Photo Lfbphotos.com
A wheeled escape ladder is used in the 1800s in London.
View slideshow of vintage LFB photos

In the early days of organized firefighting in the UK, there were firemen who manned the manual pumps and escape men who manned "street fire escapes." These were 50ft wheeled ladders that were strategically located on street corners with a watchman who, with the help of passers-by, would wheel a ladder to rescue those trapped within the burning building.

As technology improved, these hearty crews combined into organized forces summoned to deal with outbreaks of fire. In London, it became the London Fire Engine Establishment (est. 1833), which then became the Metropolitan Fire Brigade (1866) before finally in 1889 being renamed as the London Fire Brigade. Rescue was carried out until 1867 by members of the Royal Society for the Protection of Life from Fire. In essence, early organized firefighting and rescue in England's capital was carried out in a manner similar to that recognized today only in the United States and Canada — namely engine men carrying out the firefighting and ladder men carrying out the rescue work.

When the MFB was formed in 1866, the role of the RSPLF was amalgamated into it — and so MFB men then manned the escape ladders at the regular MFB fire stations. It meant the role of separate engine and ladder disciplines was snuffed out in its infancy in the UK. This is pretty much the norm around the world now, with the exception of North America.

Back in those days, technology was always evolving. Steam pumps and longer ladders were being drawn by horses, which themselves were all but replaced my motor-powered fire engines by the early 1920s. London had a significant modern well equipped fire brigade. As well as regular pumps, there were those able to carry the 50ft Escape Ladder and Pump Escapes.

Rescue Machine
Even in the London Fire Brigade of today, we differentiate between Pump Ladders and Pumps; identical vehicles but one carries a larger 45ft ladder and additional hydraulic rescue equipment always known as the Rescue Machine, while the Pump carries a shorter 35ft ladder. The Pump is still known as the workhorse because it is first due on all calls including minor fires and special services whereas the Pump Ladder only turns out on calls to fire in property and larger special service calls such as car crashes, HazMat, etc.

Most towns and cities back then had a number of stations equipped with motorized Pumps and also a Turntable Ladder at every couple of stations. Therefore, at that time there was a good balance of Aerials to Pumps often on a one:two basis. They were deployed along with the Pumps to all fires in buildings and were often elevated along with escape ladders to the higher windows of buildings to facilitate rescue or egress for fire crews going deep into the building to tackle the blaze.

When buildings were well alight, they provided an excellent vantage point to launch a number of powerful jets of water onto the burning building from above. In the days before modern fire precautions and inbuilt fire protection systems, the UK’s Aerial Ladders were witnesses to thousands of daring rescues of people trapped at windows and roofways beyond the reach of ground ladders.

World War II was a time when the UK's aerial fleet was at its peak. With our towns, cities and ports being bombed into massive conflagrations night after night, brave wartime firefighters, their numbers swollen many times over by auxiliaries fought these blazes from the street, the roofs of adjoining buildings and most frequently perched at the top of a 100ft Turntable Ladder. The government bought many of these for the fire service, which by that time had been nationalized for efficiency to enable large forces of firefighters and equipment to be mobilized across the UK. Ironically, many of them were the German Metz and Magirus models as well as the British Merryweather's that were made in London.

Post-war sell off
Following the war the National Fire Service was disbanded and returned to local control. Although many Aerials from World War II were sold off or scrapped in the years that followed, most UK fire brigades still kept a lot of Aerial appliances. In London for example we had almost 40 aerials across the Brigade in 1965, with one at every other station in the centre of London. During this period, with a shocking number of tragic fires in hotels, hostels, boarding houses, mills and factories, our Aerials were still being used for firefighting and rescues with alarming regularity.

By the 1970s, newer technology was coming on the scene in the shape of the Hydraulic Platform or "Snorkel." This proved to be a much more stable working platform with its cage and high powered monitor and were ideal for large fires in warehouses or industrial buildings, but they did not have the speed of deployment of the TLs and were not as versatile for rescue work. London remained staunch and true to its "can do" reputation as an aggressive, busy World Class Fire Brigade and by the end of the decade had only two HP's among its still considerable fleet of Aerial apparatus.

The following decade marked, in my opinion, the beginning of the end of the Aerial in the UK. Breathing apparatus was by then very simple to use with self contained compressed air BA being far easier to service than the complex oxygen re-breather sets of previous generations. The ascendancy of the Multi-Stage Pump gave us the very effective and quick to deploy high-pressure hose reel, so fire crews were now getting in quicker and further than the hearty old smoke-eaters of days gone by.

Eighty-five percent of fires in the UK were and still are fought internally by BA crews and because the UK — like most of the world outside of North America — doesn't practice much in the way of pre-attack ventilation due to construction methods and materials, the scope for Aerials was fast diminishing. With statistically only 15 percent of fires being fought defensively, people were also forgetting how to use Aerials.

Although originally aimed at the law enforcement industry, Panasonic is bringing its wearable camera to the fire service for inspections and arson investigations.

Designed as a standalone unit or able to be integrated with the Toughbook Arbitrator SafeServe software version 7.4 slated for release in autumn 2012, the Panasonic WVTW310 wearable camera features a recording capacity of up to 32 hours using H.264 compression and a battery life of approximately five hours in pre-event continuous record mode or longer without. Delivering extremely wide-angle views, the camera can be used for both day and night recording.

For the fire service, this device can be used to record fire-code inspections, fire-scene investigation and witness interviews. It also can be used by commanding officers to preserve hard-to-document initial scene images that may come into play during a later investigation, such as bystanders, vehicles, or other evidence that can easily be forgotten in the heat of a fire attack.

Software options
The wearable camera systems includes Agent software, which allows the video image data on the camera to be automatically uploaded to a personal computer via the conversion box, and Viewer software, designed to allow the wide angle original video to be played back with stabilization and image distortion correction all while maintaining the evidence integrity of the original file.

In the United States, the Panasonic WVTW310 wearable camera system has a suggested retail price of about $1,000.

"With the adoption of wearable cameras, public safety agencies can achieve total situational awareness and a comprehensive and seamless digital camera evidence capture solution, from the field to the courtroom," said Greg Peratt, director of digital video products, Panasonic. "This single camera platform will provide agencies with a wide-angle audio and video record of important officer engagements while ensuring the integrity of the chain of custody, delivering significant time and cost savings in the acquisition, management and review of recorded evidence."

I'm not sure I would believe this story if someone told me about it. We've probably all heard that old firefighter saying: "When people get in trouble they call the police (or sheriff), but when the police get in trouble they call the fire department." In this case, apparently, it was true!

Seriously though, major kudos to the NYPD officer and his partner for recognizing that he — trying to do the right thing, by the way — had gotten into a precarious position and making what must have been a very difficult radio call for help. I'm glad that he didn't, to avoid an embarrassing situation, try to climb down and get injured, or worse — 30 feet up is no joke.

And, of course, a "job well done" to the FDNY for making the double rescue.

While we can chuckle about this incident, if you're like me you've probably had plenty of occasions where one of our law enforcement partners has saved your ________ (fill-in-the-blank). I can recall many times when there's nothing I wanted more than seeing blue lights on the horizon; and our brothers and sisters in blue, brown, or gray jumped right in (often literally) to help us out.

I know that we don't always see eye-to-eye with our law enforcement counterparts (and vice versa), but the fact remains that we — along with our other response partners — are all out there in the street, depending on each other, and doing whatever needs to be done to serve our citizens together.

So, have a quick laugh at this story and then go say "thank you" to the nearest cop, deputy, trooper, special agent, inspector, constable, ranger, etc.

Stay safe and happy Police Week.

At two or three Gs, the pilot told him in the pre-flight briefing, it will feel like you are wrestling a couple of guys but holding your own. At five Gs, you'll feel like you are losing the fight and at 9 Gs nothing moves — wherever something is, that's where it stays. They went over the procedures to eject if something went very wrong.

This was part of several hours of pre-flight instruction that Hobart, Ind., Fire Chief Brian Taylor went through prior to his 45-minute flight in an Air Force F-16 last week. The flight was in honor of him being named Hometown Hero at neighboring Gary, Ind. air show, following a dramatic rescue late last year.

