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INTRODUCTION TO RRTM MANUAL JUNE 2014 INTERIM UPDATE

INTRODUCTION TO THE RRTM MANUAL

2014 INTERIM UPDATE

Purpose of the Interim Update

OUTLINE OF MANUAL UPDATES

The rope rescue participant manual supplies reference material for an introductory level rope rescue course intended to provide a common set of basic practices for provincial SAR Rope Rescue teams. The participant manual was last updated in 2002. Over this time, rope rescue equipment, techniques and training options have continued to evolve to the point that the rope rescue training is due for an update. A 2013 federal New Initiatives Fund (NIF) grant application by Emergency Management BC is intended to address this issue, but even if this project proceeds, a completely revised training curriculum will still take several years to become operational. Recognizing this situation, the JIBC Rope Rescue Instructors at their 2012 Workshop formed a Working Group both to review the content and delivery models for a NIF Grant application and to recommend interim updates to the 2002 RRTM participant manual that would better reflect current rope rescue practices. The purpose of the 2014 Interim Update to the 2002 participant manual is to bring some of the text and figures into line with improvements in techniques as they are currently being taught in the JIBC courses. The Rope Rescue Instructors Working Group (RRIWG) is also preparing discussion papers and recommendations on other aspects of the rope rescue training: • Several important technical issues and some significant

trends that are already influencing rope rescue practices in BC but have not yet been specifically endorsed by EMBC or included in a province-wide rope rescue training framework.

• Rope Rescue Team Member and Team Leader course structure, content and delivery models.

These interim manual updates (by page #) describe current practices that have evolved since 2002 and clarify some points that may have been previously unclear. Specifically: 3-20 Explain how to set up a rack for left-hand or right- hand operation; 5-6 Explain apparent anomalies in webbing anchor attachment strengths; 5-8 Clarify the easiest tying method for the Wrap-3-Pull-2;

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JUNE 2014 INTERIM UPDATE ROPE RESCUE 1a 1


TECHNICAL ISSUES

The Italian (Münter) Hitch

5-12 Clarify that three-point anchors can be set up to place most tension on the strongest of any one of the three anchor points, and add a diagram for a “one doubled leg” configuration; 5-14 Show how to use a Prusik to retain tension in a pretensioned back-tie; 5-15 Clarify the simplest method for setting up anchor extensions; 6-3 Note that optimal tandem Prusik lengths may vary from the regular 1.35m and 1.65m to adapt to pulley size and because of cord shrinkage; 6-6 Provide a more detailed description of the preferred technique for operating the tandem Prusik belay; 6-9 Add an option for passing knot on a belay line without using a second Radium release hitch; 6-15 Describe the MPD™ as a belay and multi-purpose device; 7-3 Acknowledge that EMBC recognizes other lowering devices besides the brake rack as acceptable in BC SAR when operators are trained in their use; 7-4 Clarify that angle of feed is a 4th means of controlling friction on the brake rack; 7-5 Clarify a preferred technique for most effective operation of the brake rack; 7-8 Recommend knot placement and use of 2nd rack on brake rack knot passes; 9-11 Provide a more detailed description of the recommended practice for setting up an edgeline; and 9-13 Describe a recommended default method of patient securement. Two technical questions that have arisen about the 2002 participant manual require clarification: • Use of the Italian (Münter) Hitch in SAR Rope Rescue; and • Use of equipment not described or referenced in the

Manual, e.g. sewn Prusiks, Scarabs, MPDs. Because of its use in the Radium release hitch (RRH) and other applications requiring blocking and release, the Italian Hitch is an important component of the rope rescue curriculum. However, the operation of the Italian Hitch in a single-person belay is a significant concern. Its advantages as a belay are:

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• Speed and simplicity of setup; • It requires only a single anchored carabiner; and • It is quick and easy to hold and to release when the operator

is proficient. However, as a lowering device or belay, it has significant disadvantages, which are emphatically noted in the 2002 Manual: • P. 4-10 – “NOTE: The Italian hitch should only be used

when other resources are not available. A brake rack is still best suited for lowering one-person loads and the tandem Prusik belay is also preferred for belaying. If these are available then they must be used rather than the Italian hitch. There are several reasons for this caution. The Italian hitch has a tendency to twist the rope as it passes through. This twist can stay in the rope causing problems later. While belaying, great skill is required to ensure the operator can catch a falling rescuer adequately. Many people may also find that they lack sufficient gripping ability to safely control the rope, especially when fatigued. For these and other reason the Italian hitch should only be used with caution.”

