Episode 19: Protecting Our Own Part II… The Injured Firefighter

KC FF Down

Listen here or download on iTunes, Podcast Addicts, or Podcast Republic. 

As we mentioned in Episode 15 (our first installment of the Protecting Our Own Series), this episode would not have happened without the effort put in by our friend Casey Cassidy. He’s truly a resuscitationist and constantly focuses on how we can improve our responses to extremely stressful environments. 

This episode was intended to cater, primarily, towards medics that have never worked in a fire service before. If some of the elements of this seem like review at first, we apologize. We just want everyone to start off on the same page.

ARRIVING ON THE SCENE

  • Check in with the Incident Commander
    • They will most likely have a specific location for you to stage, keeping you out of harm’s way as well as you keeping you out of the way of any operations that are ongoing.
    • If you have the ability to speak with a safety officer, they will have updates on any injuries, firefighters who need to rehab, etc.
    • Make sure you have your equipment ready to go. Hope for the best, plan for the worst.
      • Get your stretcher setup, your monitor ready… Make sure you have everything you need for an arrest or a major trauma…
    • Set up a rehab station.
      • Make sure your FF are staying hydrated!
      • Monitor vital signs and see if your people are starting to experience any fatigue.
      • Most departments, at least locally, have a two bottle limit; meaning that if you have blown through two O2 tanks, you aren’t allowed to go back into the interior fire.

KNOWING THE REAL ENEMY

  • According to a study done by the National Fire Protection Association, 56% of all firefighter fatalities in 2014 were due to a cardiac etiology.
    • As much as you want to watch out for signs of CO or cyanide inhalation, you need to remain the most vigilant for the firefighter that looks fatigued.
    • There have been reported cases of CO inhalation resulting in STEMIs…
  • Casey mentioned in one of our talks the importance of treating every unresponsive firefighter in full turnout gear like a full arrest until proven otherwise.
    • If you think about it, you are unable to assess adequate ventilation or presence of carotid/femoral pulse due to excessive barriers.
  • We stole a video from the Firefighter Down: CPR site showing how to do CPR on a firefighter while removing their gear. It’s amazing. If you haven’t watched it yet, stop this episode and go watch it. You won’t be sorry.

HYPOVOLEMIA, HEAT EXHAUSTION, AND HEAT STROKE

  • Firefighting, especially during the warmer months, is extremely taxing on the body. Due to excessive physical exertion, firefighters are prone to hypovolemia, as well as heat stroke and heat exhaustion. It’s paramount to monitor your patients for signs of hypovolemia
  • Heatstroke and Heat Exhaustion
    • Start the active cooling process as quickly as possible; remember that cold fluids used (typically for ROSC and therapeutic hypothermia) are extremely discouraged in this instance!
      • Cold packs to the groin, axilla, and neck
      • Large bore IVs and NS/LR bolus (depending on what’s available)
      • Get them out of their gear and into a cooler environment
    • Things to monitor for:
      • ALOC
      • Seizures
      • Possible airway complications
      • Cardiac arrhythmias

CARBON MONOXIDE AND CYANIDE EXPOSURE

  • CO and Cyanide work very similarly, in that they both bind to hemoglobin and inhibit the hemoglobin’s ability to carry oxygen into systemic circulation
  • Signs and Symptoms
  • If you have the ability, it would be worth considering transporting these patients to a hyperbaric chamber.
  • Prior to entering these scenes, it is extremely important to remember that your safety can be in jeopardy; act wisely.
  • Treatment:
    • If available, consider Amyl Nitrate
    • Maintain airway patency
    • Supportive care and ACLS for the arrested patient
    • Remove the patient from the scene ASAP
      • Particles of the CO/Cyanide can absolutely be found outside of the structure

DECONTAMINATION

  • It is not your role as the provider to be offering patient care to a patient that is not decon-ed. Stay out of the hot zone! Don’t add another patient to the scene.
  • Remove any gear that could be decontaminated prior to packaging the patient; you don’t need toxic chemicals in a confined space.

UNDERSTANDING THE ROLE OF HUMAN FACTORS ON SCENE

  • There will be plenty of sympathetic surge going on during scenes like this; the best thing you can do is to find calming mechanisms for yourself
    • Simulation training has been found to reduce stress simply by preparing participants for real-life scenarios.
    • Don’t forget about tactical breathing
  • Crowd control is a quintessential part of this scene
    • Bystanders are not the only people on the scene that you should be concerned about; first responders that are not involved should be put to work doing other things.
    • The last thing you need is someone who is just twiddling their thumbs and feeling aimless to start criticizing the rescue crew…
  • Removing extra, unnecessary equipment
    • By taking off SCBA, turnout gear, etc., you eliminate clutter in an already tight environment.
    • Remove any undue sounds from the scene; the last thing you need are alarms to be sounding that don’t even need to be there. Reduce the noise, reduce the stress.

WE’RE DONE… NOW WHAT?

  • These scenes are extremely stressful… If you need help, ask for it. Inquire about your department’s CISM policies, or just reach out to someone that has been through it before. Talk.
  • Sit down with all of the departments involved; in a non-judgmental manner address the areas that you feel could have run smoother and assess how to do it better. God forbid, you might need to do it again…
  • If you haven’t listened to it, yet, take a listen to EMCrit‘s talk on how to handle a stressful resuscitation when it’s over. It will change the way you handle these situations.

If you have any questions, gripes, or concerns, let us know in the show notes. We hope this helps.

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