1. Emergency Services, LLC / Copyright 2007 / Volume 07-71 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 3: Thoracic TraumaPHTLS Training 3: Thoracic Trauma Quiz EVOLUTIONS 2000 Kramer vs. Kramer Program Quiz Answers FIRELINE Airplane High-Angle Rescue Church Fire Discussion Questions HANDS-ON Industrial Confined Space Training, Pt. 2Industrial Confined Space Training, Pt. 2 Quiz Harness-Hang Syndrome Quiz Working Fire Training 07-7 Training Materials

2. Emergency Services, LLC / Copyright 2007 / Volume 07-72 TRAINING Working Fire Training 07-7 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 07-73 DISPATCH/SIZE-UP General Conditions –The Knoxville (TN) Vertical Rescue Squad responded to a private plane crash in a wooded area at the bottom of a steep incline. –Because of the location of the crash, both city and rural agencies responded with more than 200 responders on scene. –Weather was clear and dry, temperature about 30 degrees. Fireline Incident: Airplane High-Angle Rescue 07-7 Training Materials

4. Emergency Services, LLC / Copyright 2007 / Volume 07-74 DISPATCH/SIZE-UP Condition of the Aircraft –The plane was suspended approximately 40 feet above the ground in a nose-dive position. –The left wing was sheared nearly completely off. The right wing was hung up into the fork of a dead tree and had a split in it. Pieces of the tree were stuck into the right fuselage near the tail. –The windscreen was out of the aircraft and the right door was open and bent forward. Fireline Incident: Airplane High-Angle Rescue 07-7 Training Materials

5. Emergency Services, LLC / Copyright 2007 / Volume 07-75 DISPATCH/SIZE-UP Patient Size-up –There were two occupants, the pilot and his wife. –From the ground, the pilot appeared to be in distress and some pain, but he was talking and responding to questions. –The pilot’s wife, the passenger, was more verbal, crying out, and was definitely conscious and alert. –The pilot indicated that they were both pinned at the knees. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

6. Emergency Services, LLC / Copyright 2007 / Volume 07-76 DISPATCH/SIZE-UP Situation Size-up –There were no obvious anchors. –There were no obvious trees close to the plane that could be used initially. –Rescuers couldn’t climb the tree since the plane was in it and not stable. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

7. Emergency Services, LLC / Copyright 2007 / Volume 07-77 INCIDENT COMMAND /INCIDENT ACTION PLAN The plan was to reach and assess the occupants and to stabilize the aircraft for a rescue. Create a lowering system Extricate the patients Establish additional haul systems for raising the patients up a steep incline. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

8. Emergency Services, LLC / Copyright 2007 / Volume 07-78 STRATEGY/TACTICS Rescuers tried a church or steeple ladder raise (also called an auditorium raise) where an extension ladder (here, a 35-footer) is erected vertically and held in balance by four ropes. –Used in training to build confidence and trust, it’s rarely used in actual rescues. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

9. Emergency Services, LLC / Copyright 2007 / Volume 07-79 STRATEGY/TACTICS The ladder was rigged in the most desirable position and angle, and was placed “uphill” toward the tree so the ladder would reach the plane. Rescuers were careful not to touch the plane with the ladder as the stability of the aircraft was uncertain. –A firefighter/paramedic rescuer ascended the ladder to establish patient care and supply them with blankets. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

10. Emergency Services, LLC / Copyright 2007 / Volume 07-710 STRATEGY/TACTICS While there, the rescuer found a limb from which a high point anchor could be established. –This became the turning point of the entire rescue. –He attached some carabiners to a rescue rope for weight and tossed it over the limb and brought it down behind the plane, securing it at both ends. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

11. Emergency Services, LLC / Copyright 2007 / Volume 07-711 STRATEGY/TACTICS A new rescuer ascended and determined that he needed to step up on the back of the wing to reach the occupants. –There was some concern about this since the plane had not been stabilized. –He had an ascender tracking up the new line that had been rigged so he would be relatively safe. The rescuer rigged a high-point anchor system with a pulley. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

12. Emergency Services, LLC / Copyright 2007 / Volume 07-712 STRATEGY/TACTICS A ground hauling system was also set up with a 4:1 mechanical advantage piggyback system and a safety line. –This was run through a change-of-direction pulley to lower the occupants to the ground, once they were freed from the plane. Once the high point anchor was established, the plane was then secured using some huge rigging straps off the rescuers’ structural collapse truck. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

13. Emergency Services, LLC / Copyright 2007 / Volume 07-713 STRATEGY/TACTICS Pilot Rescue –Rescuers used a reciprocating saw to cut the A post on the aircraft. Upon doing so, the aircraft shifted a few inches so that idea was abandoned. –Instead, a Porta-Power kit was brought up and used inside the cockpit (a dash push) to free the pilot’s legs. –Upon removal from his pinned position, the pilot went into full cardiac arrest. –A doctor then ascended to assist with the patients and rescue. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

14. Emergency Services, LLC / Copyright 2007 / Volume 07-714 STRATEGY/TACTICS Pilot Rescue –The system was changed over to a lowering system and the doctor, using a ladder carry beneath the pilot, descended with him. –Upon reaching the ground, paramedics worked that full code arrest all the way to the hospital. –Three more hauling teams were needed to raise the patient in a Stokes basket up the steep incline to waiting transport. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

