Introduction to Firefighter Down: CPR

Sudden cardiac arrest during firefighting operations is a big concern; therefore, when the unthinkable happens, we have to be ready to provide the best care we can. We know that there are a few basic principles that underlie a successful resuscitation:
1.) Early high quality compressions (HQ-CPR): The sooner we can initiate high quality compression the better.
2.) High Chest Compression Fraction (CCF 90%): In order to maximize the chance of a neurologically intact survivor, we need to maintain near constant compressions during the entire resuscitation.
However, we may encounter a unique situation when resuscitating a downed firefighter - they can be donned in full turnout gear (TOG) with an SCBA!
This will give us, in essence, an access issue.
Our ability to initiate the fundamentals of resuscitation are hindered. Yes ... we can - and should - practice the skill of doffing an unresponsive firefighter in full gear. This can be done in many ways; however, even in the best circumstance, this will delay lifesaving chest compressions.
We've addressed this issue and developed a technique in which we can initiate immediate CPR and doff the gear without stopping lifesaving high quality compressions.
We are simply calling it Firefighter Down-CPR (FD-CPR).
Let’s protect our own ...
Learn more at: www.fd-cpr.com

[@daddydoc1115]

Took me a minute to realize the FF legs were supporting the sides of the back so you aren't pushing directly against an SCBA. Very clever!

[@kevadams1964]

Great video. Easier to understand than just reading the instructions. On a side note. Please, ditch the music.

[@Ls3bandit]

Great job, definitely something that needs to be trained !

[@cgsai2008]

Great video. Thank you for sharing.

[@cassandraralph5906]

Very clever and efficient! Well done indeed!

[@chris24542]

Smooth, good work guys

[@marcssavagevlogs3622]

God bless firefighters of the world

[@Huskerfire1]

exelent job !

[@christopherblosenski2465]

Great video! I'm preparing a training session for my fire company and wanted to show your video (screen grab below) during the presentation after discussing the 10 steps and before they start doing the exercise. Do you have an issue with me showing it in class?

[@michaeld.herbert6902]

Not at all. Also feel free to use all the resources at fd-cpr.com or reach out to us for more help or questions.

[@Eren-kk7yf]

Cool

[@hary399]

is there copyright about this video? If you know it, pls tell me. I want to make another one from this.

[@brandonculpepper4982]

If you just copy the video, you can't use it. If you take sections of the video to create something different it falls under fair use laws in the United States because you are taking that content to create more original content of your own. :)

[@michaeld.herbert6902]

Feel free to use all or part of it and just give credit to FD-CPR. creativecommons.org/licenses/by-sa/4.0/

[@itsslopy9856]

nice

[@Mgoodson]

Song?

[@izzy5347]

Omg I thought it was a manican at first!!

[@Rescue-mt7fl]

This is a very dangerous and irresponsible methodology to demonstrate or teach without data on effectiveness and perfusion rates. We would never train CPR in winter months while patients are wearing winter coats. Same here, while also wearing SCBA. There is no patient assessment and is going from a thought that you already know certain things. Prepping your patient can be done in seconds with two people. One straddles while the other is behind at the head. The one straddling pulls shoulder strap released all the way up in one motion, the one behind grabs patients hands and shoved one arm by the hand through one strap, then the other. He then grabs shoulder straps while straddling FF pops waist belt and grabs chest of coat and pulls patient up while rear FF Pulls pack back to his right. Straddling FF sets patient back down and opens collar and then knife hands down Velcro front closure with left hand while right pulls flap back. Left hand grabs zipper and pulls down rapidly then moves to position for CPR. Rear FF pops chinstrap on helmet and grabs hid and bottom of face piece and strips both off to n one move and immediately assesses ABC. This can be done in 10 seconds or less when trained. It is a great reason to spec zippers on coats and place a t handle on all zippers. Coat may be cut off up sleeves while performing treatment. Just be sure your AEDs or med bags have construction sheets vs trauma scissors to get through bunkers in a faster easier method.

[@Rescue-mt7fl]

@@RMBOYD81 I’m sorry to hear that. Keep up the fight. Your brothers and sisters deserve the best you can do.

