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Literature on the topic of rapid intervention, like many other subjects, began as individual articles, grew into larger chapters and has now evolved into entire textbooks.
It is such an important topic, in part, because the larger concept of overall incident safety has become much more of a priority than in the past. This area, again like any other, will continue to evolve. The purpose of this article is to start with the subject of rapid intervention and build on it, taking the discussion in a new direction.
Consider this scenario: At a house fire, where all departmental rules are followed and all of the firefighters act appropriately, a firefighter falls through a weakened area in the floor and radios for help using the LUNAR format (L-Location, U-Unit, N-Name, A-Assignment and Air Supply, R-Resources Needed). A rapid intervention team (RIT), already staged, enters the home and with the help of other firefighters successfully removes the injured colleague. The RIT members are successful because rapid intervention has been covered in numerous texts and training programs and the team has the proper training and equipment to complete the task. The injured firefighter is brought outside to a safe area. Rapid intervention is now complete, and all those involved in the rescue are accounted for and directed to the rehab area.
While the body of literature addressing how to remove a firefighter from a hazardous materials “hot zone” has grown exponentially, there seems to be a gap concerning the care of the injured firefighter once he’s successfully removed from a building. This gap is the focus of this article – managing an injured firefighter after a successful rescue.
Removing the firefighting ensemble
There are established practices for rescuing an injured firefighter through a window or down a ladder. However, once the firefighter is brought out of the house and medical care is initiated, a new set of questions is raised. For example, how should he be positioned? Can he be immobilized while in full protective clothing and self-contained breathing apparatus (SCBA)? Is it faster and/or safer to cut off his turnout gear and SCBA or remove it in the normal fashion?
There are published procedures for the removal of a motorcycle helmet or the pads and helmet of a football player, but no established practices exist concerning a firefighter. Yet, in comparison, football gear does not fully envelop the player and weighs less than 30 pounds, while a full firefighting ensemble does encapsulate the firefighter and can weigh up to 75 pounds (50 pounds of turnout gear plus 25 pounds for SCBA). Therefore, some type of rapid, systematic approach is needed for removing a full protective firefighting ensemble from the firefighter/patient to ensure any existing injuries are not aggravated and new ones are not created.
The rescued firefighter will present in one of three categories:
- Cardiac arrest
- Breathing, but unconscious
We could create more detailed subcategories. For example, under category 1, the firefighter could be in respiratory arrest only, or under category 3, there could be varying levels of consciousness. Whatever the circumstances, as this patient is assessed and treated the integrity of the spine and the patency of the airway both need to be protected. Just as in the management of a football player or any helmeted and/or protected patient, a system is needed.
To explore this area more thoroughly, discussions were held with firefighters and paramedics. Practice scenarios were conducted to find the best method of beginning patient assessment and treatment, while removing the turnout gear and maintaining the integrity of the airway and spine. The scenarios were meant to begin with a rapid intervention setting and evolve from there.