Replies to This Discussion

Permalink Reply by Ben Waller on September 11, 2008 at 10:15am

Moose,

You might want to check out Mike's posts again.

The drill is designed for an Engine Company, not a Hazmat Team.
The firefighters are wearing turnout gear and SCBA, and approaching from upwind and uphill. One of Mike's posts references a "quick rescue" and the "Houston FD tennis shoes". There was no reference to technical decon in any of Mike's posts. That fits exactly with the points I made, with the exception that I added the points on engineering controls and emergency decon.

Nowhere did I advocate just running in - there needs to be some size-up, some basic research at least by ERG, and an IAP. Even small county hazmat teams like yours have better hazmat references that most engine companies. Most engine companies have a paper DOT ERG, and that's it. You can successfully conclude Mike's scenario without a hazmat team being anywhere close.

The problem I pointed out is that technical hazmat rules are oriented at incidents where there is no patient. When there's no life to save, then there's no reason to hurry. A rescue situation may change that. Once again, if the patient has survived 15 minutes or more without skin or respiratory protection, it's hard to argue that we need to wait 30 to 60 minutes for the hazmat team to arrive, and another 45 minutes to an hour for technical decon to be established and a full-on hazmat recon to be done prior to having 2 firefighters spend 2 minutes in the hot zone...and THEN decide if it's practical to make a rescue.

If I identified the chemical in Mike's scenario as water-reactive, I might not fight the fire at all. If I did, I sure as hell wouldn't fight it in rubber Level A suits that put the hazmat techs at risk for "Shrink Wrap Syndrome".

You don't have to be a chemist or a chemical engineer to understand and apply engineering controls. Granted, ours may not be as effective, but the point is that ANY hazard reduction you get with engineering controls means that you don't necessarily have to wear all of the protection on our bodies.

If you're working right in the heaviest chemical concentrations while stopping a leak, and don't have a rescue problem, then by all means, take your time, wear Level A, monitor, use all references at your disposal, and set up a 472-step technical decon process if that's what is needed. In that situation, there's no reason to risk even a minor exposure. On the other hand, if you have a rescue problem, have a small quantity of a not-too-bad chemical, and turnouts and SCBA can protect you for a 2-minute exposure, then go make a quick-but-smart rescue.

It is the dose, not the chemical that makes the poison. Everything is a poison, there is nothing that is not. The NIOSH chemical reference lists hundreds of chemicals that have a TWA - Time-Weighted Average. That is a rating of safe levels of that chemical in which you can work for an 8-hour day and/or 40-hour week without known health effects. NIOSH wouldn't list TWAs if there was no permissable level of chemical exposure at all.

"All things are poison and nothing is without poison, only the dose permits something not to be poisonous." Paracelsus 1493-1541

Like I said, recheck Mike's post and photos, and you'll see that his drill lines up with what I'm saying.

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Permalink Reply by Bill Muehsam on September 11, 2008 at 11:25am

Chief, we're going to have to agree to disagree on this one. Without knowing time of exposure, concentration of product, and what the product is, for that matter, putting FF's in harms way is absolutely a bad choice for an "untrained" Engine Company.
As for advocating "not running in", that is what is happening in this scenario. THey are doing a "snatch and grab" without proper PPE, without knowledge of the product, without proper research. If any of this had been done, they probably wouldn't have attempted a rescue. If I put my FF's into a Phosgene Vapor environment, without proper PPE, I GO TO JAIL, DO NOT PASS GO, DO NOT COLLECT $200.00. Nothing that I read in this scenario, would justify an attempted rescue, nothing. These two victims have probably been exposed to high concentrations of Phosgene for over 15-20 minutes. The IDLH is 2 ppm and the LC50 is about 17ppm on a 30 minute exposure. Nasty stuff. Are you really going to put a FF in to that environment????? How many CPT's currently working on your shift, have that expertise to make that call???
Can small incidents be handled in the manner as described, absolutely. This isn't one of them. Based on our own experiences and training, each one of us would handle this differently. As for me, no one is going "down range" to effect a rescue.

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Permalink Reply by Ben Waller on September 11, 2008 at 9:18pm

Bill,

There's no phosgene involved if you don't put water on the fire and it's not raining. The phosgene is created by adding water to the rodenticide. So...don't fight the fire. A lot of the time, letting a hazardous material simply burn up is the best option. The National Fire Academy has been teaching that in the handoff class "The Pesticide Challenge" for over 20 years.

The problem here is trauma to the patients and possibly some respiratory toxicity from the fire products. A quick rescue will take care of the first problem and SCBA will take care of the second one. I'm with Mike on this one - an engine company that pays attention, doesn't fight the fire with water, stays on the upwind side, and makes a quick rescue followed by emergency decon for everybody that's contaminated is safe and effective, and the patients don't die needlessly.

