Hoarding discovery on Medical Response

hoarder-ems

The news explains the initial call for service as being a respiratory distress call that evolved into a HazMat situation, due to the suspected Meth Lab inside.  

This is a great example of the exposure potential to all first responder agencies. Let’s take a look as some learning points from this news clip:

EMS: Many EMS agencies do not carry the needed equipment needed to protect their responders from the airborne dangers of hoarding, managing the collapse risk, and facilitate a safe removal.  the need for additional resources should be made immediately. 

Police:Our brothers and sisters in blue often do not receive the awareness training when faced with hoarding conditions.  When education is taking place adding them into the classes should be mandatory. Often they will respond for a well being check and, without understanding the danger, enter a environment that is hazardous. 

 

Fire:  In the news clip the firefighters take the appropriate actions by wearing their SCBA and turnout gear while investigating the apartment.  While this may not be required on all hoarding calls it should be considered if faced with multiple animals and homes filled with fecal matter or urine.  

 

Take away 

 

The most important take away from this short news clip is the need to start identifying these conditions in our areas. Starting a unified approach to hoarding is the “best practice” to ensure all cases are identified and shared with every agency. 

 

Using building inspectors, building managers, and utility workers is a great way to gain access to building that first responders usually do not have access to. Reach out to these agencies and explain the dangers of hoarding and being the mutual working agreement to help combat this problem.


 

 

 

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Dolton Illinois Hoarder Fire Video

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Hoarder Fire from Dolton IL

Dolton,Illinois Still & Box House Fire 14641 Lincoln Avenue

Good morning from the ChamberofHoarders.com,
 
We would like to thank you for visiting our new, redesigned, site.  Look for new content added weekly!
 
Today's video comes from Dolton Illinois.  This video is a great example of the challenges faced by first arriving crews that encounter a Heavy Content Environment. Listen in as these firefighters make some key decisions of attacking this fire:
Challenges include:

    • Privacy Fences

    • Cluttered exterior

    • Blocked Entrances

    • Limited water supply (initially)

    • Heavier workload on firefighters


While watching this great video put yourself in the shoes of these firefighters as they Identify, Adjust, then attack this fire.

 



Make sure to sign up for our email list to learn more about fighting fires in Hoarding conditions!
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Chamber of Hoarders Learning Center: Behind the Scenes



 

Here is a behind the scenes look at the ChamberofHoarders.com Learning Center.  Four hours of education of Hoarding and how we need to Identify, Adjust, and attack the overloaded buldings caused by Compulsive Hoarding Disorder.

 
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Hoarding and First Responders

Since the days of the Collier Brothers in Manhattan first responders have been

   


dealing with the affects of compulsive hoarding disorder.  The ChamberofHoarders.com is a website dedicated to teaching educating first responders on the needed changes to tactics and challenges they will face when entering the hoarding environment.  From bio-hazards during a medical response to a working structural fire hoarding offers dangers that can affect responders for years.

The mission of this website is to deliver actionable content that you can put to action immediately.  Starting with this post we would like to walk you through the causes, challenges, and solutions when dealing with the conditions caused by compulsive hoarding.  Over the next 52 weeks we will be posting fresh content that offers insight into the disorder and how to change  our operations to bring everyone home safe.

History of Compulsive Hoarding: Week 1

Compulsive Hoarding Disorder is defined as  the accumulation of and failure to discard a large amount of belongings that have no apparent value, the accumulation makes living spaces unusable, and causes significant distress on the occupant (Frost and Hartl 1996) This clinical definition describes the inability to discard belongings that eventually accumulate from floor level until, eventually, ceiling height.  Compulsive Hoarders receive positive feelings from the acquiring belongings and are unable to part with them because of the negative feelings they receive when parting with them.
This collection often is comprised of things that you and I would consider to have little value. Common items collected include:

    •  Newspapers

 

    • Magazines

 

    • Books

 

    • DVD’S

 

    • CD’S



These items can differ in each case of hoarding, depending on the afflicted’s compulsion.

It’s believed that Compulsive Hoarding Disorder affects between 700,000 - 1 million people.  (Hoarding Handbook… Bratiotis,C, Steketee (2011) Many think that this number is lower than the actual number.  Many cases of hoarding go unreported as the affected person often feels ashamed or embarrassed by their disorder. They don’t want “discovered” or “exposed” and often stay hidden inside their homes without allowing anyone to enter, including family members. Not allowing visitors inside will often keep the conditions hidden until an emergency happens and we, the first responders, find the conditions as we make entry to solve the problem.

Dealing with surprise can be one of the biggest challenges to first responders. Imagine responding to a seemingly normal looking home, just to open the door and find a labyrinth of belongings that reach to the ceiling.  Most often the hoarding is discovered during a routine emergency medical call or fall assist. If you discover these conditions during one of these types of responses you need to start the pre-fire process in motion to establish a “Heavy Content” environment. Getting the information should be processed through your departments normal pre -fire planning process for constancy. Adding the plan to the normal collection of multi-family and high hazards buildings will make the plan available to the street level responders.

 

Having an understanding of the complexities associated with Compulsive Hoarding Disorder is required by the responders left to deal with the mess.  It is a complex disorder that is NOT A CHOICE.  We can not cast judgement or compare their living conditions with ours.  Remember in their eyes belongings are valuable and not just trash laying around.  Using a layer of compassion and understanding when dealing with the occupants will lead to a more successful outcome.  This care should be taken in non life threatening conditions to understand, explain, and support them.  Treating them like a beloved family member is a great method of supporting their emotional needs.

If you are mean spirited and use terms such as “trash house” or “hoarder” they can have severe reactions to yourself and crew, sometimes violent reactions. One example of this type of reaction occurred in Long Beach California as a code enforcement official showed up to a home to serve notice.  The occupant shot the code enforcement officer in the head.

“Code enforcement officers arrived at the home about 8 a.m. Thursday to serve an inspection warrant in response to hoarding complaints. When they arrived he fired at them, police said, hitting one of the code officers in the head.” source  La Times 

This illustration should help us all understand how strong the compulsion to protect their belongings is. How threatened do you think a person would have to be in order to shoot a code enforcement officer? We all should keep this illustration in mind as we respond to hoarding conditions to ensure we all come home safe.