15. Emergency Services, LLC / Copyright 2007 / Volume 07-715 STRATEGY/TACTICS Passenger Rescue –The passenger was down on the floorboard area of the passenger side of the cockpit. With the engine and nose gear gone, she was right behind the firewall. –A rescuer took a hack saw and sawed the aluminum mount from the seat along with a seat cushion which were pinning her into the dash. –From that point, she was extricated the same way the pilot was. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

16. Emergency Services, LLC / Copyright 2007 / Volume 07-716 EVENTS A Church or Steeple Ladder Raise was put in place. This enabled a rescuer to be in a position to rig a high anchor point. A ground haul system was put in place. The plane was stabilized. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

17. Emergency Services, LLC / Copyright 2007 / Volume 07-717 EVENTS Workable extrication tactics were executed (a Porta-Power and a hack saw) to remove the pilot and passenger. Additional haul systems had to be put in place to bring the patients up a steep incline to transport units. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

18. Emergency Services, LLC / Copyright 2007 / Volume 07-718 REMARKS The main responding fire department had a new chief. He and his responders were both unfamiliar with each other and their capabilities. 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

19. Emergency Services, LLC / Copyright 2007 / Volume 07-719 LESSONS LEARNED Don’t meet mutual aid responders for the first time at an incident. –The best time is at a multi-agency training event where strategies and tactics can be developed and executed. Once your basic skills are in place, challenge yourself with hard, unusual scenarios where rescuers must “think outside the box.” 07-7 Training Materials Fireline Incident: Airplane High-Angle Rescue

20. Emergency Services, LLC / Copyright 2007 / Volume 07-720 DISPATCH/SIZE-UP Policeman who is also a firefighter arrived on scene less than a minute after dispatch. He drove around the church doing a size-up. He also called the department chief en route and advised a MABAS (Mutual Aid Box Alarm System). Apparatus were on scene in five minutes. Upon arrival, the church was heavily involved. 07-7 Training Materials Fireline Incident: Church Fire

21. Emergency Services, LLC / Copyright 2007 / Volume 07-721 INCIDENT COMMAND /INCIDENT ACTION PLAN IC arrived on scene, intending to bring fire under control. –MABAS box alarm had been struck. As the building had been stripped of its contents and was slated for demolition, the strategy was for a defensive stand, rather than jeopardizing personnel. The incident gave inexperienced firefighters a chance to train on a real fire. 07-7 Training Materials Fireline Incident: Church Fire

22. Emergency Services, LLC / Copyright 2007 / Volume 07-722 STRATEGY/TACTICS Called MABAS alarm. Turned out that mutual aid alarm might not have been necessary. Upon arrival, the department had every intention of putting the fire out but it became apparent that the structure was not savable. Initially, two pumpers and an aerial arrived on scene, deploying 2.5” and 1.74” hoses and a monitor, plus the master stream aerial. Department went defensive at that point. 07-7 Training Materials Fireline Incident: Church Fire

23. Emergency Services, LLC / Copyright 2007 / Volume 07-723 EVENTS Fire discovered by police on scene. Initial box alarm was called in. MABAS alarm was called. Shortly after apparatus arrived, structure was determined to be lost. State Fire Marshal was called a day later. 07-7 Training Materials Fireline Incident: Church Fire

24. Emergency Services, LLC / Copyright 2007 / Volume 07-724 REMARKS Building construction was a brick wall building with a wood frame ceiling. It had been scheduled for demolition and had been stripped of its contents. The building was to be razed to make way for new construction for a larger retailer. By the time water was ready to flow, the church was beyond saving. 07-7 Training Materials Fireline Incident: Church Fire

25. Emergency Services, LLC / Copyright 2007 / Volume 07-725 REMARKS Though no firm evidence of arson had been uncovered as of this writing, the fire was under suspicion due to: –the time of night –the building being vacant –the status of property ownership. The building had been purchased by a large retailer. Some residents were unhappy about that and picketing by citizens had occurred. 07-7 Training Materials Fireline Incident: Church Fire

26. Emergency Services, LLC / Copyright 2007 / Volume 07-726 REMARKS The building was under an EPA asbestos abatement program (in this case, Vermiculite contaminated with asbestos). –The fire then left a pile of the same material which still had to be abated by the EPA. 07-7 Training Materials Fireline Incident: Church Fire

27. Emergency Services, LLC / Copyright 2007 / Volume 07-727 LESSONS LEARNED In hindsight, the MABAS response was probably not necessary, as the building was beyond saving. –But it’s better to have extra help and not use it. You can always send them back. You don’t want to get tunnel vision. –Even though you want to put the fire out, be open to changing conditions and the possibility that your initial strategy might have to change. 07-7 Training Materials Fireline Incident: Church Fire

28. Emergency Services, LLC / Copyright 2007 / Volume 07-728 LESSONS LEARNED Command probably should have called in the state fire marshal while the fire was in progress as the fire appeared suspicious, rather than waiting until the following day. –This was not done because the building was of no value. Responders should always be aware of their surroundings when they arrive on scene. –Look for anything different or unusual; persons who should not be on scene or are leaving the scene, etc. 07-7 Training Materials Fireline Incident: Church Fire

29. Emergency Services, LLC / Copyright 2007 / Volume 07-729 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? 07-7 Training Materials