Also remember that phosgene's 2ppm IDLH is astronomically high compared to nerve agents like Sarin and VX. Interestingly, there are U.S. military studies that actually rate turnout gear and SCBA as providing some protection from these nerve agents - chemicals that make phosgene look like a walk in the park.

Mike's point - with which I totally agree is that even the average engine company captain needs to be educated how to handle this type of incident and smart enough to do some quick reference to figure out if there's something you can do to save a life while maintaining a reasonable safety margin for the engine crew. In this case, it's pretty clear that you can do just that.

We're re-orienting my hazmat team from the mindset that we have all day to set up a multi-station technical decon line, that we always have to dress in Level A, and that we have to wear all of our protection. We're using Level B and Level B with flash protection a lot more, using TFT ProPaks to foam spills for vapor reduction, and if we have patients, we use one section of the patient decon roller system set up with or without a catch basin and a hoseline with maybe a bucket of degreaser soap and a soft brush. That posture is oriented toward reducing exposure potential through engineering controls and work practices instead of having only one way to handle every hazmat event.

Our recent statewide WMD team evaluation (18 teams rated) re-inforced this philosophy. The raters were very experienced hazmat professionals. Three were retired FDNY (two from Hazmat 1 and one from the EMS Special Ops unit), one was a retired USAF hazmat technician, and one was a radiation health physicist. Their point is that in this age of terrorism and the potential for lots of patients - instead of a tanker wreck and no patients or one dead patient - we need to focus hazmat on procedures that provide reasonable protection for the firefighters/hazmat techs while saving the patients whenever possible. Mike's scenario proves that a single engine company can do just that, as long as they're smart about how they do it.

And since when is anyone going to jail for attempting a rescue from a burning vehicle with viable patients? If your state does that, someone needs to start calling your county's legislative delegation for help.

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Permalink Reply by Ben Waller on September 12, 2008 at 1:08pm

Moose,

I missed something the first time I read your post, and after re-reading it, I have an additional comment.

You have a concern that "Like Bill mentioned, when you send in the firefighters to make a "Rescue" attempt, you loose them for the duration. What if they were the techs? We now have to wait for additional Technicians to arrive, get briefed and don their PPE, than make entry...by than it could be too late for an entire community, not just 1-2 people." That is a valid concern in some situations, but not this one, unless the truck fire is in the middle of the mall at lunch time or in some other highly-populated area.

My reasoning is that the victims in the truck are immediately threatened not only by the hazmat, but by the fire and by whatever trauma they suffered in the wreck. The rest of the community is not directly threatened, especially if the engine company either a) lets the fire burn itself out, which is a good way to reduce most pesticide hazards or b) extinguish the fire with ABC dry chemical instead of water. Either of those options eliminate the phosgene generation that occurs when this rodenticide gets wet.

That significantly reduces the threat to the rest of the community, even if your entire hazmat team is on the 1st-due engine and is now contaminated and done for the shift. And...it saves the lives of two viable patients who will likely have an unnecessary death if either extreme is chosen. The two extremes are: Sit there, wait on hazmat, and let the victims die from the fire or fight the fire with water.

Disagreement is fine. Your local situation is probably very different than Mike's or mine. If your 1st-due capabilities or a limitation in hazmat quick response makes it too dangerous for you to have the engine make the entry, then letting the patients die is OK. If that's the case, then the local fire department needs to have a written SOG that states that they'll knowingly choose not to attempt the rescue until a full-on hazmat team is there and whatever time it takes to do that is the best option.

I'm all about firefighter safety, in every all-hazard incident to which we respond. In this case, there's a reasonably safe way to make the rescue and still protect the engine company members...and the patients will be alive afterwards to thank you for it.

Take this a step farther and consider a hazmat mass casualty incident. If there are 200 victims instead of 2, are you still going to sit at the other end of the binoculars and wait on a hazmat team? If that's the choice, the likely outcome is that the walking wounded will bring the Hot Zone to you if you choose an initial defensive operation.

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Permalink Reply by Mike Schlags (Captain Busy) Retd on September 12, 2008 at 3:16pm

When I wrote this drill, I did so knowing that this actually was a real call and the outcome. I wanted to take advantage of some key teaching points here for engine companies.

