Why should fire trucks and ambulances always show up for a medical emergency?

Why should fire trucks and ambulances always show up for a medical emergency?

By Kelvin from Swift Emergencies Response Unit - Kenya

When a call comes in at the call center, dispatchers often are not given precise or complete information. As such, units are dispatched on a worst-case scenario. To ensure the highest level of care, the closest fire engine station is dispatched and EMS sends an ambulance (staffed with two paramedics and/or EMT's).

No medical call is “routine.” Most require assessing the patient, obtaining their vital signs, providing oxygen therapy, and moving them, at a minimum. EMS may also need to place an advanced airway, administer drugs intravenously, or monitor cardiac conditions. All of these procedures are completed more efficiently when the appropriate amount of help is on scene. Efficient care is our goal, and efficient care often is the difference between life and death.

Unfortunately, units have no way of knowing what they will encounter on a call until they arrive. They work in a “what if” and “all risk” business. Responding to the unknown is public safety. The public can help by calling emergency numbers quickly when there is an emergency and providing details of the emergency. Emergency hotlines are your instant go-to when the need arises. It is important that you know the numbers to call to get assistance and keep a copy with you.

Ambulance Services and Its Importance in Society

Ambulance Services and Its Importance in Society

 By: Kelvin from Swift Emergencies Response Unit - Kenya

Increase in medical ailments has led to the rise in hospitals and emergency medical services assisting patients who require emergency medical assistance at critical moments, helping them to reach the hospital on time thus saving their life.

Private and public ambulance transport services are operating in more numbers today as an inevitable service providing care to critical patients at crucial moments. In Kenya, ambulance operating centers are set up at every hospital and private EMS organization. These Ambulance operating centers function with adequate ambulance transport services to offer immediate medical care for patients. Private ambulance transport services depict a consistent rise in the growth curve each year offering non-emergency services unlike hospital ambulance transport services which primarily function for emergency needs. Some of the non-emergency services include shifting patients from one hospital to another, transporting patients for any scanning or laboratory services to the relevant facilities, or patients with any travelling disabilities in normal vehicles to hospitals for treatments.

Emergency ambulance services are usually equipped with adequate medical equipment and paramedical professionals. Sometimes, non-emergency ambulance transport services are also equipped with some basic medical aids and a para medical staff to cater the needs of immediate medical care to patients.

Let us discuss a few points about the pre-hospital medical professions - paramedics and emergency medical technicians (EMTs) who are the spine of ambulance transport services:

• Paramedics or EMTs are first treating patients even before doctors (pre-hospital care) thus saving patients through immediate medical procedures ensuring the vitals stable before reaching hospitals for further treatments.

• Paramedics and EMTs are trained healthcare professionals, authorized to attend patients with required medications and procedures based on their training level.

• Education level, standards, functions and skills of paramedics and EMTs vary with countries. However. certain standard functionalities remain common such as being trained to practice CPR procedures for cardiac arrest patients, usage of defibrillators, certain analgesic, paralytics and sedative medications for pain control, first aid to treat burns, fractures, childbirth complications, spine injury, airway management, blood control etc.

• One should respect the noble service of prehospital providers who form an integral part of ambulance services.

• The youth of our nation should involve themselves in such noble service, joining community life saving teams and can considering a career as a paramedic or EMT.

• The government could benefit from taking initiatives to support volunteer community first responders at the community level and to empower them to continue saving lives at the scene before qualified personnel arrives.

Electric Vehicle Fires

By: Chief Hank Clemmensen, AFM Board Chair

With adoption of electric vehicles (EVs) increasing around the world, firefighters need to be aware of the dangers they present and the unique challenges associated with extinguishing an electric vehicle fire.  Training and preparation is critical to prepare for advancements like the introduction of electric buses in Kenya.  Is your fire brigade prepared to respond to incidents for electric vehicles? Start training specifically for EVs, now reading this detailed article on EV fire attack and extrication basics by Patrick Durham.

https://www.firerescue1.com/electric-fire/articles/electric-vehicle-response-fire-attack-and-extrication-basics-PwPBmx8uuMuMOR2G/

Fire Dynamics

By: Mark van der Feyst

Rapid fire developments (RFD) are when we have a sudden and immediate change in the fire environment. At one moment we have thick, dark, black smoke with intense heat and the next second, we have a ball of fire from floor to ceiling – this is an RFD.

Every fire department will face RFD’s no matter what type of structure they are dealing with – if it has four walls and a roof, then there is the space and environment for an RFD. The different types of RFD’s are going to be flashover, back draft, and smoke explosions. The three are different in how they develop and react but are the same with the outcomes – deadly outcomes. RFD’s produce RIP’s (Rest In Peace) for the fire service.

