No History, No Meds

The challenges from an elderly woman's fall just start with the broken hip

Responses to the local retirement community aren't unusual for Attack One. This morning's call is for a "woman down," but the location is somewhere between the different areas of the community. A concerned staff member finally guides the crew to the side of an elderly lady lying awkwardly in a hallway, with an obvious fracture of her right hip. It's easy to see what happened: A patch of ice formed in the unheated walkway between the buildings, leading to a slip and fall. The lady says it happened around 0700 hours, and gives a very lucid history of taking her morning walk between her apartment and the assisted-care portion of the complex.

It's cold in the hallway, so the crew quickly moves the woman onto a long backboard and wrap her in a blanket. She has suffered a ground-level fall, has no signs or symptoms of a head or neck injury, and has been moving her neck actively, so they complete their cervical spine clearance per protocol. She complains only of right hip pain, and wiggles her toes actively. The cold conditions and the fact that the patient has been lying in the hall for almost two hours suggest that everyone quickly make their way to the warmth of the ambulance. The paramedic asks facility staff for any medical records but is told there are none, because the patient lives in the "independent living" area of the complex. She will have to give her own history and provide a list of her own medications.

As the stretcher is loaded into the ambulance, the patient says she's uncomfortable on the long backboard and asks to move to a more comfortable position. The crew members agree—they just needed to get her off that cold floor quickly and into the warm ambulance. They warm the patient compartment, then unwrap the patient, checking completely for injuries. The woman's right leg is shortened and externally rotated, typical of a broken hip. She indicates that it feels best if she leaves it in that position, and the crew pads her lower back and stacks a pillow and towels to keep her leg in the position she prefers. They find no other injuries.

As crew members make her comfortable, they try to get the rest of her medical history and find out what medications she's taking. The patient is vague—she knows she has a heart problem of some kind, and has had pneumonia. She denies any prior bone injuries. She cannot remember the names of any of her medications. She denies having medicine allergies.

The paramedic notes the patient's pulse is irregular. He suspects she's in atrial fibrillation, and with that rhythm it is likely she's on some type of blood thinner. He asks if she's on a medicine where they have to draw her blood every month or so, then tell her how much of her medicine to take. She confirms that. She also knows she does not take aspirin and does not get shots.

The paramedic starts an intravenous line, and while doing so puts a drop of her blood on his gloved finger. He then rubs his finger and thumb together, and notices the blood feels slippery—it doesn't cause his finger and thumb to stick together. In a crude way, that tells him the patient is on some kind of blood thinner. "You must be on a blood thinner, and that will be important to the hospital staff," he tells the patient. "If you can't remember your medicines, they will contact your doctor to get the list. Now, how about if we give you some pain medicine to make you more comfortable?"

The patient declines that, asking only that they keep her leg supported the way it is. The crew agrees to do that, and asks that if she changes her mind to let them know, and they will give her just a little morphine to help her pain as they take her to the hospital.

Hospital Management

The patient is unchanged in transit, and arrives in the emergency department stable. The crew shares what they know with the ED staff, noting they have a poor medical history and no list of medications. They offer to return to the patient's residence and try to find her medications and get any other belongings she might want.

The woman's evaluation shows only the hip fracture, and she refuses pain medication throughout her stay. Her primary care physician has her complete history and medication list, so there is no need to return to her residence. Her surgery and recovery go well, and she ultimately returns to the assisted-living part of the facility.

Case Discussion

This case demonstrates the care of a common problem in older adults who are still ambulatory. Hip fractures can present with pain anywhere from the pelvis to the knee, but are most commonly recognized by the appearance of the patient's leg and the fact that they cannot bear weight on it. Many older patients will suffer this injury from ground-level falls. It is more common among women.

It is best to be flexible in immobilizing a patient with a possible fractured hip, and be comfortable using a variety of boards, stretchers and padding materials. Use extra padding to prevent injury to the older patient's thin skin, and to increase comfort.

This paramedic was also appropriately concerned about potential use of an anticoagulant. Many older patients are on a form of blood thinner—seek that in the history. There are common histories that go with taking Coumadin, and the prehospital provider should be able to ask the right sequence of questions to determine if the patient is taking that type of medication.

Winter Safety Education

by Chris Furstenau

Now is a great time to educate the citizens of your community about some safety concerns that are unique to the winter months. Some of them may not apply to all areas of the country namely the states where fireplaces are obsolete but the other tips shared here can be beneficial to everyone. No new information is shared here, either. These are a few reminders to share with people who come through your open houses.

