全身固定伤员向地面转运：拉梯转运救援

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作者简介

    Jeremy Rifflard 于1991年加入佛罗里达州消防队，是劳德代尔堡消防局的一名消防队长。他还是美国联邦应急管理局城市搜索与救援队（FEMA Urban Search and Rescue team，FL-TF2）救援分队指挥官；最近参与的救援行动包括海地地震和艾克飓风；Coral Spring地区公共安全协会建筑坍塌技术项目首席导师；在过去的15年间通过ATEC公司向美国军方提供城市搜索与救援训练。

       脊柱受伤的人员在移动中通常需要将其颈部与脊椎固定。使用背板配合颈圈或者脊柱固定设备通常是最有效的固定伤员方式。但是，如果楼内电梯很小或者楼梯竖井狭窄，那么运送起脊椎固定的伤员来将会非常困难。在某些情况下，技术救援小队将会出警并将伤员运至地面。但是，等待一只技术救援小队到场可能需要较长时间。而多数消防中队则具有实施拉梯转运救援的装备和能力，它们需要做的只是训练。

 

图1，学员们正在利用1英寸管装扁带制作安全带将被困者固定在篮式担架内。在制作完安全带后，还要利用另一条扁带在伤员身体上制作三个“X”型交叉以固定伤员。

      若要使用绳索救援系统，首先必须保证伤员被安全固定在篮式担架中。篮式担架相较于单独使用脊柱背板，可以提供更加安全稳定的平台环境。篮式担架的周围具有可以让救援人员在移动过程中牢固抓握的横杆，这些栏杆还可以作为连接绳索装备的连接点；但并不是所有的救援篮式担架都适用于吊升救援，经验证，The general duty-rated篮式担架可以作为吊升救援的装备。技术救援小队通常将这类担架作为携行器材。

     当事故现场不是高角度救援时，经过训练的非技术救援小组人员可以使用篮式担架直接移动运送伤员。篮式担架内部没有任何活动构件，只需要很少的练习就可以学会使用。在平地上四名队员就可运送担架中的伤员。

而在高角度救援中，伤员必须被安全地固定在篮式担架中以防止身体发生移位。伤员在发生身体移位并试图抓住某物时会导致担架的倾覆。当担架在平稳的地面上移动时，可以使用担架的安全带附件将伤员简单固定。

而当伤员将会穿过有高度落差或光滑的表面时，则必须使用更强的手段固定伤员。例如使用1英寸宽的管装扁带或制式的伤员固定系统。通常，可以使用一条扁带打一个项结（girth hitch）将脚部固定在担架末端。再利用一条扁带在伤员身前交叉形成三个“X”型，并在担架上靠近头部或肩部的安全位置使用卷结（clove hitch）把扁带固定到担架上。还应使用另外一条扁带制作一个半身安全带固定伤员，以限制伤员身体重心的转移。

图2，拉梯转运救援。这种救援通常用于将伤员从二、三楼或屋顶转运至地面的现场

拉梯转运

       在技术救援队伍发展建立之前，训练有素的消防员通常使用拉梯将伤员从二、三层的窗户或屋顶救至地面。这种基础救援方式仅需很少的装备：篮式担架、一根12.7mm直径的静力绳、一条锚点扁带或类似装备、5个以上的救援用安全钩、两条管状或扁平短扁带（大约1.5-1.8米长）、1个牛角八字环或一个作为下降器使用的超大号安全钩，以及在地面的一个可以伸高至略高于救援起始水平位置的拉梯。

      首先，要在被困者周边寻找一个窗户或屋面作为救援起始位置。选择救援起始位置时，要避免起始点下方存在可能影响拉梯倾斜至地面的障碍物，还要避免救援区域上空存在电线。如果现场能找到一个完整的救援场地，经过训练的小队便可完成拉梯转运救援。

       救援演练开始时，首先要将假人使用扁带、腰式安全带或其他类似装备固定到篮式担架中。利用固定编织带将脊柱背板和伤者固定至篮式担架内可以保证在移动过程中伤者始终在担架的内部。操作中，还可以使用制式的担架固定带和锁扣系统来固定伤员，这些制式装备在使用时相对更加高效，可以在需要时快速将伤者从担架中移出。

绳索操作

       要把担架运送系统的锚点设置在房顶上或建筑内的稳固位置。只要可能，使用锚点扁带和安全钩围绕建筑物的结构部件来制作锚点（图3）。在锚点之后是下放设备，如牛角八字环或进行意大利半结缠绕的超大号安全钩。如果使用牛角八字环施救，请先将绳索穿过八字环中心的洞并绕过末端，再连接八字环与锚点的安全钩（图4）。注意：排式下降器不太适合此类救援，因为它会增加过多的摩擦力。

