3 Innovations That Will Change Technical Rescue In The s

By Pat Furr

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I’d like to share 3 innovations that I see as having game-changing potential for rescue operations in the next decade. None of these 3 are brand new, but recent advances have earned them a place in the rescue team’s toolkit.

Drones

One of the most dangerous aspects of rescue work is the time pressure that exists to reach victims before they succumb. Unfortunately, we often don’t have eyes on the victim and can’t communicate with them, so we must make assumptions about their condition. Rescuers frequently put themselves at greater risk in order to reach a victim quickly. Drones have the potential to give rescuers a clearer picture of the victim’s condition and possibly even communicate directly with them. This allows rescuers to appropriately pace their actions, to know what tools to bring to effectively treat the victim, and to avoid the same pitfalls that befell the victim. Not to sound too gruesome, but a drone can also help determine if it is a rescue or a recovery operation, which has obvious implications for the rescue operation’s pace and risk exposure.

Drones can also serve as reconnaissance tools during natural disaster rescue operations. This is a much faster and safer method of mapping an area than sending in rescuers and can be done while rescuers are pre-planning. Drones won’t completely replace manned helicopters, but they are safer, more available and more cost effective. Many drones are outfitted with software and GPS that produces maps and can geo-tag objects within centimeters of their actual location. Many also have thermal sensors, which allow for transmission of key data, and are designed to withstand extreme temperatures. Look for drones to play an increasingly important role in helping rescuers during the aftermath of hurricanes, floods, fires, tornadoes, blizzards and just about any adverse weather event.

Drones are also a great tool for getting a visual on victims at extreme height, such as on towers or tall buildings. Oftentimes these victims are not clearly visible with binoculars, making it difficult to assess their physical condition.

Drones are even being designed specifically for use in confined spaces. Previously, drones were susceptible to damaging crashes from flying in tight spaces. Also, the radio frequencies that control them were often unable to penetrate thick concrete walls. But engineers are addressing these issues and have come up with the Flyability Elios 2, for example, which features a spherical cage to protect the drone from slamming into walls. It also boasts a transmission system capable of working beyond line-of-sight, thus enabling the drone to fly into structures made of concrete, steel, and other materials.

These drones will likely help confined space rescuers in two ways… First and foremost, sending a drone instead of a human into a confined space for an inspection will become the norm, and with fewer humans doing entry work, there will be fewer incidents requiring rescue. Second, when a rescue is called for, a drone can scout the space for a rescuer, provide a visual assessment of the victim and transmit atmospheric data to the rescue team. All of these are invaluable pieces of data that will make the rescue operation safer and more effective.

Portable Powered Winches

One key skill in rope rescue is the ability to build mechanical advantage (MA) systems so that they can efficiently raise / lower / haul weighted objects using rope. I don’t expect this skill to become obsolete, but the use of portable powered winches will make rope rescue less dependent on rescuer-constructed MA systems. Winches have been around for a long time, and are a standard tool for arborists and tower workers, but they haven’t been used much in rescue until recently, as significant improvements in battery power and materials have now made them reliable and durable enough for use with human cargo. Because they are battery powered and compact, they are especially useful when manpower and operating space are limited. They are lightweight and therefore easy to pack and carry as part of a rescue team’s gear cache.

SkyHook Rescue Systems and Atlas Devices (whose APA-5 is pictured above) are among the leading manufacturers in this space. In the same way that pocket calculators take the legwork out of doing long division, winches make building efficient hauling systems that much faster and easier. That said, there are a few important caveats to consider when thinking about using portable powered winches in rescue operations. Safe use requires rescuers to factor in the weight capacity and to understand proper winch placement in a system like a tripod. Improper placement has the potential to unbalance and tip a tripod. Rescuers also need to know how to rig up a back-up rope system should the main line fail. Finally, the use of powered winches must consider the added risk of injuring the human load or damage to the system components should it become hung up. For these reasons, it is absolutely critical that the rescue load be visible to a dedicated monitor who can call an immediate stop to the haul should the load become hung up. Nonetheless, portable powered winches definitely have the potential to improve and change rope rescue operations, and I expect we’ll be training with them a lot more frequently in the coming decade.

Two-Tension Systems and Team-Style Friction Devices

The use of two-tension systems (sometimes called mirrored systems or dual main systems) is fast becoming a high-interest technique in the rescue world. Why? Since both ropes are tensioned, the load is shared, which decreases the risk of load-induced equipment failure. Also, in a two-tension system, there is no slack in the second line, so the potential free-fall distance is greatly reduced. Additionally, two-tension systems have double the mechanical advantage of traditional systems, making hauling more efficient.

