All Hell Breaks Loose…Webcast Questions

The following questions were submitted for the “All Hell Breaks Loose… And Now You’re Out of Air” Webcast for Fire Engineering. The Seattle Guys–Mike Gagliano, Casey Phillips, Phil Jose, and Steve Bernocco–want to thank everyone for the great participation and interest in air management. Where possible, similar questions have been combined. Feel free to send e-mail regarding your questions or concerns to mike@manageyourair.com, casey@manageyourair.com, phil@manageyourair.com or steve@manageyourair.com 

On behalf of Mike, Casey, Phil and Steve: Don’t Breathe Smoke
 
Q. When working within a team, you failed to mention that you are only as effective as the weakest air management firefighter.  
A. Because of the time constraints of the Webcast, we couldn’t hit all the details we typically talk about in our presentations. However, you are absolutely correct in your observation. The team will be forced out of the structure as a result of a member’s having low air. Therefore, it is absolutely critical that we learn to manage our air, work on our conditioning, operate as a team, and share the workload. The more you practice air management, the better your situational awareness will be and the more likely that you’ll make good time-to-exit decisions.

Q. What do you consider a hot zone, or how far out would you consider the hot zone, for wearing the SCBA and go on air?
A. Please review the Webcast for this answer.
 

Q. What about the toxicity of wildland smoke vs. structural smoke? What are your thoughts on using SCBA at wildland or brush fire assignments? Does wildland fire cause/contain the same poisonous gases?
A. Thanks for the question. I wish we had a solid answer for you. This is outside of the area we studied and there are probably others within that field of fire protection who could answer these questions better. Here are a few a thoughts from what we do know.

There is no question that large amounts of CO are being generated in wildland fires. Depending on what else is burning, there are going to be any number of other gases present as well. In the recent Station (CA) fire, we read reports of firefighters testing positive for cyanide because of their proximity to a burning “dump” fire. You can imagine all the stuff that was off-gassing in that situation. The fact that you are outside and don’t have all the products contained within a “box,” and that you have a steady supply of oxygen, makes it a different environment from that on which we have focused our efforts. This would be a great area of study, and maybe you are the one to take it on for the rest of us.

 
Q. Any ideas on drills to establish an individual point of no return?
A. We have listed quite a few drills on our Web site at manageyourair.com, and many more are in our book Air Management for the Fire Service. Whatever drills you decide to use, it is imperative that you try to provide realistic training situations whenever possible. Have your firefighters do work that reflects what we do on the fireground. Another key component is to add a degree of stress or distraction to the drill. Although running on a treadmill is fine for a basic idea of how you are consuming air, it does not compare to actually doing a job where your focus is on the completion of the task. Staggered workloads are also a great idea–you get the feel of doing intense work, less intense work, and even brief rest periods–all part of air usage on the fireground.
One very important thing to remember is that the Point of No Return is not the point when you die, quit, or give up hope. Just because you are in trouble does not mean it’s “game over.” The Point of No Return simply means you are now part of the problem and have to figure out a way to get out. You should determine that you are never going to give up and that you ARE going to survive before you ever find yourself in that position.
 
Q. I recommend a “check air” call every few minutes over the radio!
A. This would be an interesting concept to try, if you mean the incident commander sends a reminder, which could work depending on the amount of radio traffic. Keep in mind, though, that your air is your responsibility. Don’t rely on anyone else or anything (technology) to check your air for you. If you can make a radio reminder of air checks a workable part of your system, that would be a great adjunct to what you already do at every fire: Check your own air as you proceed through the incident.
 
Q. There is a rule in the field that if you can see your feet, there is no need for breathing air. What are your feelings on this rule? Should it be used?
A. This rule should be used only if your lungs are physiologically different from those of every other human being on the planet. If your lungs can process CO, hydrogen cyanide, phosgene, and so forth differently than the lungs of everyone else, it could work. The rest of us will suffer the toxic effects of the gases, the disorientation that comes with that, asphyxiation at some point, and unconsciousness or death–not to mention the exponentially enhanced chances of contracting multiple types of cancers.

I hope you are not among those advocating this “rule.” For those still advocating this type of approach, our prayers are with you and your families, as you are headed for disaster.

