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Emergency Services, LLC/ Copyright 2006 / Volume 06-101

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TRAINING

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FIRE MEDICS Ride-along: Alcoholicwith Ab

dominal Pain Quiz

EVOLUTIONS 2000 Kramer vs. Kramer Program Quiz Answers

FIRELINE Jarrell Farms Residence Fire “Quick Calls”

HANDS-ON WMD Drill Preparation:CBIRF &

CST (expanded segment) Quiz


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TRAINING

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


RESPONSE Upon arrival there was heavy fire extending from the

attached garage to the second floor and into the attic area.

There were many residents and onlookers. Responders made sure that no residents were injured and that there were no occupants inside.

Fire police were on scene and pointed out hydrants to incoming units.

Fireline Incident: Jarrell Farms Residence Fire

06-10 Training Materials06-10 Training Materials06-10 Training Materials06-10 Training Materials


COMMAND I.C. knew from previous experience that the

residences in this area were of truss roof construction - and this residence had suffered significant structural damage. Safety of entering crews was a big concern.

Accountability was set up immediately. This became important as the fire went to multiple alarms and additional firefighters arrived on scene. – The additional alarms also brought additional officers,

allowing for placement of them on both sides of the residence.




COMMAND With a 3500-4000 square foot structure (which had

a wall collapse in the rear), the additional supervision helped maintain safety and accountability. – One officer saw the wall was going to collapse and moved

firefighters out of the way in time. RIT was maintained in place and then later was

redeployed for other assignments after the fire was knocked down.




COMMAND The initial first-in crew was ordered out when it look

like the fire was overtaking them. The command was given to go defensive.– While going defensive with a water pipe, mutual aid arrived

and was deployed to the rear of the structure with another master stream.




COMMAND IC talked to the homeowners as to whether they

needed medical attentions and about contents of the garage, concerned about additional flammables and/or hazardous materials. – A car, two riding mowers, and gasoline cans were all visible.

The homeowner also said there was spray paint and similar miscellaneous items.




STRATEGY & TACTICS Crews had adequate water supply and pulled lines from

the first truck (19-3) on-scene.

A fire attack crew made entry in an attempt to cut off the fire. – They were ordered out when they couldn't make headway.

Tactics changed to master streams from their ladder tower fed by 19-3.

A mutual aid company arrived and laid hose in from a second hydrant at the entrance of the neighborhood; it set up another water pipe in the rear.




STRATEGY & TACTICS Firefighters took a handline off 19-3 to cover a nearby

exposure that was becoming affected by radiant heat.

As the bulk of the fire was knocked down, handlines were brought to bear on areas that the water pipes could not reach.




EMS It was a hot day and Rehab became an important

function.

Many firefighters were used because of the heat and paramedics from local EMS and nearby mutual aid companies provided staffing. Neighbors were supportive and provided their yards where shade trees assisted the Rehab effort.




EVENTS The initial fire attack crew was only in for a few minutes

when it looked like the fire had come over the top of the firefighters. They backed out.

A first-in truck went defensive with a water tower.

Mutual aid arrived and set up with an aerial in the rear.

There was a car in the driveway whose gas tank ruptured. It was leaking gas which created a trail of fire leading to the edge of the property. It was extinguished.




EVENTS Radiant heat presented a problem with exposures;

firefighters used a handline to protect a nearby residence.

There was a wall collapse at the rear of the structure.




REMARKS One of the things that surprised the IC was that it was

a weekend and the residence was occupied. – Between the time the homeowner saw smoke in the garage

and fire department arrival nine minutes later, there was a lot of fire in the residence on every floor (2-3 stories); this was a large structure.

The home was a total loss. It was believed the fire was started by a hot lawnmower in the attached garage just after mowing.