Of the three RFD’s, flashover is going to be the one that will occur the majority of time at any and every structure fire. So, what is a flashover? A flashover is the simultaneous ignition of unburned fire gases within a room. It occurs when hot gases rise to the ceiling and spread out across the walls. These hot gases are what we call black smoke – unburned particles of combustion. As it spreads out across the ceiling and the walls, it starts to heat up the items found within the room such as the paint on the walls, the furnishings, clothing, mattress, flooring material, etc. – until they all reach their ignition temperature. Once they are all at their ignition temperature, an RFD occurs.

Before a flashover occurs, there are warning signs that are presented or given off by the fire to indicate that flashover is impending. These warning signs are presented to us both visibly and tactically – our eyes can see and our bodies can feel them.

·       Heat buildup – based upon the temperature range of flashover, there will be a period of time when excessive heat buildup will occur. This heat buildup will descend down towards the lower levels of the room pushing the firefighter down to the floor. This will be the result of radiant heat being produced by the unburnt particles of combustion spreading out from ceiling to walls and then down to the floor area. When this quick increase in heat occurs, and it is an intensive heat; flashover is impending. 

·       Roll over – this is a visible indicator as it reveals itself in the smoke. A roll over or flame over is when small gaps open up in the smoke layer allowing air to mix with the unburned particles of combustion and ignite. Small flames can be seen in the midst of the smoke for momentary periods of time and then disappear. When this occurs, this is a warning sign that flashover is coming.  

·       Thick dark smoke – this is also a visible indicator as it will present itself outside the building as well as inside the building. On the inside, you will not see anything except total blackness: but on the outside, you will notice this. Whenever you have thick dark, acrid black smoke pushing out from a structure under high pressure and with high velocity, flashover is impending. This is an outside warning of what is waiting for us on the inside.

What has been described above are the common signs that we will see and feel at every fire – it is important for the firefighter to learn and understand the basic concept of what a flashover is before being able to learn the actions that can be used to aggressively cool the fire or escape the situation if warranted.

About the Author:

Mark van der Feyst is a 25 year veteran of the fire service and is currently the Senior Battalion Chief at the Six Nations Fire & Emergency Services in Canada and a part time firefighter with the Fort Gratiot Fire Department in Michigan. He has worked in both the USA and Canada for various fire departments and holds a Masters of Science degree in Safety, Security & Emergency Management from Eastern Kentucky University.

From Ideal to Real

By: Rabbi Howard A Cohen (Deputy Chief, ret.) AFM Virtual Training Coordinator

As first responders we are required to absorb an overwhelming quantity of data.  As good as our intentions are to remember all that we are taught, the reality is that we forget details.  This is why constant reviewing, drilling and periodic recertification is so important.  Even with doing our best to keep our skills sharp and our knowledge base current, the reality is that we cannot possibly be experts in every situation we might encounter in the course of work.  For example, though we may have a solid understanding of basic first aid principles, we are not doctors and therefore are limited to the extent that we can help a patient in the field.  Even if we were trained to the level of a medical doctor, in the field far removed from a hospital facility, we would still be limited with what can do.  We do not work in controlled environments or under ideal conditions.  No matter what the situation or our skill level, our response is always on a spectrum that moves from the ideal to the real.

Every three years I re-certify as a wilderness first responder.  Every three years I’m embarrassed to admit how much I’ve forgotten.  Although I wish my memory was such that I was better at calling up a lot of details and data that I rarely ever use, I don’t worry about it.  Why? Early on in my first responder career I was taught two important lessons.  The first lesson is that an emergency response in the field will always be somewhere on the spectrum from the ideal to the real.  As emergency responders we do the best that we can with the tools and knowledge that we have on the scene. This is what it means to move from the ideal to the real.  Remember, as first responders, our objective is keep the patient alive long enough to get to advanced medical care.  It is not our job, nor do we have the skills, to fix or heal patients.  Our job is to stabilize, comfort, and transport our patients.

To do our job well as first responders we do not need a medical education. This brings me to the second important lesson I have learned in my career as a first responder:  Pay special attention to the three big systems: circulatory, neurological and respiratory and do whatever you can do to keep them functioning.  The vast majority of injuries to people are not life threatening.  However, any significant trauma to one or more the three big systems has a high probability of being life threatening.  If a person is bleeding, stop the bleeding.  You do not need to know how to suture.  You do not need to know how long to keep pressure on an open wound.  You only need to know that you have to “plug” the hole where the bleeding is coming from.  If your patient is not breathing you don’t need to know how to do a tracheotomy.  You just need to know what to do to open her airway because if you can’t get your patient breathing she will die.  Ideal to the real.  Remember, it is not our job, nor do we have the skills, to fix or heal patients.  Our job is to keep them alive and as comfortable as possible as we get them to advanced medical care.

