Understanding Emergency Service Capabilities

the Synergist

Why Your Safety Plan Must Go Beyond Calling 911

BY MIKE BEWLEY

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During my 23 years with the Austin Fire Department, in my time as planning section supervisor of the Texas Division of Emergency Management, and then in my career as a public safety professional, I have realized that it is not enough for an organization’s emergency safety plan to conclude simply with the provision to call 911. However, many safety professionals have no idea of the operational implications of relying on public safety, particularly the fire and emergency medical services, to mitigate gaps in their safety plans. Any safety and emergency response plan must rely on an accurate assessment of the relevant emergency situation and fully address potential incidents that are present in the work environment.

THE ROLES OF EMERGENCY SERVICES For any emergency incident, it is important to define the roles of police, fire, and emergency medical services in the response. Under the Incident Command System, the lead agency in a multi-agency response is determined by the type of incident. If the incident is a crime or involves violence, law enforcement is the lead agency to address the response; the FBI is the lead agency for any terrorist incident.

For most, if not all, other types of responses, including fire, rescue, and hazardous materials incidents, the fire service is the lead agency. EMS will rarely be the lead agency in a response because their role is to manage patients that have been delivered to them by the fire service. Fire services and EMS will be involved in almost every rescue incident involving an injured employee at a work site. Take the example of a multi-car collision on a busy freeway at rush hour that results in several people trapped within cars: the fire service is the lead agency in this incident, responsible for extinguishing any fires and extricating victims; the role of the police is to manage traffic; and the EMS is responsible for triaging, treating, and transporting patients. The fire service’s incident commander should be located in the incident command post with the EMS and police incident commanders. An examination of the components of such a response is necessary to determine what incidents each of the agencies will address and which will be attempted. COMPONENTS OF ORDINARY FIRE SERVICE RESPONSE According to the National Fire Protection Association Code, the American Fire Service is designed to fight a structural fire in a dwelling with an area of 2,000 square feet or less with no basement exposure. The fire service is designed to address this type of incident but not high-rise fires, industrial fires, or rescues. In particular, the fire service is not designed for any complicated rescue scenario occurring in an industrial facility or construction site. Only 63 percent of fire departments in the U.S. meet the minimum staffing to fight a 2,000-square-foot house fire required under NFPA 1710, Standard for the Organization and Deployment for Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments. The fire service response is ordinarily composed of four types of apparatus: the engine, ladder truck, quint, and ambulance. Fire engine. The fire engine is the workhorse of the fire service, responding to all fires and medical calls and the first to arrive at rescue scenes. It carries 500 gallons of water, 1,000 feet of supply hose that can be hooked to a hydrant, and 400 feet of preconnected attack hose that is designed to fight a house fire, as well as a range of basic hand tools that might be used when attempting a rescue. Ladder truck. In addition to the 100-foot aerial ladder, the ladder truck carries the hydraulic shears colloquially called the “Jaws of Life,” gasoline-powered saws, and various hand tools. While the truck’s primary rescue capability is vehicle extrication, its crew’s role at a fire is to forcibly enter the fire building, conduct search and rescue, and then further open the building’s interior to expose hidden pockets of fire. Ladder trucks are most often housed with engines and will make medical calls if an engine is not available. Quint. A hybrid of a ladder truck and engine, the quint carries as much water as the engine—but less supply hose—as well as a ladder, the Jaws of Life, and a gasoline-powered saw, but fewer hand tools, as the water pump occupies most of the storage space. The hand tools are housed separately. Ambulance. Most often, the EMS is part of the fire service, although many cities use private ambulance services and in a few, such as Austin and Seattle, the EMS is a separate agency. The primary response capability of the EMS is early cardiac intervention: it is preferable to treat any heart arrhythmia, such as tachycardia or fibrillation, on the scene of the cardiac incident rather than to transport the patient to an emergency room. Paramedics will also attempt to treat status asthmaticus (prolonged asthma attack) or status epilepticus (prolonged seizure) on the scene. For critical, life-threatening injuries, the EMS crew attempts to secure an airway, insert an IV, and then drive immediately to a hospital, where the definitive intervention occurs in the operating room. FIRE SERVICE SPECIAL OPERATIONS Fire services also attempt to deal with “technical” rescues requiring specialized equipment and skills. NFPA 1006, Standard for Technical Rescue Personnel Professional Qualifications identifies nine rescue disciplines: rope rescue, surface water rescue, vehicle and machinery rescue, confined space rescue, structural collapse rescue, trench rescue, subterranean rescue, dive rescue, and wilderness rescue. To effectively address these incidents, specialized training and equipment is required. It is not feasible to maintain this training for every firefighter nor to equip every fire unit with the gear necessary, so the fire service uses established special operations units. These special operations units carry the Jaws of Life, life safety rope—which can only be used once—and all the additional rescue equipment required to deal with the scenarios listed above. These units also respond to hazardous materials incidents and will carry the relevant equipment for those as well.

