Working Fire Training / Copyright 2005 / Volume 04-6 1 FIRELINE Warehouse Fire Rutledge Apt. Fire...

Working Fire Training / Copyright 2005 / Volume 04-61

FIRELINE Warehouse Fire Rutledge Apt. Fire Discussion

HANDS-ON Ice Rescue, Pt. 1 (extended segment) Quiz

FIRE MEDICS Tracheostomies/Stomas Quiz

EVOLUTIONS 2000 Kramer vs. Kramer

TRAINING

Working Fire Training Working Fire Training 04-6 Training Materials04-6 Training MaterialsWorking Fire Training Working Fire Training 04-6 Training Materials04-6 Training MaterialsClick anywhere to view show in its entiretyClick anywhere to view show in its entirety


SIZE-UP: Crushed stone warehouse building fully involved

upon arrival– Metal construction; holding tremendous heat

Lots of flammable material on premises No sprinklers or alarms Ultimate cause of fire: electrical box malfunction

Fireline Incident: Charlestown Warehouse Fire

04-6 Training Materials04-6 Training Materials 04-6 Training Materials04-6 Training Materials


STRATEGY/TACTICS: Made interior attack

– Team went 15 feet; building vented– Team pulled back.

Took up defensive position and defensive attack Aerials (only 50’) not tall enough

– used monitors – large-diameter hose

Tanker shuttling used to augment water supply




Used partial Incident Command System No specific Safety Officer With Mutual Aid departments on scene,

accountability was high priority EMS responds

– No injuries– Rehab used.




EVENTS: Building vented via flashover twice Forced hose crew down Haz-mat not much of an issue

– Used a front-end loader to contain run-off Mutual Aid teams used hose

streams to cool adjacent oil storage shed - see video clip

Foam used



Click video to view


LESSONS LEARNED: Tried to vent blaze/ relieve heat without success Should try to vent before interior attack Fire too far along to mount interior attack

– In large part due to no early warning (no alarms) Attempt future preplans




SIZE-UP: Upon arrival, did 360-degree size-up Occupants at windows, screaming for rescue Called for 2nd alarm

STRATEGY/TACTICS Raised ladders and used aerials for rescue Provided master streams Also launched interior attack

– Simultaneous offensive/defensive attack.

Fireline Incident: Rutledge Apartment Fire



EVENTS: Advanced hose lines up stairwells Approx. 40 feet in, fire was found in concealed area. Fire had been burning awhile before discovery Interior standpipe didn’t work due to vandalism




Called in 3rd alarm. Mutual Aid arrived with more apparatus, manpower. Fire eventually vented through roof – see video clip. Water supply issues; open hydrant policies EMS on scene; rehab used for

rehydration Cause of fire was arson;

reason for delay in reporting fire



Click video to view


LESSONS LEARNED: Order of apparatus arrival may not match dispatch

order; be prepared to adjust assignments Be ready to address initial upper-story rescue issue. Initiated offensive-defensive strategy from the

beginning; knew they would go defensive eventually.

04-6 Training Materials04-6 Training Materials 04-6 Training Materials04-6 Training Materials Fireline Incident: Rutledge Apartment Fire


Department DiscussionDepartment DiscussionDepartment DiscussionDepartment Discussion

The departments involved in this month’s training pose some discussion questions that you can use as discussion-starters in your own department’s training sessions.

How will your department handle these scenarios?



Chief Bill Caldwell, Charlestown (IN) Vol. Fire Dept.:

Do you have adequate Mutual Aid to support a strong effort early at an industrial fire?

Assume you will have to deal with hazardous materials. Do you have a haz-mat team on call?

If the fire is advanced, would you risk an interior attack?

Do you preplan industrial buildings in your jurisdiction periodically?

04-6 Training Materials04-6 Training Materials 04-6 Training Materials04-6 Training Materials Fireline Incident Discussion


Bat. Chief William McKim, Wilmington (DE) Fire Dept.:

You arrive on scene and apartment residents are hanging out windows, ready to jump. What do you do?

If you think you will eventually go defensive, would you plan for that, even while making an offensive attack?

If you have an urban jurisdiction, how do you handle apparatus placement?

When do you stage apparatus in a multi-alarm fire?

04-6 Training Materials04-6 Training Materials 04-6 Training Materials04-6 Training Materials Fireline Incident Discussion


Could be necessary on nearly any body of water, from rivers to subdivision retention ponds

ASK YOURSELF: How many resources have I got in route and how are they

going to get there? Are they the right resources? How many people are trapped? Can I get to them by the regular route? Should I get a dive team ready? Are there any special EMS needs? What additional Rescue operations might be involved? What specific hazards are there to consider (utilities, haz-mat,

personal hazards, etc.)?

