995 page Navy RESCUE SWIMMER PowerPoint Training Presentation CD

995 page Navy RESCUE SWIMMER PowerPoint Training Presentation CD


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Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one CD-ROM in both Microsoft PowerPoint and Adobe Acrobat PDF file formats:

TITLE:

Surface Rescue Swimmer School Course and Refresher Course, 2005, 995 pages (slides) in one file !!

SLIDE TOPICS, SUBTOPICS and CONTENTS:

Surface Rescue Swimmer School Overview/Course Introduction
Enabling Objectives
Cite OPNAVIST 3130.6 and NWP    3-50.1 series requirements for RSS training.
Explain all safety precautions used during RSS training.
State the remedial training policy.
State the DOR/TTO policies and procedures.

Course Overview
Applicability:
The Rescue Swimmer Course is designed for individuals who have not previously graduated from Rescue Swimmer School and are reporting to a rescue swimmer billet.
Course Overview (cont.)
    Goals:
This course provides students with initial training and hands-on experience in first aid, CPR, rescue equipment, life saving techniques, day/night water entries, parachute disentanglement, search and rescue tactics, night and multiple rescue situation.  Students will undergo physical training consisting of calisthenics, swimming, and running.
Course Overview (cont.)
NAVAL WARFARE PUBLICATION 3-50.1

The NWP 3-50.1 is the Naval Search and Rescue manual.  It promotes and maintains standardization of SAR procedures, equipment, and techniques.  Course content is mandated by this manual and should be used in conjunction with the Trainee Guide.

Course Overview (cont.)
Evaluations:
Academic exams to test knowledge.
Practical exams to demonstrate correct rescue swimmer procedures.
Graded physical training events to verify effective conditioning.
Course Overview (cont.)
Extra Instruction and Remediation:
Extra Instruction (EI)
    - Designed to assist students having difficulty attaining course objectives.
   - In comparison to standard instruction, EI consists of a lower student-to-instructor ratio and is taught at the pace of the slowest student.
   - Students are strongly encouraged to seek EI.  Instructors may also assign EI.
Course Overview (cont.)
Extra Instruction and Remediation:
Remediation:
    - Assigned  to students in response to failure of a criterion test; preparation for re-test.
    - Same instructional characteristics as EI.
DROP ON REQUEST/ TRAINING TIME OUT POLICY:
Drop on Request (DOR) Policy:
    In all cases where a student states a desire to DOR from voluntary training based on concern for personal well-being, appropriate action shall be initiated, including removal from training, referral of the student for medical, counseling or remedial action as appropriate, and review of the training environment, including training techniques. The  scope and depth of these actions shall be determined by the nature of the complaint and the risk incurred in the training. A written summary of actions taken shall be made a permanent entry to the student’s service record. In no case shall a student be coerced or threatened to induce  him or her to return to training following a DOR.

DROP ON REQUEST/ TRAINING TIME OUT POLICY
A Training Time Out (TTO) may be called by any student or instructor in any training situation where they are concerned for their own or another’s safety, or they request clarification of it, procedures or requirements. TTO is also an appropriate means for a student to obtain relief if he or she is experiencing pain, hear stress, or other serious physical discomfort. The  purpose of the TTO is to correct the situation of concern, provide clarifying information , or remove the student or instructor from the possible hazardous environment………

DROP ON REQUEST/ TRAINING TIME OUT POLICY
…..A TTO may be signaled with the abbreviation TTO, the words Training Time Out, crossed hands in a (T), a raised clenched fist, or other specific signals which will be briefed prior to a specific lab, test, or exercise. If the TTO signal is not acknowledged, the signaler shall shout “Time Out” (or other action as required by the training activity). The instructor shall attempt to relieve and remove the student from the possible hazardous environment. If an adequate number of instructors are available to allow training to continue safely, the lead instructor may elect to do so. However, if this is not practical, training will be stopped until the situation is corrected.

Course Overview (cont.)
ADMININSTRATIVE PROCEDURES AND REGULATIONS:
Pre-requisite screens
 - Purpose of pre-requisite screens
 - Students screening forms
 - Medical Up-chits
Students will complete instructor, course, and quality of life critiques.
Security precautions for personal valuables.
Following participation in rescue swimmer training, entries shall be made in the appropriate training jacket.
Course Overview (cont.)
SAFETY PRECAUTIONS:
Hazardous conditions may exist in the training environment; students have a responsibility to report any unsafe/unhealthy condition they may discover.
In the event of an in-water emergency, signaled by multiple whistle blast or sounding of applicable alarm. Students will exit the pool immediately and proceed to the predestinated location and follow the directions of staff.
Course Overview (cont.)
MISHAP/NEAR-MISS/ UNSAFE CONDITION REPORTING PROCEDURES:
A mishap is any unplanned or unexpected event causing personnel injury, occupational illness, death, material loss or damage, or an explosion of any kind whether damage occurs or not.
A hazardous condition is any situation which, if allowed to go unchecked or uncorrected, has the potential to cause a mishap.


Course Overview (cont.)
MISHAP/NEAR-MISS/ UNSAFE CONDITION REPORTING PROCEDURES:
A near-miss is when a mishap is avoided merely by chance.
It is the responsibility of all Department of Defense personnel to report all mishaps, near-misses, and any unsafe or unhealthy (hazardous) condition (s). If a mishap, hazardous condition or near-miss occurs the student shall inform the instructor immediately. OPNAV 5100/11 with instructions is available for formal reporting.

Summary
Can a student request Extra Instruction (EI)?
Yes, EI is encouraged if a student is having difficulty learning course objectives.
Saying “I quit” will result in removal from training.  True or False?
True, the student would be treated as a DOR and referred to the Division Officer.
Surface Rescue Swimmer School
Pool Safety Regulations LT 1.2
ENABLING OBJECTIVES
Cite general pool safety regulations per Rescue Swimmer School Standard Operating Procedures (SOP).
GENERAL POOL SAFETY REGULATIONS
No person with any skin fungus, open sores, or disease is allowed in the pool without consent of the SAR Corpsman.
No running or skylarking.
Glass containers are not allowed on the pool deck or locker room at anytime.
Prior to entering the pool, all personnel shall take a shower.
General Pool Safety Regulations
Students will wear approved swim trunks and T-shirt pool training. Additionally, an LPU-28 will be worn during mask, fin, and snorkel training.
No smoking
Whistle blasts:
One whistle blast- Instructor is seeking student’s attention
Two whistle blast - Instructor seeking another instructors attention
Multiple whistle blasts- Emergency. Follow instructions of staff.
General Pool Safety Regulations
No jewelry ( i.e.: rings, chains, etc…)
No diving
DO NOT use ladders to climb out of the pool unless specifically told to do so.
Take off fins before standing or walking on the pool deck.
Ensure all pool drain covers installed prior to commencing any disentanglement training.
WATER EXIT
For facilities with high pool deck edge:
Students swim to ladder, remove fins, and exit one at a time.
For facilities with low pool deck edge:
Students will swim to wall and place both hands on edge of pool.
Holding onto the edge, students will push up resting on both arms extended, look left and spin left, and assume a sitting position facing the pool.
With both legs extended out of the water, remove gear and the turn to their left in order to avoid a collision.

Emergency Situations
Call for help any time you are in trouble and ONLY when you are in trouble.
If a person is in actual danger, only the instructor will enter the water to render assistance.
If you see anyone in trouble inform an instructor immediately.
Shallow Water Blackout
WARNING:
   Do not hyperventilate prior to underwater swims.  Hyperventilation can lead to shallow water blackout.

Hyperventilation (excessively rapid breathing) purges the blood of CO2, the body’s cue to breathe.
Swimmer runs out of oxygen without ever feeling the need to breathe, passes out and drowns.
Review
If you hear multiple whistle blasts you should run to the bleachers. True or False?
False, you should walk to the designated muster area.
You should walk backwards when you are wearing fins.  True or False?
False, always remove gear before standing.
Review
What does one whistle blast mean?
Instructor is seeking student’s attention.
What causes shallow water blackout?
Hyperventilation
?
Surface Rescue Swimmer School
Principles of Physical Fitness and Dry Land Conditioning
LT 2.1
TRAINING TIME OUT (TTO)
A Training Time Out (TTO) may be called by any student or instructor in any training situation where they are concerned for their own or another’s safety, or they request clarification of it, procedures or requirements. TTO is also an appropriate means for a student to obtain relief if he or she is experiencing pain, hear stress, or other serious physical discomfort. The  purpose of the TTO is to correct the situation of concern, provide clarifying information , or remove the student or instructor from the possible hazardous environment. A TTO may be signaled with the abbreviation TTO, the words Training Time Out, crossed hands in a (T), a raised clenched fist, or other specific signals which will be briefed prior to a specific lab, test, or exercise. If the TTO signal is not acknowledged, the signaler shall shout “Time Out” (or other action as required by the training activity). The instructor shall attempt to relieve and remove the student from the possible hazardous environment. If an adequate number of instructors are available to allow training to continue safely, the lead instructor may elect to do so. However, if this is not practical, training will be stopped until the situation is corrected.
Introduction
Physical training is designed to provide the rescue swimmer with a balance and progression of physical training, which will develop both upper and lower body strength and cardiovascular endurance.
Enabling Objectives
2.1  State the fundamentals of physical
      conditioning.
2.2  Perform proper physical conditioning
      exercises and Physical Training Level 1, 2, and     3.
    2.3  Explain the importance of proper technique
          and form when utilizing weight lifting                equipment.
     2.4  Review proper techniques for developing and      maintaining overall muscular strength utilizing      weight lifting equipment.
Objectives of a Rescue Swimmer conditioning program
Achieve a level of conditioning which allows the rescue swimmer to operate for 30 minutes in a sea state of three (minimum).  There is no substitute for practical preparation, but a comprehensive dry land conditioning program will assist toward this goal.
Objectives of a Rescue Swimmer Conditioning Program
Pass Level 1 Fitness Test and the Swimmer Fitness Test  
    (per OPNAVINST 3130.6).
Enhance performance of rescue swimmer duties while reducing risk of injury to self or survivor.
Job performance is enhanced for the rescue swimmer by maintaining the following:

Wellness:  is an approach to optimal health and emphasizes the swimmer’s deliberate effort to stay healthy and achieve the highest potential for well being. Wellness is an ongoing process which requires daily decisions in areas of proper nutrition, stress management, disease prevention, substance abuse control, and physical fitness.
Job performance is enhanced for the Rescue Swimmer by maintaining the following:
Physical Fitness:  is defined as the general capacity to adapt and respond favorably to physical effort.  A physically fit rescue swimmer is able to perform normal daily activities effectively and have enough energy remaining to complete a SAR mission.
General Principles
Note
   Rescue swimmers are like multi-sport athletes in that they must be able to perform a variety of physically demanding tasks on land and water. The rescue swimmer requires a variety of training workouts which focus on different goals.  Because of the high level of multi-dimensional fitness required by the rescue swimmer 6-10 training sessions per week may be required.
General Principles
Overload - system must be stressed to loads greater than it’s accustomed in order to improve.
Increase resistance, repetitions, intensity, or duration during exercise.
Specificity - Effects of exercise limited to system being stressed. To be a good swimmer, you must swim.
Progression - Continually applying overload to experience gain (Training effect).
Aerobic Conditioning
Includes aerobic endurance, cardio respiratory fitness, cardiopulmonary fitness, and heart rate training. Aerobic exercise requires large amounts of oxygen, large muscle groups, is rhythmical in nature, and should be maintained over time at a moderate intensity. 
Examples include swimming, running, bicycling, etc. Weight-lifting and most team sports are not aerobic activities.
Aerobic Conditioning
A good aerobic training program conforms to the F-I-T-T principle:
Frequency - Minimum of three times a week.  If exercising daily, “Cross-Train” (alternate different activities) so skeletal muscles are not over-trained.
Intensity - Heart and breathing rate must be accelerated, but only to a level which can be maintained for extended periods of time. This is 60%-75% of an individual’s maximum heart rate. As a general guideline, an exerciser should be breathing hard yet still be able to talk while performing aerobic activities.
Type - Must be an aerobic activity.
Time – Continuous exercise for a minimum of 20 minutes.
   
Anaerobic Conditioning
Activities which are not long term or rhythmic in nature. They allow the body to recover between efforts. Many team sports and strength/speed training are considered anaerobic.
Two workouts a week can build strength (given sufficient intensity).
Anaerobic Conditioning
WARNING
   Do not exercise the same skeletal muscle group on successive days.  Minimum 48 hours rest is required between work-outs to avoid over-use injuries and optimize gains.
Anaerobic Conditioning
A muscle which is too fatigued to contract can still be exercised using a technique called “negatives”.  For example, an exerciser performing pull-ups will reach a point where he/she can no longer lift themselves. The partner then assists (or “spots”) the exerciser by QUICKLY lifting him/her all the way up. The exerciser SLOWLY returns to the to the starting position. Do not rest at top or bottom of the cycle. This process can be repeated until the muscles achieves total failure.
Ideal Workout
An adequate warm-up period (light jogging, jumping jacks) increases the core temperature 1-2 degrees, warming up the muscles for more effective stretching and exercise.
Slow, steady stretching reduces the risk of strains and improves performance. Avoid ballistic (jerking) stretches as they can cause strains. Avoid unsupported bending at the waist as it can cause back injury.


Ideal Workout
Training Period - aerobic or anaerobic.
A cool-down period of light exercise helps the body return to its normal state.
Preventing Dehydration
Dehydration, a below normal level of water in the body, is a dangerous situation which can lead to heat injuries (heat stress and heat stroke) in the worst case and muscle cramps (including “side stitches”) and sub-par performance at a minimum.
Preventing Dehydration
Warning
Exercisers, especially in hot, humid environments, are especially vulnerable to dehydration. Up to two quarts of water per hour may be lost through sweating during exercise and one quart per day is lost through urine.
Preventing Dehydration
Drink large amounts of clear, non-alcoholic, non-caffeinated, non-carbonated beverages before, during, and after exercise.

Preventing Dehydration
Water: The recommended amount for adults is ten 8 ounce cups during a normal day.
Sports drinks with less than 8% dissolved sugar. 
   Make your own: 1 gallon water, 6 ounces sugar, 1 TBSP salt, flavored KoolAid sweetened with fructose (not sugar).

Preventing Dehydration
6-8 ounces of fluid consumed every 20 minutes of exercise can help replenish the sweat lost during exercise.
By the time an active individual feels thirsty, he/she is behind the “dehydration power curve” .
NOTE
The best indication of adequate hydration is clear to light yellow urine.
Exercises to avoid
Knee care
Avoid exercises which require the knee to bear weight while bent beyond 90 degrees.
Back Care
Avoid unsupported bending at the waist (i.e.: standing toe touch).
Exercises to avoid
Avoid doing flutter kicks, leg levers, and horizontal scissor kicks in excessive amounts.  These common exercises, mistakenly thought to strengthen the abdomen, predominantly work the Illio Psoas (hip flexor) muscles.  These muscles are attached to the top front of the leg, wrap around outside the hip, and attach to the back of the pelvic girdle.  Over-developed hip flexor cause a lordotic (sway-backed) spinal curve and result in lower back pain.
Rest and Basic Nutrition
The Rescue Swimmer School is a very demanding physical program.  Hard workouts without adequate rest or nutrition will result in over-use injuries and illness.
Rest and Basic Nutrition
Adequate rest is vital if muscles are to recover and gain strength.
   Seven to nine hours of uninterrupted sleep is adequate for many adults, however, participants in this program need to “listen to their body” and get more sleep as required.
 Rest and Basic Nutrition
Proper nutrition provides the rescue swimmer with the energy required to perform duties.
Carbohydrates: Provide energy and is the main fuel source to the cells within the body. Glucose is the main product of carbohydrate digestion. 
Rest and Basic Nutrition
    Carbohydrates are usually referred to as the following:
Simple: Derived from fruits and sugars  (i.e.: soda, candy, cake, ect.).
Complex: Derived from vegetables, grain, fruits, and beans.
Avoid fatty, fried, and oily foods.

    Conclusion:
The Rescue Swimmer School Dry Land Conditioning Program is a comprehensive, total body workout designed by an exercise physiologist from the Naval Aeronautical Medical Institute. Special emphasis is given to muscle groups utilized in rescue swimming, specifically the pulling muscles of the upper body and the muscles in front of the thigh (which power the flutter kick).
The principles of this unit apply to the training environment and the fleet.

STRETCH SET
ANKLE ROTATIONS
JUMPING JACKS
ROTATOR CUFF STRETCH
TRICEP STRETCH
QUADRICEP STRETCH
INSIDE HURDLER STRETCH
GROIN STRETCH
KNEE TO CHEST
BOTH KNEES TO CHEST
BACK TWIST
CALF STRETCH
ACHILLES STRETCH
CALISTHENICS SET
PULL UPS
FOUR-COUNT LUNGES
PUSH UPS
BENT KNEE SIT UPS
PULL UPS
TWO-COUNT SQUATS
WIDE ARM PUSH UPS
CRUNCHES
FOUR-COUNT DIRTY DOGS

CALISTHENICS SET CONT
FOUR-COUNT OBLIQUE CRUNCHES
FOUR-COUNT SUPERMANS
FOUR-COUNT FLUTTER KICKS
TRICEP PUSH UPS
CALF RAISES
CROSS KNEE OBLIQUE CRUNCHES
EIGHT-COUNT BODY BUILDERS
HIP FLEXOR STRETCH

STRETCH SET FOR STRENGTH TRAINING AND SWIMMING STRETCHES
PUSH UPS
ARM CIRCLES
FLUTTER KICKS
LUNGES
CRUNCHES
ABDOMINAL STRETCH
ROTATOR CUFF STRETCH
CHEST STRETCH
TRICEP STRETCH
QUADRICEP STRETCH
INSIDE HURDLER STRETCH
KNEE TO CHEST
BOTH KNEES TO CHEST
BACK TWIST

POST SWIM/STRENGTH TRAINING STRETCH SET
ROTATOR CUFF STRETCH
CHEST STRETCH
TRICEP STRETCH
QUADRICEP STRETCH
INSIDE HURDLER STRETCH
KNEE TO CHEST
BOTH KNEES TO CHEST
BACK TWIST
CALF STRETCH
Physical Training Test Out
Pull-ups
Lunges
Regular Width Push-ups
Bent Knee Sit-ups
Wide Arm Push-ups
Crunches
Flutterkicks
Tricep Push-ups
Run
Review
Review
What can you do to prevent dehydration?
Review
What are some examples of foods high in complex carbohydrates?
Review
Aerobic exercise should be maintained at what percentage of maximum heart rate to be effective?
?
Surface Rescue Swimmer School
Open Water Laboratories
LT  2.3
Objectives
Explain how the performance of the rescue swimmer skills is affected by current, sea state, visibility, sea life, swimmer buoyancy, and other variables encountered in the open water environment.
Perform basic rescue swimmer skills in the open water environment under daytime and nighttime conditions.
The Open Water Environment and Open Water Labs
Dramatically different from training tank.
Open water variables which affect the rescue swimmers ability to perform tasks:

Variables that affect Rescue Swimmers
Water Temperature
Wind
Sea state
Increased buoyancy of salt water and full wet suits
Visibility
Current
Open Water Hazards to Avoid
Jelly Fish, Man O’ Wars
Debris/contaminates in water
Kelp/Sargassum Weed
Purpose of Labs
In a controlled environment, provide realistic open water environment experience.
Performance of skills will not be graded,  this is for familiarity.
Questions?
Surface Rescue Swimmer School
APPROACHES AND CARRIES
LT  3.1
INTRODUCTION
During rescues, different types of approaches/carries are used depending on the survivor’s conditions and or position. The following procedures are furnished to provide basic approaches/carries to deal with any situation that may arise.
Enabling Objectives
List procedural steps for rescue swimmer approaches to, and carries of, an active/passive/unconscious survivor.
Demonstrate rescue swimmer approaches to, and carries of, an active/passive/unconscious survivor in a simulated rescue situation.
Survivor Characteristics
1. Aircrewman
Rescue Swimmers were originally tasked to assist downed aircrewman.
Aircrewman are trained in water survival and may be able to assist. (Never assume they can)
Survivor Characteristics for Aircrewman
Survivors with water survival training could become too helpful and actually be a hindrance. It might become necessary to instruct him/her to do nothing.
Survivor Characteristics for Aircrewman
WARNING
   An Aircrewman who has ejected and/or is unconscious may potentially have a spinal injury. Assess the situation and treat accordingly. Loss of ABC’s or other life threatening injury will take precedence over a spinal injury.

Survivor Characteristics for Panicking Survivors
Some rescues involve panicky survivors (even some aircrewmen).
Appearance: Wide eyes, frantic activity, gasping for air and other similar behavior.
Will attempt to grab and get on top of rescuer in order to keep his/her own head out of the water. Rescuers could be drowned in this manner.
Survivor Characteristics for Panicking Survivors
Best Defense: Do not get too close until you have assessed the situation and decided on the best approach to take for this survivor.
It may be possible to calm a panicking survivor by talking to them and explaining who you are and what you are doing.
Cross Chest Carry/Controlled Cross Chest Carry
From a position behind the survivor’s shoulder, the rescuer reaches across the chest and pulls the survivor from under the armpit with the palm of the rescuer’s hand.
Cross Chest Carry/Controlled Cross Chest Carry
The survivor’s shoulder is then tucked securely into the rescuer’s armpit and the arm firmly grasped against the survivor’s chest.
Cross Chest Carry/Controlled Cross Chest Carry
The rescue swimmer turns to the side with the hip directly against the small of the survivor’s back. The swimmer strokes vigorously with his legs, using a flutter kick to provide propulsion.
Cross Chest Carry/Controlled Cross Chest Carry
NOTE
    This procedure may be difficult to perform on aircrewmen due to their flotation and survival equipment.

Should the survivor be aggressive, the rescuer shall lock his/her hands together under the survivor’s armpit to complete a controlled cross-chest carry.
Collar Tow/Equipment Carry
WARNING
    Do not grasp survivor in a manner which may result in restricted breathing or circulation.

Grasp the survivor’s shirt collar or flight equipment from behind and between the shoulder blades with a straight arm locked at the elbow.
Collar Tow/Equipment Carry
The rescue swimmer assumes the side stroke position and strokes vigorously with the legs, using a flutter kick.
Front Surface Approach
Effective for passive or unconscious survivors. The Front Surface Approach should be the rescue swimmers first choice when approaching an unconscious survivor.
Approach the survivor with head out of water and eyes on the survivor.
Upon reaching arms length to survivor, execute a quick reverse.
Front Surface Approach
Attempt to establish communication, reassure the survivor. If necessary splash and yell to get the survivors attention.
Reach across with your hand grasping the survivor’s identical wrist (i.e.: right hand grabs right wrist, left hand grabs left wrist).
Begin kicking to plane out survivor, lean back and flutter kick.
Front Surface Approach
Pull survivor’s wrist up and across the front of swimmer’s body, turning the survivor onto his back.
When the survivor’s back is fully turned, the rescue swimmer places the survivor in a cross-chest carry.
Front Surface Approach
NOTE
If the survivor is conscious, every attempt shall be made to approach the survivor from the rear. This can be accomplished by either asking the survivor to turn around, or by swimming to the rear of the survivor and executing a rear surface approach.
Front Surface Approach
Rear Surface Approach
Most common approach used by rescue swimmers. The Rear Surface Approach should be used for all conscious survivors.
Approach the survivor with head out of the water and eyes on the survivor.
Upon reaching 6-8 feet of distance from the survivor, execute a quick reverse.
Rear Surface Approach
Attempt to establish communication, reassuring survivor.  If survivor appears unresponsive, splash or yell to get his/her attention.
Secure survivor in a cross-chest or equipment carry.
Rear Surface Approach
Underwater Approach
WARNING
  Underwater approach shall not be used if survivor is wearing a parachute.

Underwater Approach

Appropriate for active drowning survivor.
Approach from the front, keeping head out of water and eyes on the survivor.
Underwater Approach
Upon reaching a distance of 6 to 8 feet from the survivor, assess the situation.  When comfortable, execute a surface dive and swim under the survivor.
Underwater Approach
NOTE
When wearing a wet suit the swimmer must be aware of the added buoyancy of the wetsuit and avoid premature surfacing (The tending line, when attached to the rescue swimmer, may interfere with the underwater approach).
.
Underwater Approach
Swim underneath, or to the side and below the survivor, while maintaining eye contact. 
Execute a half turn (the survivor’s back should be towards the rescue swimmer), ascend towards the surface as close to the survivor as possible without touching him/her.
Underwater Approach
Upon breaking the surface of the water, immediately place the survivor in a controlled cross-chest carry. Roll with the momentum and swim to plane out the survivor.
Underwater Approach
Summary
The underwater approach is used on what type of survivor?
Summary
For the Underwater Approach, the rescue swimmer should execute a surface dive at what distance?
    6 to 8 feet.
    Questions?
Surface Rescue Swimmer School
 Releases and Escapes
LT 3.2
Enabling Objectives
List procedural steps for rescue swimmer head hold releases and escapes in accordance with NTTP 3-50.1 series.
Demonstrate rescue swimmer head hold releases and escapes in a simulated rescue situation in accordance with NTTP 3-50.1 series.
Releases and Escapes
NOTE
If caution is used and approaches are done correctly, these procedures should not have to be used. Releases and escapes are taught as a precaution.
Releases and Escapes
To allow rescuer to escape grasp of panicking survivor.
Remember that a panicking survivor will do anything to ensure he keeps his head above water. The key to these techniques is that the rescuer submerges deeply enough that the survivor goes underwater.
Releases and Escapes
A properly performed escape will simply free the rescuer from the grasp of the survivor and require a re-approach; a properly executed release will result in the release of the survivor’s grasp while the rescuer remains in control.
Front Head Hold Release
Suck- take a quick breath of air.
Front Head Hold Release
Tuck- tuck chin down and to the side.
Front Head Hold Release
Duck- Rescue swimmer extends arms outward, palms up, moving them upward rapidly several times which produces downward movement, and submerges the survivor and swimmer.

Front Head Hold Release
If the survivor’s head is on the right of the rescue swimmer’s head, rescue swimmer brings right arm up and over encircling arm and places hand securely against survivor’s right cheek, the little finger against the side of survivor’s nose and thumb hooked under the jaw.
Front Head Hold Release
NOTE
If survivor’s head is at the rescuer’s left side, the method is reversed.
Front Head Hold Release
The remaining hand is brought up beneath the survivor’s other arm seizing it in a grip with the thumb just above the elbow on the pressure point.

