• First Due Tackle by Paul Hasenmeier (Paul will be a great addition to the FireEMSBlogs.com network,  make sure you like the First Due Tackle Facebook page)
• Rediscovering the Air Chisel by Les Baker (Why so many firefighters don’t use this tool—and what they should know about its many practical uses)
• Interior Ramming vs. Exterior Spreading by Les Baker (What the interior rescuer needs to know to conduct aggressive clearance tactics to displace the roof)
• Game Plan Your Extrications by Desmond Fulton (The IS-SAVED acronym offers an easy-to-remember plan for the extrication scene)
• Episode 274: X-Trication Radio by David Dalrymple (David Dalrymple hosts X-Trication Radio once a month on Fire Engineering’s Blog Talk Radio channel. Make sure you listen when you have the chance. All the previous episodes are available on Fire Engineering’s channel. You can even stream past episodes thru your car radio. I caught up on a couple of episodes I missed during my drive to FDIC. There’s no place that you cannot turn into a training place!)
• Moditech CRS screenshot on Facebook (Moditech posts a Crash Recovery System (CRS) screenshot and asks their Facebook page followers what they notice about the vehicle and the hazards, etc on the vehicle. )
  

Thursday Morning – Look Up!

For you sky gazers out there in the Southwestern U. S., there is a rare opportunity coming up this Sunday to view a solar phenomenon known as an "annular eclipse" of the sun.  Unlike a total eclipse where the moon's shadow completely covers the view of the sun, an annular eclipse occurs when the moon is the perfect distance away from the earth where the shadow is slightly smaller than the sun's display and there is a slight ring of light showing around the edge of the shadow.

This composite photograph taken in 2005 by Fred Espenak shows
the view slightly before, during, and slightly after an annular eclipse.

Sunday's display begins in eastern Asia and crosses the North Pacific Ocean and ends in the western United States in the Texas panhandle.  The shadow will be entering the southern Oregon and northern Caifornia coastline at 01:23 GMT, which by my (unreliable) calculation is 5:23 pm Pacific time.  The map below that is provided by NASA shows the path of the eclipse and when it reaches Texas, the inevitable sunset ends the entire episode about 3-½ hours after it began in China.

NASA

If you are standing at a point within the path, you will see the "ring" for about 4 minutes before the shadow begins shifting out of sun's rays.  If this was taking place during a school day, then the kiddies would be herded out onto the playground to watch it.  But it's after school hours and on a Sunday to boot, so it becomes your responsibilty to do the herding of your young'uns to watch with you.

NASA has a very complete webpage devoted to this event if you want to get into the details of it.  They also have lots of maps including closeups of each state for you lucky folk who are in the path (or maybe planning a day trip to get to an affected area).  CLICK HERE to get to the NASA page.

We don't need any maps to find our way to the apparatus, though.  So let's get going with the equipment check while I make some more solar coffee.  See you back in the day room.

*  *  *  *  *  *  *

From Amazon:

Barska Starwatcher Compact Refractor Telescope
includes table-top tripod and carrying case.

59% off!

CLICK HERE to see the details and to order yours.

*  *  *  *  *  *  *

http://rescuingprovidence.com/the-ems/

Beginning today, and extending forever, the practice of calling 911 to have emergency services personnel dispatched to your restaurant, convenience store, doctor's office or any public place of gathering for any of the following…

Having a person who fell and is uninjured "checked"

Having a person who has ingested alcohol "checked" before allowing him/her to drive

Requesting we "check" to see if the person who was choking will be okay

Checking a person's home when they do not show up for work

Checking a person's blood pressure

Documenting a slip and fall

The EMS is not in the "checking" business.

THE EMS is no longer accepting responsibility and/or liability for things that happen on your property.

Failure to adhere to this new policy will result in THE EMS issuing a fine not to exceed $500.00 and mandatory enrollment in the "How to act like a responsible person and not dump your problem on people who respond to medical emergencies" class.

That is all. Carry on.

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NWCN.com:

Ten units responded to the blaze at The Village at Multnomah Condominiums, located at 9731 SW 40th Avenue in Portland, which broke out shortly after 4 p.m.

One firefighter fell through the roof while trying to fight the fire. From Sky-8, two other firefighters could be seen crawling over, peering into the hole, and then giving the “okay” signal. Fire dispatch radios also indicated the firefighter was okay.

Two firefighters were transported to an area hospital with burns on their knees and heat exhaustion, Corah said. A number of other people were being treated outside the apartment building for smoke inhalation.

KOIN-TV:

Portland firefighters were called to The Village at Multnomah condominiums, at 7937 S.W. 40th Ave. in Portland, sometime before 4:30 p.m. Wednesday. Responders quickly called a second alarm on this fire.

Smoke could be seen from as far away as Interstate 5 and Southwest Capitol Highway.  

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First, you must understand your response area, resource availability and the ability of your personnel.

Secondly, once you arrive on scene, paint the picture gives a “Windshield size-up”. Then you must exit the vehicle and conduct a 360 degree walk-around. If the Incident Commander does not complete the initial walk around, a seasoned firefighter or officer must complete the walk-around. They will know what they are looking for and be able to relay the critical information to the incident commander via radio or face to face. During the walk-around, scene observations are made, roof line, initial smoke and fire conditions. Reading smoke is critical.

Next, the incident commander must quickly develop a plan. One that weighs Risk vs. Benefits. Once the plan has been established, ACCOUNTABILITY has to be established and utilized. ACCOUNTABILITY has been a façade for many departments that acted as a security blanket for years.  Tactics have to be given, in order of priority based on the fire ground priorities/strategies. Once these tactics have been thought of and handed down to the company level will then employ functional assignments/tasks.

