Wounds Occurring When Not Following SOPs

Last week we discussed wounds occurring when not wearing gloves.  Not wearing gloves, and other PPE for that matter, is often a violation of departmental Standard Operating Procedures (SOPs).  Many reported injuries could have been avoided had the injured party followed their department’s SOPs.   This week we’ll focus our blog post on the importance of SOPs and how you can decrease injuries by making sure you and your team follow them on every call.

SOP Issues

The commission requires every regulated entity to adopt several SOPs. These SOPs are required to ensure the safety of all fire fighters. Unfortunately, we have seen a few areas where firefighters were not following these SOPs.  Incorporating SOPs into training is a good way to build habits leading to safer behavior on the fire ground.

In 2011, among the injuries reported, you reported 27 documented SOP violations. The majority of them involve the injured parties not wearing Personal Protective Equipment (PPE) – often missing gloves. 

Check out some examples of Wounds occurring when the injured party was not following departmental SOPs:

“Individual got burned due to not wearing PPE during grass fire.  The department has SOP's regarding wildland fires and PPE that should be used.  The department is addressing this internally.”

“He has PPE's but was not wearing the coat. He was the driver of the pumper and was rolling up the red line and was pulling it over the wire fence.  He does not have wildland PPE's.  He failed to comply as he should have had his coat on.   The department will address internal SOP issues.”

Fight like you train

Do what you can to make sure your department provides quality training experiences, by incorporating department SOPs.  These should realistically reflect situations your team will face.  Similarly, when you are on scene, react the way you were trained to react.  Don’t cut corners in training, or on the scene.  Make sure proper PPE are worn and SOPs are followed during and after training – ALWAYS.  Make it habit, so that when the time comes no one gets injured or finds themselves in a near-miss situation. 

Write effective SOPs for your department
Learn to write applicable and realistic SOPs and you’ll get higher adherence rates.  Additionally, you’ll have safer firefighters who develop better work habits.  Check out these tips and contact the TCFP Library for other departments’ examples of our required SOPs.

• Firefighter Close Calls Policy & SOP Program
• Developing Effective Standard Operating Procedures (USFA)
• The Simple Approach to Writing Effective SOPs (Fire Engineering)

Follow up from last month:  Last month we discussed a near-miss that occurred in Hutto, TX.  Firehouse Magazine’s continued coverage of that incident is in their January issue.  They address the issue of having quality SOPs, and training to them.  If you need a copy of the articles, contact the TCFP Library.

Are your department’s SOPs realistic? 

Do your department’s SOPs play an important part in training?

Wounds Due to Not Wearing Gloves

Image courtesy of jasonEscapist via flickr - click to enlarge

Last week we discussed the wounds that fire departments are reporting to us. It seems that many of these wounds could have been avoided had the department’s standard operating procedures (SOPs) for PPE been followed.  This week we’ll focus on injuries incurred when not wearing gloves.

 

“No Gloves” Injuries

Quite a few injuries result when personnel don’t wear gloves when they should. When this occurs in your department, you’ll want to ask yourself, “Why are you taking off or not wearing the gloves?” Is it because gloves interfere with your dexterity, making it difficult to perform the task at hand? Is it habit (and not a good one) that you need to correct? Should the department look into the brand or type of glove the department is using and evaluate them for their effectiveness?

Check out some examples of Wounds occurring when the injured party is not wearing gloves:

“Fire fighter was part of a three-man team that had responded to a private residence for a water flow alarm and smoke investigation. Sprinkler system had extinguished fire in main room. While doing a secondary search for extension, fire fighters discover flame and called for water supply. While refitting equipment, adjacent room flashed causing burns to fire fighter's hands before he could complete putting his gloves back on.”

“Employee was at scene of MVA and attempted to pry tail pipe on muffler away from tire. Hand slipped and received laceration to index, middle and ringer of right hand. Went to hospital ER and received stitches to 2 fingers. He was not wearing fire fighting gloves at the time of injury.”

“During overhaul operations, the firefighter was standing on the base of a "pull-down" attic ladder. He began to climb the ladder to hand tools to a firefighter working in the attic when the ladder broke. As the firefighter was falling, he grabbed the side of the ladder and lacerated his finger. The firefighter was not wearing gloves at the time of injury. The laceration required five stitches.”

“At a structure fire, fire fighter was working in an attic space checking fire conditions. He removed his gloves to use the thermal imaging camera when the attic flashed over causing second degree burns to the back of his hands. He was wearing all of his PPE and SCBA except for his gloves. He was transported to the hospital.”

“Firefighter was loading hose tray back on engine and was not wearing gloves. A burr on the metal sliced his right thumb open.”

What is the problem & how can it be fixed?

