The Federal Mining Act (BBergG) stipulates that companies operating under mining law must ensure that first aid, emergency medical care and transport for injured persons are provided in accordance with the type and size of the company and the nature of its activities. To fulfil these and other obligations, special emergency services (mine rescue teams) are trained for underground mining (Figure 1).
Fig. 1. Mine rescue teams provide first aid, emergency medical care and transport for injured persons in underground mining. // Bild 1. Grubenwehren gewährleisten Erste Hilfe, eine medizinische Notversorgung und den Transport Verletzter für den untertägigen Bergbau. Photo/Foto: © Starpics, stock.adobe.com
Mine rescue teams are trained at the main mine rescue centres, which are integrated into the Emergency Management Prevention Department of the German Social Accident Insurance Institution for the Raw Materials and Chemical Industry (BG RCI), Heidelberg/Germany. The training is specifically designed for underground operations, such as rescues from unstable mine workings or areas that are only accessible with heavy breathing apparatus. Such locations are often inaccessible to company or public rescue services.
Until now, mine rescue team members in all mining operations have been adequately trained to care for injured persons. Rapid emergency care and stabilisation of an injured person for transport to the shaft and handover to an emergency doctor is still possible in many underground operations.
However, German mining has changed significantly: there are now many small operations without their own mine rescue teams, mines with larger mine buildings and company doctors and paramedics who are no longer available for underground operations.
An analysis of past operations has shown that in lay medical rescue, the time until a patient is handed over to emergency medical services often exceeds the statutory response time. In many cases, training as a company first-aider is not sufficient to provide adequate care for serious injuries underground.
Frank Reuter, head of mine operations and the mine rescue service at the Reiche Zeche research and training mine at the TU Bergakademie Freiberg, Freiberg/Germany, developed a new rescue and training concept in 2020 together with Andreas Fichtner, then head of the emergency department at the Freiberg district hospital: Tactical Medical Mining Rescue (TMR). It is based on proven methods from military, police and alpine medicine and has been specially adapted to the challenges of mining.
The reference to military and police concepts is justified by the similar conditions in high-risk areas: limited material and human resources, complex traumas, long transport routes and the lack of initial assessment by a doctor.
The aim is for members of a mine rescue team with no prior emergency medical training to achieve a practical level of competence and range of skills in underground emergency rescue comparable to the standard of care provided by the emergency services in a two-day course. To this end, a standardised rescue plan with a modified cABCDE algorithm has been developed. This is a simple if-then algorithm that specifies the most important life-saving measures. The aim is to stabilise the condition of the injured person and ensure safe rescue until they are handed over to an emergency doctor.
First responders learn, among other things:
- Assessment of acute vital danger;
- stopping bleeding;
- stabilising breathing and circulation;
- pain management;
- breathing support independent of ambient air and, if necessary, ventilation;
- keeping the patient warm;
- transport positioning with fixed equipment;
- options for sliding and vertical rescue.
The equipment developed for use underground meets special requirements: it is compact, resistant to moisture and dirt, can be operated even in poor visibility, and can be stored for transport (Figure 2).
Fig. 2. The equipment developed for use underground is compact, resistant to moisture and dirt, can be operated even in poor visibility and can be stored for transport. // Bild 2. Die für den Einsatz unter Tage entwickelte Ausrüstung ist kompakt, widerstandsfähig gegenüber Feuchtigkeit und Schmutz, auch bei schlechter Sicht bedienbar und transportgerecht verstaubar. Photo/Foto: BG RCI
Several mine rescue teams from BG RCI member companies have already successfully completed the new training concept. It follows a proven training methodology and is divided into seven areas of competence. A similar training course called EMSiG (Advanced Measures for Paramedics in Mine Rescue) was developed by the Berlin Accident Hospital, Berlin/Germany, and is currently being used in a member company in the mining industry. Unlike TMR, however, EMSiG requires basic medical training. The action algorithm and equipment differ only slightly from the TMR concept.
The TMR concept has already been successfully applied in an emergency in a mining operation. A mine rescue team was able to stabilise a seriously injured person to such an extent that safe and painless transport to an emergency doctor was possible. The emergency doctor confirmed that the patient had been very well cared for.
Both concepts for advanced first aid are not only suitable for mining, but can also be used in surface operations where rapid rescue by the public emergency services cannot be guaranteed.