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1 Emergency Services, LLC / Copyright 2007 / Volume 07-101 TRAINING Click here to view this PowerPoint in its entirety Click here to view this PowerPoint in its entirety FIRE MEDICS PHTLS Training 6: Assessment & Management, Pt. 2PHTLS Training 6: Assessment & Management, Pt. 2 Quiz EVOLUTIONS 2000 Kramer vs. Kramer Program Quiz Answers FIRELINE Kentucky Train Derailment (expanded segment)Kentucky Train Derailment(expanded segment) Discussion Questions HANDS-ON Half-Attic Fires, Pt. 2 Quiz Rescue/Search Dogs, Pt. 3 Quiz Working Fire Training 07-10 Training Materials

2 Emergency Services, LLC / Copyright 2007 / Volume 07-102 TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show in its entirety Working Fire Training 07-10 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 07-103 DISPATCH/SIZE-UP Bullitt County, Kentucky, 20 miles south of Louisville Winds were from east to west but calm. A train derailment created a 2,000-foot plume of smoke. –25 cars of an 80-car CSX railroad train derailed. –Twelve were uprighted and taken to Louisville. –The remainder carried hazardous materials and had to be dealt with. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

4 Emergency Services, LLC / Copyright 2007 / Volume 07-104 DISPATCH/SIZE-UP Initial response on-scene (first-in engine and ladder) staged back 1,000 feet. En route to the scene, mutual aid was dispatched. –Okolona Fire sent an engine and a truck company once first-in responders were on scene. –Other mutual aid came later. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

5 Emergency Services, LLC / Copyright 2007 / Volume 07-105 INCIDENT COMMAND/INCIDENT ACTION PLAN Upon arrival, Incident Command called for more mutual aid. –Shepherdsville Fire was called and sent two ladder companies. I.C. immediately dispatched EMS. Dispatched water tankers (tenders) from Mt. Washington and Southeast Bullitt Fire Districts. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

6 Emergency Services, LLC / Copyright 2007 / Volume 07-106 INCIDENT COMMAND/INCIDENT ACTION PLAN I.C. set up Branch Command and appointed safety, planning, and liaison officers. –Unified Command was then instituted and that command post was moved to safer ground. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

7 Emergency Services, LLC / Copyright 2007 / Volume 07-107 INCIDENT COMMAND/INCIDENT ACTION PLAN Logistics –Adjacent Interstate 65 and local road 1020 were closed. –The smoke plume was 10 miles from the Louisville airport. –Restrictions were made on airspace above the fire to all aircraft at a radius of five miles. –Dispatched Region 6 WMD Haz-Mat trailer to a local hospital for decontaminations. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

8 Emergency Services, LLC / Copyright 2007 / Volume 07-108 STRATEGY/TACTICS Water Supply –A 12” main along Highway 1020 and another 8” main provided ample water supply. –At one point, firefighters were flowing 6600 gpm with no supply or pressure issues. Evacuations –Evacuations by EMS were ordered inside a mile radius. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

9 Emergency Services, LLC / Copyright 2007 / Volume 07-109 STRATEGY/TACTICS EMS –EMS began door-to-door evacuations. –Some 500 area residents were evacuated were temporarily evacuated. –Eleven potentially contaminated residents were taken to a pre-planned medical facility where they were deconned and released. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

10 Emergency Services, LLC / Copyright 2007 / Volume 07-1010 STRATEGY/TACTICS Fire Suppression –Set up three master streams on the south side and an engine company and a truck company on the north side of the incident. –Product was allowed to burn off with water and four master streams were used to control the fires. –Foam was eventually brought in from the Louisville Airport and approximately 3600 gallons were applied, starting with the cars carrying paper and plastic pellets. –Following that, water was used again. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

11 Emergency Services, LLC / Copyright 2007 / Volume 07-1011 STRATEGY/TACTICS Communications –Responders struggled with state and federal agencies not having the proper frequencies. –Local emergency responders (police, EMS, and fire) all had Zoneton’s frequencies and communicated well. Other agencies (CSX personnel, state fire marshal’s office, etc.) used rented portable radios similar to radios in the mobile command center. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

12 Emergency Services, LLC / Copyright 2007 / Volume 07-1012 STRATEGY/TACTICS Haz-Mat –Remediation & Assessment Since the cars were breached and torn apart, the only option was to let them burn. As long as they burn hot, the smoke goes high, and that removes the need to do remediation in the soil. Dams still had to be set up along all streams, creeks, reservoirs, water lines, and wells which were monitored by the EPA. All readings and monitoring results were within limits. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