You often find yourselves in urgent situations.  These situations can cause you to cut corners.  This is understandable, but doing so puts you in harm’s way.  Additionally, some gloves keep you from being able to perform your duties by limiting dexterity.  Having high-quality gloves and a variety of gloves readily available will ensure that you wear the right gloves for the job and keep yourself safe.  Taking the time to stop, pick the right gloves, and then get on with your job is worthwhile; at least when compared to missing work!

Wear high quality, appropriate, gloves that meet national standards

Care for your gloves properly

Inspect gloves properly (video)

Choosing, fitting, and buying the right gloves on Firerescue1

NFPA 1971 Standard for Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting – paying attention to upcoming revisions

Does your department provide a variety of gloves to you for a variety of types of jobs?  What’s your favorite type of glove for specific duties?

Is it realistic for you to pick the right gloves, at the right time, to do the job right?

Wounds

A wound, as defined by Webster’s New World Stedman’s Concise Medical Dictionary,

is “a trauma to any of the tissues of the body especially that caused by physical means and with interruption of continuity.”

Take a look at the wound injuries your departments have been reporting. 

The majority of these have occurred during the following four activities: Fire Suppression; Station Duties; Rescue Non-Fire Activities; and Skills Training. 

Wounds by Activity - click to enlarge

 

Within those categories, the most frequent injury types are cuts/lacerations and minor trauma contusions/bruises.  These types of wounds make up 80 percent of the wounds reported.

Wounds by Type - click to enlarge

The hands and fingers far outnumber any other body part with wound injuries - with 229 injuries. 

Wounds by Body Part - click to enlarge

Wounds occurring during Station Duties

The commission has defined Station Duties, for injury reporting purposes, as “Any activity done around the station, not an emergency response activity.”   Examples include checking apparatus, moving apparatus, checking hydrants, or maintaining the station (mowing, cleaning bays, house-keeping, etc.).

Station Duties - Wounds - click to enlarg

Check out some examples of Wounds occurring during Station Duties:

“Blade hit leg while attempting to start vent saw. The saw was not running at the time.”

“Employee reports that while at the fire station he lacerated his right hand while sharpening a kitchen knife used for preparing meals.”

Wounds occurring during Fire Suppression

Fire Suppression - Wounds - click to enlarge

Check out some examples of wounds occurring during Fire Suppression:

“Employee stated that while on location right hand was punctured pulling a wall down - a nail went through a glove sustaining injury.” 

“Firefighter was dragging a charged hose line through a burning structure and tripped over contents - bruising his shins on both legs.” 

“While cutting a fire break line, using hand tools, firefighter struck self with pulaski - not breaking the skin - causing localized swelling the size of a gold ball.  Firefighter didn't have a current tetanus shot and was transported to local hospital.”

Wounds occurring during other activities

Check out some examples of wounds occurring during Rescue – Non-Fire Activities:

“Firefighter lacerated left middle finger while working at a motor vehicle accident.”

“Employee was providing medical treatment when he was punctured by needle stick on left thumb.”

“Firefighter received injury while removing patient who was covered in broken glass at a MVA.”

Check out some examples of wounds occurring during Skills Training:

“Employee was doing extrication training.  Another employee swung an axe & it made contact with the halligan that the first employee was holding, hitting his left index finger.”

“Firefighter was doing training with a metal snap tank when a loose piece of metal sliced through his finger causing an approximately 1.5 inch cut.”

 Wounds can be avoided

On the fire ground, things are hectic and can easily go wrong.  If your team trains with department safety SOPs in mind, you’ll be safer on scene.  Using proper PPE for various situations will also help protect you from wound injuries.  In the station, and in non-emergency situations, take the time to do things right and use the proper tools for the job.  You can avoid wound injuries on the job, in any situation.

Quick tips for avoiding wound injuries:

•  Wear the proper PPE for the proper job. 
•  Follow the instructions on any equipment. 
•  Take your time, when not in an emergency situation. 
•  Train safely, so that it becomes habit in the field.

In the coming weeks, we’ll be discussing two types of wound injuries reported to us – wounds that could have been avoided had the injured party been wearing the proper (or any!) gloves, and wounds that likely occurred because department SOPs were not followed at the time of injury.

Learn From Other Departments’ Post-Incident Analyses and Near-Miss Reports

Image courtesy of  Deepwater Horizon Response on flickr

As we discussed earlier this month, your department may get some pretty interesting calls, but most calls are rather routine.  Regardless, a Post-Incident Analysis after every call can be valuable, especially if an injury is involved.  But, let’s say your department has been pretty quiet lately, or your calls have been routine.  You might need a little excitement to perk the interest of your team and keep them on their toes.  This is when other departments’ Near-Miss Reports and Post-Incident Analyses are valuable. 

