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Presentation on theme: "Emergency Services, LLC / Copyright 2007 / Volume 07-61 TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show."— Presentation transcript:

1 Emergency Services, LLC / Copyright 2007 / Volume TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show in its entirety FIRE MEDICS PHTLS Training 2: Kinematics of Trauma, Pt. 2PHTLS Training 2: Kinematics of Trauma, Pt. 2 Quiz EVOLUTIONS 2000 Kramer vs. Kramer Program Quiz Answers FIRELINE Speakman Warehouse Fire “Quick Calls” Discussion Questions HANDS-ON Firefighter Survival Skills: Self-Rescue, Pt. 2Firefighter Survival Skills: Self-Rescue, Pt. 2 Quiz Industrial Confined Space Training, Pt. 1Industrial Confined Space Training, Pt. 1 Quiz Working Fire Training 07-6 Training Materials

2 Emergency Services, LLC / Copyright 2007 / Volume TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show in its entirety Working Fire Training 07-6 Training Materials All training methods and procedures presented in this Working Fire Training (WFT) video program and training materials are based on IFSTA, NFPA, NIOSH, OSHA and all other relevant industry regulations and standards and are presented as a part of generally accepted and acknowledged practices in the U.S. Fire Service. WFT should be used under the supervision of certified trainers in conjunction with national, state, and local training standards and protocols, and the standard operating guides and procedures of the Subscriber. WFT is intended to be an ancillary source of training information and should not be used as the sole source of training for any emergency service organization. WFT accepts no responsibility for how the Subscriber implements or integrates this program into the Subscriber’s own training program, nor does the use of this program by the Subscriber imply that WFT approves or endorses any specific training methods presented by the Subscriber to its own organization. WFT accepts no responsibility for the correct understanding or application of its training methods and procedures by emergency service personnel who view this program; nor for any performance or lack of performance by emergency service personnel who may view this program and use or apply these training methods and procedures incorrectly; nor does it accept any liability for injuries or deaths of emergency service personnel who may view this program and use or apply such training methods and procedures incorrectly. By presenting this program for viewing to its organization’s members, the Subscriber, and by viewing or reading materials presented by WFT, the members and students of the Subscriber, agree to hold harmless WFT, the University of Cincinnati, VFIS, and any persons or organizations who participate in the creation and/or presentation of this training material from any legal action which might result from any line-of-duty injuries or deaths of the Subscriber’s members or any other emergency service personnel who view this program and who may use or apply such training methods and procedures incorrectly. LEGAL DISCLAIMER

3 Emergency Services, LLC / Copyright 2007 / Volume DISPATCH/SIZE-UP It was a 55-degree day in December with a steady 25 mph wind and mph wind gusts. This was a mixed commercial/residential neighborhood. The structure was a four-story vacant warehouse of Type 4 construction with heavy timbers and many open spaces, approximately 350’ by 150’. –Type 4 construction (heavy timber, HT) is that type of construction in which the exterior walls are of noncombustible materials and the interior building elements are of solid or laminated wood without concealed spaces. Fireline Incident: Speakman Warehouse Fire 07-6 Training Materials

4 Emergency Services, LLC / Copyright 2007 / Volume DISPATCH/SIZE-UP The structure was completely involved. Six engines, two ladders, and a heavy rescue arrived within five minutes of dispatch. The first two of four alarms were struck immediately. –This led to an automatic callback of all city firefighters Fireline Incident: Speakman Warehouse Fire 07-6 Training Materials

5 Emergency Services, LLC / Copyright 2007 / Volume STRATEGY/TACTICS An initial interior attack was called back. An attempt was made to cut off the fire at the midpoint of the building. Two aerial devices were set up as the fire raged out of control. Firefighters went defensive with multiple apparatus. Crews protected exposures on all four sides of the structure Training Materials Fireline Incident: Speakman Warehouse Fire

6 Emergency Services, LLC / Copyright 2007 / Volume INCIDENT COMMAND/INCIDENT ACTION PLAN The command post was set up on the #1 or A side of the building. Upon arrival, the Incident Commander discussed the situation with the two battalion chiefs on scene. An interior attack proved futile. Responders set up large diameter hose and various water devices to fight the fire. The third alarm came 15 minutes after the other two. –Called for more manpower and heavy devices Training Materials Fireline Incident: Speakman Warehouse Fire

7 Emergency Services, LLC / Copyright 2007 / Volume INCIDENT COMMAND/INCIDENT ACTION PLAN The Logistics branch was ordered to find other water supply sources. After another 15 minutes, a fourth alarm was pulled, bringing in three more aerial units. Rehab was set up approximately 40 feet from the command post. –EMS with BLS units assisted. –Callback alarm personnel replaced crews in rehab Training Materials Fireline Incident: Speakman Warehouse Fire

8 Emergency Services, LLC / Copyright 2007 / Volume INCIDENT COMMAND/INCIDENT ACTION PLAN Due to deteriorating conditions, building collapse was imminent. Apparatus was relocated and a new collapse zone was set up. I.C. took control of the Communications branch; moved away from the fireground to get perspective with division commanders. As temperatures dropped, IC ordered in vehicles to keep firefighters warm Training Materials Fireline Incident: Speakman Warehouse Fire

