BY BILL KANG
Imagine that you are working a single-family-dwelling house fire. Everything is fairly routine. The engine comes to a stop and you dismount. The officer orders you to advance an attack line to the front door; you do so. The truck company forces entry as the engine officer completes the walk-around. The fire is on the first floor in the rear, perhaps the kitchen. You and your crew advance in search of the fire. You can hear the roar of the flames as the radiant heat starts to hit you. You crawl forward with your attack line quickly to stop the fire from spreading down the hallway and to the second floor. As you turn the corner, the fire is in sight. You prepare your nozzle as the rest of the crew advances behind you. The fire is starting to roll over the ceiling as you open the nozzle and blacken the flames down. As the rush of steam flows by, you think that this was a pretty routine fire and that it should be out in a second. Overhaul and cleanup shouldn’t take too long, and your company will be back in service in an hour or so.
Suddenly, you feel the floor beneath you give. In a second, visibility goes black. You feel yourself being struck in the thigh, then the arm, and then the other arm. Everything is black. You have lost hold of the nozzle and can hear wood breaking and loud banging around you. In the next second, all is still, but you cannot tell which way is up. You try to feel behind yourself for a crew member but feel a floor and debris. As you attempt to get up, you cannot free your body from the mass of debris on you. Then you realize, “I’m trapped!”
Something has gone horribly wrong. You are separated from your crew and alone. Self-extrication is not possible, and you don’t even know where you are. Your PASS alarm starts to chirp because you have not moved for a minute. During your fire service career, you were taught that everything is done in teams, but now you’re alone.
Your training has taught you to stay calm. In an attempt to find your crew, you yell out for help, but there is no answer. Is the rest of your crew safe, or are they trapped as well? You wonder, “Where am I? Is the fire still burning?” Next, you transmit a Mayday on your portable radio, and you hear the rapid intervention team (RIT) moving into action. To help the RIT, you activate your SCBA’s PASS alarm. As the RIT conducts its search, you start to wonder when and if your fellow firefighters will get you out. What was once a routine fire has turned into a dire situation. As you wait, you look at your SCBA air supply gauge; it reads half-full on a 45-minute cylinder. You calculate that the rescue teams have approximately 22 to 23 minutes to find, extricate, and rescue you. However, you know that your air consumption normally drains an SCBA cylinder faster. How much time do you really have left? How much more time do you have to survive until you start to suffocate?
Although this is a worst-case scenario, it does highlight one of the tenets of firefighter survival: For firefighters in distress, the ability to increase air supply directly relates to survivability. Time is the crucial factor in rescuing downed firefighters. Consider the time involved in engaging a RIT. Rescuers, from a standby position, must search, locate, stabilize, extricate, and remove a downed firefighter. Given that most fire departments use SCBA with cylinders ranging from 30 to 60 minutes, those rescue steps must be executed quickly while the downed firefighter’s SCBA air supply continues to shrink. The critical step is locating the victim. An added variable to this step is the structure in which the search is conducted. Searching in a ranch-style house may not be as time-sensitive as searching in a warehouse. Nonetheless, time works against any rapid intervention efforts.
For the downed firefighter, the most effective way to leverage time is to extend the SCBA air supply. Although most SCBA manufacturers have built in features to augment the air supply without breaching the face piece seal, these features require external equipment that firefighters do not normally carry when conducting fire suppression operations. Thus, it is critical for every firefighter to learn skills that will extend the air supply in an emergency. Before examining the different SCBA survival techniques, let’s consider the factors involved in air consumption.
AIR CONSUMPTION FACTORS
Physiological factors have a significant influence on air consumption. A firefighter’s physical and psychological characteristics may play a significant role in normal air consumption and thus the ability to employ SCBA survival techniques. A high level of physical fitness correlates with efficient air consumption. Aerobic exercise increases endurance and efficiency, but strength training is also needed. A combination of strength and endurance is necessary.
