ࡱ> 68345[ bjbj ΐΐdkkk d!dk7n#####$$$4444444$m:=4$$$$$4##7&4&4&4$##4&4$4&4&4&4#/k% &44707&4=3=&4=&4\&4$$$44&4$$$7$$$$=$$$$$$$$$ :  Lexington Division of Fire and Emergency Services Special Operations Command Confined Space Manual May 2008 TABLE OF CONTENTS  I. II. III. IV. V. VI.  INTRODUCTION....................................................................................................................... 1 CERTIFICATION MAINTENANCE........................................................................................ 1 BACKGROUND ........................................................................................................................ 2 HAZARDS .................................................................................................................................. 4 OPERATIONAL CONCEPTS ................................................................................................. 8 CONFINED SPACE TASK OPERATIONS ........................................................................15 VII. CONFINED SPACE INCIDENT MANAGEMENT SYSTEM................................................. VIII. Appendices .......................................................................................................................................... Page ii I. INTRODUCTION n Purpose  The purpose of this document is to establish standards for organization, safety, training and operations of confined space operations. n Authority The Department in accordance with Department Standard Operating Procedures SOP 572.17 Kentucky s governing body is Kentucky Occupational Safety & Health (KOSH) as mandated by the Occupational Safety & Health Administration (OSHA) section 29 CFR 1910.146. n Intent The intent of this manual is to provide all members a reference material that establishes department standards that lead to effectively mitigating confined space emergencies. It is further understood that this document was developed based on safety considerations for both victim(s) and rescuer(s) in accordance with OSHA standards. Due to the potential hazards involved at a confined space operation, the procedures outlined in this manual shall personnel and victim(s). be followed to ensure the safety of all emergency II. CERTIFICATION MAINTENANCE n  To maintain certification, personnel must follow the guidelines established in the Technical Rescue Operations Manual. OSHA code 29 CFR 1910.146 (k)(2)(iv) further requires:  Employees practice making permit space rescues at least once every 12 months, by means of simulated rescue operations in which they remove dummies, manikins, or actual persons from the actual permit space or from representative permit space . III. BACKGROUND Definition n Confined Space  A space that has the following characteristics: It is configured so that a person can enter and perform assigned work. Has limited or restricted means of entry or exit. Is not designed for continuous human occupancy.  A Permit Required Confined Space may also have one or more of the following characteristics: Contains or has the potential to contain a hazardous atmosphere. Contains a material that has the potential for engulfment or entrapment. Has an internal configuration such as that an entrant could be trapped or asphyxiated by inward converging walls or by a floor that slopes downward and tapers to a smaller cross section. Contains any other recognized serious safety or health hazard. Overview of the Problem n A variety of circumstances exist that cause confined space rescue operations to be dangerous, difficult and confusing. A confined space that appears to be harmless can deceive an untrained rescuer, luring them into a potentially fatal situation. Over fifty percent of deaths in confined space are rescuers. Even after National Institute of Occupational Safety & Health (NIOSH) put out and alert of the dangers of confined space the death rate for rescuers climbed to 60%. Potential for new incidents are increasing because of: New utilities being built underground. Maintenance and repairs of existing underground utilities and storage spaces. Increased entry into confined space by construction workers, industrial workers, and utility company personnel and public works employees on a daily basis. Lack of formal training in confined space hazards and safe work practices in industry or the private sector. Unauthorized or accidental entries by mischievous, adventurous or unlucky individuals. The infrequency of confined space situations result in limited experience upon which to base operational decisions. Lack of formalized training for the rescuers: Situations can easily develop which are beyond the teams capability. Relatively simple rescue situations become complex when they occur within a confined space. III. BACKGROUND Problem