Rescue Talk™
Urgent vs Emergent Moves: The Confined Space Perspective
In Emergency Medical Services (EMS) we are taught the difference between urgent and emergent moves, though in practice the words often get blended together. An emergent move is exactly what it sounds like: you do not have the luxury of time or packaging. You take the patient out immediately because the environment itself is about to do harm. An urgent move is different. The scene is safe enough, but the patient’s condition will not let you take your time. You still move quickly, but you have some degree of control and can make limited choices about how you handle the patient before transport.
That tidy classroom distinction starts to unravel inside a confined space. Here, the rescuer’s safety is tied directly to the environment, and the atmosphere may be just as dangerous as the injury you were called to treat. Before you even reach the patient you often face two questions: is this a rescue or a recovery, and if it is a rescue, is it urgent or emergent?
The rescue versus recovery decision is one of the hardest. Imagine a worker who has been down for forty-five minutes in oxygen deficient air. You confirm no pulse, no breathing, and the path to the surface will take at least fifteen minutes. In that case the outcome is already written. It is a recovery, not a rescue, and the correct decision is to exit without initiating a dangerous removal for a non-viable patient. It may feel harsh, but it reflects the reality of survival physiology and the limits of an IDLH space.
“It may feel harsh, but it reflects the reality of survival physiology and the limits of an IDLH space. “
Now consider a different scenario. You reach a worker who still has a pulse, but their breathing is shallow and ineffective. The monitor shows a hazardous atmosphere, and you know you cannot provide ventilations for them where they are. This is the classic emergent move. You put supplied air on their face, strip packaging to the bare minimum, and remove them as fast as possible. Every extra second spent inside that space reduces their chance of survival.
Other times you may find someone who is stable even though the atmosphere is bad. Their vitals hold steady, and their breathing is adequate enough to breath with the supplied air. That gives you the opportunity to slow down enough to provide all the protection they need while being extricated from the space. A Sked stretcher or similar method may be the best option. You still need to work efficiently because the air is unfit to sustain life, but you do not need to sprint blindly toward the exit.
“Stabilization comes first. Once the patient can tolerate movement, you package appropriately and begin extraction.”
Finally, there are cases where the atmosphere is good, but the patient is not. Here you can take advantage of the safe environment to perform airway interventions or other treatments right where you find them. Stabilization comes first. Once the patient can tolerate movement, you package appropriately and begin extraction. In this case the urgency is driven entirely by the patient’s condition rather than the space.
Most of our confined space rescues come down to two guiding questions from a clinical perspective. (1) Is the patient viable, and (2) what level of intervention does the environment allow? The answers tell you whether you treat, package, drag, or withdraw. The scenarios are never simple, but if you keep those questions in mind, the safest and most effective procedure for both the patient and rescuers becomes more clear even in the most complicated holes we climb into.
