Planning for Special Needs Rescue

BY Jeff Riechmann

Fire department personnel regularly visit their local schools to teach school-age children about fire prevention. During these presentations, Exit Drills in the Home (EDITH) is also discussed. Additionally, the schools are required to have an emergency action plan and conduct regular evacuation exercises (fire drills).

Firefighters regularly practice techniques on entering a burning structure, conducting a primary and a secondary search, and removing someone from that structure. In most cases, this can be very challenging when one considers the heat, the smoke, and the firefighter’s unfamiliarity with the structure. Firefighters also practice removing a down firefighter from a structure during a Mayday situation using rapid intervention teams (RIT).

In my retirement, I lead an organization that provides people with special needs the opportunity to experience rock wall climbing at events held in numerous communities. Local emergency responders support these events with members of their technical rescue teams. These events provide firefighters with the opportunity to practice some of their rope rescue skills while enhancing their knowledge regarding how to work with people with special needs.

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Following is some general information that will help emergency responders become more aware of the challenges when interacting with children with special needs. They may not apply to every child; some children may have unique or multiple challenges.

Fire Station Tours

During fire station tours, do not allow children with special needs, specifically those with developmental challenges, to sit in the fire apparatus or any emergency vehicle. The children may think that it is okay to sit in a fire engine any time, which could cause an issue at an emergency. Also, some children may not like sirens, air horns, or other loud noises (photo 1).

Children love to pretend they are firefighters and would enjoy trying on the firefighter’s personal protective equipment (PPE), but this may not be a good idea considering the various chemicals and products of combustion that may be on the gear. Instead, our organization obtained a small turnout coat and structure helmet that we keep clean. When a child wants to try on the firefighter’s gear, we encourage the firefighters to use this special gear (photo 2).

Some children with developmental challenges enjoy feeling different textures. Consider letting these children feel some of the different items made of various materials found on an engine, such hoses, nozzles, and tools (photo 3).

Younger people, especially those with special needs, may be afraid of people in uniform, so kneel down when talking to the children and let them touch you. Be careful not to flinch if the children suddenly reach out and touch you. Encourage the children to look for a firefighter or police officer in uniform. Tell them, “We will always make you feel safe” (photo 4).

If your station has an ambulance assigned to it, consider allowing the children with special needs to tour the ambulance. This may help lessen their fear of ambulances. Have the children listen to their heart, breathe the “super clean air” (oxygen), and even ride on the gurney. Consider loading the children into the ambulance while on the gurney (photo 5).

The Isaac Foundation has created a training program for firefighters on how to conduct fire station tours for children with special needs, specifically, developmental challenges. The tour guidelines are very different from those used in a fire station tour. Information on these guidelines and training programs is at https://www.theisaacfoundation.com.

EDITH for Special Needs

Often, in public safety school programs, special education students may not receive the same information as students without special needs. But this information somehow needs to find its way to the children’s homes, especially the message about creating an emergency action plan for the home.

Evacuating children confined to wheelchairs presents special considerations when escaping a house that is on fire; it takes some additional time to move the children to the wheelchair. A young lady in a wheelchair told her roommate that if ever there was a fire in their building that she should place her on a blanket and drag her out of the building.

A young girl who is legally blind participated in one of our climbing events. The local firefighters were informed in advance that this girl would be participating. At the event, the fire officer assigned a female firefighter to work with her; we felt that the female firefighter could relate better to the girl (as a mother figure) than a male firefighter could.

After the girl had finished climbing, the firefighter escorted her outside to one of the engines at the event and allowed her to “look” at various pieces of equipment using her hands to help her create a picture of each tool in her mind. After this, the firefighter put on all of her protective equipment, including her self-contained breathing apparatus (SCBA). Kneeling down, she let the young girl touch her; all the while, the firefighter was talking while breathing air from the SCBA. The young girl was reminded that if she ever heard or felt someone like this in her room, she should not be afraid because it would be a firefighter coming to help her.

Later, this blind girl’s mother mentioned to me that it was time to develop an emergency action plan for their home. I asked if she felt comfortable doing this. She said she wasn’t, so I referred her to a fire officer supporting the event.

