One of the most necessary parts of the action plan is the requirement to consider the safety and health of everyone on the scene, especially of responders.This article is the second part of a section on action plan development. In the first part we discussed size-up considerations, resource organization and accountability (IMS), control issues, hazard evaluation, necessary equipment, rescue/recovery objectives, and decontamination procedures for rescuers. In this article we will discuss:
- On-scene safety and health procedures
- Scene termination procedures
One of the most necessary parts of the action plan is the requirement to consider the safety and health of everyone on the scene, especially of responders. In an effort to avoid missing any critical safety issues, the incident commander should consider the use of a pre-established checklist. Assigning a safety officer to look over those issues will help the incident commander to insure that identified hazards are evaluated and that accountability procedures are in place. The action plan needs to address the establishment of a rapid intervention team (RIT) to back up the entry team. Since we use the terminology of "RIT" in the fire service, I like to utilize the same for rescue, since it is the same concept. The safety officer, as part of his responsibilities, should insure that a plan for that crew is established in case they should have to go into service to assist the entrants.
The plan should be to have the safety officer maintain communication with the entry team and send the RIT team to aid if needed. The RIT should be on the same communications channel and monitoring for signs of distress that would prompt them to move in. They should be using the same or greater level of respiratory protection and should be wearing the same or greater chemical protective clothing. This team should have also have tools necessary to remove the entrants, including stokes or litters.
All safety considerations should be addressed and communicated in the pre-entry briefing, regardless of whether they exist or have the potential to exist. Among other items, some that should be discussed are signs and symptoms of chemical exposure, hypo- and hyperthermia, and stress. Rescuers should be directed to look for this symptomatology in themselves and in other personnel, and know the procedures for emergency evacuation.
Confined space entry is not only stressful; it exposes response personnel to potentially hazardous atmospheres. Performing pre-entry monitoring provides the team with the ability to tell if there is a change in the mental or physical status of a team member. Even if the evaluation is a cursory one, monitoring of the entrant's vital signs should be established in your protocols and performed prior to entry. Again, this procedure can be outlined ahead of time in a checklist format. I recommend utilizing the standards for medical monitoring as specified in NFPA 471, Response and Operations at Hazardous Materials Incidents. These standards are pretty comprehensive and easily performed by medical personnel prior to entry.
Provision should be made to insure adequate decontamination occurs upon exiting the space. The Entry Team, exiting a decontamination corridor, should undergo post-entry medical monitoring to compare vital signs to baselines. Subsequent rehabilitation of personnel is paramount. Although I haven't seen a study to back it up, a hazardous materials guru once told me that the fire service injures many more people in hazardous materials incidents by way of temperature stress in fully-encapsulated chemical gear, than we do by way of chemical exposure.
In my experience I would tend to believe him. Although heat stress is not something you tend to associate with a confined space incident, it really depends upon the environment, the duration of exposure, and the protective equipment required for making an entry. The environmental exposure to exterior supporting crews is something to consider, especially on particularly hot or cold days. Rescuers should be limited to less than 30 minutes of working time, although 20 minutes should be sufficient.
When providing on-scene rehabilitation, some sort of shelter is necessary to protect responders from heat or cold or whatever elements might be present. Shelter can range from existing buildings or structures, to commercially produced tents or specialized vehicles. If resources are available regionally, find out what they are capable of and establish memoranda of understanding so that you can use them when the time comes.
Although OSHA 1910.146 calls for all confined space rescuers to be trained in first aid, conventional wisdom leads you to believe that they should be at least EMTs in this day and age. The medical providers for the responders should be at least at the level of EMT-Basic, but I recommend that you require Advanced Life Support (Paramedic) provision.
Some of the things that affect responders (crush syndrome, electrocution, chemical exposure, etc.) will require more advanced techniques (cardiac monitoring and dysrythmia management, pharmacological intervention, advanced airway maneuvers) than an EMT can deliver. Emergency medical care procedures should be established ahead of time. In confined space rescue hypothermia, crush syndrome, electrocution, asphyxia, exposure to carbon monoxide or methane, burns, or chemical inhalation can be planned for in advance. Treatment protocols would definitely be indicated. Have the items you need to aggressively manage these on hand.
Finally, the plan should address scene termination. Considerations need to be made for removal of the victim to treatment and transport personnel. Advise those personnel on what problems were found in the space, as well as the injuries found. Once the victims have been transferred, plan to secure the space. You don't want more people entering out of curiosity, or even more importantly, to tamper with evidence. The occupational safety authority (OSHA) is going to want to investigate the scene. Keep unauthorized people out of the space and plan to turn the scene over to law enforcement if necessary.
Decontamination of equipment should be included in the plan. If equipment can not be decontaminated, proper disposal should be arranged. Some materials may require more thorough decontamination procedures, so your organization should identify companies or agencies that can provide that level of service and arrange for their use if needed.
Prior to departure from the scene, each unit should be debriefed, then advised on warning signals of exposure in case delayed effects are experienced. Personnel should be given a contact person to report to if symptoms do, in fact, arise. Follow-up monitoring, especially if hazardous materials are involved, should occur. A plan should be made to follow up on personnel in several days to check for any post-incident symptomatology.
In the next article, we will wrap up this series by implementing the action plan and following up the incident with a critique.
