Skip to content


FIrefighter Pre-Hydration – Fight Fire like a Marathon Runner

5 comments

Has anybody else noticed that it’s sweltering outside? There’s no other way to describe the oppressive heat we’ve been facing without trotting out the word “sweltering.” The word itself is almost fun to say. I recommend that you work it into as many conversations as you are able these days while you toil outside in the intense heat. It won’t keep you any cooler, but at least you’ll be adding to the vocabularies of the other sweaty people working around you. It sure beats asking them if it’s “Hot Enough” for ‘em. That gets annoying.

In the last few weeks here in Southern Wisconsin we’ve been having some terrible fires requiring response from multiple area departments. Some of them have been heat related and some of them have just come at a bad time, but all of them have had one common denominator. They’ve all been dangerously hot. Not just the fires themselves, but the oppressive, dangerous, and potentially deadly heat on the fire ground due to the weather conditions has contributed to multiple firefighter injuries. Thankfully, most of the injuries have been minor and heat-related but some of them have been worse. I don’t know if the heat contributed to all of the injuries suffered by those brave firefighters, but it certainly couldn’t have helped.

In times like these, all firefighters need to remember the fact that active firefighting activities are nearly the same as competitive sporting events. Firefighters working on active fire grounds have the same or higher demands put upon their bodies as do athletes on the playing field. It is of extreme importance to remember that fact and take appropriate action to keep yourself and your brothers and sisters safe. Extreme weather is a great equalizer. It affects all of us no matter our station in life. Everyone on the scene has the responsibility to recognize the risk they’re taking by exerting themselves outside in these conditions and take appropriate steps to protect themselves. Nobody wants to see their fellow firefighters fall ill and even less than nobody wants to be the firefighter who goes down themselves.

By design, firefighting personal protective equipment provides an effective barrier to thermal energy. This becomes a problem in hot weather because it doesn’t allow for the shedding of excess body heat and raises the core temperature of the wearer quite sharply. While after years of promoting rehab, even the staunchest believer in their own invincibility can usually be coerced or threatened enough to go to rehab after heavy work on the fire ground, rehab is of even more importance during hot weather because it allows the firefighter to shed his or her PPE and allow that body heat to escape. However, it is important to remember in times of extreme hot weather like we’re facing now that rehab after working is not enough to keep you safe from heat-related injuries and illness. It’s simply too hot for normal people to work effectively without prior planning and preparation. Athletes spend days preparing themselves before competing in physical events by resting adequately, storing up calories and carbohydrates, and pre-hydrating. We should as well.

While it is important to keep yourself nourished with healthy food, I don’t recommend that firefighters load up on calories and carbohydrates before every shift like runners before a race. I do recommend pre-hydration. To pre-hydrate is to drink water before you need it and it is important to realize that one should drink water before they are thirsty to maintain normal hydration. While the adequate daily intake of water for healthy adults varies due to temperature conditions, levels of activity, and other factors, the Institute of Medicine (IOM) recommends that adult males take in 3 liters of water per day and adult females take in 2.2 liters. The water doesn’t need to come only from drinking water, and can come from water stored in food we eat. The IOM says that if a human is producing around 1.5 liters of pale yellow to clear urine per day and is urinating at least once every 3-4 hours they are at close to normal hydration levels. However, many factors affect our hydration and it is easy for a person to become dehydrated without realizing it. Dehydration leads to fatigue, headaches, tachycardia, low blood pressure, and other nastier symptoms that greatly affect firefighting performance and safety. It has been stated that it is not uncommon for firefighters to lose two liters of water through sweat while working on the fire ground in full PPE. If you start to sweat that much when you are already dehydrated, you will not be effective for very long.

