ICE RESCUE

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ICE RESCUE

• for
• FIRST RESPONDERS

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• The following presentation will demonstrate the
  appropriate techniques to consider for use during
  an
• ice rescue emergency.
• This presentation does not qualify you as an Ice
  Rescue Technician.

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OVERVIEW

• Objectives
• County Ice Rescue Incidents
• Equipment
• Arrival
• Victim Location
• Zones
• Tactics/Technical Tactics
• Patient Care

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OBJECTIVES

• To demonstrate several basic and advanced methods
  to perform Ice rescue.
• To provide critical safety information to protect
  the first responder
• Meets
• NFPA JPR 1670 7-3.5, 7-3.7.1, 7-4.8

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COUNTY INCIDENTS

• December 16, 2005
• A sixteen year old fell through the ice on a
  small sediment pond in Gaithersburg. He could not
  swim and quickly succumbed to the icy water.
  When the sixteen year old fell through the ice,
  a friend went into the water to help him.

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COUNTY INCIDENTS

• Both young men were rescued by a landscaping crew
  who used an extension cord to pull them in.
  Tragically, the sixteen year old did not survive.
  
• Jessicas Pond, where this tragedy occurred, is
  like many other ponds which are integrated into
  our neighborhoods.

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COUNTY INCIDENTS

• January 24, 1991
• Two sisters (ages 9 and 11) died in an icy pond
  at Valley Mill Park on Randolph Rd. Using ice
  rescue suits from the first due rescue squad,
  RS-15, the girls were recovered.

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• The previous slides confirm the critical need
  for MCFRS to be trained in the response to these
  unique events.

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TRAINING

• There are two Response levels for ice rescue
• Operations level
• Technician level

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TRAINING

• OPERATIONS LEVEL
• Operations level ice rescue is shore based and
  utilizes reaching or throwing techniques to
  recover victims.
• The reach and throw techniques for ice rescue are
  very similar to those used for static and swift
  water rescue.

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TRAINING

• TECHNICIAN LEVEL
• Technician level ice rescue basically involves
  two rescuers donning dry suits and PFDs.
• A tethered rescuer would proceed to the victims
  location, secure flotation to the victim, and
  then be hauled to shore with the victim.

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TRAINING

• TECHNICIAN LEVEL
• The second rescuer is a back-up rescuer and is
  available to assist in the rescue if needed.
• This technique can be rapidly deployed and is
  extremely safe for the rescuer.

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EQUIPMENT

• Personal protective equipment
• Personal Floatation devices
• Exposure suits
• Throw bags or rope
• Hose
• Hand tools
• Ladder
• Other related equipment

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EQUIPMENT

• TECHNICIAN PPE
• PPE should be drysuit w/thermal liner PFD or
  Ice Rescue suit.
• Rescuers should always plan on being in the
  water.
• Movement in suits maybe awkward and these suits
  may leak at the neck seal.

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EQUIPMENT

• Stokes Basket
• A plastic Stokes basket or backboard can be
  tethered or attached to a highline and used as a
  sled.

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ARRIVAL

• INITIAL ON SCENE ACTIONS BY RESPONDERS
• Make a hazard evaluation of the scene, to
  determine proper action required
• Establish warm zone restrict access
• (warm zone requires PFD NO Fire Gear)
• Make verbal contact with victim

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ARRIVAL

• Establish victim location by spotting
• Attempt to provide flotation device
• Attempt a shore based rescue

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VICTIM LOCATION

• Determining the location of the victim is
  critical before victim submersion or before ice
  breaks apart. (Last Point Seen)
• Usually victim falls through an isolated weak
  spot (small area)

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VICTIM LOCATION

• The identity of this spot is critical, once
  victim submerses (enhance ability to locate)
• Once victim attempts self rescue or rescuers
  enter ice this hole may dramatically enlarge and
  make submersion rescue difficult.