 

Thanks for stopping by chamberofhoarders.com as we begin the year long journey of discovery…..

 

As always you can learn more about Hoarding in our online Learning Center… Click Here! 

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Fort Wayne Hoarder Fire

FORT WAYNE, Ind. (WANE)  A firefighter battling a Monday morning blaze at home in a

]

Picture from Wayne.com


northern Allen County subdivision fell through a floor, but was able to quickly return to his duties.

Firefighters were called to 10722 Windsor Woods Boulevard in the Windsor Woods subdivision located off Dupont Road just east of Lima Road at around 9:15 am after a neighbor called 911 after seeing smoke coming from the eaves.

Crews with the Fort Wayne Fire Department arrived a short time later and immediately went inside to look for occupants.  They found fire coming from the basement as well as the first and second floors.  However no one was inside the home.

According to Public Information Officer Stacey Fleming, firefighters efforts were hampered by the large amount of personal belongings and storage boxes inside the home.  Because of that, they moved outside to take a defensive stand.

 

Watch Video of Fire Here 

Case study Interview coming soon here on Chamber of Hoarders.com

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News Coverage of Numerous Hoarder Fires


Are the number of Hoarder Fires rising? As we research this question the evidence seems to point towards: Yes they are. Until we establish a definite way of recording data on the number of Hoarding Fires that are occuring, we rely on news stories from around the world to update us on the number of hoarder fires. They usually grab news attention due to the amount of firefighters required and the length of time it takes to manage these situations.

This post is to share some of the latest news stories from around the world about Hoarder Fires:

    1. Elderly couple die in each others arms from Hoarder Fire. UK

 

    1. Officials say Hoarding Fueled Glendale Arizona Mobile Home Fire

 

    1. Portland Firefighters had to deal with large amounts of Clutter.

 

    1. Faulty Lamp cause Fatal Hoarder Fire in St. Saviour, Jersey

 

    1. Conditions made the fire hard to fight in Fatal Mass Fire

 

    1. Body of Mich Hoarder found inside Mobile Home

 

    1. College Park Hoarder Fire turns Fatal



These are some of the most recent news stories from around the world on Hoarder Fires.  A new feature here on the Chamber of Hoarders  will be a monthly update on the news stories reporting emergencies inside the hoarding envriornments.

 

Stay safe and always remember..... Hoarder Fires: Identify, Adjust, and ATTACK!!!

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Hoarder Fire: North Huntsville Alabama

Hoarder Fire North Huntsville, Ala. (WHNT)– Firefighters are investigating a house fire on Kennan Road. At two o’clock Sunday afternoon the call came in that both smoke and flames were visible from the home. It took firefighters nearly an hour to get inside. The front entrance and the inside of the home were full of items, which blocked the entrance. Firefighters had to cut a hole in the outside wall of the home to get inside.

Read More Here

Listen in to our First Audio Blog:

Hoarder fires, often, do not become raging inferno's that threaten entire cities. Staying smaller longer is a trait often seen inside the hoarding environment.  Listen in as Ryan Pennington gives a quick thought to Hoarder Fires.

 

 

 
[soundcloud url="https://api.soundcloud.com/tracks/119616075" width="100%" height="60" iframe="true" /]
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Hoarding Assessment for First Responders

Dealing with the challenges presented by compulsive hoarding disorder is assessing how IMG_1008bad the conditions are.  When families reach out for help with a family member the mental health professionals start the treatment process with an assessment of how severe the hoarding conditions are.  There are different hoarding assessment scales available to use when assessing the severity.  As first responders we need an common scale to use when hoarding conditions are discovered.  Using common terminology to describe the severity and danger will allow the dangers communicated effectively, accurately, and evenly.

Keep the assessment simple and straight forward is key during this process.  For that reason we recommend using the Institute for Challenging Disorganizations scale that rates all conditions on a 1-5 level.  Using this scale will allow the discovering agency to give a slight problem a one and the most severe a level 5.

As first responders this scale can be adjusted for the dangers we face.  This rating scale should be used by all first responders, utility workers, and anyone tasked with entering the environment to answer an emergency or service call.

Fire Service Hoarding Scale


Level 1: The start


•             Most of the homes that we see fires in seem to be at least a level 1 home.

•             With Level 1 you will not encounter large amounts of materials but may find normal clutter with some apparent signs of insects or rodents.

•             At a level 1 all doors, windows, and hallways will be accessible.

Level 2: Build Phase


•             In a Level 2 hoarder home the amount of overall clutter has begun to appear.

•             This is the point where you would consider the amount of belongings to be over and above a “Normal Level”.

•             Trash cans over flowing, one or more exits may be blocked, and housekeeping is at a minimal level.

•             At level 2 the piles of belongings may be at or above waste level.

•             Windows are starting to be unusable as the piles continue to get larger.

 

Level 3: Big Problems Begin


•             The amount of belongings has taken control of the house and making the rooms unusable for the occupants.

•             At Level 3, the amount of clutter becomes a serious hazard for firefighters.

•             The “Goat Paths” become the only access to the small areas of usable space.

•             At Level 3, the clutter may be visible from the exterior.

•             Noticing the windows and the level of belongings being above the lower sill, if not covered completely will be a prime cue or clue that a hoarder condition is present.

•             In a Level 3, the stairwells are mostly blocked with belongings.

•             Most Level 3 homes pathways are open to all rooms they are just narrowed down to a path.

Level 4: Beginning of the end


•             The beginning of the end of the useable areas of the hoarder home starts in level 4.

•             With most of the rooms at an “unusable” hoarded level the living space is reduced to small pockets of living area among 1 or 2 rooms.

•             The piles of belongings will be at ceiling level and all but most entrances will be inaccessible.

•             All windows will be covered, while the hoarder begins to find more ways of storing more belongings in these small spaces.

•             Attic spaces will be full; all cabinets will be full, even under the floor spaces may be used to amass the huge amounts of belongings a level 4 will collect.

 

Level 5: Uninhabitable


•             Unable to enter!

•             There is obvious structural damage to the home, broken walls, no utility service.

•             All rooms including the kitchen and bathrooms are unusable; the occupant is unable to stay in the residence.