图3，锚扁带环绕建筑构件并使用安全钩连接。

图4，在绳索中将一个绳圈穿过牛角八字环中心，然后再连接安全钩和锚点前翻过八字环末端。

       在锚点制作完毕后，将绳索安装在下放装置内，然后将下放装置通过安全钩与锚点扁带连接（图5-6）。在绳索末端打一个双圈八字结，每个圈长度大约30厘米。利用安全钩将绳圈与篮式担架前端两侧的位置相连接（图7-8），收紧绳索。

图5-6，牛角八字环通常用于当作下放装置，它通过安全钩与锚点扁带相连。只要可能，要选择建筑的结构部件当作锚点。


图7，密歇根国民警卫队的救援人员将伤员固定到篮式担架内。锚点与救援起点在一条直线上。

 

图8，利用双圈八字结连接绳索与篮式担架前端。

       在救援起始点的下方地面处紧贴着墙壁设置一把拉梯。将拉梯的梯蹬拉至高于篮式担架所在起点3-5蹬的高度。将拉梯与担架连接，命令两名以上的消防员操作拉梯使梯子紧贴建筑（图10）。利用两条各1.5米长的管状扁带打水结制作扁带圈（图11）。在梯子高于窗台或屋顶一到两个梯蹬高度的位置上，左右两侧用扁带圈各打一个项结（图12-13）。

图9， 随着拉梯逐渐倾斜，篮式担架逐渐离开建筑物

图10，两名以上的消防员负责将拉梯紧贴建筑


图11，一条通过水结固定的管状扁带。


 

图12-13，在指挥员的指挥下，四名救援人员提起篮式担架并移动到救援起点处。两名靠近担架尾端的救援人员负责将担架连接到拉梯的扁带上。注意不要让担架接触地面，否则担架在跃出边缘时摩擦力将会过大。将担架固定到离地面半米高为宜。

       一到两名消防员负责稳定梯脚，另外一到两名消防员负责在上方人员下放绳索时沿着梯子方向缓慢行走以扶住梯子。还有一名队员可能要负责向下拉梯子，以补偿下降器产生的摩擦力。随后将伤员与梯子共同下放至地面（图14）。如果连接梯子与担架的扁带过短，篮式担架有可能向上抬头而不是水平移动。在到达地面时，担架也将无法放平，这会使得将被困者移出担架变得困难。所以，这两条扁带的长度最好在1.8米-3米之间。 

图14，伤者与担架转运至地面

引导绳

      如果要从三层的窗台或屋面下放救援，为了侧面的稳定性，可能需要设置引导绳（图15）。拉梯的高度越高，重心也就越高，如果演练现场使用的是10米拉梯，就要设置引导绳：当拉梯还在地面时，在拉梯顶端左右两侧各绑一条引导绳。当拉梯提升时，两名队员各握一条引导绳；当拉梯下放时，引导绳可以用于施加向下的拉力，以便帮助伤员更快下降。

      除非你已经训练了相关技术，否则请不要尝试实施拉梯转运。训练内容包括使用牛角8字环下放绳索、消防绳结的制作以及篮式担架的绑扎。通过重复的训练，水罐车、云梯车号员以及救援小组都可以利用拉梯转运实施二层建筑的救援行动。

图15，劳德代尔堡消防局的消防员使用拉梯转运将一名癫痫发作的伤员从楼顶上救下。

原文：

Getting an Immobilized Patient to the Ground: The LadderPivot Rescue

By Jeremy Rifflard

JEREMY RIFFLARD has been aFlorida firefighter since 1991. He is a captain with the Fort Lauderdale (FL)Fire Department. He is a rescue squad officer for the FEMA Urban Search andRescue team, FL-TF2. His most recent task force deployments were to the HaitianEarthquake and Hurricane Ike. He is the lead instructor in structural collapsetechnician programs for the Coral Springs Regional Institute of Public Safety.For the past 15 years, he has been an instructor and subject matter expert formilitary urban search and rescue exercises through ATEC Incorporated inJupiter, Florida.Do not attempt a ladder pivot unless youhave been trained on this technique. Practice is needed in using an 8-platelowering device to tie secure fire service knots and stokes basket packagingskills. With repetition, engine, ladder, and rescue companies can execute asecond-story rescue with a ladder pivot.

    To begin rigging a rope rescue system, thepatient on the backboard is moved and secured into the rescue basket. Therescue basket creates a more stable platform than the backboard alone. Thisbasket has a rail rescuers can grab during movement. There are areas to connectrigging components; not all rescue baskets are approved for lifting. Thegeneral duty-rated basket is an approved lifting device for elevated victimrescue. Technical rescue teams often use the basket as their “go to” device.A person with a spinal injury needs to bemoved with minimal or no manipulation of the neck or spine. A backboard with acervical collar and spinal-immobilization device is often the best practice tolimit movement of the patient. If there is a small elevator or narrowstairwell, movement of the backboarded patient can be challenging. On certainoccasions, a technical rescue team may be called to bring the patient to theground. Waiting for a technical rescue response may take a great amount oftime. Many fire companies have the equipment and ability to execute the ladderpivot rescue; all they need is training.