04-6 Training Materials04-6 Training Materials 04-6 Training Materials04-6 Training Materials Hands-On: Ice Rescue, Pt. 1


ICE SAFETY Ice Thickness Maximum Load

2 One Person 4 One person or

group walking

5 Snowmobile 8 Car

12 Light truck

What do we know about the ice? What factors effect the quality of ice?

- see video clip.


Click video to view


Types of Ice– Frazil Ice: disk-shaped ice crystals which form a thin film

and float on water’s surface. Forms in moving water where the current mixes the water to a uniform temperature more quickly. When frazil ice crystals clump together, they form Pancake Ice.

– Pancake Ice: flat, circular accumulations of frazil ice with raised edges.

– Frail Slush: Ice which forms in rivers where faster currents prevent a solid freeze.

– Snow (white) Ice: ice which appears opaque or milky. Formed when water saturated with snow freezes on an ice sheet. This ice is porous and has a low density; therefore, it is very weak.



Types of Ice (cont.)– Layered Ice: forms in layers, consisting of many different

types of ice or frozen and re-frozen snow. This ice has a striped appearance.

– Pack Ice: formed by ice floes colliding from wind or water currents, piled up and frozen, often with sharp edges. Pack Ice can leave weak holes where it freezes together.

– Clear (Columnar) Ice: new, transparent ice formed by a long, hard freeze. Clear ice derives its color from the water or bottom as seen through the ice and is generally the strongest ice. Probably not present during an ice rescue.

– Candled Ice: milky, whitish gray ice that indicates deteriorating Clear Ice. The structure breaks down along its crystalline borders as it melts. This ice can be very thick, yet very weak.



Special Ice Formations– Pressure Ridge/Ice Keel: a line or wall of broken ice

caused by forces pushing the ice up or down into the water. Pressure ridges and keels are dangerous because they reduce the load-bearing capacity of the ice.

– Thermal cracks: caused by the expansion or contraction of an ice sheet due to a temperature fluctuation. Thermal cracks can even be dry or wet. A dry crack is visible at the surface, but does not extend to the water level. A wet crack extends form the surface of an ice sheet to the water.



Approaching the incident– Size up? Information? – Witnesses? Anticipations?


– How many patients– “Last seen” point– Resources available– Environmental conditions– Surrounding area– EMS concerns– Visible or not visible

– Level of consciousness– Resources responding– Conditions of ice– Hazards in the area– Additional operations needed– Scene access and egress

Issues to Consider


Incident Management System– Scale up or down as needed or as resources are available. – A rescue may end up being more than one; perhaps an ice

rescue and a rope rescue. IMS could handle both.


Commander

Safety

Liaison

PIO

Rescue Logistics Planning

Water Ops Shore Ops

Primary w/ tenders Ropes/RiggingSecondary w/ tenders

EMST-T-T

R.I.T


Evaluate the patient’s conditions – Observing and testing the patient

Will determine the method of rescue Will determine level of medical care

– Patient contact should be established immediately and maintained throughout.

– Changes in patient status should be relayed to Command which can be adjusted as necessary.

Consider other possible injuries to patient. Determining circumstances will help evaluate the possibility of additional injuries (“Mechanism of Injury”).

– Age may determine ability of patient to survive.



Other Patient Considerations – Water temperature– Patient’s activity level– Submersion time– Injuries/Illnesses– Quality of care– Contaminants in water



Equipment Considerations – Ice rescue suits– Dry suits– Ropes rigged for patient retrieval– Personal Flotation Devices (PFDs)– Communications devices– Flotation devices for the patient (collar)– Pike poles– Ladders



Equipment Considerations (cont.) – Life rings (floats)– Throw ropes– Inflated fire hose– Boogie (flotation) boards– Advanced rope systems– Stokes or SKED stretcher– Etc.



Special Considerations– Dive team

May not come with initial response but could come on scene through Mutual Aid

Diver could be support to surface operations or conduct recovery operations should that be necessary, before help arrives.



Pre-rigging the retrieval rope– 50’-100’ water rescue rope– Butterfly knot connected to ice rescue carabiner

(possible retrieval system)– Then 2’-3’ of rope– Then a Figure-8 on a bight connected to ice

rescue suits.– SOGs may determine actual rigging of patient and

rescuer. Your department might want separate riggings for each.



Next month in Part II, we go out on the iceand train on the ice rescue techniques we’ve covered this month.



Ice Rescue, Pt. I: QuizIce Rescue, Pt. I: QuizIce Rescue, Pt. I: QuizIce Rescue, Pt. I: Quiz

Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____Select the best answer:

1. True or False:

Physical contact with patient is an important part of a rescue.

