DMC Preci 19-5-22-1.pdf

66 RESTRICTED Chapter - 11 Introduction to CSSR 1. Lesson Objectives a. Upon completing this lesson, you will be able to:...

66 RESTRICTED Chapter - 11 Introduction to CSSR 1. Lesson Objectives a. Upon completing this lesson, you will be able to: b. Define a collapsed structure search and rescue operation. c. Describe the structure of a CSSR squad and the positions within it d. List five phases of a CSSR operation. e. List the six stages of the Operations phase. f. List the five steps of the initial assessment. g. Describe how a CSSR squad fits into the Incident Command system. h. Name the four levels in the scope of operations as they pertain to CSSR. 2. Collapsed Structure Search and Rescue. According to the National Fire Protection Act (NFPA 1670) CSSR is an operation to conduct safe and effective search and rescue operations at collapsed structure incidents involving the collapse or failure of reinforced and unreinforced masonry, concrete and heavy timber construction etc. 3. CSSR Squad. An active component of an emergency response system whose purpose is to search for, locate, gain access to, stabilise and extricate trapped victims from a collapsed structure. 4. CSSR Squad Organisation Squad Leader Rescue Rescue Rescue Rescue Rescue Specialist Specialist Specialist Specialist Specialist (L) (L) – Squad members rotate positions as Logistics Person RESTRICTED  67 RESTRICTED 5. Operation phases 1. Preparation Stages 3.1 Safety and security Steps 3.2 Initial Assessment 2. Activation and Mobilisation 3.2.1 Compile information 3.2.2 Command Post 3.2.3 Operational objectives 3. OPERATIONS 3.2.4 Assign tasks 3.2.5 Reassess and adjust 3.3 Search and locate 4. Deactivation and 3.4 Gain access to patient Demobilisation 3.5 Stabilise the patient 3.6 Extricate the patient 5. Post- Operational Activities 6. CSSR Response 7 days Survival Rate (%) Buried Highly (trapped specialised Increased training/ more equipment beneath and equipped structural teams elements) 2 days 5% Estimated Time Elapsed CSSR Team scope of Trapped First in void 15% response action 8 hours spaces teams Trapped, Community beneath 30% response non-structural groups elements 4 hours 50% Improvised rescues Injured victims, by neighbors and not trapped passers-by near the collapse site Victim Status Type of Response RESTRICTED  68 RESTRICTED 7. Incident Command System. A flexible system for managing people and resources. Incident Commander Information Officer Safety Officer Liaison Officer Finance/ Operations Planning Logistics Administration Section Section Section Section 8. Scope of Operation RESTRICTED  69 RESTRICTED Affected region City or area Scene Work Site RESTRICTED  70 RESTRICTED Chapter - 12 CSSR OPERATION SAFETY 1. Safety in CSSR Operation a. CSSR op are the most complex and difficult activities that first responders team face in the line of duty. b. After the Mexico City earthquake in 1985 almost as many rescuers were killed as there were victims of the actual earthquake. 2. Unsafe Actions and Conditions a. Unsafe Actions b. Unsafe Conditions 3. Course Safety Rules a. Practice areas b. PPE c. Hygiene d. Safety Officer e. Group safety f. Safety Zone g. Rotations h. Safety Marking i. Violations 4. Course Safety Rules a. Whistle signals (1) Stop : — (2) Evacuate : (3) Continue : — b. Safety Zone c. Fire extinguishers d. Drinking water e. Maintenance RESTRICTED  71 RESTRICTED f. Rotations g. Smoking and drinking h. Weather conditions i. Safety markings j. Team safety k. Safety violations l. Miscellaneous 5. CSSR Msn Phs a. Prep b. Activation and mob c. Ops d. Deactivation and demobilisation e. Post-mission activities 6. Safety Considerations a. The CSSR team leader is responsibility for the safety of his team members b. However, SAFETY is everybody’s responsibility 7. Prep phase a. Cultivate a positive attitude b. Safe procedures and protocols c. Maintenance of equipment d. Training of personnel e. Training f. Well informed 8. Activation and Mob phase a. Establish safety procedures b. Safety in briefings c. Ensure PPE d. Ensure safety RESTRICTED  72 RESTRICTED 9. Operational Phase a. Correctly identify the risks b. Include following in daily briefings (1) Alert and alarm signals (2) Escape routes (3) Designate safety officer (4) Use of identity signs (5) Med facility location and transport 10. Safety Guidelines on Work Site a. including safety standards in work b. Monitor ops c. Accounting of personnel d. Personal rotations e. Monitor personnel for fatigue 11. Post Mission Activity a. Including all info in msn report including