 
Q. What methods would you use to teach new firefighters concepts of air management and to reteach veteran firefighters the “new” concept of leaving the fire area before low air alarm activation?
A. We handle these questions extensively in our first Webcast, our Fire Engineering articles, the Web site, and our book. At a basic level, you should implement the ROAM and make it a part of every training drill you do. If you’ll simply demand an adherence to the core philosophy that we will not breathe smoke, we will monitor our own air, and have an alarm-free fireground, things will work fine.

There is always going to be some resistance to change, especially from older firefighters, but that is all part of the job. Most positive innovations in the fire service were resisted at first. Make the case very clearly about how dangerous the smoke is. Show them the elevated risks for cancer and the very real likelihood that they will have limited medical coverage when it occurs. Demonstrate the positive aspects of enhanced fireground operations when teamwork is used as opposed to staying as long as you possibly can and continually putting yourself at a greater risk exposure to the immediately dangerous to life and health environment. Drill extensively with the ROAM concept, and you’ll soon find that you can be as aggressive as ever and will have enhanced situational awareness as a bonus.

These are a few thoughts. There are many more in the materials mentioned above. 

Q. Is there any legislative direction toward allowing departments to increase the setting of their low-air alarm from 25 percent? If we use the first half of our bottles to get into and work on the job and the second half is ours to get out with, why is it still the industry standard to have the low-air alarm go off at 1,000 pounds per square inch (psi)?
A. Please review the Webcast for the answer to this question.
 
Q. Does you department follow an SOP or AP?
A. Yes. The Seattle (WA) Fire Department has been on the forefront of progressive air management and has adopted a commonsense policy that works well for us. It is available on our Web site and can also be found on our Fire Engineering community blog. There are a few other examples listed in that blog that have been adopted by other departments as well.

Anyone wanting our policy can e-mail me at mike@manageyourair.com, and I’ll send some of the policies we’ve come across.

Q. With today’s economy and all the cutbacks, how would you help us sell our upper management or city on keeping air management a top priority?
A. There are a few things we recommend when tackling the sticky issue of dollars and cents with the powers that be. The first would be that implementing air management, as we teach it, is not an expensive venture. It requires no addition of personnel, no addition of new equipment or technology, and no extensive/expensive training program to implement. You simply begin drilling your people on the ROAM and incorporating the air management philosophy into all of your training. You can buy a book or two or have a class, if training dollars allow. But that is not essential to getting things moving.

On the flip side, you ARE going to be held accountable should one of your members suffer death or injury because of an “out of air” event. The regulatory requirements are clear, and no department can make a reasonable argument that it is not aware of the dangers associated with the modern smoke environment. This is a no-brainer from a financial standpoint. 

Q. Without rapid appropriate treatment, oxygenation of anyone who has accumulated a toxic dose of cyanide does no good. Treatment has to be quick and effective and, at the risk of sounding like an advertisement, Cyanokit is the gold standard. Even with bad budgets, departments need to seriously look at this drug. We have implemented our program by selling it as an “all-hazards” drug (sorry for the catch phrase). It works on the fireground, and not just for us as a firefighter safety issue, but for the civilians who aren’t issued SCBA. It can be used in the hazmat environment (manufacturing facilities) and is a primary weapon in the WMD environment. Treatment for smoke inhalation victims who are symptomatic needs to be high-flow oxygen and Cyanokit on the fireground. Waiting for a trip to the hospital will become the equivalent of holding your breath for the ride. I know this isn’t a question, but please get the word out that this is now the standard of care for our own (and those we protect). Thanks.
A. Thanks for the information and advice. We agree completely with your assessment and are glad to be partnering with the Cyanide Poisoning Treatment Coalition to get the message out about the Cyanokit. You can check out all the details at firesmoke.org and get some great training tools as well. The coalition is working hard to bring the message of the dangers of smoke to departments everywhere; that will include some case studies involving the use of the Cyanokit.
 