2. True or False:

Columnar ice is the most desirable but usually not present during a rescue.

3. True or False:

Depending on location and access, an ice rescue could turn into a multi-stage rescue.



Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____4. Multiple Choice:

Which of the following would be the most important in determining the condition of ice?

a. Thickness of ice

b. Weight of rescuer and patient

c. Amount of freezing and thawing

d. Number of primary with tenders

e. None of the above




5. Multiple Choice:

Which of the following is not a patient-related consideration?

a. Water temperature

b. Submersion time

c. Injuries/Illnesses

d. PFDs

e. Contaminants in water

(Answers on Slide 56)


04-6 Training Materials04-6 Training Materials 04-6 Training Materials04-6 Training Materials Fire Medics: Tracheostomies, Laryngectomies, & Stomas

PATIENT SETTINGS Standard Tracheostomy

– Adult Shiley disposable, with inner canula Long-term care settings, skilled nursing facility, and

at home,

– Children Tracheostomy Long-term care, rehab centers, and at home



PATIENT SETTINGS Cuff Tracheostomy

– Balloon & Pilot Air is inserted to inflate around tube in airway If patient is on life-support or at high risk for

aspiration, there may be air in the balloon cuff. Most tracheostomies have an inner canula which

inserts into the outer canula; it can be cleaned or disposed of, if it’s a disposable product.



PATIENT SETTINGS Uncuffed Tracheostomy

– No cuff, so there is nothing to be inflated. Most baby tubes are an uncuffed trache; tubes with no

balloon or inner canula

Obturator– A guide device to help with insertion; so if the airway is

dislodged, the inner canula must be removed and the obturator put in place, producing a rounded, smooth end that can be placed back into the stoma



PATIENT SETTINGS Reinserting Trache Tube

– Place guide or obturator inside outer canula to smooth out sharp edges at bottom of tube which allows for placement back into the airway.

The obturator must then be removed and the inner canula can be reinserted.



PATIENT SETTINGS Bagging Patients

– Most traches have a 15 mm. adapter which can be used with an Ambu bag or resuscitation bag.

– To bag patient, you’ll need the proper size of resuscitation equipment (adult, child, etc.)

Use normal resuscitation rates for adults and faster rates for babies (at least 20-30 breaths per minute). Watch for chest rise.



TUBE DESIGNS Bavona

– A cuff that takes sterile water that blows up balloon cuff and seals it in the airway.

When the water is removed, the trache Is a lot like an uncuffed tube; it will be very streamlined

Used with patients in long-term care; it has no inner canula to clean or replace.

Portex– Blue Line is the brand name with a double cuff and two

pilot balloons.



TUBE DESIGNS (cont.) Jackson

– An older design; a stainless steel uncuffed tube. They have inner canulas that can be removed and

cleaned by the patient.



STRUCTURES Stomas

– A well-healed trache site. All you’ll see is the open surgical wound. This is the patient’s breathing hole.

A true laryngectomy patient will not have communications between the trache and the upper airway or mouth because the larynx has been removed and there are no vocal chords in place

You can insert an endotrachial tube about 4” and it can be used as a temporary airway until the patient reaches the hospital.



OTHER DEVICES Heat-Moisture Exchanger

– A foam or paper filter placed over the trache to provide short-term humidity.

Most traches will need aerosol moisture worn at night. Speaking Valves

– Often referred to by the brand name, Passy-Muir. It’s a one-way valve placed over the trache. When the

patient breathes in, the one-way valve flap opens; the air can’t go out, it must go up to the vocal chords, permitting speech.



OTHER DEVICES (cont.) Fenestrated Valves

– This valve has openings or fenestrations in the outer and inner canula which allow the air to pass by the vocal chords on exhalation which permits speech.

Valves may have an oxygen adapter should a patient need supplemental 02.

Speaking Valves have to be removed if you want to use an Ambu bag placed on the 15 mm. adapter.



SUCTIONING Equipment

– You’ll need a suction canister, tubing, and suction catheters of proper size.

The catheters should never occlude more than ¾ of the inside diameter of the tube and they come in various French sizes. Pick the size that's appropriate for the patient’s airway.



SUCTIONING Procedure

– Remember to hyperoxygenate and hyperventilate your patient.

– Suction for no longer than 10” when down in the airway.

– Provide supplemental 02 and ventilate after each suction pass.



VOICE PROTHESIS Techniques

– If coughed out, be sure and secure it and bring it with the patient to the hospital, so the ENT physician can replace it.

– You may suction through a stoma with a voice prothesis (VP) in place.