When firefighters train to search a structure, they are trained to feel the door before opening it and then to open it only a small distance to verify whether it is safe. Share this information with all children, and tell them that if it is dangerous outside the room, they should shelter in place. Suggest that they block the area under the door with clothes to help slow the products of combustion from entering the room.

You are taught that when you enter a structure to always turn in the same direction. If you enter a structure and turn to the right, you should always turn to the right; sooner or later, you will be able to find a way out. You are also taught to sweep your hand up the wall in an effort to locate a window. Tell the children that if they feel an air-conditioner or heating vent, often it means there is a window nearby. Share this information with visually challenged individuals; it likely will help them to self-rescue or shelter in place during a structure fire.

Remember when sharing this information with visually challenged children to work with each child individually as you physically demonstrate how to perform these tasks (photo 6).

Firefighters always mention smoke detectors when talking to people about fire safety in the home. But, children with developmental challenges may not understand what the smoke detector is or what to do if they hear it sounding. In some cases, smoke detectors may cause the child who does not like loud noises to have a “meltdown” and go into a panic state that the caregiver may not be able to control. This could also result in the child running around the house.

Remind parents that teaching children with special needs what to do when the smoke detector sounds may be a very slow process and requires regular reinforcement. Consider allowing the children to hold a detector and push the test button so they will understand what it is, how it sounds, and that it is not anything to be frightened of.

Window Stickers

Some firefighters considered the window stickers indicating the room of a child or special needs person to be a waste of money since they would complete a thorough primary and secondary structure search regardless. The status of the emergency would also dictate their actions during a search. If the window sticker is on a window on the end of the structure opposite the fire’s location, searching that room is not as high a priority as searching a room closer to the seat of the fire. In any event, encourage parents of special needs children to contact their local fire department to learn and share information.

Another concern was that the window sticker could help a child predator to locate a sleeping child within a residence. This resulted in many departments discontinuing the use of these stickers.

Now, a reflective sticker may be placed on the bottom of the bedroom door, below the doorknob. This reflective sticker will assist crawling firefighters during the search by identifying the room of a child as well as help them to locate the doorknob quickly. Depending on the manufacturer, these stickers are available for children, people with special needs, and pets. One manufacturer offers these stickers in packs of 100 for less than $50.

School Fire Drills

Local regulations require that schools develop an emergency action plan for their facility. In most cases, schools develop these plans with little or no input from the local fire department. In addition, fire prevention specialists are often not invited to observe these drills being practiced.

It has also been my experience that substitute teachers receive little or no training in the emergency action plan and that in an emergency evacuation the substitute teacher depends on the children to know what to do.

Recently, I learned of a very concerning situation involving an elementary school. One of the children who attends the school suffers from spastic cerebral palsy and uses a wheelchair to get around. The child’s muscle spasms are not that severe. However, if the child experiences a stressor, the spasms will become more severe. This child attends classes in a room on the second floor. In an emergency, a teacher is supposed to carry the child down the stairs. This could be difficult because of the size of the child. Because of the safety concerns associated with this procedure, none of the teachers have practiced picking this child up out of the wheelchair. During practice fire drills, the student is evacuated using the elevator. The mother expressed her concern to the local chief that her son’s spasms will probably increase as a result of the emergency and since none of the teachers have tried to carry the child, she was concerned about what would happen to her child during a fire evacuation. The chief stated that he understood the mother’s concern. However, “It is the school’s responsibility to develop and practice the emergency action plan and there is nothing the fire department can do.”

At another school, the local combination career/volunteer department carries stair chairs on all ambulances, and all members are proficient in their use. The estimated response time from the fire station to the school is two minutes. The school believed that since the ambulance was close and responded on all fire department calls, the school would depend on the fire department to remove a special needs child from the upper floors. Does the emergency evacuation plan for the school complement or conflict with the fire department’s preincident plan?

Fire companies should consider the school’s emergency action plan when developing preincident plans for the school. Removing the above-mentioned child using an aerial platform may be effective. Determine a location where the aerial platform can be set up, avoiding such potential hazards as soft ground. Not all departments have access to an aerial platform, so use ladders to conduct training for removing this child.