Hobart is city of less than 30,000 residents that's mostly residential with a sprinkling of retail and light industry. The fire department operates out of three stations and carries a crew of 52 career firefighters. Last year the department responded to 3,650 calls, which includes ALS ambulance runs.

The fire
One of those calls came on Dec. 10, where Chief Taylor was the second to arrive on scene at mutual-aid call for a single-family residential structure fire. A mother and her two young children were inside. The initial report was that the mother was gone, one child had been found and the other was still missing.

"On arrival I had no intention of doing anything but command," Taylor said. "Anybody with kids knows that all rules go out the window."

Chief Taylor has three children.

One side of the house was fully involved and largely destroyed. Chief Taylor entered the structure to find the child — without his SCBA. He knew better; he's a 19-year veteran about to celebrate his second anniversary as fire chief.

"I didn't take the proper steps," he said. Tunnel vision had gotten the better of him, and part way into the structure he feared he might have gotten himself in trouble.

Fortunately, Chief Taylor's left-hand search yielded the room with the child. He was lying on the floor near the bed. Chief Taylor ran with the child to a waiting ambulance (see the accompanying video).

Lake Station, Ind., Fire Department's Lt. Robert Saylor rescued the other child.

"He wasn't breathing and had been in there for a significant amount of time," Chief Taylor said. "He's a miracle."

It was his first save and he regularly visited the child in the hospital. The doctors warned him that situations like this typically ended badly. But against the odds, the child's condition continued to improve.

That save is what landed Chief Taylor on the Hometown Hero radar and ultimately in the seat of the Thunderbird's F-16.

Pulling 9 Gs
During the pre-flight briefing, pilot Lt. Col. Jason Koltes, used a model of the plane to demonstrate what they would be doing in the air. Pulling 9 Gs takes a lot out of a person not used to it; Koltes told Chief Taylor to expect to be very tired the next day.

"It was incredible," he said after the flight. "It was so much more than I anticipated; the sheer power of that aircraft is awesome."

As thrilling as the ride was, it was important to Chief Taylor that a firefighter had been selected as the Hometown Hero.

"This was more of an honor for the fire service than for me personally," Chief Taylor said. "The fire service tends to experience a lack of recognition that it deserves. Over time, a community becomes complacent and views its fire department as an insurance policy."

The lift-assist calls won't be splashed across the news like was his rescue, or even his F-16 ride, but it means the world to that person who needs the help, he said.

Photo Rick Markley
Chief Taylor and Lt. Col. Kolte taxi to the runway.

Near miss
In the end it all worked out — the children and Chief Taylor made it out of the fire and pilot eject mechanisms on the F-16 went unused. And whether Lt. Col. Koltes learned anything from their flight is unknown, but Chief Taylor learned plenty from that December fire.

In addition to learning to keep tunnel vision in check, he learned that his and neighboring departments had problems with primary search, accountability and command structure.

Since that fire, Chief Taylor and the neighboring chiefs have met to go over the incident and how they can improve their response at future mutual-aid incidents. Additionally, they've held joint department trainings to allow the firefighters to get to know and get used to working with one another.

And while Chief Taylor paid close attention to the instructions on how the body behaves at 9 Gs, so too has he paid attentions to the lessons from a fatal fire.

I was recently a presenter during motivational and leadership training for our university; we were using John Maxwell's series on the "Five Levels of Leadership." Our focus was on the fourth level of people development.

Maxwell's series is applicable to both fire department and fire ground leadership.

As a leader in an organization, people should look up to you. Just by the position you hold, you have various levels and forms of power. Legitimate, or formal power, exists merely by the position and title that you hold.

Closely related to formal power is reward power, which is your ability to give something to an individual; coercive power is your ability to discipline or take away. Expert power comes from the experience, expertise, and knowledge that you possess.

And finally, referent power is described as how much people like you and are willing to follow or perform based on that relationship. All are effective when properly used if they exist in a leader's toolbox.

Fire officers should have high levels of all of these types of power.

Power sharing
Another form of power that successful leaders should possess is the ability to share their power. This is scary for many leaders. As humans, we are sometimes selfish and insecure about giving what we have to others because it may get in the way of that dreadful fire service monster that we call egos.

As I told the group, it is incumbent upon a leader to develop his or her team members to the level of which they themselves serve. That means developing them through the use of the power you possess and sharing that power with them.

My good friend Ron Dennis refers to this through visual analogy he calls the empowerment chain. Ron uses two sticks bound together by a chain. At first, a leader may allow the follower only one to two chain-links away from him or her because trust and assurance may not have been demonstrated or developed.

Eventually through increased trust, the leader will add more and more chain links between the two, which leads to true empowerment. When a leader develops and empowers his or her subordinates and shares the power, great things can happen. Production, confidence, job satisfaction and team harmony evolves and the work unit, and organization, will flourish.

In the fire service, this plays out when senior officers allow junior officers more responsibility and decision-making authority. However, this must be closely monitored on the fire ground as there is a difference between firehouse and fireground urgency. While this can be seen as firefighters having greater authority to do their job, they must stay within the constructs of incident command.

As with other organizations, this will allow the fire department to flourish — or in other words, become more effective at emergency response.

Pitfalls of leadership
However, leaders may encounter pitfalls if they don't have sound situational awareness of their power. Some pitfalls arise if leaders don't have two of the important tools: managed confidence and managed vulnerability.

Leaders should possess self-confidence. Depending on the levels of the different forms of power, the level of confidence will vary. Ego can create a pitfall. Ego evolves when managed confidence doesn't exist.

It is healthy and good for a leader to have self-confidence, but there is a difference between this and ego. Followers want their leaders to be confident in their ability to lead, but not cocky because of the position they hold.

Given the high number of Type A personalities in fire service leadership roles, controlling ego is a very important factor.

If confidence isn't managed, it can get out of control and destroy the morale of the team. And, the empowerment chain may be handed back to the leader as followers will find somebody else to follow.

Managing vulnerability
Managed vulnerability is a little more challenging. While fire department leaders must demonstrate strong confidence in their leadership presence, they must also have a human side and admit their mistakes.

This lets their followers know they are not immune to errors. I once had a colleague who was directly under me in the organizational structure tell me that I shouldn't apologize; it's a sign of weakness. I'm just glad I don't work in the fire department in his battalion.

If you don't get my sarcasm, I totally disagree with his philosophy. There is managed vulnerability when you can gain followers' trust and confidence by being human in admitting to a mistake and showing your opportunity for improvement. I've received much more positive feedback by demonstrating managed vulnerability than I have somebody telling me I'm weak for apologizing.

However, there is merit to unmanaged vulnerability and weakness. If leaders have no confidence, rely on others to make decisions for them, and spend more time covering up their mistakes than owning up to them, the result will be the same as a venomous ego. Followers will turn in their stick on the empowerment chain and find others to follow, or worse, take over.

This disturbs team effectiveness and leads to chaos. Weak leadership in the firehouse can have the same results to weak leadership on the fireground — out of control fires.

Keeping contact
A final pitfall demonstrates my managed confidence and managed vulnerability. I have a great team of directors that run each respective division within my department; I have confidence as a leader that I have put the right spokes in the wheel.

I also recognize that I have a habit of losing contact. This is my managed vulnerability. Because I have a strong team and have extended the empowerment chain out to these talented individuals, I allow them to get things done without a great deal of direction and day-to-day interference by me. However, that can be unhealthy.

By me empowering my leaders/followers under me, I take on more tasks. Or at times, a single project may consume an extraordinary amount of time, and I focus on that. Meanwhile, the team under me begins to feel that I am too busy for them, or by asking for my input on issue, they are adding more on me.

As a result, there is less communication between us, which can harm our relationship, or the empowerment chain breaks because they wandered out so far. I catch myself doing this and have met with my team openly and told them this, and asked them to seek my input to force communications.

Two of my directors told me that they were glad I said that because they were doing exactly what I feared, they weren't seeking my input because they didn't want to bother. By me managing my vulnerability of admitting where I had an opportunity to improve, I also managed my confidence of being a better leader and of making the change to support them more.

Know what power you possess as a leader, know how to share your power with your team, manage your confidence and vulnerability, don't lose contact with your team just because they are doing their job, and never underestimate your influence on people everyday.

Finally, be safe!

