Migrant rescues: 'You can't save everyone'

Within moments the Norwegian-flagged Ocean Viking begins to recede on the horizon, as Easy 1 hits over 40 knots per hour.

"Okay," says Jeremie, signalling to the driver Rocco to slow down.

He motions to Fulvia to prepare the rubber dummy for a CPR exercise, as the swells gently rock the boat.

Everyone is wearing FFP2 masks, a safety protocol to prevent any possible transmission of Covid from those rescued.

Despite the masks, radio communication remains audible and relatively clear - when voiced loudly and slowly.

The trick is to keep composed and not let the adrenaline affect you.

But the training still kicks in fast.

"Man overboard, man overboard!" yells Hassan.

"Port side!!" he says.

Rocco steers the boat in the direction of the casualty, a floating dummy with around the same weight as an adult male. He then pulls back the throttle for a slow, careful approach.

The team rolls it over the large orange sponson and into the deck of the raft for a rapid assessment.

"Hassan, I want to know if he is breathing or responsive," says Jeremie.

Hassan places his hands on the causality, asking if he is okay.

"He's unconscious and not breathing!" responds Hassan, as he carefully lifts up the chin to better expose the airways.

Fulvia places an adult manual resuscitator 'Ambu' bag on it, two pumps, followed by 30 chest compressions.

"Five, four, three, two, one!" says Hassan, counting down the last five chest compressions so that Fulvia can pump the Ambu bag at the right moment.

Meanwhile, Jeremie calls it in on the radio to inform the medical crew on board. The CPR continues as the swell and waves pound Easy 1 but the team appears to be in control.

Within moments they arrive at the Ocean Viking's boat landing and the casualty is lifted out with a soft stretcher, where the medical team quickly takes over.

Easy 1 roils back from Ocean Viking, the water frothing white around the outboard motors, and then speeds out to open sea to repeat the training.

When it comes to resuscitation of children and babies, the number and type of chest compressions and Ambu pumps differ.

A baby takes three compressions, using two thumbs on the breast, and one breath to resuscitate. That this is a plausible reality speaks volumes.

It also poses fundamental questions, drawing a grey line between those you can save and those you cannot.

"You can only save as many people as possible. Sometimes you have to choose," says Charlie, team leader for Easy 2.

Every rescue has a scope of influence, a coping mechanism that lays bare some harsh realities.

In some rescues, not everyone can be saved.

Rescuers need to internalise that most everything is out of their control, while a smaller bit is within their influence - and even a smaller bit within their grasp.

Balancing those concepts allows them to focus their energy. There is no point in trying to save someone who cannot be rescued, while others are more likely to survive.

Clear lines of communication are therefore crucial to fully understand the scope of influence.

Part of that involves having a shared mental model of the crisis, a unified goal to ensure accurate assessments on an approach.

But it also means avoiding a strict hierarchy command on board because assessments of what is happening can be made from different angles.

The crew therefore needs to feel confident to point out critical issues. At the same time, the search-and-rescue leader cannot be overwhelmed with information.

It means an issue can only be voiced aloud twice.

If there is no response from the leader, then it might mean he sees something else more demanding.

"For us the priority is to be able to face the most dramatic thing ever altogether. If you are alone, you won't get much done," Jeremie had told the crew, during a briefing.

The Ocean Viking is set to leave east Sardinia on Wednesday (30 June) afternoon, and then steer a course towards international waters off Libya.