lessons learned b. Hold post msn evaluation session c. Document how to improve specific safety procedures d. Treatment of PTSD e. Replace worn-out material 12. Safety Officer a. The Safety Officer has the auth to alter, suspend or terminate activities involving an imminent hazard to persons b. The safety officer or lookout works from a safe and clear visual access just outside of the direct work area c. The person must not become involved with actual hands-on job d. To do so would possibly limit his ability to continue being an observer capable of identifying hazards RESTRICTED  73 RESTRICTED 13. Safety Officer Category a. Overall b. Site-specific c. Special Hazards 14. Safety Briefing Components a. Chain of Comd b. Identifying the Safety Officer c. Safety Plan (LCES) d. Comm Plan 15. Safety Plan a. L — Lookouts b. C — Comm c. E — Escape routes d. S — Safe zones 16. Safety Briefing Components a. Medical Plan b. Rehabilitation Plan c. Specific hazards d. General safety message RESTRICTED  74 RESTRICTED CHAPTER – 13 CONST MATERIALS, STRUCTURE AND DAMAGE TYPE 1. Construction Materials a. Natural material processed by man and used in the construction of buildings, which consist of structural and non-structural elements b. Classified by composition (1) Stones (a) Marble (b) Granite (c) Slate Marble Granite RESTRICTED  75 RESTRICTED Slate (2) Organic materials a) Wood b) Plywood c) Paper d) Particle board Wood Plywood RESTRICTED  76 RESTRICTED Paper Particle board (3) Metals (a) Iron (b) Steel (c) Aluminium Iron Aluminium (4) Conglomerates (a) Concrete (b) Plaster RESTRICTED  77 RESTRICTED (c) Adobe (d) Clay Concrete Plaster Adobe Clay RESTRICTED  78 RESTRICTED (5) Ceramics (a) Tiles Tiles (6) Glass (a) Window (b) Glass block Windows Glass block (7) Plastics (a) Polyurethane (b) Thermosetting adhesive (c) Duct Tape RESTRICTED  79 RESTRICTED Polyurethane Thermosetting Adhesive c. Classified by use: - (1) Structural load bearing element (2) Decorative element (a) Façade (b) Veneer RESTRICTED  80 RESTRICTED Façade Veneer (3) Non-structural walls ad partition (4) Covering element (roofing) Non-structural walls and partition 2. Tension. Force that acts to elongate or stretch a material RESTRICTED  81 RESTRICTED 3. Compression Force. Force that acts to crush or compress a material 4. Shear Forces. Forces acting in opposite direction, parallel direction and on different and on different planes so that they cut or break a material 5. Methods Of Construction a. Unframed Structures. Structure in which the weight of the floors and roof are supported by the bearing walls. RESTRICTED  82 RESTRICTED b. Framed Structures. Structures that are erected by constructing a structural steel or reinforced concrete skeleton made of horizontal beams and vertical columns. Unframed Structure Framed Structure 6. Structural Types a. Lt frame b. Hy wall c. Hy floor d. Pre-cast concrete 7. Characteristics of a Structure a. General b. Architecture c. Structural elements d. Non-structural elements 8. Damage Types to a Building. It can be classified as two types: - a. Structural. Affecting structural (load-bearing) elements b. Non-Structural. Affecting non-structural and decorative elements RESTRICTED  83 RESTRICTED 9. Basic Collapse Patterns a. Cantilever b. Pancake c. Lean to V shape Cantilever Pancake Lean to V Shape RESTRICTED  84 RESTRICTED CHAPTER - 14 SEARCHING AND LOCATION 1. Definition. A set of tech and procedures whose purpose is to obtain a response or indication of the presence of live victims in a void space within a collapsed structure. 2. The survival rate is: - 100 91 81 90 Survival Rate (%) 80 70 60 50 36.7 33.7 40 30 19 20 10 7.4 0 0.5 24 48 72 96 120 Time Elapsed (Hours) 3. Search Squad Squad Leader Rescuer 1 Rescuer 2 Rescuer 3 Rescuer 4 Rescuer 5 a. Squad Leader RESTRICTED  85 RESTRICTED (1) Responsible for developing the search plan, drawing diagrams, documentation and making recommendation to the Incident Commander. (2) Performs the duties of the Safety Officers and is responsible for monitoring security during the search op. b. Basic Equipment for Search (1) PPE (2) Personal supplies (for 12 hours) (3) Drinking water (4) Food (5) Proper clothing (6) Marking supplies (a) Paint (b) Chalk (c) Flags (d) Cones (e) Markers (7) Communication devices (8) Warning and alert devices (a) Megaphone (b) Whistle (c) Hammer (d) Flags (9) Recce & Vision Devices RESTRICTED  86 RESTRICTED (a) Binoculars (b) Photo camera (c) Flashlight (10) Radio Equipment (a) Radio equipment to communicate with team members and Command Post. (b) Portable radios (walkie-talkie) (11) Additional Material (a) Search diagrams, pencils, color pens, clipboards (b) Technical search equipment, specialized or improvised (c) Hazardous gas detector 4. Steps to Search and Location a. Compile and analyze information b. Secure the scene c. Inspect and evaluate the structure d. Rescue surface victims e. Make markings on the structure f. Create a diagram g. Select search area h. Select search method i. Conduct search and place INSARAG markings on structure and diagram j. Analyze results and re-evaluate k. Pre-hospital treatment l. Confirm potential victim location RESTRICTED  87 RESTRICTED 50% Victims Trapped on surface 35% victims lightly trapped 15% victims trapped in void spaces 50% victims on surface RESTRICTED  88 RESTRICTED 35% victims lightly trapped 15% victims trapped in void spaces RESTRICTED  89 RESTRICTED 5. Possible location of void spaces Structurally resistant areas: - a. Basements b. Elevator shafts c. Inside hallways d. Concrete walls RESTRICTED  90 RESTRICTED RESTRICTED  91 RESTRICTED RESTRICTED  92 RESTRICTED 6. Search Modalities a. Hasty Search (Primary). This type of search is conducted to quickly detect the presence of survivors on the surface or easily accessible void spaces. Hasty search accomplishes the following: - (1) Rapid detection of victims (2) Scene assessment (information gathered as a result aids in size- up of the rescue problem) (3) Sets priority b. Extensive Search (Secondary). This type of search is conducted in a methodical manner to pinpoint the exact location of victims. It is designed to cover the entire assigned search area carefully n detail. It accomplishes the following: (1) A thorough, sys search (2) Redundant checks (3) Allows for use of alternate search resources RESTRICTED  93 RESTRICTED 7. Search Methods a. Physical Search b. Canine Search c Technical Search 8. Physical Search a. Physical search operations do not req specialists or unique, expensive eqpt. They only req the senses and some established procedures. b. This search tac is the first, and sometimes the only search method used by local emergency svc agencies that do not possess tech or canine search resources. c. Local first responders must rely on fundamental search techs. A readily accessible and willing group of volunteers can be quickly trained and supervised to safely conduct physical search ops after a disaster. Basic physical search is usually performed immediately after an incident, and may be done by locals. d. A search team may need to modify and adapt modes to fit their specific needs. RESTRICTED  94 RESTRICTED 9. Hailing Method 12 o'clock (North) “We are rescuers – make some noise so we can hear you!!” Silence is essential 6 o'clock a. The search team leader signals for silence and all work to stop around the area b. Four team members form a cross pattern, spaced at intervals of approximately 8-16 meters, in safe locations as close as possible around the search area c. Going ‘around the clock,’ each searcher calls out loudly or with a megaphone, “If you can hear me call out for help or knock five times on something” d. Instead of hailing, searchers may also knock something solid (usually metallic) that is a contiguous part of the site debris in order to elicit a response e. All searchers then listen and point in the direction of any potential response to be instructions f. If more than one searcher hears the sound, the direction in which they point will triangulate on the source of the sound of the victim g. This must be noted on the site sketch or on personal notes, where each rescuer makes a rough sketch of the area and the direction of the source of sound RESTRICTED  95 RESTRICTED h. Use a coordinate grid system and/or the clock system (using North as 12 o’clock) i. The collapse pattern, building materials and a multitude of other variables can cause voices to be heard clearer than knocking, and other times vice versa. Use both methods for greater efficiency. 