EMS response to and operations at fires in Westchester County

[elmerj 1]

Can anyone tell me what the initial assignment of EMS resources are in Westchester County to a Structural Fire (10-75 ?) with no reported injuries ? I know each town or district is different but is there a standard package ? Also, when the EMS units arrive do they check in with the Fire IC, get direction and become the Medical Branch and are they in communication with the IC via fire ground radio ?

Thanks

EJ

[Bnechis 3,961]

Can anyone tell me what the initial assignment of EMS resources are in Westchester County to a Structural Fire (10-75 ?) with no reported injuries ? I know each town or district is different but is there a standard package ?

There are 59 different standards as each dept. determines what if anything they want. On top of that as chiefs change over, the new chief gets to change the local "standard".

Also, when the EMS units arrive do they check in with the Fire IC, get direction and become the Medical Branch and are they in communication with the IC via fire ground radio ?

All depends on the dept.

[sfrd18 360]

Also, how many EMS resources are available, i.e, buses. For example, if a town only has maybe two, they may not be assigned to a fire right off the bat as they may be needed for other medical emergencies. But again, like Bnechis said, it all depends on the department.

[x129K 1,393]

When i worked @ Empress in int 90's, we were sent on the working fire transmission. I HATED the guys who would walk up empty handed or not get out of the bus at all...I always took at the minumim the BLS bag or oxygen bag. I NEVER wanted to be caught with my pants down.

I remember a J O B on Nepperhan near Executive, fire in a brick SFD, 10-29 - So they call us...the BLS Supervisor cancels my ALS bus and heads in alone..he goes on scene just about as the YFD is pulling a resident out in cardiac arrest. He got caught with his pants down..big time. I remember that victim well...his wrist watch on his left arm lens was brown and bubbled...yet his arm wasn't even burned. His face and head took the brunt of burns and he was not revived.

[x129K 1,393]

Also, how many EMS resources are available, i.e, buses. For example, if a town only has maybe two, they may not be assigned to a fire right off the bat as they may be needed for other medical emergencies. But again, like Bnechis said, it all depends on the department.

In MY eyes, in MY experience, a fire IS a medical emergency. Backfill the township if needed, but keep that bus at the fire. Way too many of us die of cardiac events at fires to not have an ALS unit standing by.

Edit; and I realize this doesnt pertain to Westchester, as I am a Dutchess resident...but a few years back when I was a Lieutenant with another department, I had a run of fires in which I was in command or the initial Officer at. I called three second alarms, which are all pre planned in the County CAD. However, I made it a point to add an ALS ambulance for standby at the scene. FOR US. At the time, this was seen as an "odd request". This is somwthing I would do still to this day.

This subject is something I could go on for days about. I feel VERY strongly about adequate EMS at fires...and not just rehab (because we ALL know my opinion of "EMS Prison"! LOL)....

Edited December 10, 2011 by x129K

[bigfitz2004 19]

Once we have a working fire transmitted. Our EMS agency is are dispatched the fire scene.

[sfrd18 360]

In MY eyes, in MY experience, a fire IS a medical emergency. Backfill the township if needed, but keep that bus at the fire. Way too many of us die of cardiac events at fires to not have an ALS unit standing by.

Edit; and I realize this doesnt pertain to Westchester, as I am a Dutchess resident...but a few years back when I was a Lieutenant with another department, I had a run of fires in which I was in command or the initial Officer at. I called three second alarms, which are all pre planned in the County CAD. However, I made it a point to add an ALS ambulance for standby at the scene. FOR US. At the time, this was seen as an "odd request". This is somwthing I would do still to this day.

This subject is something I could go on for days about. I feel VERY strongly about adequate EMS at fires...and not just rehab (because we ALL know my opinion of "EMS Prison"! LOL)....

I never said that a fire wasn't a medical emergency. Whether it's a VAC or a paid EMS, a bus should definitely be at every job, whether it be for firefighters on scene, victims(or both), or just for rehab.

I was just pointing out that it varies depending by department/town, as well as the IC's/dispatch's judgement. For example, in a city up where I live, a bus from AMR is on every box(usually), but in other cities, an ambulance is a specially-called unit by the IC or is assigned by dispatch depending on the call(i.e., victims reported trapped, jumpers, etc.).

Like R.I.T./F.A.S.T., an ambulance should be a must at every fire.

[x129K 1,393]

Wasn't singling you out per se...just ranting about something I feel very strongly about.

[tbendick 27]

As far as gear. You should be at least reporting in with trauma bag / o2, defib, and board.

[Goose 188]

like it was already said, ever tying is up to the locality and thats about as far as it goes (unless other resources are required or requested). out of habit i pack the stretcher up w/ the board, the BLS bag, ALS bag and monitor and take it out of the bus and try to stay in a visible area near the command post. they see me, i see them and it avoids the quagmire that is the radio communications in this county. when the chief says he doesn't need my partner and i, we pack up and go back into service.

[rob 249 0]

yes basic equipment is necessary also proper Ambulance placement is also something to take in effect. we in peekskill as well as cortlandt and pleasantville have rehabilation units that can respond and set up for triage and either cooling or warming stations

[Bnechis 3,961]

yes basic equipment is necessary also proper Ambulance placement is also something to take in effect.