13 Emergency Services, LLC / Copyright 2007 / Volume 07-1013 STRATEGY/TACTICS Haz-Mat –Remediation & Assessment (cont.) To check the danger of BLEVE, the state fire marshal and a CSX staffer made an assessment of the tanks to determine which were burning and whether they were breached or leaking, and how much of the contents remained. Pressure readings were also taken and revealed that the tanks were holding at approximately 60 psi. They reported to IC there was very little chance of a BLEVE. Responders continued to cool tanks and monitoring continued. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

14 Emergency Services, LLC / Copyright 2007 / Volume 07-1014 STRATEGY/TACTICS Haz-Mat –Specific Remediation One tank car leaking maleic anhydride was plugged by the state fire marshal and a CSX staffer. Four butadiene tankers were an ongoing problem. –IC wanted to get them off the tracks by moving them to a storage area. There were three options: »The full cars could be moved at full capacity. »Experts could blow tanker manways and ignite the chemical »They could initiate a dangerous flaring process. –Option #3 was chosen. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

15 Emergency Services, LLC / Copyright 2007 / Volume 07-1015 STRATEGY/TACTICS Haz-Mat –Specific Remediation Flaring Process –A pit was dug near the staging area. –Two-inch pipelines with manual valves to regulate product flow were laid from the cars to the pool. –Liquid nitrogen was used to pressurize the butadiene tanks to force the product through the lines. –Once the pipelines were laid by contractors and everything was inspected, IC gave approval to begin the process. »RIT was in place for safety purposes. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

16 Emergency Services, LLC / Copyright 2007 / Volume 07-1016 STRATEGY/TACTICS Haz-Mat –Specific Remediation (cont.) Flaring Process –A flare was then thrown into the pit to generate an ignition point. –It took 16 hours to transition from the flaring to venting process and a week to stabilize the scene. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

17 Emergency Services, LLC / Copyright 2007 / Volume 07-1017 STRATEGY/TACTICS Haz-Mat –Environmental Issues Two tankers carried cyclohexane. One tanker carried methyl ethyl ketone. Two tankers with maleic anhydride were later off-loaded to another pit and were transported to a hazardous materials disposal area approximately two weeks later. There was one empty chlorine tank car. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

18 Emergency Services, LLC / Copyright 2007 / Volume 07-1018 STRATEGY/TACTICS Haz-Mat –Environmental Issues 3500 tones of contaminated soil had to be mitigated. –It was taken to “the boneyard” where the 13 cars were moved to. –The soil was run through two sifters, sifting for train or rail car parts to be held for the NTSB and to sift the soil into a smaller compacted size and for taking EPA soil samples. 07-10 Training Materials Fireline Incident: Kentucky Train Derailment (Expanded Segment)

19 Emergency Services, LLC / Copyright 2007 / Volume 07-1019 EOC The Zoneton Fire Department had recently been remodeled to accommodate a 100-seat EOC with phones, wireless, TVs, and generator backup which really helped. Initially, the EOC was open for eight days. From Tuesday to Sunday, the EOC operated 24 hours a day with briefings at 5 a.m. and 5 p.m. with 70 people in attendance at any given time. As the incident deescalated, less people were required in the EOC and it was open only 12 hours a day with someone there to answer phones after that. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

20 Emergency Services, LLC / Copyright 2007 / Volume 07-1020 EOC After eight days, EOC operations were transferred to CSX railroad and the federal EPA. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

21 Emergency Services, LLC / Copyright 2007 / Volume 07-1021 EVENTS First units arrived and mutual aid was dispatched. Twenty-six minutes into the incident, a conductor and a train manifest were found. Railcar contents –Cyclohexane Affects the central nervous system if inhaled or ingested –Methyl Ethyl Ketone Causes skin and respiratory irritation –Aniline Fatal if swallowed or inhaled Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

22 Emergency Services, LLC / Copyright 2007 / Volume 07-1022 EVENTS Railcar contents (cont.) –Butadiene Damages the central nervous system –Also Maleic Anhydride Methionine Polyethylene Sulfuric Acid Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

23 Emergency Services, LLC / Copyright 2007 / Volume 07-1023 EVENTS Airspace to five miles out and adjacent highways were closed. Branch and Unified Command were set up. Fire suppression flowed 6600 gpm at one point and also used 3600 gallons of foam. Haz-Mat responded with dams set up on all adjacent bodies of water. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

24 Emergency Services, LLC / Copyright 2007 / Volume 07-1024 EVENTS To check the danger of BLEVE, an assessment of the tanks was done. –One leaking tanker was patched, Railcars were emptied using a flaring process. Soil was mitigated. The Ladies Auxiliary was heavily involved. 546 responders (from all agencies) worked at this incident. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