Learn from others across the country

To learn from other departments’ experiences, check out the National Fire Fighter Near-Miss Reporting System.  This service has three main goals: 

1. To give firefighters the opportunity to learn from each other through real-life experiences.
2. To help formulate strategies to reduce the frequency of firefighter injuries and fatalities.
3. To enhance the safety culture of the fire and emergency service.

Other online resources

• Near-Miss Listen & Learn (Firehouse.com) 
• Near-Miss articles (Fire Engineering)

Learn from local departments

Last week we discussed how certain injuries reported to our FIDO Injury Reporting System lead to investigations by our agency.  As we mentioned, most departments will conduct an internal investigation.  Having the reports from these investigations on hand help us complete our investigation quickly.  Contact us if you’d like to see examples of recent investigations done by the below Texas departments.

• “Northview Court Mayday” Incident Analysis – Structure Fire – Flower Mound Fire Department
• Firefighter Near-Miss Report – Firefighter Injury - Hutto Fire Rescue*

*The first part in a two-part series regarding the Hutto Fire Rescue incident appears this month in Firehouse magazine.  The second part will be in the January issue.  Check them out to learn more!  If you need a copy of the articles, contact the TCFP Library.

Do you read Near-Miss reports?

Does your department review Near-Miss reports in departmental meetings or training?

Have you ever contributed to the Near-Miss Reporting System?

Post-Incident Analysis and the Commission’s Injury Reporting

The goal of the injury reporting system is to collect data on Fire Fighter injuries throughout the State of Texas.  The data collected is evaluated to determine if there are any trends in injuries and in Personal Protective Equipment to help mitigate firefighter injuries in the future.

Thank you to everyone who has reported injuries to us!  Very often, your reports are added to our summaries, but sometimes depending on the severity and type of injury, we might open an inquiry or an investigation into it.  These steps are not intended as reprisals, but simply give us more information surrounding the injury so we can get a better understanding of how Texas’ firefighters are getting injured.  In this blog post we will be discussing the differences between an inquiry and investigation in regards to these types of injuries.

Injuries leading to TCFP follow up
As of now, we are primarily following up on reported injuries associated with burns.  When a burn occurs, the FIDO system notifies TCFP staff and the following steps are taken by the commission:

• Review the injury.
• Create a file for the incident. 
• Assign either compliance staff or the local compliance officer for follow up (depending on situation). 
• Send an inquiry request to the department.  This request will include pictures and PPE information.  See FAQ’s for specific information requested.

After TCFP staff reviews the information found in the inquiry, an investigation could be started.  This investigation would involve the assigned TCFP compliance officer visiting the department to perform a compliance investigation on the injured individual, their PPE, their training records, etc.  The officer will bring the information back to the commission and it will be used (anonymously) in our annual report.

If the injury was critical enough for us to perform an investigation, your department has probably already started an internal investigation or “near miss” report.  The information you put together on your own can be very helpful in our injury investigations.  In the few critical incidents we’ve seen over the past year, the departments have provided excellent reports that have included all the pertinent information our compliance officers require in an investigation – pictures,  what the department learned from the incident, and changes the department plans to implement.  Because this information has already been put together by the department, the compliance officers’ visits have been quick and easy.  It has been a very smooth process on both sides.  

Quick tip for you
Anytime an incident leading to an investigation occurs, the PPE involved needs to be handled as evidence and should be stored in paper containers (not plastic) to persevere the integrity of the PPE.  Wrap each piece of clothing in paper and store in a paper bag.

Why do we need information on PPE?
Throughout the year the information is reviewed to see what, if any, trends in PPE misuse or malfunction are occurring.  If there are any trends, the compliance section will review the data and provide any updates to the fire community.  

What kind of experience have you had with the commission in regards to an inquiry or investigation?

Post-Incident Analysis

Your team goes on some pretty routine calls, and some pretty interesting ones.  Most of the time things go just right, but sometimes things go wrong, or at least things could have been done differently.  Sometimes firefighter injuries occur because of the way an incident was handled.  The only real way to know what you and your team are doing correctly or incorrectly, to make sure everyone is on the same page about these things, and to ensure everyone’s safety, is to do a Post-Incident Analysis.  This is not about pointing fingers or laying blame - It’s about learning and being better firefighters, and about reducing injuries & loss of life.  There are varying ideas about when to hold your Post-Incident Analysis, but everyone agrees that they should be done.  We recommend every department do a quick debriefing after every call, and then a full post-incident analysis within 48 hours of the incident.  If the calls are simple, the analyses do not have to be long and time consuming, but do take the time to sit down and talk out each call.  All firefighters, even those not at the incident, can learn from the experience of those who were present. 