As first responders we will always strive to respond with the very best of our abilities.  That’s what we do.  However, the reality is that we are generalists trained to respond to a mind boggling variety of emergency situations that always happen under less than ideal conditions.  Ideally, we might want to respond in a certain way, in reality, the situation and our knowledge level will determine our response.  Therefore, it is important to remember that emergency medical responses in the field always fall somewhere on the ideal to real spectrum. Our goal is to do the best that we can with the tools and knowledge we have on the scene.

About the author:

Howard joined the fire service in 2001 to serve as chaplain of his local fire department. Twenty years later he retired as his department's deputy chief.  Howard planned to join Africa Fire Mission on a trip to Zambia but Covid interrupted those plans. He has since traveled twice to Kenya with AFM. He is regular AFM blog contributor and webinar instructor. Outside of the fire service, Howard serves as rabbi to Congregation Shirat Hayam in Duxbury MA. He also has a leadership and mental fitness coaching practice called code3leadershipcoaching.

Suicide Warning Signs

by: Jeff Dill

Recognizing Suicide Warning Signs in Firefighters and EMTs 

Behavioral health is a key component of an overall firefighter health and wellness program. Unfortunately, it is a difficult subject to discuss – many factors affect a firefighter’s ability to understand when a fellow brother or sister is suffering, but that does not make it any less critical an issue.

By far, the number one comment by fire and EMS chiefs associated with departments that have suffered a loss is that they didn’t realize or recognize the warning signs that their member was displaying until after the loss had occurred.

The Firefighter Behavioral Health Alliance (FBHA) tracks and validates FF & EMT suicides in the United States. A key component is validation: Whether we receive a confidential report, text message, or phone call of a tragic event of a suicide, confidentiality is always maintained.

FBHA has traveled across North America presenting behavioral health workshops with an emphasis on suicide awareness. Our workshops focus on warning signs and actions to take when a brother or sister is in need of help, and I’d like to share them with you here:

 Top 5 Warning Signs – Think “RAILS”

 1.     Recklessness/Impulsiveness: These might be subtle signs such as purchasing guns when a person has always been against them. Riding a motorcycle recklessly or charging into burning buildings against policy or procedure.

 2.     Anger: Suppressed anger or explosive anger from seemingly minor issues can be a dangerous sign. Displacement (directing one’s anger at someone else instead of the intended person) is often observed. Displacement is most often directed at a FF or EMT’s family.

 3.     Isolation: becoming distant from their career company around the station or volunteer firefighters who don’t participate in drills or calls as much. Members might even display isolation around their family. They lose interest in family activities.

 4.     Loss of Confidence in skills and abilities: Several FFs and EMTs have advised FBHA they lost confidence in their ability to get the job done due to concentrating on emotional or personal issues they were battling. A seasoned FF who can’t remember how put an engine in gear to pump is an example.

 5.     Sleep Deprivation: Loss of sleep can indicate stress, anxiety, PTS or several other emotional issues a member might be struggling with and not realize.

Recommendations:

 When you see someone struggling or just off their game, follow these recommendations as a starting point:

 1.     Be Proactive; Be Direct: We do this when responding to emergencies. We need to take the same approach when our brothers or sisters appear to be struggling.

 2.     Direct Questions: Remember these two questions if a member comes to you with suicidal ideations.

 a.     Do you feel like killing yourself now?

b.     Do you have a plan? 

 A “yes” to either one of these questions means you need to engage your department procedures or protocols if in the firehouse. If outside of the department then they need help immediately. NEVER leave them alone!

3.     Compassion: The theme in our workshop is: Be Direct and be compassionate. Stay in the moment when talking to them. It is the most difficult type of conversation but always speak from the heart.

 4.     Discretionary Time: If a member comes to you to talk about a difficult issue they are struggling with and you have never dealt with this type of issue, then let them know but also use discretionary time. Do not make statements just to fill a void. For example: I never realized you were struggling with this issue and I don’t have a lot of knowledge on this problem, but let me find out a little more about it and we will talk later. (If this is a crisis moment then do not leave member alone)

 5.     Walk the Walk: The number of firefighters, officers and EMTs/paramedics who help their brothers or sisters out by taking them to AA classes or counselors cannot be overstated.  They sit outside and wait until the appointment is over. Taking care of our own goes well beyond the station or fire ground.

 Posters and tip cards are available for your departments and personnel. Please contact Jeff Dill at jdill@ffbha.org for more information or visit our web page at www.ffbha.org.

Find out more about Suicide Questions and PTSD Question

Skills Leaders Incorporate During Team Building

By: Frank Montes de Oca

Recently, I focused a post on common traits that good leaders demonstrate. It listed characteristics common to leaders who strive to build strong, effective teams. To recap those traits are:

1. Recognize People

2. Respect Employees

3. Communicate Effectively

4. Possess Integrity

5. Provide Ongoing Feedback

Now, let’s aim attention on skills that leaders should incorporate in their continuing team building efforts. Assessing and Monitoring the Climate: How do you know your team is forming at an acceptable pace? How do you know when your team is ready to answer the challenges of delivering emergency services? If you’re not constantly assessing and determining individual and collective progress, you won’t. The steps below outline a basic approach to assessing team development and can be modified to meet the needs of the team and its members.

