Crown Partners
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Victim Centered Care: Aerial Rescue Concepts
By Sam Kezar and John Ball
 While ground workers suffer most of the accidents that occur in our industry, climbers are exposed to some unique risks. There are many ways in which a climber can be injured, from electrical shock to lacerations and fractures. There are also an infinite number of potential situations for those injuries to occur while working aloft, from being pinned by a fallen branch to chain saw kickback. How then do we prepare for this array of potential situations and injuries? The answer is practice; the step-by-step practice of aerial rescue and emergency response.
The first step, of course, is making sure crew members know CPR and first aid. Understanding first aid means the workers also know the basics of emergency response. There are two rules in emergency response: 1) safety takes priority over speed; and 2) do not enter situations where the likelihood is that you will become a second victim.
Basic trauma life support, as practiced by emergency medical technicians (EMTs) and paramedics, can help arborists respond to emergency situations. This may sound complicated, but it does not have to be, as a key recommendation is generally to stabilize the victim as best you can until these professionals arrive. This is the main goal in most tree rescues, not a rapid extraction of the victim.
The basic process for emergency response can be found in the A, B, C, D and Es. The ABCDEs provide a process that the rescuer should perform at each factor (letter) in order and not move to the next factor until the proceeding one is stabilized or functioning properly.
Air goes in and out
Blood goes round and round
Circulation will make you happy
Disability will make you frown
Environment will keep you safe and sound
Here is an example on how this process would be used.
First, upon reaching the victim, check to see that their Airway is clear. If the victim is not breathing, rescue breaths may be effective aloft. But the airway could be blocked by vomit, blood or bone fragments and it may not be possible to clear the airway while in the tree. In these instances, rapid extraction is a key to survival as the victim must be lowered to the ground and rescue breaths or CPR administered, depending on the situation.
Alternatively, if the victim is breathing, start checking for any Bleeding. When checking for bleeding, look for external (visible) bleeding as well as the low spots for pooling blood (legs, arms, lower back, etc.) indicating an internal injury. If there is external bleeding, attempt to stop the bleeding by adding direct pressure to the wound. If internal bleeding is suspected, or the bleeding cannot be controlled effectively, it is recommended that the victim be lowered to the ground; again rapid extraction from the tree may be necessary.
If the bleeding can be controlled in the tree, or there is no bleeding, proceed to check the victim’s Circulation. While checking for circulation, the rescuer is also checking for broken bones or areas where ropes or other objects are constricting circulation of blood throughout the body. If constricting ropes or objects are present, they should be removed as quickly as possible. In the case of broken extremities, check for internal bleeding and try to stabilize the broken limb or bone.
If there are no broken bones and circulation is good, the victim should remain in the tree and his or her condition m onitored while awaiting further medical help. However, if the victim’s condition worsens during this time and circulation becomes unstable, the victim may still need to be removed from the tree in order to stabilize. Monitoring while awaiting the paramedics is essential.
The next step is to check for any Disabling injuries. If there is a possibility of the victim having an injury that could disable him in any way, the victim should not be moved until the EMTs or paramedics arrive. Then, either working with them or, if requested, staying out of their way, the victim can be packaged and lowered in a way to reduce the possibility of causing further injuries. Neck collars and back braces are just two examples of equipment that can be used to limit movement while the victim is being lowered. They may also be a valuable means of stabilizing the victim while awaiting medical help.
Finally, the surrounding Environment must be stabilized and made safe for the victim and other rescuers. Any remaining loose wood or other hazards that may be present should be removed from the tree if they increase the risk to the victim or rescuers.
This ABCDE process can help arborists in deciding what to do, or not to do, in an emergency. In the past, our industry’s focus in aerial rescue has often been a speedy extraction of victims, not the best option in most rescues. If the victim has a broken back or other severe internal injury, rapid movement may have serious and life-long consequences. But, if the victim is not breathing or has severe bleeding, they may need to be rapidly removed from the tree to stabilize the condition. Following the ABCDE will hopefully assist arborists in determining what is best for any particular situation and injuries.
An important reminder is that, in any emergency response, the rescuer’s life should not be compromised. You may not be able to begin the ABCDE process if it is not safe for you to reach the victim. If the tree or rescue scene is not safe for the rescuer to enter, no rescue should be attempted until the environment can be made safe. However harsh it may seem, one death is preferable to two. The double fatalities that occur in our industry often involve a worker trying to save a fellow worker who has already been electrocuted, and then the second worker suffers the same fate.
Another reminder is that tree care companies should meet with and, if possible, have sessions with the local rescue organizations and services to become familiar with their approach to rescues. This meeting can accomplish many things. First, the rescue organization will become acquainted with you and the unique hazard to our industry. Secondly, the transfer time at an accident site may be significantly reduced due to improved communication between the two parties, the arborists and the EMTs or paramedics, thus increasing the chance of saving a life. Finally, insight may be gained in newer or alternative first aid practices that can be used, in addition to refinement of current practices. This is a very important process as most rescue crews throughout the country are not prepared for emergencies in trees.
Arborists work in a very high-risk profession. Safety should be the No. 1 concern. By training our workers to be prepared for the vast array of possible aerial emergencies, rather than just focusing on a speedy removal from the tree, we are giving our workers the tools to help save workers aloft.
Sam Kezar is an aerial rescue specialist with North American Training Solutions and adjunct professor at the University of Minnesota – Crookston. John Ball, Ph.D., is a professor at South Dakota State University in the Horticulture, Landscape, Forestry and Parks Department. Some of this information was obtained as part Sam Kezar’s graduate research at South Dakota State University under a matching grant with the U.S. Forest Service and ArborMaster Training. Kezar spoke on this same subject at TCI EXPO 2008 in Milwaukee.
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