EMS response to and operations at fires in Westchester County

[Bnechis 3,961]

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.

Do members really need to go thru rehab after 20 minutes of work?

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".

Thats what often happens.

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?

It is very rare for the IC to have enough personnel (at least in this region) so rehab is often an after thought.

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?

They should, but rarely (with the exception of hazmat incidents) do, particularly if you do not have a dedicated rehab unit.

[helicopper 1,050]

Why is rehab an EMS function?

So who should be responsible for rehab?

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.

If a FF enters rehab after a period of exertion and has what you call "elevated vital signs", you cool them down and allow them to relax for 20-30 minutes and their vital signs don't come down during that time, then I think there's a reason for transport.

What about elevated vital signs requires immediate transport absent some kind of complaint or issue? This is like saying everyone who steps off a treadmill at the gym requires immediate transport to a medical facility because of their viltal signs.

If we don't do rehab and we allow a FF to return to strenuous operations in heavy equipment and SCBA with already elevated vital signs aren't we doing them a disservice?

What would expose us to greater liability? Not doing rehab and having a FF suffer because of it or having a FF go through rehab for a while before returning to operations?

[helicopper 1,050]

Do members really need to go thru rehab after 20 minutes of work?

Thats what often happens.

It is very rare for the IC to have enough personnel (at least in this region) so rehab is often an after thought.

They should, but rarely (with the exception of hazmat incidents) do, particularly if you do not have a dedicated rehab unit.

Alright, if not after every bottle when? I agree that 20 minutes may not be much but doesn't it depend on how strenuous the work is and how challenging the environment is? Exposure to extreme temperatures may require intervention even after relatively short periods, no? I was just trying to identify a good time and bottle changes seemed like a logical choice.

It's a shame that we still don't operate with adequate resources even after all the lessons learned.

[Bnechis 3,961]

Alright, if not after every bottle when? I agree that 20 minutes may not be much but doesn't it depend on how strenuous the work is and how challenging the environment is? Exposure to extreme temperatures may require intervention even after relatively short periods, no? I was just trying to identify a good time and bottle changes seemed like a logical choice.

In general, a bottle change is an excellent time for rehab, it just is not after every bottle change (considering conditions & work load). Many SOP's I have seen talk about after the 2nd or 3rd bottle (40-60 minutes).

It's a shame that we still don't operate with adequate resources even after all the lessons learned.

Until we have regional departments we will never have the personnel available in an organized fasion to do this. We will have lots of trucks and lots of stations, but either no personnel or no way to control them.

We have proven that we are unwilling to learn this leason and are just waiting for the politicans and/or the lawyers will do it there way.

[PFDRes47cue 653]

Don't forget about the necessity of rehabbing the rehab personnel.

Also, I do not get the majority of a post from above but what really left me scratching my....head....was that an EMS rub rehab = bunker pants being removed and a FD run rehab does not???

[meat441 43]

I'm speaking from a contracted EMS provider perspective. Lets look at the equipment and supplies required for Rehab. Misting systems, Tents, chairs, blankets, towels, heaters, bottled water, tables the list goes on. I understand that Rehab is required for firefighters. But to what extent that the EMS contracted service has to provide the equipment. Fire deparment based EMS, sure. It's comes out of their budgets. Volunteers may just decide to take on the responsibility, even on a regional response. Moonachie First Aid in NJ is a prime example. Peekskill appears to have a dedicated unit for which i applaud them. But! who pay's for the insurance? Who pay's for the Fuel? Who pay's for the repairs? Who pay's for the equipment?

Contracted services only have so much money in their budgets. Same goes for the privates. What is available for the occasional response versus a busy fire department would tax any system. As you can see it's not cheap. Most FD's in our area provide their own because most cities are contracted EMS services. Contracts do not normally provide extra cash for Rehab or even standby's at high school football games, festivals or parades. The contract is for Emergency Medical services. In NJ the Board of Ed's contract for EMS coverage with privates.

These large departments carry their own and or utilize a canteen unit for refreshments. We stand buy at fire scene's and watch for firefighter's who may require EMS intervention. But pretty much they monitor their own. It's easier for a Chief officer to rotate his men on scene and tell them to take a breather.

As for the BUNKER PANTS. Most firefighters won't remove them but will remove their coats. Firefighters know from walking around in these clothes in 80 degree temps. how warm they get. Plus the interior fighting they need to accomplish.

Just bringing facts to everyone's attention. I wish all towns and cities would provide additional cost funding. But nowaday's were all trying to survive. Keep safe

[Remember585 815]

As for the BUNKER PANTS. Most firefighters won't remove them but will remove their coats.

Believe me, if someone doesn't want to drop their bunker pants, it may be due to the fact that there is nothing underneath!

