LCA's New Cot

FACT

Coordinated Interior Attack

The video link below from LA County demonstrates a coordinated interior attack with door control.  Obviously the structure of their department is different than ours, which should reinforce the importance knowing every aspect of our job.  

LINK: Interior Fire Attack

Throughout the week you are encouraged to take the knowledge from the video to the training ground and practice all three positions: Officer, Apparatus Operator, and Firefighter. Each position presents its own unique challenges that must be overcome for a successful operation.  

TACTICAL HOSE ADVANCE AND RETREAT

Firefighters constantly train on advancing a hose line into a building.  But we do not train enough on withdrawing when the scene becomes unstable.  Do you and your crew know how to get out quickly and safely?  Watch as we illustrate best practices of effectively maneuvering a hose line into and out of a structure.

Link:  Hose Line Management

Occupational Athlete

                                                                                                                 Photo By:  Traditions Training

Firefighters exemplify what it means to be an athlete.  They perform in the most hostile of environments with real consequences associated with their decisions and performance.  The game time is not scheduled and we may end up playing multiple games in a day, never knowing our exact opponent.  The physical demands are extreme as well as the consequences of not meeting the demands.

Car Fires

For the second half of this quarters minimum company standards we will be focusing on car fires.  Car fires are often looked at as being "Cut and Dry."  Simple calls that just require getting water on the fire as quickly as possible.  However, as the safety systems that have been designed to protect the vehicle occupants have become more technically advanced, they have created some significant challenges and hazards to firefighters during vehicle fire operations.

The videos below show a few examples of hazards associated with modern vehicle fires.

1. Magnesium Explosion
2. Magnesium in Vehicle 1
3. Magnesium in Vehicle 2
4. Bumper
5. Tire Projectile
6. Run Away Car Fire
7. Overhead Danger
8. Discuss Car Fire
9. Commercial Vehicle Fire

Accessing and Extricating the Patient

Below are three links to videos that demonstrate ways to access the patient and removal the patient from the vehicle.  Watch the videos and discuss with your crew additional way to streamline the extrication process.

Discussion should include ways to create room to access the patient and further ways to remove a patient from the vehicle while protecting C-Spine.  Be sure to include inverted vehicle in the discussion.

Remember, this methods are just tools for your tool box and may need to be modified to adapt to your actual scene.


Link:  Two Rescuer Patient Removal with Blanket

Link:  Removing a Patient from Inverted Vehicle Using a Hose Line

Link:  Cracking the Egg (Car Taco)

Caring For Patients With Traumatic Injuries

Watch the links below, observe how the body reacts to the forces generated from the different types of wrecks.  What injuries do you think you might find on each of the vehicles occupants?

Link:  Head on with and without safety devices

Link:  Rollover no seatbelt

Link:  Side impact

Link:  Multi-vehicle Collision

Patient Care

Being able to recognize that a patients condition is deteriorating early is a crucial component of patient care. 

Establishing baseline vitals should occur after a general impression has been formed the rapid trauma assessment completed.  Vital signs should be rechecked every 3-5 minutes until the patient is extricated and patient care has been transferred to LCA.  Extreme changes in the patients vitals may indicate reduced systemic perfusion due to blood loss (internal or external), traumatic damage to the respiratory system or other vital organs.  These changes indicate a need to reassess patient priority and may reflect the need to expedite the extrication process.

In addition to vital signs, a patients exterior appearance often reflects problems that are taking place internally.  This is why it is so important to observe not only the patients vital signs but their appearance and demeanor as well.  

Some signs that the patient’s condition is deteriorating include:

• Personality changes

• Diaphoresis (Sweating)

• Ashen in color

• Shaking or complaining of being cold

• Cyanosis (Blue in color)

Size Up and Preparing to Cut

Recapping last weeks daily training we have been dispatched to a reported vehicle accident.  After boarding the engine we have reviewed the dispatch information, figured out the best route to get to the scene and have begun considering the resources that will be needed to safely and efficiently control the incident.  

