6.1 The aim of rescue is, of course, to save life – and this aim applies in mass rescue operations as in any other. In MROs, however, there is the capability gap.
6.2 Ways of filling that gap are discussed elsewhere in this series: see guidance papers 3.1, 3.2 & 3.3. But the problem can also give rise to questions of prioritisation; and determining life-saving priorities can sometimes be extremely difficult. In the worst-case scenario the rescuer might be faced with the question: 'There are too many people here. We cannot save them all. Which do we choose?'
6.3 The fundamental aim of the IMRF's MRO project is to make this question unnecessary. With the right preparation, lateral thinking and – always – luck, we should be able to save everybody. But this is not to say that we will not have to prioritise during the rescue: we almost always will.
6.4 The SAR response will often be dependent on the decisions of the commander of the unit in distress, who will also be assessing the priorities. If there is a chance – but not a certainty – that the unit will survive, what is the balance of risks of evacuation against keeping everyone aboard? And if evacuation, or partial evacuation, is required, who should go first?
This question sometimes gives rise to innovative solutions. At least one cruise company plans to ensure that trained crew members will be the first away, so that they can establish reception facilities, or help establish them, for passengers being brought to safety behind them.
6.5 In other circumstances, SAR responders, led by the SAR Mission Coordinator (SMC) and the On Scene Coordinator (OSC), will have to prioritise similar risks. In a normal case it might be best to evacuate a craft into designated SAR units at sea – but in an MRO there will be insufficient SAR unit capacity. The priority then might be to keep the craft tenable, whether it is the casualty vessel or a survival craft of some sort. (See guidance papers 3.3, 4.3 & 4.4.)
6.6 If an evacuation is or becomes necessary, who should leave first? It might be said that the injured or infirm should take priority. But why? If it takes less time to recover more able-bodied people, it can be argued that they should be the priority, on the greatest-good-for-the-greatest-number principle. There may be other options for the hard-to-handle cases – helicopters, for example, which, while very unlikely to be the first choice to manage the entire rescue on their own, may be better suited to lift the less able survivors. (See guidance paper 4.7.)
6.7 Where a commander of the unit in distress is still able to function and communicate with the OSC and/or the SMC, the priorities should be discussed. Knowing that there are insufficient SAR units available to recover everyone, or that winch-fitted helicopters are en route, may enable the commander to reprioritise. S/he may have no choice, of course: but, as ever, reliable information is key to good decision-making.
6.8 If people can be left where they are – on the parent vessel, in survival craft etc – and brought to safety that way, this should be the preferred option, for it helps solve the mass rescue problem. However, those in authority must keep the situation under close scrutiny and remain ready to commence evacuation and recovery at sea if it becomes necessary.
6.9 When evacuation is, or becomes, necessary, it should ideally be orderly – although this will not always be the case. Rescuers may find themselves faced with having to recover people from the water as well as from survival craft etc. In these circumstances another prioritisation process is required.
6.10 People in the water should always be prioritised over people out of it, even if the latter are not in proper survival craft. Survival times in water are significantly shorter than in air in the same ambient conditions. People without lifejackets or other buoyancy aids should be prioritised over people who have them and are using them more or less correctly, keeping their heads above water. People making no noise and unresponsive when questioned should be prioritised over people shouting for help: they are probably closer to drowning. Detailed discussion of the effect of environmental and other factors on available rescue time may be found in IAMSAR Volume II Chapter 3.8.6.
6.11 People who are very young or old, injured or otherwise disabled, or in mental distress should generally be prioritised; although rescuers may benefit from recovering some apparently capable survivors first, to help with further recoveries and/or to tend their companions as they are brought aboard. Remember that people already picked up will need support while others are still being retrieved. For the same reason, capable people should also be among the last to be picked up, as they will be needed to help the less able prepare for recovery.
6.12 Rescuers should also be aware of the dangers of 'circum-rescue collapse'. Some 20% of those who die as a result of immersion in cold water do so just before, during, or shortly after their retrieval.
6.13 After rescuers are as sure as circumstances permit that everyone has been recovered from the water, they should turn to those survivors who are out of it. The principles discussed above again apply, with people on makeshift rafts etc taking precedence over those in purpose-built survival craft.
6.14 We must also consider the matter of the clearly and the apparently dead. Both should be retrieved if possible, with the apparently dead being the priority. Remember that someone found floating face down in the water is not necessarily dead – but they soon will be if not recovered and treated. In an MRO, initial triage may have to be very rapid and hard-headed. An unresponsive person with their airway above water may be on the point of drowning: their recovery should take precedence over that of somebody who apparently already has drowned. But the latter should also be picked up and, even if no other treatment can be given immediately, placed in the recovery position. They too may survive.
6.15 Some people will be clearly dead when found, usually because of visible injuries sustained. While the living and those who may still be alive must be recovered first, bodies should be picked up too, if practicable. The main reasons for this are that:
||the person's family and friends are also victims of the incident, and they will be helped, to some degree, by having their loved one's body returned to them
||everyone involved in the incident needs to be accounted for
||a body left in the sea is likely to attract the attention of other rescuers subsequently: investigating it will waste their time, and may put them at extra risk
||accident investigators and other authorities will prefer to have bodies recovered to help them fulfil their own responsibilities.
6.16 Bodies should be placed on the rescue unit out of sight of survivors if practicable.
6.17 It may be impracticable for bodies to be recovered, usually because attempting to do so would place the rescue unit's crew at unacceptable risk. This is a decision for the rescue unit's commander. If it is so decided, the OSC and SMC must be informed of the fact, including the number of bodies concerned, their location, and the reason why recovery was not attempted or completed.
6.18 IMO's MSC Circular 1185, Rev.1, 'Guide for Cold Water Survival', includes guidance on treating the apparently dead. Advice on 'handling of deceased persons' may be found in IAMSAR Volume II Chapter 6.18 and Volume III.
6.19 The next stage of the rescue operation is considered in guidance paper 2.6. The difficult question of accounting for everyone involved is considered in guidance paper 2.5.