25 Emergency Services, LLC / Copyright 2007 / Volume 07-1025 REMARKS A decon facility had been preplanned for such an eventuality and was put into service. Foam application for fire suppression was delayed for about a day-and-a-half. –It was used later on after water brought the fire under control somewhat. The initial five-mile airspace restriction was reduced to three miles and 2000 feet after input from the airport and UPS (a primary airport user). Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

26 Emergency Services, LLC / Copyright 2007 / Volume 07-1026 REMARKS Include OSHA in Unified Command. Consider using alert sirens to get citizens to check local media to see what’s going on. Institute a plan of media briefings and pool reporting. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

27 Emergency Services, LLC / Copyright 2007 / Volume 07-1027 REMARKS Use Reverse 911 to evacuate residents in affected areas. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

28 Emergency Services, LLC / Copyright 2007 / Volume 07-1028 LESSONS LEARNED/BEST PRACTICES Set up Incident Command quickly, using NIMS procedures, and institute Unified Command. –No one from any agency tried to intercede because everyone was on the same page. Maintain communications between Unified Command and outside entities. Regarding safety, make sure key players are always involved, especially OSHA. Eventually you’ll need manpower, not apparatus. –Transport responders in from a remote staging area. –In this case, from the location of the EOC which was physically removed from the incident. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

29 Emergency Services, LLC / Copyright 2007 / Volume 07-1029 LESSONS LEARNED/BEST PRACTICES To release airspace restrictions once they’re in place will take a call to the duty officer at the state EOC office. Fireline Incident: Kentucky Train Derailment (Expanded Segment) 07-10 Training Materials

30 Emergency Services, LLC / Copyright 2007 / Volume 07-1030 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? 07-10 Training Materials

31 Emergency Services, LLC / Copyright 2007 / Volume 07-1031 Kentucky Train Derailment / Bullitt County, KY Fire Chief Robert L. Orkies, Zoneton (KY) Fire District As with all disasters of this magnitude, get the resources rolling ASAP. Are hazardous materials transported through your jurisdiction by rail? Do you have relationships with those rail carriers? Do you preplan or train for derailments or wrecks with them? Part of your preplan should include an analysis of water supply and access to it along the right-of-way. We were lucky; we had large mains to work with adjacent to the tracks. If you don’t, plan for water supply (shuttles, etc.) As you see, we had a witch’s brew of some very nasty chemicals. WEARING OF SCBA AND ALL PPE IS IMPERATIVE when responding to such an incident because of the airborne material and its caustic nature if inhaled or contacted. Fireline Incident Discussion 07-10 Training Materials

32 Emergency Services, LLC / Copyright 2007 / Volume 07-1032 Kentucky Train Derailment / Bullitt County, KY Fire Chief Robert L. Orkies, Zoneton (KY) Fire District Anticipate communications needs and possible frequency conflicts. An Interoperability Box such as the one featured in Working Fire Training Issue #07-8 is a really good idea. Be prepared to maintain and staff a local EOC 24 hours a day for as long as the incident is very active. You will have to interface with haz-mat and EPA agencies to work out a mitigation plan and arrange for the space and time to do it. Whenever airspace restrictions are involved, immediately contact your state EOC because you’ll need them to release the restriction when the time comes. Fireline Incident Discussion 07-10 Training Materials

33 Emergency Services, LLC / Copyright 2007 / Volume 07-1033 OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: the composition of yellow-orange smoke and its effects the pressure-driven nature of a fire in a confined space. CODES, STANDARDS & REGULATIONS NFPA 1410, Standard on Training for Initial Emergency Scene Operations NFPA 1710/1720, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career/Volunteer Fire Depts. NFPA 5000, Building Construction and Safety Code® Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

34 Emergency Services, LLC / Copyright 2007 / Volume 07-1034 YELLOW-ORANGE SMOKE COMPOSITION Wood is cellulose, a long polymer molecule consisting of carbon, hydrogen, and oxygen. If there were no oxygen in the cellulose polymer, it would yield 18,000 BTU per pound, the same as gasoline & fuel oils! Wood burning in an attic is similar to wood burning in a kiln, another low-oxygen venue (which is how charcoal is produced). Without sufficient oxygen, wood does not burn completely or cleanly. Instead it produces a lot of nasty components which are extremely FLAMMABLE! Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

35 Emergency Services, LLC / Copyright 2007 / Volume 07-1035 YELLOW-ORANGE SMOKE COMPOSITION For example, burning a ton of wood yields 600 lbs of charcoal – plus all of the following: –5,000 cubic feet of gases –47% Carbon Dioxide –30% Carbon Monoxide –10% Methane –3% Hydrogen –52 gallons of vapor and liquid –12 gallons of Acetic Acid Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