Front Head Hold Release
In one continuous motion, the survivor’s head is pressed out and around with the right hand while the left hand is lifting the survivor’s arm over the rescue swimmer’s head and sweeping it across the far side. 
Front Head Hold Release
This is a pressing movement and it is continued until the survivor’s back is to the rescuer.
Front Head Hold Release
The left hand continues to hold the arm until the right hand can be shifted from the survivor’s face to the chest, and the survivor is brought into a controlled cross-chest carry.

Front Head Hold Release
NOTE                          
 If survivor’s head is at the rescuer’s left side, the method is reversed. 
Front Head Hold Release
If survivor places a scissors lock on the rescue swimmer with the legs, the scissors lock is rarely held after the head hold is released. However, if it is not released the rescue swimmer uses one hand between the ankles to unlock the crossed feet.
Front Head Hold Escape


Front Head Hold Escape
Without pause, the rescue swimmer places both hands on the front of survivor’s hips with the heels of the hands against the body, fingers extended and thumbs grasping the survivor’s sides.

Front Head Hold Escape
By forcefully pressing and extending the arms, the rescue swimmer pushes the survivor’s body back and up toward the horizontal position. This leverage will loosen the survivor’s grasp.
Front Head Hold Escape
By tucking the chin inward and hunching the shoulders, the rescue swimmer’s head is freed. Survivor is then pushed away.
Rescue swimmer surfaces to reassess the situation.
Rear Head Hold Release


Rear Head Hold Release
    Rescue swimmer places both hands on survivor’s wrist either top or bottom, and ...
Rear Head Hold Release
pulls toward rescue swimmers hips, ...
Rear Head Hold Release
Rear Head Hold Release
By twisting inward and down on the suvivor’s wrist and pushing the survivor’s elbow upward, the grip is released. Rescuer slides survivor over his/her head until the survivor is in front of the rescuer with the survivor’s forearm straight across survivor’s back and survivor is in front of rescue swimmer.
Rear Head Hold Release
From this position behind survivor, rescue swimmer shall release grip on the elbow while maintaining control of the wrist, reaching over the survivor with the free hand and then place survivor in a controlled cross-chest carry.
Rear Head Hold Escape


Rear Head Hold Escape
Rescue swimmer brings hands up to under side of each of the survivor’s elbows.
Rear Head Hold Escape
    While keeping chin tucked in and hunching the shoulders, rescue swimmer pushes forcefully upward freeing the head.

Rear Head Hold Escape
Survivor is then pushed back away. Swimmer turns to face survivor, prepared to prevent subsequent grasps.
Rear Head Hold Escape
Rescue swimmer swims well out of reach of survivor, surfaces, and decides which rescue procedures to use. 

Summary
Why do rescue swimmers need to know releases and escapes?
To allow rescuer to escape grasp of panicking survivors.
What is the first thing a rescue swimmer should do in the event a survivor grabs him/ her?
Suck, Tuck, and Duck
Summary
After a rear head hold escape or a front head hold escape, what should the rescue swimmer do?
Reassess the situation
Why should the rescue swimmer utilize a control cross-chest carry?
So that the rescue swimmer remains in control. The survivor is active.
Summary
Why is hand placement necessary during releases and escapes?
So that the use of pressure points are utilized.
Surface Rescue Swimmer Course
 Water Entry Indoctrination
LT 3.3
OBJECTIVES   
List the procedures for day/night water entry from ship/rescue boat per NTTP 3-50.1.
Perform day/night water entry procedures from ship/rescue boat per NTTP 3-50.1.

Day Water Entry (Forecastle)
Don rescue strop (do not use arm retainer straps).
Connect swimmer’s tending line to “V” ring on left shoulder of swimmer harness (underneath strop).
Swimmer assume ready position at deck edge (sit or stand).
Perform final gear check.
Lower swimmer to the water by J-bar davit on command from rig captain.
Day Water Entry (Forecastle)

WARNING
Be prepared to fend off ship with hands and feet if ship is rolling (rough seas).
Swimmer will never jump over the side or get out of rescue strop until the rescue strop is in the water.

Swimmer swims clear of strop upon water entry.
Clear mask (if necessary).
Give hand signal “I am alright”.
Day Water Entry (Rescue Boat)
Deploy from the starboard bow.
Coxswain puts engine in neutral.
The rescue swimmer prepares for deployment.
Prepare to deploy swimmer after receiving permission from boat officer/coxswain.
Swimmer will sit on starboard bow.
Boat crewmember holds swimmer by harness, maintaining control of the swimmer while both scan water for debris.
Boat crewmember gives rescue swimmer one tap on the shoulder, then swimmer will roll to his/her left and come to rest on both hands, fins in water.
Day Water Entry (Rescue Boat)
Night Water Entry (Forecastle)
Don rescue strop (do not use arm retainer straps).
Note
The rescue swimmer, the rescue strop, and the rescue hook shall be illuminated by chemical lights before lowering.
Connect swimmer’s tending line to “V” ring on left shoulder of swimmer harness (underneath strop).
Swimmer assume ready position at deck edge (sit or stand).
Perform final gear check.
Lower swimmer to the water by J-bar davit on command from rig captain.

Night Water Entry (Forecastle)
WARNING
The swimmer shall never jump over the side or get out of rescue strop until the rescue strop is in the water.
Swimmer swims clear of rescue strop upon water entry, clears mask, and gives night hand signal “I am alright”.

Night Water Entry (Rescue boat)
Deploy from the starboard bow.
Coxswain puts engine in neutral.
The rescue swimmer prepares for deployment.
Prepare to deploy swimmer after receiving permission from boat officer/coxswain.
Swimmer will sit on starboard bow.
Boat crewmember holds swimmer by harness, maintaining control of the swimmer while both scan water for debris.
Boat crewmember gives rescue swimmer one tap on the shoulder, then swimmer will roll to his/her left and come to rest on both hands, fins in water.

Night Water Entry (Rescue boat)
Boat crewmember will give rescue swimmer three taps on shoulder and release swimmers harness.
Note
During night operations, the rescue swimmer shall be illuminated with a chemical light before entering the water
Note
The rescue swimmer tending line is optional when deploying from the rescue boat. The coxswain shall remain in close proximity and maintain visual contact of the rescue swimmer in the water.
Rescue swimmer pushes away from boat, enters water, clears mask, and gives night signal  “I am alright”.


Review
How many taps will the swimmer receive  to push off the rescue boat and enter the water? 
3

Review
True /False   The Rescue Swimmer is allowed to jump off the side of the forecastle to save a survivor? 
False

Review
What side of the Rescue Boat will the Rescue Swimmer deploy from? 
Starboard
Review
After water entry  the Rescue Swimmer will give what signal? 
“I am alright”

Questions?
Surface Rescue Swimmer Course
CANOPY ESCAPE
LT 3.4
INTRODUCTION
Performing your duties as a rescue swimmer, the possibility exists that you could find yourself either under or on top of a parachute canopy. The purpose of this lesson is to familiarize rescue swimmer with techniques to handle such a situation.
OBJECTIVES   
List procedural steps for parachute canopy escape.
Perform a hand-over-hand escape from underneath a collapsed parachute.
Dangers of Collapsed Parachute
Inability to breathe through a wet parachute.
Possibility of the parachute sinking and taking survivor with it.
Rescue swimmer becoming entangled.
Rescue swimmer or survivor panicking and becoming more entangled.
Entanglement In a Collapsed Parachute
Should a rescue swimmer inadvertently jump or swim onto a parachute canopy:
Do not panic!
Turn onto your back.
Arch your back to help float your body.
Scull with the hands while repeatedly opening and closing the legs slowly, no more than shoulder width, until clear of the parachute.
Once clear of parachute, swim clear of area.
Trapped Under Collapsed Parachute
Grasp shroud line in parachute seam.
Lift high above head.
Swim backwards; utilizing a punching hand over hand movement, keeping them high enough to create an air pocket.
Once at the apex, reach high to create another air pocket.
Continue along one given shroud line until clear of parachute.
SUMMARY
Dangers of Collapsed Parachute

Entanglement in a Collapsed Parachute.

Trapped Under Collapsed Parachute.
Questions
What is the Number One thing you need to do when you get trapped Under a Parachute?
DO NOT PANIC
How do you proceed while under the Parachute?
HAND-OVER-HAND
Surface Rescue Swimmer School
Disentanglement Procedures
Free Floater/Helicopter Aircrew
LT 3.5
Enabling Objectives
List disentanglement procedures in both day and night conditions for survivors both with and without aircrew survival equipment.
Demonstrate disentanglement procedures in both day and night conditions for survivors both with and without aircrew survival equipment.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
                         WARNING
   Inhalation of composite fibers resulting from aircraft fires and/or aircraft material damage may be harmful to rescue personnel.  If smoke is present, the rescue swimmer shall be deployed up wind and will approach the aircraft in a manner as to avoid any smoke.  Discard wet suit if it becomes impregnated with composite fibers.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
                         NOTE
   Equipment worn by the survivor determines the procedures to be used in parachute disentanglement.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
ASSESS the situation to determine if survivor (s) are conscious, unconscious, passive, or active. Assessing the situation begins before water entry. The situation may change at any moment.
ESTABLISH communication to determine the condition of the survivor and make approach. Ask, “Are you OK”? The rescue swimmer shall continually evaluate the medical condition of a survivor during the entire course of rescue.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
CLEAR head, neck, and chest area. If survivor is conscious ask about any known injuries or conditions.
CHECK FLOTATION, evaluate the condition of survivor’s flotation.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
                          NOTE
   When the survivor has damaged or no flotation, the rescue swimmer may give up his/her SAR 1 vest. If the rescue swimmer chooses to give up flotation, he/she shall use appropriate conscious or unconscious survivor procedures as outlined in Lesson Topic 3.8 Combative Survivor Procedures.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER

DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
NOTE
For a non-breathing survivor, if any delay occurs with the rescue platform, continue with rescue breathing procedures according to American Red Cross for the Professional Rescuer.
DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
As the rescue boat is approaching:
      -  Ensure the area is clear.
      -  Establish a left hand cross chest carry, grasping the survivors lifting “V” ring in left hand.
If helicopter recovery, allow the rescue hook to touch water, discharging static electricity.
Connect large end of rescue hook to survivor’s lifting “V” ring.

DISENTANGLEMENT PROCEDURES FOR FREE FLOATER
WARNING
When connecting to a survivor who has an SV-2, vest, ensure that the chest strap on the survivor is loosened slightly to avoid injury to the survivor.
Use appropriate procedures for rescue device selected.
Perform SAFETY CHECK on rescue device, signal up hoist.

DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
                              NOTE
        For a non-breathing survivor, if any delay occurs with the rescue platform, continue with rescue breathing procedures according to American Red Cross for the Professional Rescuer.

As the rescue boat is approaching:
Ensure AREA IS CLEAR.

                               NOTE
Survivor’s lifting device is located on the right side of the vest.
Lifting device could be covered by a nylon restraining flap.



                              
DISENTANGLEMENT PROCEDURES FOR AIRSAVE VEST WITH INTEGRATED BODY ARMOR (CMU-33/P22P-18 & PRU-60/P22-15) AND ASAIP VEST WITH INTEGRATED BODY ARMOR (CMU-30/P22P-15 & PRU-61)
Use appropriate procedures for rescue device selected.
Perform SAFETY CHECK on rescue device, signal “ready for pick-up”.

ARMOR PLATE REMOVAL PROCEDURES
ARMOR PLATE REMOVAL PROCEDURES
ARMOR PLATE REMOVAL PROCEDURES
ARMOR PLATE REMOVAL PROCEDURES
RAFT EXTRACTION PROCEDURES
RAFT EXTRACTION PROCEDURES
RAFT EXTRACTION PROCEDURES
RAFT EXTRACTION PROCEDURES
RAFT EXTRACTION PROCEDURES
RAFT EXTRACTION PROCEDURES

Surface Rescue Swimmer Course
Disentanglement Procedures
(Jet Aircraft) LT 3.7
Objectives
List disentanglement procedures for personnel wearing  Jet aircraft survival equipment.
Demonstrate disentanglement procedures for personnel wearing Jet aircraft survival equipment in day/night conditions.
NOTE
Equipment worn by the survivor determines the procedure to be used in parachute disentanglement.
WARNING
   Spinal immobilization is essential to ejection egress aircrew. Aircrew who eject from aircraft must be presumed to have spinal injuries. The rescue swimmer should treat all survivors involved in an incident with a “high index of suspicion” as a probable head, neck, or spinal injury regardless of whether the survivor reports any pain or injury.
WARNING
  The parachute should never be allowed to come between the rescue swimmer and the survivor, as the rescue swimmer could lose sight of the survivor or could become entangled in the parachute or suspension lines.
Disentanglement Procedures for PCU/33 Integrated torso Harness
ASSESS situation to determine if survivor(s) are conscious, unconscious, passive, or active.  Assessing the situation begins before water entry.  The situation may change at any moment.
Disentanglement Procedures for PCU/33

ESTABLISH communication to determine the condition of the survivor and make approach. Ask, “Are you O.k.”? The rescue swimmer shall continually evaluate the medical condition of a survivor during the entire course of a rescue.
Swim to the parachute edge closest to the survivor and opposite the apex of the parachute canopy.
Lift the edge of the parachute, pull shroud line(s) until the survivor is within reach and the canopy is gathered into the rescue swimmers hand.


Disentanglement Procedures for PCU/33

Grasp survivor’s harness between the shoulder blades and pull survivor into the wind and away from parachute.  Obtain control of survivor “ICIC”.
Remove oxygen mask. CLEAR head, neck, and chest area.  If survivor is conscious ask about any known injuries or conditions.

Disentanglement Procedures for PCU/33
If survivor is still wearing oxygen mask completely remove it from both bayonet fittings and push mask through chest strap, and away from survivor.
NOTE
   CHECK FOR BREATHING. Give two breathes if required. 
Disentanglement Procedures for PCU/33
 Check flotation. (inflate manually or orally if necessary).
Disentangle from head-to-toe, checking for injuries during disentanglement process.
Disconnect parachute risers by releasing shoulder kock fittings.
Remove parachute risers and throw them to the side, ensuring they do not fall back onto survivor.

Disentanglement Procedures for PCU/33
SWEEP ARMS, ensuring that survivor’s arms are completely clear of debris.  Once it has been verified that the survivor’s arms are clear, cross the arms across the survivor’s chest.
SIDE CONTROL, using the side of the survivor as a reference, proceed hand-over-hand along the:
Disentanglement Procedures for PCU/33
Left side, Move down towards the legs removing any shroud lines along the way. Release oxygen hose (if applicable) from RSSK, and then disconnect mini-Koch fittings on lap.
Move back up the left side and go down the right side toward the legs, removing any shroud lines along the way.  Disconnect the mini-Koch fitting on lap.  This releases the RSSK.

Disentanglement Procedures for PCU/33
Move back down the left side and ensure there are no entanglements around the survivors left leg.  Repeat for right leg.

Tow survivor clear of parachute and DISCARD RAFT (if applicable).
NOTE
At the discretion of the rescue swimmer the raft may be punctured with a knife and sunk before , during, or after the survivor has been removed.


WARNING   
Loss of ABC’s is a serious life threatening condition requiring immediate medical treatment. This condition takes precedence and survivor should be recovered by the fastest means possible.
NOTE
The litter should be the primary recovery device if survivor is an ejected aviator or other survivor suspected of having a spinal injury based on swimmers evaluation.
Disentanglement Procedures for PCU/33
Perform FINAL CHECK, head-to-toe to ensure that all shroud lines and parachute suspension lines are clear.
SIGNAL rescue platform.
Day – Arm raised, thumb up
Night – Arm raised, waving high intensity chemlight.

Disentanglement Procedures for PCU/33
NOTE
        For a non-breathing survivor, if any delay occurs with the rescue platform, continue with rescue breathing procedures according to American Red Cross for the Professional Rescuer
As the rescue boat is approaching
     a. Ensure the AREA IS CLEAR.
     b. Establish a left hand cross-chest carry, grasping survivor’s gated “d” ring in your left hand.
Disentanglement Procedures for PCU/33
If helicopter recovery, Allow RESCUE HOOK TO TOUCH WATER, discharging static electricity.
USE APPROPRIATE PROCEDURES for rescue device selected.
Perform SAFETY CHECK on rescue device, signal “ready for pick-up”.
NOTE

   If rescue scenario involves E-2C Hawkeye aircrew, all of the procedural steps are identical with those of ejection seat aircraft. The difference in gear is purely mechanical and will require deviations in technique only.
Review
Surface Rescue Swimmer School
Disentanglement Procedures
(Back Pack)
LT 3.6
Enabling Objectives
List parachute disentanglement procedures for personnel wearing U.S Navy Back Pack parachute assembly.
Warning
Spinal immobilization is essential to ejection egress aircrew. Aircrew who eject from aircraft must be presumed to have spinal injuries. The rescue swimmer should treat all survivors involved in an incident with a “high index of suspicion” as a probable head, neck, or spinal injury regardless of whether the survivor reports any pain or injury.
Note
Equipment worn by the survivor determines the procedures to be used in parachute disentanglement.
Warning
The parachute should never be allowed to come between the rescue swimmer and the survivor, as the rescue swimmer could lose sight of the survivor or could become entangled in the parachute or suspension lines.
Disentanglement Procedures for Back Pack Harness.
ASSESS situation to determine if survivor(s) conscious, unconscious, passive, or active.  Assessing the situation begins before water entry.  The situation may change at any moment.
ESTABLISH communication to determine the condition of the survivor and make approach.  Ask “Are you OK”?  The rescue swimmer shall continually evaluate the medical condition of a survivor during the entire course of a rescue.
Disentanglement Procedures for Back Pack Harness.
    Swim to the parachute edge closest to the survivor and opposite the apex of the parachute canopy.
 
   Lift the edge of the parachute, pull shroud line(s) until the survivor is within reach and the canopy is gathered into the rescue swimmers hand.

Disentanglement Procedures for Quick Fit Harness.
Grasp survivor’s harness between the shoulder blades and pull survivor into the wind and away from parachute.  Obtain control of survivor “ICIC”.
Remove oxygen mask, if applicable.  CLEAR head, neck, and chest area.  If survivor is conscious ask about any known injuries or conditions.
Disentanglement Procedures for Quick Fit Harness.
                        Note
Check for breathing.  Give two rescue breaths if required. 

                        Warning
When the HGU series helmet is worn with the LPP-1 life preserver, do not inflate vest until chinstrap is loosened or helmet is removed.
Disentanglement Procedures for Quick Fit Harness.
Disconnect survivors quick ejector snap located on the chest and check flotation (inflate manually or orally, if necessary).

Warning
If releasing the quick ejector snap is not done prior to inflation and the survivor is wearing an LPP-1, there is the possibility of the LPP-1 crushing survivor’s chest.  At a minimum, it will be hard for the survivor to breath.  This warning also applies to the U.S. Chest pack, Back Pack, and Seat Pack Harness.
Note
If the survivor is wearing a Chest Pack, one of the Butterfly Spring Snaps, that connect the pack to the harness, must be released to gain access to the chest quickly.
Disentangle from head-to-toe checking for injuries during disentanglement procedures.
Disentanglement Procedures for Quick Fit Harness.
Remove shoulder straps and SWEEP ARMS, ensuring that survivor’s arms are completely clear of any debris.  Once it has been verified that survivor’s arms are clear, cross the arms across the survivor’s chest.

Disentanglement Procedures for Quick Fit Harness.
SPINAL HIGHWAY, using the spine as a reference, submerge and proceed hand-over-hand keeping one hand on the survivor at all times. Release quick ejector fittings on the survivor’s legs.  After fittings are released, submerge as before and remove all parachute suspension lines from survivor’s legs.  Submerge as many times as necessary to remove all debris.
Warning
If survivor has a suspected back injury, use the side of the survivor as a reference. Proceed hand-over-hand along the side, keeping one hand on the survivor at all times, and remove all possible entanglements.
Disentanglement Procedures for Quick Fit Harness.
Tow the survivor clear of the parachute.  If the survivor is still not free of the parachute or harness, use the washboard method.
Warning 
If the survivor has a suspected back injury do not use the washboard method.

   a.  Grasp survivor with both hands on the back of the flotation device.
   b.  In quick succession, push and pull survivor fore and aft.  Make sure that the survivor’s head is kept above water.
Disentanglement Procedures for Quick Fit Harness.
Discard raft (if applicable).
Note
At the discretion of the rescue swimmer the raft may be punctured with a knife and sunk before, during, or after the survivor has been removed.
     Warning
Loss of ABC’s is a serious life threatening condition requiring immediate medical treatment.  This condition takes precedence and survivor should be recovered by the fastest means possible.

Disentanglement Procedures for Quick Fit Harness.
Perform final check, head-to-toe to     ensure all shroud lines  and parachute suspension lines are clear.
 Signal rescue platform.
      a. Day – Arm raised, thumb up.
      b. Night – Arm raised, waving high intensity chemlight.
Disentanglement Procedures for Quick Fit Harness.
                             NOTE
  For a non-breathing survivor, if any delay occurs with the rescue platform, continue with rescue breathing procedures according to American Red Cross for the Professional Rescuer.
Disentanglement Procedures for Quick Fit Harness.
As the rescue boat/helicopter is approaching:
      a.  Ensure the AREA IS CLEAR.
      b.  Establish a left hand cross-chest carry, while grasping the survivor’s lifting “V” ring in your left hand.

                      
Disentanglement Procedures for Quick Fit Harness.
                     Warning
     When connecting to a survivor who has an SV-2 vest, ensure that the chest strap on the survivor is loosened slightly to avoid injury to the survivor.

Disentanglement Procedures for Quick Fit Harness.
Allow rescue hook to touch water, discharging static electricity.
Use appropriate procedures for rescue device selected.
Perform Safety Check on rescue device, signal “ready for pick-up”.

Ballooned Canopy Procedures
Establish communications during approach to survivor.
                    Warning
Do not go under canopy; it may collapse and trap survivor and swimmer.

2.  Swim to chute edge closest to survivor and opposite the apex.
Ballooned Canopy Procedures
Lift edge of parachute; pull one shroud line until survivor is within reach.
With free arm, turn survivor around and grasp back of harness, pull to edge of canopy.
In one motion, lift skirt over survivor’s head and pull survivor clear.

Ballooned Canopy Procedures
With survivor out from under the parachute, continue pulling survivor into the wind and away from the parachute canopy.
When well clear of parachute canopy, use disentanglement procedures applicable to type of harness the survivor is wearing.
Summary
Questions?
If the survivor is wearing an LPP-1, what must be done prior to inflation?
Release the chest quick ejector snap.
How should a swimmer approach a ballooned canopy?
Swim to the chute edge closest to survivor and opposite the apex.
Surface Rescue Swimmer Course
Combative Survivor
LT  3.8
Objectives
Describe characteristics of a panicking survivor.
State procedures for survivors emergency flotation for both              conscious and unconscious victims.
Demonstrate emergency flotation procedures for conscious and       unconscious victims in a simulated rescue situation.
List procedural steps for a combative survivor.
Demonstrate combative survivor procedures in a simulated rescue     situation.
State modified recovery procedures for a combative survivor.
Demonstrate modified recovery procedures for a combative     survivor in a simulated rescue situation.
State procedures for providing care for combative survivor while     aboard the rescue platform.
Describe appropriate combative survivor hand signals.
Demonstrate appropriate combative survivor hand signals.
Survivor Characteristics
Naval rescue swimmers are sometimes faced with situations where the survivor can be categorized as uncooperative.  Uncooperative survivors can be categorized into two distinct types:
            Panicked
            Combative
Panicking Survivor
Some rescues involve panicky survivors (even some aviators).
Appearance: wide eyes, frantic activity, gasping for air and other similar behavior.
Will attempt to grab and get on top of rescuer in order to keep his/her own head out of the water. Rescuers could be drowned in this manner.
Best defense: Do not get to close until you have assessed the situation and decided on the best approach for the survivor.
Panicking Survivor
It may be possible to calm a panicking survivor by talking to them and explaining who you are and what you are doing.
Another means of calming a panicked survivor is to provide flotation.
Procedures for giving up flotation Conscious/Unconscious Survivor
NOTE
When the survivor has damaged or no flotation, the swimmer may give up his/her SAR-1 vest.
 If the swimmer chooses to give up flotation, the rescue swimmer shall use the following conscious or unconscious survivor procedures.
Procedures for giving up flotation Conscious
Conscious survivor:
Approach the survivor and establish communication, using the front surface approach.
Upon reaching a distance of 6 to 8 feet from the survivor, execute a quick reverse.

Procedures for giving up flotation Conscious
Remove rescue swimmer’s mask, unclip and remove SAR-1 , and replace mask.
Inflate SAR-1, hold onto end of SAR-1 strap, and pass to survivor.  Instruct survivor to place SAR-1 over his/her head with pocket facing out.
While survivor is donning SAR-1, the swimmer shall swim around to the right and behind survivor with strap in right hand.
Place left hand across chest under SAR-1 and grasp buckle.  Bring strap under both arms and clip into buckle. Tighten strap.
Procedures for giving up flotation Conscious
Perform disentanglement procedure.
Procedures for giving up flotation to an unconscious survivor
Approach the survivor using the front surface approach and establish communications or determine unresponsiveness.
Upon reaching a distance of an arm’s length from the survivor, execute a quick reverse.
Remove rescue swimmer’s mask, unclip and remove SAR-1, and replace mask.
Inflate SAR-1 and place right arm through neck hole with pocket facing in.
Procedures for giving up flotation Unconscious
Use front surface approach procedures
NOTE
Remove survivor’s oxygen mask/helmet/cranial if applicable.
Place SAR-1 over survivor’s head with pocket facing out. This is done with rescue swimmer’s right arm, while keeping survivor in left hand cross-chest carry.
Place left hand across chest under SAR-1 and grasp buckle. Bring strap under both arms and clip into buckle. Tighten strap.




Procedures for giving up flotation Unconscious
Check for breathing. Give two breaths if required.
Perform disentanglement procedures.

Combative Survivor
WARNING
   Combative survivors may not initially desire to be rescued and may actively resist assistance from the rescue swimmer. The combative survivor may intentionally try to harm the rescue swimmer or themselves when approached. This type of behavior can continue indefinitely, even after repeated attempts by the rescue swimmer to provide assurance in recovery.
Combative Survivor
Indications that a survivor might be combative are:
Prior mentally unstable behavior, suicide attempt, voluntarily jumping into the water.
Suspected or known enemy, foreign personnel demonstrating hostility towards Americans, or suspicious personnel aboard vessels being detained.

