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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?
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?
Replies to This Discussion
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Permalink Reply by Kimberly A Bownas on
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I agree with you Spanner. The whole thing with goving O2 to a firefighter and then letting them go back to work worries me. We don't do that. We take vitals and if they need further treatment then they go and get treament and aren't allowed back to work.
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Permalink Reply by anne potter on
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naw I do that because I am a lousy speller and if I large cap it i tend to catch my mistakes more... no just not yelling lousy speller.lol... don' take it to heart.......
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I Agree a little shot of O2 yes ,but Iv fluids on scene big nono.. If they need that they need transport... Your Sogs may be laxed ,but your state Health won't be when they come after you... I would check into you r state health and see what you can and can't do on scene.. wow..
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Are you kidding me this practice has been going on for years.. A build up of co that fast.. been a nurse for many years yet to see one tank do that.. If there is he should have failed the fit test along with his physical a long time ago... a shot of o2 compare to spending ten minutes on it yes a problem ,but please a shot ... Don't be uneasy the co is okkkkk,,, I guess these new o2 bars that are opening which I agree alittle weird but all the new co problems we are going to have
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Permalink Reply by Spanner 122 on
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I think you are completely misunderstanding what I am saying. What has been going on for years? Giving a shot of O2 to a firefighter while on scene. If you look at some other responses, I think you'll see it's not that common.
Or maybe you meant a build up of CO. Again, not all that common anymore. If a firefighter is wearing his/her SCBA, this is not going to be a problem. That was my point. So why else are you treating with O2 and allowing a firefighter to return to work. You know they aren't just sitting at a desk. I never once said CO is okay, and yes it is possible to see a build up. Read the research, it's a component of incomplete combustion, if this happens, O2 should of course be given, but NO RETRUN to work.
No firefighter should ever return to duties after receiving any kind of treatment (maybe after a bandaid, but let's be reasonable). If your fire department's SOP's do not state this, they are putting their fire fighters in danger. I don't care how long you've been a nurse, you cannot always tell if that firefighter's symptoms simply require a shot of O2 or could be leading to a cardiac event while on scene and without proper equipment. If you feel the need to hook a firefighter up to the pads so you can tell the difference, then I'm thinking there's some reasonable doubt to keep him in rehab. (just trying to cover all arguements).
Maybe this is why the fire departments across North America are still suffering so many LODD's on scene. The firefighter doesn't want to admit he can't go back to work, so EMS lets him. Is this a possibility? Of course it's not the reason in every case, maybe even only one. But why is there even one? If a firefighter needs treatment, he is sidelined. PERIOD.
PS - what does an O2 bar have to do with CO problems. People aren't bellying up to these places because they have a build up of CO. I dont' see the comparison you are trying to make at all. They are bellying up because of the "high" or clarity that comes with it... not to mention, a pretty good cure for a hang over. No offsense, but you asked for opinions, don't tell me my departments SOPs are wrong because it differs from what you would like to do on scene.
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Permalink Reply by judy on
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as a response to EMS on a fire scene : ALWAYS follow your protocals,
AS for giving O2 at the firefighters request don't think so ....Always remember if that firefighter needs O2 he may have injested Smoke or other nasty chemicals .... The rehab should decide if O2 is needed ...we are volunteer and when we have a structure fire the squad responds and sets up rehab. At the rehab we check all firefighters that have been on the fire scene ,we always have a walk around , because we have firefighters that think the can go forever at a fire. At rehab, we take a set of vitals and then we have them sit and drink some fluids( do not over hydrate) After about 10 to 15 minutes, we do a second set of vitals. If their vitals have come down then the firefighter is cleared by the ems crew to beable to go back to work. If it hasn't changed then we make them wait some more and retake the vitals again and go from there. We don't transport every single firefighter that comes to rehab. We only transport who really needs to be transported, you should go by either your protocol or SOG/SOP's for your department are on rehab.. If you dept does not have SOG's always look at NFPA 1580 It is very well outlined ....