Pre-hydration is all about keeping your water tank full before you respond and is as simple as drinking water throughout the day and maintaining your hydration levels. Since fighting a fire in full gear can be compared to running a marathon, we may want to emulate their guidelines. Marathon runners are taught to drink 20 to 32 ounces of water 2 to 3 hours before running and then to drink 8 to 10 ounces of water every 20-30 minutes before they run. While actually running, they are advised to drink 8-10 ounces of water every 20-30 minutes as well. It is not advisable to intake a large amount of water before engaging in strenuous activity because it takes time for the water to move from the stomach to the large intestine and be absorbed into the blood stream. Too much water in the stomach at once can lead to nausea and vomiting during periods of strenuous activity. Sports drinks with electrolytes like Gatorade, Power-ade, and others like them should be consumed occasionally to replace any electrolytes lost through sweating however there is no need to pre-load yourself with them as the body does not store more electrolytes than it needs and excretes any excess quite rapidly. Replacing lost electrolytes through food is of great value, and most can be replenished by eating fruit like a banana. In addition, avoid soda pop, carbonated beverages, or beverages that contain high amounts of caffeine and/or sugar as these drinks can actually contribute to dehydration by acting as diuretics.

It is easy to encourage pre-hydration among your crews. People need to drink water before they feel thirsty, and should continuously drink small amounts of water through the day. Place water in conspicuous areas throughout the station and the living quarters. Water that is out of sight is out of mind and can be forgotten. By placing water right in the line of sight of everyone, they are reminded of the need to have a glass or two. You can make the drink more attractive by adding commercial flavorings like lemonade, crystal light, or Mio mixes that add taste without adding too much sugar. Another trick is to place the bottles of water in the engine next to every staffed seat and encourage every firefighter to drink a bottle during any response to a working incident.

By pre-hydrating, you will ensure that you and your fellow firefighters hit the fire ground with full water tanks and can perform at peak levels in this oppressive heat. Keep yourself hydrated and stay safe out there. We’ve sickened and injured too many firefighters lately and I don’t want it to keep up. Turn the tide and drink up. You’re worth it.

Coming Soon – The Law of Unintended Consequences meets the fire service

3 comments

Remember the post I put up a few days ago entitled “A Predatory Ambulance Fee”? It talked about how the Elgin, IL city council is planning to help recoup their costs for Fire and EMS services by charging for refusals.

(This is the link if you didn’t read it: “A Predatory Ambulance Fee”)

This just in:

Apparently they’re not done proposing new fees in the city. They seem to be very serious about recouping their costs and finding new ways to monetize their services. According to this article posted on Firefighter Nation, they’re planning on adding quite a few new fees to their repertoire.

Here’s the link: “Illinois Department Considers Charging Non-Residents for Fire Services” Read it and see what you think.

The article only mentions two specific fees, a $500 per hour fee for an engine response and $2200 for “a serious car accident where someone has to be transported by helicopter.” These fees are interesting enough, but the article also hints that there are further fees forthcoming.

The chief is quoted as saying that he expects most of these fees to be covered by insurance. After all, he says… that’s what insurance is for.

The chief may be very correct with that statement; insurance exists to pay for the unforeseen costs of bad things that happen to people who pay for it. Insurance companies pay these costs based upon rigid contracts they sign with their customers and charge their customers rates based upon the average risk they assume on behalf of the customer. They will only pay for what they are contractually obligated to pay for. While I have no knowledge of whether or not insurance will actually pay for the charges Elgin is proposing in practice, I’m assuming the city of Elgin doesn’t either and if they don’t seem to care whether the people they are saddling with these kinds of fees are insured for them or not, why should I?

It’s not like these insurance companies aggregate risk across all of their customers and will pass the overall cost of these fees to everyone in the area causing everyone’s insurance rates to go up, right?

Remember, I am not against fire departments, cities, and/or EMS services finding new and innovative revenue streams or ways to defray costs. The City of Elgin is not a villain here. It is very expensive to operate a service and I completely understand wanting to recoup some of those costs. These kinds of fees are somewhat the result of a rigid and over-regulated EMS payment system that chains our entire industry and squashes most hopes of innovation. I believe in EMS payment reform. In fact, I demand it.

But guys? While you’re by far not the only department in the US proposing and implementing things like this… you’re all opening Pandora’s Box. Your citizens are going to fight this, the press won’t be good, and you may end up creating more of a wave of dissatisfaction than you’re really prepared to endure. Think about Moline, IL and what they’re going through right now. Could you imagine their chances of winning their fight if they had implemented these fees?