Now as you are approaching the incident a more detailed size-up process begins.  Your size up should parallel your perspective of the scene.  As you approach the scene from a distance you have a wide view…Think big picture (ie apparatus placement, roadway and overhead hazards).  As you get get closer to the incident your view narrows and the details of the scene become more apparent (Number of vehicle, vehicle placement and vehicle damage).   Combining all of this information will provide all of the data needed for an accurate initial scene size up report and influence your initial incident action plan.

Reading the wreck and understanding how energy is transferred  is critical in the scene size up process.  When two vehicles collide the energy that was once movement, is transferred first to the other vehicle and then to the occupants inside.  Understanding which of the body systems are affected by that energy transfer can help us predict patient injury and determine patient priority.  

Triage is the act of categorizing each patient according to severity of injury and transport priority.  Triage is vitally important but it is NOT static.  Patients must be continuously evaluated for changes in their condition.  Adjustments to your IAP may be necessary if a patient’s condition deteriorates.

  

Inner Circle and Outer Circle must be completed at the accident scene to ensure that all occupants of the vehicles are accounted for and that there are no hidden dangers that might put your crew in harms way.

Vehicle Stabilization- Stabilize the vehicle using the resources and equipment on scene to ensure that there is no movement of the vehicle during the extrication process that might endanger the crew or further injure the occupants of the vehicle. 

Access Patient- Once the vehicle is stabilized, access to the patient can be made and patient care can begin.  C-spine precautions should be taken if the mechanism of injury dictates.  This is also when a initial patient assessment should be made to establish a baseline from which future patent evaluations can be measured. 

*** Next week we will be detailing patient assessment skills and how the patients vitals and appearance reflect their condition

Prepare to Extricate / Extricate- Extrication is no longer the simple act of grabbing a set of hydraulic tools off the engine and starting to cut.  Modern extrication involves and understanding of the vehicles construction, safety systems and power systems i.e. gas, electric, or hybrid. Before you begin the actual extrication, the power should be isolated and the interior trim removed near all cut points to ensure that no pressure cylinders or seatbelt tensioners are cut during extrication.

As a crew, watch the link below

Extrication Techniques Of The Week:  http://www.lacofdturnout.com

Big Picture Extrication

Next week we will be starting a new "Minimum Company Standards" training series.  We will be taking a multifaceted approach combining vehicle extrication and vehicle fires.  For both subjects there will be a large emphasis on scene size up and patient care.

The importance of the scene size-up cannot be over emphasized.  A quality scene size-up sets the tone for the entire operation.

Size-up should begin the moment that the call is dispatched.  In the case of a vehicle accident, the dispatch information may include:

-Where the accident is located
-Number of vehicles involved
-Number of potential patients

From the information above you can begin your size-up.

First and foremost review the dispatch. We occasionally miss vital information as we are preparing to get on the apparatus.  Review the information on CAD to ensure that there was no dispatch information or updates missed.  

Next, know where you are going.  If you are familiar with your first due area and specifically where the accident has occurred you will be able consider potential hazards and begin to preplan for apparatus placement.

The number of vehicles and patients involved should immediately make you think "RESOURCES".  What am I going to need to ensure that this call is a success.

*This initial dispatch information should stimulate thought...but REMEMBER this information is often from a passerby with zero emergency service experience and may not accurately depict what you will find when you arrive on scene

As a crew, discuss some areas in your first due district that accidents are likely to occur and develop a plan to safely and effectively run an operation.

Brush/ Grass Fires

Spring is finally here and with it comes grass fire season.  Although the sense of urgency is generally lower with grass fires due to a reduced chance for loss of life or property, there are still real hazards that need to be considered.  

THE TEN STANDARD FIRE ORDERS

Fight fire aggressively but provide for safety first.

Initiate all action based on current and expected fire behavior. 

Recognize current weather conditions and obtain forecasts. 

Ensure instructions are given and understood.

Obtain current information on fire status.

Remain in communication with crew members and IC

Determine safety zones and escape routes.

Establish lookouts in potentially hazardous situations. Retain control at all times.

Stay alert, keep calm, think clearly, act decisively.

 Common Denominators of Fire Behavior on Tragedy Fires

1. Most incidents occur on smaller fires or on isolated portions of larger fires.

2. Most fires are innocent in appearance before the flareups or blowups. In some cas- es, tragedies have occurred during the mopup phase.

