By Robert Owens
According to the Center for Disease Control (CDC), heartdisease是美国所有男女之间的领先杀手。大约385,000名美国人每年死于心脏病，每年有715,000名美国人报告至少一次心脏病发作（CDC，2013）。虽然这些统计数据令人担忧，但是有一个固有的风险是一个增加心脏骤停的可能性的消防员。
据堪萨斯医疗中心大学动脉粥样硬化和LDL-Apperesis中心主任帕特里克Moriarty博士称，这是77名消防员，平均年龄为39岁，透露，大多数人的牌匾增长了52年 -旧（Colwell，2009）。这归功于stress, sleep deprivation, and high-calorie meals.
Gregg C. Fonarow博士，医学教授和助理首席of the cardiology division at the University of California—Los Angeles led a similar study of firefighters and found that particulates in fire smoke leads to inflammation of arteries, increasing the chance for heart disease or stroke (Colwell, 2009). The study also revealed that, despite an average firefighter age that would be considered “young,” the subjects’ arteries resembled those of people some 13 years older.
Dr. Jim Brown from Indiana University—Bloomington studied Indianapolis, Indiana, firefighters for six months, monitoring their heart rates. Findings included firefighters operating at 100 percentcapacityof their hearts for hours, and high heart rates even during sleep not allowing their bodies to reach rapid eye movement (REM) and recover (Brown & Stickford, 2007).
As of this writing, the United States Fire Administration has recorded 16line-of-duty deaths (LODDs)2014年，除了五个心脏或脑血管血管相关的情况下。这是什么意思呢？
Simply, firefighters have heart attacks. This concept should be nothing new. The data have been there for years. These events occur at the station, after a shift, and even on the fireground. Although programs such as “Saving Our Own” or “Firefighter救援“培训专注于调用五月天或定位和拆除拖延的消防员，从火环境中拯救或者当他们在现场或站点崩溃时，没有提到一个照顾消防员。
Just as firefighters face extraordinary factors thatinfluencetheir potential to experience a heart attack or stroke, dealing with a firefighter in cardiac arrest is not a straightforward event; it takes different skill sets, procedures, resources, and composure to result in good outcomes.
Different Skills
One of the biggest obstacles we face when dealing with the firefighter cardiac arrest is his turnout gear and self-contained breathing apparatus (SCBA). To perform appropriate基本的（BLS）和先进的寿命支持（ALS）干预，例如除颤，插管，血管进入和药物管理，齿轮必须被移除。虽然暴露患者通常是一个简单的任务，但转盘齿轮使它变得更加复杂。如果消防员刚从消防环境中拆除，则齿轮将过热，摆在更大的挑战。使用他赤手裸手或甚至赤手覆盖着紧急医疗服务（EMS）手套的提供商将迅速从EMS提供商转向烧伤患者。当用于切割齿轮本身时，创伤剪刀也可能是无效的，因为通常的换档齿轮集合中的耐用性和分层。消防手套提供所需的热保护，但不是体内物质隔离。面对需要触摸和去除过热的岔篷齿轮时，建议穿上EMS手套的分层技术，然后是灭火手套。拆下过热的个人防护设备（PPE）时额外放心，因为不要对患者造成烧伤。这项技能必须迅速但仔细完成。一旦PPE和SCBA被移除并且辅助热量不再是一个问题，就可以丢弃消防手套，并将EMS手套已经到位，节省了患者护理的关键时刻。
Resources
The average cardiac arrest requires an “all hands on deck” mentality, especially with all of theactionsthat must take place such as intubation, medication administration, vascular access, defibrillation, airway management, and documentation. Consider the event and add in the uniqueness of the patient being a firefighter; this adds a completely new dimension to the resource demands. Following are questions you need to consider beyond patient care techniques, and the answers to these questions will dictate additional actions you must take.
- Is the firefighter wearingPPE? If so, you will need to take the appropriate steps to remove it.