Then again, perhaps they should implement them in Moline and let the revenue sources balance their budgets… In Moline they say they’re operating at over a $340,000 budget deficit and maybe these kinds of fees would offset that deficit enough that they could make their EMS financially viable.

Or maybe the marketplace will decide and departments that do this kind of thing will be put “out of business” (for lack of a better term) by competitive forces.

I would be willing to bet that there’s someone out there that would only charge $450 an hour for an engine response and only $2100 for a “serious car accident”. There are probably plenty of people and companies that would be happy to do fire response for profit. That’s what happens when governmental services start acting like monopolies in a capitalistic system, they get replaced by free market alternatives. Back in Ben Franklin’s day the fire service was a private endeavor that was only made public when the cost of providing protection wasn’t profitable enough to serve the ends the people wanted it to serve. Make the fire service profitable and private industry may find a way to make a solid business model out of it. Don’t believe me? Think Fed Ex and UPS versus the US Postal service.

I’m not saying it’s a good or bad thing. It’s why private industry exists. If there’s an opportunity to make money doing something, someone will step up to make money doing it. These fees, if they become lucrative, may just be the opportunity for private industry to find a business model that didn’t exist before.

I am able to understand why Elgin wants to implement these fees… but I think that this is a situation ripe for the Law of Unintended Consequences. If I could give cities proposing these kinds of fees some advice I would tell them they should find every single efficiency within their existing budgets before they set about increasing revenue through raising fees. Make no mistake, within the contemporary political climate; citizens are going to scrutinize every aspect of your budget when you start trying to get them in the wallet. You may not like what they find.

I don’t have the ultimate answer but I’m keeping an eye on this story. You should too.

The day I didn’t die – Firefighter Close Calls

16 comments

Laying prone on the quivering floor, I had been pushed down flat on my stomach by the searing heat and smoke. I was as terrified as I’d ever been as I frantically yanked and tugged on the inch-and-a-half hose line that was stretched down the basement stairs towards the engine company that had disappeared down the dark hole an eternity ago. What had started out as a small, concealed fire with light wispy smoke conditions had quickly deteriorated into this hellish, searing inferno that I was convinced was killing the three men below me.

Twenty minutes before this, my two man tanker company had been first on scene to this structure fire that had been dispatched while we were returning from a small brush fire. We were the closest unit and were first on scene. Light staffing that day caught us when this fire was reported during the height of our daytime volunteer shortage. These factors combined a two-man tanker company together with a two-man brush-truck company to make a primary search of the structure. The light smoke and little heat had lulled us into a false sense of security as we entered the single-family home. The concealed fire between the first floor and the basement caught us unaware. It spread quickly and weakened the floors we were standing on. When I found the first floor had been weakened, I sent out my partner to inform command as we were on the tanker and had no radio communications inside the structure. Unfortunately, another engine company with a hot-shot lieutenant arrived and, despite my fervent protestations to the contrary, he took his three firefighters down the stairs to the basement. I stayed to mark their exit.

Outside the air-horns sounded their three quick blasts, calling for an evacuation of the structure. I stayed, waiting for the crew to emerge from the staircase so that I could lead them to safety. They never showed. The intense heat burned me through my turnout gear as I screamed as loud as I was able through my SCBA mask into the abyss. I tugged on the hose and screamed at them to return, only taking a break to recognize the ringing of my low-air warning bell on my air tank. I had no idea how long it had been ringing, but when I noticed it, it was slow. Instead of a sharp ring, it was a slow ding that was getting slower as I was sucking as much air as I could to yell down the staircase.

This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor. I also knew that the men below me needed me to be there for them when they came out of the basement. They needed me to be there to lead them to safety.

It was a decision that made me choose between leaving my brothers to perish by saving my own life, or staying to face my own probable death. Ding… Ding… Ding… the sluggish bell ticked off my air supply, inching ever closer to the point where it would just stop, leaving me to asphyxiate.

That moment, I chose to flee and save myself. It’s why I’m sitting here typing this story.

