Attach 03 NET Manual ID04200024 Nov 23 2020.pdf

TCCC CASEVAC NET

TABLE OF CONTENTS

Safety Rules

CASEVAC Set Introduction

Rescue Knots .................................................................. 1.1 SOCOM Rigging Kit Equipment ....................................... 2.1 Anchoring and Rigging .................................................... 3.1 Litter Rigging ................................................................... 4.1 Hauling Systems .............................................................. 5.1 Lowering Systems ............................................................ 6.1 Rescue Breaching/Lifting ................................................ 7.1 Monitor Vitals/Defibrillation............................................. 8.1 Oxygen/Airway/Ventilation .............................................. 9.1 Fluid Warming/IV Resuscitation ..................................... 10.1 Re-Warming ...................................................................... 11.1 Hyperbaric Chamber ....................................................... 12.1 Individual Skills Practice .................................................. Appendix 1

We would like to thank the following manufacturers for the use of their User Manual images and written instructions where inserted:

RG Medical Diagnostics Verathon Medical Auto MedX Hyperbaric Technologies Incorporated General Dynamics/Itronix Infusion Dynamics Masimo Corporation Zoll Medical Corporation Remote Diagnostic Technologies Ltd.

SKEDCO Incorporated

WARNING: The techniques presented in this Study Guide are intended as a reference only for TCCC CASEVAC NET students. Proper training is required prior to the use of any equipment or techniques shown herein.

SAFETY RULES

SAFETY .1

During this training, safety must be a top priority at all times – including during set-up and breakdown of stations. You must remain alert at all times!

1. Instructors are in charge at all times. However, anyone can stop an evolution for inspection by saying “STOP!” Always ask if you are unsure about anything.

2. Proper PPE (including helmet, gloves and eye protection) must be used at all times.

3. Safety lines and back-up hardware are mandatory.

4. All rigging must be inspected by sight and touch. A final safety check of rigging, systems and personnel must be performed by a INSTRUCTOR prior to life-loading.

5. Know your equipment – proper name, strengths, weaknesses. Inspect it for wear and damage before, during and after each use. Maintain it according to manufacturer’s recommendations.

6. Control your equipment – do NOT lay it down, clip it to your harness! Dropping rope bags or equipment from structures is not permitted.

7. Do not walk or stand on rope. Do NOT smoke near rope or any nylon equipment.

8. When near an edge or positioned to allow a potential fall, proper fall protection must be used – personnel must be tied off to an anchor system suitable for a single-person load.

9. Remain alert at all times...complacency kills!

Safety is not just a rule, it’s an attitude, a way of life. It is the responsibility of each person involved in the rescue operation. It is the most important aspect of rescue – it is literally a matter of life and death!

WARNING: Proper training, including hands-on application, is required prior to use of any technique or equipment shown in this study guide.

TCCC CASEVAC SET INTRODUCTION

INTRO .1

CASEVAC SET New Equipment Training (NET)

Terminal Learning Objective Statement:

Given a TCCC CASEVAC set and a current SOF mission profile, the SOF Operator will be able to select, stage, and effectively employ the appropriate CASEVAC SET modules that will preserve the force and facilitate its reconstitution by reducing preventable battlefield deaths and minimizing the effects of injuries.

Performance Specification:

The TCCC CASEVAC Set is made up of four distinct kits; each filling a different capability gap. The TCCC CASEVAC Set facilitates the rescue, recovery, and evacuation of casualties; stabilizes and sustains casualties the event of a delayed or difficult CASEVAC and is capable of adapting to military and non-military modes of transportation.

SOF gaps include insufficient Medical Evacuation (MEDEVAC) ambulance capability of supporting SOF under fire in denied areas. SOF utilizes specialized military air, land, and sea mobility platforms, as well as indigenous modes of transportation, to accomplish their missions.

The overall intent for the CASEVAC Set is to have individual modules capable of being used independently based on current SOF mission requirements. A grab-and-go mentality should be used when employing the CASEVAC Set. The specifications listed are not all encompassing but pose the minimum requirements in order to meet the SOF mission. The design of the CASEVAC Set focuses on the desired functional effectiveness; not on an item-specific compilation of equipment.

The CASEVAC Set shall include the training needed to pack, operate, and operator level service the equipment/supplies contained within (e.g. changing batteries, reset the device). The training shall include an automated interactive training compact disc (CD) for the Service and Operator Manuals (2 each of any device requiring instruction) and a Packing List incorporated into each Module of the CASEVAC Set.

New Equipment Training:

The emphasis of this New Equipment Training (NET) will be placed on the E-1, E-2 and E-3 Modules of the Extraction Kit. Additional instruction and familiarization on selected items out of the Mobility, Transportation, and Sustainment kits will also be included.

A majority of the equipment items in the entire TCCC CASEVAC Set require no NET as these equipment items are already familiar to the following SOF occupational series personnel:

United States Army Special Operations Command (USASOC): 68W_W1, 18D;

Marine Special Operations Command (MARSOC): 8404;

Naval Special Warfare Command (NAVSPECWARCOM) - Advanced Special Operations Combat Medic (ADSOCM): 8404;

Air Force Special Operations Command (AFSOC): 1T and 4N.

INTRO .2

The Four Kits:

Extraction Kit

The Extraction Kit is made up of three Modules (E-1 through E-3)

E-1 The E-1 Module shall have the capability to extricate casualties from all terrain to include water obstacles during day or night in transition to a rigid litter for ground/air evacuation.

E-2 The E-2 Module shall have the capability to conduct immediate water rescue and ground safety line operations for vertical hoist extractions of casualties. Tag lines shall be a minimum of 75’ and include a breakaway link. Throw ropes shall be 60’ and be floatable with an identifiable bag.