3. Flareups generally occur in deceptively light fuels.

4. Fires run uphill surprisingly fast in chimneys, gullies, and on steep slopes.

Other Considerations:

• Be proficient in the use of all brush fire equipment including brush pumps, indian packs, water cans and brush brooms

• Always fight the fire from the unburned side

• Pay attention to topography-fire can move surprisingly fast up hills and in gullies  

• Maintain Accountability in larger incidents

• Be aware of the surrounding, rocks and logs hidden in the tall brush present  trip and fall hazards that may result in a sprained ankle or broken foot

• Hydrate- On hot days start drinking as soon as you wake up to pre-hydrate

• Consider an ambulance for stand-by in high heat or large extended incidents

• Discuss water supply site options 

• Focus on wind direction and changing weather conditions

• Consider ground conditions (mud, swamp land and heavily wooded areas) that may inhibit suppression efforts

• Wear the proper PPE ( consider eye protection)

• As you make your way up the fire line periodically check behind you for rekindles

Platinum 600 On The Fire Ground

You are a leader...For those of you reading this training, you are a leader.  If you are working shift, or taking the time to be proactive and read this on your own time, you are a leader.  Being a leader means that the other members of the department are going to be looking to you for guidance and direction especially in the first 10 minutes of a structure fire operation.

Much like the platinum 600 is critical in patient care, the first 10 minutes are just as vital with fire ground operations.  The decisions that are made and the actions that are taken in the first 10 minutes will often determine the outcome of the fire operation.  As a leader in this department it is crucial that you not only understand the tactics for first due operations but are also proficient in each of the tasks associated with these tactics.

For this week we are going to be focusing on two man first due drills.  The purpose of this drill is to encompass all of the tasks that may be required of the first due engine.

• Dress out drill
• Hand Jack 200' of LDH
• Fully Extend 24' ladder to building  
• Deploy 200' Pre-Connect or Wye-Line
• Charge Line 
• Navigate hose line through the bay to mezz
• Save Rescue Randy from the mezz and bring outside 

Remember: Lead from the front and Inspire those Around You!

Platinum 600-Predicting Injuries

Daily we are asked to make life or death decisions on a moments notice.  We arrive on a scene, do a quick scene survey and develop an IAP all within the first minute.  These decisions that we make and the actions that we take within the first 10 minutes may very well mean the difference between life and death for those involved.  With that being said the importance of an accurate scene size up cannot be overstated.  One component of a quality scene size up is predicting potential internal injuries based on the mechanism, and treating the patient according.

MVA Size Up
Provides Clues to:
-Type of Injury
-Forces Involved

3 Impacts
Car vs Car or Object
Person vs Interior of Car
Internal Organs vs Other Solid Structures in the Body

The following video provides invaluable information about injury prediction and the platinum 600.  Watch the video and discuss how we can utilize the information on our future scenes.

Video Link:  Platinum 600

In addition to providing valuable information you also can get .5 credits if you get an account to the American CME site and take a short quiz.

SO We Are Ready

For training this week we will be continuing with the theme of readiness and honing our fire-ground skills.  

Weather permitting take this drill outside to test your first due fire operation skills.

In teams of two set your gear up outside of the engine. When timer says go:

1. Dress out 
2. Officer packs up and gives a Blue Card initial radio report
3. Apparatus Operator must engage the pump 

The team of firefighters must then formulate a plan to complete the following tasks in the order of priority as if they were the first due engine on an actual fire scene.  Each of these tasks can be done as an individual or completed as a team.

• Pull 200 feet of 5" from the engine
• Fully stretch a 24' ladder to the hose tower
• Pull a wye line to the exterior man door
• Attach a 100' high rise pack to the gated wye
• Charge the line

1. Both firefighters must meet at the door with SCBA and tools
2. Firefighters must stretch the hose line through the predetermined course in the bay to the mezz.
3. Your Victim must be located and removed from the building
4. Time stops when the victim and both firefighter are clear of the building 

To be successful in this evolution communication and cooperation are paramount.  When the drill is completed, discuss the evolution.  What went good and what could be improved.

To make the drill more challenging replace the 24' ladder with a 35' and incorporate the collapsed floor and wall breach props into the scenario as the week progresses.

Be Safe and BE READY!

