Casualty extrication from a fire risk area

[Mike Smertka]

Sorry, I know hypoxia is lack of oxygen, cut and paste error forgive me.
   
  Mike

Mike Smertka <medic0947969 at yahoo.com> wrote:
  Mr. Crumpton,

I have worked as a firefighter/paramedic for many years in the US prior to becomming a European medical student. Getting a patient (pt) out is the first and only priority. Here are several things to consider:

1. The purpose of breathing apparatus(BA) is to allow you to survive in a hostile environment, not conducive to human life. The lack of airway may actually protect the pt. here in the US the temps in a structure fire can exceed 815.56 degrees C. When I was in fire school to demonstrate the physiologic effect we heated an oven to 260 degrees C and tossed in a plastic bag to represent lung tissue. It desintigrates in less than a second. When I spent time with the Slovak and Polish fire services as an observer, I noticed in central europe many of the buildings are concrete. I have only been to London once, so I can't speak to the rest of the UK. I would assume, that the fire load build slower than in US construction materials, but in a fully involved structure would be much higher. Similar to an oven. The other consideration is opening an airway in such an environment would remove the only barrier protection from the heat internal organs have leading to thermal burns in the
airway. From the perspective of thermal burns alone getting out seems the best practicce. 

2. Other products of combustion include Hydrogen Cyanide. There are now studies being done showing this is a much higher contributor to fire death than previously thought. So much so the major burn/trauma center where I live in the US has made cyanide antidote one of the first treatments of fire victims. Other products include carbon monoxide (CO) carbon dioxide (CO2) and phosgene. (from burning cryogens, plaster, and modern wood glues.) All of these are inherently poisonous. So in the interest of Hazardous materials treatment, again removal from the scene and some gross decon goes a long way. Furthermore, products of combustion can be absorbed transdermally, that is why firefighters now wash their turnout gear instead of wearing it dirty as a badge of honor.

3. "Buddy breathing" or other similar techniques. In Ohio, we used to practice sharing our airmasks with our partners in case of emergency. This has been shown to be a bad practice. Our BA in positive pressure, so as soon as there is not a seal of the mask, it blows air out at full force. simply by inserting a air tube of my "partner" into my mask I have lost 30 minutes of air in 5 minutes. 2 people breathing 5 minutes of air in a smoke filled building is not a good idea. The net result seems to be becomming disoriented from hypoxia, and lack of oxygen and the decision making ability decreases from there, along with the amount of survivable time. A few years ago a company came out with a "rescue breather" which was basically a emergency BA for victims. Anecdotal evidence showed it took too long to put on, was just another thing to carry, decreasing time to finding victims, and had no way to protect the airway from the tongue, particularly with an unconcious patient
receiving positive pressure ventilation from it. In addition in was compressed breathing air, not medical grade oxygen. (which I certainly would not carry into a fire) There is no effect of displacing the CO from the pt hemoglobin. All of this while you are in a structure than can collapse due to fire stress on it. 

Simply getting yourself and the patient out, while sounding old fashioned, is still the best practice I have ever heard of. I have more poetically heard it said:
"He who fights and runs away, lives to fight another day"
you could also say in this case "discretion is the better part of valor"

It doesn't sound like this was the answer you were looking for, I hope this helps a little.
Mike


tuganddawn at talktalk.net wrote:
Dear all,

I am a firefighter and paramedic working in Oxford UK. I am currently researching the extrication of casualties from smoke logged and fire risk buildings by Breathing Apparatus (BA) crews. I am currently undertaking my BA training and am acutely aware of the dificulties encountered when working in this type of environment but, as a dual professional, feel that there must be a better way of dealing with casualties. Current practice is still quite archaic and simply follows the "just get them out" mantra.
Does anyone on the list know of any programs or ideas that allow a BA crew to secure a basic airway, administer clean air and manually handle the casualty in an ergonomic and practical way without sacrificing the safety and efficacy of the crew?
In any event, thanks for your time and trouble ladies and gentlemen and I look forward to hearing your ideas.

yours with Kindest Regards

Tristan "Tug" Crumpton
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