A Swift Water Rescue Primer for EMS Providers

By: Greg Merrell, EMT

Swift/flood water incidents are dynamic and require rapid and effective decision-making to perform a successful and safe rescue. Situational awareness is critical during water rescue incidents to ensure safety for the victim(s) and for the rescuers. It’s important for EMS personnel to understand the hazards of swift water in the event they respond to these incidents.

Swift water rescue is a specialized rescue discipline, which has principles and techniques that involve a difficult and dangerous environment. Only highly trained rescuers should enter and attempt to rescue an individual caught in swift or flood waters.

This article is intended as a primer for EMS responders who are dispatched to a flood or swift water incident-it’s not a how-to article for EMS responders. EMS responders should obtain specialized rescue training and certification if they wish to be directly involved in these complex rescue operations.

Scene Size-Up

Swift water refers to moving water in nearly any environment, including areas that aren’t ordinarily inundated by water, like a flooded urban area. The flooded urban area rescue can be the most common swift water incident first responders will face.

Any time a swift water rescue incident occurs, it’s considered to be a dangerous operation and there’s extreme risk to all involved. The actions of the first arriving units form the foundation on which the incident will be built.

A risk/benefit analysis should be conducted before initiating rescue operations. The risk to not only the victim(s) should be evaluated, but the risk to the rescuers as well. The risk to rescuers must include a true and honest assessment of the personnel on scene and their capabilities, along with the equipment immediately available and the training level of the responders.

As with all emergency incidents, scene size-up is vital, and this size-up doesn’t begin when the call to 9-1-1 comes in and you are dispatched. Scene size-up for swift water incidents should begin long before the emergency incident. Responders should get out into their local area and look at the places in their community that continuously flood year after year. These areas can be pre-planned for hazards, access points and rescue tactics.

Once the 9-1-1 call is received and first responders are dispatched the size-up should continue en route. This is done through aerial views of the area on a mobile data computer or on a tablet, cell phone, or laptop. This aerial view gives responders a look at the area prior to flooding to spot danger areas that may be covered by flood water upon arrival.

The aerial map view also offers a chance to identify dangers to victims in the water, such as waterways that may go below ground, therefore requiring rescue prior to this point. It can also identify rescue points to be utilized, such as bridges and/or clear areas for victim access. This will assist in allocation of resources and personnel to best execute a rescue.

As an initial rescuer approaches an emergency scene they begin the on-scene size-up process. The on-scene size-up must involve looking at the entire scene. Don’t get tunnel vision focusing only on the victim. Initial responders must identify current and potential on-scene hazards and determine if a water rescue is possible. The initial responders must also learn to read the water conditions and learn hydrology.

The chaos of the incident can lead to a responder becoming overwhelmed and unable to make sound decisions. At many of these incidents rescuers will have overwhelming pressure from the victim’s family and friends and bystanders to “do something!”

The initial decision-making is critical to the success of the rescue. Make decisions with your mind, not with your heart. They should be made based on training, judgement and experience not mandataed by outside pressures.

Many rescue experts utilize the observe, orient, decide, act (OODA) loop method to process the information received about a swift water rescue emergency and take the most appropriate action in an efficient manner:

>> Observation: Collection of data by means of the senses.

>> Orientation: Analysis of data to form one’s current mental perspective.

>> Decision: Determination of action based on one’s current mental perspective.

>> Action: Physical playing-out of decisions.

Upon arrival, all involved emergency personnel need to practice effective situational awareness. This involves being aware of what’s happening around you, as well as communicating and utilizing accurate available information in effective decision-making. Poor situational awareness is a major contributor to accidents, injuries and rescue failures.

Witness Interviews

Scene size-up includes obtaining as much high-quality and reliable information as quickly as possible. Witness interviews are important to obtaining victim information to assist with rapidly locating and rescuing the victim(s).

Witness interviews should be conducted as soon as possible. Key witness interview techniques involve separating the witnesses so you can obtain each individual’s account of what happened and determine the number of victims.

