As a firefighter, you have undoubtably practiced rapid intervention techniques and scenarios. This practice may have come through evolutions around the firehouse or company drills at your training center or at an acquired structure. Articles and videos on the subject are plentiful. Have you considered the possibility that you may have to perform a rapid intervention on a hazardous materials incident? If not, the time is now.
Conducting a rapid intervention with a Level C entry team would be the easiest and like the techniques we have already practiced except for SCBA. Remember that Level C only uses a cartridge respirator. There would be no SCBA to convert to a harness to make moving the injured technician easier. In this case, extraction would be like moving any patient not wearing any type of personal protective equipment. The one exception would be placing the injured member either on a RIT pack with SCBA or oxygen due to their condition. In this case, the extra pack or tank would have to be removed with the injured member.
Conducting a rapid intervention with a Level B entry team would be identical to those techniques we practice for structural firefighting. With Level B, the SCBA is worn on the outside of the chemical protective clothing like it is worn on the outside of structural firefighting gear. In this case, the removal would be exactly like a structure fire scenario. The SCBA straps could be quickly converted to a rescue harness and the injured member placed on the SCBA carried in the RIT bag. The injured member is then removed as they would be from a structure fire.
But what about a rapid intervention with a Level A entry team? Unfortunately, there is no one correct way to handle this situation. This could get extremely complicated due to the nature of the Level A protective ensemble and the location of the injured technician. If the technician is located at grade level, the extraction will be much easier. What if the technician is located above grade on a catwalk inside a chemical facility or on top of a chlorine rail car? What if the technician is located below grade in a basement or vault? In these cases, not only does patient packaging become critical, but rope skills and hauling systems may be required.
This will be an exceedingly difficult operation at best. With a downed technician in a Level A suit, there is nothing to grasp for additional leverage and there is no way to manipulate the SCBA straps into a makeshift rescue harness. You are dealing with something resembling a 200-pound sack of potatoes. Packaging will be critical, not only for the safety of the patient, but also for the safety of the rapid intervention team as well. In a situation such as this, it is imperative that you be able to think outside of the box and maintain your composure.
Does your Level A suit have a pass-through where you can hook up and emergency SCBA bottle? If not, is this something you have considered? It is an option on some suits, but not all. If you have dismissed it due to cost or the “It will never happen here” syndrome, please think again. If your Level A suit does have the pass-through, are you able to use it? Do you practice with it? If not, the time to start is now. You may not be able to open the suit right away depending on the atmosphere. (More on that later.)
When moving an injured team member in a Level A suit, placing them on their back on a hard surface such as a backboard or Stokes basket may not be possible due to the SCBA. Precious time may be wasted in properly securing the injured technician in a Stokes basket or on a back board. In evolutions I have conducted, it is much easier to use a flexible extrication device such as a SKED or a Mega Mover. The SKED will naturally curve around the injured technician and can be easily pulled out of the Hot Zone. Alternatively, the injured technician can be rolled onto the Mega Mover and each member or the Rapid Intervention Team can grab a handle and evacuate the Hot Zone. As with any skill, these evolutions must be practiced until proficiency is attained.
Once the injured technician has been removed from the Hot Zone, now they must be removed from the Level A suit. Since this is an emergency, technical decontamination will probably take too long. This is a prime example of when emergency decontamination is required. The biggest problem will be in removing the technician from the Level A suit. In this case, it will be easier to remove the Level A suit from the technician.
In a normal situation, we would unzip the suit after decontamination takes place. Under the best of circumstances, this is an arduous process requiring many twists and turns on the part of the technician in addition to assistance from personnel staffing the Decontamination Corridor. This will take too long in an emergency.
It will be much easier to cut the suit. Use a pair of trauma shears, a seat belt cutter, or a skinning knife with a gut hook to protect the person inside the suit. It will be extremely difficult to cut through the zipper. It may be easier to completely cut around the zipper and totally remove it from the suit. Make one long cut parallel with the torso and similar cuts down each arm and leg. You will also have to make a cut around each wrist to cut off the plastic cuff installed in the suit. After you have isolated the cuffs, they can easily be removed with the gloves. Once we have cut the suit away from the technician inside, they can more easily be removed. After removal, they can get the medical attention they need.
As stated previously, there is no “one size fits all” approach when it comes to rapid intervention in the Hot Zone. Each incident, situation, suit, and size of the team will all have an affect on how the extraction is done. I would encourage you to plan a drill around this subject and see what your team does and how they react. Utilize an old training suit that you do not mind cutting into. You can either discuss the scenario ahead of time or make it a surprise to truly test your team’s abilities.
Deploying a rapid intervention team into the Hot Zone on a hazardous materials event to rescue an injured team member is definitely a high risk/low frequency type of event. Your team has probably never had to do it. That is no excuse not to be prepared. The next call you run could be the one where your team’s luck runs out and someone’s life will hang in the balance. Be ready and be prepared.