When to wear your fireman suit

Craig Alan Evans

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With all the new talk about fire base EMS and fire departments in general I thought this would be a good topic for discussion. I work in a fire department as an EMS Lt in charge of a two person paramedic medic unit. We are cross trained and carry full protective gear and SCBA with us. These are the situations I teach my crews to suit up for and why. How does it work where you are? Do you have protective gear for these situations? Would you like to if you don't? Do you think it's unnecessary ? What are your thoughts, feelings, and experience with this? I love getting everyone's perspective from around the globe.

http://www.craigalanevans.blogspot.com/2012/08/when-to-put-on-your-fireman-suit.html?m=1
 

DesertMedic66

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1) as a private non-fire ambulance company we do not respond to structure fires. If we do respond we are not going to be fire due. If we are on scene before the fire department we can't do anything since we are non fire based.

Im sure someone will make an argument about about being first on scene and there being a trapped victim inside.

2) vehicle fire is pretty much the same as above. If we even respond we stage outside of the immediate area to let fire do their thing. If we are first on scene and the fire is small I may try to pull someone out but it depends on certain things.

3) In my area cut and rescue operations are up to the fire departments. Normally the fire medic will take over control of the scene and lead the operation based on patient care. We just stand by with the gurney.

Our PPE's consist of a reflective vest, safety helmet, gloves, and goggles. We do not have any extra room on the ambulances to store bunker gear. If we are doing anything that requires more PPE then fire department will take over (they automatically respond to every 911 call with us).
 

medicsb

Forum Asst. Chief
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Never had SCBA on any vehicle I've worked and I've never had the need for one. Mostly never had a need for turn-out gear, but I would wear it in the rare instances that I actually had to crawl into a car.

Where I worked, as a medic, we were there for SICK patients and rehab. Any patients would be brought to us and we'd only go to them if it was in a "safe" location, and then I was only going over to do a 6 foot exam to determine how sick they were (awake vs. not awake; pulse vs. no pulse) and give BLS some direction. If the patient didn't need ALS, then they went with BLS and I would just give them a friendly wave (which was the majority).

Overall, I think your recommendations are reasonable, though I don't think you need to wear turn-out gear for triaging at the scene of a large fire. Your job as someone assigned to medical care should be to stay in a safe place so you can do your job. Let the fire crew bring the patient to you.
 
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1) as a private non-fire ambulance company we do not respond to structure fires. If we do respond we are not going to be fire due. If we are on scene before the fire department we can't do anything since we are non fire based.

Im sure someone will make an argument about about being first on scene and there being a trapped victim inside.

2) vehicle fire is pretty much the same as above. If we even respond we stage outside of the immediate area to let fire do their thing. If we are first on scene and the fire is small I may try to pull someone out but it depends on certain things.

3) In my area cut and rescue operations are up to the fire departments. Normally the fire medic will take over control of the scene and lead the operation based on patient care. We just stand by with the gurney.

Our PPE's consist of a reflective vest, safety helmet, gloves, and goggles. We do not have any extra room on the ambulances to store bunker gear. If we are doing anything that requires more PPE then fire department will take over (they automatically respond to every 911 call with us).

This. In my city we do respond to about 90% of the calls Fire goes on.
 

abckidsmom

Dances with Patients
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It's a little more clear for us, our county runs a 1-man engine company. The first due medic crew fills out that crew and works in a suppression role.

We just don't have the manpower for EMS to fill an EMS Only role. Last fire we went to, we pulled an unconscious guy out of the living room, loaded him up and drove him to the ER, leaving the other 5 people to finish with the apartment fire.

We put our gear on for every fire call because we are the backup, the RIT, and in many cases we are the primary attack crew. I've driven 20 minutes to a more rural area of the county and arrive to find the first due engine with a line pulled to the door, nozzle on the porch waiting for us.
 

Bullets

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Unless you are engaging in actually structural fire fighting, structural ppe is not needed

If you review your NFPA, vehicle extrication is considered a technical rescue and only requires PPE of that type. My agency provides EMS rescue and we wear long sleeve bdu shirts, just add gloves and a helmet during operations. We have USAR rated gear which is optional.
 

CritterNurse

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I'm not fire-trained, but what equipment I bring with me depends on what dispatch said the problem was. The helmet stays home unless the call sounds like a fire or a MVA. The reflective vest and/or jacket stays home unless its a fire, night time, inclement weather, or cold enough for a jacket. In the case of a MVA, I will grab a set of extrication gear from the station house when I go up there for the ambulance.

Usually I just put on my boots, grab my wallet from my purse, and grab my stethoscope on the way out the door.
 