Combative Survivor
Combative survivor procedures:
WARNING
   The rescue swimmer shall not be deployed into the water to recover enemy or hostile survivors armed with weapons.
WARNING
   Recovery of enemy or hostile survivors should only be attempted using a rescue boat or ships J-Bar davit with armed security personnel on station in the rescue boat or ships forecastle. Helicopter recovery of an enemy or hostile survivor should only be used under operational necessity.
Combative Survivor
WARNING
   A single rescue swimmer should not attempt the recovery of a combative survivor without assistance from a rescue boat and/or a second rescue swimmer.
Combative Survivor
Approach survivor and establish verbal communication. Attempt to calm the survivor with verbal reassurance and commands.
If survivor is actively combative, do not attempt to immediately gain physical control of the survivor. The rescue swimmer should remain a safe distance (6 to 8 feet) from the survivor and assess the situation.
Combative Survivor
If survivor does not have operable flotation, the rescue swimmer should attempt to provide a flotation device to the survivor while still maintaining a safe distance.
Communicate with the rescue platform and brief the situation.
Request assistance utilizing radio or hand signals.
Request rescue boat assistance.

Combative Survivor
Request the assistance of a second rescue swimmer. The second rescue swimmer is  backup to the primary rescue swimmer and has the following responsibilities:
Ensure the safety of the primary rescue swimmer.
Assist the primary rescue swimmer as needed.
Deploy with rescue equipment requested by the primary rescue swimmer.

Combative Survivor
Once on scene, the backup rescue swimmer may assume/help with communication duties to the rescue platform.
Assist the primary rescue swimmer as required.
NOTE
  There are no dual rescue swimmer procedures. The backup rescue swimmer should act as a safety observer and assist the primary rescue swimmer as required.
Combative Survivor
Use the following modified recovery procedures:
Maintain 6 to 8 feet distance from survivor, remain vigilant (ready to render immediate assistance) Wait for the survivor to tire, calm down, and/or ask for assistance.
Be patient. Attempt to calm the survivor and provide flotation to the survivor if needed and/or practical.
Combative Survivor
Assume physical control of the survivor only when deemed safe. Do not attempt to rescue an actively combative survivor unless the following conditions occur:
The survivor requests assistance.
The survivor becomes unconscious/incapacitated.

Combative Survivor
Ensure the survivor has no weapons.
If conscious, direct the survivor to maintain hands in view at all times.
Once physical control is established, the rescue swimmer shall remain vigilant for survivor to become actively combative or the presence of any weapons.
Recover survivor using appropriate device.
NOTE
   The rescue boat or ships J-Bar Davit is the preferred recovery vehicle. If a rescue boat or ship is unavailable, recovery may be made to a helicopter.
Combative Survivor
WARNING
   In all cases (whether the survivor is determined to be combative, panicked, or cooperative) the rescuer shall not hoist the survivor from an overland or maritime environment without the proper application of the selected rescue device to include any and all safety straps or safety devices per all applicable publications and instructions.
Combative Survivor
Rescue Strop
The rescue swimmer shall, in all cases, correctly employ the arm restraining straps prior to signaling “ready for pick-up”.
Combative Survivor
Care and control of a combative survivor on board the rescue platform:
The rescue platform shall notify the on-scene commander of the situation, survivor’s condition, and request medical and security personnel assistance at the rescue platforms location.
The rescue platform crew shall remain vigilant during transit. A member of the crew or security personnel shall be stationed next to the survivor at all times during transit to provide immediate physical control if required.
Combative Survivor
WARNING
   Restraints will preclude the survivor from being able to egress/swim in the event of an aircraft mishap or rescue boat capsizing during transit. Rescue personnel may need to provide assistance to the survivor to egress the rescue platform in the event of a mishap.
Combative Survivor
Once onboard the rescue platform, the survivor should be secured into a Medevac litter at the earliest opportunity. If aboard a helicopter, cabin doors and windows should be secured.
NOTE
   The rescue personnel shall assess condition of survivor and provide medical treatment during transit.
NOTE
   Once rescue platform is safely aboard ship or ashore, transfer survivor to awaiting medical and/or security personnel.
Combative Survivor
Hand signals:
Request rescue boat assistance:
The rescue swimmer extends both arms directly overhead, palms placed together.
Request the assistance of a second rescue swimmer:
Rescue swimmer faces the rescue platform, raises one arm from side of body diagonally (45 degrees) palm down, fingers extended straight out, rotate arm in circular motion.
Questions?
True or false.  The rescue swimmer shall be deployed into the water to recover enemy survivors armed with weapons.
False.  The rescue swimmer shall not be deployed into the water to recover enemy or hostile survivors armed with weapons.
Questions?
What is the hand signal for requesting rescue boat assistance?
Both arms extended directly over head, palms placed together.
What is the hand signal for requesting assistance of a second rescue swimmer?
Rescue swimmer faces the rescue platform, raises one arm from side of body diagonally (45 degrees), palms down fingers extended straight out, rotate arm in circular motion. 
Surface Rescue Swimmer                                                   School                                                                                        Rescue Swimmer’s Equipment                                                                                                                                 LT 4.1
Enabling Objectives
State requirements for the maintenance of rescue swimmer’s equipment per current NAVAIR 13-1-6 series manuals/Maintenance Requirements Cards (MRC’s)
Explain the functional operation of rescue swimmer’s equipment.
Enabling Objectives
Wet Suit
Mask, Fins, and Snorkel
Rescue Swimmer Harness (HBU-11)
LPU-28 (SAR-1)


Rescue Swimmer’s Equipment
Wetsuit Ensemble
Preferred commercial grade.
Neoprene rubber sandwiched by non-chaffing nylon.
Consists of:
Jacket with long sleeves.
Trousers, Farmer John type.
“Shorty” assembly.

Wetsuit Ensemble
Booties
Worn with fins to protect the feet.
Worn at the discretion of the rescue swimmer, unless atmospheric conditions dictate otherwise.
Gloves
Worn at the swimmer’s discretion.
Shall be the five finger type.
Wetsuit Ensemble
Hood
Worn at the swimmer’s discretion.
Reduces chill factor generated by rotor wash.
Reduces heat loss through the head.  Sixty percent of all body heat is lost through the head.
Minimum of a wetsuit top shall be worn during all rescues.
Wetsuit Ensemble
Entire wetsuit shall be worn as per OPNAVINST 3710.7, specifically:
When water temperature is above 50°F and air temperature is above 32°F (wind chill corrected), full wetsuits shall be worn at the commanding officer’s discretion.
Whenever the water temperature is below 50°F or air temperature is 32°F (wind chill corrected),  or below, full anti-exposure protection is mandatory.
U.S. Divers Wrap Around Mask
Allows rescue swimmers to see clearly underwater by providing an air space in front of the eyes.
Double skirted for comfort and optimum seal.
Wrap around offers a wide field of view and greater peripheral vision.
U.S. Divers Wrap Around Mask
Plastic adel clamp on top of mask provides means to attach the four inch General purpose Chemical Light to the swimmer.
Mask fogging is prevented by coating the interior of all three lenses with commercial mask lens defogger, toothpaste, or saliva.

U.S. Divers Wrap Around Mask
Mask shall be tied off on either the left or right shoulder strap of the rescue swimmers harness and not passed through the neck of the SAR-1 Vest.  The mask shall not be tied off to the LPU-28.


U.S. Divers Rocket Fins
Fins provide greater propulsion, speed, power, and mobility.  U.S. Divers Rocket Fins are the only authorized fins.
Slots or vents:
Redirect the flow of water through the fin and toward the tip.
Most efficient when used with the flutter kick.
Fins have a stiff blade which may cause calf cramps.
U.S. Divers Snorkel
Permits the rescue swimmer to breathe easily while conducting in-water operations.
Barrel can be straight or gently curved.
Flexible hose connects barrel to mouthpiece.
Snorkel attaches to mask strap with a snorkel keeper. 
 Rescue Swimmer’s Harness HBU-11

Incorporates one lifting device attached to the harness.


Surface Rescue Swimmer’s Harness HBU-11
Lifting “V” ring
Located center of chest.
Attaches to rescue hook.

Surface Rescue Swimmer’s Harness HBU-11
Has left and right riser pockets which contain the following equipment:

Two six inch General Purpose Chemical Lights for signaling or illumination of rescue devices.
Carried in the left riser pocket.

Surface Rescue Swimmer’s Harness HBU-11
Two four inch High Intensity Chemical Light for use with the swimmers mask.
Carried in the left riser pocket.
J-hook Knife
Used only as a last resort to cut shroud lines.
Carried in the right riser pocket.
Has curved end for safety.
Surface Rescue Swimmer’s Harness HBU-11
One Strobe Light
Located on right shoulder strap.
Used for emergency signaling by the swimmer.
Covered with a blue lens for swimmer identification.
Scabbard Knife, attached to chest strap.
LPU-28 (SAR-1)
Provides emergency flotation for the rescue swimmer.  SAR-1 may also be used to provide flotation for survivor.
Provides a minimum of 30 pounds of buoyancy.
Single cell construction.
Velcro on right shoulder is for attaching strobe light or the AN/PRC-149 to the LPU-28.
LPU-28 (SAR-1)
Storage pouch is in front.
Normal inflation is through the oral inflation tube, emergency inflation is accomplished with CO2 cartridge.
Relief valve under storage pouch alleviates over inflation.
LPU-28 (SAR-1)
Rescue Swimmer’s Equipment Maintenance
Care and Preventative Maintenance
Fresh water rinse all equipment.
Hang in a cool, dry, windless place.
After drying hand fold wet suit loosely.
Lubrication:
Coat zippers, mechanical parts, and fins with     silicone spray lubricant.
Do not expose mask, fins, and snorkel to direct sunlight unnecessarily as this will accelerate the deterioration of the silicone rubber.
Rescue Swimmer’s Equipment Maintenance
Inspection Intervals for Rescue     Swimmers Equipment
By the swimmer prior to deployment.
Look for signs of deterioration.
Dry rot, corrosion.
Tears, worn or broken components.
Quarterly by the rescue swimmer per MRC.
Summary
Summary
Questions?
Surface Rescue Swimmer School
   Mask, Fins, and Snorkel
LT 4.2
 Introduction
During this unit of instruction the rescue swimmer will learn the proper procedures for donning the mask, fins, and snorkel. It is very important that the rescue swimmer becomes familiar and comfortable with utilizing the mask, fins and snorkel in an aquatic environment. This unit will train the rescue swimmer trainee with methods to safely clear water from their mask and snorkel during a rescue situation.
 Enabling Objectives
Demonstrate procedures for donning mask, fins, snorkel and procedures for clearing the mask and snorkel.
Perform side/crawl strokes while wearing mask, fins, and snorkel.
Masks
Check for proper fit and seal.
Hold lightly in place without using strap.
Seal edge should touch everywhere with no air leaks, gaps, or pressure points.
Inhale gently.
Good fit - Mask will stay in place with light pressure alone. You should feel comfortable and secure.
Mask Donning Method
Put mask on face.
Pull strap over back of head.
Mask Clearing Methods-Replacing water with air
Method A
Press the top of the mask against forehead with palm of hand and slowly exhale through your nose.
Air displaces the water and is forced out the bottom of the mask.
Mask Clearing Methods-Replacing water with air
Method B
Place hands on sides of mask, then lift bottom of mask slightly away from face, and slowly exhale through your nose.
Air displaces the water and is forced out the bottom of the mask.
Snorkel
Attaches to left side of mask by snorkel keeper strap.
  Snorkel Clearing Methods                              Exhalation Method
As swimmer returns to surface, keep face submerged so that tip of snorkel is above water and forcefully exhale through the mouth into the snorkel.  Take a slow deep breath and exhale forcefully again to clear any residual water and then breath normally.
  Snorkel Clearing Methods                                 Gravity Method
As swimmer returns to surface, look upward toward the surface keeping snorkel pointed downward, just prior to reaching the surface exhale into snorkel, as your face clears the surface continue exhaling and flip snorkel tip up by looking down.  Take a slow deep breath and forcefully exhale into snorkel, then breath normally.
Fins
Fit - Fins come in small, medium, and large sizes; with adjustable heel strap to accommodate different foot sizes. Work fins over foot as far as possible then pull strap up over heel. Straps should be adjusted so fins fit snugly.  Straps that are too tight can cause painful foot cramps and loose straps will cause the fin to fall off.
Fins
Kick - Modified flutter kick is used when swimming with rocket fins.
Legs are kept straight, knees slightly bent, and toes pointed.
Alternately flutter the legs up and down, moving them at the hip.
Fins are kept underwater when swimming on the surface.
Surface Diving
Feet-first surface dive
Begin the dive while treading water, push arms down towards side while executing a flutter kick.
Push up and out of the water pointing fin tips down.
Allow body to sink until head is submerged, keep hands by your side.
Rotate palms outward and push arms upward towards the surface.
Level out and swim forward underwater.
Surface Diving
Pike Surface Dive
Bend at the waist, and look at the bottom of the pool.
Lift your legs completely out of the water.
Let the weight of your legs force you down, pull with your arms.
Diving Precautions
When diving beneath surface, pain and discomfort may arise from:
Mask squeeze
Sinus squeeze
Ear squeeze
To alleviate pain and discomfort you can either:
Exhale slightly into mask.
Valsalva to equalize sinuses and ears.
Ascend slightly if equalization will not occur.
Diving Precautions                                                                                        
            WARNING
If unable to equalize pressure using these methods, surface immediately. Continued descent could rupture ear drums and damage sinus membranes.
Summary
Summary
Questions?
Surface Rescue Swimmer School
Primary Rescue Devices and Procedures
LT 4.3
ENABLING OBJECTIVES
Explain the functional operation of the following Rescue Devices per
  NTTP 3-50.1:
Double Rescue Hook
Modified Rescue Strop
Rescue Litter/ SAR MEDEVAC Litter, Trail line and Gloves

 ENABLING OBJECTIVES
Demonstrate procedures for placing a survivor into the following rescue devices in a water environment:
Double Rescue Hook
Modified Rescue Strop
Rescue Litter/ SAR MEDEVAC Litter
Rescue Litter Sling Assembly
COMMUNICATION PROCEDURES
Efficient communications keeps ship, boat crew, deck crew, and swimmer aware of a developing rescue situation and allows rescue platform to provide needed support to swimmer  (i.e.: deployment of rescue devices).
The radio offers an optimal secondary means of communications.
COMMUNICATION PROCEDURES
Hand signals are the primary means of communication between rescue swimmer and the rescue platform in a maritime environment.
All crewmembers must be familiar with the meaning of standard hand signals.


HAND SIGNALS


I am all right               (Raised arm, open hand, fingers extended).
HAND SIGNALS



Move in for pickup - Raised arm, thumb up.
HAND SIGNALS


In trouble, need assistance - Vigorous waving of one arm.
HAND SIGNALS
Deploy Raft -Clenched fists, arms crossed overhead.
HAND SIGNALS
Deploy Pneumatic Webbing Cutter - Clenched fist, arm pumping motion
HAND SIGNALS
Deploy Rescue Litter - One arm raised with open palm, fingers extended over the swimmer’s head and touching the first arm at the elbow.
HAND SIGNALS
Deploy Rescue Net - Both arms raised, palms open, fingers extended at a 45 degree angle to the swimmer’s head.
HAND SIGNALS
Ready to be hoisted- Raised arm, thumb up.
HAND SIGNALS


Stop Hoisting - Raised arm, clenched fist.
HAND SIGNALS


Lower Cable -  Raised arm, thumb down.
HAND SIGNALS


Deploy Personal Flotation Device -  Either hand palm down on crown of head.
HAND SIGNALS


Request Assistance of Additional Rescue Swimmer -  Either arm out, palm down, rotating in circular motion.
HAND SIGNALS


Request Rescue Boat Assistance -  Both arms raised over head, palms together.
HAND SIGNALS (NIGHT)


I’m all right (Night)- Swimmer’s lighting device (chemlight) on, raised arm, palm open, fingers extended. 
HAND SIGNALS (NIGHT)
Move in for pick-up (Night)- Wave chemlight.
HAND SIGNALS (NIGHT)


In trouble need assistance (Night)- Blue strobe on.
DOUBLE RESCUE HOOK
The Double Rescue Hook is the primary rescue device.
All other rescue devices can only be used with the Double Rescue Hook.
LOAD RATINGS OF THE DOUBLE RESCUE HOOK NAVAIR 13-1-6.5.
Large hook,  rated @  3000 lbs., shall be the only hook used to hoist personnel.
Small hook,  rated @  1000 lbs., is to be used only for lightweight items such as mail.
The equipment ring,  rated @ 1500 lbs.,  can be used to hoist light equipment and mail .
 DOUBLE RESCUE HOOK 
Night time illumination
Attach chemlight strap to equipment ring and attach two chemlights to strap.
MODIFIED RESCUE STROP
Rescue device used with Double Rescue Hook. The Modified Rescue Strop is a buoyant device with a red waterproof cover designed to accommodate one survivor.
MODIFIED RESCUE STROP
A webbing strap runs through the cover and has a “V” ring at both ends for attaching the Double Rescue Hook. Two arm retainer straps are attached on the outside to hold survivor in the strop.
MODIFIED RESCUE STROP
Night time illumination:
Two chemlights are attached to the strap.  Strap is attached to  Rescue Strop lower “V” ring.
 MODIFIED RESCUE STROP
NOTE
   Arm retainer straps shall be in the stowed position when lowering the Rescue Strop.
PROCEDURES FOR MODIFIED RESCUE STROP
Signal for pick-up.
Once under davit, signal the swimmer signals a closed fist to stop hauling in.
Approach hoist with survivor in an appropriate carry.
Working behind the survivor,  with arm retainer straps outboard,  the Rescue Swimmer shall pass the free end of the strop under one arm,  around the back and under the other arm.
MODIFIED RESCUE STROP

Connect the Rescue Strop free end lifting “V” ring to the large hook.
Position the Rescue Strop tightly under the survivor’s armpits and on the upper half of the survivor’s back.
Modified Rescue Strop
WARNING
   Arm retainer straps shall always be used when hoisting survivor with the Rescue Strop.  This prevents the survivor’s arms from rising and the survivor from slipping out of the Rescue Strop.
MODIFIED RESCUE STROP
Pass the arm retainer straps over the survivor’s arms, route under the Rescue Strop and across the survivor’s chest.
Connect the snap- hook arm retainer strap to the “V” ring arm retainer strap.
Pull webbing on the “V” ring arm retainer strap until the arm retainer straps are secured tightly around the survivor’s arms.
MODIFIED RESCUE STROP

If swimmer is to be hoisted,  connect swimmer’s  lifting “V” ring to the large  Hook.
Perform safety check.
Signal “Ready for Pick-up.”
MODIFIED RESCUE STROP
Rescue swimmer and survivor are hoisted up.  After reaching the rescue platform,  the rescue swimmer and crew shall assist the survivor.
MODIFIED RESCUE STROP
Once the survivor is inside and on the deck of the rescue platform,  the rescue swimmer shall maintain positive control of the survivor until the crew gives a thumbs up.  A thumbs up indicates to the rescue swimmer that the crew has the survivor in positive control on the rescue platform.
RESCUE LITTER/SAR MEDEVAC LITTER CHARACTERISTICS
Both are for use with suspected back injury  victims and unconscious survivors.
Both are designed to be used over land or in water with flotation assemblies.
Rescue Litter requires a flotation kit for over water use.  When flotation is installed, litter floats with survivor’s head slightly reclined from the vertical.
RESCUE LITTER
SAR MEDEVAC LITTER
1. Adjustable Carrying Harness (2 ea.)
2. Vertical Hoisting Sling
3. Foot Restraint Assembly
4. Locking Couplers
5. Lumbar Support Pad
6. Head Restraint
7. Hoisting Connecting Cable
8. Patient Straps
9. Patient in Litter
10. Chest Flotation
 RESCUE LITTER/SAR MEDEVAC LITTER CHARACTERISTICS
WARNING
   If survivor is wearing the bright orange Quick Donning Anti-exposure Suit, it may counteract the self-righting feature of the Rescue Litter and the SAR MEDEVAC Litter.
RESCUE LITTER/SAR MEDEVAC LITTER CHARACTERISTICS

Both have a two piece rescue litter hoisting sling, which attached to the Double Rescue Hook.  Sling is color coded short red to head and long white to feet.
RESCUE LITTER/ SAR MEDEVAC LITTER CHARACTERISTICS
The SAR MEDEVAC Litter folds in half and can be stored in a backpack and weighs approximately 40 lbs. It can be hoisted vertically or horizontally with its own sling,  making it especially useful in restricted access situations. 
SAR MEDEVAC LITTER
RESCUE LITTER/ SAR MEDEVAC LITTER CHARACTERISTICS
Night time illumination:
Two chemlights are attached to each strap.  One strap is attached to the head of the litter, one to the foot.
Both litters utilize a “trail line” controlled by the swimmer in the water to control litter deployment, and stabilize the litter during hoisting.
TRAIL LINE ASSEMBLY
One hundred and twenty(120’) feet in length.
Three-eighths inch thick polyethylene,  diamond-braided line.

SECURING SURVIVOR TO THE RESCUE LITTER (STOKES LITTER)
Rescue Litter has five restraint straps.  They are stowed with four retaining straps.
Procedure for securing survivor:
The rescue swimmer shall guide the survivor into the positioned litter by using the collar tow or equipment carry.

SECURING SURVIVOR TO THE RESCUE LITTER
Once positioned, the swimmer shall the the top restraint strap from the front of the litter and secure it around the survivor’s chest. The strap is pulled loose from the right side, placed under the arms but over the chest, and attached to the fitting on the left.
Next, working from the chest strap down, secure the rest of the restraint straps.
SECURING SURVIVOR TO THE RESCUE LITTER
Once the restraint straps are secured, attach the chest pad over the survivor’s arms. The rescue swimmer may encounter some difficulty if survivor has flotation; however, flotation shall not be removed. Instead, remove chest pad from litter and continue with rescue. If practical swimmer will return chest pad back to rescue platform when hoisted.

SECURING SURVIVOR TO THE RESCUE LITTER


 SECURING SURVIVOR TO THE SAR MEDEVAC LITTER
Litter will need to be assembled by rescue platform crew prior to lowering to swimmer.
Litter has integral cervical collar and head restraint, four survivor restraint straps, one chest flotation pad assembly strap, and one foot restraint assembly.
SECURING SURVIVOR TO THE SAR MEDEVAC LITTER
 The rescue swimmer shall guide the survivor into the positioned litter by using the collar tow or equipment carry.
Once positioned, the swimmer shall take the top restraint strap from the front of the litter and secure it around the survivor’s chest. The strap is pulled loose from the right side, placed under the arms but over the chest, and attached to the fitting on the left.

SECURING SURVIVOR TO THE SAR MEDEVAC LITTER
Next, working from the chest strap down, secure the rest of the restraint straps.
Properly adjust foot restraint assembly.
Once the restraint straps are secured, attach the chest pad over survivor’s arms. The rescue swimmer may encounter some difficulty if survivor has flotation; however, flotation shall not be removed. Instead, remove chest pad from litter and continue with rescue. If practical swimmer will return chest pad back to rescue platform when hoisted.
Secure head restraint assembly if possible. Do not remove survivor’s helmet if neck/back injury is suspected.


GENERAL LITTER PROCEDURES



GENERAL LITTER PROCEDURES



Signal for litter.  (Trail line will come out first.)
GENERAL LITTER PROCEDURES
WARNING
   The weight bag shall be deployed so as not to strike rescue swimmer or survivor.


GENERAL LITTER PROCEDURES
   The rescue platform shall deploy the trail line ensuring that it is attached to the litter. The gloves shall be tied on by a slip knot located just above the weight bag.

GENERAL LITTER PROCEDURES

WARNING
    The rescue swimmer shall wear trail line or authorized rescue swimmer gloves with leather palms in order to prevent rope burns to the hands.
GENERAL LITTER PROCEDURES
Put on gloves.
The rescue swimmer shall pull on the trail line gently until the entire line is deployed.
Signal “thumbs-up” indicating ready for litter.
Use trail line to control the litter and pull it into position as it is lowered.
The ship lowers the rescue litter into the water with hoisting slings attached to the rescue hook behind the litter.
Disconnect hoisting slings from rescue hook, placing hoisting slings outside of litter.  Do not allow hoisting slings to foul restraining straps.
GENERAL LITTER PROCEDURES 
Position survivor on litter, adhering to warning regarding survivor’s buoyancy and the self-righting feature of the litter.
Secure survivor using procedures appropriate to the litter.
GENERAL LITTER PROCEDURES
Ready the Rescue Litter hoisting sling and signal the rescue platform to move in for pickup.

Hook the Rescue Litter hoisting sling (both sides) to the large hook.
GENERAL LITTER PROCEDURES 
Conduct pre-hoisting safety check, ensuring survivor is securely within litter, litter is attached to large hook, tending line is attached to proper side of the litter (aircraft dependent), sling cables are in correct positioning, swimmer is wearing gloves, and cable is clear and not wrapped around the litter or the swimmer.
Signal for “up-hoist”.
GENERAL LITTER PROCEDURES
NOTE 
   Extreme care shall be utilized during  trail line evolutions in shallow waters.  Cease hoisting immediately if the weighted bag becomes snagged on the bottom.  Hoisting when this occurs may cause possible harm to personnel and/or equipment.
GENERAL LITTER PROCEDURES
GENERAL LITTER PROCEDURES

With the litter and trail line on board, the crew shall lower the hoist cable and recover rescue swimmer.
SUMMARY
True or False: The swimmer is the only one on the crew who must know his/her hand signals?

SUMMARY
What are the load ratings of the Double Rescue Hook?
SUMMARY
When stored in the backpack, how much does the SAR MEDEVAC Litter weigh?
Questions?
Surface Rescue Swimmer Course
ALTERNATE RESCUE DEVICES
LT. 4.4
INTRODUCTION
During this unit of instruction the rescue swimmer will learn the alternate rescue devices used in different rescue scenarios. The various equipment listed below will aid the rescue swimmer in these situations. Along with knowing this equipment, the rescue swimmer will become familiar with the maintenance requirements before using the gear.
OBJECTIVES
State the requirements for maintenance of emergency rescue equipment per NAVAIR 13-1-6 series, NTTP 3-50.1, and current maintenance requirement cards (MRC’s).
Describe the functional operation of the following Emergency Rescue Equipment per NTTP 3-50.1:
OBJECTIVES
 V-Blade rescue knife
 Grapnel Hook
 Boat Hook
 Level “A” Medical Kit
 Life Rafts
 Heaving Line
 Tending Line
 Life Rings

OBJECTIVES
 Chemical Light Strap
 Chemical Light
 Blanket
V- Blade Rescue Knife
Fixed cutting area, on one end cuts material up to ¼” thickness.
DZUS (pronounce ZEUS) fastener remover to remove access panels on aircraft (if necessary).
Handle grip fits either hand comfortably.
Used to cut parachute risers.



