To Breathe or Not to Breathe; It Shouldn't Be a Question

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There is an abundance of material written and spoken about the things firefighters do wrong. We are bombarded daily about omissions, corrections that need to be made to our behavior/culture and truckloads of Monday-morning quarterbacks second-guessing every action. That material should continue to receive considerable attention because the outcomes usually end up in hospital emergency rooms or funeral homes.

But there is another method we should consider; borrowing from military history. Military strategists don't just pore over what went wrong at battles and campaigns; they also surgically dissect what went right. They don't just look at the "dumb luck" of events; they study the decisions made and resulting outcomes that won the battle and preserved soldiers' lives.

The astute strategist recognizes the value of establishing and reinforcing best practices. Then instruction is developed that focuses more on the proper read of the topography, placement of troops and effect of critical support functions. This is a lesson the fire service needs to devote more time and attention to - the study of favorable outcomes that result from doing the right thing.

Welcome to the inaugural edition of the Near-Miss Tool Box. The vision of this quarterly column is to provide two reports from the National Fire Fighter Near-Miss Reporting System that focus or emphasize the value of using best practices. We're borrowing a page from the great military academies' playbooks. By focusing on the positive outcomes that result from following best practices and highlighting the repeated theme in lessons learned (to follow best practices), we hope to buttress the case for using those practices to improve firefighter health and safety.

This first edition's focus is the benefit of using self-contained breathing apparatus (SCBA) during overhaul. Extending the time a firefighter stays on SCBA at any fire situation is a reasonable step to take, given the data and information emerging about the acute and long-term toxicity of the post-fire environment. The first report, number 08-287, takes us to the second floor of a single-family dwelling where first-floor crews have extinguished a fire and second-floor crews are checking for extension and beginning overhaul.

"...(Unit number deleted) advanced a dry line to the second floor in case fire was found. Upon entering the second floor, a TIC (thermal imaging camera) revealed no excessive heat or active fire from the top of the stairs. (Unit number deleted) crew made their way to the front area of the second floor and began opening the knee walls along side D. Fire was found on the inside of the knee walls at the eave line extending midway down the D side from the A/D corner. Vertical ventilation was completed by the tower and (unit number deleted) crew took out the A-side window. Smoke conditions improved greatly, allowing (unit number deleted) crew to walk around the area, moving furniture/debris and extinguishing the last remains of fire in the knee walls. The crew was still on SCBA, but had no heat and good visibility. The 2nd floor was divided into three rooms with the front room being 8x10 in size. The wall dividing the front room from the middle room had a closet.

"During the extinguishment and overhaul phase on the second floor, flames began coming from the top of the closet wall. Another crew member stated there were flames coming from the middle room extending into the hall towards the engine crew. The hoseline was directed to the flames in the closet and then to the hallway. Immediately following this action, conditions rapidly deteriorated. Thick black smoke and rapidly increasing high-heat conditions occurred resulting in the immediate order to evacuate through the Division A window."

The second report, number 06-476, is dispatched as a brushfire, but the crews find a fully involved vehicle fire in a field. The firefighters advance on the fire in full personal protective equipment (PPE) and attack from a distance. The scene picks up with the transition from extinguishment to overhaul just getting underway.

"The officer then ordered me to open the hood to complete the fire attack. The vehicle was just smoldering at this time. As I got the hood open and began to fold it back, I realized that my partner and I were not wearing our masks. Mine was hanging at my side filled with foam and my head was surrounded by smoke/steam from the engine compartment. At no time did command, my officer, engineer or partner remind us to use our SCBA...I had to wash out my mask, which thankfully I did not need on those other calls. I was experiencing a pounding headache. I administered myself O2 (oxygen), which cleared the headache. The headache was CO (carbon monoxide) poisoning. We never did an incident debrief so this was never brought up..." From the lessons learned: "Always mask up, even during overhaul. If you experience a problem, document it."