Communication from the crews to the Incident Commander or Operations sector and communications from the Incident Commander or Operations sector to the crews has to be a priority. This is the only way to achieve better accountability.  Benchmarks have to be utilized by using a checklist (Tactical Priorities). These bench marks will drive the overall tactics, which in turn will cause the incident commander to reevaluate their strategies.

This will not be foreign material to “Modern” departments, however “Legacy” departments will be at a loss with the information and the mind set of what has to be accomplished.

I commend those that are a “Modern” department and I pray for those that are still a “Legacy” department. There is more at stake than an ego and hiding behind the “It’s always been done that way” attitude. Families, communities and organizations are at stake. If you are an officer and want to gamble, go to Vegas or Atlantic City. Don’t gamble within your own department.  If you don’t want to stand up for your safety, your family’s safety and change within the department. Then do the fire service a favor and change professions and allow someone else who is willing to affect change to take your place. Start early with young firefighters, introduce them to the NFPA standards, professional journals, well grounded web sites. Learning never stops and more than ever, we as a fire service cannot sit idle by as hydrocarbon based materials become more and more volitile and building construction becomes more lightweight/deadly.

And you thought the fire service had turf wars and arbitrary rules

Spend $11,450 and three weeks at Harvard to attend the "Senior Executives in State and Local Government" program at the John F. Kennedy School of Government. You will receive no academic credit.

Possess a state or National Registry EMT-Basic card and some universities will grant three to six semester hours of transfer credit. Even if the instructor's level of education is a General Education Degree – the adult version of a high school diploma.

Welcome to the world of academic accreditation.

Click: "Academic Accreditation Details for "Firefighting 2.0" to read my article posted on the Fire Engineering website.

It is a response to Fire Engineering Editor-in-Chief Bobby Halton's March 2012, Editor's Opinion, "Firefighting 2.0."

Mike "FossilMedic" Ward

If you recall, we have a young patient, a 32 year old male, with a heart rate too rapid to count. He is alert and oriented, and has a good pressure (126/70). He has been in the following rhythm for at least two hours:

So, what do we know about the rhythm? It is wide and fast, with a rate of 262. Since wide+fast=VT until proven otherwise, you couldn't be faulted for running it as VT.

Unfortunately as a "Snapshot Case", we don't know the outcome of this patient. However, our mission was to come up with a differential for this rhythm, so I'll share some thoughts:

•  A-Flutter with 1:1 conduction: With rates approaching 300, it would be appropriate to consider it. I don't see any evidence of flutter waves though.
•  
•  SVT with LBBB aberration: The QRS is wide, but not that wide at 130 ms. V1 is negative, and there are monomorphic R waves in leads I and V6.   This is typical morphology for LBBB. Also, let's look at a clear QRS, from lead III:

           You can see that the initial downstroke of the QRS is sharp, and occurs in less than 20 ms. This as well favors SVT/LBBB over VT. If it is SVT, it could be either      AVRT (WPW)  or AVNRT.

• VT: The rhythm is wide and fast, and it is possible that this is VT. The QRS is not that wide but it could still be fascicular VT (but i would have expected RBBB morphology) or RVOT VT (which would not have RBBB, but then i would expect the inferior leads to be positive not negative). It doesn't seem to meet any criteria that rule in VT (no initial R wave in aVR, concordance, etc), but that does not rule out VT. And then there is the sharp initial deflection of the QRS, instead of a slower activation. And of course the patient's age and history do not favor VT.

All in all, i think any of the above are reasonable in this case. We can't know for sure, but I lean towards SVT with LBBB aberration, probably rate related, unless he happens to have LBBB as a baseline.  You may have other thoughts, and I'd love to hear them!

As far as treating the patient, his mental status is good, his pressure is good, and he has been tolerating this rhythm for at least two hours. I think he's a good candidate for a trial of Adenosine, which might reveal the answer. If that fails, there is Amiodarone, cardioversion, or diesel as far as my protocols go. 

With no clear cut answer, I'm sure you all will have some good thoughts to add to this discussion. Sometimes, we just don't know for sure, but we still have to hone our skills of considering our differentials.

Thanks for reading, and I'm looking forward to your comments!

Allen Carlyle on the left and Shane Cranfield on the right.

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Previous STATter911.com coverage of this story here & here

Salisbury Post:

Two former East Spencer firefighters and a former police officer were found not guilty this week during a non-jury trial five months after a junior firefighter was shocked with a stun gun.

The incident was said to have occurred at a department Christmas party. The two firefighters — former Chief Shane Cranfield and former Assistant Chief Allen Carlyle — were accused of using a stun gun on junior firefighter John Resino, 18.

According to arrest warrants, the stun gun came from former East Spencer Police Officer James Lambeth.

WBTV-TV:

“I want to say thank you to all my true friends who stood behind me,” Shane Cranfield told WBTV Tuesday afternoon.  When asked if had been confident about the outcome, Cranfield said “I had my doubts, I knew I didn’t do it, but I still.”

Cranfield said he believed inconsistencies in Resino’s story led to the not guilty verdict.  Even though he was found not guilty, Cranfield said the accusations have taken their toll.

“I have lost my position as the Chief of the East Spencer fire department, as well as my part time paid position. My reputation, career, and life have been ran threw the mud and destroyed.  I have been blacked balled throughout the county and shunned by people I have known for years and considered to be my brothers. Along with me, two other people, firefighter Alan Carlyle and officer James Lambeth, have also faced the same ridicule and public embarrassment as myself.”

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Go read, and weigh in with your comments. We'd love to hear them.

I had a couple of thoughts after watching this video.

• Suit up and get ready before you get to the roof.
• Make your cut and get off the roof.