Sites  n The following areas are examples that may present a potentially hazardous situation and should be treated as a confined space: Manholes Utility vaults Tunnels Sewer systems, storm/sanitary Wells/cisterns Trench/excavations Open pits Sump pits/sump rooms Silos Storage bins Hoppers Brewer vats Septic tanks Caves/ mines Tank cars Reaction vessels Industrial smoke stacks/chimneys/boilers Collapsed structures- below grade basements Cold storage facilities Large industrial transformers Ship holds Auto repair lift pits Water treatment plants- carbon tanks, diffusers Sanitary sewer pumping station Blind elevator shafts/ elevator pits IV. HAZARDS  n Each confined space has its own specific problems and hazards. In order to protect personnel from being injured or killed they must be well trained and understand the hazards they encounter. The hazards can be categorized into two parts: Atmospheric hazards Physical/Mechanical hazards Atmospheric Hazards n Atmospheric hazards are not easily seen, smelled, heard or felt and can represent deadly risks to those who must work around or enter confined spaces. Rescuers must realize that a 1% drop in oxygen may indicated and increase of 10,000 PPM of another substance. Oxygen Deficient or Enriched n Any atmosphere containing less than 19.5 percent oxygen by volume is considered oxygen deficient. Any atmosphere containing more than 23.5 percent oxygen by volume is considered oxygen enriched. Oxygen concentrations can change for four main reasons. n Consumption: Combustion operations such as furnaces, smoke stacks and boilers. The exposed area can remain low in oxygen long after fire and combustion operations are over. Bacterial action in oxygen rich sewer systems. An aerobic bacterium eats the oxygen. Fermentation actions such as those in brewer vats, grain silos and feed storage bins. Chemical reaction such as the slow oxidation process, which takes place during rusting of steel and iron tanks, consumes oxygen. n Displacement: Gases that form within a confined space such as the build up of CO2 and methane in sewer systems, silos, vats, bins and hoppers, displace oxygen. Gases introduced from outside the space such as leaking storage tanks or pipelines and illegal dumping. Purging operations. n Absorption: Oxygen can be absorbed by a second substance/product such as in carbon storage tanks and activated charcoal filtering systems n Enrichment: An atmosphere containing more than 23.5% of oxygen is considered oxygen enriched and enhances the flammability of combustibles. IV. HAZARDS Flammable/Combustible Atmosphere  n OSHA regulation states that a flammable/combustible atmosphere is present when flammable gas, vapor or mist is present in excess of 10 percent of the lower flammable limits (LFL) or the LEL. These atmospheres can occur for the following reasons. n Biological: Decaying vegetation/ organic matter which produces methane Fermentation process such as those in wine vats, storage bins, grain elevators also produce methane. Anaerobic bacterial systems such as those in sewer systems, sewage treatment plants and sanitary landfills have a bacterial metabolic process to deprive area of oxygen and produce methane. n Normal Product Storage: Where storage of flammable liquids, chemicals and toxins are in a confined space. n Maintenance Procedures: Paints, solvents and residue created. Cleaning, scaling and painting processes. n Inappropriate Presence: Illegal dumping. Storage tank leakage entering into a confined space enclosures. Ruptured pipeline breaks resulting in a product entering a confined space. n Airborne Combustible Dust: An atmosphere is considered hazardous when it has a concentration of combustible dust that meets or exceeds its lower explosive limits. This condition may be approximated as a condition in which dust obscures vision at a distance of five feet or less. Toxic Atmospheres n A substance is considered toxic if the concentrate or dose exceeds the permissible exposure limit as published in Subpart G, Occupational Health and Environmental Control, or in Subpart Z, Toxic and hazardous Substances. Each toxic substance has its own unique guidelines and are too numerous to list. IV. HAZARDS Toxic Atmospheres (continued) n Naturally Occurring  Biological Decay:  Hydrogen Sulfide  Results from the natural decomposition of sulfur bearing organic matter. Concentrations in raw sewage are high. Virtually as toxic as hydrogen cyanide. Recognized as a major hazard in the oil refining and sewage treatment industries. Has a classic rotten egg odor. Rotten egg odor may not be present at high concentrations due to paralysis of the olfactory nerve, which controls the sense of smell. CO2 Found in aerobic bacteria systems, which produce CO2 as an end product of its metabolic process. Methane