Q. One of the first victims in the Providence (RI) fires who tested positive for toxic levels of HCN was a driver at the pump panel.
A. Great observation. This fact should really make everyone stand up and take notice. If you have not read the facts regarding the Providence exposures, I suggest you get the smoke inserts available at firesmoke.org. The interesting thing about these incidents is that they would not have been recognized at all had it not been for a motivated emergency room doctor who ordered the tests. These tests are generally not done for firefighters. It begs the question of how many exposures are going undetected.
 
Q. There are IDLH levels for HCN and CO individually, but what is the concentration or ratio of a mix of HCN and CO that is considered IDLH? AT what temperature does cyanide start to off-gas?
A. If you go to firesmoke.org and read the smoke supplements they produced, there are outstanding studies that were done in Europe that show the deadly way in which CO/HCN have worked together to kill people at fires. The presence of HCN combined with CO is much more deadly than just CO. The technical data contained in those reports is too lengthy for this type of format, but you can get it all free from the Cyanide Poisoning Treatment Coalition.

Here’s what you should be concerned about, however. You are not going to know at any given time the concentrations with which you are dealing an emergency. The only time judging the concentrations are going to matter is in postfire, overhaul type situations during which everything can slow down. There is a movement to add things like cyanide monitors to the firefighters’ gear. That’s an interesting approach, but it begs the question about where we are going to fit monitors for all the other stuff in smoke. Where will the benzene, phosgene, gas monitor fit?

The point should be to wear your SCBA and manage your air. That takes the deadly effects of the smoke off the radar as far as impact. Everything else is half measure that may or may not work depending on the circumstances.

The following is a reply from Dr. Alan Hall, who partners with the Cyanide Poisoning Treatment Coalition:

As far as off-gassing of HCN (or H+ CN-) from various nitrogen and carbon containing materials (natural and synthetic), this indeed will very much depend on the specific material(s) involved, the situation (if combustion or pyrolysis without flaming is involved), and what very local/specific oxygen concentrations and partial pressures are involved.  There is no easy answer.
 
As a general rule, whenever any material (natural or synthetic) that contains both nitrogen and carbon is either burning or smoldering (pyrolysis without flaming), some amount of HCN will be released. There are literally hundreds of studies on this subject that go far beyond my expertise as a medical toxicologist. 
 
In the field, the issue is to suspect that HCN MAY be there and to take proper precautions to protect firefighters and victims, including absolute adherence to respiratory protection/air supplies guidelines/regulations, rapid extrication of victims from the fireground, airway management as indicated, and provision of the highest concentration of oxygen possible in individual circumstances, standard advanced life support care as soon as possible, and consideration of administering the safest currently available cyanide antidote, hydroxocobalamin, as soon as possible for those with altered mental status; soot in the nose, mouth, throat, or in expectorations; and particularly to those with hypotension (=/< 90 mmHg systolic in adults and similar age-appropriate values in children). If rapid screening for lactic acidosis can be done (plasma lactate =/>10 mmol/L), this is an additional indication for administration of hydroxocobalamin as soon as possible–preferably by paramedics in the field, but at least as soon as possible on emergency department arrival.
 
I realize this does not completely answer the question, but perhaps it cannot be directly answered with currently available data. For example, in some fireground studies done in the 1980s, in the same room of a smoke-filled burning building, air cyanide concentrations varied by three to four or more orders of magnitude (an order of magnitude is 10 times – 1 to 10 to 100 to 1,000 to 10,000, 100,000, etc.) in different areas of the same smoke-filled room and about the same from standing height to lying on the floor in the same location in the room. Even with direct-reading cyanide air monitors, it’s so far just not practical in the field to decide who HAS a cyanide poisoning component in smoke inhalation victims and who does NOT based on rapidly obtained objective environmental or biological monitoring data.  There’s still a place for prehospital and emergency department clinical judgment, which is really all we have as of the present time.
 
This is the best I can do for now. Who knows in 20 years?
 
If all you want to know is when hydrocyanic acid will become hydrogen cyanide vapor, all you need to do is consult any MSDS sheet or the HCN document in the HSDB (Hazardous Substances Data Bank) from the National Library of Medicine.  Just go to www.nlm.nih.gov, select anything that says “environmental” from the menu on the left, select HSDB, and type in Hydrogen Cyanide and look at physical-chemical properties for the vapor pressure (NOT vapor density). But I don’t think that was the question (you can find similar data in the Coast Guard CHRIS manual and any number of references a hazmat team likely keeps on hand).
 
