As the year draws to a close, it is worth reviewing some of the legal issues to hit the fire and emergency medical services in 2011.

Social media is a big deal for emergency service organizations
Emergency service organizations, states, dispatch centers and non-profits are implementing social media in ways that have positively impacted public safety. At the same time, social media channels present a variety of liability risks that must be managed.

Organizations that use social media to engage in two-way conversations with the public are particularly at risk. For example, emergency service organizations that allow members of the public to post in their social media channels may face First Amendment liability when they attempt to remove or edit offensive posts.

These organizations may also face liability if members of the public place calls for help using social media channels and receive no response.

When using social media to communicate with the public, emergency service organizations should use social media like a news feed, not a telephone, providing information but not receiving it.

Organizations must also have published attorney-reviewed social media policies that use disclaimers to discourage citizens from using social media as an alternative to the 911 system.

Restricting social media use among paid employees also has risks. Disciplining employees for comments or other postings they make in social media channels outside of work may create First Amendment liability.

Recent actions from the National Labor Relations Board ("NLRB"), the federal agency responsible for employee-labor relations, suggest that a social media policy that is overly restrictive of employee speech violates the National Labor Relations Act even if the offensive policy is never enforced.

Organizations with paid employees should review internal social media policies to determine whether a particular restriction is necessary to preserve the core operations of the organization.

Provisions that punish employees for making offensive or annoying comments in social media channels during non-working hours will generally not pass muster.

It is extremely important to consult with an attorney licensed to practice in your state prior to terminating any employee for their use of social media.

And the labor laws, they are a changing...
The laws governing the relationship between employers and unions are being revisited in a dramatic fashion after years of stagnation.
At the national level, Obama administration policies are shifting the employer-labor balance in favor of the unions. Recent NLRB complaints, NLRB appointments and executive orders have signaled a sharp union-friendly departure from the Bush administration.

Although most emergency service workers' unions fall under the purview of the state labor laws, many states model their labor laws after the federal law and NLRB interpretations are influential.

At the same time, some Republican-controlled states are attempting to sharply curtail the collective bargaining rights of public sector unions.

Wisconsin, Ohio, Tennessee and Indiana have considered restricting or already restricted collective bargaining rights.
Even in those states that have not modified the laws, government officials are becoming increasingly resistant to any pay increases for both union and non-union paid responders.

In many cases, officials have relied on volunteers to minimize the impact of funding and personnel cuts.
As states continue to experience budget shortfalls, there will likely be continued shifts in this area which organizations must monitor.

Mutual aid agreements
The continued trend of waning volunteerism and cuts to paid departments have emphasized the need to revisit or readjust mutual aid agreements. Although some states have adopted statewide mutual aid systems by statute, many communities rely on agreements with surrounding departments not only to manage large incident but for day to day coverage.

Although the components of mutual aid agreements will be addressed in a future article, effective agreements must clearly define the relationship between responders from different organizations, allocate risks and create functional mechanisms for reimbursements.

Specifically, mutual aid agreements should deal with the chain of command, workers' compensation coverage, reimbursement for expenses and equipment damage, EMS and hazmat billing rights and payment of overtime.

This article is not intended as legal advice and there is no substitute for competent legal counsel licensed to practice in your state.

Let's look at the way we displace the side(s) of vehicles today. First off, be it a car, SUV or even a pick-up truck, most vehicles today have four doors (two on each side) more often than not.

When we "pop" doors today, the door materials often shred, tear and rip apart, leaving us to attack it another way or try to cut the door off.
Why does this happen? Well, think of doors of having "hard" points and "soft" points.

The lightweight door materials are coupled with high-strength latches and hinges by the door crash beam, and the whole ensemble is tied tighter together than before due to vehicle construction and design and its inherent ability to move crash energy throughout the vehicle structure.

So we know door "pops" have issues. But today's cutters can make short work of cutting hinges and latches. Why not just cut them in the first place?

Cutting hinges and latches to remove the door creates much less stress and strain on the vehicle, which eases stress on the patient and the tool operator.

The evolution actually goes faster and smoother, making it safer. The key for this cutting technique is the ability to "visualize what you seek" (i.e. observe the hinge and/or the latch).

We must ensure the cutter blades get completely around the hinge or latch. We do not want to place the tips of the cutter on the hinge, which will make the tool "tip loaded" and cause damage to the blades.

To do this, we must make space between the door and vehicle body so we can get the blades in and around the objects to be cut.

Watch tool reaction during this technique! Many times, we're cutting square or rectangular material, which will cause the cutter to "swing" or torque quickly.

Also, ensure you have hard protection in place between the tool work and the patient and interior rescuer. As with roof post cuts, when you find wires in your path, cut them with a hand cutter like medic shears or battery cable cutters.

Why? Because many vehicles feature side-impact airbags in doors and side curtains in roof edges; these devices are impacted by static electricity as well as pressure and shock. When you're using the cutters, static charges can back surge into the wiring.

As well as door displacements, side removals call for using cutters to make relief cuts into the B-post. These areas are usually well reinforced, so cuts can be difficult.

Displace trim at the base and top of the B-post to check for seat belt pretensioners, side curtain cylinders and the adjustable seat belt bracket.

However, you will find that in taking both doors and the B-post as one unit — i.e. the total side removal goes faster — gives us almost the same amount of space as a roof removal and makes instant access to remove the patient from the vehicle.

It also sets us up for a rapid dash lift if we need to displace the dash to make additional space for disentanglement. The total side removal evolution has a quite a few names and can be done a few ways.

However, I am going to describe to you how to perform a B-post tear or a maxi-door evolution.

These areas are usually well reinforced, so cuts can be difficult. We need to displace trim at the base and top of the B-post to check for seat belt pretensioners as well as side curtain cylinders and the adjustable seat belt bracket.

There are a variety of ways to facilitate a side removal, but one of the most effective ways is to perform a B-post tear.

We start off with forcing the latch on the back door. Open the door fully; in fact, hyperextend the door forward a little. Then, taking the power hydraulic cutter make a relief cut into the base of the B-post, key point as deep and as straight as practical.

Cut the top of the B-post as close to the roofline as possible. With the spreader, place one tip or arm above the relief cut on the base of the B-post and the other tip or arm against where the floor rises vertically to meet the rear seat.

Open the spreader. As the tool opens, the base of the B-post is pushed away from the vehicle's rocker panel and the relief cut tears forward.

As it does, the weakest points are the spot welds on the base of the B-post; they pop and the base of the roof post comes away.

Sometimes the tear isn't straight and might have bits of metal still connected. Take the cutter and cut them away. Then the entire side swings out on the front door hinges.