• p. 6-10 – “The Italian Hitch provides good friction and a relatively dynamic belay however it does require a strong grip and diligence on the part of the belayer. A drawback to using an Italian hitch is its tendency to twist or kink the rope, especially after prolonged use. This problem is reduced considerably by feeding the belay rope through the hitch rather than allowing the load weight to pull it through.”

• p. 6-11 – “Care must be taken with the Italian Hitch as it takes precise hand motions to be able to move the rope and still catch a fall. The Italian hitch is a method that needs constant practice. The Italian hitch belay will not pass a hands-off test and should be used with caution by well trained and experienced users.”

In preparing this Interim Update, the JIBC RRI Working Group concurs in all the cautions and recommends that the Italian hitch should continue to be used “with caution by well trained and experienced users” when preferred lowering and belaying systems are not available as described in the 2002 manual.

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Use of Equipment not described in the

2002 Manual

Successful operation of the Italian hitch demands a high level of training, practice and proficiency, but the same can be said of many other techniques, including even the tandem Prusik belay, which consistently challenges many trainees on evaluations. The Italian hitch is a core element in a wide range of rope-related activities and it deserves to be properly taught to members of the BC SAR community and to be mastered by them as a valuable tool for use in appropriate situations. As noted on p.1-4 of the 2002 participant manual, the purpose of the Manual is to describe preferred methods for tested and proven common techniques that conform to the 4 principles (“standards”) and other requirements of the rope rescue training (p.2-4). As might be expected, rescue equipment has evolved and new equipment is constantly becoming available. Current (2014) items such as sewn Prusiks, the Conterra “Scarab™” descent control device, and the CMC Rescue “MPD™” (Multi-Purpose Device) may offer advantages over equipment referenced in the 2002 participant manual under certain circumstances. Questions have arisen about the acceptability of such new equipment in SAR rope rescue training. Therefore, it is appropriate to clarify the parameters for using equipment not so referenced: 1. The guiding principle remains as stated on p.2-4:

“Equipment used in EMBC SAR Rope Rescue must be designed for the purpose and used according to the manufacturers’ specifications. It must also meet applicable standards of manufacture and testing”

2. It is expected that all members of EMBC SAR Rope Rescue teams will maintain training and proficiency in the use of the equipment and techniques in the basic RRTM training curriculum in order to ensure efficient interoperability throughout the provincial SAR service.

3. SAR Rope Teams wishing to employ equipment and techniques other than those in the basic RRTM training curriculum common set of basic equipment and practices may do so (subject to points 1 & 2 above) as long as individual rescuers are trained and proficient in the use of any equipment and techniques they employ. • As noted on p.1-4, rescuers are cautioned to be careful

about replacing the uniform equipment and techniques with others from outside sources that do the same thing,

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as these may not have been sufficiently tested and proven.

• As noted in 2. above, in order to ensure interoperability, teams choosing to use other than the uniform items of equipment must also remain prepared to default to the common basic equipment and techniques as necessary.

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EQUIPMENT

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JUNE 2014 INTERIM UPDATE ROPE RESCUE 3-20a

MULTI-PERSON LOWERING DEVICES (CONT’D.)

Brake Bar Rack

Replace paragraph 4 with the following: Most bars are slotted so that they snap onto the frame when positioned. Some racks have a bar in the second position that has a straight slot that will not snap onto the frame and must be held shut by the pressure of the rope. This bar is sometimes called the “idiot bar” and is designed to help indicate when the bars are threaded backwards as the bar will swing open on its own when the rope pressure is not there to hold it in place. NOTE: 1. When installing bars onto the ’J’-rack, be aware that the

rack can be set up for right or left handed operation, depending on whether the short arm faces right or left when the load rope enters over the top of the first bar. For efficiency, the operator’s control hand should be on the short arm side of the rack, so depending on how the bars were originally set up, the operator may have the rope entering on the bottom of the 1st bar in order to have the control hand on the short arm side. Most 1st bars have a “training groove” to guide initial placement of the rope for threading. [In Figures 3-11a, b & c, Figure 7-2 and 7-4, the brake racks are all set up for left-hand use. In Figure 7-5, the knot-passing brake rack (right side) is threaded for left-hand operation.]