KNOW Your First Due Area

How well do you know your building layouts in your 1st due area.  Understanding the layout and type of construction in your response district will greatly aid both search and fire control efforts.

There are numerous cape cod style home throughout our district.  Look at the house below.

-Can you Identify the home's layout from the exterior?
-Where are the stairs located?
-What are some specific dangers that this home creates for firefighters?
-How do we overcome these dangers?

-Discuss scenarios with a working fire in different locations throughout the home
-How would you plan on achieving fire control
-What hose line would you use
-What are some rescue considerations
-What are some ladder placement considerations

I encourage you to drive around your first due district and have a similar discussion about the other building types in your area and the specific challenges that they present.

Once discussion is complete we will be doing a modified agility course to help prepare us physically for the challenge of an aggressive interior attack and/or rescue.  Keep track of your times on the paper attached to the gear rack, and try to improve using better technique, changing pace, or better fitness.

Doing What Works- Determining Tactical Priorities

For Training this week watch and discuss the following short clips linked below.

Consider:
-The tactical priorities
-Were the objectives met
-Are there alternative methods for obtaining the desired result
-Overall disposition of the scene

LINK:  San Bernardino House Fire

LINK:  Phoenix Roof Vent

Continuous Improvement

The time spent in rehearsal pays dividends when the curtain goes up and we're called upon to perform. 

It isn't glamorous, it isn't exciting, but it is what separates the great from the mediocre and it helps ensure that when called upon to perform the 1% of what is 100% important we will function as we are trained.

We're judged by our last performance, and we're only as good as the work we put in before we are to compete.

Perform your first due diligence today.

  -Fully Involved

This week we will be continuing with the theme of readiness.  Everyday we will be starting out with a bunker dress out drill.  Compare your times to the times you did last week.  There should be an improvement.  As the week progresses we will be adding in additional elements and challenges to the confidence course at station 61.   This will include mask blackout, elements of search, and radio ops in a structural collapse.  

Never stop training...Continuously find ways to push yourself physically and mentally to be a better firefighter today than you were yesterday. 

Developing Confidence

Most of humanity has developed a dependence on their senses of vision, touch and hearing to accomplished their day to day activities.  Firefighters however do not have that luxury.  We are asked to enter harsh uninhabitable environments wearing 40-50lb of gear that greatly reduce if not eliminate our sight, dexterity and hearing. In order to overcome these limitation we must be fully confident in our gear and have the ability to work quickly and efficiently in-spite of our impaired senses.  Building this confidence can be done through a method known as stress inoculation.  Gear confidence through stress inoculation occurs by exposing yourself to tight and uncomfortable situations that you may encounter on the fire ground, managing your stress response, and working through the situation.  This builds confidence in knowing that you have done something and can do it again when the stakes are higher.

For this weeks training we will be gearing up for time then navigating a series of obstacles that may include entanglement, wall breaches, confined space, and searches in full turns out gear.  Each of these challenges are designed to push you physically and mentally in a controlled environment.  

Day 1

Dress out speed drills 

• Organized all of your gear at your feet including SCBA 

• When time starts don your gear as quickly as possible

• Time stops when ALL gear including mask and pack and gloves are donned, air is on and you are ready to make entry.

• 5 second deduction if there is skin or mask straps showing 

• Evolution should be done a minimum of 3x 
• The goal is be fully dressed out in 90 seconds or less

Training

CPR and Zoll Auto Pulse

CPR 

CPR is a vital operation in the fire service.  Rapid quality CPR can literally mean the difference between life and death.  With that being said, once learned, CPR in itself is a simple task.  Often the most challenging part of CPR is moving the patient from where the arrest occurred to a location that quality CPR can be performed.  It is not unusual to find patient in the tight confines of a restroom, garage or workshop.  It is vitally important that the crew of 1st responders be able to quickly formulate a plan and efficiently move the patient to a location that quality CPR can take place.  In an operation where time is of the essence, every member of the responding crew should have a task, that when working in conjunction with the other members of the crew increases the speed and efficiency of the operation.  This task may include moving the patient, moving the furniture or clutter out of the way to make a path, or setting up the medical equipment so that CPR can be initiated as soon as the patient reaches the new location.