Grapnel Hook
Multi-prong steel hook.
Used for recovering aircraft parts, body parts, or hooking a sinking parachute that is out of the reach of the boat hook.
Weighs 4 lbs. and is attached to 100 feet of 1.5” circumference nylon line via a ¼” chain.






Boat Hook
Six foot wooden staff.
Has brass hook and prod at one end.
Normally used to fend off or hold on in a boat.
For SAR, used by boat crew to snag and retrieve parachute.






Level “A” Medical Kit
Designed for use by the rescue swimmer and the rescue platform.
Carried on all SAR capable platforms.
Rescue swimmer shall have a working knowledge of all contents.
Life Rafts
Used when numerous survivors are at the rescue scene.
Can support four times the rated capacity if survivors are placed around outside of raft.
Can also be used for staging survivors during disentanglement.
Discard life raft if it becomes a hindrance to the rescue.
Discard rafts by puncturing prior to leaving scene.

Life Rafts
Note
   An empty floating raft could start an unnecessary rescue effort.
Life Rafts
Heaving Lines
3/8” polypropylene line, 100 feet long, with a weighted and padded orange vinyl throwing ball.
Used during “ship alongside” recovery to get a line to a survivor.
Thrown passed and over the head of survivors.
Tending Line
3/4” circumference
300 yard, 800 lb test polypropylene line.
Has a 2 3/8” snap hook on one end.
Assembly attaches to swimmer’s harness.
Life Rings
24” diameter, doughnut-shaped, inherently buoyant material, with at least 100 feet of heaving line attached.
Has rope attached to perimeter to provide survivors with a handhold.
Normally used for man overboard, but may be used anywhere that extra flotation is needed.
Thrown passed and over the head of survivors.
Chemical Lights
Two types currently in use:
30 minute high-intensity
12 hour general purpose
Self contained, compact, easily stored.
Emit Omni-directional light.
Windproof, waterproof, nonflammable and require no batteries.
Chemical Light Strap
Nylon strap with three snap hooks.

One snap hook on each end and one in the middle.
Blankets
Standard wool blanket is 6x8 feet.

Used for treatment of hypothermia.
Review



Questions?
Surface Rescue Swimmer School
Aviation Life Support Systems
LT 4.5
Enabling Objectives
Explain the functional operation and hardware associated with various parachute harnesses.
List the types of harnesses outlined in NTTP 3-50.1.

Enabling Objectives
Describe the procedures for donning/doffing the following assemblies:
Helmet assemblies
RSSK assemblies
Oxygen mask assemblies
Survival vest/flotation assemblies
General Equipment
Anti-Exposure Suits
Imperial Wetsuits (quick-donning)
Bright orange in color.
Worn over the flight suit/clothing.
Positive buoyancy may negate self-righting features of MEDEVAC litter.
Some have lifting “V” ring in the center of the chest.
Flight Helmets
Covered with high visibility reflective tape.
Provide limited flotation.
May hinder communications between survivor and rescuer.
Helmets are not removed until survivor is aboard rescue platform.

Oxygen Masks
Form fit to face.
Attach to helmet with bayonet fitting.
Oxygen supply hose connects to Rigid Seat Survival Kit (RSSK) or aircraft console.
Always disconnect mask from helmet first to eliminate the possibility of suffocation.
Flotation Devices
Aircrew Flotation Devices
Naval aircrew flotation is provided by an LPU series life preserver assembly attached to either an SV-2 survival vest or a PCU parachute harness.

Aircrew Flotation Devices
Some jet aircrew may have an automatic inflation device, such as the FLU-8.  This device is activated within 8-15 seconds upon immersion in the water, and will require no action on the part of the rescue swimmer.
Manual inflation is accomplished by pulling the beaded handles located near the aviator’s hips.

Aircrew Flotation Devices
Oral inflation is accomplished by loosening the knurled knob on the inflation tube, holding it down with your teeth, and blowing into the tube.  This method will require the most effort on the part of the rescue swimmer.
Other Flotation Assemblies
Worn by flight deck personnel and aircraft passengers.

Aircrew Flotation Devices
Inflated by CO2 or orally.
Pull cord for CO2 inflation.
Oral inflation.
Backpack Parachute
Backpack Parachute
Large fixed wing land base aircraft crew (P-3, C-130) wear an NB-series Back Pack Type Parachute with quick donning harness.
Backpack Parachute
Harness is worn over the SV-2 survival vest and flotation.
Harness must be removed to separate the survivor from the parachute.
Removed by releasing three quick ejector snaps, one at the chest, and one for each leg.
Torso Harness-style Parachute/Rigid Seat Survival Kit Release
Torso Harness-style Parachute and Rigid Seat Survival Kit Release
Jet and E-2 aircrew wear a PCU-Series Torso Harness.
The torso harness is not removed during the rescue. The parachute must be separated from the torso harness.
For Navy gear, the parachute is separated by releasing  the Koch fittings which attach the parachute risers to the harness.


Torso Harness-style Parachute and Rigid Seat Survival Kit Release
Most jet gear incorporates Sea Water Activated Release System (SEAWARS) which automatically release the Koch fittings upon complete immersion in salt water.  This system poses no danger to the rescue swimmer and requires no action of the rescue swimmer.
Manual release is accomplished by separating the male portion of the Koch fitting assembly  (located on the right and left upper chest area) from the female ends (on the parachute risers).
Torso Harness-style Parachute/Rigid Seat Survival Kit Release
A Rigid Seat Survival Kit/Seat Kit Unit containing a raft, oxygen, and survival gear is attached to the lap belt of the torso harness.
    E-2 aircraft, incorporates a lap belt type detachment from the RSSK.

Torso Harness-style Parachute/Rigid Seat Survival Kit Release
Disconnect oxygen hose from RSSK by lifting the knurled locking ring and pulling firmly on the supply hose.
After ensuring the oxygen hose is disconnected, remove the RSSK by releasing the mini-Koch fittings located near the aviator’s hips.
USAF/OTHER PARACHUTE HARNESSES
USAF harnesses closely resemble Navy Backpack Type.
Risers may be attached with Frost, Koch, or J1 Capewell Fittings.
Seat kits may use mini-Koch fittings or a fitting closely resembling automotive lap belts.
Hoisting Attachment Points
For hoisting, the rescue hook or rescue swimmer’s snap hook may be attached directly to the aviator in one of two ways:
Hoist via the lifting “V” ring of an SV-2 vest (if so equipped).
Hoist via the gated “D” ring of a PCU torso harness.
Review
Review
Questions?
Surface Rescue Swimmer School
Survivor Marker/Locator Devices
LT 4.6

INTRODUCTION
During this unit of instruction the rescue swimmer will learn about Survivor Marker/Locator Devices. This will help the rescue swimmer in identifying survivors and distinguish between the different types of markers being used. The rescue swimmer must understand that some of these devices can be hazardous to the swimmer and survivor.
Enabling Objectives
Explain the purpose and hazards of the following Survivor Marker/Locator Devices per NTTP 3-50.1:
MK-25 Marine Location Marker
MK-58 Marine Location Marker
Electric Marine Marker Light
MK-13/MK-124 MOD 0 Day/Night Distress Flare
MK-79 Pencil Flare
Signal Mirror
Sea Dye Marker
Survivor Markers
Survivor markers are devices launched by aircraft/ships to provide day or night reference points to the position of survivors.
Procedures for deploying pyrotechnic devices are contained in the NAVAIR 11-15-07.

Survivor Markers
WARNING
   Should fuel be observed or suspected to be present in the water, pyrotechnic devices SHALL NOT BE USED due to ignition hazards.
WARNING
   All flares burn “white hot” and can cause serious burns if allowed to come into contact with skin.
Survivor Markers
WARNING
   Avoid breathing potentially hazardous pyrotechnic fumes.


Survivor Markers
Survivor Markers
Survivor Markers
MK-58 Marine Location Marker
Produces a yellow flame and white smoke; burn time 45 minutes.
Survivor Markers
Survivor Markers

Electric Marine Marking Lights
Battery powered, an alternative to pyrotechnic devices when flammables are present or suspected.
Survivor Signaling Devices
MK-13/MK-124 MOD 0 Flares
This signal is used for day or night distress signaling as appropriate by personnel on land or at sea.
Emits orange smoke for day use and red flames for night use.
Burn time for each is approximately 20 seconds.
MK-124 is the replacement for the MK-13 and it’s intended use is the same as MK-13, but is designed for single hand operation.
Survivors Signaling Devices
MK-79 Signal Kit Personal Distress (Pencil Flare)
Intended to be used by downed aircrew members or personnel in life rafts as a distress signaling device.
Produces a single red star display at a minimum altitude of 250 feet.
Burns for a minimum of 4.5 seconds.
Survivor Signaling Devices
Non-pyrotechnic Visual Signaling Devices
Includes lights, strobes, and mirrors.
Pose no hazard to swimmers.
Sea Dye Markers
A dye packet dissolves in sea water.  Dye packets create a large, highly visible fluorescent signal.  Standard Navy issue is a bright green color; other colors may be used.
The dissolved dye poses no hazard to swimmers.

Review
Mk-25’s burn time is?



Questions
Surface Rescue Swimmer  School
SAR Publications and Reports
LT 4.7
INTRODUCTION
During this unit of instruction the rescue swimmer will learn about all of the Navy’s Search and Rescue doctrines. The rescue swimmer will also be able to name these doctrines and be able to complete a SAR Report for a given scenario.
ENABLING OBJECTIVES
Identify the title and content of publications applicable to a rescue swimmer.

Identify the steps to complete a rescue report SAR form 3-50.1/1, when given a rescue scenario.

NTTP 3-50.1 NAVAL SEARCH AND RESCUE (SAR) MANUAL
The most frequently used SAR publication.
This manual is intended to promote and maintain standardization of SAR procedures  and techniques within the U.S. Navy.
These procedures shall serve as a basis for SAR evaluation programs. Therefore, it is essential that this manual be maintained and readily available to unit personnel.



NTTP 3-50.1 NAVAL SEARCH AND RESCUE (SAR) MANUAL
Items covered in this manual are:
Search and rescue equipment
Aviation maritime SAR procedures.
Rescue swimmer procedures.
Surface vessel SAR procedures.
SAR medical procedures.
Rescue report form (SAR Form 3-50.1/1 )
NAVAIR 13-1-6.5 AVIATION CREW SYSTEMS MANUAL ON RESCUE AND SURVIVAL EQUIPMENT
Purpose of each volume is to provide technical  information related to configuration, application, function, inspection, and maintenance of a particular category of aircrew safety and survival equipment.
NAVAIR 13-1-6.5 AVIATION CREW SYSTEMS MANUAL ON RESCUE AND SURVIVAL EQUIPMENT
 Two volumes that are of particular interest to the rescue swimmer are:
 - NAVAIR 13-1-6.2 Inflatable Survival Equipment
 - NAVAIR 13-1-6.5 Rescue and Survival Equipment
ATP-10 NATO SEARCH AND RESCUE (SAR) MANUAL
Manual deals with operations based upon the doctrine of search and rescue.  It presents the techniques and procedures for allied SAR problems.
Rescue swimmers should be aware of this manual and familiarize themselves with it.
NWP 3-04.1 HELICOPTER OPERATING PROCEDURES FOR AIR-CAPABLE SHIPS
This publication sets forth the mandatory operational procedures and training requirements for the employment of helicopters.
Paragraph 1.3.14 - Ship Search and Rescue                              Team.
Paragraph 4.3.2 - Search and Rescue Requirements.
Paragraph 4.3.2.1 - Plane Guard Ship Procedures.
Paragraph 4.3.2.2 - SAR Helicopter Equipment.
NWP 3-22.5 SAR TACAID
Promotes standardized, efficient, and sound SAR tactics.
Every SAR capable ship and aircraft carries this publication.
OPNAVINST 3130.6 SERIES NAVAL SEARCH AND RESCUE (SAR) STANDARDIZATION PROGRAM
Provides for standardization of Navy search and rescue policies, procedures, training, and evaluation program.
Contains requirements for initial/ refresher training.
Outlines minimum annual proficiency training requirements.
Joint Pub 3-50/3-50.1/3-50.2 NATIONAL SEARCH AND RESCUE MANUALS
Provides guidance to federal agencies concerning implementation of the National Search and Rescue Plan.
Establishes standards and provides common procedures, techniques, and terminology to all federal forces, military and civilian, that support civil search and rescue (SAR) operations.
OPNAVINST 3710.7 NATOPS GENERAL FLIGHT AND OPERATION INSTRUCTIONS
This instruction prescribes general flight and operating instructions and procedures applicable to the operation of all naval aircraft and related activities.
Chapter 8 is of interest to aircrew and rescue swimmers. Briefly explains; initial training, extended wear of wet suits, effects of exercise, smoking, alcohol, illness, and drug use.
Locating SAR Reference Publications
These publications are stored in the Combat Information Center (CIC) of ships and may be checked out from the NWP custodian for short periods.  In squadrons, the pubs are held by the Technical Publications Librarian.  
Review
The ______ manual deals with operations and procedures for Allied SAR problems.
ATP-10
The NWP 3-22.5 is called what?
SAR TACAID
Review
The ______ manual deals with Navy search rescue policies, procedures, training and evaluation programs..
OPNAVINST 3130.6 series

The JCS 3-50 is called what?
National Search and Rescue
Questions?
Surface Rescue Swimmer Course
Rescue Boat Operations
Lesson Topic 4.8
Enabling Objective
List all procedures and equipment used for the rescue of an aviator by rescue boat.
Rescue Boat Operations
NOTE
The deployment method of the rescue swimmer shall be dependent upon the type of rescue boat utilized.  This will require follow on training at your command.
Rescue Boat Approach
The rescue boat shall remain close, but stay clear of the rescue until the helicopter rotating anti-collision lights are turned off. 
At this signal, the rescue boat will assume the responsibility for the rescue.
Rescue Boat Approach
Unless the boat coxswain can see the crash site, the boat should be maneuvered in accordance with radio communications or flag/pyrotechnics from the ship.
Approach  Survivor   
Upon approaching survivor in the water, the rescue boat crew must determine if the helicopter is effectively effecting the rescue.
The rescue boat shall never pass between helicopter and the survivor.  This will avoid the possibility of becoming fouled in the helicopter hoisting cable when it is determined that the helicopter has yielded the rescue to the rescue boat.
Approach  Survivor
The motor whaleboat approach should be made directly to the survivor, keeping the survivor on the port bow.  The cast of the boat’s screw in reverse will set the boat alongside the survivor.
The Rigid HIB approach should be made directly at the survivor, keeping the survivor on the bow until the swimmer is deployed.  The RHIB is then brought alongside the survivor.  The out drive allows the RHIB to be backed either to port or starboard.
Rescue Boat Approach to parachute
Personnel in the water with a parachute attached, shall be approached with caution.
        -The survivor may be entangled in the          parachute shroud lines which may be     submerged and not visible to the boat crew.
In making an approach on the parachute,  ensure boat speed is slow enough to avoid going over the parachute.
Streamed Parachute
A streamed parachute should first be hooked and pulled into the rescue boat. (Explain streamed parachute).
This will provide a positive means of preventing loss of the survivor.
If the survivor is entangled in the shroud lines, a swimmer should be put into the water to assist.
Streamed Parachute
It has been found that when shroud lines are cut in the water,  the problem of disentanglement increases;  therefore, shroud lines should be lifted clear and pulled away from the survivor.

Sinking Parachute
If the parachute sinks below the surface before the boat hook snags it,  the swimmer secures a line on the pilot and then attempts to free him from the parachute.
When the pilot is free of the parachute, he is pulled into the boat facing inboard to prevent injury to his back when coming over the gunwale.

Rescue Priority
All Rescue Boat shall attempt to rescue the MOST severely injured survivor first. (If the crewman is left by his aircraft he is automatically reverted to survivor status).
Rescue Position
All small boat recoveries of personnel from the water shall be attempted with the survivor facing of the gunwale of motor whale boats an outboard of the tube on RHIB.
The rescue swimmer shall assist the survivor in the water.
First Aid
Once on board the Rescue Boat,  the survivor’s injuries should be investigated and first aid applied as necessary. Treat all survivors for shock.
Summary
If the Helo abandons the rescue,  how will it signal the Motor Whale Boat ?
Helicopter will turn off it’s rotating anti-collision lights.

On what side is the survivor positioned to rescue boat?
Port Bow

Which way should survivor be facing when entering rescue boat ?
Face first into boat
SUMMARY
Questions?
Surface Rescue Swimmer Course
Search and Rescue (SAR) Tactics
LT 4.9
INTRODUCTION
    During this lesson, you will receive all the information needed to provide a sound, safe search and rescue (SAR) tactics foundation.  Although it is not possible to provide answers to all the different rescue scenarios, applying these basics will enable you to deal with any situation that arises.
OBJECTIVES
State the five stages of the Search and Rescue Operations.
Describe SAR area conditions, and survivor conditions which will allow for the execution of a multiple victim rescue.
Develop a rescue plan to effect a rescue of multiple survivors, when given a rescue scenario.
OBJECTIVES
Describe procedures for recovery of survivors from motor whale boat/RHIB and forecastle.
Identify hand signals applicable to the specific rescue, when given a rescue scenario.
Demonstrate procedures for parachute disentanglement of multiple victims in a simulated rescue scenario.
Search and Rescue System
The search and rescue system is a system which consist of a sequence of events called stages.  Each stage represents a part of the logical approach to the overall rescue operation.
Awareness Stage - SAR system becomes aware of incident.
Initial Action Stage - SAR Facilities are alerted.
Planning Stage - Plan of operations is developed.
Operations Stage - SAR facilities proceed to the rescue scene, conduct search, rescue survivors, assist distressed craft, provide emergency care for survivors and deliver to suitable medical facility.   
Search and Rescue System
NOTE
   The NTTP 3-50.1 contains information for the safe and effective application of search and rescue (SAR) procedures and the execution of SAR operations. However, it is not a substitute for sound judgment. A dynamic SAR environment may require onsite deviations or modifications from procedures prescribed therein to successfully accomplish a SAR mission.
Search and Rescue System
NOTE cont.
The existing risk of deviation must continually be weighed against the benefit of deviating from the NTTP 3-50.1. Some examples of areas where deviations or modifications of procedures are most strongly advised against, are as follows:

Search and Rescue System
NOTE cont.
If a rescue crew member makes the decision not to properly utilize/apply any of the above mentioned safety devices or deviates from authorized procedures, he/she shall communicate his/her intentions to the rest of the Search and Rescue Unit (SRU) crew prior to deviation. This will help utilize the full potential and experience of the crew to make a decision to deviate from authorized procedures.
In all cases, all associated risks should be weighed prior to a decision to deviate from or modify a procedure as set forth in the NTTP 3-50.1.
SEARCH AND RESCUE SYSTEM
Mission Conclusion Stage- SAR platforms return to base.  Rescue swimmer assist in completion of rescue report.
   NOTE
   The helicopter is normally the primary means of rescue during all-weather day and night operations, except when the weather is below 300 feet and 1 mile visibility, then Motor-Whale Boat or Forecastle.  However, the goal is to use the fastest and most effective rescue platform for the given situation.  Whichever is first on the scene will effect the rescue unless unable.  The others should stay clear so as not to hamper the rescue operation and remain ready to assist if needed.
RESCUE PLATFORMS
Helicopter

Motor Whaleboat or RHIB (Rigid Hull Inflatable Boat)

Forecastle
Rescue Scene Initial Assessment (from rescue platform):
Upon arrival at the accident scene, assess the situation.  Assessment begins in the rescue platform prior to swimmer deployment.  The following factors should be determined prior to rescue swimmer deployment.

NOTE
    Swimmer must be aware that the situation can change.

Rescue Scene Initial Assessment (from Rescue Platform):
Number of survivors.
Location of survivors and their relation to, and the distance from each other, and the rescue craft.
Visible injuries to the survivors:
a. Conscious/unconscious
b. Visible bleeding

Flotation devices inflated/not inflated.
Rescue Scene Initial Assessment (from Rescue Platform):
Parachute entanglement problem or presence of ballooned parachute.
Sea state, wind direction, and water temperature.
Fuel in the water.
Debris littering the scene and its relation to survivors.
Presence of sea predators.
Feasibility of attempting multiple/single rescue.
Rescue order established according to apparent injuries.  The worst injured survivor shall be rescued first.
Conditions for Multiple Rescues:
A multiple rescue occurs when there is more than one survivor and the rescue swimmer remains in the water aiding in the recovery of survivors.

Factors which should be considered before attempting a multiple rescue:
Sea State.
Visibility.
Your Location.
Distance between survivors.
Conditions for Multiple Rescues:
WARNING
    To avoid fatigue, the rescue swimmer shall avoid multiple rescues when a great deal of swimming is required between survivors.  Additionally, the reduced visibility during night/IFR rescues makes multiple rescues hazardous.
In the event of a multiple rescue the rescue swimmer shall:
Signal the rescue platform to deploy raft(s)
Inflate the raft(s) if necessary and commence boarding the survivors into the raft(s).
Survivor(s) and Swimmer Recovery Procedures
Motor whaleboat/RHIB and helicopter recoveries shall be performed per NTTP 3-50.1
NOTE
    Prior to all rescue boat deployments, aviation SAR swimmers shall familiarize themselves with rescue boat recovery procedures as outlined in the NTTP 3-50.1. The rescue boat shall remain close, but stay clear of the rescue until the helicopter rotating anti-collision lights are turned off. At this signal, the rescue boat will assume the responsibility for the rescue.
Survivor(s) and Swimmer Recovery Procedures
Rescue Position
All recoveries of personnel in the water shall be attempted with the survivor facing the gunwale of the boat.
Ship-Alongside Rescue
When helicopter is not available.
When sea precludes lowering of whaleboat/RHIB.
When the rescue can be accomplished more expeditiously by ship.


Survivor(s) and Swimmer Recovery Procedures:
NOTE
   When directed from the bridge, every attempt should be made by the deck recovery detail to deploy life rings, yellow low padded monkey fist, etc., to gain contact or positive control of the survivor.  If the distance is great, a swimmer should be lowered into the water.

Shipboard recovery (Forecastle)
Primary means for hoisting personnel from the water to the forecastle is the J-Bar Davit system with a modified rescue strop attached.
Survivor/s and Swimmer Recovery Procedures
Advantages:
Aircrew survivors are familiar with the strop.
Rescue strop floats.
The rescue strop can be tossed a short distance which is an advantage over nets, litter, and seats that must be brought directly over or under the survivor. 


Survivor/s and Swimmer Recovery Procedures:
First Aid
On board the rescue platform, First Aid and treatment for shock shall be administered to survivor as necessary.

NOTE
    Rescue reports show that almost all survivors are in some form of shock.
Review
QUESTIONS?
Surface Rescue Swimmer Course
Inanimate Object Recovery
Lesson Topic 4.10
Enabling objectives:
List the procedures for recovering a REXTORP/Drone.
List the safety precautions for recovering a REXTORP/Drone.
Perform procedures for recovering a REXTORP/Drone.

OSCAR
Description
Kapok filled mannequin.
Typically bright orange.
Used for training of ship’s personnel.
OSCAR
Recovery Method (Commanding Officer’s decision)
Normally from the forecastle by deck division with grapnel hook.
Alternate methods are from the forecastle or rescue boat with rescue swimmer (method of choice for this topic).

OSCAR
Procedures
Swimmer is deployed from forecastle (via rescue strop) or from rescue boat.
Rescue swimmer should complete disentanglement procedures (to hone skills).
Recover via rescue strop or litter to forecastle or into rescue boat.
OSCAR
Safety Precautions
When in close proximity of the rescue vehicle, inanimate objects shall be kept between the swimmer and the rescue vehicle to provide a buffer zone. OSCAR poses no danger to the swimmer. However, the swimmer should not “drop his guard” and become lax. Ever present dangers are:
OSCAR
Ship’s hull.
Rescue boat propeller or screw.
Sea predators or jelly fish.
Sea state.

**WARNING**
OTTO Fuel II is highly toxic, failure to observe all safety precautions contained in SW515-AO-010/MK46 could result in injury or death

The only torpedo that the rescue swimmer is authorized to enter the water to recover is the REXTORP (MK46 training shape). The hazards of Otto Fuel II, used in other torpedoes, make a waterborne recovery too dangerous.
Torpedoes
Description of Recoverable Exercise torpedo (REXTORP)
Length - 102”
Diameter - 12.75”
Weight - 517 lbs. with ballast and 337 lbs. without ballast
Fuel - none
Propulsion - none (has two non-functional propellers)
Torpedoes
Ballast - a total of six separate lead weights totaling 180 lbs.
Color -
Nose is anodized orange/red.
Ballast section is anodized orange with a blue band.
All other sections are a natural anodized finish.
Propellers are anodized red.
Torpedoes
Floating Characteristics - When surfaced, the REXTORP floats at a vertical attitude with approximately 10” of the nose exposed above the surface.
Torpedoes
Recovery Methods
   Torpedo Retriever - This method is accomplished with the use of poles, snares, and cages. The weapon is hauled aboard ship via a ramp or crane. The use of a motor whale/ RHIB eliminates the requirement to deploy a swimmer.
Torpedoes
Helicopter.
Shipboard via davit and hoist (due to weight).
Assisted by swimmer (method of choice for this topic).
Assisted by boat crew (requires calm seas).
Torpedoes
Procedures
Swimmer prepares for normal deployment from forecastle or rescue boat.
Swimmer deploys.

WARNING
Due to floating characteristics of the REXTORP it is extremely difficult to move in rough water.  The swimmer shall never place themselves between the REXTORP and the ship.  Injury or death to swimmer could result.


Signal for nose cage.  (Used because torpedoes do not have an attachment point for the tow line)
Approach and inspect.
Install nose cage.

CAUTION
Insure the handle on the nose cage is used to prevent injury to hands.
Torpedo
Signal ship or rescue boat to haul REXTORP alongside ship
Signal ship for hoisting strap.
Install hoisting strap with a double wrap around body of REXTORP at center of gravity (may require adjustment to balance REXTORP).
Signal ship for up hoist.
Swimmer is recovered.

Torpedo
Safety Precautions
DO NOT attempt a waterborne recovery of other types of torpedoes due to the hazards of Otto Fuel II.
Drones
There are numerous types of drones that the rescue swimmer might recover. A drone is an unmanned flying object used to simulate planes, missiles, etc. For this topic the MQM-74C will discussed.
Drones
Description
Length – 12’ , 7”
Wingspan – 5’ , 6”
Flotation - nose cone, fuel tank, oil smoke tank, and aft flotation bag.
Color - international orange.
Recovery Methods
Helicopter.
Shipboard via davit and hoist (due to weight).
Drones
Assisted by swimmer (method of choice for this topic).
Assisted by boat crew (requires calm seas).
Procedures
Swimmer prepares for normal deployment from forecastle or rescue boat.
Deploy with tow line.
Approach drone with care.
Attach tow line to recovery ring.
Drones
Place two half hitches on drones nose with tow line.
Signal ship or rescue boat to haul drone alongside ship.
Signal ship for hoist.
Attach hoist to recovery ring, tow line becomes tag line for swimmer to guide drone.
Signal ship for up hoist.
Swimmer recovered.
WARNING
Watch for the drone parachute. It should release automatically upon impact with the water. If not, it is easily unhooked and allowed to sink.