30. Emergency Services, LLC / Copyright 2007 / Volume 07-730 Airplane High-Angle Rescue / Knoxville, TN Captain Mike McCreary, Knoxville (TN) Rescue Squad This is a great example of why training is so important. One of our squad members remembered the Church or Steeple Ladder Raise from a previous training evolution that other rescuers hadn’t attended. His remembering it allowed us to bring an appropriate solution to the incident. Time was of the essence because of the severity of the injuries. However, the timeline was impacted by the difficult access to the plane. In spite of the urgency, take your time and plan your approach carefully and safely. You do not want rescuer casualties! In this case, having paramedics who were also trained in high- angle rescue really saved time. Encourage your paramedics (especially if they are not also fire/rescue-trained) to get some of this training. 07-7 Training Materials Fireline Incident Discussion

31. Emergency Services, LLC / Copyright 2007 / Volume 07-731 Church Fire Chief Dave Liebowitz, Silvis (IL) Fire Department Get fire investigation officials involved early with suspicious fires. Don’t be afraid to put mutual aid systems to work, even if it turns out later they might not have been necessary. Preplanning may or may not tip you off that asbestos might be present in a structure. You might assume it exists with all old buildings but it’s a good thing to ask about it in advance. Be sure your firefighters are wearing SCBA if you have any reason to believe that asbestos might be present – and then call the EPA. We breathe enough bad stuff despite our best efforts, so mask up whenever it makes sense. 07-7 Training Materials Fireline Incident Discussion

32. Emergency Services, LLC / Copyright 2007 / Volume 07-732 OBJECTIVES/OUTCOMES After watching this segment, the student shall learn about: the implications of a bad atmosphere in a confined space tactics for removing an inverted patient from a grain hopper tactics for dealing with Class 3 harnesses with dorsal attachment. CODES, STANDARDS & REGULATIONS OSHA 29 CFR 1910.146, Permit-Required Confined Spaces ANSI Z117.1-1989, Safety Requirements for Confined Spaces Hands-On: Industrial Confined Space Training, Pt. 2 07-7 Training Materials

33. Emergency Services, LLC / Copyright 2007 / Volume 07-733 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. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

34. Emergency Services, LLC / Copyright 2007 / Volume 07-734 CONFINED SPACE SIMULATOR This scenario is conducted in a confined space simulator simulating a grain or bulk storage hopper with three smooth sides which funnels down to a storage vessel below. It also has an auger pipe down below through which bulk materials would be transported up out of the storage area. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

35. Emergency Services, LLC / Copyright 2007 / Volume 07-735 SCENARIO ASSUMPTIONS We assume that the auger has been removed for maintenance. Also simulated is the presence of toluene, a benzene-like chemical found in such things as paint thinners, glue, resins, and epoxy products. These can leave residue behind. Human exposure to toluene must be limited! This presents time constraints! 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

36. Emergency Services, LLC / Copyright 2007 / Volume 07-736 SCENARIO ASSUMPTIONS In the real world, toluene might be present in the general atmosphere at a chemical plant for reasons not related to any particular scenario. At a real-world industrial venue, supplied air would probably be close at hand. We are assuming here that it’s not available, so space ventilation will be critical. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

37. Emergency Services, LLC / Copyright 2007 / Volume 07-737 SCENARIO BRIEFING In this scenario, there was a bulk material with toluene as a component. As the auger evacuated the material out of the storage area, a toluene residue was left behind. A worker in the vessel kicked up a vapor cloud and we assume that’s what has overcome him. –He is unconscious at the bottom of the auger pipe. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

38. Emergency Services, LLC / Copyright 2007 / Volume 07-738 Scenario Begins Preparation –Preplanning this space with plant personnel can really save time in ascertaining what chemicals might be involved. –The team leader realizes what’s happened and the team is actively ventilating the space. –As mentioned above, the team is unable to do a supplied air rescue at this time. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

39. Emergency Services, LLC / Copyright 2007 / Volume 07-739 Scenario Begins Confined Space Atmosphere Monitoring –Before lowering rescuers, atmosphere readings are taken again. –Initial monitor readings showed a low O 2 reading (14%) in conjunction with an LEL monitor reading of 40. If we have O 2 off the scale, then we can’t really trust what the LEL is doing. O 2 must be 20.9 before you can trust any other readings. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

40. Emergency Services, LLC / Copyright 2007 / Volume 07-740 Scenario Begins Confined Space Atmosphere Monitoring –Another point is that even though we know that Toluene has an LEL of 1.2%, toluene can’t be measured specifically with a typical 4-gas monitor. You would need a more industrial-style monitor such as the kind found in fixed installations. – The best we can do is get that oxygen level back up around 20.9, the calibration level, so our monitor readings will be accurate, as our basic monitoring keys off that. Refer to the Atmospheres Hands-On segment in 07-5. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

41. Emergency Services, LLC / Copyright 2007 / Volume 07-741 Scenario in Process Initial Rescue Procedure –The victim is trapped head-down, lying on his back in the auger tube and covering the dorsal attachment point on his basic Class 3 construction harness. –The rescue strategy is to lower rescuers into the space in suspension, trying not to touch the walls of the storage vessel to avoid disturbing any residual toluene present. –The rescuer will hook the victim to a haul system. –The first rescue is lowered into the space and inverts to do a scene size-up and to deal with the patient. –Be prepared to pull up or otherwise maneuver the air hose in the space to accommodate rescue work. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

