As a member of the local fire & rescue company in a rural part of PA, I get the benefit of unlimited free training from the county for fun & knowledge, and just enough real emergency situations to keep it all interesting. We do lots of emergency planning and training, and of course, I respond to as many calls as I can.

Along the way, I've had time to acquire the firehouse nickname "Gadget" because of all the stuff I have in my jeep and on my person- like a GPS, several flashlights, rope and more. You folks here know what I mean.

As much as I take a ribbing about all the gadgets and stuff I have, I've used all of them at one time or another either on the scene or on the go with family and friends.

But on the scene - a fire, a vehicle extrication, whatever - there's some principles that I've applied to my own "preparedness" kits.


1. Carry a few tools that do many jobs well.

In my right pocket of my turnout gear is an ordinary utility knife from Sears and a pair of 8" diagonal cutters. In my hands is either an Ax or a Halligan Tool. That's it. You can't imagine how much you can do with just a Halligan tool, but it's a striking tool, prying tool, forcible entry tool…and more.
This carries over to my personal kits, and I've found that I had too much specialty gear in my emergency kits - stuff like cups, where a zip-lock bag will do the same job and more. In some cases, like with cooking gear - I dispensed with almost half the stuff I had in the kit. Plates? Who need's 'em when you have a cook pot to eat from? A few forks and it's "family style" dinner!

2. Don't get into a situation in the first place.

Yesterday, we had a truck crash that was really bad - a 14' truck slid off the road, struck a rock, spun back onto the road, tipped over, spun some more and then slammed into a utility pole and dumped its load of 160 gallons of liquid oxygen. The driver walked out - he was wearing a seatbelt. An extrication we did earlier this year with a car into a tree injured the driver so badly that I could not find his FACE - just a mass of bloody flesh, hair, teeth and other gore. Yet, his car was less damaged than the truck yesterday - and was going slower for sure.
We also have gone to fires that started out so small - a pan on the stove on fire, a chimney fire - yet they exploded into a huge, destructive fire for want of a $20 fire extinguisher. Each vehicle I own has a fire extinguisher, as does my kitchen, workshop, basement office and shed. I have actually used my extinguisher to douse a fire in my shed caused by a welding spark that "couldn’t" have flown all the way to the shed.
In terms of my personal preparedness, well, that's the whole idea behind this forum. Avoiding being in bad situations by letting people know where you're going, having appropriate equipment for your environment and so on.

3. You'll never make it alone.
While this is not a "survivalist" site in the terms of apocalyptic end of times collapse of society types of folks, admittedly, we're all a little concerned with What To Do When It All Gets Crazy. Indeed, much of our preparedness seems to stem from a desire to protect ourselves and our families from harm - in some cases, even if that means NOT helping someone else.
But I can assure you that in real emergencies, it's no time to be selfish. It would be deeply insane for anyone from my fire company to go into a burning building alone. In the same way it would deeply insane of you to have a "Go Bag" without a plan of where you are going to GO. Who's on the other end of your trip? The Interstate? A hotel?
Coordination, communication, preplans. We have a paper mill that closed down here this year. All of the local fire departments got together and did a "walk through" in case it ever goes up. We're making a plan we might never have to use.
I have a friend with a vacation house 150 miles north of here. I have a key to his house in my emergency kits. He has a key to MY house in his kits. We have plans we might neve have to use.
That's just my 2/100's of a dollar.

martinfocazio,

Well stated, I concur. Within practical limitations, it would be great if everyone lived by the philosophy of "It's always better to have it and not need it, than to need it and not have it." Leading by example is a great way to encourage this.

Regards,
Comanche7

If I ever get in a car accident, I want you to be the guy behind me. I know you will stop to help.
If you don't have "it" in your car, check my trunk! It is probably there.
The kicker is, you do this as a volunteer.

Nice job.