Care should be exercised to avoid the sharp edges of the wings when attaching the tow line to the recovery ring located above the wings.

**WARNING**
If the swimmer is tasked to recover debris from an aircraft mishap, extreme caution should be utilized to avoid injury from hazards and unexpended ordnance, i.e.; parachute ballistic spreaders, ejection seat ordnance, etc. Information concerning these hazards can be obtained from your ships safety  officer and the Material Safety Data Sheet.
Miscellaneous
Other objects may range from a bag of garbage to a bale of marijuana.

Recovery methods; apply basic drone/REXTORP recovery procedures to other objects.

Miscellaneous
Rescue swimmers shall not be endangered in order to recover an inanimate object.

Review
CPR for the Professional Rescuer
As a professional rescuer, you are a key part of the emergency medical service (EMS) system.  Whether you are paid or volunteer, in your position you will be summoned to provide care in an emergency.  Unlike a citizen responder, you have a professional duty to act in an emergency and to provide care.  Your actions are often critical and may determine whether a seriously ill or injured person survives.  To provide appropriate emergency care, you must have adequate knowledge and skills as well as self-confidence.  This course is for people with responsibilities for delivering emergency care and/or ensuring public safety.  The role of professional rescuers are varied and include firefighters, police officers, paramedics, and RESCUE SWIMMERS.  
Lesson 1:  The Professional Rescuer and Breathing Emergencies
Page 1 in your student manual
Lesson Objectives:
Know the responsibilities and characteristics of the professional rescuer.
Know the series of events that occur when the EMS system is activated.
Know legal considerations that affect a professional rescuer.
Know how to recognize and care for a breathing emergency.
Lesson Objectives:
Demonstrate how to perform an initial assessment.
Demonstrate how to perform rescue breathing for an adult, child, and infant.
Demonstrate how to use a resuscitation  mask.
Demonstrate how to use a bag-valve-mask (BVM) resuscitator  with two rescuers.
Demonstrate how to care for an obstructed airway (adult, child, and infant).

The purpose of the CPR for the Professional Rescuer course is to teach professional rescuers (those with duty to act) the skills needed to respond appropriately to breathing and cardiac emergencies.
To receive the course completion certificate for the CPR for the Professional Rescuer, the participant must:                                                                                                               -Attend all class sessions.                                                                         -Participate in all skill sessions and scenarios.                                                                                        -Demonstrate competency in all required                 skills.                                                                                              -Pass the final written exam with a minimum          grade of 80 percent in Section 1 (24 correct            answers out of 30 questions.)

Upon successful course completion, each participant will receive an American Red Cross Universal Certificate indicating CPR for the Professional Rescuer which is valid for 1 year.
Responsibilities and Characteristics of a Professional Rescuer
Page 2 in your participants manual

Professional rescuers have many different occupations.  However, all share important responsibilities that include:                                           -Responding to an emergency when on the job.        -Using techniques that require professional                training and are not generally used by the lay              public.                            -Ensuring personal and bystander safety.            -Gaining safe access to the victim.                -Determining any life-threatening conditions          or injuries that may be present.                -Summoning more advanced medical                personnel when necessary.                    -Providing needed care for a victim.                -Assisting more advanced medical personnel           as needed.       

The characteristics of a professional rescuer include:                                             -Maintaining a professional appearance and               attitude.                            -Keeping your skills and knowledge up to               date.                                -Controlling your own fears.                    -Maintaining a healthy lifestyle.
The Emergency Medical Service System.
Page 2 in your participants manual

The emergency medical service (EMS) system is a network of community resources and medical personnel that provides emergency care to victims of injury or sudden illness.
The EMS system functions like a series of events linked in a chain.
The basic principle of the EMS system is to bring rapid medical care to a victim of injury or sudden illness.


The survival and recovery of critically ill or injured people depends on:                                                                  1. Recognition and lay citizen response.               2. Early activation of the EMS system.            3. Professional rescuer care.                     4. Pre-hospital care provided by advanced                 medical personnel.                        5. Hospital care.                         6. Rehabilitation The emergency medical
Recognition and Lay Citizen Response:
This link depends on a responsible citizen who takes action when a injury or illness occurs.
This person must first recognize that             an emergency has occurred and then             activate the EMS system by calling              9-1-1 or local emergency number                 (NAS Pensacola 2-3333).
The citizen responder may provide care to an ill or injured person while waiting for advanced medical personnel to arrive.
Early Activation of EMS:
This link involves the EMS dispatcher who receives the call for help.
The dispatcher quickly determines what help is needed and sends the appropriate medical personnel.
Some dispatchers may be able to provide lay citizen responder with instructions on how to provide basic care for a victim until advanced medical personnel can arrive.
Professional Rescuer Care:
The next person to arrive on the scene who is trained to provide a higher level of care than the citizen responder is often referred to as a professional rescuer.
This person has more advanced training, which allows him or her to better assess the victim’s condition and take appropriate actions, which may include caring for life-threatening conditions.
This level of care often provides a critical transition between a citizen responder’s initial actions and the care of more advanced medical personnel.

Traditionally this role has been associated with police officers and firefighters but can also include other occupations, such as lifeguards, athletics trainers and members of industrial safety teams.
Pre-hospital Care by Advanced Medical Personnel:

The arrival of emergency medical technician (EMT) is the next link in the EMS system chain of survival.
Depending on the level of training and certification (basic, intermediate or paramedic), the EMT can provide more advanced care and life-support techniques.
Paramedics provide the highest level of pre-hospital care.  They serve as the field extension of the emergency physician.
Hospital Care:

At this level a wide variety of medical personnel are involved in patient care, including physicians, nurses and other health-care professionals.
If more specialized care is required, the emergency department physician involves the appropriate medical specialist.
In addition to nurses and physicians, many other allied health-care personnel may help provide care, such as trauma surgeons, respiratory therapists and radiology technicians.
Rehabilitation:

Rehabilitation is the final link in the chain of survival.
The goal of rehabilitation is to return the victim to his or her previous state of health.
Legal Considerations.
Page 4 in your participants manual
Duty to Act:

While on duty, a professional rescuer has a legal responsibility to act in the event of an emergency.
Failure to provide care could result in legal action.
Standard of Care:
Professional rescuers are expected to meet a minimum standard of care, which may be established in part by your training program and in part by state or local authorities.  This standard requires you to:                                                            -Communicate proper information and               warnings to help prevent injuries.                -Recognize a person in need of care.                -Attempt to rescue a person needing                   assistance.                            -Provide emergency care according to               your level of training.
Negligence:
If you fail to follow the standard of care, which results in someone being injured or causes further harm, you may be considered negligent.  Negligence includes:                                                    -Failing to provide care.                    -Providing care beyond your scope or               level of training.                        -Providing inappropriate care.                -Failing to control or stop any                   behaviors that could result in injury.
Good Samaritan Law:
Most states have Good Samaritan laws that protect people who willingly give emergency care without expecting anything in return.
Good Samaritan laws, which can differ from state to state, may protect you from legal liability as long as you act in good faith, are not negligent and act within your level of training.
Check your local and state laws to see if Good Samaritan laws protect you.
Consent:
You must obtain permission from an injured victim before you provide emergency care.
To  obtain consent, you must:                            -State your name.                        -Tell the victim you are trained to help.            -Ask the victim if you can help.                -Explain what you think may be wrong.            -Explain what you plan to do.
A person can withdraw consent at any time.  If this should occur, step back and summon advanced medical personnel.  Be sure to document any care you have given until that point.    


If the victim does not give consent, do not provide care.  Instead make sure advanced medical personnel have been summoned.
A victim who is unconscious, confused or seriously ill may not be able to give consent.  In these situations, consent is implied.
Implied consent assumes that a victim would give consent if able to do so.  Implied consent also applies to minors when a parent or guardian is not present.
Refusal of Care:
In some instances, a person who desperately needs assistance may refuse care.  Even if the injury is serious,  you must honor his or her wishes.
If a person refuses assistance, explain to him or her why he or she needs care.
Always have a witness hear and document, in writing, any refusal of care.    

Do Not Resuscitate (DNR) Order:




DNR orders are written instructions from a physician that protect a victim’s right to refuse resuscitation efforts.
The DNR may be present in paper form on the victim, on an ID bracelet, on or near the door of a residence or on the patients history chart.
For additional information, check your local and state laws relating to DNR orders.    

Battery:
Battery is the legal term used to describe the unlawful, harmful or offensive touching of a victim without consent.  You must obtain consent before touching a victim.    

Abandonment:
Once you begin, you need to continue care until advanced medical personnel or someone with equal or more advanced training arrives and assumes responsibility for care.
You can be held legally responsible for abandoning a person in need if you stop providing care.    

Confidentiality:
While providing care, you may learn information about an ill or injured person that is private and confidential.
Do not share this information with anyone except for law enforcement or advanced medical personnel whom are directly responsible for the continued care of the victim.
Check your local and state laws regarding patient confidentiality.    

Record Keeping:
Document all injuries and incidents.
A record can provide legal documentation of what you saw, heard and did at the scene.
Make sure you are familiar with any specific forms that you will need to complete.    

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GOOD SAMARITAN LAWS ARE DESIGNED TO PROTECT PEOPLE FROM?



LEGAL ACTIONS, AS LONG AS THEY ACT IN GOOD FAITH AND DO NOT GO BEYOND THEIR SCOPE OF TRAINING.
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BEFORE PROVIDING CARE FOR A CONSCIOUS ILL OR INJURED PERSON, YOU MUST?



OBTAIN A PERSON’S CONSENT.  UNLESS THAT PERSON IS A MILITARY MEMBER.
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A VICTIM OF ILLNESS OR INJURY REFUSES CARE.  YOU SHOULD?



EXPLAIN TO THE VICTIM WHY HE OR SHE NEEDS CARE.
HONOR  THE VICTIM’S WISHES AND DOCUMENT THE REFUSEL OF CARE.
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DEFINE NEGLIGENCE?


PROVIDING INAPPROPRIATE CARE.
FAILING TO PROVIDE CARE.
FAILING TO CONTROL OR STOP BEHAVIOR THAT COULD CAUSE FUTHER INJURY .
Chapter 2 Preventing Disease Transmission
BSI Precautions to Prevent Disease Transmission:
Steps taken to isolate or prevent the risk of exposure to any type of body substance are known as body substance isolation (BSI) precautions.
The risk of getting a disease while providing CPR is extremely low.  Practicing BSI precautions reduces the risk even further.                                                                           NOTE                        To learn more about preventing disease            transmission you can contact your local                      American Red Cross and enroll in the                  “Preventing Disease Transmission” course.    

How Diseases Spread:
To contract a disease, all four of the following conditions must be met:                                -A pathogen is present.                    -Enough of the pathogen is present to cause              disease.                            -You are susceptible to the pathogen.                -The pathogen enters your body.     

Pathogens can enter your body in four ways:
Serious Communicable Diseases:
Some communicable diseases can spread easily from one person to another.  The diseases described below are serious.  BSI precautions are the best preventive measure you can take as a professional rescuer.                                                        -Herpes{NO CURE}                         -Meningitis                            -Tuberculosis                            -Hepatitis{NO CURE} *(Page 10)                -HIV/AIDS{NO CURE} *(Page 10)     

REMOVING GLOVES:
Partially remove the first glove.  Pinch the glove at the wrist, being careful to touch only the glove’s outside surface.  Pull the glove toward the fingertips without completely removing it.  The glove is now partly inside out.
Remove the second glove.  With your partially gloved hand, pinch the outside surface of the second glove.   Pull the second glove toward the fingertips until it is inside out,  and then remove it completely.
Finish removing both gloves.  Grasp both gloves with your free hand.  Touch only the interior surface of the glove. 
After removing both gloves, discard gloves in an appropriate container.  Wash your hands thoroughly.   

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COMMUNICABLE DISEASES THAT ARE USUALLY INCURABLE INCLUDE?



HERPES
HEPATITIS B
HIV/AIDS
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DISEASE TRANSMISSION RESULTING FROM AN ANIMAL OR INSECT BITE IS AN EXAMPLE OF?



VECTOR-BORNE TRANMISSION
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IF YOU ARE EXPOSED TO BLOOD OR OTHER BODY FLUIDS?



WASH THE EXPOSED AREA AS QUICKLY AS POSSIBLE AND TELL YOUR SUPERVISOR AND WRITE DOWN WHAT HAPPENED.
Chapter 3 Breathing and Cardiac Emergencies
Emergency Action Principles.
Page 16 in your participants manual
Emergency Action Principles:
The Emergency Action Principle are a standard plan of action used by professional rescuers in an emergency situation.  The steps of the Emergency Action Principles include:                                    1.  Survey the scene and approach the victim.        2.  Perform an initial assessment.                 3.  Summon advanced medical personnel.              4.  Perform a secondary assessment.   


Survey the scene and approach the victim.                                                Determine whether the scene is safe, what happened, how many victims are involved and if any bystanders can help.  If the scene is unsafe, call for more advanced professionals.

Identify and care for life-threatening conditions.                                            -Check for consciousness;                     -Check for ABC’s (airway, breathing and               circulations);                            -Check for severe bleeding.

Summon more advanced medical personnel.                                                Summon more advanced medical personnel if you find any of the following life threatening conditions                                            -Unconsciousness or disorientation;                -Breathing problems (difficulty                   breathing or no breathing);                    -Chest pain or discomfort lasting more than               3-5 minutes or that goes away and comes               back;                                -No sign of circulation (signs of circulation               include a pulse, normal breathing, coughing           or movement in response to rescue breaths);        -Severe bleeding;                        -Persistent abdominal pain or pressure;                               

                                            -Suspected head, neck or back injuries;            -Severe allergic reactions;                    -Severe headache or slurred speech (possible           stroke);                            -Seizures that occur in the water, that last more           than 5 minutes, that repeat one after another           or cause injury;                        -Seizure victims who are pregnant, diabetic,               or who do not regain consciousness after a               seizure;                            -Vomiting or passing blood;                    -Severe burns;                             -Suspected broken bones;                    -Suspected poisoning.                               

Perform a secondary assessment.                                                    Identify and care for additional conditions only if you are sure that the victim does not have any life-threatening conditions.  This assessment includes interviewing the victim and bystanders and conducting a head-to-toe examination.  Be sure to watch for changes in consciousness and breathing.                                                             Professional Rescuer Tip:                If any life-threatening conditions develop while you are performing a secondary assessment, stop whatever you           are doing and provide care immediately.
Head-to-toe Examination

Check the Head:        -Feel the skull for    deformities, open       injuries,           tenderness and     swelling.

Check the Neck:        -Gently feel the sides       and back of the       neck.            -If there is           discomfort or        suspected injury to       the head, neck or        back, immobilize the      head.

Check the Shoulders:    -Feel the shoulders      and the collarbones.    -Ask the victim to      shrug his or her      shoulders.

Check the Chest:        -Feel the ribs and the       breastbone.        -Ask the victim to       take a deep breath       and exhale.        -Look and listen for       signs and symptoms       of difficulty           breathing.

Check the abdomen:    -Apply slight           pressure to each       side of the upper       and lower abdomen.

Check the Pelvis:        -Push down and in      on both sides of the      pelvis with your      hands.

Check the arms and hands :    -Feel both sides of          each arm and hand,          one at a time.            -Ask the victim to try          to move his or her          fingers, hands and          arms.

Check the Legs and Feet:    -Feel both sides of      each leg and foot,      one at a time..        -Ask the victim to try      to move his or her      toes, foot, ankle and      bend the leg.

Check the Back:        -Gently reach under      the victim and feel      his or her back.
Professional Rescuer Tip: For a child, perform a toe-to-head examination (reverse the steps).  Explain to the child and parents or caregiver what you are going to do and ask questions the child can easily answer.  Attempt to reduce the child’s anxiety while gaining his or her trust and cooperation.  Move slowly, get as close to eye level as possible and keep your voice calm and reassuring.
Moving a Victim:
Do not move the victim unless it is necessary.   
Unnecessary movement can cause additional injury and pain and can complicate the victim’s recovery.   
Tell the victim not to move.  Tell any bystanders not to move the victim.
Move an injured victim ONLY IF-                                                    -The scene is or becomes unsafe.                -You have to reach another victim who may               have a more serious injury or illness.            -You need to provide proper care (e.g. someone           has collapsed on a stairway, does not show               signs of circulation and needs CPR, CPR                needs to be performed on a firm, flat surface.   


Clothes Drag:  To move a victim who may have a head,                neck or back injury.               
Tow-person Seat Carry:  To carry a conscious victim who                        cannot walk and has no                     suspected head, neck or back                     injury.

Walking Assist:  To help a victim who needs assistance                       walking to safety.

Blanket Drag:  To move an unconscious victim in an                    emergency situation when equipment is                                                          limited.   

Foot Drag:  To move a victim too large to carry or move           otherwise.

Resuscitation Mask:
Resuscitation masks are flexible, dome-shaped devices that fit over the victim’s nose and mouth and allow you to breathe air into the victim’s lungs without making mouth-to-mouth contact.
Additional benefits of using a resuscitation mask include:        -The possibility of disease transmission is               reduced.                            -A seal is created over both the victim’s mouth            and nose.                            -The device can be connected to supplemental           oxygen, thus increasing the oxygen                   concentration in the air that the victim                       receives.   


The resuscitation mask should have the following characteristics:                                -Easy to assemble and use.                    -Made of a transparent, pliable material                 that allows you to make a tight seal on                  the victim’s face.                        -Have a one-way valve for releasing                     exhaled air.                            -Have a standard 15mm or 22mm                    coupling assembly (the size of the                     opening for the one way valve).                -Have an inlet for delivering                         supplemental oxygen.                    -Work well under different                       environmental conditions (extreme hot               and cold).

Initial Assessment:
The purpose of the initial assessment is to identify life-threatening conditions.  This includes checking the victim for:                                        -Consciousness.                        -Airway.                            -Breathing.                             -Circulation.                            -Severe bleeding.               
Begin the initial assessment with the victim in the position in which you find him or her.  If you are unsure whether or not the victim is breathing, carefully position the victim on his or her back, while supporting the head and neck and turning the body as one unit.   


Open the airway to check for breathing using the head-tilt/ chin-lift method.  Use the jaw-thrust maneuver if you suspect a head, neck or back injury.
Check for signs of circulation (pulse, normal breathing, coughing or movement in response to rescue breaths).   
Check for severe bleeding by scanning the entire body.   

Breathing Emergencies:
A breathing emergency occurs if a victim has difficulty breathing or stops breathing.
Breathing emergencies can be caused by:                    -Obstructed airway (choking).                -Respiratory distress or illness (e.g.,                    pneumonia, emphysema, or asthma).            -Injury to the chest and lungs.                    -Heart attack.                            -Coronary heart disease, such as angina.            -Allergic reactions.                        -Electrocution.                            -Shock.                            -Near drowning.                        -Poisoning or drugs.   

Breathing Emergencies:
A victim who is having difficulty breathing is in respiratory distress. 
Respiratory distress is often caused by an injury or other condition, such as asthma, emphysema, or anaphylactic shock.                   
Signs and symptoms of respiratory distress include:            -Slow or rapid breathing.                    -Shortness of breath.                        -Dizziness or lightheadedness.                -Flushed, pale, ashen or bluish skin.                -Chest pain or discomfort.                    -Making wheezing, gurgling noises.                -Tingling in hands or feet.   

Breathing Emergencies:
Care for respiratory distress by:                        -Summoning advanced medical                     personnel.                            -Using BSI precautions to prevent                    possible disease transmission.                -Obtaining consent.                        -Helping the victim rest in a comfortable                 position that makes breathing easier.            -Reassuring and comforting the victim.            -Assisting the victim from getting chilled                or overheated.                            -Giving supplemental oxygen if it is                  available and you are trained to do so.
   

Breathing Emergencies:
If not cared for, respiratory distress can turn into respiratory arrest.   

Rescue Breathing:
Provide rescue breathing for a victim who is not breathing but shows signs of circulation.  To determine if a victim is not breathing, perform an initial assessment.    

Bag-Valve Mask (BVM) Resuscitator:
A bag-valve-mask (BVM) resuscitator is used to ventilate a non-breathing victim.
A BVM can also be used for a victim in respiratory distress.
The BVM consists of a self-inflating bag, a one-way valve and a mask.
Using a BVM reduces the risk of disease transmission and increases the level of oxygen being delivered to the victim.           
The BVM is highly effective when used correctly by two rescuers.   

Airway Obstructions:
Choking is the most common cause of respiratory emergencies.
A victim whose airway is blocked can quickly stop breathing, lose consciousness and die.
An airway obstruction can be anatomical (tongue, swollen tissues) or mechanical (a foreign object, such as a toy, or fluids, such as vomit or blood).   

Airway Obstructions:
An airway obstruction can be partial and complete.  Victims with a partial airway obstruction may be able to make wheezing sounds, while those with a complete obstruction cannot speak, breathe or cough effectively.
A conscious victim who is clutching his or her throat with one or both hands is usually choking.  Be sure to obtain consent before you provide care.
Abdominal thrusts may not be effective for a conscious victim who is pregnant or too large to reach around.  Perform chest thrust instead.   

Wrap-Up:
Always follow BSI precautions to protect yourself from disease transmission when giving care.
Follow the emergency action principles:                -Survey the scene.                        -Perform an initial assessment.                -Summon more advanced medical                     personnel.                            -Perform a secondary assessment.
The initial assessment helps you identify and care for life-threatening conditions.
The secondary assessment helps you identify and care for additional conditions.   

To care for a victim who needs rescue breathing, perform an initial assessment and give:                        -1 rescue breath about every 5 seconds                for an adult.  Each rescue breath                     should last about 2 seconds.  After 1               minute (about 12 breaths), recheck for                signs of circulation and breathing for no                more than 10 seconds.                    -1 rescue breath about every 3 seconds                    for a child and infant.  Each rescue                    breath should last about 1 1/2 seconds.                After 1 minute (about 20 breaths),                    recheck for signs of circulation and                   breathing for no more than 10 seconds.   

To care for a victim who is choking, give:                -Abdominal thrusts for a conscious or               unconscious choking adult or child.            -Back blows and chest trust for a               conscious infant.   
Cardiac Chain of Survival:
The links in the cardiac chain of survival include:            1.  Early recognition of the emergency and early access to EMS.  The sooner advanced medical personnel or the local emergency number is called, the sooner EMS arrives and takes over.                        2.  Early cardiopulmonary resuscitation (CPR).  CPR helps supply oxygen to the brain and other vital organs to keep the victim alive until an automated external defibrillator (AED) is used or advanced life support arrives.    3.  Early defibrillation.  An electric shock called defibrillation may restore a normal heart rhythm.  Each minute defibrillation is delayed reduces the victim’s chance of survival by about 10 percent.   

                                        4.  Early advanced life support.  Advanced Life Support is given by EMS personnel who provide further care and transport to the hospital.                               

                                            - Be calm and reassuring.                    - If local protocols or medical direction permit,           give aspirin if the victim can swallow and has           no contraindications (e.g., allergic to aspirin,           has stomach ulcer disease or taking “blood               thinner” such as Coumadin, Warfarin or other           anti-platelet drugs).                        - Assist the victim with his or her prescribed               medication and give supplemental oxygen if          it is available and you are trained to do so.            - Monitor the victim for signs of circulation               and breathing.                        - Give CPR if the victim loses consciousness           and shows no signs of circulation.                               
Cardiopulmonary Resuscitation (CPR)
Cardiac Arrest:
Cardiac arrest is a life-threatening emergency.  Without oxygen, the brain will begin to die within 4-6 minutes.   
Cardiac arrest occurs when the heart can no longer circulate the blood effectively.           
Signs and symptoms of cardiac arrest include unconsciousness, no breathing and no signs of circulation.
Cardiac arrest can occur without warning or a victim may experience the signs and symptoms of a heart attack prior to the arrest.
The most common cause of cardiac arrest in children and infants is an unrecognized respiratory emergency.   
Appropriate care for a cardiac arrest includes early CPR abd early defibrillation.   
Signs and Symptoms of a Heart Attack:
Early recognition of a heart attack and early activation of the EMS system can save lives.
Additional signs and symptoms of a heart attack that diabetics, women or the elderly may experience include:            - Feeling of indigestion or pain in the abdomen.        - Feeling sick or uneasy.
To care for a person who is having a heart attack:                - Summon more advanced medical personnel.        - Use BSI precautions to prevent disease                transmission.                        - Obtain consent (when possible).                - Have the victim sit in comfortable position                that makes breathing easier.   

CPR is a combination of rescue breathing and chest compressions.
CPR circulates blood containing oxygen to the vital organs, such as the brain, helping to keep the victim alive until advanced medical personnel arrive and take over.
CPR must be performed on a firm, flat surface.
CPR techniques for children and infants are modified for their smaller body size and faster breathing and heart rates.   
Two-Rescuer CPR (Adult):
In two-rescuer CPR for an adult, the ratio of chest compressions to rescue breaths is 15 to 2.
In two-rescuer CPR for a child and infant, the ratio of chest compressions to rescue breaths is 5 to 1.
When two rescuers begin CPR together, the first rescuer does the initial assessment and the second rescuer gets into position to give chest compressions.
When CPR is in progress by one rescuer and a second rescuer arrives, the second rescuer should ask whether advanced medical personnel have been summoned.
If advanced medical personnel have not been summoned, the second rescuer should call before assisting with care.   

If advanced medical personnel have been summoned, the second rescuer can then help perform two-rescuer CPR.
As the first rescuer completes the cycle, the second rescuer gets into position at the chest and finds the correct hand position.  The first rescuer checks for signs of circulation, and if none are found, then the first rescuer tells the second rescuer to begin chest compressions.
The rescuer at the chest signals for a change of positions by substituting the word “change” for the word “fifteen” for an adult victim or for the word “one” if the victim is a child or infant.

Upon hearing that signal, the rescuer at the victim’s head completes the cycle by performing 2 rescue breaths and then moves to the chest and locates the correct hand position for compressions.  The rescuer at the victim’s chest moves to the head, rechecks for signs of circulation and breathing for no more than 10 seconds and signals the rescuer at the chest to resume compressions, if necessary.   
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The Emergency Action Principles include?