LESSONS LEARNED Knowing the jurisdiction was a great benefit on this

incident.– Firefighters knew it was an area covered by hydrants in close

proximity and which were in good condition. Knowing the construction of the residences in the

neighborhood is important.– Truss roof construction; IC knew the trusses wouldn't last long,

making collapse an issue. IC should understand that there's a little bit of chaos at

every incident. He had great support from mutual aid chiefs on scene.




LESSONS LEARNED Engineered wood, with its possible risk of emitting toxic

fumes when burned, was also used in the construction of these homes.

CONSTRUCTION NOTE Engineered Wood

– A general term for new composite woods being used more and more in construction.

Many of the adhesives in this kind of wood contain formaldehyde! – It will release formaldehyde in the finished product - which will

assuredly happen during combustion.




CONSTRUCTION NOTE Here are three types:

– Phenol-formaldehyde resins are a yellow-brown adhesive, commonly used in exterior exposure products.

– Melamine-Formaldehyde is a white, heat-and-water-resistant resin, often used in exposed services in more costly designs.

– Urea-Formaldehyde is non-waterproof and the cheapest and most commonly used.

Firefighters won't always know which type they're dealing with.

If you suspect engineered wood is burning in the structure, always wear your SCBA!




Fireline Incident: “Quick Calls”


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


QUICK CALL #1 – WORKER STRANDED ON LEDGESIZE-UP/EVENTS A building scaffold along side the building gives way,

leaving one of the workers, perhaps a window washer, stranded on the ledge of the building.

Firefighters come to his aid by removing the window glass to gain access to the ledge.




QUICK CALL #1 – WORKER STRANDED ON LEDGESIZE-UP/EVENTS The worker gestures to the firefighter to wait while he

unhooks his safety line.

He hands the safety line to the rescuer and then takes the hand of the rescuer who helps him off the ledge.




QUICK CALL #1 – WORKER STRANDED ON LEDGEQUESTIONS/CONSIDERATIONS There was a point in the transfer when the worker

was untethered. What if the worker had stumbled during the transfer? What if it had been windy? The worker could have

lost his balance. Even just being 4 feet away, being secured to

nothing stable, the worker might even have involved the rescuers, perhaps taking one of them with him, had he fallen.




QUICK CALL #1 – WORKER STRANDED ON LEDGEQUESTIONS/CONSIDERATIONS As you probably already know, things can go south in

the blink of an eye. Would it have been safer if the rescuers had rigged a

safety line with a firm anchor point? The worker was wearing a safety harness which

could have been hooked to the safety line. – If the harness was not up to code, or had the worker not

been wearing one, there was sufficient time to harness him and hook him into some kind of haul system were he to fall.




QUICK CALL #1 – WORKER STRANDED ON LEDGEKRAMER’S APPROACH A good outcome of this rescue. But there was a

problem. There was a point when the worker was untethered.

The key point is to make sure that one safety line is

in place on the victim before another is removed. That way, if the firefighters or the victim loses footing, we don't lose our victim.




QUICK CALL #2 – “FIREFIGHTER FRICASSEE”SIZE-UP/EVENTS It’s tough to see, but the aerial is extended low over

the fire, right above a window or a vent that flames out.

It’s hard to get perspective on distance, but

compared to the other aerial positioned to the left, it appears that the aerial with the firefighter on the ladder might be too low.




QUICK CALL #2 – “FIREFIGHTER FRICASSEE”SIZE-UP/EVENTS It’s also not clear why the firefighter was where he

was. – It looks like he was already moving down the ladder when

the flame-out occurred. Fortunately, the firefighter appears to be unhurt.




QUICK CALL #2 – “FIREFIGHTER FRICASSEE”QUESTIONS/CONSIDERATIONS Could this incident have been avoided?

Was the ladder too low to the fire for present conditions? – Or was the apparatus placed too far away, thereby lowering

the angle of the ladder, bringing it too close to the fire?




QUICK CALL #2 – “FIREFIGHTER FRICASSEE”QUESTIONS/CONSIDERATIONS It’s hard to know, but do the firefighters on the other

aerial bear any responsibility for warning of the proximity of the aerial to the fire?