Q. Why are you saying to try and disentangle yourself or rescue yourself before calling the Mayday? Time and air are your greatest enemies during a Mayday. Why not call the Mayday first and cancel it if you’ve rescued yourself?
A. I had hoped to answer this live, but we ran out of time. This is one of those areas where it is difficult to say, “Do this all the time.” What we mean by getting to a position of safety prior to calling the Mayday is to get away from something that is going to immediately harm or kill you.
 
You have to move quickly to get away from things like fire or imminently falling debris. I assure you that you will not be calling a Mayday while fire is burning you. That is what we mean. In some entanglement situations, it is going to be much better to call the Mayday prior to trying to get out because then help is already coming. But if you are tangled with an appliance over your head about to fall, you’d better get loose first.
 
Our approach is to try and do things realistically. Calling the Mayday should be a huge priority and should be done as quickly as possible. You should definitely call the Mayday prior to trying to self-rescue if you are not in immediate danger of getting killed. Always get help coming as quickly as possible. I hope this clarifies the difference.
 
Q. Although National Fire Protection Association 1404 says these “shall” about air management, isn’t it about time it’s enforced by each department and nationally through strict training? Well done by the way. The more this is talked about, the more chance we have of the message’s getting through. Brian, United Kingdom
A. Thanks for watching the Webcast, and our hats are off to all firefighters in other countries who are already doing a great job with air management. NFPA 1404 mandates that each department “shall” have an individual air-management program for each member. In the appendix, it lists the things that “should” be included in the program. There is a great effort underway to make that language mandatory as well. The reason for this is that the ROAM is working, and it is working regardless of the size of the department or the type of constituency it serves.

We appreciate your support and kind words. We are working with many other committed folks like you to see that firefighter asphyxiation in structures becomes a rarity.

 
Q. Under this 50-percent rule, do your still use the two-bottles-to-10-minutes rehab? How does Seattle enforce the low-pressure alarm rule?
A. Just to be clear, we do not recommend you exit with 50 percent of your bottle, and we don’t support any efforts to make that policy or get the low-air alarm changed to 50 percent. We’ll address this further in another response.

We recommend using the ROAM so that you can tailor your time-to-exit decision to the actual incident, not some predetermined exit time that does not fit the majority of incidents you will go to. In our current system, we have found the following to work very well:

• If you use one cylinder (30- or 45-minute) and leave before your bell hits, you can change cylinders and work another acceptable work cycle before going to rehab.

• If you use one cylinder and violate the ROAM by going past your low air alarm, you’ve worked an extended work cycle and must go to rehab after only one cylinder.

This works great because it puts the onus on the firefighter to act professionally and stay within the recommended work cycle time. If you violate it, you go to rehab earlier than those who operate correctly.

For those using 60-minute cylinders, we recommend one? work cycle and then go to rehab.
 
Q. Would a rescue situation be a reason to stay in longer than 25 percent of the cylinder life?
A. That’s a great question and a difficult one to answer in a short space. We know that every firefighter is willing to risk a lot (or everything, if you prefer) to save a life. That happens across the country in fire departments of every size and shape.
 
A known rescue, and particularly that of a downed firefighter, might be one of those situations where you would make the conscious decision to use some of your emergency reserve to effect the rescue. This has to be balanced against the possibility/probability that you may become part of the problem in the form of the next rescue needing to be saved.
 
There are no hard-and-fast answers, and situations are so varied that it makes it impossible to address them all. What you can do is train realistically so that when these situations occur, you have some foundation on which to make the best decisions possible. That might mean using your emergency reserve to help keep the victim/firefighter alive because relief air is close by. It may mean dropping a tag line at the victim and getting out so you can make way for a fresh crew to follow your line back to the victim with the air/rescue they need. We do need to recognize that we accomplish nothing by becoming part of the problem. That will simply require even more resources and delay help to the initial victim.


