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Firefighter Down!

There were 60 line of duty deaths in the fire service in 2018. There have already been 19 in 2019 at the time of this writing. in 2017, 179,000 firefighters were injured.

Fighting fires is a dangerous, stressful and life-threatening occupation.

Sporting a civilian shirt and tie, rather than his trademark New Orleans EMS uniform, well-traveled conference presenter Ken Bouvier—recently retired from his post as deputy chief of operations at NOEMS—presented "Managing Firefighter Injuries—Firefighter Down" May 31 during EMS Pro Expo at Foxwoods Resort and Casino in Connecticut.

Most injuries, deaths and health complications sustained by firefighters can be prevented by sufficient safety measures and proper training, Bouvier stressed to his audience.

"You can't take a shortcut in the fire service. If you do, you're probably going to get hurt," said Bouvier, who began his career as a volunteer firefighter in 1975 before serving as a firefighter-EMT and later fire chief of Monsanto Chemical Company. He went on to outline common injuries and conditions that can plague those in the fire service:

  • Heart attack (roughly half of all deaths)
  • Internal trauma (vehicle accident)
  • Asphyxiation (carbon monoxide)
  • Crush injury
  • Electrocution
  • Strokes
  • Drowning
  • Heat emergencies
  • Burns

As a career firefighter, Bouvier knows the dangers well. He suffered a heart attack in 2012 the night after climbing eight flights of stairs on a call. Preventive health screens and testing, in addition to job-specific training, are critical to keep firefighters safe and healthy, he said. At a minimum, these should include:

  • Hearing exams
  • Respiratory fit testing
  • Eye exams
  • Annual physicals
  • Pulmonary function tests
  • Physical fitness training

While injuries and fatalities sustained while fighting active fires capture the headlines, training injuries are an equally important concern. Almost 25,000 firefighters were injured during training in 2017, said Bouvier. One non-negotiable strategy is to staff a safety officer who's well-versed in the most current safety measures and codes.

Around 40,000 musculoskeletal injuries including sprains and strains plague firefighters every year. Institute department-wide physical fitness programs for both volunteer and career staff. And rather than overexerting firefighters with exercises that don't make sense—such as playing basketball in full bunker gear—make the training program job-specific. "Test them like they really work," Bouvier advised. Have a health and fitness coordinator to oversee the program.

Bouvier ended his talk by laying out the action plan for specific injuries sustained while fighting fires.

In cases of suspected carbon monoxide exposure, establish an airway, apply oxygen via nonrebreather mask or positive pressure ventilation, monitor and treat pulmonary edema, and consider transport to a hyperbaric facility. Be sure to carry a Cyanokit and use it if indicated.

Firefighters can sustain gunshot wounds, either from rounds exploding in burning homes or from criminals mistaking them for the police. In the case of a gunshot wound, resort to your basic EMS training: establish scene safety, determine responsiveness, open and maintain an airway, apply oxygen, consider intubation, treat major bleeding, consider cervical spine immobilization, start IVs of lactated Ringer's or saline, apply cardiac monitoring, and rapidly transport to a trauma center.

Finally, the Incident Command System is essential to maintain effective coordination of facilities, equipment, personnel, procedures, and communications surrounding a fire response, Bouvier concluded. No different from an EMS response, each crew member knows his role and responsibilities. Deviation from the command structure introduces the element of risk to the entire operation.

"Plans are in place for a reason," said Bouvier. "We need to follow them."

Editor's note: Ken Bouvier is a featured speaker at EMS World Expo, to be held Oct. 14–18, 2019 in New Orleans. Visit

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