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Firefighters tackle a wide variety of challenging operational scenarios and suffer significant stress and physiological demands during the discharge of their duties.1 Because the majority of modern fire department emergency calls are for EMS, it is possible for physicians to be less familiar with the fire and rescue operations of the department they work with. EMS physicians must be aware of the unique operational challenges of firefighting and the potential role that the physician plays on the fire ground and their duties as the fire department physician.


  • Understand basic fire ground operations, including training requirements, fitness requirements, firefighter protective gear, and various tasks performed on the fire ground.

  • Understand basic fire ground rehabilitation, including the need for rehab, firefighter physical fitness, the rehab station itself, and common medical/traumatic injuries.


While on the fire ground the firefighter may be asked to perform a multitude of tasks, including fire suppression, search and rescue, ventilation, and salvage and overhaul (Box 65-1).2 Fire suppression is the actual spraying of water and/or chemicals onto and around the fire, extinguishing it. Search and rescue is a systematic search of the entire building for victims. It consists of a primary search, which is rapid but thorough, and a secondary search, which is a more thorough search performed only after the fire is under control. Ventilation is the removal of heated air, smoke, and gases from the structure that is then replaced with cooler air. Ventilation increases firefighter visibility and decreases hot, toxic gases created by the fire. Finally, salvage and overhaul is an attempt to minimize property damage from the fire and the associated suppression activities, while also trying to detect hidden fires and determine the point and cause of origin.

Box 65-1 Fire and Rescue Operations

  • Engine company operations

    • Rescue operations

    • Establishing a water supply

    • Lead initial fire attack with hose lines

    • Manning of backup fire hose lines

    • Ensuring exposure protection (spraying adjacent structures to keep them cool)

    • Use of heavy duty water streams for attack and containment (master stream)

    • Tactical use of building fire protective systems

    • Overhaul (searching for hidden areas of heat or fire after fire attack is over)

  • Truck/ladder company operations

    • Rescue operations

    • Ventilation (tactical opening of roof, windows, doors, walls to allow heat out)

    • Laddering (placing ladders for rescue and egress)

    • Forcible entry (making entry into the building or opening for engine company)

    • Ladder-pipe operation (for ladder truck)

    • Utility control (managing electric and gas supplies)

    • Salvage of property

    • Checking fire extension and overhaul

  • Rapid intervention team (RIT)

    • Search and rescue for firefighters

    • Aid in escape/evacuation of firefighters

    • Provide rescue air supply

    • Aid in continuous scene safety assessment

  • Other department services

    • Advanced rescue operations (vehicle, high angle, swift water, open water, confined space, dive team, etc)

    • Hazardous materials

    • Fire and injury prevention

    • Fire investigation

    • Codes enforcement


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