Sorry, our Department Can't Comply with Rehab Standards

Posted on Mon, 24 Nov 2008 13:19:30 UTC

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.

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!

How to buy ice-rescue equipment

Posted on Fri, 29 Jan 2016 23:24:11 UTC

Winter weather means rescue operations that involve several unique risk factors that pose threats to rescuers: hypothermia, drowning and mechanical injuries from ice, just to name a few.

Fire departments should evaluate their level of risk for engaging in ice-rescue operations as well as the anticipated frequency for such special operations.

Structural firefighting personal protective equipment has no place for operations in or around water, especially frozen over water. Ice-rescue operations — rescuing persons trapped on ice or who have fallen through ice into very cold water — require that rescue personnel have the appropriate PPE as well as the right tools for the job.

Ice-rescue suits, more commonly known as exposure suits or Gumby suits, are the necessary level of PPE for personnel during ice rescues. Exposure suits are designed and constructed to provide protection from the effects of cold water (hypothermia) as well as buoyancy for the rescue.

Many suit manufacturers also include pockets on their suits so that other ice rescue equipment such as ice claws are readily available for self-rescue.

Tool time
Water rescue rope bags are a critical ice rescue tool as part of the basic water rescue progression: reach, throw, row and go. Look for bags with a wide mouth (easier to manipulate with gloved hands), rope that floats, and rope in bright colors for easier visualization and tracing when throwing toward a victim.

A buoyant victim retrieval sling is a device that's floatable and extends the rescuer's reach to a victim by 6 feet. It is bigger and easier to grasp than a rope throw bag, and the rescuer can clip the ends together to form a high float sling that the victim can slip over their head. A retrieval sling is also very useful when approaching a victim via boat and getting them safely into the boat.

Ice picks are a necessary tool for both the victim and the rescuer alike. Providing a set of ice picks to a victim who still has the strength and dexterity to pull himself out of the hole in the ice can limit the exposure of rescuers for falling through the same ice.

Newer ice picks come in both floatable and non-floatable models with retractable tips. Look for ice picks with bright colored sheaths to aid in locating in snowy or low-light conditions.

Every rescuer on scene needs the appropriate PPE for ice rescue operations, but not everyone — boat operators, line tenders or rescuers working from the shoreline — needs an exposure suit.

Staying afloat
Flotation jackets, exposure coats and overalls are lower-cost PPE options that protect rescuers from the hypothermic effects of cold-water spray and wind, incidental contact with cold water and frigid air.

Floatation jackets and suits can provide a degree of buoyancy should a rescuer suddenly become a victim by slipping into the water from a shore position or if a rescue boat capsizes.

Personal floatation devices are a basic necessity for all personnel — those not in an exposure suit — working in and around an ice rescue operation. Make sure to use PFDs that are specifically designed and approved for rescue operations.

That means they are designed to keep the rescuer in a heads-up orientation as opposed to a face-up orientation as with recreational boating and sporting PFDs. PFDs for rescue work should have U.S. Coast Guard approval as a Type III or Type V PFD.

There is a number of supplemental equipment that can enhance the safety, efficiency and effectiveness of ice-rescue operations including helmets, cleats and lights.

Helmets specifically designed for swift water rescue are equally suited for ice rescues and provide a better level of protection from a fall on ice or a frozen shoreline than a structural firefighting helmet, which is designed primarily to protect the skull from physical trauma coming from above.

Ice cleats are extremely useful in preventing slips and falls. Cleats can also have a positive affect on a rescuer's ability to maintain their footing and operate more safely and effectively while on the ice or working on frozen or ice-encrusted shorelines.

For ice rescue operations at night probably nothing is more useful than a head-mounted LED light. Good hands-free illumination of one's work area is a critical, yet too frequently overlooked, safety practice. Look for headlamps that include a red diffuse lens option that can enhance a rescuer's night vision.

Helping a civilian hero

Posted on Wed, 20 Jan 2016 21:29:34 UTC

As you know from time to time I use this column for reasons other than to provide grant updates and information. This is one of those occasions. I think all of us over the past two months have had enough ham, turkey, cookies and AFG to last for a while.

As a respite from all the grant headaches, I will share some good news about a recent investigation that I was part of. I know at this point you are thinking how in the world could good news and investigation be used in the same sentence?

After 15 years as a fire chief, I had that same opinion. Whether it was a cause-and-origin investigation for a structure fire or an investigation of an apparatus crash, none of them ever seemed to involve good news.

This was a bit of a different scenario. It was late in the afternoon of Sept. 6, 2014. A severe thunderstorm had just rolled through our area and my pager was going off.

I assumed it would be flooding or a tree down. Instead the dispatcher announced it was a vehicle accident with entrapment. As I proceeded down the road, my chief responded and the dispatcher gave him an update that subsequent callers confirmed entrapment and reported that the vehicle was now on fire.

First on scene
This was an automatic-aid call for my department. However, the location of the incident was closer to our station and we would probably arrive on scene before the home department.