Survey the scene.
Perform initial assessment.
Summon advanced medical personnel.
Perform secondary assessment.
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The Cardiac Chain of Survival consist of?



Early recognition and early access to EMS.
Early CPR.
Early defibrillation.
Early advanced life support.
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How often would you give breaths for a 6-year-old boy when performing Rescue Breathing?



Once every 3 seconds.
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What is the ratio of chest compressions to rescue breaths for a 35-year-old woman?



15 chest compressions and 2 rescue breaths.
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What is the most common cause of cardiac arrest in children and infants?



unrecognized respiratory emergency.
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Surface Rescue Swimmer Course
Primary Survey LT 5.4
Objectives
List the procedures used in a primary survey.
Demonstrate primary survey procedures used in a mock trauma (moulage) scenario without injury to personnel or damage to equipment.
Primary Survey Procedures:
A head-to-toe examination conducted in one of two rescue situations.  During in-water rescue situations once the survivor is in the rescue platform, and during overland rescues prior to transporting the survivor to the rescue vehicle.
Used to identify all life threatening injuries, which must be treated as they are found.

Arriving on the Scene:
Scene Safety: Upon approaching the scene during an overland SAR, it is imperative that you evaluate the safety of the area in order to protect yourself and your crew.
NOTE
    During in-water rescue scenarios onboard the rescue vehicle, it is understood that the scene is safe.  However, it is necessary to evaluate the scene at all times.

Arriving on the Scene
Body Substance Isolation: Take BSI precautions prior to touching the survivor.
Determine Responsiveness: Attempt verbal communication with the survivor after or during BSI procedures.
Initial Assessment
Check the Airway:
If survivor is conscious and talking to you, check for severe bleeding and begin Primary Survey.
If survivor is unconscious, open the Airway using a “modified jaw thrust.”
Check Breathing: Verify that the survivor is breathing.  If not breathing, give two breaths.  If unable to get the breaths in begin Obstructed Airway procedures.

Initial Assessment
NOTE
If it is necessary to perform abdominal thrusts, expose the abdominal area prior to pressing on the abdomen.

Check Circulation: Verify that the survivor has a pulse.  If no pulse, begin CPR procedures.
Initial Assessment
Check for Severe Bleeding: Take a quick look at the body from head to toe identifying any severe bleeding prior to beginning CPR.

NOTE
    If severe bleeding occurs during chest compressions, it may be necessary to expeditiously bandage a wound in order to continue.

Primary Survey:
Cervical Collar: While maintaining in-line stabilization of the head, sweep the back of the neck checking for blood and/or deformities.  Determine the correct size c-collar needed, verify placement, and secure it.  Once in place, you may let go of the head.
Primary Survey
Life Threatening Injuries:
Quickly look at the head checking for severe bleeding. If no severe bleeding, move directly to the chest.
Expose the survivor’s chest and abdomen. Look for and treat all life-threatening injuries present.
Expose an arm, look for and treat all life-threatening injuries.  Repeat for the other arm.
Follow the same procedures for the legs.
Primary Survey
NOTE
Following the order of assessment, if blood-soaked clothing is identified, expose and treat that extremity first.

Life-Threatening injuries include:
Problems with/ ABC’s
Sucking Chest Wounds
Severe Bleeding
Amputation with Severe Bleeding
Primary Survey
Abdominal Evisceration
Obvious Bruising (internal Bleeding)
Critical Burns
Head, Neck, or Spinal Injury
Heat Stroke
Severe Hypothermia
Psychiatric Emergencies
Severe Shock
Primary Survey
Check Breathing-  Check for equal rise and fall of the chest by resting your hands on the survivor’s chest, in the front and back.  Looking for breathing quality and rate.
Check Circulation- Check pulses at the wrists (radial) and at the feet (dorsalis pedis), looking for equal quality and rate.  Check capillary refill in fingers and toes, looking for circulation return within 2  seconds or less.  Check skin temperature by resting the back of a gloved hand on the survivor’s forehead and/or chest.
NOTE
Do not wipe contaminated gloves on yourself.
Primary Survey
Perform Blood Sweep- Begin by wiping gloves clean or replacing them with a fresh pair.  Starting at the head, sweep under the body and inside the clothing looking for any bleeding you can’t see.  If blood is found, investigate it.
Reassess ABC’s- Verify that survivor is still breathing and has a pulse.
Transport or Continue:
When performing a Primary Survey in an overland situation, once reassessment of the ABC’s has been completed (and ABC’s are adequate), prepare to transport the survivor to the rescue vehicle.  Follow steps for logrolling onto the SAR MEDEVAC litter.
During an in-water rescue, upon completion of the Primary Survey, continue directly into the Secondary Survey.
Rules for Splinting
Splinting is always performed during the Secondary Survey.
When splinting legs, ensure extremities are in-line prior to applying a splint.
Ensure that the joints above and below the injury are immobilized.
If an open wound found or bruising is present, ensure a tie is placed above and below the area.
Tie knots across the top of the splint, not against skin.
Always check capillary refill after splinting.
Identification and Treatment of Injuries:
Open Chest Wounds “Sucking Chest Wound”
Presentation:
Open wound to the chest with a sucking sound during breathing
Bleeding and bubbles coming from the chest
Exit wound may be present
Treatment:
Immediately place a gloved hand over the open wound to create a seal.
Open Chest Wounds “Sucking Chest Wound”
Treatment cont.
Evaluate wound size.  If wound is smaller than a petroleum gauze foil wrapper, use foil to create a one-way valve.  If wound is larger, use plastic from an IV bag cut to size.
Tape on three sides.  Top, bottom, and side closest to middle of the body.

Open Chest Wounds “Sucking Chest Wound”
Treatment cont.
Check for an exit wound.  If an exit wound exists, determine its size. Use a combination occlusive and field dressing placed over exit wound using survivor’s body weight to create a seal.  During an overland SAR, it may be necessary to log roll the survivor to get a clear view of the injury prior to treatment.
Deviated trachea is a sign that the one-way valve is no longer working.


Open Chest Wounds “Sucking Chest Wound”
Treatment cont.
To relieve pressure, peel dressing up using un-taped side and “burp it”.  May hear a rush of air as pressure is relieved.
Lay survivor injured side down if feasible.

Closed Chest Wounds
Presentation:
Difficulty breathing
Deviated Trachea

Treatment:
Place the survivor in an injured side down shock position.  Shock position is the only treatment
Flail Chest:
Presentation
Difficulty breathing
Section of the rib cage moving opposite of normal breathing (This is not unequal breathing).
Bruising to the chest area.
Flail Chest
Treatment
Place a saline bag over the affected area taping the top and bottom of the bag to the chest.  May use cravats if needed, but ensure that they’re not too tight as to further hinder breathing.
Check for other broken ribs before placing tape.
May use a rolled up burn sheet
Amputations
Presentation
Severely torn or missing limb.
May have severe bleeding present.
Limb may be fractured
Treatment
Control Bleeding First: Apply direct pressure with a field dressing and tightly wrap with an ACE bandage.
Splint the amputated end during the Secondary Survey.  Using a SAM splint, wrap around the end of the amputation in a “U shape” and secure it with at least two ties.
Open Fractures
Presentation
Visible bone and/or fragments with an open wound.
Bleeding can be mild to severe.
Treatment
Control Bleeding First:  Place donut-shaped gauze bandage around the exposed bone and cover with a field dressing.
If it’s necessary to move an arm to control bleeding from an “open hand fracture”, visualize and palpate for other injuries before moving it.
Open Fractures
Treatment cont.
Ensure the dressing is snug and tied on the side.  Do not cross dressing ties over the wound. This will apply unwanted pressure on the exposed bones.
Splint fractures during the Secondary Survey.
For fractures of the lower arms, use a SAM splint underneath the arm (palm side) with hand in the neutral position.  Secure with at least three ties with wrist and elbow immobilized.
Open Fractures
Treatment cont.
For fractures of the upper arms, use a SAM splint across the outer aspect of the arm and secure with at least two ties.  Utilize a sling and swath (swath at a minimum).  Ensure the swath is not too tight as to hinder breathing.
To splint fractures of the hands, wrap roller gauze around the hand and wrist, to create a bulky soft splint.  Avoid covering fingertips.
Open Fractures
Treatment cont
For upper leg fractures, use a SAM splint across the side of the leg above the hip to below the ankle.  Secure with at least five ties.  Ensure the leg is placed in-line prior to splinting and that the hip, knee, and ankle are immobilized.
For lower leg fractures, use a SAM splint across the side of the leg above the knee to below the foot.  Secure with at least four ties.

Closed Fractures
Presentation
Bruising or deformity may be visible.
Treatment:
If bruising is present, assume a bone is broken and treat as a fracture.
Some bruising may be difficult to see.  A thorough Secondary Survey must be performed to identify all injuries.
Splint during Secondary Survey.
Abdominal Evisceration
Presentation
Open abdominal wound with internal organs visibly exposed and/or spilling out.
Treatment
Soak large field dressing with Normal Saline.
Place the large field dressing under exposed organs and fold over the organs, covering all wound areas.
Tie on the side, ensuring no pressure is placed directly on exposed organs.
Pelvic Fractures
Presentation
Instability or grinding feeling when pressing in against the hips.
Grinding sounds accompanying pressing in against the pelvis.
Survivor may feel like they’re coming apart and survivor may be in extreme pain.
Bruising to the abdominal and/or pelvic region may be present.
Pelvic Fractures
Treatment
Fold burn sheet and place it inside of the trauma sheet to fill space between the legs.
Place a Triangular Bandage across the hips, two on the upper legs and two on the lower legs (applying cravats at the hips, then applying them from the feet up.)
NOTE
During overland SAR, the pelvis shall be checked and, if necessary, treated prior to logrolling the survivor onto the litter.
Penetrating Puncture Wounds
Presentation
Foreign object protruding from any area of the body.
Treatment
Secure object with Roller Gauze on each side of the penetrating object.
Cut a hole in the middle of a field dressing large enough for the object to fit through and apply field dressing.  Tie on the side to avoid direct pressure.
Ensure object is secure and visible to personnel to prevent further penetration.
Puncture Wounds
Presentation
Puncture wound to any area of the body

Treatment
Place a field dressing on wound and tie over the top of the wound.
Check for an exit wound.
Eye Avulsion
Presentation
Eye missing or protruding from the socket
Treatment
If eye is missing, cover affected side with a field dressing.  Always cover both eyes to minimize movement due to sympathetic oculomotor function.
If eye is protruding from the socket, soak Roller Gauze with Normal Saline.  Apply Roller Gauze to each side of the eye and cover both eyes with a field dressing.
Ensure dressing is snug and tied on the side.
Simple Rib Fractures
Presentation
Complaining of difficulty breathing
Bruising, tenderness, or pain (guarding) to affected area.

Treatment
Sling and swath the arm of injured side, if no injuries to the arm are present.
 Severe Burns
Presentation
Signs of second and third degree burns (blisters and/or charred skin) to any area of the body.
If burns to the chest are present, check for singed nose hairs indicating an inhalation injury.

Treatment
Cover burned areas with a burn sheet cut to size, one sheet thick.  Secure loosely with safety pins.
Lightly palpate burned areas for broken bones during Secondary Survey.
 Severe Burns

NOTE
Any sterile dressing that touches the deck or becomes contaminated, is considered useless and SHALL NOT be used.
Review
First thing you do when arriving on the scene?

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Surface Rescue Swimmer School
Practical First Aid
Lesson Topic 5.3

Objectives

Explain the purposes of First Aid.

List the different types of injuries and the appropriate treatment for each in accordance with the lesson plan.
TOPIC OUTLINE
Purpose of first aid for rescue swimmers:
Save life.
Prevent further injury.
Prevent infection.
Treat for shock.
Basic Principles of First Aid:
Act quickly, but effectively.
Reassure the survivor in a calm manner.
Reveal only enough of the survivor’s injuries to ensure cooperation.
Do not discuss the survivor’s injuries with others while the survivor is in hearing range unless you’re uncertain about an injury or course of treatment.
If survivor is in danger of further injury, remove them from the danger as quickly and smoothly as possible, without putting yourself at risk.

First Aid Procedures
Treatment begins once access to the survivor has been established.
First Aid treatment begins on the rescue platform.
All SAR capable platforms utilize the Level “A” Medical Kit.  The first step in the treatment of injuries is protecting yourself from bodily fluids as much as possible.  Always utilize the surgical gloves found in the Level “A” Medical Kit at a minimum.
Wounds:


     There are 5 classification of wounds:
Classification of Wounds
Bruise


Scrape/Abrasion
Laceration (torn/ragged edges) and Incision (smooth edges).
Avulsion Skin tissue partially or completely torn away with severe bleeding possible.


 Puncture Most susceptible to infection.


Wounds
Infection is secondary to a wound. Never close or bandage a wound until it has been irrigated or cleaned out as much as possible.
If severe bleeding is present, do not worry about cleaning out the wound, control the bleeding.
Open Wounds
Three types of bleeding:
Arterial : Large vessels that carry blood away from the heart.  Bleeding is bright red and spurts from the wound.
Capillary : Small vessels that carry blood to all body parts.  Bleeding is slow and oozes from the wound.
Venous : Veins carry blood to the heart.  Bleeding is dark red and flows in a steady stream.
Dressings and Bandages:
Dressings: pads placed directly on the wound to soak up blood and keep germs out.  These will not stick to the wound.
Bandages: used to wrap and hold dressings in place, apply pressure to help control bleeding, and help support an injured body part.  Bandages include:  Band-Aids, Triangle bandages, and Roller bandages made of gauze or elastic material.
Field Dressings are a combination Dressing and Bandage in one.

Control severe bleeding using the following methods: Direct Pressure Place direct pressure on the wound using a sterile field dressing. A dressing may be created using any available equipment as necessary.
Control severe bleeding
Elevation– elevate the affected extremity above the level of the heart.

NOTE
    Do not elevate an extremity until it has been properly splinted if a fracture is suspected.
Second Dressing
Apply a second dressing if first bandage becomes blood-soaked. Wrap dressings in place with a roller bandage as needed.  Ensure bandage is tied off or taped to prevent loosening.

Pressure Points
Apply pressure to the artery by pressing against the underlying bone at a point closest to the wound and midway to the heart.
Tourniquet:
Used as a last resort.

When you use a tourniquet, you risk sacrificing a limb in order to save a life.
Tourniquet:
Tourniquets are only placed on the extremities (arms and legs). Normally placed 1 to 1.5” above the wound.
If possible, place the tourniquet below a joint.
Write the time and location of the tourniquet on the front of survivor’s shirt.
Write a capital “T” on the survivor’s forehead.
Leave the tourniquet visible.
Never use string, wire, or any thin material less then one” wide.
Tighten only enough to control bleeding.
Never loosen a tourniquet once it is in place.
Warning


    When practicing on a simulated survivor do not tighten a tourniquet!

Signs of Internal Bleeding:
Tender, swollen, bruised, or hard areas of the body (i.e.: the abdomen).
Rapid, weak pulse.
Skin that feels cool, moist or looks pale or bluish.
Vomiting or coughing up blood.
Excessive Thirst.
Becoming confused, faint, drowsy, or unconscious.
Shock:

A life-threatening condition usually due to severe bleeding and caused by a lack of blood circulating throughout the body.
Signals of Shock:
Restlessness or irritability (often the first indication).
Altered level of consciousness.
Pale, moist, cool skin.
Rapid breathing.
Weak, rapid or absent pulse.
Late Stages of Shock:
Bluish coloration around the lips, eyes, and/or the nail beds due to a prolonged lack of oxygen.
Loss of consciousness.
No breathing or absent pulse.
             Shock:
    All survivor’s will be in some form of shock.  Position survivor for transport in the rescue vehicle in one of the following five positions:

                             NOTE
Maintain in-line stabilization of the head and neck if a head, neck, or spinal injury is suspected.
Traditional Shock Position:
Use this position unless the survivor’s injuries preclude it (if no other shock position is needed).
Feet are elevated 6”-12” above the level of the heart.
When spinal injuries are suspected, lift the foot end of the SAR litter instead of the feet.
Flat on Back Position
Use when head injury is suspected, the survivor has an eye injury, flail chest, signs of internal bleeding in the abdomen or torso are present, or the survivor is unconscious upon your  arrival.
Position the survivor on their back, keeping the body as straight as possible.

   
Side Position
Used for survivor with nausea and vomiting, bleeding from the mouth, large amounts of oral secretions, a sucking chest wound, deviated trachea, or compressed air injury is suspected.
Place survivor with an open or closed chest wound, injured side down.  This position allows gravity to assist in drainage of  blood and keeps the uninjured  lung up.
If a compressed air injury is suspected, place the survivor left side down to keep air bubbles from forming in heart vessels.
   
Knee’s Flexed Position
Used for a survivor with abdominal injuries. (Something going into or coming out of the abdomen.) This position does not include internal bleeding in the abdomen.
Lay survivor on their back and raise their knees to approximately 45 angle.  This will ease tension on the abdominal muscles.

Semi-Seated Position
Not to be used if you suspect head, neck, or spinal injuries, or the survivor has ejected.
Used for survivors with medical problems such as a heart attack or trouble breathing.
Position the torso at a 45 angle with legs flat.

   
NOTE
Survivor should be placed in the appropriate shock position upon completion of the Secondary Survey if feasible.
Head, Neck, and Spinal Injuries:
Only an x-ray can truly determine internal head, neck, or spinal injuries.  Suspect a head, neck, or spinal injury when:
Fall from height greater than the survivor’s height.
Any diving (head first) mishap.
Any person found unconscious for unknown reasons.
Any injury involving severe blunt force to the head or trunk.
Any injury that penetrates the head or trunk.
Any person thrown from a motor vehicle or not wearing a seat belt.
Any injury in which the victim’s helmet is broken.
Lightening strike.
Ejected Aircrew.

Signals of Head, Neck, and Spinal Injuries:
Change in level of consciousness.
Complaints of severe pain or pressure in the head, neck, or back.
Tingling or loss of sensation in the hands, fingers, feet, or toes.
Partial or complete loss of movement in any body part.
Unusual bumps or depressions on the head, neck, or spine.
Signals of Head, Neck, and Spinal Injuries
Blood or other fluids in the ears or nose.
Heavy external bleeding of the head, neck, or back.
Seizures.
Impaired vision or loss of balance as a result of injury.
Bruising of the head, especially around the eyes and/or behind the ears.

Treatment of Head, Neck, and Spinal Injuries in-water rescue:

Treat all unconscious survivors or ejected aircrew as possible head, neck, and/or spinal injuries.
Upon gaining access to the survivor and establishing ABC’s are present, perform all necessary disentanglement procedures and  stabilize the spine utilizing the SAR MEDEVAC litter as required.
This may prevent a potentially life threatening or permanent neurological injury from occurring.
As a rescue swimmer, you’re goal is to get the survivor into the rescue platform as quickly and effectively as possible.
WARNING
In a water rescue situation, the survivor may be placed in a litter and hoisted horizontally to prevent the effects of hydrostatic squeeze.
Hydrostatic Squeeze
Water exerts pressure on a body immersed in it.  This effect is called hydrostatic squeeze.
Vertical removal from the water relieves the pressure and causes blood to flow back to the lower extremities increasing the level of shock.
Rescue Litter Procedures
Requires both a Lead and an Assistant Rescuer.
Lead will establish ABC’s, while the Assistant takes in-line stabilization of the head. Assistant will verbally direct the movement of the survivor during transfer to the litter.
Lead will apply the cervical collar and conduct a Primary Survey treating all life threatening injuries.
Lead will position the litter next to the survivor and position themselves perpendicular to the survivor’s hips.
On the Assistant’s 1...2...3 count, lead will grip the survivors hips, log-roll the survivor toward them, and check the back for injuries.
The survivor is then rolled onto the litter and secured inside the litter straps.

  Fractures and Dislocations
A fracture is a complete break, chip, or crack in a bone; classified as open or closed.
Open fractures: involve open wounds.  Any wound in which bone is seen or exposed is an open fracture.
Treat the wound first.  Stop the bleeding.
Do not attempt to set a broken bone.


Closed Fractures:
A closed fracture is a broken bone without an open wound.
Splint in place.
  Do not attempt to set a broken bone.

Dislocations:

The separating of bones between a joint. 

May be very painful. Splint in place unless circulation below the joint is compromised.
Splinting: There are three types of splints.

                  Rigid
Splinting:

Soft
Splinting:
Anatomical
Splinting:
Splinting is done during the Secondary Examination.  After splinting an extremity, always check for a capillary refill to ensure proper circulation.
If circulation is compromised or the injured extremity cannot be placed into the litter appropriately, it may be necessary to move the extremity to an in-line position.

Rib Fractures

Simple - 1 or 2 ribs broken, can be in several places.
Rib Fractures
Flail Chest - 2 or more consecutive ribs broken in 2 or more places.  Usually recognized by a section of the rib cage moving opposite of the normal breathing pattern.



   

Open & Closed Chest Wounds
Open Chest Wound- also known as a “sucking chest wound,” occurs when air leaks into the chest cavity from an opening in the chest wall.
Due to increased air pressure outside of the body, the air is drawn into the chest as the survivor exhales, and causes the lung to collapse.


Closed Chest Wound:
Occurs due to a puncture in the surface of the lung causing an increased air pressure in the chest cavity and forcing the lung to collapse.  May be identified by the presence of a deviated trachea.


Abdominal Evisceration:
Extensive laceration to the abdominal wall causing some of the internal organs to push out.


Pelvic Fractures:
The upper body rests on the spine connected to the pelvis. The legs are seated in the pelvic girdle. Essentially, the pelvis is the center of the body.
A survivor with a pelvic fracture will feel like they are  coming apart and  may be in extreme pain.
Gently press downward and inward against the hips to test for movement, grinding, and survivor response to pain.

Burns
Burns result from heat, electricity, chemicals, and radiation.
Burns are determined by the depth of tissue damage:
1st Degree (Superficial) - A sunburn. Involves the top layer of skin.
Burns:
2nd Degree (Partial Thickness) - Recognized by the blisters.
Burns
3rd Degree (Full Thickness) - All layers of skin and most or all underlying structures are destroyed.  Identified by black or white charred tissue.


Burns
Steps for care:
Assess the scene and remove the victim from the source.
Cover with a loose, dry, sterile dressing.
 Do not use ointments or petroleum  products on the burn.
 Critical Burns
Any burn that:
Involves difficulty breathing.
Covers more than one body part.
Involves the head, neck, hands, feet, or genitals.
Results from chemicals, explosions, or electricity.


   
Environmental Injuries - Heat Related Injuries:
Heat Cramps - painful muscle spasms, usually in the legs or abdomen. 
Care includes:
Laying the victim down in a cool place.
Give cool water or moderate amounts of commercial sports drinks.
Light stretching of affecting muscles may help.
Do not give salt or salt tablets, as they may worsen the condition.
Heat Related Injuries
Heat Exhaustion - more severe condition of heat cramps.
Signals include:
Normal to sub-normal skin temperature. Skin may cool, moist, pale, or flushed.
Headache.
Nausea/Vomiting.
Weakness and Fatigue/Exhaustion.
Care is the same as Heat Cramps.
Heat Related Injuries
Heat Stroke - the least common, but most severe heat emergency.
Signals include:
Red, hot, dry skin. Sweating has greatly reduced or has stopped.
Change in level of consciousness (may be disoriented).
Rapid, weak pulse.
Rapid, shallow breathing.
Care for Heat Stroke:
Cool the survivor immediately.  Apply ice or cold packs to the wrist, ankles, groin, armpits, and  neck. These areas are where heat is retained and the arteries are the most shallow.
Ice or cold water baths are a last resort, as they may trigger dangerous heart irregularities. 
Do not apply rubbing (isopropyl) alcohol.
 Environmental Injuries - Cold Related Injuries:
Hypothermia – condition where the body core temperature drops because of a failure to keep warm.
Signals include:    
Shivering- most important indicator regarding the survivor’s condition.
Numbness
A glassy stare
Apathy - loss of hope
Loss of consciousness

 Environmental Injuries - Cold Related Injuries:
NOTE
Even in warm water, hypothermia is a life threatening condition.

  Care for Hypothermia:
Remove any wet clothing and dry survivor.
Gradually re-warm by wrapping in blankets and dry clothing (if available).
Move survivor to a warm place.
Buddy warming may be necessary for survival.
Never rapidly re-warm the survivor, this may trigger dangerous heart irregularities.
 Compressed Air Injuries:
May occur anytime a survivor breathes compressed gases underwater.
Helicopter Emergency Escape Device Systems (HEEDS).
Seat Pan Oxygen.
Self Contained Underwater Breathing Apparatus (SCUBA).
Compressed Air Injuries
                             Air Embolus and    
     Decompression Sickness (DCS or “bends”)

Breathing compressed air underwater causes gases to be absorbed into the blood.
Rapid ascent relieves pressure on the gases, causing them to come out of solution.
Air Embolus and DCS are caused by gas bubbles which expand during ascent. These can either block blood vessels, become trapped within joints, or they may travel between tissues. 

Compressed Air Injuries
Disorientation or personality change.
Dizziness or blurred vision.
Numbness, Tingling, or Paralysis.
Chest pain.
Blood froth from mouth or nose.   
Convulsions.
Coughing or shortness of breath.
Unusual fatigue or weakness.
Skin itch.
Pain in the arms, legs, or torso.
Treatment of Compressed Air Injuries
Both Air Embolus and DCS require urgent recompression.  Transport the survivor to capable facilities ASAP.
While the survivor is awaiting transport, administer CPR/ Rescue Breathing as required.
Keep airway open.  Survivor may vomit.
Keep survivor lying (left side down) and quiet. This position causes bubble(s) to rise away from heart.

Dead-On-Arrivals (DOA’S)
Treat the victim as humanely and gently as possible.  Recovery is necessary for autopsy investigation and proper burial.


Psychiatric Emergencies
A sudden onset of behavioral or emotional responses that, if not responded to, may result in a life-threatening situation.  In almost all cases, First Aid treatment is a calm, professional, understanding demeanor without aggravating the survivor.
Review
State the purpose of First Aid?
Questions…?
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Surface Rescue Swimmer School
Level A Medical Kit LT 5.2
INTRODUCTION
    During this unit of instruction the rescue swimmer will learn about the different components that make up the Level “A” Medical Kit. Being familiar with these devices will help the rescue swimmer expedite the rescue. Furthermore, the rescue swimmer will know where the devices are located to assist in moulage.
Enabling Objectives
List the contents of the Level “A” Medical Kit per NTTP 3-50.1.
State the purpose of each item in the Level “A” medical kit per NTTP 3-50.1.
Level “A” Sar Medical Kit
Level “A” Sar Medical Kit
The Level “A” Medical Kit is designed for all units that maintain SAR capability.
It is made of heavy-gauge nylon with labeled pockets for storage of medical items.  In the stow position it is 22” by 11”, with a length of 52” when fully opened.  It contains five separate pockets.