The E-2 Module shall have the capability for vertical hoist operations. Static ropes shall be 150’ e-z bend with a To Be Determined (TBD) minimum strength. Rope bags shall be sized appropriately. Bag will include rappelling gloves (as ordered) in small – extra, extra Large (XXL) sizes, compatible ascenders, and locking gate carabiners.

E-3 The E-3 Module shall have the capability to pry and cut wreckage to facilitate rapid extrication. It should be powered by either battery or diesel/JP8 powered (TBD) and man packable.

The E-3 Module shall have the capability to lift and move large objects, i.e. vehicles, wreckage, building debris, etc., high enough to remove casualties trapped underneath. If a pneumatic device is used, it should be capable of using the vehicle as its primary air source.

Mobility Kit

M-1 The M-1 Module shall have the capability to secure and safely transport a casualty on a rigid litter through all phases of TCCC to Level III medical treatment.

M-2 The M-2 Module shall have the capability to attach the rigid litter from the M-1 Module to current SOF ground/air mobility or ad hoc platforms utilizing a quick ejector snap for one handed operation.

The M-2 Module shall have the capability to provide day/night landing zone marking using a standard aviation self-anchoring marker panel in 2 sizes or a multi-use, multi-color emergency lighting system for LZ and/or patient litter marking; either chemical or battery.

The M-2 Module shall provide a casualty marking system to identify basic triage categories on casualties.

The M-2 Module shall have the capability to carry additional initial TCCC medical supplies to include TCCC Form One (US Army Medical Material Agency {USAMMA} provided). Reflective warming blankets shall incorporate warming cells. Nitrile gloves shall be provided at a minimum of two pair per size per kit and be of a color to best identify bleeding of the casualty. Headlamps shall provide for blood identification, utilize a common battery and be capable of multiple color lighting (LED, IR, Green, White & Red).

The M-2 Module shall be compatible with Modular Lightweight Loadcarrying Equipment (MOLLE) / Pouch Attachment Ladder System (PALS) configurations.

INTRO .3

Transportation Kit

T-1 The T-1 Module shall have the capability to monitor casualty vital signs to include blood pressure (T), oxygen saturation (T), cardiac output (T), heart rate (T), temperature (O), and carbon dioxide levels (O). The device (s) will have a readable screen under any light or light sensitive condition and the ability to manually cancel audio-visual alarms. This module shall include a thermometer - Digital, Clinical.

T-2 The T-2 module shall incorporate all accessories and supplies necessary to operate and charge the associated pieces of medical equipment.

The T-2 Module shall have the capability to provide casualty electric cardiac therapy to include external defibrillation (T) and cardiac output monitoring (T). The device(s) will have a readable screen under any light or light sensitive condition and the ability to manually cancel audio-visual alarms.

T-3 The T-3 module shall incorporate all accessories and supplies necessary to operate and charge the associated pieces of medical equipment.

The T-3 Module shall have the capability to generate a fraction of inspired oxygen (FiO2) of 50% without use of a pressurized cylinder.

The T-3 Module shall have the capability to provide casualty mechanical ventilation (T) to be used with the oxygen generation capability in 4.1.4.4.1 (O). This module shall include Advanced Airway Management capability.

T-4 The T-4 module shall incorporate all accessories and supplies necessary to operate and charge the associated pieces of medical equipment.

The T-4 Module shall have the capability to store and transport 2 (T) 4 (O) standard blood storage bags.

The T-4 Module shall have the capability to warm blood to 32° C (T) 38° C (O) for casualty transfusions similar to the "Golden Hour Container.”

The T-4 Module shall have the capability to provide controlled casualty fluid resuscitation administered intravenously.

The T-4 Module shall have the capability to monitor casualty bodily fluid input and output.

T-5 The T-5 Module shall have the capability to warm casualties with decreased body temperature using a full-body wrap with hood and heat packs. These devices shall incorporate active heat and be light weight while utilizing battery and/or vehicle power.

The T-5 module shall be capable of warming casualties in cold temperatures.

T-6 The T-6 Module shall have the capability to mount the medical equipment contained in modules 1-5 within the Transport to the rigid litter specified in Mobility. The device shall mount anywhere on a standard NATO litter and be capable of holding portable medical equipment, including a ventilator, suction, monitor, infusion pump, power supply and steel and carbon-fiber oxygen cylinders. Electronic

INTRO .4

Casualty Cards or Personal Digital Assistant (PDA’s) can be ruggedized wireless handheld computers capable of recording an injured soldier’s name, vital statistics, and the initial medical treatment to be quickly transmitted to follow-on casualty care providers.

Sustainment Kit

S-1 The S-1 Module shall have the capability to provide and sustain the control of life-threatening bleeding for 2 (T) 5 (O) casualties for up to twenty four hours. This Module shall include a pressure dressing with built in tension bar.

The S-1 Module shall have the capability to provide and sustain the treatment and prevention of shock for 2 (T) 5 (O) casualties for up to twenty four hours.

The S-1 Module shall have the capability to provide and sustain the protection of wounds to include burns from contamination, infection or further injury for 2 (T) 5 (O) casualties for up to twenty four hours.

The S-1 Module shall have the capability to provide and sustain pain management without adverse effects for 2 (T) 5 (O) casualties for up to twenty four hours.

The S-1 Module shall have the capability to provide and sustain the control of vomiting for 2 (T) 5 (O) casualties for up to twenty four hours.

The S-1 Module shall have the capability to provide portable suction with a capacity of 500mL for 2 (T) 5 (O) casualties.

The S-1 Module shall have the capability to provide additional TCCC Operator and Medic Kits supplies for 4 (T) unit Operators. This module shall include Supplies, Trauma, Operator & Medic Kits;

a bi-folding backboard; cervical spine immobilization w/ tracheal access; headlamp providing blood identification with a common battery and LED; IR, green, white and red lighting; a low signature Night Vision Goggle (NVG) secure flashlight; a blunt tipped seatbelt cutting tool capable of window breakage [straight blade blunt tip knife]; Structural Aluminum Malleable (SAM) Splints x 2; and provide the capabilities of an altitude sickness chamber.