2. The bars on ‘J’-racks must be threaded onto the short arm and moved around the frame to positions on the long arm. An extended 1st (load end) bar, known as a “hyperbar” is recommended, as it can be locked in place to keep bars from sliding around to the short leg and makes tying-off easier. If bars are threaded only onto the short arm and the lock nut at the end of the arm loosens or falls off, the bars could fall off the rack, seriously affecting lowering speed (understatement!).

ANCHOR SYSTEMS

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Webbing Attachments

Insert as second paragraph: Note that the approximate strengths listed for the various tubular webbing anchor attachments are not derived solely from the rated webbing strand strength less ~1/3 for the knot (p.4-4). While the approximate rated strength of the simple slung webbing anchor (~22kN) is fairly obviously 2/3 of the strength of two strands of webbing, and that of the basket hitch (~40 kN) is close to twice that strength because the strands are quadrupled, the wrap 3-pull 2 sling gains only ~5kN over the basket hitch because the pressure of the outer strand on the inner strand at the load carabiner contributes to failure at ~45kN.

ANCHOR SYSTEMS

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Wrap-3-Pull-2

Replace 2nd paragraph on p. 5-8 with the following: To tie, place the mid-point of a piece of webbing at the opposite side of the anchor from the load. Then pass both ends around the anchor in opposite directions, bring them together on the load side of the anchor but not snugly against it, and tie them together using an overhand bend (water bend). The two unknotted webbing strands are then pulled forward and clipped with a carabiner and the bend is snugged against the anchor, facing the load. The location of the bend is easy to inspect and minimizes loading on the bend, thereby retaining high strength and leaving the knot easy to untie. (Fig 5-3) Note that the angle between the anchor legs at the carabiner should not exceed 90º. Properly rigged, this attachment can have a strength of approximately 45kN, the loading at which the pressure of the outer strand on the inner strand at the load carabiner contributes to failure.

ANCHOR SYSTEMS

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Tied-Off Multi-point

Replace two paragraphs on “Tied-Off Equalization with the following: A single long piece of rope or webbing can be drawn around two or more anchor points to create a separate loop for each (“doubled all around” – see Fig. 5-8). With the ends of the rope joined and the bights oriented in the anticipated direction of pull, a knot can be tied to join and isolate each of them at once. Care must be taken to ensure each leg is the right length and each anchor bears its share of the load. There are different ways of rigging a tied-off multi-point. For example, each end of the rope can go to single anchors with the middle of the rope slung around a third (“one doubled leg”). In this configuration, more loading may be placed on the strongest anchor if desired by doubling the rope on that anchor regardless of the relative positions of the three anchors, as shown in Fig. 5-9a.

Note that, when more than two strands are being tied off to form a multi-point anchor, an overhand knot may be easier to tie than a figure 8 on a bight and the bulk of the knot makes it both strong and relatively easy to untie.

ANCHOR SYSTEMS

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Pretensioned Back-Ties

Replace paragraph 3 with:

The block and tackle should be tied as a 3:1 mechanical advantage with 11mm rescue rope. If 8mm cord is used, a 5:1 should be rigged. Once rigged, it should be very tight, hence the name “pretensioned”. To gain and hold the appropriate amount of tension on 11mm rope, hitch a long (1.65m or 1.70m) Prusik onto the 3rd (haul) strand of the block & tackle and clip the Prusik sling into the anchor carabiner, resetting it each time the strand is tightened. To gain the appropriate amount of tension, a vectoring technique should be used in which the strands at the mid-point of the back-tie are pressed down and the slack thus created is pulled through on the redirected 3rd strand and captured by the Prusik. Once set firmly at the desired tension, the Prusik will hold the tension, but the redirected 3rd strand may be tied off around the other three strands as an additional back-up if desired (fig. 5-11). • Circumstances will dictate whether to have the progress

capture end of the block and tackle at the high or low end of the pretensioned back-tie (preference to pull up or down to tension; disposition of spare rope, etc.)

• A second pretensioned back-tie can be added to another anchor behind the primary anchor to create a strong three-point anchor system.