10. Search Patterns / Line Method 4 m 4 m 4 m A variation of the hailing method is to set up several searchers in a straight line across the site, or in grid patterns, as when performing the physical/void search. Use the line search method in auditoriums, cafeterias and offices with multiple partitions. a. Spread search team members in a straight line across the open area, 3 to 4 meters apart. b. Slowly walk through the entire open area to the other side. 11. Physical Search Pattern for Interior Spaces a. Occasionally you will encounter structures that have not totally collapsed and contain large, open areas or a building with many intact rooms, having live victims, unable to remove themselves or communicate, will be found. b. An organized approach will yield the best opportunity to locate a victim, and to declare the area search. RESTRICTED  96 RESTRICTED “Go right, stay right.” c. After entering the structure, turn to the right, stay in contact with the right wall, either visually or physically, until the entire accessible area has been searched and the team returns to the starting point. d. If the search team needs to exit and cannot remember the direction they entered, simply turn around and stay in contact with the same wall, either physically or visually, keeping it on your left. e. Team members on the ends of the line search perimeter rooms using the go right-stay method. f. The procedure may be repeated in the opposite direction. 12. Canine Search a. Uses the acute sense of smell of dogs specially trained to detect live RESTRICTED  97 RESTRICTED humans. b. Certified canine teams with highly specialized dogs provide the best way to locate trapped victims in a large area in the shortest amount of time. They are able to access areas too small or too unstable for humans to enter. Canines can be used for hasty and extensive ops. c. A thorough site search with two well-qualified search dogs has a high probability of conclusive results. The disaster t d. Rained search canine is trained to detect those victims that are still alive. Rescuers should coordination their activities with that of the canine team during their search. op. 13. Technical Search a. Req highly trained personnel and specialized eqpt for sound and temperature detection, video, vibration, etc. Can be carried out using specially manufactured or locally improvised eqpt. b. The latest state-of-the-art electric search eqpt has added a new dimension to the search function by extending its range. Whenever possible, dogs RESTRICTED  98 RESTRICTED and electric devices should be utilized together. Technical search equipment can be classified in two groups: - (1) Visual search instruments (2) Elec listening devices 14. Victim management a. Precautions during a search b. Steps for initial contact with a located victim 15. Precautions During a Search a. Never make inappropriate comments the victim should not hear b. Keep your comments on a positive note. Always assume someone is listening to you c. The victim is in the worst possible position and fighting to stay alive, and you can enhance their chances of survival by being positive about the possibility of finding and extricating them. d. You may be the first person the victim is able to communicate with; therefore, it is important to project a sense of confidence and hope. 16. Initial Contact with a Located Victim a. Identify and overcome language barriers b. Identify yourself as a rescuer, projecting confidence and calm in your voice and choice of words. c. Obtain the following information: (1) Name (2) Adult or child (approximate age) (3) Type and extent of injury (4) Hydration status (5) Warmth (6) Degree of confinement d. Provide emergency medical treatment as quickly as possible RESTRICTED  99 RESTRICTED e. Ask about other potential victims and their condition f. Inform the victim of rescue operations g. Inform the victim if you have to leave for short periods h. Provide protection from the environment as much as possible i. Consider direct or indirect intervention of a relative or friend, etc. 17. Improvised Search Equipment a. Acoustic detection (use to amplify sound through a crack or opening in a building): - (1) Stethoscope (2) Recorder with microphone mounted on a pole b. Visual detection (1) Telescopic mirror with illumination (2) Common video camera RESTRICTED  100 RESTRICTED c. Sound Transmission (1) Loudspeaker mounted on an extension, with microphone (2) Portable radios RESTRICTED  101 RESTRICTED CHAPTER -15 INSARAG MARKING SYS 1. Definition. A sys used to identify structures, conditions, hazards and victim status in a standardized, simple and clear fashion that can be understood by all local, national and international rescue personnel. All markings must be conspicuous and made using a high contrast, durable, fluorescent colour. 2. Marking System Information Category a. Assigned areas or work sites. b. Structure assessment and victim location. c. Gen hazards. d. Facility and vehicle markings. e. Team and function marking. 