Legible House Numbers

When people call the fire department, they expect a rapid response to mitigate the emergency or crisis they are facing. Now that winter is upon us, it is getting dark earlier and earlier everyday. How many times have we struggled to find a specific house because the numbers aren't legible from the street? The numbers are old and faded, they are covered by trees and shrubs, or they are located in an obscure location, all of which can cost precious time when responding to an emergency. House numbers should be large enough to read from the street, they should be in number form as opposed to word form (e.g., "2" instead of "two"), and they should be illuminated. Most hardware stores sell solar-powered landscape lights that just need to be assembled and placed; no electrical work is required. Ask residents to check out their homes from the street to see if a perfect stranger--the fire department--could locate and read the numbers quickly in the dark.

This problem can be fixed quickly. In many places around the country where snow and ice are prevalent, our response times will be a little slower just because of the slippery road conditions. If we can save some time by not having to search for hidden address numbers, we have just helped our cause.

Snow and Ice Removal

Remind residents to have their sidewalks and driveways cleared off. In our jurisdiction, it is not uncommon for snow and ice to be piled high enough so that it takes two to three minutes to get from our trucks to the front door. When people are informed that brain cells die after six minutes without oxygen, it really impresses upon them the importance of having quick access to the patient or victim we are called to help. An extra couple of minutes can go a long way in creating a positive outcome to an incident. This problem is easy and inexpensive to fix, too.

Access to Fire Hydrants

Another common obstacle in winter emergencies is the lack of access to fire hydrants. Here again, the solution costs nothing but a few minutes of residents' time. If every homeowner, tenant, and landlord would maintain the area around the fire hydrant on their property, damage to property would be drastically reduced. An all-too-common tale is the one of the house that burned to the ground because the closest fire hydrant was buried under snow, frozen solid, or--worse yet--packed with debris. Many times, this is a water department, not a fire department, issue. Ask residents who have a fire hydrant on their property to make sure they remove the snow around it. Snow plows will bury them while plowing the streets. Kidsl bury them while shoveling the snow for their parents. When urging people to maintain the fire hydrants, some will say, "There isn't a hydrant in my front yard." Politely explain that the fire department will use the hydrant nearest to the burning house and that it would be unwise to assume that the hydrant has been maintained. Ask the homeowner, "If your house were on fire, would you be comfortable with the accessibility of the nearest hydrant?"--in other words, do they trust their neighbor to clear the nearest hydrant?

If snow is not an issue in the community you serve, maybe there is another type of obstacle. We have all seen hydrants blocked with landscaping, parked cars, shoes stuck in the connections, missing caps, and so forth.

Other Hazards

If winter means fireplaces and chimneys are used regularly in your community, stress to your customers the importance of having a clean chimney. If you ask a resident the last time he had the chimney inspected and he responds, "I don't know," chances are good that it is time for a sweep. Chimney fires can be easily prevented.

Let's not forget the more common winter fire hazards, such as problems with portable space heaters, holiday decorations and lights, and poorly maintained furnaces. These emergencies can be prevented by using common sense, employing safe practice, and reading and following the manufacturer's instructions. Helping people help themselves keeps everyone safe, which is our number one job.

OSHA Issues Compliance Directive to Address Flu Prevention for Health Care Workers

For the protection of frontline health care and emergency medical workers at high risk of infection, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a compliance directive to ensure uniform procedures when conducting inspections to identify and minimize or eliminate high to very high risk occupational exposures to the 2009 H1N1 influenza A virus.

The directive closely follows the Centers for Disease Control’s (CDC) guidance.

“OSHA has a responsibility to ensure that the more than nine million frontline health care workers in the United States are protected to the extent possible against exposure to the virus,” said acting Assistant Secretary of Labor for OSHA Jordan Barab. “OSHA will ensure health care employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure.”

In response to complaints, OSHA inspectors will ensure that health care employers implement a hierarchy of controls, and encourage vaccination and other work practices recommended by the CDC. Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing. The directive also applies to institutional settings where some workers may have similar exposures, such as schools and correctional facilities.

The CDC recommends the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for health care personnel who are in close contact (within 6 feet) with patients who have suspected or confirmed 2009 H1N1 influenza.

Where respirators are not commercially available, an employer will be considered to be in compliance if the employer can show a good faith effort has been made to acquire respirators.

Where OSHA inspectors determine that a facility has not violated any OSHA requirements but that additional measures could enhance the protection of employees, OSHA may provide the employer with a hazard alert letter outlining suggested measures to further protect workers.

The 2009 H1N1 influenza is transmitted via direct or indirect person-to-person spreading of infectious droplets passed when an influenza patient coughs, sneezes, talks or breathes. Transmission occurs when expelled infectious droplets or particles make direct or indirect contact with the mucus membranes of the mouth, nose or eyes of an uninfected person. The OSHA directive and other guidelines show steps to eliminate the hazard.

Under the Occupational Safety and Health Act of 1970, OSHA’s role is to promote safe and healthful working conditions for America’s men and women by setting and enforcing standards, and providing training, outreach and education. For more information, visit http://www.osha.gov.