[MoFire390 118]

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?

i see what ur saying but when u have members of departments who think they need to be superman and not rehab at all...clearly monitering of firefighters should be more consistant with the number of LODD's that happen after the call and during the call.

[meat441 43]

For the paid professional, most wear Station Wear. For the volunteers, i don't think they respond to the firehouse NAKED. But i wouldn't want to know that. LOL

[meat441 43]

We are EMS and become responsible to document patient activity. At least in Jersey it's required. Not sure for other states. Here becomes the problem. Be truthfull and think about how many firefighters take care of themselves physically. Paid more then volunteers. EMS providers are even worse? Lots of dirty water dog's. I've seen a Chief officer exit a highrise building for the 3rd time. Fully packed dripping in sweat and bending over to catch his breath. As my partner and i approached him he waved us away. Still trying to catch his breath after 2 more minutes i radio'd to our BLS unit for a streatcher. I approached the deputy and pointed that we were going to take him. He still resisted and refused. The deputy finally ordered him. He was addmitted at the hospital for 2 day's for dehydration. This was a chief officer. Firefighters will listen to their own before others. Everytime i saw him at a fire scene he would come over to us, I would shake my head and he would reply with, (I KNOW). To bad he (HAD) to retire a few month's after that. Great firefighter.

Monitor them when needed. But we are limited in our resources just like FD, we're even worse. Would it be wrong to say that apparatus carry water, jugs, towels, misting fans. Believe me there is more room on fire apparatus then an ambulance. With our limited personnel we can monitor them as their leaving the structure. If a firefighter has a medical emergency we are there, not to where more radio traffic is required or having to find us. I think it's going to be a long time before we see extra EMS personnel. Keep Safe

It comes down to all Fire departments need to be better equipped for Rehab. No matter what the FD's can muster more resources than EMS can. What FD would not show up for a mutual aid call. They come for RIT why not for Rehab.

[Guest alsfirefighter]

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

I guess the best way to start to answer your question is that for the majority of fire departments there would have to be an incident command model they are following with actual command structure titles long before they would check in with the "fire IC" and then become the "medical branch." And you want communication with the fire IC too. lol.

[elmerj 1]

Heres my next question. If a Firefighter encounters a situation that requires them to transmit a "Mayday" resulting in serious personal injury to said Firefighter, how many EMS agencies have practiced or are trained to immeadiately recieve the injured member from the RIT and address life threatining situations (hypoxia, respiratory / cardiac arreast or major bleeding)in the area immeadiarely outside the IDLH enviornment,understanging of course that you can not do patient care in a somke or fire enviornment. Do you think it will be a mad dash to the ambulance with the member or, a methodical administartion of lifesaving care coupled with removal to the transport ambulance ?

Before you answer the question, take a deep breath and hold it. While your holding your breath answer the question. Notice how uncomfortable you start to get areound the 30 to 45 second mark. You want to breathe dont you ? Now think about the guy you are running down the street with not getting adequet ventilatory support getting one handed chest compressions or no AED in place (is the guy in V-Fib or not ?) because your in an uncontrolled scene moving rapidly to the transport ambulance. When was the last time they took a breath ? Think about it, a mad dash to the ambulance with limited or no care or a methodical practiced interaction between EMS and the RIT with good solid patient care giving the injured Firefighter the best shot at survival. Which one do YOU want ?

Ok what say you all ?

EJ

[firecoins 2]

We do not operate in a smokey area. The pt MUST be moved to a safe area for treatment to begin or the ems providers will be holding their breath. Treatment begins in the rig or in a safe area near it.

[ny10570 745]

We do not operate in a smokey area. The pt MUST be moved to a safe area for treatment to begin or the ems providers will be holding their breath. Treatment begins in the rig or in a safe area near it.

You can't find a safe environment within a few hundred feet of the fire? How about get outside the collapse area; rapid assessment, initial interventions, and then remove to the vehicle. You may very well discover this isn't just a simple fire victim and maybe shouldn't be removed from the scene. What if you have two or even 8 patients coming out? Are you treating and triaging at the ambulance? That initial stop in a safe place and can now become your triage area.

[Guest alsfirefighter]

Heres my next question. If a Firefighter encounters a situation that requires them to transmit a "Mayday" resulting in serious personal injury to said Firefighter, how many EMS agencies have practiced or are trained to immeadiately recieve the injured member from the RIT and address life threatining situations (hypoxia, respiratory / cardiac arreast or major bleeding)in the area immeadiarely outside the IDLH enviornment,understanging of course that you can not do patient care in a somke or fire enviornment. Do you think it will be a mad dash to the ambulance with the member or, a methodical administartion of lifesaving care coupled with removal to the transport ambulance ?