I knew where I was in the structure. While it was pitch black from smoke and I was blind, and while every movement made my skin contact my turnout gear and burned me, I turned tail on my stomach and frantically crawled towards the doorway I knew it was only a few feet away. I knew I could make it. I knew my brothers were dead or dying. I knew…

“CRACK” went the floor as it opened up to reveal the inferno underneath my belly. I felt myself falling I saw the flames come up and envelop me. My vision turned from completely black to completely orange as I felt myself falling into the intense heat. I screamed and reached out ahead of me into the darkness. I clawed and flailed forward, grasping on to anything that I could grab to save me. God willing, my fingers found the concrete steps out the outside door to the residence. Inch by excruciating inch I pulled myself up and out into the light and the fresh air.

As soon as I was out of the house I stopped breathing as my SCBA mask sucked into my face for lack of air in the tank. I ripped it off of me and sucked in the sweet outside air. Waiting for me outside, about to try and find me, were the three firefighters who had went into the basement. They had evacuated through a basement door. Nobody knew that I was still inside waiting for them until they made a headcount in the confusing scene and found that I was not accounted for.

Looking back at this experience, I am proud of myself for finding out that I will go up to the last possible second to try and save my brother firefighters… although thinking about the decision I made to turn tail and run, I’m almost ashamed that I didn’t stay past that point of no return.

Of course, my policy is that I go home at the end of the day every day… but still.

Close calls are terrifying experiences. Thinking about losing any one of my coworkers or colleagues is unfathomable. It can happen, however, and we combat this reality with safety and organized command structures. This call was years ago in my career but it sticks in my mind at every call I’ve been to since that day.

Train hard. Keep your wits about you. Take everything seriously.

 

The Hole a firefighter fell through in a strucure fire (uninjured)

The Hole I fell through in a strucure fire (look right by the door)

Follow Up to the Shine Factor – Grunts: Part 1

1 comment

 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

————————————————

The other day I determined the most important piece of equipment in my ambulance for the day. It varies from shift to shift, you see. Sometimes it’s one of the sexier tools we carry, like the IO (intraosseous – Into bone marrow) drill or the $25k cardiac monitor. That day, it was definitely NOT sexy but nonetheless it attained the status of the most important piece of equipment of the day. It was (drum roll please): The emesis basin.

For my non-EMS audience (Yes!! I’m getting one!! Keep telling your friends!!) “Emesis” is a medical term for “Raalllpfffegh” or, more technically, “barf”. It’s puke, vomit, throw-up, and the like. It’s something that, (apologetically) has been mentioned a few times in my writings. For EMS people, as I keep saying, it tends to be an integral part of our careers. The “Emesis basin” is a polite, professional term for a puke bucket; A portable version of the Porcelain Goddess that people pray to on hungover mornings if you will. Having one on the ambulance is necessary for a lot of reasons, none the least of which is to keep the puke out of your shoes. If you ever want to see a medical person scramble, and I mean any medical person, yell that you’re going to need an emesis basin quick like.

Quick sidebar story: The other day I was working the clinic when a patient asked for someone to come into his room. He said “I think I’m gonna throw up!” and he definitely looked like he wasn’t kidding. The problem was, when calculating his probable trajectory; I saw that he was aiming for the exact ground level cabinet where the emesis basin was stored. I had to act fast. I sprung into action, diving commando style towards the cabinet. Seconds ticked like hours. Quickly I opened the door and grabbed for the basin, cursing myself in my head for the lack of dexterity I had in getting the basin out the door. If only I had more time! I could…

Yes, he puked on me… Only a little bit though… He just peppered my scrubs a bit with splatter off the floor.

So anyways, the emesis basin was the most important piece of equipment on the ambulance the other day. The patient needed it and needed it right then and there and I got it for her. Luckily for me we had one. Yep, we had ONE; Just ONE bucket that I used ten minutes into my hour long transfer. It was my fault too, because it was my ambulance for the day and therefore the responsibility to check the stock levels and functionality of the equipment was mine and mine alone. The fact is, though, that the emesis basin just isn’t on my mental list of things that I absolutely have to check. I check the biggies really well every shift. I make sure that there’s plenty of EKG electrodes because I really like 12-lead EKGs and I’ll do the fancy right sided ones when I think that they’re necessary. I check to see that we have a good supply of all sizes of IV caths just in case I need to turn multiple people into pin cushions. I check the airway stuff religiously, and even do a monthly op check on my monitor every shift just to make sure it works. That, and I follow our check list to the letter every time.