Best regards
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I guess it is cool to have difference.. I can see your point ,but not alot of people are going to get on here and say that it happens of course not..no they are not bellying up to these o2 bars for that reason ,but ok... ... But you are taking something small and keep building on it we started off on a shot of O2 to heart attacks... If your firemen is in your rig and needs more than a shot I would say a problem has accured... Commen sence kicks in.. I have been a EMT for 27 year s ran alot of calls have a pretty good insight on knowing the difference between the need for a shot or a need for o2.... .. Your right Can't know everything,but it does happen and has happen for a long time... maybe not your dept.. Rehab is the greatest thing to come along... As far as Ems letting a firefighter back on scene thats the ems call bad or good... can't fix that... I have yet to have a problem maybe the luck of the draw nor any other dept that I have come across.. we have discussed rehab very detailed when it started in our region at our ems region meeting and what will happen on scene.. so far been to most yet cross the fingers that a problem has not occurred.. Alot of problems at scenes where EMS is not called.. We are not dummies I hope and no matter what the practice of each dept is along as we are there to protect out firemen... Fair enough..
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I would never call you a dummy, that would be fairly jeuvenile. I simply am stating, that any treatment beyond a bandaid deems a firefighter unable to return to work. Common sense tells me, if you need O2 for any reason, you either A-don't really NEED it, B) You had better get to the gym more often, C) need to stay in rehab.
You will find, if you check many departments SOP/SOG's that this is the case. As Judy mentions NFPA 1580 should be your guideline if there are no SOP's. Don't let a firefighter bully you into giving him O2 and/or allowing him to return to work. I;ve seen firefighters with elevated vitals, nauseous or even vomitting, who think they can get back in there and work. We don't always know what's best when there's work to be done.
How can you not change whether or not EMS allows a firefighter to return to work. You tell that firefighter's capt that he/she is unable to return, they too should be in rehab, crews travel together. If it is the capt, you tell the chief. Like I said, we don't always know what's best for us, those who do should be making the calls? I'm glad our EMS have no concerns about keeping us in rehab. If you are allowing them to return to work when they shouldn't, you aren't protecting them.
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Oppps made a mistake it is NFPA1584....... as a response to EMS on a fire scene : ALWAYS follow your protocals,
AS for giving O2 at the firefighters request don't think so ....Always remember if that firefighter needs O2 he may have injested Smoke or other nasty chemicals .... The rehab should decide if O2 is needed ...we are volunteer and when we have a structure fire the squad responds and sets up rehab. At the rehab we check all firefighters that have been on the fire scene ,we always have a walk around , because we have firefighters that think the can go forever at a fire. At rehab, we take a set of vitals and then we have them sit and drink some fluids( do not over hydrate) After about 10 to 15 minutes, we do a second set of vitals. If their vitals have come down then the firefighter is cleared by the ems crew to beable to go back to work. If it hasn't changed then we make them wait some more and retake the vitals again and go from there. We don't transport every single firefighter that comes to rehab. We only transport who really needs to be transported, you should go by either your protocol or SOG/SOP's for your department are on rehab.. If you dept does not have SOG's always look at NFPA 1584 It is very well outlined ....
Best regards
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Permalink Reply by Ben Waller on
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Judy,
How do you "over hydrate" a firefighter?
I'm thinking that if a firefighter drinks too much liquid that the kidneys will take over and get rid of the excess.
I'd be much more concerned about not adequately hydrating a firefighter due to an unfounded fear of overhydration.
Just my $0.02.
Ben
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How many times have you peed today? What color is your pee?" Questions that are a bit too personal, perhaps? Not on a fire line! Hydration is one of the most important personal-care tasks we can do on a fire.
Improper hydration — such as dehydration — leads to headache, dizziness, nausea, fatigue, and overall diminished function. Having such symptoms is unhealthy for the individual and for the team. They can lead to poor decision-making on the part of a leader; they can lead to poor performance on the part of a firefighter. The combination of both can have very negative consequences regarding the outcome of firefighter safety and the fire event.
Interestingly, at the other end of the hydration-dehydration spectrum is a condition to which few of us in fire operations give much thought — that of over-hydration, or hyponatremia. I'd not given this any thought until taking a Wilderness EMS class recently. After all, who would think of such a possibility in firefighting conditions where many are sweating buckets? But hyponatremia is a possibility on the fire line. While in the bigger picture it's perhaps not as common as dehydration, nevertheless it remains a definite possibility.