Before you answer the question, take a deep breath and hold it. While your holding your breath answer the question. Notice how uncomfortable you start to get areound the 30 to 45 second mark. You want to breathe dont you ? Now think about the guy you are running down the street with not getting adequet ventilatory support getting one handed chest compressions or no AED in place (is the guy in V-Fib or not ?) because your in an uncontrolled scene moving rapidly to the transport ambulance. When was the last time they took a breath ? Think about it, a mad dash to the ambulance with limited or no care or a methodical practiced interaction between EMS and the RIT with good solid patient care giving the injured Firefighter the best shot at survival. Which one do YOU want ?

Ok what say you all ?

EJ

Some of you answers are going to come down to the provider, their experience and how the FAST may react depending on how they train. As far as finding an area outside the collapse zone...in all actually that's one and half times the height of the structure. Statistically firefighters have issues in single family dwellings...not going to be much unequipped EMS crews are going to be able to do inside such smaller structures. HIgh rises they should be staged 2 floors below the fire floor. If you couple in several other factors its no surprise that resuscitation rates of firefighters and civilians with smoke/toxic gas inhalation is very low. For one most FAST removals...are not going to be all that fast. On average by study it takes 12 firefighters to rescue 1. IF they are not breathing at the time they are found for removal...chances are there is going to be no opportunities to attempt, be conducive or safe to attempt resuscitation at the point of find. Once they come out..in order to be evaluated, treated and transported equipment is going to have to be removed. And with the most recent studies...most are experience high exposures to cyanide which in this county..no one is carrying cyanokit.

So as a firefighter I want as immediate treatment...if I have signs of life as I can get. If I have none..and I've been down a while...let me go...I don't want to be lingering with no brain activity or as broccoli for my kids to suffer worse.

As a provider...I'm jumping on your a** as quick as I can and I can pretty much guarantee at that point I won't be the only medic on you and we'll get multiple things going at once.

Lack of rehab is a management issue! If you have a policy...enforce it. PERIOD. I've been advocating rehabilitation for not just fire scenes but at training, communication with PD for their needs for certain types of SWAT deployments, etc. It is tough..but eventually it breaks through.

[ny10570 745]

most are experience high exposures to cyanide which in this county..no one is carrying cyanokit.

FDNY*EMS is currently carrying cyanokit on every ALS ambulance and have administered it over 50 times as of a few months ago. There's also Houston, Tampa and others, but most if I remember correctly are fire based systems (they have a bit of a vested interest in firefighter safety). As a result of user feedback, a new manufacturer (Meridian), and some increased demand the price is starting to come down. What was once nearly $1,000 per adult dose is now $650.

With a 3 year shelf life and new training kits made by the company I don't see why more depts aren't carry this.

Edited December 12, 2011 by ny10570

[ems-buff 81]

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.

Larchmont FD is I believe the only FD Rehab in the southern part of the county.. We have a complete set up of cooling chairs, mistfans, water, gaterade, and protein bars.. While some members are EMT's we believe to use the combine efforts of the onscene EMS as well as our members and equitment to provide proper rehab.. A majority of the sound shore chiefs know of our unit, and i would hope they use us..

As far as the EMS stand point.. alot of members have made vaild points.

In my experience there should be at a minium, 2 ambulances at the scene. with the 1st arriving unit to be dedicated to the scene . With one of those units being ALS..

Also on a side question.. Do you think the Fire IC should be incharge of EMS at the scene.. Meaning he asked for what he needs.. or should that be done by the 1st arrival EMS crew/supervisor/EMS officer?

[helicopper 1,050]

i see what ur saying but when u have members of departments who think they need to be superman and not rehab at all...clearly monitering of firefighters should be more consistant with the number of LODD's that happen after the call and during the call.

This is a management problem. Superman retired long ago (I think he lives somewhere in the Keys now) and it is up to today's managers to properly manage and direct their subordinates to go to rehab or whatever is needed.

[Guest alsfirefighter]

FDNY*EMS is currently carrying cyanokit on every ALS ambulance and have administered it over 50 times as of a few months ago. There's also Houston, Tampa and others, but most if I remember correctly are fire based systems (they have a bit of a vested interest in firefighter safety). As a result of user feedback, a new manufacturer (Meridian), and some increased demand the price is starting to come down. What was once nearly $1,000 per adult dose is now $650.

With a 3 year shelf life and new training kits made by the company I don't see why more depts aren't carry this.

I am aware the city is carrying it...that's why I said "county" in my post. I know in many places in Europe its standing orders for admin to anyone removed from a fire. I have been an advocate of adding it to the formulary for Westchester and Hudson Valley regions and speak of it in my Emergency Incident Rehabilitation class I developed and deliver in the area. But for some even that cost is pretty high even though I don't think cost should ever really be a factor. I mean we rotate Cardizem like crazy but aren't carrying the safest and by far the easiest to administer medication for cyanide exposure.

