Chief Denies ALS Provider Access to Serious PI Scene

[FFD941 20]

(Full Story) Firefighterclosecalls.com

At a serious auto accident last week, one of the regular crews we work with showed up, and our IC (Chief of Dept.) stopped them from going into the "hot zone". Now, the young people entrapped would have benefited from ALS while extrication was in progress, but our policy for turnouts extends to everyone on scene.

Opinions?

[RWC130 594]

As a Volunteer Firefighter and EMT having been in similar situations

I would have to agree with the actions of the Fire Chief (I/C)

Obviously HAZARDS were present,

Fire Chief does have Control of the scene

He made the right call in interest of SAFETY!

EMS should have some type of PPE if in a "Hot Zone"

If you don't have PPE then you don't belong in a "Hot Zone"

have the patient(s) safely extricated and brought to you.

Just take a look at ALL of the NYS Department of Health EMS

Practical Exam Sheets "SCENE SIZE UP"

"DETERMINES THE SCENE IS SAFE"

It's a "C" Critical Failure!

Prob that for a GOOD REASON!

As much as we all want to rush in and help someone

No PPE is it SAFE?

Yes, it happens all the time EMS treating the patient without proper PPE during

a Pin Job such as C-Spine, Starting IV's, Admin O2/BVM and myself included have had

the pleasure of treating my own cuts and picking glass out of my ............!

SAFETY FIRST!

Just my TWO cents!

[Bnechis 3,961]

About adoz. years ago federal OSHA cited both Abbey Richmond and Empress for failing to provide proper PPE to their employee's at MVA's. The law ("William Stiger Act of 1970...General Duty Clause) requires employeers to protect their employees from hazards that they are likely to be exposed to (like, broken glass and sharp metal, and flash fire). They both went out and purchased turnout coats, gloves and helmets (I guess, legs are not needed). FDNY went out and equipped BEMS.

If more IC's would take responsibility, and keep people out who dont have proper PPE, then maybe the agencies will do the right thing an get the PPE that is needed.

Now the tough one is to keep the PD without PPE out of the hot zone.

[firemoose827 324]

About adoz. years ago federal OSHA sited both Abby Richmond and Empress for failing to provide proper PPE to there employee's at MVA's. The law ("William Stiger Act of 1970...General Duty Clause) requires employeers to protect their employees from hazards that they are likely to be exposed to (like, broken glass and sharp metal, and flash fire). They both went out and purchased turnout coats, gloves and helmets (I guess, legs are not needed). FDNY went out and equipped BEMS.

If more IC's would take responsability, and keep people out who dont have proper PPE, then maybe the agencies will do the right thing an get the PPE that is needed.

Now the tough one is to keep the PD without PPE out of the hot zone.

I agree with you. Luckily the IC had the brains to hold them back but at the same time not be a prick about it either. He didnt do it just to flash his authority he did it out of concern for the safety of the EMS Crew. He did the right thing.

Our squad bought us EMS turnouts, and they have helmets on the rigs with extrication gloves and goggles too. Anyone caught on the scene of an MVA without any of these will be brought up on charges. This stemmed from a call 2 years ago when a car rolled over on its side and there was a driver pinned under the steering wheel. One chief got on scene after the ambulance had already arrived to find the entire crew standing in or near gasoline leaking from the engine, and the engine still running. Needless to say the squad captain had the order in less than a month later and the entire squad now has to take "Fire Scene Support Operations" regardless if you are a firefighter or not.

[helicopper 1,050]

I don't disagree with the decision to require PPE during an extrication; I just wonder if the best time to communicate that requirement was during an extrication call? Had the chief previously notified this provider that they would not be allowed to operate without PPE in such conditions?

As is so often said, the time to exchange business cards or discuss problems is not during the call, it's in pre-planning, drills, and training.

Couldn't the Chief have provided the paramedic with an FD set of turnout gear so the patient would get the care he required on this particular call in a timely fashion and follow-up after the fact with agency as he did?

With regard to law enforcement and PPE in a "hot zone", are we now going to refer to every accident scene as a "hot zone"? You know there is an odor of gas at every gas station too, does that mean people will need PPE to fill up their cars (along with a second mortgage but that's a separate thread)? I'll be the first to harp on the need to properly equip all first responders but not every accident scene is a haz-mat nor is it a "hot zone" so what are we using for that determination?

