Rescue Junkies Training

Timed intentionally with April 20th.

 

Cannabis, marijuana, pot, weed, grass, bud, kind, reefer, ganja, etc - all the subject for today's lecture.

Plant: Cannabis sativa

Why?

Fourth most popular recreational drug in the US (ETOH, Caffeine, Nicotine)

Approx 100 million Americans have tried cannabis (1/3 of Americans), with 25M used in the last year

Legal

Schedule I Controlled Substance per Federal law

Locally 'legal' in 9 states

 

What are cannabis products?

Chemicals from the cannabis family of plants, specifically cannabis sativa

 

There are 113 (+) cannabinoid chemicals - two key (THC and CBD)

 

THC - Tetrahydrocannabinol

Psychoactive component of most cannabis consumed

Typical signs/symptoms

Paranoia

Hallucinations

Tachycardia

Dry mouth

Bloodshot eyes

Increased enjoyment of food or hunger

Distortion of perception of time

Anxiety

Increased libido

Increased awareness of sensations

Most sought-after component for most recreational users

Typical concentrations for commercial buds:

3-20% THC, with some options for more THC content or more CBD content

Can be concentrated in other forms

Hash oil can be up to 90% THC!

 

CBD - Cannabidiol

More of a sedative cannabinoid compound

Attributed to most of the 'medicinal effects' of cannabis

'Indications'

Antianxiety

Antipsychotic

Anti-convulsive

Anti-addiction

Anti-emetic(Nausea (chemotherapy))

Rheumatoid arthritis

M/S

Other nerve stuff

Glaucoma

Typical signs/symptoms:

Anti-anxiety

Anti-psychotic

Sedative

 

Medical incidents

"""Overdoses"""

Not technically overdose

Symptoms causing the creation of new problems

Psychotic events

Anxiety attacks

Cardiac symptoms

Cannabinoid hyperemesis

Commonly insist that weed STOPS vomiting

Found in hot shower

Treatment: Capsaicin, waiting out the THC

Other complications

 

Fire incidents

Grow houses

Often concealed in ordinary residential structures

Grow process involves hydroponic circulation systems, CO2 tanks, lights, climate control and more

High power consumption

Often stealing power to avoid detection

Wiring is sub-code

Fires tend to be electrical therefore in origin

Significant risk from smoke and in overhaul

Can also be booby trapped and a risk to firefighters on approach

Recommended response actions

Control utilities

Be cognizant of non-controlled power even though the main breaker is cut off

Maintain PPE for ALL of the call

Notify law enforcement as soon as cannabis is identified

 

Butane hash oil

Butane is used as an organic solvent to 'wash' out THC from cannabis leaves and stems

Extracting valuable component from what would otherwise be waste

Trimmings are placed in a tube, then injected with butane, which is then dripped onto a pyrex dish on a hot plate

This then causes the butane to vaporize, leaving a high purity THC resin

Obvious problem with this method

Explosive range of butane: 1.8-8.4% in air

Flash point: -60 degree science (-76F)

Colorless, slight 'gassy' odor

Cloud of explosive gas fills the area where they are working

Then a thermostat or other open contact switch operates and creates a spark

Boom

Fire

On arrival to the fire

Size Up

Scene safety

Exploding butane cans

Suppress the fire

Protect exposures

Ensure LE knows

 

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LODDs

FF Larry Marusik (March 10, 2018). Severe burn injuries fighting a grass fire in Texas.

Asst. Chief Michael Edwards and LT Tom Craigo of Pratt FD died from a rollover traffic accident injuring three other firefighters of their rig (March 24, 2018, West Virgina)

LT Michael Davidson, FDNY (March 23, 2018) Died fighting a five alarm movie set fire in Harlem. 

 

 

 

Pathophysiology

What is pathophysiology?

Following the path of a medical problem

Why?

