BY NICHOLAS A. MARTIN
Rescuing a down firefighter requires completing and coordinating a variety of tasks. In such a high-stress situation, rapid intervention team (RIT) members can easily become flustered and perform tasks out of order such that they conflict with each other. Not knowing the full details of the situation at the time, RIT members may be uncertain as to at what point the RIT should begin, who does what, and what is done first.
Below is a sequence of easy-to-remember steps for preparing a down firefighter for removal. There may be any number of reasons a firefighter is down; each situation is unique and requires a unique rescue. You may need to take additional steps beyond those listed here to resolve the situation, such as removing debris to access the firefighter. However, the steps below will almost always be necessary once you have accessed the down firefighter.
Although access issues, collapse, and so forth may delay firefighter packaging, RIT firefighters must always immediately ensure a reliable air supply to the down firefighter and overcome any obstacles. Air supply buys the RIT time to make the rescue. This sequence of steps begins with the RIT at the down firefighter’s side and the down firefighter in a mostly accessible position.
Asphyxiation and suffocation kill long before burns or other trauma. Whether the down firefighter is conscious or unconscious, you must ensure that he can breathe to survive the rescue effort. Although the necessity of each step may vary with the specific situation, in almost any situation you must immediately ensure that the down firefighter has air to his intact self-contained breathing apparatus (SCBA) face mask.
Troubleshooting potential SCBA problems in the heat and smoke under the stress of rescuing one of your fellow firefighters can be an insanely daunting task. Also, you should check certain SCBA parts before others. For example, during training, we often find the first thing RIT firefighters want to check for is the cylinder’s air pressure, but that doesn’t much matter if the firefighter’s face piece is missing. To solve this problem, RIT firefighters should follow this step-by-step troubleshooting guide.
In the rescue of a down firefighter, everyone will want to help, but it is very easy to get “too many cooks in the kitchen.” Only one firefighter should be evaluating and addressing a down firefighter’s air situation, receiving assistance only as requested and when necessary (e.g., to reposition a larger firefighter or to move debris).
Avoid the temptation to try to do multiple things at once to the down firefighter. As an instructor in the District of Columbia Fire Department’s “Back to Basics” RIT program in 2008, I witnessed hundreds of experienced firefighters performing RIT evolutions and learned many valuable lessons. Often, crews attempted to speed things up by trying to simultaneously manage the air emergency and package the down firefighter. This actually made both tasks more difficult and time consuming. Air is the priority. This isn’t to say that the other rescuers should just sit on their hands; they can complete other tasks while the air emergency is addressed, such as checking the area for alternate egress, gathering additional tools, or providing an updated Location, Unit number, Name, Assignment, and Resources (LUNAR) report to the incident commander (IC).
1 Rescue position. A down firefighter may be found in a variety of positions, perhaps fully or partially covered in debris. To whatever extent possible, you need to quickly move him into a position where you can assess and fix any air emergencies. At a minimum, you need to access the face. Ideally, you want to get him into the “rescue position” (photo 1). Here, the rescuer is at the down firefighter’s back with the down firefighter in a sitting position. Position yourself behind the down firefighter and move him into an exaggerated sitting position. Put your knee into his lower back and allow him to rest back on your chest (photo 2).
|1 Photos by author.|
This position offers the following advantages:
The down firefighter is oriented in the same direction as the rescuer—i.e., the rescuer’s left is the down firefighter’s left. When working face-to-face, the rescuer must think “cross-brained,” which often leads to confusion and a delay in identifying the correct location of SCBA parts.
In the rescue position, the rescuer has easy and immediate access to all parts of the SCBA that need to be addressed at any air emergency without the need to move or reposition the victim: the face piece, the high-pressure connection, the buddy breathing connection, and so forth.
2 Face piece. The presence or absence of an intact SCBA face piece is the most important part of solving the air emergency. The down firefighter could have four million psi of air in his cylinder, but it doesn’t matter if it isn’t being delivered to his mouth/nose. To check, simply place your hand on the down firefighter’s face. If you feel the mask, try to determine by touch whether it is intact or damaged. Also check that the mask-mounted regulator (MMR) is attached. With your hand on the MMR, you may be able to feel whether the firefighter is breathing. A quick turn of the purge valve will also tell you if there is any air in the cylinder and, if so, if the mechanics of the SCBA are intact enough to deliver it to the face piece.
