Air management and the prevention problem


patient care scenarios

CarolinaFireJournal - TIM WOJCIK
TIM WOJCIK
10/18/2009 -

Let me take a quick second to stand on my soapbox. Have you ever noticed that we in the fire service are quick and passionate when it comes to training on things like RIT, Mayday Drills and Self Rescue? This is a good thing, but have you also noticed that we tend to be equally as passionate against preventive training and actions? Have you ever been written up for not wearing a seatbelt or using a backer? What was your response? I bet there was passion, but not the good kind!

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We must change our culture so that we are constantly monitoring and checking on each other WHILE we are inside. Firefighters are the best at taking care of each other after a tragedy occurs, but we sometimes fail at preventing these tragedies from occurring in the first place

According to the USFA, approximately 22 percent of firefighter deaths (in 2007) were a result of vehicle crashes. A whopping 44 percent of firefighter deaths were caused by heart attacks. These two categories, make up 66 percent of firefighter deaths. In contrast only 32 percent of firefighter deaths in 2007 occurred while engaging in activities on the scene of a fire. RIT training is hugely important and can not be underrated, but the question remains to be asked, “Why are we not as passionate about PREVENTING these situations?” Additionally, “Why are we not as passionate about preventing vehicle accidents or heart attacks?”

I know we TRAIN on these other things, but do we have a PASSION for PREVENTION? The simple answer is that for many of us, it just isn’t as “cool” to train on cardiac health, vehicle driving or other preventative issues. This is a cultural problem that has got to change if we truly want to prevent firefighter deaths.

How we manage our air

Another cultural problem that must be addressed to prevent firefighter deaths is how we manage our air. When my generation entered the fire service, air management training consisted of, “When the bell rings, relax, don’t panic. You have PLENTY of air. Just find your way to the door.” No lie, that was pretty much it. That and, “If something goes wrong, you can just filter breathe by sticking your low pressure hose in your coat.” Um, Houston, we have a problem.

Let’s talk about three better ways to manage your air. The first thing that I want you to consider is your point of entry into the building. While working as the safety officer at a large commercial fire, I noticed firefighters entering the building via a door close to the A/D corner. This was the most visible entry point. The incident commander’s walk around however had revealed that the fire was most likely in the area of the B/C corner. Visibility was virtually non-existent throughout the entire structure. There was also a door in the area of the A/B corner. This is a no brainer right? You will use less air if you enter the building closer to the seat of the fire. Take advantage of the walk-around. Work smarter, not harder. I also want to talk about this concept called “the point of no return.” Depending on who you ask, it has a few different meanings. Most commonly, the point of no return is defined as the position or distance within a hazardous environment at which you have just enough air to RETURN to a safe atmosphere.

Some people will tell you that this is further defined as the point at which you have used one-half of your working air. I would argue that the point of no return is somewhat before you have used one-half of your working air. You are likely to use more air on your way out then on your way in (you’re tired, working harder, maybe even panicked).

So, what’s the point in all of this? The practical application of this knowledge is that you must CHECK your air supply several times while you are in the structure and do not exceed the point of no return. It is no longer acceptable to wait for the bell to go off before checking your air supply. Remember, when the bell sounds, you are no longer on “working” air -- you are on reserve/emergency/ SURVIVAL air. This should be the air that you use to get you through a crisis, not casually back to the front door.

At this point, you might say “I don’t have time to check my air over and over again, I’m busy trying to find this fire.” Believe it or not, there are several natural points during interior operations for you to check your air. The first obvious one is anytime that you go on air. Additionally, as you advance through the structure (especially if you are using a thermal imager), you will most likely stop at several points to orient yourself and scan the room. This is a great natural time to check your air. Once at the seat of the fire, many people actually pause to check the nozzle position, figure the lay of the land, stare in wonder at the beauty of the fire, or post pictures to Facebook (okay, that might be a little sarcastic, but you get the point). This is another time to take a couple of seconds to check your air supply. The point is that there are natural opportunities while you are inside to check your air. Rule of thumb -- anytime you stop forward motion, check your air. Better yet, check your partner’s air. Keep each other honest.

The last point of air management that I want to make is exactly that. We need to watch out for each other. In a recent air management class, we discussed several case studies. In most of these studies, the firefighters reported interacting with other firefighters while trying to find the way out after a crisis. The general flow was like this: Interior team (or firefighter) one is low on air or has some other problem. They ask team (or firefighter) two where the front door is. Team two points team one in the right direction but does not recognize that they have a problem and continues to move forward.

This type of situation actually occurs more often than we think. In a couple of studies, team one actually had low pressure alarms sounding or were filter breathing, while team two continued to move forward. At this point, team one may or may not make it out.

Has someone ever asked you for directions while inside a hazardous environment? Did you just give them directions or did you REALLY check (and not just take their word for it) to make sure they were okay? Did you check their air? Did you look them in the eye? These things are important. If someone is asking you where the door is, they are at the very least disoriented. This should be your first sign of a problem. Disorientation will kill you in an IDLH environment. Someone asking for directions should ALWAYS prompt you to take further action. Make SURE they are okay. Make SURE they get out. Anytime you pass or encounter another firefighter in an IDLH environment, it is your responsibility to make sure that they are okay. Check their air and look them in the eye. Firefighters are proud, but this exchange might be the ONLY chance you have to prevent a disaster.

Air management may not be the most exciting topic to train on, but it is vitally important. We have discussed some simple things that you can do to make sure that you, and your fellow firefighters, have enough air to get out. Remember that “reserve” air, after the bell, is exactly that. It is reserve air and should not be counted in your “working” air calculations.

Consider your point of entry. Pick the entry point that will require the least amount of air to get to the fire. Check your air supply often while you are in an IDLH environment.

We must change our culture so that we are constantly monitoring and checking on each other WHILE we are inside. Firefighters are the best at taking care of each other after a tragedy occurs, but we sometimes fail at preventing these tragedies from occurring in the first place. Be proactive. Make sure your friends are okay before a critical event occurs. Every time you pass or encounter a firefighter on the inside is a chance to prevent a LODD. Take advantage of every opportunity to prevent LODDs.
 
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After serving for several years as the Training and Safety Officer for a 300 member county-wide Fire-Rescue agency, Mr. Wojcik now works as an educator for the Palmetto Health/University of South Carolina School of Medicine Simulation Center in Columbia, SC. With 20 years of public safety experience behind him, Tim’s major focus is the use of high tech/high fidelity simulation to train prehospital providers. He continues to serve as a Firefighter/ Paramedic with the Lexington County (SC) Department of Public Safety and recently spoke at the National Association of EMS Educator’s Symposium in Orlando, FL. Tim can be contacted through his website at http://tawojcik.tripod.com
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