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A Marine Triage System

Posted in MRO News

Jonathan Cornelius of ABSAR writes:

The IMO defines a 'mass rescue operation' (MRO) as one 'characterized by the need for immediate response to large numbers of persons in distress, such that the capabilities normally available to the search and rescue authorities are inadequate'. So, how does a small nation with minimal resources respond to and conduct an MRO?

In November 2012 Antigua & Barbuda Search and Rescue (ABSAR) was asked to participate in an airport MRO exercise involving an airline crash offshore. In our preparation we realized that we did not have adequate SAR units for such an event.

Our challenge was, how to deal with an MRO when the only SAR units available are small boats? We needed a marine-based triage system to help prioritize which persons needed most urgent rescue in order to best utilize our limited capabilities.

We began by researching online for a marine triage method, then contacted the IMRF and other agencies for methods already in use. We discovered that no known method existed.

So we created our own ABSAR Marine Triage System, using the Simple Triage and Rapid Treatment (START) method as a basis. A preliminary draft was circulated to the IMRF mass rescue operations project working group for feedback.

In addition we put together a land-based mass casualty kit that can be moved to a staging area close to the crash site. This allows for secondary triage and treatment of injured persons as they are brought ashore.

ABSAR Rescue 1, our 27 foot RIB, has been stationed on a lift at a marine facility near the V.C. Bird International Airport. Subsequently we positioned a large capacity life raft and spare life jackets at this location in order to facilitate responding to a MRO involving an airline crash at sea.

On June 4, 2014 we had the opportunity to utilize our system in a simulated aircraft crash. The scenario had a Boeing 737 crash 1 mile offshore with 97 persons aboard.

The Antigua Barbuda Defense Force Coast Guard and ABSAR both responded, with the Coast Guard acting as On Scene Coordinator. Both SAR units were utilizing the ABSAR Marine Triage System. triage2

The exercise proved that it worked well, allowing us to quickly and easily prioritize the victims we encountered to determine whether they required urgent assistance or not. We have since modified and simplified the protocol, to ensure additional safety of the victims in an MRO scenario.

The IMRF says that "during an MRO on-scene support should be provided in priority order: preventing drowning, providing shelter, providing detection aids, providing medical care and sustenance, providing communications. If rescue personnel can be deployed to tend survivors while they await rescue, so much the better."

With these guidelines in mind we propose the following ABSAR Marine Triage System:

First on-scene asset deploys life rafts and asks all victims who can, to swim to the
  nearest raft and wait for assistance: all these will be designated MINOR
Pass flotation to all victims unable to swim to life rafts
Consider placing a rescuer with a radio in the life raft
Consider picking up any victims who are not in groups of 2 or more
  Victim Assessment
  o Turn over any face-down victims: not breathing, DECEASED
  o Respirations more than 30 per minute: IMMEDIATE
  o Capillary refill over 2 seconds: IMMEDIATE
  o Unable to follow commands: IMMEDIATE
  o All others: DELAYED

The goal in a MRO is to save as many lives as we can with the resources available at that time. The water environment complicates airway problems through drowning of persons who might still be breathing in a land-based scenario. For this reason, DELAYED victims should be picked up along with the IMMEDIATE victims in order to prevent deterioration.

In the marine environment, this method effectively creates three groups: MINOR (those who can swim), IMMEDIATE / DELAYED (those who will be rescued first), and DECEASED victims (those who will be recovered last).

The IMMEDIATE and DELAYED victims will go through a second triage once they have been delivered to a place of safety. During this simulated exercise, ABSAR found this method of marine triage to be highly effective in rapidly rescuing all victims and thereby maximizing the use of very limited resources.

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International Maritime Rescue Federation
50 Allardice Street
Stonehaven
AB39 2RA
United Kingdom

Tel: +44 (0) 1569 767405

E-mail: info@imrf.org.uk

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