In the water-based environment, we find ourselves operating in a space that is truly fluid. Evolving, changing, reactive, dynamic. This is not dissimilar to the fire environment. Structural presentation, building integrity and construction style, smoke and fire behavior.
These are all moving pieces during a working fire. When we find a victim in a structure fire, we have to quickly assess the victim, determine their immediate needs, then assess the environment and problem solve.
The water rescue scenario is not any different. However, we train far less on it when compared to structural firefighting. The result is far too many near miss and NIOSH reports in which the consistent cause of derailment was an inability to apply the right process to the water rescue. That is my own libertarian take on it. What am I implying? I am implying that in most cases we have not established the right foundation to make the attempted water rescue. Foundations are best built systematically. Our rescue preparations should be the same.
For the purposes of this discussion, I’d like to explore the importance of the process for water rescue and what the process consists of. We can then move into specific examples of the process properly applied to retrieving victims from different water environments or hazards.
Have a Simple Process
A process should be simple and have only a few key elements. It should also be versatile and unlimited in its application. To progress through that decision-making process efficiently, we must have a strong foundation. We must have an adequate level of knowledge, skill and ability. Let’s break each of these three ingredients down: KSAs (Knowledge, Skills, and Abilities)
- Knowledge: We must have a working knowledge of the characteristics and hazards associated with the water that we are operating in. Whether it is swift water, flood water, ice, or a specific water feature such as a pillow or hole, we should understand how to recognize them, identify them and interpret them. We must have the knowledge to know what is required to safely and effectively perform rescue sequences in that environment or feature. This should be career long development of continuing education and experience.
- Skill: We must have the adequate technical expertise to apply to the operation. This is all about practice. From initial training for certification to advanced training in mastery level courses, we learn techniques and then we perform those techniques with repetition after repetition until they become precise and sharpened. With each repetition, we are additionally developing experience. Experience based on the environment as well as our successes and failures during each evolution.
- Ability: We must have the ability to apply our knowledge and skill. Not just in training and repetitions but when it matters most and lives are in the balance. This is a much broader term and includes everything from adequate resources to proper physical and mental conditioning. This is the preparation for performance component. Meaning, we can be knowledgeable and skilled, but if we are grotesquely out of shape or ill equipped, then our ability to apply any of that knowledge and skill is severely limited.
Now that we have established the foundation, we can recognize that in order to make sound decisions and perform at a high level, that foundation of training should be in place long before we arrive on the scene of the rescue. Our foundation should also be vetted. This means we should allow outside agencies or instructors to evaluate and assess our training process to ensure that we are considering approaches that may be more advanced or practiced than what we already know internally. It also helps spur on innovation, growth and compliance with ever changing standards and practices. Internal training that is isolated for too long will often result in stagnate, stale and antiquated practices. This can be accomplished by sending your own in-station instructors to outside training courses or by bringing outside training groups into your stations.
Water-Based Victim Rescue Process
Now let’s discuss the actual process for water-based victim rescue. We must be capable of quickly recognizing water characteristics, interpreting them and applying the right solution. Quite simply:
- What is it?
- What does it do?
- How do I deal with it?
Let’s take for example, a river with swift water. We are headed up river in our motorized boat headed towards our victim. As we approach, we see a large tree that has fallen into the river and our victim is clinging to the upriver side of the tree. Our victim appears fatigued and doesn’t have much time before they succumb to the current.
- What is it: Strainer. The tree is acting as a strainer in the water and our victim is compressed by the current against the upriver side.
- What does it do: It diverts water creating intense pressure on the upriver side of the tree and increases the flow of water around the tree, under the tree, and potentially over the tree. The result is everything from eddys to holes on the down river side of the tree with potential current differentials as well as potential displacement of the tree. The water will want to take the victim where it naturally wants to divert.
- How do I deal with it: I must quickly analyze all of the potential and existing characteristics of the water as it interacts with the strainer. I must understand all of the advantages and disadvantages of those characteristics for my approach to the victim as well as my extraction of the victim. I must know the strengths and weaknesses of my crew and my craft and make a quick decision based on our collective KSAs.
If we break down various water environments, we can discuss the specifics on applying the right KSAs to the specific technique of extracting victims from the water. It sounds like it should be easy, but the water is ever changing and often completely unforgiving. In a split second, the inability to properly read the water and manage your rescue position, can have fatal consequences. The system must be applied to the victim as well as the water environment. There is no way to describe every possible water rescue scenario. So, we will keep this relatively basic and confined to primary water rescue techniques used to retrieve victims from the water. We will then add the matching environment or scenario where that technique is best suited.
Parbuckling: This involves coming alongside of a victim, and using an implement to help roll the victim into the boat. This may require two rescuers but can typically be performed by one rescuer while the pilot stays on the tiller. The boat should approach the victim in a controlled manner and the victim should be secured in a linear fashion parallel to the side wall or sponson of the boat. Boats can be pre rigged with cargo nets, webbing, or cordage. Rescuers can also deploy sections of throw line or EMS blankets. With all of these equipment options, the deployment concept remains the same. We are going to anchor the equipment on the inside of the craft by attaching it to designed anchor points or simply standing on it. We then pass the equipment or implement into the water and under the victim, reach over the victim and bring it back towards the boat. This creates a “burrito” or a roll or a V bridle around the victim. We then pull on the free end or top side of the implement and sit down into the boat. This action rolls the victim in.
System Application: Flat Water application, limited wave or wind sweep, victim is commonly floating face down or face up and in an obviously unresponsive state. Commonly a recovery mode technique where injury management is not as high priority. Requires basic KSAs with one rescuer minimum and one pilot holding position of the boat or going to neutral and assisting the rescuer.