On May 22, 2011 one of the worst tornados in U.S. history, an EF-5 that measured more than a mile wide, ripped through Joplin, Mo., leaving 161 dead and an estimated $2.8 billion in damages. The city is mourning its losses and rebuilding.

Everyone in the fire service knows that an unexpected, mass-casualty disaster can strike any community. And everyone in the fire service knows that one of the best ways to prepare for future incidents is to learn from past incidents.

So we put the question, "What have you learned from Joplin?" to three fire-service experts. And we ask that you tell us what you learned.

Meet the Experts

Chief Richard B. Gasaway has served 33 years as a fire and EMS professional, including 22 years as a fire chief and 19 years training fire service leaders throughout the United States and Canada. In addition to his dedication to leading and training emergency service personnel, Chief Gasaway has a second passion in his pursuit to understand how the brain works. Dr. Gasaway has immersed himself in the study of brain science, relating the findings of numerous research studies, including his own doctoral research, to help improve emergency service personnel situational awareness and decision making under stress.

Chief Adam K. Thiel is fire chief in the National Capital Region and a former state fire director for the Commonwealth of Virginia. He has 20 years in the field and serves as FireRescue1's editorial advisor. Chief Thiel's operational experience includes serving with distinction in four states as a chief officer, incident commander, company officer, hazardous materials team leader, paramedic, technical rescuer, structural/wildland firefighter, and rescue diver. He also directly participated in response and recovery efforts for several major disasters including the 9/11 terrorist attacks, Hurricane Gustav, and Hurricane Isabel.

Jim Yeager has been with TEEX since 2003, and currently serves as a training manager. In 2011 he was responsible for managing 40 training and exercise in Disaster City, across the nation and internationally. In addition he works with international US&R teams and assists them in meeting INSARAG standards. He has been a member of Texas Task Force 1 since 1997 and has served as a canine handler, logistics specialist and is currently a search team manager. He has responded to over 60 search and rescue missions to include the Space Shuttle Columbia, Hurricanes Katrina, Rita, Ike and the Joplin tornado.

Richard Gasaway: "The tragedy that struck Joplin served to underscore several very important situational-awareness lessons. The one take-away I hope every community will consider is the importance and value of planning.

Many first responders focus on developing the skills to be proficient for high-risk, low-frequency events such as structure fires. This is good.

However, first responders in every community or region should also unite and engage in the process of planning for horrific events such as the massive destruction of a tornado.

It is nearly impossible to predict how things will play out in real time when such a catastrophe strikes. However, getting the key players together to discuss the potential of seemingly incomprehensible scenarios can be extremely valuable even if the script never plays out as it was planned.

One of the best lessons that can come from planning for large scale incidents is the development of what I term incident situational awareness (SA), one of three forms of situational awareness essential for responders (personal SA and team SA being the other two). Incident SA means, in part, being aware of the broader incident and the role that other responders are playing in it.

Every response agency has its own mission and goals to accomplish during a disaster. While many of these goals are complimentary, some of them may be competing.

Possessing an awareness of the mission and goals of other agencies and responders will improve teamwork and effectiveness across all responders. It will also reduce miscommunications and conflict.

Incident SA is vastly improved by planning that involves the agencies that will meet under such tragic circumstances.

I close by offering a quote from President Dwight D. Eisenhower: "In preparing for battle I have always found that plans are useless but planning is indispensible."

My heartfelt sympathy is extended to all affected by this tragedy, especially the first responders who bore the double stress of personal loss while stepping up to serve."

Chief Adam K. Thiel: "The amazing recovery of the Joplin, Mo. community — after last year's tragic tornado destroyed an estimated 7,500 buildings and claimed 161 lives — is a lesson for us all. It's hard to believe it has only been a year, since the lessons from Joplin have already — to their great credit — been widely shared throughout the emergency management field.

In my own region, based on lessons learned and shared from Joplin, we're taking steps to better prepare for several contingencies. One of the major ones is the potential need to evacuate an entire hospital, something we flirted with — and narrowly avoided — during "Snowpocalypse" (the 2009/2010 blizzards).

We often think that our job as firefighters and EMS providers stops in the emergency room of the local hospital; Joplin taught us to re-visit that assumption. What if your local hospital had to close on short notice due to a tornado or other catastrophe?

It certainly got us thinking.

We've purchased, with the aid of federal grant dollars, small utility vehicles to facilitate rapid patient movement across and through large hospital campuses. These UTVs are deployed across the region and maintained by local fire-EMS agencies that will contribute them to a regional response when needed. They are also useful for the many special events we handle on a year-round basis.

In addition, we've purchased and cached large numbers of simple army litters for quickly moving patients through crowded hallways, around, over and through debris, and outside to waiting UTVs — and ultimately to ambulances or ambulance buses. We have also cached supplies of essential products — bottled water, IV solutions, dressings, etc. — across our region to help receiving hospitals handle the potential influx of patients if a neighboring facility has to be evacuated or closed.

If you haven't had the chance to read and review all the material coming from Joplin, you're missing out. One of the best ways we can honor those who lost their lives in this tragedy is by seeking opportunities to use the lessons learned in our own communities."

Jim Yeager: "There were five major things we learned from our response to Joplin.
We learned about the power of storms. It's always an important reminder to see the damage a tornado can do for us to plan our training exercises.

We deployed under EMAC human remains detection dogs; this is a non-standard package for us. We have now developed pre-designated equipment lists to support these deployments.

We also learned that it is critical to have access to trained and certified human remains canines and to know their capabilities and limitations so that we can meet the full spectrum of search needs.

We used some new technology to push information to the team in the field that we had not used before. This gave the team access to intelligence that allowed us to better perform our jobs on the ground. In addition we used the technology to capture information and send it back to our headquarters in real time. This helped us paint a better picture so they could better support us in the field.

And last, it was nice to see the pioneer spirit in the people of Joplin. After the storm they accounted for friends and neighbors and started cleaning up."

AP/Minnesota Daily, Stacy Bengs
Firefighters size up the scene after the bridge collapse in Minn. last week.

Years ago, when I took my first search and rescue class, the instructor talked about the six-sided review of a building or incident. "Look up, look down, and make sure you look all around before committing yourself," he told us.

Over the years, I have thought of that simple saying on many emergency incidents and have passed it on to thousands of my students during training. The bottom line: Don't get sucked into something before you give it the old once over.

It's easier said than done sometimes, especially when lives hang in the balance and quick action will affect the outcome of an incident. But what about all of those other occasions when you may have the time to do it right?

What is your approach and thought process when you come across a technical rescue or any type of rescue for that matter? Is it a well executed series of steps or a fly by the seat of your pants operation?

Good team members, the right tools and practical training shouldn't be under valued, but that doesn't replace mentally being on your game.

To do that, you have to do something that most people hate or are too lazy to do Rescue is a thinking game you need to play the "what if" game. "What if a car goes over that edge, what if that building falls down, what if that place blows up, what if I have to cut that guy in half to get past him, what if I have to crawl in that hole to get that victim?"

It's not enough to just know how to use the tools, or be well practiced or to have a cohesive team. Rescue is a thinking game, and the people who can plan ahead, see something coming and be ready for it are worth their weight in gold.

Organized chaos
You're always behind before you get there, that's a given. But how far ahead of the incident are you when you arrive? I used to work for a battalion chief who would say, "You don't bring a crisis to an emergency." Sure it's organized chaos at some scenes, but your level of organization and the ability to achieve the required levels under the most impossible circumstances is the real key.

How many of us can say that we are "masters" of our craft and how many want to be? Chances are, if you're reading this column, you're already a student of the trade, which makes you a cut above the rest. But there is a lifetime of learning to be done and every day is a school day in our profession.

If you think that you know it all, have seen it all or have it done it all, we're all in trouble and chances are you're probably a liability at a significant incident. Confidence should never be replaced by arrogance.

Rescue is a thinking game. The best people who have seen a thing or two tend to mostly be humbled by the experience — they don't say much, but when the going gets tough they often get going.

I love watching new firefighters, they have so much energy and so much enthusiasm, and they're great to be around. It's also fun to watch them expend all of that energy to no successful end sometimes. But with age and experience comes wisdom!

The veteran firefighter may not always be as enthusiastic, but that tempered approach, years of real world experience and knowledge of the tricks of the trade often carry them through most calls.