 

This scale should be used in a pre-planning phase of operations.  It allows a common terminology and assessment scale to be shared between first responders.  Stay tuned for more assessment processes to share the discovery of Heavy Contents with all first responders.
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Hoarding Firefighting: Lesson from a Live Fire Experience

When firefighters enter a burning building many different factors come into play.  One huge factor that can affect the outcome of the operation is the presence of increased amounts of belongings, caused by a person afflicted with compulsive hoarding disorder.  As their collection of stuff accumulates the danger in hoarding firefighting increases.

[caption id="attachment_882" align="alignright" width="180"]Firefighter Enter Hoarding Firefighter Enter Hoarding


Over the past two years of reaching out to fire departments from around the world some common challenges kept coming up.  Inability to hit the seat of the fire, shielding from the heat , and difficulties in escape were top of the list.  This past weekend the chamber of hoarders had a unique opportunity to enter a “live fire” environment to experience these variables.

With the assistance of the Frontier Fire Company in Wheatfield New York a hoarding environment was set up and multiple scenarios were run.  The results were a confirmation of all the research collected. Each variable was looked at individually and together with great success.  It truly served as a reminder that hoarding changes our operations and if we are unwilling to adjust our operation it may not be successful.

Shielding from the Heat

With many safety measures in place the fire rotations started with a firefighter between the stacks of belongings with a thermal imager.  What we learned was a confirmation and an amazing result. While the other instructors took a beating from the heat in front of and behind the stacks of stuff the inside firefighters documented floor temperatures of 125 degrees with thermal imagining, shielded from the heat.

Documenting these temperatures was an unofficial, non- scientific example of the true dangers of the hoarding environment.  No monitors, measuring equipment, or recording devices were in place, just a group of firefighters with thermal imaging cameras watching something amazing.  The hoard shielded the firefighter from the heat.  It restricted the heat and pushed it past and around.  These results proved a multiple amount of points.

  • Hoarding can give interior firefighters a false sense of environment

  • Shielding can allow firefighters to push further inside without experiencing the normal heat levels

  • Stacks of stuff can trap firefighters

  • Victims can have more survivable thermal temperatures when insulated with hoarding.


With the recent research on flow paths coming to light the need to adjust them for hoarding  firefighting was revealed inside the burn room in New York this past weekend. It reconfirmed the dangers of the insulation provided by the interior conditions.  This insulation can hide the hidden heat and dangers until it’s too late.  Most firefighters advance into burning buildings using their senses to determine how far and deep they are to go.  In hoarding conditions they may keep pushing unaware of the hidden dangers waiting for them. Dangers that could present themselves in the form of rollover, flashover, or backdraft, trapping the firefighters because they don’t have secondary means of egress.

[caption id="attachment_883" align="alignright" width="120"]Hoarding Firefighting Hoarding Firefighting


 Conclusion

Confirmation that the shielding is real was not a surprising result.  This weekend just reconfirmed what we have been learning from survival stories from around the world.  Hoarding conditions can act as an insulator keeping high temperatures away from the victim or firefighter in the middle.  We need to educate firefighters to be aware that this shielding can lead to poor judgment to just how far we should push.

Identify, adjust, and attack when Hoarding is discovered!!!!!!!

 FDIC Flow Path Video. 

 
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Often Ignored Hoarding Dangers

How much risk are you willing to take?  While attending the 2013 Ohio Fire and EMS expo in Columbus Ohio last week it seemed clear that first responders don’t fully understand Hoarding Dangers and how they can affect safety.  Having the opportunity to travel and meet the brave men and women who serve as first responders is a HUGE honor.  In this past week’s travel is where this lack of understanding became crystal clear in these conversations.It’s like clockwork that when someone hears that I am studying responses in Hoarding Conditions they immediately start into a story of a response.  These stories always involve the words “lucky” and/or “fortunately” something happened or it could have been bad.  As an educator these words are like fingernails on a chalkboard.

[caption id="" align="alignright" width="265"] Hoarding Dangers: Glassware Image from http://hoardingwoes.wordpress.com/2012/09/30/hoarding-the-glassware/


I would like to share two conversations that came from Ohio.  Sharing these conversations is not a judgmental or an effort to “bash” anyone, but rather an attempt for everyone to learn from their experience.

Hoarding Danger in Piles:

The most troubling story was, by far, the firefighter who described a fire where they had to crawl over piles and piles of belongings to fight the fire.  They described hoarding at a level 3 and went on to explain that the interior firefighters had to crawl over multiple stacks of belongings to access the fire, which sounded rather small.

The conversation described the difficulties of traversing the stacks and how “lucky” they were to make the fire room and have a successful firefight.  With the hair standing up on the back of my neck I began to question them and after some time the “I never thought of that’s came”.  Often we all don’t think of a certain danger until someone exposes us to it.  Their response is common when dealing with hoarding conditions.  Without being judgmental we should all be exposed to the danger possessed by the stacks of stuff.

Let’s review some of the factors and why firefighters should not crawl over stacks of stuff and exactly how dangerous it is.

  • Stability of the Piles

  • What are the Stacks Comprised of (magazines, books, Glassware)

  • Collapse Risk

  • Entrapment dangers (wires, yarn, extension cords)

  • Weight of the firefighter

  • Need for rapid escape

  • Height of Stacks (putting firefighter closer to the ceiling and hotter temps)


Each of the above danger can place a firefighter in a life or death situation at a moment’s notice.  Mix one with another and a recipe for disaster is on the horizon.

Example: Firefighters making an interior push choose to crawl over a stack of glassware. The weight of each firefighter plus gear added to the instability of the stacks causes a collapse of the stack downward then adding a side collapse covering the firefighters with sharp glass.

You can see the dangers in the above example.  Not knowing what is in the piles of belongings should be the number one reason why we should NOT crawl over stacks of belongings.  Adding the weight of a firefighter to an unstable situation can lead to a mayday.   Do the occupants crawl over the stacks or walk around them?

Occupants use the pathways to access the usable space inside the house and so should we.  Using the “goat paths” for interior access is the safest way to gain interior access without collapsing piles of belongings on beneath the firefighters.  Think about walking to the stage of a theater, would you crawl over the rows of seats or use the isle to access the stage.

It was a Clean Hoarder House:

Another hoarding story from this trip was a assistance call where they described a Clean Hoarder Environment.  This mindset is troubling because of the hidden dangers that may not be seen because of the accumulation of belongings.