Unfortunately, the age old question of who's in "control" of the scene arises again here... Can't we all agree that there is a shared responsibility for command and control? The FD has fire/rescue duties and law enforcement has investigative/evidentiary duties; each is of significant importance.

[Bnechis 3,961]

I don't disagree with the decision to require PPE during an extrication; I just wonder if the best time to communicate that requirement was during an extrication call? Had the chief previously notified this provider that they would not be allowed to operate without PPE in such conditions? As is so often said, the time to exchange business cards or discuss problems is not during the call, it's in pre-planning, drills, and training.

Very true. Hopefully they were advised prior.

Couldn't the Chief have provided the paramedic with an FD set of turnout gear so the patient would get the care he required on this particular call in a timely fashion and follow-up after the fact with agency as he did?

Not likely. Most FD's dont carry spare gear on calls. It use to be common to see VFD rigs with gear racks, but I've not seen that on any new rig in 20 yrs. Proper sizing is important to safety and its not likely that he will have ff's give up gear for another agency.

With regard to law enforcement and PPE in a "hot zone", are we now going to refer to every accident scene as a "hot zone"? You know there is an odor of gas at every gas station too, does that mean people will need PPE to fill up their cars (along with a second mortgage but that's a separate thread)? I'll be the first to harp on the need to properly equip all first responders but not every accident scene is a haz-mat nor is it a "hot zone" so what are we using for that determination?

My issue with law enforcement and the "hot zone" was more geared toward the ESU officers wearing gloves, a bump cap and short sleeve shirts while activly performing extrication. Other threads have complained of FF's wearing polester under turnout, but if an officer without turnouts is exposed to a flash fire, that uniform will be the last one he ever has (at least until the burn unit scrapes it off him).

If people understode and respected the hazards of gasoline they might. We all know its flammable, but did you know that its vapor can travel 15 feet/sec. that means when your filling up and the driver infront of you lights up, it could flash back to you. Gasoline and all other fluids & gasses when they are flowing creat a static charge that can (and has) ignited itself. This is particularly a problem if you get in and out of your vehicing during fueling (thats why NYS UFP&BC Code requires no latches on the nozzle at self serve pumps) Its also a problem if your filling plastic cans (particularly in the coated pick-up truck bed). And lastly the maincomponent in Gasoline is Benzene, a known human carsanogenic. The NIOSH recomended maximum exposure to this is ZERO. A 100 years ago (before gasoline and other petrolium based products) knowbody got cancer....hmmmmm Maybe this is why the Plastic industry (based on petrolium) keeps advertising how important plastics are to our survival...It will take another 100 yrs before they will be sued like big tabaco.

Unfortunately, the age old question of who's in "control" of the scene arises again here... Can't we all agree that there is a shared responsibility for command and control? The FD has fire/rescue duties and law enforcement has investigative/evidentiary duties; each is of significant importance.

Agreed. In NR this issues are clearly defined and both side understand this.

[MFVFD179 0]

Not likely. Most FD's dont carry spare gear on calls. It use to be common to see VFD rigs with gear racks, but I've not seen that on any new rig in 20 yrs. Proper sizing is important to safety and its not likely that he will have ff's give up gear for another agency.

Are you talking about career FD about spare gear or just VFD because I would say thats not entirely true (about VFD). All of our trucks (except our brush truck) have spare sets of gear. I do believe it was required for us to put gear on our newest trucks (2006 Marion, 2004 Marion, 2002 Saulsbury) but I'm not positive. Our two ambulances have turn out coats, helmets, and goggles for the crew at accident scenes.

If you follow this link (our department trucks pictured by EMTBravo) to about half way down, you will see the inside of our rescue truck (19-6-1). This picture shows the gear in the truck.

[Guest alsfirefighter]

I understand the issue at hand and is one as a very safety concsious FF/Paramedic and advocate I think there are a few other thoughts that could have come into play here. At a minimum I would think then that he put protected BLS providers in there to manage any immediate threats and to provide the psychological intervention needed while the operation is on going to reassure the patients there is nothing to worry about. Lets keep in mind the 3 incident priorities:

1. Life Safety 1A is us...1B is them. Risk versus benefit comes into play here, if those patients really needed ALS intervention then they should have been allowed access and the ability to comes down to the other incident priority #2. Also were the patients that expendable as well? What was their level of protection other then the ability for us to use incident priority #2 for them as well.

