Posted By Near Miss Team/ Sunday, March 10, 2019 / Print
What was the initial size-up?
Burn patient at the front door.
A single medic unit was dispatched to a third-party report of a patient that was burned while huffing propane. The medic unit requested an assist due to the vague information of the patient’s condition. My engine responded as the assist. While responding on the engine we discussed the possibility of there being a fire. I had my turnout pants on because I was exercising at the time. The tailboard firefighter put his pants on while responding (remaining restrained of course) and we spotted a hydrant as we arrived. We did not take it very seriously, as there was no concrete information reporting any kind of a fire. The medic unit arrived first and met the patient at the front door. He told them they could not go into his house. He walked to the medic unit. After a primary assessment the paramedic determined this patient required an RSI (get him tubed before edema occurs in the airway) for predicted clinical course. When our engine arrived, the patient was in the medic unit and the paramedic advised me we were doing an RSI. I jumped into the unit to assist. As I did, I turned to the tailboard firefighter to go check the house to make sure there was no fire. The firefighter was one month out of the academy. He entered the house with police officers and determined there was no fire in the room where the explosion happened or throughout the first floor. He returned and advised me that there was no fire and that the police were inside taking pictures and investigating. He stated that there was significant physical damage from the explosion inside a small bathroom, but nothing was burned (other than the patient of course). We continued to secure an airway on the patient and to transport to the emergency room code three. The tailboard firefighter followed in the engine as the engineer was also a paramedic and remained in the medic unit for patient care along with me. After transfer of the patient, as we were returning to quarters, I acted on an uneasy feeling that we needed to re-check the house for fire. We returned to the house. The police officers were gone. There was a large dog inside at the front door barking at us. I did not feel we had cause to enter the house. The lights were on and I could see most of the first floor and into the basement through windows. There was no smoke seen. As we were about to leave the engine operator noticed what looked like smoke or steam across the ridge line. We walked around the back of the house and could smell wood burning. Upon shining a light on the back side of the house we could see light smoke coming from a large roof vent or chimney. I requested the police to return to the scene and we entered the house. The tailboard firefighter donned his PPE for protection from the dog and directed it into the basement. We opened the attic access and saw light smoke in the attic. I requested an additional engine respond as we donned full PPE. We made access into the attic via an attic ladder and observed flames in the attic space above the bathroom. I upgraded to a residential structure fire and we pulled ceiling and ultimately extinguished the fire with a water can. Approximately five to six 2x6 ceiling joists were burning along with some blown in insulation. The explosion occurred because the patient lit a cigarette after huffing propane.
Describe the lessons learned at this event. What recommendations do you have to prevent a similar occurrence?
Things NOT done well: 1. Upon hearing the details I should have been thinking two incidents – a medical patient and a flammable gas incident. This should have prompted me to add an additional unit to handle the second incident. At the very least, once I arrived and was advised of a critical medical patient I should have added an additional unit then. I got tunneled in on the medical patient and missed the second incident within the incident. 2. Within the second part of the incident we had two potential hazards here – a potential fire from the explosion and a LPG leak. I sent in a firefighter with no PPE and without a four-gas meter knowing we had a critically burned patient from an explosion of LPG. Not acceptable. We did not know if there was a fire and we did not know if the LPG was secured or continuing to leak from the original container. I also exposed two PD officers. How to prevent: The Natural Gas Company gave us some training on response to LPG and NG incidents several years ago. They told us that “we are crazy” if we are entering these incidents without a gas meter, monitoring as we go. Whether it is an LPG explosion, gas leak, or odor investigation we should position up wind, don full structural PPE, and use a four-gas meter before entering the hazard zone. This should be done as a team and definitely not with the least experienced firefighter. Things done well: 1. Act on hunches. If you have a feeling you should go back and check on something, do it. It’s worth the time to be sure we have completed our job. 2. Once we knew we had a fire we upgraded to a full structure fire response until we had the fire controlled. It’s easier to turn units away than waiting for them when you’re behind.
What changes are being implemented due to this event?
None. Review of SOG's and best practices.
Describe the leading practices you noticed at this incident:
When dispatched to an EMS event, not analyzing the dispatch information and looking at the whole picture. Tunnel vision into the medical problem therefore missing the whole situation.
Which of the following occurred, if any:
Date the event occurred:
Approximate time the event occurred:
Location of the emergency/ event:
Was a 360-degree size-up performed?
Tunneled in on this being a medical incident.
Which strategic mode was initially implemented?
Were you responding to a known a life hazard (i.e. CPR in progress, known rescue, critical patient entrapment, etc.)?
How many life hazards were there?
Patient with extensive burns.
List any other info that was important for situational awareness. What were key indicators and factors to consider?
The incident was dispatched as a burn patient from a LPG explosion while huffing propane. There was no report of fire, but the reporting party was not at the location. There was also no report of the status of the LPG.
Not enough resources
Were unsafe act(s) performed?
Categorize the unsafe act:
Explain the unsafe act:
Entering a building of a reported LPG explosion without proper PPE, without monitoring of the LEL and as a single person.
Resources and Weather
Which of the following resources were on scene when the event took place?
Approximate number of personnel per unit:
Ambulance (Medic, Squad)
Did the weather/environmental conditions impact operations or the event?
Were there civilian injuries or fatalities?
How many civilians had major injuries?
What was the nature of their injuries?
What caused the injuries?
A patient lit a cigarette in small bathroom after huffing propane; it caused an explosion. There were burns to the patient's skin and airway.
Were there any firefighter injuries?
Was there substantial property/equipment damage or other cost?
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