RIT. Not Just for Fires

Watching and waiting for work

By Bill Carey
23 October 2021

On Monday 11 October Escambia County, Florida Fire Rescue experienced a firefighter down incident during training. News reports and a Facebook post by the Escambia County Professional Firefighters stated that a firefighter suffered cardiac arrest during search training at a former shopping center [1].

The firefighter’s crew immediately acted removing him from the building, removing his gear, and starting life saving measures. An update a day later stated that the firefighter was in ICU but conscious and awake, and by the week’s end the stricken firefighter was discharged from the hospital and resting at home.

Barring the numbers of on-duty deaths due to COVID-19 for this year, stress, and overexertion, leading to heart attacks and sudden cardiac arrest, continues to be the cause of most firefighter fatalities each year. You would have to go back to 2001 to find the most recent year when stress and overexertion were not the leader [2].

The subject is no stranger to firefighters and is often presented in the magazines, on the websites, and in the conferences. For several decades, and even today in some areas, responding to firefighter cardiac arrest was often separate from rapid intervention training (RIT). Training on RIT usually focuses on proactive fireground operations and looks at fire behavior, collapse, disorientation, and the missing firefighter.

The data presented by Don Abbott’s Project Mayday is showing us that rapid intervention teams are near the bottom of the list of percentages about who is rescuing the mayday firefighter. This is being made known more and more in various presentations. The extreme downside reaction to this information is that the importance of a RIT is lessened in the eyes of some firefighters and officers. It is an extreme because that attitude toward the assignment is narrow, limited to inside the fire building.

Years ago, at Andy Fredericks Training Days I spoke about how we can widen the area of operation for the RIT by adding EMS and thinking outside the fire building as the data suggests, to intervene before a line of duty death occurs. A year later the International Association of Fire Chiefs (IAFC) launched the “If You Don’t Feel Well, Don’t Make It Your Farewell,” campaign to reduce cardiac line of duty deaths [3].

Fire Chief Gary Ludwig, the IAFC president and chairman of the board, and FireRescue1/Fire Chief board member and columnist, started the campaign with a video illustrating how ignoring the symptoms during cardiac incidents often leads to death.

It is a good effort that should be shared more and included in the ongoing fireground size-up for ourselves individually and for the RIT. It should also come into play during training as some of the examples below show. It should be commonplace to expect a firefighter down during a fire, but we generally don’t think this way in our training. Attention to the probability of an actual mayday during training other than live fire or simulated fire training can be lackadaisical. The fatality data shows that the stress and overexertion on the body strikes firefighters outside the fire building and while at training, more often than while inside fighting a fire or searching a room.

Florida lieutenant suffers sudden cardiac death following training.
RIT drill based on a collapse with a firefighter trapped.
Complaint of chest muscle pain, thought to be caused by heavy upper body workout.

Indiana captain suffers fatal heart attack after multi-unit drill.
Fire attack training in an abandoned restaurant, extinguishing simulated fire.
Arm numb after using bathroom after training debrief.

Indiana fire chief suffers heart attack at vehicle fire.
Collapsed while talking to truck driver.

New Hampshire firefighter suffers sudden cardiac arrest at brush fire.
Collapsed while pumping engine.

Illinois firefighter suffers cardiac event while on EMS call.
Chest pains and heart attack while doing chest compressions.

Vermont firefighter suffers heart attack at brush fire.
Drove tanker to scene and collapsed after approximately 10 minutes.

Maryland firefighter suffers fatal cardiac event during training.
FADO collapses while inside SCBA maze.

Texas fire chief suffers sudden cardiac death at structure fire.
Chief collapsed while pulling supply line to hydrant.

Mississippi firefighter suffers sudden cardiac death while at grass fire.
Found unresponsive in hose bed during fire.

The scope of RIT operations should be wider than the view of the fire building. Does that mean we should have more than one RIT on the simplest of fires? Should we have a RIT standing by during any physically intense training? Not necessarily. Instead, we should use common sense. If on the fireground your RIT does not include an EMS crew, then add one to it. If you are doing any type of fire attack, search, and ventilation training, then it would be prudent to have a RIT, with EMS, standing by for the possibility of having to remove someone from inside a burn building, or immediately untangle them from a prop, or lower then from the training tower. Or at the very least, have an EMS crew standing by. There are plenty of investigations from deaths during training where an EMS crew was not on the scene.

“That’s easy to say for training, but what about fires when you have very limited staffing?” A very realistic question with no easy answer. However, if your firefighters are trained in Firefighter Down: CPR [4], you can increase survival chances somewhat by being prepared and knowing how to respond. The opposite is just hoping everyone will know what to do.

Firefighter Down: CPR looks at the causes of firefighter-related cardiac events and how to quickly begin CPR on a down firefighter in full turnout gear including SCBA. The class is not only about removing turnout gear and starting compressions, but includes lessons on preventing sudden cardiac death and how to include this technique and EMS personnel into your hands-on training.

Rapid removal of PPE is imperative to transfer care of the firefighter to EMS. The training looks at the advantages and disadvantages of diverse types of PPE and certain items such as wristlets and bailout harnesses. The more effective Pit Crew CPR approach compliments the skills and is a universal subject for both fire and EMS personnel that can be easily plugged into any hands-on training taking place.

The fatality data and the mayday data show us that RIT effectiveness inside is small and that many deaths occur outside, at the pump panel, in the cab, while pulling hose, or during and after training. Widening our view of the rapid intervention area leads us to see the larger areas where firefighters are stricken and where we can increase a downed firefighter’s chances of survival.

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