Once the entire side is out past 90 degrees, we can cut the hinges, displace the hinges with a spreader or push the entire side further back and tie it off.

This will facilitate disentangling our patient quickly and safely. Remember though, rescuers, ALWAYS place hard protection between our tool work and the patient and interior rescuer.

ALWAYS cut wiring with a hand tool and not power hydraulics due to static concerns and ALWAYS cover up sharp edges, as this evolution will create a lot and in close proximity with our patient.

Try this evolution. I have found it goes faster than a normal door displacement in our work today, is much safer to both the patient and tool operator and creates almost the same amount of space as a roof displacement but on the same side as the patient, so we can have immediate access and disentanglement pathway for our patient.

As always — be safe out there, rescuers!

Have you ever pondered the origin of the famous quote, "You want to have your cake and eat it, too?" No you say? Well, this sometimes misquoted proverb is from the work of an early English writer named John Heywood. What Mr. Heywood actually said was, "Would ye both eat your cake and have your cake?" But there are some cases where you can absolutely have the best of both.

In speaking with fire and EMS agencies about the Assistance to Firefighters Grant program, there is a great deal of confusion about just how many applications each eligible agency may submit in a given year. Some say one, others two.

Very rarely is the correct answer given. According to the 2008 published guidance for the Assistance to Firefighters Grant, each eligible agency may submit one application for each "program area" for a total of three.

The 2009 AFG workshop has not provided any information which would lead one to believe that there will be changes in this area. The three AFG program areas are:

• Fire/EMS Operations & Safety
• Fire/EMS Vehicle Acquisition
• Regional Projects

Each individual application is scored independently of the others, and submitting multiple applications will not affect an application's score. One caveat to this is any agency hosting/participating in a regional application is prohibited from requesting the same equipment as part its own application. Doing so will result in both applications being made ineligible.

Part of the 2008 AFG guidance reads:

In FY 2008, you may submit one application per application period in each of the program areas, (i.e., one application under Operations and Safety, one under Vehicle Acquisition, and/or a separate application as a regional host). If multiple applications are submitted on behalf of one organization within one of these program areas, either intentionally or unintentionally, we will deem all of that organization’s applications in that program area to be ineligible. For example, if any applicant submits two applications for Operations and Safety, both applications will be deemed ineligible.

Fire departments or nonaffiliated EMS organizations that will benefit from a regional project may also apply for funding under the AFG, as long as they are not requesting the same items as the host applicant for the regional project. For example, if a host applicant applies for a multi-jurisdictional communications project, a participating organization that will receive some of the communications equipment can apply for other needs as long as it does not apply for duplicative communications equipment. Host applicants MAY NOT apply to address other needs beyond the regional project on the regional application; however, a host applicant may submit a request to meet its own, non-regional needs in a separate application.

While the 2009 AFG guidance has not yet been published, workshops for the 2009 AFG program are ongoing. I would encourage you to attend, get the facts, and increase your chances for success in 2009!

Best of luck!

The tones drop and your company is dispatched to a working fire. The job is in your still area and the dispatcher says he has received multiple calls on this fire. You and your crew know you have work and everyone has their game face on.

Thoughts start racing through your mind and as you expeditiously get your PPE on, your size-up has already begun.

When teaching classes and attending classes on the subject of size-up, many start with the company arriving on the scene. It's obviously an important part — but our size-up begins before the call comes in.

I have asked classes when the size-up begins and many will give the typical answer of "when you arrive on the scene." But we should be pulling information about the call before we ever get on the truck.

The company officer should know as much as possible about their still area, or first-in area. They should have a good knowledge of what type of occupancies are typical, water supply issues and the best direct route to any call.

This information is learned and remembered over time and experience. Information of this nature is a responsibility of the company officer and the members of the crew.

We have received the call and we now know the address and area that the call is in.

That alone should give us a good impression of what we are likely dealing with. We should know if that area is primarily single story, two story, basements or no basements, or mostly commercial.

Are these single family or multi-family buildings? Is there a high percentage of elderly or young children in these households? Information that we need to know and should know as soon as we get the address.

We also have to consider that if we were awakened from sleep it is very possible that the occupants are either still inside or had been awoken as well. Are there kids still sleeping or could there be someone with a disability who was not able to exit?

Waking out of a deep sleep requires us to get sharp fast and we have to ensure that our crew is ready to go and in the right frame of mind.

While responding, have a brief discussion to make sure everyone knows their assignments. They have the proper tools and we know what we are going to do when we get there.

The officer is going to take the thermal imaging camera and do a 360-degree survey very quickly. The other firefighters split duty between pulling the line while the other is forcing entry if needed.

This discussion is very brief and to the point.

The company officer has to take into consideration the weather along with the vehicle operator. Poor road conditions can make our response delayed, in turn making any tenable spaces untenable and allowing fire growth to increase. Seconds can make a difference and we have to take that into account.

There has to be some discussion about water supply and if a pre-connect is going to be used or if we need to lead off. In some instances we lay to the hydrant, depending on how we attack the fire and how long our additional resources will take to arrive.

The operator and the officer should have a good idea of hydrant locations and how reliable the water supply is.

Is this an area that has newer, larger mains or are they as small as 4 inches and old? It all plays a part in our planning.

As we pull up to the fire building, we are identifying the type of occupancy, approximate size, special features like additions, multiple levels and approximate age of the building.

The type of occupancy will determine how many possible victims we are accounting and searching for, and possibly the age of potential victims. The size could dictate how much fire hose we need to stretch and will determine our deployment choice.

The age of the building will help us with looking for fire spread, balloon frame versus platform, and types of roof systems, floor systems and interior finishes.

We want to look for what I like to call the "character" of the occupancy. Are there cars in the driveway and nobody out front? Are there kids' toys in the yard or other indications of youth like basketball goals or skate boards laying around?

One thing to remember is that young kids, preadolescent, will hide under a bed, in a closet or under the blankets.

An older child will try to hide in a bathroom or shower. So, it is important that we identify these possibilities. Are there window coverings in the basement windows, maybe identifying a living area? These are just a few but not all of the "character"
factors.

Finally, we have to look at the fire conditions and the condition it is currently in and where it is going to be in five or 10 minutes. What is the smoke doing? What color is it?

Is it forcible or lazy? Do we have flames showing from one window, no windows or is it through the roof? We start to get into the tactical side of things at this point.

The point is to be prepared for any call in your area before you get. There should be a general knowledge of the area that you cover and sound decision-making comes from that knowledge.

Don't over think your size up and make sure you consider all of the factors and information being presented. Don't discount something because it has never happened before.