#2: Incident Stabilization. If the gas odors were such an issue...suppress them. Were all members around the vehicle performing the extrication in full PPE including SCBA? If not they only have partial flash fire protection. If it was that much of an issue...perform the normal hazmat operations to keep the fluid contained and then supperss the vaports. Additionally as far as glass and such, this does happen, use of a few quick pieces of tape or spray adhesive will limit the amount falling into the car as best you can. For everyone that utilizes the glass master...ever see the fine particulate of glass that thing spits out? Inside and outside the vehicle? Cover the patients, and cover the providers...turnout gear or not.

I also like the Chief doing what he thought was best...but to take a stand during an operation when the problem was probably brewing or stemming for quite some time might not be the best place to take it. I do not applaud anyone here and I certainly hope the EMS providers agency takes the appropriate actions to solve the issue.

MFVFD: That is the reason why he put "most" FD's do not carry spare sets of gear. I know many departments that do not have extra SCBA facepieces on appratus once they issued personal ones.

Edited June 20, 2008 by alsfirefighter

[ny10570 745]

Damn, ALS once again beat me to my addition. While the chief handled the political side of it very well and his intentions are great, they don't make much practical sense. You could be buttoned up head to toe in nomex, but if you don't have a protected air supply on when the car flashes you're going to be well protected corpse. Why not make the scene safe for the pts in the car and for those operating my eliminating any threats. FDNY insists that EMS wear their PPE and love to brag about the flash resistant characteristics, but fail to explain who are hands, heads or airway are going to fare.

Bnechis, you are dead on about ESU. Turf war bull asside, its the biggest complaint about how ESU operates in NYC. Eventually something is going to go wrong and one of these guys are going to needlessly get hurt or god forbid get killed by something that could easily have been prevented.

[joetnymedic 43]

I know for a fact that Westchester EMS has a turnout coats, goggles, and a helmet in each of their flycars unless they took a BIG step backwards. I know when I left there in Feb. 02 to go to Metro/TransCare - They, Westchester, had the turnouts in the flycars and were ordering them for the rigs. Should Turnouts be worn at a crash scene, well - yeah. Not sure about you guys but I really don't feel like getting stitched up myself or picking glass out of everywhere - which you wind up doing to some extent anyways. When I vollied with Sleepy Hollow same deal -Spota made sure there was turnout gear on the rigs in the appropiate size for that crew and he made sure it was worn. You all know the saying "be part of the solution, not the problem". In other words, take care of yourself, because if you wind up out of commission, you're no good to anyone, including yourself. One thing I can definately say about WEMS is they were very safety concious about their employees, unlike the former Westchester Ambulance/Danbury owners and I'm not even going to start to go there.

You guys and Gals, all Stay Safe out there.

Joe

Edited June 21, 2008 by joetnymedic

[Bnechis 3,961]

I know for a fact that Westchester EMS has a turnout coats, goggles, and a helmet in each of their flycars unless they took a BIG step backwards.

I noticed in both this and other posts that While FD uses helmet, goggles, coat, gloves, pants, boots and at the same scene EMS leaves out the pants and boots.........Cover your A**

[FFD941 20]

I don't disagree with the decision to require PPE during an extrication; I just wonder if the best time to communicate that requirement was during an extrication call? Had the chief previously notified this provider that they would not be allowed to operate without PPE in such conditions?

Couldn't of said it better Pre-Plan and Train and things like this don't happen.

With the way society is today I wouldn't be surprised to see some sort of law suit out of this, even though all involved recovered.

[Guest alsfirefighter]

Couldn't of said it better Pre-Plan and Train and things like this don't happen.

With the way society is today I wouldn't be surprised to see some sort of law suit out of this, even though all involved recovered.

Really? I'd say I'd be shocked to see one. I see this comment about "today's society" and lawsuits, etc, but how many times in the past 5 years has your agency been sued by a customer? Does it happen...absolutely, but we only hear of the most outragous or big money items. Not picking on you FFD...just the comment as I see so often in posts...particularly on the EMS side.