But to be in the class above, you have to love it a little more to be really, really good at it. Superstars train harder, practice longer and are very, very focused.

So what does it take to be a master of disaster? Out of the box thinking, the ability to write down your first 20-30 moves on any type of rescue with a twist and a constant desire for perfection. And don't forget the lifetime of learning, listening and talking about the "what ifs" of our job.

A paramedic on a 10-10-14-14 schedule has a busy first night with constant calls. At 5 a.m. she is treating an elderly patient with a severe hip fracture and is preparing to administer a small dose of pain medication in the form of 2 mg of morphine IV.

The patient received no relief from the pain at all, which surprised the paramedic, who attributed it to the small dose. At the hospital her partner pulls her aside and asks why she administered magnesium sulfate to the patient.

A firefighter gets down to the end of his 24-hour shift. Normally his department is not very busy at night, but last night he was up from midnight until 6 a.m. with several nuisance fires and alarms.

On his way home he nods off at a traffic light until he is awoken by the honks of several other motorists. He makes it home, but believes he may have nodded off several other times due to being so exhausted.

Good sleep
We have heard since we were children that a good night's sleep was important for one's health and performance the next day.

Unlike many things children are told, this is quite accurate. Sleep is a vital process that most animals need to maintain health and wellbeing. At least 7 to 8 hours is recommended for everyone for mental and physical health, immune system function and energy conservation.

The normal pattern of sleep for humans follows the circadian rhythm. This rhythm is standard wake-sleep cycles over 24 hours that not only matches daylight hours to a large degree, but also one's internal clock.

Unfortunately, up to 20 percent of the nation's workforce does not work a schedule that is amenable to this sleep cycle. These workers include virtually all public safety workers as well as others in healthcare, utilities and transportation.

Essentially all of these shift workers have a high level of responsibility for other people or critical infrastructure, and must make decisions at all times. This is not necessarily ideal for someone who is tired.

This is nothing new to us in emergency services. However, it always seems that some firefighters can handle long shifts and nightshifts better than others.

If you are one of those people who seems to have trouble being a shift worker, there are a number of ways you can try to improve the situation.

Variety of work
It is important to understand that there is an inherent difference between working a 24-hour shift at a slow fire station and working an overnight on an urban medic unit. The slow station will often permit you to get sleep at night whereas the urban medic unit will not.

Unfortunately it can actually be more dangerous at the slow station when you get the short straw and respond to calls all night long when you had no sleep during the day. At least at the busy medic unit you knew you were unlikely to get any sleep and hopefully planned for it (and slept).

The challenge is, do you nap during the day before a night at a slow station or hope and pray and tough it out if it is busy? A single busy night may be reasonable to recover from, but monitor the calls to make sure that formerly slow station is not routinely becoming more active.

Poor daytime sleep
Being able to sleep during the day can be difficult. Make sure the room is dark and the phones are turned off. Family and friends should respect this time and leave you alone. Use earplugs to block out noise from the outside.

However setting up the first daytime sleep is just as important. If you are working a block of nightshifts and plan to not nap at all on the day before the first shift, this can be dangerous. You could be awake for more than 24 hours before you get home, and no one will be as sharp on hour 20 as they would be if they gotten more sleep.

In order to get sleep the first day, you need to be a little tired. I have tried two ways to accomplish this.

For many years, I would stay up until 2 or 3 a.m., then sleep for about 4 hours and get up with my family in the morning. I then would try to nap in the afternoon for 4 hours.

More recently, I have adjusted and instead of getting up at 7 a.m., I sleep straight through until 11 a.m. This larger block of sleep worked better for me. However, everyone is different — experiment to see what works for you.

Intrinsic sleep illness
Consider the possibility that there may be a medical condition that is contributing to poor sleep — namely OSA, or Obstructive Sleep Apnea. This is a condition where during the night someone has multiple periods of apnea — they stop breathing.

Often related to body habitus, it usually (but not always) is associated with being overweight. A sleep study is used to diagnose OSA, and losing weight or the use of continuous positive airway pressure at night can be used to improve the quality of the sleep.

If everything else has been considered and there is still no improvement, there is the possibility that you may be affected with Shift Work Sleep Disorder. This is associated with excessive sleepiness, insomnia during the day and unrefreshed feelings upon awaking.

Treatment for SWSD or any sleep-related issues needs to be tailored to the individual. In some cases, minimizing or eliminating night shifts may be the only option.

While this may work in some areas of public safety, in many cases it may not be possible. What other options are available?

It has been shown that brief naps, 20 to 30 minutes, during down time at work can improve safety and performance. Some employers do not permit this, and in many cases the workload prevents this possibility. But if you find yourself with some down time, consider lying down for a few minutes. It may not make you feel completely refreshed but it may be safer when you drive home in the morning.

Meds: Pros and cons
If your primary issue is sleeping during the day, then taking medication that improves sleep can be considered. These can include diphenhydramine (Benadryl), which is over the counter, an alcoholic beverage, or prescribed medication such as zolpidem (Ambien) or zaleplon (Sonata.)

However, in most cases, drinking alcohol or taking medications can actually adversely affect the quality of sleep and impact performance of the next nightshift. Occasional use may be considered after discussing with your doctor, but they should not be used regularly.

Conversely, medication can be taken to help a sleepy person become more alert. One of the more common substances is caffeine, either in the form of coffee, tea or tablets.

There are some side effects, and caffeine can be somewhat addictive, just ask anyone who is forced to miss their daily cup of joe.

Amphetamines and other illegal and legally prescribed medications have been used for this purpose. However, they are much more addictive and the physical effects can actually be dangerous, so they cannot be recommended.

New medications
A new class of medication, available since 1998, has been studied for use by shift workers. Modafinil, also known as Provigil, is a stimulant with an unknown mechanism of action.

One study found that there was a small but significant improvement in performance over placebo (sugar pill). However one-third of those taking placebo had an improvement also; so it is difficult to determine how much improvement was directly related to the drug.

Individuals who took modafinil still had sleepiness and impaired performance, and it did not facilitate adaption to a night work schedule.

Another study found that there was a decrease in the number of accidents and near misses, but there were still high rates. An additional concern is that it may be difficult to fall asleep during a nightshift, and the medication may give a false sense of security.

Overall it is believed that it may be worthwhile for the isolated need for prolonged wakefulness, but not regular night work.

A new version of the medication has come out recently as modafinil is getting ready to go off patent. Armodafinil (Nuvigil) also has been studied, and 77 percent of those who took the medication felt more alert. However, so did 57 percent of those who took a placebo. It is also quite expensive, more than $10 per pill.

Shift work and working nights is an inherent part of working in emergency services. Everyone responds differently to the stressors of this type of schedule.

It is important to prepare before a night shift by getting enough sleep before the shift, napping during the shift if tired and able to do so, and recognizing when we are too tired to continue working or drive home.

Stay safe.

For most of my career I have focused on the dangers of moving vehicles at the scene of motor vehicle collisions and incidents adjacent to roadways. A bit of research online will give you great tips on fighting vehicle fires.

I often talk about the explosive hazards and the potential unknowns, but rarely have I discussed the potential for the car involved in fire moving from its location. And while these dangers are real, there are ways you can prepare yourself for the next fire.

I have noticed a trend recently when searching for online fire videos. I am finding more videos that show vehicle fires that eventually move from their initial location.

Under a certain fire load it is quite possible that brakes will fail to a degree that the vehicle will be free to move. Depending on the slope of the road surface, the vehicle can move into the direction of the firefighters and apparatus on scene.

The following video shows a situation in which the vehicle involved in fire not only becomes a hazard for the firefighters, but oncoming traffic as well.

The best way to protect yourself at these types of incidents is to be proactive. I typically tell firefighters to come prepared to fight and expect the worst; vehicle fires are a bit worse. A few simple moves will protect you and your crew from potential disaster.

The following video presents a similar case in which during operations the vehicle involved loses its breaks and rolls downhill.

Without Monday-morning quarterbacking, what could have been done differently?

Truck placement, attack angles and chocks will eliminate all chances of moving-vehicle danger. Position the apparatus uphill and upwind. This will put you in a position that you and your crew can attack with more visibility, reduced heat and less chances for advancing through fuel spills.