9 Emergency Services, LLC / Copyright 2007 / Volume INCIDENT COMMAND/INCIDENT ACTION PLAN High daytime temperatures and freezing at night caused slip and fall safety issues – something to make a part of the IAP Training Materials Fireline Incident: Speakman Warehouse Fire

10 Emergency Services, LLC / Copyright 2007 / Volume EVENTS There were a quick succession of additional alarms. Rehab was set up. Water demands outstripped supply Training Materials Fireline Incident: Speakman Warehouse Fire

11 Emergency Services, LLC / Copyright 2007 / Volume EVENTS Building began to collapse, endangering responders. Upon apparatus relocation, hoses were cut and abandoned Training Materials Fireline Incident: Speakman Warehouse Fire

12 Emergency Services, LLC / Copyright 2007 / Volume EVENTS Temperature dropped significantly by evening, eventually reaching freezing with a wind chill. Conditions began icing which created another safety factor. –Firefighters were tripping and falling. This continued for the next few days during fire watch Training Materials Fireline Incident: Speakman Warehouse Fire

13 Emergency Services, LLC / Copyright 2007 / Volume REMARKS First responders knew the battle was lost from the beginning. –They could only stage a holding action. Rehab was set up before adequate supplies of water and coffee were available. Water supply (six-and eight-inch mains) was not keeping up with demand for water. There was a concern for people being in the building; vagrants, vandals, possible jumpers. –Cadaver dogs found nothing during overhaul Training Materials Fireline Incident: Speakman Warehouse Fire

14 Emergency Services, LLC / Copyright 2007 / Volume LESSONS LEARNED Held off on cutting fiber optic utility lines which would have brought down the banking system in Delaware – a casualty loss of $40 million Training Materials Fireline Incident: Speakman Warehouse Fire

15 Emergency Services, LLC / Copyright 2007 / Volume LESSONS LEARNED The structure was a total loss but there was no loss of life and only two injuries. Jurisdictions should preplan vacant structures and note the lack of internal fire suppression systems. –Consider making building owners responsible for this. Warm days with freezing nights in winter will create slip and fall conditions Training Materials Fireline Incident: Speakman Warehouse Fire

16 Emergency Services, LLC / Copyright 2007 / Volume “Quick Calls” is a back again this month. We’ll show you a video clip of some fire or emergency incident and give you some details about it. You discuss it within your department and then Chief Bill Kramer, WFT’s educational consultant, will give his thoughts on handling the incidents. You may or may not agree, but either way, it’s more exposure to an incident that your department could run into. So let’s get prepared! 07-6 Training Materials Fireline Incident: “Quick Calls”

17 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #1 – FIRE INSPECTIONS AT BARS & CLUBS SIZE-UP/EVENTS These bars and clubs had poor postings or inadequate access to emergency exits. Some exits were blocked by chains or obscured by curtains. Exits not visible Exit signs not illuminated 07-6 Training Materials Fireline Incident: “Quick Calls”

18 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #1 – FIRE INSPECTIONS AT BARS & CLUBS SIZE-UP/EVENTS Inspections are often done during the day when establishments are empty. –Owners sometimes know when inspections are due. –Follow-ups on violations are sometimes not done consistently Training Materials Fireline Incident: “Quick Calls”

19 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #1 – FIRE INSPECTIONS AT BARS & CLUBS QUESTIONS/CONSIDERATIONS Do you have night clubs or bars in your jurisdiction where owners may tend to skirt the safety codes? Do you have any new establishments you haven’t inspected yet? Who’s responsible for doing inspections and how often? Could a catastrophic club fire/incident happen in your jurisdiction? 07-6 Training Materials Fireline Incident: “Quick Calls”

20 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #1 – FIRE INSPECTIONS AT BARS & CLUBS KRAMER’S APPROACH Who shares the enforcement for overcrowding of night clubs? –The fire department can enforce occupancy limits –But the club owner has an obligation to keep his/her place of business safe. –The patron must take responsibility for personal safety. The responsibility of night club safety is shared three ways Training Materials Fireline Incident: “Quick Calls”

21 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #2 – ROOF WORK SAFETY SIZE-UP/EVENTS A fire attack crew makes entrance on the ground floor. Meanwhile, a truck crew is opening up the roof. A couple of things to note: –We have seven crew members working on this pitched roof. –The roof appears to be burned through in a few places Training Materials Fireline Incident: “Quick Calls”

22 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #2 – ROOF WORK SAFETY SIZE-UP/EVENTS Firefighters seem to be working extremely close to some of these burned areas on the roof. One firefighter is working “uphill,” pulling debris down the roof, with his back to a charred weakened area. One misstep backward could spell trouble Training Materials Fireline Incident: “Quick Calls”

23 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #2 – ROOF WORK SAFETY QUESTIONS/CONSIDERATIONS What is the relationship to the size of the crew to the size of the roof? Do you have any protocols as to how to work on a pitched roof? Should roof workers ever be harnessed with a safety line? Does your department always send a Safety Officer up with a roof crew? 07-6 Training Materials Fireline Incident: “Quick Calls”