ANCHOR SYSTEMS

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Anchor Extensions Replace present entry with the following: In situations where anchors are some distance from the working area it may be necessary to extend the anchors to a point more convenient or safer for rescuers to operate parts of the system. For distances less than 10m, extensions can use a single strand of 11mm rope, a loop of webbing, or equivalent. For distances of 10m or more, anchors are extended with three strands of rescue rope to the attachment point. Three strands are used in order to reduce rope stretch which can create problems with long extensions. The extension can be set up most quickly by tying a figure 8 on a bight in one end of the extension rope, clipping the bight into the anchor end carabiner, placing a load end carabiner on the rope a metre or so from the anchor and then looping the rope back through the anchor end carabiner (fig. 5-10a). Holding the load end carabiner tightly and the extension rope end loosely, one can move to the desired extension point, allowing the rope to pay through the two carabiners. At the desired extension point, allowing extra space for the knot, tie a figure 8 on a bight in the working end of the rope and clip the bight into the load end carabiner, mirroring the anchor end (Fig. 5-10b). This setup naturally equalizes loading among the three strands. • If considerable excess rope remains after the extension has

been set up, the excess may be useful for some purpose at the load end. However, if it is in the way at the load end (e.g., because the direction of load shifts), the extension may be “flipped” end for end after initial setup to place the excess rope at the anchor end.

BELAY SYSTEMS

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RESCUE BELAYS

Multi-Person Belays

(Rescue Sized Loads)

Tandem Prusik Belay

Replace last two paragraphs on p. 6-3 and all of p. 6-4 with the following:

The tandem Prusik belay in conjunction with a load release hitch is currently the common basic technique for belaying rescue-sized loads in BC SAR Rope Rescue. This belay system is proven to stop rescue loads reliably yet still be able to release.

A variety of other devices have been developed to belay a rescue-sized load. Examples include the 540°™ Rescue Belay Device and the CMC MPD™ which are described later in this chapter.

The tandem Prusik belay system is taught in this course to ensure that all EMBC SAR rope rescue teams are familiar with it and are proficient in its use.

The default belay method for rescue-sized as well as single person loads is the tandem Prusik belay in conjunction with the Radium release hitch. (Fig. 6-1a) The belay consists of short and long Prusik slings attached to the belay rope with three-wrap Prusik hitches which are then attached to the Radium release hitch. The Radium release hitch is in turn attached to the belay anchor system. Though it is noted elsewhere in this manual that a single Prusik will continue to slip if excessively loaded, the tandem Prusiks will slip only slightly and then grip to hold the force of a falling rescue-sized load.

The tied loop length of tandem Prusiks is critical so that the short and long Prusiks have the necessary spacing between them to grip effectively in their tandem arrangement. These lengths are also designed to work well with the optional “2 inch” Prusik minding pulley (PMP). Cord for the Prusiks has normally been cut to lengths of 135cm for the short and 165cm for the long, before being tied into Prusik slings. Once tied, these slings measured approximately 39cm and 56cm respectively. However, as of 2014, factors such as shrinkage of 8mm cord and variations in pulley size make it advisable to - • soak new cord and dry it before cutting to length and/or• begin with longer lengths (140mm short and 170mm long are

recommended) so that the joining bends can be adjusted ifcircumstances dictate.

NOTE: New rescue rope and 8mm cord often retains a slippery coating from manufacture and rope and cord may have a wide variation in gripping ability depending on construction and

BELAY SYSTEMS

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materials. Belays relying on the gripping ability of 3-wrap Prusiks must therefore be carefully checked by the belayer, if necessary in consultation with the Team Leader, to ensure that they are gripping effectively before the belay can be considered ready. Prusiks that repeatedly cannot be made to engage effectively should be replaced before the belay becomes operational.

Note that the optional PMP serves no purpose when lowering. If it is necessary to add or remove the optional pulley during an operation:

1. Stop the operation and set the ratchet or secure the brake onthe load rope.

2. Tie a figure 8 on a bight in the belay rope above the pulleyand clip the bight into the main belay anchor. This maintainsthe integrity of the belay in the unlikely event that the loadside fails in the brief interval that the Prusik carabiner isopened to add or remove the pulley.

3. Once the pulley has been added or removed, lock the Prusikcarabiner, unclip and untie the figure 8 on a bight and resumethe operation.

BELAY SYSTEMS

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JUNE 2014 INTERIM UPDATE ROPE RESCUE 6-6a 1

Tandem Prusik Belay

Replace “Belay operation, lower” section with the following: Belay operation, lower: • With one hand at the anchor end holding the Prusiks in a

vertical, thumbless grip, pull 30-50cm of rope upwards through the Prusiks with the other hand.