I find this is a common issue with inexperienced crews. They get to close to the scene with the ambulance then get trapped in by hoselines and we need to get additional ambulances to cover them.

I am also surprised to see how often these inexperienced crews pull forward into fire scenes, in some cases this means having to back out a long narrow street if they have to transport, very time consuming if they have a critical fire victim. We make them back out, turn around and back in. They tend to remember that and don't do it a 2nd time.

[helicopper 1,050]

Is one ambulance enough for a working structure fire? You have to be available for potential civilian victims as well as ready to treat injured FF(s)? Since the FD operates with two-in/two-out (as a minimum for illustration only), wouldn't it be prudent to have at least two ambulances available in case both require urgent care?

It also takes extra hands to work a cardiac arrest so if a victim is removed from the fire, it would be better to have the extra hands already on site.

None of this considers the type of structure, time of day, or conditions, either. If you have a multi-family dwelling at 3 AM or a smoky fire in an office building at 3 PM you should probably add to the assignment. I remember an early evening fire in an apartment building that had about a dozen ambulances staging.

[MoFire390 118]

In cortlandt vac 1 rig to the scene also rehab unit. Additional crew reports to the building to staff 2nd rig if needed

[NJMedic 96]

Just as a bench mark: We are a career department and will send a BLS ambulance and supervisor to every "working" fire in our areas. If a jobs comes in as someone trapped a paramedic unit will b sent. The supervisor to add units as they see fit. Typically one person monitors the fire channel in order to get a heads up with problems on the fire ground. EMS will check in with the IC and let him now we are there. Our FDs are very good with the rehab process. If the job goes to a third alarm we typically with send our mass casualty response unit.

[NWFDMedic 58]

I still find it hard to believe that some departments in this day and age don't have at the very least a BLS ambulance respond to all confirmed fires. As far as sending additional resources, I guess that depends on what kind of situation you have and how easy or hard it would be to mobilize additional resources.

My department used to respond with its FAST team to a neighboring department that did not always have and ambulance on scene of fires. I actually told my chief at the time that we should be bringing our own ALS ambulance to protect our members if that department did not change their policy. When that was refused, I refused to respond mutual aid to that neighboring department and still will not go there to this day.

[JJB531 652]

I still find it hard to believe that some departments in this day and age don't have at the very least a BLS ambulance respond to all confirmed fires. As far as sending additional resources, I guess that depends on what kind of situation you have and how easy or hard it would be to mobilize additional resources.

My department used to respond with its FAST team to a neighboring department that did not always have and ambulance on scene of fires. I actually told my chief at the time that we should be bringing our own ALS ambulance to protect our members if that department did not change their policy. When that was refused, I refused to respond mutual aid to that neighboring department and still will not go there to this day.

Not to wander off topic, but to refuse to respond mutual aid, who are you really hurting? The agency or the patient?

[PFDRes47cue 653]

Where I run, we will typically get 2 transport buses, a Medic, and a rehab unit. Does not always work this way. We backfill as needed, etc.

[NWFDMedic 58]

Not to wander off topic, but to refuse to respond mutual aid, who are you really hurting? The agency or the patient?

I am not putting myself at an unnecessary risk. There are plenty of other members who respond to that district. I will simply stay back and man apparatus for our district, allowing them to go mutual aid. I believe it is the responsibility of incident command to create a safe environment for all responders (or as safe as possible, we all know all emergency services cannot always be a 100% safe situation). If they are not doing so, I am reserving my own right not to participate.

[JJB531 652]

I am not putting myself at an unnecessary risk. There are plenty of other members who respond to that district. I will simply stay back and man apparatus for our district, allowing them to go mutual aid. I believe it is the responsibility of incident command to create a safe environment for all responders (or as safe as possible, we all know all emergency services cannot always be a 100% safe situation). If they are not doing so, I am reserving my own right not to participate.

I didn't decipher if you were referring to your mutual aid participation as a firefighter or as an EMS provider. As a firefighter, I can understand why you would choose not to respond to calls for service in their district if you feel your personal well being is being unnecessarily placed in jeopardy.

[Bnechis 3,961]

I still find it hard to believe that some departments in this day and age don't have at the very least a BLS ambulance respond to all confirmed fires.

Unfortunatly, in Mt Vernon this week we saw how fast the scene of a basic working fire can deteriorate. 1 BLS ambulance is not enough for us. If there are fire victims, then its even worst. In many communities FD assits EMS, particularly in treating/transporting critical patients. When there is a working fire, FD no longer has personnel to spare for the EMS assits, so EMS needs to have greater resources to cover that component.

I have been a a number of fires where we went from no patients to 3, 4 or more in a matter of minutes. Nice to have EMS ready.

As far as sending additional resources, I guess that depends on what kind of situation you have and how easy or hard it would be to mobilize additional resources.

If it is hard to mobilize them, then it is even more important to get them started early. No one wants to be doing CPR on a fire victim on the front lawn, while EMS is toning out for any available driver or EMT.

