By Michael Morse
“What the heck do I know about triage, I’m a firefighter!”
During a trauma call, every person’s on-scene role is vital. The engine company is usually first-due and needs to effectively spot the apparatus; establish scene safety; and give a brief, detailed report. The officer of the company, having spent proper time training and talking about what he expects from whom, is able to assess the scene and request additional resources as needed. The officer’s crew each has tasks to complete. Depending on staffing levels, a firefighter can be designated to control traffic and set up flares or cones if the trauma is on a roadway. Another firefighter with emergency medical technician training can do a patient assessment, control bleeding, and airway management. If the luxury of a four-person crew is on scene and there are multiple casualties, triage can begin.
Every firefighter needs to know about triage at a mass casualty incident. It’s one of the skills we hope we never have to use. In my experience, one of the best ways to stay fresh and knowledgeable about mass casualty incidents is to stay current with happenings around the world. Sadly, every few weeks, a community is beset with tragedy. Active shooters are prevalent. Tornadoes wipe out communities, trains derail, passenger planes crash. Using these tragic news stories as training opportunities puts real-world urgency into training discussions. Talking about what happened, how the emergency agencies responded, and what you as a company would have done in similar circumstances sinks in; before long, a toolbox of skills is embedded in the company’s collective skill set.
Another vitally important skill for all firefighters is to know exactly where they are in any location of their response district and how to get from Point A to Point B from that location. Any firefighter worthy of the department patch on his sleeve can get the trucks where they need to be when they are dispatched. We learn our streets, study our maps, and know every street in our district and how to get there from our station. The trick is to know how to get anywhere from anywhere.
“I need a driver…”
The ambulance crews sometimes need a driver. Knowing how to get to the hospital from the scene without using valuable mental space makes the trip what it needs to be: a gently, steady progression toward the emergency room.
- Slow and steady wins the race.
- Unless speed is essential, safe, quickly, and steady wins the race.
- The physics of turning is amplified 50 times while treating a patient in the back of a moving vehicle. Take corners slowly.
- Rapid stops are catastrophic. Plan accordingly.
- Rapid starts are just as bad.
- Keep an ear on the goings on in the back. Statements like “I’m starting a line” are clues to take it easy. “I’m clear, you’re clear, everybody clear?” is another.
- Turn off the sirens when approaching the emergency department loading dock.
- The ambulance bay at a busy emergency department is a demolition derby waiting to happen. This is no time to rush. Find the best spot and back in, if you can.
- Turn off the emergency lights, and shut down the vehicle (a properly trained firefighting crew knows how to operate ALL of the vehicles in operation at any given time).
- Exit the vehicle, open the rear doors, and follow the orders of whoever is in charge. Empty vehicles should be locked.
Joint training with emergency medical services, whether part of or separate from your department, can make the difference when the bell tips and seconds truly count. Familiarization with vehicles, their crews, and basic standard operation procedures creates a good working environment within the department or with different agencies that respond to the same emergency.
Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.
More Michael Morse