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    Default USFA Official: Fire Service Must Adapt to Changing World

    I noticed something in one of the stories on the main page and figured I'd bring it up for discussion. The article on the main page, the same title as the thread, had a statement from a firefighter/official at the national fire academy:


    Aside from demographics, he said that the job too is changing, including the tactics used by fire crews.

    "Stop fighting interior fires," he said. "Don't go into those fires anymore. It's not worth it. They build disposable houses these days. Our lives are not disposable."

    By fighting fires from the outside, he believes firefighters will be safer and more line of duty deaths will be prevented.


    Now maybe he was taken out of context a bit by the interviewer, but I think saying "Stop fighting interior fires" is painting with too broad of a brush. I completely agree that firefighters are not disposable and that safety is important, but I think it's a disservice to the people we are supposed to be protect to not aggressively, but smartly, enter a building for search and extinguishment.

    It just seems like there is a lack of a balanced approach in tackling fire service issues. I think health screenings and physicals would go a long way in cutting LODD's coupled with new technology for PPE. Instead of advocating better training and firefighter fitness, we seem to be moving toward Risk Nothing to Save Nothing everytime out.

    Obviously not all department have that philosophy or will abandon it in favor of super safety practices.

    Just trying to stir some discussion.

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    Quote Originally Posted by Squad50FF View Post
    I noticed something in one of the stories on the main page and figured I'd bring it up for discussion. The article on the main page, the same title as the thread, had a statement from a firefighter/official at the national fire academy:


    Aside from demographics, he said that the job too is changing, including the tactics used by fire crews.

    "Stop fighting interior fires," he said. "Don't go into those fires anymore. It's not worth it. They build disposable houses these days. Our lives are not disposable."

    By fighting fires from the outside, he believes firefighters will be safer and more line of duty deaths will be prevented.


    Now maybe he was taken out of context a bit by the interviewer, but I think saying "Stop fighting interior fires" is painting with too broad of a brush. I completely agree that firefighters are not disposable and that safety is important, but I think it's a disservice to the people we are supposed to be protect to not aggressively, but smartly, enter a building for search and extinguishment.

    It just seems like there is a lack of a balanced approach in tackling fire service issues. I think health screenings and physicals would go a long way in cutting LODD's coupled with new technology for PPE. Instead of advocating better training and firefighter fitness, we seem to be moving toward Risk Nothing to Save Nothing everytime out.

    Obviously not all department have that philosophy or will abandon it in favor of super safety practices.

    Just trying to stir some discussion.


    No inside firefighting is just waht LaFireEducator wanted to hear!!


    This is what the safety sallies want to hear. Fight 'em from the outside at the street!

    Stay Safe and Well Out There....

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    This guy sounds 50/50, idiot and realist.

    Fighting fire from the outside all the time, and going out of our way to recruit minorities are 2 of the stupidest ideas. We need to be recruiting the BEST of the BEST, not who is the flavor of the month. And aggressive interior attack is what puts fire out, saves property and saves lives, not standing on the outside.


    He is right when he stated that WUI, EMS and tech rescue are going to be more common, and we need to train up more on those areas.
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    Fighting all house fires like it's lightweight construction, is just as silly as fighting everything like it's an older dimensional lumber. I'm not going to let people die or property be needlessly destroyed in a home built in 1920 because I'm afraid of houses built in 2000. We need intelligence and skill, not cowardice.

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    Quote Originally Posted by nameless View Post
    Fighting all house fires like it's lightweight construction, is just as silly as fighting everything like it's an older dimensional lumber. I'm not going to let people die or property be needlessly destroyed in a home built in 1920 because I'm afraid of houses built in 2000. We need intelligence and skill, not cowardice.
    well said. .
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    Blanket statements are rarely relevant in the real world.

    Fight all structure fires from outside? WHY? Even if the building is of truss construction as long as the fire doesn't "Escape the compartment" into the void spaces of the attic area we can fight it like any other structure fire we have ever fought.
    Crazy, but that's how it goes
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    Quote Originally Posted by CaptOldTimer View Post
    No inside firefighting is just waht LaFireEducator wanted to hear!!


    This is what the safety sallies want to hear. Fight 'em from the outside at the street!

    Being brought into a thread I didn't post in .. Again.

    Have at the discussion boys without me. I know how I feel.
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    Quote Originally Posted by nameless View Post
    Fighting all house fires like it's lightweight construction, is just as silly as fighting everything like it's an older dimensional lumber.
    A lot of us know that - but too many of us don't.
    Opinions my own. Standard disclaimers apply.

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    I understand what the message is... but I can't agree with it. I look at this as putting down our weapons and accepting defeat.

    If we adopt blanket defensive operations, we basically will surrender the ground every time. When we have fires in large warehouses, tenement structures, apartment buildings, motels, hotels, office buildings, etc... the loss will be much greater than what we have come to expect.