[irishfire2491 24]

Leave the ambulance on the outside of the scene, (Stretchers are easy to go over the 5inch hose, ambluance on the other hand NOT so much) If your department has or can get access to a Rehab unit try to get that as close to the fire scene as possible, REHAB Doesnt work if you have to walk a distance to it. and leave it there until the last fire truck leaves the scene. If your ambulance has to transport and you are awaiting a second ambulance to the scene for the standby you at least still have the REHAB unit to allow you to be able treat another victim and or rehab your Firefighters.

[elmerj 1]

Thanks for the information. This is great stuff.

EJ

[NWFDMedic 58]

Leave the ambulance on the outside of the scene, (Stretchers are easy to go over the 5inch hose, ambluance on the other hand NOT so much) If your department has or can get access to a Rehab unit try to get that as close to the fire scene as possible, REHAB Doesnt work if you have to walk a distance to it. and leave it there until the last fire truck leaves the scene. If your ambulance has to transport and you are awaiting a second ambulance to the scene for the standby you at least still have the REHAB unit to allow you to be able treat another victim and or rehab your Firefighters.

Actually, conventional wisdom says that rehab should be away from the fire scene. Rehab working or not working has nothing to do with its distance from the fire scene. If command constantly promotes an environment where rehab is routinely performed then it will become part of the firefighting process.

[JJB531 652]

Positioning rehab away from the immediate vicinity of the fire scene helps provide a form of "mental rehab". Firefighters who are still in the immediate reach of the incident may remain mentally focused on the incident, instead of promoting the mental rest that they may need.

[NWFDMedic 58]

Positioning rehab away from the immediate vicinity of the fire scene helps provide a form of "mental rehab". Firefighters who are still in the immediate reach of the incident may remain mentally focused on the incident, instead of promoting the mental rest that they may need.

It also puts firefighters out of the sight of command and reduces that urge to use firefighters in rehab prior to being cleared to return to duty. While the Rehab Sector has to understand that there are sometimes extenuating circumstances, the use of rehabbing firefighters as you're "backup plan" is poor planning. Taking tired firefighters and putting them back into a high stress situation can cause even more problems rather than fixing them. Command should try to operate as if those firefighters are not there and have or request sufficient resources to do the job without them until they are ready to return.

[MoFire390 118]

Unless the departments u r with know if someone from ems pulls a firefighter for rehab they better report it to IC....irish knows a lot about rehab. And so does als...should be a few before we hear from him.

[helicopper 1,050]

Unless the departments u r with know if someone from ems pulls a firefighter for rehab they better report it to IC....irish knows a lot about rehab. And so does als...should be a few before we hear from him.

EMS shouldn't be "pulling FF for rehab", it should be a regular part of the FF rotation through operations. Gotta change bottles? Gotta go through rehab.

Otherwise it is almost always forgotten and if you leave it to the FF you'll always hear "no, I'm good. Just give me another bottle". This brings us back to another point that has been discussed here before, do IC's have enough resources to properly rotate people or do they have "just enough" to get 'er done?

Not to shift gears too much but does rehab document each contact with an FF to identify potential trends toward a problem? Are they comparing initial vital signs with vital signs after an hour or two to detect that someone's blood pressure is high?

[Remember585 815]

Our 10-75 policy is for local EMS to bring one BLS ambulance, one Mutual Aid BLS rig and an ALS unit. The theory is to have one rig committed to the scene and one for transport. Since we don't do EMS anymore, we have left it up to EMS to make arrangements to have these resources, as well as a Rehab unit. If EMS hasn't asked for something, the FD IC will.

Sadly, the last fire we had (a 2nd Alarm) we never saw the local EMS.

As Grandpa said in "Grumpy Old Men," "You can wish in one hand, and crap in the other..."

[meat441 43]

Why is rehab an EMS function? Providing Rehab at fire scene's thru EMS could be a detrimental issue for a lot of FD's. My reasons are this. If a firefighter reports to a Rehab area being provided by EMS, it would equate to (turnout gear) being completely removed for cooling down purposes. Very rarely will firefighters agree to removing bunker pants. This is needed for the cooling application of the body. Next, most firefighter vital signs could be elevated upon entering Rehab thru EMS. My reasoning is this. If elevated BP's or elevated pulse rates would require us to transport to a medical facility. How about body temp's? Heat exhaustion? It is a very physical demand placed on the body. Truthfully, how many firefighters would have periods of elevated vitals and would require long duration Rehab time in EMS/Rehab area. What would be the norm for a stable firefighter condition. Elevated vitals would dictate to me for immediate transportation to a medical facility. I have seen this time and time again especially at Hazmat's for pre entry vitals to be accomplished. We would recommend to the IC that the firefighter vitals are abnormal. Then to be told the firefighter feels ok to enter and it would be ok. Cmon. What would you expect us to do when we document all this and the firefighter and chief blow it off? What i'm saying is let the FD provide what rehab services should be required for their personnel and performed by the FD. When EMS is required for medical reasons, then get us involved. If i provided Rehab you would loose half of your onscene firefighters. This would be because i'm required to transport (you) to a medical facility. Lawsuits run the gamit nowaday's. I would have to protect you and me. Be SAFE.