The Danger of a ‘Rescue First’ Approach in Confined Spaces

A recent prosecution by the Health and Safety Executive of Futamura Chemical UK Ltd has highlighted a critical flaw in how many organisations respond to confined space emergencies.

The instinctive reaction when someone collapses in a confined space is immediate rescue - get them out and then start first aid.

In many cases, that instinct can make the situation worse. The Futamura case demonstrates why.

A worker, Mr Cole, was discovered collapsed in a pump room after exposure to gas. A delivery driver attempted to help but was also overcome by the gas. Both men were eventually rescued from the area. The rescuer regained consciousness however, tragically, Mr Cole later died in hospital. An inquest concluded that hydrogen sulphide exposure had contributed to his death.

This pattern is well known in confined space incidents. Atmospheric hazards such as toxic gases or oxygen deficiency are often the cause of collapse. Entering the space without recognising that hazard exposes rescuers to the same conditions. What begins as one casualty can quickly become two or even more.

Standard workplace first aid training rarely prepares workers for this scenario. Most courses focus on treating injuries once a casualty has been moved to a safe environment.

In confined spaces, however, the environment itself is frequently the cause of the medical emergency. That means the response must be different.

David Nice, Director of Brooklyn Specialist Training Solutions and a former paramedic, has repeatedly warned that many confined space incidents are made worse by an over-reliance on extraction rather than stabilisation.

He explains: “Normal rules just don’t apply in a confined space medical emergency, which means standard first aid practices aren’t enough to protect both the victim and the first aider.”

Brooklyn Specialist Training Solutions addresses this issue through its Confined Space Casualty Care training.

Central to the course is FAMOUS PE, a structured 30-second decision-making framework designed to guide responders in the first critical moments of an incident. FAMOUS PE moves on from the standard DR ABCD.

Under F – Foreseeable Risks, responders identify what is most likely to cause further harm – like arterial bleeding or toxic gases – these immediate dangers are prioritised and managed before and during rescue, not after.

Recognising dangerous atmospheric gases early allows teams to deploy breathing apparatus before or during rescue, preventing continued exposure to toxic gases and protecting rescuers from becoming casualties themselves.

David added: “Confined space first aid its outside traditional first aid thinking. If you don’t address further risk to life first, then in a critical situation, the person will not survive extraction and, potentially, the rescuer will not either. We need to start approaching confined space first aid differently or there will be many more deaths and poorer outcomes.”

The lesson from the Futamura case is clear: confined space incidents require confined space-specific first aid thinking, not a default “rescue first” response.

To learn more about the Brooklyn STS Confined Space Casualty Care course, contact us today.