Ten Commandments for the Fire Service

Many fire departments around the country seem to be drifting aimlessly through the world. They drift thither and yon, not really knowing what to do where to go and how to act. These issues and many other came to the fore during a recent seminar which was held at St. Joseph's University in Philadelphia.
The Cumberland Valley Volunteer Fireman's Association (CVVFA) held an all-day seminar on the topic of Reputation Management. This educational endeavor dealt with a topic frequently overlooked by the fire service; reputation management. If you think about it, we have complete control over the image which our fire agencies project to the citizens we protect. Unfortunately we ignore this control factor and stumble about making waves wherever we go.
Unfortunately, many among us take great pains to move through life without any sort of plan to present a proper image to the public; the people who are paying the tab for our mission. Many times we in the fire and emergency service world are our own worst enemies. You and I are all know people who seem to do stupid things whenever they are provided with an opportunity to strut their stuff. These folks play the role of the dumb-ass seemingly just because they can.
After a day spent in a full-group learning assembly and small group breakout sessions, our attendees came to the conclusion that people around the United States are in need of a single set of operational guidelines. Someone in the audience said something that hit my mind and stuck.
That person's thought caused me to say quite simply that it sounded as though that person was suggesting that the fire service needed their own Ten Commandments of Organizational Conduct. Part of the debate centered around the right of any one person to dictate to other people how they should act.
Many people were concerned about the external imposition of standards. Heck, we live in a world of standards, all of which see to shape our performance in one way or another. If we can have standards which dictate how we are to perform the operational tasks of being a firefighter, why not a standard on the ways in which we should treat each other.
Then it came to me. Write them yourself, I thought. So here they are. Please stay with me here folks because I am about to lay a philosophical ground work for many, many future discussions. These are just my thoughts folks. Nothing is cast in concrete, but I think that they each deserve consideration. Perhaps they can form the foundation of a new and more vibrant 21st Century model for being a member of the fire service.
1. Every firefighter has a right to feel safe in their environment.
2. Every firefighter has a right to expect fair treatment.
3. Every firefighter has a right to expect honesty from their department.
4. Every firefighter has an obligation to care for their fellow firefighters.
5. Every firefighter has an obligation to train diligently, both as an individual and as a team member.
6. Every firefighter has a right to expect well-trained and capable leadership.
7. Every firefighter shall owe a duty of obedient follower-ship.
8. Every firefighter's words must serve as their bond.
9. Every firefighter shall owe a debt of service to the people that they have sworn to protect.
10. No firefighter shall expect any special benefit or privilege because of the gift of service they give to their community.
Now, let me take a moment to fill in the blanks on each of my suggested commandments. When I state that every firefighter has a right to feel safe in their environment, I mean that we must stop needlessly endangering our people by exposing them to preventable, unsafe acts. I am sick and tired of the outdated and overused philosophy of the fire service which revels in the glory of death. There is nothing that says we have to die to prove how tough and brave we are.
Every firefighter has a right to expect fair treatment. This is not a hard thought to justify. Let us cast a weather eye toward the philosophy which we now call the Golden Rule. It has its origins within the Bible and gives each of us the best possible guidance for dealing with other people. Simply stated I would urge you to treat other people as you yourself would like to be treated. Do you like being harassed? Do you like being teased or mistreated? Do you like to be picked on? I do not know about you, but I sure as heck don't like to be treated that way. See my friends, this is not rocket science.
Every firefighter has a right to expect honesty. None of us likes to be the victim of mushroom management. I do not know about you but I am not pleased when someone works to keep me in the dark and keeps offering up cow plop hors des oeuvres. Just tell me what you would like to see and provide a couple of good justifications for me and let me get to work.
Every firefighter has an obligation to care for their fellow firefighters. They need to operate safely so that they do not become a sudden burden to their buddies. They must also take care to point out the hazards of the environment to their fellow members. They need to be candid and honest in their interactions. Better to have an accident prevented than a funeral planned.
Every firefighter has an obligation to train diligently, both as an individual and as a team member. This obligation is the basis for effective team building. Each member of the team must be trained to the level necessary to perform all necessary and expected operational tasks. If a person fails to take their training requirements seriously, they have the potential to become the weak link in their organization's operational chain. You and I know what happens to the weak link in chains when the weight and stress of the emergency comes.
Every firefighter has a right to expect well-trained and capable leadership. Many of you might doubt the importance of this, but not I. Far too many of our problems come from the habits practiced by the myriad of poor leaders among us. My research on the topic of leadership over the past several years has led me to one inescapable conclusion. Bad leaders kill people and bad leaders kill organizations. Every firefighter has the most basic of rights to expect that their leaders will know what they are doing and will work to get them home safely.
One part of the organizational equation which is frequently overlooked involves the requirement for people to understand that there is a need for loyal and capable followers. People are always praising leaders and ignoring followers. We, as a fire service, need to elevate and celebrate the role of the follower.
People in subordinate positions must be able to process and complete the orders provided by those people who are in positions of leadership.
This follower-ship development program is easier to achieve when the concerned, caring, and capable leader is able to create an atmosphere of support and loyalty. What I am proposing here is the thought that there is a leadership-follower-ship equation which requires the active participation of all parties. Ignore this at your own peril.
Every firefighter's word must serve as their bond. How can we ever hope to develop an atmosphere of trust if we are always looking over our shoulder wondering whom to trust? The twin concepts at work here are honesty and integrity. A student once asked me to define each. My response to that person was quite simple. Honesty always involves doing the right thing. Integrity involves always doing the right thing, even when no one is watching. My friends it truly is that simple. Imagine the strength of an organization whose members never have to worry about selfish motives.
Far too many people in today's fire service suffer from the crippling disease of selfishness. There is an inward organizational focus. For these people it is all about getting things for the members. There motto is quite simple. "It's all about me." The heck with the citizens we are sworn to serve. I would suggest that if we are to create a strong, community-oriented organization, we must begin to live the example of selfless service to others. This will not simply happen. The people must be taught by the example of their leaders. When the leader-follower equation begins to develop along these lines great things will begin to happen. This is a tremendous goal, but one which can only come about as the result of a conscious, active effort to reach it.
Sadly, I see a world which has grown seemingly more selfish over time. I believe that there are people out there in our fire service who think that they should be showered with special gifts and special privileges just because they are firefighters. This is a special form of selfish behavior. These are the people who believe that they should be allowed to drive as fast as they want and not get tickets.
These are the folks who believe themselves to be exempt from the laws of physics and gravity. These are the people who believe themselves smarter than others. In the volunteer fire service these are the people who insist on muttering the ludicrous phrase, "you can't tell me what to do, I am a volunteer." In the career service, these are the people who depend upon the system to protect the weaklings and malcontents.
Do not get me wrong here folks. There is nothing wrong with providing benefits to those who perform the dirty and dangerous work of the fire service. I enjoyed excellent union-negotiated contractually-protected benefits when I was in the Newark Fire Department. As a long-time volunteer in the Adelphia Fire Company, I participate in our Length of Service Award Program (LOSAP). But none of this entitles me to break the law and act like an ass because of what I do.
You and I do what we do for reasons best known only to ourselves. Let me offer one of the primary reasons I have identified. See if it applies to you. When I am doing the interviews for my municipal consulting work, I always ask the following question: What do you like the most about being a department member? Without a doubt the primary answer revolves around one primary thought: the feelings of camaraderie, friendship, and family.
Let this feeling of family and inclusion be the goal for which we all strive. Let these ten commandments of fire service conduct serve as the luminaries which line the path along which you move. Let their light guide you in ways of truth, honesty, and dedication to serve your fellow travelers in the fire service. If there is to be an effective fire service in the 22nd Century we must work on these commandments every moment of every day.

