Skill Development Course PRACTICAL RESCUE MANAGEMENT Instructor Manual
Practical Rescue Management Instructor Manual Contents Course Arrangements 1 Introduction 3 Rescue Management Part 1 5 Helicopter Operations 6 Rescue Management Part 2 7 Putting It All Into Perspective 8 Rescue Management Scenarios 10 Issue 1.1, September 2009 Copyright British Sub-Aqua Club 2009 Published in the United Kingdom British Sub-Aqua Club, Telford s Quay, South Pier Road, Ellesmere Port, Cheshire CH65 4FL Telephone: 0151-350 6200 Fax: 0151-350 6215 www.bsac.com All rights reserved. This Instructor Manual may not, in whole or part, be copied, photocopied, reproduced or translated, or converted into any electronic or readable form without prior written consent of British Sub- Aqua Club V1.1 Copyright BSAC 2009 i
Practical Rescue Management Instructor Manual BSAC is grateful to the members who contributed to the development of this course and its supporting materials. In particular: Lizzie Bird Trevor Davies Jeff Reed Richard Scarsbrook Maxine Smith Paul Smithson ii V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual Course Aim To teach divers how to manage the resources at their disposal in order to make the most effective use of them in a rescue situation. The course also provides an opportunity for further instruction in personal rescue skills to complement those undertaken during diver training, but the emphasis will be on the development of rescue management skills. Course Overview The course content is based upon the Dive Leader syllabus, and follows the relevant parts of the BSAC Diver Training Programme very closely. Instructors should base their teaching on the PRM Instructor Manual (which refers to DTP materials where appropriate), the PRM visual aids, and on the information given in the BSAC publication Safety and Rescue for Divers. The course programme is designed to be delivered at any confined open water location, and to avoid the need for any decompression. The emphasis must be on class participation, and extensive student involvement is essential. Session Contents Mins Introduction Assemble, introductions, 15 administration Discussion: the nature of accidents; prevention, anticipation; discuss 45 rescue scenarios; draw out priorities Training, buddy checks, think first; Rescue safety, recovery, Management security; remove Part 1 (DT9) casualty to point of safety; first aid priorities, 40 continuing care, records; summoning emergency services, evacuating the casualty Break Change for diving Rescue Management Scenarios Break Outline review Helicopter Operations (DT10) Rescue Management Part 2 (DT11) Putting it all into perspective Open water scenarios concentrating on management of a variety of situations. Aspects covered include: how the incident was assessed; the actions that were taken; how the tasks were delegated; how delegation allowed multiple tasks to be carried out concurrently; the actual rescue skills used Review achievements / difficulties of practical scenarios Direct lift; high line transfer; alternative small boat technique Course Arrangements Personnel issues and the media; incident reporting and fatalities; the legal process Course debriefing; issue course documentation; open forum; disperse 240 15 15 30 15 The above sequence is preferable, but it is acceptable to present DT10 and DT11 immediately after DT9, and to give the final session informally as part of the debrief, if circumstances such as excessive travelling time between the open water and dry venues make it necessary. Duration One day. Entry Level BSAC Sports Diver. Qualifications Awarded Qualification card confirming course attendance, supplied by BSAC HQ on payment of fees and confirmation of attendance on the course. There are no examinations or assessments. V1.1 Copyright BSAC 2009 1
Course Arrangements Instructors may also sign up Dive Leader lessons DT9, 10, 11 and DO5 in each member's qualification record Course Registration Branches wishing to run a Skill Development Course must order the packs two weeks in advance from the BSAC Shop and pay the relevant course pack/ registration fees for all students on the course. This can be done online via the BSAC website, by telephone, or by post. Instructor Requirements Qualifications Instructors must be BSAC Open Water Instructor or above. Student:Instructor ratio Approximately four students to one instructor. The course includes: Tutored discussions - groups should be small enough to allow each student a reasonable amount of participation in the time available, but not so small as to exclude a range of experiences and viewpoints (guideline - 4:1) Rescue management scenarios: groups should be large enough to enable students to experience the issues involved in rescue management and have enough resources to make the rescue, but small enough that everyone gets their turn as Rescue Manager in the time available (guideline - 6:1, and not less than 4:1). These exercises can be run with fewer students, if other suitably-qualified helpers participate as casualties and rescuers to be managed. Theory lessons (guideline - one instructor to any number of students) Practical Rescue Management Instructor Manual communications equipment, boat boxes, as appropriate. Personal open water diving equipment and protective clothing. Venue Facilities Suitable classroom with teaching aids. Open water site, maximum water depth required 6m; access to different types of shoreline, eg, shelving beach, rocks, jetty. Administration HQ will supply the appropriate course packs and a Course Report form, on receipt of an order. After the course the organiser should return the