24 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #2 – ROOF WORK SAFETY KRAMER’S APPROACH NFPA and IAFF say that adequate staffing should mean safety. But in this incident, firefighters have gone overboard. –There are too many firefighters on this roof, getting in each other’s way. –A Safety Officer should be present to minimize crew size and danger, based on how many the roof can realistically support Training Materials Fireline Incident: “Quick Calls”

25 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #3 – DISPATCHING MIX-UP SIZE-UP/EVENTS A fire department was dispatched to a residence fire. After Dispatch had some confusion with the address, a department responded. Upon arriving at the address, the department determined the residence was not in their jurisdiction and elected not to fight the fire Training Materials Fireline Incident: “Quick Calls”

26 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #3 – DISPATCHING MIX-UP SIZE-UP/EVENTS The homeowners called 911 again. In taped transcripts of the calls, the operators were obviously confused as to exactly where the address was and which department to dispatch. Another local department, only a few blocks from the fire, finally responded Training Materials Fireline Incident: “Quick Calls”

27 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #3 – DISPATCHING MIX-UP QUESTIONS/CONSIDERATIONS What is your district’s dispatching policy? –Are all addresses clearly covered by a primary department? Do you have mutual aid and/or automatic aid agreements in place with adjacent departments? What does this story do for public confidence in the fire service in general? 07-6 Training Materials Fireline Incident: “Quick Calls”

28 Emergency Services, LLC / Copyright 2007 / Volume QUICK CALL #3 – DISPATCHING MIX-UP KRAMER’S APPROACH It’s hard to believe a fire department can respond to a fire and not engage it. –Laws have been written to soften borders between jurisdictions. –Firefighters are free to save lives and property, regardless of jurisdiction. A more effective solution would be for the department who responds to fight the fire, but to call the department whose jurisdiction it really is, and then work out the details Training Materials Fireline Incident: “Quick Calls”

29 Emergency Services, LLC / Copyright 2007 / Volume Fireline Incident Discussion The departments involved in this month’s training and WFT pose some discussion questions that you can use as discussion-starters in your own department’s training sessions. How will your department handle these scenarios? 07-6 Training Materials

30 Emergency Services, LLC / Copyright 2007 / Volume Speakman Warehouse Fire / Wilmington, DE Ops. Chief Joseph Kalinoski, Wilmington (DE) Fire Department Batt. Chief Michael Donohue, Wilmington (DE) Fire Department When you roll up on a real barn-burner, do you immediately think about how much water you’re going to need and whether you have enough? Do you start logistical planning right then? Check this USFA training on water supply planning: A huge fire should be thought of as a resource burner. Think manpower, apparatus, more manpower, rehab, more manpower. Have you ever seen a building collapse exceed the One-Third-the-Height- of- the-Building-Collapse-Zone rule? It can happen, depending on what kind of forces are at work. Rule of Thumb: when you encounter a very large, hot-burning structures with plenty of fire load, it’s going to come down -- violently. Leave extra room for your collapse zone. Fireline Incident Discussion 07-6 Training Materials

31 Emergency Services, LLC / Copyright 2007 / Volume “Quick Calls” Chief & Professor Bill Kramer, Open Learning Fire Science Program, University of Cincinnati Regarding inspections, fire departments, building owners, and patrons share responsibility for safety. Consider revisions in inspection policies regarding frequency, time of day for inspections, and follow-ups. Always put a Safety Officer on a roof and staff it according to roof size, taking into account possible roof weakening which may have resulted. Treat roof openings with great respect! Don’t crowd the edges. Laws exist allowing firefighters to respond to any fire. Should there be a question about jurisdictional responses, fight the fire first and ask the jurisdictional questions later. Work out any dispatching details or miscues – but make the Fire Service look good! Fireline Incident Discussion 07-6 Training Materials

32 Emergency Services, LLC / Copyright 2007 / Volume OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: how to modify PPE into a Class 2 harness how to give older gear the same utility with a Hasty harness how to perform a self-rescue from an upper floor window or opening. CODES, STANDARDS & REGULATIONS NFPA 1500, Standard on Fire Department Occupational Safety and Health Programs. Department SOGs on in-service limits of rescue ropes. Hands-On: Firefighter Survival Skills/Self-Rescue, Pt Training Materials

33 Emergency Services, LLC / Copyright 2007 / Volume PURPOSE OF TRAINING Firefighters may find themselves on an upper floor with no interior means of egress available. They may find themselves at an upper window or opening to which no ladder has yet been thrown or the window is too high to be reached by a ground ladder. A simulated upper window was constructed. –This allows upper window bail-out techniques to be practiced Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

34 Emergency Services, LLC / Copyright 2007 / Volume PURPOSE OF TRAINING Firefighters should train yearly or more often on these techniques. –If you train on something often enough, it will become second nature. –It's important for firefighters to develop confidence that they can rescue themselves if they get caught in an unusual situation. –This confidence can be reinforced by frequent use of the training prop Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

35 Emergency Services, LLC / Copyright 2007 / Volume SAFETY FIRST! These techniques can be used with any PPE. However, some of the techniques as explained here involve changes or modifications to PPE. –Not all departments may want to or be able to execute these changes. –Some firefighters may feel the changes will make PPE too bulky or uncomfortable. –It’s a question of choice for each department and their SOGs. These are offered as lifesaving techniques, viewing convenience and comfort as secondary issues Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