When working with the school on emergency procedures, recommend that the school acquire a stair chair for removing individuals with mobility issues from the upper floors. Unfortunately, most schools will probably oppose this since these chairs can cost between $500 and $3,000.

Communicating

Some children with developmental challenges may have limited or no vocalization ability. This can be compounded by the stressors inherent in the incident, such as coming face-to-face with someone in uniform.

As with fire station tours, consider kneeling down to get on the same level as the child so you can look the child in the eye. At times, these children may want to reach out and touch you; encourage it.

If a parent or caregiver is close by, that person may be able to convey to you what the child is trying to say. However, if the parent or caregiver is not available and the child is having a difficult time trying to convey the message, encourage him to point at the subject.

Keep in mind that these children may respond better to a younger person. I have found the child will respond better to a woman (i.e., a mother figure) than a scary old man! Stuffed animals and toys can also be used to help calm the child.

For deaf children, you can communicate using a pencil and paper. If talking to the child, make certain that the child is looking at you before you begin speaking; touch his arm to get his attention.

Before speaking, remove any food or gum from your mouth. The child may read lips; your chewing may make it more difficult. Also, do not place anything in front of your mouth that will block the child’s view.

Some fire companies have placed a sign language chart with the alphabet on it in their medical aid/trauma bags to help with communication. Some of the basic sign language hand signs are taught in emergency medical technician classes. This is a simple idea that should be highly encouraged. In photo 7, the firefighter demonstrates the sign for “Help.”

For the blind child, touch the child’s arm to get his attention; then introduce yourself and begin speaking. Ideally, keep the number of people communicating with the child to a minimum to avoid confusion, especially if everyone is trying to talk at once. If it has been a few minutes since you last spoke to the child, identify yourself again before speaking so that the child knows who is talking.

Children with developmental challenges may not even look at you when you talk to them. They are not being disrespectful; it is just how they are. Use extreme caution before touching a child. Some children with special needs do not like to be touched. It could result in a meltdown.

Since some do not like loud noises, turn down or off your portable radios, or consider using an earphone. Keep in mind that these children may not like sirens and air horns (another consideration during station tours).

Some children may have service dogs. Some of these dogs are trained to identify a preexisting medical condition moments before it strikes to alert the individual to take the appropriate action. In some cases, the service animal may help keep a child calm, especially during an emergency. Find out what purpose the service dog is trained for when developing a plan of action for dealing with the child.

Containing the Children

Some children with developmental challenges may be difficult to keep to one spot; they love to run around. If you turn your back on them for a second, they will be gone! This is a concern not only during an emergency evacuation but also if this child should become lost in the outdoors.

When I discussed this with a search and rescue team, the members commented that they teach people that if you ever become lost, stay right where you are since the search and rescue team will come to you. But children wth specific developmental challenges may not stay in one spot. The search and rescue team members pointed out that not only would they have to recheck locations that already had been checked but they would probably require the response of additional search and rescue resources.

This is a concern for the metropolitan area as well as for a forest. The child with special needs can wander from the playground or away from home.

Structure Fire Rescue

A variety of medical issues can include periodic muscle spasms, such as spastic cerebral palsy and traumatic brain injury. Parents informed me that with some of these children, the spasms may cease when the child goes to sleep or loses consciousness. At the other end of the spectrum, in some cases, no medications will stop the spasms. In some cases, a stressor like a structure fire could intensify the spasms. Compounding the issue, some of these individuals are verbally challenged or completely nonverbal. If trapped in a structure fire, they will not be able to call out to get your attention.

During a rescue, if the child experiences muscle spasms while being removed using ladders or an aerial device from the structure’s upper floors, that spasm could cause the firefighter, the victim, or both to be thrown from the ladder. The victim’s size would be a factor in this situation. And do not forget that stressors like being in a structure that is on fire may also increase the spasms.

When I discussed this with firefighters, many felt that this would be an excellent opportunity to use the bucket/basket of an aerial device to remove the individual from the structure. However, there was concern about the ability to properly position the truck to make this rescue. Again, if made aware of this individual’s needs prior to an incident, the company officer could develop a preincident plan for this residence that also considers the availability of the apparatus.