If you feel a face and no mask, this is a critical problem—the first task will be to put a mask on the down firefighter. This is an intricate skill that requires practice. If you are the RIT team, you should have your RIT SCBA with you. Assume that the firefighter removed his SCBA mask for a reason—there was either a problem with the mask or the bottle. As a result, do not put the down firefighter’s mask back on him—place a new mask on him using the RIT SCBA instead.
Similarly, if the mask is present but the MMR is disconnected, assume that the down firefighter experienced a malfunction, and do not reuse the original SCBA. In this case, connect the MMR from your RIT SCBA to the down firefighter.
3 Bottle pressure. After checking to see that the down firefighter has a face piece with an MMR attached, check for the bottle pressure. You can either check the shoulder-mounted air gauge (typically on the right shoulder) or push the member forward into the exaggerated rescue position (photo 3). From this position, you can easily access the neck of the firefighter’s SCBA bottle including the on/off valve; the pressure gauge; and (on many brands) the high-pressure connection, also called the universal air connector (UAC).
However, compared to checking the shoulder-mounted gauge, using the exaggerated position option has the advantage that the rescue firefighter will already be in a position to access the on/off valve or UAC in an attempt to resolve the problem.
If the down firefighter’s air pressure is low or empty, connect the high-pressure hose of the RIT SCBA to the UAC. This will equalize (transfill) the pressure in both bottles. For example, if the down firefighter’s SCBA were empty and the RIT SCBA had 4,500 pounds per square inch (psi), air would exchange until both had 2,250 psi. Equalization can take anywhere from 30 seconds to a couple of minutes, depending on environmental factors, individual brands, and the amount of air being transferred. As such, the RIT firefighter must manually monitor the transfer of air using the bottle gauge. This process of transfilling can be repeated numerous times during extrication as necessary.
It is important to note: Do NOT leave the high-pressure hose connected to the UAC. In training, we discovered numerous times that the high-pressure hose has poor resistance to lateral stress and would break where the braided hose met the coupling during drags or movement.
4 Mechanical failure. If the down firefighter has an intact SCBA face piece with the MMR attached and air in his bottle but is still not getting adequate air delivered to his face, assume that his SCBA has suffered a mechanical failure. Depending on the brand and configuration of your RIT SCBA, you may have numerous solutions available to select from, based on the circumstances:
- Replace the down firefighter’s MMR with the RIT SCBA MMR. Note that while the MMR is removed, the firefighter will have a gaping hole in the mask, allowing smoke and heat into his airway. Hence, you must accomplish this exchange quickly. If possible, the down firefighter should hold his breath while it is done.
- Disconnect the down firefighter’s MMR at the buddy-breathing connection and hook it to the low-pressure hose on the RIT SCBA.
- Connect the low-pressure hose of the RIT SCBA to the down firefighter’s emergency breathing support system (EBSS) hose. On some brands, this may require use of a double-male connection to connect the two female couplings.
Remember that various manufacturers may have different limitations or capabilities—it is important to know the abilities of your SCBA and RIT SCBA before you need it during an incident.
Repositioning the SCBA waist strap or belt to convert the SCBA into a harness is the first step in packaging the down firefighter. This configuration allows you to use the harness as a dragging device or for lifting or lowering harness operations from a limited height. To convert the waist strap, first secure the waist strap between the down firefighter’s legs. If you do not do this, the down firefighter will likely be dragged out of the SCBA during removal.
When converting the SCBA to a harness, tighten and secure the SCBA shoulder straps; however, do not do this before the belt is properly placed. Tightening the shoulder straps tends to move the SCBA higher up the down firefighter’s back, reducing the available length of the belt strap and making conversion of the belt strap more difficult. I have repeatedly witnessed firefighters encountering significant difficulty in converting the belt after tightening the chest—in some situations, on larger firefighters, it may not even be possible to convert the belt if you attempt it after the chest is tightened.
