Taking care of the rescued firefighter

A complete firefighter rescue includes EMS activities; here's what on-scene commanders need to know for all downed-firefighter operations to work

We've all placed a great deal of emphasis on improving firefighter safety on the fireground by developing and implementing Rapid Intervention Team strategies, procedures and training. To date, many of those initiatives have focused on finding the firefighters in distress and removing them from the hazard area.

We have to be able to seamlessly move from firefighter rescue to firefighter patient care. And that will entail additional training and practice on the part of both firefighters and the EMS providers — who may not be firefighters.

Why? Because in addition to a firefighter who may be in need of life-saving medical intervention, such an event is also a workplace injury site if the firefighter survives, or the site of a line-of-duty death if resuscitation efforts are unsuccessful or the firefighter later succumbs to his injuries.

Therefore, firefighters and EMS providers alike must be trained and prepared to manage the scene from both the medical intervention and evidence preservation perspectives — think Chicago Fire meets CSI.  

What's necessary?
The initial incident commander and those resources on the initial alarm must be proactive in their positioning of fire apparatus and ambulances. The commander must ensure that apparatus has not closed off all means of egress from the incident scene. 

The responding ambulance crew must position their vehicle as close to the scene as possible, in the cold zone, and in the direction of travel away from the scene. Having a critically injured firefighter — or civilian — in the patient compartment is not the time to be trying to get the ambulance turned around and headed away from the scene.

Once their ambulance is properly positioned, weather permitting, the EMS crew should take the stretcher and initial patient care equipment bags and report to the commander. The EMS crew must ensure that their equipment cache includes:

  • EMS PPE (disposable gloves, masks and gowns) to prevent contact with soot and other carcinogenic substances that may be on the firefighter's PPE.
  • Evidence collection bags (preferably paper) to collect any clothing that's removed from the firefighter during patient care.
  • Large plastic bags (33-gallon) to collect the firefighter's structural PPE and SCBA.
  • Several bed sheets for use as temporary screens to shield the patient care efforts from the prying eyes of news media representatives and civilians with wireless phone cameras. 

The incident commander should assign the crew to a position in the cold zone, as close to the primary means of egress being used by firefighters, for as long as firefighters are in the hazard area and actively conducting fire suppression operations.

Beyond treating the injured firefighter
The extraction of the injured firefighter from the fire building must continue until the patient is at the location of the EMS crew in the cold zone. Without this direction from the commander, patient care is going to start wherever the rescue team deposits the patient.

The front porch or the front yard at the base of the steps, the warm zone, is no place to properly and safely render patient care, even if the EMS providers are cross-trained firefighters.

The first patient care priority must be the safe removal of the firefighter's SCBA and PPE to ensure that EMS providers have maximum access for patient care interventions like IV access, drug administration, intubation, etc. All removed clothing, PPE, and SCBA should be promptly bagged so as not to lose or contaminate any items for the ensuing injury or death investigation.

Once the patient's airway, breathing and circulation have been secured, the patient should be quickly and safely moved to the ambulance via the stretcher. A fire officer should be assigned by the commander to accompany the patient as an official departmental liaison officer and to maintain communication with the on-scene commander.

Once the patient is safely aboard the ambulance, it should immediately proceed to the appropriate medical facility according to the EMS agency's medical protocols.

Practice protocols
The care and treatment of any injured firefighter is a critical responsibility for the commander and the foundation for that task must be put in place by the initial incident commander and the first arriving fire and EMS resources. This task becomes even more critical when the injured firefighter required extrication from a structure by a rescue team.

Fire departments should have this critical operation outlined for their personnel in the form of a Standard Operating Guideline. If the EMS agency that will provide patient care and transportation is a separate and autonomous organization, their leadership should be a part of the development of the SOG.

Just as important as having the SOG in place is practicing its implementation by all agencies involved. The time to test the SOG is not when a firefighter's life depends upon it working.

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