The fire service is not designed for any complicated rescue scenario occurring in an industrial facility or construction site.

NFPA 1710 requires that in the case of a structure fire, all required personnel assemble on the scene within nine minutes from when a response is initiated. Special operations units are spread throughout a response area in order to arrive within the nine-minute time period.

The major flaw in this system is that these units are not waiting to be assigned solely to the rescue conditions above but are often also the units designated to respond to all fires, medical calls, and hazardous materials incidents within their response area. When a rescue condition develops inside the response envelope of any particular special operations station, it is likely that unit has been already assigned to another call, meaning the next closest special operations station has to make the response.

In addition, special operations stations tend to be located in the core of a city and next to major access highways and arterial roadways. The nine-minute response time is based on ordinary traffic conditions, not the congested traffic conditions that a major city might experience during rush hour, which increases the arrival time of any particular special operations unit.

CHALLENGING RESCUE SCENARIOS A typical rescue scenario associated with the construction industry can illustrate how constrained the incident timeline is for a successful rescue. For example, consider an employee whose fall is arrested by a harness in such a way that the employee is left dangling in the harness.

As explained in a 2015 article in the Journal of Emergency Medical Services, suspension trauma immediately starts a cascade of physiological events that can lead to the employee passing out with an obstructed airway. Death may result in healthy people within as little as 10 minutes. Even if the employee is removed from the harness before passing out, the metabolic process that occurs without oxygen present forces the muscles to shed large proteins that the kidneys cannot filter, resulting in renal failure. The blood that has pooled in the legs also contains potassium chloride that, if not managed carefully, could result in cardiac arrest when the tainted blood reaches the employee’s heart.

It would be extraordinarily challenging for fire service special operations and EMS units to arrive at the incident scene within the 10-minute window, since the nine-minute response threshold addresses only the arrival of equipment on the scene and does not take into consideration equipment setup and deployment.

In addition to the difficulty of emergency services arriving in time to save an employee’s life, the rescue itself is often difficult. Consider another common rescue scenario that might occur at a construction site: trench collapse.

In March 2013, two workers were trapped in a collapsed trench in the Pacific Palisades neighborhood of Los Angeles. The worker who survived was buried up to his waist and rescued after 5.5 hours. It took nine hours to recover the body of the second worker.

Emergencies such as those described here, requiring a rapid response time, a difficult rescue, or both to save an employee’s life, mean that it is not reasonable for an organization’s safety plan to rely on a 911 call as a fallback. LIMITS IN THE TRAINING OF RESCUE SERVICE PERSONNEL After graduating from the fire service academy, I was assigned to a special operations unit with the Austin Fire Department. I am certified as a rescue diver, swift water rescue technician, and master fire instructor. I also served as the field training officer for all three AFD shifts. (Fire departments typically organize personnel into three shift teams that rotate through 24 hours on and 48 hours off duty.) In my experience, it is almost impossible for the personnel assigned to special operations units to maintain proficiency in each of the nine rescue disciplines. In reality, these units are most proficient at the types of calls they respond to most often.

Table 1. Emergency service calls made to the Austin Fire Department and responded to by special operations units during 2010–2012 broken down by type, number, and percentage. Source: Austin Fire Department Special Operations.