42. Emergency Services, LLC / Copyright 2007 / Volume 07-742 Scenario in Process Rigging –Normal safety precautions in working around an open hole are to be followed including the handling of gear over the hole. –Two 4:1 mechanical advantage systems will be rigged; one for the rescuer and one for the victim. –These can be rigged off the same tripod if it is industrially rated. Otherwise, one line may go straight into the hole using edge protection. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

43. Emergency Services, LLC / Copyright 2007 / Volume 07-743 Scenario in Process Handcuff Knots –The initial plan was to lower the victim’s 4:1 haul system with handcuff knots. These would be attached to the victim’s ankles and have him be hauled out upside-down. This is not the safest way to lift a body and is not advisable unless urgency is required! Though the victim is simulated to be unconscious, our live “victim” indicated that the handcuff knots were very painful. –The rescuer tries to reposition the knots, but this plan may not work as conceived. –If the victim were indeed unconscious, rescuers wouldn’t know if the knots were painful or not – something to be considered. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

44. Emergency Services, LLC / Copyright 2007 / Volume 07-744 RETHINK ISSUES & CONSIDERATIONS At this point in the rescue, we have an unconscious victim in serious condition with a heart rate of 40 and respirations of 4. Time is becoming of the essence. The initial lifting strategy (by the ankles) is proving to be unworkable (in addition to concerns about its safety and possible discomfort to the victim, as mentioned above). 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

45. Emergency Services, LLC / Copyright 2007 / Volume 07-745 RETHINK ISSUES & CONSIDERATIONS The team also considered to haul him out inverted by hooking on to his harness in the front, but this was not advisable as the construction-style harness has only one dorsal point of attachment and is not rated for lifting any other way. –Adopting this method puts the victim at great risk. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

46. Emergency Services, LLC / Copyright 2007 / Volume 07-746 RETHINK ISSUES & CONSIDERATIONS Another Problem!! We started with a 14% O 2 reading and a 40% LEL reading which can’t be trusted because of the low O 2 reading. –After ventilation, the O 2 was back where it should be but we still can’t get an exact reading on the Toluene PPM anyway with a 4-gas monitor. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

47. Emergency Services, LLC / Copyright 2007 / Volume 07-747 RETHINK ISSUES & CONSIDERATIONS The rescuer has ignored warnings against kicking up any more toluene residue. –He says he feels fine but there is no question that the rescuer is now suffering from Toluene exposure. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

48. Emergency Services, LLC / Copyright 2007 / Volume 07-748 RETHINK ISSUES & CONSIDERATIONS The team leader has to make a decision about sending in a fresh rescuer. Notice how time consumption, changing conditions and resources used impact decision-making. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

49. Emergency Services, LLC / Copyright 2007 / Volume 07-749 NEW STRATEGY A fresh rescuer will go in the hole. Upon exiting, the first rescuer is rehabbed with fresh air. The new plan is to drop another 4:1 line (“blue line”) down which the rescuer connects to the front straps of the victim’s construction-grade harness. –This will only be done to uninvert the patient. The other 4:1 (“red line”) will pull the victim up by his ankles just enough that his head clears the auger tube. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

50. Emergency Services, LLC / Copyright 2007 / Volume 07-750 NEW STRATEGY The victim will then be un-inverted (turned right-side up), the blue line 4:1 will be hooked to the dorsal attachment, and the victim will be hauled up. The rescuer commands the haul team to pull the “red rope” (handcuff knot haul line on ankles) until the victim’s head clears the auger tube. The haul team then lowers on the red line and raises on the blue line to un-invert the victim. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

51. Emergency Services, LLC / Copyright 2007 / Volume 07-751 NEW STRATEGY Both lines are then lowered until the victim is resting on the wall of the hopper. The rescuer can then reattach the blue line to the dorsal attachment. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

52. Emergency Services, LLC / Copyright 2007 / Volume 07-752 CONFINED SPACE TRIAGE As rescuer and victim were being hauled out, the monitor sounded, indicating 11% on LEL. This presents an important decision to be made: who comes out first, the victim or the rescuer? Given the amount of time the victim has been in the hole, he/she probably needs air the most. In fact, we know the victim’s vital signs are marginal. However, the rescuer has been exposed to the toluene as well -- but we know he is alive. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

53. Emergency Services, LLC / Copyright 2007 / Volume 07-753 CONFINED SPACE TRIAGE We save the one we know has the best chance and certainly we do all we can to keep responders safe. The smart decision is to bring up the rescuer first. ALTERNATIVES The atmosphere and a relative inconvenient position of the victim worked together to force changes in team strategy decisions. The atmosphere caused time to be another variable in play. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

54. Emergency Services, LLC / Copyright 2007 / Volume 07-754 ALTERNATIVES Dragging the victim out by the ankles might have been quicker, in spite of causing the pain to the victim. –Of course, we wouldn’t have known that had the victim been truly unconscious – because of that, that tactic might have been employed. One would have to balance the pain incurred vs. faster (but less safe) extraction. An ankle haul is not the safest way as the handcuff knots might slip. –However, as the inverted victim being raised passed the rescuer, with another line in the hole, he could have snapped the other line on to the dorsal attachment as a safety. –In this case, the safety would be more certain than the main line. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

55. Emergency Services, LLC / Copyright 2007 / Volume 07-755 ALTERNATIVES Another, similar option would have been to lower the rescuer, have him roll the victim over enough to make the dorsal attachment to his own (the rescuer’s) harness. Then haul both out together with the victim inverted, using the red ankle line as a safety, but not bearing the weight of the haul (the reverse of the previous option). –Both would arrive at the top together with the victim slightly underneath the rescuer. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