[caption id="" align="alignright" width="240"] How clean can it be. Hoarding Dangers


While the environment may look “clean” from the view point of a responder, do we truly know what lies beneath the hoard.  Without access to walls, rooms, and the inability to see the floor do we truly know what’s underneath the stacks of stuff.  The answer is NO.

 

Stacks of belongings in the home can hide dangers for first responders.  Rodents, insects, mold, and animal excrement’s can all be dangerous to responders and all can be hiding beneath stacks of stuff that appear to be clean.  Without the ability to clean and maintain a home, due to the hoarding, the occupant may never truly have the ability to clean, sanitize, or remove problem areas.  This accumulation can be dangerous for them and us.

If you find a hoarding condition that must be entered we MUST assume the worse situation possible and choose to wear our PPE properly.  Assuming that the hoarding area is “clean” is an assumption that can lead to Bio Hazard exposure.  Once discovered we should take the appropriate precautions and choose to wear ALL of our PPE to make sure we don’t care these dangers home to our families.

 

Review:

Emergencies in hoarding conditions should be identified, adjusted for, and then attacked with different approaches by all first responders.  Crawling over debris and not choosing to wear proper PPE are just two dangers that could cause injury or death.  Make the choice to avoid them both when, not if, you are called to enter the hording environment.

 

 
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Hoarding Dangers for First Responders

Hoarder Fire

Since the days of the Collyer Brothers, in Manhattan, first responders have been dealing with the excessive accumulation of belongings caused by compulsive hoarding disorder. We have just “dealt” with the challenges and continued on our way to solve the problem. Today we are seeing an abundance of these types of emergencies.  Many different theories exist on why we are seeing an increase in the number of compulsive hoarders, but without a doubt emergency responders are seeing an, almost, epidemic level of responses inside hoarding conditions.

Compulsive Hoarding disorder is defined as: The accumulation of and failure to discard large amounts of belongings that have little or no value.  This compulsive accumulation eventually takes over their home to where it cannot be used for its intended purpose.

How does this disorder directly affect the first responders?

As the accumulation of belongings start the dangers to the occupants and first responders big to pile up, just like the stacks of stuff.  The challenging environment that follows offers challenges with entry, exit, and an increase in available fuel for a fire.  Along with these challenges firs responders can be faced with multiple biological dangers caused from rodents, human, and animal waste.  Each one of these dangers is major challenges for first responders.

[caption id="attachment_158" align="alignright" width="180"]Photo Courtesy of Twin Cities Fire Wire. Photo Courtesy of Twin Cities Fire Wire.


Who discover these environments?

People that are afflicted with compulsive hoarding disorder are very reclusive and often do not allow people to enter their homes.  Many of these folks feel “embarrassed” or “ashamed” as they are aware of how their disorder is seen by people.  If no one is allowed to enter their home it is common for the first responders are often the first people to discover the conditions. They will keep to themselves until they have a medical emergency, fire, or experience a need to call 911. This call brings the local responders to the environment, often unprepared for what they find.

What are the Cues and Clues that hoarding is Present?

One of the most common questions asked: “Can you tell from the outside of a house that Hoarding conditions exist?”  The answer is, YES.  While it is not a 100% certainty there are some common ques and clues that can lead you to assume that the home is filled with belongings.   Identifying these common clues will lead to a better informed decision making process and adjustments to keep responders safer.

Why did you choose this topic?

Many folks ask why Ryan chose this topic.  Just like many fire departments that call for presentations on this topic my home department ran back to back fires in hoarder conditions.  Much like most to Google I went and what was discovered was amazing, NOTHING.  Keyword searching for Hoarder Fires, Hoarding Firefighting, Hoarding dangers to First Responders, and others resulted in large amounts of documentation of the Mental Health Aspects of this disorder, but no attention was being given to the first responders who go rushing in…

How often are these emergencies happening?

It seems like every day another story of a hoarding emergency is being reported, somewhere in the world.

Here are some links from the Past week:

Baldwin Fire Company

Wayland Massachusetts

Evendale Ohio

These are just three examples in the past number of weeks.

How can the Chamber of Hoarders Learning Center Help?

With training budgets shrinking faster than a sinking ship, we searched for an affordable alternative to offer our class to the fire-ems service.   From these request the chamber of Hoarders Learning Center was born.  It is a 24-7, 365, accessible, and affordable option for responders to sit through 4 plus hours of education.  It can be viewed on mobile, desktop, tablet, or any device with internet access.chamber_hoarders_special_offer

Do you travel to present?

Yes, Ryan Pennington has presented his program to over 600 first responders in 2013.  If you are interested in hosting a program contact  Ryan33@suddenlink.net  Make sure to watch the presentation page for upcoming dates of presentations
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Hoarder Fire Case Study

Hoarding Firefighting Case Study




Here is a case study of a Cluttered House fire from Wayland Massachusetts.  This is a small glimpse of the complete study that will be added to the Chaberofhoarders.com learning center.

In this Hoarder Fire case many points are reviewed as the firefighters battled a "cluttered" condition.  We would like to thank Kyle Marcinkiewicz  for submitting these great photos and description.  You will find more about this fire inside the Learning Center.

 

 

Make sure to visit Kyle's Website to see more Pictures

kjmphotography.zenfolio.com 
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Hoarder Firefighting: In a mess, use your PASS

[caption id="attachment_40" align="alignright" width="180"]Hoarder Fire Hoarder fire. Picture Courtesy of sdfirephotos.com


Are you prepared to call a mayday, right now?  One of the most often asked question from my students is how do you know when you should call a mayday.  The answer always comes back to, anytime you can’t get yourself out or find yourself in need of assistance, PERIOD!  There are many situations that require a firefighter calling the mayday and one that holds true is a firefighter who finds themselves inside the trenches of a Hoarder Home.  Without knowing, an interior structural firefighter can find themselves with stacks of belongings that can extend up to ceiling level causing a huge problem in advancing hoses, searching for victims, and any other fire ground tasks.

How far do you push into these conditions?  At what point do you call a mayday?

These are two questions that should be considered by the individual firefighter while using some common variables.