Lynch Signs Law Banning Burning Of Demolition Debris

Governor Says Burning Poses Health Risks

CONCORD, N.H. -- Gov. John Lynch signed a law Tuesday permanently banning the burning of toxic construction and demolition debris.

Vermont has a similar ban, and Maine allows the debris to be burned with some restrictions.

New Hampshire's ban takes effect Jan. 1. Communities can continue to burn untreated wood at their transfer stations until 2011 if it's supervised by a solid waste facility operator.

In signing the law, Lynch kept a campaign promise to permanently stop the debris from being burned and from being imported from other states for incineration.

"The burning of toxic construction and demolition debris poses an unnecessary and unacceptable danger to New Hampshire," said Lynch. "With this new law, we are protecting the health of New Hampshire's people and the health of our state's environment."

Lynch said the state is working to reduce many toxic substances, such as mercury, from entering the environment in other ways, and it makes no sense to do that and then allow it to enter through a smokestack.

Last year, Lynch signed a law extending a moratorium on burning the debris, which was set to expire Dec. 31, but called for a permanent ban because of the health risks posed by airborne pollutants. Lynch said a temporary moratorium was not sufficient protection.

"The risks are too great to rely on temporary measures," he said.

Lynch and Environmental Services Commissioner Thomas Burack are working to find alternatives for the materials' disposal. Burack said a special task force will issue its preliminary report by the end of the year.

The ban is a first step in the long-term effort to dispose of the debris in better ways, which Burack called the "three Rs."

"The three Rs are reduction, reuse and recycling," he said.