36 Emergency Services, LLC / Copyright 2007 / Volume 07-1036 YELLOW-ORANGE SMOKE COMPOSITION For example, burning a ton of wood yields 600 lbs of charcoal – plus all of the following (cont.): –3 gallons of Methanol (MEOH), or wood alcohol –.7 gallons of acetone (in fingernail polish remover) –22 gallons of water-soluble wood tars –3 gallons of light oils (aldehydes, esters, ketones, acids) –8 gallons of pine tar –3.5 gallons of cresol and creosote (known carcinogens). Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

37 Emergency Services, LLC / Copyright 2007 / Volume 07-1037 YELLOW-ORANGE SMOKE COMPOSITION That’s what’s in this yellow-orange smoke. –It’s ignitable and will do so EXPLOSIVELY! Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

38 Emergency Services, LLC / Copyright 2007 / Volume 07-1038 YELLOW-ORANGE SMOKE COMPOSITION Other facts –Also in that smoke are: Free radicals, pieces of chopped up molecules that can cause cancer Pine and wood tars that can accumulate on and obscure windows in a fire. If any PVC piping is involved, hydrochloric acid will be present. If any sulfur is involved, sulfuric acid will be present. Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

39 Emergency Services, LLC / Copyright 2007 / Volume 07-1039 PRESSURE-DRIVEN FIRES Chemistry explains part of the yellow-orange smoke’s explosive behavior, but that’s not all of it. Fire is a positive-pressure generating “engine.” –Our atmosphere consists of approximately 78% nitrogen and 21% oxygen. –As a fire heats a space, the nitrogen, which doesn’t burn, expands substantially. –As nitrogen is heated, like a heated propane tank about to BLEVE, its temperature and pressure both increase. –The internal pressure of a container of gas that’s heated to 1,000 degrees – a typical ceiling temperature in a fire -- will increase to 40 psi, assuming the container can hold it. Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

40 Emergency Services, LLC / Copyright 2007 / Volume 07-1040 PRESSURE-DRIVEN FIRES Fire is a positive-pressure generating “engine” (cont.). –Nitrogen under pressure creates positive pressure which pushes fire, making it move around and climb walls. Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

41 Emergency Services, LLC / Copyright 2007 / Volume 07-1041 PRESSURE-DRIVEN FIRES So combustible materials and pressure are what makes these half-attic confined space fires so dangerous. –Just as if you cut a charged hose line apart and water under pressure would shoot out, so can fire under pressure when released quickly from one of these hazardous confined spaces. Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

42 Emergency Services, LLC / Copyright 2007 / Volume 07-1042 PRESSURE-DRIVEN FIRES IF YOU ARE PULLING A CEILING OR OPENING A WALL ADJACENT TO ONE OF THESE SPACES CONTAINING FIRE, THIS IS THE DANGER!!! FIRE MAY ENGULF THE SPACE YOU ARE IN! BE SURE YOU HAVE A CHARGED HOSELINE READY! Hands-On: Half-Attic Fires, Pt. 2 07-10 Training Materials

43 Emergency Services, LLC / Copyright 2007 / Volume 07-1043 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ 1. True or False: Yellow-orange smoke indicates a fire burning with insufficient oxygen. 2. True or False: A fire in a hip wall, because it’s confined, poses no danger to firefighters. 3. True or False: A pressure-driven fire can chase you. 07-10 Training Materials Quiz: Half-Attic Fires, Pt. 2

44 Emergency Services, LLC / Copyright 2007 / Volume 07-1044 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. Which chemical is NOT found in yellow-orange smoke? a. Acetic acid b. Methanol c. Acetone d. Pine-Sol e. Cresol f. None of the above 07-10 Training Materials Quiz: Half-Attic Fires, Pt. 2

45 Emergency Services, LLC / Copyright 2007 / Volume 07-1045 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. The internal pressure of a container of gas that’s heated to 1,000 degrees will increase to _____ psi. a. 20 b. 40 c. 60 d. 80 e. None of the above (Answers on Slide 95) 07-10 Training Materials Quiz: Half-Attic Fires, Pt. 2 Printable quizzes follow the answers on slide 95 in the.PDF version of these training materials.

