RESCUE LIFTING SYSTEM AND SARRRAH–PROJECT:  RECOVERY DEVICE FOR THE RESCUE OF DIVERS AND MEN-OVERBOARD IN ACCIDENTAL HYPOTHERMIA
 

Baumeier W.¹, Schwindt M.², Bahlmann L.¹, Schmucker P.¹

¹Medical University of Luebeck, Dept. of Anaesthesiology, Germany (Director: Prof. Dr. P. Schmucker)

²University of Applied Sciences and Arts, Hildesheim, Dept. of Social Education, Germany

Objectives

Rescue of helpless persons from the sea is very demanding for rescuers and the available rescue devices alike. When a shipwrecked mariner, a near drowned person or a diver for instance, meets with an accident, they are subsequently found by the Search and Rescue services and they are secured afloat. The next step in the technical rescue chain is to bring this person onto a safe and secure platform. This is the most difficult step in the rescue chain. The devices which have been available for this purpose have been inadequate up to now, and their use has been associated with a high risk of death for the most seriously hypothermic accident victims. The following details of accidental hypothermia at sea, in conjunction with rescue measures, will be explained, as well as a double strap system (RLS – Rescue Lifting System) for gentle and safe rescue from the sea. The medical project ‘SARRRAH’ (Search and Rescue, Resuscitation and Re-warming in Accidental Hypothermia) studies the rescue and treatment process of severely hypothermic patients and also includes the specific details, which are affecting the patient’s health status within the scope of technical rescue and transport.

In the following article the project ‘SARRRAH’ will be outlined. First results are expected to be available in the next years.

Background

An accident at sea including immersion will almost always lead to accidental hypothermia. Hypothermia has an enormous influence on the physiological functions of the human body. The metabolic turnover slows down and impairs the organic functions. The effects on brain, muscle and circulation functions, is of importance for the technical rescue of hypothermic patients:

·         A cooling of the brain entails derangement and deceleration of brain function as well as impairment of consciousness. Even victims who are still responsive cannot be expected to be able to help themselves in any way.

·         The muscular system which is cooling down, leads to increasing rigidity due to muscle stiffness with considerable impairment of coordinated grasp functions.

·         Because of the circulatory centralization into the body core, the cooling process of the body parts nearby the vital organs slows down. Increased diuresis occurs with consecutive hypovolemia. Adjusted to the decreased metabolism bradycardia and arterial hypotension appear. The heart can no longer react adequately to changed circulatory situations, which for instance can be inflicted by a change in position of the body. Even the slightest irritations can disturb the conduction system, which is particularly sensitive at this temperature, and can lead to cardiac arrest caused by ventricular fibrillation.

Golden (4) in particular has dealt with circum-rescue collapse associated with rescue of immersion victims. The circulatory collapse can come about as a result of a number of factors: primary among these are

o        loss of hydrostatic assistance to venous return, and

o        re-imposition of the effects of gravity,

o        hypovolaemia, increased blood viscosity,

o        diminished work capacity of the hypothermic heart and

o        reduced time for coronary filling, dulled baroceptor reflexes, unmeetable demands to perfuse skeletal muscle, psychological stress and pre-existing coronary disease.

Golden showed in a study, that during a lift with a single helicopter strop vertically from the water after an immersion for 30 min at 15°C, the central venous pressure fell by approximately 12mmHg.

During rescue operations, it has consistently been observed that shipwrecked mariners, who have been alive whilst in water, suffered from lethal cardiac arrest when winched up in the helicopter strop.

Rollnik (5) also deals with cardiovascular reactions during rescue operations with different sling systems. Rescue in a double sling system in an approximately horizontal position, induces only moderate heart rate changes which were significantly lower (about 30 bpm) than with conventional techniques with one sling lifting in a vertical position.

The rescue operation is only the first step of the emergency treatment of patients with severe accidental hypothermia. The correct and gentle handling of the victim must be followed by specialized medical procedures of First Aid and transportation to specialized centres, which have the facilities to warm up these patients even under the influence of cardiac arrest.

The optimization of all successive procedures determines the recovery and therefore the final outcome. Statements about the efficiency of a specific rescue procedure can only be made, if the treatment and healing process to the point of discharge from hospital is being monitored by scientific criteria. These kinds of studies are demanding and have not been made so far.

The Rescue Lifting System

At the University of Applied Sciences and Arts in Hildesheim/Holzminden/Göttingen, Germany, the ‘Rescue Lifting System’ has been developed, which makes a gentle rescue possible of maritime victims at sea., Special double beckets have been constructed in a such a manner that one strap floats on the water surface and is easily caught and placed under the arms, while the second strap sinks in the water to be easily put under the knees or the thighs of the victim. For security reasons the sinking strap compared to the floating strap is slightly longer. Therefore it is possible to create a ‘deckchair’ seated position while lifting, which has been proven to be medically ideal. Furthermore, the sinking strap adopts a drag-anchor position in water, so that the light floating strap cannot be displaced too much in heavy seas and strong winds. This particular design and the auxiliary devices, work together to lift the victim in a horizontal position over the boat’s side with the muscle power of two helpers, or alternatively by means of derricks or cranes over greater heights. The application in severe weather conditions has been taken into consideration as well as the rescue of unconscious victims via the double winch procedure together with a helper, who, lying in the double sling pulls the victim onto his own body and gets lifted up in “twin position”. Divers fully equipped can also be rescued with the ‘Rescue Lifting System’ from the sea.