When discussing this with the parents, some suggested that firefighters use a special harness to lower the individual with special needs to the ground, although there is not a harness available that was designed for this type of rescue. Obviously, in an active fire situation, time is of the essence, and attempting to place a harness on an individual may not be feasible. Most fire companies do not carry a harness that could be used in this situation.

Removal Tools

As mentioned above, several of the parents suggested placing an individual who suffers from muscle spasms into a harness when lowering them via a ground or an aerial ladder. What do we carry on our apparatus that could be used to help safely and efficiently remove someone from a structure? Can you place one of these pieces of equipment on a person quickly and efficiently, whether it is a person with special needs or even a down firefighter? Is there something in your rapid intervention team kit (RIT bag) that you could use? Could you use a firefighter’s bailout kit?

Firefighters are known for their ingenuity. They will always find a method to solve the problem. Sometimes it might not be pretty, but in the overwhelming majority of the cases, it works.

McCall (ID) Fire and EMS is a combination career and on-call fire department serving a resort community of 3,000 residents; the population can swell to more than 50,000 tourists on weekends and during the annual Winter Carnival. On-duty staffing consists of four firefighters who cross-staff an engine and ambulance. Additional apparatus is staffed by call firefighters on an as-needed basis.

The on-duty crew was approached and asked the question, “How would you remove an individual suffering from spastic cerebral palsy with moderate to severe muscle spasms, possibly increased as a result of the stressors associated with the incident, from the upper floors of a structure involved in fire?” Questions like, “How quickly can the fire be knocked down?” and “Where is the fire located in relation to the victim?” were included in the discussion and influenced the methods discussed.

Several types of harnesses and lifting devices were tried. The following were determined to be the most effective methods during our drill. Departments will need to evaluate these methods and come up with their own to include in their department’s operating procedures.

The firefighters looked at the Kendrick Extrication Device (KED) and felt that this could be used in the described situation. If necessary, the arms of the victim could be secured within the torso area of the KED. The KED could be lowered down a ladder; however, a harness would need to be used over the KED to control the victim during the descent. In this situation, the head would not be secured unless the situation required it. It was felt that the smooth material with which the KED is constructed would help the KED to slide down the ladder.

Time permitting, the victim could be placed in a basket stretcher. If the arms were flailing, the wrists could be secured to the edges of the stretcher using wrist restraints from the ambulance.

McCall firefighters carry a large 25-foot loop of webbing in their turnout coat pockets. The webbing could be rigged on the victim in a hasty harness and the victim could be lowered either down the side of the structure or down a ground or an aerial ladder.

Another use for the webbing was to create “handcuffs” on the victim’s wrists. Once the “handcuffs” are placed on the victim, the victim can then be lowered down the side of the structure. This method kept the victim’s hands securely together and over the head in a method very similar to the rescue wristlets used in confined space rescue.

During the training session, it was pointed out that perhaps the best method for removing this victim would be to use the RIT. It was agreed that removing this victim would require additional equipment that would not be needed to remove a victim with no physical challenges. Those involved felt that this additional equipment would be contained in the RIT kits and that the RIT team may be the best resource for removing this victim.

The goal of this article is to provide thought and action provoking ideas to be discussed in your department. It is important to remember that every person with special needs is different: What will work with one child will not work with another child. Methods and techniques for removing an individual from a structure fire, whether it be a residence or a school, should be evaluated and tested prior to the incident.

As issues with the potential rescue of an individual with special needs are identified, open and honest discussion is extremely important. School administrators should encourage fire companies to observe practice fire drills to gain a better understanding of what to expect at an incident at that school. Conduct postfire drill critiques and take appropriate corrective action to bring the school’s emergency evacuation plan and the fire department’s preincident plan closer together.

Although this article was directed toward children with special needs, many of the topics discussed also apply to the elderly. Again, the company officer will need to determine the course of action to take during an emergency, whether it be a fire or medical incident.

Jeff Riechmann is the event coordinator for the nonprofit Courageous Kids Climbing. He was a firefighter for 23 years with the Kern County (CA) Fire Department. He also served for more than four years in the U.S. Air Force and for 20 years in the U.S. Air Force Reserve.