following the following procedure (photos 7-9):


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1 Find the middle of the webbing and make a girth hitch around the rail at the foot end of the basket.
2 If you use a foot wrap, pass the working ends up between the feet, and then wrap the ankle.
3 Proceed to the nearest upright cross member of the basket on the same side of the corresponding ankle wrap.
4 Pass the webbing around the cross member, and begin to cross it in a shoelace fashion to the other cross members until it ends up at the head of the basket. Avoid wrapping the webbing over the top rail of the basket; instead, pass it around the upright cross members if possible.

Based on a number of factors present during a rescue operation, members must decide the position of the stokes basket (horizontal or vertical) while it is being moved on rope. Some factors to consider when deciding whether to go with a horizontal or vertical lowering/raising include the following:

  • Patient injuries (fractures, severe blood loss, cardiac-related, etc.).
  • Amount of operating space.
  • Available personnel.
  • The type of lowering or retrieval system being used.

COLLAPSIBLE STRETCHER

This stretcher is made of a collapsible material designed for a variety of applications based on specific situations. The main advantage of this device is its light weight and portability. Similar to a halfback, this device is also well suited for confined-space situations. All rescue operations involving a collapsible stretcher patient packaging device require a backboard, regardless of whether you suspect spinal injuries or not. The collapsible stretcher relies on the backboard for rigidity.

The collapsible stretcher and a stokes basket essentially perform the same function using different materials. The rescue team should base the selection on some of the following factors:

1 If the patient and operational site are difficult to access, the collapsible stretcher, which is stored in a user-friendly canvas bag with shoulder straps, is easy for one member to carry.
2 If you have to drag the patient or subject him to rough terrain, the encapsulating nature of the collapsible stretcher will protect him.
3 If you have to pass the patient through a tight space, the collapsible stretcher has a smaller profile than the stokes basket. If space is not a problem, the stokes basket might be the device of choice.
4 Either of these devices is an excellent vertical and horizontal patient raising or lowering packaging device; which one to use is really up to the rescue team.

Some very basic collapsible stretcher tips follow:

1 These devices have a memory. Remove the collapsible stretcher from the bag and place it on the ground.
2 Unfasten the straps, step on the foot end of the collapsible stretcher, and unroll it completely to the opposite end.
3 Bend the collapsible stretcher in half on both ends and roll it back, also on both ends. The collapsible stretcher should now lie flat.
4 Prior to securing the straps, make sure the victim is securely lashed to the spine board; this will provide the primary means of immobilization while transporting him.
5 Position the backboarded victim on the collapsible stretcher with his shoulders even with the grommets in the stretcher’s back panel.
6 Lift the collapsible stretcher’s sides and fasten the straps to the buckles opposite the straps.
7 Feed the foot straps through the unused grommets at the foot end of the device and fasten them to the buckles (photos 10, 11).


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•••

Technical rope rescue operations require critical thinking, concentration, and organization; victim packaging is just one component of a successful rope rescue operation. One of the first things we are taught in the fire service is that size-up begins with the receipt of the alarm; technical rope operations are no different. When responding to a rope rescue operation, it is critical to have as much information as possible to determine what packaging device might be required. Rope rescue operations are dynamic and change as the operation evolves. Having a game plan on arrival will certainly help get the operation going.

TOM DONNELLY is a lieutenant with Fire Department of New York Rescue Company 1. He previously was a firefighter with Ladder Company 176 and Rescue 2. He is an instructor in the FDNY Technical Rescue School and has been an instructor with the Suffolk County (NY) Fire Academy for 15 years. He has been a volunteer firefighter with the Deer Park (NY) Volunteer Fire Department for 23 years. He has a B.S. degree in human resource management from St. Joseph’s College, Brooklyn, New York, and is an FDIC instructor.

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