In the event the vehicle rolls free, you and your crew are free from the hazard. Some say that it would be difficult to throw a chock under a tire during suppression. I say nothing is too difficult with proper training.

The person choking the tire would move alongside the attack line with the protection of the nozzle. That same person could be your tool man who forces the hood or truck depending on the particular run.

Finally, attack angles are critical in vehicle fires. On your approach to the vehicle, avoid direct lines from tires, bumpers, hatches and strut-related compartments. Consider the slope and grade around the vehicle. Do not put yourself in the following situation where you end up chasing the car, or even worse, getting run over by a burning vehicle.

These few tips should help you during your next training session and your next vehicle fire. Remember to be proactive, watch your apparatus placement, and train with chocks. This is one hazard we can eliminate as firefighters.

Since the advent of modern firefighter clothing following the initiative of Project FIRES by the International Association of Fire Fighter, there has been a requirement in NFPA 1971 for turnout clothing to provide continuous moisture protection. This was primarily included to keep liquids from entering the front closure and fly sections of the garments.

Other requirements have been included to ensure that the liner, including both the moisture barrier and thermal barrier, be extended to a specific distance to the outer shell hem at the collar, the sleeve ends, and bottom hem of the coat and to the waist and pant leg ends as part of trousers.

Liquid protection had been a rising concern for the fire service even before the IAFF Project FIRES. For some departments, the idea that firefighter clothing have waterproof characteristics dates back to the coated slickers and other clothing that functioned more like rainwear than what now has come to be appreciated as bunker gear.

It was not uncommon to find the use of coated outer shells 30 years ago. Whereas in past decades, liquid exposure primarily focused on hot and cold water, concerns have extended to fireground chemicals and contaminated blood and body fluids.

Providing protection

The manner in which the moisture barrier provides liquid protection is straightforward; this material is generally a laminate of a high temperature, flame-resistant polymer film to one or more textile fabrics.

As the film is continuous over the material layer. Seams between individual pieces of the moisture barrier found in the pattern for creating the liner convey this same physical barrier.

In contrast, the overall clothing item, whether coat or pants, only keeps liquids out if specific features are included to create overlaps and coverage of the body, particularly at closures and interfaces.

For example, the front closure of all turnout clothing includes a flap. In order for liquid not to enter the front of the coat, the flap must have moisture barrier as part of its layering. In addition, the it must butt up against the edges of closure area, and the inside of the shell along the sides of the front closure area must include strips of moisture barrier to accomplish overlaps of waterproof material

Similar arrangements must be made in the trousers fly. An entirely different type of design is used in the wrist area where not only must the liner extend to near the end of the sleeve, but a wristlet must be in place to help secure the sleeve on the wearer's hand and keep all three layers in place.

The shower test

NFPA 1971 includes significant design features to accomplish the moisture and liquid protection. However, it also relies on a comprehensive test. The whole-garment liquid-penetration test, also known as the shower tests, evaluates complete coats and pants for their ability to prevent liquid penetration.

The test involves placing garments on a manikin that is already dressed in long sleeve, full leg undergarments intended to show water spots. The manikin is then placed on a rotating platform and sprayed by surfactant-treated water from five different nozzles for 20 minutes.

Three nozzles are positioned above the manikin and two are positioned to the lower sides. The test is intended to deliver a uniform spray to different portions of the clothing but in reality the majority of liquid impinging on the clothed manikin surface from the overhead nozzles and liquid runs off the manikin clothing by gravity.

A surfactant is added to the sprayed water for making the quality of water more penetrating and representative of liquids other than water such as hydrocarbons and blood, which can have surface tension values that are less than half of the value for water.

Since only the coat and pants are evaluated, the top portion of the collar is covered with a plastic bag over the manikin head and cups are placed inside the sleeve ends to prevent liquid spray from entering these areas. Thus, the evaluation of liquid-tight performance is limited to those areas of the manikin that are actually covered by the clothing.

Pass/fail performance is exclusively judged on the observation of liquid penetrating to the clothing interior. This may be in evidence by either wetness of interior layers or liquid spots on the underlying clothing worn underneath the coat and pants set.

Test shortcomings

While the test method is straightforward in principle, there is a substantial amount of criticism in the interest for its application to turnout clothing. The test is heavily dependent on how the manikin is dressed and obvious care is undertaken in how the closures are secured and the garments are oriented on the manikin.

Folds and creases in the clothing often create channels that direct liquid along various paths and sometimes into less protected areas, such as a collar area diverting liquid towards the front closure. An exposure time of 20 minutes is considered unrealistic if one considers the overall liquid exposure of test (five nozzles spraying approximately 0.8 gallon per minute).

Manufacturers that test their garments as part of the certification to NFPA 1971 often complain that the test is not reproducible and can create changes in garment features that result in overdesign that goes beyond end user expectations.

Despite the criticisms for the test, where complaints most have some validity, we are proponents of the shower test. That's because firefighters are increasingly being exposed to fireground hazards that include a variety of liquids, much of it hose spray runoff, of varying degree of health effects as well as blood-borne pathogens.

Nevertheless, we agree that changes to the test may be needed to meet the intended level of liquid protection afforded to firefighters. After all, the hood is a porous knit with no barrier performance whatsoever.

A better mousetrap

Yet, liquid protection is one of those tradeoff areas. Firefighter want and need liquid protection, but overdesign for liquid-barrier performance creates an imbalance with other garment effects, most notably thermal stress/comfort, mobility, and ease of donning.

To this end, our company, International Personnel Protection, Inc. has undertaken a project sponsored by the Department of Defense's Technical Support Working Group, to establish an improved liquid-integrity test for first responder protective ensembles. This project is aimed at revising or replacing the existing test with equipment and procedures that are more relevant to firefighter exposures, yet still provide a characterization of overall liquid protection.

In addition, our goal is to devise liquid penetration sensors using a simple electrical principle that provides a clear determination of penetrating liquid and will establish the ability to determine when and where the liquid penetration occurs.

This activity will involve a high degree of validation, particularly to show that the proposed method is reproducible with the concurrence of those laboratories performing the tests for product design and certification. We plan to provide a short survey that assesses end user expectations relative to liquid protection to guide this effort in addition to support from the NFPA’s Fire Protection Research Foundation for providing technical advice through an advisory panel.

With 2008 under way, it's time for us to reflect on the year past and to begin developing our plans for the future. Here are eight straightforward ideas that company officers can use right now to help their crews stay ahead in 2008.

1. Be an informer
Passing on relevant information about decisions, plans and activities to the people (your firefighters) who need it to do their work is vital. You can't expect them to accomplish goals that they know nothing about. Discuss the daily objectives at the morning briefing, including any training, inspections, pre-fire plans or scheduled community education. You can never provide too much information to your people.

2. Promote the team
Crew cohesion, or working together as a team, is an important human factor in firefighter safety and for getting things done. Problems with crew cohesion have been identified with several near-misses and tragic accidents. Look for and promote good work practices that safely and effectively accomplish team objectives. Stress the importance of how individual capabilities contribute to the team's success.

3. Create a training plan to keep your crew ready Your training goal should be to prepare your firefighters to be ready to operate safely and effectively at any intensity level, anywhere, anytime, and to return home alive. Readiness training demands teamwork, dedication and sustained practice. Create a flexible and believable training plan that addresses the training needs for your crew while prioritizing those training needs, focusing on safety first.

4. Address problems as they occur
Be willing to confront problems head on and have those tough conversations with your firefighters. A team that is comfortable talking openly with each other, and willing to air their disagreements or problems, will move forward together. Identify and remediate all performance issues immediately, understanding that everyone operates at a different level.

5. Define your expectations and keep them believable
It's pretty simple. Let your crew know what you expect of them. Here are a few examples: Be safe by responding safely, following operational policies, maintaining and operating equipment properly, and practicing personnel accountability. Be proficient by training for readiness and improvement, arriving on scene ready to work, communicating effectively, and following the chain of command. Be professional by practicing a positive image all the time, everywhere you go. Be nice to each other and everyone you meet. If your team makes an effort to follow these basic expectations, you will have a safe and rewarding year.

6. Motivate them
Recognize the likes and differences of your firefighters to help you motivate them to be a more productive team. Appeal to their individual emotions and values to generate enthusiasm for their work. Invite their participation when making decisions, and allow them to have responsibility in carrying out their work activities.