This month we’ll focus the blog on Post-Incident Analyses - how they factor in to avoiding injuries, how they factor into the TCFP injury reporting system, and generally how to learn from others’ analyses. 

What to include in your analysis and how to do it right

• Hold the Post-Incident Analysis session within a few days of the incident. 
• Take notes at each meeting and put them together in an organized format, so that patterns or triggers can be identified later. 
• Make the Post-Incident Analysis process a part of your department’s SOPs.  (Contact our library if you need help obtaining examples of SOPs.) 
• Talk about what went right, what went wrong, what could have been done differently, and how you can improve. 
• Let everyone have their say about the incident, one at a time, without interruptions. 
• Don’t blame anyone for anything, just explain what happened, as you see it. 
• Include those at the incident, and invite those not at the incident, so everyone can learn.  If only those at the incident are present, distribute the notes to the entire department. 
• Include any pictures or video taken. 
• Talk about what the team did and did not do, not what individuals did or did not do. 
• Discuss department policies and procedures, and how they affected the incident and might be changed in the future. 
• If you’re an officer, talk about your possible missteps or faults first, so everyone else feels comfortable doing the same after you.

It’s not just about venting

Post-incident Analyses lead to great ideas for training.  Take what you’ve learned – what you could do better and where things went wrong – incorporate when you’ve learned into your SOPs and train, train, train until your team gets it right. 

Does your team perform Post-Incident Analyses?  Are they helpful?  Are they taken seriously?  Are they done constructively?

Have any of your Post-Incident Analyses lead to new training initiatives at your department?

Chemical Exposures – Protection & Safety

During October and November we’ve discussed Exposures on this blog.  Most recently our focus has been on Chemical Exposures.  In thinking about these, we’ve discussed general information regarding dealing with HazMat situations, and more specific issues such as working with your local fixed facilities.  Knowing the basics about dealing with possible hazmat incidents is key to safety, and being prepared by coming up with plans with your local fixed facilities helps prevent Chemical Exposures even more, but having the right protection and being able to monitor what’s in the air is paramount to keeping your team, and your communities, safe no matter what you face.   That’s why we’ll finish up this series with a focus of protecting yourself and your communities from possible Chemical Exposure during any incident, whether it occur at a fixed facility incident, road accident, general structure fire, or even a wildland fire.  Let’s start by stating that each department should have their teams crossed trained to be ready to face HazMat incidents, especially unexpected ones, and have quality decontamination tools on hand, even if they have to use DIY solutions.  Below are some details to get you up to speed, and give you some things to think about, regarding PPE, Decontamination, and Air Monitoring.

PPE

Wearing quality PPE, including respiratory protection is the best thing you can do to prevent Chemical Exposure in any incident.

            Hazardous Materials PPE (OSHA)

PPE resources for first responders (CHEMM)

Decontamination

Image Copyright Nat Bocking. This work is licensed under the Creative Commons Attribution-Share Alike 2.0 Generic Licence. To view a copy of this licence, visit http://creativecommons.org/licenses/by-sa/2.0/ or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.

Knowing how to quickly and effectively decontaminate anyone who comes in contact with a hazardous material during an incident is something that can best be done after proper preplanning and practice.  Keep in mind that decontamination should be started by first responders.  Waiting for the HazMat team can cause dangerous delays.

Air Monitoring

Always perform some sort of air monitoring to determine the safety of all those present – civilians who will likely be evacuated and the first responders dealing with the situation.  Air monitoring should also be done after an incident to ensure the safety of the emergency personnel dealing with salvage and overhaul, and the civilians who will be re-entering the area.   Finally, remember that not all PPE protects you from all hazardous materials, so monitoring air should be your first step when deciding what PPE to use when entering a HazMat incident.

Image courtesy of Deep Water Horizon response via flickr

• During incident
  Air Monitoring at Structure Fires, Fire Engineering, 2010

• After incident
  Hazmat Survival Tips: Air Monitoring during Salvage and Overhaul Operations (Fire Engineering, 2008)

TCFP Library Audio-Visual Resources

HAZMAT INCIDENT MANAGEMENT STEP 4: PROTECTIVE CLOTHING & EQUIPMENT 

HAZMAT/WMD SELF PROTECTION FOR FIREFIGHTERS 

HAZMAT INCIDENT MANAGEMENT STEP 7: DECONTAMINATION 
AIR MONITORING PART 1: CONTAMINATION ASSESSMENT  
AIR MONITORING PART 2: DIRECT READING INSTRUMENTS  

Newest Research

Check out this new study regarding all these issues!  It's a MUST READ!

Does your department's SOPs follow OSHA guidelines?