4. Location Reference — Exterior 5. Loc Reference — Interior RESTRICTED  102 RESTRICTED 6. Identifying Floors Floor 2 Floor 1 Ground Floor Basement 1 7. Identifying Columns D D 1 D 2 D 3 D 4 C C 1 C 2 C 3 C 4 B B 1 B 2 B 3 B 4 A A 1 A 2 A 3 A 4 1 2 3 4 F r o n t o f B u i ld i n g RESTRICTED  103 RESTRICTED 8. Marking Format Figure: Sample Marking: “Work in Progress” RESTRICTED  104 RESTRICTED Figure: Sample Marking: “Work completed” 9. Potential Victim Location Note: Draw a large “V” as close as possible to the location of known or potential victim(s). RESTRICTED  105 RESTRICTED 10. Confirmed Live Victims 11. Confirmed Dead Victims D - 2 12. Extricated Live Victims RESTRICTED  106 RESTRICTED 13. Extricated Dead Victims 14. Operations Work Zone 15. Collapse / Hazard Zone RESTRICTED  107 RESTRICTED 16. STANDARD SYMBOL SHAPES Facilities - circles Zones - irregular shapes Command function - box Reference point - triangle Time notation (with arrow point- 22/11 23/11 0700 Hrs. 1900 Hrs. ing to activity site) CP Command Post AP Airport Emergency Operations EOC Centre LZ Landing Zone BoO Base of Operations H Hospital Office of Scene Operations OSOCC Coordination Centre F Fuel OSOCC Reception Area RECEPT Emergency Medical WS Reference Work Site Point (include description) RESTRICTED  108 RESTRICTED CHAPTER - 16 TOOLS, EQUIPMENT AND ACCESSORIES 1. Definitions a. Tools. A tool is a device that is used to perform or facilitate manual or mechanical work, using only the strength of the operator. Examples: Tin snips, hand saw and sledge hammer Figure 1. Brick hammer and adjustable wrench b. Equipment. A piece of equipment is a machine or device that performs a physical task, whose operation depends on an external power source in order to increase work capacity, examples are circular saw, chipping hammer and reciprocating saw: - Figure 2. Chainsaw and rotary hammer drill RESTRICTED  109 RESTRICTED c. Accessories. An accessory is a component that supplements or completes a tool or piece of equipment, and which increases the operator’s ability to perform a task, examples are chain saw’s chain and drill bits. Figure 3. Carpenter’s apron and chipping hammer bit. 2. Classifying Tools, Equipment and Accessories According to their Use a. Search TEA. Search tools, equipment and accessories are used in searching for potentially trapped victims and locating the min collapsed structures. They can be used individually or in conjunction with each other b. Rescue TEA. Rescue tools, equipment and accessories are those used to penetrate a structure and gain access to a victim in a CSSR operation (Figure 4). Figure 4. Rotary rescue saw(K-12) and reciprocating saw c. Operations Support Equipment and Accessories. This category includes all items and devices used to aid in conducting a CSSR operation and which support rescue activities (Figure 5). RESTRICTED  110 RESTRICTED Figure 5. Generator and hand-held two-way radios 3. Personal Protective Equipment. Personal protective equipment (PPE) is required in order to prevent injuries while working on a CSSR operation. Some basic PPE items are shown below: - Figure 6. PPE items: work gloves, eye protection and safety helmet 4. Classifying Tools and Equipment According to Power Source a. Electrically-powered. Use to cut, penetrate and break materials. Figure 7. Electric drill and circular saw RESTRICTED  111 RESTRICTED b. Pneumatic (Air-Powered). Uses pressurized air to cut, hammer and lift. They can be powered by a motor driven compressor or pressurized cylinders. Figure 8. Pneumatic (air) chisel c. Internal Combustion. They use fuel motors and cannot be used in confined space. Figure 9. Generator d. Hydraulic They use the same principle as of pneumatic tools but instead of pressurized air, pressurized hydraulic fluid is used. Figure 10. Hydraulic bottle jacks RESTRICTED  112 RESTRICTED e. Other Types Figure 11. Hoist (come-along) 5. General Steps for Use and Maintenance. There are seven general steps you should follow when using any tool or piece of equipment in a CSSR operation. These steps are in addition to the specific instructions for each particular tool or piece of equipment. a. Before (1) Put on all required PPE (2) Verify availability of fuel and power sources. (3) Verify proper operation of tool (4) Check required accessories for each tool or piece of equipment (5) Follow all safety rules (course rules and manufacturer’s rules) b. During (1) Use proper technique when using a tool or piece of equipment. c. After (1) Follow proper cleaning and maintenance procedures for each tool or piece of equipment. d. Tips for Using Equipment. Follow these important guidelines when using various pieces of equipment: - (1) Always use the proper bit or blade for the material to be penetrated and make