Has the structure of the ladder itself been compromised from the flames? What are your SOGs for ladder maintenance?




QUICK CALL #2 – “FIREFIGHTER FRICASSEE”KRAMER’S APPROACH A close call on the aerial ladder with a firefighter almost

incinerated. I don't really have too much of a problem with the proximity of the aerial ladder to the fire itself. To do our jobs right in the fire service, sometimes we have to get close to the fire.

The key, however, is to wear protective clothing, have good safety procedures, and have that aerial operator on the turntable ready to move that ladder in a hurry. And there are safety considerations before we ever get to the fire: testing the aerial regularly and making sure our equipment works. Those are the keys in this incident.




QUICK CALL #3 – FAILED RESCUE ATTEMPTSIZE-UP/EVENTS Witnesses said the man on the roof had been waving

and shouting to cars and people in the street.

The rescuers’ concern is that the man on the roof may jump.

A rescuer approaches the man from the rear, apparently without warning, and attempts to grab him.




QUICK CALL #3 – FAILED RESCUE ATTEMPTSIZE-UP/EVENTS We don’t know whether the rescuer was commanded

to attempt a rescue or if Incident Command was aware of his intentions.

An autopsy revealed that the man on the roof was clean of alcohol or drugs. This tragic event is still under investigation, but what can we learn from it?




QUICK CALL #3 – FAILED RESCUE ATTEMPTQUESTIONS/CONSIDERATIONS First, should the rescuer have attempted to grab

him? Should he have been commanded to do so?

Should the police or a negotiator have dealt with him first?

Should the rescuer at least have been harnessed and rigged to a safety line?

What is your SOG for a rescue situation like this?




QUICK CALL #3 – FAILED RESCUE ATTEMPT

KRAMER’S APPROACH In hindsight, we might say a rescue harness might

have worked. Giving more time for negotiating might have worked - very true.

I think we have to give an "A" for effort to the individual who felt that he would be successful.

But because of the outcome, we have to issue a failing grade to the fire department.




Fireline Incident DiscussionFireline Incident DiscussionFireline Incident DiscussionFireline Incident Discussion

The departments involved in this month’s training 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?



Jarrell Farms Residence Fire / Hockessin, DEDeputy Chief Drew Outten, Hockessin (DE) Fire

Department

Being familiar with the neighborhood helped our department get going in a hurry once we arrived on scene. Knowing hydrant locations was a big help. – Does your department preplan hydrant locations in residential

areas?


Fireline Incident Discussion



Department

The speed of this fire was very impressive. A fire that burns quickly quickens the tempo of incident command decisions as well. – You must be sure that the speed of the fire won’t move faster

than the time it takes to execute the command decisions you make. Anticipation and thinking two steps ahead are really important in such a case.





Department

This fire happened on a weekend when family members were home. – Therefore, the accountability of occupants is critical as the

likelihood of an occupant being overcome and left behind in the house is high.

– Find out who is home as quickly as possible. Surveying neighbors might help.





Department

A fire starting from a hot lawnmower is a longshot, but it’s obviously possible as this fire indicates. This might be a good point to add to any training or briefing you give to citizens regarding fire safety in the home.




“Quick Calls”Chief & Professor Bill Kramer, Open Learning Fire

Science Program, University of Cincinnati

Regarding rescues, always make sure rescuers and victims are harnessed and/or anchored. It’s the best way to protect against the unexpected or unpredictable.

Operating aerial ladders is a technique to be developed. – Part of the challenge is observation of fire behavior and

anticipating if changes in fire conditions will impact what’s happening with the aerial.

– Adjustments to aerials aren’t instantaneous -- that’s why anticipation of conditions can get a change or adjustment underway early.