S-2 The S-2 Module shall have the capability to provide advanced airway care up to and including surgical airway procedures. Suction kits shall be manual and disposable. Combi-tube, Tracheal, Airway shall be of sizes 4, 5 & 6 and be non-latex. Nitrile gloves shall be provided in XL size and be of a color (green) to best identify bleeding of the casualty. Laryngoscope blades will be both metal/durable and disposable to include both Miller #3 and Macintosh #3 types and the handles will be fiber optic utilizing AA batteries. A minimum of 48 AA batteries must be supplied. Forceps shall be angled to guide a tracheal tube into the larynx or a nasogastric tube into the esophagus under direct vision. They shall also be capable of placing pharyngeal packs and removing foreign bodies.

The S-2 Module shall have the capability to provide casualty mechanical ventilation (T) to be used with an oxygen generation capability giving a fraction of inspired oxygen (FiO2) of 50% (O).

The S-2 Module shall have the capability to provide additional TCCC Operator and Medic Kits supplies for 4 (T) unit Operators.

RESCUE KNOTS E-2 MODULE

PAGE 1.1

While there are many knots available to rescuers, TCCC CASEVAC NET encourages mastering a few knots that are applicable for most situations. These represent a “good cross section” of the most popular rescue knots. Remember… practice, Practice, PRACTICE!

TERMINOLOGY:

1. KNOT – fastening made by tying together pieces of rope or intertwining a rope.

2. BIGHT – U-shaped bend in a rope; the open loop in a rope formed when it is doubled back on itself.

3. LOOP – turn in a rope that crosses itself to create a closed loop.

4. ROUND TURN – full wrap of rope around an object so that both ends emerge from the same side.

5. SHORT LEG (OR WORKING END) – portion of rope used to make all of the bends to tie the knot. Also referred to as “running” or “loose” end.

6. LONG LEG (OR STANDING END) – portion of rope that is stationary when tying a knot.

For example, the short leg (end used to make the bends) in a “loop” crosses over the long leg (stationary portion). The long leg encompasses the area from the origin of the rope to the knot; also called “standing end.”

TYPES OF KNOTS:

1. LOOPS – any knot that creates a closed loop for attachment (Figure-8; Double-8; Bowline).

2. HITCHES – used to attach a rope (or webbing) to an object. A hitch binds on the object – if object is removed, the knot will fall apart (Clove; Girth; Prusik Wrap).

3. BENDS – used to join ropes (Figure-8 Bend; Double Fisherman; Square Knot; Water Knot).

4. SPECIALTY KNOTS – (Friction Knots, Tied Harness, Belay Knots).

EFFICIENCY:

4-TO-1 RULE:

1. 4-to-1 rule refers to the efficiency of rope during bending. If a rope is bent around an object at least four (4) times its diameter, there will be minimal loss of efficiency due to bending. The “tightness of the bends” determines the efficiency ratings of knots. Note: Most rescue knots have a 20-to-28% efficiency loss.

Example: To prevent efficiency loss with ½ inch rope, the knot must have no bends smaller than 2-inches.

2. Although not possible when tying most knots, this rule must be followed as much as possible (ropes over square edges, ropes through pulleys, etc.)

3. IMPORTANT: In order to maintain maximum efficiency (strength) of ropes and rope systems, AVOID ACUTE BENDS! The sharper the bend, the greater the efficiency loss.

PAGE 1.2

STEPS IN KNOT TYING:

1. DRESS…Try to keep the ropes free of twists – with legs running side-by-side.

2. LOAD…Once tied, the knot should be pulled tight to avoid any accidental movement when line is loaded. TEST LOAD before life-loading!

3. SAFETY…Refers to securing any loose ends. If knot has a loose end (tail), it should be secured using another knot (a safety knot).

4. PRACTICE…Most important concept in tying knots… Practice!!

1. OVERHAND KNOT:

Purpose: Used as a “frost” knot to focus multi-point anchor bridles.

E-2 MODULE

PAGE 1.3

Barrel Knot as a safety Purpose: Used as a safety knot to secure loose ends.

This knot, when used as a safety, is less likely to untie. It is used as a safety knot for hitches, when running a loaded knot over an edge or when the knot will see tensioning and slacking of the line repeatedly. The Barrel Knot should be tied in such a way that it is adjacient to and touching the primary knot.

RESCUE KNOTS

PAGE 1.4

2. FIGURE-8 STOPPER KNOT:

Purpose: Used to stop rope end from moving through a device (Gi Gi, etc.). Closes the system if Edge Man is using a self-belay system.

3. FIGURE-8 ON-A-BIGHT:

Purpose: Anchor knot that creates a single loop that will not slip. Limited to a two way pull only.

Knot will be significantly weakened if subjected to a multi-directional pull.

Efficiency loss: approximately 20%

PAGE 1.5

4. BOWLINE KNOT:

Purpose: May be used as a static (non-moving) anchor knot.

Efficiency loss: approximately 27% to 33%

Finish with safety tied on the inside of the closed loop.

WARNING A bowline knot should NEVER be used in moving applications because it can untie when going over an edge. Always safety the loose end!

PAGE 1.6

5. CLOVE HITCH END LINE:

Purpose: Adjustable anchor hitch often tied to round anchor points (horizontally or vertically). It may also be tied with webbing.

Finish with safety tied around standing section of rope.

Efficiency loss: approximately 40%

5a. CLOVE HITCH MID-LINE:

PAGE 1.7

6. BUTTERFLY KNOT:

Purpose: Bridle knot that provides a mid-line attachment point and is designed to take a three-directional pull.