Step 1: Develop (or copy) a set of guidelines or standards that are achievable and measurable.

Step 2: Make sure the guidelines or standards are relevant to your team’s mission.

Step 3: Train team members individually and collectively to the standards.

Step 4: Assess members individually and the team as a whole.

Step 5: Share the team assessment outcome with all team members.

NOTE: Communicate throughout the process to ensure no one is left behind and a sense of ownership or buy-in is present throughout the team. Some departments are managed by standards, guidelines and rules developed by others outside the department or unit. Some might have been developed years ago. To ensure relevance, make sure the guidelines are up-to-date to meet the challenges of the community. Showing Trust in Your People. In the life safety business, it’s understandable to be cautious of taking everything on face value. It is human nature; somewhat of a self-preservation practice to question. There’s a saying that serves supervisors and team leaders well: Trust and verify. That is trust people or groups, but for the sake of safety, check every once in a while to make sure the facts are what they appear to be. Regardless of how you manage to certify the accuracy of the statement or claim, demonstrating trust, confidence in and support of your people is an integral practice for leaders. Ensuring a Respectful Workplace.

This attribute was mentioned in the last blog and is #2 above. This takes it a step further by requiring all members to demonstrate respect for each other and every community member with whom they interact. Regardless of gender, age or personal beliefs, it is integral to an effective team that respect is practiced at all levels. Enforcing Accountability and Fairness

Providing emergency services requires a relationship between the responder, his/her supervisor and the citizens served. To ensure the service rendered is of the quality expected, all members must be accountable for their actions. To achieve this the unit leader holds himself/herself to the established standards and in turn holds all members accountable for their actions as well. The peak of the team’s development occurs when team members hold each other accountable. Duties should be assigned based on fairness and the individual abilities of those assigned. As soon as favoritism is witnessed or suspected, a breakdown in unit cohesiveness occurs. Therefore, to prevent this all assignments, assessments and training must be distributed equally and fairly.

Communicating, Managing and Sharing Expectations The underlying message in this post is communication. When managers and supervisors maintain an open, two-way communication loop, unit effectiveness thrives. Members want to know what is expected of them. And in turn they expect their supervisors to know and respect what they expect. This level of honesty and openness builds teams who operate with resiliency, pride and effectiveness.

Go forth and lead!

Frank Montes de Oca served as a firefighter/paramedic for over 38 years finishing his career as a fire chief and emergency services director at three departments. His focus continues to be first responder development, team building and firefighter safety and survival. Chief Montes de Oca can be reached at frm1@me.com. Visit his website www.responder1.org to find information and training programs focused on first responder safety, survival and leadership development.

Incident Command: Coordinating with limited resources

By: Chief Mike Kull

In a perfect world, every time our Fire Brigade receives a call for service, we will have all the manpower we need and all of the necessary equipment available at a moment’s notice.  Of course, we don’t live in a perfect world and no matter where you are serving as a firefighter, there will be times that you will not have all of the resources you may need to properly respond.  So, what do we do to prepare for those times when we don’t have everything we THINK we NEED?

            The first step is for us to do an HONEST review of our available resources and manpower from our own fire station.  What is the lowest number of firefighters we have available to respond?  What equipment do we have that will be available and in good working order order for EVERY call?  This is where we start our preparation and training.  If we can only expect to have two firefighters available to respond to a call for service, we can make that work!  As we train at our stations, we train with only two firefighters performing tasks that we will be expected to do at an emergency.  We continue training and practicing as a two-person team until EVERYONE can complete all tasks with only two people.  Now, if we respond to an incident and we have more than two firefighters available, it will make the tasks go quicker and easier.  While we are practicing and training, we will be sure to use the equipment that we will have available and in good working order for every call.  We will be sure to properly MAINTAIN that equipment so that it is always available and in good working order.  If we then have other equipment available to us at an incident it will, again, make our jobs quicker and easier.

            Once we have become very good at working with low manpower and minimum equipment, our next step is to become familiar with other resources.  Is there another Fire Station or Brigade near-by that can bring more firefighters or other equipment?  If so, it is important to take the time to visit with those other firefighters and to practice and train with them as well. They may not always be available when you call them for help, but you will be familiar with them and their equipment if they do arrive to help.