[NJMedic 96]

Medics Played a Critical Role in Worcester Fire

Donna Boynton, Staff Writer - TELEGRAM & GAZETTE (Massachusetts)

Posted: Mon, 12/12/2011 - 03:53am

Updated: Mon, 12/12/2011 - 03:59am

State Fire Marshal Stephen D. Coan said yesterday that Worcester Emergency Medical Services paramedics headquartered at the former Providence Street fire station were among the first to report the fire at 49 Arlington St. that claimed the life of Firefighter Jon Davies.

"They may not have been the first, and they may not have been the only ones to report the fire, but they have been critical in providing investigators with information about what they were first seeing," Fire Marshal Coan said, following a press conference.

He and Deputy Chief Geoffrey Gardell could not confirm that the paramedics played a role in alerting and evacuating the residents prior to the arrival of the Fire Department.

Fire Marshal Coan also did not elaborate on what the EMTs did see when they initially noticed the fire, saying it was part of the ongoing investigation.

"They are playing a critical part in the investigation, and played a critical part in reporting the fire," he said.

Worcester EMS is an ambulance service owned and operated by UMass Memorial Health Care and is under contract to provide ambulance service to the city. The city leases the station to the ambulance service.

Worcester EMS ambulances are based at the former Providence Street station, and they were in quarters and observed the fire, Fire Marshal Coan said.

The Providence Street station, nicknamed "The Rock," was closed in 2009 after serving as a fire station for 110 years. Closing the station was estimated to save the city between $85,000 and $100,000 a year in capital and operating costs. However, the measure was met with opposition from residents of the Grafton, Vernon and Union hills areas it served.

At the time, the Fire Department said fire response would not be diminished by the closing, and that sentiment was echoed yesterday by City Manager Michael V. O'Brien, who said the response to the fire was not delayed and was "under three minutes," in line with national standards.

[NJMedic 96]

I was one of the writers of NJ's Incident Rehabilitation Guidelines for EMS. If anyone wants a copy please drop a note to me at brian.carney@rwjuh.edu

[MoFire390 118]

This is a management problem. Superman retired long ago (I think he lives somewhere in the Keys now) and it is up to today's managers to properly manage and direct their subordinates to go to rehab or whatever is needed.

ur right thats why departments need to get a rehab SOG in place weather some people like it or not. its time for modern day firefighting not "old school" firefighting

[ny10570 745]

Sorry ALS. Im a boob. I saw country, not county when I wrote my reply.

[Fireman488 57]

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

Our department is fortunate that we operate 2 BLS ambulances.

EMS-wise our "Working Fire Assignment" calls for the following:

Our 1st due ambulance to the scene for Triage.

Our 2nd due ambulance to the scene for Rehab.

A mutual aid ambulance (agency depending on the location in our Fire District..we have 3 mutual aid areas) to the scene for possible transport(s).

A Greenburgh PD medic to the scene for standby.

They communicate with the I/C on the fireground frequency.

This SOP has worked well for us.

Edited December 14, 2011 by Fireman488

[helicopper 1,050]

I guess the best way to start to answer your question is that for the majority of fire departments there would have to be an incident command model they are following with actual command structure titles long before they would check in with the "fire IC" and then become the "medical branch." And you want communication with the fire IC too. lol.

Since Operations is supposed to be built from the bottom up and since 95% of our responses don't rise to the level requiring branches, how about starting with the Medical GROUP and building from there?

If there is a single command, it would not be the Fire IC, it would be the IC.

But now here's a wrinkle. Since statutory authority exists for multiple agencies having jurisdiction including, but not limited to the FD, wouldn't that put us into Unified Command on almost every incident?

[Guest alsfirefighter]

Sorry ALS. Im a boob. I saw country, not county when I wrote my reply.

Hey..I wrote it and had to read it twice cause even to me my brain saw "country" when I read it fast. lol

[Guest alsfirefighter]

Since Operations is supposed to be built from the bottom up and since 95% of our responses don't rise to the level requiring branches, how about starting with the Medical GROUP and building from there?

If there is a single command, it would not be the Fire IC, it would be the IC.

But now here's a wrinkle. Since statutory authority exists for multiple agencies having jurisdiction including, but not limited to the FD, wouldn't that put us into Unified Command on almost every incident?

Yup and Yup. You know the answer to your last one as well as I do. In fact we were part of a call review a few years ago which some on the fire side just can't let it go. On top of it try getting 3 reps from the main emerg. services disciplines to even be in the same area. Its like where's waldo still to this day.