Efficiency loss: approximately 25%

Pass bight under both sections laying on palm.

PAGE 1.8

7. DOUBLE FISHERMAN’S BEND:

Purpose: Used to join two ropes of equal (or slightly unequal) diameter together for load-bearing applications. Finish with approximately a 4” tail on each side of the completed knot.

Efficiency loss: approximately 21%

PAGE 1.9

8. SQUARE KNOT:

Purpose: Used to “bind” two ropes of the same diameter together.

WARNING Square knots should not be used in load-bearing applications or to support a human load! Always safety the loose ends.

When finished, both tail ends must emerge from the same side of knot. If the rope ends emerge from opposite sides (one top, one bottom), it is not a square knot and will slip more easily when a force is applied.

PAGE 1.10

9. WATER KNOT:

Purpose: Preferred method for joining two pieces of webbing for load-bearing applications.

Finish with approximately a 4” tail on each side of the completed knot.

Efficiency loss: approximately 35%

PAGE 1.11

10. MUNTER HITCH:

Purpose: Used primarily as a “belay hitch” – allows belayer to catch a falling load. It can also be used to secure haul line to harness during hauls instead of relying on grip strength.

PAGE 1.12

11. KLEMHEIST:

Purpose: Formed using a “prusik” loop of a small diameter accessory cord wrapped around a larger diameter rope – it acts as a “rope grab” on the larger rope.

PAGE 1.13

12. TIED FULL BODY HARNESS

Applications: When a patient must be removed rapidly, a tied full-body harness can be applied in seconds for a “Snatch & Grab” rescue. Tied full-body harnesses may also be used in conjunction with some short-spine immobilizers to lift or lower a patient to safety when litters cannot be used.

Equipment: 24-ft piece of 1-inch tubular webbing tied in a loop using a water knot.

Run webbing through patient’s legs up high to the patient’s shoulders.

Split webbing and bring a loop to the front of patient passing underneath patient’s armpits.

Place webbing over shoulder with about three feet hanging in front of rescuer.

Place webbing loops around wrists, reach from the outside in, and grasp webbing that is resting on shoulder

Tighten webbing harness by pulling up and out from the patient.

While maintaining tension on webbing grasp webbing that is across patient’s chest.

Bring webbing from chest to join the other two loops and connect with a carabiner.

PAGE 1.14

13. DAISY CHAIN

Purpose: Storing or transporting rope or webbing.

This is primarily used for storing the 20’ x 1” Tubular Webbing o If the webbing is already tied in a loop with a water knot:

Start at the end of the tied loop with the water knot

Create an open loop and hold the loop with one hand

Pull a bight of webbing through the loop a few inches to form a new loop

Continue pulling bights through the newly formed loops until you are running out of material

To lock the Daisy Chain, pull the final material all the way through the last loop

NOTE: To unfurl the Daisy Chain, start at the end opposite the water knot and pull the locking stow free.

o If the webbing is not already tied into a loop with a water knot:

Fold the 24’ webbing into one long bight with two equal length legs

Starting at the bight end of the material, create an open loop and hold in one hand

The procedure is the same from this point forward

NOTE: To unfurl the Daisy Chain, start from the end with the two free tails of material.

SOCOM RIGGING KIT E-2 EQUIPMENT

PAGE 2.1

SOCOM RIGGING KIT

The SOCOM Rigging Kit is made up of lightweight man packable equipment items and systems that give the SOCOM Operator a unique capability to provide a variety of companion rope rescue and tagline operations. The kit consists of the High-Angle Recovery Kit, a 170’ tag line, a 70’ throw line, lighting, rescue knife, ISH Full Body Harness and Tether, and Duck Bill anchors all packaged into a rucksack modified specifically to provide a secure and balanced carrying system.

HIGH ANGLE RECOVERY KITt The High-Angle Recovery Kit is unique in how it allows rapid access to three sections of the same 200’ 9.5 mm Technora static kernmantle rope. The key is the design of the High-Angle Recovery Kit bag. It is a three chamber bag with two main chambers and a smaller central pocket. This allows the 200’ rope to be split into two working sections of rope, with easy access to the mid-point of the rope, which is identified by a pre-tied Butterfly Knot. This arrangement allows for one section of the working end to be dedicated to a mainline lower or haul, while the other working end can be utilized for operations such as the construction of a stand-alone Mechanical Advantage, as a leading edge fall restraint line, or as a tied anchor. The specific rigging procedures of the High-Angle Recovery Kit are covered in more detail in other chapters.

Static Rope:

9.5 mm X 200’

Technora Sheath

Minimum Breaking Strength 6,655 lbs.

Weight 8.4 lbs. (200’)

Resistant to approximately 930 degrees Fahrenheit

Auto Locking Carabiner:

CMC Pro-Tech Auto Lock Petzl Williams Tri Act o NFPA Light Use 25 kN o Weight 3.6 oz. 88 grams o 3 Sigma Minimum Breaking Strength 6,969 lbs. 5,620 MBS

PAGE 2.2

Pulleys:

Prusik Minding Side plates

1.25” Single Sheave

Minimum Breaking Strength 5,000 lbs.

Weight 2.1 oz.

Friction Control (Belay Device):

Kong Gi Gi

Weight 2.2 oz...

Minimum Breaking Strength 22 kN, 4,945 lbs.