[FFD941 20]

Nope I totally see what your saying... I was just saying that the way people are sueing over anything now adays, I could see this as a potential problem. No insult taken

[ckroll 101]

I noticed in both this and other posts that While FD uses helmet, goggles, coat, gloves, pants, boots and at the same scene EMS leaves out the pants and boots.........Cover your A**

What to wear is a complicated issue. I'd like to point out that many times its IPE [impersonal Protective Equipment] not PPE. My fire gear is fitted and I wear it always. [30 coat, 28 pants, 4 1/2 boots] When responding as EMS, however, I rely on a generic coat and helmet. I have yet to put on a coat from the back seat where my finger tips extended beyond the cuffs. That's not protection, that's useless. Showing up at a scene looking like a kid going out in a parent's turnouts for halloween is silly. And shared gear is not all that clean. A filthy jacket and leather gloves does not comfort a patient. If they are needed, they are needed, but if they aren't, excessive safety for incidents may be overkill, and worse if gear doesn't fit.

Each incident needs intelligent evaluation for hazards and those who refuse to wear proper protection are idiots. That said, the majority of incidents can be safely managed with EMS wearing goggles and sharing the cheesy yellow blanket with the patient. Does the EMS worker need more protection than will be offered to the patient?

[notch138 7]

I feel that the IC did his job, and followed rule number 1 EVERYONE GOES HOME AND GOES HOME SAFELY. He did what he needed to do for a reason. He has EMT's with the pt an yes you "should never" deny advanced care but there are unsafe situations and personal are not equipped for the job, you have to do what you have to do.

We something similar. We use a paid EMS service and they provide us with an ALS bus. When we have our old EMS company we were called out for a roll over MVA with poss. entrapment. being the first member and the scene I started to eval the situation (scene safety, numb of Pt's things like that) about a minute later EMS arrived with no gear on the bus. Being the only EMT with gear, I had to go into the vehicle, and yes the PT would have been better of with ALS but he got the best we could give him at the time, and that's all we could do.

I say good call Chief, its easier to say NO YOU CAN NOT GO IN, then I am sorry you got hurt.

[DOC22 1]

I must say I agree with what the Chief did, as well. Ok, so the victims weren't treated by a medic in the vehicle, get them out and bring them a few yards from the hot zone to the waiting medic. Just because the medic could not enter the hot zone he/she can wait outside for extrication to be cmpleted

[Bnechis 3,961]

What to wear is a complicated issue. I'd like to point out that many times its IPE [impersonal Protective Equipment] not PPE. My fire gear is fitted and I wear it always. [30 coat, 28 pants, 4 1/2 boots] When responding as EMS, however, I rely on a generic coat and helmet. I have yet to put on a coat from the back seat where my finger tips extended beyond the cuffs. That's not protection, that's useless. Showing up at a scene looking like a kid going out in a parent's turnouts for halloween is silly. As shared gear is not all that clean. A filthy jacket and leather gloves does not comfort a patient.

It is a shame that EMS agencies place so little concern for the well being of their staff. Is PPE expensive...Yes, but agencies who make this a priority instead of some other "extras" are protecting their people, the patients and complying with state and federal (PESH & OSHA) law.

If they are needed, they are needed, but if they aren't, excessive safety for incidents may be overkill, and worse if gear doesn't fit.

How do you know if it is needed, prior to your arrival? You don't thats why PPE is put on before you arrival. Once onscene if its not on it never gets on. Most ff's put turnouts on before arrival. Cops don't wait to arrive to put there vest on, is it overkill on most calls? I don't need to buckle my seat belt until just before the crash..........

Each incident needs intelligent evaluation for hazards and those who refuse to wear proper protection are idiots. That said, the majority of incidents can be safely managed with EMS wearing goggles and sharing the cheesy yellow blanket with the patient. Does the EMS worker need more protection than will be offered to the patient?

1st Maybe the patient should be given more protection.

2nd Since we teach rescuer safety is primary, then yes EMS should have more protection than the patient. They are already injured, if we get injured the care for them is delayed.

3rd the majority of MVA's include poping a door, but once we start cutting there is a major potential for sharp edges, glass and other hazards, since you don't know what the MVA will be until you get there, you need to have PPE prior.