56. Emergency Services, LLC / Copyright 2007 / Volume 07-756 ALTERNATIVES Then haul both out together with the victim inverted, using the red ankle line as a safety, but not bearing the weight of the haul (the reverse of the previous option)(cont.) –Extra lines in the hole make these options possible. –Consider rigging extra lines when the parameters of the rescue get complicated. LESSONS LEARNED As mentioned above, preplanning confined spaces with plant personnel can really save time in ascertaining what chemical might be involved. 07-7 Training Materials Hands-On: Industrial Confined Space Training, Pt. 2

57. Emergency Services, LLC / Copyright 2007 / Volume 07-757 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: The O 2 concentration really has no affect on the LEL monitoring of other gases. 2. True or False: Supplied air breathing apparatus could really be a great alternative if it’s available. 3. True or False: Toluene is often found in industrial environments. Just take its reading on your basic, 4-gas monitor. 07-7 Training Materials Quiz: Industrial Confined Space Training, Pt. 2

58. Emergency Services, LLC / Copyright 2007 / Volume 07-758 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. A confined space rescuer might work inverted because: a. it’s easier to breathe that way b. It’s easier to reach and work with the victim c. the confined space might not allow you to work inverted later. d. All of the above e. Two of the above f. None of the above 07-7 Training Materials Quiz: Industrial Confined Space Training, Pt. 2

59. Emergency Services, LLC / Copyright 2007 / Volume 07-759 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. Which issues are most important in making command decisions during a confined space rescue? a. Environment/atmosphere issues b. Manpower deployment c. Status of the victim d. Parameters/limitations of the space itself e. All of the above Printable quizzes following the answers on slide 108 07-7 Training Materials Quiz: Industrial Confined Space Training, Pt. 2

60. Emergency Services, LLC / Copyright 2007 / Volume 07-760 OBJECTIVES/OUTCOMES After watching this segment, the student shall learn about: the conditions where Harness-Hang may occur short-term tactics for dealing with Harness-Hang during rescue proper post-rescue patient care and information to be communicated to the receiving hospital. CODES, STANDARDS & REGULATIONS OSHA Standards 29 CFR 1926.500, Safety and Health Regulations for Construction, Fall Protection 29 CFR 1926.104 a-f, Safety belts, lifelines, and lanyards Hands-On: Harness-Hang Syndrome 07-7 Training Materials

61. Emergency Services, LLC / Copyright 2007 / Volume 07-761 SIZE-UP/PROBLEM IN EVIDENCE Prior to OSHA harness/fall protection regulations, when workers slipped and fell while working, they fell to the ground. Therefore, when rescuers arrived on scene, they dealt with injuries resulting from a fall. Now when workers fall when aloft, instead of falling to the ground, they often become caught by their harnesses. That’s a good thing, but problems can result. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

62. Emergency Services, LLC / Copyright 2007 / Volume 07-762 THE HARNESS The basic Class 3 construction harness has a dorsal attachment point located in the middle of the back of the harness, between the shoulder blades. –When hanging, the harness will be suspended by not more than a six-foot lanyard (required by OSHA). The problem is, once the victim has fallen and is hanging suspended from the back between the shoulders, he can’t pull himself up, and must be rescued from that situation. –In the meantime, his circulation, particularly in the legs, will be compromised. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

63. Emergency Services, LLC / Copyright 2007 / Volume 07-763 RESCUE WARNINGS Upon arrival on scene, if the victim is conscious, tell him/her to move. –This will help maintain circulation, thereby avoiding occlusion of the blood in the lower limbs. If the victim is unconscious or can’t move, this is a very serious event. –Blood continues to be pumped but isn’t returned to the heart. –Blood starts to pool. –It becomes unoxygenated. –It builds up toxicity. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

64. Emergency Services, LLC / Copyright 2007 / Volume 07-764 RESCUE WARNINGS Tests conducted on Harness-Hang conclude that a hanging victim will sustain serious injury within 6-10 minutes. No one has lasted longer than 10 minutes. In Golden Hour terms, these are the “Platinum 10 Minutes.” Once the victim is unconscious, this is a load-and-go event. These people must be rescued immediately! 07-7 Training Materials Hands-On: Harness-Hang Syndrome

65. Emergency Services, LLC / Copyright 2007 / Volume 07-765 TRANSPORT WARNINGS Once rescued, procedures must change! You can’t just put the patient on a stretcher or gurney and transport. –If you do, all that unoxygenated blood with high toxicity has a clear path to the heart and when it gets there, cardiac arrest will occur! Keep the patient sitting up or perhaps in a kneeling position to allow the blood flow to reach the heart slowly. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

66. Emergency Services, LLC / Copyright 2007 / Volume 07-766 TRANSPORT WARNINGS Upon reaching the Emergency Room, the ER staff must be informed that the patient was in a harness- hang situation. –They may or may not understand the significance of that! Be prepared to explain it! 07-7 Training Materials Hands-On: Harness-Hang Syndrome

67. Emergency Services, LLC / Copyright 2007 / Volume 07-767 TRANSPORT WARNINGS Communicate the fact that blood toxicity levels are high. –This condition can be easily counteracted, but ER personnel must know about it. –Blood tests will have to be run so a course of treatment may be started. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