Divert the suction catheter downward into the stoma, rather than to the back where the VP is, so you don’t knock it lose by accident.



THE COMMON EMERGENCIES Airway Obstruction

– The channel is either occluded with a mucous plug or a kink or twist in the airway.

If you can’t pass a suction catheter through the inner channel of the airway, you need to remove it – see video clip.

– The patient should have a clean, spare airway or trache that can be replaced using the obturator.

Click video to view



THE COMMON EMERGENCIES (cont.) Bleeding

– Most often, caused by erosion through one of the innominate arteries on either side of the trache.

Usually seen in traches that have been in place for a long time

– It’s a very severe and rapid event and will result in significant blood coming out of the trache.



THE COMMON EMERGENCIES (cont.) Bleeding

– You must remove the trache itself and tamponade the artery through the opening or stoma.

Take a gloved finger and tamponade off the side where significant bleeding is present.

– It’s not unusual to have some bleeding resulting from cough or suctioning, but blood streaking is not an innominate artery erosion.



THE COMMON EMERGENCIES (cont.) Infection

– Very common in normal patients resulting from pneumonias and resultant respiratory distress.

– Infections are also possible at the stoma site with significant pus which may create bleeding.



THE COMMON EMERGENCIES (cont.) False Passages

– When you reinsert a tube, it may be displaced and may not be in the true trachial channel; you may find a false passage

There may be air that escapes into the skin folds that you may feel as crepitus along the chest wall.

– If you are not able to pass a suction catheter or bag the patient, just as with an airway obstruction where you aren’t effectively breathing for the patient, it may be in a false passage.



ABCs If the airway is intact and functional,you can Ambu bag a

patient in respiratory distress or provide supplemental 02 until more advanced care arrives or until transported to hospital.

If the airway is not functioning and the patient has intact vocal chords and upper hypopharyngeal, you can actually bag the patient with a mask and occlude the trache or stoma hole.

The airway can be removed, the patient can be bagged with occlusion of the airway in the normal fashion that you do CPR.



ABCs (cont.) Remember the ABCs – airway, breathing, and functional

suctioning must be available for tracheostomy patients at all times.


Tracheostomies, Laryngectomies & StomasTracheostomies, Laryngectomies & Stomas: : QuizQuiz



1. True or False:

Minor bleeding may be normal with some tracheostomy activity.

2. True or False:

Sizing of equipment for the patient is over-exaggerated.

3. True or False:

It’s possible for a trache patient to be bagged with occlusion of the airway and respirated in the normal way that you do CPR.





4. Multiple Choice:

If a voice prosthesis is coughed out, you should:

a. secure it

b. bring it to the hospital

c. let the ENT replace it

d. try not to replace it yourself

e. All of the above





5. Multiple Choice:

Which of the following is NOT found in a trache patient?

a. Heat-Moisture Exchanger

b. Speaking Valve

c. Hemi-Valve

d. Bavona Tube

e. All of the above

(Answers on Slide 56)


Continuing EducationContinuing EducationContinuing EducationContinuing Education

Kramer vs. Kramer: Offensive vs. Defensive OperationsComplete written responses to the following three essay questions:

1. Briefly critique the apartment fire in Wilmington, Delaware this month. How were the offensive and defensive operations coordinated?

2. What is the policy in your organization for determining how and when to choose between offensive and defensive operations?

3. List some basic guidelines used to decide when an offensive fire should become a defensive fire.

…CONT.

If you’re enrolled in the Open Learning Fire Service Program at the University of Cincinnati, here’s your opportunity this month to earn one college credit hour for watching Working Fire Training.


Continuing EducationContinuing EducationContinuing EducationContinuing Education

ENROLLMENT INFORMATION:

For more information on enrolling in the Open Learning program to gain college credit, call Fire at 800-516-3473 for a brochure or, to register directly, call the University of Cincinnati at 513-556-6583. Associates and Bachelors programs are available. Call to have your transcripts evaluated.

Send your responses to:

Professor Bill KramerUniversity of Cincinnati

College of Applied Science2220 Victory Parkway, ML #103

Cincinnati, Ohio 45206



Thanks so much for viewing Working Fire Training!

See you next month – stay safe!

Answers to Hands-On Quiz on Slides 28-30:1. False 2. True 3. True 4. c. 5. d.

Answers to Fire Medics Quiz on Slides 51-53:1. True 2. False 3. True 4. d. 5. c.

Working Fire Training / Copyright 2005 / Volume 04-6 1 FIRELINE Warehouse Fire Rutledge Apt. Fire...

Documents

Transcript of Working Fire Training / Copyright 2005 / Volume 04-6 1 FIRELINE Warehouse Fire Rutledge Apt. Fire...