Becomes a simple asphyxiate in high concentrations. Can be found in areas such as sewers, storage bins, grain elevators, caves, wells and mines. n Normal Product Storage and Operation: Carbon Monoxide - One of the most common asphyxiates encountered in industry. Sulfur Dioxide  Is the manufacturing by product in some industries. Particularly in the paper and plastic industry sulfur dioxide is enormous. Nitrogen Compounds  Widely used in various industrial applications and can affect the respiratory tract. n Inappropriate Presence: Illegal dumping. Accidental introduction  pipeline/storage tank leak. Atmospheric Considerations Atmospheres that test or appear safe initially can suddenly change for a variety of reasons including: n Disturbance of airflow: During ventilation or initial opening of a confined space can disturb the natural airflow. n Humidity and Temperature: Change in temperature and/or humidity can affect the atmosphere. n Depletion of Oxygen: Oxygen levels can become fatally low in a brief period of time in a confined space. Do not be lulled into a false sense of security by the presence of a conscious patient. The oxygen levels within the confined space may not support needs of additional persons (rescuers) entering the confined space. The carbon dioxide from exhaled breath can displace the available oxygen. IV. HAZARDS Atmospheric Considerations (continued) n Maintenance Operations:  Scaling operations used to remove loose rust and sediment from tanks. The petroleum industry has experienced instances where storage tanks were rinsed and vented for several days. They were tested with monitoring devices that indicated no hazardous atmosphere. When workers began scaling operations, oxygen deficiency arose or flammable vapors were released and/or ignited. n Disturbance of Residue: Maintenance workers or rescuers disturb sediment and/or sludge, which may release flammable or toxic vapors. n Stratification of Gases: Due to vapor densities the atmosphere may result in multiple gases at different levels within the space. This will directly influence the ventilation and monitoring techniques. Physical/Mechanical Hazards n The type of physical/mechanical hazard will depend on the specific space encountered and its primary function. The following are examples of the physical/mechanical hazards that may be present in or around a confined space: Electrical High Water Steam Collapse Smoke/fire Darkness Animals, Insects, Reptiles Moving parts/operating machinery Flowing product/Engulfment Unstable contents Slippery surfaces Tapered floors/ Converging walls Hypothermia Thermal High Noise Levels Vibrations Exposure to Raw Sewage/ Chemicals Limitations of Rescuers, Skills, Equipment V. OPERATIONAL CONCEPTS n This portion of the confined space manual is written to provide all members with a reference manual that establishes department standards for effective procedures at confined space operations. Due to the potential hazards involved at a confined space operation, the procedures outlined in this manual must be followed to ensure the safety of all emergency personnel and victim(s). First Responders n Establish Command. n Size-up: Recognize that a confined space emergency exists. Gather information from on site contacts: Confined space permit Number and location of victims Type of confined space On site preplans Determine nature of the emergency: Trapped Lost/unaccounted Injured/medical problem Body recovery n Site control and scene management: Isolate the space and deny entry. Establish hot zone of 150 feet in diameter. Establish staging area for incoming units. Position non-SOC/TR apparatus outside of the hot zone. Maintain access for the SOC/TR apparatus. Control utilities that negatively affect victim (i.e. leaking gas, flowing water or product, operating machinery, etc.). n Request/confirm resources As every emergency is different, the situation will dictate the need for additional resources. Technical Rescue Response Utility company Hazardous materials team Specialized equipment Research capabilities Special PPE Decon if necessary Police department assistance V. OPERATIONAL CONCEPTS First Responders (continued) n Recognize and identify hazards: Hazardous or potential hazardous atmospheres. Hazardous materials. Temperature extremes. Physical and mechanical hazards. n Establish communications with victim(s).  