THINKING ABOUT THE UNTHINKABLE
HEALTH & SAFETY
The Serious Injury/Death Checkoff List
You must be prepared to deal professionally with a sad reality that could hit any department.
THE RECENT ACCOUNTS of firefighter deaths resulting from building collapse and explosions are a grim reminder of what we already know: Firefighting is still one of the world’s most dangerous professions. The Annual Report on Firefighter Deaths published by the National Fire Protection Association states there were 131 firefighters killed in the line of duty in 1988. Our injury statistics average at 102,000 every year. While many of these injuries will be of only a moderate nature, a significant number wall be serious enough to forever affect, or end, the life of the firefighter.
While fire departments around the country spend millions of dollars and thousands of hours in preparation for emergencies in their communities, little planning goes into preparing for a serious injury or death to a response team member. Certainly, the emphasis in department safety programs is, and should be, on prevention. Yet to avoid planning for an emergency involving a responder is to ignore the obvious: Foreground injuries and deaths will continue to occur in the foreseeable future.
Preplanning for such an incident serves two main functions. First, the normally detached, professional response that we work so hard to develop is tested to its limits when the patient becomes a friend or co-worker. Inevitably, we become affected by our emotions, and just as inevitably we become a bit less effective. Preplanning will limit the degree to which our emotions control our actions.
Secondly, the fact that the incident occurred at all tells us that somehow, somewhere, our preventive safety plans failed. We must analyze every bit of information we can gather from the scene to find the failure. Policies and procedures must be adjusted. An unforeseeable and unexpected event can be properly called an accident. If w e fail to gather information and apply all we learn, that same event occurring a second time is no longer an accident —it is negligence.
In response to these concerns, the Lansing (MI) Fire Department developed the serious injury/death checkoff list. The checkoff-style form and a corresponding standard operating procedure have been incorporated into the department SOPs and training regimen.
The form itself is deceptively simple. This is intentional. Since it will not be frequently used, it must be “friendly” to the command officer who has not seen or dealt with it for some time. It does not deal with setting standards for the care and transportation of the victim. These important issues are dealt with in other department SOPs. What it does is walk the command officer through the most important steps that need to be accomplished immediately after such a traumatic incident. The check-box format facilitates the process in the field where the accident occurs. The serious injury/death checkoff list is intended to be a worksheet, not a report or record.
THINKING ABOUT THE UNTHINKABLE
AT THE SCENE
We are used to dealing with the concept of chain-of-evidence at possible crime scenes. The first section of the serious injury/death checkoff list similarly deals with protecting the accident scene. The area must be secured and not disturbed any more than is absolutely necessary. Custody must not be released to the owner until all investigations are completed. Even then, documentary photographs should be taken for the questions that will certainly arise hours or days later.
All clothing and equipment of the victim left at the scene must be located and impounded. Did the newly designed turnouts perform to specifications? Did a malfunctioning SCBA contribute to the incident? We may never know if they are damaged or mishandled before a thorough inspection.
All personnel who witnessed or who have information about the incident must be identified and instructed to prepare statements. Names of those so instructed should be noted, and a specific date for submission of the statements should be stipulated.
AT THE HOSPITAL
We must continue to impound the victim’s clothing and equipment as it is removed at the hospital. Also, since the hospital may not be aware of its existence, the victim’s department vital medical information record should be called for. If your department does not currently keep such information, it should strongly consider doing so. It would not be surprising to find that a victim’s family cannot be located following an accident, or just as often, that they are unclear about the victim’s medical history, medications, allergies, etc. A short, concise medical summary is easily maintained and, when stored in a central location such as the dispatch center, can be readily accessible 24 hours a day, seven days a week.
In the case of an on-duty death, we must concern ourselves with doing all we can to protect the family of the victim. A major concern for many personnel is the federal death benefit. And indeed, if not handled properly, there can be pitfalls in the process. When the death results from a traumatic event at the fire scene, such as a fall, burns, or building collapse, there are few questions and little debate about the granting of benefits. If, on the other hand, the death might be from a “medical” (nontraumatic) cause such as heart disease, the federal authorities may require more documentation. Due to the wording of the legislation, they must establish that the death was caused by the events at the emergency scene. In such cases, it becomes extremely important that the attending physician order toxicology studies. It may also be critical that the family allow an autopsy if requested; to refuse may be to deny critical information. A department representative, with the aid of the serious injury/death checkoff list, will remember to discuss such items with the family.
THINKING ABOUT THE UNTHINKABLE
A series of notifications needs to take place. For all serious injuries or deaths, the fire chief should be notified directly. He may choose to call the victim’s family personally and will want to arrange transportation for the family to the hospital by a department car.
A safety committee representative must be notified so the committee can prepare for its investigation of the incident. In the case of a death, the office of the Public Safety Officer Death Benefit Program must be contacted as soon as possible after the incident. Because the command officer at the scene will probably not make all of these calls, it should be noted to whom and when these reponsibilities were delegated.
STANDARD OPERATING PROCEDURE
It is important to have a corresponding standard operating procedure to accompany the checkoff list. In it the department should give special consideration to specifying when the checkoff list should be used. What constitutes a serious injury? Life-threatening internal injuries can be all but invisible to anything but an X-ray or CAT scan. The effects of smoke inhalation are often not evident for hours or days after an incident but may ultimately be fatal. In short, there may be too little information at the scene to determine precisely the ultimate severity of the injuries. Each department must set its own standard, but consider that it is far better to implement the plan too often than not to use it even once when it was needed.
Who will be responsible for completing the items on the form? If not the command officer, proper authority must be allocated so that the steps can be covered without time-consuming questions and delays. What priority shall the form receive? Must it wait until the fire is formally declared extinguished or the incident resolved? Questions such as these are best dealt with ahead of time, by cool heads in calm circumstances.
There are several critical steps that need to be taken immediately after the serious injury or death of a co-worker. It is unrealistic to expect that we can spontaneously remember each of these items during the confusion that will almost certainly follow such an event. The presence of a simple checkoff form, outlining the most critical steps to be covered, will serve to guide us in our efforts to give our co-workers the best possible care in the worst possible situation.