36 Emergency Services, LLC / Copyright 2007 / Volume SAFETY FIRST! The district opted for these changes for specific reasons. –Firefighters sometimes become pressed into service or new roles or duties quickly without being able or remembering to strap on a truck belt. –To help prevent an unsafe condition, the district went to the built-in belt which gives great functionality ; the district believes this to be a safer solution. Once again, each department must decide for itself whether such modifications works within its system and culture Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

37 Emergency Services, LLC / Copyright 2007 / Volume BUNKER PANTS WITH BUILT-IN HARNESS All District members have a Class 2 harness built into their gear. –It's basically a truck belt built into their bunker pants that you can use as a ladder belt with a built-in carabiner. Advantages –Having the carabiner readily available as a part of a built-in harness system makes for a safer evolution. –It’s more solid than SCBA straps, for example. –It also shortens rigging time Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

38 Emergency Services, LLC / Copyright 2007 / Volume BUNKER PANTS WITH BUILT-IN HARNESS Advantages (cont.) –In the event a firefighter finds himself in a basement, perhaps injured and unable to stand or assist himself physically, if he can attach a rope to the carabiner, he can be hauled out Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

39 Emergency Services, LLC / Copyright 2007 / Volume CONVERSION OF OLDER GEAR USING A HASTY HARNESS With older bunker pants you can achieve nearly the same utility. –Don your bunker pants and drop the outer liner. –Tie a Hasty harness around the lumbar support and tie it all together. –You end up with what amounts to a Hasty harness around your belt. –You can put a carabiner through the loops and hook a variety of things through them Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

40 Emergency Services, LLC / Copyright 2007 / Volume UPPER STORY WINDOW SIMULATION The training mezzanine has a window approximately 15 feet above the ground. This is a little taller than most second-story windows but it’s better to train on the worst-case scenario. Regardless, with this technique, you are only limited by the amount of rope you carry. –A 40-foot rope could get you down from a three-story structure Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

41 Emergency Services, LLC / Copyright 2007 / Volume WINDOW BAIL-OUT Preparation –Firefighters in the district always carry a bag hooked to their SCBA which includes 40 feet of rope, an ascender, and a carabiner. –Firefighters always wear their SCBA which means the rope bag will always be with them Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

42 Emergency Services, LLC / Copyright 2007 / Volume WINDOW BAIL-OUT Procedure –Prepare the Halligan The idea is to use your Halligan bar as an anchor point. Select a spot on either side of the window, a few inches above the window sill and about 4 or 5 inches outside the window frame. Drive the point of your Halligan bar into the wall at that spot. The Halligan will be angled downward from that point toward the edge of the window sill. The Halligan should cross just above the corner of the window Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

43 Emergency Services, LLC / Copyright 2007 / Volume WINDOW BAIL-OUT Procedure (cont.) –The Rope System Take the carabiner attached to the rope with the ascender and pull it out of the rope kit bag. Pull some slack and tie the rope to the Halligan at the mid-point of the shaft. Tie a clove hitch or a half-hitch knot at the mid-point of the shaft about 6 inches from the ascender tied to the end of the rope. If necessary, slide the ascender about 6 inches away from the knot. Run the rope back through the carabiner and cinch it tight as a safety Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

44 Emergency Services, LLC / Copyright 2007 / Volume WINDOW BAIL-OUT Procedure (cont.) –Rigging the System Then attach the large carabiner on the belt harness to the ascender. Throw the rope bag out the window to the ground below. Insert the Halligan into the purchase point previously established. Rig the rope through the ascender Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

45 Emergency Services, LLC / Copyright 2007 / Volume WINDOW BAIL-OUT Procedure (cont.) –Exiting the Window Climb up on the window sill, putting your hand over the knot on the Halligan and positioning the bar so that it crosses the corner of the window. –Be sure and keep your hand over the knot on the Halligan. With one leg still on the inside, lean out the window and load the system. As the system will support you, swing your leg over the sill and prepare for descent Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

46 Emergency Services, LLC / Copyright 2007 / Volume WINDOW BAIL-OUT Procedure (cont.) –Exiting the Window Use the ascender to lower yourself to the ground Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

47 Emergency Services, LLC / Copyright 2007 / Volume PRE-RIGGED BAIL-OUT SYSTEM Preparation –With this technique, the bunker pants already have the rope bag in a side pocket. –A Munter hitch is pre-rigged to the belt carabiner, with a loop tied at the end of the rope Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

48 Emergency Services, LLC / Copyright 2007 / Volume PRE-RIGGED BAIL-OUT SYSTEM Procedure –Just slide the Halligan through the loop, place it in the window, and use it as outlined above. –The Munter provides the descent control as you let yourself down. –The advantage here is that the rope system is always ready with no rigging necessary. Just hook the system into the belt carabiner and you’re ready to go Training Materials Hands-On: Firefighter Survival Skills/Self-Rescue, Pt. 2

