Confined space rescue

THE GREAT ESCAPE

More than 60 per cent of confined space fatalities are would-be rescuers. That’s why developiong a safe and effective rescue program is so important.

By Bob Salo

In the summer of 1993, the Vancouver Fire Department responded to workers in trouble inside a barge that was undergoing repairs. This barge had large ballast spaces that were more than seven feet deep. To inspect one of the spaces, a worker entered it without monitoring the air quality. He soon lost consciousness. When another worker outside the space was unable to get a response from him, the fire department was called and a first aid attendant at the site was summoned. This attendant and the second worker entered the space to attempt a rescue.

When the fire department arrived at the scene, two firefighters donned their self-contained breathing apparatus and climbed down a ladder to assist. However, to fit through the opening, rescuers had to remove their air cylinders and have them passed down to them. They found all three workers in various levels of consciousness. They attached two of the workers to spine boards and managed to lift them up to other rescuers waiting outside the opening. While struggling to lift the attendant out of the space (he weighed over 250 lbs.), one firefighter lost his facepiece. He struggled for air while being assisted out of the space. The last person brought out, the first aid attendant who had attempted the rescue, died at the scene and could not be resuscitated.

More than an hour later the air was tested and found to contain only 15 per cent oxygen. (Normal air contains 20.9 per cent, and the acceptable range for human occupancy is considered to be 19.5 per cent to 22.5 per cent). It was found that oxidation (rusting) of steel in the ballast chamber had consumed much of the oxygen in the space.

The workers were inadequately trained in the potential dangers of the confined space where rusting was visible. They also did not have a "rescue plan," which would have required the attendant (or "hole watch") to remain outside the space and immediately summon rescue personnel in case of trouble. Unfortunately, at the time of this incident, the responding fire department personnel had not completed confined space awareness or rescue training. They did not test the atmosphere in the confined space before entering. The firefighters used self-contained breathing apparatus (SCBA) instead of supplied-air respirators (SAR), and thus were not properly equipped to enter a small-diameter opening. As a result, one firefighter’s facepiece was pulled off, endangering his life. The fire department now has a well-trained rescue team equipped with air monitoring equipment, hardware communications equipment, and SARs.

In another case, this one in Altona, Manitoba in 1996, three workers were loading a rail tank car with canola oil when a hose fell into the tank. One of the workers went in to retrieve it. When he did not come out, a second worker went in after him to investigate and try to help. Then, when there was no response from either man, the third worker went into the space.

When professional rescuers arrived, they found all three workers unconscious in the tank. Two of the workers died, and the third was sent to the hospital in critical condition.

The workers were inadequately trained in the hazards of confined spaces. They were also unaware that the tank car had been filled with nitrogen to prevent the canola oil from spoiling. The first worker should not have entered the space to retrieve the hose, and the other workers should not have entered the space to attempt a rescue. Instead, they should have immediately summoned rescue personnel.

Alarmingly, statistics show that up to 60 per cent of confined space fatalities are not the initial victim, but the would-be rescuers who tried to save them! The lack of training, or inadequate training, puts employees at great risk -- and this applies to those who work in confined spaces as well as to those who attempt (or those responsible for) their rescue.

In a confined-space emergency, the need to "do something" is tremendous, especially when a co-worker’s life is in danger. And, those responsible for rescue are expected to take immediate action, regardless of their training or experience in dealing with confined space emergencies. However, one of the most important lessons in confined space emergencies is knowing when not to take action. And having a "little" training in confined space rescue often gets the individuals involved in even more trouble -- many times resulting in multiple fatalities.

Creating a safe and successful confined space rescue team should be the goal of any organization, including both municipal agencies and industrial facilities. Let’s clarify what is meant by safe and successful:

* Safe means possessing the ability to identify and understand hazards (both physical and atmospheric), and the knowledge to deal with those hazards safely. In other words, can rescue team members enter a confined space without themselves becoming victims?

* Successful means having the proper training, equipment and experience to effect a confined space rescue in an efficient and timely manner. Can the rescue team use their skills to enter a confined space, treat and prepare (or "package") the victim for evacuation, and remove him within a reasonable time period?

Both municipal and industrial rescue teams must be prepared for confined space emergencies. The training provided for these emergency responders must be "well-rounded." For example, municipal teams are generally strong in incident command procedures, the use of breathing air equipment, and emergency response because they are called to emergencies on a daily basis. However, they may lack adequate training in air monitoring equipment, and they may be unfamiliar with specific chemicals at any given site. Industrial rescuers, on the other hand, are normally strong in familiarity with site specific hazards, air monitoring, and entry procedures; however, they may lack emergency response experience because they are called on fairly infrequently.

EXTERNAL AND INTERNAL RESCUE

The majority of confined space regulations relating to rescue appear to assume that the worker in trouble will be wearing a full-body harness and will be attached to a life-line with tripod or other lifting device. This would be the basic arrangement for an "external rescue" or retrieval. The term is used because the rescuers do not enter the space to effect the rescue. The worker entering the space (the "entrant") is rescued via his life-line and a lifting device consisting of a winch or a pulley system. It is the safest form of confined space rescue because the rescuers do not physically enter the space.