Zoll Auto Pulse

The Zoll Auto Pulse as with all equipment is only as good as the person operating it.  Every firefighter should be proficient with it's set-up and operation including changing bands and being able to trouble shoot minor problems.

The Zoll AutoPulse is an automated, portable, battery powered chest compressor which provides compressions as an adjunct to performing manual CPR.  Use of the AutoPulse is intended to reduce the impact of rescuer fatigue and will enable the rescuer to address additional patient needs.  

The AutoPulse provides thoracic compressions that distributes the compressive force throughout the thoracic cavity.  This results in a higher cardiac output than can be produced by manual compressions alone.  Higher cardiac output means more efficient oxygenation of tissues and thus higher survivability potential.

Emotionally a full arrest can be the most stressful call you will go on. Being comfortable operating all required equipment will reduce your stress level and increase pt survivability.

Auto Pulse Considerations

• Intended for adults 18 and over

• Chest circumference  range:  29.9”-51.2”

• Not intended for patients with traumatic injuries

• Start CPR IMMEDIATELY  when indicated

• Ensure that patient remains properly aligned while en route to the hospital

• Only place patient face up on the Auto Pulse Platform

• If system error occurs, immediately revert to manual CPR

MSA Altair 5X 4 Gas Monitor

The value of 4 Gas Monitor that we carry on our apparatus, like most tools, is directly related to the proficiency of the person operating it.  This week we will be developing a deeper understanding of the capabilities of the MSA Altair 5X 4 gas monitor that we use and equally important understanding what its limitations are.

The start up on the Altair 5X provides information about the devices settings and ensures that the all components are functioning properly.  Below we will be reviewing each of the start up screens and and develop an understanding of the information of the information they provide.

Start Up Screen

When the pump test screen comes up, pump must be blocked  to ensure that the pump is functioning properly.  Hold your finger over the pump until the pump test pass screen appears.

The monitor measures the concentration of 4 separate gas types.  It is important to understand how each of these measurements relate to the safety of the atmosphere in which we are working.

Combustable Gas is measured in percentage of LEL (lower explosive limit) it is important to remember this number does NOT represent the percentage of combustable gas in the ambient air but rather the percentage of the lower explosive limit of the combustable gas.

The percent of oxygen measures the total percent of Oxygen in the ambient air.

Carbon monoxide and Hydrogen Sulfide are both measured in parts per million

During the startup process the monitor displays the low alarm settings

*** It is important to remember that the normal percentage of oxygen in the ambient air is 20.8%.  If the percentage of O2 begins to drop, it means that the oxygen is being displace by another unknown gas.

As well as the high alarm settings

If the gas concentrations meet of exceeds the alarm set point the device will:

-Alarm message displays and flashes in combination with the corresponding gas concentration

-Back light turns on

-Alarm Sounds

-LED lights flash red

***If combustable gas exposure exceeds 100% of LEL the monitor enters a lock alarm and XXX will be displayed in the combustable gas category 

STEL (short term exposure limits) setting-displays the average exposure over a 15 minute period

Example:  If you are exposed to 35 ppm for 10 minutes and 5ppm for 5 minutes your short term exposure would equal 

25 ppm

TWA (Time Weighted Average)  The average exposure to a substance over an 8 hour period.  Generally speaking this function will be reserved for occupations that work in hazardous environments for long periods of time.  

The Fresh air set up screen provides the monitor with a baseline from which to compare the potentially hazardous environment which we have been called to monitor.  If you are not in a truly fresh air environment hit NO.  Hitting NO will revert the the monitor to it's previous fresh air set up and thus provide a true baseline.  

The sensors in the monitor are sensitive to changes in pressure, temperature, and humidity.  Going from a cold dry exterior environment to a warm and humid interior environment may effect the accuracy of the monitor readings.  Give the device time to adjust to the new environment before taking readings.  In addition, when monitoring an area move slowly.  It takes time for the air sample to move through the pump and reach the sensors.  If you are moving too quickly and the monitor alarms, you may be well past the problem area   Finally, remember the monitor is designed to warn us of a hazard before it becomes life threatening.  If the device alarms always error on the side of caution.  We carry a supply of air with us everywhere we go.  Use it.