7. Recognize and praise them, at the right time
Provide praise and recognition for excellent (not ordinary) performance. If it's really good work, put it in writing. Be specific about what you are praising. Give praise for weak performance that’s improving. Recognizing their efforts shows your appreciation for the work they do.

8. Support and mentor them
Act friendly and considerate. Be patient and helpful. Do things to facilitate your firefighters' skill development and career enhancement. Be responsive to their requests for assistance or support, and set an example for proper behavior. Be their leader.

Take some time and see if you can add a few ideas to the list. Even if you can only address a few of these recommendations you'll be on the road to developing a fresh attitude and healthy approach for a new and exciting year.

In the fire service, accountability is usually thought of as a system incorporated into fire ground operations that keeps track of personnel on scene. While this is certainly important, it is only just one aspect of it.

Accountability encompasses a lot more than just keeping track of people. Let's consider how the fire service is accountable to the general public.

The fire service is funded primarily by taxpayers. Tax-supported services will be found in large, small urban settings as well as rural settings. There are fire departments that are supported only by donations raised each year and perhaps some money from insurance companies and relief associations.

Regardless of where the money comes from, there is a factor of accountability from the fire service to their financial supporters. We are there to serve their best interests with fire protection and emergency service response. In essence, we are an insurance policy for that specific area and to the people who live there.

Crossing the line
The general public supports their local fire department on a whole, but there are times when they become outraged at what firefighters may be doing. I am referring to what is being released on social media outlets by way of video.

This video certainly has an element of humor to it, and in the fire station, it is understood as part of the culture of being a firefighter. Broadcasting this video and many others like it on social media outlets is where the fire service does itself an injustice.

Firefighters have some idle time in the fire station that will allow for some recreational activities to take place such as fitness, cooking and perhaps a few pranks. While the topic of pranks in the fire station can be debated, they still exist and do add value to the camaraderie of the crew working together.

However, those pranks do not need to be broadcasted to the world to see. By doing so, it allows the general public to start questioning what exactly they are paying for if we are producing pranks during our idle or down time.

The consequences
The more negative attention the fire department receives translates into rescinded funds.

It also leads the general public to mistrust us. If we are constantly producing videos or pictures of pranks in the fire station, the trust factor of our service delivery will be questioned.

So how does this handicap a fire department?

The small dominos that are being lined up are in the form of financial aid and policy creation. The less money given to the fire department, the less we can do in terms of maintenance, replacing old equipment, and even perhaps personnel.

The more policies we have to create in reaction to our idle or down time only reduces the ability to enjoy our job and build moral among the crew.

Keep what happens in the fire station in the fire station and this way we can still be accountable to the general public in a positive way.

The National Fire Protection Association (NFPA) 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises, attained "standard" status in March of 2008. Emergency services organizations must begin implementing the standard this year. Certainly it is the desire of every fire and EMS administrator to protect their department members in the areas of health and safety. As time proceeds, it will be interesting to monitor the a cceptance and practical application of these standards. Can we expect the "perfect emergency scene" to exist throughout the nation consistently? Where will departments fall short? Are these mandates doable, especially with shrinking budgets and manpower limitations?

Let's look at the nine key components of NFPA 1584, highlighting some practical concerns. I will be taking the "devil's advocate" role in responding to the requirements of the standard. You may note an air of cynicism that is seldom heard in the fire service. This is a very serious topic and my approach is only to show that "If there is a will, there is a way." Organize your team and resources and continue networking in order to achieve success.

Relief from climatic (weather/environmental) conditions:
Firefighting is done in extreme weather conditions. Mother Nature doesn't provide our world with moderate temperatures and working conditions. How can we escape the extreme heat or cold? We just won't respond to calls if it is too hot or cold.

Rest and recovery:
Depending on how many units are in staging, I'd love to take a 30 minute break with every bottle change. We operate two-man engine companies and the closest mutual aid company is twelve minutes out. "Hey chief, I'm tired, can I go lay down?"
We need a 3rd alarm just to get enough bodies to the scene.

Cooling or re-warming:
The only heat source is the inferno we're here to put out. Wearing all this turnout gear causes me to dehydrate before I even get into the structure. City council dinged our request for air conditioned cabs. We're lucky they let us have the air conditioners on at the firehouse. My idea of cooling is sit in the shade of the ladder truck.

Re-hydration:
Where's the closest vending machine? No one filled the engines water cooler today.
We used to carry bottled water on the rigs but the guys would drink them during truck checks. Hopefully the neighbors will show up with some lemonade to help out America's Bravest. Fire trucks have water in them, don't they? Drink that water.

Calorie and electrolyte replacement:
Hey neighbor, while you're making that lemonade, how about a turkey on rye with extra pickles? No name, free game. The mobile canteen showed up with day old doughnuts and week old bologna sandwiches. Luckily I ate a big lunch because this looks like a long one. That's why we never implemented a physical training program. We like to have our guys with some extra fat on them.

Medical Monitoring:
What do you mean my pulse and blood pressure are too high? That is my NORMAL resting pulse and BP. Maybe these extra few pounds I've been carrying around make it tough. After a couple cups of coffee and some doughnuts, they will go back to normal.
Chief needs three more hand lines stretched and we need all bodies.

EMS Treatment in accordance with local protocol:
Where are the medics? We've got an apartment building roaring and the EMS rigs are two blocks away. Just give me some O2 and I will be fine. It's not bad chest pain. Probably the chili dogs with onion I ate for lunch. I don't want to look soft in front of the young guys.

Member accountability:
I lost my tags. My crew got split up and the captain detailed me to re-fill air bottles.
I don't want to look soft by hanging out in rehab.

Release from rehabilitation:
This will not be a problem. You either get back to work or go to the hospital in the bus.
It feels kinda good here in the air conditioned rehab unit. With all that 5" that needs to be re-loaded, maybe I need to drink another liter of juice.

We all know that changing old habits comes slow for some. Budget constraints do create real challenges in meeting the needs of your department. Truly, for any department to be 100 % compliant in meeting these standards, much planning and focusing will be required. Develop a team of interested staff members to research, develop and implement these life-saving standards. Although it may take months to reach your ultimate goal, it is never too late to make improvements. Best of luck with your efforts to ensure the health and safety of your people. They are worth it!

By Bill Delaney

Reactions to Lt. Ray McCormack's speech at FDIC were varied, with people picking sides — sometimes very emotionally.

My own take on the speech was somewhere in the middle. He never said do not be safe. I think he was really trying to say he fears we are taking the "be safe" component to an extreme. He has stirred a good debate and I applaud him for having the conviction to stand up for his beliefs.

But the one big thing that was missing from all of the discussion that followed the speech, and seemingly absent from all fire service debates/discussions, is the bastard child of the fire service: the culture of prevention.

You know, that annoying little member of our family who we always try to make sure is relatively unseen and certainly never heard from? After all, most of the debate related to "The Speech" does not happen if the fire, gasp, is prevented and never happens in the first place!

There is much national gnawing and gnashing of the teeth as staffing on trucks are being reduced, stations closed, revolving station closures, etc. amidst the current economic climate.

No doubt we should be screaming from the highest mountain tops about all of that as it does involve the wellbeing of our people and those we serve. We are, however, eerily quiet when it comes to public educators and other "prevention" components of our service when they get cut.

Why is this? Well, for me, it is because we DO have a culture of extinguishment! That is where Lt. McCormack was all wrong in his speech. The culture of extinguishment is more than alive and well and probably always will be in a vast majority of departments in the United States.

Don't believe me? Take a look at your own department's budget priorities. Next, look at the departments around you. In the Washington, D.C.–Metro area, we have two departments that now have no public educators and three that cut staffing by more than 50 percent.

Meanwhile, one that has taken its few remaining educators and trained them as inspectors and let them know that most of their duties will fall under revenue generating inspections. I will admit that the last one at least has a prevention component to it so not all is lost.

The old adage is that you cut what you do not perceive to be the greatest value. Fortunately my chief values our risk reduction efforts (as well as firefighter safety) and let it be known that cutting our public education staff is not even an option for discussion.

But actions speak louder than words and the vast majority of departments across our great land have spoken. The proponents of the speech can rest easy — I firmly believe that the culture of extinguishment is alive and well in our great country!

