Responding to One of Your Own - Patient Care - @

Responding to One of Your Own

What to do when the unexpected happens



David P. Keseg, MD, FACEP | | Wednesday, January 19, 2011

On Feb. 6 2010 at 22:51, units from the Columbus Division of Fire were called to respond to a house fire. Firefighters were faced with heavy smoke conditions in the residence from a working fire in the basement. E16’s crew, led by Lt. Mike Polaski, worked their way down the stairs to the basement and made an interior attack.

The fire was knocked down, and the firefighters were given an all-clear, signifying no civilian patients remained in the residence. Companies operating in the basement were still working in limited visibility conditions and were on air from their self-contained breathing apparatuses. Just as they were wrapping up, Lt. Polaski suddenly collapsed. He was unconscious and not breathing. One of the rescuers, Jeff Ross, remembers thinking to himself, "This can't really be happening.”

The Response
The Columbus Division of Fire has done a great deal of training in rapid intervention company operations and “Saving Our Own” rescue techniques. This training came in handy during Lt. Polaski’s rescue because of the crew operating in the basement with him. Providers immediately pulled him up the basement stairs. Once they reached the first floor, they found Lt. Polaski’s to be in complete cardiac arrest with no pulse. One of his firefighter colleagues, Tom Cerny, immediately began CPR and others delivered oxygen via a bag-valve-mask. He was placed on a cardiac monitor and was found to be in ventricular fibrillation (V-fib).

The firefighters continued CPR and then defibrillated him. Lt. Polaski briefly went into a normal sinus rhythm but then went back into V-fib. He was rapidly moved to the medic vehicle while CPR and ventilations continued. En route to the hospital, he was shocked a second time, intubated and had an IV placed. Amiodarone was administered per protocol, and he was shocked a third time. After the third shock, he developed a normal sinus rhythm (NSR) with good radial pulses. He also started to have some respiratory effort.
He maintained the NSR with good pulses during transport to the hospital. On arrival, he received induced hypothermia treatment in the emergency department (ED) and was sedated and paralyzed. He was gradually rewarmed in the intensive care unit and then began to wake up after 48 hours. He received a cardiac catheterization and didn’t have any significant blockage, and an implantable cardioverter defibrillator was placed. Before his discharge, he had a full neurological recovery.

Firefighter Cerny said that although they’d all taken care of cardiac arrest patients before, it was different taking care of one of their own. But he says, “There were a thousand things that needed to go right, and in this situation, all of them did go right.”

Lt. Polaski said, “You never think it’s going to happen to one of your own colleagues, much less yourself. I was fortunate to be where I was surrounded by trained professionals who knew exactly what to do. I’m alive because of what they did, and I will be forever grateful for that.”

Lessons Learned
This case presents several take-away lessons. First, never allow your personnel to work alone. If Lt. Polaski’s collapse wasn’t witnessed or if there was a significant delay in the initiation of CPR, his results could have been much different.

The benefits of the Columbus crews’ training in RIC operations and “Saving Our Own” rescue techniques cannot be overstated. These programs played an important role in the resuscitation of Lt. Polaski. The crew’s immediate mayday transmission set off a coordinated chain of events that included rapid patient removal to a safe operating area, delivery of ALS equipment and personnel to the location, immediate resuscitative measures including quality CPR performance, defibrillations and medication therapy.

Early CPR and defibrillation, return of spontaneous circulation in the field, early alerting of the hospital and the ED’s hypothermia treatment all added to the success of Lt. Polaski’s resuscitation.

Take the time to review your agency’s RIC and firefighter down procedures to make sure EMS and ALS response are incorporated into them and practiced on a routine basis. They were lifesaving measures in the case involving Lt. Polaski and could in a future case involving one of your personnel.


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Related Topics: Patient Care, Special Patients, Lt. Polaski, JD Vasbinder, Dave Keseg, Columbus Division of Fire


David P. Keseg, MD, FACEPDavid P. Keseg, MD, FACEP, is the medical director for the Columbus Division of Fire.


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