Finding the source is the first step to fixing something

Examples of pathophys in action

Trauma

Cardiac

Neuro

Sepsis

 

Single Vehicle Rollover

What is this call?

Typically exactly that

Can be nonsense, often though a legit call

 

Cause

Center of gravity for vehicle passing over wheels

Overcorrection

Rock or something

Going up or down a hill

PPE

Structure or extrication gear

No air pack, but have it nearby

Traffic vest

Response

Code 3 response to scene (unless reliable no-injury/no hazard determination)

Be alert to traffic conditions (is there a slowdown approaching)

Look for tire tracks off the road, up embankments, down hills, etc

 

On Arrival

Proper size up

I-dentify yourself/unit

D-escribe what you see

E-xplain what you're going to do

A-ssume command

L-et others know what to do

"Dispatch engine 5" "engine 5" "Engine 5 is on scene of a single vehicle rollover, Highway 10, eastbound mile marker 12, single SUV on it's side, moderate damage.  I'll be out investigating; show Engine 5 as Old Lake Command, continue incoming units."

Control traffic

Do a 360 of the vehicle

Identify hazards

Make contact with occupant

 

Typical findings

Option a - "Everyone's fine".  Driver climbed out after the crash, found sitting on the guardrail on the phone with their insurance company

Quick physical exam?

Work as a refusal/treat&release/no pt

Option B – "oh shit" Driver is trapped, extrication needed

Get to work

Stabilize vehicle

Treat PT

Extricate

Transport

 

Routine actions

Stabilize vehicle

Pop windows

Extrication

Fluid control

Fight fires

 

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Introductions

 

The Pulaski

What is it

 

History

Created by Ed Pulaski in 1911

Forest service ranger in the northwest

Refined more and more through 1913, production began in 1920, national standard tool in the 30's

Function

Limbing

Grubbing

Trenching

Pros

Fairly lightweight

Well balanced

Multiple functions

Can be used in multiple terrains

Cons

Not super effective at some tasks (clearing grass, duff, etc)

Shorter handle

Can require more sharpening

Two sharp parts, not just one, so twice the cut risk

Recommended brands?

FSS (General Services Admin)

Council Tool

http://amzn.to/2HTZUEA

http://amzn.to/2Gendf5

Rogue Tools

https://roguehoe.com/product/55hx-the-beast/

Other options

Truper

http://amzn.to/2GRuNtY

Seymour

http://amzn.to/2G8Mojf

 

https://www.fs.fed.us/fire/fmt/fmt_pdfs/047_03.pdf

Traumatic Shock

Causes

 

Signs

 

Symptoms

 

DDx

 

Treatment

 

Smoke Investigations (Outside)

What is this call

 

When dispatched

 

En Route actions

 

Where to go?

RP's Location

 

Known high-spots

 

Suspected fire location

 

PPE for response

Wildland gear?

 

Structure gear?

 

If you see smoke

Is this a known location?

Location (yours)

Bearing to smoke

Smoke color

Size of plume

Behavior in the air

Flames?

 

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Introductions

 

Gear Review:

Supraglottic airways and why they suck

 

Carbon Monoxide:

What is it

Pathophiz

DDx

Treatment

 

Ventilation:

Purpose

Remove contaminants

Control fire spread

Addition of air can accelerate combustion, but also can allow heat to escape

Most small, contained fires are ventilation limited – not fuel limited

Backdraft and flashover: Training Backdraft

Render an environment safer

When is it called for?