As these two-tension systems become more popular, team-style friction devices (like the Petzl Maestro) will be a fixture in a rope rescuer’s toolkit. These are critical components of a two-tension system because they provide the three primary functions two-tensioned systems require – friction control, belay, and haul. By providing two mirrored tensioned systems during a lower, the forces on either of the systems are essentially cut in half. This greatly reduces stress on the system and is more easily managed by the operator working with heavier rescue loads. Also, as mentioned previously, using a mirrored 3:1 or 5:1 Z-rig through a Maestro or other similar device during hauling operations will double the mechanical advantage compared to using a single haul system. Applying two 3:1 mirrored MAs results in a 6:1 total MA. This can reduce the manpower required for the haul team, which is beneficial for a variety of reasons.

There exists a healthy debate in the rescue world over the pros and cons of two-tension systems versus more traditional single-main / single-backup systems, but it appears as though two-tension systems are winning the argument and will become the standard in the coming decade. 

Two-tensioned systems hold the advantage in many of the rope rescue operations where dedicated mains / dedicated belays are currently being used. But there are still a few situations where the dedicated main / belay system will remain the best-practice approach. It is important to train with both types to determine what works best for your response area. Two-tensioned systems require a different type of coordination between team members, but they are quickly mastered with practice.

Embrace the Changes Technology Brings Us!

Technological advances are impacting every sector of industry from microprocessors to rescue gear. Precision engineering and advances in materials have made the gear rescuers use today smaller, lighter, smoother, faster and safer than ever. Some advances are incremental, and you only recognize the progress when you look back over a long time-horizon. For example, a retired U.S. Army Ranger recently told me that when he was in Ranger School in the ’s, he rappelled off 60-foot towers and the only descent control technology he had was a pair of leather gloves! Clearly, we’ve come a long way since then, and the quality of devices a rescuer can use to safely control their speed during a descent is remarkable. Other technological advances are more immediately impactful and noticeable. Whether it happens slowly or rapidly, we as rescuers have a duty to always be evaluating innovative new equipment and techniques so that we can keep improving the overall effectiveness and safety of rescue operations.

About the Author:

Pat Furr is a Corporate Safety Officer, VPP Coordinator, Chief Instructor and technical consultant for Roco Rescue. In addition to penning articles on a variety of safety and technical rescue topics for Roco Rescue’s blog, Pat teaches Confined Space Rescue, Rope Access, Tower Work/Rescue and Fall Protection programs across the country. He sits on the National Fire Protection Association’s Committee for Technical Rescue and helped author NFPA , which outlines the professional qualifications standard for technical rescue personnel.

A retired U.S. Air Force MSgt/Pararescueman, Pat also helps design innovative equipment that improves safety in the industry, including a Class III rescue harness, a revolutionary fall protection harness, and a specialized anchor hook used for container access operations.

Unmanned aerial vehicles for EMS & rescue applications

Out-of-hospital cardiac arrest (OHCA) affects nearly 360,000 individuals in the United States and about 300,000 in Europe each year. Survival rates are low.1,2

In Sweden, 5,312 OHCA cases were reported to the Swedish register for cardio-pulmonary resuscitation (SRCR) during .3 CPR was initiated either spontaneously by bystanders, guided from the dispatch center through CPR or on arrival of EMS, which took place after a median of 13 minutes from cardiac arrest.3

Overall 30-day survival was 11% (n = 577) and a majority of these (93%) had a favorable neurological outcome, with a cerebral performance category (CPC) score of 1—2.3

Time to treatment with a defibrillator is the single most important factor for survival, and each minute without CPR treatment decreases the chance of survival by 10%.4,5 Early use of a defibrillator within the first five minutes has a potential to save up to 50—70% of all patients suffering from an OHCA.6,7

Early CPR performed by bystanders, dual dispatch using firefighters and public access defibrillation programs (PADs) have been introduced in Stockholm County and have been shown to reduce time to defibrillation.6

These interventions have proven successful in both urban areas and in public locations, but despite EMS response time improving in rural areas of Stockholm County with dual-dispatch intervention, it had little or no effect on survival.8

A lot of effort is put in to PAD projects around the world, and there are a variety of systems for alerting bystanders of nearby AEDs, or other ways of dispatching AEDs to OHCA victims. However, AED usage in OHCA is still low in relation to the proportion of available AEDs.7

A novel way of decreasing the delay in remote areas with long EMS response times from collapse to first shock, may be to use an unmanned aerial vehicle (UAV–more commonly referred to as a “drone”) to quickly deliver an AED to bystanders.

Drones have been predicted to be increasingly used by EMS for delivery of medical products,9,10 however, regulations on limitations in wind, flight endurance and payload need to be developed in order to ensure drones are utilized safely.