Meanwhile, Regenesis Corp., formerly Bio Energy LLC, which operates a co-generation plant in Hopkinton, Lynch's hometown, is appealing to the state Supreme Court to be allowed to burn the debris.

Regenesis had obtained state permits to burn wood chips from construction and demolition debris in 2003, but the permits were later revoked. It then sued for the right to resume burning the same type of wood chips it had previously used, without going through a new permitting process.

Lynch and other burn opponents said a ban was needed to prevent the state from becoming a dumping ground for out-of-state construction and demolition waste.

Of New Hampshire's neighbors, only Vermont has a similar ban.

In Vermont, it is illegal to burn the debris or any type of home or commercial refuse. Yard waste and other organic matter can be burned with a permit, according to Darren Allen of the Vermont Agency of Natural Resources.

Massachusetts bans burying pavement, brick, concrete, metal and wood in landfills, but does not ban wood from disposal in municipal incinerators.

Last year, Maine Gov. John Baldacci signed a law imposing new restrictions on burning the debris, which is imported into Maine by the ton and is used as a cheap biomass fuel. The law limits the volume of wood from construction and demolition debris that may be substituted for conventional fuel in boilers to 50 percent per year. The law also established a standard to make sure the debris is as clean as technically possible.

Some 600 million pounds of construction and demolition debris were burned in biomass boilers in Maine in 2004. The state Department of Environmental Protection said more than 80 percent of the total came from out-of-state sources.

Simply blocking waste from being imported into Maine isn't an option because such restrictions have been deemed unconstitutional.

Many fire volunteers fail to stay safe: Unbuckled seat belts can turn would-be rescuers into victims themselves

Bryan Chu, Albany Times Union, N.Y.

Apr. 22--An emergency radio scanner crackles. An alarm sounds. Fire police officers suit up, jump into their vehicles and rush to the scene.

The only problem is that fire police, and their fellow firefighters, often forget to do the very thing they ask of other drivers -- buckle their seat belts.

Then, instead of being the rescuers, they can become the victims.

Take the case of Edgar Scott, a 75-year-old Menands volunteer fire police captain, who died when his box-van collided with a propane tanker while making a U-turn on Interstate 787. Scott, who was not wearing a seat belt, was tossed from his vehicle.

Scott and other fire police -- who are in charge of crowd and traffic control at emergency scenes -- account for the largest percentage of on-duty deaths for those in the fire service industry, including paid and volunteer.

And, among both fire police and firefighters killed, failing to wear seat belts already has been cited more often this year than last, according to the United States Fire Administration. Of nine killed this year, six were not wearing seat belts and were thrown from their vehicles. Of the eight who died in 2006, two were not wearing seat belts. The worst year in the past five was in 2003, when 30 were killed, eight of whom were not wearing seat belts.

"This is a huge problem," said Kelvin Cochran, second vice president of the International Association of Fire Chiefs, a nonprofit professional association of more than 12,000. "We've seen enough deaths this year. We need to take drastic measures to change this trend."

A seat belt mandate is not on the books for fire departments in New York. Actually, the state is one of 37 that does not mandate seat belt use for all firefighters, according to 2003 figures from Critical Incident Stress Management Perspectives Inc., a training and consulting practice that prepares fire departments for deaths among its membership.

The state's seat belt laws include an emergency responder exemption that excuses firefighters and fire police from buckling up. According to the Fireman's Association of the State of New York, the exemption exists because every second counts and being held up by a seat belt could cost a life.

But the anti-seat belt use rationale could be deeper than that. Members of fire departments believe they are immune to injury, said Daniel McGuire, president of Critical Incident, which was recently hired by the New York State Association of Fire Chiefs to give three-hour workshops to every county in New York until 2008.

"They think nothing is going to happen to (them)," he said. "There's a real machismo attitude."

That occurs against a backdrop of New York having more on-duty fatalities overall than any other state last year. Fourteen died, accounting for 13.3 percent of deaths nationwide, the national fire administration reports. From 2001 to 2006, there were 59 on-duty fatalities in New York (excluding deaths during the terrorist attacks of Sept. 11, 2001).

Among fire service deaths nationally, some 25 percent occur when firefighters and fire police are responding to or returning from incidents, the national fire administration reports.

In a November 2003 poll by Firehouse.com -- a Web site used by firefighters and fire chiefs -- more than 11,000 people responded to the topic of seat belt usage. Forty-five percent answered they don't wear seat belts at all times when responding to emergencies. In the same poll from April, 36 percent of 8,000 people said they don't wear seat belts.

Wynantskill fire police Capt. Richard Trumbull, who requires seat belt usage at his fire department, doesn't understand why this is happening.

"It's common sense," he said. "If you want to survive, then you need to wear a seat belt."

Nationwide campaigns are pressing fire departments to require seat belt usage.