Once fire is located, to ventilate the fire space and ease interior attack

Clear out a gas leak or carbon monoxide

Confined space

Basic principles

Pressure differentials

Air moves from high pressure to low

Pressure can be created by

Mechanical compression

Entrainment

Heat/fire

Coordinated

Communicated

Controlled

Practical application

Positive pressure

Fan at the door

Contaminant leaves through other openings

https://photos.smugmug.com/Stations-Units/Firehouse-42-Foxfield/Station-42-Foxfield/i-CHLmxsD/0/1a53bb60/X3/Sams023-X3.jpg

Negative pressure

Fan at door and window

Air intakes however it can

Hydraulic negative pressure

Using a 30% fog stream to entrain air

Helpful to exhaust from a specific space

Push-pull

Fans at multiple ends

Exhaust fan and intake fan

Vertical

Utilizes fire draft to exhaust and move air

Procedure: cut a hole in the roof.  Coordinated,

Horizontal

Open a window or door

Allow exhaust

Can supplement with a fan if fire draft is insufficient

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Introductions

 

Gear Review - Jackson Nemesis Sunglasses

Pros

Inexpensive

Disposable

Good uv protection

Good sunglasses (uniform lenses)

ANSI Z87 rated as safety glasses

Sort of like oakleys

Cons

Kinda tactical timmy looking

Polarized option is available, but not great

Can be somewhat flimsy 

Verdict

Great sunglasses at a great price

Would recommend

Link: Sunglasses, each: http://amzn.to/2GFKOBT

12 pack: http://amzn.to/2ELqYJ9

Clear: http://amzn.to/2EZgTaF

Indoor/Outdoor: http://amzn.to/2GFKYsZ

 

"Critical" Cardiac Pharmacology

Epi

Atropine

Amiodarone/lidocaine

Calcium

Bicarb

Adenosine

 

Interior Odor Investigations

Basic call:

Someone smells something inside

 

Critical question

Smoke or gas?

Dispatch may communicate one or the other

RP may say one or the other

Alarm or no alarms?

 

PPE

Full structure gear

Air pack on – perhaps not on air per se

4-Gas Monitor

Make sure to power up and zero BEFORE going inside

Stay away from truck and breathing people

 

Smell of Gas

Look at meter readings as you enter and search the structure

%LEL is most critical, then look for drops in oxygen

Check appliances, utility rooms, where the gas line comes into the structure

See if stove is off or if there are pilot lights that are out

If you have a %LEL >10%

On air

Don't throw any switches etc

Vent the structure

No LEL?

Locate the source of increasing %LEL

Ventilate

Shut off gas to the appliance

 

Smell of Smoke

Tools

What kind of smoke?

Lots of smoke?

Fireplace?

TIC

Check appliances

Look for signs of fire

Hot outlets etc

Introductions

 

Duty Bag

Purpose

Contents

Function

5.11 (NOT THE RUSH 2), the Two-Banger

http://amzn.to/2E7tyI4

Maxpedition Jumbo Versipack

http://amzn.to/2GFE3ko

 

Crush Syndrome

Enright's got a medical topic this time...

Definition

Extremity or multiple extremities are crushed

Crushed= no blood flow in/out, BP maintained because volume is absent/compressed

Crush must remain for 45+ minutes

Crush syndrome itself is the reperfusion injury to the body

Drop in blood pressure

K+

Myoglobin

P

Pt can appear minor injury (except crushed) and can be A&Ox4, then die in minutes from crush being released

Crush syndrome =/= compartment syndrome

Similar pathophis, but different cause and slightly different treatments

Compartment syndrome can be secondary to crush

Signs/Symptoms

Limb or body part has been crushed >45 minutes

No circulation or sensation in the limb

S/S of shock

Treatment

Do not free the limb until treatment is ready - HAVE A PLAN

Consider field amputation

2x large bore IV

NS or LRS

1-2L bolus just prior to freeing

2 amps NaBicarb

Cardiac monitoring

Then free pt

PRN pain meds

Rapid transport to trauma center

Be prepared with CaCl and albuterol in case of Hyper-K+

Also remember comfort/shock care

Warmth

Airway (clean air)

Maintain oxygenation

 

Preparation

Education of other first responders

Identify incidents with crush syndrome risk

MVA w/ entrapment (rare)

Collapses

Trench incidents

Terrorist incidents / explosions

Start additional resources early

Tech rescue team?