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VICTIM LOCATION

• Last Point Seen
• Create line of site markers using fixed objects
• Interview witnesses
• (to improve accuracy interview separately)
• Ask to describe accident from location they
  observed
• How many victims
• Did anyone make it to shore
• Do they know the victim (name, age, address)

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VICTIM LOCATION

• Make verbal contact with victim.
• Mark the victims location utilizing shore objects
  IE tree, apparatus etc. before submersion.
• It helps if the
• spotters make
• note of something
• directly behind the
• victim on the
• opposite shore.

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ZONES

• COLD ZONE
• Area more than 10 feet from the waters edge.
• Increased by on scene conditions
• Utilized for Command Post, staging bystanders

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ZONES

• WARM ZONE
• Area within 10 feet of the waters edge.
• Increased by a variety of on scene conditions
  (steep, slippery slopes near waters edge)
• Warm Zone restricted to participating rescuers

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ZONES

• HOT ZONE
• The water is considered the Hot Zone

Hot Zone
Cold Zone More than 10 Feet from waters edge
Warm Zone 10 Feet from waters edge
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TACTICS

• Talk
• Reach
• Throw
• Row
• Go

Rescue Options are not sequential. The best
technique should be used.
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TACTICS

• Talk
• Attempt verbal contact with victim
• Reassure them
• Direct them to attempt a self rescue

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TACTICS

• Reach (Shore based rescue Methods)
• Pike poles
• Ladder
• Inflated hose
• Aerial apparatus

Use of a ladder can work, but notice the rescuer
circled in red. Never stand, lay flat to
distribute your weight.
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TACTICS

• Throw (Shore based rescue methods)
• Rope throw bag- good out to about 75 feet
• PFD attached to rope
• Note Shore based methods depend on the victims
  ability to hold on. The effects of hypothermia
  and added weight of wet clothing may prevent
  victim from holding on or even following
  instructions.

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1. While holding knotted end of rope, swing bag
backwards and thrown
ROPE THROW BAG
Rope Throw Bag is Thrown toward victim
Note You may have to recoil the rope and toss
again.
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SHORELINE TECHNIQUES
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TACTICS

• A ladder and
• ropes can be
• used to reach
• extended
• distances.

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TECHNICIAN TACTICS

• Row
• If available
• Dont overload
• Use inflatable boats

Utilization of boats can be used as shown above
to direct the boat to the victim. Other uses of
boats should ONLY be done by boat trained
personnel.
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TECHNICIAN TACTICS

• Go
• Preferred method because victim is not expected
  to assist in rescue
• One person rescue
• Approach victim from the side or back
• Wear dry suit or ice rescue suit with tether
• Keep low center of gravity on ice
• If in water float on back , paddle with hands
• Secure victim, using loop method
• Signal to rescuers on land to begin pulling a
  shore

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TECHNICIAN TACTICS

• Go

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TECHNICIAN TACTICS

• MAKING CONTACT WITH VICTIM
• The best approach to a victim is from the side
  or back.
• The ice in front of the victim is likely weak due
  to the victims attempts of self rescue and will
  break under your weight.
• If you have a backboard it can be placed along
  the edge of the hole to spread your weight.

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TECHNICIAN TACTICS

• MAKING CONTACT WITH VICTIM
• The victim could grab at a rescuer as they
  approach, but they will likely be to hypothermic.
• If the ice the victim is holding onto in front of
  them is broken, it is likely they will submerge.
• If attempting a rescue of an animal be aware that
  they may bite as a fear response.

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TECHNICIAN TACTICS

• Movement on ice should be done by
• Crawling
• Sliding on top of a backboard
• Sliding while inside a basket litter

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TECHNICIAN TACTICS

• MOVEMENT ON ICE
• The critical step to movement on the ice is to
  disperse the rescuers weight is by laying down
• To enhance movement in this position ice awls or
  even screwdrivers can be utilized .
• In addition Rescuers can utilize a backboard or
  some type of litter.