46 Emergency Services, LLC / Copyright 2007 / Volume 07-1046 OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: – procedures for a dog and water search team – how to conduct a search – how a dog alerts from a boat – the controversy surrounding PFDs on dogs. CODES, STANDARDS & REGULATIONS NFPA 1670: Standard on Operations and Training for Technical Search and Rescue Incidents Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials

47 Emergency Services, LLC / Copyright 2007 / Volume 07-1047 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials WATER SEARCH EXERCISE Search Simulation & Procedure –The dog team deploys a scent can under the water with a scent similar to human flesh. –Body oils come to the surface from a submerged body and that’s what the dog picks up on. –A search with the dog in the boat is conducted back and forth across the search cone, downwind from the supposed point of origin. –The point of origin is often based on reports of where the victim was last scene.

48 Emergency Services, LLC / Copyright 2007 / Volume 07-1048 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials WATER SEARCH EXERCISE Search Simulation & Procedure (cont.) –Working into the wind and based on the dog’s reactions, the search covers the width of the search cone and narrows back to the point of origin of the scent and, theoretically, the location of the victim.

49 Emergency Services, LLC / Copyright 2007 / Volume 07-1049 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials DOG RESPONSE The dog will give different alerts depending upon the breed. –The dog will use his nose and lick at the water as part of his sensing process to pick up the body oils off the water. –One of the dog’s alerts will be pawing at the water indicating she is picking up a scent. As the dog gets closer to the point of origin and the scent becomes stronger, she will act more excited.

50 Emergency Services, LLC / Copyright 2007 / Volume 07-1050 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials DOG RESPONSE As the boat moves into the wind, if the dog stops giving alerts, the search point has past the point of scent origin.

51 Emergency Services, LLC / Copyright 2007 / Volume 07-1051 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SEARCH TEAM This is at least a three-person operation: –Canine handler and dog –Boat pilot –The support person who operates as the eyes and ears for the pilot and the dog handler, watching for debris in the water, low-hanging branches, structures, etc. This person also helps control the dog as she moves around in the boat. (see below). Upon reaching the point of scent origin, the water team deploys an orange buoy. The team then continues to criss-cross the area to pinpoint the location more accurately.

52 Emergency Services, LLC / Copyright 2007 / Volume 07-1052 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials RECOVERY OPERATIONS Once the dog continues to react to that point, the decision is then made to either bring in divers or start a dragging operation. EARLY DOG TEAM ACTIVATION It’s important to call for the dog team early on. –In any kind of search and rescue operation where time is critical, call for assistance as soon as possible. –Early arrival can cut down on the man hours necessary to bring about a recovery.

53 Emergency Services, LLC / Copyright 2007 / Volume 07-1053 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SAFETY Protective Floatation Devices (PFDs) are worn by all humans in the boat. In calm, flat-water searches, the dog does not need to wear a PFD.

54 Emergency Services, LLC / Copyright 2007 / Volume 07-1054 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SAFETY However, there is an ongoing discussion as to whether the dog should wear a PFD in rough water. –There is a concern that the PFD will become a hindrance should the dog become entrapped and not able to work. –This discussion will continue. You should consult your own department protocol as to how to handle this situation.

55 Emergency Services, LLC / Copyright 2007 / Volume 07-1055 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SEARCH IN PROGRESS The search could be brief or it could take days, depending upon weather conditions, wind, and terrain on the bottom of the body of water. Not all dogs are capable of working on water (some just don’t like water) but many can be taught. Of those that are capable, they can only be worked for so long – usually 45 minutes to an hour. A dog will become very emotional once she picks up a scent.

56 Emergency Services, LLC / Copyright 2007 / Volume 07-1056 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SEARCH IN PROGRESS Not all water recovery efforts are successful, but canines can help eliminate bodies of water as possible places where the missing person might be. Dogs can also identify other places, such as islands in the body of water, as places that might harbor a missing person. –For example, using the wind, a canine might be able to locate a victim on shore.

57 Emergency Services, LLC / Copyright 2007 / Volume 07-1057 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SEARCH IN PROGRESS Upon picking up a scent, the dog will bark an alert. –The dog will move around in the boat, trying to position herself to receive the strongest scent. –This is where the support person in the boat comes in handy.

58 Emergency Services, LLC / Copyright 2007 / Volume 07-1058 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SERVICES PROVIDED Air scent searches to find people lost in a wilderness. –This happens a lot in winter with missing hunters. Finding victims involved in vehicle accidents who cannot be found. Alzheimer’s patients who have wandered away from nursing homes. Structural collapse where it is neither safe nor possible to search with people.

59 Emergency Services, LLC / Copyright 2007 / Volume 07-1059 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials SERVICES PROVIDED Confined space rescues where it is not practical nor possible to use a person for finding victims. Trench rescues where a canine can assist in keeping victims and responders safe. Searching airplane crash sites which can be very widespread. Searching for drowning victims Searching for forensic evidence (blood, etc.) and crime scene recognition to assist law enforcement.

