By Ken Webb
Much work has been done over the last three decades to improve the quality of firefighter personal protective equipment (PPE). We are long removed from the minimal protection provided by hip waders and rain coats that were used by some of Canada’s largest fire departments up to the early 1990s.
By Ken Webb
Today’s PPE ensemble, combined with the latest in respiratory-protection devices, affords firefighters the best available opportunity to survive the hazards in a modern-construction dwelling containing materials that burn much more quickly and hotter than they did just 30 years ago. Even with the latest and greatest in available technology, there are situations in which firefighters are seriously injured or killed as a result of acute exposure to the intense heat associated with hotter and faster-developing structure fires.
I first heard Winnipeg firefighter Lionel Crowther’s story at the 2015 Canadian Burn Symposium in Toronto. While working an overtime shift on the evening of Feb. 4, 2007, a response to a house fire produced results that have changed Crowther’s life. We now know Crowther and his crew likely encountered a change in fire conditions as a result of flow-path dynamics. Crowther suffered burns to 70 per cent of his body, 30 per cent of which were full-thickness burns. Captains Harold Lessard and Thomas Nichols died on scene and firefighter Ed Wiebe suffered injuries that put him in critical, but survivable, condition. Firefighters Darcy Funk and Scott Atchison sustained minor injuries.
Crowther was exposed to extreme heat levels for an extended period of time as he was unable to make an exit when fire conditions changed; he sustained burns that may have been caused by the compression of superheated gasses trapped in his bunker gear. (For more about Crowther go to afterthecocoon.com/burn-survivors/lionel-crowther/)
NFPA 1971 sets the minimum performance requirements for personal protective equipment (PPE) and also specifies the test methods by which the PPE is measured. The newest test is the stored energy test, which was added in 2013. Industry experts recognized the thermal protection offered by bunker gear also results in heat being stored in bunker gear. The trapped, superheated gas, when compressed at pinch points in the suit at the knees and the elbows, causes burns. Another common place where superheated gases are trapped is behind the backplate of the SCBA.
Crowther’s story closely resembles that of Winnipeg firefighter Barry Borkowski, who suffered significant injuries on Oct. 9, 1994. Since retiring as a captain in 2005, Borkowski has worked to implement design changes to bunker gear.
The evolution of engineering of bunker gear has resulted in significant improvements in protection of firefighters; NFPA 1971 has evolved as a result of different types of firefighter injuries, and now measures more factors. But with the improvements have come some challenges: the retention of superheated gasses inside the PPE envelope has resulted in burns during the handling of firefighters who have been removed from fires.
Representatives from the International Association of Fire Fighters were invited to attend the 2015 Toronto burn symposium and participate as presenters. At the 2014 symposium, much of the information presented contained American-specific details. In 2015, I was asked to co-present – from a Canadian perspective – with Judy Knighton, a registered nurse and burn specialist at the Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre in Toronto. Knighton and I were tasked to identify best practices in handling and managing the care of responders who sustained burns. Knighton handled to the transport and treatment priorities in her presentation titled Emergency Management and Outpatient Care of the Person with Burns. I addressed management of the patient immediately following removal from the hazardous environment in my presentation, Managing the Handling of the Rescued Firefighter.
Emotions among fellow firefighters run high when a firefighter is rescued from a fire. As with all hazardous situations in which patients are involved, the primary concern should be rescuer safety. It is important that the rescuers wear full PPE when managing care for a rescued firefighter, and be purposeful and careful when handling the super-heated firefighter. The rescuers need to:
- Avoid off-gassing from firefighter;
- Avoid skin contact with hot bunker gear.
Considerations and steps to safely remove the PPE ensemble:
- Have the firefighter remain standing
• Allow some time for the PPE envelope to passively cool and off-gas or use a positive-pressure ventilation fan to speed up the process
• Do not use a hose line to cool the firefighter while he or she is in the PPE ensemble.
• Use two rescuers to facilitate the removal of the PPE ensemble
• Protect the rescued firefighter from the stored heat in the bunker gear
• Avoid sitting, laying down, bending limbs prior to dissipating stored heat
- Loosen the SCBA shoulder straps; communicate your planned actions and co-ordinate the loosenin
- Disconnect the chest strap
- Loosen and unbuckle the waist belt
- Remove and replace the neck flap
- Open the front jacket flap while unclasping/unzipping the coat
- Open the jacket
- Remove the stage 2 regulator
- Roll the coat and the SCBA over the shoulders
- Remove gloves and the remainder of the coat
- Unclasp the pants, and remove the suspenders, letting the pants fall
- Roll the pants over the boots, and assist in removal of boots.
- Remove helmet, balaclava and mask.
Initial burn treatment:
- Rapid access to definitive care ASAP
- Use water to cool small minor local burns
- Cut away clothing if necessary to avoid debriding when fabric remains in the burned tissue
- Protect open burn wound with dry sterile burn dressings
- Facilitate rapid transport to definitive care
Initial assessment of burns on scene are quite often not overly reliable; some burns that appear to be minor end up being severe while some burns that seem to be significant end up being less severe.
All regions in the country have burn centers associated with leading-edge hospitals that are best suited to manage the care of burn patients. It is worthwhile to ascertain where your firefighter will go when they sustain significant burn injuries. Our partners in emergency medical services will facilitate movement of firefighters to these facilities.
Fire services are very good at preplanning occupancies so they are aware of the different hazards. Situational awareness training is also helping firefighters recognize and react when fire conditions are about to change. These are initiatives designed to limit the risk to firefighters when emergencies occur. Through articles like this and presentations at conferences such as the Canadian Burn Symposium, we hope to spread the word about how to manage the superheated firefighter to limit injuries to the rescuer and the rescuee. These are low-incidence, high-risk situations that need to be planned for before they happen.
Ken Webb is a 22-year career fire fighter at Toronto Fire Services who is also paramedic trained. Ken served 15 years as a captain in the professional development and training division. For the last eight years, Ken has been the manager of the firefighter pre-hospital care program at the Sunnybrook Centre for Pre-hospital Medicine in Toronto.