These are not all of the factors that need to be considered during a size-up, but a short list of basic examples that will lead to additional information for you to base decisions on.

As always, train hard, be persistent in gaining and passing along knowledge, and I'll see you next month From the Fireground.

Photo Jamie Thompson
Apparatus on display at the FDIC in Indianapolis in April.

E-One had an extremely busy year, with several new products being launched including a new ARFF Vehicle, the Titan Force 6, with a five-person cab, exterior pump panel, multiple roof and bumper turrets, 3170 gallon poly water tank and a 437 gallon poly foam tank.

Also designed was the urban pumper, with a low ergonomic hose bed and a hybrid energy command vehicle for homeland security use. At FRI in Atlanta, it introduced a new SUV command vehicle — Comms-One — which promotes command interoperability in radio communication.

In more recent months, KME introduced the Challenger pumper line. The Challenger family features 36 different body configurations in steel, aluminum or stainless with 29" deep body compartments for added storage. It has numerous hose bed and compartment configurations including high capacity and low, easy-access hose beds. All can be built on KME Custom or commercial chassis.

Meanwhile, Ferrara's main launch in 2007 was the Heavy Duty 5 section Midmount ladder, which touts a shorter wheelbase and a lower overall height.

In addition, Crimson has built a new pump panel — ControlXT — in conjunction with Fire Research Corporation. It incorporates a more easy-to-read panel with engine information, water and tank level gauges, pressure governing systems and other customer-selected controls and displays. ControlXT will be standard or optional on all Crimson product lines.

Finally, Rosenbauer America debuted the T-Rex in 2007. In conjunction with Metz, the new articulating platform sets up in 25-30 seconds, has an aerial height of 102' equipped with a 2000 gpm pump and room for 115' of ground ladders. It also features a platform collision avoidance feature and a 1400 lb tip capacity.

All of the manufacturers are building and designing with firefighter safety in mind, which in my book is something that should continue in the coming years. More attention is being placed on larger cabs with more room for firefighter comfort and safety, lower hose beds and increased storage space as well as multi-tasking vehicles because we are all trying to do more with less in this day and age.

Just when you think nothing else could be possible, the fire apparatus engineers come out with another new idea that takes the industry by storm. With all of these new innovations that were introduced this year, I can hardly wait for the offerings in 2008. It should prove to be an interesting year. If that is not enough, newer stringent EPA Diesel Engine requirements crop up again in 2010. Oh well!

Vertical ventilation is one of the most hazardous tasks accomplished on the fireground. Vertical ventilation should only be accomplished when it is necessary and can be completed safely.

The key to success in delivering this tactic is to have two means of egress, limit total time of work on roof, don't let the ventilation hole get between you and your means of egress and don't loiter to admire your work when complete!

Vertical ventilation can be accomplished by utilizing existing openings in the roofing deck or making our own.

Natural openings are those structural items that require a hole to exist in the roof of a structure. The size of the opening should be selected based on availability and the largest possible. Multiple floor structures should have a number of options available.

Vertical shafts that run the height of the building will work the best, such as stairways, elevators and large utility shafts. Remember that skylights, scuttles, monitors, attic vents and swamp coolers can all be removed to assist with ventilation.

NOTE: Ladders should be used to provide safer footing for any pitched roof operation and to spread the load on any flat room. There should always be two means of escape for any roof operation and a protection hose line should be in place on the roof.

Roofs should also be checked to make sure they are safe to work on. Spongy material, bubbling tar, melted snow or dry spots on a roof, or smoke or heat emitting from the roof are some of the signs that the integrity of the roof may be compromised.

When accessing your ventilation spot, select your ventilation site based on closest area over the seat of the fire as well as an area where a sufficient size hole can be cut. Crews accessing the roof should have, as a minimum, a gas-powered saw (chain or circular), an axe to louver the decking after the cut (and if the saw quits) and a pike pole/trash hook to punch the ceiling when necessary.

Some crews will say always take a roof ladder with you. If your roof pitch is such that you don't feel comfortable working without one, take one.

In addition, recent rain or snow, or standard pitches on concrete or tile roofs may warrant the addition of a roof ladder.

Ensure the primary firefighter to access the roof is able to sound the roof for stability. Sound your rafters all the way to where your cut will be.

Locate and mark the position of the rafters for the individual utilizing the saw. Remember that a four by four hole will be considered a minimum sized hole.

Don't cut the roof rafters — in a truss system that may be weakened by fire, this could be an initiator of a collapse of the roof support system.

When cutting your ventilation hole, consider making your farthest cuts first to ensure your last cut places you closest to your egress point. Louver the roof deck and prepare to punch the ceiling on the ceiling of the floor under your cut.

DO NOT PROCEED without checking with command — interior crews must be ready! Once given the go ahead by command, punch the ceiling.

Again, consider making the farthest holes and work towards your egress. All personnel should be in full SCBA for this event. Once the ventilation task is complete, get off the roof!

Remember that ventilation is a task that will be required on all fires! The primary questions are when and how. The primary purpose of ventilation is to remove all accumulations of heat and combustion products.

At this time, I would like to stand firmly upon my soap box and preach. While all methods of ventilation have their place in the tool box of tactics, I consistently see firefighters who have forgotten that we are at a fire to search, rescue and extinguish fires -- not to see how many windows we can break on a single fire.

I have been on small fires that have been extinguished and noticed as I exited the structure that nearly every window had been broken out! Why?! This is a problem for a few reasons:

• I cannot perform positive pressure on a structure that will not retain pressure!
• I am forced to consider a boarding company to ensure a possible crime scene is not contaminated after we leave.
• The total cost of repairs can be reduced if these windows do not need replacing.
• We look stupid when we break out windows from areas where there was no fire involvement

Remember, we are there to make things better if possible, not drive up the bottom line costs for home repair/replacement after a fire! I now step off the soap box and continue with the closing of the article.

This article quickly addressed one of the hallmarks of our profession. This skill of ventilation is an art and can make or break the direction of numerous activities on a fireground.

We owe it to ourselves to be practiced at this process so that we can create an environment that will allow for safe, rapid victim location and rescue, fire location and extinguishment and creating the safest possible environment for our brothers and sisters to work in.

If it’s been a while since your crews walked through a ventilation process, take the time to practice. If nothing else, walk through how your team will perform a vertical ventilation scenario as a crew. Perfect practice makes for safer effective crews.

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.

There are obviously a lot of tools, gears, gadgets, and equipment that make up a fire station's resources. Here are a few things to consider when buying some of the most important pieces of equipment for your firehouse:

Exhaust Removal Systems
Exhaust removal systems help to create a safer environment for firefighters in confined environments by protecting them from noxious vehicle exhaust. According to NIOSH, studies show that an "occupational carcinogenic hazard exists in human exposure to diesel exhaust."