Consider the following athletes: a marathon runner and a power lifter. A marathon runner possesses optimum aerobic endurance but may not possess the strength necessary to carry and use the additional weight of turnout gear, SCBA, and equipment. Conversely, a power lifter possesses the strength but may not have the aerobic endurance to climb multiple flights of stairs. Balancing strength and endurance is necessary to enable firefighters to carry out the fireground tasks needed. Although this discussion of physical attributes tends to focus on the ideal, the reality is that one of the leading causes of firefighter deaths is cardiovascular disease. Little statistical data related to obesity among firefighters are available, but one can conclude that firefighters need physical fitness not only for their own health but also as a function of survival in a Mayday situation, to decrease SCBA air consumption.
Psychological conditions also influence air consumption. One of the most common conditions to examine is claustrophobia, the fear of being closed in. The nature of firefighting places members in many claustrophobic situations: confined space rescues; searching in small rooms; working in dark places; and perhaps, foremost, wearing an enclosed face piece. Claustrophobia may cause panic attacks, a side effect of which is increased respiration, thus affecting SCBA air consumption negatively. It is difficult to gauge a person’s claustrophobia. Although some may be highly sensitive and feel uncomfortable once any room door closes, others may have only a few triggers. Whether a firefighter knows he is claustrophobic or not, the key is the awareness and knowledge of management techniques. Other psychological conditions may also affect respiratory rate and air consumption, but claustrophobia is perhaps the most common.
Familiarity with SCBA is another factor. How often do firefighters use their SCBA? A unique characteristic of open-circuit SCBA is the positive pressure it creates in the face piece, which primarily prevents contaminants from entering the firefighter’s respiratory system. Positive pressure provides an air pressure above atmospheric pressure and thus assists the firefighter when he inhales. An unintended consequence is that normal breathing is disrupted. Although the firefighter does not need to make as much of an effort to inhale, this could produce discomfort and increase air consumption. Additionally, breathing compressed air can be a factor, since the compressed air from cylinders is generally cooler than ambient air. For those who do not tolerate cold breathing air, this may affect their air consumption. With positive pressure or cool breathing air, SCBA familiarity is critical to mitigating these factors. As firefighters use their SCBA more regularly, they become accustomed to the positive-pressure effect and cool breathing air conditions. Familiarity with how the SCBA manages air and the breathing adjustments a user should make to avoid overconsumption is essential, including using emergency features such as emergency purge valves.
Previously, the fire service had developed methods of air conservation, but many SCBA survival techniques were developed under the assumption that a firefighter in distress will have a partner present. Hence, buddy breathing techniques and devices are applicable, provided that the partner is not also in distress. However, we’re focusing now on the firefighter in the worst-case scenario, alone and unable to escape.
A search of the National Fire Academy’s holdings revealed a number of older techniques developed for older SCBA with flexible low-pressure hoses. Most of these techniques involved compromising the firefighters’ respiratory systems by exposing them to the immediately dangerous to life and health (IDLH) atmosphere. Although a person suffocating behind a face piece may remove the face piece in desperation, past history has demonstrated that this practice can be fatal. In at least three firefighter line-of-duty death reports, the National Institute for Occupational Safety and Health has noted that the victim had removed the face piece and the air supply was depleted.
Within the enclosed face piece, various authors have recommended different breathing techniques; most of these center on how to breathe. You can do a search for survival breathing techniques and find as many techniques that recommend breathing in through the nose and out through the mouth, and vice versa. Consequently, a consistent way to breath was not identified. Additionally, no evidence was found to favor one air flow avenue over another.