68. Emergency Services, LLC / Copyright 2007 / Volume 07-768 TREE TRIMMER INCIDENT In one incident, a tree trimmer had accidentally touched a hot power line while aloft and kept going in and out of consciousness. However, in this case, the worker was wearing a seat-style harness, which allowed him to slump over during unconsciousness, rather than being suspended from behind his back. –As he would slump over, his head and heart would go below his waist, returning circulation to his brain and he would revive – only to repeat the process. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

69. Emergency Services, LLC / Copyright 2007 / Volume 07-769 TREE TRIMMER INCIDENT In this case, the victim was encouraged to move. Even just moving the toes and legs slightly will help a great deal toward maintaining blood circulation and reducing toxicity. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

70. Emergency Services, LLC / Copyright 2007 / Volume 07-770 RESCUE TIPS Let’s assume your victim is hanging 12-15 above the ground and is maintaining consciousness. –One thing you can do is take a length of pipe or a timber that’s long enough and position it under the victim so it gives him something he can step up on to. – This will relieve the pressure on his legs long enough until a rescue can be accomplished. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

71. Emergency Services, LLC / Copyright 2007 / Volume 07-771 RESCUE TIPS Another self-rescue product that is available is a piece of webbing constructed like a ladder. –It comes in a pouch which can be attached to the harness. –Upon deployment, it allows the victim to stand and put weight on her legs, thereby decreasing body weight on the harness and allowing circulation to continue until rescue. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

72. Emergency Services, LLC / Copyright 2007 / Volume 07-772 RESCUE TIPS If possible, rig a temporary safety line that will allow the victim to take his weight off his harness. The victim could use her hands to create a loop/step for her foot and then “step up” into the loop on the safety line. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

73. Emergency Services, LLC / Copyright 2007 / Volume 07-773 SUMMARY Encourage the victim to keep moving – not wild motions that will expend energy – but even moving the feet and toes will help maintain circulation through the legs. Use the techniques mentioned above if possible to maintain circulation. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

74. Emergency Services, LLC / Copyright 2007 / Volume 07-774 SUMMARY If these techniques are not possible, immediately following the rescue, rather than reclining the patient, take care to keep the victim in a kneeling or sitting position. The body will have a chance to reduce its blood toxicity rather than allowing such tainted blood to reach the heart all at once via a prone position. –This will help prevent cardiac arrest, an otherwise likely event. 07-7 Training Materials Hands-On: Harness-Hang Syndrome

75. Emergency Services, LLC / Copyright 2007 / Volume 07-775 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: As blood starts to pool, toxicity will be increased. 2. True or False: An unconscious victim cannot be affected by Harness-Hang. 3. True or False: You can count on Hospital ER workers knowing about Harness-Hang syndrome. 07-7 Training Materials Quiz: Harness-Hang Syndrome

76. Emergency Services, LLC / Copyright 2007 / Volume 07-776 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. Once lowered to the ground, a Harness-Hang patient should NOT: a. lay down b. kneel c. be put in a seated position d. Stand up e. All of the above f. None of the above 07-7 Training Materials Quiz: Harness-Hang Syndrome

77. Emergency Services, LLC / Copyright 2007 / Volume 07-777 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. Short-term techniques the victim can employ prior to rescue include: a. encouraging him/her to move legs and/or position b. position a ladder or pole under the victim so he/she may step up and unweight the harness c. the deployment of a webbing ladder which may be hooked to the harness attachment point so the victim may step up on to it. d. All of the above. e. None of the above. 07-7 Training Materials Quiz: Harness-Hang Syndrome Printable quizzes following answers on slide 108

78. Emergency Services, LLC / Copyright 2007 / Volume 07-778 OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: the physiology and operation of the thorax how certain trauma impacts that physiology and operation what kinds of injuries may result from thoracic trauma. 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 3: Thoracic Trauma 07-7 Training Materials

79. Emergency Services, LLC / Copyright 2007 / Volume 07-779 PHYSIOLOGY A lot goes on in the thoracic area that’s involved in a lot of trauma, frequently mortality and morbidity, but there are some things we can do to save people’s lives that are very dramatic and rewarding. During inspiration, the diaphragm goes down, the ribs separate a little bit, and the negative-pressure space of the pleural area allows the atmospheric air to come in. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

80. Emergency Services, LLC / Copyright 2007 / Volume 07-780 PHYSIOLOGY During expiration, we do the opposite. The diaphragm goes up, the chest cavity bellows in and the air goes out. However, if we’re not getting enough oxygen or we’re building up too much CO 2, other muscles and body parts will become involved as a reaction to the desire to breathe: –muscles in the neck (sterno-mastoids) –the back (latissimus dorsi, serratus anterior and posterior) –flaring nostrils of the nose All will be fighting to move air in. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

81. Emergency Services, LLC / Copyright 2007 / Volume 07-781 GAS EXCHANGE The delivery of oxygen into the body and CO 2 coming back from our metabolism all comes from the blood passing by under low pressure. –Breathing is all about getting air and blood to the alveolar sack. –When we have a trauma, it doesn’t get there. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

82. Emergency Services, LLC / Copyright 2007 / Volume 07-782 GAS EXCHANGE Thoracic trauma can interfere with gas exchange in the lungs if the alveolar sacks get torn, bruised, ruptured, or fill up with blood. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