            Now that we have become well trained with our own firefighters and our own equipment as well as with the available resources from nearby firefighters, we must look for other places to find the resources we need.  Are there police officers at the incident that can help us control the crowd or traffic nearby?  Are there members of the COMMUNITY that can assist us with tasks that do not put them in danger?  Is there a nearby business that may have tools or equipment that could be useful?  Are there hand tools that are not designed for firefighting that we may be able to use?  Can we build our own tools out of resources available nearby?

            All of this takes place BEFORE we are called to service.  It is important to identify the types of emergencies that we will be called to.  Then we must try to learn what equipment and resources we will need to help out at that emergency. We can PRE-PLAN what we will need so that we can practice those skills with our limited manpower and equipment and learn how to be successful. 

            In order to become a Fire Brigade that can perform well with limited resources we must practice and train often within our own Fire Stations and also those nearby.  We must utilize resources available in our community and we must find ways to use tools and equipment that are available to us to perform our jobs as firefighters. We must know the types of emergencies we will be called to and what resources we will need.  As we practice and train with very limited resources we become very good at our jobs and we can perform even better as more resources are found or arrive to help.

 About the Author:

Chief Mike Kull is a Fire Chief in rural Pennsylvania and successfully deals with limited resources on every call. He has been serving his local community for 25 years. Chief Kull serves as Fire Chief and Administrator of his local volunteer fire department as well as serving as a local elected official and has served in various government roles for his entire career. He is also a Forest Fire Warden with the PA Bureau of Forestry and serves on his church council.

Introduction to the Principles of Emergency First Aid

By Howard Cohen

Not all firefighters are emergency medical technicians or paramedics, but often we are the first responders to scenes where it is necessary to provide life saving first aid.  Therefore, it is important for all firefighters to have at least a basic knowledge of first aid.  The purpose of this short article is to provide foundational principles for responding to trauma in situations where immediate life saving medical help is required.  In no way should this article be considered first aid training.  However, with the basic and limited information contained within, and no other training, you may still be able to save someone’s life.

Scene Survey: The First Task

Size up:  Regardless of your level of technical first aid training or medical knowledge, when responding to an incident that involves injuries your first task is to gather as much information as you can about the situation.  This is done through a careful size up.  It is critical that you assess the risks and dangers before rushing in to administer aid. Ask yourself, “What is trying to kill or harm me?”  Is it traffic, wildlife, fire, an unstable building, falling objects, or flooding waters? You do not want to become another casualty or cause further harm to the patient.

Number of patients:  Once you’ve made the scene safe and stable now is the time to determine how people are part of the incident.  It is easy to get fixated on patients who are calling out in pain, overlook those who are unconscious, or miss those who are not visible.  It is also easy to rush to aid a person whose injuries appear more life threatening than they are, for example someone who is bleeding from a superficial head injury, while someone else nearby has stopped breathing.

Primary Survey:  The Second Task

The primary survey is an assessment of the three main life supporting functions.  These are the respiratory, circulatory, and nervous systems, also known as the ABCDs.  Any problems involving one of these systems represents an immediate threat to the life of the patient and must be addressed immediately.   

ABCDs:  Once size up is completed, the scene is safe (or as safe as you can make it), and you have a sense of the number of patients needing aid,  initiate a primary survey of the patients by checking the status of the three conditions which represent an immediate threat to life.

Airway:  Check to be sure that the mouth and airway are cleared and air is actually going and out.

Blood is Circulating:  Check to make sure that blood is not pouring out and that it is circulating.

Disabled:  Check to see if the spine is stable and the central nervous system is operating normally.  Due to the limited scope of this article I will not be saying any more about injuries that involve the head, neck or spine.

Basic Life Support (BLS)

Basic life support is the immediate treatment of one of the three life threatening emergencies found during your primary survey.  The purpose of BLS is to provide temporary support to keep the patient alive while a secondary survey is conducted and/or until advanced treatment is available.

The simplest way to begin a primary survey is to ASK the patient, “How are you?” If he answers then you know that his airway is not obstructed (A), his heart is beating (B & C) and the brain is functioning (D).  If the patient does not respond or responds in an unusual way you will need to look more closely.  

Airway:

Airway problems are a result of an obstruction to the pharynx or larynx.  The obstruction can be complete or partial.  A complete obstruction is rapidly fatal, but can be effectively and dramatically treated by clearing the airway.  There are various ways an airway can become obstructed such as from vomit, a foreign object or swelling caused from trauma, an irritant or allergic reaction.  It is imperative that you clear the airway but you must do so without causing any additional harm to the patient.

Breathing:

It is possible for a person to have an open airway but still have difficulty breathing.  This can be the result of an injury to the brain, spinal cord or diaphragm.  The method for assisting a patient with breathing when more advanced medical care is not available is called positive pressure ventilation or artificial respiration (mouth to mouth).  The rate of inflation should be about 12 breaths per minute or one every 5 seconds.  Breaths should be about 1 to 1.5 seconds.  Faster breaths can force air into the stomach which can lead to vomiting.

