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FIREFIGHTER INJURIES protective clothing and SCBA? Is it faster and/or safer to cut off his turnout gear and SCBA, or remove it in the normal fashion? There are published procedures for the removal of a motorcycle helmet1 or the pads and helmet of a football player, but no established practices exist concerning a frefghter. Yet, in comparison, football gear does not fully envelop the player and weighs less than 30 pounds, while a full frefghting ensemble does encapsulate the frefghter and can weigh up to 75 pounds (50 pounds turnout gear plus 25 pounds SCBA). Therefore, some type of rapid, systematic approach is needed for removing a full protective frefghting ensemble from the frefghter/patient to ensure any existing injuries are not aggravated and new ones aren't created. Clearly, no two rescue scenarios will be the same. However, it's possible to create general categories, such as conscious versus FIGURE 1: Rescuers most commonly placed an injured firefighter supine, but tilted because of the SCBA. FIGURE 2: Initiating in-line manual stabilization of the head and neck. FIGURE 3: Cutting the front of the hood will facilitate its removal, expose the head harness and allow the provider to reposition his hands. FIGURE 4: The head is now stabilized from the mandible and occiput, the hood is pulled away, and the harness or mesh can be loosened or cut. FIGURE 5: The shoulder strap is cut at the lower, adjustable section to avoid the padding and air lines. unconscious, or ambulatory versus non-ambulatory. It is also possible to identify typical patterns, such as the frefghter who falls or becomes lost, calls for help but is still able to self-rescue. It is important to remember, though, that the specifc injuries will always be different, depending on the events that led to the rescue. In the context of the injured frefghter who has been rescued from a building, the frefghter will present in one of three general categories: 1) cardiac arrest, 2) breathing, but unconscious, or 3) conscious. Of course we could further create more detailed subcategories. For example, under category 1, he could be in respiratory arrest only, or under category 3, there could be varying levels of consciousness. Whatever the circumstances, as this patient is assessed and treated the integrity of the spine and the patency of the airway both need to be protected. Just as in the management of a football player or any helmeted and/or protected patient, a system is needed. In order to explore this area more thoroughly, discussions were held with frefghters and paramedics. Practice scenarios were conducted in order to fnd the best method of beginning patient assessment and treatment, while removing the turnout gear and maintaining the integrity of the airway and spine. The scenarios were meant to begin with a rapid intervention setting and evolve from there. The frst point of discussion was the initial presentation of the patient, which would represent the conclusion of the rapid intervention process. It was found that a conscious and oriented frefghter, with minor injuries, could walk out of a building, alone or with assistance, and then assume a position of comfort while he doffed his gear or was assisted in doing so. This would be the frefghter who was able to self-rescue, or who received minimal assistance—perhaps one who had received soft tissue injuries or an extremity fracture. The patient who is seriously injured or unconscious, or whose mental status is decreased, however, would be carried, dragged or lowered out of a building. In this scenario, it was noted that almost inevitably the rescuing frefghters would lay the patient supine but tilted to one side because of the air cylinder (Figure 1). Consequently, this is probably the most common position in which rescued frefghters would present, and would represent the starting point for their assessment. Assessment of the ABCs can begin immediately, with the turnout gear still on. It is not an accurate assessment until the face piece is removed, but if the patient is breathing adequately this will be heard through the mask. Slow or shallow breathing may also be heard, depending on the actual rate and quality. However, one of the frst actions, as soon as the patient is out of the IDLH (Immediately Dangerous to Life or Health) atmosphere, is to disconnect the regulator from the mask. Assessing the ABCs of the conscious patient will clearly be easier, and further, he will be able to state the location of his pain or injuries. Depending on the mechanism of injury, a cervical injury should be suspected; depending on the method used to rescue the frefghter—for example, the frefghter's carry or inward ladder method2—the spine may or may not be stabilized. So, as with other patients, this must be started simultaneously to the ABCs EMSWORLD.com | JUNE 2013 47