The "Everyone Goes Home Tour," started by the National Fallen Firefighters Foundation, aims to reduce the number of fire service on-duty deaths by urging such safety protocols as seat belt usage. The nonprofit foundation based in Emmitsburg, Md., was created by Congress.

Dr. Burton A. Clark, a volunteer firefighter in Laurel, Md., started another campaign pushing fire departments across the nation to wear seat belts. Clark started the National Seat Belt Pledge after Christopher Brian Hunton, 27, of the Amarillo, Texas, fire department died in April 2005 from injuries suffered in an accident. He was not wearing his seat belt. So far, 28,000 firefighters have signed the pledge vowing to buckle up.

"This is something we can stop overnight," Clark said. "Most fire departments have rules, but they don't enforce, they just ignore it. Consequently, it creates a culture of unsafe behavior."

Cochran's solution for seat-belt awareness at his fire department in Shreveport, La., is a three-strike rule that could result in a fine or suspension by the third infraction. No one has received a third strike.

The National Fire Protection Association -- an international nonprofit organization that advocates fire prevention and public safety out of its Quincy, Mass., headquarters -- has a national seat belt policy that many fire departments have adopted. The policy states: "All persons riding in fire apparatus shall be seated and belted securely by seat belts in approved riding positions at any time the vehicle is in motion."

While the Capital Region continues to mourn the death of Scott, many fire police and firefighters are voicing a need for change and more safety awareness among their peers.

"You need to be safe yourself before you can help others," said Brooke Wagner, a fire police officer at the Averill Park & Sand Lake Fire Department. Chu can be reached at 454-5080 or by e-mail at bchu@timesunion.com.

BLACKOUT SAFETY TIPS

Top Safety Tips for a Blackout

• Only use a flashlight for emergency lighting. Never use candles!
• Turn off electrical equipment you were using when the power went out.
• Avoid opening the refrigerator and freezer.
• Do not run a generator inside a home or garage.
• If you use a generator, connect the equipment you want to power directly to the outlets on the generator. Do not connect a generator to a home's electrical system.
• Listen to local radio and television for updated information.

How Can I Prepare Before a Blackout Happens?
Assemble essential supplies, including:

• Flashlight
• Batteries
• Portable radio
• at least one gallon of water
• a small supply of food.
• Due to the extreme risk of fire, do not use candles during a power outage.

If you have space in your refrigerator or freezer, consider filling plastic containers with water, leaving about an inch of space inside each one. (Remember, water expands as it freezes, so it is important to leave room in the container for the expanded water). Place the containers in the refrigerator and freezer. This chilled or frozen water will help keep food cold if the power goes out, by displacing air that can warm up quickly with water or ice that keeps cold for several hours without additional refrigeration.

If you use medication that requires refrigeration, most can be kept in a closed refrigerator for several hours without a problem. If unsure, check with your physician or pharmacist.

If you use a computer, keep files and operating systems backed up regularly. Consider buying extra batteries and a power converter if you use a laptop computer. A power converter allows most laptops (12 volts or less) to be operated from the cigarette lighter of a vehicle. Also, turn off all computers, monitors, printers, copiers, scanners and other devices when they're not being used. That way, if the power goes out, this equipment will have already been safely shut down. Get a high quality surge protector for all of your computer equipment. If you use the computer a lot, such as for a home business, consider purchasing and installing an uninterruptable power supply (UPS). Consult with your local computer equipment dealer about available equipment and costs.

If you have an electric garage door opener, find out where the manual release lever is located and learn how to operate it. Sometimes garage doors can be heavy, so get help to lift it. If you regularly use the garage as the primary means of entering your home upon return from work, be sure to keep a key to your house with you, in case the garage door will not open.

If you have a telephone instrument or system at home or at work that requires electricity to work (such as a cordless phone or answering machine), plan for alternate communication, including having a standard telephone handset, cellular telephone, radio, or pager. Remember, too, that some voice mail systems and remote dial-up servers for computer networks may not operate when the power is out where these systems are located. So even if you have power, your access to remote technology may be interrupted if the power that serves those areas is disrupted. Check with remote service providers to see if they have backup power systems, and how long those systems will operate.

Keep your car fuel tank at least half full because gas stations rely on electricity to power their pumps.

Follow energy conservation measures to keep the use of electricity as low as possible, which can help power company(ies) avoid imposing rolling blackouts.

Specific Information for People With Disabilities
If you use a battery-operated wheelchair, life-support system, or other power-dependent equipment, call your power company before rolling blackouts happen. Many utility companies keep a list and map of the locations of power-dependent customers in case of an emergency. Ask them what alternatives are available in your area. Contact the customer service department of your local utility company(ies) to learn if this service is available in your community.