“Quick Calls”Chief & Professor Bill Kramer, Open Learning Fire

Science Program, University of Cincinnati

This failed rescue attempt is very troubling. Without further information, it appears that this might be a classic case of freelancing -- though we don’t know if this attempt had been approved by IC. – The mindset for any rescuer should be (just like in Quick Call

#1 this month), “If I fail, what’s the worst that can happen?” “What’s my fall-back position or Plan B?”

– Wearing a well-anchored harness is good start.




OBJECTIVES/OUTCOMESAfter watching this segment, the student shall understand: the structure and function of CBIRF and CST how these teams are mobilized and how they integrate with local first responders.

CODES, STANDARDS & REGULATIONS This training is relevant as established by Nunn-Lugar-

Domenici legislation, Presidential Decision Directives 39 and 62, and eventually Defense Reform Initiative Directive 25. Also NFPA 471, Hazardous Materials Incident Response.


Hands-On:WMD Disaster Drill Preparation: CBIRF & CST


WMD AcronymsCBIRF = Chemical Biological Incident Response ForceDOD = Department of DefenseCBRNE = Chemical Biological Radioactive Nuclear or highly ExplosiveSEMA = State Emergency Management AgencyFEMA = Federal Emergency Management AgencyCST = Civil Support TeamsMOU = Memorandum of UnderstandingESO = Emergency Services OfficerIRF = Incident Response ForceNBC = Nuclear-Biological-ChemicalTBI = Total Body IrradiationFPL = Force Protection LaneHUO = Hazardous Unexploded OrdnanceWMD = Weapons of Mass DestructionSMES = Subject Matter Experts ( pronounced “Smeez”)




CBIRF Description & Function

– CBIRF (Chemical Biological Incident Response Force) is a Department of Defense (DOD) organization that provides local first responders with a CBRNE (Chemical Biological Radioactive Nuclear or high-yield Explosion) capability.

– CBIRF typically pre-stages for high-level security events in case of CBRNE attack and assist federal, state, and local entities for mass-casualty decon, extraction, detection and identification of any hazards, and post-mitigation of high-yield explosive events.




CBIRF Description & Function

– During a large event (Oklahoma City bombing, the World Trade Center collapse, etc.) CBIRFs can come in and provide local continuation of effort for local department responders.

– After six hours on scene, first responders will need relief and if mutual aid is already committed, CBIRFs can provide that continuity.




CBIRF CBIRF Response Path

– To have CBIRF respond and render assistance, a local jurisdiction would have to contact their SEMA (State Emergency Management Agency) office who would go to FEMA who would go to the Department of Defense.

– From there it would come down through the Commander of the U.S. Northern Command, who would task CBIRF directly.

– CBIRF, in turn, would provide support out of the Under-Secretary of Defense, Homeland Security Branch of the Pentagon.




CBIRF CBIRF Response Time

– In a realistic scenario, it would take four to six hours for the request to run through the chain of command, assuming there are no delays.

– However, there are a number of MOUs (Memoranda of Understanding) in place with strategic partners which expedite the timeline.




CBIRF Different from CST (Civil Support Teams)

– CSTs specialize in detection and identification capability with limited decontamination ability.

– They are basically state property and the governor can mobilize CSTs within his state's borders nearly at any time.

– CBRFs are more robust and still must be mobilized through the federal chain of command described above.




CBIRF CBIRF Response Procedure

– Upon notification of an incident response need, CBIRF Command issues a Command Recall. Members have two hours to respond for:

– an accountability muster– a last-minute gear check– receive a briefing on the incident or scenario– have their medical vital signs taken (any time they don

their PPE)– receive appropriate medicants assuming there is

knowledge of which chemical agent is involved, gained from the first responders on scene.





– Once the vehicles are loaded, the team is ready to "punch out."

– First, however, an assessment team will leave about a half-hour in advance of the rest of the team to get briefed by the Incident Commander so the rest of the team can be briefed upon its arrival.