83. Emergency Services, LLC / Copyright 2007 / Volume 07-783 THORACIC ASSESSMENT Observation –Presence of breathing. –Check for patients who might be straining their neck, using accessory muscles, flaring nose –Rate of breathing When calculating the Revised Trauma Score (www.trauma.org), the rate of respiration is very important.www.trauma.org Varying degrees of respiration rates mean trouble. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

84. Emergency Services, LLC / Copyright 2007 / Volume 07-784 THORACIC ASSESSMENT Auscultation –Listening for air sounds with a stethoscope. Palpation –Feeling the chest can tell you whether or not things are in proper position. –Palpation may reveal the crepitus associated with broken ribs. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

85. Emergency Services, LLC / Copyright 2007 / Volume 07-785 THORACIC ASSESSMENT Palpation –Tension pneumothorax is also something you can feel. Classic signs of a tension pneumothorax are: –deviation of the trachea away from the side with the tension – a hyper-expanded chest that moves little with respiration. –an increased percussion note. –The central venous pressure is usually raised, but will be normal or low in hypovolaemic states. –By listening, if full of air, the chest would sound very hollow. »i.e., If it were full of blood, it would sound dense. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

86. Emergency Services, LLC / Copyright 2007 / Volume 07-786 THORACIC TRAUMA Mechanisms of Injury: Blunt Trauma –Vehicle wrecks, high-speed impacts would bring blunt trauma. –Example A 33 year-old motorcyclist loses control of his bike. You find him lying on the gravel in obvious ventilatory distress. He admits to having had “one beer.” 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

87. Emergency Services, LLC / Copyright 2007 / Volume 07-787 THORACIC TRAUMA Mechanisms of Injury: Blunt Trauma –Example (cont.) Primary Survey –A. Patent airway –B. Paradoxical motion of the right chest, diminished BS on the right side, VR rapid. –C. No external bleeding, radial pulse fast –D. GCS score 14 (E-4, V-4, M-6) 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

88. Emergency Services, LLC / Copyright 2007 / Volume 07-788 THORACIC TRAUMA Mechanisms of Injury: Blunt Trauma –What injuries do you suspect? –There is a lot of kinematic energy present. One injury might be a flail chest which is identified as paradoxical movement of a segment of the chest wall –i.e., indrawing on inspiration and moving outwards on expiration. It’s caused by multiple broken ribs in multiple places. –This is often better appreciated by palpation than by inspection. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

89. Emergency Services, LLC / Copyright 2007 / Volume 07-789 THORACIC TRAUMA Mechanisms of Injury: Blunt Trauma –How would you manage this patient? Maintain airway Apply a bulky dressing (bandage) to try and stabilize the paradoxical movement. Provide extensive oxygen support with BVM (bag valve mask) if necessary. Perform ongoing assessments for pneumothorax and other respiratory complications. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

90. Emergency Services, LLC / Copyright 2007 / Volume 07-790 THORACIC TRAUMA Mechanisms of Injury: Penetrating Trauma –Gunshots, knife wounds or impalements would be examples of penetrating trauma. –Example An intoxicated 50 year-old male is found with a self-inflicted injury to his left chest. A steak knife is impaled in the left third intercostal space on the midclavicular line. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

91. Emergency Services, LLC / Copyright 2007 / Volume 07-791 THORACIC TRAUMA Mechanisms of Injury: Penetrating Trauma –Example (cont.) Primary Survey –A. Patent airway –B. VR rapid normal BS bilaterally –C. No external bleeding, fast pulse rate, no palpable radial pulse, muffled heart tones –D. GCS score 14 (E-4, V-4, M-6) –E. JVD (jugular vein distention) noted 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

92. Emergency Services, LLC / Copyright 2007 / Volume 07-792 THORACIC TRAUMA Mechanisms of Injury: Penetrating Trauma –What do these findings suggest? Evidence in C on previous slide indicates the patient is going into cardiac shock with fluid in the pericardium. –Normally the pericardium contains just a few drops of lubricating fluid. –If blood collects there (maybe 300 cc or 10 oz.), that will collapse mainly the right ventricle, right atrium of this low-flow system and shut it down. –This suggests pericardial tamponade. »This is a difficult diagnosis in the field; in the hospital ultrasound readings make it easier. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

93. Emergency Services, LLC / Copyright 2007 / Volume 07-793 THORACIC TRAUMA Mechanisms of Injury: Penetrating Trauma –What is your management? This condition demands immediate hospitalization. In the field, fluids are the initial treatment to maintain normal blood pressure until pericardiocentesis can be performed. Medications that increase blood pressure may also help sustain the patient's life until the fluid is drained. The patient may be given oxygen; this reduces the workload on the heart by decreasing tissue demands for blood flow. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

94. Emergency Services, LLC / Copyright 2007 / Volume 07-794 BLUNT CARDIAC INJURY Blunt cardiac trauma can result in: –Contusion with possible electrical conduction disturbance –Acute valvular injury* –Rupture of the myocardial wall* –Disturbance medicine have improved to the point that they support patients with bruised hearts while they heal. *Fairly rare and severe enough that the patient would probably die en route to the hospital. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

95. Emergency Services, LLC / Copyright 2007 / Volume 07-795 BLUNT CARDIAC INJURY Blunt cardiac trauma result –Dysrhythmias are the most common manifestation –These injuries may mimic a myocardial infarction It has the same symptoms: –it looks the same on the EKG –the same enzymes, like troponin and serum troponins (STs) will go up. It’s an injury but it’s not caused by a coronary artery being blocked but by an outside injury due to force and/or impact. –With these injuries, shock is rarely seen. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

