EMS at the fire

[Guest partyrock]

Where should EMS be staged at a fire? I very recently saw a fire where a vac was stationed over 100 yards from the fire while two emt's appeared to wander aimlessly through the sceen. Luckily this FD had some what of a rehab station...more of one guy ensuring rehab occured for any ff who got too close (excellent job). Sadly this isn't the only place I see this. At nearly every fire EMS was off to the side completely detached from operations. My personal opinion is prep your rig to treat and transport what ever sh!t hitting the fan scenario you prepare for. Then go and establish a rehab area where the ff's are. They are not going to come to us. The one place they all will eventually go at one time or another is to the bottle change area. Why not start there. All this being said why on earth are people not doing this for their own yet? There is no reason for you to rely on EMS to rehab your own people. isn't the first rule of firefighting is to protect your life and that of your fellow firefighter? Thanks for letting me rant.

[GAW6 66]

In the "perfect world" there should be (2) ambulances at a fire scene; (1) to treat and (1) to transport. The treating unit should be close to the scene; the transporting unit should be in a position where they are not blocked in, obviously!

[Guest alsfirefighter]

Anywhere, where the ambulance can get out to transport. The equipment they will need for rehab/treatment sector is portable and should be in one set place. They shouldn't be roaming around at all. Ideally the gurus on the subject in books say it is best to even get the rehab and treatment area a bit away from the scene for a "mental break" also.

[HCFRFF 0]

Ambulances in my department are staffed with a EMT or EMT-I and a Medic. 1 medic unit is dispatched to all reported fires. upon arrival depended on the size of the fire the crew from the medic unit will dress up and pack out and help in fire supression. Most of the time the medic units are on-secne first and are able to give a good size up, locate water supply and check for entrapment or injuries. If theres no injuries they will pack-out and perticapate in fire suppression. While doing so they may request for a 2nd unit for rehab/txp. If at anytime there is a injury or a victim is found, that crew is pulled out to perform PT care. All employees with HCFR are certified as at least a EMT. All medic units are equipt with SCBA's except for 3 units which are staffed with non-cross trained personnel (who worked for HCEMS before the EMS&FIRE merger and had the option not to cross train)

Sorry for getting off the subject-

the medic units know to park in a postion where they will be able to get out of the scene in case of tranport or a pt is needed. for the most part they may park down the road alittle bit, load all nesecery Medical equipment onto strecher and report to the command post or to the front bumper of the first in engine. there they can determine where to set up a rehab, where water is given and vitals are taken. if your vitals are not WNL you are held in rehab untill they are WNL. Everyone who uses a SCBA most go through rehab and name,vitals are recorded.

[firemoose827 324]

Where should EMS be staged at a fire?  I very recently saw a fire where a vac was stationed over 100 yards from the fire while two emt's appeared to wander aimlessly through the sceen.  Luckily this FD had some what of a rehab station...more of one guy ensuring rehab occured for any ff who got too close (excellent job).  Sadly this isn't the only place I see this.  At nearly every fire EMS was off to the side completely detached from operations.  My personal opinion is prep your rig to treat and transport what ever sh!t hitting the fan scenario you prepare for.  Then go and establish a rehab area where the ff's are.  They are not going to come to us.  The one place they all will eventually go at one time or another is to the bottle change area.  Why not start there.  All this being said why on earth are people not doing this for their own yet?  There is no reason for you to rely on EMS to rehab your own people.  isn't the first rule of firefighting is to protect your life and that of your fellow firefighter?  Thanks for letting me rant.

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Funny you mention this. My dept just recently yelled at our ambulance FOR rehabing our members!! Our squad was doing an excellent job bringing water and gatorade to ff's and asking to check their BP, because just like you said, most ff's will not voluntarily go to rehab. It's a Macho thing I guess, but I have heart disease running through my family and I am the first one there each time I exit the building. But then the chief got upset saying that ff's were complaining that everytime they came out they were barraged with EMS people. I personaly think that is a good thing with all of the heart attacks you read about in the fire mags and newspapers. I strongly believe that EMS should have rehab either by staging or near the CP somewhere out of the way so that the IC can access them easily. Just my opinion though. Stay Safe

[Guest]

To All:I have to strongly agree with you about our Squad doing Rehab... I have seen our squad doing rehab... we did a very good job... The fire behind the theater... that was a very good job that we did.... like one of our firfighters got overheated, ya know what would have happened if the squad wouldnt have been there.... we would have had a man down... then the squad would have been getting yelled at for not being there and caring....I feel that a squad should be there and doing the rehab..... IT NEEDS TO ME DONE OR THERE IS GOING TO POSSIBLY A MAN DOWN then we are in trouble!!!!!!!!!!!!!!!!

Stay Safe Everyone!!!!!

I'll see you when the whistle blows!!

