Casualty Respiratory Protection and Resuscitation During Protracted Rescue | |
| By Brian Robinson, United Kingdom Reprinted with permission from Technical Rescue Magazine | |
 The majority of readers of this fine magazine (have to say that, don’t I?) will be well versed and practised in the art of resuscitation using either mouth to mouth or bag & mask techniques. When the casualty is in a different situation where the air is contaminated and dangerous and it may take from 10 minutes to several hours to get a casualty out, those resuscitation and rescue techniques change drastically. This could be during confined space rescue, mines rescue or even a trapped casualty in a fire situation requiring extrication of the casualty from maybe 4m depth, to having a mines rescue team stretcher a casualty out perhaps 4000m. The rescuers by definition and practice will already have their own respiratory protection in the incidents mentioned above (well covered in previous issues of T/R), but that will not have an indefinite duration, making rescue / extrication a speedy affair. A lot of "proper procedure" and casualty stabilisation goes out the window, it almost becomes a scoop & run job.
Priorities will become;
Ideas of things we may use to protect a casualty; Escape BA which may be a short duration compressed air set, typically ten minutes, or a longer duration Oxygen escape set, although if a casualty is immobile a 10 minute set can easily become a 20-25 minute set because of reduced breathing capacity. Obviously when using either, the casualty must be breathing on their own, but in certain cases may not have to be conscious. With the facemask used on an unconscious casualty it is possible to put them in the recovery position, however the inner ori-nasal mask will not allow the rescuer to view expelled vomit etc. A trick with certain masks, like the Dräger Panorama Nova or Sabre Vision 3 allow quick removal of the inner mask possibly causing minor fogging inside but otherwise no detriment on breathing. Oxygen escape sets mainly have a mouthpiece and nose-clip rather than facemask, so in this case it is almost impossible for a casualty to retain the mouthpiece unless conscious. Vomit in either air or oxygen sets can cause BA set valve blockage and also high volume of oxygen given off in contact with moisture in the chemical oxygen type along with caustic solution, beware!!! Ranging from 20 to 90 minutes at a 40 ltr / minute walking pace gives an extended duration for an immobile casualty. With both the above escape apparatus, we have a compact, lightweight unit to provide an easily adapted solution to our problem. Standard BA set or airline units can be utilised much as an escape set to give longer duration protection but with the disadvantage of extra size and weight for the rescuers to carry in, and certainly an encumbrance on the casualty carrying system during evacuation. Most brigades utilise a second man attachment on BA sets, enabling a standard facemask and demand valve to be plugged into the second man attachment of one of the rescuers BA set. If a spare mask and D/V is carried by the rescue team, it could be utilised for a casualty. The obvious downfall is the rescuer will be effectively "tethered" to the casualty by hose and with the reduced duration of two persons breathing from the same cylinder. It should never be considered that a rescuer share his own mask with a casualty, buddy breathing. To do so would put the rescuer at risk.
Automatic Oxygen Resuscitators are now exactly as the term says, automatic. They are also (almost) idiot proof and safe for use in any environment. After ensuring a good airway and by using a compact and lightweight unit correctly, such as the Sabre MARS Pro featured in our pictures, BNOS Microvent, LifeTec Oxylator etc., it is possible to;
By utilising 100% oxygen with the resuscitator, the casualties lungs are being saturated with every ventilation / inflation, getting rid of any affected air in the lungs or blood stream quicker, giving a much better chance of spontaneous breathing occurring and casualty recovery. It should be remembered that if it is to be a protracted rescue, you want to get the best duration out of the unit by using 200 bar cylinders, a 2ltr X 200 bar composite cylinder giving a theoretical 37 minutes at 12 breaths / 900ml / min. with minimum weight. Time to throw away those 137 bar cylinders. It should be noted that some automatic resuscitators use a small portion of the oxygen to "drive" the unit, reducing theoretical duration of the set. Automatic resuscitators are also available to plug into the second man attachment of a compressed air BA much the same as the demand valve and mask mentioned earlier, but obviously then giving 21% oxygen and not 100%. Intubation is usable with both the bag & mask or automatic resuscitator options, but intubation may be exceptionally difficult to achieve in a cramped and restricted area, and on the primary rescue team there may not be anyone qualified to carry intubation out. It may fall to "old fashioned" airway management using Guidal airway and the recovery position.
Summary Several options exist for the safe evacuation of a casualty from a foul atmosphere, but certainly for the unconscious and non-breathing scenario, the automatic oxygen resuscitator has to be favourite if used properly. Cardiac massage during such a rescue is very difficult as with use of a bag and mask, it may put too much strain on a rescue team to try this option. The rescuers always come first, and their safety is the priority. Brigades and rescue teams should plan ahead and after risk assessment find out the best equipment to be used in their situation and train with that equipment to obtain its optimum utilisation, to both the casualties and rescuers benefit. Brian Robinson, March 01’ |
A bag & mask resuscitation unit coupled with 100% oxygen flow will certainly work on a non breathing casualty, but having to dedicate a rescuers total time to the bag in a restricted area or on a stretcher carry or lift will make operation of the bag all but impossible. A bag and mask without oxygen input would not be suitable, feeding bad atmospheric air straight to the casualty.
Casualty packaging can be achieved relatively easily on a spine board, roll up or basket stretcher, but it is important to realise the safety of any cylinders used by escape sets or resuscitators. Cylinders or complete units should be secured to the stretcher or harness, which with an automatic resuscitator is easy. They are designed with hoses that will facilitate securing the cylinder and regulator unit between the lower legs, the control module at top leg or hip area yet still having enough hose to go to the mask unit. A head harness can secure the mask to the casualty’s head, so long as the airway is kept clear and no leakage occurs around the mask. Also don’t forget, the casualty will (normally!!!) live with fractures or abrasions of limbs etc., forget those to a certain extent and concentrate on the breathing and respiratory protection. No protection- casualty dies anyway.