Bleeding & Circulation:

Uninterrupted circulation of blood is essential to staying alive.  There are essentially two kinds of disruption to the circulation of blood that you can address as a first responder:  cardiac arrest and bleeding.  Cardiac arrest means the heart has stopped beating.  While doing your primary survey if you discover that the patient has no pulse it means her heart has stopped beating and she is in cardiac arrest.  It is important to note that under adverse situations, or if the patient is in shock, it can be hard to find a pulse.  The carotid pulse is the strongest to feel and easiest to access.  It is found on either side of the larynx in the neck.  If there is no carotid pulse, the heart is not beating. CPR (cardiopulmonary resuscitation) is the only treatment for cardiac arrest.  Even with hands-on training, it has limited potential to restore and sustain life.

The second kind of disruption to circulation is caused by a major loss of blood.  Blood loss must be controlled as a part of BLS.  Bleeding can be internal and both hard to identify and stop, or external, but not necessarily obvious.  Addressing internal bleeding is beyond the scope of this article and most first responders in the field.  External bleeding is controlled by direct pressure over the bleeding site with your hand, but preferably with a cloth or bandage.  This is not to absorb the blood.  It is to provide even pressure across the wound.  Expect to apply direct pressure for 10 or more minutes.  If the bleeding is not stopping, remove the bandage and check for the source of blood and then reposition your hand.  

There is no easy rule for deciding when bleeding is severe.  A rule of thumb is that if it looks like a lot of blood, then it probably is.  However, it is worth noting that severe  bleeding can be missed if the patient is wearing a lot of clothing or the blood is absorbed into the ground around the patient.

Conclusion:

When it comes to developing first aid skills, like all skills a firefighter needs to master, training and practice are essential.  At the same time, it is important to read about the principles and theories undergirding these skills.  However, there is no substitute for training and practice.

References:  

The Outward Bound Wilderness First-Aid Handbook; Jeff Isaac & Peter Goth.

The Field Guide of Wilderness & Rescue Medicine; Jim Morrissey & David Johnson.

Opening an Unconscious Patient’s Airway with a Manual Manipulation:  

https://www.youtube.com/watch?v=AifzmrpA7ao

https://www.redcross.org/take-a-class/cpr

About the Author

Howard retired from the Bennington Fire Dept as a deputy chief.  He spends a lot of time writing and teaching various aspects of firefighting.  He religiously works out every morning, doing a mix of high intensity interval training (HiiT), dumbbells, kettlebells, barbells and cycling. When he is not doing something for the fire service or working out he is the rabbi of two small congregations.

Firefighter Safety- Using your PPE

By Brad Banz, Retired Chief, Colwich, Kansas Fire Dept. and Retired Captain, Wichita, Kansas Fire Dept.

 Today’s firefighters are asked to do much more than just respond to fires.  In the modern world, we respond to automobile accidents, dangerous goods (haz-mat) incidents, various types of rescue calls, utility emergencies, EMS calls, and now add in terrorism and pandemic to the list, not to mention anything else that may occur.  

    Firefighters are exposed to a spectrum of hazards as a result of the wide variety of incidents that we respond to.  We are exposed to environmental heat from working around fire, as well as the excess heat our bodies produce from extreme exertion.  The fires today we are responding to burn hotter than they did even 30 years ago.  An example is burning a cotton mattress versus a modern sofa made of polyurethane foam and polyester fabric.  The cotton mattress when burned will release heat at a rate of 140-350 kilojoules per second.  The sofa will release heat at a rate of 3,210 kilojoules per second.  Ten times the amount of heat.  We are exposed to cold, falling objects and debris, blood and biohazards, suffocation hazards, and crushing hazards.  We are also exposed to a toxic assortment of chemicals, not only from the dangerous goods incidents we respond to, but from each fire, no matter what the contents.  

   The reason I share this is not to scare anyone from the job, but to hopefully educate everyone on the hazards that are there so they can better equip themselves to more safely do the job.  Because we respond to more incidents and are exposed to a wider variety of hazards, we must do a better job as firefighters of focusing on safety.  One of the most fundamental things firefighters can do is to wear their PPE.  

