Risk Management Models: Special Operations

Risk Management Models

The collapse zone that pinned the victim to the floor was inside the west door, approximately one third down the south wall on the right. This view is looking at the west side of the building after the emergency phase has ended. Broken trusses can be seen hanging from the wall. (Photo by Lloyd Schultz.)

“Behold the turtle. He makes progress when his neck is out.”

-James B. Conant

Emergencies of all types are inherently dangerous because of the unsettled nature of incidents and the dynamics involved in both their development and abatement. Consequently, the hazards and risks to emergency responders are abundant, and injuries and death are a very real possibility for all emergency medical services (EMS) and fire department personnel. What is needed to help minimize risk to responders is effective leadership to model risk management in the field; an effective and sanctioned risk management model in policy form; and comprehensive training on how to use a risk management model for any emergency. What follows is a real life incident that applied a risk management model and saved a life!

Department Implementation

As the fire chief for a village, paid-on-call fire department, I recognized the importance of developing and applying a risk management policy for our department employees to follow. Most fire departments do not have formal risk management policies, or statements, or mantras, and my department was no exception.

A fairly well known risk statement from the National Fire Academy was worthy of consideration: Risk a lot to save a lot. Risk a little to save a little. Risk nothing to save nothing. However, this seemed to be too simplistic. While there are several other risk management models that have been developed over the years, one stood out as being very comprehensive and yet specific enough to be applied at nearly every type of emergency. We will get to the one statement that was selected for our fire department.

The purpose of a risk management policy is to help provide as safe a working environment as possible for all department personnel through an administrative control. Yet, merely proclaiming a risk management model as “the way” is a hollow approach and deceptive to all members unless proper training supports the policy. Therefore, the risk management model was presented as a new policy at a department training session. The reasons for the policy were outlined, and then several scenarios were presented and discussed thoroughly so that all personnel understood the application and utility of risk management. In short, I wanted to make it abundantly clear that our goal was for everyone to go home after each emergency response with their safety and well being completely intact.

Over the course of several months and after application of the risk management model at all emergencies, the concept of risk management seemed to take root in department members. Our own approach was to include the risk management model in all incident checklists and even laminate it on the dashboard of all emergency vehicles. The premise was to get it out in front of everyone to see and use so that it became part of our response fabric and cultural mindset. Numerous and repetitive uses of the risk management model were exercised each week during both EMS and fire training sessions. Essentially, we slowly turned each department member into a risk management officer.

Risk Management Model Policy

The International Association of Fire Chiefs developed and issued a policy regarding rules of engagement as a general order for all responders. That policy states: To address risk at each emergency, and to minimize risk to each responder, all personnel are expected to consider and operate with this risk model in mind:

  • DO NOT risk your life for lives or property that cannot be saved.
  • Extend LIMITED risk to protect savable property.
  • Extend vigilant and measured risk to protect and rescue SAVABLE lives.

The Incident

Just over three years ago, an extremely windy day had ensued on a hot, late August afternoon in southern Wisconsin. At a construction site for a future semi-truck wash facility, workers were installing large-span, lightweight, wood trusses onto the top of the wood-frame walls. This was a large pole frame type of building, approximately 110 feet long and 50 feet wide, and the trusses were craned into place where workers at the top of the 20-foot walls secured them into place. To rely on the strength of the ends of the building, the trusses were installed on each end initially and then worked toward the middle.

After three trusses were installed on each end, and while the fourth truss was being positioned on the east end, a wind-induced collapse occurred. The last truss fell against two other trusses on the east end and they fell to the floor of the building, shattering apart as they fell and pulling the south wall in toward the center of the building.

At the same time, the last truss installed on the west end also collapsed and fell to the ground. It was at this location that four construction workers were involved in the immediate collapse area; one of them on the ground was struck by the truss remains and pinned to the floor.

Other on site workers immediately checked on the four workers and found that one of them was unconscious but breathing and bleeding profusely from a head wound. Even though he’d been wearing a hard hat at the time, the force of the falling truss destroyed his head protection and violently forced him to the sand and fine-gravel floor. One of the workers immediately called for emergency help and police, fire, and EMS responded. Meanwhile, with the remaining trusses and the south wall flailing in the high winds, the remaining workers on site did not enter the collapse area. After a quick head count, it was soon determined that the worker who was struck and bleeding was the site foreperson.