Table 1 breaks down the number and percentage of each type of call that AFD’s special operations division responded to within a two-year period. Over 98 percent of AFD’s special operations division responses fell into only five categories: hazardous conditions, such as residents reporting that they smell gas in their homes; rescue conditions, which means that special operations units were assigned as a precaution; wilderness rescue, often involving an injured or disabled hiker; still water rescue, such as assisting people on a disabled boat or a stranded canoeist; and hazardous materials. The other types of rescue responses each made up less than one percentage point of the total. Trench rescue responses do not appear at all.

IMPLICATIONS FOR SAFETY PLANNING No plan is bulletproof: it is incumbent on safety professionals to recognize that however diligently they attempt to eliminate and mitigate safety incidents, they will occur. However, most safety plans do not cover the organization’s initial response to an incident before the arrival of emergency services. Understanding first responders’ capabilities, organizations must prepare a plan that bridges the 10 to 20-minute time period between the beginning of the incident, the arrival of emergency services, and the set up and deployment of appropriate resources. Safety, risk management, and industrial hygiene professionals’ safety planning should encompass the entirety of the incident event.

For operations in which an employee fatality may occur, safety precautions must take place before the operation begins and for every operation that the safety plan covers. This will not come about without substantial training, oversight, and cultural change in management. Organizational change can be hard, but the aftermath of an employee fatality is worse.

Returning to the examples discussed previously, OSHA requires rescue capabilities to be present at operations with confined space hazards but not for operations with employee fall hazards. In situations such as these, it is imperative that the organization has a rescue strategy because waiting for properly trained and equipped emergency services to arrive may take too long to save the employee. The only way to build this capability is for the organization to conduct correct training with the correct equipment—repeatedly. Skill levels diminish rapidly without repetition and practice.

While the training requirements to maintain basic firefighting skills are quite rigorous, the specialized skills needed to conduct special operations rescue are extraordinary. The result of this training, however, is that employees assigned to rescue feel confident in their abilities, and they can more rapidly and proficiently react to an emergency because they have mentally prepared for the incident through repeated training.

COLLABORATING WITH LOCAL FIRE SERVICES Nonetheless, certain rescue scenarios are beyond the capabilities or risk profile of an on-site rescue effort. In these cases, the organization should plan to meet and augment the response of emergency services. The best way to build this capability is to have fire services tour the facility or construction site. Organizing such an event may be difficult due to the three shifts that typically comprise a fire service rotation. All three shifts should tour the facility, and the group should include every fire unit that would respond to a technical rescue. During the tour, areas requiring technical rescues should be identified.

There may be different nomenclature for technical rescues used by different fire departments, but whatever the term is, it should be included in all safety planning documents and in the first information relayed to the public safety answering point—that is, the 911 dispatcher. The 911 caller should be able to clearly request the appropriate kind of technical rescue at the facility or work site’s street address. Including the term “technical rescue” prompts 911 dispatchers to redirect necessary resources more quickly than if they have to make the determination themselves.

On arrival, the fire service must be guided to the location of the incident. OEHS professionals should be prepared for the possibility of many units arriving behind the first. To reduce response time, it would be beneficial to choose a pre-identified staging area. Such planning is just as instrumental to the success of fire operations as it is to organizational emergency response efforts.

With a more accurate understanding of the operations and rescue capabilities of the American Fire Service, professionals in charge of employee safety and well-being can devise safety plans and actions to ensure that if employees are involved in a rescue incident despite the organization’s best efforts, every action is taken to ensure survivability.

MIKE BEWLEY, MBA, MA, CSP, spent 23 years in the Austin Fire Department, retiring with the rank of captain. While in AFD, Mike specialized in training for firefighter rescue, particularly in low-occurrence, high-risk scenarios. He is currently the safety manager for AFD.

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RESOURCES

Journal of Emergency Medical Services: “Redefining the Diagnosis and Treatment of Suspension Trauma” (June 2015).

Los Angeles Times: “Pacific Palisades Trench Accident Victim Dies, Second Man Rescued”(March 2013).