As discussed in part one there is a high physiological risk associated with firefighting and its environmental conditions. Some of these include exposure to high heat and humidity and an environment of high toxicological risk. In part one of this report we discussed what occurs once an arrest has taken place and the importance of gold standard cardiopulmonary resuscitation (CPR).
We have also outline the problems associated with delivering CPR to a downed firefighter, such as extended rescue times, exposure to the fire environment and heavy duty turnout ensemble, and self-contained breathing apparatus. This prolongs equipment removal, and inhibits delivering effective resuscitative care.
In part two we examine a new emerging cardiac arrest drill, specifically pertaining to a down firefighter. Its merits and subsequent proof of concept beta testing, conducted at Charles Sturt University. We will outline the data gathered to assess viability and efficiency of drills used to rapidly disrobe access and resuscitate a firefighter suffering from a cardiac arrest wearing full turnout and SCBA. Finally we will discuss the potential use within fire departments to increase the chances of survivability of a down firefighter suffering a cardiac arrest.
On analysis of the data gathered first changes can be seen in the time dependent data, as it shows an over 50% decrease in time taken to start cardiovascular compressions, when comparing the standard Fire and Rescue drill to the FDCPR / FDCAD method. There is also a further decrease in all other parable recorded time dependent interventions. Also it is important to note there is reason to believe there is scope to reduce time to first compressions with further alterations to task roles within the newer method due to additional information post testing.
CPR Time data
The patient related clinical data shows that minimising time until first compression is imperative to increase survivability in any arrest scenario. When compared to a standard CPR drill as a base line, all three drills outlined similar results pertaining to compression depth, compression rate and hand placement. Both of Firefighter down drills matched the International liaison committee on resuscitation (ILCOR) guidelines, of a 5 cm depth of chest compression and a rate of 100 compressions a minute. The associated scores were assigned by software (QCPR) from data measured through the manikin. Difference’s in the drills efficiency were seen largely due to a CPR score that is mostly a combination between ventilation, intervention time and compression scores as seen in the example (Image 1). Though in the FDCPR or FDCAD test there was an outlier due to user error of the clinical simulation manikin causing no ventilation data to be recorded for the FDCPR or the FDCAD method, and unfortunately this test could not be repeated due to learning biases. Even though this error eventuated there was still a 15% increase in the CPR score when comparing the FDCPR / FDCAD and F&RNSW methods (Image 1).
This is most likely due to the time efficiencies of the drill allowing compressions to begin before the patient is removed from the firefighting equipment.
Decibel readings were obtained to define a casualty could be assessed through and SCBA. It was assumed that the SCBA mask would act as a funnel channelling air out of the exhalation valve causing a rush of air due to its positive pressure.
The decibel readings taken showed the SCBA acted as an amplifier in turn improving the rescuer’s ability to hear sounds of breathing.
Additionally the watch and feel test reported 98% of rescuing firefighters could identify chest rise and fall and breathing when a hand is placed on the chest and felt little to no impairment from firefighting ensemble. Also that air can be felt moving out of the casualties SCBA by a rescuing firefighter placing an un-gloved hand over the exhalation valves on a breathing apparatus mask.
Surveys were then given to participants to assess the confidence and teach ability of the drills to assess any change pre and post introduction to the FDCPR / FDCAD method.
On analysis of the confidence and encoding CPR drill data, it showed an initial pre-assessment score of equal proportions within neutral and positive tiles. This response was expected due to the test participants being emergency responders, and being trained in BLS on an annual basis. Though when asked to comment, many participants stated “I did not even know a drill or procedure existed until now” and participants were observed as being unsure of where to begin.
On completion of drill instruction and assessment the post drill data outlined a change of 42% from neutral to positive. Participants comments became more positive such as “Awesome, much better than what exists now”.
Rescuer physiological and accelerometry measures were acquired during all three drills via the Hexoskin biometric shirt (www.hexoskin.com.au). Although not a key part of the proof of concept study, the measure of rescuer physiological changes (HR, RR, minute ventilation) deserves further study. Additionally, there is an opportunity to correlate G forces as measured by the Hexoskin during CPR with the QCPR and observed measures. This research has not been conducted anywhere in the world and this study is the first to examine these measures. This data outlined an increase in the rescuers vital signs such as heart rate, respiratory rate, and minute ventilation during all CPR drills and a further increase when the firefighter was required to wear personal protective equipment. Although there did not seem to be a decline in CPR efficiency of any of the drills within the short time period being assessed. Saying this it could be assumed fatigue would set in an accelerated rate and rescuers should remove their personal protective equipment as soon as reasonably possible to reduce losses in CPR efficiency.
Finally throughout the study different equipment was placed on firefighters throughout the CPR evolutions such as radios, flashlights, webbing, thermal imaging cameras, and utility belts. Throughout the process there was no restriction caused by any of this equipment but it was important to note that on removal it should be placed away from the casualty allowing the 360° of access to the patient. This 360° of access allows for greater efficiency and ability to change roles throughout the resuscitation effort.
In conclusion, research has outlined positive trends towards the use of a FDCAD / FDCPR creating a possible improvement in survivability for a down firefighter. With small alterations to the FDCAD / FDCPR method, outcomes are expected to increase positively.
Though it is important to note the testing has shown strong trends, further testing is needed to validate these results. A larger sample size is required to better represent the firefighting population.
It is also important to understand that this is a multifaceted issue and it is necessary to carry out further improvement and investigations in areas of firefighting. This should include firefighter health education, firefighters being physiologically prepared for a response in terms of proactive hydration, fitness and fatigue management.
Developing strategies to combat fire ground issues, such as physiological recovery from the fire ground environment and the decontamination of harmful substances for example particle contaminants and gases such as Co, and HCN.
Finally having an effective, time efficient method of response, casualty location, patient/ load management, and extraction by rapid intervention teams this will further increase the rate of survivability if an arrest occurs.
If these measures are accounted for by Fire Departments around the world, they may not only improve chances of survivability once an arrest of a down brother or sister firefighter has occurred, but through education lower the occurrence of arrests altogether.
For information regarding this process please read the academic paper and the watch demonstration video. Also information can be found on the FD-CPR website of Leland Fire and rescue.
The author firefighter and researcher Glen Beasley can be contacted for any further questions.
For more information, go to www.fire.nsw.gov.au