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Trainer’s Corner: Saving our own through RIT

Although the temperature is over 33 C, it is tolerable in the shade of the restaurant patio. Several of us are grabbing a late lunch. We have already put in eight long hours of work and desperately need a break. Then the "tones" go off. Without a word my son and I push away from the table, no time to finish our meal, no farewells, no big deal. The page-out continues as we cross the street to the firehall: "Osoyoos Fire Department, you are responding to a vehicle fire on Rd. 21." Our family and friends watch us go, they'll pay the bill (we hope). Donning our gear we jump into the responding apparatus. The lieutenant radios dispatch: "Dispatch, Unit 2 responding with 5." "Roger that Unit 2; time out 14:20." The siren wails while three of us don our BAs. We wave at our family and friends out on the patio. (Just another day in paradise.)

Our driver skilfully works his way through traffic while the lieutenant gives us our instructions. Then he dons his BA, and we all sit quietly, each lost for a brief moment in our own thoughts. It's hot and I should have grabbed a water. And those deep fried perogies are not sitting so well.  The Chief has arrived on scene first and is now giving us an update. The vehicle on fire is not on the roadside as we imagined, but in a two-bay structure, adjacent to a residence.

This is one of those unforeseen variables that challenges fire fighters physically, mentally and sometimes even emotionally. There was no chaos, orders were clear, we followed our protocol and the fire was knocked down quickly. No fire extensions. Nothing out of the ordinary. For all intents and purposes it was a routine call (I know there is no such thing, but work with me here). With all the things that didn't go wrong I broke a personal rule; I didn't drink a bottle of water en route. Once in BA there would be no time to hydrate until bottle change (rehab). For at least 20 minutes I'd be active in the heat of the day and the added heat of the fire all the while dressed in full PPE and breathing air through a BA. I really should have hydrated. My poor choice could have had a profound impact on my life and the safety of my team members.

Fire fighters, especially volunteers never know when they may be called out. It could be on a hot summer day, a freezing cold morning, right after a 12-hour shift, or during an intense argument. We could be overwhelmed with personal issues, financial or relational. The pager knows and cares nothing about what its carrier is going through. It thinks nothing of interrupting us during a meal, birthday party, sound sleep or divorce court proceedings. We need to be in a constant state of readiness physically, mentality and emotionally. We of all people must know and respect our own limitations.

We speak of fire prevention, but what about fire fighter death prevention? We are all aware that fire fighting is a dangerous profession where injuries and death are a part of the job, but we can and must do more to reduce the risks. Preventable line-of-duty deaths must be addressed. At the very least we should know how to Save Our Own! The Canadian fire services must get a better attitude and appreciation for Rapid Intervention. Dare I suggest we become active in reducing the deployment of Rapid Intervention Teams (RIT) by having fitness programs and annual physicals for both career and paid-on-call fire fighters.

We have discovered that children playing with matches can start fires, so prevention says, "don't play with matches." When we finally understand that fires don't kill as many fire fighters as heart attacks do, prevention should encompass fitness programs and annual physicals.

Sudden cardiac death is the leading cause of death in the line of duty for fire fighters, whether volunteer or career.

An American report shows that 50 per cent of the deaths among volunteer fire fighters and 39 per cent of deaths among career fire fighters were caused by heart attacks. In both categories of fire fighters, most heart attacks occurred among people aged 45 to 54. The majority were attributed to stress and over-exertion for both volunteers (98 per cent) and full-timers (97 per cent).

You may want to briefly review the following symptoms with your members:
· Chest pain or discomfort.
· Pain or discomfort in areas near the heart such as the arms (often a radiating pain), the neck, jaw, back or stomach.
· Difficulty breathing, nausea, sweating or dizziness.

If you find a victim (or yourself) experiencing these symptoms, you must act quickly and calmly. If your RIT discovers a fire fighter in this condition they must remove the victim and get them to EMS as soon as possible. A fire fighter suffering from severe MI (Myocardial Infarction) could enter cardiac arrest within moments of the onset of symptoms.

If the victim is conscious:
Reassure the victim: Keeping victims calm may reduce their anxiety and improve their chances of survival.

Remove the victim quickly: MI victims have a greater chance of survival if they receive emergency medical care, as soon as possible. EMS should be moved as close as possible to the determined egress point, should RIT be deployed. If the victim goes into cardiac arrest during rescue, EMS care can start immediately outside the structure. In the case of cardiac arrest, the patient should not be moved to the ambulance; care should not be delayed. Immediate defibrillation is required.

Bring EMS to the victim: In some cases, if conditions permit it may take less time for EMS to reach the victim than for the downed fire fighter to be brought to EMS. All necessary safety protocols should be followed. Having RIT members with EMS qualifications will be an asset in such situations. Note: I am of the strong opinion that RIT should be AED certified.

Important guidelines to follow
EMS should be present at all structure fires (including live fire training): Not only should a minimum of a basic life support ambulance be assigned to all structural fire calls, but NFPA 1403, Standard on Live Fire Training Evolutions, Section 4.4.11 (2002 edition), states that when working in acquired training structures, "Emergency medical services shall be available on site to handle injuries."

EMS stages at point of egress: The closer EMS crews are to the point of egress, the quicker they can assist. In the case of MI or cardiac arrest this is vital. Defib must be provided immediately.

Although having an assigned RIT works well in full-time departments it does not work in most paid-on-call or volunteer departments. No matter the method of assigning a RIT it should never be considered some form of punishment. RIT is a vital part of fireground safety. RIT should not be made up of inexperienced fire fighters. Consider who you would want responsible for your life safety should you become disoriented or trapped.

 Be warned, rapid intervention is time-consuming and taxes resources. It is very easy to underestimate what it takes to save our own. Quite likely, the first RIT will locate and supply air to the downed fire fighter(s). It will be the second RIT who replaces the first (when they run out of air) that will actually begin the extrication. Whether this team completes the job or are spelled off again by the initial team is all dependant on the task before them.

When a PASS sounds, or a "Mayday" comes blaring over the radio it becomes the ultimate test of a fire fighter's discipline. This brings me to a personal point of concern. There is a real danger of not hearing the PASS due to the many times they go off during the course of an incident or a training session simply because the fire fighter was standing still. Can you imagine activating your PASS in a real emergency only to hear the IC yell out, "wiggle." I'm not sure how to correct this.

Resources: Henry Ford Medical Association, Health Day News; RIT Manual Canwest Fire Services; Rapid Intervention Team Instructors Course, Oklahoma State University; Portland Fire Department, Portland, Oregon.

Ed Brouwer is the Fire Chief/Training Officer for Canwest Fire and a member of the Osoyoos (B.C.) Fire Dept. The 18-year veteran fire fighter is also a Fire Warden with Ministry of Forests, a First Responder III instructor/evaluator, Local Assistant to the Fire Commissioner and a fire service motivational speaker and chaplain. E-mail ed@thefire.ca .