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Confined Space Rescue Response Checklist

 

q Secure scene: Use PA system - Send sentry - Barricade Area

 

Jobs:

q Leader q Safety q Medical q Lowering q Logs

q Ventilation   q Monitoring    q Haul team     

q Belays q Backup team  q Rehab.     q Haul system

 

Equipment:

q Monitor q Full harnesses q Patient air q Pre-rigged haul

q Ventilation q Radios q Tripod q Medical equip.

q SCBA/SAR q Lighting q Air bottles q Rope rescue equip.

 

q Information? Ask:   Attendent - Witnesses - Permit

        How many/who? - Doing what? - When?

        Hazards? - Where/Layout?  - Entry permit?

        Medical history? - Other access? - Attendant?

 

q Communication w/patient?

        Did you fall? - Crawl towards opening? - Any others?

       Other injuries? - Connect to haul system? - Don't move!

 

q Air monitoring?   Initial - Continual - Entry team? - Use log

 

q Exterior Rescue? 

        Using lifelines - Patient self help - Remote connection

 

q Negate hazards? 

        Electrical - Lockout /tagout, Ventilation, Fall Protection,     

        Block / bleed,      Purge: Air, steam, CO2, Nitrogen,  

        Mechanical,    Entrapment,    Engulfment

 

q Medical? KED Patient air Backboard BP Monitor

        C-collar Pat. Harness Medical bags Litters

 

Innovative Access, Inc. IA\forms\cs_check.lwp

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(Teams have been posting this reminder form on doors and walls)

 

RESCUE CHECKLIST

 

þ MONITOR

þ VENTILATION

þ RADIO'S

þ SCBA'S / SAR

þ LIGHTING

þ ROPE RESCUE EQUIP.

þ PATIENT AIR

þ TRIPOD

þ LITTERS

þ MEDICAL EQUIP.

þ FULL BODY HARNESSES

þ SPARE AIR BOTTLES

 

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TEAM LOG

 
Team Member PSI Start On Air Time Entry Time 10 min. check 20 min. check Off Air Time Exit Time PSI Finish
                 
                 
                 
                 
                 
                 

 

PATIENT LOG

 
Patient Name / Number Air or O2 ? Air Available Time Air Applied Time Air Change-out Time Air Removal Time
P1          
P2          
P3          
P4          

 

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RESCUE HISTORY

Atmospheric Tests                                                                     Page_____
Time                                      
Results                                      

 
TIME  LOCATION                                           DATE             TYPE
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

 

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