Death certificate search

Currently, in most policies we can deal with rescue on or above the surface of water, the procedures and requirements for this have been covered in great depth. However once a casualty disappears below the surface, even in front of our eyes we do not officially have the capability to deal with it. Following two years of extensive personal research, assumptions have been disproved and a solution found to the question of how the Service can deal with these incidents safely.

The research was conducted in conjunction with a Certificate in Education programme at the University of Plymouth. The research project has received support from the HSE Diving Division, HMFSI, Mid and West Wales Fire Brigade (MWWFB) Marine Rescue Unit, the National Water Working Group, the medical profession, the Royal Navy and the commercial diving industry.

DIVING UNITS IN THE FIRE SERVICE? CAN WE AFFORD NOT TO?

Quantitative and qualitative methods were used in the collation of evidence, using FINDS messages, Internet searches, medical journals and research papers, and contact with other brigades around the world. For confidentiality reasons some of the sources of data cannot be disclosed.

There is much debate over the issue of survivability which indicates possible survival times greater than initially projected this is supported by medical evidence from several research papers and medical journals. This is an area which is still subject to further re search.

The papers examined clearly point out that it is important that there is no delay in starting resuscitation on casualties as soon as they are brought out of the water and rapid transportation is made to the accident and emergency department (AandE) department for advanced life support procedures. The criteria for stopping resuscitation is quite extensive and the decision would normally rest with the AandE consultant. Reasons of survival for such long periods can be linked to the mammalian or diving reflex, which is believed to be present in 15 per cent of people and occurs when cold water stimulates the Tri-Geminal nerve in the lace on impact to the water.

The policies introduced prohibited the use of BA to attempt sub surface rescue due to the dangers involved, which is supported by the research. The focus on survival time should not override the factors surrounding safety in dealing with the incident. Incidents which require rescuers submersing their faces or reaching to unstable objects, such as vehicles be low the water surface, should be dealt with using diving capability due to the risks involved.

Another factor considered is that of the presence of 'air pockets', a recent case in Hong Kong showed that two casualties who were trapped in air pockets of a capsized vessel at 30m survived, the first being rescued after three hours, the second after six hours.

Submersion can present a dilemma when survival is possible but no sub surface capability is present; improvisation has previously been used to achieve operational objectives. This was highlighted at the 'Blue Lagoon' incident in Luton and Bedfordshire where in the presence of an angry crowd of members of the public, the firefighters in the light of medical information and under immense pressure made attempts to rescue the victims. The victims of the incident were resuscitated for several hours in hospital before death was declared. Contrary to popular belief, police divers do not have and are unlikely to have the remit for Underwater Search and Rescue, their role relates specifically to 'Scenes of Crimes and Recovery of Evidence'.

Another more relevant justification is that of providing safety cover for crews working at water related incidents such as ship firefighting. This is the primary role of MWWFB's marine rescue unit who have had this capability since 1986, having an exemplary safety record, executing this function efficiently and effectively.

In July 2004 they attended an incident in Pembroke Docks where a vehicle entered the water with a person reported trapped. Whilst the casualty did not survive, the incident was successful due to the fact that a safe system was used by the divers throughout and the vehicle removed from the water to prevent risk to shipping and members of the public who may use the area.

With the changing environmental factors such as global warming presenting an increase of frequency and severity of flooding, the Fire Service, especially being the prime rescue agency under the new white paper with the role for dealing with incidents such as flooding amongst others, will have to cater for these requirements. An incident which occurred in Devon involving an elderly couple trapped in a house struck by flooding, resulted in an ambulance paramedic swimming through the property and 'duck diving' below submerged doorways and successfully rescuing one casualty. Although no-one could doubt the bravery of those involved, there was no awareness of the risks involved and no provision for a safe system of work.

Many Fire Services provide this capability, such as the USA, Canada, Hong Kong, France, Germany, Spain, Holland, Denmark, Sweden, Norway and South Africa. From my observations they seem to have similar budgetary controls and restraints as we do in the UK. Therefore, I would suggest that they provide this capability on evidence based sound judgement through presence of identifiable risks and hazards. The Hong Kong Fire Service 8 has continued significant investment in the diving capability in the form of Dive Sup port Vessels and other equipment.

LEGAL ISSUES

If Service personnel through their operational duties don a breathing apparatus system, airline or self contained and submerge below the surface of the water or liquid, they are classed as divers at work.

The Issue of Sub Surface rescue is covered specifically by the Diving at Work Regulations 1997, the requirements of which are laid out in Approved Codes of Practice. The Fire Set vice is by no means exempt from these requirements, the use of conventional fire fighting BA sets for sub surface rescue at tempts by firefighters untrained in commercial diving practices is in breach of these regulations.

Another issue that came to light in the research is that, to make use of amateur diving clubs or for the purposes of such rescues is in breech of regulation 4.

The regulations require that for diving operations to conduct in accordance with the law, the service must ensure there is:

* An appointed contractor someone is in a position of budgetary and strategic decision making authority, to ensure the overall sate running of all diving projects

* Competent and trained supervisors--to oversee the operations

* Divers hold qualifications on the approved list and have an in-date diving medical

* A project plan with risk assessments is complete

* The equipment used is in suitable and in accordance with the standards

* There is an emergency evacuation plan prepared.

This list is not exhaustive but identifies some of the main points of the regulations.

TEAM STRUCTURE

To ensure that diving operations are conducted safely there are requirements in relation to the way in which a response team would have to be structured.

Following review of the structure of teams in the military, police, the Hong Kong Fire Service and MWWFB it was established to provide a safe system of work, that the team should consist of five members:

* One Supervisor--A qualified diver responsible for the safe running and control of the diving operation

* One Diver--deployed as a working diver during the operation with specific tasks

* One Standby Diver--a qualified diver in a state of readiness to enter the water with the sole function of providing safety cover to the working diver

* Two Attendants--to support the diver and the standby diver before, during and after the operation.

In the case where it is required that Surface Demand Diving Equipment (where the divers' primary gas supply is fed from then surface via an Umbilical hose) is used, the team size should be a minimum of six to allow for an air distribution panel operator to be nominated. For most operations Self Contained Underwater Breathing Apparatus is more appropriate due to the speed at which it can be deployed.

It should be noted that it is not a requirement that the attendants are trained divers but must be competent, although in a protracted incident having more trained divers on site would enable the operation to continue.

In establishing their capability brigades must identify the areas of highest risk and have the resources located near that area as required under the IRMPs.

TRAINING ISSUES