There are two types of exhaust systems available to fire departments: direct source capture systems and filtration systems. The direct source capture systems are categorized into two sub categories: exhaust evacuation systems and direct source filtration systems.

Exhaust evacuation systems
These consist of control panel, a track-mounted hose and cables, an exhaust fan and ducting. The system attaches directly to the tailpipe, thereby capturing all exhaust emissions and carrying them out of the building via a fan and duct system.

Requirements of the systems include adequate electrical power (amperage and electrical phase capability) and a duct to the exterior of the building to vent the exhaust. Consideration should be given to the location of this discharge point regarding neighboring occupancies and intake points of a breathing air system if located in the same station.

When operational procedures are followed for attachment of the systems, especially if the vehicle backs into the station, firefighters attaching the systems will not be exposed to diesel exhaust. Remember that backing spotters are necessary any time a vehicle is moving in reverse.

Vehicle-mounted filtration systems
This system consists of a filter diverter, filter and an electronic control unit. The system automatically operates for 10-99 seconds after the vehicle starts. This time is adjustable to suit the department’s needs and allows the vehicle to leave the station. The system also activates when the vehicle is in reverse gear. After the vehicle is shifted out of reverse gear, the system will continue in the filter mode for the pre-set time allowing the vehicle to back into the building and shut it off.

Filtration systems
These are sometimes referred to as "hoseless" systems and are mounted to the ceiling. Harmful exhaust components are forced through a series of three disposable filters. The filters trap certain particles and chemically absorb other diesel exhaust components. The system automatically activates through a system of door switches or electric eyes that detect vehicle movement. Filtration systems involve the least amount of work necessary to install an exhaust removal system. No vehicle modification is needed and only an electrical power source and ceiling mounting space are needed in the fire station.

EPA rules
The Environmental Protection Agency (EPA) 2007 Highway Diesel Rule (EPA07) requires a reduction in the diesel particulate matter and nitrous oxide in diesel exhaust emission. Manufacturers have adapted their products to work with the vehicle changes necessary to meet EPA07.

Regeneration is a process to eliminate particulate matter in the ATD. It is recommended that this regeneration process be conducted outside of the fire station. EPA07 does not address issues relevant to diesel exhaust indoors; however, NFPA Standard 1500 and most building codes do. Therefore, a vehicle exhaust extraction or filtration system is highly recommended to protect firefighters from the risk of exposure to harmful diesel exhaust emissions.

Gear Racks
One piece of fire station equipment that is used daily is the gear rack where firefighters store their gear between shifts. There are several different options when considering gear racks.

Design
Racks need to have an open air design to allow gear to thoroughly dry. If gear remains wet, it will wear our faster and cause steam burns to firefighters. Commercially purchased racks are available with wheels allowing them to be moved throughout the station. Others are designed to be secured in one location such as stand alone, or wall-mounted units. Options can also include having locking doors to secure gear. However, locking doors can be a problem when quickly locating keys if gear needs to be accessed or moved, such as in a major emergency.

Size
Racks should be large and tall enough to allow wet turnout pants to be pulled up to fully dry. They should also be painted or coated to prevent rusting. Some companies have a 15 year warranty against rust and corrosion. A last resort in difficult economic times is to build your own racks. This can be an option to help manage costs but may have drawbacks depending on the experience of the builder.

Fitness Equipment
As firefighters we are prime candidates for acquiring and hopefully utilizing appropriate exercise equipment within the confines of our firehouse. The best way to select such equipment is to take a reverse engineering approach. What health issue kills firefighters (cardiac), and what serious injuries are firefighters most likely to sustain during our career (back, shoulder, etc.)?

Cardio Equipment
It makes sense to start with your heart. While there are numerous products out there designed to improve cardiovascular health, the gold standard by which all are compared is the treadmill. It is simple to use, versatile (walk, jog, incline, etc.) and can be placed in a climate controlled environment (unless it’s stuck in an apparatus room). Stair climbers, elliptical machines and other similar products are useful and can offer great cardio options but seem to get less overall use.

Strength Training
From a muscular strength and endurance standpoint there are also many options. Standard barbell, dumbbell, and squat rack options can be effective, but there is plenty of evidence to suggest that improper application can lead to acute or chronic injuries. Multi-station, cable based units are also effective and possibly safer from a solo participant standpoint. Today’s flavors include kettle bells, medicine balls, Bosa or Swiss balls that provide an infinite amount movement options with moderate resistance. Education ultimately is the key ingredient to long term success.

Cost
From a purchasing philosophy get the best you can afford. Treadmills in particular are notorious for breaking down when buying on the cheap. A great treadmill starts with a great motor (A/C preferred) and frame, and commercial grade products generally run in the $4-7k range.
Keep in mind that whatever the tools available for training, participation is the goal. Safely exercising goes hand in hand with participation and education ensures a successful experience. Keep on moving!

This How to Buy guide was compiled from articles written by FireRescue1 contributors Michael Petroff, Jim Sideras, and Captain Shawn Perry.

People of St. Louis remain calm. This is not the apocalypse nor the end of civilization as we have come to know it. Albert Pujols has left the building. However, there is still a good team in town with great players.

It would seem the baseball great has signed a contract for many millions of dollars to play baseball with the Anaheim Angels during the next baseball season.

The contract is worth $240 million guaranteed, and incentives that are worth another $10 million. So, he could conceivably make $250 million over the next 10 years.

According to the LA Times, the contract is back-loaded and Pujols will make $12 million for the next season. Basically, $1 million a month.

Now what I find ironic about this is last year the St. Louis Cardinals baseball club made an offer, from what I have been able to gather, to Pujols somewhere in the neighborhood of $195 to $199 million for nine years.

However, at the beginning of last year, the City of St. Louis was grappling with the prospect of laying off 30 firefighters to cut $1 million dollars from the St. Louis Fire Dept. budget. This, by the way, is what Albert Pujols makes a month.

The point could immediately be made that I am comparing apples to aardvarks. That is a valid point and one I can't argue with.

I am comparing a municipal budget that relies on assessed property values and tax revenue to the finances of a professional sports team.

But I just can’t get past the irony of that whole thing. The Cardinals were willing to pay almost $200 million for a baseball player, but the city was going to lay off 30 firefighters to save $1 million. There is enough irony there to sink a battle ship.

I guess it's what is important to people. I don’t know many firefighters who make a million dollars a year. Firefighters take a lot of risks. You could include police officers in that also.