    Of course, many times these examples put our people at the highest risk. Improved training and tactics perhaps should be advanced, but the risks will still remain.

    There are times we must take a defensive posture. I swallow hard when conditions tie my hands in this way. I just cannot subscribe to the reasoning to take offensive strategies from our toolbox.
    HAVE PLAN.............WILL TRAVEL

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    Quote Originally Posted by PaladinKnight View Post
    I understand what the message is... but I can't agree with it. I look at this as putting down our weapons and accepting defeat...

    ...There are times we must take a defensive posture. I swallow hard when conditions tie my hands in this way. I just cannot subscribe to the reasoning to take offensive strategies from our toolbox.
    I didn't take his comments as a blanket "put down your weapons." I think his cautionary message is that we can't just go charging in any more - we need to think twice.

    There are times when we do need to (and still can) be aggressive. But we also need to realize that a box made of toothpicks and cardboard is a deathtrap for us and increasingly it's simply time to step back and protect the exposures.
    Opinions my own. Standard disclaimers apply.

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    I agree with what is likely the underlying message - new construction methods require us to re-think the use of our "traditional" methods when encountering one that is on fire and adapt appropriately. Doing so would definitely have the potential to reduce FF LODDs.

    However, it would seem to me that in regards to reducing LODDs, the need to change our tactics in order to achieve that reduction is of a lower priority to making changes in other areas. The vast majority of LODDs each year seem to be the result of medical issues (work stress, lack of fitness and underlying medical condition) and MVAs (apparatus and POV). Annually, very few appear to be the direct result of offensive fire operations in buildings of lightweight construction.

    So, it's quite possible that many FDs have already adapted to the lightweight construction threat and a true focus on things like fitness and safe driving could yield a much greater impact on reducing the number of LODDs annually.

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    My thoughts can be found here....

    http://backstepfirefighter.com/2011/...-fail-mission/
    ‎"The education of a firefighter and the continued education of a firefighter is what makes "real" firefighters. Continuous skill development is the core of progressive firefighting. We learn by doing and doing it again and again, both on the training ground and the fireground."
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    Quote Originally Posted by BLSboy View Post
    This guy sounds 50/50, idiot and realist.

    Fighting fire from the outside all the time, and going out of our way to recruit minorities are 2 of the stupidest ideas. We need to be recruiting the BEST of the BEST, not who is the flavor of the month. And aggressive interior attack is what puts fire out, saves property and saves lives, not standing on the outside.


    He is right when he stated that WUI, EMS and tech rescue are going to be more common, and we need to train up more on those areas.

    Quote Originally Posted by nameless View Post
    Fighting all house fires like it's lightweight construction, is just as silly as fighting everything like it's an older dimensional lumber. I'm not going to let people die or property be needlessly destroyed in a home built in 1920 because I'm afraid of houses built in 2000. We need intelligence and skill, not cowardice.
    Can't say it any better myself.

    Well said...sirs!
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    Quote Originally Posted by FireMedic049 View Post
    The vast majority of LODDs each year seem to be the result of medical issues (work stress, lack of fitness and underlying medical condition) and MVAs (apparatus and POV).
    There seems to be a growing sentiment that the cause of at least some of our "after the fact" deaths (returns to station, doesn't feel well, collapses, cannot be revived despite efforts of rescuers on scene at the time) may be due to cyanide poisoning, as opposed to "poor lifestyle choices."

    Studies I've heard of (third hand, unfortunately) have shown that even fire personnel working outside the fire building show increased levels of cyanide after an incident.

    In Europe it is now apparently standard practice to give smoke inhalation victims a "Cyanokit" - the antidote for cyanide. Recovery rates have markedly improved, from what I hear.

    While we often do need to improve our lifestyles, we also need to be looking for other reasons for some of these otherwise unexplained deaths.

    There's a lot of crap in that smoke we breathe (and even more of it after the fire is "out").
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by tree68 View Post
    There seems to be a growing sentiment that the cause of at least some of our "after the fact" deaths (returns to station, doesn't feel well, collapses, cannot be revived despite efforts of rescuers on scene at the time) may be due to cyanide poisoning, as opposed to "poor lifestyle choices."

    Studies I've heard of (third hand, unfortunately) have shown that even fire personnel working outside the fire building show increased levels of cyanide after an incident.
    Not to get off course here but...

    Three or so months ago we reviewed all the LODD's in Florida over the last few years. Those who did not die from vehicle accidents or injuries sustained on a call or training died as a result of sudden cardiac arrest. Some had heart conditions that were unknown or that they did not disclose but nutrition, fitness level and improper rehab were at the top, not inhalation of toxic fumes. What we need to push for are complete NFPA physicals and mandatory physical fitness standards and mandatory rehab as laid out by the NFPA and IAFF.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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    "What we need to push for are complete NFPA physicals and mandatory physical fitness standards and mandatory rehab as laid out by the NFPA and IAFF."