sure that it is firmly installed in the equipment before operating. (2) Do not operate a drill utility in contact with the material to be RESTRICTED  113 RESTRICTED penetrated. (3) Conversely, when operating a rotary saw bring it up to full speed before making contact with the material to be penetrated. (4) When drilling, do not stop the drill while the bit is inside the material–doing so may cause the bit to jam in the material. Likewise, do not allow the blade of a rotary saw to come to a stop while cutting material–remove it fully first. (5) If a drill bit becomes jammed in the material and you are unable to remove it with normal drill action, do not use the whole drill as a lever on the bit–remove the drill from the bit and try to loosen it with hand tools. e. Equipment Monitoring Form. The Equipment Monitoring Form on the following page is as a sample for tracking all activity and usage for a piece of equipment. The Maintenance Log and Use Log portion scan be broken out onto separate pages, as those portions can become lengthy. Because the form records maintenance, it is essential from the safety standpoint. RESTRICTED  114 RESTRICTED CHAPTER - 17 LIFTING AND STABILITIES LOADS 1. Before Lifting or Moving a Load. The following factors be examined before lifting or moving a load: - a. Weight of the load. b. Consequences when the load is moved (what will happen) c. Selection of the method for lifting or moving the load. 2. Method for Lifting Loads a. The Lever. The lever is the simplest method for lifting a load. A lever is a rigid bar, either straight or bent, that is free to move on an affixed point called a fulcrum. b. The fulcrum is the object or place that supports the load when a lever is used to move another object. c. Applications of Levers: - (1) To move a load that is too heavy to move by hand. (2) Pulling/hauling (3) Raising d. There are three components that make up a lever fulcrum, load, and force: (1) Fulcrum (2) Load (3) Force e. Three classes of Levers. Levers are divided into three classes based on where the fulcrum is located in relation to both the load and force. RESTRICTED  115 RESTRICTED (1) Class One Lever. The fulcrum is placed between the force and the load, which provides the greatest mechanical advantage when lifting a load vertically. You can increase the mechanical advantage by using a longer lever. Examples: - Figure 1: Class one lever examples (F = fulcrum) (2) Class Two Lever. The load is placed between the force and the fulcrum. This is the most useful and efficient lever for moving objects horizontally. Examples: - Figure 2. Class two lever examples (3) Class Three Lever. The force is placed between the load and the fulcrum. This type of lever is used when force may be sacrificed for distance, and reduces mechanical advantage. Examples: - Figure 3. Class Three lever RESTRICTED  116 RESTRICTED f. The Come Along. Provides mechanical advantage for lifting and pulling using a lever and gear ratcheting system. It consists of an anchor hook on one end and another hook attached to a retractable chain or steel cable. Figure 4. The come-along g. The following figure shown the many uses of the come-along. Figure 5. Various uses of the come-along h. Hydraulic Jacks. These devices are operated with a lever to apply hydraulic pressure. Hydraulic jacks are used primarily for lifting heavy loads. Though they usually have only a short reach, they are extremely powerful–and-operated bottle jack can lift as much as 50 tons. It is RESTRICTED  117 RESTRICTED important to keep the hydraulic jack perpendicular to the ground – the jack is not designed to handle lateral loads. Figure 6. Various bottle jacks. 3. Using Cribbing to Stabilize Loads a. Cribbing. The construction of a stable platform using wood places, which is used to stabilize and support loads. Cribbing is constructed of 10 x 10cm - sized wood pieces arranged as a column to support the weight of an object. Wedges are used to fill in small spaces and secure the object in its position as it is being lifted. Shims are also used to change the angle of thrust in order to achieve optimum contact with uneven or sloping surfaces. b. Failure of a wood cribbing system is slow and noisy as the wood fibers are crushed. This usually provides ample warning of impending failure for rescuers. c. The requirements for improvised cribbing are: - (1) The material must be flat on both surfaces (2) The material must be able to with stand the weight of the object being supported. e. Examples include: Furniture, bricks, concrete blocks, tires, and rims RESTRICTED  118 