What about our armed forces? Young men and woman who go to foreign lands and get killed or maimed to protect the freedoms that allows me to sit here and write this.

I didn’t join the fire dept. to achieve rock star status or make as much money as the Buffets (Warren or Jimmy). I am glad because I would have been really disappointed.

And besides, what would I do with $250 million? We do need a new screen door. The wife wants hardwood flooring. I have a fishing reel that doesn’t retract line until you turn the handle a few times. I guess I might get crazy and have that fixed.

Now please, don't come away from this thinking I am anti Albert Pujols. Not at all. How could you not like him? A perennial all star, rookie of the year and more accolades than we have room for here.

He is the third of three players in the history of baseball to hit three home runs in a single World Series game. The other two being Babe Ruth and Reggie Jackson; you have heard of them.

In 2009, he was named Sports Illustrated Player of the Decade. He hit a home run in a playoff game in Houston that went so far so fast, the Strategic Air Command almost scrambled fighters to intercept it.

Mr. Pujols has been blessed with talent and ability that few have even come close to. He has made the most of it and now has a big payoff. That’s how it works.

If he came by the house and we got the screen door open, had a few beverages and played a couple of games of Pictionary, I bet he would be a fun guy.

Meanwhile, back in St. Louis, it appears the mayor and city are lining up to take a shot at the fire dept. pension. Oh gosh, I said it: the "P" word.

I would like to meet the person who sold our nation's fire service on the ridiculous concept that we should be able to retire. Come on. Seriously?

OK, firefighters work 25 years or longer in an occupation that is very dangerous. We work daily in toxic, explosive environments that might collapse at any moment in all kinds of weather and conditions.

We are exposed to every dangerous medical and transmittable blood borne disease known to man every day. This is, of course, on a good day.

We work holidays, birthdays, anniversaries and all kinds of firsts. We miss first fish, first steps, first words and others.

We are gone during times of disaster, leaving our families to spend our time protecting others who depend on us when they call 911.

We stand a better chance of contracting cancer or heart disease than the average citizen does of hearing Rick Perry saying something goofy at a presidential debate.

I will take out the word comfortable from my retirement wishes. I will give up the phrase "retire comfortably" and replace it with retire and survive.

I just want my pension to do more than pay for my insurance. But all over the country, pension and insurance benefits are being attacked. I really can't imagine me, with my limited social skills, being the Wal-Mart greeter.

I attended a CPR event the other night. A long beloved family member had taken their last breath. Our team of lifesavers intervened and delivered this person to the hospital with a self sustaining pulse.

They weren't asked to sign autographs. They didn’t get offers from other EMS services to come and work for them with a big raise.

I couldn't help but think had I stopped CPR for a moment to allow the computerized defibrillator to analyze the situation and had glanced over and seen Albert Pujols in the living room taking a couple of practice swings with his bat.

Would all of his millions helped? Probably not. I, of course, knocked over an end table and lamp.

In the opening paragraph, I encouraged the citizens of St. Louis to remain calm and even mentioned another team in St. Louis that has good players.

Not just the St. Louis Blues. I mean, of course, the St. Louis Fire Dept. Now there is a great team the public can get behind and support. They are not going to leave town. They will just show up when a person is having a bad day be it morning, noon or night, rain or shine.

Isn't St. Louis the place that went to all ladder trucks and quints years ago? I should have applied there; I could always be on the truck.

Good luck Albert and the St. Louis Fire Dept. They both have a lot ahead of them this year.

A Happy Ending…
I do like a happy ending. If you have followed the curious case of that fine American Battalion Chief John Grillone who got in trouble for singing the National Anthem there is good news. You can refresh yourself here. Chief Grillone has been returned to active duty in the 13th Battalion of the Philadelphia Fire Dept.

Believe me nobody is happier about this than me. I was about to go on a hunger strike over this issue.

As always let me hear from you…

American voters made a decision in the midterm elections in November this year. The decisions were based on a decision to change the status quo. The U.S. Fire Service apparently made a similar decision earlier in the year, too. The number of line-of-duty deaths recorded in 2010 is near the lowest in the past decade. The number of Safety Officers certified by the National Board of Firefighter Professional Qualifications (Pro-Board) through the Fire Department Safety Officers Association is at a record annual total.

The causes for the reduction in LODDs are not readily measurable. Although the number of deaths is down, the statistics do reflect a status quo or even regression in some ways. Statistics through November show that 68 percent of LODDs occurred away from the incident scene, or responding to the incident scene. Heart attack was the cause of 58 percent (46) of the deaths, vehicle collision 14 percent (11). Twenty-one firefighters who died were over the age of 61. The oldest was 86. Two firefighters were under the age of 21.

The National Fallen Firefighters Foundation's Everyone Goes Home Firefighter Life Safety Initiatives call for the certifications of firefighters. Perhaps the fire service is implementing and adopting this Initiative. The training required for certification may be a factor in the reduction of fireground deaths. However, 8 percent (6) of the LODDs involved firefighters losing their lives due to building collapse, being overtaken by advancing fire conditions or becoming disoriented.

The FDSOA, NIOSH, the IAFF and the IAFC all worked to reduce the number of LODDs in 2010. The FDSOA through safety officer training certification, NIOSH by investigating LODDs and making remedial recommendations and the IAFC's Rules of Engagement and the IAFF's Fire Ground Survival Program both show a commitment to reducing firefighter fatalities.

Technological improvements may be another LODD reduction factor. Several firefighters report "new" use of seat belts because of the strong reminders that come in the form of warning lights and buzzers in newly delivered apparatus.

Increased awareness of air management has changed the way departments treat low air warning alarms. Changes in roadway operations is apparent in most photos and videos, in the form of roadway safety vests on most (if not all) responders.

All of these improvements in safety operations and awareness may be contributing factors in the relatively low number of LODDs in 2010. Perhaps the "no fear" culture of the fire service is changing and we are entering a time when risk management prevails and we employ intellectual aggressiveness.
We still must address our biggest cause of LODDs — heart attack. We must look at age as a factor that increases risk. The Fire Service Joint Labor Management Wellness-Fitness Initiative should receive a renewed effort.

The fire service is committed to reducing LODDS, but the efforts must seriously review the statistics and make the necessary changes.

By Jay Lowry

A great deal. Unlike 20 years ago, we live in a very connected world and the global market is influenced by local events with repercussions felt in cities and towns across the United States.

When Greece received a bailout from the European Union, stocks plummeted in the United States — and didn't stop dropping for a while.

Why should firefighters or EMS care?

