Protocol Spin-off

[FireMedic65]

I have been thinking about this for awhile and I felt it was in order. I am my fire departments chief medical officer. We have "rules" set in place for a 2 bottle limit into structure fires, for example. We run a variety of calls, such as wildland, structure fires, SAR, water rescue. Living here the temps can range from bitter cold to pretty darn hot. Humidity is also a problem.

Anyway, with that background, I felt I should put something in place for evaluations. Say, for example a firefighter comes out of a fire and I feel they do not look capable of returning, I have the authority to say no. Yes, we have rehab.

I guess what I am trying to say is I would like ideas and suggestions on how to place protocols for such situations where myself, an appointed/trained person, or another EMT/Medic clears them to return to duty on the scene. I do not really see anyone having a problem with this, I just want something in writing, since there is nothing in our SOG for a medical officers duties/authority.

Thanks in advanced.

[Richard B the EMT]

With apologies if you've mentioned that you are one, and I forgot it, something like this needs the input of an MD or DO as the Department Medical Director. I admit my own uncertanty if Chief Medical Officer qualifies, although one with the title can certanly provide significant input.

There should be a committee consisting of the Department Medical Director, Chief Medical Officer, Chief of Department, all department senior chiefs, battalion chiefs, senior-most EMTs and Paramedics, union local presidents or their designees (if a union shop), and neighboring department's similar senior commanders, especially of they already have protocols in place. Check with any and all departments with which your department has mutual aid agreements.

[FireMedic65]

Thank you Richard, I appreciate the input and I will bring it up with the Chief.

[crotchitymedic1986]

I would add that it is not enough to have the policy, you should have a notebook in your vehicle that lists what every firefighter's normal vital signs are (maybe by badge number or something so you wont have HIPPA issues). 160/88 doesnt sound too bad, unless you know that is close to their normal, might change your mind if you knew the normal was 104/60. Write a policy that states they can not return to fight fire until their v/s are within 10-20% of their normal.

[island emt]

To add to crotchity's comment:

We have a notebook with a separate page of medical info for every member of our department, that contains name, DOB, preexisting medical conditions / treatments, medications prescribed, primary care physician's name and phone #, next of kin info and contact #' , preference of which hospital to be transported to if needed, Full set of monthly vitals at rest and quarterly after wearing SCBA while exercising.

This gives us a baseline at rest and under stressful conditions to base our opinions of whether or not to allow them to return to interior service.

Our airpack/cascade station is manned by EMT's who oversee rehab and have the authority to make a FF sit out for a break while need rehab. This is supported by SOG's and the safety officer & chief.

While some might not being told to take a break , it is in the interest of avoiding stress/heat related injuries & heart attacks.

We also use the RAD-57 to monitor all FF's when they come to rehab.

[emtannie]

We have a specific protocol for firefigthter assessment at scenes. I have tried to attach the protocol as a gif file, but if you can't open it, let me know, and I can email it to you.

The biggest problems I have had with this protocol aren't with the protocol itself, but with the firefighters.... it is hard to get them to hold still and allow themselves to be assessed, and harder to convince them to take a break when their HR or BP is too high.

I agree with other posters that you need to talk to your medical director. And good for you for doing the legwork first! Your MD will be a lot more cooperative when you go to them and say "this is what I want to do, and here is what I think the protocol should look like, and this is why I think it should be like this."

Good luck!

[FireMedic65]

Thanks Annie. My chief is in full agreement with me about this and will back me up. I do not expect crews to line up and wait to get a BP taken or anything. I just wanted something in place in case someone decides to be a hero and run off when they aren't physically capable. This is meant more or less for my current station. My first priority on the fire scene is to be a fire fighter. My goal is to train people at our one vehicle that acts as a rehab and a cascade to look for these signs and symptoms and all that jazz and have them sit out for a little. These are more or less guidelines, not procedures.

I will talk to the medical director though. Since, most of the time I would be the only EMT with our station. Everyone else is first aid trained, but first aid training doesn't touch anything like this. It is a fine line though since I cannot always be there, not everyone will want to comply, and won't always have someone available to check vitals. But, if I could at least show people what to look for I can at least put it in place that they sit down for a little and cool off, or warm up for that matter (since it is winter now).

I like crotchity's idea a lot. It would be a great idea to have baselines for others to go by. We we have numbers on our tags so it would work out that way.

But, like like I said, this would only be a guideline if myself or another trained/qualified person deems them unfit to return to duty at that time. I should have made that more clear in my original post. I do not want to make this a SOP. I will start with one station where I operate out of and see how it works and expand later if I must.

Thanks everyone!