Setting up a successful public access defibrillator (PAD) program should be on the forefront of every fire and EMS agency’s agenda. The American Heart Association notes that for every minute a person is in a cardiac arrest, their survivability decreases by 10 percent. Having easy-to-use PADs that are quickly accessible by the public increases the probability of delivering life-saving defibrillation sooner.

Here are the top five things to consider when starting a PAD program, along with some of the strategies I used to start a PAD program that has grown to more than 1000 PADs over just a few years.

Involve the stakeholders
With any successful startup program, getting the key players involved at the beginning is critical. Start by inviting those organizations and individuals who are the stakeholders – those with a vested interest in the success of starting a PAD program. This group should include fire, law enforcement, EMS, 9-11 communications, hospitals, cardiologists, the local American Heart Association, and other interested parties.

Start with regularly scheduled meetings and open discussions on the importance of PADs to the survival of cardiac arrest patients. You may begin the initial meeting by walking the group through the continuum of care that each member provides, starting at 911, through prehospital responders, to hospitals, and finally outpatient care. This helps everyone understand the many vital roles needed to help increase survivability. This group may grow and develop subgroups as other key tasks or steps are identified.

Funding
After the stakeholders have bought in to the program, one of the next steps is locating funding. Funding will be integral to starting and maintaining the program. A well connected stakeholder group may be able to tap into their individual networks to locate funding, and this task may also turn into a subgroup of the stakeholders. Funding may come from a variety of other sources, including community grants, endowments, fundraising events, matching funds, or other programs.

Hospitals may also have access to funding sources or use other methods to lower costs. For example, in one successful program, a hospital used its purchasing power to lower the costs for PADs. They did this by purchasing in PADs in volume at 100 units at a time, and also by helping to negotiate a lower price. This lead to a lower cost through a volume discount and lower shipping costs per unit. The hospital also offered to use their staff to help augment the program, store, and even tracking individual PADs. Their CEO was an early member of the stakeholder’s committee, and he quickly understood the importance of PADs to saving lives. He was used as part of the negotiating team to help get the lowest possible price for the PADs.

PAD selection and training
The team should determine whether the program will use a single model of PAD, or whether a variety of brands will be used. An argument for a single model is that as the program grows certain things become easier (and cheaper) due to economy of scale such as training, system upgrades, recalls, purchasing batteries and patches. Having one brand may also create a direct pipeline to the company for maintenance and support. Since CPR training includes PADs, if one particular brand of PAD is selected, then models for that particular device can be incorporated into training. This ensures realistic training based on the system.

The team should also ensure the PAD model integrates with the brand of device that prehospital responders are using. This will allow for similar defibrillation technology and protocols from PAD to responders, and ultimately the receiving hospital.

During this step, the team can also begin to focus on the location and placement of the initial PADs in the community. The team should consider sites where mass gatherings are common, areas with large populations over 50 years old, schools, and sites that take EMS longer to respond.

Marketing
This can be ongoing from the beginning of the process, and is important for creating “buzz” in the community. Once word is out, you may be surprised at the demand for the program from individuals and businesses.

Some marketing ideas can also be turned into fundraising opportunities. Two ways to get the word out and involve the community are mass CPR training days, and a contest to name the PAD program. The front of the PAD cabinet is also a prime marketing location and can be used to further market the program with contact information and logo placement.

The PAD program can also rely on local media for marketing. Depending on the situation, consider asking for coverage of successful cardiac arrest “saves,” or giving awards to citizen heroes for taking action.

System Integration
Early on, prehospital providers may be reluctant to embrace the program. Some may view it as encroaching on their turf and won’t fully understand the value PADs bring to increasing survivability. You should clearly explain that PADs will keep patients alive and offer responders a better opportunity to provide their skills to potentially survivable patients. Here are some integration considerations:

• The dispatching center should have a database that will notify the call taker if a PAD is located at the site, and also provide instructions for use. Some computer aided dispatch programs (CADs) have the capability to flag addresses with PADs located on the property.
• Some groups may not embrace the change because they may be required to perform new roles or change their operation, i.e. police may have to carry PADs in their patrol vehicles. It is important to overcome these arguments, as police often beat firefighters and EMS to the scene and can start defibrillation even sooner.
• First responders should understand the importance of PADs and also be able to transition from a PAD to their device for transport. There needs to be guidelines and training on switching from a PAD to a more advanced cardiac device, and also when should they continue using the PAD.
• This goes back to the importance getting key players from various agencies together so they can communicate the importance of the program back to their organizations.

Conclusion
These are only some of the areas to focus on prior to setting up a PAD program. These programs are easy to start and garner great success by increasing patient survivability from sudden cardiac arrest. If fire and EMS agencies do not step up and provide the necessary leadership to start a PAD program, some other organization will fill that role and take a significant new standing in your community. A successfully implemented PAD program is one of the only tools presently available for a city or EMS system to increase the rates of patient survivability from sudden cardiac arrest.

Feel free to contact me for any questions on PAD programs. I've helped start several programs, including one which received the national heart safe community award.

Three interesting products were demonstrated at the European Resuscitation Council 2012 Congress in Vienna, Austria, last week. They are all so brand-new that they're not even available in the U.S. yet.

Physio-Control based out of Redmond, Wash., unveiled its newest product, TrueCPR, a standalone CPR feedback device designed to provide rescuers with real-time feedback on chest compression depth, rate and quality. TrueCPR utilizes Triaxial Field Induction (TFI), a magnetic technology that overcomes erroneous overreporting of compression depth from devices currently on the market when used on a mattress or stretcher. Physio-Control expects to launch TrueCPR in Europe shortly and in the U.S. in 2013.

RhinoChill, a unique therapeutic hypothermia induction device, was on display by Benechill International, from Wallisellen, Switzerland. Designed for initial induction of therapeutic hypothermia in the pre-hospital environment, RhinoChill uses a nasal cannula like an intranasal cooling catheter to cool post-cardiac arrest victims rapidly. An inert coolant is delivered through the catheter while flowing oxygen or compressed air to facilitate evaporative cooling of the brain, effectively lowering core body temperature. BeneChill International currently markets RhinoChill in Europe and expects approval in the U.S. in the future.

The Corpuls CPR, a new automated CPR device, was introduced by Corpuls, Inc. of Kaufering, Germany. Expected to be released in Germany and the rest of Europe in 2013, the battery-operated device includes an integral long backboard and features adjustable depth and rate parameters. The manufacturer has no current plans to bring the device to the U.S. market.

NICETOWN, Minn. — When an overly curious firefighter found himself unable to get free from a drainpipe he'd wandered into, a group of adorable kittens swung into action.

Fellow firefighters spent hours trying to coax their shift mate out of the pipe, but he wouldn't budge.

"We tried everything, but Big John just wouldn't come out," said one distraught firefighter. "We thought … I'm sorry, give me a minute … it was all so emotional. We thought Big John was lost forever. All I can say is (sniff, sniff), thank God for kittens."

The kittens quickly formed a chain linking front paws to tails and made their way into the drainpipe.

The experience left the firefighter traumatized, but he credited his rescuers for their calm performance.

"I was pretty spooked when I first felt one of those kittens grab my foot...and I'm not proud to say I may have let out a wail and scratched at him," said Big John. "But when the lead kitten, Mr. Cuddles, reached me and started to purr, I knew everything would be OK."

Once Big John was calmed, Mr. Cuddles secured the firefighter with his front claws and the chain of kittens slowly retreated out of the pipe, pulling Big John with them.

Reunited with his teary-eyed brothers, Big John said the drainpipe looked like a fun, cool place and he wanted to see what was inside it.

"Honestly, I didn't give much thought to why I was going in there or how I was going to get out," said Big John, when asked how he ended up in the situation. "I just saw a shiny reflection moving around and went after it."

Asked about the heroic rescue as the kitten team licked themselves clean, Mr. Cuddles said, "Meow."

"Meow," repeated one of the firefighters. "Can you believe how humble these kittens are? They probably don't even realize they're heroes and think they are just doing their job."

Incidents involving heavy fire involvement of single-family dwellings, constructed of lightweight building materials present several significant fire suppression and fireground safety issues to arriving companies. The first arriving incident commander must conduct a 360-degree size-up of the situation as the first step in developing a safe, effective and efficient incident action plan.

