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40 APRIL 2016 | EMSWORLD.com This firefighter, after being rescued, would have needed medical care initiated immediately, while still dressed in full turnout gear, and would depend on you to remove his gear without causing or aggravating injuries. This is why you should have a good under- standing of turnout gear, how to begin assessment through it and how to remove it. After a successful rapid intervention operation has been com- pleted and a firefighter is outside the building, basic assessment of airway and breathing may be initiated because breathing may be heard through the SCBA face piece. Obviously, the protective ensemble must be removed. Additionally, depending on whether the firefighter was injured or became ill, cervical stabilization should be started. Some goals of rapid intervention are to locate, get air to and remove an injured firefighter. Generally, cervical stabilization may not be addressed during the removal of the firefighter. The typical extremity, cradle and blanket carry are examples. Thus, once the firefighter is outside, this would probably be the first opportunity to manually stabilize the head. As you approach the head of a firefighter, you will see three items in order: the helmet, protective hood and face piece. The helmet should be snug on the patient's head, with earflaps down and chin- strap fastened. The only concern in a rapid removal would be the chinstrap, which could be either cut or simply unfastened. After the helmet is removed, a provider would look at the hood, which could simple be pulled off. However, if trauma is truly a concern, the front of the hood may be cut and removed while stabilizing the patient's head. 3 Under the hood is the face piece, which covers the face and is held in place by straps. Like the helmet, the straps may be either cut or unfastened. At that point, the firefighter patient's head, face and neck are now completely exposed, allowing a com- plete ABC assessment and the beginning of airway management. As you move to the torso, the SCBA and turnout coat could be simply unfastened and removed, but the challenge is to remove them with a minimum of patient movement. A provider's first instinct might be to start pulling straps and unfastening buckles, but with a better understanding of the design and construction, a firefighter patient's ensemble may systematically be rapidly removed. SCBA harness straps may be unfastened or cut. If there's a chest strap, it's normally thin and accessible. If shears are close by, it may be easier to cut. The waist strap is thicker, but also very accessible. It normally has a very basic buckle, and is probably easier to unfasten normally. The shoulder straps may not be removed without moving the patient's arms, so it may be faster to cut them. This would need to be done at the lower, adjustable section because it's much thin- ner. The upper section includes padding, hoses and the integrated PASS device. The SCBA may now be pulled away or left behind the firefighter, supporting him while the turnout coat is addressed. There are multiple methods of fastening turnout coats, including Velcro, zippers and snaps. Thus, the front of a turnout coat should be unfastened in the normal manner. Removing the turnout coat quickly and with a minimum of patient movement could be the most challenging step in this pro- cess. The coat could simply be pulled off, but this causes quite a bit of patient movement. Because of trapped heat, an injured firefighter will probably have a layer of sweat between his skin and the turn- For More Information Circle 34 on Reader Service Card