In a typical external rescue, a worker, outfitted with the appropriate personal protective equipment, enters a confined space that has been assessed and tested. The worker enters the space under his own power or is lowered in. A life-line is connected to his or her full-body harness and to retrieval equipment located outside the space. In an emergency, the attendant operates the retrieval equipment to pull the entrant from the space without exposing additional personnel to possible hazards. Prerequisites to this scenario include a proper confined space entry program, planning, adequate equipment, and appropriate training for all workers.

An internal rescue, as the name implies, requires a rescuer to enter the space to effect the rescue. And there are many situations that require a more complex internal rescue procedure, such as when an entrant has detached his life-line. Other examples might involve multiple entrants, entanglement hazards, or when medical packaging is required. Another problem requiring rescuers to go in happens when the internal configuration of the space prevents the attendant from simply "pulling" the worker from the space. To extract the entrant under those circumstances, rescuers must put themselves at risk by physically entering the space.

And, of course, internal rescue is often the only alternative in emergency situations in which entrants have not followed the proper confined space procedures, and have not made provision for external rescue. When external rescue is not appropriate or possible for any of these reasons, provisions for internal rescue must be clearly established. Internal rescue obviously requires much more planning, preparation, and training for responding personnel.

TIMELY RESPONSE

Response time is a critical factor in confined space emergencies. Often the difference between a "rescue" and a "body recovery" may be just a matter of a few minutes. When evaluating confined space rescue capabilities, the time it takes for rescue personnel to arrive at the site must be a primary consideration. Whether relying on an "off-site" rescue team (such as a municipal fire department) or an "on-site" emergency response team, the rescue service that the emergency plan relies on must be adequately equipped and trained to respond quickly and effectively to a rescue summons.

From the professional emergency responder’s viewpoint, rescue time can be divided into distinct blocks as shown below:1. Reaction time -- the time period between when the entrant experiences a problem requiring rescue, and the moment when the attendant recognizes that the entrant has a problem.2. Contact time -- the time taken by the attendant to actually contact the rescue team.3. Response time - the time taken by rescuers to arrive at the scene after being notified.4. Assessment time -- the time taken by a rescue team to size-up the problem and determine the appropriate strategy for effecting a safe, efficient rescue.5. Preparation time -- the time taken by a rescue team to set-up for the rescue.6. Rescue time -- the time taken for the rescue team to reach, treat, package, and evacuate the victim from the confined space.

Of course, response time is only a part of the entire process. All of the other times must also be considered when evaluating rescue response requirements. However, employers must use caution. Response time calculations that include access to the victim should be used only as a goal. Rescuers should not be pressured by a mandated time limitation when entering a hazardous confined space to perform a rescue. Normally, the most life-threatening rescue emergencies (such as when hazardous chemicals or atmospheres are involved) require the most assessment and preparation time before entry. Rescuers should keep this in mind when establishing team protocols or suggested operating guidelines.

For planning purposes, the following chart shows an estimated "time-line" for rescue response.

Sequence of events and estimated time elapsed:
1. Incident occurs and rescue team is notified. 0-to-3 minutes
2. Rescue team arrives at scene within 10 minutes. 3-to-13 minutes
3. Rescue team sizes-up and prepares to initiate the rescue. 13-to-23 minutes
4. Rescue team reaches and evacuates the patient. 23-to-38 minutes
5. Patient is transported and arrives at the emergency room. 38-to-53 minutes

It is important to note that there are numerous legitimate reasons why a rescue response could exceed the above times. They are simply benchmarks that can be used to establish training needs and operating guidelines. They also provide "response goals" to strive for in training exercises or when conducting performance evaluations. A safe confined space rescue should take a minimum of 15-to-20 minutes to accomplish if the team is responding to the scene versus standing by at the entry site.

RESCUE STAND-BY / RESCUE AVAILABLE

Certain regulations require "emergency action plans" for hazardous work areas. Therefore, it is imperative that the appropriate rescue response be determined before each entry. Because each entry -- even of the same confined space -- may involve different circumstances, the response classification must be evaluated each time. The entry supervisor, ideally in conjunction with a rescue team member, must decide whether to require "rescue stand-by" (the rescue team is standing by at the entry site, ready for immediate action) or "rescue available" (the rescue team is available to respond upon request).

Rescue stand-by requires the rescue service to be ready at the entry site in order to be able to enter the space immediately and reach the victim within two to four minutes. The team must prepare prior to the entry by assessing the hazards, determining a rescue strategy, making team member assignments and pre-rigging equipment. It is also recommended that the team rehearse the rescue procedure in advance.

Rescue available requires the rescue service to be available for emergency response upon notification. An approximate response time of 10 minutes to the entry site is recommended. Once on site, rescue personnel should be able to reach the worker in approximately five minutes. Typically, an on-site rescue service should be able to meet these goals. The response time for off-site rescue services (such as fire departments) can be determined by requesting their documented "average response times". Most emergency response agencies are required to keep these records. (A monitored, controlled "practice drill" is one very effective means for determining the response capabilities of a rescue service for both off-site and on-site services. Many municipal rescue agencies would be willing to help set up such drills as both a test of their systems and an opportunity to train their people.)