     Let’s talk a little about how PPE makes us safer.  Coats and pants are made of 3 layers of material.  The outer shell provides a first layer against heat and cold, and some protection against moisture.  The middle layer is the vapor barrier.  As the name implies, it provides a barrier against steam and some chemical vapors.  The inside layer is the thermal barrier.  The layering of it, along with the outer layers, create a stronger barrier against heat.  The level of heat protection is dependent upon the materials the coats and pants are constructed of.  They will give limited protection against some dangerous goods, but are not meant to be the primary PPE for all responses.  In any circumstance, to insure maximum protection, coats and pants should be fastened all the way.  Boots can be constructed of leather or rubber and must have steel toe and foot protection to protect from crushing injuries as well as penetrations.  Gloves are made of leather or other materials.  They are lined to protect our hands from thermal injuries and have wristlets to protect our wrists as well.  Hoods are made of Nomex or carbon fibers.  An adequate hood offers protection to our necks and overlaps down on to the tops of our shoulders, and protects our necks and all exposed skin on our heads from heat.  They should be pulled up whenever operating in a hazardous environment.  A good helmet should have an adequate face shield, chin strap and neck protection.  It should also be clean and not cracked.  The face shield should be in a down position when working in an environment where tools or equipment are being used or blood, biohazards, or other chemicals may be present.  

    Any time we are entering an environment that is filled with products of combustion, heat, fire, or unknown atmosphere we should be wearing a breathing apparatus.  This includes during the overhaul process after the fire is contained.  If your department/brigade does not have BA then you need to structure your firefighting tactics accordingly.  

    As I addressed earlier, one of the biggest hazards we face is responding to medical and trauma related emergencies, and the risk of biohazards.  We need to make sure to protect ourselves by wearing the proper gloves, protective glasses, masks, and if the situation calls for it, gowns and facial protection.

    I have briefly covered the hazards and the PPE we can use to lessen the risks that we face.  Firefighters need to consistently practice an attitude of safety every day, and watch out for each other.  Thank you, and let’s all stay safe out there.

The Importance of Firematics

by Nicholas Higgins

It has been said time and time again, "You can never train too much for a job that can kill you." As we are aware, firefighting has many aspects to it. Many of these are common to every fire department, no matter their location, size, or status (career or volunteer). Other aspects are specialized areas that not all departments focus on or specialize in, such as medical, hazardous materials or technical rescue. In any case, having a sound basis in the area of “firematics” is a stepping stone to success for yourself and for your crew. We will briefly touch on key areas every firefighter should have a sound understanding and strong knowledge of. Many of these areas are touched on briefly in probationary/training school and then oftentimes, pushed aside once graduated. However, these areas are the core foundation for everything we do as firefighters and lay the groundwork for everything else we do on the fire ground. The skills of understanding these concepts, terminology and definitions is in fact, simple in theory. The difficulty is understanding the strategies and tactics behind them in order to implement them. All good leaders and firefighters must understand these core areas of which everything else is built from. 

The areas I would like to briefly touch upon are: building construction, fire behavior, reading smoke and size-up.

Building Construction

In the American Fire Service, there are oftentimes six different types of building construction however this may be different in various parts of the world based on the materials used to build structures. As firefighters, it is imperative that we know our enemy and know everything we can about it. Without having at least an understanding of our enemy, it becomes difficult to defeat it. In almost every one of our cases, the enemy is the building structure. In order to be a successful firefighter in any capacity, on any apparatus, in any area, understanding and having a solid foundation of building construction knowledge is vital. Just as a world-class fighter studies their opponent in the months leading up to a fight, us as firefighters MUST study our buildings in our areas, so we too are prepared to fight…and WIN. 

The most vital piece of information I can provide here is simple. It makes a difference in knowing the different types of structures and how to identify the differences, however, what makes it even more important is the ability to identify the types and how they will react under fire conditions while in the moment! This leads us to fire behavior.

Fire Behavior

Fire behavior is the foundation on which all firefighter knowledge is built upon. Moreover it is our understanding of fire behavior from which we can gain an understanding of fire and how to suppress it properly. The lack of fire behavior knowledge creates an even greater risk for serious injury or death. Understanding fire behavior is truly being able to operate as a firefighter. The understanding of fire behavior is the basis for understanding fire suppression and the understanding how to properly perform other tactics such as ventilation, forcible entry on some occasions and overhaul.

As society changes or in many cases evolves, so does fire behavior. The reasoning behind this is simple - the introduction and presence of synthetic materials (also known as plastics). These materials in their solid form are petroleum- based products, therefore producing an increase in the output of thermal energy. This reasoning alone is a cause for a more rapidly spreading fire regardless of the type of structure it is in. More so than not, it is causing our enemy (the building) to have more fuel to hurt us. To understand fire behavior, it is important to understand the phases that come along with it and it’s attributes – ignition, growth, full development (flashover is present) and decay (back draft is likely). To understand these areas takes years of studying and training to become proficient but having the basic concepts down is a great start to proficiency in fire behavior for firefighters of all levels and experience.

With fire comes smoke.

Reading Smoke

An important aspect on the fireground for many reasons is understanding smoke and smoke behavior. Many clues from the smoke alone can help identify the location and status of the fire. Command and company officers, as well as firefighters, need to be able to read and interpret all of the clues while conducting their size-up upon arrival and throughout the incident. 

Here are some clues to take into consideration: potential fuel, density, color, velocity, and volume.