  • How high are the stacks of Stuff

  • Are we experiencing small collapse of belongings


How high:


Determining the level of belongings can alter an interior attack.  Making this determination can be the challenge due to smoke conditions. Using the stream of your hose or an extended hand tool can give you an estimate of how high the stacks are.  If you carry a 24-36 in haligan you could use it to sweep above your head to determine the height.  If you choose this technique you will need to be mindful of the location of the other firefighters with you.

Either choice of techniques should be used with caution as the resulting collapse could cover up unannounced victims, secondary means of egress, or uncover hidden pockets of fire.  Most often the only part of the hoarder stacks that are burning are the top layer.  By knocking over the stacks you could expose more fuel, maybe even more flammable fuels such as newspapers that were once insulated from the heat source.

Collapsing Stuff:


Whether it’s caused by your sweeping tool or just by itself falling debris should be considered when inside the hoarder environments.  Often the pathways, or “goat paths” , that traverse the interior of the hoarding can be narrowed to a level that causes the advancing firefighter to knock stuff over, just by traveling through them.

 Hoarding Mess:


These two variables should be considered if you find yourself inside the hoarder environment.  Both can cause an added level of danger to an interior firefighter. Often, hoarding conditions can NOT be identified from the exterior of a building.  This can expose an interior firefighter to the dangers once they have passed the point of no return (5 feet inside a structure).

If you find yourself in this condition take these two variables into consideration when determining how far you want to push inside.

If you are experiencing ceiling level stuff or collapsing debris it might not be a fight that you want to take on. Even worse, if these conditions cause you to become disoriented, entangled or low on air make sure that you are ready to call the mayday and activate your pass alarm.  It is better to call and cancel the mayday, than to find yourself in a collapsed stack of stuff and running out of air.

If you’re in a mess, use your pass and make sure that hoarding doesn’t trap you inside without a way to escape a rapidly progressing fire condition!

If you would like to learn more about hoarder firefighting make sure to check out the Learning Center here on ChambeofHoarders.com.   4 + hours of content on Hoarder Firefighting 
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Hoarder Homes: If the Clutter don’t Kill You…..

After spending the last two days reviewing pages and pages of tragic events, which lead to a Line of Duty Death, searching for the effects of clutter, hoarding, or large amounts of debris. A huge point of learning kept coming up.  It wasn't the clutter that killed the firefighter; it was the clutter that kept the firefighter from being able to escape the primary killer….a rapid fire event or collapse.

[caption id="attachment_505" align="alignright" width="135"]Hoarding Photo Courtesy of the Dix Hills Fire Dept,


This point of learning kept me up all night long trying to figure out how to share this information with all firefighters in a sensitive, yet stern way. The last thing that any of us should do is disrespect a fellow firefighter when learning how they died, but we all should honor them by learning the how’s and why’s.

How’s and why’s constantly included these factors.

  1. Extended burn times

  2. Hidden pockets of fire.

  3. Elevated collapse risks

  4. Blocked secondary means of egress


While some had one, most had two or three of the above factors that contributed to the death of a firefighter.  We can make adjustments for these factors, most of us do. But we need to make sure that we are adjusting for them ALL.  One can be dangerous, but combine multiple factors together, and it is a firefighter killer.

We need to take some steps to make sure we don’t underestimate our enemy, the fire.  Using some common assessments during the firefight can give you a buffer of safety and keep you thinking about the potential for death.

1)      Double burn time estimates

2)      Use outside crews to coordinate secondary means of egress

3)      Scan the building for exits while approaching

4)      Constant updates to command as your hose advance progresses

5)      Be aware of Hidden Fire

Keeping these tips and keeping your head will allow you to expect the unexpected, when dealing with the large amounts of clutter.  Adjusting how we operate in a hoarding situation will allow us to search, attack, and overhaul the home safely.

HOARDER HOMES ARE NOT BREAD AND BUTTER FIRES……...

Make sure you Identify, adjust, and attack to make sure we all come home safe!!!!!!
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Keep the stuff off us: Stabilizing the Piles of a Hoarder Homes

[caption id="" align="alignright" width="300"] Hoarder Fire NSW Fire Department


One question that keeps coming up, time and time again, when dealing with hoarder homes, is how do we keep the piles of belongings stable and prevent them from falling on us or the occupant.  This is a challenging question with a multiple different answers, dependent on the situation.  From fighting a fire to removing a patient on an ems run this challenge can be met head on to keep the stuff off of us. Let’s look at a few simple ways to keep the massive amount of belonging in their place while we perform our tasks.



Firefighting:

The most challenging part of fighting a fire in hoarder conditions is keeping the belongings in the same place.  From a VEIS search to advancing a hoseline dealing with the stacks will be difficult.  One way of stabilizing these piles is to avoid them at all costs.  The clinical term used is “Goat Paths” and this is how the occupant accesses their home.  By using these pathways will allow you to minimize the movement of the belongings, if the pathways are wide enough to allow.  Enviably you will know some things over, but if you make an effort to keep the hose low on the stacks and crawl toward the bottom of the pile you can help prevent a collapse.

While staying low will not be an end all, cure all it will use the base to keep them in place. Another benefit in staying low is to avoid the heat that you will be exposed to if you choose to go over the piles of belongings.  Every 12 or so inches equals 100 degrees and with some hoarding conditions that means a 200 degree spike.

If you can’t stay low you may be creative in your thought process.  Bringing an attic ladder, or two, or a salvage cover can offer you a tool to help keep the stuff in place.  If you choose an attic ladder, try to place it at waist level, when standing, to stabilize the middle of the pile.  This will be a labor intensive task and you will need to pay close attention to your air supply.  Often times there will not be enough space to lay it flat, so you will need to angle it upward to the ceiling level to capture as much surface area as possible.  Choosing a salvage cover will also be challenging.  Pre-rigging it for a quick and sometimes not complete deployment will be needed.   If fire conditions allow you can carry it inside and deploy it over the pile.  The cover will need to have some weight to it, not the lighter weight blue style.  During this process you may need to knock over some of the pile to help stabilize it.  When choosing this method a thermal imagining camera and due diligence is needed to make sure you are NOT exposing the firefighters or cover to high heat conditions.

