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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 Ben Waller on
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OK, so you give them an IV. Then what happens?
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Permalink Reply by anne potter on
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ok what will happen???? tell me my guess is nothing ,but you keep leaning into something soooooo what.. she is getting clearance to let go.. vitals are good .. pt is good /.... what really what .....
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Apparently you're willing to risk your firefigher's lives on a guess???
If they're so dehydrated that you can't rehydrate them orally, then they are probably too dehydrated to safely treat and release.
Sports teams do IV rehydration under the supervision of a physician, and they don't have anywhere near the heat stress or LODD risks that firefighters do. The fact that the ER is busy and doesn't want to see any more patients when we have hot, dehydrated firefighters shouldn't be a factor in whether or not a seriously dehydrated firefighter gets transported. We all know that EMS personnel can paint the picture either way, and the ER doc will usually go along with whatever we tell them.
Yes, I'm "leaning into something". I'm leaning into rehab not taking unnecessary risks with firefighters lives.
Apparently you're now saying "So What" to the chance that one of the firefighters will go back to the station or go home and have a fatal, heat stress-induced heart attack.???
Look at the NFPA stats on this. Heart attacks are killing around 50% of firefighting LODDS every year. A lot of those occur AFTER the incident is over. I'll repeat - if the firefighters can cool off and ORALLY rehydrate successfully, then they probably don't need transport. If they require IV rehydration, you're risking their lives if you treat and release. I'm certainly not comfortable taking that risk. I've had a close friend die after fighting a fire and getting treated and released. That raises the bar much higher than "So What" in my book.
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Permalink Reply by Christy on
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I'm not even going to argue this because I can tell it won't matter what I say...you are going to disagree. Our medical director trusts the medics and our training. Our protocols are written based on his faith and trust in us. I will leave it at that.
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Permalink Reply by Spanner 122 on
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Thank you Ben. Far too few people seem to be taking the all too real dangers of heat induced cardiac events. It's a REAl and ever-present problem, even in the middle of winter for us. I get emails from the secret list almost every single day regarding another LODD, why not do our best to prevent what we can prevent. If you treat and release to the point of IV or even O2 you have no control and no jurisdiction over what they will do next... go back to the fire, do overhaul even when the fire is out, there is still a ton of work to do. Even rolling hose can get your heart rate and body temperature up again.
Maybe, just maybe someone can be given fluids and released, but released to what? Released to go home and drink more fluids and relax? Fire fighters don't get this option. If I was treated at a fire and went back to the hall, what's to say I won't get another fire call, or MVC with extrication or even an alarm call that takes me to the 16 floor with my highrise pack.
Far too many variables. I am glad we transport when firefighters need treatment. They may be looked at and released at the hospital, usually released to go home and not back to shift (unless it's a minor injury of course), but anything else is not worth the risk and I'm guessing it's not worth the lawsuit. I hope these treat and release on scene incidents are well documented.
Protocols written on faith and trust as opposed to the hard facts on cardiac events, heat, exhaustion and over exertion are a recipe for tragedy, in my opinion.
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Permalink Reply by FETC on
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Whoa,
Back up the bus... treatment without reports is never done. You stated a while ago that a patient must be transported if administration of an IV or meds was given, which is not true here. I never said a report wasn't being done with these treatments. That is a completely different and liable issue. Even in the assessment of a firefighter at a fire, (patient medical reports) are completed.
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Good for you stick to your guns your doing nothing wrong... always make good decisions on scene.. My guess is your firefighter s trust you also...along with your medical DR's... I talked to our Meical regional people copied the disussion that has been going on always nice to get a sec look at the what is going on... Even though we don't Iv fluids to the fireman,we do give o2.. The best answer I got is that as long as your medical control signs off on it.. Your good... They have heard of it happening the IV rehyrdrate, and feel that training is the main thing .. As far as heart attacks can happen any where even spending alot of time on here talking about it.... Trust yourself and your vitals ,look at your fireman before you send them out... Trust your medial control ,make sure you give a good report when calling .. They will be trusting you for that.. And have a great summer doing what you have been trained to do....
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Permalink Reply by Art "ChiefReason" Goodrich on
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Giving oxygen is a medical intervention.
If a fire department has it on their rescue truck, etc. there had better be firefighters qualified and at the proper licensure for providing medical aid.
Rehab isn't where you go for a time out. It plays a very critical role at any fire incident and protocols should be followed when rehab is indicated.
Just "giving O2" is NOT rehab. Rehab goes far beyond that and should be done by those qualified to do it.
TCSS.
Art
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Permalink Reply by Joe Stoltz on
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Here is a link to an almost parallel discussion. Check out Fire Siren's comment regarding the baby aspirin:
http://station.firefighternation.com/forum/topic/show?id=889755%3AT...
This has my attention, since I'm one of those of a "certain age". Something for the ambulance medical directors to consider as well.
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Joe:
And your link is all the more reason why Rehab should be taken seriously.
This is where any post activity problems may arise. A good medical surveillence program would go a long ways towards reducing cardiac related events.
IMHO.
Art
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I agree completely, Art. Another thing would be for all firefighters to get over the nasty habit called denial. "I'm feeling fine" or "I'll be all right in a few minutes" should be taken as a signal to treat and transport. We may be "fine" in a few minutes but what happens later? Or if we don't get "fine?"
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This is news to me, and really a very good practice. I can't tell you how many times I have had heat exhaustion at a fire scene and not been transported. I came close, one time, when I grayed out while working on a roof. There was talk about ropes, pulleys, etc. but I recovered enough to make it down a ladder under my own power.
I was observed in the ambulance for a while but I insisted I was all right and refused - graciously and thankfully - to be taken to the ER. After all, it's just heat exhaustion, right?
Taking away the right to refuse treatment while working at an incident makes great sense to me.
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