    On high-angle rescues, the patient must besecured in the rescue basket to prevent his weight from shifting from side toside. The shifting weight of a patient who reaches out to grab at something cancause the basket to tip. The patient can be secured with a seat belt attachmentif the patient is carried on level, stable ground.Nontechnical trained personnel can move thebasket when the incident is not a high-angle rescue. The basket has no movingparts and requires minimal training to carry it. Four persons can carry apatient in a basket on flat pathways.

     If the patient will be moved across anelevation or a slippery surface, the patient should be secured with a strongerdevice, such as a one-inch tubular webbing or a manufactured patient tie-insystem (photo 1). The webbing can be girth hitched to the foot end of thebasket. Typically, a webbing will cross the patient three times in an “X” pattern and be finished with a clovehitch knot with a safety near the head or shoulder area of the basket. Thepatient may be secured with a webbing harness in addition to the “X” pattern to limit side-to-side weightshifting.

The Ladder Pivot

    Before the evolution of the technical rescueteam, trained firefighters used a ladder pivot to move a patient from a second-or third-floor window or roof (photo 2). This is a basic technique thatrequires minimal equipment: rescue basket; a ½-inchstatic kernmantle rescue rope; a rated anchor rigging strap or similar device;five or more general duty-rated carabiners; two short tubular or flat webbings(about five to six feet in length); a rescue 8 plate or an extra-large offsetcarabiner as a lowering device; and a ground ladder that will extend just aboveyour departure point.

   The rescue drill begins with the backboardedmannequin/patient being secured into the stokes basket with a webbing, waistharness, or similar device. With a webbing attachment, connect the backboardand patient to the basket. This will keep the patient inside the basket duringmovement. There are manufactured webbing and clasp systems to tie the patientinto the basket. These systems are very efficient; the patient can be quicklyremoved when four clasps or buckles are released.Survey the structure to find a window or roofthat is adjacent to the patient. This will be your departure point. The areabelow the departure point must be clear of obstructions that would interferewith a raised ladder’s tilting to the groundand of overhead electrical wires. If you have the departure point and aclearing below, a trained group can accomplish a ladder pivot rescue.

Rigging

    Anchor the basket system to a sturdy pointon the roof or inside the building. Whenever possible, strap the anchor on astructural component of the building. Wrap the anchor strap around thestructural component and carabiner the buckles (photo 3). Attached to theanchor strap is a lowering device (descender) such as an 8 plate or a MunterHitch on an extra-large offset carabiner. If a rescue 8 plate is used, load therope bight through the center hole of the 8 and over the end before attachingthe carabiner to the anchor strap (photo 4). Note: A bar rack is not a desirable lowering device because itadds too much friction.

    Place a ground ladder against the buildingbelow the designated departure point. Raise the ladder with three to five rungshigher than the height of the basket’sdeparture point. Tie the halyard. Using two or more firefighters, place theladder flush against the building (photo 10). Secure two tubular webbings, eachabout five feet long, in a loop with a water knot (photo 11). Girth hitch theloops to a rung and beam one or two rungs above the roof or window level oneach side of the ground ladder (photos 12-13).After the anchor is rigged, place the ropein the lowering device and attach the lowering device to the anchor strap witha carabiner (photos 5-6). Tie the end of the rope with a double-loop figure 8knot with loops about 12 inches in length. Using a carabiner, attach one loopto each side of the head end of the basket (photos 7-8). Tension the rope toremove any slack.

    One or two firefighters will foot the ladderon the ground. One or two other firefighters will walk down the ladder as arescuer lowers the rope from the departure point. Additional rescuers may haveto pull downward on the ladder to compensate for friction on the loweringdevice. The ladder and patient are lowered to the ground (photo 14). If thewebbings attached to the ladder are short, the basket will slightly head upinstead of move evenly. The basket will not lie flat on the ladder when itreaches the ground. This may make it difficult to remove the patient from thebasket. The preferred length of the two pieces of webbing attached to theladder is between six and 10 feet.

Guy Ropes

If the basket is coming out of a third-storywindow or from the roof, guy ropes may be needed for side stability (photo 15).The higher the ladder, the higher the center of gravity. If the 35-foot ladderis used for this drill, attach guy ropes: While the ladder is on the ground,place one guy rope on each side of the raised ladder tip. One person shouldhold each rope as the ladder is raised. When the ladder is being lowered, guyropes can be used to apply downward pressure to facilitate a level lowering ofthe patient.