Crowley Rescue and Safety Training

1. THE ENVIRONMENT The LaFargeville Crowley facility makes fresh milk from area farms into pasteurized yogurt, cream cheese and cottage cheese, so temperatures inside the plant range from equipment and liquids that are heated to 160 degrees to frigid storage and shipping areas. There are many areas of the work floor that are always wet, and high-speed moving machinery that could easily cause injury by snagging loose gear.

You MUST stay vigilant for danger to you, your partners and your patient. Make sure that coats, shirts, long hair, blankets and equipment bags can't get caught on moving machinery.

There are several areas where pipes cross the floor; if you have to lift a patient on a stretcher over piping or on wet surfaces:

If the emergency call takes you into the cold storage and shipping areas, watch for slippery spots on floors, and be especially alert for speeding forklifts.

ALWAYS pay attention to directions and other safety hazards pointed out by Crowley or LVFD personnel as you walk throughout the working area.

In case of a fire or catastrophic damage, be aware that there are bulk storage tanks of toxic, potentially lethal gases and liquids within the plant. In case of any potential toxic cloud release, DO NOT enter the area of the plant until cleared by fire and/or HAZMAT personnel to do so. DO NOT BECOME A VICTIM. (See Section 6. HAZMAT SCENE SAFETY below).

The plant's MSDS (Material Safety Data Sheets), are kept in large binders in the hallway outside of the office.

2. CONFINED SPACES We train yearly for rescues from confined spaces at Crowley, specifically horizontal and vertical bulk storage tanks where workers may become injured while cleaning or repairing machinery. Confined space injuries are a leading cause of injuries in industrial settings, so there is a rigid system of checks and safeguards for anyone entering a confined space.

BEFORE ENTERING ANY CONFINED SPACE, IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT ALL SAFETY PRECAUTIONS HAVE BEEN TAKEN.

These precautions include personally verifying that LOCK OUT TAG OUT (see below), safeguards are in place and effective, and that the air quality inside the confined space is safe for human life. This is especially important in the case of an unconscious patient in a confined space: he may have become unresponsive because of a lack of oxygen or the presence of toxic chemical fumes.

Both Crowley and the LaFargeville Fire Department have handheld air monitors like the one shown at left. The safest thing to do is to is to have both testers check air quality and personally make sure that both show that the space is safe with an oxygen content of between 19.5 and 23.5 percent, and that flammability/combustibility hazards are within safe limits. Federal law requires that persons entering the space be allowed to personally watch these tests. Then, at least one member of the rescue team must take an air monitor in with them which will sound an alarm if conditions become unsafe.

3. LOCK OUT TAG OUT Industrial sites are required to maintain and use LOCK OUT TAG OUT (LOTO), procedures to warn workers of, and protect workers from, dangerous conditions, including unexpected equipment start up. LOTO places physical barriers on controls that isolate the power source(s) that operate the machinery (electricity, hydraulics, air pressure, gravity), on equipment itself (to block movement), as well as other dangers. The person who installs the LOTO devices has the ONLY key(s) that will unlock them. In the photos below, LOTO devices have been placed on the electrical breaker that supplies power to a tank's moving parts, and on the piping that would allow liquids to enter the tank.

In the rush of a traumatic accident with injury to a co-worker, workers may forget to use LOTO. YOUR life may be at stake if you have to enter a confined space, or work around dangerous machinery.

YOU should insist that someone carefully explain the LOTO procedures used, YOU should verify who has the LOTO key(s), and YOU should verify that the equipment will NOT operate.

NOTE: EMERGENCY SHUT OFF SWITCHES AND EMERGENCY STOP BUTTONS DO NOT COUNT AS LOCK OUT TAG OUT DEVICES !

4. THE EQUIPMENT In addition to TIERS and LVFD equipment, the primary rescue tool for use in confined space rescue is the SKED® stretcher, this flexible but thick plastic sheet with built-in

handles and straps. It's specially designed to slide under and around a patient, then immobilize the patient into a secure cigar-shaped package for easy movement and to fit through tank access hatches for removal to a stretcher.

IMPORTANT NOTICE: The Sked® does not provide adequate head/neck/back immobilization by itself. If the need to extricate the patient is not immediate, application of a cervical collar and a KED, short backboard or long backboard is essential per protocol.

5. HOW TO DO IT Always verifiy that BSI/Scene Safety and Lock Out Tag Out procedures are followed. If there isn't a fresh air fan available, the interior of the tank will quickly get very warm and humid, so make sure to take off any coats, hats or heavy job shirts. Make sure rescuers are closely monitored and rehydrated in case of extended extrication times. If there are cleaning or other chemicals being used, entrants may be required to dress in a lightweight chemical suit.

These photos show ground-level (left), and eye-level physical hazards inside bulk tanks.