Think about it: you're working a 15 hour operational period , in 90-plus degree heat, performing arduous physical tasks — and you are sweating buckets! During these periods of high intensity output, while you’re sweating profusely, the sodium in your body is also lost — leading to a decreased sodium concentration in your bloodstream.
But wait! You're hydrating, right? You're drinking water from your canteen, camelback, or water bottle regularly. So, why are you experiencing symptoms similar to dehydration — nausea, cramping, confusion, and overall diminished function?
Problem compounded
At this point, you may think you're still dehydrated, and so naturally you drink more water. But, you may actually be compounding the problem, because water alone will increase the problem of hyponatremia, where you have too much water and not enough of the electrolyte sodium in your bloodstream.
At its most extreme, hyponatremia may cause seizures, coma and/or death. In January, a Californian woman who took part in a water-drinking contest run by a radio station to win a video game system died of water intoxication. Maybe you've watched some of your fire buddies doing the 4-4-40, drinking 4 quarts of water in 4 minutes or less and holding it for 40 seconds before vomiting, extreme behavior that should not be practiced on the fire line.
No matter the circumstances that lead to hyponatremia, treatment is relatively straightforward. Upon noticing the first signs and symptoms in yourself or a peer, such as nausea, cramps, disorientation, drink or provide a sodium-containing sports drink and/or eat salty foods, assuming the person is conscious and has a patent airway.
Of course, the best way for a firefighter to avoid the problem is to plan ahead: Use sodium-containing sports drinks and eat salty foods before and during energy intensive firefighting ops, provided there is no previous history of hypertensive medical conditions.
Firefighters should hydrate sensibly and include electrolyte-containing products in their hydration-nutrition-sustenance efforts. Remember, everyone's hydration needs differ — it's important for firefighters to know their own hydration requirements.
Best Regards
and Happy Peeing LOL
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Judy,
Hyponatremia is not the same thing as "overhydration".
Hyponatremia occurs from sodium-based electrolyte loss, regardless of the amount of fluid in the body. Hyponatremia is actually much more common with profound dehydration than in adequately hydrated or re-hydrated firefighters. In other words, hyponatremia isn't necessarily dependent on water intake.
Overhydration, also knows as "water poisoning" is extremely rare, and typically does not occur in the short term, such as during one operational period.
http://en.wikipedia.org/wiki/Water_intoxication
It's going to be tough to get any firefighter to ingest 10 liters of water during 20 minutes of rehab - that's half a liter per minute for the entire 20 minutes.
A couple of other points - there's a big difference between working a 15-hour operational period and working a couple of cylinders on a structural fire. We don't see lots of firefighters dying of heat stress during long operational periods, because the people that work those periods are usually wearing wildland or USAR PPE, or maybe just BDUs and USAR helmets.
The issue here is returning to work at structural firefights, where we do kill lots of firefighters with heat stress. Those are typically not operational-period incidents.
Your point about having a firefighter ingest sodium-containing food or drink at the first sign of heat cramps, etc. is well-taken, but heat cramps are more common from loss of potassium, not sodium. Eating potassium-containing foods like a banana or potassium/sodium containing energy bars might be an even better option.
If a firefighter is dehydrdated, he or she loses circulating blood volume. That thickens the blood and makes the firefighter more prone to blood clots - the causitive factor in heart attacks...specifically heat-stress-induced heart attacks.
If you start rehydrating with hypertonic sports drinks, the electrolytes in those drinks actually pull more circulating blood volume from the cardiovascular system to the GI tract...further concentrating the bloodstream.
So...start rehydrating with water to improve the circulating blood volume and dilute the blood, then add sports drinks or other ingested electrolytes. That helps prevent the short-term, but potentially deadly effects of using hypertonic sports drinks as the initial oral rehydration fluid.
If firefighters are displaying ANY sign of heat stress - heat cramps, nausea/vomiting, heat exhaustion, or especially heat stroke, then that firefighter should NEVER be allowed to return to the firefight. Anything more than mild heat cramps that are easily remedied with oral electrolytes at the scene is an indication to transport the firefighter via EMS for physician evaluation and potential hospital treatment.
If you do have a prolonged incident that requires operational periods, keeping the op periods to 12 hours or less is recommended. That reduces cumulative heat stress, gives plenty of time for R&R, and ensures equitable workload distribution between the day and night shift responders.
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