- Is this still an active scene? If so, you need to make the appropriate assignments and reassignments to ensure activities such as fire suppression and hazard mitigation continue. The company with the injured firefighter is no longer an available resource.
- How many ambulances are on scene? The fallen firefighter will be transported off of the scene by ambulance, regardless of the severity of the injury. This ensures not only that the best care is provided but it also removes the distraction created by a fallen member at an incident scene. Many departments issue an additional alarm at the initiation of a firefighter Mayday. Although this is good, EMS resources are sometimes not accounted for in these added alarm assignments. You need to account for EMS resources to maintain the capability to treat any additional firefighters. It is also recommended that you assign two ambulances to any significant incident; one to treat civilians and one to treat responders.
Composure
This may be the hardest thing to maintain during an event like this, but it is likely a key to successful outcomes. The incident commander (IC) and anyone participating in the treatment of the downed firefighter must maintain composure. Everyone will be asking questions and wanting to help. The look they see on your face and the tone they hear in your voice will often dictate if the scene returns to functioning or deteriorate into chaos. Isolation is a great tactic to use when trying to maintain your composure. Simply get in the back of the ambulance to provide a buffer between you and the rest of the incident; this will allow you to keep away everyone but the treatment team and prevent treatment by committee. This will also allow for rapid transport, if that decision is made, or, if ceasing resuscitation is warranted, it will isolate the victim from the rest of the incident scene. The body covered with the sheet is hard enough to view in a front yard; it will be multiplied ten-fold when it is the body of a colleague.
Training
准备规则是光场;消防员的心脏骤停没有什么不同。现在我们知道消防员患者护理的独特方面，我们必须将这些变量添加到我们的培训计划中并开始找到克服它们的方法。携带您的常规心脏肺重新扫描（CPR）时装模特，并添加投灯齿轮和SCBA。在戴着消防手套的同时练习换档齿轮和SCBA，然后过渡到EMS手套。188金博网网址多少如果您有一套旧的换档装备，请尝试查找不同的方式来删除它（创伤剪，小包，其他商用设备）。钻你的ALS和BLS心脏骤停技能（静脉接入，气道管理，CPR等）。尽可能多的基本技能在火车上执行是成功的关键，基本的EMS技能将是消防员失望时成功成功的关键。即使是消防员作为病人的独特性，良好的CPR仍然有效。在处理平民时，它并不那么简单。
Firefighters are more susceptible to cardiovascular events than the average person because of their work environments and exertion levels. Additionally, firefighters operate in unique environments, situations, and outer ensemble. The fire service is in the midst of a cultural change where fitness, health and wellness are taking a front seat. However, until we see a reduction of cardiac related LODDs, fire and EMS departments across the country need to be prepared to deal with a firefighter cardiac arrest. Will you be ready?
Photo found onWikimedia Commonscourtesy of Tim Evanson
参考
布朗J，Stickford J.Physiological stress associated with structural firefighting observed in professional firefighters.Accessed March 24, 2014, fromwww.indiana.edu/~firefit/pdf/Final%20Report.pdf
Colwell C.消防员比正常动脉研究发现窄。2009年，3月13日。2014年3月24日从http://consumer.healthday.com/cardiovascular-and-health-information-20/heart-stroke-related-stroke-353/firefighters-have-narrower-than-normal-arteries-study-finds-625032.html。
Centers for Disease Control.Heart disease facts。2013, Aug 28. Accessed March 24, 2014 fromwww.cdc.gov/heartdisease/facts.htm。
Robert C. Owens Sr.is a lieutenant and EMT-intermediate with the Henrico County (VA) Division of Fire. He began his fire service career with the Mechanicsville (VA) Volunteer Fire Department. He previously served as a career firefighter in Stafford County (VA). He is Virginia Department of Fire Programs-certified Instructor 2 and Fire Officer Level 4 and a mass-casualty incident management instructor for the Virginia Office of EMS. He has a bachelor’s degree in fire science from Columbia Southern University.