Once all witness interviews are complete, a second interview should be conducted to obtain any missing information that was gathered in other witness interviews.

Witnesses should also be placed in position they were in when they witnessed the event. This will allow a rapid re-creation of the incident, utilizing multiple witness locations to triangulate the victims last known point.

Although it’s important to get information, this needs to be a quick and detailed interview. Time is critical in swift water rescue. Witness questions need to be direct and designed to keep their answers short and on point to the incident to obtain information that will assist in rescue efforts.

Planning

During the planning phase, initial responders must take into account the need for a back-up plan and possibly a back-up to the back-up plan. A swift water rescue incident is dynamic and rescuers must be prepared to change and adapt their current plan. The military acronym for planning, PACE-primary, alternate, contingency and emergency plans-serves well for a swift water rescue.

Part of the planning process, abbreviated with the acronym LAST, requires rescuers to identify a method to accomplish each of the four phases of rescue:

>> Locate and verify the actual number of victims and their possible locations.

>> Access to victims can be challenging even after located. This can be aided through size-up procedures utilizing aerial views while en route. Hasty search teams sent out to spot victims can also assist search crews with determining best victim access points.

>> Stabilizing the victims is important but this also includes stabilizing the scene. This involves notifying law enforcement for crowd control and also calling for additional resources such as swift water technical response personnel, either within your department or in mutual aid organizations.

> Transport the victim(s) to a medical facility if necessary. It’s important to evaluate the victim for signs and symptoms of hypothermia regardless of ambient air temperature.

Communication

Communication is a vital aspect to all emergency incidents, including swift water rescue. Emergency incidents are very dynamic and the flow of information-sharing is a key factor to successful and safe operations.

The initial plan must be conveyed to all rescuers involved. Often times there’s a plan by the incident commander, but it’s not shared or understood by the personnel that must carry out that plan. Lack of communication flow can inhibit rescue efforts and affect the safety of all personnel on scene.

Due to the high risk involved in a rescue incident and the inability to have visual contact with all personnel involved in the rescue process, communication via radio communications is vital. The use of dedicated tactical (TAC) radio channel can aid in communications. A TAC channel can separate normal departmental radio communications from your incident, reducing unnecessary radio traffic. Accountability is mandatory in a swift water rescue scenario.

Hasty search teams sent out to search for victims that have been swept downstream must understand who they’re looking for and the number of victims. This information is obtained in effective witness interviews. The communication to these teams of the demographics of the victim is important to finding them. Information, if known, that needs to be provided to search crews is: age, sex, clothing, swimming ability and mental capacity.

Communication needs to function effectively both up and down the chain of command. Obviously, information needs to be transmitted from the top down, but search teams must also communicate information back up chain to the incident commander.

This information needs to include; victim found, information from found victim if there are additional victims, any signs of victim (clothing, shoes and/or witnesses) and need to deploy rescue teams to search large areas of debris where victim may be located.

Communication also includes identifying locations along the waterway. The proper way to communicate positioning utilizes the following terms: upstream, downstream, river right and river left. Upstream and downstream are self-explanatory. River left is the left bank while looking downstream and river right is the right bank while looking downstream.

This terminology is important to understand when relaying information either from command post to search teams and/or rescuers as well as information from these teams back to the incident commander.

Night Operations

Night operations bring additional challenges to the swift water incident and can make victim rescue even more difficult. Flashlights and helmet lights are imperative during search and rescue operations. Portable scene lighting should also be used whenever possible.

An effective way of maintaining accountability of all on scene personnel during night operations is use of chemical light sticks (chemlights). These should be placed on top of the helmets of rescue personnel for easy identification. Use of multiple chemlight colors is an easy way to track not only rescuers, but to identify squads and/or teams. For example, a blue chemlight can identify Squad 1, a green chemlight for Squad 2, an orange chemlight can identify swift water technicians (the only rescuers allowed in the water) and a red chemlight can be placed on all rescue personnel but will be lit only in case of emergency. If anyone on scene spots a lit red chemlight a Mayday can be called identifying an emergency situation.