• Bring the pulling (load end) hand down to form a high arc or

loop and take up any slack between the load hand and the load, keeping the load hand in a vertical position

• Keep both hands in a vertical, thumbs up (“hitchhiker”) position and allow the rope to slide through the load hand, checking for slack by maintaining a constant or periodic pull (back-tension) towards the anchor with the heel of the load hand.

BELAY SYSTEMS

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• To allow the Prusiks to grip and to reduce the potential for

injury should the belay be engaged, avoid wrapping your thumbs around the rope and keep the opening between finger tips and the heel of the hand pointed toward the load.

• As the rope arc or loop diminishes, quickly bring the rope-load hand up to the Prusik hand and pull out another arc or loop.

• Make sure the Prusiks remain snug on the rope throughout the operation.

In the event of a failure of the load system, the pull of the belay rope should allow the Prusiks to snap out of the operator’s hands and grab quickly without the belayer having to do anything; i.e., if the system engages, let go! Rehearse this mentally while belaying.

BELAY SYSTEMS

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Passing a Knot in the Belay Line

Replace page 6-9 with the following: There are several effective methods for passing a knot on the tandem Prusik belay. The recommended default (Option 1) requires only a second set of Prusiks and a carabiner. A fallback (Option 2) can be used if no duplicate belay system components are present at all. While it is always useful to have an extra RR hitch available if needed, a second RR hitch is not essential to a belay knot pass, may not be available if equipment is in short supply, or may consume valuable time to make up if not already pre-tied. OPTION 1: Employing a second set of tandem Prusiks and a carabiner:

1. Belay until the knot in the belay line is within 30cm of the tandem Prusik belay.

2. Tie the second set of tandem Prusiks on the other side of the knot in the belay rope and clip them through a carabiner passed through exactly the same figure 8 bight and the loop at the load end of the RR hitch as the existing Prusik carabiner. Lock the second carabiner.

3. Unlock and unclip the carabiner holding the original set of Prusiks and remove the original Prusiks from the rope.

4. Continue the belay with the second belay system.

BELAY SYSTEMS

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OPTION 2: If no extra belay system components are available: 1. Belay until the knot in the belay line is within 30cm of the

tandem Prusik belay. 2. Tie a figure 8 on a bight in the belay rope above the knot

and clip the bight into the belay system anchor. 3. With the belay rope now anchored securely, the original

Prusiks can be removed and replaced on the opposite side of the knot.

4. Once the Prusiks are set, the belay rope knot can be unclipped from the anchor and untied and the belaying operation can resume.

Note: Do not deploy the Radium release hitch as part of the knot passing procedure. The belay line is untensioned during the knot pass and should it catch a falling load while the Radium release hitch is being deployed, it may not be capable of stopping the load. By planning ahead during a lower, you can have the second set of Prusiks attached to the belay line on the other side of the knot well ahead of time. During a raise, as soon as the knot is close enough, the second set of Prusiks is attached to the belay rope below the knot and clipped into the load end of the release hitch (Option 1). If no additional belay system components are available, the belay rope is temporarily tied off to the belay anchor and the original Prusiks are relocated (Option 2). It is vital that there is an intact belay at all times when there are people on-rope. Inadvertently doing the steps of passing a knot in the belay line in the wrong order can result in a lack of a belay. As with all aspects of rope rescue, practice is required.

BELAY SYSTEMS

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MAY 2014 INTERIM UPDATE ROPE RESCUE 6-14a

CMC Rescue MPD™

Insert additional page following p.6-14: Developed over nine years of research, the CMC Rescue MPD™ (Multi-Purpose Device) integrates a high-efficiency pulley with an integral rope-grab mechanism. The manufacturer notes that these features “allow it to be used as a lowering device on the main line and belay line systems and to be quickly changed over to a raising system without switching out or replacing hardware. The combination of essential features into a single device simplifies on-scene rigging, expediting the rescue.” CMC Rescue cites as advantages of the device: reduced weight, fewer components, faster rigging, quick changeovers, simplified training and lower risk.

The MPD is simple and easy to operate by comparison with the descent control, belay and progress capture pulley components in current basic BC rope rescue training (as per the 2002 participant manual). It is particularly practical in “mirrored” two-rope systems.

