Are we paper working ourselves to the point of creating a greater hazard?
When a confined space rescue standby team arrives on a site there are many documents they require. A hazard assessment, entry procedure, rescue procedure, possibly an entry permit, WHIMIS info, gas monitor paperwork and likely a few more that I have missed. The hole watch / rescue team leader could easily be looking at a minimum of 30 pages of documents. One could argue that these are no longer simply onsite procedures to be reviewed, but rather are competing with War and Peace. And just like reading such a novel, once you get to page 30, your memory of what was at page 1 will be limited.
For this article we are specifically focusing on the Rescue Plan or Rescue Procedure, an area of Ronin’s expertise. In creating documents and training clients we have had many interactions with different regulatory authorities across Canada. In some cases, we have had to add more and more information to these rescue plans to placate these regulatory inspectors. The longest plan we have had to produce to date was 11 pages long. Yes, you read that correctly – 11 pages for a rescue plan. Please think about that for a minute. You’re on site, you’re the team leader, the rain is pouring (it’s Vancouver) or the wind is howling off the lake with a light snow (it’s Toronto). Either way, in those environments, having paper documents in your hands is a quick way to destroy them. The hole watch assigned space #3 hits the air horn to initiate the emergency protocol. A worker has become unconscious in the space. You sprint over to the hole, start your assessment process and try to effectively use that 11-page document. The issue though is that you can barely remember the specific, sequential steps spread over endless pages of text that you are required to follow. You will need to go back and refer to the plan line item by line item. At this point you’re trying to protect the document from the elements and read it at the same time that you need to be at the space and can’t hide in a dry room somewhere. Is it realistic to have your rescue team review, line by line, the entire rescue plan, for 11 pages, prior to entering the space to perform the rescue? Is it realistic to think that the team will remember every item on the 11-page document? I would assume that it’s a resounding no to both questions.
So what do you do?
At Ronin our backgrounds are quite diverse. Most of us have a military and emergency service background. In the Military some of us (from the better branch – the Infantry J) were taught how to lead section, platoon and company attacks. Yes, there were guidelines for these operations however, there was also the “commander’s intent”. There was a great deal of planning and training that went into operations. When the rubber met the road, the onsite team leader would conduct a quick “hazard” assessment based on the situation, then utilizing their knowledge of the plan, guidelines and “commanders intent” deliver a very brief orders process and send their troops into the operation. One can see some of the similarities between this process and a rescue process. Both are situations where a leader needs to complete a quick assessment, make a decision based on incomplete facts using pre-determined action plan as best as the situation allows. In the Military there is not an 11-page document you need to refer to and check the boxes in prior to mounting an operation. The Military spends a great deal of time instructing its leaders (months and years) in both hazard identification as well as providing realistic scenarios in order for them to successfully operate in this fashion. Granted, the Military does have a higher tolerance for risk than most other professions.
In the Fire Service many of us (from the operational side of the fence) were taught how to lead firefighters on an emergency scene. Once again there are operational guidelines, general principles and policies. However, once faced with an incident the onsite team leader conducts a quick “hazard” assessment of the situation, writes down an incident action plan (IAP) on a portable dry erase board and deploys the firefighters to do their assigned tasks. Some of the calls that a fire department responds to are technical rescues, so there is a direct correlation between this response and a private rescue provider’s response. There is a little more documentation required in the fire service than the military – the creation of the IAP for instance. This is likely due to a more risk adverse attitude in the fire service as opposed to the military (the more “no fail” the mission, the less risk adverse the organization is) as well a lesser level of training in the fire service. This may rub folks the wrong way, however having been part of both organizations, the Army trained me for much longer and at a higher level of realism then the fire service did. That being said the Fire Service still provides months of training and years of experience to a leader prior to leading an incident. Regardless of these differences between the military and fire service, the fire service does not use an 11-page document either to check off when they respond to the same technical rescue event that a private rescue provider does. Please take a minute to ponder that; Ronin employs some firefighters on their days off. On Friday in a blue fire department shirt Fire Officer Bloggins can respond to a confined space rescue emergency with only an IAP. On Saturday, Rescue Team Lead Bloggins requires an 11-page document to perform the exact same rescue. One could even argue that the onsite rescue team has more information about the hazards than the fire service does as they have access to all documentation as well as having taken part in the tail board and other site orientations. Yet this onsite team is not allowed the latitude to direct the team in response to the incident, they must have a pre-written document based on the most likely scenario that may occur.
This is not to say that the military and fire service do not plan. They plan extensively. They continually review their plans, update them where required and train to be efficient in the execution of the plan. Both organizations also have immediate actions that they do to certain regular events. These in reality are standard plans for regular events. Both services understand however that the situation on the ground is bound to be fluid and the team leader needs to have the latitude to alter the plan as required. Both services understand that having plans are required, however reviewing them when the balloon goes up is too late and trying to read them during an operation is borderline ludicrous.
Both the military and fire service are examples of organizations that pre-plan and pre-train and rely on the experience of the staff to allow for a less proceduralized onsite document. Both agencies rely on the skill of the leader to assess and mitigate the situation rather than relying on layers of policy and paperwork. So does this come down to training and experience? Absolutely. For instance, we require hundreds of hours of training and experience, both with a professional public emergency response organization as well as on sites for Ronin Team Lead before he/she is qualified. And why wouldn’t we? We are stating that we will rescue your staff from immediate danger under potentially difficult circumstances. We need to know what we are doing. The question in our opinion is where is the point on the graph where training/experience and length of procedures balance out? What is that elusive point where you have enough training that a reasonable amount of pre-planning is acceptable for the situation? If the team is trained in the hazards they will be exposed to and competent in rescue procedures and planning, how long does the document need to be? An interesting point here also needs to be considered. The rescue is the rescue. The rescue does not change because a less trained or equipped team is performing it. So what is that elusive magic number of rescue training and planning hours that is required for that rescue – because that will not change no matter who is doing it.
Are we looking at this from the wrong view point? Instead of how long the training and planning process is should we just look for performance? Walk onto the site and throw a 50 pound bag in the space – and tell the team leader to fetch. You will know within 5 minutes whether or not the team has plans and is trained – no matter what the length of the document on site is.
Another question that regularly arises is how detailed does the rescue plan need to be? Are we pigeon holing our team leaders into a course of action? Do we want everything written in a procedure? Face it, rescue and recovery can be a messy business. Who is going to sign off on the line that states when removing a deceased worker, from the space, you will need to break their arm in order to exit the hole. Or perhaps the procedure calls for a 5:1 mechanical advantage yet due to factors such as patient weight, size and extent of injury that team leader decides that a 3:1 is justified. The TL just violated their own procedures, which in all areas is a violation of regulations.
We are not advocating that teams go and throw away their rescue plans. In fact, we believe that planning is essential. Pre-planning and pre-training. On site the team should be just updating their regular plans for the specific situation. We would to like to open the thoughts and discussions. Discussions about how realistic is it to use a lengthy emergency procedure on site that pigeon holes your rescuers. Discussions about how much training and pre-planning do you really need to perform a rescue.
Please remember – No plan survives contact with the enemy, Helmuth von Moltke the Elder