Accessing the exterior:

One pressing problem with hoarding is accessing the exterior of the home.  From collections in the back yard to side yard full of belongings gaining access can be a hazardous.  Using some of the above mentioned tactics can be used, but also using ground ladders to stabilize the outside belongings may also be used. Laying it on top, to the side, or a combination of both can be used to make pathways of access.  Removing of privacy fencing of other barriers may be necessary to make this achievable due to the fact that they often use them to “Hide” their hoard.

You may also choose to use a salvage cover in combination with grounds ladders to make a stable environment as well.  Much like a ladder chute, to collect water, you can use two ladders and a salvage cover to make pile of belongings more stable to walk around, or worst case, climb over.   Climbing over these massive amounts of material can be challenging even with chutes and ladders to help offer stability.

 

Conclusion

From stabilizing the piles to maneuvering around them entering a hoarded environment offers man challenges.  Taking the time to stabilize the pile will allow you a greater level of safety as your exit routes will stay clearer.  One thing needs to be remembered when crawling in, your way out may become blocked, no matter how hard you try.  Using the paths to fight a fire or access a patient is a “best practice” when dealing with hoarding.  Getting creative and using some technical rescue skills will also allow you to enter and exit safely.  Remember that unless you practice these you WILL NOT be proficient at them.  Add some of these recommendations to your next drill and see if you can stabilize the stacks……..
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Hoarder Home: If you see something, say something!

Welcome back into the chamber of hoarders.  After some time away we are back and well into summer preparing emergency responders to face the challenges of compulsive hoarding disorder environments.  This week we are going to look back at a training topic that we have visited before, with a new twist.  It is vitally important to allow firefighters to communicate their findings on each response; this is even truer when faced with massive amounts of clutter found inside hoarder homes.  From pulling on scene to making a interior attack, each and every firefighter should be taught what to say, who to say it too, and how to say it when a hoarding environment is suspected.  Example, “ interior to command we are experiencing Heavy Content”, “command received.”  Often this is where this line of communication ends, not allowing incoming units or firefighters that didn’t receive this message aware of the potential for danger.  It’s time for us to change how we process, receive, and announce situations.

 

[caption id="attachment_388" align="alignright" width="275"]Courtesy of Oxford Pa Fire Department Courtesy of Oxford Pa Fire Department


Firefighter Level

Being the eyes and ears of the responders is a role that each firefighter should be given.  Constantly scanning, evaluating, and searching for potential dangers should be trained on until they become automatic. During this training is where we should introduce them to cues and clues that a hoarding situation is present.



Here are a few:

  • Blocked doors and Windows

  • Cluttered yards or Porches

  • Cars Full of Belongings


If you encounter any of these situations a message should be transmitted to command.  Announcing the presence of hoarding conditions will put everyone in a more defensive mindset and allow the commander to call for additional resources.  Extra manpower, more apparatus, and needed rehab sector are all areas that need reinforced when dealing with hoarder conditions.  If the IC doesn’t know they need them, why would they call for them?  Make the call, even if you are wrong.  If they are not needed they can be released and returned to service.

 

 

 

Incident Commanders

Being in command of a fire when the announcement of heavy contents is made requires some direct actions.  First action is to communicate the findings to the dispatch center to share the message with everyone responding and on scene. Second action is to call for more help.  With hoarding conditions firefighters air consumption will be greater, thus lowering their work time and will need a longer rehab period because of the stresses placed on them while working in these overloaded spaces.  Knowing this a commander should request additional units to respond to the scene. Third action should be a second rapid intervention team.  If a firefighter is inside and experiences a Mayday, it will require a larger number of firefighters to access and remove them.

A good rule of thumb for any commander is the rule of doubles.  If you discover hoarding double the number of firefighters, RIT team members, and double the rehab time allowing your firefighters to adequately recover from the larger workload. The worst thing that you could do is place your firefighters into a stressful environment and not allow them time to recover before going back.

Conclusion

If you see something, say something!

If you hear something, Dispatch Something!

 

If you allow your firefighters to make the announcement of a potential hoarding situation it will allow all commanders to use the rule of doubles and call for the help needed.  Hoarding can place us all at a greater risk do to the compression of belongings that has taken years to accumulate.  Make the adjustments if you are faced with these conditions and make sure we all go home!
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Hoarder Homes: More Dangers than Fire

As first Responders we understand the dangers associated with responding to many types IMG_0835of emergencies.  From auto accidents on busy interstates to working house fires with potential hazardous materials we train on these types of events and how to protect ourselves from dangers associated with them. One danger that continues to be overlooked is the exposure risks found inside hoarder homes.  Often with the accumulation of massive amounts of belongings come the associated risks from exposure to many types of infectious disease and bio-hazards materials.  A first responders can be exposed to these dangers when walking into a situation to assist, such as a emergency medical run or assistance call.  Many of us have suspected that the houses we have been going into were dangerous, how dangerous may have been severly underestimated.  Let’s review some of the potential exposures first responders may face inside the hoarded environment.



Air Quality

Airborne contaminants inside a hoarding environment can present dangers not seen by the naked eye.  Often when entering these environments first responders do not take in account the unseen dangers.  From elevated ammonia levels to aerosolized mold anyone who enters these areas unprotected can be facing danger.  These elevated levels can be caused my animal urine, decomposing animals, fecal matter, and mold.

One common risk that can be managed with ventilation is the exposure to ammonia.  Ammonia is a irritant to the eyes and upper airway tract at or below the exposure threshold of 50-PPM (Parts Per Million). Without the proper application of ventilation the responder can be exposed to up to 150 PPM of ammonia.  This is 3 times more than the limit set by OSHA.   Ref.. (The Hoarding of animals Research Consortium) Without accurate gas meters the only detection device we will have in our sense of smell.  If you identify a heavy content environment and begin to smell high ammonia levels do not enter without aggressively ventilate the structure or use a SCBA to reduce the risks when high ammonia levels are present.

 Misc. Exposures

Without understanding the risks first responders are potentially risking their own personal health and safety when entering the hoarded environment.  Here is a list of potential exposures that have been documented inside a hoarded environment.

Human to Human

  • Listeria

  • Hepatitis A and B

  • Scabies

  • Pneumonia

  • Shingle


Animal to Human

  • Tapeworm

  • Hanta Virus

  • Psittacosis

  • Cat Scratch Disease


How many of these diseases are communicable?  Without even knowing that we have been exposed we can take them home to our families, my worst fear.  If we don’t take the time to protect ourselves from exposures we could potentially place our families at risks.