completed form without delay to BSAC HQ, who will issue qualification cards to students and record their course attendance on the membership database. For regionally run courses: on completion of the course, instructors should forward outstanding fees, accounts and expense claims etc, to the course organiser Costs BSAC course fees cover the cost of course packs and certification cards, and are payable in advance to register and purchase student packs. For branch run courses, instructor expenses, venue fees, and any other costs are the responsibility of the students and their organisers. For regionally run courses, students must pay the appropriate regional course fee to the Skill Development Course Organiser at time of booking. Equipment Preferably, one or more inflatable boats / RIBs for exercises involving recovery of casualty into boat. If the venue is such that it is not practicable to use a boat, either use scenarios that do not require one, or land casualties into a simulated boat. Selection of buoyant aids (as may reasonably be expected to be available at a dive site), throwing ropes etc, in quantities to suit the number of student groups. Rescue equipment needed to support scenarios: oxygen administration sets, first aid kits, AED, 2 V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual introduction Guideline duration 15 min Theory Lessons Lesson Objectives This lesson sets the scene for the course overall. It briefly outlines the course content, domestic/logistics and timetable. Achievement Targets At the end of this lesson students should: understand the objectives and structure of the course. understand what is required of them during the course. understand the domestic and logistical arrangements for the course. understand the course timetable. Additional visual aids On courses where the instructors and students do not know one another, it may be useful to insert an extra VA introducing each instructor. Practical rescue management Introductions Introduce the instructors, and get the students to introduce themselves. Introductions can be minimised or omitted on courses where the participants already know one another. Ask the students to describe incidents they have been involved in, or know of in their branch. Course aims The aims of the course are to teach divers how to manage the resources at their disposal in order to make the most effective use of them in a rescue situation. The course also provides an opportunity for further instruction in personal rescue skills to complement those undertaken during diver training, but the emphasis will be on the development of rescue management skills. Domestic arrangements Fire exits, catering facilities, house rules, etc. Locations Cover the different venues that will be used during the course, if necessary Timings Outline the timetable for the course, including breaks, lunch, and finish time. Either issue a printed timetable, or add it to this VA. Guideline durations for each session are provided in the Course Arrangements section of these notes V1.1 Copyright BSAC 2009 3
Theory Lessons Course outline Practical Rescue Management Instructor Manual Rescue Management Part 1 Personal rescue skills are important, but if an incident is to be resolved effectively, the activities of all involved must be co-ordinated. Managing this effort is the role of the Rescue Manager. This lesson introduces rescue management and is supplemented by further practical and classroom lessons Rescue Management Scenarios This lesson provides practical experience of applying the concepts discussed in Rescue Management part 1. A range of scenarios is included, covering shore and boat diving. Helicopter Operations In incidents requiring urgent evacuation of the casualty, helicopters are often used. This lesson explains some of implications for divers of operating in close proximity to helicopters, and outlines the possible techniques that may be used to transfer the casualty from a boat to a helicopter. Rescue Management Part 2 This lesson complements the earlier lesson Rescue Management Part 1. It covers aspects which could not be adequately included in the open water lesson and other aspects which follow on after an incident. Putting It All Into Perspective Review of the course 4 V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual rescue management part 1 Guideline duration 85 min Lesson Objectives Theory Lessons Personal rescue skills are important, but if an incident is to be resolved effectively, the activities of all involved must be co-ordinated. Managing this effort is the role of the Rescue Manager. This lesson introduces rescue management and is supplemented by further practical and classroom lessons Achievement Targets At the end of this lesson students should understand: that rescue management starts long before an incident occurs the long term factors that contribute to incident prevention the factors occurring on site that enable potential incidents to be anticipated the activities which contribute to the overall resolution of an incident the need for activities to be co-ordinated - the role of the Rescue Manager Visual aids and instructor notes The content in this lecture is identical to the content of lesson DT9 in the BSAC Dive Leader course. The visual aids supplied with the PRM instructor resources differ only by using a theme which is specific to PRM, and are otherwise the same as their DT9 equivalents. Use the PRM visual aids with the DT9 instructor notes from the latest Instructor Resources CD. Check the Current updates page on the BSAC website to see if there are any changes to apply. The formal lesson is preceded by a 45 minute tutored discussion session, identified separately in the PRM Syllabus and the Course Arrangements section of this manual. The DT9 notes cover both sessions. V1.1 Copyright BSAC 2009 5