Communications should only be attempted if it can be done without entering the space. All personnel approaching the entrance to the space to make contact shall don all PPE including SCBA. Under no circumstance shall any part of the first responder enter the space. SOC/TR Operations n Report to command. n Recon the site. n Institute the Technical Rescue Operations Incident Command System. As outlined in the Technical Rescue Operations Manual. n Develop action plan: Evaluate actions and information gathered by the first responder. Evaluate the confined space permit if applicable. Answer the following questions: What is normally stored in the confined space? What operations are normally performed in the confined space? What atmosphere could be formed in the confined space? What has been done differently in the current operation as compared to normal operations? Risk benefit analysis viability of victim/rescuers safety. Note weather and time of day. Consult any available preplans: Blue prints, maps, on site resources. Number of entry points. MSDA sheets. Confined Space Rescue Pre-plan. V. OPERATIONAL CONCEPTS SOC/TR Operations (continued) n Request additional resources as needed: Light and air unit Additional technical rescue units/personnel Cranes, back hoe, etc Heating/cooling units Industrial purging systems Shelter Rehab supplies Haz-Mat Unit n Re-assess apparatus positioning: Ensure exhaust from apparatus not contributing to the problem. Ensure all non SOC/TR units are clear of the site. Ensure the scene is accessible for additional TROT resources. n Team Briefing:  Clearly define the incident action plan to all rescue team members. The plan and briefing should include the following: Site description, including illustration. Team assignments for the operation. Personal protective gear requirements. Communication plan. Rehabilitation/decontamination procedures. Emergency evacuation signals and procedures. n Pre-entry Procedures: Rescue Officer (entry supervisor) fills out entry permit Monitoring: Approach entry point in full PPE and on breathing air. Monitor space as described in the monitoring procedures under the Task Operations Section. Ventilation: Begin ventilation as early as possible but not prior to initial monitoring being completed. Consider the potential for changing UEL atmosphere into and explosive atmosphere due to the ventilation. Consider using on site ventilation system if they are safe to use to supplement ventilating the space. Open all openings to the confined space to assist the ventilation process Use positive pressure ventilation. Set up fan as described in the ventilation procedures under the task operations section. V. OPERATIONAL CONCEPTS SOC/TR Operations (continued) Lockout/tag out:  Lockout/tag out as described in the procedures in the task operations section of this manual. Control and eliminate ignition sources: A staffed hose line will be n place when a flammable atmosphere is encountered or anticipated. Consider the use of other suppression agents such as foam and dry chemical Be aware of ignition sources such as vehicles and static electricity. Entry Preparation and Procedures n An Entry Supervisor shall be assigned by the Technical Rescue Operations Section Officer in charge of the division/group. n An entry team shall consist of at least two personnel. n A back up team of at least two personnel shall be in place prior to allowing the entry team(s) into a confined space. They will be equipped and outfitted with at least the same level of protection as the entry team. They will assist the entry team as needed without entering the space. The back up team will remain in place until all personnel have exited the space. If the original back up team is going to be used as an entry team, another back up team must be established and in place prior to any additional entries. n Each entry team shall have: At least one atmospheric monitor. Two forms of communication . Emergency Buddy Breathing System (EBBS). n Each team member shall have: Appropriate level of PPE, which will include the use of SABA/SCBA. This will be dependent on the type of space, monitoring results and ventilation actions At least two light sources which may include any combination of the following: Hand lights Helmet lights Chemical light sticks (Cylume sticks) Personnel alert device V. OPERATIONAL CONCEPTS Entry Preparation and Procedures (continued) n The Technical Rescue Safety Officer shall: Check each entry personnel for readiness. Serves as Attendant as required by OSHA. Establish and track an entry team rotation. Record the following: Entry times Time in the confined space Exit times Number of entries by an individual  n Personnel shall not cross the  plane of entry to a confined space with any part of their body with out the appropriate level of PPE. Breaking the  plane of entry will be considered as a confined space entry. The plane of entry is considered to be an imaginary area surrounding the entry point. DO NOT PLACE YOUR FACE IN THE OPENING TO ASSESS THE SITUATION OR COMMUNICATE WITHOUT PROPER PROTECTION. n Any confined space with a vertical drop of five feet or greater will require a rope retrieval system to be attached to the entrant. A