Tank surfaces will be extremely slippery if wet, and vertical tanks (right), are especially treacherous. There is no good footing inside them, so rescuers will have to balance on the bottom agitator as best they can.

Entry to horizontal tanks is best accomplished with the help of others, usually head first. Vertical tank hatches are at the top of a steel ladder, witb another ladder inside.

If standard head, neck and back immobilization will be needed--as with an unresponsive patient--then some real ingenuity may be needed in vertical tanks. In horizontal tanks, immobilize as needed then slide the Sked® under the patient (see photos, below), then tighten all straps to "package" patient for movement. If the victim is crossways in the tank, slide the Sked® underneath first, semi-tighten strapping, then turn the Sked® and patient longways in the tank bottom before tightening straps.

Also notice that the ends of the Sked® are designed to curl up and over the head and feet to secure the patient, especially for vertical movement.

Crowley uses large tanks of ammonia, chlorine and other toxic chemicals in its day-to-day operations. In case there is a leak of toxic chemicals, special care must be used to safeguard rescuers even before the plant site is approached.

On the way to Lafargeville, radio Jefferson Fire Dispatch to ask for a wind direction. Remember that wind is always given in the direction that it is coming from, so a "southwest at 10 miles per hour" wind is coming FROM the southwest: you should also plan to approach FROM the southwest so that any chemical fumes are being blown AWAY from you.

The wind in LaFargeville may not be the same as the wind at the airport or 9-1-1 center, so you need to look at the bright orange windsock on top of the white tank next to the Crowley plant. The windsock tapers from the large end--where wind enters the sock--to the small end, so the windsock is in an arrowhead shape pointing in the direction of the wind. In the photo above, the wide end of the windsock is toward you, so the wind is blowing AWAY from you. You are in the CORRECT direction from which to stage away from the plant. Rescuers may be limited to triage of any walking wounded until other victims are brought out, or conditions permit your entry into the plant area.

There is an ammonia detection system installed in the plant which detects the presence of ammonia and can automatically shut off ammonia valves. The alarm panel is located on the "front porch" where the main plant entrance is, with a red light directly above it. If the light is flashing, a high level of ammonia has been detected somewhere inside. Wait for qualified personnel to determine whether SCBA (air packs), need to be used by anyone entering.

There is also an emergency shut off for the ammonia system located on the exterior wall of the plant, behind the maintenance garage. To activate, use the hammer on the chain to break the glass and allow the plunger to come out of the box. This will stop ammonia flow from the main tank, but there still is likely to be fumes inside. There is also an emergency warning light directly above the shut off. Wait for fire or HAZMAT teams before entering the plant, especially if you aren't sure of your personal safety, or have a history of asthma, COPD or other breathing disorder. Stage away from the plant and call for additional personnel.

SOMEONE has to establish immediate command responsibility to control access and provide crucial information via radio and cell phone. MEDICAL COMMAND should be responsible for setting up a First Aid station, getting additional medical personnel and equipment on scene and organized, and checking fire or HAZMAT personnel exiting the scene to check vital signs, provide first aid, rehydration and rehabilitation. Call for the Medical Support Unit (TIERS Utility One), which has medical supplies and should be loaded with water for both rehydration and easy rinsing of body areas affected by chemical fumes.

AMMONIA DANGERS Anhydrous Ammonia is a colorless gas with an extremely strong odor in concentrations as low as 5 percent. It is lighter than air UNLESS the air is humid or cold, or a combination of the two. An alkali, it is explosive in high concentrations and is hygoscopic = combines easily with water.

This is both bad and good news: The bad news is that fumes combine with body sweat to form Ammonium Hydroxide in armpits, the crotch area, under hatbands and helmet bands and on the scalp, on sweaty skin inside heavy fire coats, on the face underneath SCBA masks, in boots, etc. The good news is that it is easily removed from skin by flushing with COLD WATER.

Exposure to strong smells can cause Olfactory Senses Overload. We've all been in a dairy barn, at a fire scene or other situation where we "get used to" strong odors after a few minutes; the brain stops recognizing the smell after continuous exposure. Work with Incident Command to make sure that anyone entering the scene is timed to make sure that they come out at agreed time intervals to be rehabbed and checked for respiratory damage.

BLS CARE Initial signs of exposure to ammonia fumes are coughing, chest pain, and eye irritation as the ammonia combines with water to form Ammonium Hydroxide. Longer or more concentrated exposure will cause burning sensations to the eyes, nose and throat, coughing, wheezing, stridor, and altered mental status.

CALL MED CONTROL FOR ORDERS TO GIVE NEBULIZED ALBUTEROL AND/OR NEBULIZED ATROVENT, RUN INTO THE HUMIDIFIED O2 STREAM; CONTINUE GIVING ALBUTEROL AND ATROVENT UNTIL YOU RUN OUT, THEN PUT NORMAL SALINE IN THE NEBULIZER AND CONTINUE ADMINISTERING.