RESTRICTED f. Types of Cribbing. (1) Box Crib. Built with wood blocks in a square configuration, using two parallel blocks per layer. Layers are set at 90 degrees to each other with the ends of the wood blocks overlapping each other by 10cm. The box crib has an open center. Box Cribbing Capacity 10cmx10cmbeams: 11,000kilos 15 cm x 15 cm beams: 27,000 kilos Figure 7. Box Cribbing (2) Platform (Cross-Tie). Built with woodblocks in solid layers of or more wood pieces each. Layers are set 90 degrees to each other. Little or no space is left between the wood pieces. The ends of the wood pieces must also overlap each other by 10 cm. Platform Cribbing Capacity 10cmx10cmbeams=48,000kilos 15cmx15cmbeams=120,000kilos Figure 8. Platform cribbing g. General Guidelines for Cribbing. Failure of a wood cribbing system is slow and noisy as the wood fibers are crushed. This usually provides ample warning of impending failure for rescuers. RESTRICTED  119 RESTRICTED h. Height limit. The general rule is to limit cribbing to three times the width of the pieces of wood being used for cribbing (3:1 height - to- width ratio). For example, if the pieces of wood are one meter wide from one side of the first crib to the outer side of the last crib (across), the cribbing should not exceed three meters in height. i. Always overlap corners by approximately 10 cm. This prevents splitting off corners of individual pieces, which can affect overall stability. j. Procedure for Lifting and Stabilizing Bad. This procedure consists of gradually lifting the target object or load and inserting one layer of cribbing after another until sufficient clearance and stability are obtained. Make sure to use full PPE before starting any work. (1) Make an initial opening using a pry bar or similar tool. (2) Set up a lever system with the pry bar. (3) Lift the load gradually to create an opening large enough to setup the first layer of cribbing under it. Use wedges to prop up the load gradually as you are lifting; if the pry bar slips or breaks, this will prevent the load from dropping any distance. It is not necessary to lift the full height of the next layer of cribbing all at once. (4) Raise the fulcrum, raise the load again, and setup the next level of cribbing with the wood pieces at 90 degrees to the previous layer. (5) Reposition and raise the fulcrum and continue to raise the load until enough clearance is obtained to extricate the victim safely. Figure 9. Methods for safely lifting a load. RESTRICTED  120 RESTRICTED k. Safety Measures for Cribbing (1) Lift an inch, crib an inch. (2) Never place hands beneath a load while cribbing. (3) For max stability, the heigh cribbing should not exceed three times the width of the cribbing blocks (3:1 ratio). 4. Rolling a Load. You can use metal tubes to roll heavy loads instead of lifting them. Follow the simple steps below using the picture as a guide. a. Raise the load slightly using a Class One lever, just enough to slide three metal tubes underneath it (use the lifting technique for cribbing). b. Using Class Two levers, push the load in the desired direction. The tubes may be fanned to turn the load as it rolls. RESTRICTED  121 RESTRICTED CHAPTER - 18 PRE - HOSPITAL TREATMENT 1. Mechanisms of Injury and Their Consequences. It is very important for the rescuers not to lose sight of the primary objective of a CSSR operation. Their first responsibility is to assess, stabilize and extricate victims with the least possible injury. a. Crushing or Compression. Potential injuries and consequences: - (1) Compartment syndrome (2) Crush syndrome (3) Wide variety of fractures (4) Internal hemorrhaging b. Falls. Potential injuries and consequences: - (1) Fractures of the extremities, skull and spinal column. (2) Internal and external hemorrhaging. c. Low Temperatures. Potential injuries and consequences: - (1) Hypothermia and associated complications. d. Blunt Trauma. This can be caused by impact by furniture, loose objects or materials from the structure (at high velocity in explosions). Potential injuries and consequences include: - (1) Internal and external hemorrhaging. (2) Shock. (3) Various Injuries. (4) Severe contusions. e. Contained Air. (1) Itis common in collapsed structure situations to encounter large amounts of air borne dust, and in some situations hazardous and / or flammable vapours. RESTRICTED  122 RESTRICTED (2) Potential injuries and consequences: - (a) Respiratory difficulties (b) Cardiac arrest. (c) Respiratory arrest (d) Neurological Problems. f. Lack of water and food (1) Dehydration. (2) Starvation (3) Shock (4) Renal failure g. Prolonged Isolation and desperation (1) Traumatic stress. 