Fireground Functions for Firefighters on Medical Duty
All photos by author except above photo by Tony Greco
For many firefighters, our first few years or more may be spent on the “box.” Sure, we may hop on the engine or ladder from time to time, but mostly we’re resigned to the EMS med unit, “the box.” And that’s fine: Helping people is helping people, and some of us even like running medical calls. However, as the hundreds of “emergency” calls for “stubbed toes” and “haven’t pooped in two weeks” pile up, some of us may begin to wonder why we became firefighters to begin with. We might begin to believe we are little more than ambulance drivers with air packs. Brothers and sisters, you are not alone in this way of thinking, but you are also mistaken. You have the training, you have the ability, and you have the tools.
Pumps and water do not a firefighter make. You are more likely to come across a fire or a motor vehicle accident (MVA) coming back from the hospital than as an engine parked in the bay. Your department didn’t just put extinguishers, self-contained breathing apparatus (SCBA), tools, and firefighters on your apparatus because they like to spend money. They put them there to do work. The examples below are functions you can perform right now while riding the “box.” No specialized or expensive gear is required, just tools and equipment you probably have laying around at your station right now, or that you could buy for less than $20 at your local hardware store.
Car fire in the engine compartment. Once you’ve parked your rig to block traffic and you’ve packed out, do a 360° scene survey to check for patients, leaks, and other hazards. Then, approach from a 45° angle, grab your halligan, and smash the pike end of it through the front corner of the hood. You’ll find that you’ve made a hole about the size of a nozzle of an ABC extinguisher or water can. If that tactic doesn’t work, put the pike end back in to the hole you created and pry up that corner of the hood to gain access to the engine compartment.
(1-2) Punch through the hood with a halligan and insert your water can nozzle for car fires.
Garage fire.This tactic will also work on a roll down garage door for a garage fire. Take a baseball swing with the pike of your halligan and insert the nozzle of your water can or ABC extinguisher.
(3-4) Punch through the garage door with the pike of your halligan and insert your water can nozzle for garage fires.
Through-the-lock forcible entry. A wedge, a striking tool, and a flathead screwdriver or a shove knife can get you into many residential homes for medical alarms or fire alarms without destroying someone's door and frame, sometimes even faster than conventional forcible entry. Check out Rise above Training's Facebook page for excellent through-the-lock videos.
Gaining entry through a gate with an induction loop.This trick can work for fire or medical calls when you come across a gate with an induction loop (lines cut into the pavement that allow a gate to open as a vehicle approaches.) Chances are you have an old metal clipboard on your truck as a backup for when your tablet goes down. Slide the clipboard under the gate and over the induction loop, using a hook or another tool for extra reach. You will fool the sensor into thinking a vehicle is over it and cause it to open up.
(5-6) Bypass the induction loop with a metal clipboard.
Hydrant line. If you work in a well hydrant-ed area, consider carrying a couple of sections of 1 ¾-inch hose with a smooth bore nozzle and a reducer to hook up; this will let you keep the fire in check until the engine arrives. Perhaps your department already has a utility/high-rise hose pack on your EMS units that can do the same thing.
If the fire is in the attic, punch a hole through the soffit, open up your line, and deflect the stream off the underside of the roof. Click here for a link to UL’s site on the effectiveness of this tactic.
(7-8) Connect a section of 1 3/4 with a smooth bore and a reducer to a hydrant to keep the fire in check.
Hazardous materials. Although you won’t be donning a level A suit to mitigate an anhydrous ammonia leak, there are still several ways to handle a hazmat scene if you’re first on scene and on the box. At a minimum, your truck has an Emergency Response Guide book (ERG) that will allow you to identify the product (or at least the container) and determine the initial isolation distances. Relay this information to oncoming crews and determine what additional resources you’ll need. If the driver is available, he can be a wealth of information as to the contents and how to control the leak from the truck. If the leak is from the saddle tank of a tractor trailer, consider plugging it with a wooden wedge and pounding it in with a non-sparking tool to slow it down. If that isn’t an option, grab a shovel and dam and dike or divert the product with dirt. For small leaks in vehicle fuel tanks, rub a bar of soap on the puncture and it will seal the leak temporarily.
If I could recommend one piece of equipment that may not be on all trucks but should be, it would be a carbon monoxide (CO) monitor. Your crews may be going into homes for medical calls 6that present as headache, dizziness, shortness of breath--all symptoms of CO poisoning. When you arrive to a CO call, make sure your crew is packed out, evacuate the building, assess for medical need, ventilate the building by opening doors and windows, and determine the source of the CO. While a CO monitor is not necessary to perform these tasks, it is tremendously useful when it comes to determining a hidden source and if the scene is safe for the occupants to return.
