全身固定傷員向地面轉(zhuǎn)運：拉梯轉(zhuǎn)運救援

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作者簡介

    Jeremy Rifflard 于1991年加入佛羅里達州消防隊，是勞德代爾堡消防局的一名消防隊長。他還是美國聯(lián)邦應(yīng)急管理局城市搜索與救援隊（FEMA Urban Search and Rescue team，F(xiàn)L-TF2）救援分隊指揮官；最近參與的救援行動包括海地地震和艾克颶風；Coral Spring地區(qū)公共安全協(xié)會建筑坍塌技術(shù)項目首席導師；在過去的15年間通過ATEC公司向美國軍方提供城市搜索與救援訓練。

       脊柱受傷的人員在移動中通常需要將其頸部與脊椎固定。使用背板配合頸圈或者脊柱固定設(shè)備通常是最有效的固定傷員方式。但是，如果樓內(nèi)電梯很小或者樓梯豎井狹窄，那么運送起脊椎固定的傷員來將會非常困難。在某些情況下，技術(shù)救援小隊將會出警并將傷員運至地面。但是，等待一只技術(shù)救援小隊到場可能需要較長時間。而多數(shù)消防中隊則具有實施拉梯轉(zhuǎn)運救援的裝備和能力，它們需要做的只是訓練。

 

圖1，學員們正在利用1英寸管裝扁帶制作安全帶將被困者固定在籃式擔架內(nèi)。在制作完安全帶后，還要利用另一條扁帶在傷員身體上制作三個“X”型交叉以固定傷員。

      若要使用繩索救援系統(tǒng)，首先必須保證傷員被安全固定在籃式擔架中?；@式擔架相較于單獨使用脊柱背板，可以提供更加安全穩(wěn)定的平臺環(huán)境?；@式擔架的周圍具有可以讓救援人員在移動過程中牢固抓握的橫桿，這些欄桿還可以作為連接繩索裝備的連接點；但并不是所有的救援籃式擔架都適用于吊升救援，經(jīng)驗證，The general duty-rated籃式擔架可以作為吊升救援的裝備。技術(shù)救援小隊通常將這類擔架作為攜行器材。

     當事故現(xiàn)場不是高角度救援時，經(jīng)過訓練的非技術(shù)救援小組人員可以使用籃式擔架直接移動運送傷員。籃式擔架內(nèi)部沒有任何活動構(gòu)件，只需要很少的練習就可以學會使用。在平地上四名隊員就可運送擔架中的傷員。

而在高角度救援中，傷員必須被安全地固定在籃式擔架中以防止身體發(fā)生移位。傷員在發(fā)生身體移位并試圖抓住某物時會導致?lián)艿膬A覆。當擔架在平穩(wěn)的地面上移動時，可以使用擔架的安全帶附件將傷員簡單固定。

而當傷員將會穿過有高度落差或光滑的表面時，則必須使用更強的手段固定傷員。例如使用1英寸寬的管裝扁帶或制式的傷員固定系統(tǒng)。通常，可以使用一條扁帶打一個項結(jié)（girth hitch）將腳部固定在擔架末端。再利用一條扁帶在傷員身前交叉形成三個“X”型，并在擔架上靠近頭部或肩部的安全位置使用卷結(jié)（clove hitch）把扁帶固定到擔架上。還應(yīng)使用另外一條扁帶制作一個半身安全帶固定傷員，以限制傷員身體重心的轉(zhuǎn)移。

圖2，拉梯轉(zhuǎn)運救援。這種救援通常用于將傷員從二、三樓或屋頂轉(zhuǎn)運至地面的現(xiàn)場

拉梯轉(zhuǎn)運

       在技術(shù)救援隊伍發(fā)展建立之前，訓練有素的消防員通常使用拉梯將傷員從二、三層的窗戶或屋頂救至地面。這種基礎(chǔ)救援方式僅需很少的裝備：籃式擔架、一根12.7mm直徑的靜力繩、一條錨點扁帶或類似裝備、5個以上的救援用安全鉤、兩條管狀或扁平短扁帶（大約1.5-1.8米長）、1個牛角八字環(huán)或一個作為下降器使用的超大號安全鉤，以及在地面的一個可以伸高至略高于救援起始水平位置的拉梯。