Tubular Webbing:

Length 20’ and 24’

Minimum Breaking Strength 18 kN, 4,000 lbs.

http://shop.pmirope.com/images/products/new/thumb_SMC_Prusik_M_Pulley.jpg http://www.patrollersupply.com/images/products/image_1986.jpg

PAGE 2.3

Sewn Slings:

Metoleous 18 mm Sewn Sling

22 kn MBS

Anchor Strap:

Rated at 5,000 lbs. MBS end to end

8’ non adjustable

Accessory Cord (Prusik Sling):

Length 1 ea. 6’ and 1 ea. 5’

Diameter 8 mm

13.4 kN (3012 lbf) MBS

PAGE 2.4

Mechanical Cam:

ADDITIONAL SOCOM RIGGING KIT EQUIPMENT ITEMS:

Integrated Stealth Harness (ISH)

ISH Belt o Worn through trouser belt loops o Front and rear attachment loops rated at greater than 3,000 lbs. MBS o Side gear loops rated at 675 lbs. Not for life loading o Donning

Buckle the Cobra quick connect so the adjustment is on the right side of the buckle.

Adjust the waist belt for a snug fit.

The webbing tail should have at least three inches remaining. The excess webbing can be neatly stowed by passing the webbing tail back to the left over the slider bar and tucked between the slider bar and the left side of the buckle frame.

http://www.extremeoutfitters.us/images/products/thumb/ishlegssidelarge.1.jpg http://mistymountain.com/store/graphics/00000001/ISH-belt.jpg

PAGE 2.5

ISH Leg Loops o Donning

Completely loosen the right and left leg loop by relaxing the adjusting buckle of each loop.

Orient the tie in loop to the front of the leg loops thus identifying the left and right leg loop (The elastic leg loop hold up strap should be to the rear of the leg loops).

Step into the leg loops and pull up high onto the thighs and into the crotch.

Attach the leg loop front attachment loop to the ISH Utility Belt front attachment point with the locking carabiner provided (Orient the carabiner so the gate is up and away from the belt).

Attach the rear elastic hold up strap to the surface mounted side squeeze buckle below the rear attachment loop (It may be necessary to offset the buckle to the left or right to clear a midline belt loop of the trousers).

Adjust the leg loops for a snug/comfortable fit.

Orient tie in loop to the front and elastic strap to rear.

ISH Chest Harness o Donning

Don the chest harness by disconnecting the single Cobra buckle on the wearers left side of the harness.

Ensure the product label is to the wearer’s back and facing in.

Connect the single cobra buckle and adjust the fit around the chest.

Route the 5,000 lb. MBS nylon loop through the dedicated section of the ISH belt keeping the front attachment loop clear.

Adjust the fit of the shoulder loops and the nylon loop snugly.

WARNING: Must be used in conjunction with ISH Belt. The unique construction and interface between the ISH Belt and the ISH Leg Loops intentionally creates tension on the utility carabiner that connects the leg loops to the belt. It is important to ensure that any life loaded attachments to this carabiner does not create a side load condition.

Prior to life loading this carabiner, inspect and adjust the orientation as needed to avoid a side load condition.

http://mistymountain.com/store/graphics/00000001/ISH-leg-loops-thumb.jpg http://mistymountain.com/store/graphics/00000001/ish-chest-front-thumb.jpg

PAGE 2.6

ISH Tether

The ISH Tether is designed as a personal restraint and positioning tether with a Minimum Breaking Strength of 3,600 pounds.

o The tether is designed to be used on board aircraft as a restraint/positioning device.

o A backup loop is available adjacent to the Kong carabiner for locking attachment during ground operations.

o A center attachment point is available if the tether needs to be shortened for positioning or to reduce impact forces in the event of a fall.

o Both ends of the tether has a permanently attached double action connector.

Duck Bill Anchors

Duck Bill anchors are included in the rigging kit.

They are an option if there are no suitable anchors available.

They can be driven into the soil using the included driving rod driven by the sledge hammer out of the extrication kit.

Mode #40 300 pound working load in normal soil.

Test load the duck bill anchor system prior to life loading.

170’ Tagline Pre-tied with Figure 8 and weak link on each end

Includes auto locking carabiner on each end http://mistymountain.com/store/graphics/00000001/ish-tether-thumb.jpg

PAGE 2.7

70’ Throwline Line floats

Can be attached to Tag line to extend to total of 240’

HANDLED ASCENDERS:

Mechanical ascender designed for personal use only.

Strengths:

Ease of use and training.

Attach and detach from lines quickly and easily.

Allows good hand-hold.

Aids in ascending.

Limitations:

Light use only.

Not designed to handle shock loads or as belay devices.

Can break at as little as 1,200 lbs.

Rope size specific.

Teeth of cam can cause rope damage.

EQUIPMENT GUIDELINES:

Care and maintenance – follow manufacturer’s guidelines for care, use, cleaning, storage, inspection and guidance for taking out of service.

Inspect all equipment for wear and damage – prior, during, and after each use (training and rescue). Always inspect by sight and touch.

Do not attempt to alter or make repairs – contact the manufacturer before making any alterations. This includes marking if punching or inscribing (including etching) is involved.

Avoid hard-linking – avoid non-flexible hardware attachments in a system. If torsion occurs, damage or failure could result. This refers when linking two or more hardware components or when connecting to a fixed anchor point, such as an eyebolt.

Dropped hardware guideline – if dropped onto a hard surface from 3 ft. or less, inspect the equipment for obvious damage. For a fall of 5 ft. or more, contact manufacturer or replace the equipment. Replacement is typically less expensive than having the equipment tested.

Be mindful of strength ratings.

Handled Ascenders

ANCHORING & RIGGING E-2 MODULE

PAGE 3.1

DEFINITION: Refers to the assembly of rope, webbing and hardware to form anchoring and associated rope rescue systems.

ANCHORING PRINCIPLES:

1. Anchors are “The Foundation” of rope rescue systems – and may also be the most challenging to assess since most anchor points are improvised.

2. Question ALL anchor points! Anchors should be carefully assessed for suitability.

3. Choosing proper anchor points requires good judgment and improves with experience.

Note: It does no good to have ropes rated at 5,000 lbs. when the anchor strength is only 300 lbs!

