Between 4,000 and 6,000 drowning deaths occur annually in the United States. For every drowning, there are six to 10 near-drownings that result in permanent neurological impairment.

Water and ice rescues present a unique set of challenges compared with other types of rescues. FIRE CHIEF recently spoke with Gerald Dworkin, a consultant with Lifesaving Resources. He has more than 40 years of professional and volunteer experience as a firefighter, EMT, water- and swiftwater-rescue technician, and ice-rescue technician. Currently he is a firefighter/EMT with the Harrisville (N.H.) Fire Rescue Department. Dworkin also serves on the board of directors for the National Drowning Prevention Alliance. Dworkin regularly presents at fire, rescue, EMS and aquatic-recreation conferences, and frequently consults as a forensics expert in drowning and aquatic-injury litigation. He has advised on more than 225 cases to date.

Why is it important for fire departments to regularly review their training programs for water and ice rescues?

Environmental changes are impacting weather patterns across North America, resulting in unprecedented natural disasters. Devastating mid-Atlantic snowstorms and severe flooding have forced fire and emergency services to re-visit their planning for natural disasters.

In any emergency situation, it falls on the fire-rescue department to respond, stabilize and resolve the incident. If they cannot, hopefully they have the mutual-aid resources that can respond quickly. Unlike a hazmat operation that you can isolate, in a water or ice rescue operation every second is absolutely critical.

The biggest challenge is the time element in water and ice rescue. Time is not a luxury and every second is critical. This is especially true with cold water because, for the victim, the seconds are ticking away in terms of inducement of hypothermia, which is going to compound and complicate the entire rescue operation.

At what temperature is water considered cold?

Typically we look at 70°F water as being a dangerous situation. Anything less than 70° is going to induce hypothermia. But the reality is, if you're in the water long enough, don't have appropriate gear and don't assume an appropriate behavior, then anything colder than 98.6° is going to start lowering your body temperature. You need to know what to do if you're a victim, and rescue personnel need to have the appropriate personal protective gear to deal with the situation.

For example, when we're dealing with moving-water situations, nine times out of 10, the fire-rescue departments respond wearing cold-water or ice-rescue suits. This is not the appropriate gear to use for moving-water situations for three reasons:

• 1. If you breech that suit in any way, it then becomes a sea anchor.

• 2. Dexterity is a problem with these suits. In extreme water and swiftwater rescue operations, you need to have a lot more dexterity than these suits provide.

• 3. During an ice-rescue emergency, an ice-rescue suit has a static tether line, so nothing can go wrong. If you get in trouble, you can be pulled in from the shore with your tether line.

But in moving water, if you slip and you are under tension, that moving water is going to keep your head below the surface of the water. That's why approved moving-water rescue vests allow you to pull the toggle and get out from the tension. Ice-rescue suits don't have that feature; if you have a fixed tether line and you are caught under water, the only thing you can do at that point is have the people on shore release the line. You'd go floating down stream with 200 or 300 feet of line and if that gets entangled, you're going to drown.

I see news stories about people wearing inappropriate equipment and, unfortunately, somebody's going to die. Recently a Los Angeles firefighter was seriously injured in water rescue and a West Virginia firefighter drowned in a water rescue.

What should be considered when preplanning for water rescues?

Just as target hazards are identified for structural fires and public-meeting places, the same thing needs to happen in the local community regarding water rescues. The process should take into account not only physical structures and occupancies, but also bodies of water — e.g., lakes, rivers, streams, ponds, swimming pools, hot tubs, ocean beaches, boat launch areas, youth camps, lowhead dams and fishing areas — within a community that can pose a heightened risk or danger to the public while they are engaged in aquatic recreational activities. The process of identifying physical hazards, as well as activities that place people at heightened risk, is referred to as threat assessment.

In late spring, you may have frozen lakes with a lot of ice-fishing houses and people who are driving on the ice to get to them. Those are activities that place people at higher risk. Preplan where you'll stage the apparatus and how to respond to the incident. If people are out in the middle of a lake 600 yards off shore, and all you have is 300 feet of shore-based line, if something happens you've got a major incident. Preplan the equipment that will respond and play "what if?" In the fire service we do that all the time for structure fires and the same type of strategic planning needs to take place for water emergencies. Boats, equipment, survival suits and personal protective gear all need to be part of the preplanning process.

Is there a suggested template or generic SOP for water or ice rescue?

There are no standardized SOPs for anything in the fire service that I've seen, and I think the same holds true for water rescues. SOPs that are developed for a department need to be specific to the equipment available, the community threat assessment and the level of training. There are a lot of cases where departments can share SOPs for laying out the format, but specific developments are community specific.

Training is a vital element. Regardless of the size of the department, ice-rescue and/or water-rescue awareness training should be provided — at minimum — to all personnel that would include:

• Procedures for size-up of existing and potential conditions.
• Procedures for identifying the resources necessary to conduct safe and effective ice- and/or water-rescue operations.
• Procedures for implementing the emergency response system for ice- and/or water-rescue incidents.
• Procedures for implementing site control and scene management.
• Procedures for recognizing the general hazards associated with ice- and/or water-rescue incidents, and the procedures necessary to mitigate these hazards within the general rescue area.
• Procedures to determine rescue versus body recovery.

Besides awareness training, what other types of training should be offered, if possible?

A comprehensive training regimen would encompass the levels of incident response: awareness, operations and technician.

