First In

By Michael Morse

Most firefighters I know like nothing more than to be first in. It is one of the most thrilling moments in any firefighter’s career: the scene size-up, positioning the apparatus, relaying information to incoming companies, and picking the right tools to the job. The outcome of the entire operation rests on the shoulders of the first-arriving crew, so it is imperative we get it right, every time. There is little wiggle room for mistakes when lives are on the line; every wrong move escalates in a matter of seconds, and it takes far too long to recover. Often, there is no time to recover from poor decisions made when first-in companies are not prepared.

We do not have the luxury of starting over. The public depends on us to get it right EVERY time. And well they should, for it is their lives and their emergencies that we are responding to. If we believe that responding to medical emergencies is somehow less worthy that “the real deal,” we are missing an opportunity to be continue being good firefighters. Every bit of knowledge matters. Every EMS call has the same potential for growth and gratification as a building fire or other emergency that doesn’t involve living people. The chance to save a life is far greater on a medical call than on any other response, and it just makes sense to be fully prepared as a company, an officer, and a firefighter.

The pressure and stress that goes along with the knowledge that we cannot make mistakes can be alleviated with proper training.  We are great at doing just that when it comes to the fireground; half the fun of being a firefighter is getting ready to respond to emergencies and practicing how best to do so. Countless hours are spent drilling, learning, practicing, evolutions, running pumps, laying feeders…the list is lengthy.

But what about EMS training? How many fire companies devote time to that? It is not nearly as much fun as fire training, and the chance of getting yourself or your crew killed due to lack of it is far less than if you were clueless at a structure fire. Nevertheless, EMS training should be part of a good fire company’s training regimen. It does not have to be tedious; a little creativity goes a long way to making a training session something to be enjoyed.

Simply talking about what to do at an EMS call keeps us sharp. It is always a good idea to think and talk about what to do during a cardiac arrest, electrocution, childbirth, or amputation. The EMS crews may be on their way, but guess who is first due? You are, and the people who have been waiting for help care not that you arrived in the big red truck. To them, you are salvation. Grabbing the right tools, radioing a proper report, performing proper CPR, and administering ALS care (if you are equipped) and BLS (if not) WILL save lives, lessen suffering, and promote goodwill for the entire department.

Here is a little something every fire company can do: there is a great chance that one or more of your crew is somehow, shall we say…not well. What to do? First, we need to find out if the member is having a seizure, is intoxicated, has a head injury, or is simply suffering from Firefighter Personality Disorder. One of the best methods of determining a person’s level of consciousness is The Glasgow Coma Scale. We can use it on each other to practice. My guess is many laughs will ensue, and something useful will sink in as a result.

Glasgow Coma Scale

 

1

2

3

4

5

6

Eye

Does not open eyes

Opens eyes in response to painful stimuli

Opens eyes in response to voice

Opens eyes spontaneously

N/A

N/A

Verbal

Makes no sounds

Incomprehensible sounds

Utters inappropriate words

Confused, disoriented

Oriented, converses normally

N/A

Motor

Makes no movements

Extension to painful stimuli (decerebrate response)

Abnormal flexion to painful stimuli (decorticate response)

Flexion / Withdrawal to painful stimuli

Localizes painful stimuli

Obeys commands

Talk about EMS. It does not hurt, and I think you might be surprised by how much you as a fire company actually know. Not everybody can know everything, but a good, properly trained fire company can.

Michael MorseMichael Morse recently retired from his position as captain, Rescue Co. 5, with the Providence (RI) Fire Department after 23 years. He lives a few miles from his old station with his wife, Cheryl, a couple of Maine Coon cats and their dog, Mr. Wilson. He writes about his experiences as a firefighter/EMT in his books, Rescuing Providence and Responding, and contributes articles to many fire/EMS-related publications.

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