49 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ 1. True or False: Modifications to PPE mentioned are not mandatory. 2. True or False: The advantage to a pre-rigged system is that you don’t need your own rope. 3. True or False: You can convert older gear by tying a Hasty harness around your SCBA support Training Materials Quiz: Firefighter Survival Skills/Self-Rescue, Pt. 2

50 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. Which procedure order is correct? a. Establish Halligan purchase point – Tie rope to mid-point of Halligan -- Attach carabiner to ascender – Throw rope bag out window and climb down. b. Attach carabiner to ascender – Tie rope to mid-point of Halligan – Establish Halligan purchase point -- Throw rope bag out window and climb down. c. Tie rope to mid-point of Halligan – Run rope back through carabiner as a safety -- Establish Halligan purchase point – Attach carabiner to ascender Training Materials Quiz: Firefighter Survival Skills/Self-Rescue, Pt. 2

51 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select which does NOT belong : 5. To use a pre-rigged bail-out system, you will NOT need: a. a carabiner b. a Munter hitch c. rope in rope bag d. Gibbs ascender e. All of the above 07-6 Training Materials Quiz: Firefighter Survival Skills/Self-Rescue, Pt. 2 (Answers on Slide 106)

52 Emergency Services, LLC / Copyright 2007 / Volume OBJECTIVES/OUTCOMES After watching this segment, the student shall learn about: extractions from a very narrow space with stairs slack generation issues with Sked stretchers rigging and slack generation issues with Class 3 harnesses. CODES, STANDARDS & REGULATIONS OSHA 29 CFR , Permit-Required Confined Spaces ANSI Z , Safety Requirements for Confined Spaces Hands-On: Industrial Confined Space Training, Pt Training Materials

53 Emergency Services, LLC / Copyright 2007 / Volume TRAINING PARTNER: AMERICAN EMERGENCY RESPONSE TRAINING (www.americanert.com) AERT provides emergency response training to emergency teams across the United States with mobile "live" fire and Confined Space Rescue training units. Training is also provided at fixed site facilities outside Mobile, Alabama and in St. Thomas, U.S. Virgin Islands. All AERT programs meet and/or exceed OSHA and NFPA required training regulations and standards Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

54 Emergency Services, LLC / Copyright 2007 / Volume CONFINED SPACE SCENARIO – INITIAL BRIEFING The venue calls for a 60-foot vertical drop down a stairwell (Marine-style stairs). –This amounts to about six flights of stairs at a 45° angle which is typical aboard a ship. If space and configuration allows, you can rig your haul system so the lifting happens through the void space in the middle of the stairwell while rescuers basically walk up and guide the Stokes or Sked up the stairs. –The stairwell space will determine whether this will be a vertical or horizontal lift. In this case, it’s vertical Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

55 Emergency Services, LLC / Copyright 2007 / Volume CONFINED SPACE SCENARIO – INITIAL BRIEFING If the space doesn't allow for that rigging, then rescuers will have to work hard to bring the Stokes or Sked up the stairs. –See “Working with Stairs – Manhandling” below. A Sked stretcher might take up less space than a Stokes and might be the stretcher of choice in a very tight space. A Sked is used in this training. –However, using a Sked in a tall vertical raise has its own set of issues. See below Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

56 Emergency Services, LLC / Copyright 2007 / Volume PREPARATION Rescuers call down below to see if the victim answers. They drop a tool to get an idea how deep the stairwell by listening for a bounce. Rescuers began monitoring the atmosphere air quality demands extra ventilation. The rescue crew receives a briefing from a liaison person on the ship who gives specifics about the shaft and stairwell Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

57 Emergency Services, LLC / Copyright 2007 / Volume RIGGING PROCEDURE The rescue strategy was to rig a tripod over the stairwell opening. –When positioning the tripod over the opening, offset it slightly so the apex of the tripod isn't directly over the hole. –This allows you to access the top of the tripod to hang equipment, and should you drop something, it won’t go directly into the hole and endanger any rescuers below. Be sure your equipment staging area is somewhat removed from the rescue area around the opening. –Less clutter around the rescue area makes for a safer scene Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

58 Emergency Services, LLC / Copyright 2007 / Volume RIGGING PROCEDURE The rigging system involved a redirect from the top of the tripod to the haul team. The haul team found an anchor point and attached the main line to a rigging plate. A Rescue Eight belay device with a Munter hitch was attached to the rigging plate and used as a rack to control descent. –Other options can be substituted. Always double-check the safety and rigging of harnesses on all rescuers before they are lowered Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

59 Emergency Services, LLC / Copyright 2007 / Volume RIGGING PROCEDURE Fish-Stringer Technique –This confined space consists of a 20-foot drop to a staircase below. From that point to the bottom of the hole, rescuers may want to consider the Fish-Stringer technique. –This is when rescuers, having reached the stairs, can unhook from the main line and use a carabiner or a prussic to hook to the same safety or belay line, which is now called a tag line since it bears no weight. –Much like clipping fish to the same line, you can reduce the number of knots to be tied and the number of ropes in the hole with this method Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

60 Emergency Services, LLC / Copyright 2007 / Volume RIGGING PROCEDURE Fish-Stringer Technique (cont.) –The tag line can then become an emergency haul line if needed Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

