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Accessing a casualty

Hazard Knowledge

When a casualty has been located, the primary focus should be on their rescue. Within the LAST acronym, ‘Access’ may form part of the rescue plan. How access is made will vary depending on the type and location of the rescue. This phase includes:

  • Carrying out a risk assessment and communicating the findings when the casualty is located
  • Identifying the agency with the appropriate capability to access the casualty
  • Updating search management records using progress and activity reports

The impact of any secondary hazards on the casualty should be managed, as this may influence their safety. For example, incidents may involve electrical cabling or infrastructure, which prevent a rescue being performed at an appropriate pace. This may have a detrimental effect on the casualty, either through the ongoing impacts of the environment or the physical restrictions of the entanglement.

Secondary hazards in the hazard area may have been managed, but need to be reconsidered if accessing the casualty will require the movement, manipulation or cutting of objects.

Activity to access the casualty may require personnel to work closer to secondary hazards, and it is likely that additional secondary hazards will become apparent during the casualty rescue process.

Other secondary hazards include hypothermia or heat illness in the casualty, especially if the rescue is protracted, or being carried out in severe hot, cold or wet conditions.

It is important to realise that other emergency responders may have different ways of working and have different priorities to the fire and rescue service. This may also include their approach to appropriate levels of personal protective equipment (PPE). Co-operation and communication are important to resolve the incident. All agencies should be focused on the casualty, making the incident safe and using a casualty-centred rescue approach.

Personnel should be aware that their actions could impact on the rescue of the casualty, their condition or on the medical treatment being provided. Personnel may need to stabilise a casualty until resources or specialist teams are able to assist with the access to and rescue of them.

Medical equipment

Working alongside other emergency responders, such as the ambulance service can present hazards. In this guidance, the term 'equipment used by other agencies' refers primarily to equipment used by the ambulance service. This will include 'sharps', such as hypodermic needles and scalpels, drugs and oxygen.

The hazards posed by the equipment used by other agencies include:

  • Puncture wounds
  • Cross-contamination
  • Cuts
  • Lacerations
  • Explosion

Casualties may have prescribed or non-prescribed medical equipment with them; this may be on them, in their personal possessions or nearby, for example in a vehicle. If a casualty is carrying or wearing a medical alert tag, bracelet or card, this may give an indication about medical equipment they are likely to have with them.

It is reasonable to assume that the ambulance service will take responsibility for their own equipment. However, it is also reasonable to assume that when medical treatment of a casualty is taking place inside a mode of transport, some equipment may be scattered. Other agencies do not always practise the discipline of creating an ordered equipment or tool point, which can create issues for maintaining a safe working environment.


Using medical oxygen in small and confined spaces, or using oxygen cutting equipment while a casualty is receiving oxygen therapy, can produce an oxygen-enriched atmosphere; this can support combustion or create a flammable atmosphere.

The use of tools, equipment or defibrillators in an oxygen-enriched atmosphere, could present a risk of combustion. Medical oxygen should not be contaminated with grease or oil, due to the associated risk of ignition between a fuel and an oxidiser.

Rescue tools

In this guidance, the term 'tools' relates to different types of specialist rescue equipment, including manual tools and those powered by battery, pressurised air systems (pneumatic) and hydraulic systems, such as:

  • Cutters
  • Rams
  • Spreaders
  • Combination tools
  • Reciprocating saws
  • Angle grinders
  • Disc cutters
  • Chisels
  • Oxygen cutting equipment

Poor housekeeping of tools can impact on the outcome of an incident. For example, a tool left on the ground in the path of a casualty being moved could result in them being dropped if an emergency responder was to slip on the tool.

The hazards posed by tools to operators and casualties may occur as a result of a malfunction, misuse or in normal use, can include:

  • Noise
  • Vibration
  • Musculoskeletal disorders
  • Projectiles
  • Entanglement
  • Impact injuries
  • Crush injuries
  • Amputations
  • Sparks
  • Burns or scalds
  • Hydraulic injection injury, sometimes referred to as epidermal injection
  • Irrespirable exhaust gases
  • Dust or toxic particles
  • Corrosives
  • Toxic materials
  • Irritants
  • Flammable substances

For further information, refer to Operations - Failing to manage health, safety and welfare.

Fire and rescue service equipment should be well-maintained and tested, and only used by trained operators. However, advances in materials, ageing equipment or inappropriate use of tools can cause safety events. This could include the failure of equipment, causing the collapse or sudden movement of loads under pressure.

Although tools are manufactured with safety features to prevent and protect against misuse or malfunctions, operators should still be aware of the potential for tools to cause harm through inappropriate use or poor handling.

The operation of tools such as high-pressure crash rescue equipment, has the potential to cause a hydraulic injection injury, whereby hydraulic fluid is forced out of the tool hydraulic lines or equipment, usually as a result of damage. Due to the pressures that hydraulic equipment operates at, this liquid can be forced into the body resulting in severe injury and possibly death. For further information regarding fluid injection injury refer to can be found by reading the Health and Safety Executive (HSE) Hydraulic injection injury - safety alert.

Cutting and spreading using tools

When cutting an object, operators should be aware of the potential for unexpected movement and a release of stored energy from the object that is being cut. This release of energy may dispel foreign objects and dust, as well as causing injury to personnel or the casualty.

When an object is cut there is also the potential for the structure related to the object, moving unexpectedly or before personnel are in a safe position. This unexpected movement may cause injuries through direct contact with a person or to a casualty’s neck or spine.

At an incident that requires the use of tools, the speed at which a casualty is rescued to prevent further deterioration may need the use of simultaneous and co-ordinated activity from multiple tool operators.

Respiration of particles

Material deformation, due to collision or the cutting of materials to remove structural elements, produces a range of material particulate sizes. Inhaling these particles to the upper and lower respiratory tract poses a significant risk to emergency responders and casualties, during the extrication phase and the recovery phase, when clearing up may be carried out.

Respirable airborne continuous filament particles have the potential to enter the lungs and can cause lung disease.

Dermal irritation

Dust or fibres, produced during a collision or when accessing casualties, can cause irritation to soft tissues such as the skin and eyes if there is direct contact. Irritation is more prevalent if soft tissue is exposed to resin-coated fibrous material, especially glass fibre reinforced polymer (GFRP) and carbon fibre reinforced polymer (CFRP).

Dust or fibres can gather on tools, equipment or personal protective equipment (PPE) and can be transferred to other people or surfaces.

Manual handling of a casualty

When extricating or moving a casualty, personnel will have to employ manual handling techniques.

Inappropriate manual handling may cause the condition of the casualty to deteriorate, or injure personnel. The level of difficulty to move the casualty to safety will depend on the location, position and weight of a casualty, and how they need to be moved. For further information refer to Operations: Manual handling.

The hazards associated with manual handling when rescuing casualties may be increased by:

  • The environment, including:
    • Working at height
    • Working in an enclosed or confined space
  • Weather conditions
  • The distance to a place of relative safely
  • Available resources
  • A lack of appropriate equipment
  • The condition of the casualty