One of the first things my instructor said when we started talking about "off duty" responsibilities that for the love of the job we will stop by and help people in the accidents or just pay courtesy call just in case. Somebody asked how you can help a person without an ambulance or supplies. Instructor answered that as an EMT your car will become a second ambulance whatever you like it or not. And it is true. All my friends have their cars stocked well. Short of AED, long board and stretcher my car has everything I need including oxygen supply. It makes me feel at ease to have it just in case. When you are prepared nothing ever happens. <img src="images/graemlins/cool.gif" alt="" />

Matt

Hey Matt, what sizes of airways do you carry in your "civilian" kit? We have a 3-year old that would probably need like a 70mm, and a 5-month old that would probably need a 55mm. Are the protocols for infants different than older children or adults?

Your young one will be classified as an infant and 5 yo will be classified as a child.

With infants it’s very easy to overextend the head when trying to open the airway. Also brachial pulse (arm) should be used for monitoring. No finger sweep on little babies, since it can lodge the object into their cavity even deeper. You also have to learn that numbers for pulse are higher for kids same goes for number of resps. Also if you are single rescuer on a baby/child you do a cpr for a minute than call 911 or even better carry them with you (if there is no trauma). On adults you call 911 and than start with cpr.

On a kid (infant and child up to 8 yrs) you do 5 comp per 1 breath. On adult you do 15 comp per 2-3 blows.

Also tidal values of lungs for the child and adult are different. I only have an adult bag valve mask (BVM) in my car but I roughly know how to use it. Make sure (if you have one) that you don’t deliver full volume of air from adult bag to a child or an infant. Look at the chest when delivering so you see equal bilateral expansion.

I carry set of child airways (40mm which is considered infant size) , 50 and 60. And adult set which is 70 (small adult) to 110. They have to be measured the right way for each person (corner of the mouth to tip of the ear lobe) and I wouldn’t recommend using them if you are not trained.

Above is just basics in the nutshell. There is no substitute for training.

Matt

Post deleted by Skater

Although you asked Matt, I will throw my 2cents in. First do you have the appropriate training to use supplemental airways? If not do not attempt to purchase and use them in an emergency situation. You can cause soft tissue damage and if the improper size is used, you can actually block the airway. If you do have the training, then be aware that supplemental airways are most effective when used in conjunction with a CPR mask (I am not talking about a CPR shield) or BVM with high flow O2. If performing CPR without CPR mask or BVM with high flow O2, then the use of adjutant airway is not helpful. Both the CPR mask and BVM require two hands on the mask to achieve an effective seal around the mouth and nose. Even with the appropriate training, those without actual experience generally form a poor seal around the mouth, have inadequate head positioning, ventilate too rapidly or with too much force, resulting in inflation of the stomach or inadequate ventilation. Pete

If you need an airway for yourself you won't be giving anyone instructions.

Post deleted by Skater

Even if Daryl Strawberry was right beside me you wouldn't want me standing at the plate at a critical moment during the world series. Some of the training involved in properly using something like an airway is the hands-on training of actually inserting one in a dummy and the supervised experience of actualling being on some calls in the ambulance as the EMT responsible. This isn't something that just any shmoe can do safely with a little coaching. If someone doesn't have the training then you are far better off giving them a CPR mask and some breathing instructions than trying to coach them through using an airway. Furthermore, if someone needs an airway they ned the ambulance too. If the ambulance isn't there then the airway probably isn't going to make much difference. Sometimes with an airway, BVM + Ox at 100% you might buy a couple of minutes. BTW, if you use an airway on a partially conscious individual, or one that becomes partially conscious due to restoring breathing, they will / may vomit violently and aspirate their vomit into their lungs which may cause bleeding depending upon stomach contents. Are you going to coach the individual with no experience through handling that?

