Pet Rescue 6162

[Irmgard Rossie]

TheCity of Jasper hosted a Trench Rescue Class for the Public Works and Fire Department personnel. This was a 24 hour class taught by Instructor Brandon Johnson with Texas A&M Engineering Extension Service (TEEX), which included a class room portion and hands on skills to show how to rescue someone in an emergency collapse situation. Employees learned how to determine different types of hazards and things to look for while digging a trench. Employees also performed simulated rescues and learned how to set up shoring to make it safe to enter the trench. We hope this knowledge will help us prevent an emergency from happening and if one does, we can handle the situation and save a life.

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Purpose: Local infiltration analgesia (LIA) is widely applied in patients undergoing total knee arthroplasty (TKA). In daily practice, adrenaline is added to the LIA mixture to achieve vasoconstriction. However, adrenaline has some possible negative side effects (e.g. tissue necrosis). This trial investigated whether ropivacaine alone is at least as effective for postoperative pain relief after LIA.

Methods: Fifty patients scheduled for primary TKA were included in this prospective randomized, double-blind, controlled pilot study receiving high-volume (150 mL) single-shot intra-capsular LIA with ropivacaine (2 %) with (Ropi+) or without (Ropi-) adrenaline (0.01 %). All patients received the same pre-, peri- and postoperative care with multimodal oral pain protocol. Postoperative pain was assessed before and after the first mobilization and during the first 48 h postoperative using the visual analogue scale (VAS). Secondary outcomes were rescue medication use, early mobilization, length of hospital stay, adverse events (AE's) and readmission rates. Patient reported outcomes measures (PROMS); Oxford Knee Score and WOMAC, were obtained preoperative and 3 months postoperative.

Conclusion: To prevent possible negative side effects (e.g. tissue necrosis), adrenaline should be omitted from the LIA mixture. Single-shot LIA with ropivacaine alone results in clinical acceptable adequate pain control and can be used in daily TKA practice.

On October 29, 2003, a 38-year-old male career fire fighter (the victim) was killed and a 48-year-old male career Captain was severely injured when fire overran their position while protecting a residential structure during a wildland fire operation. The National Institute for Occupational Safety and Health (NIOSH) was notified of this incident on October 30, 2003 by the U.S. Fire Administration (USFA). On November 18, 2003, a Safety and Occupational Health Specialist and the Senior Investigator from the NIOSH Fire Fighter Fatality Investigation and Prevention Program conducted a site visit where photographs of the incident scene were taken. A meeting was held with an Assistant Chief and Unit Forester from the California Department of Forestry and Fire Protection (CDF). On November 19, 2003, a phone interview was conducted with the home owner of the incident site.

Weather Conditions

At the time of the incident a strong onshore pressure gradient had developed with sustained winds of 17 miles per hour (mph), and gusts of up to 31 mph out of the west. At approximately 1430 hours, the temperature was 70 degrees Fahrenheit with a relative humidity (RH) of 30%.

Engine 6162 crew began clearing brush along the driveway to Residence #2 while the Captain assessed the area around the structure. Although the Captain had concerns, after further assessment, the crew determined that the structure is defendable and decides to stay.

The Superintendent of the Hotshot crew, while standing in the meadow (safety zone), observed unexplained fire along the ridge between Residence #3 and Residence #2 and then between Residence #2 and Residence #1. He radioed his crew who informed him that they were not conducting firing operations. He ordered them to retreat to the meadow.

The task force was in the staging area approximately three hours before receiving an assignment (at 1400 hours) to provide structure protection. A fifth engine (Type I) crew was assigned to them at this time. The task force worked with a number of crews providing structure protection until they were relieved to return to the incident base at approximately 2130 hours.

On October 29, 2003, the Task Force leader attended the morning briefing at 0700 hours. The crew was assigned to a Branch and Division on a flank of the fire. The Task Force Leader met with the Division Supervisor at this time for any additional instructions and information. The Task Force Leader then met with his crews and briefed them on their assignment before proceeding to the rendezvous point (approximately 40 miles from the staging area) where they would meet with the rest of the Division (Photo 1). The task force arrived at the rendezvous site and was assigned to provide structure protection. The Task Force Leader then received a map and debriefing from a Strike Team Leader that had been working in the area. Fire fighters reported to NIOSH investigators that the fire at this time was moving slowly with spot fires on both sides of the state road. The crews began mopping up operations in a small subdivision on the south side of the road before receiving a new assignment at 1100 hours (Photo 1).