Incident Management

First on the scene was a local police officer who verified the collapse. He was quickly joined by a Wisconsin State Patrol officer. Both of these officers immediately entered the collapse area to render aid to the pinned construction worker, with the local officer bracing the leaning south wall the best he could. Shortly after the arrival of the police officers, a fire engine arrived with five firefighters followed by a rescue with one paramedic and one emergency medical technician. A few minutes later, a grass fire truck arrived with two additional firefighters.

The incident commander (IC) who arrived on the engine conducted a quick assessment and, combined with on scene information, considered an entry into the collapse zone for rapid victim removal. His thought process was that the worker may have life-threatening injuries and need to be removed as soon as possible to save his life. The IC reflected on the department’s risk management model policy and the three statements. He knew he was presented with a savable life but that it presented a significant risk for his personnel to enter the collapse area. Consequently, while he would locate outside the collapse zone, he committed to sending only three people into the hazard area to package and remove the patient based on these observations and situational awareness.

The remaining trusses at the roof area appeared to be secured and nonmoving. The remaining trusses did not appear to have forces applied to them from collapsed trusses.

The unsecured trusses appeared to be all on the ground or at least secured at one point that appeared to keep them stable. The south wall would need to be secured promptly and simultaneously with the rescue effort as the high winds were unrelenting. A firefighter used the grass fire truck to act as the anchor and prevented the south wall from collapsing further with rescue rope.

The worker was bleeding profusely and time was of the essence. A medical helicopter was dispatched by the IC. Because of extreme risk, all personnel would need to wear their fire helmets with the paramedic wearing a hard hat. These responders entered with a patient backboard, EMS supplies, and hand tools to attempt a rescue.

On entry, the paramedic assessed the patient and found he suffered a severe head injury with a possible cranium fracture and was unconscious but breathing. The patient was also bleeding from the mouth. Cervical traction was applied with a cervical collar, the head wound was addressed, and the patient was rapidly placed on the backboard and secured. Within five minutes of responder arrival, the patient was removed from the collapse zone and administered more medical care in a safe area. All responders safely vacated the hazard area at the same time as patient removal and began to assist the paramedic in securing the patient’s airway. At this point, the patient began to be combative because of his brain injury. After sedation and more immobilization, intravenous lines were established and extremity fractures were splinted. Shortly after this on scene medical care, the patient was loaded into the emergency medical helicopter transport approximately 20 minutes post extrication. The patient was flown 41 miles due east to Milwaukee’s Froedtert Hospital for definitive medical care.

The Aftermath

It was later learned that the patient was a 36-year-old male who suffered a skull fracture and brain injury, an abdominal injury with an internal bleed, and extremity fractures; he was consequently kept in a coma for two weeks. The paramedic who treated the victim stated that a few more minutes left untreated would have surely meant death for this man. The best part of this story was that he endured a lengthy rehabilitation period that led to a full recovery. This survivor, and his very grateful wife, showed up at the fire department exactly one year later, walked in, and stated that he was reporting back to work two weeks after that.

Although all responders in the collapse area were subjected to danger, it is apparent, in retrospect, that careful but expedient thinking considered “extending vigilant and measured risk to protect and rescue savable lives.” It is a tribute to the leadership present, in consideration of the department’s risk management model policy, and the effective training in the months leading up to this incident that changed this potential tragedy into a triumph.

Author’s note: As the chief of the department, I interviewed all responders who responded to this incident and determined that the actions taken to save this man’s life were nothing short of heroic and completely consistent with our risk management model and policy. Essentially, these dedicated responders “risked a lot to save a lot” in the finest fire service tradition. Consequently, these responders were given written commendations and received awards at the next annual award ceremony. The Wisconsin State Patrol trooper who entered the collapse zone with his first-aid kit also received an “Officer of the Year” award for his actions.

The author wishes to thank paramedic Jim Lilly for his contributions to this article.

Clarion UX