1. EMS SUPPORT to HIGH-RISE FIREFIGHTING OPERATIONS Wake County EMS System City of Raleigh Fire Department

2. OUR SINGLE OVERRIDING OBJECTIVE Prompt, Compassionate, Clinically excellent patient care…… …… whenever and wherever needed.

3. The Changing Raleigh Skyline

4. One Meridian Plaza Philadelphia, PA - February 23, 1991

5. EMS High Rise Fire Support ô Policy corresponds to RFD High Rise Fire Operations policy ô Prepared in cooperation with RFD ô RFD principal point of contact – Battalion Chief Rob Johnson ô Policy effective September 1, 2008

6. What is a high-rise building? ô Portions are beyond the reach of the fire department’s aerial equipment. ô Potential for stack effect, reverse stack effect, or stratification. ô An unreasonable evacuation time may be expected. ô Greater dependency on internal fire protection systems will be required.

7. Strict ICS Compliance ô Safe, effective mitigation of the incident. ô Minimizing risk to responders. ô Free-lancing and operation outside the ICS is strictly prohibited.

8. Dispatch RFD High-Rise Box Assignment EMS First Alarm Assignment ô 2 District Chiefs ô 3 EMS units ô EMS T-1 ô Notification of Command Staff and Logistics Officer

9. Dispatch RFD Working Fire in a High Rise EMS Second Alarm Assignment ô 3 EMS units ô Command Duty Officer (on-call chief) ô EMS Command Staff ô MD-1, MD-2

10. INCIDENT COMMAND POST Ground Floor, Lobby ô RFD Division Chief (Shift Commander) is the IC.

11. First Arriving EMS Unit ô Report to the Command Post ô Full turnout gear ô ALS response compliment including Stretcher Stretcher Stair chair Stair chair Oxygen plus one spare bottle Oxygen plus one spare bottle Primary responsibility is the welfare of firefighting personnel. This unit will become the Medical/Rehab Group. Primary responsibility is the welfare of firefighting personnel. This unit will become the Medical/Rehab Group.

12. First Arriving District Chief ô Reports to ICP in full turnouts, with ALS carry gear and ICS gear (command board, etc.). ô Assumes position of Medical Branch Director at the ICP.

13. Second Arriving EMS Unit ô Report to the Command Post ô Full turnout gear ô ALS response compliment including Stretcher Stretcher Stair chair Stair chair Oxygen plus one spare bottle Oxygen plus one spare bottle ô Primary responsibility is Lobby Triage and Treatment (firefighters plus civilians).

14. Second Arriving District Chief ô Reports to ICP in full turnouts, with ALS carry gear and ICS gear (command board, etc.). ô Prepares to serve as Medical/Rehab Group Supervisor.

15. Third-Arriving EMS Unit ô Leave unit at designated BASE location ô Bring full ALS response compliment ô Report to ICP report in full turnout gear to Medical Branch Director One serves as AIDE/SCRIBE or as directed. One serves as AIDE/SCRIBE or as directed. One serves as EMS LOGISTICS officer. One serves as EMS LOGISTICS officer. Assist with establishment of Lobby Triage/Treatment area.Assist with establishment of Lobby Triage/Treatment area. Assemble supplies as requested for movement to MEDICAL/REHAB.Assemble supplies as requested for movement to MEDICAL/REHAB.

16. EMS TRUCK-1 ô Position unit at designated BASE or in an appropriate location outside of the collapse zone (at least ½ block away). ô Outside Medical Ops - prepare to establish TRIAGE TRIAGE TREATMENT TREATMENT TRANSPORTATION TRANSPORTATION ô Establish pathways ambulance ingress/egress routes AND ambulance ingress/egress routes AND patient movement pathway from lobby to TRIAGE patient movement pathway from lobby to TRIAGE Use cones, barrier tape, etc. Use cones, barrier tape, etc.

17. Additional EMS Units ô Primary function is TRANSPORT unless otherwise directed. ô If assigned non-transport function, leave vehicle at BASE location. ô Bring PPE, stretcher, patient care equipment to Outside Medical group location. ô Await assignment. Outside Medical Group supervisor is responsible for outside accountability.

18. Inside Operations MEDICAL/REHAB GROUP

19. Fire Floor Lobby Operations/Staging Medical/Rehab Command Post Lobby Triage/Treatment Medical/Rehab may be located with Operations

20. Medical/Rehab Group (inside) ô When/as directed by IC and Medical Branch Director, move to an area near OPERATIONS – adjacent to or one floor below, as directed. ô Take all necessary equipment and supplies. ô Set up in locations that will not impede traffic (not in stairwells). ô All movement up and down in the fire building is strictly controlled by the IC. ô EMS personnel will typically be escorted by fire suppression personnel. ô Accountability at both LOBBY and OPERATIONS (level 3 accountability)

21. Medical/Rehab Group ô Conduct rehab operations per protocol. ô Provide medical aid as needed. ô Inform OPERATIONS if personnel should not return to firefighting operations. ô Medical/Rehab Supervisor – maintain communications with Medical Branch Director.

22. Outside Operations

23. Outside Medical Operations ô Receive casualties From inside fire building From inside fire building Walk-up self-evacuated Walk-up self-evacuated ô Perform Triage, Treatment, Transportation, Medical Communications ô Perform initial and periodic hospital notifications

24. BASE Ambulance Ingress Ambulance Egress Patient Movement Corridor TRUCK-1 Outside Medical Fire Building

25. Additional Operations ô One EMS chief officer to RWECC to supervise county coverage and mutual aid ô Medical Branch Director augment groups as per the needs of the situation ô Utilize physician assets at Outside Medical

26. COMMUNICATION ô ICS positions require two radios Medical Branch Director Medical Branch Director Medical/Rehab Group supervisor Medical/Rehab Group supervisor Lobby Triage supervisor Lobby Triage supervisor Outside Medical Ops supervisor Outside Medical Ops supervisor Medical Communications coordinator Medical Communications coordinator ô Radio Frequencies One to assigned TAC channel – on command, switch to VEH RPTR channel per IC instructions. One to assigned TAC channel – on command, switch to VEH RPTR channel per IC instructions. Designated channel for EMS operations Designated channel for EMS operations Adapt as necessary Adapt as necessary Monitor diligently Monitor diligently

27. Be Safe! REMEMBER Everybody goes home alive!