SKIP BREATHING
One method that consistently appeared in different works is skip breathing. Originally developed by scuba divers, the method is performed by a single firefighter. The first step is for him to inhale and hold his breath until normal exhalation. When the firefighter feels the need to exhale, he takes an additional breath and then slowly exhales. After the firefighter has exhaled, he should hold his breath again until he needs to inhale. However, the person should not hold his breath to the point of discomfort. The holding period may last only a couple of seconds and varies from person to person. The process is repeated until the downed firefighter is rescued or receives additional air through a buddy breathing tether or additional SCBA. One area of contention is the amount of air conserved in skip breathing, which varies from person to person, as does air consumption. However, skip breathing will conserve air.
You may ask, “Why don’t we use skip breathing whenever we use SCBA?” Because for firefighters, the sole purpose of skip breathing is as a survival tool, not a method of enhancing job performance. Firefighters engaged in skip breathing must concentrate on their breathing, not other tasks. Also, holding your breath can have physical consequences, such as hypoxia. Additionally, during normal firefighting operations, firefighters expend lots of energy and need additional oxygen to accommodate this demand.
Performing skip breathing brings the physiological factors into the forefront. Although the physical performance of skip breathing is simple, the mental concentration required provides the best means of air conservation. As a firefighter engages in skip breathing, he must concentrate on regulating his breathing.
First, the downed firefighter should progress through normal Mayday procedures, such as calling for help on the radio, engaging the PASS, and so forth. If the member is trapped and waiting for rescue, that person should begin skip breathing as soon as possible to conserve as much air as possible. This will increase the time available for the RIT to find the firefighter. When a firefighter engages in skip breathing, he should concentrate on each inhalation and exhalation and the length of time he holds his breath. This activity also serves as a coping mechanism against panic or any other physiological factor that would increase the number of respirations.
Although skip breathing is simple, it must be practiced to ensure proficiency. To increase familiarity with their SCBA, all firefighters should become accustomed to using the SCBA and how it works, feels, and behaves. Likewise, other firefighting tasks should be practiced with SCBA engaged to help individuals gauge their personal rate of air consumption.
In preparing for the worst-case scenario, firefighters should ensure that they are physically prepared and adequately trained and have developed and practiced coping mechanisms for physiological factors. Likewise, firefighters should become accustomed to working with SCBA in place, learn how to manage air consumption with that particular SCBA, and become familiar with the SCBA if they have not used it for some time.
Firefighters are responsible for their individual physical and physiological factors. A person with claustrophobic tendencies should know his degree of sensitivity in such situations and the severity of the reaction it triggers. Skip breathing is one intrinsic coping mechanism, but individuals must develop their own coping mechanisms based on their individual needs.
Physically, each individual must address his fitness level from a global perspective. Although maintaining physical fitness is considered good practice in our society, it seems to be difficult to accomplish for firefighters and society at large. For firefighters, physical fitness is essential not only for their health and job success but also for the team’s well-being. The fire service is based on the team concept; each member must make a fair contribution to the group effort. Ensuring that you are physically ready to do and survive the job is part of this. Supervisors, peers, and subordinates can provide external motivation, but each individual must make the ultimate choice of acting on these objectives.
Ultimately, when a downed firefighter’s air supply has been exhausted, the chance of survival is greatly diminished. In the face of suffocation, it is foolish to think a firefighter would not panic and remove his face piece. Once this occurs, the respiratory system is compromised and at the mercy of an IDLH atmosphere. The rescue team’s time to search and provide assistance is also greatly diminished, and chances for survival become slim. Air supply is an essential component of firefighter survival and RIT effectiveness. It should be part of all firefighters’ in-service or indoctrination training to maximize air supply, especially during a Mayday or the worst-case scenario described above.
Bill Kang is a captain with the Montgomery County (MD) Fire and Rescue Service. He has 22 years of fire suppression and technical rescue experience and is a member of the Montgomery County Urban Search and Rescue Task Force (MD-TF1). His disaster experience includes the Oklahoma City Bombing; the 9/11 response to the Pentagon; and Hurricanes Frances, Ivan, and Katrina. He has a master’s degree in public administration from George Mason University and will complete the National Fire Academy’s Executive Fire Officer Program in 2006.