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TECHNICIAN TACTICS

• RESCUER SETUP
• Each Rescuer entering the ice/water should be
  attached to a tether.
• There should be a rope for each rescuer and
  victim combined.
• Although against normal practice DO NOT lock
  carabineers.
• Carabineer threads will freeze and make removal
  difficult.

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TECHNICIAN TACTICS

• BREAKING ICE
• Rescuer should hear ice cracking before it
  breaks. Keep moving and try to stay ahead of
  breaking ice.

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TECHNICIAN TACTICS

• If rescuer breaks through ice, use ice awls to
  pull upper body up on ice, lift legs to the side
  and onto ice surface. If ice begins to break,
  quickly roll away from hole and hope ice holds.

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TECHNICIAN TACTICS

• Removal of Victim
• The first method is to remove the victim from the
  water utilizing a looped rope.

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TECHNICIAN TACTICS

• The second method requires the rescuer to enter
  the water to assist with victim removal onto the
  ice surface.

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TECHNICIAN TACTICS

• Stokes basket utilization will enhance victim
  removal. (slide across ice)

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TACTICS

• Care should be taken when removing victims across
  icy edges, these edges maybe sharp and can cause
  injuries.
• Victim removal to the warm zone can quickly be
  achieved by sliding the victim over the ice
  rather then attempting to pull through the
  water/broken ice.

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PATIENT CARE

• If a victim is not shivering they are likely in
  at least moderate hypothermia.
• There have been documented cases of victims being
  revived after 60 minutes submersion with no
  detrimental effect.

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PATIENT CARE

• HYPOTHERMIA
• A decrease in the core body temperature to a
  level at which normal muscular and cerebral
  functions are impaired.

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PATIENT CARE

• HYPOTHERMIA
• Conditions leading to Hypothermia
• Cold temperatures
• Improper clothing and equipment
• Wetness
• Fatigue, exhaustion
• Dehydration
• Poor food intake/decreased metabolism
• No knowledge of hypothermia
• Alcohol intake causes vasodilatation leading to
  increased heat loss
• Age

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PATIENT CARE

• HYPOTHERMIA
• What are Hypothermia temperatures?
• Any temperature less than 98.6 degrees can be
  linked to hypothermia (ex. Hypothermia in the
  elderly in cold houses).
• Consider overnight temperatures
• Consider temperature in unrelated situations
  such as pedestrians struck by autos, or patients
  in auto-collisions most people do not wear
  coats, hats, and gloves when they drive.
• Concrete and dirt are tremendous heat sinks and
  will quickly cool the body.

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PATIENT CARE

• HYPOTHERMIA
• Signs and Symptoms of Hypothermia
• Watch for the Umbels, stumbles, mumbles,
  fumbles, and grumbles which show changes in motor
  coordination and levels of consciousness

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PATIENT CARE

• HYPOTHERMIA
• Signs and Symptoms of Hypothermia
• Mild Hypothermia and Moderate Hypothermia- core
  temperature 90-95 degrees F
• Shivering not under voluntary control
• Cant do complex motor functions (ice climbing or
  skiing) can still walk talk
• Vasoconstriction to periphery, pale, mottled skin
• Radial pulses may be difficult to feel or absent
• Dazed consciousness
• Stiffness of muscles, loss of fine motor
  coordination particularly in hands.
• Slurred speech
• Irrational behavior Paradoxical Undressing
  person starts to take off clothing, unaware s/he
  is cold
• I dont care attitude flattened affect

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PATIENT CARE

• HYPOTHERMIA
• Signs and Symptoms of Hypothermia
• Severe Hypothermia core temperature less than
  90 degrees (immediately life threatening)
• Muscle rigidity develops because peripheral
  blood flow is reduced and due to lactic acid and
  CO2 buildup in the muscles
• Shivering is no longer present
• Skin is pale
• Pupils dilate
• Pulse rate decreases
• At 90 degrees the body tries to move into
  hibernation, shutting down all peripheral blood
  flow and reducing breathing rate and heart rate.
• At 86 degrees the body is in a state of
  metabolic icebox. The person looks dead but is
  still alive.