Level “A” Sar Medical Kit
Inventory IAW NTTP 3-50.1 as  follows:
Medical Kit, Bag and Panel.
Pocket One contains:
Two packets of 5 Band-Aids.
One box of 10 Ammonia Inhalants.
One package of Safety Pins.
One roll of 3”  by 5-yard surgical Adhesive Tape.
Level “A” Sar Medical Kit
   Pocket One contains (cont.):
One, 2”  wide Non-pneumatic tourniquet.
One eye dressing First Aid Kit, containing two eye patches and two tubes of medicated ointment.
One pocket mask, one pair of bandage scissors, and one mini-Maglight.
Level “A” Sar Medical Kit
Pocket Two contains:
Two compression Skull Cap Head Dressings.
Four, 4x7”  First Aid Field Dressings.
Four, 37x37x52”  Muslin Triangular Bandages (Cravats).


Level “A” Sar Medical Kit
Pocket Three contains:
Three, 4”  Cotton Roller Bandages (Kerlix).
Three, 4.5”  x 5-yard Elastic Bandage Gauze (Ace wraps).
Five, 4x4”  Petrolatum Gauze.
Level “A” Sar Medical Kit
Pocket Four contains:
One, 11¾-” square First Aid Field Dressing.
Two Universal (SAM) Splints.
Level “A” Sar Medical Kit
Pocket Five contains:
One Burn-Trauma Dressing sheet, One casualty Blanket, Two USP 0.9% Sodium Chloride Injection (IV) bags.
Cervical Collars - No neck, Short, and Regular.  One biological Hazard Protection Kit.
References
Information relating to the description, configuration, maintenance, and inspection of the Level “A” Medical Kit can be found in the NAVAIR 13-1-6.5, Section 14-23.
Information relating to the development and application of the Level “A” Medical Kit can be found in the NTTP 3-50.1.
Pre-Deployment Equipment:
As an essential part of the pre-deployment equipment check, you should always evaluate the condition and security of your medical equipment.
Verify that the tamper seal (if applicable) on the medical kit has not been broken and inventory the bag as needed.
Surface Rescue Swimmer Course
Secondary Survey LT 5.5
Objective
List the procedures for a secondary survey.
Demonstrate secondary survey procedures in a mock trauma (moulage) scenario without injury to personnel or damage to equipment.
Secondary Survey
The Secondary Survey is to be conducted upon completion of the Primary Survey in a rescue situation, or once the survivor has been transported to the rescue platform.
Examine the survivor from head-to-toe by physically touching the body.  Visually inspect all body surfaces using a Mini Maglight before palpating and squeezing the body part.


Secondary Survey
Remove all of the survivor’s clothing to ensure a thorough assessment.  If needed, cover the survivor with a blanket and expose only the areas necessary to complete the survey yet not chill the survivor.
Rip or cut clothes along a seam to expose injuries.
Secondary Survey
NOTE
    During the Secondary Survey, treat all non life-threatening injuries and burns; and perform splinting as required.

Head
Look for obvious depressions and bleeding around all areas of the head.
Gently feel for lumps and soft spots.
Secondary Survey
Eyes:
Look for foreign matter, unequal pupils, eye movement, and pupillary reaction to the light.
Look for swelling, deformity, and bruising around the eyes (raccoon eyes - indicates a possible base skull fracture).
Ears:
Look for blood or cerebrospinal fluid flowing out.
Look for bruising behind the ears (Battle signs - indicates a possible base skull fracture).
Secondary Survey
Nose
Look for blood, fluid, or airway obstruction.
Look for burned nose hairs.

Mouth
Look for foreign objects.
Amputated tongue or bleeding in the mouth.
Fractured or displace teeth.
Anything that can cause an airway obstruction.
Secondary Survey
Neck
Deviated Trachea or bleeding.

Chest
Starting at the shoulders, look and palpate across shoulders, collarbones, and sternum.
Palpate for any broken ribs in front and in back.
Secondary Survey
Abdomen
Look for obvious bruising and swelling.
Palpate for tenderness or rigidity, unless an obvious injury is present.  If bruising is present, note it and move on.

Pelvis
Gently squeeze hips to check for deformity or fractures.
If a pelvic fracture is suspected and has not been splinted, splint at this point.
Secondary Survey
Arms
Cut and remove clothing.
Look and feel for broken bones, deformity and swelling.
Have the survivor simultaneously squeeze your fingers with both his hands to check for equal strengths and sensations.
Do not check for strengths if a fracture is suspected.
If a splint is required, perform splinting of the extremity as you come to it.
Secondary Survey
Legs
Cut and remove clothing.
Look and feel for broken bones, deformity and swelling.
Have the survivor simultaneously push against your hands (GAS PEDALS) with both feet to check for equal strengths and sensations.
Do not check for strengths if a fracture is suspected.
If a splint is required, perform splinting of the extremity as you come to it.
Secondary Survey
Back
In an in-water rescue situation, if bleeding from the back is identified, log roll the survivor and examine for any abnormalities.  Treat appropriately.
Shock Position
Treat for the worst injury.
Traditional: Use this shock position unless injuries preclude it.
Flat:  Used for head or eye injury; flail chest; internal bleeding (bruising) of the torso, abdomen, or pelvis.
Knee(s) Bent: Used for something going into or coming out of the abdomen.  May utilize one knee bent if a fracture exists in the other leg.
Shock Position
Side down
Left side down:  Used for compressed air injuries and a left side open or closed chest wound.
Right side down:  Used for a right side open or closed chest wound.

Semi-Seated: Medical emergencies such as: heart attack, stroke, or shortness of breath.
Survivor Status Report
Used to inform the Boat/Bridge of the survivor’s condition.  Pertinent information to be passed on to the medical facility should include:
Approximate age
Gender
Level of Consciousness (fully, semi, or unconscious).
Approximate weight
What happened; Victim of a --- (describe the incident)
Helicopter Aircraft Commander (HAC) Report
List of injuries, starting from the head, include cervical collar (if applied), state if CPR or Rescue Breathing was performed, state the injury, bandage applied, and splint used.
Pulse: Initial and others if taken
Shock position
List of any known allergies
Any medication taken
Blood Type (A+, A-, B+, B-, AB+, AB-, O+, O-).
Helicopter Aircraft Commander (HAC) Report
NOTE
If allergies, medications and/or blood type are not known, state that they are “not known.” Do not say “no known.”
Example:  I have a 21 old unconscious male, approximately 175 pounds, victim of a helicopter crash, injuries are as follows..; allergies are (list, if any), patient is on (list medication, if any), Blood type is , breathing is (quality and rate), pulse is (quality and rate), currently in (shock position).

Helicopter Aircraft Commander (HAC) Report
Reassessment
    You should reassess your survivor’s condition every 5 minutes ( at a minimum) until arrival at a treatment facility.

Review
What are the three major points to check during the Secondary Survey?
Review
What indicates a possible base skull fracture?
Review
What is the shock position for a survivor with head injuries, flail chest, or internal bleeding of the torso?
?
Surface Rescue Swimmer Course
Primary Survey LT 5.4
Objectives
List the procedures used in a primary survey.
Demonstrate primary survey procedures used in a mock trauma (moulage) scenario without injury to personnel or damage to equipment.
Primary Survey Procedures:
A head-to-toe examination conducted in one of two rescue situations.  During in-water rescue situations once the survivor is in the rescue platform, and during overland rescues prior to transporting the survivor to the rescue vehicle.
Used to identify all life threatening injuries, which must be treated as they are found.

Arriving on the Scene:
Scene Safety: Upon approaching the scene during an overland SAR, it is imperative that you evaluate the safety of the area in order to protect yourself and your crew.
NOTE
    During in-water rescue scenarios onboard the rescue vehicle, it is understood that the scene is safe.  However, it is necessary to evaluate the scene at all times.

Arriving on the Scene
Body Substance Isolation: Take BSI precautions prior to touching the survivor.
Determine Responsiveness: Attempt verbal communication with the survivor after or during BSI procedures.
Initial Assessment
Check the Airway:
If survivor is conscious and talking to you, check for severe bleeding and begin Primary Survey.
If survivor is unconscious, open the Airway using a “modified jaw thrust.”
Check Breathing: Verify that the survivor is breathing.  If not breathing, give two breaths.  If unable to get the breaths in begin Obstructed Airway procedures.

Initial Assessment
NOTE
If it is necessary to perform abdominal thrusts, expose the abdominal area prior to pressing on the abdomen.

Check Circulation: Verify that the survivor has a pulse.  If no pulse, begin CPR procedures.
Initial Assessment
Check for Severe Bleeding: Take a quick look at the body from head to toe identifying any severe bleeding prior to beginning CPR.

NOTE
    If severe bleeding occurs during chest compressions, it may be necessary to expeditiously bandage a wound in order to continue.

Primary Survey:
Cervical Collar: While maintaining in-line stabilization of the head, sweep the back of the neck checking for blood and/or deformities.  Determine the correct size c-collar needed, verify placement, and secure it.  Once in place, you may let go of the head.
Primary Survey
Life Threatening Injuries:
Quickly look at the head checking for severe bleeding. If no severe bleeding, move directly to the chest.
Expose the survivor’s chest and abdomen. Look for and treat all life-threatening injuries present.
Expose an arm, look for and treat all life-threatening injuries.  Repeat for the other arm.
Follow the same procedures for the legs.
Primary Survey
NOTE
Following the order of assessment, if blood-soaked clothing is identified, expose and treat that extremity first.

Life-Threatening injuries include:
Problems with/ ABC’s
Sucking Chest Wounds
Severe Bleeding
Amputation with Severe Bleeding
Primary Survey
Abdominal Evisceration
Obvious Bruising (internal Bleeding)
Critical Burns
Head, Neck, or Spinal Injury
Heat Stroke
Severe Hypothermia
Psychiatric Emergencies
Severe Shock
Primary Survey
Check Breathing-  Check for equal rise and fall of the chest by resting your hands on the survivor’s chest, in the front and back.  Looking for breathing quality and rate.
Check Circulation- Check pulses at the wrists (radial) and at the feet (dorsalis pedis), looking for equal quality and rate.  Check capillary refill in fingers and toes, looking for circulation return within 2  seconds or less.  Check skin temperature by resting the back of a gloved hand on the survivor’s forehead and/or chest.
NOTE
Do not wipe contaminated gloves on yourself.
Primary Survey
Perform Blood Sweep- Begin by wiping gloves clean or replacing them with a fresh pair.  Starting at the head, sweep under the body and inside the clothing looking for any bleeding you can’t see.  If blood is found, investigate it.
Reassess ABC’s- Verify that survivor is still breathing and has a pulse.
Transport or Continue:
When performing a Primary Survey in an overland situation, once reassessment of the ABC’s has been completed (and ABC’s are adequate), prepare to transport the survivor to the rescue vehicle.  Follow steps for logrolling onto the SAR MEDEVAC litter.
During an in-water rescue, upon completion of the Primary Survey, continue directly into the Secondary Survey.
Rules for Splinting
Splinting is always performed during the Secondary Survey.
When splinting legs, ensure extremities are in-line prior to applying a splint.
Ensure that the joints above and below the injury are immobilized.
If an open wound found or bruising is present, ensure a tie is placed above and below the area.
Tie knots across the top of the splint, not against skin.
Always check capillary refill after splinting.
Identification and Treatment of Injuries:
Open Chest Wounds “Sucking Chest Wound”
Presentation:
Open wound to the chest with a sucking sound during breathing
Bleeding and bubbles coming from the chest
Exit wound may be present
Treatment:
Immediately place a gloved hand over the open wound to create a seal.
Open Chest Wounds “Sucking Chest Wound”
Treatment cont.
Evaluate wound size.  If wound is smaller than a petroleum gauze foil wrapper, use foil to create a one-way valve.  If wound is larger, use plastic from an IV bag cut to size.
Tape on three sides.  Top, bottom, and side closest to middle of the body.

Open Chest Wounds “Sucking Chest Wound”
Treatment cont.
Check for an exit wound.  If an exit wound exists, determine its size. Use a combination occlusive and field dressing placed over exit wound using survivor’s body weight to create a seal.  During an overland SAR, it may be necessary to log roll the survivor to get a clear view of the injury prior to treatment.
Deviated trachea is a sign that the one-way valve is no longer working.


Open Chest Wounds “Sucking Chest Wound”
Treatment cont.
To relieve pressure, peel dressing up using un-taped side and “burp it”.  May hear a rush of air as pressure is relieved.
Lay survivor injured side down if feasible.

Closed Chest Wounds
Presentation:
Difficulty breathing
Deviated Trachea

Treatment:
Place the survivor in an injured side down shock position.  Shock position is the only treatment
Flail Chest:
Presentation
Difficulty breathing
Section of the rib cage moving opposite of normal breathing (This is not unequal breathing).
Bruising to the chest area.
Flail Chest
Treatment
Place a saline bag over the affected area taping the top and bottom of the bag to the chest.  May use cravats if needed, but ensure that they’re not too tight as to further hinder breathing.
Check for other broken ribs before placing tape.
May use a rolled up burn sheet
Amputations
Presentation
Severely torn or missing limb.
May have severe bleeding present.
Limb may be fractured
Treatment
Control Bleeding First: Apply direct pressure with a field dressing and tightly wrap with an ACE bandage.
Splint the amputated end during the Secondary Survey.  Using a SAM splint, wrap around the end of the amputation in a “U shape” and secure it with at least two ties.
Open Fractures
Presentation
Visible bone and/or fragments with an open wound.
Bleeding can be mild to severe.
Treatment
Control Bleeding First:  Place donut-shaped gauze bandage around the exposed bone and cover with a field dressing.
If it’s necessary to move an arm to control bleeding from an “open hand fracture”, visualize and palpate for other injuries before moving it.
Open Fractures
Treatment cont.
Ensure the dressing is snug and tied on the side.  Do not cross dressing ties over the wound. This will apply unwanted pressure on the exposed bones.
Splint fractures during the Secondary Survey.
For fractures of the lower arms, use a SAM splint underneath the arm (palm side) with hand in the neutral position.  Secure with at least three ties with wrist and elbow immobilized.
Open Fractures
Treatment cont.
For fractures of the upper arms, use a SAM splint across the outer aspect of the arm and secure with at least two ties.  Utilize a sling and swath (swath at a minimum).  Ensure the swath is not too tight as to hinder breathing.
To splint fractures of the hands, wrap roller gauze around the hand and wrist, to create a bulky soft splint.  Avoid covering fingertips.
Open Fractures
Treatment cont
For upper leg fractures, use a SAM splint across the side of the leg above the hip to below the ankle.  Secure with at least five ties.  Ensure the leg is placed in-line prior to splinting and that the hip, knee, and ankle are immobilized.
For lower leg fractures, use a SAM splint across the side of the leg above the knee to below the foot.  Secure with at least four ties.

Closed Fractures
Presentation
Bruising or deformity may be visible.
Treatment:
If bruising is present, assume a bone is broken and treat as a fracture.
Some bruising may be difficult to see.  A thorough Secondary Survey must be performed to identify all injuries.
Splint during Secondary Survey.
Abdominal Evisceration
Presentation
Open abdominal wound with internal organs visibly exposed and/or spilling out.
Treatment
Soak large field dressing with Normal Saline.
Place the large field dressing under exposed organs and fold over the organs, covering all wound areas.
Tie on the side, ensuring no pressure is placed directly on exposed organs.
Pelvic Fractures
Presentation
Instability or grinding feeling when pressing in against the hips.
Grinding sounds accompanying pressing in against the pelvis.
Survivor may feel like they’re coming apart and survivor may be in extreme pain.
Bruising to the abdominal and/or pelvic region may be present.
Pelvic Fractures
Treatment
Fold burn sheet and place it inside of the trauma sheet to fill space between the legs.
Place a Triangular Bandage across the hips, two on the upper legs and two on the lower legs (applying cravats at the hips, then applying them from the feet up.)
NOTE
During overland SAR, the pelvis shall be checked and, if necessary, treated prior to logrolling the survivor onto the litter.
Penetrating Puncture Wounds
Presentation
Foreign object protruding from any area of the body.
Treatment
Secure object with Roller Gauze on each side of the penetrating object.
Cut a hole in the middle of a field dressing large enough for the object to fit through and apply field dressing.  Tie on the side to avoid direct pressure.
Ensure object is secure and visible to personnel to prevent further penetration.
Puncture Wounds
Presentation
Puncture wound to any area of the body

Treatment
Place a field dressing on wound and tie over the top of the wound.
Check for an exit wound.
Eye Avulsion
Presentation
Eye missing or protruding from the socket
Treatment
If eye is missing, cover affected side with a field dressing.  Always cover both eyes to minimize movement due to sympathetic oculomotor function.
If eye is protruding from the socket, soak Roller Gauze with Normal Saline.  Apply Roller Gauze to each side of the eye and cover both eyes with a field dressing.
Ensure dressing is snug and tied on the side.
Simple Rib Fractures
Presentation
Complaining of difficulty breathing
Bruising, tenderness, or pain (guarding) to affected area.

Treatment
Sling and swath the arm of injured side, if no injuries to the arm are present.
 Severe Burns
Presentation
Signs of second and third degree burns (blisters and/or charred skin) to any area of the body.
If burns to the chest are present, check for singed nose hairs indicating an inhalation injury.

Treatment
Cover burned areas with a burn sheet cut to size, one sheet thick.  Secure loosely with safety pins.
Lightly palpate burned areas for broken bones during Secondary Survey.
 Severe Burns

NOTE
Any sterile dressing that touches the deck or becomes contaminated, is considered useless and SHALL NOT be used.
Review
First thing you do when arriving on the scene?

?
Review
The Level “A” Medical Kit contains how many pockets?
?
Surface Rescue Swimmer Course
Secondary Survey LT 5.5
Objective
List the procedures for a secondary survey.
Demonstrate secondary survey procedures in a mock trauma (moulage) scenario without injury to personnel or damage to equipment.
Secondary Survey
The Secondary Survey is to be conducted upon completion of the Primary Survey in a rescue situation, or once the survivor has been transported to the rescue platform.
Examine the survivor from head-to-toe by physically touching the body.  Visually inspect all body surfaces using a Mini Maglight before palpating and squeezing the body part.


Secondary Survey
Remove all of the survivor’s clothing to ensure a thorough assessment.  If needed, cover the survivor with a blanket and expose only the areas necessary to complete the survey yet not chill the survivor.
Rip or cut clothes along a seam to expose injuries.
Secondary Survey
NOTE
    During the Secondary Survey, treat all non life-threatening injuries and burns; and perform splinting as required.

Head
Look for obvious depressions and bleeding around all areas of the head.
Gently feel for lumps and soft spots.
Secondary Survey
Eyes:
Look for foreign matter, unequal pupils, eye movement, and pupillary reaction to the light.
Look for swelling, deformity, and bruising around the eyes (raccoon eyes - indicates a possible base skull fracture).
Ears:
Look for blood or cerebrospinal fluid flowing out.
Look for bruising behind the ears (Battle signs - indicates a possible base skull fracture).
Secondary Survey
Nose
Look for blood, fluid, or airway obstruction.
Look for burned nose hairs.

Mouth
Look for foreign objects.
Amputated tongue or bleeding in the mouth.
Fractured or displace teeth.
Anything that can cause an airway obstruction.
Secondary Survey
Neck
Deviated Trachea or bleeding.

Chest
Starting at the shoulders, look and palpate across shoulders, collarbones, and sternum.
Palpate for any broken ribs in front and in back.
Secondary Survey
Abdomen
Look for obvious bruising and swelling.
Palpate for tenderness or rigidity, unless an obvious injury is present.  If bruising is present, note it and move on.

Pelvis
Gently squeeze hips to check for deformity or fractures.
If a pelvic fracture is suspected and has not been splinted, splint at this point.
Secondary Survey
Arms
Cut and remove clothing.
Look and feel for broken bones, deformity and swelling.
Have the survivor simultaneously squeeze your fingers with both his hands to check for equal strengths and sensations.
Do not check for strengths if a fracture is suspected.
If a splint is required, perform splinting of the extremity as you come to it.
Secondary Survey
Legs
Cut and remove clothing.
Look and feel for broken bones, deformity and swelling.
Have the survivor simultaneously push against your hands (GAS PEDALS) with both feet to check for equal strengths and sensations.
Do not check for strengths if a fracture is suspected.
If a splint is required, perform splinting of the extremity as you come to it.
Secondary Survey
Back
In an in-water rescue situation, if bleeding from the back is identified, log roll the survivor and examine for any abnormalities.  Treat appropriately.
Shock Position
Treat for the worst injury.
Traditional: Use this shock position unless injuries preclude it.
Flat:  Used for head or eye injury; flail chest; internal bleeding (bruising) of the torso, abdomen, or pelvis.
Knee(s) Bent: Used for something going into or coming out of the abdomen.  May utilize one knee bent if a fracture exists in the other leg.
Shock Position
Side down
Left side down:  Used for compressed air injuries and a left side open or closed chest wound.
Right side down:  Used for a right side open or closed chest wound.

Semi-Seated: Medical emergencies such as: heart attack, stroke, or shortness of breath.
Survivor Status Report
Used to inform the Boat/Bridge of the survivor’s condition.  Pertinent information to be passed on to the medical facility should include:
Approximate age
Gender
Level of Consciousness (fully, semi, or unconscious).
Approximate weight
What happened; Victim of a --- (describe the incident)
Helicopter Aircraft Commander (HAC) Report
List of injuries, starting from the head, include cervical collar (if applied), state if CPR or Rescue Breathing was performed, state the injury, bandage applied, and splint used.
Pulse: Initial and others if taken
Shock position
List of any known allergies
Any medication taken
Blood Type (A+, A-, B+, B-, AB+, AB-, O+, O-).
Helicopter Aircraft Commander (HAC) Report
NOTE
If allergies, medications and/or blood type are not known, state that they are “not known.” Do not say “no known.”
Example:  I have a 21 old unconscious male, approximately 175 pounds, victim of a helicopter crash, injuries are as follows..; allergies are (list, if any), patient is on (list medication, if any), Blood type is , breathing is (quality and rate), pulse is (quality and rate), currently in (shock position).

Helicopter Aircraft Commander (HAC) Report
Reassessment
    You should reassess your survivor’s condition every 5 minutes ( at a minimum) until arrival at a treatment facility.

Review
What are the three major points to check during the Secondary Survey?
Review
What indicates a possible base skull fracture?
Review
What is the shock position for a survivor with head injuries, flail chest, or internal bleeding of the torso?
?
Rescue Swimmer Refresher Course
Overview/Course Introduction
LT 1.1
Enabling Objectives
Identify the OPNAVINST 3130.6 series requirements for RSS training.
Identify the NWP 3-50.1 series as it applies to RSS training.
Identify and adhere to all safety precautions used during training.
State the DOR/TTO policies and procedures.
Course Overview
Applicability:
    The Rescue Swimmer Refresher Course is designed for individuals who have graduated from Rescue Swimmer School and are reporting to a rescue swimmer billet from a non-swimmer billet.
Course Overview (cont.)

Goals:
Students in the course will receive refresher training in Rescue Swimmer procedures and will learn of recent developments in equipment and procedures
Course Overview (cont.)


Evaluation:
Students must demonstrate correct Rescue Swimmer procedures during lab evaluations and demonstrate adequate physical fitness for Rescue Swimmer duties.
Requirements and Restrictions

Taken directly from the current OPNAVINST’s 3710.7 and 3130.6.  Type Commanders may direct more stringent requirements and restrictions for their personnel.
Refresher training (CAT II) is for previously qualified rescue swimmers for a period of one year or more.  This two-week course will familiarize the student with new or updated procedures and equipment.  Re-qualification in CPR for the Professional Rescuer will be included.
Requirements and Restrictions (cont.)
Following participation in Rescue Swimmer training, entries shall be made in the appropriate training jacket.
The NWP 3-50.1 is the Naval Search and Rescue Manual.  It promotes and maintains standardization of SAR procedures, equipment, and techniques.  Course content is mandated by this manual and should be used in conjunction with student guide.
Drop On Request / Training Time Out Policy
Drop on Request (DOR) Policy:

All RSSTP courses are designated as high-risk training and are voluntary.  Accordingly, students have the option to individually request termination of training.

Drop On Request / Training Time Out Policy
Drop on Request (DOR) Policy:
         In all cases where a student states a desire to DOR from voluntary training based on concern for personal well-being, appropriate action shall be initiated, including removal from training, referral of the student for medical, counseling or remedial action as appropriate, and review of the training environment, including training techniques. The  scope and depth of these actions shall be determined by the nature of the complaint and the risk incurred in the training. A written summary of actions taken shall be made a permanent entry to the student’s service record. In no case shall a student be coerced or threatened to induce  him or her to return to training following a DOR.

Drop On Request / Training Time Out Policy
Training Time Out (TTO) Policy:

 A TTO may be called in any training situation whenever a student or instructor expresses concern for personal safety or a need for clarification of procedures or requirements exists.



Drop On Request / Training Time Out Policy
Training Time Out (TTO) Policy:

          A Training Time Out (TTO) may be called by any student or instructor in any training situation where they are concerned for their own or another’s safety, or they request clarification of procedures or requirements. TTO is also an appropriate means for a student to obtain relief if he or she is experiencing pain, heat stress, or other serious physical discomfort. The  purpose of the TTO is to correct the situation of concern, provide clarifying information, or remove the student or instructor from the possible hazardous environment.  A TTO may be signaled with the abbreviation TTO, the words Training Time Out, crossed hands in a (T), a raised clenched fist, or other specific signals which will be briefed prior to a specific lab, test, or exercise. If the TTO signal is not acknowledged, the signaler shall shout “Time Out” (or other action as required by the training activity). The instructor shall attempt to relieve and remove the student from the possible hazardous environment. If an adequate number of instructors are available to allow training to continue safely, the lead instructor may elect to do so. However, if this is not practical, training will be stopped until the situation is corrected.


Course Overview (cont.)
Administrative Procedures and Regulations:

Purpose of Student Screening forms, student critiques, and “medical up-chits.”
In-water screening/testing, and remedial training.
No alcohol consumption in the 12 hours prior to training.
Security precautions available for personal valuables.
Course Overview (cont.)
Safety Precautions:
Inform students of any known hazardous conditions that exist in the training environment, and of their responsibility to report any unsafe/unhealthy condition they may discover to the training staff.
Inform students of the location of emergency equipment, fire exits, and the local procedures used in the event of a fire or other emergencies.
Course Overview (cont.)
Mishap/Near-Miss/Unsafe Condition Reporting Procedures:
A mishap is any unplanned or unexpected event causing personnel injury, occupational illness, death, material loss or damage, or an explosion of any kind whether damage occurs or not.
A hazardous condition is any situation which if allowed to go unchecked or uncorrected has the potential to cause a mishap.