PPE Discussions.

What types of PPE do you carry?  First responders only have a few choices available when selecting respiratory and splash protection.  At a MINIMUM we should be using our N-95 mask and turnout gear when entering a hoarded environment.  While a n-95 might not protect you from all contaminants it will offer some level of protection.  If the levels are extremely elevated a SCBA can be used to enter the environment.  Choosing to use a SCBA is the best option that we have available as first responders but does offer some challenges interacting with the occupant, if conscious.  We will have more info on that coming, but for this article just realizing that you should be wearing one will be enough.

Protecting yourself from contact with biohazards can be another challenge as the belongings will be stacked so  high touching them will be unavoidable.  Using gowns, coveralls, tyvex suits, or turnout gear can offer contact protection as you enter.  While none of these seem practical, except your turnout gear, they should be considered when entering this dangerous environment.  One key point is the potential for patient and/or responder decontamination.

 

 

Conclusion:
First responders worldwide have been dealing with hoarding conditions for years.  When was the last time you considered that the dangers inside can harm you and your family.  Taking the time to identify that hoarding is present, choosing the most appropriate levels of PPE, ventilating the area, and having decontamination available you will increase your safety and reduce the exposure to harmful materials.  Would you ever go into a fire unprotected?  Hoarding conditions can cause multiple problems for first responders and we have the potential to be “Most Exposed” during an assistance or EMS call.  Take the time to identify, adjust, and attack hoarding with the proper level of PPE.
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Firefighters: Can we really go inside?

One of the more common themes told by firefighters when asked about fires inside hoarded environments is “we won’t go in” or “can we go inside”.  The answer to this question is complicated and cannot be answered with a yes or a no.  Many different variables come into play when making the decision to enter a burning building that is filled with belongings.  From the size of the fire to the potential of victims being trapped, there is a large amount of decisions needing made in a small amount of time.  Let’s look at some examples of the decision making process to determine if we can really go inside a hoarded environment.

[caption id="attachment_324" align="alignright" width="120"]Hoarder Fire 4/2013 Hoarder Fire 4/2013


Pre-Planned Structures

One of the biggest keys to a successful fireground is being prepared before the bell rings.  Being aware and informed that a building has a large amount of belongings before it catches fire will allow you start the size up days in advance. If you find a building that is beyond capacity a “no entry” tag can be assigned and firefighters will not be allowed in.  Making the decision can be taxing on our personnel if a report of persons trapped is transmitted.  For the other levels of Heavy Content a number value can be assigned to allow an estimate of conditions.  The Institute for Challenging Disorganization uses a rating scale from one to five.  A level one would be clutter just outside the limits of “normal” while a level five would be packed from floor to ceiling. (http://www.challengingdisorganization.org/)



If you have these buildings pre-planned to their levels an incident commander can take this into consideration before committing firefighters to the interior.  Making this assessment can be made during or after an ems run, during a fire alarm instillation, or a drive by the location.  Gaining access to private homes will prove to be the biggest challenge.  Multi-Family dwellings make it easier with the allowing of once a year inspections and property owners access.  Adding hoarding homes to your pre fire process will offer a level of awareness and share it to everyone on the fireground.

 

Points of Entry

The next point of emphasis in making the determination to send firefighters inside is the blocked doors and windows.  Having a secondary means of egress should be a point of importance when sending firefighters inside.  If things were to go bad, can they get out?  If they cannot you should make it so they can.  Opening the structure up can intensify the fire but will also offer a level of increased safety if an escape is needed.  Beginning the Pre-Overhaul Process is a great way of making an escape route.  Removing windows, blocked doors, and sill removals should be used on all exterior windows. (caution, venting behind hose crews should not be allowed as the fire can be drawn back onto them!)

Compulsive hoarding disorder can absolutely take over a house.  From cluttered  living rooms to blocked doors often in these conditions  primary entrances and exits are blocked.  This means that taking a 1 ¾-inch handline and stretching it to the front door will not allow access to the house.  Being creative and attentive to the size up clues and ques will allow a hose team to make the correct choice of points of entry.

 

Conclusion

Can we go inside a Heavy Content fire and put it out?  Without talking in circles too much I will leave that up to you.  Use the points in this blog for some reference in reviewing with your crew.  Firefigthers have been crawling into these conditions for many years, many with successful outcomes.  If we use our heads and use the size ups, prepare secondary means of exit, and closely monitor conditions from the exterior and interior it will allow the incident commander to make the call.  Just remember that many rescues are made within six feet of an exit.  Stay safe and remember to be Heavy Content ready!
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Hoarder Fires Prevention

If your house catches fire while you are inside, what would you do?  This message is shared with people of all over the world by first responders.  The question that is asked most often is “how do you get out if a fire happens?”  For a person afflicted with compulsive hoarding disorder this task may not be possible as their exits have slowly became blocked with their collection of belongings.  Cluttered exits, windows, and doors can slow their exits to a point that a rapidly spreading fire can overwhelm them in a matter of seconds.  That is why prevention of fire is such an important message for fire departments. How can we help the afflicted with hoarding and explain the risks associated with fires in hoarded conditions?  Let’s look a little deeper into Hoarder Fires prevention and offer a few quick tips.

It is easy to comprehend that a house filled with belongings such as books, newspapers, and plastic products has a larger amount of fuel available to burn if a fire happens.  This amount of combustible material can make a fire spread rapidly preventing an occupant from escaping.   Most say that fire doubles in size every 30-second, and assuming that this prediction is when normal contents are present imagine how fast a fire could develop if it has access to these combustible materials and a breath of fresh air!



This is why the family, friends, and first responders should have the same mission of helping to offer solutions to this often tragically ending problem.  Offering some simple advise may not be enough to convince someone to let go of their belongings due to the complexity of this disorder, but as first responders we need to keep getting our message to these people and explain the risks associated with hoarder fires to everyone we can reach.  Honesty is best and this is sometimes where we may need to be brutal explaining, “Sir or Ma’am, if your house catches on fire we may not be able to get you out”.  We need to be sure to hammer home the need for there to be more than one exit in the living quarters.

