Winter Incident Rehab and Response

Example Fire Incident:  In the inclement weather the wires and trees iced up, winds blew the trees down along with the wires. Most of the region lost power. It's the evening's third structure job in a row: One involved candles, the other a kerosene heater.  This was a working fire in the garage/carport area of a two story house. The fire extended up the garage, but not obviously into the house and was caused by a man putting gasoline into his generator while it was still running!  Apparently he didn't want to interrupt his daughter while she was using her computer. In the process, he was burned across arms and feet, but paramedics did not expect any life-threatening injuries. No inhalation. The incident was reported at 1620 hours, and was under control by about 1655 hours. The on-scene Rehab Sector was initiated within 10 minutes, and included cold weather options as the temperature is 30 degrees F. The original crews were fairly tired, because of the back-to-back responses, and relief crews were not available due to heavy call volumes. 

Cold weather and power outages force a modified version of Fire Rehabilitation. Fluids are still important. However, warm fluids may be more comfortable and palatable to the crews, especially late in the operation. Power outages may require the use of portable lighting, even to illuminate the street areas where equipment is operating and may need to be powered by portable generators. Just like the one that just burned this unfortunate homeowner, generators pose a threat to operations.

Rehabilitation operations were set up in the covered carport area of the home next door. Crews reported, and had baseline assessments of pulse rate, oxygen saturation, and carbon monoxide levels. As they arrived, two of the firefighters had high levels of carbon monoxide on the CO-oximeter. These two reported they were not involved in firefighting, so the level must be incorrect. They had been inside the house confirming no smoke or extension into the living area, and then were helping the family recover some valuable items. They did not utilize their breathing apparatus after they confirmed no smoke in the house. 

The rehab sector officer confirmed their CO-oximeter readings on their fingers. Neither firefighter reported a headache, nausea, or shortness of breath.  Both felt tired, but related that to the nature of their busy shift.

With a level of carboxyhemoglobin at 15%, and no symptoms, the two were asked to stay in rehab until they had rehydrated and rested, and then their levels would be re-checked. But the Rehab officer was concerned. He asked about their exposure at previous fires, and the condition of the exhaust system in their vehicle, or whether they had been standing near the exhaust of other vehicles. Neither firefighter seemed to have another source of exposure. And none of the other firefighters, including the ones who were responsible for fire suppression, had carboxyhemoglobin levels over 5%.

The Rehab officer asked Command for assistance in locating the source. Command found the officer from the ladder truck, who carried the ambient air gas detectors for the Department. They found very low levels of carbon monoxide in the area around the burned carport, in the street near the fire department vehicles, and even in the cab of the engine that the two firefighters had responded in. It was a windy afternoon, so smoke had dissipated from the area of the fire very quickly. 

To be complete, the crew took the air meter inside the house. Very quickly the meter "lit up," reporting ambient carbon monoxide levels of 100 parts per million in the living areas, both on the main floor and the second floor. They quickly exited the structure, and reported to Command their findings. Neither could smell any smoke in the house, so there had to be an alternate source.

Command asked to speak with the wife of the man burned in the fire. She was at one of the neighbors' houses, trying to get the children arranged before she was taken to the hospital to be with her husband. The Rehab officer requested that Command round up all of the family members and bring them to Rehab area for screening. If the house was full of carbon monoxide, each person in the house had to be considered as a victim. They could all be screened quickly using the pulse CO-oximeter. 

The wife was brought to meet Command at the Rehab location. Her carbon monoxide level was 22%. She was complaining of a headache, which had been present throughout the day, which she attributed to the stress of the power outage, and the cool temperatures inside the house. She reported the house was ordinarily heated by electricity, and had all electric appliances.  The generator in the garage was the only hydrocarbon-powered piece of equipment that had been in use. 

The three children arrived from various friends' houses in the neighborhood.  All three had carboxyhemoglobin levels over 25%.  When asked, each reported feeling ill during the day, and the youngest had been vomiting before the fire. At that point, the family members were all asked to sit in the Rehab area, placed on 100% oxygen by mask, and Command requested two EMS units and personnel from dispatch. EMS set up at the Rehab area.

Mom was asked:  "Who else was in the house today?"  Two neighborhood friends had been in the house for the afternoon, since the generator had powered up the family computer and all had been playing computer games. The Rehab and EMS officers asked for those children to be located and brought to the now expanding EMS sector, formerly Rehab. Command also asked EMS to call the hospital where the husband had been removed, to advise them that likely he was carbon monoxide poisoned also. 

Mom also asked if the firefighters would check the house for the family cat, because she had not been seen all day. 

Command asked that the incident now be declared an MCI. Crews checked the house, using breathing apparatus, and found no other potential source of CO. It must have been the now-burned generator, which was operating all day in the carport/garage area. The family actually had carbon monoxide detectors in the house, but they were electric-powered, and therefore non-functional with the power outage. The generator was located in the garage and open carport, and the door into the house left partially propped open to allow the wiring to come in. That was the pathway for the CO-containing exhaust. The family had been symptomatic, but attributed it to the cold house and "the flu." 

Everyone in the house for the day had been accounted for when the two children from the neighborhood were brought to EMS.  Each of those two had carboxyhemoglobin levels over 20%. The cat was found, unconscious, under a bed.  She was resuscitated by an EMS crew.

The victim count was now 6 at the scene, plus the father at the hospital, and one groggy cat. The hospital reported the carboxyhemoglobin level in the father was 26%. The family and friends requested that all be taken to the same hospital as the father, and the emergency department was able to accommodate that bolus of patients. Two EMS units were able to safely transport all 6 victims from the scene. The father was reported to be doing well, with only partial thickness burns, and he was going to be treated and cleared for release that night.

The fire area was overhauled, and the house ventilated well until interior carbon monoxide levels were zero. 

The two initial firefighters had their pulse CO-oximetry values fall to 1-2% just breathing ambient air. They had no symptoms, and so were allowed to return back to service.

The fire and declaration of an MCI grabbed the attention of the local media, so the PIO was able to give an important message to the community. With widespread power outage, there were a number of dangerous activities that threatened lives in the community. The PIO asked the community to use extreme caution with candles, kerosene heaters, and electric generators.

The Rehab sector cleared the victims and returned to its usual duty monitoring the firefighters.

Incident Resolution:  All family members were treated and released, including the husband. The house was habitable the next day. Four firefighters that were able to go to the next set of fires that evening.  And the cat recovered. 

Appropriate to the scene, the Rehab sector will include these elements in a cold weather incident:
• Shelter to include seating
• Fluid and Calories
• Equipment rehabilitation, like thawing and drying
• Health evaluation, including carboxyhemoglobin levels determination
• Warming equipment for the firefighters
• Work with the PIO to provide consistent messages to the public regarding safe behaviors in cold weather and power outage incidents

This fire had burned an individual and almost burned them out of their home. But the fire perhaps saved the lives of all the family members, as there house was filled with a deadly toxin. The incident was identified because of the follow-up dedication of the Rehab officer. The finding of an individual with carbon monoxide poisoning by fire and EMS personnel requires immediate investigative work. What is the source? Who all is at risk? Can the source be cleared before returning the building to service? CO incidents require an exhaustive look for additional victims or hazards, to prevent avoidable deaths.

Good rehabilitation programs are a big step in preventing acute injuries and the fatigue that can cause judgment errors.  Rehab at a cold weather incident, so you can manage the next incident safely, or go home to your family without being injured. Make it your goal to be a healthy retiree.

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