60 Emergency Services, LLC / Copyright 2007 / Volume 07-1060 Hands-On: Rescue Dogs, Pt. 3 07-10 Training Materials CONTACT A TEAM To find a team in your area if your department doesn’t already have a relationship with one, contact your State Fire Marshal’s office for the location and resources of teams in your area.

61 Emergency Services, LLC / Copyright 2007 / Volume 07-1061 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: It’s not safe to have the dog walking around the boat. 2. True or False: The jury is still out as to whether a dog should wear a personal flotation device when working in a boat. 3. True or False: It’s advisable that a water search team be less than three people. 07-10 Training Materials Quiz: Rescue Dogs, Pt. 3

62 Emergency Services, LLC / Copyright 2007 / Volume 07-1062 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. A search pattern is performed in what kind of a pattern? a. Cylindrical b. Up and down c. First above, then under the water d. Criss-cross e. All of the above 07-10 Training Materials Quiz: Rescue Dogs, Pt. 3

63 Emergency Services, LLC / Copyright 2007 / Volume 07-1063 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. The search covers the width of the search ________. a. pyramid b. square c. cone d. circle e. None of the above. (Answers on Slide 95) 07-10 Training Materials Quiz: Rescue Dogs, Pt. 3 Printable quizzes follow the answers on slide 95 in the.PDF version of these training materials.

64 Emergency Services, LLC / Copyright 2007 / Volume 07-1064 OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: the basics and specifics of conducting the primary survey assessing trauma patients CODES, STANDARDS & REGULATIONS Pre-hospital Trauma Life Support Training, National Association of Emergency Medical Technicians and the American College of Surgeons. Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials

65 Emergency Services, LLC / Copyright 2007 / Volume 07-1065 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials AIRWAY Manual stabilization of the cervical spine. How is the airway assessed? –If the patient is conscious, just talking to her is one of the simplest ways. What interventions might be needed? –You’ll know by talking to the patient, observing her color, chest rise and fall, level of consciousness, how she responds to your voice, etc.

66 Emergency Services, LLC / Copyright 2007 / Volume 07-1066 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials AIRWAY Muscle tone is another great indicator – especially in children. –Bad muscle tone in children is a bad sign. You’ll know immediately if the patient needs oxygen (O 2 ), or a Bag Valve Mask (BVM) if she’s not breathing. –If the patient is having poor ventilation due to shallow breathing, provide some positive-pressure ventilation.

67 Emergency Services, LLC / Copyright 2007 / Volume 07-1067 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials BREATHING The stethoscope is our greatest tool. –Environmental noise (engines idling, highway traffic, radio chatter, etc.) may make it difficult to hear chest sounds. –You’ll have to decide whether you can trust your ears. Don’t just use your stethoscope as your only way to assess whether respiration has been compromised. –Use your eyes to observe respiratory signs and ask the patient straight out, “Are you having trouble breathing?”

68 Emergency Services, LLC / Copyright 2007 / Volume 07-1068 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials BREATHING Use your hands to palpate the chest and anterior and posterior neck; feel for deformities.

69 Emergency Services, LLC / Copyright 2007 / Volume 07-1069 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CIRCULATION Assess for and control external hemorrhage; check for immediate life threats. Assess perfusion. –Pulse Rate, quality, regularity, location –Skin Color, temperature, moisture, capillary refilling time

70 Emergency Services, LLC / Copyright 2007 / Volume 07-1070 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CIRCULATION Watch for signs of compensatory shock. –Sweaty “glow”, extremely high pulse, catecholamine and/or norephenephrine release, and circulatory pinch-down as the body forces blood to the vital organs.

71 Emergency Services, LLC / Copyright 2007 / Volume 07-1071 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CIRCULATION Capillary Refilling Time –With adults and children, it’s recommended to use a good core location like the sternum. –Do a nice push with your thumb on the sternum and see what kind of snap-back time you observe.

72 Emergency Services, LLC / Copyright 2007 / Volume 07-1072 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CIRCULATION Stay away from extremities because the body’s compensatory mechanisms may not give you a true indication.