Akulahawk

EMT-P/ED RN
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Unless you are engaging in actually structural fire fighting, structural ppe is not needed

If you review your NFPA, vehicle extrication is considered a technical rescue and only requires PPE of that type. My agency provides EMS rescue and we wear long sleeve bdu shirts, just add gloves and a helmet during operations. We have USAR rated gear which is optional.
When I "left" Santa Clara County, they were requiring EMS providers to provide some kind of similar PPE to their employees (all ambulance providers). They required helmets, goggles, reflective jackets, and sturdy gloves to be provided for all EMS providers assigned to that unit. That PPE was to be worn at all MCI events and vehicle collision scenes, or anytime the Providers deemed it necessary to don the PPE. Given the expense, you can imagine just how... thrilled the smaller EMS providers were.
 

Achilles

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Turnout gear is meant to protect you from fire, broken glass, high heat. Not blood, vomit and other bodily fluids, I've worn my structural FF gear on a call.
If I'm rescuing someone from a fire or accident, I'll keep it on.
 

DrParasite

The fire extinguisher is not just for show
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Unless you are engaging in actually structural fire fighting, structural ppe is not needed

If you review your NFPA, vehicle extrication is considered a technical rescue and only requires PPE of that type. My agency provides EMS rescue and we wear long sleeve bdu shirts, just add gloves and a helmet during operations. We have USAR rated gear which is optional.
Craig, Bullet's is right.

We don't send an ambulance to vehicle fires, unless there is a report of injuries. typically 1 engine or 1 engine and 1 ladder will put it out.

For structure fires, if you are trained as a structural firefighter, and operating as a firefighter/EMT, than you should dress to play the part. So if it's burning, and you are putting wet stuff on red stuff, by all means dress up. If you are just being an EMT, then you can get away with a helmet and coat if you are near the fire, and probably get away with just a helmet if you are in the rehab zone (and might not need the helmet).

As for MVAs w/ entrapment, you DO NOT need structure fire gear. You can get away with brush gear (jacket and pants), leather gloves, boots and helmet. you aren't crawling into a burning car while it's on fire, so you don't need the thermal protection.

Side note: unless you are working for a fire department, or an agency that does rescue, there is a very good change you will have minimal PPE issued to you other. Your truck might have a helmet and might have a coat and gloves (which you will be lucky if it fits), especially if it's a private company.
 
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Side note: unless you are working for a fire department, or an agency that does rescue, there is a very good change you will have minimal PPE issued to you other. Your truck might have a helmet and might have a coat and gloves (which you will be lucky if it fits), especially if it's a private company.

I'm lucky to work for a private agency that issues every employee brand new, properly fitting PPE including helmet and googles. They go on the rig at SOS and come off the rig at EOS. They're also to be kept in our personal vehicles at all times off duty, along with a spare uniform, as there have been several occasions where off duty crews were called in to work.
 

Tigger

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Turnout gear is meant to protect you from fire, broken glass, high heat. Not blood, vomit and other bodily fluids, I've worn my structural FF gear on a call.
If I'm rescuing someone from a fire or accident, I'll keep it on.

A lot of turnout gear can now be ordered with bloodborne pathogen resistant barriers in it. The fire guys in my station have new gear with it, they wear the bunkers to medicals after about four or so, seems to make since.
 

EMDispatch

IAED EMD-Q/EMT
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im sure someone will make an argument about about being first on scene and there being a trapped victim inside.

fireems.jpg

Extreme circumstances, the crew helped rescue around 20 people trapped in the upper floors because the fire was set in the single stairwell. Fire Department was volunteer, and on scene in under 5 minutes. When they arrived, victims were jumping out of third story windows and throwing children out the windows.

But once again extreme circumstances, and did not involve interior operations.
 

joshrunkle35

EMT-P/RN
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I thought it was important to wear turn out gear to all ambulance calls so that the patient could be reassured that you are indeed a fireman, which has everything to do with patient care.
 

NomadicMedic

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I'm sure patients appreciate firefighters stomping into their house wearing boots and dirty bunker gear. In most cases, fire departments don't allow bunker gear into any of the living quarters. Why would it be okay to wear that into someone's house?
 
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luke_31

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Probably because it's not their house so the firefighters don't care if they make a mess with the bunker gear they are wearing. But that is one man's opinion.
 

NomadicMedic

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I don't necessarily know if it's a case of not caring, I'd hazard a guess that it's more a traditions thing. "When we get up in the middle of the night, we wear bunker pants."