2. Crush Syndrome a. Complications resulting from blood toxicity that arise after an extremity or muscle mass has been compressed and circulation compromised for an extend period of time. b. Crush syndrome can result when an extremity is caught under pressure between two objects It is common in trapped victims of collapsed structures. Swelling may be a major problem with resulting loss of blood supply distally. Patients may suffer (tourniquet shock) when the object is removed and toxins that have been built up behind the blockage are released and travel to the heart with often fatal results. c. According to studies on patients with crush syndrome, if they receive proper treatment in a timely manner, there is a 60 percent chance of remaining alive. Crush syndrome does not necessarily occur in every incident where a victim is trapped. As a general rule, the syndrome may be considered present on the basis of three criteria: - RESTRICTED  123 RESTRICTED (1) Involvement of a muscle mass (2) Prolonged compression (3) Compromised circulation d. For instance, entrapment of a hand is unlikely to initiate the syndrome. Compression time may be as short as one hour but the average time is four to six hours or greater. e. The major problem that faces the rescuer when dealing with suspected crush injury is dissuading helpful by standers from attempting to remove the compressive force prior to treatment. (1) Signs and symptoms of crush syndrome (a) Anxiety (b) Difficulty breathing (2) Decreasing blood pressure (3) Changes in body temperature (4) Rapid pulse (5) Cardiac deficiency (6) Loss of consciousness (7) Absent pulse and capillary refill in the distal limb (8) Shock 3. Compartment Syndrome. a. An increase in pressure in the closed space of the muscle caused by tissue swelling that causes destruction of music fibers and nerves. b. Compartment syndrome usually develops over a period of several hours and may not be present initially. It may be the result of crush syndrome, closed or open fractures, sustained compression, or after blood flow has been returned. As the duration and magnitude of interstitial pressure increases, necroes of soft tissue eventually develops. While compartment RESTRICTED  124 RESTRICTED syndrome can occur in most areas of the body, the more common sites are the forearm, calf and thigh. c. There are two prerequisites for compartment syndrome to occur: - (1) An envelope within the tissue that limits the available space (2) A cause of increased pressure within the envelope d. Signs and symptoms of compartment syndrome: - (1) Swollen limb in an unconscious patient (2) Severe pain, disproportionate to the injury (3) Pain on passive stretching of the muscles in the compartment (4) Diminished pulse (5) Poor capillary refill (6) Decreased sensation in the affected extremity (7) Shock (8) Dehydration (9) Loss of motor function in the affected limb 4. General Treatment for Trapped Patients a. Do not remove the source of pressure until treatment has begun. b. Check ABC’s c. Protect the patient from possible hazards resulting from the rescue attempt. d. Administer oxygen e. Immobilize the neck and spine f. Maintain body temperature g. Protect the patient from the environment h. Monitor the patient's cardiac state j. Allow qualified medical personnel to provide the required treatment RESTRICTED  125 RESTRICTED k. Place the patient on the backboard or stretcher, immobilize him or her, and proceed with removal from the site, using correct procedure at every step. l. Remember the protocols for contact with victims that were covered m. The specific treatments for crush syndrome and compartment syndrome must be administered by qualified emergency medical personnel. Consult the reference material for this lesson. 5. Immobilizing a Patient on a Backboard a. Stabilizing the patient’s head. b. Place the cervical collar. c. Rotate the patient onto the backboard. d. Inspect the patient’s back. e. Centre the patient on the backboard. f. Specific treatment for trapped victims (In case of trained health care provider or doctor): - (a) ABC’s (b) Oxygen (c) I.V. prior to removing compressive force (paramount!) Adult: 1000 ml. N.S. bolus. 50 mg. Sodium Bicarb. (d) Monitor EKG (e) Treat any obvious injuries (f) Splint the affected limb without applying pressure. (g) Keep the extremely level with the heart. (h) Reassess pulses g. Immobilize the patient onto the backboard. h. Check pulse, motor function and sensation after immobilizing the patient. RESTRICTED