61 Emergency Services, LLC / Copyright 2007 / Volume HAUL TEAM The haul team has rigged a 4:1 mechanical advantage and takes commands from the team leader. The rescuers asked the Sked to be raised about five feet. –This is how long of a haul they need before they have to reposition the Sked around the stairs. One way to keep track of this is to have a member of the haul team observe the prussic or rigging knot and signal when five feet of rope have passed Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

62 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM Working with Stairs - Floating Technique –If you can lower your haul system through the void space in the middle of the stairwell, you can haul or “float” your Stokes or Sked up one set of stairs – the five feet mentioned in the last slide. –Then twist or maneuver the Stokes around and bring it up the next of stairs, and continue all the way up. –It might be beneficial to add a swivel to the system to eliminate any twisting of the rope Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

63 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM Working with Stairs - Floating Technique (cont.) –If you actually rotate the Stokes in consecutive revolutions (as with a horizontal lift) as you come up the stairwell, which might be necessary in tight quarters, you'll definitely need a swivel Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

64 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM Working with Stairs - Manhandling –The other technique would be to either carry or drag the Sked up the stairs -- to be avoided, if possible. This might be your only option depending upon the space and construction of the stairwell. –In this evolution, one of the taglines in the hole becomes a safety line to the main haul system of the Sked, should it be dropped Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

65 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM Based on the tight quarters in the stairwell, rescuers are executing a vertical raise using a Sked stretcher. At each stair level – every five feet -- where the stairs reverse themselves, rescuers must scoot the Sked around the banister to ready it for the next raise Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

66 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM Upon extraction at the top, there’s a problem. –The knot in the vertical haul rope has hit the pulley of the tripod before the Sked has cleared the deck opening. The patient must be dead-lifted by the deck team in order to clear the opening Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

67 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM What happened? One of two things: –By procedure, the lashing rope of the Sked which becomes the vertical lifting rope. –This should be snugged up tight so the knot in the vertical lifting rope is positioned right at the plastic head of the Sked. –Either the patient was not lashed tight enough so there was too much slack in the vertical lifting rope between the knot and the head of the Sked to begin with -- OR… 07-6 Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

68 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM What happened? One of two things (cont.): –The slack increasd during the 60-foot lift. This can happen with a Sked during a long lift. –The weight of the patient pulls additional slack out of the lashing system which increases the distance between the knot in the vertical lifting rope and the head of the Sked Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

69 Emergency Services, LLC / Copyright 2007 / Volume RESCUE TEAM What happened? One of two things (cont.): –What may then happen is the knot on the Sked hits the pulley in the haul system before the bottom of the Sked can clear the deck Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

70 Emergency Services, LLC / Copyright 2007 / Volume CLASS 3 HARNESS The 3rd rescuer was wearing a Class 3 harness with D rings on top of the shoulders which allows for a spreader bar system. –The spreader bar system is often used for industrial applications where a long hang time is anticipated. –Some designs have a rear clip-in point between the shoulders where the system hooks in Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

71 Emergency Services, LLC / Copyright 2007 / Volume CLASS 3 HARNESS If fire department rescuers are anticipating a long or difficult rescue with excessive hang time, a spreader bar system might be considered. –The length of the straps from the D rings to the hook-in carabiner could have been shortened Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

72 Emergency Services, LLC / Copyright 2007 / Volume CLASS 3 HARNESS Also, Class 3 harnesses can develop a tremendous amount of slack if care is not taken to avoid it. –They should be fitted to be extremely tight, with leg loops and rear loops shortened Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

73 Emergency Services, LLC / Copyright 2007 / Volume CLASS 3 HARNESS It is advisable for the wearer to get into a crumpled or fetal position when donning, so when the harness is hung, it remains close to the body Training Materials Hands-On: Industrial Confined Space Training, Pt. 1

74 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: Calling down to the patient for a response is always a good first step in initiating a confined space rescue. 2. True or False: Double-checking harnesses and moving staging and equipment away from the opening is a good idea. 3. True or False: An ascender, a rack system, or a Munter hitch could not be a part of a haul system Training Materials Quiz: Industrial Confined Space Training, Pt. 1

75 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. Things which can affect the slack in a haul system: a. Choice of mechanical advantage b. Patient lashed too loosely c. Tag lines d. Swivels e. All of the above 07-6 Training Materials Quiz: Industrial Confined Space Training, Pt. 1

76 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. Factors that don’t apply to a Class 3 harness include: a. spreader bar system b. extended hang time c. shoulder D rings d. mechanical advantage. e. None of the above (Answers on Slide 106) 07-6 Training Materials Quiz: Industrial Confined Space Training, Pt. 1

77 Emergency Services, LLC / Copyright 2007 / Volume OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: the forces at work in vehicle crashes and other accidents how certain impacts cause certain injuries how certain injuries can be anticipated/expected from certain crashes and impacts. CODES, STANDARDS & REGULATIONS Pre-hospital Trauma Life Support Training, National Association of Emergency Medical Technicians and the American College of Surgeons. Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt Training Materials

78 Emergency Services, LLC / Copyright 2007 / Volume RESTRAINT DEVICES Seat/Lap Belts –Vehicle occupants should apply seat/lap belts across the pelvis, just as when patients are strapped on to a backboard. –Occupants should strap across bony areas and not soft tissue areas: chest, pelvis, leg. They should not strap across the belly. –If belts are not being worn correctly by occupants, you will see that with corresponding injuries Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