If you use a motorized wheelchair or scooter, have an extra battery. A car battery also can be used with a wheelchair but will not last as long as a wheelchair's deep-cycle battery. If available, store a lightweight manual wheelchair for backup.

If you are Blind or have a visual disability, store a talking or Braille clock or large-print timepiece with extra batteries.

If you are Deaf or have a hearing loss, consider getting a small portable battery-operated television set. Emergency broadcasts may give information in American Sign Language (ASL) or open captioning.

Using a Generator
If you are considering obtaining a generator, get advice from a licensed professional, such as an electrician. Make sure the generator is listed with Underwriter's Laboratories or a similar organization. Some municipalities, Air Quality Districts, or states have "air quality permit" requirements. A licensed electrician will be able to give you more information on these matters. Always plan to keep the generator outdoors -- never operate it inside, including the basement or garage. Do not hook up a generator directly to your home's wiring. The safest thing to do is to connect the equipment you want to power directly to the outlets on the generator. Connecting a cord from the generator to a point on the permanent wiring system and backfeeding power to your home is an unsafe method to supply a building during a power outage.

For more information about using generators safely, see the Generator fact sheet.

What Do I Do During A Blackout?
Turn off or disconnect any appliances, equipment (like air conditioners) or electronics you were using when the power went out. When power comes back on, it may come back with momentary "surges" or "spikes" that can damage equipment such as computers and motors in appliances like the air conditioner, refrigerator, washer, or furnace.

Leave one light turned on so you'll know when your power returns.

Leave the doors of your refrigerator and freezer closed to keep your food as fresh as possible. If you must eat food that was refrigerated or frozen, check it carefully for signs of spoilage. See the Red Cross brochure called, "Help The Power Is Out" for more information.

Use the phone for emergencies only. Listening to a portable radio can provide the latest information. Do not call 9-1-1 for information -- only call to report a life-threatening emergency.

Eliminate unnecessary travel, especially by car. Traffic signals will stop working during an outage, creating traffic congestion.

Remember that equipment such as automated teller machines (ATMs) and elevators may not work during a power outage.

If it is hot outside, take steps to remain cool. Move to the lowest level of your home, as cool air falls. Wear lightweight, light-colored clothing. Drink plenty of water, even if you do not feel thirsty. If the heat is intense and the power may be off for a long time, consider going to a movie theater, shopping mall, or "cooling shelter" that may be opened in your community. Listen to local radio or television for more information. Get more tips on the preparing for a heat wave.

Remember to provide plenty of fresh, cool water for your pets.

If it is cold outside, put on layers of warm clothing. Never burn charcoal for heating or cooking indoors. Never use your oven as a source of heat. If the power may be out for a prolonged period, plan to go to another location (relative, friend, or public facility) that has heat to keep warm.

Energy Conservation Recommendations

• To conserve power to help avoid a blackout, the power industry recommends:
• In heating season, set the furnace thermostat at 68 degrees or lower. In cooling season, set the thermostat at 78 degrees or higher. Consider installing a programmable thermostat that you can set to have the furnace or air conditioning run only when you are at home. Most power is used by heating and cooling, so adjusting the temperatures on your thermostat is the biggest energy conservation measure you can take.
• Turn off lights and computers when not in use. This is especially true about computer monitors - avoid using a "screen saver" and just simply turn the monitor off when you won't be using the computer for a while. Turn the computer off completely each evening. It is no longer true that computer equipment is damaged from turning it off and on.
• Close windows when the heating or cooling system is on.
• Caulk windows and doors to keep air from leaking, and replace old windows with new, energy-efficient windows.
• Clean or replace furnace and air-conditioner filters regularly.
• When buying new appliances be sure to purchase energy-efficient models.
• Wrap the water heater with an insulation jacket, available at most building supplies retailers.
• If you have to wash clothes, wash only full loads and clean the dryer's lint trap after each use.
• When using a dishwasher, wash full loads and use the "light" cycle. If possible, use the "rinse only" cycle and turn off the "high temperature" rinse option. When the regular wash cycle is done, just open the dishwasher door to allow the dishes to air dry.
• Replace incandescent light bulbs with energy-efficient compact fluorescent lights.
• Use one large light bulb rather than several smaller ones.

For More Information
If you would like more information about rolling blackouts and how to deal with them, contact the power company that serves your area.

School Bus Accidents

By Leigh T. Hollins

Since I first wrote about school bus extrication in the December 1997 and January 1998 issues of Fire Engineering Magazine, not much has changed concerning school buses themselves. School buses are built to federal, state, and local standards that have stayed mostly the same, which is that school buses must be designed and built tough enough to withstand significant impact while protecting our children inside the passenger compartment. This is accomplished through a design that uses heavier-than-normal vehicle construction techniques, a high-profile chassis, seating compartmentation, and various safety features.