mechanical advantage raising system shall be attached to entrants prior to entry to assist in quick retrieval of the entrant if required. n If the confined space has a potential for engulfment (i.e. storage bins, silos, hoppers) or if the space has sloped and/or tapered floors, independent support lines shall be used by the entrants. This will allow them to work above the product surface. n Entrants shall use a class III harness when rope systems are used for entry/egress. n All Rope operations shall adhere to the Fairfax County Rope Operations Manual. n Any lids, covers, doors or hatches that must be opened during entry must be secured open to eliminate accidental closure. n If at any time the air supply is lost to an entrant the entry team will exit the space using the emergency escape procedure described in the task operations section of this Manual. V. OPERATIONAL CONCEPTS Entry/Exit Procedures  n Team members must stay together while in the confined space. 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An exception to this would be if the tag line would endanger the rescuer by becoming an entanglement hazard. SABA does not require the use of a tag line as the airline fulfills this function. n While in the confined space, consider using chalk, Cyalume sticks and/or other methods to indicate direction of traffic, victim location, area searched and points of egress. Victim Removal/Extrication n The number one priority in a confined space with a hazardous atmosphere is to remove the victim to a safe environment. n Determine victim rescue vs. body recovery. n Consider providing victim with a supplemental air supply (i.e. RIT pack, spare SCBA, SABA mask, etc.). n Consider mechanism of injury from falls, entrapment or engulfment and package accordingly. n Extrication activities, which involve disturbing the structure or machinery within the confined space, shall only be under taken after evaluating the impact of these actions. Will the action: Cause a shift in the product? Create a more hazardous environment? Cause the structural integrity of the enclosure to be impaired? Cause an increased hazard to the entrants? V. OPERATIONAL CONCEPTS Incident Termination  The following actions shall be conducted at the conclusion of any confined space operation: n Personnel accountability: Fire Department on scene. Other civilian/agencies that were involved. n Assess personnel: Conduct a post entry medical screening. CISM debriefing as necessary. Relieve from duty if needed. n Team briefing: Establish assignments for equipment removal/rehab. Remove, decon, inventory and arrange replacement as needed. Turn scene over to responsible parties. n Documentation of incident: Confined space permit shall be filed within seven days. The atmospheric monitoring log shall be attached to this report. Exposure reports shall be filed within seven days. Technical rescue incident report shall be completed by the technical rescue officer and filed within 24 hours. Post incident analysis report shall be distributed to all technical rescue stations within 30 days. The technical rescue program manager shall complete this report. VI. CONFINED SPACE TASK OPERATIONS Monitoring (Haz-Mat 1) n Perform P.H. paper test prior to using monitors. n Bump test instrument before every use.  n Monitoring shall begin on approach to the confined space entrance. Personnel initially monitoring the space shall wear full PPE and SCBA/SABA for protection from unknown atmospheres. n Report atmospheric monitoring in the following order: Oxygen Flammable Toxins n When performing a vertical entry, atmospheres may be stratified. Most air contaminates and vapors can be found in low lying areas. The atmosphere should be tested every four feet. If a sampling tube is used, allow two minutes for the delay of the sensor response. n Monitoring shall be conducted and recorded every 10 minutes. However, continuous monitoring is preferred. n Consider the shape of the confined space and the potential for pockets of gas. n Consider actions that could change the atmosphere: Wind Ventilation Humidity Temperature Rescuers n Know your monitors limitations/capabilities: Oxidizers can cause toxic sensors to give a false reading, possibly in the negative PPM. High humidity can create condensation on the sensors. Gas molecules may not pass through the water layer. Extremely cold environments can cause NiCad batteries and LCD displays to perform poorly or not at all. Radio frequency interference may be a problem with false alarms. Certain toxic atmospheres may require more specialized monitoring. Hazardous Materials units can help you with your assessment. VI. CONFINED SPACE TASK OPERATIONS Monitoring (continued)  n The following atmospheric conditions shall be considered an IDLH environment: Oxygen deficient: 