At the same time, a knowledge of basic equipment and techniques remains important as a common foundation for all provincial SAR rope rescue. Use of the MPD by BC SAR rope team members trained and competent in its operation is consistent with the principles (“standards”) cited in the 2002 Rope Rescue Manual. However, note that, pending further assessment, EMBC has not sanctioned the use of shared load systems by BC SAR rope teams. Further information about the features and operation of the MPD are available from the manufacturer’s website, http://www.cmcrescue.com/equipment/mpd/

LOWERS

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LOWERING DEVICES

Brake Bar Rack

Replace first two paragraphs with the following: There are many lowering devices available to the rescuer. These devices provide friction that enables us to control the load easily with the strength of our hand. For multi-person loads it is essential to have an in-line device (to reduce twisting of the rope) that offers variable friction. A number of other devices meet these requirements and may be used in the BC SAR program by personnel trained and proficient in their use. However, the brake bar rack remains the descent control device on which all BC SAR RRTMs are certified through the JIBC training program and as such it continues to have a role as the default lowering device for team interoperability. The brake bar rack is: • A variable friction device • Able to control rescue-size loads • An in-line device that does not twist ropes • Able to control two ropes simultaneously

LOWERS

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Varying Friction

Replace first two paragraphs with the following: There are basically four ways to adjust the friction provided by the brake bar rack: “Coarse adjustment” - • Change the number of bars in contact with the rope • Change the distance between the bars “Fine adjustment” - • Change the angle of the in-feeding rope up or down to

increase or decrease friction on the last (anchor end) bar of the rack. Note that pulling the rope around the last bar and sharply toward the load forces the bars together and maximizes the available friction, providing an effective stop. However, if the action is taken with fewer than the full 6 bars engaged for a two-person load, it may be difficult to hold the load and add remaining bars.

• Change the operator’s grip to increase tension on the in-feeding rope and place greater pressure on the friction surface of the bars.

LOWERS

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Lowering Procedure

Replace first paragraph and Fig. 7-1 with the following: For optimum efficiency, the rack should be operated: • From the long-arm side of the rack with the operator facing

toward the load so that both the rack and the outgoing rope can be viewed at a glance (like a dashboard and the road ahead in a car);

• With the rope stacked or bagged on the short-arm side; • The operator’s non-control (usually left) hand gripping the

anchor-end bars from below to move them forward or back to adjust friction;

• The operator’s control (usually right) hand on the rope behind the rack at a distance sufficient to avoid entanglement in the rack and to allow movement up or down to increase or decrease the angle of rope feed over the last anchor-end bar;

• During the lower, variations can be made in the number of bars, the spacing of the bars with the left hand, the angle of approach and the degree of grip so as to provide finger-tip control of speed in response to commands and the situation.

• Emergency stops can easily be effected by tightening grip, compressing the bars and increasing the angle of wrap around the last anchor-end bar.

• It should never be necessary to push the rope into the rack to generate movement, especially as doing so will result in a jerky lower.

LOWERS

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PASSING A KNOT DURING A LOWER

Replace Steps 1 - 3 of the knot pass procedure at the bottom of the page with the following: Knot pass procedure: Step 1 may be skipped if a second person is assisting. 1. Stop the lower when the knot approaches the brake bar rack.

Leave enough rope (about 30 cm) for tying-off in such a way that the knot will be captured against the rack in the back-loop of the tie-off, and then complete the tie-off. Thus placing the knot against the brake rack in the tie-off will shorten the distance that the auxiliary brake device will have to let out to transfer the load back onto the main lowering system.

2. Attach the Prusik to the rope immediately below the brake. 3. The Prusik is attached to whatever type of auxiliary brake

system is being used, which should be tied off. Note that this auxiliary system should be set up on the long arm side of the main brake rack to leave the operating (short arm) side of the rack unimpeded. [Figure 7-4 shows this accurately, though the brake racks shown are set up for left-hand, not right-hand use.]

STRETCHER RIGGING

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EDGE PERSON

Edge Lines

Replace third paragraph with the following: The edge position is potentially one of the more hazardous positions in rope rescue, as the person stationed at the edge relies on a single rope for fall restraint but may be tempted to load it, in which case a belay is essential . The set-up procedure for the edge position is therefore critical: 1. Select a suitable anchor point, separate from the rescue

system anchors and preferably to one side of, but close to, the line to be taken by the rescue ropes. Note: The edge person's rope should be perpendicular to the edge. If it is attached to an anchor too far to one side, the rope will allow the person to go over the edge at some points, and the rope will undergo a sawing action as it is drawn across the edge while he/she falls.