There is a steady drum beat for financial reform including pension reform, eliminating deficit spending and reducing salaries. These are local effects of a national and even international problem. NFPA 1710 staffing is being attacked as wasteful and the financial crisis helps those who want to have barebones service.

Some firefighters state this was the worst budget year in history. Not hardly.

In many areas, the big bust will be the 2011-2012 and 2012-2013 budget cycles.

The mood of the country coupled with rising debt, deficit spending, massive entitlement programs and loss of investor confidence will combine to make the current situation look tame.

Warren Buffett is known as the "Oracle of Omaha" because of his financial acumen. Testifying before Congress last month, and in subsequent interviews, Buffett discussed rising concerns over municipal bonds.

He has divested, as have others, in muni-bonds because cities and counties are finding it very hard to make payments. This is very bad news.

All is not lost. Fire and EMS will survive but both must plan for tighter budgets while educating the public on the importance of the services performed.

The economy will rebound eventually but don't expect it to happen soon. Even so, the effects will have consequences for years to come.

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.

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 Bob Smith
Director of Strategic Development, APCO International

It's 0300 hours, you're in the front right seat of the first due engine on a multi-story residential structure fire with several exposures. As you climb out of the truck and start your size-up you've got about 10,000 things going through your head.

How many personnel are responding to this fire? Is that enough? What units are responding? Is that enough? Should I call for an additional alarm? Or two? Where should I position the ladder when it gets here? And dozens more. The number and complexity of those things you'll need to consider won't really start to dwindle until the clean-up is over and units are returning to the station.

One of the many things being considered during this process is that of personnel accountability. Who's on the scene, where are they and what are they doing? Another issue is incident development. How long has this fire been burning? How long have we been at this offensive interior attack? Is it time to switch tactics to a defensive exterior attack?

Well let's take a moment to discuss an often overlooked resource that can assist an incident commander with personnel accountability and monitoring incident progress — the communications center. An adequately trained and staffed comm center can assist incident commanders in a multitude of areas beyond the traditional dispatch, information management and resource tracking.

PARs in the fire service
Let's start with accountability. Conducting personnel accountability reports (PAR) during an event of any size has become second nature to the fire service. Effective department accountability programs should incorporate PARs on incidents of any size and of any nature.

A PAR is a tool that allows incident commanders to ensure all personnel on scene are safe and accounted for. This action can easily be carried out by the comm center and many jurisdictions have done just that by training their comm center personnel on how to conduct PARs and how to relay the PAR's findings to the IC. One less action needed to be carried out by the IC.

Another tool that comm centers can provide an IC to assist with personnel safety are regular time checks during an incident. Time checks can be designed so that beginning at a certain point in the incident — say 10 minutes after the first unit arrives on scene or the IC announces that knockdown has begun — the comm center staff will notify the IC every 10 to 20 minutes.

We all know that 10 minutes worth of free burning in a traditional structure fire can make the difference between a successful knockdown and leaving nothing but the foundation. Also, most departments have limits to the amount of time they will allow personnel to remain inside a building during interior attack modes.

This "heads up" from the comm center allows the IC to monitor the passage of time during an incident without having to actually watch a clock themselves. One less action needed to be carried out by the IC.

Emergency evacuations
Another area that allows for comm centers to assist ICs during an incident is playing a role in a department's emergency evacuation process. Many agencies across the country have developed emergency evacuation plans that incorporate steps such as having the comm center make evacuation announcements over primary and tactical channels and even activating pagers and radio alerts on scene.

To accomplish this, the comm center personnel must be trained in the department's evacuation plan and the plan must be tested regularly. In addition, comm centers that serve multiple fire departments should encourage all departments to adopt similar evacuation procedures to prevent confusion should a department need an evacuation announcement made during an incident.

All of these actions combined with routine responder safety actions such as monitoring the radio for Mayday calls or other unexpected traffic can increase the level of service and assistance your local comm center can provide to your department.

To accomplish this though, the comm center must have a highly trained and professional staff equipped with the most current tools and resources available. It is the responsibility of every firefighter and officer to encourage your local comm center to ensure their personnel are trained and equipped to the highest level. Because as the old saying goes, "the life you save may be your own."

It may seem a long time ago now, but it was a brutal summer, ending in the final week of September when Los Angeles posted an all-time record high temperature of 112 F. It was also around this time when the NFPA published the Loss of Life data for 2009, and the record shows a significant decrease in deaths related to fire rescue activities. We need to celebrate the success stories of decreasing fire rescue injuries and loss of life.

Incident rehabilitation was featured in dozens of local media pieces over the summer months on how workers were coping with the hot conditions, and many were accompanied by pictures of proud rescuers who were given the opportunity to briefly rest, cool, rehydrate, and be evaluated. This was occurring before they resumed work at that incident scene, or at the others that would occur before the shift ended.

I also watched this summer the rehabilitation that professional athletes utilize in hot weather during football, soccer, and baseball games. We should view ourselves and our operations as "more valuable." Why? Our job is actually much more difficult then theirs. Ours is completely unpredictable. The athletes know they don’t have to play another full game an hour from now. Our public safety personnel do not.

I witnessed an occasion this summer where five firefighters were brought from the same incident, fortunately none with life-threatening problems. What was the issue? Nothing particular to that individual fire scene, but due to the fact that three working incidents had been managed back-to-back by the crews, with the third being the most difficult, on the hottest day of the year.

And those crews were not even halfway through their shift yet! In extreme weather conditions, rehab must be diligently applied at the first incident, to enable our professionals to prepare for the incident or two or six that still may be coming.

Consider taking a picture of one of a group of your fire/EMS personnel rehabbing at a working incident or training, and pair it up with a photo of a football team cooling on the sidelines. Make sure everyone of your personnel understand the priority of team preparedness, and the physical benefits of optimal performance by every team member. Rehab is a vital part of professional sports, and of professional emergency operations.

In the agencies where I work, we had many hot weather incidents, and all were managed using an incident rehabilitation program that has evolved over the past few years.

What is notable is that we started with the process, and now we are moving to the "props" that will make it more effective and more professional. Agencies have invested in cooling systems, fans, shades, drink dispensers, icemakers, and other equipment that increase the effectiveness of the process. There are no "Gatorade" signs hanging around (and no commander gets a Gatorade shower at the end of the incident), but the rehab area is beginning to look more organized.

It is our opportunity at the end of summer operations to reinforce the benefits of incident rehabilitation within our organizations and with our members. Even as we prepare in many locales for cold weather rehabilitation, there is no time like the present to prepare for another hot summer starting in about six months.

Here's a five item list to consider.