Hydrology & River Dynamics

Swift water appears chaotic and confusing to the untrained eye. Swift water has three common characteristics; it’s powerful, relentless and predictable. There are distinct patterns to moving water, and developing the ability to identify swift water characteristics is a valuable skill for every rescuer.

This skill can be applied in performing an effective scene size-up and developing a successful rescue strategy. Understanding hydrology and being able to “read” the water can identify potential victim locations and lead to immediate hazard and potential hazard identification.

Zoned Approach

Safe working and observation zones must be identified and managed. These zones are broken down into the hot, warm and cold zones, similar to those of a hazmat incident.

The hot zone is the area covered by water. This is often the greatest hazard, and must be approached only by personnel trained to work in that environment. Trained personnel must also be equipped with the proper equipment for their level of training.

The warm zone is the area comprised of the shoreline area within 10 feet of the water. There’s a possibility of personnel in this area to accidentally slip and fall into water. Therefore, all personnel in this area must be equipped with a personal flotation device and also a water rescue helmet, if available. The warm zone may be extended based on terrain such as slopes and uneven ground

The cold zone is where incident command, support staff and EMS transport personnel work. It’s located in an area of little or no danger.

Rescue Priorities

There are numerous options when developing a rescue plan. At any given water rescue incident, there’s often several ideas that may work; however, it’s important to keep the plan simple while at the same time ensuring rescuer safety.

The first priority of all rescues is safety of rescue personnel. This is best accomplished by avoiding water entry. As the incident develops, it may be necessary to increase the risk and approach the water and possibly make water entry.

If at all possible, rescue plans should involve getting a personal flotation device to the victims. Each plan should follow the following list of priorities, each moving from lowest risk to highest possible risk. The acceptable risk for a rescue should be based on personnel, training and equipment on scene as well as the immediate risk of the victim.

Preach/Teach: Communicate with the victims by any means available to encourage them to self-rescue is possible. Establish eye contact with the victim, maintain a positive attitude and encourage the victim. Communication with the victim should be direct, short and to the point.

Reach: This is the first and easiest form of water rescue. This method should be used when a subject can be saved by an outreached arm, an outreached leg, or an extended branch. Persons in danger of drowning are often experiencing an adrenalin rush and are very confused, so remember to yell clear, simple and distinct orders to grab the extended object. An order such as, “grab the stick and hold on” is simple and useful.

In swift water applications, the current is very strong so be ready for a jolt when the current pulls on the subject in the water. It may not be possible for a single rescuer to actually remove an individual from the water after the subject has been grabbed. If so, hold the subject close to an edge, maintain an open airway, attempt to protect him from further injury and wait for additional help to extract the subject.

Throw: This type of rescue describes when something is thrown to a subject to assist them such as throw lines, life rings and floats. The use of a rescue throw bag should be practiced to proficiency by every swift water rescuer at all levels. Throwing should be accompanied with orders given loudly and clearly by a single person to prevent confusion.

Row: This includes any kind of boat or raft operation. The intent is to either have the subject climb into the watercraft or to simply hold onto the craft until the subject can be dragged to safe water.

Go: This involves the deployment of an in-water swimming rescue. These are planned and practiced maneuvers that apply to the engagement of a drowning subject in open water. When considering the dangers of open water swimming rescues, compounded with the dangers of swift water, swimming rescues are considered to be a very dangerous type of rescue.

Helo: Helicopter rescue may be appropriate in specific situations, however there needs to be an understanding that this requires sound decision-making that matches the capabilities of the involved personnel and aircraft.

Life Jackets & PPE

Life jackets are known as personal flotation devices (PFDs). The U.S. Coast Guard has developed an approval and rating system for the five types of recreational and industrial PFDs:

Type 1: Off-shore jacket geared for rough or remote waters where rescue may take a while. They provide the most buoyancy, are excellent for flotation and will turn most unconscious persons face up in the water.