Study Design

In , the Centre for Resuscitation Science at the Karolinska Institute in Sweden initiated a drone project, with the intent to reach victims of cardiac arrest in rural areas at an earlier stage.

Drone technology was evolving, and a methodology for facilitating early defibrillation with such a system had not yet been described in the literature. Neither EMS and first responders, nor volunteers via smartphones, could reach the victims in time.

A geographical information system (GIS) was used to predict optimal locations for drones equipped with AEDs in Stockholm County. In this deployment strategy, a total of 3,165 OHCAs occurring between — were analyzed by weighing OHCA incidence per 100,000 inhabitants and EMS response time.12

The GIS model predicted 20 optimal locations of drone placement (10 in urban areas and 10 in rural areas). The time savings in urban areas was estimated to 1.5 minutes, with the drone arriving before EMS in 32% of cases. However, in 124 cases of rural OHCA, the drone was calculated to arrive before EMS in 93% of cases, with a mean time savings of 19 minutes.12

The coastline and archipelago surrounding the city of Stockholm is heavily inhabited during summertime, with no additional EMS resources. EMS response time is prolonged in the area, especially on the islands where publicly accessible AEDs are rare. Similar GIS findings have been made in Canada and the U.S., supporting the benefits of providing such a model.13,14

Different AED delivery methods were tested, including landing the drone, parachute-release, and using a latch-release from a low altitude.

The latter two methods, however, introduced risks of imprecision and of damaging the defibrillator after dropping it onto the ground.

Following the explorative GIS data and the testing of AED deployment, researchers submitted applications to the transportation board to operate test flights where the drone could be seen within a pilot’s range of sight. These flights were planned over nine months, and the team focused on mapping the geographical area, predefining flight corridors so the drone flew above uninhabited areas, setting up routines and informing local authorities, EMS and members of the community.

Redundant communication systems and a high-quality video link within the 3G/4G network was used to remotely monitor and pilot the aircraft. With a daily notice to airmen, dispatch and flights based on historical OHCAs were performed in October , with the results published in JAMA in June .15

A local dispatch center was set up at a fire station within the proposed testing area in Norrtälje County, and direct communication with air traffic control was maintained during these short flights, which were operated at a median of five minutes at low altitude (100 meters) at a maximum distance of 9 kilometers.

Data showed that the drone could be deployed from dispatch within just three seconds, with a total median time savings of 16 minutes from dispatch to arrival onsite vs. EMS.15

The short delay for dispatch didn’t take into account time for uncovering the drone from its housing, an important factor to take into account when considering future integration into control structures.

All test flights followed predefined routes that ensured residential areas were geo-fenced, in order to minimize risks and disturbances in the community. Additional risk mitigation tactics included the use of redundant communication systems, return-to-home features and emergency controlled landing.

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Even though straight flight lines seem intuitive, there are advantages in defining altitudes and flight corridors in order to minimize interference with other aircraft. Additionally, the use of radar or airborne collision avoidance systems are also advised. In order to arrive within 3—5 minutes after a cardiac arrest, early recognition at the dispatch center is crucial, followed by early dispatch of the drone and prompt flight times.

Although a battery-powered drone was used during the study, the size of the vehicle and the fuel used raised some questions. From the victim’s perspective, it doesn’t matter whether the drone weighs five or 100 kilograms. They don’t care where the drone gets its power to fuel operation (e.g., battery, hydrogen or jet fuel), as long as the response time is short and the AED is presented to a bystander in an intuitive way that minimizes the time to defibrillation.

In Stockholm, trained civilian “SMS lifesavers” have been strategically positioned throughout the service areas and dispatched using a smartphone app since .16 These volunteers have the potential to be co-alerted to pick up an AED delivered by a drone, especially if the landing site is > 100 meters from the location.

Experience shows that there’s risk involved in landing the drone in a public space. The drone’s lights, siren and engine noise tends to attract attention, and its still-rotating propellers can present a danger.

It’s believed that by using a winch in the future to lower the AED may promote safer delivery to bystanders, EMS or other first responders who are on site.

Communications with the drone may also improve when the drone is elevated, instead of hidden behind obstacles such as houses or hills. This will also conserve battery power/fuel so that the drone can still return to base if landing isn’t feasible.

Important questions have been raised regarding the feasibility of implementation at the community level and there may be many challenges.17

Although regulations differ in various countries, aviation legislation is similar across all high-income countries, with regulations focusing on safety for people on the ground as well as those in manned aircraft.

Drone technology is already at a level to facilitate early defibrillation in OHCA. However, there are several considerations and questions that must be asked in order to take a structured approach to evaluating all the links in the chain of drone deployment.

