EMS standby at structure fire.

We are a volunteer BLS service in a very small town. We are paged to standby at structure fires, which thankfully, we do not have too many. The fire department is also volunteer and I am also a firefighter.

Our protocols demand we obtain consent prior to initiating treatment (of course) and once we have started our assessment/treatment we expect to transport. The patient has the right to decline treatment/transport at any time. Pretty basic I assume.

My question: Do you do anything different when on standby for a fire? Do you follow all protocols, or can you (for example) give a firefighter a little shot of O2 at their request without doing a full workup and transport? As a firefighter we have O2 on our rescue vehicle for just such occasions. As an EMT I don't think I can give O2 unless doing a full assessment and transport. The black and white answer is of course to follow protocol, but is that the only answer? My thought is to direct the firefighters to the rescue vehicle, there are firefighters capable of running the O2. What is the RIGHT way to handle this?

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Permalink Reply by Ben Waller on July 29, 2008 at 12:11pm

Spanner, B-I-N-G-O!

Apparently, some of the posters refuse to understand that many firefighters who have heat-stress-induced heart attacks have them AFTER they leave the scene.

When a firefighter has the fatal heart attack later, back home or at the station, it doesn't absolve the Rehab EMTs/Paramedics, the local medical director that wrote the protocol, or online medical control who OK'd the treat and release of the responsibility. "He wasn't having chest pain when I pulled the oxygen mask off and let him go back to duty" won't be much of a defense.

If the lawyer asks to see a NFPA 1584-compliant firefighter rehab protocol, and your department (fire or EMS) can't show it, then just ask the plaintiff's attorney how many zeros he wants on the settlement check.

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Permalink Reply by Art "ChiefReason" Goodrich on July 29, 2008 at 9:17pm

Personally, I think a firefighter would stand a better survival rate if he DID have a cardiac event while at the scene.
His care would be almost instantaneous and quite possibly improve his/her outcome.
After they return to the station or go home, the chances of them ignoring the signs/symptoms are there and will most likely let Nature take its course.
But, I have never heard of O2 induced heart attacks.
TCSS.
Art

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Permalink Reply by Spanner 122 on July 29, 2008 at 9:29pm

lol... I think that was the point. I don't think any of us had even insinuated that O2 would bring on an event... it was being at the point where you need to be treated and then being released to go back to the scene that could potentially lead to the event.

I for one, would not want to push it, just to have a heart attack on scene.

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Permalink Reply by Paul Montpetit on July 29, 2008 at 11:38pm

Firefighters today require....yes, require rehab...we take this very seriously.....When you come out you go to rehab for evaluation...and that means rehydration AND a set of vital signs.....if your Blood pressure is up (usually is for a bit) you don't go back in till it has come down.....and we also try to stick by the 2 bottle rule....once you have gone through 2 bottles on your airpack then you are dome on the interior.....sometimes situation doesn't allow for this but we try very hard to stick with it...as for consent...its not protocol it is the law...you can be charged with assault if you try and treat someone without obtaining their consent.....if they are unable to verbally give it to you it can be considered "implied consent" Thats means a rational person would normally consent to the treatment that may be required....The key is DOCUMENT everything..addage is if it isn't written down it wasn't done...stay safe and always keep the faith..........Paul

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Permalink Reply by Ben Waller on July 29, 2008 at 11:42pm

Art,

There is no such thing as an oxygen-induced heart attack, as far as I know. The issue is that a couple of the people in this conversation are insisting that it's OK to give firefighters oxygen at the scene, then release them with no follow-up care or even let them go back to firefighting. Spanner and I have been trying to convince them that if a firefighter has enough symptoms to need oxygen at the scene, then that firefighter is at great risk for a heart attack, and that classic MI symptoms may not be present at the scene.

The absence of symptoms at the scene does not equal the absence of heat-stress-induced heart attack risk. I agree - absolutely - that firefighters who are symptomatic at the scene have a greater chance of getting those symptoms treated in time to save their lives.

Giving them oxygen at the scene and then letting them return to duty very well might take away that chance, regardless of some folks' insistance to the contrary.

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Permalink Reply by Eric on November 11, 2008 at 12:34pm

My department works automatic mutual aid with two of our neighboring departments for the main course of the work, our local rescue squad, one department as a standby department and one department specifically for F.A.S.T./R.I.T. Our rescue squad is there, obviously for anything serious, but for rehab. Once a firefighter goes through an air bottle, or has been in the structure doing work for a decent amount of time, they go to rehab. At rehab, you get your vitals checked (blood pressure, pulse rate, etc.) that is recorded with the time and then you sit there until those rates get back toward normal. You get water, and whatever else you need.