'SARRRAH'-Project

The 'SARRRAH'-Project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) (2) was devised at a medical workshop of the German Maritime Rescue Services (DGzRS) and it is being further developed at the Department of Anaesthesiology at the Medical University of Luebeck. The project partnership includes the German Institute for Naval Medicine, the DGzRS, eight hospitals on the North and Baltic Sea coasts, and the Institutes of Forensic Medicine.

SARRRAH involved establishing a strategic plan to co-ordinate emergency measures and a syllabus for personnel training for the primary treatment of hypothermia, in partnership with the civilian and national SAR (Search and Rescue) schools, thus achieving continuity among all sectors of the emergency services.

It involved furthermore, establishing new or modified procedures for rescue, transportation, resuscitation and monitoring of maritime accident victims, suitable for use even in extreme conditions and by both professional and amateur rescue personnel.

It had to be ensured that hospitals are capable and equipped to effectively treat cases of severe hypothermia. All rescue co-ordination centres and doctors on-call in their respective roles in emergency situations, had to be informed. A standardised documentation system has been introduced. This documentation can also be used for patients with hypothermia resulting from non-maritime accidents. A 24-hour hotline is central to the operational plan and makes it easier for personnel to ensure quality control and effective use of the documentation system. In Germany, the Medical University of Luebeck will be the co-ordinator for records and will collate all documentation and manage data.

A new resuscitation kit has been distributed and training resources have been developed. Further information can be found on www.sarrrah.de

Conclusion

It is a basic fact that people with hypothermia have a much better chance of successful resuscitation than critically ill people with normal body temperature, but only if the hypothermia is sufficiently taken into consideration throughout rescue and medical intervention. It is therefore necessary to establish clear and realistic procedures for emergency response, rescue and medical treatment based upon up-to-date and proven knowledge. The first step in the rescue chain must be done perfectly. Golden (4) made it absolutely clear, that “removal from water in the horizontal posture is preferable, in all circumstances, if it can be achieved. It also appears very likely that any demand for physical effort on the part of the victim at the time of rescue carries a risk of precipitating collapse and death. With the inevitable “circumstances permitting”, immersion victims should be handled with the utmost gentleness and as the potentially critically ill patients that they are.”

On the other hand, if rough circumstances do not allow this gentle handling, no time should be wasted and  risk to the life and health of rescuers or the loss of the victim should be minimised. If the person with severe accidental hypothermia is handled in a rough manner, a fatal circulation arrest can be the result. Trained rescuers will have little problem performing resuscitation procedures to the point of arrival at a hospital which is equipped with a device for rewarming under extracorporeal circulation (3, 6). The tolerance of the hypothermic brain against hypoxia is well known and the chance of survival is very high (1).

Normal sling arrangements can cause discomfort to the arms and chest, which may lead to cardiovascular stress and an increase in heart rate due to possible restricted breathing. The newly developed ‘Rescue Lifting System’ seems to prevent rescue stress and also rescue collapse. The SARRRAH project will help to find out which equipment and procedures will lead to the best outcome, i.e. which will help the most persons with severe hypothermia to survive.

The encouragement of co-operation between international maritime rescue services and land based emergency services by the SARRRAH project will enable the accumulation of important data in the shortest possible time.

Literature:

1. Bacher A, Spiss CK: The two sides of mild hypothermia. AINS 1998 Jun, 33:6

2. Baumeier W: Projekt SARRRAH: Primärrettung und Aufbau der Rettungskette bei ausgeprägter Unterkühlung – medizinische und logistische Aspekte nach der Rettung aus dem Wasser. Unterkühlung im Rettungsdienst. Turner E, Kaudasch G (Hrsg.) – Lengerich; Berlin; Rom; Riga; Wien; Zagreb : Pabst Science Publ., 2000, ISBN 3-935357-02-8

3. Farstad M, Anderson KS, Koller M, Grong K, Segadal L, Husby P: Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study. Eur J Cardiothorac Surg 2001 Jul; 20(1):58 – 64

4. Golden F St C, Hervey G R, Tipton  MJ: Circum Rescue Collapse: Collapse, sometimes fatal, associated with rescue of immersion victims. J Roy Nav Med Serv 1991; 77, 139 – 149

5. Rollnik JD, Witt K, Hänert W, Rix W, Schwindt M: Rescue Lifting System (RLS) might help to prevent death after rescue from immersion in cold water. Int J Sports Med 2001; 22: 17 - 20

6. Walpoth BH, Beyhan NW et al: Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporal blood warming. N Engl J Med 1997 Nov, Vol 337, 1500 - 1505

Published:

EUBS 2001 Annual Scientific Meeting Proceedings

27^th  Annual Meeting, 30^th Anniversary of the European Underwater and Baromedical Society on Diving and Hyperbaric Medicine, September 12 – 16, 2001, Hamburg, Germany.

Contact:

Project SARRRAH (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia):

Dipl.-Ing. Dr. med. Wolfgang Baumeier

Dpt. of Anaesthesiology

University Hospital of Schleswig-Holstein

Ratzeburger Allee 160

D-23538 Luebeck, Germany

Tel.: +49 – (0)451 – 500-0 (pager 1455)

Fax.: +49 – (0)451 – 500-3504

E-Mail : baumeier@uni-luebeck.de

www.sarrrah.de

Rescue Lifting System (RLS) :

Prof. M. Schwindt

Rolandstr.35

D – 31137 Hildesheim, Germany

Tel.: +49 – (0)5121 – 66243