The Mission Commander, the senior Marine in charge, and the Emergency Services Officer (ESO) inform the team where to set up and what the mission is.





– The chain of command starts with the Mission Commander, to the Incident Response Force (IRF) Commander, to the Nuclear-Biological-Chemical (NBC) officer, to the team members themselves.




CBIRF CBIRF Decon -- Deployment

– Full Site: TBI (Total Body Irradiation) tents dedicated to:

non-ambulatory casualties those who have to be stretchered in an ambulatory tent for those walking wounded who have

contaminated themselves down-range but still have the ability to process themselves

an FPL (Force Protection Lane) tent/site dedicated to CBIRF, CST, and local responders.




CBIRF CBIRF Decon -- Deployment

– Half Site: One tent with one roller system to handle the

non-ambulatory casualties One shower system to handle ambulatory casualties One FPL as mentioned above.

– Another deployment involves an HUO (Hazardous Unexploded Ordnance) Lift Package where no tents are used.

It's basically a Half Site in a much larger area and all three (ambulatory, non-ambulatory, and an FPL) all go inside the same containment area.




CBIRF CBIRF Decon -- Agents

– The primary decontamination sources are bleach solutions:

A 5% solution that's mostly used for gear decon or the outside of clothing

A 0.5% solution used on skin or incidental contact between the responder's outer clothing or PPE and exposed skin.

– Secondary Sources Based on the scenario and the contaminant in question, they

can also use:– plain hot soap and water– a sodium bicarbonate solution (basically, a baking soda

solution that can decontaminate)




CBIRF CBIRF Decon -- Agents

– Secondary Sources Dry decontamination can also be used, primarily in radiological

events, which consists of an adhesive material which will pull those particles off the exposed skin and clothing.

– i.e., alpha and beta particles which will stick to the outside of the skin.

– Other factors help determine what solutions are used: Some chemical agents are water-reactive and won't allow water

to be used on the site. Other chemicals might react to the chlorine that's used in

bleach which would determine the use of hot and soapy water.




CBIRF Monitoring Agents

– Depending upon the type of agents present, various chemical agent monitors might be used:

Chemical: a multi-ray system, such as the PGM-50 Radiological: the ANPD-77, or a similar hand-held device, the

VDR-2 Chemical detection paper:

– M8 paper will detect Nerve-VX, Mustard-H and Nerve-G gases, including Sarin GB, Tabun GA and Soman GD. It will identify the agent class with different color dots: Yellow for Nerve G, Red for Blister H and Green for Nerve-V.




CBIRF Monitoring Agents

– Depending upon the type of agents present, the various chemical agent monitors might be used:

Chemical detection paper: – M9 paper is used to detect the presence of liquid chemical aerosols,

including Nerve-G, Nerve-VX, and Mustard-H gases. It will turn pink, red, reddish-brown, or red-purple when it detects a liquid agent in the air.




CBIRF CBIRF Staffing:

– Decon Team Leader: Stays on the cold-zone side of the vapor control line separating

the cold zone from the warm zone. The Team Leader controls everything from that point.

– An ambulatory decon line within one of the tents where patients can walk and process themselves.

This line only needs one marine to stand out in front as a control measure:

to make sure patients are staying in the showers long enough yet not too long

to maintain order and control the flow of people through the tent.





– A non-ambulatory tent where two lanes are in operation where there are:

four cutters who cut the clothing off the patients two washers who scrub down the patients and make sure

they're clean one Assistant Team Leader who controls the flow from the front

of the tent one monitor at the rear of the tent who makes sure that

decontamination was successful. A dedicated crew member makes sure the flash heater (to heat

water) is running properly and makes sure there is a constant supply of water into the decon site.





– It's a 15-person crew including the two members on the FPL. There are eight more marines who are totally dedicated to

carrying stretchers, four in the front of the site and four in the rear.