First responders trained at the awareness level also should be trained in procedures to identify the approximate location of a victim once the victim has submerged below the surface, and they also should be capable of manning tether lines for operations- and technician-level personnel who venture out onto the ice or into the water for rescue or recovery operations. Awareness-level personnel also can be trained and equipped to perform basic shore-based rescues like throwing a line or rescue bag to the victim, or extending an object or device from shore. However, to function in this capacity, first responders must be equipped with basic rescue and personal protective equipment, and must be trained in their proper use.

First responders at the operations level must, obviously, meet the training and expectations of the awareness level and must be able to perform shore-based rescues, as well as be able to aid technician-level personnel by assisting with the set-up and deployment of specialized rescue equipment, and by manning and directing shore-based operations and tether lines.

At the technician level, personnel would have the additional responsibility of organizing and implementing the type of rescue or recovery operation necessary, depending upon the physical and emotional condition of the victim, the equipment resources available, the location of the victim, and the personnel resources available. Technician-level functions at ice- and/or water-rescue incidents must include the development and implementation of:

• Procedures for self-rescue unique to ice and/or water incidents.
• Procedures for reach, throw, row and go techniques unique to ice or water rescue.
• Procedures for the use of watercraft or specialty equipment unique to ice and/or water rescue.

However, in order to accomplish this level of rescue, technician-level personnel must be adequately equipped to protect themselves from the elements and to effectively and safely perform the rescue or recovery operation.

In January, a member of the Point Edward Volunteer Fire and Rescue Department in Ontario, Canada, died during an ice-rescue training program when he got trapped under the ice. What do departments need to do to perform safe water- and ice-rescue training drills?

Water emergencies are hazardous and risky for personnel, which is all the more reason that personnel need to be properly trained so that safe techniques become automatic.

I am a firefighter, and every once in awhile when I have the opportunity, I don an SCBA so I'm more accustomed to it and so that it's use is second nature to me. All departments drill on suppression issues — running lines and raising ladders — for the same reason, and the same thing holds true for water and ice rescue.

Here's a classic example: A call comes in for someone hanging onto the ice shelf. Every second is critical. You have to get there, don your PPE as quickly as possible, and hopefully your lines are pre-rigged and tied so that you can take your piece of equipment and go. It's no different from anything else we do in the fire service. We need to drill and, hopefully through the appropriate training, things will become automatic and people will be less at risk than someone who is just gung ho.

Does lack of radio communication in water rescue raise yet another challenge for responders?

Absolutely. If you're putting a rescue swimmer out in the water, at that point that person has no radio communications. The shore-based person may have a radio, but the two need to be able to communicate with each other, and the only way will be with hand or whistle signals.

Consequently, hand signals and whistle signals should be established beforehand. Whistles should be plastic and have a pea-less design. All personnel operating within the water or ice environment should be knowledgeable of the pre-determined operational and emergency signals before stepping onto the ice or advancing near the water.

The Keene (N.H.) Fire Department is an exceptional department for a rural area with limited resources, given its progressive approach to threat assessments and preplanning. Keene has had a preplan for a nearby lowhead dam, and over the past six years it has been implemented on four significant incidents with victims in cardiac arrest.

Keene's preplanning for water rescue requires 10 personnel to respond to the incident and puts two rescue swimmers into the water to get a line across the river to get a boat upstream. In order for this operation to take place, there are seven different teams operating. Plus, you've got the roar of the lowhead dam, fast-moving water; even if you had radios, it would be very difficult to hear and operate. So they have their hand and whistle signals preplanned, so that everyone knows what needs to be done.

• Read the "Conducting Training & Drills" sidebar to learn about ice- or water-rescue training program.

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Conducting Training & Drills

During any ice- or water-rescue training program, personnel health and safety should be the first and foremost concern. All participants must have a thorough understanding of the hazards and risks associated with the environment and the situation for which they are drilling. Appropriate PPE must be provided to all "go" rescue personnel, as well as all shore-based personnel. Firefighter turnout gear should never be worn by anyone while in, on or around the water, unless they are specifically engaged in firefighting actions.

During ice-rescue training, all "go" rescuers should be outfitted with appropriate ice-rescue suits that provide insulation from the cold, buoyancy, and protection from rocks, debris and ice. Suits should be thoroughly inspected beforehand and should have integral gloves, rigid-sole boots and a tether/harness system. Helmets should be provided as well to protect against slip-and-fall injuries. All shore-based rescue personnel, as well as observers within 15 feet of the water, should be provided with U.S. Coast Guard-approved personal flotation devices (PFDs), float coats, or anti-exposure coveralls.

Designated "victims" must be tethered at all times, as should all rescue personnel who venture out onto the ice and into the water. During training and rescue operations, the use of 3/8-inch waterline is recommended for use as a safety tether line, while a 7/16-inch waterline is used as the primary rescue line that is secured to rescue personnel. The tether line is attached to the front of the rescuer for ice rescue in order to expedite the extraction of victims and rescuers from the water and onto the ice shelf.

During water-rescue training, all "go" rescuers should be outfitted with either wetsuits or swiftwater rescue drysuits, along with gloves, water-rescue boots, a designated water-rescue PFD and a helmet. All shore-based rescue personnel should be outfitted with PFDs. The difference between a regular PFD and a designated water-rescue PFD is that water-rescue PFDs have an integrated, quick-release tether/harness system.

Ice-rescue wetsuits and swiftwater dry suits, along with PFDs and other equipment, should be regularly inspected and continuously maintained, as should all other designated water-rescue and ice-rescue equipment. Ropes should be checked, as should their rope bags, carabiners and other accessories.

— Gerald Dworkin