Extrication. Anytime you’re working in traffic, wear all your gear and park your rig to block traffic. Do a 360° scene survey to check for patients, leaks, power lines, and other hazards. Start by shutting off the car, cutting seat belts, removing plastics, and looking for un-deployed airbags. If the door isn’t too badly mangled, don't be afraid to go back to basics and force it with your irons; if you can get to it, shear the metal surrounding the Nader pin. Another option is to crush the crease between the fender and door with a halligan to gain access to the hinges and use a ratchet (10-13mm) to take them off. Cut the check strap with bolt cutters and cut through the wiring harness with trauma shears, then pry the door off. If neither of these methods work, at the very least you’ve created an outstanding purchase point for the spreaders when they arrive.
If the patient is pinned beneath a car, use the jack from their vehicle to free them, cribbing as you go. It should go without saying that patient care is your Number One priority after scene safety.
(9-10) Extrication with a ratchet and a set of irons.
A dumpster fire threatening an exposure. In Fire Officer's Handbook of Tactics, Chief John Norman of tying off a burning dumpster that was threatening an exposure to Ladder 103’s tow eyes and pulling it away from the building when their engine wasn’t anywhere nearby. The same tactic could be applied to your truck. Tie off the dumpster to your apparatus with your rope bag and pull it away from the building. Once it’s in a safe location, check the exposure for extension. If that’s not an option and there’s a hydrant nearby, take that 50-100-foot section of 1 ¾-inch hose and a nozzle and drown the fire. Insert an inflated medical glove to stop up the drain on the bottom of the dumpster to keep your water from running off.
Read the building. Chances are if you’re one of the first on scene and not on a hoseline, you’ll be assigned to search. Get to know the building. Do a 360ยบ, note the exits, the bathroom vents, the bedroom locations, tap on the windows to see if they're impact glass, etc. If you are first on scene of a fire, collect information from the neighbors or occupants, force the door, get low, stretch out, and look for The Four L’s (per Seattle Fire): Lives, layout of the room, lift of the smoke, and location of the fire. Relay all that information to command and incoming crews. Check out this article for much more on reading buildings.
(11) After forcing the door, get low and look for the 4 L's.
Take one percent. If your department is anything like mine, you are probably required to recertify every couple of years for any number of medical classes: CPR, ACLS, PHTLS, ITLS, PALS, and probably a few more that you’ve let expire. Keeping your medical skills in top form is part of your job, but so is being a firefighter. If your department doesn’t offer many fire classes, take ownership of your education, and go find them. I challenge you to take just one percent of your time and one percent of your money and put it back in to your career. Before the year is out you will have three-and-a-half days and plenty of money to take a class, buy a tool, or read a book.
This is YOUR Company. Eventually, the time will come when you’ll get off the box and you’ll be riding in the right seat of the engine. Take this opportunity to practice your arrival reports and being in command when you’re first in on multi-unit incidents. When you go to medical calls, start thinking about water supply, securing utilities, hose stretches, and exposures. Do company-level fire training using only tools and equipment you have on the EMS med unit. When you read a Fire Engineeringarticle, read it with an eye of “How can I use this on my truck?”
Not all these will work for you and your department. The intent is to get you back in the mindset that you are a firefighter. There are some fire department EMS units that don’t carry any firefighting tools beyond bunker gear and SCBA-- go through your chain of command and remind them what your truck is capable of and why it’s worth the investment to put at least a set of irons on your truck. If you’re the first on scene and there is work to be done, get to it. Don’t just stand there with your hands in your pockets waiting for the engine to show up. Any number of things could get between that engine and your scene, and you will be expected to do something. A halligan and ax always start, and you don’t need to know pump pressures to work a water can.
Through-the-lock forcible entry. A wedge, a striking tool, and a flathead screwdriver or a shove knife can get you into many residential homes for medical alarms or fire alarms without destroying someone's door and frame, sometimes even faster than conventional forcible entry. Check out Rise above Training's Facebook page for excellent through-the-lock videos.
Hazardous materials. Although you won’t be donning a level A suit to mitigate an anhydrous ammonia leak, there are still several ways to handle a hazmat scene if you’re first on scene and on the box. At a minimum, your truck has an Emergency Response Guide book (ERG) that will allow you to identify the product (or at least the container) and determine the initial isolation distances. Relay this information to oncoming crews and determine what additional resources you’ll need. If the driver is available, he can be a wealth of information as to the contents and how to control the leak from the truck. If the leak is from the saddle tank of a tractor trailer, consider plugging it with a wooden wedge and pounding it in with a non-sparking tool to slow it down. If that isn’t an option, grab a shovel and dam and dike or divert the product with dirt. For small leaks in vehicle fuel tanks, rub a bar of soap on the puncture and it will seal the leak temporarily.
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