CBIRF CBIRF TRAINING & QUALIFICATIONS

– CFBRFs come from every service area in the Marines. Many are infantry members (O3s), communicators (06s), and

specific NBC-trained (Nuclear-Biological-Chemical) personnel who run the site.

– High levels of knowledge of chemical agents or chemical warfare are not necessary to be a decon team member. Basic skills and procedures can be taught and trained for.




CBIRF CBIRF TRAINING & QUALIFICATIONS

– However, there are specific injuries that may come from certain CBRN events such as a chemical explosion for which specific knowledge, such as EMT qualifications, will be necessary.

For example, some patients may come through the decon site with medical dressings which will have to be removed so decontamination of the wound or injury can take place. Pressure dressings are loosened so decontamination can be performed underneath them.

On the other hand, tourniquets and C-spine immobilization collars are never removed during decon.




CST Description & Function

– Civil Support Teams are a joint force of the Army and Air National Guard and can function as a hands-on unit or in an advisory capacity with all kinds of reach-back assets they can bring to bear at an incident:

DTRA, the defense threat reduction agency Department of Energy, Environmental Protection Agency, etc.

– CST knows contacts at these agencies on a first-name basis. That can be an immense timesaver for first responders.




CST CST Background

– Currently, there are 40 CSTs around the country, based around the original FEMA regions (in the case of this team, FEMA Region 7, covering Missouri). Click video.

By the end of 2008, there should be 55 teams throughout the nation.

Some populous areas have more than one team.

– Contact your state National Guard or SEMA to find out if there's a CST in your area.



CST CaptainScott ZimmermanClick video to view

Distributionof CST


CST CST Expertise

– When fire department-based Haz-Mat teams arrive on scene, they know they're dealing with something bad.

– The traditional role of civilian/municipal hazardous materials technicians and operators is to deal with various kinds of haz-mat spills and chemical releases which are usually industrial-related. These are the typical hazardous materials responses.

– With as much time these teams must spend in this kind of training, there's not a lot of time available to train on very specific chemical-, biological-, and nuclear-type agents. But with the Civilian Support Teams (CSTs), that's ALL they do.




CST CST Expertise

– This is a big advantage for training officers of first responder departments because they can rely on an agency that is the subject matter expert in these terrorist areas.

They don't have to spend as much time in training themselves for these events.

– The CST expands an Incident Commander's ability to deal with these kinds of threats and events since that's all CST does.




CST CST Expertise

– If a Chemical-Biological-Radioactive-Nuclear Event (CBRNE) or WMD agent/event occurs, is known, or is suspected, CST gets called. They are considered the subject matter experts (SMEs, pronounced "Smeez") for chemical and biological warfare agents used in a terrorist manner.




CST CST Response Path

– There are two ways for CST notification: The informal chain where CST members go out to build

relationships with first responders, incident commanders, fire chiefs, emergency management personnel, police chiefs, highway patrol -- all the people CST might work with in a large crisis situation.

– It's better to know whom you're going to be working with in advance and all these people have CST's direct-line phone number so they can call for advice, consultation, or a request for help.





– If CST receives an alert, it has the ability and authority to self-deploy an advance team to get the ball rolling. CST can also be recalled if not needed after mobilization.

A CST advance team involves a commander, a modeler, an operations officer, and a recon team leader.

– These personnel are briefed by phone en route so they understand the situation prior to arrival.

Upon arrival, the advance team contacts the command post and coordinates the effort with the incident commander or his representatives.





In a big incident, they could be interfacing with the Haz-Mat Operations section in the ICS which is a very appropriate place for the CST to be.

– In such an incident of that size, the CST commander would be in the Unified Command area with the deputy commander interfacing with the local ICS and the Operations Officer while the rest of the CST would work with local Haz-Mat operations.

There would be a lot of integration but CST is under the total command of the local or unified incident commander.

If the incident commander prefers, CST can serve only in an advisory capacity or become more involved with recon and detection.