79 Emergency Services, LLC / Copyright 2007 / Volume RESTRAINT DEVICES Shoulder Harnesses –In older vehicles that had motorized shoulder harnesses, occupants would often neglect to fasten their lap belt. –Crashes involving these vehicles would yield down-and- under and neck-hanging injuries. –Seat/Lap belts must be worn with shoulder harnesses for proper immobilization! 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

80 Emergency Services, LLC / Copyright 2007 / Volume RESTRAINT DEVICES Airbag Deployment –Typical injuries are burns and abrasions on the forearms. –On older vehicles, airbags used a talc-like powder propellant, and although it wasn't toxic, it was an irritant. Asthmatics would often have a reaction to this powder, so watch for respiratory after-effects following airbag deployments. –Smaller passengers may also receive airbag injuries to the face. –Rear-facing infant car seats, if not secured properly, will flip backward if struck by an airbag deployment Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

81 Emergency Services, LLC / Copyright 2007 / Volume MOTORCYCLE CRASHES With frontal crashes, typically, pelvis-femur injuries occur. As the rider ejects off the bike, the feet may become caught on the footrest pegs, snapping the femur as the body launches forward Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

82 Emergency Services, LLC / Copyright 2007 / Volume MOTORCYCLE CRASHES With lateral crashes often resulting from sideswipes, you'll see crushed or broken legs or possible hip injuries from side impacts. Wearing helmets has lowered head and brain injuries by 300%! 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

83 Emergency Services, LLC / Copyright 2007 / Volume PEDESTRIAN VS. VEHICLE The lower in height the vehicle is, the lower the injury will be on the pedestrian. With lower-height vehicles, pedestrians tend to be launched over the hood into the windshield with resulting head and neck trauma. Taller vehicles tend to inflict greater damage directly to the upper torso. –The patient may then fall underneath and perhaps be run over – incurring additional injuries to be watched for Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

84 Emergency Services, LLC / Copyright 2007 / Volume FALLS When the human body hits a street or any hard surface, there is rapid deceleration. As with any kind of fall, the hardness of the surface the person is falling on will have a lot to do with the severity of injury. –Obviously, soft ground is much more forgiving than asphalt Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

85 Emergency Services, LLC / Copyright 2007 / Volume FALLS Fall Height –If the fall is three times the height of the person, that is considered a life threat. –Be prepared to “load and go.” 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

86 Emergency Services, LLC / Copyright 2007 / Volume FALLS Falling and Landing Feet-First –A feet-first landing forces the energy of the fall up the body and can cause fractures all the way up: Bilateral heel fractures Ankle fractures Distal tibia/fibula fractures Knee dislocations Femur fractures Hip injuries Spine compression fractures (C3 and C4 fractures if the person lands on their heels) 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

87 Emergency Services, LLC / Copyright 2007 / Volume FALLS Landing with Outstretched Arms –This leads to Scaphoid and Colles fractures of the wrist which are very common. –Shoulder dislocations and back injuries occur from a rapid deceleration. –Fractures of the clavicle, the most broken bone in the human body, are likely Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

88 Emergency Services, LLC / Copyright 2007 / Volume FALLS Landing Head-First –Eye injuries –Facial injuries –Brain-damage 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

89 Emergency Services, LLC / Copyright 2007 / Volume RECREATIONAL ACTIVITY MECHANISMS People do all kinds of things for recreation. You must take a look at what they were doing and how fast are they were going before they hit... and what they hit. Depending on the activity and its speed, hidden injuries can be anticipated, much as they can from auto wrecks. Any protective equipment participants might have been wearing may help to mitigate injuries Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

90 Emergency Services, LLC / Copyright 2007 / Volume BLAST INJURIES With explosions, there are primary, secondary, and tertiary injuries. Primary –The explosion itself and the pressure/heat shockwave and impulses it sends out. –Resulting concussion: damage to organs; most commonly, the hollow organs or gas-containing organs Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

91 Emergency Services, LLC / Copyright 2007 / Volume BLAST INJURIES Primary (cont.) –This is not unlike the “paper bag effect” where the passenger sees the accident coming and gasps or inhales deeply in anticipation. The air in the lungs then blows out from the impact like a popped paper bag, causing trauma Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

92 Emergency Services, LLC / Copyright 2007 / Volume BLAST INJURIES Secondary –Injuries from flying debris, depending upon the size of the debris –Areas affected Skin Internal organs Skeleton (broken bones) 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

93 Emergency Services, LLC / Copyright 2007 / Volume BLAST INJURIES Tertiary –Impact of the body against an immovable object –Areas affected: Areas of impact or referred energy 07-6 Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

94 Emergency Services, LLC / Copyright 2007 / Volume PENETRATING WOUNDS Stabbings, gunshots, impalement injuries – key issues Stab Wounds –Low-velocity penetrations –Type of weapon Knives, ice picks, shivs, etc. –Number of wounds (be sure you have found them all) Depth of penetration Anatomic structures along potential path (organs, arteries, etc.) Cone of injury –what area below the skin (tissue, organs) is affected by the movement of the weapon, its angle, penetration depth, etc Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