Theory Lessons helicopter operations Guideline duration 15 min Practical Rescue Management Instructor Manual Lesson Objectives In incidents requiring urgent evacuation of the casualty, helicopters are often used (about one reported incident in four involves the use of a helicopter). This lesson explains some of implications for divers of operating in close proximity to helicopters, and outlines the possible techniques that may be used to transfer the casualty from a boat to a helicopter. Note: Outside the UK, helicopter techniques may vary, and in some parts of the world diving may be conducted beyond the coverage of helicopter operations. For courses run in such locations, instructors should adapt these lesson notes by substituting evacuation techniques appropriate to the local geographical area. Achievement Targets At the end of this lesson students should understand: Actions necessary to prepare and operate a boat for close to a helicopter The different lifting techniques that may be employed by the helicopter crew to transfer a casualty from a boat to a helicopter: o o o Direct lift High-line transfer Alternative small boat technique The need to obey all signals from the helicopter crew Visual aids and instructor notes The content in this lecture is identical to the content of lesson DT10 in the BSAC Dive Leader course. The visual aids supplied with the PRM instructor resources differ only by using a theme which is specific to PRM, and are otherwise the same as their DT10 equivalents. Use the PRM visual aids with the DT10 instructor notes from the latest instructor Resources CD. Check the Current updates page on the BSAC website to see if there are any changes to apply. 6 V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual rescue management part 2 Guideline duration 30 min Lesson Objectives Theory Lessons This lesson complements the earlier lesson 'Rescue Management Part 1' and the open water lesson 'Rescue Management Scenarios'. It covers aspects which could not be adequately included in the Open Water lesson and other aspects which follow on after an incident. Achievement Targets At the end of this lesson students should: Understand the potential impact of an incident on relatives or friends of the casualty and on the rescuers themselves Appreciate how to deal with the media Understand the importance of the incident report Understand the legal processes which follow on from an incident resulting in a fatality Understand what they can do to best serve those processes Visual aids and instructor notes The content in this lecture is identical to the content of lesson DT11 in the BSAC Dive Leader course. The visual aids supplied with the PRM instructor resources differ only by using a theme which is specific to PRM, and are otherwise the same as their DT11 equivalents. Use the PRM visual aids with the DT11 instructor notes from the latest instructor Resources CD. Check the Current updates page on the BSAC website to see if there are any changes to apply. V1.1 Copyright BSAC 2009 7
Theory Lessons Practical Rescue Management Instructor Manual putting it all into PERSPECTIVE Guideline duration 15 min Lesson Objectives Despite the obvious hazards, diving is a safe sport, and incidents are rare. One of the reasons for this is that divers are safety conscious, and through courses like this, train so that most potential incidents are avoided altogether, and those that do occur are managed effectively. This brief lesson is intended to end the course on a positive note, by setting rescue management in the context of making diving the safe sport that it is. The key points which the students should take away with them are summarised, course documentation is handed out, and students are given a final opportunity to ask questions. If the logistics for the course are such that it does not resume at the dry venue after the rescue management scenarios, the contents of this session should be delivered informally 'in the car park' as the final debrief at the end of the course. Achievement Targets At the end of this lesson students should: Understand the role that rescue management plays in making diving safe Have had an opportunity to ask any remaining questions Summary The vast majority of dives are without incident There are no exact figures to show what the incident rate is in diving, because although incidents are recorded there are no reliable statistics on the total number of dives done each year. However, conservative estimates put annual number of dives in the UK at more than one million. This means that the incident rate is much less one per 2000 dives (>99.95% incident free), while less than one dive per 100,000 results in a fatality (>99.999% safe). Studies have shown that even apparently harmless activities such as cycling and golf are more dangerous. Studies in other countries have produced similar findings. Diving is a safe sport. Being prepared for eventualities keeps us safe "There are inescapable risks in submerging yourself in a larger volume of water than you can drink whilst holding your breath" was how a former BSAC Chairman summed up the potential dangers of diving. By focusing on what could go wrong, using techniques like the ones taught on this course, we can control the risks, and deal effectively with the consequences if the risks do materialise. Incident prevention Prevention is better than cure. Remember the incident pit. Rescue management Scenarios Helicopter evacuation Post-incident management 8 V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual Practise Practise Practise! Theory Lessons Because diving is so safe, divers are rarely called upon to deal with a real incident, so their rescue skills can become rusty. Deal with this problem by constant practice. Conclusion Other BSAC courses First Aid for Divers, AED Workshop, Oxygen Administration, Lifesaver and Advanced Lifesaver Awards Course documentation Hand out Student Packs and any other material, as necessary Open forum V1.1 Copyright BSAC 2009 9