2. Attach a sling anchor capable of accommodating changes in load direction. Simple slung or pre-tied webbing anchor sling attachments are quickest to set up. Tie-offs using the edge line rope itself are not advisable as they may be slower to set up and adjust, less directionally flexible and may unnecessarily commit surplus rope.

3. Tie a figure 8 on a bight in one end of a suitable length of rope and “cast” the knotted end from outside the control zone so that the knot rests at the desired position at the edge (this being the point beyond which the edge person could not stand without using a rope for primary support rather than as a fall restraint).

4. Extend the remainder of the rope back to the selected anchor, tie a figure 8 on a bight and clip it into the anchor sling. Adjustable tie-offs such as the blocked Italian hitch must not be used, as they rely on another person’s correct operation and tying, while for safety, an edge person must be entirely responsible for his/her own set-up and take-down.

5. Place a positioning Prusik on the edge line and clip it into a locking carabiner on the edge person’s harness lower attachment point. The figure 8 edge-end bight should be retrieved and clipped into a separate locking carabiner at the same attachment point, or a single carabiner (e.g., the DMM Belaymaster) that prevents the gate from being loaded, may be used for both Prusik and restraint rope bight attachment to the harness. (Tying into the harness lower attachment point, as opposed to clipping in, is also acceptable but it is less efficient in time.)

STRETCHER RIGGING

Patient Securement

Replace pages 9-13 to 9-15 with the following: Whereas “packaging” refers to addressing the subject’s medical needs, safety and comfort (the “Stabilize” phase of the acronym “L.A.S.T.), “securement” refers simply to the means of securing the subject into a stretcher for safe transport. Packaging takes precedence over securement. NOTE: Rescuers must work closely with those providing medical care to the patient to ensure the patient's needs are met during evacuation, and so that the efforts of rescuers do not exacerbate his/her injuries. The securement methods used will depend on those needs. What is depicted here is meant to be a baseline form of securement that may need to be adapted to meet the patient's individual needs. The securement shown here may be inadequate and in some cases, inappropriate for certain patient injuries and/or conditions. A well-secured patient package should NOT be able to slide toward the head end or foot end, side to side or lift out of the stretcher once secured, including when the stretcher must be flipped to clear the airway of a patient who has vomited. The securing straps should allow rescuers' access to the injury site and to monitor their condition. Take care that the straps do not impair circulation or respiration, or aggravate injuries. Care must be taken with some commercial securing systems: • Seatbelt-style buckles can freeze, jam or malfunction, or

easily open accidentally; • Velcro straps may become clogged with dirt or snow, or

lose much of their holding power when wet. Remember that the stretcher functions for the subject as the load line attachment point, so the patient package must be secure regardless of the stretcher’s position in case anything unexpected should happen. At the same time, a belay attachment to the patient package, be it a clamshell or spine board with straps or an improvised seat harness, is required as a backup against the risk of failure in the stretcher or its securement. Rescuers should practice proper securements with their subjects even if it is for a short carry-out or over seemingly easy terrain. The securement may need to be adapted to ensure no straps impinge on the patient's injuries. Again, work closely with the medical aid provider to ensure the best form of securement for the patient's needs. Advanced first

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STRETCHER RIGGING

Securement Systems

Head End

Securement

aid training is required to make proper decisions in these circumstances. Most stretchers in common SAR use come equipped with straps that may offer effective final securement of the patient package but additional securement is usually required in order to keep the packaged subject from sliding out of the stretcher toward the head end or foot end. The subject must also be supported during a slope rescue where the subject will otherwise slide down the inclined stretcher, which is at least very uncomfortable and could also exacerbate injuries. BC SAR Rope Rescue has evolved relatively simple and widely applicable techniques for head and foot end securement, using 25 mm webbing. The head end technique employs two 3m lengths and the foot end a single 5m length. An additional 5m length of webbing may be needed to rig an improvised “diaper” harness for the patient if desired (Fig. 9-10). If the available stretcher is not equipped with an effective final securement system, a diamond lashing built with two 5m lengths of 25mm webbing is recommended (see Fig. 9-9a). These attachments are recommended because they offer good security, are easy and quick to tie and are effective in securing the patient. They can also be easily applied over bulky insulation, as in the case of a hypothermic patient. Head end securement (Fig. 9-7a): This recommended option for fixing the subject’s head position in the stretcher should be set up before the subject is placed in the stretcher as follows: • Secure one end of a 3m length of 25mm webbing to a

stretcher post, rail or other tie-down point within 30cm of the mid-point of the stretcher and mirror on the opposite side with the second length of 3m webbing. These straps must not be allowed to slide along the stretcher rail. These straps should be laid diagonally across the upper part of the stretcher to cross behind the subject’s back before the subject is placed in the stretcher.