Leverage: This usually requires a backboard. The approach is made under control again but we orient the victim perpendicular to the side of the boat with their head closest to the boat. The backboard is then plunged straight down into the water between the boat and the victim. As the buoyancy of the board offers resistance, push the board towards the victim’s feet and allow to come naturally to rest under the victim. Secure the backboard strap under the victim’s arms and across the chest. Then bring the head of the backboard up top the top side of the boat and withdraw the victim from the water. The board should be used as a lever with the side of the boat functioning as a fulcrum. If rescue swimmers are in the water, another option on this is to leave the backboard in a slightly vertical position while securing the victim with the upper strap. The victim can then be bounced slightly up and down to create upward momentum and buoyancy and more easily transferred up onto the side of the boat.
System Application: Flat Water application, limited wave or wind sweep, victim is commonly floating face down or face up and in an obviously injured state. Commonly a rescue mode technique where injury management is the highest priority. Requires basic KSAs with one rescuer minimum but two preferred and one pilot holding position of the boat or going to neutral and assisting the rescuer. The secondary rescuer can enter the water and support the victim’s injuries during the packaging and transfer.
Bounce: In this technique, the victim is secured by a manual grab from the rescuer to the side of the boat. The boat holds position and the rescuer bounces the victim up and down two to three time and then pulls them into the boat. The rescuer must assume a high position up on the side of the boat and get a firm and reliable rasp on the victim. This is difficult if the victim does not have a PFD on. The rescuer must also be careful to produce enough bounce for the desired movement but the victim should not be dunked to the point that their head or face are pushed underwater. On the last momentous bounce and the rescuer should pull up and then sit down into the boat bringing the victim in on top of them.
System Application: Flat Water or Moving Water application, limited current, victim is commonly floating in a defensive swimming position or upright position and is conscious and relatively active. Commonly a rescue mode technique where injury management is not a high priority. Requires advanced KSAs with one rescuer minimum and one pilot holding position of the boat. The pilot must be skilled enough to counteract the turn forces that will be applied to the boat when the victim is secured in current. The rescuer must be skilled enough to hold onto the victim and pull them in quickly. This is a physically demanding technique on the rescuer and presents specific hazards to the victim in the way of a motor that is not reduced to neutral. The victim cannot be lost under the boat or down the side of the boat without the pilot quickly transitioning to neutral. In current this will result in the boat being at the mercy of the river. Approaches must be made from a down river position and the victim should be allowed to come to the boat. As the pilot throttles up to maintain position, the victim will have increasing drag and result in more resistance and force for the rescuer to overcome.
Peel Out: The peel out technique requires timing, communications and coordination but is by far the most efficient technique. The set up for this is the same as the bounce. However, the pilot must be proficient at eddy turns or peel outs and he must know the turning radius of the boat. Additionally, the water space must be wide enough to make the turn. The rescuer should also make sure that he grabs the victim and secures them on the front third of the boat. If the victim and rescuer set up too far back, they will end up on top of the pilot and will not develop the natural bounce needed to get the victim into the boat with ease. As soon as the victim is secured. The pilot initiates a tight turn towards the side that the victim is on. This turn will bring the bow of the boat and thus the victim partially out of the water as the turn progresses. Additionally, the wake produced by the outboard will push under the victim approximately half way through the turn and help push the victim into the boat. The rescuer must time his pull to marry up with the bow lift and wake production and then simply sit down into the boat and the victim will follow.
System Application: Flat Water or Moving Water application, moderate to swift current, victim is commonly floating in a defensive swimming position or upright position and is conscious and relatively active. Commonly a rescue mode technique where injury management is not a high priority. Requires advanced KSA’s with one rescuer minimum and one pilot maintaining operation of the boat. The pilot must be skilled enough to set up the boat with appropriate spacing to make the turn. He or she must also be capable of performing advanced peel out or eddy turns while communicating with the rescuer. The rescuer must be skilled enough to hold onto the victim and pull them in at the proper time. This is also a physically demanding technique on the rescuer and presents specific hazards to the victim in the way of a motor that is not reduced to neutral. The victim cannot be lost under the boat or down the side of the boat without the pilot quickly transitioning to neutral. In current this will result in the boat being at the mercy of the river. Approaches must be made from a down river position and the victim should be allowed to come to the boat. This technique reduces much of the motor hazard to the victim as the motor is moving away from the victim during the turn and it is also reducing the workload on the rescuer.
Pinning: Pinning is applied when we position the boat with a proper ferry angle and throttle control to stabilize a point of contact between the boat and an object such as a tree, bridge column or vehicle. This is typically used for conscious victims that can assist in their own rescue sequence by following directives and command and initiating their own movements.
System Application: Flat Water or Moving Water application, limited to swift current, victim is commonly stuck on an object. Commonly a rescue mode technique where injury management can vary. Requires advanced KSAs with one rescuer minimum and one pilot holding position of the boat. The pilot must be skilled enough to read the water as it interacts with the object and position the boat properly to avoid high siding or being swept away with the object it displaces. The pilot will also have to determine the proper angle and amount of throttle necessary to keep the boat in a stabilized position with the object. The rescuer must be skilled enough to coach the victim into the boat safely as well as potentially exit the boat and secure the victim on the object to ultimately assist them into the boat. This may require additional resources to free the victim depending on their entanglement with the object.
To summarize, rescuers must develop strong and continually growing KSAs. Both individual rescuers and rescue crews should be disciplined in approaching rescue evolutions with a system to help process information efficiently and accurately and translate into high impact and proper actions. Practice, practice, practice and let the experiences you develop sharpen your capabilities. Stay safe and Train Hard!