    I'm all for higher fitness and health standards. But what it boils down to is this-how many of the guys that we work with are we willing to put out of work to get to 0 LODDs?

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    Quote Originally Posted by gunnyv View Post
    I'm all for higher fitness and health standards. But what it boils down to is this-how many of the guys that we work with are we willing to put out of work to get to 0 LODDs?
    I don't want to see anyone let go but on the flip side, are you willing to bite it because these guys would rather eat crap and sit in the Lazy-Boy all day? I'm all for helping these guys out, thats part of the brotherhood. Get them on a workout and nutrition plan, make it part of training. Devise some sort of competition for those who are overweight and out of shape, I don't know any FF who is not somewhat competitive. Bottom line is that improving our health will limit a lot of LODDs.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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    Quote Originally Posted by Firemedic 61 View Post
    Those who did not die from vehicle accidents or injuries sustained on a call or training died as a result of sudden cardiac arrest.
    How many that had been in or near an IDLH atmosphere recently had toxicology screens done?

    I'll certainly agree that the cause of death of a member who hasn't seen a working fire in several days or longer and who succumbs to a heart attack will most logically be laid to heart disease. I also agree that healthier living could well reduce the number of those deaths.

    What I'd like to see more attention paid to are those deaths that occur within some short period after a member returns from a fire, and even those who succumb on the fireground. Unless we look at other possible causes (like poisonous gas inhalation), we aren't going to reduce that portion of our fatalities.

    If one of your firefighters experienced the following symptoms, would you suspect cyanide poisoning?
    ...general weakness, giddiness, headach, vertigo, confusion, and perceived difficulty in breathing.
    I didn't think so.

    That's from Wikipedia.
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    Quote Originally Posted by tree68 View Post
    How many that had been in or near an IDLH atmosphere recently had toxicology screens done?
    As part of their autopsy yes, every one did and the MEs did not relate toxicity as cause of death.

    Quote Originally Posted by tree68 View Post
    If one of your firefighters experienced the following symptoms, would you suspect cyanide poisoning?


    I didn't think so.

    That's from Wikipedia.
    No, your 100% right, but every one of those symptoms requires ALS treatment and transport under our SOG's
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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    Quote Originally Posted by Firemedic 61 View Post
    As part of their autopsy yes, every one did and the MEs did not relate toxicity as cause of death.
    That's good to hear, as it applies to my point.
    No, your 100% right, but every one of those symptoms requires ALS treatment and transport under our SOG's
    But you realize that if, in fact, the patient is suffering from cyanide poisoning, your best paramedic, doing a perfect job, is simply wasting his/her time unless they administer a Cyanokit...
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by tree68 View Post

    But you realize that if, in fact, the patient is suffering from cyanide poisoning, your best paramedic, doing a perfect job, is simply wasting his/her time unless they administer a Cyanokit...
    Absolutely, even though we have them we wouldn't know until they got to the ER and had a toxicology report done that cyanide was the underlying problem. We only administer the kits for known exposure. Hopefully in the future we'll be able to test everyone in the field.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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    Quote Originally Posted by Firemedic 61 View Post
    Absolutely, even though we have them we wouldn't know until they got to the ER and had a toxicology report done that cyanide was the underlying problem. We only administer the kits for known exposure. Hopefully in the future we'll be able to test everyone in the field.
    First off, I am NOT attacking you, or your dept. What is the reason for not administering Cyanokits to suspected exposures?

    Indication

    Cyanokit is indicated for the treatment of known or suspected cyanide poisoning.
    Identifying Patients with Cyanide Poisoning

    Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.

    The presence and extent of cyanide poisoning are often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Cyanokit should be administered without delay.

    Smoke Inhalation

    Not all smoke inhalation victims will have cyanide poisoning and may present with burns, trauma, and exposure to other toxic substances making a diagnosis of cyanide poisoning particularly difficult. Prior to administration of Cyanokit, smoke-inhalation victims should be assessed for the following:

    Exposure to fire or smoke in an enclosed area
    Presence of soot around the mouth, nose or oropharynx
    Altered mental status

    Although hypotension is highly suggestive of cyanide poisoning, it is only present in a small percentage of cyanide-poisoned smoke inhalation victims. Also indicative of cyanide poisoning is a plasma lactate concentration ≥ 10 mmol/L (a value higher than that typically listed in the table of signs and symptoms of isolated cyanide poisoning because carbon monoxide associated with smoke inhalation also contributes to lactic acidemia). If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.
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    Just found this while surfing about. One of the stories happens to be about my former dept.

