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INTRODUCTION

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Rescue of patients from environments and circumstances that pose uniquely high levels of risk or that require the use of specialized techniques and equipment fall into a special category of medical operations. Although the average EMS physician, or prehospital provider, will not routinely encounter these circumstances, operational medical effectiveness requires some basic knowledge of these rescue types, their hazards, and specific medical challenges.

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OBJECTIVES

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  • Define technical rescue and the major types of technical rescue.

  • Describe principles of medical support of general and specific types of technical rescue.

  • Describe a practical approach to medical support of general and specific types of technical rescue.

  • Discuss EMS physician–specific responsibilities.

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TECHNICAL RESCUE

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The NFPA standard 1670 defines rescue as “those activities directed at locating endangered persons at an emergency incident, removing those persons from danger, treating the injured, and providing for transport to an appropriate health care facility” and technical rescue as “the application of special knowledge, skills, and equipment to safely resolve unique and/or complex rescue situations.”1 Although the technical aspects of the rescue described here may be beyond the ability and training of most EMS physicians, the medical aspects of the rescue, and the safety concerns for the rescuers, make this an essential area of awareness for EMS physicians and medical directors. In contrast to rescue, recovery operations (retrieval of property or victims' remains) are nonemergency operations and should only be carried out in situations where risk assessment is favorable and operational planning has been completed in a thorough and deliberate manner with all alternatives considered.

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In addition to being aware of the capabilities of the agencies operating in the EMS system, EMS physicians should also consider their community and the special features that may call for technical rescue operations. The existence of a mine or caves, open water or rivers, mountainous features, open wells, tall buildings, or other potentially challenging features should be considered. Partnering with municipal agencies, such as the department of public works, department of water, waste management, city planning, and emergency management can aid the medical director and other EMS system leaders engage in the necessary needs assessment.

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NEEDS ASSESSMENT

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A needs assessment is used to identify the level of response that should be expected of the system and at an agency level (Box 71-1). The first step is to perform a hazard analysis and risk assessment in order to determine the potential needs of the community. The next step is to consider the resources and capabilities of each agency and of the system as a whole. It is possible that a community or system may have identifiable hazards that require technical rescue capability that the system cannot support because of a lack of resources. This should lead to active pursuit of grants, training, or mutual aid agreements with agencies/systems that have the ...

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