Fireground EMS

Firefighting activities are not generally part of emergency medical provider education and training; however, EMS providers should have a working knowledge of practices to ensure appropriate and safe operations.

Since EMS is provided on the fireground virtually every day, EMS providers need a basic understanding of three factors: need for EMS, responsibilities and specific functions. The major components of fireground EMS involve treatment and transportation of injured victims and firefighters, rehabilitation of firefighters and EMS providers, operating within the incident command system and communication interoperability. EMS and fire officers must be attuned to these factors to ensure the safety and well-being of the public and emergency service responders.-

Scope

Fireground functions are some of the most hazardous activities performed by EMS personnel. According to the National Fire Protection Association (NFPA), 37,860 firefighter injuries occurred on the fireground in 2002.1 The United States Fire Administration (USFA) identifies heart attacks as the No. 1 killer of firefighters, with most of them occurring on the fireground.2 According to NFPA statistics, firefighter injuries on the fireground ranked as follows: strains and sprains (41.6%); wounds, cuts, bleeding and bruises (21.7%); burns (8.5%); thermal stress (6.4%); smoke or gas inhalation (5.9%).3 This does not include occupant injuries.

Responsibilities

The No. 1 responsibility of EMS on the fireground is to ensure its own safety. Operating in an area away from fire suppression activities can aid in the overall safety of most EMS functions. Treatment of fire victims should be the next priority, coupled with treatment of injured firefighters. Even though rehab is essential, it may have to take a backseat until sufficient resources arrive.

Dedicated personnel should be capable of handling all applicable functions. Skill competencies can be based on the need as reflected by NFPA statistics.

Functions

EMS functions on the fireground go beyond providing care. It is crucial that EMS operates within the parameters of an incident command system and has interoperable communications.

Although the incident may dictate traditional command versus unified command, integrating EMS in ICS is a critical part of the emergency operation. Regardless of the incident, EMS must function within an incident command structure and consider implementation of triage, treatment, transportation and rehab sectors. Even if the incident does not warrant all sectors, command and control as demonstrated by ICS is still essential.

Interagency communication interoperability is another crucial area. All emergency service entities must work to ensure interoperable communication, not only with fireground command but with any applicable emergency operation.

Generally speaking, patient treatment should occur in the most reasonably safe place. Unless patient transportation is immediately warranted, patients should be moved to the triage or treatment sector.

Rehabilitation

Firefighting and related activities are taxing to the human body. Exertion and exhaustion set in, often when the emergency provider is unaware or ignores the signs and symptoms. Rest, nourishment, hydration and a medical evaluation are crucial components of any emergency service rehab program. Dedicated EMS personnel with supporting portable equipment and applicable transportation should be assigned to the rehab sector. A rehab area should be established anytime there is a working structure fire or extended operation. The area should be supplied with proper nourishment, a rest area and a medical evaluation area. As emergency workers are rotated through rehab, it must be understood that EMS controls the rehab process, and only personnel who have been medically cleared may return to active status on scene.

Action Steps

EMS departments should approach fireground operations proactively. Here are steps agencies can take to preplan response:

• Get involved with local fire service agencies in the preplanning process.
• Evaluate existing communication equipment to ensure interoperability.
• Develop standard operating guidelines for safe and practical operations.
• Provide EMS personnel with appropriate personal protective equipment.
• Educate and train EMS personnel on the guidelines.
• Conduct tabletop drills and integrate drills with other agencies.
• Revise policies/practices; drill and retrain at least annually.

Summary

The incident commander must ensure that EMS is able to effectively communicate and function as the incident warrants. EMS should provide appropriate services to the general public and emergency responders. With routine cross-training and drills, EMS functions can become common practice when the incident is anything but routine.

References

1. National Fire Protection Association Journal, p. 66, November/December 2003.
2. FEMA-USFA, https://www.usfa.fema.gov/dhtml/inside-usfa/fa-220.cfm
3. National Fire Protection Association Journal, p. 67, November/December 2003.