Course Overview (cont.)
Mishap/Near-Miss/Unsafe Condition Reporting Procedures (cont.):
A near-miss is when a mishap is avoided merely by chance.
It is the responsibility of all Department of Defense personnel to report all mishaps, near misses, and any unsafe or unhealthy (hazardous) condition (s). If a mishap, hazardous condition or near miss occurs the student shall inform the instructor immediately. OPNAV 5100/11 with instructions is available for formal reporting.

Summary
CAT II is designed for a previously qualified Rescue Swimmer who has not performed the duties of a swimmer for what period of time?
One year or more.
Saying “I quit” will result in removal from training.  True or False?
True, the student would be treated as a DOR and referred to the Division Officer.
?
Rescue Swimmer Refresher Course
Pool Safety Regulations LT 1.2
Enabling Objective
State the general pool safety regulations.
General Pool Safety Regulations
No person with any skin fungus, open sores, or contagious disease is allowed in the pool without consent of the SAR Corpsman.
No running or skylarking.
Glass containers are not allowed on the pool deck or locker room at anytime.
Prior to entering the pool, all personnel shall take a shower.
Students will wear UDT swim trunks, T-shirt (optional), and either shorty wet suit or wet suit top during pool evolutions.  Additionally, an LPU-28 will be worn during mask, fin, and snorkel training.
No smoking except in designated areas.

General Pool Safety Regulations (cont.)
Whistle blasts:
One whistle blast - Instructor is seeking student’s attention.
Multiple whistle blasts – Emergency.  Follow instructions of staff.
No jewelry ( i.e., rings, chains, etc.).
No diving unless specifically told.
Take off fins before standing or walking on the pool deck.
Ensure all pool drain covers are installed prior to commencing any disentanglement training.
If parachute is to be used for night time evolutions, the apex shall be marked with a chemlight.

General Pool Safety Regulations (cont.)
Students shall wear an activated chemlight attached to their swim mask whenever they are in the pool in a night time evolution.  If available, student chemlights should be different in color from other chemlights being used for lighting other devices.
If different color lighting devices are being used, ensure this is briefed prior to start of night time evolutions.
Students shall use ear wash after all swimming events.
Emergency Situations
Anytime you are in trouble, yell for help.
If a person is in actual danger the instructor only will enter the water to render assistance.
If you see anyone in trouble inform an instructor immediately.
Shallow Water Blackout
WARNING:
        Do not hyperventilate prior to underwater swims.  Hyperventilation  can lead to shallow water blackout.

Hyperventilation (excessively rapid breathing) purges the blood of CO2, the body’s cue to breath.
Swimmer runs out of oxygen without ever feeling the need to breathe, passes out and drowns.
Shallow water blackout (passing out under water) can cause death.
Hyperventilation is strictly prohibited.
Review
If you hear multiple whistle blasts you should run to the bleachers. True or False?
False, you should walk to the designated muster area.
What does one whistle blast mean?
Instructor is seeking student’s attention.
What causes shallow water blackout?
Hyperventilation


?
Rescue Swimmer Refresher Course
   Practical First Aid Training/Mock Trauma
LT 2.2        

Enabling Objectives
Respond to an emergency per current American Red Cross standards.
Administer CPR per current American Red Cross standards.
Administer Standard First Aid per NAVEDTRA 12081 standards.
Administer Practical First Aid in a mock trauma (moulage) scenario.
First Aid
Purpose of first aid for Rescue Swimmers:
Save life.
Prevent further injury.
Preserve resistance and vitality.       (prevent infection and treat for shock)
First Aid (cont.)
Basic principles which further the purposes of
First Aid:
Act quickly, but effectively.
Reassure the survivor in a calm manner.
Reveal only enough of the survivor’s injuries to ensure cooperation.
Don’t talk to others of the survivor’s injuries while the survivor is in hearing range.
If survivor is in danger of further injury, remove them from the danger as quickly and smoothly as possible.
Basic Order of Treatment
If survivor is in the water and not breathing, give two full breaths.
If survivor is unconscious or has ejected,always treat as a possible head, neck, and/or back injury.  The spine shall be stabilized prior to moving the survivor whenever circumstances permit.

NOTE
 As a SAR swimmer, your primary objective is to get the survivor into the rescue platform before attempting                                        an advanced first aid.

Advanced first aid begins once the survivor is in the rescue vehicle.

Basic Order of Treatment (cont.)
Conduct primary survey
Establish a working airway, breathing and circulation.
Stop severe bleeding.
Place cervical collar on the survivor if spinal injury is suspected.
Conduct secondary survey
Primary Survey  Hemorrhage Control
During Primary Survey procedures, hemorrhage control is performed by the following five methods:
Direct pressure
Elevation (contraindicated with a known/suspected fracture)
Bandage (followed by second bandage as necessary)
Pressure points
Tourniquet (used as a last resort!)

WARNING
     When practicing on a simulated survivor, do not
                           tighten tourniquet.

Applying a Tourniquet
When you use a tourniquet, you risk sacrifice of a limb in order to save a life.
Tourniquets are only placed on the extremities (arms and legs).  They are normally placed 1 to 1.5 inches above the wound.
Write down the time and location of tourniquet, place on front of survivor’s shirt.
Write a capital “T” on the survivor’s forehead.
Leave the tourniquet visible.
Never use string or wire or thin materials.  Use a ready-made or improvised material at least one inch wide.
Tighten only enough to stop the bleeding.
Never loosen unless advised by a physician.
Secondary Survey
During the secondary survey, examine the survivor from head to toe and treat for further injuries that are found.
Remove only enough of the survivor’s clothing to ensure a thorough survey, yet not chill the survivor.
Rip or cut clothes along a seam to expose injury.
The treatment of secondary injuries and illness is a combination of first aid and common sense.
The basic order of treatment can vary depending on the situation and injuries.
If survivor is having trouble breathing, place the survivor in a comfortable position (semi-seated) which allows treatment to occur without worsening injuries.  If this position worsens injuries, but the survivor can breathe okay until treated, treat injuries first.

NOTE
 Place in semi-seated position only if neck and/or back injuries are                                        not suspected. 


Wounds & Treatment Procedures
Facial and Scalp Wounds
Ensure that the tongue, injured soft tissue, or other material, do not obstruct the airway.
Position the survivor so that blood will drain out of the mouth and nose.
Remember that facial wounds, as well as scalp wounds, bleed freely.  Do not let that scare you and keep you from properly treating the survivor.
Open Fractures
An open fracture is a broken bone with an open wound.
Treat the wound first.  Most bleeding can be stopped by applying direct pressure on the wound or by applying digital pressure at the appropriate pressure point.
Dress the wound. 
Do not attempt to set a broken bone.


Wounds & Treatment Procedures (cont.)
Once the survivor is aboard the rescue platform, the medical equipment available to the rescue swimmer is the Level “A” medical kit.  Nomenclature and quantity is described in the NWP 3-50.1 manual.
Keep the rescue vehicle commander informed of survivor’s condition to include the following pertinent information:
Age (approximate)
Sex
Blood type, allergies, and medications (if known)
State all injuries

Treating Shock
Most survivors will be in shock.

                    WARNING
  In a water rescue situation, the survivor may be placed in a litter and hoisted horizontally to prevent the effects of hydrostatic squeeze.

Hydrostatic Squeeze is caused by the relief of outside water pressure against the body.
Removal from water has similar effect as shock or near shock, and causes a pooling of blood in the extremities increasing shock.
Treating Shock (cont.)
Position the survivor for transport in the rescue vehicle in one of the following five positions:
Traditional Shock Position – feet elevated above the level of the heart.  Use this position unless survivor’s injuries indicate the use of another position.
Flat on Back Shock Position – use when serious head and/or spinal injuries suspected.  Position survivor on their back, keeping the body as straight as possible.  Maintain in-line stabilization of the head and neck.
Treating Shock (cont.)
Semi-Seated Shock Position – used for survivor with difficulty breathing, or with superficial head, neck, or chest injuries.  Not to be used if head, neck, or spinal injuries are suspected.
Knee’s Flexed Shock Position – used for survivor with abdominal injuries.  Lie survivor on their back and raise their knees to approximately 45 degrees.  This will ease tension on the abdominal muscles.
Side shock Position – used for survivor with nausea and vomiting, bleeding from the mouth, large amounts of oral secretions, or an open (sucking) chest wound.  With a sucking chest wound, place survivor injured side down.
Underwater Injuries
May occur any time a survivor breathes compressed gases underwater.
Helicopter Emergency Egress Device Systems (HEEDS)
Seat pan oxygen
Self-Contained Underwater Breathing Apparatus (SCUBA)
Two life threatening conditions may occur:
Air Embolism
Decompression Sickness (the Bends)

Underwater Injuries (cont.)
Signs and Symptoms:
Air Embolism
Dizziness
Blurred vision
Chest pain
Disorientation
Personality change
Paralysis or weakness
Bloody froth from the mouth or nose
Convulsions
Decompression Sickness
Unusual fatigue or weakness
Skin itch
Pain in the arms, legs, and/or torso
Dizziness
Coughing and/or shortness of breath
Numbness, tingling, or paralysis

Underwater Injuries (cont.)
Treatment:
Both Air Embolism and Decompression Sickness require urgent recompression.
Administer CPR as required.
Keep the airway open as survivor may vomit.
Keep survivor lying down (left side down) and quiet.  Embolism bubble will rise away from the heart in this position.
Underwater Injuries (cont.)
Transportation:
Unpressurized aircraft fly at lowest safe altitude and limit altitude changes.
Ensure rescue vehicle commander contacts hyperbaric chamber before arrival of the survivor.
Keep rescue vehicle commander informed of the survivor’s condition.
Review
What are the five steps in controlling hemorrhage?
Direct Pressure, Elevation, Bandage, Pressure Points, and Tourniquet
What should never be done to a fractured extremity?
Never attempt to set a broken bone
Which shock position is used unless injuries indicate otherwise?
Traditional Shock Position
What are the two types of underwater injuries?
Air Embolism and Decompression Sickness
?
Rescue Swimmer Refresher Course
Enabling Objectives
Demonstrate the proper methods of communication between the rescue swimmer and the rescue platform per NWP 3-50.1:
Hand Signals
Radio Communication
Demonstrate the functional operation of the following Rescue Devices per NWP 3-50.1:
Double Rescue Hook
Modified Rescue Strop
Rescue Net
Rescue Litter/ SAR MEDEVAC Litter, Trail Line and Gloves
Rescue Seat

Enabling Objectives (cont.)
Place a victim into the following rescue devices in a water environment:
Double Rescue Hook
Modified Rescue Strop
Rescue Net
Rescue Litter/ SAR MEDEVAC Litter
Rescue Seat

Communication Procedures
Efficient communications keeps pilot, hoist operator, and swimmer aware of a developing rescue situation and allows rescue platform to provide needed support to swimmer  (i.e., deployment of rescue devices).
Hand signals are used whenever radio communications are not possible.
Primary means of communication between rescue swimmer and the aircraft in a maritime environment.
All crewmembers must be familiar with the meaning of standard hand signals
The radio offers an optimal means of communications.
Hand Signals


I am all right -    Raised arm, open hand, fingers extended.
Hand Signals


Move in for pickup - Raised arm, thumb up.
Hand Signals


In trouble, need assistance - Vigorous waving of one arm.
Hand Signals

Deploy Raft -Clenched fists, arms crossed overhead.
Hand Signals


Deploy Radio -
    Hand held to ear.
Hand Signals
Deploy Pneumatic Webbing Cutter - Clenched fist, arm pumping motion
Hand Signals
Deploy Rescue Litter - One arm raised with open palm, fingers extended over the swimmer’s head and touching the first arm at the elbow.
Hand Signals
Deploy Rescue Net - Both arms raised, palms open, fingers extended at a 45 degree angle to the swimmer’s head.
Hand Signals


Rescue Seat - Both arms out stretched palms up.
Hand Signals
Deploy oxygen/suction unit -
    One palm cupped over mouth and nose, clenched fist in front.
Hand Signals
Deploy medical kit - Both arms raised, palms overlapping and touching top of head.
Hand Signals
Ready to be hoisted - Raised arm, thumb up
Hand Signals


Stop Hoisting - Raised arm, clenched fist
Hand Signals


Lower Cable -  Raised arm, thumb down.
Hand Signals
Failed Hoist - Clenched fist over clenched fist followed by a thumbs down by hoist operator
Hand Signals (Night)


I’m all right - Swimmer’s lighting device (chemlight) on, raised arm, palm open, fingers extended. 
Hand Signals (Night)
Move in for pick-up - Wave chemlight.
Hand Signals (Night)


In trouble, need assistance -
    Wave signal device (smoke flare).
Hand Signals (Night)


In trouble need assistance -
    Blue strobe on.
Double Rescue Hook
The Double Rescue Hook is the primary rescue device.
All other rescue devices can only be used with the Double Rescue Hook.

Load Ratings for the Double Rescue Hook IAW NAVAIR 13-1-6.5.
Large hook,  rated @ 3000 lbs., shall be the only hook used to hoist personnel.
Small hook,  rated @ 1000 lbs., is to be used only for lightweight items such as mail.
The equipment ring,  rated @ 1500 lbs.,  can be used to hoist light equipment and mail.
 Double Rescue Hook
Night time illumination
Attach chemlight strap to equipment ring and attach two chemlights to strap.
     Procedures for Helo-Deployed                         Rescue Hook
  WARNING
Never touch any rescue device before it is grounded on deck or by water entry,  doing so may cause electrical shock.  Helicopter rotors can build up a significant static electrical charge.

When connecting to a survivor who has an SV-2 vest, ensure that the chest strap on the survivor is loosened slightly to avoid injury to the survivor.
Procedures for Hoisting Survivor and Swimmer Simultaneously
If swimmer and survivor are to be hooked to the Double Rescue Hook and hoisted simultaneously:
Signal ready for pickup
Allow hook to ground
Hook up survivor
Hook up swimmer
Perform safety check
Signal for “up-hoist”

Procedures for Hoisting Survivor and Swimmer Simultaneously
If survivor is to be attached to the gated “D”-ring of the swimmer’s harness, and both swimmer and survivor are hoisted by the swimmer’s “V”-ring:
Attach survivor’s gated “D” / “V”-ring to swimmer’s
    “D”-ring.
Signal ready for pickup
Allow hook to ground
Hook up survivor
Hook up swimmer’s “V”-ring to large hook of Double Rescue Hook.
Perform safety check
Signal for “up-hoist”

Procedures for Hoisting Survivor and Swimmer Simultaneously
Modified Rescue Strop
Optional rescue device used with Double Rescue Hook.  The Modified Rescue Strop is a buoyant device with a red waterproof cordura cover over foam which is designed to accommodate one survivor.
Modified Rescue Strop
A webbing strap runs through the cover and has a “V”-ring at both ends for attaching the Double Rescue Hook.                                  Two arm retainer                                        straps are attached                                             to the Modified                                            Rescue Strop to hold                                            survivor in the strop.                                                  

Modified Rescue Strop
Night time illumination:
Two chemlights are attached to the strap.  Strap is attached to  Rescue Strop lower “V”-ring by the crewman.
Procedures for the Modified Rescue Strop
Signal for pickup.
Allow rescue device to touch water.
Approach hoist with survivor in an appropriate carry.
Working behind the survivor,  pass Modified Rescue Strop free end under survivor’s one arm, around the back, under other arm, making sure that the arm retainer straps are placed outboard.  Connect Modified Rescue Strop free end lifting “V”-ring to the large hook on Double Rescue Hook.
 Procedures for the Modified Rescue Strop
                   NOTE
Arm retainer straps shall be outboard when placing the Modified Rescue Strop on the survivor.

Assure strop is positioned tightly under survivor’s armpits and positioned on upper half of survivor’s back.
Procedures for the Modified Rescue Strop
WARNING
   Arm retainer straps shall always be used when hoisting with the rescue strop.  This prevents the survivor’s arms from raising and the survivor from slipping out of the rescue strop.
Procedures for the Modified Rescue Strop
Connect the arm retainer strap by passing the arm retainer straps over the survivor’s arms,  route under the Modified Rescue Strop and across the survivor’s chest.

WARNING
Arm retainer straps shall be routed under the Modified Rescue Strop after they are passed over the survivor’s arm.

Procedures for the Modified Rescue Strop
Connect the snap-hook arm retainer strap to the “V”-ring arm retainer strap.
Pull webbing on the “V”-ring arm retainer strap until the arm retainer straps are secured tightly around the survivor’s arms.

WARNING
The possibility exists for an unconscious or physically incapacitated survivor to slip through the Rescue Strop if their arms are not secured at the side with the arm retainer straps.
Procedures for the Modified Rescue Strop

If swimmer is to be hoisted,  attach swimmer’s “V”-ring to the large hook   of the Double Rescue Hook.
Perform safety check.
Signal for “up-hoist”.
Procedures for the Modified Rescue Strop
The rescue swimmer may use his feet to stabilize entry of a conscious survivor into the aircraft, but shall not release the survivor’s arms until:
The survivor is securely on the aircraft deck.
The hoist operator signals that they have positive control of the survivor within the aircraft.
 Rescue Net
Conically-Shaped Bird Cage.
Primarily used for multiple rescues.
Never send  unconscious victim up alone in Rescue Net.
A “V”-strap is provided for securing the net in the rescue vehicle.

Rescue Net
                    WARNING
   In order to utilize the net,  the front support rods must be locked in placed to prevent the net from collapsing on the survivors.  Collapsing of the net could result in the survivor(s) drowning.
Rescue Net
Night time illumination:
Two chemlights are attached to the strap.  Chemlight straps are attached to nylon rope just above the middle frame flotation on both sides of the net opening.
Rescue Net Procedures
Signal for net.
Allow device to ground.
Place Rescue Net opening directly in front of the Rescue Swimmer without disconnecting it from rescue hook.
Place survivor in a collar/equipment tow and swim into rescue net backwards while positioning the survivor on either side of the net facing out.
Ensure that survivors body is entirely in the net.

Rescue Net Procedures
WARNING
   Survivor shall not attempt to get out of the rescue net until directed by the crewman.

Place one arm across the net.
Signal for “up-hoist”.
When net reaches the helicopter, crewman shall hook up safety strap from the Rescue Net to the decking of the helicopter.  The crewman shall assist the survivor inside the helicopter.
Rescue Net Procedures
V-Strap attachment to aircraft:
Rescue Litter / SAR MEDEVAC Litter
Litter Characteristics:
Both are for use with suspected back injury  victims and unconscious survivors.

WARNING
An aircrewman who has ejected and/or is unconscious may potentially have a spinal injury, assess the situation and treat accordingly.  Loss of ABC’s or other life threatening injuries will take precedence over a spinal injury.

Both are designed to be used over land or in water with flotation assemblies.
Rescue Litter requires a flotation kit for over water use.  When flotation is installed,  litter floats with patients head slightly reclined from vertical.
Rescue Litter / SAR MEDEVAC Litter
Rescue Litter / SAR MEDEVAC Litter
1. Adjustable Carrying Harness (2 ea.)
2. Vertical Hoisting Sling
3. Foot Restraint Assembly
4. Locking Couplers
5. Lumbar Support Pad
6. Head Restraint
7. Hoisting Connecting Cable
8. Patient Straps
9. Patient in Litter
10. Chest Flotation
 Rescue Litter / SAR MEDEVAC Litter
WARNING
   If survivor is wearing the bright orange Quick Donning Anti-Exposure Suit,  it may counteract the self-righting feature of the Rescue Litter and the SAR MEDEVAC Litter.
Rescue Litter / SAR MEDEVAC Litter
Both have a two piece Rescue Litter Hoisting Sling which  attached to the Double Rescue Hook.  Sling is color coded short red to head and long white to feet.
The SAR MEDEVAC Litter folds in half and can be stored in a backpack and weighs approximately 40 lbs.  It can be hoisted vertically or horizontally with its own sling,  making it especially useful in mountainous and restricted access situations.  It has replaced the Neil Robertson Litter for use on submarines, and is an alternative to the Rescue Litter.

SAR MEDEVAC Litter
Rescue Litter / SAR MEDEVAC Litter
Night time illumination:
Two chemlights are attached to each strap.  One strap is attached to the head of the litter,  one to the foot.
Both litters utilize a “trail line” controlled by the swimmer in the water to control litter deployment and stabilize the litter during hoisting.
Trail Line Assembly
One hundred and twenty (120’) feet in length.
Three eighths inch thick polyethylene,  diamond braided rope.
A weak link for breakaway capability.
Gloves and line are deployed together via a 5 pound shot bag.

Securing the Survivor to the Rescue Litter
Rescue Litter has five restraint straps.  They are stowed with four retaining straps.
Procedure for securing survivor:
Position survivor in litter.
Place the top restraint strap under the arms but over the chest and attach to the fitting on the left side.
Next, working from the chest strap down, secure the rest of the restraint straps.
Once the restraint straps are secured, attach the chest pad over the survivor’s arms. The rescue swimmer may encounter some difficulty if survivor has flotation.  However, flotation is not be removed or deflated.  Instead, remove chest pad from litter and continue with rescue.  If practical, swimmer will return chest pad back to helicopter when hoisted.



Securing the Survivor to the Rescue Litter


 Securing the Survivor to the  SAR MEDEVAC Litter
Litter will need to be assembled by hoist operator prior to lowering to swimmer.
Litter has integral cervical collar and head restraint,  four patient restraint straps, one chest flotation pad assembly strap, and one foot restraint assembly.
Securing the Survivor to the   SAR MEDEVAC Litter
Procedure for securing survivor:
Position survivor in litter.
Placed the top restraint strap under the arms but over the chest and attach to the fitting on the left side.
Next, working from the chest strap down, secure the rest of the restraint straps.
Once the restraint straps are secured, attach the chest pad over survivor’s arms.  The rescue swimmer may encounter some difficulty if survivor has flotation.  Flotation shall not be removed.  Instead, remove chest pad from litter and continue with rescue.  If practical, swimmer will return chest pad back to helicopter when hoisted.
Properly adjust foot restraint assembly.
Secure head restraint assembly if possible. Do not remove survivor’s helmet if neck or back injury is suspected.

General Litter Procedures


Signal for litter -  Trail line will come out first.
General Litter Procedures

WARNING
   The weight bag shall be deployed so as not to strike Rescue Swimmer or survivor.


The hoist operator shall                                            deploy the trail line ensuring                                            that it is attached to the                                                 litter. The gloves shall be                                                         tied on by a slip knot                                                               located just above the                                                         weight bag.

General Litter Procedures

                           WARNING
   The rescue swimmer shall wear trail line or authorized rescue swimmer gloves with leather palms in order to prevent rope burns to the hands.
General Litter Procedures
Rescue Swimmer shall wear trail line gloves.
The Rescue Swimmer shall pull on the trail line gently until the entire line is deployed.
Signal “thumbs-up” indicating ready for litter.
Use trail line to control the litter and pull it into position as it is lowered.
Allow rescue device to touch water.
Disconnect hoisting slings from rescue hook placing hoisting slings outside of litter.  Do not allow hoisting slings to foul restraining straps.
General Litter Procedures
The Rescue Swimmer shall guide the survivor into the positioned rescue litter using the collar tow or equipment carry.
Position survivor on litter, adhering to warning regarding survivor’s buoyancy and the self-righting feature of the litter.
Secure survivor using procedures appropriate to the litter.

General Litter Procedures

                           WARNING
   If the survivor is wearing a buoyant antiexposure suit such as the Imperial Dry Suit, it will affect the flotation characteristics of the litter and may negate the self-righting feature.
General Litter Procedures
Ready the Rescue Litter Hoisting Sling and signal the aircraft to move in for pickup.
Hook the Rescue Litter hoisting sling (both sides) to the large hook.
General Litter Procedures
Conduct pre-hoisting safety check,  ensuring survivor is securely within litter,  litter is attached to large hook,  trail line is attached to proper side of the litter (aircraft dependent),  sling cables are in correct positioning,  swimmer is wearing gloves,  and cable is clear and not wrapped around the litter or the swimmer.
Signal for “up-hoist”.
General Litter Procedures
General Litter Procedures

When the litter is at the aircraft entrance,  the swimmer shall use the trail line to maneuver the litter such that the survivor enters the rescue platform per platform specific procedures.
General Litter Procedures

With the litter and trail line on board, the crewman shall lower the hoist cable and recover Rescue Swimmer.
Rescue Seat
Two folding flukes for sitting.
Bright orange flotation collar for high visibility.
Swimmer or survivor must lower the flukes.
Two adjustable yellow  safety straps with friction adjusters.
Used for both land and sea rescue.

Rescue Seat
Night time illumination
There is no available place to attach the chemlight strap to the Rescue Seat.  Chemlights shall be attached to the rescue hook equipment ring during night operations.
Procedures for use:
Signal for device.
Allow device to ground.
Pull down fluke and have survivor sit on it, facing the rescue seat.
Rescue Seat
WARNING
If hoisting an unconscious survivor with the rescue seat, the rescue swimmer shall be hoisted along with the survivor.

NOTE
    If survivor is wearing an inflated LPU Life Preserver, the waist lobes may need to be disconnected prior to attaching the adjustable safety strap.
Rescue Seat
Position riders, pass adjustable safety straps under riders arms and around their back and secure strap to the “V”-ring.  Tighten until survivor is secured against flotation collar.
Have the survivor wrap arms and legs around the flotation collar.
Perform final safety check.
Signal for “Up-hoist”.
NOTE
   If the rescue swimmer elects to be hoisted with the survivor, the rescue swimmer shall wear the adjustable safety strap in the same manner as the survivor.
Rescue Seat
RESCUE EQUIPMENT INSPECTION
Visual Inspection Prior to Use
Inspect fabric for cuts,  deterioration,  and abrasion.
Inspect seams for proper adhesion and stitching
Inspect all hardware for security of attachment,  corrosion,  damage,  wear,  and if applicable,  ease of operation.
Check for sharp edges and projections.
Ninety day inspection cycle for equipment conducted by maintenance personnel.
RESCUE EQUIPMENT INSPECTION
WARNING
   Unauthorized modification to, and deviation from, prescribed life support and survival equipment by individual crewmembers could create unknown safety hazards. 
SUMMARY
True or False: The swimmer is the only one on the crew who must know his/her hand signals?

SUMMARY
What are the load ratings of the Double Rescue Hook?
SUMMARY
When stored in the backpack, how much does the SAR MEDEVAC Litter weigh?
Questions?


On Sep-16-09 at 17:55:35 PDT, seller added the following information:


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