By answering the following three questions, the entry supervisor can determine which of the two response modes (rescue stand-by or available) is appropriate.(1) Is the hazard (or potential hazard) immediately dangerous to life or health?(2) Is supplied breathing air required for entry?(3) Would the entrant have difficulty exiting the space unassisted?

If the answer to any of these questions is "yes," then rescue stand-by would be warranted, which would require rescuers to be standing-by at the entry site. If the answer to all three questions is "no," then the appropriate response mode would be rescue available or "on call."

The entry supervisor should have the authority to classify an entry as "rescue stand-by" even if all three of the above questions are answered "no". The entry supervisor’s experience (or instinct) may indicate a potentially serious problem for rescue from that particular space.

Classifying each entry as rescue stand-by or rescue available may be the most effective means to identify the appropriate rescue response mode. All work spaces should be categorized in order to provide documentation that proper evaluation has occurred. Once this is completed, a more informed decision can be made as to what is required for meeting "timely response" requirements. This categorization system also balances the impracticality and expense of providing "rescue stand-by" for every entry, while recognizing that entrants are occasionally exposed to obvious hazards requiring the availability of immediate rescue response.

PROGRAM DEVELOPMENT

Considering the many factors involved, the development and maintenance of a safe, effective confined space rescue program can be overwhelming. Once management’s support has been confirmed, other critical issues include:

* establishing team structure, membership criteria, and operating guidelines;* securing the proper training and equipment;* scheduling regular practice drills and performance evaluations; and,* complying with applicable standards (such as those of the National Fire Protection Association) and regulations.

Team structure and size: The team’s structure, including leadership and individual roles, must be clearly defined for the team to function effectively. While team size will vary depending on available manpower, coverage area, and site specifics, normally a team of six members is considered minimum with a goal of at least eight members.

Membership criteria: The "attitude" of a prospective team member may be the most important consideration. Being an effective team member requires interest, enthusiasm, and an investment of personal time to develop and maintain skills. It is highly recommended that participation in the rescue team be voluntary rather than based on "job assignment." Volunteers are usually much more willing to learn and perfect their skills. Finally, because rescue activities are physically demanding, prospective rescue team members should be in good physical health.

Training: Due to the many hazards involved, all staff should be trained at least to an "awareness" level in confined space rescue. These responders must be able to recognize that an incident is a "confined space rescue emergency" and to immediately summon rescue personnel. While an "external" rescue (retrieval) can be attempted if circumstances permit, employees and untrained responders must understand the importance of not entering a confined space to attempt a rescue.

For confined space rescue personnel, training should include classroom lecture as well as extensive "hands-on" field work. Topics such as safety systems, rigging, anchoring, lowering systems, victim packaging, mechanical advantage systems, confined space hazards, compliance issues, team building, communications, and problem solving should be addressed and practiced in the field. As with any emergency response program, follow-up training and regular practice drills are essential for maintaining skills. Competence comes from confidence, and confidence comes from practice!

Additionally, practice drills must be realistic, effectively simulating the environments that rescuers will face in confined space emergencies. Training props must adequately represent the types of confined spaces for which the rescue team will be responsible. It is recommended that rescue teams inventory and "type" confined spaces according to established criteria. For example, the team would consider the opening size, configuration, and accessibility. Another important consideration would be the internal configuration, whether congested or non-congested. Once the spaces are typed, a matrix can be developed to assure adequate training and practice in the various types of confined spaces identified.

How much training is needed? Basically, the answer is "how ever much it takes" for the team to be able to perform confined space rescues in a safe, efficient, and timely manner. However, most rescue professionals agree that for personnel who are expected to perform internal confined space rescues, a minimum of 40 hours initial training is needed. In fact, 80 hours is recommended.

The number of different confined space types on site and their complexity play a key role in determining the number of initial training days needed. Keep in mind that a two- or three-day course often gives the rescuer just enough information to get into serious trouble.

Refresher training, following the initial training program, is critical to the success of any rescue program. In order for team members to fully develop and maintain their skills, a minimum of 24 hours quarterly is recommended. Rescue skills must become "second nature" to responders when dealing with the intensity of an actual emergency.

The final component in a safe and successful rescue program is the provision of annual "individual" and "team" performance evaluations conducted by a qualified confined space rescue professional. These evaluations are an excellent way to determine (and document) rescue capabilities. This documentation is very important for liability and compliance purposes and should be done for all training, practice drills, and performance evaluations.

Effective confined space rescue operations result from proper training, equipment, and experience. Organizing a safe, successful confined space rescue program takes commitment, time, and money. A clear, step-by-step action plan will assist you in meeting your goals of preparedness and compliance. Remember, a little knowledge can be dangerous, and in confined spaces, it can be deadly.

Captain Bob Salo has 27 years of service with the District of North Vancouver Fire Department. He has been a rescue instructor for The Roco Corporation since 1991 and is currently the chief instructor for Roco Rescue of Canada, Inc.

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