From Fire Scene to Cath Lab

Around 5 p.m. on a mid-September afternoon, three local volunteer fire departments were dispatched to a reported structure fire. Along with the fire crews, an EMS unit was also dispatched, consistent with our emergency responder rehabilitation program.

Upon arrival of the first volunteer fire chief, the scene, which was in the southern portion of our rural county, was marked a working fire. Once crews arrived, they initiated their attack and the fire was quickly contained. When the fire was extinguished, the fire crews began their clean-up routine, consisting of cleaning tools, rolling hose and performing final checks for fire extension.

While performing "mop up," as it is commonly called, a firefighter began feeling pressure in his chest and felt overheated. This firefighter was a healthy 48-year-old without any previous medical history.

Fire command had already cleared the EMS unit, but felt it was appropriate to summon the paramedic crew to return to evaluate the firefighter. Although he insisted he was only overheated and complained of vague symptoms, EMS performed an ECG and recognized an ST elevation myocardial infarction (STEMI). The paramedic encountered an agitated patient who adamantly refused transportation, but who utilized the assistance of fire command to convince the patient to receive proper treatment.

EMS initiated transportation to the appropriate facility 30 miles away, by-passing three community hospitals that did not offer the capability of performing a percutaneous coronary intervention (PCI).

On arrival at the hospital, the EMS crew escorted the patient to the cath lab, where he received a stent in his left anterior descending artery, breaking the heart center's record with a 14-minute door-to-balloon time. The firefighter did well and was discharged home a few days later.

Discussion

This case was successful because of programs that have been placed into action in this rural county. Not very long ago, there would have been a different outcome for this firefighter and his family. First, no ambulance would have been dispatched to a structure fire unless there was an injured civilian. If an ambulance was called for a sick firefighter, it would not have had standards or equipment for obtaining a 12-lead ECG, even with vague symptoms, and the patient would have been transported to one of the three local facilities where he would not have received a PCI. Now, because of programs working together and a very observant EMS crew, a life was saved. Let's look a little closer at each component that led this call to a positive outcome.

Firefighter Rehab

Our county initiated this protocol two years ago in an effort to assist local fire departments with meeting the standard NFPA 1584 guidelines for emergency responder rehab.

Once our protocol was adopted and the policy in place, we encouraged all 24 fire departments to begin a rehab program and vowed to be the "EMS component" as referenced in the standard. This met resistance at first, and is still accepted only to various degrees. Some fire departments participate and some continue to operate without rehab policies, but all dispatched structure fires get an ambulance. Even without all fire departments fulfilling the standard, the success of our program from an EMS perspective is that an ambulance responds hot to all reported structure fires, and EMS crews are trained to observe firefighter safety. When responding with departments that do not have a rehab policy, EMS crews understand they should at least be standing in the cold zone with their jump bag, defibrillator and oxygen, ready if a firefighter collapses.