96. Emergency Services, LLC / Copyright 2007 / Volume 07-796 BLUNT CARDIAC INJURY Example –A 60 year-old female is involved in a head-on MVC. –Looking at the vehicle, you surmise that this was a high- energy impact. The steering wheel is bent and the patient denies using her seat belt. –The patient has been extricated upon your arrival. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

97. Emergency Services, LLC / Copyright 2007 / Volume 07-797 BLUNT CARDIAC INJURY Example (cont.) –Primary Survey A. Patent airway B. VR normal BS clear; bruising over sternum C. No external bleeding, irregular pulse, normal pulse rate D. GCS score 15 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

98. Emergency Services, LLC / Copyright 2007 / Volume 07-798 BLUNT CARDIAC INJURY What injuries do you suspect? –Cardiac contusion Sternums on older patients are thinner and washed out, and by not wearing her seat belt, hers undoubtedly took an impact. The impact energy was transmitted to the heart. Less of these are seen now due to airbag deployment. Something to think about –The irregular pulse is something you would monitor during transport, making sure that PVCs don’t start bundling with the patient going into ventricular tachycardia. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

99. Emergency Services, LLC / Copyright 2007 / Volume 07-799 BLUNT CARDIAC INJURY How is this problem managed? –Getting more air to the heart will help it withstand the injury. –You might need to use some antiarrythmic medications. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

100. Emergency Services, LLC / Copyright 2007 / Volume 07-7100 VEHICLE CRASH VICTIM CARE Crash victim is complaining of chest pains –Would you treat the patient with aspirin for a possible MI? –Are the chest pains from the impact during the crash or a heart attack prior to? So, probably no to the aspirin. –The aspirin is for the person who is just sitting and has an MI because you’re trying to open up that coronary artery. This is different. In this case, the body is bruised and is trying to use platelets at that moment. Aspirin is an anti-platelet which would work against that. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

101. Emergency Services, LLC / Copyright 2007 / Volume 07-7101 VEHICLE CRASH VICTIM CARE If there were an accident and you’re not sure whether the MI symptoms came before the accident as a real heart attack or as a result of the accident, hold off on the aspirin. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

102. Emergency Services, LLC / Copyright 2007 / Volume 07-7102 SUMMARY The thoracic cavity contains the vital organs that oxygenate and distribute blood to the rest of the body. Only a few key interventions can be performed in the field. In an emergency, a small needle (such as a standard intravenous needle) may be placed into the chest cavity through the ribs to relieve pressure and allowing the lung to re-expand. Early recognition and management of thoracic injuries should result in improved patient outcomes. 07-7 Training Materials Fire Medics: PHTLS Training 3: Thoracic Trauma

103. Emergency Services, LLC / Copyright 2007 / Volume 07-7103 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: The gas exchange between O 2 and CO 2 involves the alveolar sack. 2. True or False: Three methods of thoracic assessment include observation, auscultation, and manipulation. 3. True or False: A crash victim is complaining of chest pains. Assuming he/she might be having an M.I., would you automatically treat the person with aspirin? 07-7 Training Materials Quiz: PHTLS Training 3: Thoracic Trauma

104. Emergency Services, LLC / Copyright 2007 / Volume 07-7104 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. Classic signs of a tension pneumothorax are: a. deviation of the trachea away from the side with the tension b. a hyper-expanded chest that moves little with respiration c. an increased percussion note d. the central venous pressure is usually raised. e. All of the above 07-7 Training Materials Quiz: PHTLS Training 3: Thoracic Trauma

105. Emergency Services, LLC / Copyright 2007 / Volume 07-7105 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. A flail chest would be indicated by: a. intact ribs b. a paradoxical movement c. outdrawing on inspiration d. moving inwards on expiration e. None of the above 07-7 Training Materials Quiz: PHTLS Training 3: Thoracic Trauma Printable quizzes following answers on slide 108

106. Emergency Services, LLC / Copyright 2007 / Volume 07-7106 Kramer vs. Kramer Essay Questions Asbestos Precautions 1. Should firefighters take extra precautions when fighting a fire inside a building containing asbestos? Why or why not? 2. Should firefighters take extra precautions on the exterior of a building known to contain asbestos and involved in a fire? 3. Describe a real or hypothetical structure fire involving large amounts of asbestos. What special actions, in your opinion, were taken or should have been taken? 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. 07-7 Training Materials Evolutions 2000 – Continuing Education

107. Emergency Services, LLC / Copyright 2007 / Volume 07-7107 ENROLLMENT INFORMATION: For more information on enrolling in the Open Learning program to gain college credit, call Working Fire Training at 800-516-3473 for a brochure or, to register directly, call the University of Cincinnati at 513- 556-6583. 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 45206 07-7 Training Materials Evolutions 2000 – Continuing Education

108. Emergency Services, LLC / Copyright 2007 / Volume 07-7108 Thanks so much for viewing Working Fire Training! See you next month – stay safe! Answers: Hands-On – Industrial Confined Space Rescue, Pt. 2 : Quiz on Slides 57-59 1. False 2. True 3. False 4. e 5. e Harness-Hang Syndrome: Quiz on Slides 75-77 1. True 2. False 3. False 4. a 5. d Fire Medics – PHTLS Training 3: Quiz on Slides 103-105 1. True 2. False 3. False 4. e 5. b TRAINING Working Fire Training 07-7 Training Materials