95 Emergency Services, LLC / Copyright 2007 / Volume PENETRATING WOUNDS Stabbings, gunshots, impalement injuries – key issues Gunshot wounds –Velocity - medium/high It depends on the type of weapon (eg. military weapons cause more damage than civilian weapons) and ammunition. –Projectiles (bullets, pellets, etc.) Profile –Size, caliber of ammunition Fragmentation –Whether the bullet broke into pieces or not –Shotgun pellets will create the most fragmentation Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

96 Emergency Services, LLC / Copyright 2007 / Volume PENETRATING WOUNDS Stabbings, gunshots, impalement injuries – key issues Gunshot wounds (cont.) –Tumble/Pathway Whether the projectile is tumbling/spinning upon entry and the movement of the projectile after entry –Cavitation The amount of damage to tissue will depend upon what kind of tissue and how dense it is (fat vs. muscle vs. bone) Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

97 Emergency Services, LLC / Copyright 2007 / Volume ENTRANCE VS. EXIT WOUNDS Entrance Wounds –The skin flap or edge will be pulled into the wound. –There may also be some abrasions, burning or tattooing at the entrance site as the bullet will pull or tear the skin as it passes through. –However, the skin will most likely be smoother than at the exit site Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

98 Emergency Services, LLC / Copyright 2007 / Volume ENTRANCE VS. EXIT WOUNDS Exit Wounds –The skin will be more ragged, split and fragmented as the bullet bursts through it. –As opposed to the entrance wound, the skin will be pulled outward. –Shotgun exit wounds will create the most fragmentation because of all the pellets Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

99 Emergency Services, LLC / Copyright 2007 / Volume SCENE SAFETY Patient care is #1 but scene safety is a top priority. –Don't bring the weapon with you to the hospital -- don't even touch the weapon if you don't have –Disturb the scene as little as possible; don’t move anything you don't have to. –If you do move something, be sure and document it as it will become an issue in court. –If you have to appear in court, your actions must be well documented Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

100 Emergency Services, LLC / Copyright 2007 / Volume SCENE ASSESSMENT The cornerstone of assessment is early consideration of kinematics to predict hidden injury Training Materials Fire Medics: PHTLS Training 2: Kinematics of Trauma, Pt. 2

101 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: Shoulder harness-only systems yielded up-and-over and neck-hanging injuries. 2. True or False: A rear-facing infant car seat can be pushed against the back of the passenger seat by an airbag deployment. 3. True or False: Motorcycle crashes cause femur injuries as the rider gets his feet caught under the footrest pegs Training Materials Quiz: PHTLS Training 2: Kinematics of Trauma, Pt. 2

102 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. With feet-first landing fall, which damage would NOT occur: a. Bilateral heel fractures b. Ankle fractures c. Distal tibia/fibula fractures d. Femur fractures e. Skull fracture 07-6 Training Materials Quiz: PHTLS Training 2: Kinematics of Trauma, Pt. 2

103 Emergency Services, LLC / Copyright 2007 / Volume Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. With gunshot wounds, which of the following apply? a. Vibration b. Tumble/pathway c. Shell impact d. Projects e. None of the above (Answers on Slide 106) 07-6 Training Materials Quiz: PHTLS Training 2: Kinematics of Trauma, Pt. 2

104 Emergency Services, LLC / Copyright 2007 / Volume Kramer vs. Kramer Safety Procedures for Collapse Zones 1. Provide a brief listing of the unusual factors (types of exposures, collapse zones, etc.) at the large factory fire in Wilmington, DE. 2. Should a fire department prepare safety procedures (e.g., collapse zones based on the “ordinary and predictable”) or extend safety to include even the “remotely possible”? 3. Provide a few guidelines describing how you would balance safety with practicality on the fire ground. If you’re enrolled in the Open Learning Fire Science Program at the University of Cincinnati, complete written responses to the following three essay questions to earn one college credit hour for watching Working Fire Training Training Materials Evolutions 2000 – Continuing Education

105 Emergency Services, LLC / Copyright 2007 / Volume ENROLLMENT INFORMATION: For more information on enrolling in the Open Learning program to gain college credit, call Working Fire Training at for a brochure or, to register directly, call the University of Cincinnati at Associates and Bachelors programs are available. Call to have your transcripts evaluated. Send your responses to: Professor Bill Kramer University of Cincinnati College of Applied Science 2220 Victory Parkway, ML #103 Cincinnati, Ohio Training Materials Evolutions 2000 – Continuing Education

106 Emergency Services, LLC / Copyright 2007 / Volume Thanks so much for viewing Working Fire Training! See you next month – stay safe! Answers: Hands-On – Firefighter Survival Skills: Self-Rescue, Pt. 2: Quiz on Slides 49-51: 1. True 2. False 3. False 4. a 5. d Industrial Confined Space Rescue, Pt. 1: Quiz on Slides 74-76; 1. True 2. True 3. False 4. b 5. d Fire Medics – PHTLS Training 2: Quiz on Slides : 1. False 2. True 3. True 4. e 5. b TRAINING Working Fire Training 07-6 Training Materials


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