Seat belts on school buses continue to be an issue nationwide, with laws that vary state by state and local decisions that may or may not require their use. With that said, our approach to the rescue and extrication side of responding to a school bus incident remains mostly the same as in the 1990's. Since the 1990's, responder training and the equipment used has changed. The Fire Department Instructors Conference (FDIC) and other regional and national conferences have greatly enhanced responders' knowledge of heavy extrication. Just considering the FDIC conferences at which I have taught and the group with which I travel the U.S., we have instructed about 2,500 emergency responders in school bus rescue in the last 10 years. Couple that with the 2001 release of Fire Engineering's School Bus Extrication video (now available on DVD) and the number of responders nationwide with an enhanced knowledge of school bus rescue techniques probably climbs to between 3,500 and 4,000. That is a major difference--up to 4,000 emergency responders with a greater level of knowledge in school bus rescue and extrication.

Here are a couple of "nuggets" for you to ponder:

Are you familiar with the term "Rescue Corridor"? You will need to know about it if you are moving patients off a school bus. A rescue corridor refers to the movement of rescuers and equipment in one way and the movement of patients out another way.

Unified Command? You bet...fire, EMS, law enforcement, and school district reps must all work together to mitigate a school bus incident, even a minor one

Is your fire department prepared for this? School bus incidents require responders to be trained in heavy rescue, mass casualty incidents, and command and control. Only then will you have the knowledge to be successful when a school bus full of kids strikes something large or rolls over on its side.

How will you communicate with a school bus full of mentally disabled students? Use your resource wisely. In this case, the adult aide on the bus was the only one who understood the students. What if the aide was injured? Prepare now!

Accidents happen every day; some just have a greater "wow" factor. What if this bus, which was loaded with 55 elementary students, had rolled over on its side? Do you know what to do? Normal vehicle extrication skills and tools will not work. A hybrid school bus?? That's right, the first one in service in the nation. Are you keeping up with technology? These new hybrids have 1,300 pounds of lithium ion batteries on one side, offset by 1,300 pounds of steel counterweight on the opposite side. 1. Will this affect our operations? 2. Where is the high-voltage cable? 3. What color is the cable? 4. Where is the emergency shunt switch? Only up-to-date training will answer these questions. (Answers: 1. Yes, such factors as dealing with high voltage, stabilizing a bus that has rolled onto its roof with an extra 3,000 pounds as the new high center of gravity will alter your tactics. 2. Left side middle, under bus. 3. Orange 1" cable. 4. Left side, under bus, at front of battery bank.

You must have "real world" experience...hopefully on the drill ground first.

National Incident Management System

NIMS Training

Training is one of the important NIMS Implementation activities that Federal, State, Territorial, Tribal, and Local entities must complete as they work towards becoming fully compliant with the NIMS. State, Territorial, Tribal, and Local jurisdictions will be required to meet the FY 2007 NIMS implementation requirements as a condition of receiving federal preparedness funding assistance in FY 2008.

It is important to recognize that NIMS implementation will not end in FY 2007. The NIMS is a dynamic system, and the doctrine as well as the implementation requirements will continue to evolve as our prevention, preparedness, response, and recovery capabilities improve and our homeland security landscape changes. It is critical NIMS baseline training becomes an integral part of the organization’s training program. Organizational changes as a result of new hires, promotions or mission changes amplify this training requirement. Additionally NIMS processes will still have to be exercised in future years.

The successful implementation of the NIMS depends on the participation and integration of all Federal, State, Territorial, Local, Tribal entities and community-based organizations, including public, non-governmental, and private organizations that have a role in preventing, preparing for, responding to, or recovering from an incident. States, Territories, Tribal entities and Local jurisdictions should therefore consider and include appropriate organizations in their NIMS implementation efforts, including private sector emergency medical and hospital providers, transportation systems, utilities, and special facilities such as industrial plants, nuclear power plants, factories, military facilities, stadiums and arenas.

The NIMS Integration Center (NIC) has developed guidance that outlines the content and objectives for acceptable NIMS training materials. This guidance is contained in the National Standard Curriculum Training Development Guidance document dated March, 2007. Any agency or organization sponsoring NIMS training is responsible for ensuring that the materials being taught adhere to the guidelines provided in the National Standard Curriculum Training Development Guidance. In addition, the sponsoring organization must also verify the qualifications of the instructors based on the guidance provided by the NIC. Certificates of course completion are also the responsibility of the sponsoring agency or organization.

NIMS Courses

Currently, there are six courses that are required in order for an individual or organization to be considered NIMS compliant through FY 2007. To determine what level of training an individual needs according to their level of responsibility during a multi-jurisdiction, multi-agency, multi-discipline incident, click here: www.fema.gov/pdf/emergency/nims/TrainingGdlMatrix.pdf