• Once the subject has been placed in the stretcher and positioned, take one strap from behind the subject’s shoulder, lay it across the chest and tie an overhand-on-a-bight with a 5cm bight at a point just below the patient’s solar plexus.

• Pass the other shoulder strap through the bight of the knot in the first strap and with light and equal tension on both straps, secure their ends to anchor points at or near the

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STRETCHER RIGGING

Foot End Securement

original tie-down points. Do not pull these straps tight with force.

The end effect will be an H-shaped shoulder harness that will hold the shoulders against movement toward the head of the stretcher without tightening on the subject’s neck. In tests, the subject can be placed head-down in a vertical position relatively comfortably without significant shifting. Foot securement (Fig. 9-8a): • Secure one end of a 5m length of 25mm webbing to a

stretcher post, rail or other tie-down point within 30 cm of the mid-point of the stretcher.

• With the subject in the stretcher, run the webbing - o between the feet, below and around the far-side foot

under the arch of the foot, o across, around and under the arch of the other foot, o back up between the feet, o up to and around an anchor point approximately

opposite the starting point, o back down and through the loop that passes across the

top of the feet, o up again to and around the original tie-down point.

• Once the subject is comfortably snug between the head and foot supports, tie off the end of the foot webbing.

• If a foot or leg injury precludes capturing both feet with this system, a similar wrapping pattern can still be used to support the other foot.

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Final Securement: The Diamond

Lashing

As noted in Packaging on p.9-12 of the manual, especially if the subject is to spend any time in the stretcher, it is crucial to provide padding behind the knees and possibly also between the legs and in the small of the back. Such padding should be placed as the feet are being secured. Also, avoid any twisted straps or bunched-up clothing or blankets under the patient that might form bed sores. Bed sores can form in as little as 30 minutes and can be very painful and slow to heal. The 2002 Manual suggests that a subject may be prevented from sliding toward the foot end of the stretcher by using an adjustable sling running from one tie-point toward the head end of the stretcher, through the subject’s seat harness and up to a tie-point on the opposite side of the stretcher. However, seat harnesses are designed to support the wearer in a bent or seated position, not fully extended. A subject firmly secured in a stretcher and supported in this way for any period of time should be monitored for adequacy of comfort and circulation. In the absence of effective stretcher straps, the final securement of subject to stretcher is effected by crossing two 5m lengths of 25mm webbing back and forth from side to side of the stretcher in a diamond pattern over the length of the stretcher (Fig. 9-9a). The webbing is best run through tie-points low in the stretcher if possible, but may be run around the rail if no lower tie-points are available or accessible. Using two separately attached lengths of webbing offer a degree of redundancy should one come untied or fail. The following lashing process can be performed by a single rescuer but is easier with one on each side of the stretcher: • Attach one end of each 5m length of webbing to tie-points

on the stretcher rails on opposite sides below the subject’s

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feet. • Bring the free ends of each length of webbing diagonally

forward toward the head of the stretcher, alternately passing from side to side around the opposite side rail or tie-down point so that the webbings cross in a diamond pattern toward the head of the stretcher. Ensure that the webbing and crossing points are positioned to avoid pressure on sensitive areas such as the knees or points of injury that are not well protected or padded.

• The final crossover point should be located high enough on the subject’s chest to hold the patient package securely but not so high that it may pressure the neck should the subject shift toward the foot end of the stretcher. As rescuers are responsible for patient safety during the rescue, the patient’s arms will normally be secured inside the lashing.

• Before tying the ends of the webbing to the final head-end tie-point or rail, the lashing should be snugged up comfortably across the patient by lifting at each crossing point from foot toward head and moving any slack upward to the final head-end tie-points.

• If the top crossover point is close to the patient's neck, it can be lowered by wrapping the two sections of webbing together two-three turns before continuing them to the rails or tie-down points for final anchoring.

• Once the diamond lashing has been tied satisfactorily, the webbing ends can be tied off to an upright post below the stretcher rail.

• Shorter lengths of webbing may be used to secure separate sections of the patient package if subject injuries preclude final securement with continuous lengths of webbing or if access is desired to certain areas without untying the entire package.

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