Type 2: Near shore buoyant vest good for calm waters when quick assistance or rescue is likely. Type 2 vests will turn some unconscious wearers face up in the water, but the turning is not as pronounced as with a Type 1.

Type 3: Flotation aid good for calm waters when quick assistance or rescue is likely. They’re not recommended for rough waters since they won’t turn most unconscious persons face up. Type 3 PFDs are used for water sports such as waterskiing.

Type 4: Throw device cushions and ring buoys are designed to be thrown to someone in trouble. Since a Type 4 PFD is not designed to be worn, it’s neither for rough waters nor for persons who are unable to hold onto it.

Type 5: Special use device approved for special uses and conditions identified on their label, including swift water rescue.

Personal protective equipment (PPE) to be carried by individual rescuers includes:

>> PFD: Type 3 for shore-based operations and type 5 for water entry rescues;

>> Helmet: Helmets should be worn by all rescue personnel, even if only working along shoreline. Fire or tactical helmets should not be used. Helmets for swift water rescue must have vent holes to allow water to pass through.

>> Wetsuit or dry suit: Thermal protection necessary for crews entering the water.

>> Footwear: Proper footwear are comfortable shoes that have ankle support and are lightweight and allow water to pass through. They should allow for rescuers to walk long distances in uneven terrain.

>> Gloves: Swift water rescue often involves rope operations. Gloves should allow for protection from rope burn as well as thermal protection from cold water and cold environmental conditions.

>> Eye protection: This will protect rescuers from foreign objects such as sticks and tree limbs making contact with their eyes, affecting their vision and causing them to become a victim instead of a rescuer.

>> Whistle: Use whistles that don’t have a pea-that’s the ball inside the whistle-it can swell up when it gets wet and is easily jammed. Whistles should be attached to every PFD in a place that’s immediately accessible when needed. Whistle blast communication is important due to the noisy environment caused by moving water.

>> Knife: A blunt tip knife, to avoid possibly puncturing an inflatable boat and/or raft, is a must for every swift water rescuer.

>> Lights: Each rescuer should be equipped with flashlights, headlamps and chemlights during all night operations and all operations that may approach nightfall.

>> Throw Bags: A rescue throw bag is an essential tool for all rescue personnel involved in swift water rescue. Effectively deployed by a proficient rescuer, a rope deployed from a throw bag contacts the victim and decreases personal risk for the rescuer by eliminating direct water entry. A standard throw bag contains 50-75 feet of 3/8-inch or 1/4-inch polypropylene rope, which floats on the water surface.

Conclusion

Swift water rescue incidents are one of the most dangerous and dynamic incidents a first responder may face. Preparation, training, risk/benefit analysis, scene size-up, communication, organization of resources and proper personal protective equipment are important factors in developing and determining the initial rescue plan.

Prior to implementing and executing any rescue plan, the incident commander should assess the following risk assessment questions.

>> Supervision: Is qualified person in charge of operational phase of rescue?

>> Planning: Was adequate information obtained about the hazards, victims and rescue?

>> Contingency resources: Are additional resources required? If so, are they available?

>> Communication: How well are personnel briefed and what are communication procedures?

>> Team selection: Are the rescue crews qualified and trained for the rescue chosen?

>> Team fitness: What are the mental and physical states of the rescuers?

>> Environment: Are time, temperature, precipitation, topography and/or altitude affecting rescuers or rescue operations?

>> Incident complexity: What’s the severity of risk, exposure time to elements and probability of a mishap among rescuers?

The development of a checklist for first responders to swift water incidents is a great way to ensure that all details are covered. A checklist will ensure a proper scene size-up, set-up and crew briefing. It will aid all responders in obtaining the proper personal protective equipment and executing search and rescue operations safely and efficiently.

Personnel selection and proper training and equipment are essential to an effective and safe water rescue. As in all rescue disciplines, safety is paramount in swift water rescue operations.

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