Post deleted by Skater

No, No, No. No way no how. They require skill and practice to use correctly. Pete

I am a member of a technical rescue squad. That means we perform Trench, Confined Space, Building Collpase, Rope, Swiftwater, Dive, and SAR. These require equipment not carried by typical fire or rescue. Our members tend to have a rather extensive list of equipment in their personal vehicles since most of us are severe rescue junkies.

One fella was telling the story recently where he had happened onto a vehicle accident on the interstate. He donned his turnout gear, grabbed a tarp and halligan tool and approached the scene. He performed patient assessment.
The local crew began arriving on the scene. He suggested they bring out specific equipment from their rescue truck and perform the extrication in a particular manner. Instead of cutting the posts supporting the roof which was supporting the overturned car, he recommened making non-structural cuts to create an opening to remove the victim. The locals did not yet have an officer on scene and followed his lead.

When an officer did arrive, he wanted to know who this guy was in different turnout gear and why he was running the scene! Luke has been on the fire departement for 20+ years as a training officer as well as a captain on the technical rescue team for 5 years. Luke understood he would not want someone on his scene not covered by insurance and bowed out.

All the tech rescue team members tend to have very full trunks. We have a friendly competition to see who has the most or newest gadgets. It is amazing to see what people will pull out of their vehicles. One guy pulls a 10' enclosed trailer behind his expedition. He is single and his vehicle is filled with so much equipment, so there is only room for the driver.

Hey Skater,

I work in NYC and EMTs are very against others helping them. Why? Law suits. And I’m not even talking about patients suing me. I am protected under Good Samaritan Law unless I abandon or neglect the patient. I’m talking about you (helpful bystander) suing me. Sleazy NYC lawyers want to get chunk out of everything. As a helpful bystander you are not trained in Body Substance Isolation or lifting techniques. There is a potential of you being injured. If something happened to you (hepatitis infection/thrown back) at the scene maybe later if medical bills escalated you decide to sue me. As the highest ranking and most qualified "official" figure on the scene I have to make the call of what to do. When right moment comes people rush in to help, sometimes all the reason goes out of the window. And later on when reality sets in everyone is looking to “get paid” and it’s very hard to prove that you do not have back injury or that you didn’t suffer from psychological trauma.

Now before you tell me that you would never do such a thing I will agree with you. But in NYC a lot of people look out to make a buck even if that's thru human suffering and trampling fellow man. I lived in Georgia and such thing would never cross anyone’s mind unfortunately this is Big Apple. I saw what people did after 911 and I don’t think that human beings can get any lower than that.

But if you and I found ourselves on the accident scene and it was serious I would be glad to have you around. Even for such things as monitoring the patient for signs of deterioration, keeping traffic clear, help in splinting, holding, etc etc...

Matt

Post deleted by Skater

I absolutly agree that having non-skilled use equipment on hand for the bystander to use is helpful. For the moment, setting aside from the issues raised by Matt re: the legal ramifications of enlisting bystanders, anyone is qualified to take out a stack of sterile gauze and press it on a flowing wound to stop the blood, most would be competent in deploying flares to signal for help or direct traffic, many would be able to make the appropriate calls on their cell phones. If you are not a certified EMT and you enlist individuals to provide this type of first aid along with yourself while you await the EMT's then you are probably also covered by the good samaritan laws. OTOH, if you are certified and you enlist non-certified personnel there are BIG VERY BIG liability issues for everyone. Further if you enlist their aid in performing treatments that are restricetd by lisencing or certification (Airway management, CPR, administering drugs) for which they don't carry the credentials then you or they or both will end up owing people a bunch of money if not in jail.

That said.

In a true disaster survival situation where the EMT may be days away or not available at all and you have some training then you are operating under Mass Casualty Incident [MCI] rules of triage and if they won't make a day without intervention they probably won't be getting more than a minute of your time anyway. Under those rules many uses of bystanders are acceptable that are not normally. I'm sure that Matt can relate some stories about how the MCI rules were applied / ignored and the consequences to the involved individuals from his experience with 9-11.