Some tips on converting the belt follow:
- Do not release the waist strap until the last step! I have seen many firefighters instinctively release the waist strap prematurely; then, when it is necessary to perform other steps before refastening the belt, the loose ends are dropped. They often end up underneath the down firefighter or are otherwise lost, adding significant delay when they must be located.
- Convert the belt after you have assessed and managed any air emergencies, which you should have done from the “rescue position” above. After the air has been addressed, the RIT firefighter should simply ease the down firefighter back into a supine position.
- When the down firefighter is lying on his back, one hip/leg will naturally be sitting higher than the other, because of the SCBA. To avoid unnecessary movement, start with this side.
- Grasp the waist strap with one hand and use the other hand to follow along the strap toward the back until you locate the tension device. Fully loosen the belt.
- Use the leg of the down firefighter that is on the down side as leverage to flip the down firefighter’s hip. Grab the down leg at the ankle and move it 90° toward the body and push the ankle to the other side, toward the shoulder. This will quickly flip the down firefighter with minimal effort (photo 4).
- While you have that leg in your hand, place it on your shoulder and position yourself between the down firefighter’s legs.
- Using the technique above, fully loosen the other side of the down firefighter’s belt.
- With both sides of the belt now fully extended, position your hands on the belt, one on each side of the buckle.
- Release the buckle, and in one motion—without dropping either side—bring the ends underneath the leg of the down firefighter that is resting on your shoulder, and refasten the buckle.
- You may now put the down firefighter’s leg down. Conversion of the belt is complete. On smaller firefighters, you may need to make the belt snug, but this is not always necessary.
Once the belt is converted, tighten and secure the shoulder straps. Removing slack from the shoulder straps prevents the down firefighter from being pulled out of his SCBA and also increases the efficiency of the down firefighter’s SCBA as a drag device. This is especially evident in lifting and lowering operations or when moving the down firefighter on stairs.
Other than simply cinching the shoulder straps tight, there are a few options for securing the straps so that they do not accidentally come loose while moving. The available options may vary based on the SCBA design and manufacturer. One option is to tighten the shoulder strap and then run the free end through the tab on the shoulder buckle (photo 5).
Another method is to tie the running end of the strap around the shoulder strap to keep it tight. This method can be difficult because the free end must be fed between the tight shoulder strap and the down firefighter’s personal protective equipment. To overcome this, the RIT firefighter should place one hand, palm up, under the down firefighter’s shoulder strap and tighten the shoulder strap with the other hand (photo 6). The running end of the strap is then held between two fingers of the hand that is under the strap, allowing the end to be pulled through easily. This creates a small loop. Pass the running end through the loop, and pull; the shoulder strap is secure.
Once you have ensured that the down firefighter has a reliable air source and you have quickly converted his SCBA into a harness, the RIT will be ready to perform whatever extraction technique is necessary for the situation. Note that the above steps should be a quick operation. Although the time will vary with the situation’s complexity, proper training should minimize the time these steps require to no more than a couple of minutes.
Successful rapid intervention efforts are usually not the product of some “whiz-bang” technique or skill; they are a combination of ingenuity, teamwork, communication, and excellent basic firefighting skills. Rescuing an unconscious or disabled firefighter is one of the most emotionally and physically challenging events of a firefighter’s career. It is understandable that the rescuers may be flustered. It is important to remain task oriented and avoid initially performing tasks that will later hinder other necessary tasks. Following the above sequence will help the RIT remain on task and will prepare the down firefighter for removal quickly.
NICHOLAS A. MARTIN is a sergeant with the District of Columbia Fire Department and a captain with the Kentland (MD) Volunteer Fire Department. He has more than 17 years of firefighting experience, has a bachelor’s degree in fire science from the University of Maryland, and has a master’s degree in public safety management from the Johns Hopkins University. Martin is a vice president of Traditions Training, LLC, and an FDIC instructor.
Nicholas Martin will present ” ‘Combat-Ready’ Firefighting” on Thursday, April 19, 2012, 1:30 p.m.-3:15 p.m., at the FDIC in Indianapolis.
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