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PATIENT CARE

• HYPOTHERMIA
• Signs and Symptoms of Hypothermia
• Death from Hypothermia
• Breathing becomes erratic and very shallow
• Semi-conscious
• Cardiac arrhythmias can develop any sudden
  physical shock may set off Ventricular
  Fibrillation. Patients must be handled very
  gently.
• Heart stops, death

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PATIENT CARE

• HYPOTHERMIA
• How to assess if someone is Hypothermic
• If shivering can be stopped voluntarily mild
  hypothermia
• Ask the person a question that requires higher
  reasoning in the brain (count backwards from 100
  by 9s). If the person is hypothermic, they wont
  be able to do it. Note there are also
  conditions such as altitude sickness that can
  also cause the same condition.
• If shivering cannot be stopped voluntarily
  moderate severe hypothermia
• If you cant get a radial pulse at the wrist it
  indicates a core temp below 90-86 degrees
• Although ETOH may be present, do not assume that
  symptoms are alcohol induced

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PATIENT CARE

• HYPOTHERMIA
• Treatment
• Remove the patient from the cold environment.
• Avoid further heat loss by removing wet clothing,
  replacing with dry blankets and insulating
  material. Use a thermal (space/Mylar) type
  blanket and take special attention to cover the
  patients head.
• PASSIVELY re-warm the patient within a warm
  environment.
• If available administer warmed oxygen (wrap
  oxygen hose around a heat pack).
• IV fluids should be kept warm prior to
  administration with an approved warmer (they
  should not be above 98 degrees).

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PATIENT CARE

• HYPOTHERMIA
• CPR and Hypothermia
• When a person is in severe hypothermia they may
  demonstrate all the accepted clinical signs of
  death
• Cold
• Blue skin
• Fixed and dilated pupils
• No discernable pulse
• No discernable breathing
• Comatose unresponsive to any stimuli
• Rigid muscles

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PATIENT CARE

• HYPOTHERMIA
• CPR and Hypothermia
• But they still may be alive in a metabolic
  icebox and can be revived. Your job as a
  rescuer is to re-warm the person and do CPR if
  indicated. A hypothermia victim is never cold and
  dead only warm and dead. During severe
  hypothermia the heart is hyper excitable and
  mechanical stimulation (such as CPR, moving them
  or after drop) may result in fibrillation leading
  to death. As a result CPR may be contraindicated
  for some hypothermia situations.

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PATIENT CARE

• HYPOTHERMIA
• CPR and Hypothermia
• CPR Procedures
• Check radial pulse, between 91.4 and 86 degrees F
  this pulse disappears
• Check for carotid pulse wait at least THREE
  full minutes to check for very slow heartbeat
• NO CPR if the ECG shows an organized rhythm of
  20/min or greater
• If pulse but not breathing or slow breathing,
  give rescue breathing (also adds heat).
• If no discernible heartbeat begin CPR and be
  prepared to continue persons with hypothermia
  have been given CPR for up to 3.5 hours and have
  recovered with no neurological damage.
• Begin active re-warming via IV fluids and oxygen.
• DO NOT deliver more than one set of stacked
  shocks with AED without medical control.
• ALS providers should treat rhythms by the
  appropriate algorithm.

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PATIENT CARE

• COLD INJURIES
• Tissue temperature in cold weather is regulated
  by two factors, the external temperature and the
  internal heat flow. All cold injuries described
  below are intimately connected with the degree of
  peripheral circulation. As peripheral circulation
  is reduced to prevent heat loss to the core these
  conditions are more likely to occur.