You can approach a hazmat scene where there is a life safety issue, if you keep your exposure minimal. Using radiological standards, ie. time, distance and shielding is good guideline to follow. You are wearing full PPE. If you are wearing the PPE correctly, you will have no exposed skin, minimizing dermal exposure potential. Keep in mind that structure fires alone cause production of very dangerous and carcinogenic materials that we routinely expose ourselves to on a daily basis. We get paid to make these life saving decisions. Having an engine company stand around, and wait to do a rescue until hazmat shows up was not part of this drill. All engine companies will more than likely want to stand back and wait for the hazmat team to show up. This is wrong in my opinion and this mindset needs to go away. If we do have a credible event that occurs on our soil, hazmat teams more than likely will not be showing up at every call, should something disastrous occur that stretches local resources thin. This is a scenario that demands that engine companies react, and do quickly. To not do so furthers the chemical insult to the victim and minimizes any chance of survival. You can go through an emergency gross decon to remove your turnouts. I plan on posting a discussion covering this in the future. When you attend the Homeland Defense CO training, one of their key objectives is to get you to trust your PPE.

The quick, down and dirty way to handle this call is to:

1. arrive and size up the situation, quickly
2. establish command over the radio
3. get some assistance coming your way
4. make the decision to perform a rescue for the two victims, using uphill, upwind, upgrade, etc. and carry a dry chem with you when you are walking to the scene, this is not the time to be indecisive, walking back and forth between the accident and your engine, formulate a plan, act on it and get out of there...
5. isolate the incident, in this case by simply spraying a dry chemical extinguisher, the fire and resulting vapor production is minimized. Note: letting a pesticide fire burn may be appropriate in some cases but when you have downwind issues and non-ambulatory or elderly people down wind, coming up with a way to smother the fire, possibly using dry chem or foam should be considered. In the real incident, they elected to use water. This was a mistake and in my opinion is always a mistake to use water as a first line of defense against a hazmat related fire. Runoff is not your or the environments friend here.
6. Once you've done the immediate life safety rescue's, now you can determine whether to evacuate or shelter in place.

N-95 Masks: My comment to use these may be out of the box thinking but here's my rationale. Once people are removed to a safe staging area, possibly there could be a redline hose there or someway to rinse off the patients face or simply brushing any particles away, in doing so, and coupled with placing a N-95 mask over their face, any particulates that are on your turnouts will not be as readily breathed in by the victim. The concern for fit testing these masks is a joke. Just pinch the note area and cup the bottom, all your doing here is minimizing any future respiratory exposure. You are protected in the warm zone, so should the patient. This is a rescue situation and what you are doing is protecting the patient from further harm. Once you get the patient to an organized decon and treatment area, the masks is removed and the patient is stripped and flipped, etc.

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Permalink Reply by Mike Schlags (Captain Busy) Retd on September 12, 2008 at 3:47pm

Now we are totally on board, this option was discussed at our drill(s) and was only caught by some of the more experienced Captain's and crews. I didn't want to throw this into the conversation because it's difficult enough for folks to get the idea that it's ok to make a quick rescue. What this would accomplish would be to reduce the already diluted smoke for those performing the rescue uphill and upwind. Therefore, minimizing OUR exposure. Right on!

Yea, I know it goes against a lot of stuff we have heard over the years, and I know because I was one of those authors. So, I'm willing to be the old dog who learns new tricks here, others should as well. Nothing stays the same forever and we are allowed to get smarter. We need to use all the tools in our box and our imaginations. What we cannot do is sit a safe distance away and wait for someone else to handle it. The buck stops here as they say, and this scenario demands that you save lives with minimal risk to your crew. Imagine to the horror of people watching the incident live as fire crews stood by a safe distance away while babies were dying. I know all about the candle to moth syndrome, I'm just saying that we need to take all the factors into consideration and make some of those tough choices that we get paid to make.

Remember when you first learned about doing decon? By simply removing the clothing, over 90% of the contaminants are removed from the patient, higher if you are dealing with radioactive materials. Typically, exposure is limited to hand, feet and the face. Btottom line here is that people, unless they are dipped in vat of sodium hydroxide, generally can be decontaminated from exposure quite well. Where you run into problems is where people have been exposed to some of the pesticides that make it difficult to remove from the patient because they internally contaminated. What this means to healthcare personnel is that the patient will off gas what ever they breathed in. We do the same thing after structure fires. Don't believe me? Next structure fire, when you are showering, how many days does it take before you no longer can smell the smoke off gasing out of your pores? You've been dosed... : (

I plan on sharing how to do the various types of decon in the future. I'm glad this post has been met with success. As long as it gets us thinking about options and gets people that are exposed the appropriate level of care, then we are going to do just fine... TCSS, Mike

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Permalink Reply by Moose on September 12, 2008 at 3:58pm