• Have you cooperated with your mutual aid and other nearby organizations to establish a consistent rehab process? Maybe even develop a regional rehab unit.
• Have you extended your program to cover the law enforcement, utility, and media personnel who are sweating in the same sunshine as you are? This builds incredible positive public relations.
• Have you considered and applied local donations of equipment and supplies to enhance the rehab operation? For those of us with the tightest budgets, it is worthwhile.
• Is the rehab operation paperwork filed with the incident report? Does someone check the sheets to make sure all working crews received rehab, or is some other process in place to ensure compliance of all crews with the program?
• Have you begun to use the rehab program as a bridge to other physical (and mental) well-being programs for your personnel? Some agencies have used the development of the rehab program to initiate an interaction with local universities, sports medicine programs, and nutritionists. That interaction then extended to other programs that brought routine fitness evaluations, nutrition training, and wellness programs into the organization.

Our personnel deserve the time, respect and attention to detail. The incident rehabilitation process is a critical process that ensures that each emergency operation can be carried out as safely as possible. And that detail will allow us to produce healthy retirees.

Cutting costs and still getting what you want is beginning to take on a new meaning. Do you replace apparatus based on longevity (a 15-20 year plan), or do you base it on the condition and use of your engine, truck, heavy rescue or squad? In any case, fire departments are holding onto their apparatus a few more years.

If your engine is pump-tested on an annual basis and passes, you might be able to push back the purchase of a new apparatus. And in the case of an aerial ladder, if the ladder and components are tested and X-rayed and present no problems, you could do the same.

You could also consider buying used from a fire apparatus broker with a good reputation. You can find some good bargains out there if you are willing to make some adjustments to what you need.

If you decide that this isn't the way to go for your department, then you might choose to order a program apparatus from one of the apparatus manufacturers. A program vehicle is limited on the amount of options you can order, but you're trying to save money anyway.

A demo is another way to go. Most major manufacturers build these for shows around the country as well as for dealers to show prospective buyers. At various shows around the country, you can sometimes see fire departments write out checks right on the show floor to buy a vehicle.

Again, you might not get exactly what you want, but if it's close and saves you money, why not?

Analyze your immediate and future needs. Do you need a 2000GPM pump, or will a 1250GPM single-stage work for you? Is the 515HP diesel engine a must-have, or can you settle for a 475HP? Can you get by with simple manual gate valves and hardwiring, which, by the way, a great deal of fire departments are going back to, or do you need flow valves and wiring connected to computers?

There are many features you can delete or downsize without really affecting the purpose or the operation of your new purchase. Not to sound like a dinosaur, but since the objective is to extinguish fires and you can get away spending $250,000-300,000 for an engine, then why spend $500,000-750,000 to accomplish the same goal?

Shop around. A great many fire apparatus dealers and manufacturers will work with you and give you some good prices during this down economy. The decision is up to you and your apparatus committee.

You are getting ready to clear your EMS unit from a fire standby when the Truck Captain asks you to check out Chuck, one of the members of his company.

He was walking around the side of the truck when he walked into an open cabinet door, striking his head pretty hard. He did not pass out but has been feeling dizzy for the past 20 minutes since the incident.

His fellow members of the company tell you he seems a little "dazed" and although you don't know Chuck very well, he does some a bit slower than normal. He tells you, "I think I just got my bell rung — I'll be fine."

So, what do we do with Chuck? In emergency medical services, we need to consider the worst case scenario. In the case of a traumatic head injury, the worst case scenario is bleeding in the brain.

Assuming he does not have a neck injury (which is always possible, but we have discussed that in previous columns), the next consideration is a concussion.

Let's take a look at both of those conditions so we can convince Chuck what to do and what to expect over the next few days and weeks.

Even surprisingly mild trauma such as a fall from standing can cause bleeding in or around the brain. There are some situations where the risk is greater than normal.

Patients that are elderly have an increased risk because the human's brain shrinks slightly with age. This means that there are blood vessels between the brain and skull that are somewhat stretched and have an increased tendency to be damaged and bleed.

In addition, this potential space between the smaller brain and the skull allows blood to accumulate before symptoms can be present.

A younger patient would have symptoms more quickly because of the pressure on the brain. In older patients it takes some time for this pressure on the brain to build up.

If Chuck takes any blood thinners, the risk of bleeding is also increased. These include warfarin (Coumadin), Plavix, heparin and possibly full dose aspirin (although aspirin is much less of a risk than the other three.)

While if he was taking these medications he probably should not be working as an active firefighter, that is a discussion for another time, and there is always the possibility that he is not completely honest with everyone — he may want to hide that he is on these medications so he can continue to work, so make sure you ask.

In Emergency Medicine, we try to figure out which patients need imaging such as a CT Scan and which patients do not.

We can't CT every patient with a bump on the head or we would be irradiating a lot of healthy brains and clogging up the emergency department.

It is beyond the scope of this article to discuss the specific rules that are sometimes used, but it is helpful to know some of the symptoms or conditions on the list so we can use that information to convince Chuck that he really needs to go to the hospital and likely will need a CT scan to rule out bleeding.

Some of these conditions include:

• Persistent headache
• Vomiting
• Age over 60
• Drug or alcohol intoxication (hopefully not applicable in this case but intoxicated patients are difficult to accurately assess)
• Persistent anterograde amnesia (They cannot remember new things)
• Seizures
• Not fully alert, or a Glasgow Coma Score 14 or less (15 is normal)

If these conditions are present in Chuck or any patient with a head injury, use this information to convince them to go and get checked out, as the risk of bleeding is higher.

OK, so let's assume Chuck does not have bleeding in his head. But he continues to be a bit dizzy and is speaking more slowly than normal. Thus, he likely has a concussion.

The definition of a concussion is controversial because of the implications for athletic activity, work and liability.

One feature often debated is if a loss of consciousness is needed for a patient to have a concussion. In general the consensus is now that loss of consciousness is not required.

So the best definition of a mild concussion is a transient alteration of mental status after a blow to the head that can include headache, dizziness, nausea and unsteadiness.

A more severe concussion includes a loss of consciousness and amnesia.

Does every concussion need to go to the hospital? Probably not — we see a number of protocols in the athletic arena that indicate that if the symptoms are very brief and there is no loss of consciousness, and the athlete is back to normal in less than 15 minutes, they may even be able to return to the field.

Now this varies significantly based on the level of play — a little leaguer would likely not return to play, but a pro hockey player in the Stanley Cup probably would.

How does this apply to our firefighters? Well, it does give us a number of cases to study to try and figure out what is the best course of action — a lot of athletes are experiencing concussions so there is a lot of money and research looking at them.

But the immediate issue is that we don't really know the risks of allowing patients who have had a concussion to return to play or work.