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PATIENT CARE

• COLD INJURIES
• Factors influencing cold injuries
• Low ambient temperature
• Wind chill increases rate of freezing
  dramatically
• Moisture wet skin freezes at a higher temp than
  dry
• Insulation
• Vasodilatation or Vasoconstriction
• Previous cold injuries
• Body type
• Dehydration
• Caloric intake, Diabetes, some medications,
  Alcohol
• Other injuries compromising circulation.

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PATIENT CARE

• COLD INJURIES
• Cold-induced Vasodilatation
• When a hand or foot is cooled to 59 degrees F,
  maximal vasoconstriction and minimal blood flow
  occur. If cooling continues to 50 degrees,
  vasoconstriction is interrupted by periods of
  vasodilatation with an increase in blood and heat
  flow.

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PATIENT CARE

• COLD INJURIES
• Tissue Freezing
• As tissue begins to freeze, ice crystals are
  formed within the cells. Do not rub tissue it
  causes cell tearing from the ice crystals. Cell
  destruction results in tissue death and loss of
  tissue. Tissue cant freeze if the temperature is
  above 32 degrees F. It has to be below 28
  degrees F because of the salt content in body
  fluids. Distal areas of the body and areas with
  a high surface to volume ratio are the most
  susceptible (e.g. ears, nose, fingers, and toes
  this little rhyme should help remind you what to
  watch out for in yourself and others).
• Surface frostbite generally involves destruction
  of skin layers resulting in blistering and minor
  tissue loss. Blisters are formed from the
  cellular fluid released when cells rupture.
• Deep frostbite can involve muscle and bone.

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PATIENT CARE

• COLD INJURIES
• Cold Response
• Circulation if reduced to the exposed area to
  prevent heat loss.
• The area may be pale, cold.
• It may have sensation or be numb.

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PATIENT CARE

• COLD INJURIES
• Frostnip
• Freezing of top layers of skin tissue
• It is generally reversible
• White, waxy skin, top layer feels hard, rubbery
  but deeper tissue is still soft
• Numbness
• Most typically seen on cheeks, earlobes, fingers,
  and toes

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PATIENT CARE

• COLD INJURIES
• Frostnip Treatment
• Re-warm the area gently, generally by blowing
  warm air on it or placing the area against a warm
  body part (partners stomach or armpit)
• Do not rub the area this can damage the
  effected tissue by having ice crystals tear the
  cell

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PATEINT CARE

• COLD INJURIES
• Frostbite
• Skin is white and wooden feel all the way
  through
• Superficial frostbite includes all layers of skin
• Numbness, possible anesthesia
• Deep frostbite can include freezing of muscle
  and/or bone, it is very difficult to re-warm the
  appendage without some damage occurring

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FROSTBITE
Frostbitten Toes
Frostbitten Hands
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PATIENT CARE

• COLD INJURIES
• Frostbite Treatment
• Remove patient from cold environment
• Handle potential frostbitten areas gently
• Cover lightly with gauze and protect from further
  heat loss
• Initiate IV LR KVO if appropriate
• Consider morphine for pain (2-10mg IVP/IM)

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PATIENT CARE

• COLD INJURIES
• Frostnip
• Freezing of top layers of skin tissue
• It is generally reversible
• White, waxy skin, top layer feels hard, rubbery
  but deeper tissue is still soft
• Numbness
• Most typically seen on cheeks, earlobes, fingers,
  and toes

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SUMMARY

• What can you do?
• You can attempt a rescue using Shore Based
  Methods
• Deploy spotters whose line of sight to the victim
  are at 90 degree angles to each other
• Ensure that everyone going onto the ice is in
  proper PPE (ice rescue suits)
• Ensure that preparations have been made to treat
  the victim for Hypothermia

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SUMMARY

• DO NOT
• Wear turnout gear on the ICE
• Wear station uniforms onto the ICE
• Attempt a rescue without the proper equipment or
  level of training

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• In cooperation with the
• Public Safety Training Academy
• and
• Special Operations Section