73 Emergency Services, LLC / Copyright 2007 / Volume 07-1073 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DISABILITY/LEVEL OF CONSCIOUSNESS The Glasgow Coma Scale (GCS) is a great barometer to use to describe a patient’s level of disability. –The GCS is scored between 3 and 15, with 3 being the worst, and 15 the best. –It is composed of three parameters: Best Eye Response, Best Verbal Response Best Motor Response, as follows:

74 Emergency Services, LLC / Copyright 2007 / Volume 07-1074 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DISABILITY/LEVEL OF CONSCIOUSNESS The Glasgow Coma Scale (GCS) (cont.) –Best Eye Response: Spontaneously To verbal commands To pain No eye opening Give a verbal command: “Open your eyes!” to see if they follow commands. Use a tissue squeeze: supraorbital pressure, pressure to ear lobe, trapezoid pinch, and nail bed pressure are all used (the nail bed pressure may generate a spinal reflex and not a localizing response).

75 Emergency Services, LLC / Copyright 2007 / Volume 07-1075 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DISABILITY/LEVEL OF CONSCIOUSNESS The Glasgow Coma Scale (GCS) (cont.) –Best Verbal Response: Oriented Confused Inappropriate words Incomprehensible words No verbal response Ask the patient, “What happened to you?” to see if and how they respond. Add a “T” to the GCS score if patient is intubating so the ER will know the tube was in place when the test was conducted.

76 Emergency Services, LLC / Copyright 2007 / Volume 07-1076 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DISABILITY/LEVEL OF CONSCIOUSNESS The Glasgow Coma Scale (GCS) (cont.) –Best Motor Response: Obeys commands Localizes pain Withdrawal (from pain) Flexion (to pain) Extension (to pain) No motor response Give the command, “Hold up two fingers” and observe motor response. Use a tissue squeeze: supraorbital pressure, pressure to ear lobe, trapezoid pinch, and nail bed pressure as described above.

77 Emergency Services, LLC / Copyright 2007 / Volume 07-1077 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DISABILITY/LEVEL OF CONSCIOUSNESS The Glasgow Coma Scale (GCS) (cont.) –Best Motor Response: Other motor response tests include: –having the patient squeeze your hand –having her raise her arm if the arm has been cleared and has no deficits. You can conduct musculoskeletal exams all the way from head to toe.

78 Emergency Services, LLC / Copyright 2007 / Volume 07-1078 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DISABILITY/LEVEL OF CONSCIOUSNESS Pupils –Check the patient’s pupils Sometimes pupils are overlooked during the initial assessment, especially if we don’t have a pen light handy. But they can be covered later during C-spine immobilization when there is an obvious opportunity to check the eye, ears, and nose.

79 Emergency Services, LLC / Copyright 2007 / Volume 07-1079 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials EXPOSE/ENVIRONMENT Use your own discretion and good judgment about exposing patients to the environment (especially in cold weather) to check for life-threatening conditions. Conserving body heat is very important and should be a high priority if the patient must be exposed.

80 Emergency Services, LLC / Copyright 2007 / Volume 07-1080 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials SIMULTANEOUS ASSESSMENT It's easy to get distracted by a particularly ugly injury while a less-visible or non-visible injury such as head trauma may be life-threatening to the patient. Don’t overly focus on the other stuff but do all of your primary assessments.

81 Emergency Services, LLC / Copyright 2007 / Volume 07-1081 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DECISION-MAKING Trauma-related Accident Scene assessment Primary survey Life-threatening or multisystem injuries YesNo

82 Emergency Services, LLC / Copyright 2007 / Volume 07-1082 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DECISION-MAKING Trauma-related Accident (cont.) Initiate Rapid TransportSecondary Survey Reassess Secondary SurveyManage injuries as appropriate Initiate Transport YesNo

83 Emergency Services, LLC / Copyright 2007 / Volume 07-1083 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials DECISION-MAKING Your assessment will set the timetable for transport. –If it’s life-threatening, initiate transport immediately, regardless of what other injuries may be present. –A respiration-pulse-mental status (RPM) failure says you must get off the scene, regardless of the angulated fracture that may also be present.

84 Emergency Services, LLC / Copyright 2007 / Volume 07-1084 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CRITICAL TRAUMA PATIENT If the patient is: –unresponsive or unconscious –her radial pulse is absent, and –she had labored respirations in the 40s, continuing the primary assessment is pointless. Load and go! Start IVs and O 2 en route. If a patient did have a life-threatening injury that was not readily apparent and the primary survey IS conducted, no experienced provider should miss that injury. It should be picked up.

85 Emergency Services, LLC / Copyright 2007 / Volume 07-1085 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CRITICAL TRAUMA PATIENT Once a life-threatening injury is stabilized en route, a secondary survey should be conducted prior to arrival at the hospital if time allows. The critical trauma patient may have: –an inadequate or threatened airway –impaired ventilations. A patient who’s breathing 20 times per minute with no chest rise and fall is not oxygenating himself. Without good, deep, full respirations, that patient is in trouble!