– In the formal chain, the incident commander: contacts his local EMA who contacts SEMA who contacts the governor's office who then contacts the Adjutant-General of the National Guard who contacts his operation officer who contacts the CST.

– This chain takes a lot longer than the informal chain to get personnel on the ground.




CST CST Response Time

– Once CSTs are involved, they can have people downrange in 90 minutes or quicker if they can use any existing decon lines that may be set up.

– The advantage of having made advanced contacts with local departments is that the CST is already familiar with local departments’ capabilities and what their decon lines look like.

– Some local departments have adopted the CST style of decon line which makes response even that much quicker.




CST CST Detection Capabilities

– CST has strong detection abilities with its analytical lab and can give a nearly 100 percent determination of what substance is being dealt with.

– Their sampling techniques have been approved and standardized using the same methods as the FBI.

Samples retrieved could be sent to the FBI in Quantico, VA for analysis.




Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____

1. True or False: CST is a marine unit

2. True or False: It’s quicker to follow the CBIRF chain of command to get a response.

3. True or False: CBIRF and CST both encourage first-name basis awareness with first responders.

4. True or False: Dry contamination techniques are used mostly in chemical incidents.

WMD Disaster Drill Preparation: CBIRF & CSTWMD Disaster Drill Preparation: CBIRF & CSTQuizQuizWMD Disaster Drill Preparation: CBIRF & CSTWMD Disaster Drill Preparation: CBIRF & CSTQuizQuiz


Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____Select the best answer:

5. M9 paper is used to detect:

a. liquid radioactive aerosols

b. Nerve-F gas

c. Nerve-XY gas

d. Mustard-G gas

e. None of the above




6. Which of the following are part of a CST Command Recall?

a. An accountability muster

b. A last-minute gear check

c. Receive a briefing on the incident or scenario

d. Have their medical vital signs checked (any time they don their PPE)

e. None of the above




7. Which of the following is correct?

a. In general, CSTs can arrive sooner than CBIRFs

b. You can reach CBIRF through your SEMA office.

c. A CST advance team involves a commander, a yodeler, an operations officer, and a recon team leader.

d. CST will only assist with detection work.

e. All of the above.


(Answers on Slide 90)


ASSESSMENT Establishes patient contact

– The paramedic introduces herself to the patient and asks what his problem is. The patient tells her that he has abdominal pain.

She asks about his drinking and how much he's had to drink. He says he drank a fifth of vodka and a quarter of another fifth.

– She takes his vital signs; his blood pressure is a little high. – The patient tells her he's on blood pressure medicine but

hadn't taken it that day. – She asks him to which hospital he would like to be transported.


Fire Medics: Ride-along: Alcoholic with Abdominal Pain


ASSESSMENT Establishes patient contact

– During this conversation, the paramedic assesses that the patient is very drunk, moaning, and disoriented.

– The paramedics were told by bystanders that the patient had vomited though no evidence of that was apparent.

– Otherwise, the patient's breathing and airway are fine. – The patient reports no cardiac or heart discomfort but that he

has high blood pressure.




TRANSPORT Assisting patient to ambulance

– After taking his vitals, she asks whether he can walk or not.

As patient's room is up a steep flight of stairs, it would be easier for everyone if he were ambulatory.

If not, additional manpower would be needed to bring him down the stairs.

– As this was in winter, the paramedics made the patient as warm as possible with blankets and assisted him down the stairs.




TRANSPORT Assisting patient to ambulance

– The patient was not provided with shoes. The paramedic said she was more concerned with getting the

patient to the hospital as quickly as possible. Also, in his current condition, the patient was oblivious to the

cold.






TRANSPORT Ambulance Ride

– During transport, the paramedic asks the patient when he started drinking.

He said he had begun drinking that morning. It's now night. Later at the hospital, he would say he had started drinking around

4 p.m.

– He also reported that he has pancreatitis. He was given an IV to restore fluids. His blood pressure was taken again.