      首先，要在被困者周邊尋找一個窗戶或屋面作為救援起始位置。選擇救援起始位置時，要避免起始點下方存在可能影響拉梯傾斜至地面的障礙物，還要避免救援區(qū)域上空存在電線。如果現(xiàn)場能找到一個完整的救援場地，經(jīng)過訓練的小隊便可完成拉梯轉(zhuǎn)運救援。

       救援演練開始時，首先要將假人使用扁帶、腰式安全帶或其他類似裝備固定到籃式擔架中。利用固定編織帶將脊柱背板和傷者固定至籃式擔架內(nèi)可以保證在移動過程中傷者始終在擔架的內(nèi)部。操作中，還可以使用制式的擔架固定帶和鎖扣系統(tǒng)來固定傷員，這些制式裝備在使用時相對更加高效，可以在需要時快速將傷者從擔架中移出。

繩索操作

       要把擔架運送系統(tǒng)的錨點設(shè)置在房頂上或建筑內(nèi)的穩(wěn)固位置。只要可能，使用錨點扁帶和安全鉤圍繞建筑物的結(jié)構(gòu)部件來制作錨點（圖3）。在錨點之后是下放設(shè)備，如牛角八字環(huán)或進行意大利半結(jié)纏繞的超大號安全鉤。如果使用牛角八字環(huán)施救，請先將繩索穿過八字環(huán)中心的洞并繞過末端，再連接八字環(huán)與錨點的安全鉤（圖4）。注意：排式下降器不太適合此類救援，因為它會增加過多的摩擦力。

圖3，錨扁帶環(huán)繞建筑構(gòu)件并使用安全鉤連接。

圖4，在繩索中將一個繩圈穿過牛角八字環(huán)中心，然后再連接安全鉤和錨點前翻過八字環(huán)末端。

       在錨點制作完畢后，將繩索安裝在下放裝置內(nèi)，然后將下放裝置通過安全鉤與錨點扁帶連接（圖5-6）。在繩索末端打一個雙圈八字結(jié)，每個圈長度大約30厘米。利用安全鉤將繩圈與籃式擔架前端兩側(cè)的位置相連接（圖7-8），收緊繩索。

圖5-6，牛角八字環(huán)通常用于當作下放裝置，它通過安全鉤與錨點扁帶相連。只要可能，要選擇建筑的結(jié)構(gòu)部件當作錨點。


圖7，密歇根國民警衛(wèi)隊的救援人員將傷員固定到籃式擔架內(nèi)。錨點與救援起點在一條直線上。

 

圖8，利用雙圈八字結(jié)連接繩索與籃式擔架前端。

       在救援起始點的下方地面處緊貼著墻壁設(shè)置一把拉梯。將拉梯的梯蹬拉至高于籃式擔架所在起點3-5蹬的高度。將拉梯與擔架連接，命令兩名以上的消防員操作拉梯使梯子緊貼建筑（圖10）。利用兩條各1.5米長的管狀扁帶打水結(jié)制作扁帶圈（圖11）。在梯子高于窗臺或屋頂一到兩個梯蹬高度的位置上，左右兩側(cè)用扁帶圈各打一個項結(jié)（圖12-13）。

圖9， 隨著拉梯逐漸傾斜，籃式擔架逐漸離開建筑物

圖10，兩名以上的消防員負責將拉梯緊貼建筑


圖11，一條通過水結(jié)固定的管狀扁帶。


 

圖12-13，在指揮員的指揮下，四名救援人員提起籃式擔架并移動到救援起點處。兩名靠近擔架尾端的救援人員負責將擔架連接到拉梯的扁帶上。注意不要讓擔架接觸地面，否則擔架在躍出邊緣時摩擦力將會過大。將擔架固定到離地面半米高為宜。