19.5% or lower. Oxygen enriched: 23.5% or higher. Toxicity: levels that exceed the permissible exposure limit (PEL) for any substance Airborne combustible dust: a concentration of combustible dust that meets or exceeds its lower explosive limits. This condition may be approximated as a condition in which dust obscures vision at a distance of five feet or less. Flammability: 10 % of the LFL or LEL: Rescuers shall not enter confined spaces containing atmospheres with greater than 10% of the LEL regardless of the PPE worn. There is no adequate protection for an explosion within a confined space. Ventilation n Ventilation shall not be conducted until after initial monitoring is accomplished. n If conducive, utilize all natural or man made openings into the confined space to assist with ventilation process (i.e. manholes, hatches, natural openings). n Ventilate all levels due to stratification of gases. n Consider size and shape of the area and the effects on effective ventilation: Use electric powered blowers only The blower intake fan should be positioned: At least five feet from the opening to eliminate the churning of bad air At least one foot off the ground to eliminate drawing of ground level contaminates into the confined space As not to interfere with communications The ventilation hose should be positioned: As not to block access and egress 1-3 feet from the floor space for the most effective air flow. This will also help prevent creating an airborne dust hazard VI. CONFINED SPACE TASK OPERATIONS Ventilation (continued) n Lockout/Tag out:  Determine the presence of all energy systems that may include one or more of the following: Electrical Pneumatic Hydraulic Gravity, momentum, stored energy  Be aware that emergency back up systems may be present  Utilize plant personnel or on site workers to assist with lockout of the systems If a positive lock out control cannot be achieved, a member of the fire department shall be posted at the controls until all operations are terminated. This person reports directly to the technical rescue safety officer. Mechanical moving machinery shall be brought to a zero mechanical state to eliminate any rotation or movement from slack in the system. Lockout/Isolation Procedures n Techniques for lockout/isolation procedures: Use multi-lock hasps and padlocks for each entrant; give keys to the technical rescue safety officer. Use product control/pipe plugs and/or air bags. With mechanical linkage, remove drive belts and/or chain sprocket in place. Valves will be chained or otherwise secured. Use of spectacle or skillet blinds, for blanking/blinding. Remove/misalignment of piping. When blanking/blinding or removal/misalignment cannot be performed, at a minimum two valves in a product flow line must be shut. Double block and bleed of systems. Blocking up to control gravity, momentum and stored energy systems. If there is no way to guarantee the control of the flow into the space and the space is subject to the introduction of hazardous materials, then the space will be considered as containing that hazardous material. The appropriate level of protection clothing will be required. VI. CONFINED SPACE TASK OPERATIONS Entry Team Communications  n Communications shall be maintained between rescuers, command and support personnel. n Any emergency communications shall follow Lexington Division of Fire and Emergency Services procedures. n Status report from the entry personnel should include: Team designator Accountability status Location Air levels (SCBA) Monitor readings Situation update Victim condition if applicable VI. CONFINED SPACE TASK OPERATIONS . Airline Management n Use accountability tags of rescuers on the manifold with the corresponding airline. n Airlines shall be: Marked with tape or ribbon near the couplings to identify the separate lines Monitored and managed by an assistant during entry and egress. Laid out in a manageable fashion (i.e. figure 8 or serpentine). No longer than 300 feet in length Connected to form 300-foot lengths, unless the distance is absolutely known (i.e. tank car). The airline system uses Hanson quick connect fittings. Safety collar shall be turned out of the unlock position to prevent accidental disconnect of the airline. Consideration should be given to placing a rubber boot or duct tape over the couplings to help prevent unintentional disconnection. Rescuer Guidelines n Entry teams shall routinely check their escape cylinder to ensure that the cylinder did not accidentally open. If the cylinder is inadvertently opened, the rescuer will deplete the emergency air supply without warning. The rescuers only air level indicator is the gauge on the cylinder, there is no low air alarm for this cylinder. n Always keep the escape cylinder with in hands reach. When operating