Practical Lessons Practical Rescue Management Instructor Manual Rescue management scenarios Guideline duration 4 hr 15 min Lesson Objectives This lesson provides practical experience of applying the concepts discussed in Rescue Management Part 1 (DT9). A range of scenarios is included, covering shore and boat diving. Achievement Targets At the end of this session students should: Have experienced managing at least one rescue scenario Have participated in at least one other scenario Have developed an understanding of how to take a strategic view of an incident including: Assessing the activities required Prioritising those activities Delegation of activities to personnel with appropriate skill Equipment Needed See Course Arrangements section, above. Lesson Contents The content in this lecture is the same as the content of lesson D05 in the BSAC Dive Leader course. Use these PRM notes in conjunction with the DO5 instructor notes from the latest Instructor Resources CD. Check the Current updates page on the BSAC website to see if there are any changes to apply. The open water rescue scenarios should concentrate on the management of rescue activities. It is not intended that they become lessons for teaching personal rescue skills. The exercises will require prior detailed thought and planning by the instructor. Having the scenario mapped out on a slate will help to ensure that the students and any other participants are briefed properly, and will also act as a check-list for the subsequent monitoring and debriefing of the students. Each scenario should commence with an instructor brief on the exercise and, where appropriate, a SEEDS brief and detailed buddy check. Make sure that the student acting as Rescue Manager understands the nature of the incident. The initial exercises should be run in slow time, so that as the exercise progresses the instructor can draw from the students the sequence of actions that they are to take, and what considerations they should be taking into account. Where appropriate, the exercise should be stopped to discuss any points and possibly try alternatives. Once the students have fully assimilated the concepts, the pace of the exercises should be increased to a more realistic rate. Remember, however, that this is a teaching exercise, not an assessment. Following each exercise the instructor should conduct a full group debrief. This debrief should cover the following: How the incident was assessed The actions that were taken How the tasks were delegated How delegation allowed multiple tasks to be carried out concurrently The actual rescue skills used Following the entire set of scenarios, carry out a 15 minute Outline Review with the whole course, reviewing the achievements and difficulties of all the scenarios. A number of example scenarios are included in DO5. Instructors may need to tailor the scenarios to suit 10 V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual Practical Lessons local conditions, and may also need to construct other scenarios depending on the number of students, their progress and abilities. The following notes give additional guidance on constructing and running scenarios. Group size and staffing By its nature, this lesson requires a group of divers, ideally a ratio of six divers per instructor, but no less than four. Every student should have at least one turn as Rescue Manager of a scenario which requires enough coordination to make it a useful personal learning experience for them. The lower limit for group size is set by the need to have sufficient people available to carry out the rescues, while the upper limit is set by the time it takes to run enough scenarios to give everyone their turn. It is not necessary for all the members of a group to be PRM students. Other instructors and suitably qualified and briefed helpers may participate as casualties, as rescuers to be managed, and as bystanders. PRM students should take an active part in each rescue, but bear in mind that if they are underwater or far from the main group - towing or being, a casualty, for example - they will be unable to observe the scenario properly. Try to ensure that this type of activity is minimised for the students, and shared out fairly between them. Incident statistics The following chart is based on the BSAC Diving Incidents Reports from 2005 to 2008, and shows the approximate proportion of reported incidents falling into different categories. About two thirds of all incidents involve divers with abnormal symptoms following a dive (note that "DCI not diagnosed" and "treated for DCI" refer to diagnosis and treatment by qualified medical personnel, and not to first aid given at the dive site). These proportions may be helpful in deciding what types of scenario to include in the course. Incident breakdown Symptoms after diving - DCI not diagnosed Engine failure Lost divers Other boat problems Equipment problem Slips, trips, falls etc, Poor technique Miscellaneous Symptoms after diving - treated for DCI Additional scenarios Thousands of examples of real incidents can be found in the BSAC Diving Incidents Reports, which are published on the BSAC website. Alternatively, instructors may prefer to use examples from their own experience, or to create examples from their imagination. Each of these approaches is equally valid. Although every incident is different, most of them fall into a relatively small number of categories when looked at from the point of view of how they present to the Rescue Manager. The following list is not exhaustive, but may prompt ideas for additional scenarios: Accidental injury Boat damaged/immobilised - all divers on board Boat damaged/immobilised - divers down Distressed divers on surface V1.1 Copyright BSAC 2009 11