       一到兩名消防員負責穩(wěn)定梯腳，另外一到兩名消防員負責在上方人員下放繩索時沿著梯子方向緩慢行走以扶住梯子。還有一名隊員可能要負責向下拉梯子，以補償下降器產(chǎn)生的摩擦力。隨后將傷員與梯子共同下放至地面（圖14）。如果連接梯子與擔架的扁帶過短，籃式擔架有可能向上抬頭而不是水平移動。在到達地面時，擔架也將無法放平，這會使得將被困者移出擔架變得困難。所以，這兩條扁帶的長度最好在1.8米-3米之間。 

圖14，傷者與擔架轉(zhuǎn)運至地面

引導繩

      如果要從三層的窗臺或屋面下放救援，為了側(cè)面的穩(wěn)定性，可能需要設(shè)置引導繩（圖15）。拉梯的高度越高，重心也就越高，如果演練現(xiàn)場使用的是10米拉梯，就要設(shè)置引導繩：當拉梯還在地面時，在拉梯頂端左右兩側(cè)各綁一條引導繩。當拉梯提升時，兩名隊員各握一條引導繩；當拉梯下放時，引導繩可以用于施加向下的拉力，以便幫助傷員更快下降。

      除非你已經(jīng)訓練了相關(guān)技術(shù)，否則請不要嘗試實施拉梯轉(zhuǎn)運。訓練內(nèi)容包括使用牛角8字環(huán)下放繩索、消防繩結(jié)的制作以及籃式擔架的綁扎。通過重復的訓練，水罐車、云梯車號員以及救援小組都可以利用拉梯轉(zhuǎn)運實施二層建筑的救援行動。

圖15，勞德代爾堡消防局的消防員使用拉梯轉(zhuǎn)運將一名癲癇發(fā)作的傷員從樓頂上救下。

原文：

Getting an Immobilized Patient to the Ground: The LadderPivot Rescue

By Jeremy Rifflard

JEREMY RIFFLARD has been aFlorida firefighter since 1991. He is a captain with the Fort Lauderdale (FL)Fire Department. He is a rescue squad officer for the FEMA Urban Search andRescue team, FL-TF2. His most recent task force deployments were to the HaitianEarthquake and Hurricane Ike. He is the lead instructor in structural collapsetechnician programs for the Coral Springs Regional Institute of Public Safety.For the past 15 years, he has been an instructor and subject matter expert formilitary urban search and rescue exercises through ATEC Incorporated inJupiter, Florida.Do not attempt a ladder pivot unless youhave been trained on this technique. Practice is needed in using an 8-platelowering device to tie secure fire service knots and stokes basket packagingskills. With repetition, engine, ladder, and rescue companies can execute asecond-story rescue with a ladder pivot.

    To begin rigging a rope rescue system, thepatient on the backboard is moved and secured into the rescue basket. Therescue basket creates a more stable platform than the backboard alone. Thisbasket has a rail rescuers can grab during movement. There are areas to connectrigging components; not all rescue baskets are approved for lifting. Thegeneral duty-rated basket is an approved lifting device for elevated victimrescue. Technical rescue teams often use the basket as their “go to” device.A person with a spinal injury needs to bemoved with minimal or no manipulation of the neck or spine. A backboard with acervical collar and spinal-immobilization device is often the best practice tolimit movement of the patient. If there is a small elevator or narrowstairwell, movement of the backboarded patient can be challenging. On certainoccasions, a technical rescue team may be called to bring the patient to theground. Waiting for a technical rescue response may take a great amount oftime. Many fire companies have the equipment and ability to execute the ladderpivot rescue; all they need is training.

    On high-angle rescues, the patient must besecured in the rescue basket to prevent his weight from shifting from side toside. The shifting weight of a patient who reaches out to grab at something cancause the basket to tip. The patient can be secured with a seat belt attachmentif the patient is carried on level, stable ground.Nontechnical trained personnel can move thebasket when the incident is not a high-angle rescue. The basket has no movingparts and requires minimal training to carry it. Four persons can carry apatient in a basket on flat pathways.