86 Emergency Services, LLC / Copyright 2007 / Volume 07-1086 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CRITICAL TRAUMA PATIENT Check for signs of hemorrhage –Not all hemorrhages are external or visible. –Look for signs of internal sanguination. Check for signs of shock –Rapid, thready pulse –Altered level of consciousness –Moist, waxy skin All signs of the body compensating for the hemodynamic instability.

87 Emergency Services, LLC / Copyright 2007 / Volume 07-1087 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CRITICAL TRAUMA PATIENT Look for mechanisms of injury –Evidence that something is going on internally that you can’t see. Abnormal neurological status –Make eye contact with the patient and ask informational questions: “What’s your name? What’s the date? Where are you?” Penetrating Trauma –Not seen often, but when found in any core areas of the body (head, thorax, or abdomen), a penetrating trauma must be considered to be life-threatening.

88 Emergency Services, LLC / Copyright 2007 / Volume 07-1088 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials CRITICAL TRAUMA PATIENT Amputation or near-amputation –Again, not seen often, but depending upon what extremity is involved, it could be a life threat. –An amputated toe does not present the same issue that an amputation at the knee or mid-shaft of the femur does. Trauma combined with complicating factors –One example would be trauma with myocardial infarction (MI) or with pregnancy, diabetes, or burns. –Paramedics and EMTs must be smart and quick enough not to get caught up in the distracting issues but deal with the life threats first.

89 Emergency Services, LLC / Copyright 2007 / Volume 07-1089 Fire Medics: PHTLS 6: Assessment & Management, Pt. 2 07-10 Training Materials FIELD GUIDES All of this information is available in field guides so you don’t have to memorize it. –It is recommended that all EMS staff carry one. –Informed Guides publishes an excellent field guide for paramedics/EMTs and can be ordered through Working Fire Training at a discount. Call for information. Call 800-516-3473 or email to: info@workingfire.com

90 Emergency Services, LLC / Copyright 2007 / Volume 07-1090 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: Deep chest rise-and-fall means good oxygenation. 2. True or False: Good muscle tone in children is a good sign. 3. True or False: If life-threatening injuries are found, do a secondary survey before transporting. 07-10 Training Materials Quiz: PHTLS 6: Assessment & Management, Pt. 2

91 Emergency Services, LLC / Copyright 2007 / Volume 07-1091 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. The Glasgow Coma Scale is NOT used to assess: a. Mental Response b. Eye Response c. Motor Response d. Verbal Response e. None of the above 07-10 Training Materials Quiz: PHTLS 6: Assessment & Management, Pt. 2

92 Emergency Services, LLC / Copyright 2007 / Volume 07-1092 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. A patient is unresponsive or unconscious, his radial pulse is absent, and he has labored respirations in the 40s. What do you do? a. Load and go b. Start IVs c. Start O 2 d. All of the above e. None of the above Printable quizzes follow the answers on slide 95 in the.PDF version of these training materials. (Answers on Slide 95) 07-10 Training Materials Quiz: PHTLS 6: Assessment & Management, Pt. 2

93 Emergency Services, LLC / Copyright 2007 / Volume 07-1093 Kramer vs. Kramer Essay Questions Haz-Mat Responses: Air Pollution vs. Ground Contamination 1. Describe if and when circumstances could dictate that a fire department is better advised to let a fire burn rather than extinguish it. 2. In your opinion, which, in general, is more dangerous to the environment? A. Ground contamination from chemical runoff, or B. Air pollution from the same chemicals when allowed to burn. 3. Briefly outline a set of guidelines to help fire ground commanders decide when and when not to extinguish a fire. 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. 07-10 Training Materials Evolutions 2000 – Continuing Education

94 Emergency Services, LLC / Copyright 2007 / Volume 07-1094 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 07-10 Training Materials Evolutions 2000 – Continuing Education

95 Emergency Services, LLC / Copyright 2007 / Volume 07-1095 Thanks so much for viewing Working Fire Training! See you next month – stay safe! Answers: Hands-On – Half-Attic Fires, Pt. 2: Quiz on Slides 43-45: 1. True 2. False 3. True 4. d 5. b Rescue/Search Dogs, Pt. 3: Quiz on Slides 61-63: 1. False 2. True 3. False 4. d 5. c Fire Medics – PHTLS Training 6: Quiz on Slides 90-92: 1. True 2. True 3. False 4. a 5. d TRAINING Working Fire Training 07-10 Training Materials Printable quizzes follow these answers in the.PDF version of these training materials.


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