    Treatment of Choice Emerges for Smoke Inhalation

    Oct 14, 2011 11:33 AM

    By Glenn Bischoff (glenn.bischoff@penton.com)

    In yet another case, two children fell victim to a house fire, and weren’t discovered until the secondary search. “It was amazing that they were alive at all,” Persse said. “They got a lot of smoke.”

    The Cyanokit was administered to both children, who ultimately recovered. While he couldn’t state with certainty that administration of the drug by itself was the difference between life and death in each of these instances, Persse believes that it was an enormous factor.

    “It’s kind of hard to argue that, when you see them go from being completely limp to blinking their eyes and moving their hands and feet within minutes of starting the drug.”

    Just about the only downside to the Cyanokit, in Persse’s mind, is its cost, which has caused the Houston Fire Department to limit its issuance to district-chief cars. “We didn’t put them on the paramedic units because we have way more paramedic units than we have district-chief cars, but there will be a district chief at every working fire and every paramedic has been trained on the Cyanokit,” Persse said. “That’s how we balance the expense problem with the availability challenge.”

    That said, Persse advised that fire departments shouldn’t let the cost issue prevent them from arming themselves with the Cyanokit.

    “I know that there are a lot of fire departments across the nation that are hesitant to use it because of the cost, and that’s a decision they’re going to have to make,” Persse said. “But if it was my family member, I’d want them to get it.”

    Mike McEvoy, EMS coordinator for Saratoga County (N.Y.) Emergency Services, which has been using the Cyanokit to treat firefighters for 2½ years, agreed that cost is an issue, one that is compounded by the fact that the kit has an expiration date. However, McEvoy said that his agency came up with a clever strategy for solving this dilemma.

    “We place them along the Interstate corridor, and so we’re able to get them to any scene within 15 minutes,” he said. “That helps us to turn them over so that we’re replacing them before their expiration date.”

    McEvoy’s agency is so sold on the Cyanokit that it now is administered to anyone who shows “significant evidence” of smoke inhalation, firefighter and civilian alike.

    “When you look at the number of people who die in the United States from structure fires each year, very few of them are burned; most of them die from inhalation injuries,” McEvoy said. “Every time we read about one of those we wonder if the care for that patient included giving them [the Cyanokit], and if not, perhaps that’s the reason the patient did not survive.”

    In Hillsborough County, Fla., in which the city of Tampa is located, four firefighters in the last four years have been treated for hydrogen-cyanide exposure using the Cyanokit. In one instance, the firefighter was overhauling a small structure fire.

    “It was a shed and all of the walls were down, so they didn’t think they needed to be on air packs,” said Robert Marschall, training officer for Hillsborough County Fire Rescue.

    The firefighter was at the center of the structure knocking down a hotspot when the fire “smoldered up,” according to Marschall, who added that the firefighter started to become symptomatic immediately after inhaling the smoke. There were a lot of symptoms.

    “He had periods of shortness of breath, his heart rate went fast and then slow, and he had periods when he was awake and then unconscious,” Marschall said. “He had a headache, he had some weakness and confusion, he was restless and anxious, and he had a metal taste in his mouth.”

    Marschall took a Cyanokit to the hospital, spoke with the emergency-room doctor and convinced him that it was the treatment of choice for hydrogen cyanide exposure through smoke inhalation.

    “He was very receptive and within four hours, our firefighter was ready to go home,” Marschall said.
    AJ, MICP, FireMedic
    Member, IACOJ.
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    This message has been made longer, in part from a grant from the You Are a Freaking Moron Foundation.

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    The cost is a major factor here - some ten times the cost for the same exact item in Europe, which is one reason they are using it as much as they are, and we aren't. This can probably be fixed with a few well-placed kicks in the pants.

    Just as we make certain presumptions about any number of medical conditions (and our treatment is often based on them), methinks we need to start making the presumption that if someone is exposed to smoke and is symptomatic they get the dose. As already noted, this presumption should extend to firefighters who have been recently exposed to smoke.

    The contents of smoke have recently been re-analyzed (it was last done in depth in the 70's, if I was told correctly). I'm not sure where to look for the results, and I forget who it was that did the testing.

    I did hear of a screen that was done that involved all firefighters at one or more fire scenes. Even the chauffeur(s), who never entered the building(s), showed elevated levels of cyanide.

    Granted, that doesn't discount healthy living. There is the very real possibility that cyanide exposure may be the "straw that breaks the camel's back" for someone who's not as healthy as they should be.

    And that's just cyanide. What else is there in that smoke that can hurt us that we haven't accounted for yet?
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by BLSboy View Post
    First off, I am NOT attacking you, or your dept. What is the reason for not administering Cyanokits to suspected exposures?
    No sweat AJ, we actually do administer to suspected exposures as well, I see I left that out. Also add dilated pupils to the list.
    Last edited by Firemedic 61; 11-13-2011 at 09:14 PM.
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