I just know that it is a carcinogen and contaminant factor. I don't understand why any department still allows bunker gear to be worn In a situation that doesn't involve the need for structural firefighting PPE.

As an aside, I work for an ALS third service. We don't do any firefighting nor do we physically cut cars. However, we are expected to be in the "action circle" and to make entry into vehicles to stabilize the patient if needed. Each medic is issued Globe extrication gear, Bullard helmets, kevlar gloves, ESS goggles and accountability tags. There's no excuse not to be wearing proper PPE when you're in a hazardous situation.
 
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Wes

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You know, the more I hear about paramedicine in Delaware, the more impressed I am. How's the clinical medicine? Progressive?
 

46Young

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If you're not a trained firefighter, whose job description involves fire suppression, you're not covered under the presumptive cancers. As such, there's no reason why you should be anywhere near the IDLH.

When I worked in NYC EMS, wen we were at a Fire75 or MCI21 (structure fire standby), we brought our equipment close to the building, but out of the collapse zone. I left NYC in 2007. At that time, FDNY was providing it's EMT's and medics with structural PPE, excluding SCBA (IIRC). They were required to don the gear on MVA's, but I think it was necessary anywhere else. Their Haz-Tac crews had SCBA's and such, because they were Hazmat Ops.

I've worked in a few different single role EMS systems, where the fire side were only first responders or non-transport BL at the most. At no time were we required to enter the IDLH for ay reason.

At my current place of employment, we're similar to the OP's system, and run mutual aid with them frequently. All of our transport crews carry full PPE and SCBA at all times. We typically respond in our station uniforms (or PT gear with coveralls and safety shoes as the case may be), and get dressed (don PPE) if necessary. What's considered necessary varies from person to person, and BC to BC. Whether we get dressed at the station, or stage and then get dressed, the same exact amount of time passes by, so it makes no difference if we wait until we get dressed at the fire. If anything, if there's a patient U/A, we (txp crew) delayed care a few moments by getting dressed at the firehouse.

Some BC's expect the first due medic unit to help with exterior fireground tasks (if no patients U/A), or even take in a back-up line inside if the second due engine is delayed. Even if we're just helping to throw ladders and pop doors, we typically use our PPE, less SCBA. If we're assigned to rehab on a high-rise fire, we're two floors below the fire floor, so we'll be working with full PPE and SCBA (but not on air). Inside of the fire building, no one-s doing any ALS; the most that you're going to do for someone is assist/carry them out. The only people with spare air packs are the RIT crew, and that pack is for the mayday caller. No real pt care will occur until the patient is outside of the building, and I don't need structural PPE to do curbside pt care. For a car fire or pin job, we'll always be responding with an engine, and all of our engines have at least one medic, so that medic will be in PPE and addressing the patient in the car, with maybe a BLS provider assisting them. How much ALS can you really do inside of a car, that requires two medics? In our system, it's typical for the engine medic to get inside the car with the pt, and the right bucket FF will stand by with a charged hose line. A Heavy Rescue Squad will be there with four people doing the cut job. There's no need for te txp crew, in our system, to get dressed for a pin job or car fire.

In understaffed/underfunded systems, particularly ones that use "single pull," (leave your gear in the middle of the bay and jump on whatever unit gets a call, due to lack of staff), it may be necessary to perform both suppression and medical treatment on the same call. In that case, I say have PPE with you, and just get dressed when it's necessary to do so. The car's on fire? Throw on your gear and get to work. Bodies hanging out of a window, get dressed and go to work. In either case, when getting dressed first (maybe for no reason), and getting dressed at the scene, the time to the patient is virtually the same. In the dead of summer, I find it difficult to concentrate on medical skills if I'm hot and dehydrated, and restricted by my PPE that's been on for a while. If I can work without my coat on, for the sake of argument, then maybe I didn't need the PPE in the first place. In fact, our high heat advisories tell us to remove our PPE ASAP during an incident to prevent hyperthermia, dehydration, and saturating our gear in sweat, which pre-disposes us to steam burns in a structure fire.
 

jefftherealmccoy

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I thought it was important to wear turn out gear to all ambulance calls so that the patient could be reassured that you are indeed a fireman, which has everything to do with patient care.

Nope.

We run ambulance and engine to calls that need the extra man power. The two on the ambulance are required to wear regular station uniform and boots. The engine crew can put on turnout bottoms if it's past 10 or they were in the middle of a work out. But they're not allowed into the home unless their boots are clean.

OP-
We wear turnouts on car accidents, downed wires, all fires (except wildland), gas leaks, fire alarms, anything where there could possibly be a hazard to our skin, or there's a possiblity of donning SCBA.
 
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