At approximately 1150 hours, the pilot of Helicopter 523EH noticed spot fires near Residence #1. The helicopter operation was then moved to the ridge on the east side of the drainage where they are assigned to protect structures. The Task Force Leader arrived at the ridge and begins to size-up the structures, beginning with Residence #1. At approximately the same time, a California Department of Forestry (CDF) Captain and a Fire Apparatus Engineer (FAE) arrived on the ridge in a pickup truck (Utility 3334) and drive to Residence #1.

A Hotshot crew and two bulldozers arrived at Residence #1 with part of the Hotshot crew and one of the bulldozers beginning direct perimeter control in that area. Engine 6162 crew proceeded up the driveway of Residence #2 while the victim and a fellow crew member cleared overhanging brush near the driveway. The driver positioned Engine 6162 approximately 60 feet to the south of the structure (Photo 2).

At approximately 1225 hours, the CDF Captain and FAE arrived in a pickup truck and began lighting fire near the garage without speaking with the Captain from Engine 6162 (Photo 2 and Map 2). The Captain from Engine 6162 saw the CDF Captain and fire fighter and believed that they had seen him near the house. Approximately 15 minutes later, the crew noticed that the fire activity below them was beginning to increase.

The Engine 6162 crew began to observe an increase in fire activity down slope from their location as fire was now making an up-canyon, up-slope run in the heavy brush and oak fuels (Photo 4). The fire was wind driven and was making a continuous run toward Residence #2, covering a distance of approximately one-half mile in about two minutes. The Engine 6162 crew gathered behind their Engine as the fire intensity increased. The victim manned a 1 -inch handline at the rear of the apparatus while another fire fighter manned a handline at the front. The fire fighter on the handline at the front of the apparatus had to extinguish the juniper bushes on the patio behind them as hot embers began blowing into the brush near the residential structure. Conditions were beginning to deteriorate quickly as the smoke began reducing visibility and the heat intensified. The crew members reported to NIOSH investigators that the sky began to glow orange and that the heat appeared to be coming from the south or southwest (behind them). There was a significant increase in the wind as the flame front blew across the driveway near the garage cutting off their escape route (Photo 2). The ornamental bushes between Engine 6162 and the house began to burst into flames.

Recommendation #1: Fire departments and fire service agencies should ensure that the authority to conduct firing out or burning out operations is clearly defined in the standard operating procedure (SOP) or incident action plan (IAP) and is closely coordinated with all supervisors, command staff and adjacent ground forces.

Discussion: It may be advantageous or necessary to conduct firing or burn-out operations in certain areas during a fire. Each and every fire fighter must be assigned to a team of two or more and be given specific assignments when conducting such an operation.1 Firing out operations is a way of attacking a very intense fire. Burning out is used to widen a control line by eliminating unburned fuels between the control line and an advancing fire front.2 Any firing out or burning-out operation requires considerable preparation, organization and coordination. Safety must be given first priority. No operation, regardless of strategic importance or other critical factors, is worth risking human life.3 Overall fire strategy and authorities must be clear to all personnel employing firing out or burning-out, since fire behavior or fire control operations on adjacent divisions are likely to be affected.4

Regardless of the purpose and which tactic is chosen, certain basic safety procedures should be followed when conducting firing out or burning-out operations because any additional fire may increase the risk to life and property.

Recommendation #2: Fire departments and fire service agencies should ensure that all resources, especially those operating at or near the head of the fire, are provided with current and anticipated weather information.

Recommendation #3: Fire departments and fire service agencies should stress the importance of utilizing LCES (Lookouts, Communications, Escape Routes and Safety Zones) to help identify specific trigger points (e.g., extreme fire behavior, changes in weather, location of fire on the ground, etc) that indicate the need for a crew to use their escape route(s), and/or seek refuge in a designated safety zone.

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