in tight areas move the cylinder in a position where it can be operated easily if there is a sudden loss of air. n Rescuers must manage the airline while inside the confined space. Be aware of areas where the line will get tangled, cut or snagged. If this happens, stay calm and try to determine the cause. Try to unhook the line or have their partner assist in untangling the line. VI. CONFINED SPACE TASK OPERATIONS Rescuer Guidelines (continued)  n The rescuers should retrieve slack in the airline prior to preparing to go through a portal or other small opening. n The rescuers must maintain awareness of their distance from the entry. Remember you only have a limited amount of escape air. (Rated for 10 minutes.) Emergency Escape Procedures n Anytime an entry team member s escape cylinder is opened for any reason, both team members must exit the confined space. Do not continue an operation with a partially full cylinder. n If the air supply is lost while removing a victim, the victim should be left and the team will leave the space together. n If the airline supply fails, there will not be a low air warning alarm to notify the rescuer. The first indication will be a decreasing airflow to the rescuer. This will be quickly be followed by the face piece collapsing against the rescuers face as they pull a vacuum. n Escape using EBBS: Turn on the escape cylinder Alert the second rescuer of the loss of air Communicate with the entry officer of the air supply problem If the second rescuer has not lost supplied air, use the (EBBS) and exit the space together If supplied air is returned, disconnecting of the EBBS hose is acceptable in order to expedite exiting the confined space n Escape without using EBBS: Turn on escape cylinder. Alert the second rescuer of the loss of air. Communicate with the entry officer of the air supply problem. Cycle the cylinder or utilize the donning switch as the team exits the space. Prior to going through small portals or openings, take a breath and make sure there is enough air to complete the task. If a difficult egress point is encountered where it will take several seconds to complete, turn the cylinder on until the task is complete. During the escape periodically check to see if the air supply has been re- established. If the air supply has been re established leave the emergency air cylinder off and exit the space. VI. CONFINED SPACE TASK OPERATIONS Victim Packaging/Removal  n Remember the #1 priority is removal of the victim to a safe environment. The patient must be packaged for removal based upon the rescuers evaluation of the injuries sustained and the current atmospheric conditions. n Patient removal techniques: Reeves, SKED (full/half), KED board or improvised material on site (i.e. conveyor belt) works well as a drag device to maneuver patient through narrow horizontal spaces. The SKED is not a spinal immobilization device and will bend under the weight of the patient if used for any lifting. A spinal immobilization device must be used if any vertical or horizontal lifting of the patient is required. LSP half board is a rated lifting device as well as a spinal immobilization device. Use when a vertical lift is required. If a KED board is left in place and the patient is being lifted vertically, a full body harness or seat and chest strap must be placed on the victim. Extreme situations requiring rapid patient removal due to dangerous atmospheres will warrant the use of quick application body harness or wristlets for removal. Place a helmet on the patient, when possible, to protect the patients head during removal. Maintain the patient s airway during a prolonged raising evolution. The use of two attendants may be required, one above and one below the victim. Plan ahead for additional resources. Communicate request to outside support along with situation. When packaging the patient, preplan which way the patient will exit the space. Keep in mind any elevation differences and room to maneuver the patient. Whenever possible position all team members to the egress side of the patient during removal. This is so the patient will not block means of egress if there is a loss of air to the rescuers. In certain situations it may require placing a rescuer on either side of the victim during removal. These moves need to be quick to reduce the amount of time the victim is separating the rescuers. Ensure the path is clear of all obstructions. Consider using a utility line to the victim so other team members can assist with hauling of the victim. This needs to be carefully orchestrated to prevent further injuries to the victim. Do not use electric winches to remove the victim(s). Winches allow little control and could cause injuries to victim and rescuers.     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