 

Q. A comment: The problem is (1)  understanding fire behavior (including construction of buildings, etc.) and (2) know your PPE (all of it). You focus too much on how to get out of trouble or how to help a fellow firefighter get out of trouble. You should focus on how not to get into trouble in the first place, and you can do that only through knowledge! But I still like your presentation. Dr. Stefan Svensson, Sweden
A. First off, it is an honor to have such a great contributor to the fire service as you watch and comment on our program. Dr. Svensson is a brilliant tactician and cares very deeply about firefighter safety and survival.
 
Your comment about focusing too much on how to get out of trouble is not the case, however. The majority of our message relates to not getting into trouble in the first place, as we stated early in the program. If you watch our first Webcast, we cover that in much more detail than we were able to in this program.
 
The All Hell Break’s Loose program focuses, by design, on those times when you do everything right (or wrong) and now are in trouble. This can happen to firefighters no matter how well they know fire behavior, construction, or PPE. Your points are well taken that the bulk of our training should be focused on doing things correctly and not getting into trouble in the first place. We do need to spend some time, however, dealing with the day when everything goes wrong. That was the focus of this particular presentation.
 
Your second comment about needing to know your PPE inside and out is spot on. The Seattle Guys are proud to work with great leaders like Dr. Svensson to help get that message out to the fire service.
 
 
Q. How is the third breathing type-technique (Reilly) performed?
A. Here are some of the breathing techniques that have been found to be effective in conserving air in emergency situations. They are not useful during heavy workloads and are meant for emergency conservation situations.
 
Skip Breathing without Taking an Extra Breath
          Inhale fully.
          Hold your breath for the normal exhalation time.
          Exhale slowly.
          Repeat.
          Important: Stay mentally and physically calm.
          Visualize good air exchange.
 
Skip Breathing with Taking an Extra Breath
          Inhale fully.
          Hold your breath for normal the exhalation time.
          Take an extra breath before exhaling.
          Exhale slowly.
          Repeat.
          Important: Stay mentally and physically calm.
          Visualize good air exchange.
 
Count Breathing
          Inhale for 5 seconds, slowly and fully.
          Hold for 5 seconds.
          Exhale for 5 seconds.
          Hold for 5 seconds and repeat cycle.
          Important: Stay mentally and physically calm.
          Visualize good air exchange.
          The time can be varied depending on exertion level, conditioning, and stress level
 
The Reilly Emergency Breathing Technique (Hum Breathing)
          Inhale as you normally would.
          While exhaling, “hum” your breath out in a slow, consistent manner.
          The “hum” is low, and usually cannot be heard over the low-air alarm. In situations when a firefighter needs to disentangle his SCBA or rapidly move around obstacles, it may be difficult to continuously “hum” after each breath. Breathe as you normally would, and use the technique intermittently.
 
The Reilly technique is fully explained and demonstrated in the “To Hell and Back 4” DVD, available from firesmoke.org and The People’s Burn Foundation.
 
 
Q. How can we obtain a whole copy of this video for future training?
A. We typically put the basic PowerPoint™ up on our Web site for use in your training efforts. Unfortunately, many of the video clips/pictures do not belong to us, and our agreement with those who let us use them is that they can be used for the presentation only. Your best bet is to use the Fire Engineering Webcast and as a drill for crews.  Always feel free to contact us if you have any specific questions.
 
Q. How are you generally deciding that the atmosphere is safe during overhaul/investigation? (There were many questions similar to this one.)
A. When you are talking about overhaul and the removal of the SCBA, the real question you are asking is: When can you be sure that the air is safe to breathe? The answer is 24 to 48 hours after the event. Multiple studies have shown that combustible materials continue to off-gas until well after the firefighters have left the incident scene. If you don’t want your people exposed to carcinogenic and hazardous gases, have them wear their SCBA throughout the event. If you don’t care if your people get cancer, CO poisoning, or cyanide poisoning, let them take off the SCBA during overhaul. Our position is that there is no excuse to knowingly expose firefighters to toxic gases. The overhaul environment is full of toxic gases. Wear your SCBA during overhaul. 