     If the patient will be moved across anelevation or a slippery surface, the patient should be secured with a strongerdevice, such as a one-inch tubular webbing or a manufactured patient tie-insystem (photo 1). The webbing can be girth hitched to the foot end of thebasket. Typically, a webbing will cross the patient three times in an “X” pattern and be finished with a clovehitch knot with a safety near the head or shoulder area of the basket. Thepatient may be secured with a webbing harness in addition to the “X” pattern to limit side-to-side weightshifting.

The Ladder Pivot

    Before the evolution of the technical rescueteam, trained firefighters used a ladder pivot to move a patient from a second-or third-floor window or roof (photo 2). This is a basic technique thatrequires minimal equipment: rescue basket; a ½-inchstatic kernmantle rescue rope; a rated anchor rigging strap or similar device;five or more general duty-rated carabiners; two short tubular or flat webbings(about five to six feet in length); a rescue 8 plate or an extra-large offsetcarabiner as a lowering device; and a ground ladder that will extend just aboveyour departure point.

   The rescue drill begins with the backboardedmannequin/patient being secured into the stokes basket with a webbing, waistharness, or similar device. With a webbing attachment, connect the backboardand patient to the basket. This will keep the patient inside the basket duringmovement. There are manufactured webbing and clasp systems to tie the patientinto the basket. These systems are very efficient; the patient can be quicklyremoved when four clasps or buckles are released.Survey the structure to find a window or roofthat is adjacent to the patient. This will be your departure point. The areabelow the departure point must be clear of obstructions that would interferewith a raised ladder’s tilting to the groundand of overhead electrical wires. If you have the departure point and aclearing below, a trained group can accomplish a ladder pivot rescue.

Rigging

    Anchor the basket system to a sturdy pointon the roof or inside the building. Whenever possible, strap the anchor on astructural component of the building. Wrap the anchor strap around thestructural component and carabiner the buckles (photo 3). Attached to theanchor strap is a lowering device (descender) such as an 8 plate or a MunterHitch on an extra-large offset carabiner. If a rescue 8 plate is used, load therope bight through the center hole of the 8 and over the end before attachingthe carabiner to the anchor strap (photo 4). Note: A bar rack is not a desirable lowering device because itadds too much friction.

    Place a ground ladder against the buildingbelow the designated departure point. Raise the ladder with three to five rungshigher than the height of the basket’sdeparture point. Tie the halyard. Using two or more firefighters, place theladder flush against the building (photo 10). Secure two tubular webbings, eachabout five feet long, in a loop with a water knot (photo 11). Girth hitch theloops to a rung and beam one or two rungs above the roof or window level oneach side of the ground ladder (photos 12-13).After the anchor is rigged, place the ropein the lowering device and attach the lowering device to the anchor strap witha carabiner (photos 5-6). Tie the end of the rope with a double-loop figure 8knot with loops about 12 inches in length. Using a carabiner, attach one loopto each side of the head end of the basket (photos 7-8). Tension the rope toremove any slack.

    One or two firefighters will foot the ladderon the ground. One or two other firefighters will walk down the ladder as arescuer lowers the rope from the departure point. Additional rescuers may haveto pull downward on the ladder to compensate for friction on the loweringdevice. The ladder and patient are lowered to the ground (photo 14). If thewebbings attached to the ladder are short, the basket will slightly head upinstead of move evenly. The basket will not lie flat on the ladder when itreaches the ground. This may make it difficult to remove the patient from thebasket. The preferred length of the two pieces of webbing attached to theladder is between six and 10 feet.

Guy Ropes

If the basket is coming out of a third-storywindow or from the roof, guy ropes may be needed for side stability (photo 15).The higher the ladder, the higher the center of gravity. If the 35-foot ladderis used for this drill, attach guy ropes: While the ladder is on the ground,place one guy rope on each side of the raised ladder tip. One person shouldhold each rope as the ladder is raised. When the ladder is being lowered, guyropes can be used to apply downward pressure to facilitate a level lowering ofthe patient.