Smoke is fuel. In today's world and the modern-day fire service, the products of combustion are highly toxic, flammable and potentially explosive. The smoke’s chemical composition is different at each fire due to the different fuel sources yet, one thing remains the same; smoke contains high levels of carbon monoxide.

Density identifies the thickness of the smoke, it’s level of energy and if there is a potential for a flashover or for fire spread.

Color tells you how flammable the smoke is and what is burning.

Velocity tells us how fast or slow the smoke is moving and by doing so helps determine the location and its flow path.

Volume on the other hand doesn’t speak to firefighters about smoke or fire but it does give firefighters the amount of fuel that is burning. By knowing how much fuel is burning, provides insight to the size and intensity of the incident.

Understanding smoke provides the fundamentals for reading and identifying changes in fire and smoke conditions in the interior or exterior of a structure, along with identifying and possibly preventing flashover or fire spread.

Size-Up

The size-up is for all intents and purposes, our game plan or battle plan, if you will, against the structure we are working at. The size-up is where firefighters and fire officers gather information in order to make safe, efficient, and effective fireground decisions. Fireground decision making, as we know, is meant to be quick, but with an emphasis on safety and ensuring the tactics are done efficiently and effectively. This is done in three phases; the pre-incident size-up, the on-scene size-up and the after action review. All three of these have their purposes.

Pre-incident size-up allows firefighters to gather as much information as we can about the structure and contents inside and helps guide our on-scene strategies and tactics.

On-scene size-up is where firefighters utilize our pre-incident size-up and put it to work. This size-up is where more information is provided specific to the incident and can now confirm our findings from the pre-incident size-up. Further, this is where company operations are assigned and take place.

After-action-review is the final stage in the pre-planning process. This is the time for firefighters and officers to discuss and share the information obtained and to discuss the success and failures experienced at the incident. It is also a time to ask a few key questions. 

What did we expect to happen?

• What actually occurred?

• What went well and why?

• What can we improve upon and how?

The benefit of asking these questions allows for strengths to be easily identifiable and make it easier to uncover areas of weakness. By uncovering areas of weakness, you can develop ways to improve them!

In closing, I’d like to leave you with this piece of advice. If we think of firematics as an orchestra and each piece getting broken down into sections, we can identify each area as its own unique piece yet, an integral piece to the orchestra as a whole. With practice, each section sounds in harmony and sync with one another, but without practice or even a section missing, the harmony and synchronization doesn’t happen. This is the same for firematics, you cannot have one without the others.

For further information on these topics, you can refer to my book, “The 5-Tool Firefighter” where these concepts are laid out in greater detail along with other areas of interest to guide all firefighters on their journey to success.

About the author
Nicholas J. Higgins is a firefighter and district training officer for Piscataway Fire District #2 in Piscataway, NJ. He is a New Jersey State Level 2 Fire Instructor, a National Fallen Firefighters Foundation state advocate and a member of the Board of Directors for the 5-Alarm Task Force Corp. a 501 (c) (3), non-profit organization. Nick is the founder and contributor of The Firehouse Tribune website.

Transitioning Leadership

by David A. Moore, Jr.

In late 2012, when I first shared the idea of creating the organization that would become Africa Fire Mission, my wife Nancy's reaction was one of bewildered amusement. 

My how things have changed since that night in 2012!  Africa Fire Mission has grown from an idea into an award-winning, international non-profit organization that has provided life saving training and personal protective equipment to thousands of firefighters on four continents.  When AFM started, all we needed was as small corner of our basement and now we occupy a professional office and storage facility. We have blossomed from a small group of volunteers in Cincinnati to a large, international, group of volunteers. 

Over the years, AFM has adapted to new opportunities and made many changes to best serve others.   January 3rd, 2022 marked a significant change in the leadership of AFM.  On that date, Nancy Moore was named Executive Director of AFM. 

As 2019 came to a close, I recognized that it was time to transition out of the role of Executive Director and we began the search for my replacement.  At this point, Nancy had taken on the role of Director of Programs for AFM and she was leading day-to-day operations.  The Board, along with Nancy and myself, recognized that she was the perfectly suited to be the next executive director. We have worked diligently to ensure a smooth transition. 

Nancy has spent years working in small business and non-profit management, social work, and the fire service. She is deeply committed to empowering our partners to continue their growth while supporting their changing needs. Nancy's diverse background gives her the mastery, leadership and vision to carry AFM into the future. 

As I step back from my role as ED and into my new role on the board of directors, I am excited to see the new places and programs that AFM is able to work in and on under Nancy's leadership.   

Please join me in congratulating Nancy on her new position and encouraging her as she grows AFM into the future.   

Sincerely,

David A. Moore Jr., MPA, CFO, MIFireE 

Founder, Africa Fire Mission