MD to the scene?

Flights?

Protocol Reference: San Francisco FD/EMS: https://acidremap.com/sites/SanFrancisco/

 

Firehouse Cooking

Stew components, throw into crock pot and cook for 8 hours on low

Meat

Beef

Pork

Buffalo

Elk

Venison

Vegetable

Carrot

Celery

Green bean

Starch

Beans

Corn

Potato

Rice/Noodle

Seasoning palate

Southwestern

Chile powder (red chilies)

Cayenne pepper

Cumin

Garlic

Asian

Sesame

Garlic

Ginger

Soy sauce (light)

Mediterranean

(Consider lamb for meat)

Feta

Olive

Garlic

Coriander

"Greek Red Rub"

Thai

Red pepper

Chunky Peanut butter

Sesame

Savory (nothing wrong with the basics)

Salt

Pepper

Garlic

Butter 

(consider searing meat with above spices first)

 

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Introduction

 

News

 

Flashlights

Fenix LD12/streamlight protac 1L-1AA

Pocket EDC light

Maglite

Classic 4D flashlight and similar

Streamlight Survivor

90 degree light

Low profile and regular

 

Electrical Therapy

Defibrillation

Monophasic

Biphasic

Cardioversion

Pacing

 

 

2:1 Mechanical Advantage Systems

What does it do?

System to raise victims and rescuers from a scene down a hill

Can be stored rigged and ready to use

Simple, easy for setup and operations

Suitable for low to medium angles

 

Functions

Multiplies force of people pulling up

 

Design

Anchor at the top

Moving pulley connected to the load

Rope back up to change of direction pulley at anchor (optional)

Requirements

2x distance to pt of rope

Stokes basket

2 or 3 pulleys

Can use either a progress capture mechanism with a pulley or a tandem prusik progress capture

Personnel

3 members of litter team

Edge attendant

Haul team

Safety?

 

Limitations

Uses 2x as much rope

Not easy to convert to other systems

Prerigs can breed complacency and incompetence

 

Should you use?

Soft maybe. 

Perhaps with backup rigs that don’t have highly trained members

Introduction

 

Gear: Fire Extinguishers

ABC Dry Chem

Monoammonium phosphate

AB and C

Blankets, melts then smothers burning fuels

Nonconductive

It works, but isn't great for basically anything.  Super messy.

BC Dry Chem

Sodium Bicarb

BC only, but will sort of work on A

Same use as ABC

CO2

BC

Good for electrical and grease

Not terrible on A, but must protect from reiginition

Static risk!

Water Cans

Class A or sort of B

With or without foam

Fantastic- basically the best option for professionals with ordinary combustibles and normal fires

 

Airway Pharmaceuticals

NAVEL

Ipratropium anticholinergic

Albuterol ẞ-2 agonist, potassium

Oxygen

 

Booster Reel

What is it?

Semi-rigid hoseline on a reel

Introduced by Seagrave in 1910!  Actually for chemical trucks (Bicarb reaction for pressure)

Initial hoses could be charged up to 800 psi!

Most commonly found on type 3 or smaller engines

Some type 1's though do have them

Can be mounted on the front, amidships, in a rear compartment or as part of a skid unit

Generally 150-200' length with semi-permanent nozzle attached

1-inch hose

Hydraulics

Can flow 10-60 GPM, general performance more like 30 GPM

Friction loss:

52 psi at 30 GPM

184 psi at 60 GPM

NP~= 100 psi

Required PDP= 52+100 = 152 minimum…

Can be more in the 200+ range if trying to get more GPM

Advantages

Easy to deploy and store

Can be charged on the reel (to a degree)

Disadvantages

Low flow rate

Limited length

Limited nozzle options

 

Appropriate uses:

Trash fires

Dumpster or small outside fires

Grass fires

Wildland initial attack

Transitional attack with an undercrewed engine

Cleaning trucks

Inappropriate uses:

Interior operations

Car fires

Defensive fires

Long hose lays

 

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Introduction

Brought to you by the letters C2H5OH

      H   H

H - C - C- O - H

     H   H

 

Gear Review: Notebooks

Rite-in-the-Rain notebooks

Pros: Durable, waterproof, clear and effective

Cons: Cost, needs a pencil or sharpie etc to work

 

Memo books

Pros: cheap, can write on anything, can tear pages out

Cons: not durable, not waterproof, etc.