ANCHOR TYPES:

1. BOMBPROOF ANCHORS are anchors that are so structurally sound that if it were to fail, the entire structure may collapse. Examples include: steel beams, concrete columns, a truck frame, the corner of a building. Pad for abrasion or sharp/abrupt edges. Bombproof anchors are very identifiable, safe and simple to use.

2. SUBSTANTIAL ANCHORS (“non-bombproof” anchors) are described as anchors that are capable of supporting the load, but do not meet the definition of a “bombproof” anchor. Rigging experience is important when selecting and using these anchors – i.e., at what size does a pipe, beam, rock, or tree become a good anchor? Anchor considerations include: age, attachment, distance between supports, and type of pull force being exerted (up, down, sideways).

Because these anchors are not “bombproof,” they must be backed up with additional secondary anchors. A primary to a secondary anchor may be used or the weight of the load may be shared equally between two or more anchors. It’s critical that each of the anchors chosen is capable of supporting the expected loads. However, the best choice is a bombproof anchor followed by multiple anchors that are individually able to support the load.

3. POOR ANCHORS are incapable of supporting the expected load. With static rope, even short falls will generate a lot of force to the anchors. Attempting to link and self-equalize numerous weaker anchors to form one good anchor should be a last resort. In urban environments, anchors are generally available. In addition, a vehicle can be used as an anchor. Do not settle for anything less than a “substantial anchor.”

ANCHOR POINT EXAMPLES:

1. STRUCTURAL STEEL

2. MASONRY/BULK CONCRETE

3. VEHICLES AS ANCHORS

Anchor to structural members only – axles, cross members in the frame, posts.

Attempt to pull from the side of vehicle.

Chock wheels, set brakes.

Ensure that anchor straps are not against sharp edges, grease, acids, heat.

Park vehicle perpendicular to the angle of system pull.

Ensure that damage to critical vehicle systems does not occur (brake lines, self-inflatable restraint systems, etc).

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INAPPROPRIATE:

Bumpers.

Sharp unprotected edges.

Mufflers, catalytic converters, exhaust pipes.

Facing headlights or taillights (should be pulling from side of vehicle).

Non-structural elements.

4. WOODEN BUILDING STRUCTURES

a. MAY provide good anchor points when used in BULK (i.e., use an entire wall or corner section between windows).

b. Also consider age and condition of the structure.

5. NATURAL ANCHORS:

a. When using natural anchors, use large, deep-rooted, live trees or other natural anchors.

b. Use appropriate “Rigging Principles” as described.

6. DUCK BILLS

Duck Bill anchors are included in the rigging kit. They are an option if there are no suitable anchors available. They can be driven into the soil using the included driving rod driven by the sledge hammer out of the extrication kit.

To set the duck bill anchor, drive the head of the duck bill as shown in the picture below to a depth of approximately 18 inches.

Drive 3 each at an offset for maximum strength.

Create a load sharing anchor bridle by threading rope or webbing through the swaged loops.

WARNING: Always test Duck Bill anchor system prior to life loading.

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SINGLE POINT ANCHOR/BASKET HITCH:

The Basket Hitch is probably the quickest and easiest anchor to construct. It also quadruples the breaking strength of the material that you are using to create the anchor (not taking into account any efficiency loss due to knots). For example: a basket hitch using 1” tubular webbing would create an anchor bridle of nearly 16,000 pounds (12,000 pounds due to Water knot).

Single Point Anchor Basket Hitch

ANCHOR BRIDLES:

Careful consideration must be given to the angle of anchor bridles. If the angle is more than 120 degrees, the system can actually be a load multiplier. For example, a 100 lbs load may generate more force to the anchors than just the 100 lbs.

A 100 lbs load on a 179-degree angle will generate 5,730 lbs to each leg of the bridle and each anchor. A true 180-degree angle (straight across) between two anchors can generate over 6,000 lbs of force to each anchor.

If less than 120 degrees, the system starts to share the load instead of multiply it. This can result in a safer system since neither of the legs or anchor is seeing the entire load. With a 45-degree angle, each leg and anchor will only see 54% of the load (basically, half the load); thereby, reducing the possibility of blowing an anchor.

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DIRECTIONAL ANCHORS (CHANGE of DIRECTION):

Refers to redirecting a rope’s path. Directional anchor points can be created in a variety of ways, including fixed anchor points and bridles (rigged between two anchor points to generate one anchor point for positioning).

LOAD DISTRIBUTING ANCHOR SYSTEMS / ANCHOR BRIDLES:

These multipoint anchor systems can be extremely useful when rigging to anchor points that do not line up or the load must be distributed between two non-bombproof anchors.

Two types of multipoint anchors:

1. Load sharing:

The load on the anchor points will be equal only when the load is directly at the center of the angle.

“Directional Anchors”

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2. Load distributing (self-equalizing):

The force on the anchor points remains evenly distributed regardless of what direction the pull force is from.

NOTE: If one of the anchors of the self-equalizing anchor fails, the bridle will run-out towards the load until the bridle becomes taught. This will create a shock load on the remaining anchor. To avoid this situation, tie a “Frost Knot” into the bridle by gathering all the legs of the bridle and tying an overhand knot to focus the load onto all the anchors.

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GENERAL RIGGING PRECAUTIONS:

1. Back-up all anchor points with a secondary anchor if the anchor is not considered “bombproof.”

2. Pad all abrasion points or sharp edges and inspect them frequently. “Round out” edges with padding or rope guards, if possible.

Note: Remember the 4:1 Rule (acute bends in rope = loss of efficiency)

3. Keep the number of components to a minimum – KISS (Keep it Safe & Simple!) Minimize the use of components in rigging systems to allow for their use in other elements of the rescue process.

4. If the structural integrity of any rigging component is questionable – discard or replace it!

If in Doubt, Throw it Out!

