atsb final report released 16 may 2013 - Ambulance Service of NSW

winch training at increased height the operations manual required that a comparisonof the training benefit was to be made with the potential risk to the involvedpersonnel. The conduct of winch training that did not involve live winching was notsubject to height constraints. The ACM advised that the majority of his live winchtraining was basic winch training. However, his line training and check flights, aswell as a number of his currency flights, were reported to have involved advancedwinching at increased height.Ambulance Service of New South WalesRole of the Special Casualty Access TeamThe Special Casualty Access Team (SCAT) was developed by the ASNSW about30 years ago to enable paramedics to access patients in hazardous or remotelocations. The SCAT training manual described the role of SCAT paramedics asfollows:The ultimate role of SCAT is to provide ‘Clinical Access’ – the ‘Access,Triage, Treatment & Evacuation’ of patients in order to provide medicalcare. SCAT also provides medical oversight of the immediate environmentand personnel for the duration of a mission.…SCAT skills are unique – not recreational, not rescue, not mountaineering,but ‘Clinical Access’.ASNSW management representatives advised that the improved capability ofhelicopters and rescue winches had greatly affected SCAT operations. This hasresulted in the vast majority of patients in difficult to access areas now beingretrieved by helicopter rescue winch, rather than via ground rescue teams.SCAT personnel have been involved in a number of high profile, visuallyspectacular rescues that are well-known within the SCAT paramedic community.This includes the previous rescue that was referred to by the duty paramedic whenplanning to access the injured canyoner. That previous rescue was conducted by adifferent helicopter operator.ASNSW management advised that SCAT officers were trained in access proceduresand in the equipment used for those procedures. That training was adapted to themission at hand on an as required basis. This was the case with the high profilemission that was referred to by the duty paramedic when planning to access theinjured canyoner, and involved the application and adaptation of existingprocedures and training. However, the ASNSW reported that the earlier rescue wasextensively risk managed and included the use of a command and control systemunder the supervision of an accredited rescue agency.A number of SCAT paramedics advised that several missions over the years hadused innovative patient retrieval methods that involved the adaptation of skillslearnt during training. In respect of the plan to retrieve the injured canyoner,ASNSW management considered that the use of a self-stabilising system and themethod used to deliver the winch hook were both innovative as they were neitherdocumented nor trained for, and had not been previously undertaken. Whileacknowledging that a level of innovation may be required to complete missions, theuse of those techniques was considered by ASNSW management to be beyond the- 32 -