"SmokeEater" Rich

Funny you mention this.  My dept just recently yelled at our ambulance FOR rehabing our members!!  Our squad was doing an excellent job bringing water and gatorade to ff's and asking to check their BP, because just like you said, most ff's will not voluntarily go to rehab.  It's a Macho thing I guess, but I have heart disease running through my family and I am the first one there each time I exit the building.  But then the chief got upset saying that ff's were complaining that everytime they came out they were barraged with EMS people.  I personaly think that is a good thing with all of the heart attacks you read about in the fire mags and newspapers.  I strongly believe that EMS should have rehab either by staging or near the CP somewhere out of the way so that the IC can access them easily.  Just my opinion though.  Stay Safe

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[TRUCK6018 50]

My dept just recently yelled at our ambulance FOR rehabing our members!!  Our squad was doing an excellent job bringing water and gatorade to ff's and asking to check their BP, because just like you said, most ff's will not voluntarily go to rehab.  It's a Macho thing I guess

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Your department should be praising the ambulance squad for doing rehab. Macho thing or not, this day and age it should be mandatory for a firefighter to sit out after a prescribed time. Several departments SOP's I know of say after sucking down two scba bottles, you sit out, no questions asked. You are required to go to rehab, get evaluated by EMS (vitals, etc.) and rehydrate. If EMS says you're done, because they don't like what they see, you're done! No questions asked. Their decision over rules the IC.

Additionally, I agree with having two ambulances on scene. One for rehab, one for transport (if needed).

Edited February 18, 2006 by TRUCK6018

[bob803 1]

It is funny when you see an ambulance co show up time and time again and how professional they really are. Taking the time to do the many things that are mentioned in other posts. most of the time I think the ambulace does have a hard time getting close to the scene. So many have no other alternative except to load the stretcher and move towards the rehab center. Anyway

Have you ever noticed that one idiot can screw all this up when at a fire scene I think that I am in good hands until one of the PARAMEDICS decides that instead of getting all of the necessary gear together he jumps out of the ambulance with the damn camera in hands taking photos.

Anyone else experience this phenom from Empress that brings the rest of the Empress team down.

[IzzyEng4 427]

Being a firefighter and EMT I have suggested this several times.

An ambulance should be at least two blocks away at a fire call initially, especially if the incomming units have not arrived or completely set up yet. If it is a crew of two on the rig (thinking small), the EMT riding shotgun should hop in the back and get the equipment ready. One the fire units are in place, the operator of the rig should park the unit as close to the scene as possible, making it easy to get out and not impeding any multi alarm units that may come in afterwards, or getting themselves blocked in. The crew from the first rig sould report to where the command center is and await for a staging location.

Obviously, a second ambulance should be ordered and parked outside of the fire lines or near the first rig in and wait to see if they are needed also at the firescene or stay with the ambulance ready to go in if needed. The ambulances in my mind should be parked at the side of the scene that would be the most direct route to the hospital incase of any injuries.

The one concern that I have is a toss up if there are reports of people trapped in a building. I think they should get as close as possible but also far enough away not to get blocked in. I have seen many problems with this and it only becasue we need to get the trapped occupants out and to the hospital if they are injured. We think too fast.

Also too, this is also depending on if this is a company like AMR or volunteer for manpower. If it is a private service, you may have multiple rigs there to facilitate the needed manpower. With vollies, many may come in there own cars. Needless to say, no mater what type of ambulance service, if several EMT's / Medic's show up at a scene, they have to be staged just like firefighters do. Don want too many peas in the pod, (I like to think of staging like I have done in several mass casulty drills)

Just my thoughs and they can be worked on and imporved by all here if you like.

[WAS967 97]

At the Peekskill Fire last year we had two rigs at scene I believe, with a third in services at the VAC down the street to cover the city. The first in bus parked near the scene but not so close as to get in the way of fire ops. (For those of you there, we were right next to where the Salvation Army canteen setup. The second bus was down the street well out of the way of the 5" lines and all, so that egress was not a problem. The first rig unloaded the stretcher and had it's gear ready to go in case they were needed in a pinch. Obviously at the onset, if any casualties are found during initial search, they'd be put to work treating them. Otherwise, in the absence of initial injuries, they should ideally setup with the FAST team. We then had the rig closed up and the heat blasting. We used this as our rehab for those who needed to get out of the cold and warm up and maybe get some oxygen.

I was the ALS unit and was up the hill and out of the way. I wasn't dedicated to the scene (and actually did do a call in the city while the call was going on). Having an ALS unit at a fire standby is not a BAD idea, but dedicated is kind of pointless. Yeah it's good the have ALS there in case something goes bad. But what if something bad happens a mile away? Do I not go? Sorry guys, call another ALS unit and they'll rotate in. I'll be up the road where I'm needed.

Rehab is all to often neglected on many fire scenes. At the Peekskill job we kind of winged it. Salvation Army is a great resource for warm/cold fluids and snacks. Ultimately it's up the fire departments to lay out protocols for rest time and rehab. How many have protocols or P&Ps for rehab?

[Remember585 815]

Ultimately it's up the fire departments to lay out protocols for rest time and rehab. How many have protocols or P&Ps for rehab?

We have a detailed SOG for fire scene rehab. Our SOG calls for one of our Ambulances, the Medic* and one Ambulance Mutual Aid for rehab services. We've invested in two cool-air misting fans and we keep several bottles of water on the apparatus.

*Our Medic will be on scene and ready should we need them, but they keep themselves available (or call another ALS Unit) for coverage in the area. In addition we've added the Salvation Army Canteen to our greater alarm response plan to supplement the R&R of the troops.