[@firelitelight]

Uhhh but hes in an SCBA so tbe air tank would break his fall

[@K1ngDre-DMZ]

Funny, not one time did anyone check for a pulse to confirm he was in cardiac arrest and not respiratory arrest or ever open his airway. Yeah it's training, but do it the right way before some fancy technique to get his pack off

[@michaeld.herbert6902]

Andre Morales When do we check a pulse? This is a great question! One that we've certainly considered ourselves while creating this technique. The FD-CPR process is the missing link in the rescue of a downed firefighter - a complex, dynamic and multi-faceted event. It serves as a bridge form extrication from the hot zone by a rapid intervention team to the ultimate medical attention provided by medical providers - without compromising further no-flow time in a potential cardiac arrest. We've decided upon the common AHA guideline of: unconscious and not breathing or not breathing normally as an indication that somebody is pulseless. The initial assessment of a downed firefighter (DF) will be by the firefighters that find and perform the extrication from the hot zone. The RIT or FAST members will establish if the DF is responsive in any form. Breathing can be assessed through the regulator; however, pulse checks are usually not performed in extremis environments while the firefighter is donned in full turnout gear. Not only will it be difficult to palpate a pulse point in a firefighter with full PPE, the rescuer would have to remove his glove to perform this task. Something that we would not recommend in a hazardous environment. In the case of an unresponsive firefighter, we feel the likelihood of cardiac arrest is high if: • no audible breathing through the SCBA can be noted • the air alarm is ringing • the gauge is empty • the facemask was removed in a toxic environment, or • rescuers witnessed a sudden collapse of a firefighter In these situation, we believe that delaying chest compressions is of greater consequence than performing CPR on someone with a pulse. The evidence out there shows that CPR is unlikely to cause harm to a victim who happens to be only deeply unresponsive. Similar practices are performed nationwide with dispatch-directed CPR for lay people. Two of the most common Emergency Medical Dispatch (EMD) questions upon receiving a 911 call are: • Is the patient conscious? And, • Is he/she breathing normally? If the caller advises that they are unresponsive and not breathing, not breathing normally or gasping, the pre-arrival instructions (PAI) are to perform chest compressions until trained providers arrives. Since public lay rescuers cannot reliably detect the absence of a pulse in a timely fashion, the requirement to identify the absence of a pulse to start CPR was removed in the 2000 and 2005 AHA CPR Guidelines (Circulation 2005; 112(24): IV-3). Another thing to consider in support of the AHA guidelines were a few studies of healthcare providers of all levels (EMT through MD) that found pulse checks only a bit more accurate than a coin toss; thus, if there is any doubt it is best to begin CPR. Our advice, based on the best available evidence and the AHA guidelines, is that this technique is a special means of extrication and as such will necessitate some deviation from the standard algorithms. Thankfully this is only for a short duration, perhaps 30-45 seconds. Once the firefighter is successfully doffed, the usual resuscitation bundle can begin with a pulse check if that is common in your area, and continue with 30:2 C.A.B. ordering, or 10:1 with upstroke ventilation, or even continuous compressions manually or via mechanical devices. If the firefighter was not thought to be in cardiac arrest, instead of compressions the second rescuer will work to remove the firefighter quickly with rescuers 3 and 4. In our conversation with other departments, many have adopted this technique to help them remove any unresponsive / semi-conscious firefighters from their gear (such as during rehab or other areas). Either way, it seems to be the fastest method to doff an unresponsive firefighter in turnout gear. Hopefully this answers your fancy statement. Should you have further questions, please stop by any professional fire department and ask for more advise on current, evidence-based practices. Thank you!

[@nickdawn3985]

Well said. People with basic CPR training will have a hard time to understand the complexity and circumstances this would take place under.

[@laceygilmour2216]

Michael Herbert that is true.. i am no firefighter or medic... but i know a lot of First aid. delaying CPR can be fatal. now if someone saw the collapse then CPR can be started once gear is off... but if no one saw it then CPR should be started right away....

[@margief1798]

there's to be nothing between your hands and patient chest. no exceptions.

[@nickdawn3985]

No exceptions? There is a whole different world when dealing with first responder emergencies.

[@roygumpel8415]

"no exceptions" . where did you learn That?

[@smally2187]

I've done CPR hundreds of times..through t-shirts and body armour and everything in between. Every case of CPR presents an exception, while other crew members remove clothing and prepare Dfib pads. You don't stand and wait while clothing is removed. Immediate compressions means just that. Intervening clothing presents no effect, a compression of proper depth and cadence circulates oxygenated blood regardless of what's between your hands and the skin.