But I took the emesis basin count for granted, and it almost cost me another vomit bath.

Now, I’m not shying away from my responsibility to check out every piece of equipment on my truck before I head out the door every morning, but really if I was down to my last basin, so probably was the crew before. Since I don’t think that they had to use one, so probably was the crew before them. Then it goes right back to me, when I probably didn’t check it that shift either. More of my fault there then.

Luckily I had the one that I did.

I would wager that one of the most annoying things that can happen to an ambulance person is to find out that you’ve run out of something you need at the worst possible time. Everyone hates that. If it happens a lot it can really tear down The Shine Factor of your organization a lot. It makes the EMT that it happens to blame themselves a bit, but also blame their coworkers a lot more. Nobody likes to bear the blame entirely on themselves so they rationalize that while they may have not exactly checked that exact piece of equipment, the previous crew obviously didn’t either. Then anger starts, and eventually apathy blooms.

Here’s what a grunt like me can do to put an end to this: (Yes, very very simple, I know) Check your freaking truck!

I don’t mean check it like you are told to do per the rule book, I mean check it out thoroughly every single shift. Pull everything out. Make sure that it works. Make sure you know how to use it (couldn’t we all use a refresher on the traction splint?) Make a production of it to whomever happens to be around to see you do it. While you’re doing it, take the extra minute or two to spray something on the surfaces and wipe them off with a towel. It may not be a full decon, but it at least make things cleaner and more sanitary.

A strange thing will happen here, I guarantee it.

First, you will KNOW for sure that your truck is in tip-top response readiness. You can’t fix the fact that it may have 200k+ miles on it, but you sure can make sure that you’ve done your part. It’s a good feeling. Trust me.

Second, you’ve now just picked up a big part of the responsibility for increasing the shine factor in your organization by taking away a big potential aggravation spot for your other crews. They may not deserve it all the time… but at least you’re doing your part to keep everyone happier and to make sure that every patient in that ambulance doesn’t have to suffer additionally from the lack of needed equipment.

Third, by making this a production, and even by turning this into a game, you’ve single-handedly improved the overall care that your organization provides and therefore the pride that your coworkers have in the service. If you do your best truck check, and then challenge another crew to find something that you may have missed, you’re pulling their pride into it too. Make it a bet. Put breakfast or something like it on the challenge. Their pride is on the line too, and that will get them invested.

At a service I worked for in times past, we always stayed with the same truck day in and day out. Since I’m pretty much OCD on truck cleanliness, I got into a competition with another medic from a different station that was riddled with the same OCD that I was. We polished, shined, cleaned, vacuumed, and tried to generally outdo the other with how brightly our truck shone in the sunlight. If I would have had the ability, I’m sure that we would have taken surface cultures to see how sanitary our trucks were (and THAT would be a great topic for an upcoming piece!). That competition put our personal pride into making our trucks the cleanest and shiniest they could be. Once we were invested personally, our pride inspired us to clean the trucks better than any management policy ever could. In fact, management’s best option to further motivate us would probably have been to offer prizes and recognition for the competition. Positive reinforcement other than negative sanctions that there would have been. It works.

Here are some things that I resolve to check each shift:

  • The batteries in my ear thermometer
    • And I’ll make sure that we have the little cover things too
  • I want at least two of every size ET tube in case the first one gets all mucked up
  • Every blade too.
  • I’m actually going to get out the test solutions and calibrate my glucometer. (Yea, when was the last time you did THAT)
  • The child car seat.
  • The portable suction unit, both manual and mechanical.
  • The cot. I’ll bet that the one you’ve got needs at least ONE thing tightened and has at least ONE speck of blood on it.
  • The number of towels in the cabinet. Does anyone else put one on their knee when they
    kneel down at the side of the cot and put the patient’s arm on their knee to cushion the bumps? How many times have you had blood run down on your pants? Now, be honest, how many times have you just felt it easier to walk around that way for the rest of your shift? (Guilty. Ewww)
  • Every other little thing, too.

As always, “Get out there and polish some chrome”

 

—————————————————————-

 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

Related Posts with Thumbnails

Random Posts Widget created by Best Accountant Services