5. Avoid hard-links which can cause equipment damage if eccentric loading occurs. Hard linking occurs when rigid pieces of hardware are attached directly to substantial anchor points with no soft attachment point to allow for the twisting of the system.

6. Re-check all rigging after each use by sight and touch.

7. Avoid nylon-on-nylon…this is very dangerous!

CAUTION Avoid crossing loaded ropes or webbing during rigging.

8. DO NOT USE knives or scissors around loaded ropes. When loaded, rope is much easier to cut!

Keep sharp objects away from loaded ropes!

EDGE RESTRAINT/HAZARD ZONE:

Warning! Establish anchors for either a tie off, an active belay, or self-belay of any personnel working close to an unprotected edge.

Examples of unprotected edges are:

1. Floor openings/holes.

2. Leading edges of structures that have no guardrails or parapets.

3. Cliff edges.

4. Wells and cisterns.

Attempt to limit the number of personnel exposed to the unprotected edge to the minimum required to perform the task. The team leader should establish a Hazard Zone and restrict any unrestrained personnel from entering. This can be done with verbal instructions or by using some sort of physical marking system.

Providing edge restraint can be accomplished in several ways. Often times, the quickest and least manpower intensive method is to use the ISH Tether clipped around a suitable anchor that allows movement to the edge for viewing the rescue package, communicating to the lower or haul team, and assisting with maneuvering the rescue package. If there is no suitable anchor available set back from the edge to attach the ISH tether to, alternate methods should be used.

Active Belay:

An active belay is accomplished by establishing an anchor at a safe working distance from the unprotected edge and manning a friction control device or knot with one operator who provides a belay for a second operator as he approaches the edge. This can be done using the remaining working end of the High-Angle Recovery Kit rope and using a Munter Hitch or, the Gi Gi if it is not being used in the lowering system to provide the belay.

Once the Edge Man is in a safe working position, it may be desired to tie off the active belay system to free up the belayer for other duties. This can be easily done by having the Edge Man back up towards the belay anchor approximately1- 2 feet. The belayer can now tie either a Figure 8 on a

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Bight or Butterfly in the standing section of the belay line immediately behind the friction device and clip it to a separate carabiner attached to the anchor. The belayer can then remove the belay line from the original friction control device. The edge man then eases towards the edge to ensure the tie off is adjusted correctly.

Self-Belay:

A self–belay is accomplished by establishing an anchor a safe distance from the unprotected edge and tying off the remaining section of the High-Angle Recovery Kit rope to provide a fixed rope to mount a Klemheist which will provide a traveling self-belay. Ensure a stopper knot such as a Figure 8 Stopper or a Figure 8 on a Bight is tied on the end of the fixed rope.

Note: As added safety, the Edge Man can tie a Figure 8 on a Bight on the working end of the rope.

Standing at the anchor, he can toss the rope to the edge. He can then pull the rope back towards the anchor observing the end of line Figure 8 and positioning it a couple feet from the edge. At this time, tie a mid-line anchor knot (Figure 8 on a Bight or Butterfly) at the appropriate point and clip it to the anchor. Pull the end of the fixed line in and clip the end of line anchor knot to the harness. The Klemheist can now be tied in such a way that it must be bumped to travel away from the anchor. Clip the traveling Klemheist to the harness using the same carabiner that the end of line Figure 8 is mounted and the system is set up for a self-belay with the system being closed should the Klemheist slip.

KEY POINTS:

1. Remember that all rescues stand on two legs:

Safety Efficiency

2. While there are many methods of rigging, concentrate on simplicity to ensure the safest and most efficient method. KISS – Keep it Safe & Simple!

LITTER RIGGING E-1 MODULE

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IMPORTANT:

Primary Consideration must be given to victim’s injuries (spinal injuries, etc.) when determining proper litter rigging techniques (vertical versus horizontal).

Secondary consideration is the terrain/structure that must be negotiated. For example, a victim’s injuries might indicate that a horizontal litter configuration would be the best in terms of medical protocol, but if the terrain/structure can only be negotiated with a vertical litter (shafts or narrow gullies) then the decision is forced by the terrain.

TYPES OF LITTERS:

1. Rigid Basket Litters (Stokes Type Basket) – made of structural metal or combination of metal and plastic components. Strong, versatile and provides excellent protection for victim;

however, may not fit into smaller confined spaces (narrow openings, etc.)

2. Flexible Litters (Sked Stretcher) – made of flexible, high-strength plastic which allows victim to be packaged to the smallest possible profile for passing through narrow openings.

VICTIM LASHING FOR SKED:

NOTE: The Sked has built-in lashing straps.

1. Secure victim to a short-spine immobilizer, if necessary, before placing in the Sked – the short spine board provides rigidity for the Pike and Pivot technique.

2. Position victim on Sked – if properly positioned, the upper lashing strap should cross at the victim’s mid-chest level. Do not allow this strap to cross near the neck. Center the victim laterally.

3. Position victim’s arms at side inside the device.

4. Prior to lashing, determine whether the victim will be packaged horizontally or vertically.

5. Bring the four black lashing straps across victim’s body and fasten to the corresponding buckle on opposite side.

6. Attach the two foot-straps to their corresponding Cobra buckles leaving approximately 4” to 6” between Sked and victim’s feet to allow for slippage.

7. For most applications, position the victim’s feet between these two foot-straps (feet together with toes pointing forward).

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HORIZONTAL SINGLE-POINT BRIDLE:

Straps: Two nylon straps, one head and one foot strap rated at 9,000 lbs. are used for horizontal lifting or lowering.

Used at the head-end, the head strap is 4-inches shorter than the foot-strap and creates a “heads up” positioning for the Sked.

Procedure:

1. Start by laying “head” strap under the Sked. Strap should be in line with the lift-slots (diagonal openings near head).