Incident commanders and firefighters must be especially cognizant when hostile fire has significantly attacked the building's attic area and roof support assembly.

• Describe the building construction of the fire building.
• Based on the observed fire conditions, what would be your projection for fire travel within the structure?
• Based on the conditions observed as the arriving commander, what should be your initial mode of operations: offensive, marginal or defensive?
• There are three key functions for the incident commander: communication, control and coordination. How would you assess the commanders' performance of these three key functions? What did they do well and what would you improve upon?
• What are your thoughts regarding the amount of time that the fire was allowed to free burn while initial tactical operations were being set up on Side A of the structure?
• What changes, if any, would you have made in the first five minutes of the scenario if you were the incident commander?
• The interior fire attack was conducted using Class A foam as the extinguishing agent. What is your understanding of the advantages of Class A foam or Compressed Air Foam as an extinguishing agent compared to plain water?

Becoming a student of building and content hazards does not mean that you have to go out and get a builder's license, but you do have to keep up with what is happening in terms of building construction. I am sure you have heard the Francis Branningan quote many times over: "The building is your enemy, so know your enemy."

With that in mind, let's learn a bit of history about building hazards.

Wooden shingles have "been the cause of incalculable loss of property because of its susceptibility to ignition from sparks and through its efficiency in communicating fire it has been the known culpable factor in the rapid spread of most of the largest conflagrations on record."

That is a quote from the 1926 NFPA brochure called "The Menace of the Wooden Shingle." Obviously, the fire service has known about the hazards wooden shingles represent, but hasn't been able to change the minds of builders at large, since wooden shingles still represent a fire problem today.

Modern fire load
The home furnishings industry has been changing the furnishings in our homes from a natural-based material to plastic-based material. We knew the dangers that were inherent by adding plastics in large quantities to homes, but again, we were unable to change the minds of the manufacturers.

We pushed for legislation that would put residential sprinklers in all new homes, but again we were beaten down by the home builders in most cases. While these battles need to be waged for the safety of civilians and firefighters, we have to realize that we must also prepare ourselves for living with the changes that are being thrown at us.

Let's take a look at how today's furnishings burn, compared with those of a just a few years back. This is a major wake-up call to firefighters that fires burn differently today than they did a generation ago. Today's fires burn hotter and faster.

Learn from the video and pass it on to others in your department to learn from as well.

The fire service was not a big fan of the engineered I-beam, but it didn't make much difference. Today, they are out there in large numbers and it will continue to grow. We need to learn about how quickly these beams can fail when exposed to fire. A number of studies have been done on just this topic, so learn from them.

The NIOSH website includes many LODD reports that can be reviewed for learning. The site is easy to navigate and search, so spend some time reviewing past incidents and be better prepared because of it.

As a fire service, we need to be involved in standing up for what we know is right. We also have to realize that many battles will not be won. The best things we can do is to make sure we are aware of the hazards that exist, and try to prepare for the battle ahead with this information in mind.

It was horrifying to watch the national news coverage of the large clouds of smoke billowing near the finish line at the Boston Marathon. The two powerful shock waves knocked the runners down in their tracks. Unquestionably, the next attack on an American city was under way with sketchy reports and details available.

Preparing for a fire-rescue response to a similar incident in any community is difficult at best. However, it is our "moment of truth" when all eyes are upon us and our response to a horrible mass-casualty incident will be celebrated or criticized based on how we perform our duties.

At scheduled events, like the Boston Marathon, perhaps the single most effective tool that we have at our disposal is the time to develop a comprehensive operational plan long before the event. This operational plan may take from weeks or months to prepare.

Under attack checklist

1. Structured planning process for planned events; use discretionary time.
2. Detailed and updated mass casualty incident plan.
3. Practice and rehearse both the structured plan and MCI plan.
4. Be able to expand personnel and apparatus.
5. Keep open lines of communications.
6. Have personal protection.
7. Preserve the crime scene.

When I was at the D.C. Fire Department, we had a standard process to gather and distribute detailed planning information before small to large events. The plan must incorporate all response partners and support agencies, describing their duties and responsibilities for any type of event that might occur.

The event plan outlines likely-to-possible situations from a rapidly changing weather front to an all out terrorist attack that can harm hundreds.

Along with the detailed event-planning document, the next most important component is detailed standard operating guidelines detailing the department's response to a mass casualty incident.

Activating the plans
In Washington, D.C., during my watch, we implemented the MCI SOG when nine or more people were injured or sick. This may sound like an arbitrary number, but in reality the D.C. Fire Department had access to eight Level-1 trauma-unit beds, hence the ninth person involved activated the plan.

A Metro bus involved in a fender-bender would assuredly cause our plan to be activated. An MCI was declared once or twice each month. These alarms were for mostly low-acuity medical needs.

Of course, the underlying management philosophy was that practice makes perfect performance.

That bill came due in the nation's capital on June 22, 2009. Nine died and hundreds were injured when a train traveling at 59 mph collided with a parked train.

Incorporate a methodology to exercise the MCI plan on at least a monthly basis for all operational members. A great example would be to conduct a required detailed training session every week.

DCFD actually broke this drill into two segments during my tenure: the training days were MCI Task Force Tuesdays and Trauma Thursdays to make sure that we were ready. With a four-platoon system each shift attend one of each segment every month.

Fast growth
Next, the department has to have the ability to expand — both staff and apparatus — to meet the needs of the event and of their community.

For example, during the first inauguration of President Barrack Obama, DCFD doubled in size for a 24-hour period (one full shift). This was the largest National Special Security Event held to date.

The plan required us to double the size of the department with one complement of members and apparatus inside the restricted zone from the U.S. Capitol to the White House to include the parade route to the National Mall. Nearly 400 members were on duty to protect our city from any events that would occur outside the restricted zone.

The planning paid large dividends in that we responded to more than 2,100 alarms that day. A typical day in D.C. would net about 450 emergency responses for help.

Some departments may not have the resources to expand to twice its size. For departments in this situation, think regionally and consider the need for response of your mutual-aid partners during large-scale planned and emerging events.

Communications
Open and on-going communications with all response partners is a critical element for protecting folks and understanding what response assistance may be needed. Activate a Joint Operations Center and/or an Emergency Operations Center hours before a planned event and as soon as possible during an emergent event.

A representative from every response agency must be present at the JOC and/or EOC. Each agency must send a reasonable ranking representative (at least a battalion chief for fire-rescue) to coordinate and communicate all activates. If the response system has a fusion (information and intelligence) center, maintain a direct link to obtain any critical information to guide the command team with responder safety efforts.

Personal protection and responder safety becomes a huge challenge. There are some basic precautions that should always be used.

Personnel safety
Park the fire and rescue apparatus in the safest and most protected position possible. The best protection methods will be time, distance and shielding. Of course, when there are people bleeding and fires raging out of control, it will be difficult to impossible to use any of these three considerations.

Next, remember that a secondary device is always possible and perhaps likely. Most first responders will remember the video clip of the Georgia Bureau of Investigation's agent walking near a trash dumpster collecting evidence at a bombing incident.

This event was unfolding at a Planned Parenthood clinic in North Atlanta. As the GBI agent approached the area close to this dumpster all hell breaks loose.

When the secondary device is detonated, the agent’s hair can be seen sweeping straight back over her shoulders. Thank goodness that she was not seriously injured, but was very close to being a very seriously injured victim.

Communications with all other agencies may be another way to keep on top of hazards and threats. Also, pay close attention to details and be on the highest level of alert possible when asked to be in an unknown hazard zone.

Evidence preservation
The last critical element is that crime scene preservation concerns must be considered. This is a low priority compared with saving and protection human life. However, after saving life, preserving the evidence and allowing the police agencies to bring the culprits to justice is a high priority.

Operational planning, on-going training, and communications are the keys to your success in events like the one that just rocked Boston. Take the time to plan for large-scale events; these efforts will deliver an outstanding return on the investment.

Don't go it alone; ask for help with the process if needed. Send me a note if you need an event operational planning template or an MCI policy. There are dozens out there.

As with everything, training is the key to being successful at unusual and stressful events. When all else fails, fall back on your training and preparation. Finally, open and active communications cannot be overstated during these types of terrorist events. Make sure that everyone is on the same page of the plan and knows what is happening.