There is a mounting chorus calling for the extended use of SCBA throughout operations at the incident scene. As the firefighters on the second floor of 08-287 convey, having their SCBA on, even in the face of improving conditions, works to their favor when conditions deteriorate suddenly. They are not hampered by stinging eyes, choking smoke or the reheating of the environment that would, without SCBA, impair their thought process. The crew exits the building safely, then quickly reorganizes on the porch roof to mount an attack that completes extinguishment. Remaining in SCBA kept them in the fight. Protected lungs kept the group organized during their exit, enabling them to quickly regroup and re-engage.

The value of remaining in SCBA is also reinforced by the reporting firefighter in 06-476. This firefighter states that he and his partner are wearing, but not using, SCBA. He also acknowledges that this action is contrary to their training. As a result, he suffers the pain of omission when he describes experiencing a "pounding headache." The headache is alleviated by self-administered O2. The reporting firefighter says the headache was from CO poisoning; a likely cause. However, not to be ruled out are any of the other combustion products liberated from a vehicle fire.

The quest for fuel economy and crash survival has delivered a breed of vehicle that is more carbon/polymer-based than metal. As a result, when the vehicle catches fire, the toxicity of the smoke is disastrous to human tissue. The list of byproducts includes hydrogen cyanide, benzene, hydrogen fluoride, cyanate esters, polyesters, vinylesters and carbon monoxide. The reporting firefighter makes the point concisely when he says, "Always mask up, even during overhaul."

The cumulative effects of incidents like 06-476 are being researched, but the anecdotal evidence is already clear in the shortened average life span of firefighters versus the general population. An additional factor is the individual reaction to the event. Some firefighters may begin the debilitating process on their first whiff of a burning auto; others may need to inhale the smoke from dozens. The unknown is the wild card.

We all know of colleagues who retire from active service only to be diagnosed with a growing list of cancers well before their peers in the general population. While advances in medicine are curing more cancers every year, the number of cancers contracted in the fire service community is still of great concern. The message is clear, but the practice is haphazard. Follow the actions of the reporting firefighter in 08-287 and the recommendation of the reporting firefighter 06-476. You can't go wrong either way.

For more information on the National Fire Fighter Near-Miss Reporting System or to submit your own near-miss report for others to learn from, visit www.firefighternearmiss.com. The program is funded by the U.S. Department of Homeland Security's Assistance to Firefighters Grant Program and is managed by the International Association of Fire Chiefs. Additional support of the program is given by Deputy Chief William Goldfeder and Gordon Graham, founders of FirefighterCloseCalls.com.

The 2009 24/7/365 Safety Calendar is available. The calendar can be downloaded at www.firefighternearmiss.com or e-mail kkeenan@iafc.org to order copies for your stations and members. This year's calendar features drills by some of the fire service's most well-known authors.

JOHN TIPPETT is a battalion chief with the Montgomery County, MD, Fire and Rescue Service. He has been with Montgomery County for 32 years and currently is assigned as the safety battalion chief. Tippett has spent most of his career in Montgomery County's Operations Division as a firefighter, company officer and field battalion chief. He has been a Level II Instructor since 1988, teaching a variety of topics at Montgomery County's training academy as a lead and adjunct instructor. Tippett assisted in developing Montgomery County's Officer Candidate School, Command Development Center and Crew Resource Management (CRM) rollout. He has also served as a shift deputy safety officer. Tippett is Task Force Leader for FEMA USAR Maryland Task Force 1. He holds an associate's degree in fire science from Montgomery College and was recognized by the International Society of Fire Service Instructors (ISFSI) as Instructor of the Year for 2006. For the past five years, Tippett has worked as a project manager for the International Association of Fire Chiefs (IAFC), including developing materials for transporting CRM to the fire service, improving fire safety in the Native American community and assisting in the development of the National Fire Fighter Near-Miss Reporting System, where he is the fire service project manager.

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