2. Insert loose ends of head-strap through lift-slots on each side from outside inward.

3. Equalize straps and bring pre-sewn loops together above the Sked.

4. Shorten the bridle legs for a more “heads up” litter position and to prevent the liter from log rolling once suspended.

To shorten bridle straps:

Wrap looped ends of bridle straps around webbing handles on each side of Sked.

Three-to-four wraps will place the victim at about a 45-degree “heads up” position.

5. Attach both loops to the rope system with a single carabiner.

Normally, the angle created by legs of bridle strap is not very wide. Since side-loading is not a factor, only one carabiner is needed.

6. Repeat these steps for foot bridle strap – shortening foot-strap is normally not needed, but could be done in same way.

7. Attach foot and head carabiner to main-line.

Horizontal Bridle

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Tag-line Attachment Ground Operations:

Use two tag lines on same sides of the Sked to prevent spinning.

Each tag line may be secured to one of the handles of the Sked with a carabiner or a

Bowline knot.

Note: By joining the 170’ tag line and the 70’ throw line the maximum length of the tandem tag lines will be approximately 120’.

Tag Lines for Ground Operations

Tag-line Attachment Rotary Wing Operations:

Use the 180’ Tagline o Attach the “Weak Link” to the center grommet at the foot end of the litter with a Girth Hitch.

o Open the other end of the QA tagline bag to make the standing end of the line available for rapid attachment of the additional 70’ Throw Line if needed to provide 240’ of usable tag line.

o Offset several meters from the litter to provide adequate control of the litter to prevent spinning and to direct the head end of the litter into the cabin of the aircraft if needed.

Note: Standing directly under the litter to tag as it is being hoisted provides virtually no control of the litter as it encounters rotor wash.

VERTICAL SINGLE-POINT BRIDLE:

Procedure:

1. Properly position the fully immobilized victim and loosely fasten all lashing straps including foot straps.

2. Tie two Butterfly Knots in the middle of the supplied 30-ft. 3/8-inch rope.

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3. Pass each end of rope through grommets at head-end of stretcher (from back to front).

4. Center the knot between grommets and remove slack.

5. Continue feeding rope through unused grommets (from outside to inside). Keep slack out of rope as you go.

Note: If needed, place padding between victim’s shoulder and the ropes. If the victim is on a short spine board, either clip the shoulder handles of the short board to the bridle or run the bridle rope through the short board handles to prevent the victim from sliding towards the foot end of the litter. (See picture below)

6. Pass rope over first lashing cross-strap and through the next set of grommets on the side of the Sked.

7. Continue routing rope through side grommets. (Route through at least four grommets on each side of Sked)

8. Bring rope ends over the third lashing cross-strap.

9. Continue to bring rope through next grommet used for securing foot straps.

10. Continue downward, passing the ropes out of the bottom grommets at the foot of the Sked.

11. Tie the two ends of the rope together with a square knot.

12. Before tightening the knot, fully tighten all black lashing cross straps. Remove all remaining slack in bridle rope.

13. Tighten the square knot.

14. Cross the tail ends and bring them up over the feet and back though a grommet below the lower handles.

15. Tie a second square knot with safeties.

16. Attach the primary rescue system.

Note: The square knot is not to be used for load-bearing applications; however, it is recommended by Skedco (the manufacturer) for removing slack from the bridle rope. The square knot will not see a load due to the friction provided by multiple grommets.

Vertical Bridle Routing Through OSS Handles Vertical Bridle Foot End Finish

Tag-line Attachment:

Use two tag lines on opposite sides of the Sked to prevent spinning.

Each tag line may be secured to one of the handles of the Sked with a carabiner or a

Bowline knot.

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PIKE AND PIVOT

The pike and pivot technique is unique way to haul a vertical litter over the edge of a low point without the need for a gin pole or other portable highpoint anchor. It is an adaptation of a crevasse rescue technique that TCCC CASEVAC NET has incorporated into other rope rescue environments. The technique requires minimal pre-rigging of the vertical litter prior to the lift. The technique is covered in the chapter on Hauling. To rig for the pike and pivot:

1. Route one end of the 24’ tubular webbing under the Main line at the head end and rout both ends towards the left and right foot end carrying handles.

2. Tie the ends of the webbing to the left and right foot end carrying handles with a clove hitch or bowline.

Note: Ensure the Pike and Pivot Bridle is routed under the mainline.

3. Tie the middle of the webbing to the mainline with a clove hitch above the anchor knot.

4. To minimize the potential of the webbing hanging up during the haul, Daisy Chain and tuck the excess webbing inside the litter or clip to mainline above anchor knot.

Pike and Pivot Bridle Routing

FLOATATION

The SKED litter floatation consists of inflatable bladders with built in CO2 bottles and oral inflation ports and a ballast bag to ensure that the litter floats in a head up attitude.

The bladders are equipped with a quick dump valve to deflate the float logs in seconds.

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Attachment to the SKED Litter:

Identify the left and right floatation logs and attach them to the stretcher so the inflation cartridge and manual inflate nozzle are oriented towards the head. Use the horizontal slots and pass the female portion of the strap through the slot from outside in. Bring the male portion of the buckle over the top edge of the litter and attach to the female buckle.

Pass the female end of the buckle through the parallel slots on the side of the litter.

Route the two uppermost cross straps through the web loops on each side of the chest floatation pad and loosely attach to the corresponding buckle on the opposites side of the stretcher.

Attach ballast bag to the inside of the foot end of the stretcher. Pass the Velcro straps from inside out through the foot end side grommets and wrap back over and attach to the velcro mating on the ballast bag. Note: Fill ballast bag with approximately 15 pounds of rocks, or gravel when ready to deploy.

Attach the two long webbing handles to a left and right unused grommet at the shoulder area by passing the handle from outside in. Recommend girth hitching these handles to help prevent them floating out of position or being lost.

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