– She queries him again about the abdominal pain, asking him to describe the pain on a 1 to 10 scale and whether the pain radiated out or was localized. He shows her exactly where he feels the pain.




TRANSPORT Call to hospital The receiving hospital in this incident only allows nurses

specifically certified on the hospital's telemetry phone to use it.

– The paramedic calls the hospital en route and gives a briefing of the patient's:

complaint presentation vital signs assessment observation of behavior patient treatment, and whether or not the treatment either helped or hurt.




TRANSPORT Call to hospital

– The ambulance's ETA is also provided.




HOSPITAL ARRIVAL Patient reporting to staff

– He changed his behavior information at the hospital.

Said his pain was much more severe than he had told the paramedics in the ambulance.

He also told them he had only started drinking around 4 p.m. when he had told the paramedics that he had started that morning.

Denial is typical of alcoholics and information provided should always be considered to be suspect.





– The patient also told bystanders that he had vomited but no evidence was found.

This is important as vomiting might suggest other conditions which might be treated and the vomit may impact the patient's airways.

Blood in the vomit would also be significant regarding the course of treatment.





– Also, the patient had reported that he didn't think the pain was associated with his pancreatitis.

The two major causes for pancreatitis are alcohol and gallstones.

With a normal MRI and MRCP (which could not be checked in the field), that would leave gallstones to be a very unlikely possibility.

So, in fact, the patient's alcohol consumption might well have been the cause of his pancreatitus and the source of the pain.


Ride-along: Alcoholic with Abdominal PainRide-along: Alcoholic with Abdominal PainQuizQuizRide-along: Alcoholic with Abdominal PainRide-along: Alcoholic with Abdominal PainQuizQuiz


1. True or False: The two major causes of pancreatitis are gallstones and diabetes.

2. True or False: Alcoholics are usually very honest because the alcohol keeps them from being deceitful.

3. True or False: If a patient can’t walk themselves downstairs, that will mean extra help will be needed.



4. An initial assessment of the patient could include which of the following?

a. Checking the nebulizer

b. Checking vital signs

c. Checking ABCs

d. Two of the above

e. Three of the above

Ride-along: Alcoholic with Abdominal Pain Ride-along: Alcoholic with Abdominal Pain QuizQuizRide-along: Alcoholic with Abdominal Pain Ride-along: Alcoholic with Abdominal Pain QuizQuiz



5. Calling into the hospital to give a briefing during transport should not include:

a. complaint

b. palpitation

c. vital signs

d. assessment

e. observation of behavior

Ride-along: Alcoholic with Abdominal Pain Ride-along: Alcoholic with Abdominal Pain QuizQuizRide-along: Alcoholic with Abdominal Pain Ride-along: Alcoholic with Abdominal Pain QuizQuiz

(Answers on Slide 90)


06-10 Training Materials06-10 Training MaterialsEvolutions 2000: Continuing EducationEvolutions 2000: Continuing Education


1. Briefly critique the failed roof rescue attempt which resulted in the fall and death of a victim.

2. Why could a similar event with a similar outcome have happened -- or not happened -- in your jurisdiction?

3. Briefly list a few guidelines or procedures that you would compose for your department that would ensure the greatest chance of a successful outcome in similar circumstances.

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.

Kramer vs. KramerQuick Calls: Failed Roof Rescue


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 KramerUniversity of Cincinnati

College of Applied Science2220 Victory Parkway, ML #103

Cincinnati, Ohio 45206





Thanks so much for viewing Working Fire Training!

See you next month – stay safe!Answers:

Hands-On – WMD Disaster Drill Preparation: CBIRF & CST:Quiz on Slides 71-74:1. False 2. False 3. True 4. False 5. e 6. e 7. a

Fire Medics – Ride-along: Alcoholic with Abdominal Pain: Quiz on Slides 85-87:1. False 2. False 3. True 4. d 5. b

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