Practical Lessons Distressed diver surfaces then sinks Diver reports symptoms after uneventful dive Diver reports abnormal dive, with or without symptoms Diver rescued to surface by buddy, buddy is competent and well Diver rescued to surface by buddy, buddy is distressed Diver surfaces without buddy following uneventful dive Diver surfaces without buddy who was seen to be in trouble underwater Divers find body Divers overdue DSMB 'distress signal', pre-arranged/not pre-arranged Distress signal seen/received flare, Mayday, etc Null incident - nothing happens Practical Rescue Management Instructor Manual Unfit/unwell, diver or non-diver The following lists may help generate ideas for fleshing out scenarios with sufficient detail to make them realistic, workable, relevant and different. Illnesses/injuries DCI, O 2 hit, CO 2 hit, near drowning, heart attack, stroke, food poisoning, exhaustion, hypothermia, hyperthermia, head injury, drunk/drugged, infectious diseases, ears/ sinuses, marine creature bites & stings, bad fill, bad back, cuts & bruises, fractures, burns, shock, blast injury, hangover, obese, fatigue, unfit, mental state, prescribed medication Accidents/occurrences capsize, man overboard, slips, trips, falls, collision, trailers, hit by propeller, falling objects (including diver), fire, explosion, assault Conditions/circumstances - exhausted, panic, caught by current, rough sea, unable to exit water, ladder/lift broken, entangled, trapped, slippery (ice, weed), poor visibility, noisy, engine failure, electrical failure, aground, adrift, sinking, darkness, O 2 cylinder empty/run out/lost key, no mobile signal/landline Rescuer/casualty characteristics large person, small person, type of equipment (standard, independent AS, multiple cylinders, rebreather, 'Christmas tree' diver, nitrox, trimix), specialist skills (medic, coxswain, strong swimmer, lifesaver, AED, oxygen, engineer, etc), experienced/beginner, responsiveness (AVPU), breathing/not breathing normally, non-english speaking Scenario embellishment A technique which many instructors find effective, is to brief members of the group privately to act out roles which will make the Rescue Manager's job more difficult, by simulating the presence of disruptive people with their own agenda. Used wisely, this approach can be both instructive and good fun. However, make sure that people do not get carried away with acting to the extent that it detracts from other students' learning of the core rescue management skills. Embellishment is best reserved for later scenarios, once the basic skills have been grasped. The following roles have been used successfully on PRM courses in the past. Use them or not as you see fit. Power struggle A very assertive person, either within the group or a bystander, perhaps someone from another diving group on the same site, keeps giving instructions to members of the group, and countermanding the Rescue Manager's directions. The Rescue Manager has to get them under control. Grieving relative - A close relative, typically a partner, close friend, or parent of the seriously injured casualty is on the scene. They are distraught, and get in the way of rescue and first aid activities. The Rescue Manager has to get them under control. ASBO.-.There are some obnoxious youths nearby who are shouting abuse, throwing stones, firing air rifles, vandalising property, etc. The Rescue Manager has to get someone to get them away from the 12 V1.1 Copyright BSAC 2009
Practical Rescue Management Instructor Manual Practical Lessons scene. Press A photographer/videographer is trying to take closeup photographs and is getting in the way and upsetting the casualty and the casualty's friends. An alternative/complementary role is for the press person to ask intrusive questions about the incident (but note that dealing with the press is in DT11, which comes later in the course). Argy-bargy - The group includes two people who begin to argue with one another. Apportionment of blame is often a good topic for the argument. The argument becomes very heated, and distracts the rescue efforts. This embellishment can be combined with elements of Grieving relative. The Rescue Manager has to get them calmed down or moved away. Chaos - This is a non-role, in the sense that a scenario is run without a Rescue Manager. Usually, chaos ensues because nobody is in charge. Hypochondriac - A diver exhibits excessive, and unwarranted (by the circumstances of the scenario) anxiety about his/her health. They claim to have almost every symptom that is suggested, and distract attention from other, genuine, casualties. The Rescue Manager has to deal with them safely. Ailing buddy The buddy of the primary casualty appears well at first, but quietly deteriorates to the point of collapse. This could happen at any point from during the initial rescue until the end of the scenario. The Rescue Manager has to notice and take appropriate action. V1.1 Copyright BSAC 2009 13