We believe that if a person who has had a concussion has another one while still symptomatic, it might be bad, but we don't know specifically why.

Based on a number of the classifications of concussion and the recommended actions, I believe that if our firefighters still have any symptoms that last longer than 15 minutes, or have any of the risk factors for bleeding listed above, then evaluation in the emergency department is definitely indicated.

What about long term? There is a "Post Concussion Syndrome" that is the constellation of symptoms that can continue for weeks or months after the initial trauma.

These symptoms can include headache, difficulty concentrating and dizziness. This syndrome is not often seen in children or in countries where there is little to no litigation and compensation issues, so maybe there are some exacerbating circumstances.

But one could see how a firefighter with these continued symptoms would have a hard time returning to work.

Back to Chuck. He has already had symptoms for longer than 15 minutes so he should be checked out at the hospital. He may or may not get a CT scan, but I think it is clear he has had more than just having his "bell rung."

The National Hockey League and the National Football League are finally realizing that concussions are a serious threat to their players so we should recognize the threat to our firefighters. I believe we do, so let's stay vigilant.

Stay safe.

As 2011 ended, we marked the 40th anniversary of one of the most influential pieces of legislation involving the nation's fire service. In 1971, the United States Congress appropriated funding to establish the National Commission on Fire Prevention and Control. Up to this point, subjects such as fire suppression, fire prevention and related topics were perceived not to be a national problem but a local issue.

After two years of work, the Commission released its report entitled "America Burning." The report was groundbreaking for its time. It called for a national fire academy, the development and enforcement of uniform building codes and the establishment of a national fire administration, along with other initiatives. The report estimated that 12,000 people were dying annually as the result of fires in this nation.

"America Burning" also recommended that more emphasis be placed on fire prevention, increased training of fire service personnel and educating the public about fire safety.

In 1987, the USFA convened a workshop to examine the changes that had taken place as a result of the Commission's recommendations and to develop plans for the fire service that would take us into the 21st century.

In 1999, President Clinton appointed a panel "to reexamine the evolving role of the fire services in the safety and sustainability of today's American communities." The commission's report reached two major conclusions:

1. "The frequency and severity of fires in America is a result of our nation's failure to adequately apply and fund known loss reduction strategies. The primary responsibility for fire prevention, suppression and action on other hazards dealt with by the fire services properly rests with state and local government. Nevertheless, a substantial role exists for the federal government in funding and technical support."

2. The panel's chair, George K. Bernstein, stated, "Until the USFA is empowered by funding and staffing to truly become the leader in our nation's firefighting efforts, unless the fire services are adequately funded, and unless local communities enforce known fire preventive and suppression measures, the establishment of this commission and its efforts to develop recommendations will have been an exercise in futility."

The reason I have given you this historical information is because it appears that the current congressional leadership is about to diverge from this four-decade-old policy. Recently the U.S. House and Senate passed the Fiscal Year 2012 Appropriations Plan.

The 2012 spending plan lowers the amount of funding for the AFG and SAFER programs to $337.5 million. This is a collective reduction of $135 million from FY 2011, when both programs were funded at $405 million. The USFA is cut by $1.5 million, and the program's budget is now more than 40 percent less than it was in 2002.

Congress further reduced the amount available to other Homeland Security Initiatives, including Urban Areas Security Initiative, the State Homeland Security Grant Program and Citizen Corps. These programs were cut by nearly 50 percent from their 2011 funding levels.

We have made substantial progress in the fire service in America since the National Commission on Fire Prevention and Control first issued its report. Civilian fire deaths have decreased by 66 percent, and firefighter fatalities have dropped from 157 to 87 in 2010.

At the same time, the number of calls answered by our nation's firefighters has continued to increase. Now a fire call is received every 1.18 seconds in our country. Also, the number of firefighters answering these alarms has been drastically reduced.

In particular, the number of volunteer firefighters in this country has dropped by 10 percent in the past 25 years. During that same time, the average age of volunteer firefighters has increased dramatically. In 2009, the percentage of volunteer firefighters over the age of 50 was 21.8 percent; this is nearly double the amount it was just 12 years earlier.

The fire service in America needs to respond to related cuts in the federal budget, and we need to do it quickly. In the time it took you to read this article, fire departments in our nation responded to nearly 200 alarms.

We need to tell our federal legislators that the foundation laid by the Commission on Fire Prevention and Control needs to be supported and built upon rather than destroyed. We need to tell them that programs like AFG, SAFER and the Fire Prevention and Safety Grants are working and now is not the time to take steps backward.

Too many candidates get sucked into concentrating too much on the check-off list for their tactical without realizing it. In the process, they lose control of the fire and their score gets hammered.

What's your best tactic for rescue or knocking down the fire? An aggressive attack on the fire! Go fight the fire with your resources. In the process you will get the necessary boxes checked off on the rating sheet, could put out the fire and get a top score.

Yes, you want to cover all the bases to make sure the boxes are checked off on the rating sheet, but again, isn’t the best tactic for extinguishment and rescue an aggressive fire attack?

However, concentrate on a solid plan. Many candidates put too much into play out of sequence early on in the exercise and make the problem bigger than what the raters have actually given them. Often, candidates will give assignments to units to place positive pressure ventilation, a crew to pull ceilings, assign more than one unit to carry out search rescue and other tasks, call the canteen truck, and add a rescue problem that wasn't given to them.

This is before they have the first line on the fire, a RIT team assigned, utilities pulled and a crew sent to the roof for ventilation. The fire gets away from them and they are out of equipment and resources before they realize what happened. How long can you tread water?

These are major areas the raters will be checking off on your scoring sheet that can rack up big points. You must come out swinging. Once you have proven you can handle the call from the beginning, you're nailing it. As soon as the raters know you got it, they will help you over the top to that next badge. It's a beautiful thing when it happens.

Have a plan
Here's a simple example of a fire problem: You give an on-scene size up at a fire involving a residence with fire blowing out a bedroom window. You order your engineer to hook up as you and your firefighter start pulling lines. If you followed this sequence, you have just lost the fire!

The problem here is you went from size up directly into tactics. Most candidates start off on the right foot with a size up of the fire. Then they make a fatal mistake in going directly into tactics without a plan. They confuse tactics with a plan. Once given the fire problem, focus all your energies on developing a plan.

Without a plan, you are out of control. What was your plan on this fire problem? By just taking a few more moments, you would have one. When confronted, candidates that go immediately to tactics regroup and say, "My plan is to confine and put out the bedroom fire." O.K., but if you didn't say it, you didn't have a plan. Size up, plan, and then tactics.