If not planned properly, integration of drones at the dispatch center could delay traditional EMS response or dispatcher-assisted CPR.

In addition, arrival of the drone on scene may cause prolonged hands-off intervals, as the bystander waits for the drone vs. performing high-quality CPR.

Designing an AED drone system for use in real-life OHCA cases is complex, requiring interaction of technology, regulations, bystanders and EMS control structures. Each area or region considering drone delivery of AEDs will need thorough testing in order to facilitate safe arrival of the drone and actual use of the AED during the first minutes of an OHCA.

Drones for Drowning

At the same time our researchers were studying drone delivery of AEDs on land, AED-equipped drones were also deployed for several historical drowning incidents of OHCA that occurred at Tylà¶sand public beach, where the victims were discovered too late in the drowning process.

Tylà¶sand is visited by nearly 50,000 bathers on a sunny summer day, with strong rip currents present in high wind conditions.

Off-the-shelf drones (specifically, the DJI Phantom 4) were tested in simulated settings to determine whether the drones could successfully send live video from an altitude of 60 meters down to rescuers using a tablet to watch the video and quickly locate submerged victims.18

The first drones for search and rescue purposes in Scandinavia were implemented in June at Tylà¶sand surf-lifesaving club.

In addition to providing situational awareness and facilitating early positioning of submerged individuals, there are future possibilities of providing early flotation to drowning victims by dropping self-inflatable buoys.

The drones may also see future use for ice rescue, with the drones delivering buoyancy and lines to victims trapped in breaking ice. Testing this concept is already underway in the Gà¶teborg area.

Conclusion

Drone systems have a strong potential to facilitate lifesaving medical interventions, such as transporting and delivering an AED in cases of OHCA. Our three-year vision is to implement a drone system that will autonomously dispatch to OHCA patients in suitable areas, defined by current regulations in the jurisdiction, controlled airspace considerations, and other factors associated with air traffic security.

We would like to encourage fire departments and EMS systems worldwide to learn more about the potential of deploying drone technology for both OHCA and water lifesaving purposes.

References

1. Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: Heart disease and stroke statistics– update: A report from the American Heart Association. Circulation. ;133(4):447—454.

2. Atwood C, Eisenberg MS, Herlitz J, et al. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. ;67(1):75—80.

3. Swedish CPR Council. (.) Annual report . Retrieved Dec. 7, , from www.hlr.nu/hjart-lungraddningsregistret/.

4. Valenzuela TD, Roe DJ, Cretin S, et al. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation. ;96(10):—.

5. Waalewijn RA, de Vos R, Tijssen JG, et al. Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic. Resuscitation. ;51(2):113—122.

6. Valenzuela TD, Roe DJ, Nichol G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. ;343(17):—.

7. Ringh M, Jonsson M, Nordberg P, et al. Survival after public access eefibrillation in Stockholm, Sweden: A striking success. Resuscitation. ;91:1—7.

8. Nordberg P, Jonsson M, Forsberg S, et al. The survival benefit of dual dispatch of EMS and fire-fighters in out-of-hospital cardiac arrest may differ depending on population density–A prospective cohort study. Resuscitation. May;90:143—149.

9. Floreano D, Wood RJ. Science, technology and the future of small autonomous drones. Nature. ;521():460—466.

10. Thiels CA, Aho JM, Zietlow SP, et al. Use of unmanned aerial vehicles for medical product transport. Air Med J. ;34(2):104—108.

11. Abrahamsen HB. A remotely piloted aircraft system in major incident management: Concept and pilot, feasibility study. BMC Emerg Med. ;15:12.

12. Claesson A, Fredman D, Svensson L, et al. Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest. Scand J Trauma Resusc Emerg Med. ;24(1):124.

13. Boutilier JJ, Brooks SC, Janmohamed A, et al. Optimizing a drone network to deliver automated external defibrillators. Circulation. ;135(25):—.

14. Pulver A, Wei R, Mann C. Locating AED enabled medical drones to enhance cardiac arrest response times. Prehosp Emerg Care. ;20(3):378—389.

15. Claesson A, Bäckman A, Ringh M, et al. Time to delivery of an automated external defibrillator using a drone for simulated out-of-hospital cardiac arrests vs emergency medical services. JAMA. ;317(22):—.

16. Ringh M, Rosenqvist M, Hollenberg J, et al. Mobile- dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med. ;372(24):—.

17. Mark DB, Hansen SM, Starks ML, et al. Drone-based automatic external defibrillators for sudden death? Do we need more courage or more serenity? Circulation. ;135(25):—.

18. Claesson A, Svensson L, Nordberg P, et al. Drones may be used to save lives in out of hospital cardiac arrest due to drowning. Resuscitation. ;114:152—156.

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