You might look into your local volunteer opportunities in EMS. When I did (shortly after 9-11) I discovered that they would help fund the cost of the EMT-Basic course in return for a dedication of weekly volunteer service. 1 12 hour night per week and 1 24 hour weekend shift per month. Worked for me. Now, if I see someone on the side of the road in trouble I stop and if they need airway management I am equipped and if the vomit, I have a suction unit to clear the stuff. I carry a collar but not a long board. so I can stabilize them in-place in the vehicle while awaiting the ambulance.

Yes, it does feel good knowing that you are prepared to help.

I was working in the building on 9-11 (46th floor) but I wasn't an EMT at this time as much as I wish I was. I was in WTC 2 for both hits and got out of the concourse area when building collapsed. I stayed out of the EMS way because my minimal army training and total unfamiliarity with MCI protocols would just make me part of the problem not part of the solution. My experiences refer to people suing left and right, ripping of relief agencies, Red Cross and foundations...

But that being said… I think that people should use their common sense if faced with emergency situation. And after it is over there should be responsible for their actions.

Matt

Post deleted by Skater

If you can afford it you might take the course anyway. Took 3 months of two nights a week and about $1700.00 in NH to get the natl-registry certification.

Too bad there's not an AirEMT program for frequent flyers.

I would say our team members, including myself are similarly prone to the same affliction. We often joke that our personal gear combined comes close to what the team has as issued equipment. In fact many of us gear heads have unique items, the team cannot afford. We frequently use our personal gear and supplies on rescues. One thing we do require is an annual inspection of all personal equipment and again after use in an actual rescue. Pete

A side note: We are planning on having Reed Thorne from RTR (Ropes That Rescue) come here in the spring for a team-based class. We think there may be some extra spaces if you are interested, let me know. Pete

$1700???!???! It's $750 in NY.

That's not the first time someone pointed out that I got Ripped! Nonetheless, I am now trained and I wouldn't have missed it for anything. I enjoy my volunteer shifts though I suspect I see a lot less action than you do in NYC.

Hey I'm starting paramedic program this January and thats $6000 cash out of my pocket. Ouch.

Matt

I'm waiting till I have enough volunteer hours in to qualify for that. In the mean time I will be taking my WEMT certs during January in the White Mountains. Brrrrr.....

Matt, glad to hear your decision to proceed with paramedic training. Some suggestions; having been in the field as an EMT-B, you have both some advantages and disadvantages over those who enter paramedic training without field training. As we all know there is the book/classroom way of doing things and the real world way of doing things (sometimes resulting in bad habits). When you are in class and when you take your written and practical exams, try not to bring your real world way of doing things into the school realm. Having field experience will allow you to place into perspective the theories taught in the classroom, but always keep in mind, you will be tested on the classroom material. Likewise, and I am sure you already know this, until you are approved to perform ALS skills, do not be tempted. It places both you and your preceptor in serious jeopardy. With the new DOT requirements for paramedics, a lot more theory is being taught to give you the diagnostic capabilities and the ability to provide the expanded scope of practice that paramedics are now required to provide. The current EMT-B and EMT-I programs are more geared towards the techniques and skills of care. There is greater emphasis on anatomy, physiology, pharmacology and pathophysiology then in the past. With 12 lead ECG’s being the new standard of care, do not become overwhelmed with the volume of cardiology material, take things slowly and thoughtfully and you will do fine. There are a lot of good supplemental books out there to help you. If, your current assignments include riding on a combination BLS/ALS ambulance, pick the brain of those paramedics you have come to respect, both new and old, for both have valuable lessons to teach. When it comes time to take your National Registry Exam, get plenty of rest. While the written was challenging, it was nothing compared to the stress of the practical. Take care, I am sure you will do great. Pete

Thanks for the info. My question was one of curiosity, not something I'll actually be performing myself, since I don't have supplementary airway training.