Now that the easy answer is available, you can get much more information about overhaul and the SCBA in our book, or you can go to www.firesmoke.org and look for the pamphlet “Smoke: Perceptions, Myths, and Misunderstandings.” There is no detector that will ensure the safety of your people. A detector that identifies, tests for, and notifies the user for each and every one of hundreds of gases produced at a fire does not exist. CO detectors and cyanide detectors, at their best, provide only a localized identification of the toxicity of one toxic gas for a short time period. Why accept an unknown exposure to toxic gases when no exposure is so easy to ensure? 

Q. How long does your reserve usually last?
A. It depends. The amount of time that the reserve might last depends on too many factors to make a prediction for an individual firefighter over time. Some of those factors include the size of the cylinder, fitness, stress, workload, environment, and temperature. What we know for sure is that the longer you are operating within an IDLH environment, and within the encapsulation of your PPE, the faster you will breathe your air. This is a normal reaction to increases in workload and body core temperature. If you add the stress of being in a low-air emergency or other emergency situation, you increase stress. The autonomic nervous system response to mortal danger is a fight-or-flight response that increases heart rate, respiratory rate, and an adrenaline response. Each of these can make your situation worse, which is the reason we want to remove the low-air alarm from the incident scene completely.
 
Q, What do think about using 45-minute bottles vs. 30-minute bottles?
A: There is an entire chapter devoted to this question in our book. If you adopt the 45-minute cylinder and an air-management philosophy, the work-rest interval is about the same as using a 30-minute cylinder. Historically, firefighters have demonstrated the ability to use two 30-minute cylinders, with a short break between, without adverse impacts on their safety. If you try the same with the 45-minute cylinder and no air management, the work cycle increases while the rest cycle (time to change out) stays the same. The result is that firefighters have increased heat loads and body core temperatures. We advocate that fire departments institute air management regardless of the cylinder size. Use of the 45-minute cylinder provides the best balance between the customary work-rest interval and increasing the available reserve and implementing air management. Interestingly, if you are using a 45-minute cylinder and reach the 50-percent activation on your HUD, that will be the exact same amount of air as you used in your 30-minute cylinder when the low-air alarm activates.
 
Q. Is there any reason departments should go to one-hours bottles, or does the amount of work you are doing get to be too much? (There were many questions similar to this one.)
A. We advocate that firefighters have an appropriate amount of air for safe entry, work, exit, and reserve. The volume of reserve air is identified by regulating agencies as 25 percent of the rated capacity of the cylinder. Cylinder technology is rapidly advancing to the point where the machine will easily be able to outwork the human. Increases in available air should not change the established work-rest interval of the 30-minute, two-cylinder rule, which allows a firefighter to use two 30-minute cylinders before a trip to rehab. The 45-minute cylinder and air management meet this requirement. If you choose to increase the work time by increasing the cylinder size, there is a big downside in workload and heat stress. Everyone wants to stay inside and work just a little longer. The system should be set up to make the operating environment as safe as possible.

It may be advisable to use a 60-minute cylinder for RIT as long as the RIT team is going to be sent to rehab after only one cylinder. That does not change the requirement that firefighters exit the hazard area BEFORE the low-air alarm activates. The RIT team’s job is to increase the survivability of the firefighter in trouble. Running low on air does not increase that survivability.

Q. How do you view the new ‘slim packs’ impacting the departments across the board in regard to ability to get into ‘smaller’ areas … tighter quarters… and buddy breathing situations?
A. We are excited about technology increasing the safety and effectiveness of firefighters. New materials that are lighter weight have no downside that we can identify. Lower profiles could prove useful, although we would hesitate to recommend going into tighter spaces on the fireground. The use of low-profile maneuvers should be limited to exiting under duress or the “rare and unusual circumstance” for firefighting, and additional time should be set aside to exit. We recommend making a big hole for entry into a firefighting environment. Lower profiles would decrease the dynamic load on the firefighter’s frame and, therefore, decrease the workload and the heat generated. Decreasing the load on the chest and back is always a good thing.

Last, but not least, buddy breathing is a Mayday, every time, as soon as possible. We think the ROAM would decrease the probability of buddy-breathing situations, but we support providing firefighters the tools and training necessary to handle the worst when it arrives.

 

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