Most of the time, these explanations that we offer may not be enough for someone to seek help for their affliction, we need to keep a constant stream of information to the hoarders and their family.  When fires happen we all use our training and knowledge to help us through, however hoarder fires changes the complexity of the call!  Hoarder fires change the complexity of our job in many ways.  Here are a few suggested tips that need to be started now continued in every fire department:

Tips for Hoarder Fire Safety:

  • Be understanding of the disorder

  • Use EMS runs to gain access to private residences

  • Contact family members

  • Start a public information campaign

  • Allow neighbors to report conditions

  • Add clutter dangers to school programs


First Responders around the world are called upon to enter homes everywhere to assist with various types of emergencies.  Hoarding, though fairly new in recognition, should be near the top of the list on the prevention detail of your fire dept.  A great place to start this discussion is with the children in school. Children can be a huge influence on their parents, by adding some subtle mentions about blocked doors, windows, and clutter to your next fire prevention talk; you can start at the school age with understanding that hoarding can put occupants at a greater risk.  Talking at this age will allow you to start the prevention message before the fire happens and make it safer for the occupants and firefighters.

Preventing fires is a high priority job for every fire department.  Adding information to help friends, family, and occupants of hoarding conditions should be a priority of us all to help keep hoarder fires from happening.
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Hoarding Class Testimonial

On April 6th, 2013 I attended the Wyoming County Fire School held in Saulsville, WV at the Southern WV Community College. During my 6+ years of service in the Fire and EMS field, training like this is normal. I registered with about 30 other first responders for a class called “Hoarding Fires” taught by Charleston Firefighter/Paramedic Ryan Pennington.


While I have had innumerable training sessions on everything from restaurant fires, residential fires, brush fires, and vehicle fires, I had never received a hoarding class. I honestly never gave it any thought, just assumed that since there is more fuel to burn in a hoarding or heavy content fire, you would just use more water and a bigger shovel.


How wrong I was… The class only lasted for about 4 hours, but it blew me and my fellow firemen away how something that we deal with on a fairly regular basis was so dangerous. We weren't hounded with scientific theories and clinical study findings, just simply the proven and indisputable facts of what signs always present, and how to proceed safely.


One thing Ryan repeatedly expressed was the need to do a “380” degree scene size-up, which included not only the standard trip completely around the residence to assess for hazards, but to also look for the signs of a possible heavy content fire. Everything that was taught in the course was logged away in the back of our minds, and we moved on to lunch, and then the next class.






              Once classes had let out for the day I returned home and got ready for my shift as a Deputy Sheriff in my county. Being a Deputy, Volunteer Firefighter, and Paramedic has it’s advantages. My job allows me the flexibility to respond with my fire company, the Pineville Fire Dept. St. 400, when I am not on another task. Every time I hear the tones drop for my department, I go to the scene, and a lot of times I arrive before them.


I try to give a quick assessment, a scene size-up, and fill in the gaps of any information that may have not been relayed to them during the page. Tonight was no different. Around 8:30pm I am driving around the area when I hear the tones for my department drop and the dispatcher advise there is a structure fire just outside of city limits, about 2 miles away from me. I mark en-route and arrive on scene about the time my department and their automatic mutual aid go en-route. I see a single story residential dwelling with heavy smoke and flames presenting from the “A” side.


I position my cruiser past it to deny any traffic coming down and blocking the engine, and then radio Capt. Mike Johnson who was responding on the first due engine, and give him a quick size-up. I then get out and walk around the residence checking for any hazards, and ask the neighbors if the owners are home. I walk back towards my cruiser to keep a few eager onlookers in check as the engine arrives. After taking care of my official duties, I turn back to fire side of it and go back to the residence to see if any of my fire dept guys need anything.


As I go back to the residence I look through a large window in the front of the house and notice that all I can see is things piled up in front of the window. Then what I had just learned that morning suddenly comes back into my mind. “Do a 380” I can hear Ryan saying, “Take a few extra seconds to do the scene survey and it may save you an injury or worse.” I go back to the engine where Capt Johnson is the incident commander and tell him, somewhat enthusiastically, that I think this is a heavy contents fire. As I am taking to him Firefighter Josh England, who had been in class with us that morning, came over with the same excitement I had and said “Look in those windows!!


This is a heavy contents fire!” “Are we sure that the residents are not in there?” Capt Johnson asked me, “Yes, the neighbors saw them leave prior to the fire becoming visible” I responded. “We’re not going in. Defensive attack only” And with those orders from the Capt, 2 1¾” lines were placed at the front and rear of the residence, and 1 2½” was placed at the side and we began our defensive attack.


After the fire was knocked down we began doing overhaul. As the fire had burned away a great portion of the front of the residence, pile after pile, after pile, of garbage was visible in the front rooms of the residence. One group of firefighters went to the rear of the residence, which was still intact, and had to force the door open because there was so much trash piled up against it. An attached garage was full to the top with trash literally touching the ceiling.


The visible rooms were all full of garbage as far as the eye could see. While no official cause to this fire has been determined at this time, due to several factors, the cause of this fire is suspicious. It is possible that a flammable source was added to the residence and ignited, which only added to the already dangerous heavy content environment.



            Upon finishing overhaul we took some time to reflect about the fire, and what we could learn from it. Immediately those of us who had just received the heavy content training began explaining to the others why we didn’t make entry, and why it was more dangerous than the normal structure fire. Several of us began contact Ryan and relating to him how we had just finished working a heavy content fire, and thanking him for the training. All in all it was a very successful day.


We saw the signs, Capt Johnson made the right decision, we got the job done, and most importantly everyone went home safely. Had we not have known to do a 380 survey, didn't know how to recognize the signs of a heavy contents fire and didn't know the added dangers of them, there is a great possibility that we would have treated this as a “normal” residential fire and may have proceeded with an interior attack.


This could have resulted in one of our men getting injured, or even killed. There is no doubt that the heavy contents course taught to us by Ryan Pennington completely changed our way of thinking about fires, and taught us how to assess the situation a little closer before we go about putting out the fire. It may have just kept us from making a serious mistake and costing us the health of one of our brothers. Thankfully we are all still here alive and well, a little smarter, and all very much jump seat ready.


Dwight Meadows,


 Fire-Medic


Pineville WV Fire Dept.
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