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Control measure

Triage casualties: Water rescue and flooding

Control measure knowledge

One of the most important decisions to be taken at water incidents is whether actions are being taken to rescue or recover casualties. A rescue can be carried out when people are obviously alive or are considered able to survive. A recovery is made when people are known to be deceased or not able to survive.

The distinction between rescue and recovery is important because it should influence the incident commander’s decision-making. The level of acceptable risk for a rescue is considerably higher than that for a body recovery in almost all circumstances.

Survivability model

A model has been developed to help incident commanders decide if a casualty is survivable and involves decision-making with other emergency services and other rescue organisations that might be on scene.

The model is designed to give casualties every reasonable chance of rescue and resuscitation and is balanced against the risk of harm to responders when carrying out rescues.

The main factors to be considered are the length of time the casualty has been submerged and the water temperature. Water temperature in the UK averages about 10°C, but can range from 0°C to 25°C, depending on the location and the type of water. Available medical evidence suggests that water temperatures in the region of 6°C to 7°C or less are required for prolonged survival times in submerged casualties, sometimes described as ‘icy cold’.

It is not possible to know for certain when a casualty became submerged, so the clock should start when the first attendance arrives on scene. It should not be assumed that the person has been submerged for longer than this.

The incident commander should carry out a risk assessment, balancing the likelihood of casualty survival against the likelihood and severity of harm to rescuers.

It is anticipated that after 30 minutes all three emergency services will probably be on scene. This may include specialist teams from the ambulance service and other rescue organisations. The incident commander should liaise with officers from the other services to decide how to proceed. The first element to consider is the likelihood of survival. This clinical decision will be taken by the ambulance service based on the criteria above, or in their absence, by the incident commander. If the water is freezing cold the casualty should be considered survivable, although the likelihood of survival reduces as time passes. The risk assessment should be revisited to decide if rescue should continue or if the incident should switch to body recovery.

If a decision is taken to continue the rescue then, at 60 minutes, the incident commander should liaise again with the senior officers from the other services. If the water is cold and the casualty is known to be young and/or small they should be considered survivable, although again their chances further reduce as time passes. The risk assessment should be revisited to decide if rescue should continue or if the incident should switch to body recovery.

After 90 minutes, the incident commander should liaise again with the senior officers from the other services when the decision should be taken to switch to body recovery because the circumstances are regarded as no longer survivable.

The police are responsible for body recovery, but fire and rescue services may become involved depending on local policy. Personnel should not be put at undue risk to perform a body recovery and incident commanders should consider the likelihood that an investigation may be required. See National Operational Guidance: Operations - Evidence preservation.

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Strategic actions

Fire and rescue services should:
  • Ensure that all personnel, including emergency service mobilising and fire control room staff, are aware of the guidance for the rescue or recovery of persons from water and the survivability model

  • Have a body recovery policy

Tactical actions

Incident commanders should:
  • Triage casualties and prioritise rescue activities

  • Use the survivability model to determine actions at incidents involving submerged casualties

  • Jointly agree search and rescue or recovery response with other agencies based on survivability model