 

Field Notes

Pros: cheap, accessories, variants

Cons: falls apart, not good for tearing out pages

 

Phone/Tablet

Pros: easy to use, already have it, some detailed fancy apps for note-taking

Cons: risky to use on scene, require battery charge, may get busted

 

Premise

Reasonable and intelligent courses of action that may differ from the standard or norm.

 

 

Case 1: Hazmat spill

Call: E5, M2, E7, BC2, TR1, R5: crash with injuries, interstate 70, urban area- vehicle into tanker truck (time 20:00, Monday PM)

 

Conditions on arrival:  SUV vs tanker truck with placard 1993 (Diesel fuel).  Driver of SUV trapped in vehicle, driver of truck reports no one else in truck, believes the fuel is leaking.  You observe a leak from the tank onto the ground/snow

Highway is shut down by state police, and are asking about evacuations and such.

Crash is located near an apartment block (just off the freeway), and other housing and commercial structures adjacent to freeway.

Weather

Cold! Air temp of 5F, 3" snow on the ground, light winds (0-4 mph).  RH 20%

 

What would you do ?

 

What the book (ERG) says:

Initial isolation: 150 ft

Large spill: Isolate 1000 ft downwind

Affect rescue and then later deal with spill

 

What actually makes sense:

Flashpoint of diesel fuel: 136F

What actual risks exist to the responders?  What risks to the public?

Fire?  No, not really.  Temp is far below the flashpoint so not a real concern

Tox?  Limited

Crash?  Yes, driver is trapped

What actions make sense?

Affect rescue - PPE: full structure gear with SCBA

Plug the leak

Keep highway closed.

 

Case 2:

glucagon for bb overdose

Intentional overdose of benzos

La protocols

Opiate for chest pain

Opiates for anything

CaCl for neurotoxin

Prophylactic bicarb/CaCl

Therapeutic hyperventilation

 

Case 3: Training with Failure as the Only Result

Classic example: Kobayashi Maru exercise

The notional primary goal of the exercise is to rescue the civilian vessel Kobayashi Maru in a simulated battle with the Klingons. The disabled ship is located in the Klingon Neutral Zone, and any Starfleet ship entering the zone would cause an interstellar incident. The approaching cadet crew must decide whether to attempt rescue of the Kobayashi Maru crew – endangering their own ship and lives – or leave the Kobayashi Maru to certain destruction. If the cadet chooses to attempt rescue, the simulation is designed to guarantee that the cadet's ship is destroyed with the loss of all crew members.

 

From

 

Attempt to rescue the Kobayashi Maru's crew and passengers, which involves violating the Neutral Zone and thereby provoking the Klingons into hostile action or possibly an all-out war; or

Abandon the Kobayashi Maru, preventing war with the Klingons but leaving the crew and passengers of the freighter to probable death.

 

From

 

 

Training too often has a happy ending - switching to contingency isn't required, nothing unusual is required

Introductions

 

News: Train Crash

- Amtrak 501, Dupont, WA-

77 passengers + 3 crew

3 dead

Total of 90~ transported

 

Crashed onto interstate from speeding

80 mph in a 30 mph curve

Will cover in more depth once more information is released.

 

Hypothermia

Causes

Environmental

Traumatic

Etiology

 

Signs/Symptoms

 

Treatment

 

Downed power lines

Causes

 

Risks

 

Mitigation

 

 

Support and contact!

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