Thanks Chief. I guess what I was thinking was more of an outside the box, outside of this drill. In my area, if you are not trained to handle the situation you do nothing. IE, if the first arriving Engine has 4 interior firefighters with no haz-mat training, they dont go in. Additionally, we are volunteer here, I know Mike is in a career dept with companies set up, I dont know if you are or not. But in my area its the Haz-Mat team, Encon, or State Haz-Mat Bureau that handles the haz-mat.
A long time ago, probably a few years at least, there was a haz-mat incident at a local gas station. It was around 10 pm and the attendant was closing the station and cleaning when he and another employee started to feel lightheaded, and like they were passing out. They barely made it outside before they did pass out and a motorist called for fire to respond. Well, our chief did not feel like waiting for haz-mat, said it was only too much bleach, told 2 firefighters to wrap duct tape around their sleeves and pant legs, wear their packs, go in and drain the sink with the bleach solution. Well....5 minutes later the firefighters are crawling out cause they were feeling lightheaded and dizzy. They failed to ID the chemicals involved and wait for the proper level of training to show up. The employees mixed bleach and ammonia together.
Thats just where my thoughts came from. We are in two different worlds, and unfortunately my area has a lot of catching up to do with training and tactics. Im working on it though! lol
Thanks.

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Permalink Reply by Ben Waller on September 12, 2008 at 4:06pm

Mike,

I think that putting a vacuum cleaner filter (N-95) on a patient's face may make them more hypoxic and be a bigger risk than putting one on. In other words, I think that the cure might be worse than the disease for a lot of these patients.

That violates the first rule of medicine; "Primum non nocere" - First, do no harm.

If you need to protect the patient's airway from particulate than may have contaminated the turnouts, do it with a non-rebreather. That will keep the particulates out and will help patients with respiratory exposures with their hypoxia.

Timing - protect the patient's airway after you make the emergency Hot Zone rescue. Every patient care class out there - ITLS, PHTLS, AHLS, and the national standard EMT, EMT-I, and paramedic classes all teach to rescue the patient from the fire first, then worry about patient care. Airway protection, however you do it, is patient care.

Other than this one point, I think you drill and the thought process behind it are exactly on target.

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Permalink Reply by Moose on September 12, 2008 at 4:07pm

Man...I was taught totally different, just this past June. I wish you were there Mike to talk to our instructors about these things cause now Im confused.
Ive seen it through out my training, I would take a course of study, learn the book smarts and the hands on applications, only to go into the field and see everyone doing it totally different. But, you are across the country in CA, and Im here in NY so I guess the training standards are screwed up here in NY. I see it with Firefighter I and II, Rescue Ops, and now Haz-Mat as well. Im in the wrong state!!! LOL
Can anyone help a brother out?! lol
Good topic brother, thanks for sharing.

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Permalink Reply by Ben Waller on September 12, 2008 at 4:12pm

Moose,

Lightheaded and dizzy from mixed chlorine and bleach in a sink sounds like a respiratory exposure to me. I've run a number of those incidents, all indoors, and the answer every time was that engine and truck companies used negative-pressure smoke ejectors to vent the structure and had firefighters in turnouts and SCBA move the mop bucket outside or drain the janitor's sink, whichever was appropriate.

The guys on that incident may not have had a good mask seal, or they may have been out of shape/overexerted by ambient weather, or they may have had psychosomatic symptoms, which are common around hazmat incidents.

Skin exposure to the chlorine/ammonia mix is usually evidenced by burning sensations on the skin...especially in places where you have skin folds/creases and/or where you're sweating.

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Permalink Reply by Jason Brooks on September 12, 2008 at 4:14pm

If business was booming and they werent over $500 bucks, I just might send you one so that you could look like a fireman next time you are on TV. In our area we always have EMS with us, fire based, so having a gurney on scene is always an option. But, you are right about the funding. We have the HazSkeds with the team as well as old gurneys for patient removal. A good old backboard is always a good option as well. And don't forget, each guy on our department got issued webbing for drag straps. Wrap and drag them out.

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Permalink Reply by Mike Schlags (Captain Busy) Retd on September 12, 2008 at 11:54pm

Have you done the COBRA training yet in Anniston, AL? That's where I was first introduced to the HazSkeds. Not a bad concept... Little bumpy but hey, do they want out of the methyl-ehtyl-death atmosphere or what? The military and the federal metropolitan medical strike teams have litters that consist of a standard military stretcher and a wheel attachment that enables one person to maneuver a victim. A tad pricey but good quality. I believe it's manufactured by Raven?
I like the issuance of webbing for drag straps. Another excellent example of a progressive department. Nice...

Someday, I'm going to get a leather helmet, and I might add, a real firefighter's helmet. I like that twin sun visor option that tucks away under the font bill. Of course, I've never actually seen one... but I've seen pictures! And maybe I might have seen one in a museum or an old one that must of had someone with a hat size of 5.

Later brother, Mike

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