As we approached, the scene thick dark smoke and flames were visible. At that time, there were a number of thoughts going through my head — none of them good.

The incident scene was directly across from the entrance to a state park. When we arrived, one of the park rangers informed us that the driver had been pulled from the wreckage and was in the EMS unit.

The vehicle had left the roadway and struck a wooden utility pole. The car came to rest on a grassy embankment, upright and against the pole. The top of the pole broke off in the crash, taking down wires — including a 12,470-volt line — and fell between the car and the base of the pole.

Because the power line was still charged and everyone was out of the car, we decided to just let it burn itself out until the utility provider arrived. Everyone was amazed that someone was able to pull the victim from this vehicle and not be injured or killed.

The following day, as our PIO, I was contacted by the local paper and asked about the actions of the rescuer. In her story, the reporter went to great lengths to stress the risk taken by the person in performing this rescue.

Hero recognized
The following spring, I received a letter from the Carnegie Hero Fund Commission. Although I had never heard of the group, it was established by industrialist and philanthropist Andrew Carnegie in 1904 to recognize civilian heroism throughout the United States and Canada.

The group had received a nomination for Steven A. Martin, the individual who had rescued the accident victim six months earlier. They asked that I fill out a questionnaire on the incident, which was followed up by a telephone interview from their investigator.

He informed me that he was also going to interview the EMS crew, the park rangers that were on scene as well as other witnesses. He later got back in touch and asked if I had any photos of the scene.

Months went by and I never heard anything. Then, on Dec. 17, I received an email that Martin was one of 24 people nationwide selected to receive the Carnegie Medal and a financial grant for his heroic actions — OK, this tale does have some connection to grants after all.

I was proud and pleased to have been a part of this process.

You would like to read a synopsis of his heroic actions and more information on the Carnegie Medal and the history of the Carnegie Hero Fund Commission at the web site and Facebook page. You'll also find the address and phone number to nominate a civilian hero.

Take the time to read about Martin and the other winners. You'll discover that many performed daring rescues involving fire, swift water and in one case a runaway vehicle.

It's great to pause and recognize those who, with little or no training, helped avert disaster. For me, it was an honor to play a small role in helping one hero get that recognition.

8 predicted trends from a firefighting historian

Posted on Wed, 23 Dec 2015 23:06:47 UTC

Four years ago I cut the cable to my television and now rely mostly on streaming and DVDs from the local library.

Right now I'm watching "Route 66," a show from the early '60s about two young men driving around the United States in a Corvette trying to put some meaning into their lives and to perhaps find a future.

I watched this show while growing up in that era. I learned a lot about what it means to be an American, its size and scope as a country, and about the people who live and work there. The takeaway for me was and is that while places look different, the people who inhabit them are similar and form strong bonds to those close to them.

Before "Route 66" aired, "Rescue 8," had a short run plus years of syndicated reruns. I loved the "Rescue 8" stories.

The storyline has two rescue specialists with the Los Angeles County Fire Department rescuing people from dangerous and often life-threatening situations. In 1972, the same year that "Emergency!" aired, Dennis Smith's book "Report from Engine Company 82" was published.

Nothing — be it a TV program, big-screen motion picture, or book — before or after has captured the reality of late-20th century firefighting in America like Smith's book. In that story we get a view of riding to a fire, pulling a line, and advancing on a fire in New York's fire-ravaged Bronx of the 1960s and 1970s.

Between fires (and there were a lot of fires) at the firehouse we get another look into the intense bond that forms between firefighters who share an experience.

What bonds us
We say with conviction that there is a bond shared between all firefighters. That may be wishful thinking.

The bonding is not all-inclusive and honest, solid bonds are only formed when there is agreement and acceptance between at least two people. Group bonding takes more work and is more difficult to achieve.

In firefighting earning trust and respect is not easy. Without the trust and respect of the firefighters with whom you work you have a difficult road ahead and no support (no one will have your back).

In the fire service give a lot of lip service to the idea of a shared bond. And while it is true that firefighters share a history centered on pride, integrity, service, courage and heroism, the same cannot be said for having a shared bond.

The act of officially becoming a firefighter pays your initial dues and establishes a connection more than a bond. Bonds are forged on mutual trust and respect, without those elements there is no bond.

Bonds are important, and confusing them with connections weakens the nature of potential human relations. Connections are essential to forming bonds, but bonds are more complex than simple connections.

Source of strife
We are connected members of the American fire service, but we're anything but unified. Unification entails having some shared bonds. In part this comes from the fact that fire departments are organized and governed at the local level of government.

We are a country of people that prefers to be governed by people with whom we have some connection or, even better, shared bonds. With people come egos, with egos come conflict and strife.

Our resources, communities, schools and even our municipal services are prizes to be sought and manipulated for gain by ego-driven people holding themselves up as so-called leaders. We find reason to dispute and discredit nearly everything and everybody.

We're like people trapped in house fire refusing to be rescued because we object to the way the firefighters have laddered the building.

We seek to be seen as professionals, but we cannot find an organizing principle or organization around which to place our flags. We are instead members of tribes proudly carrying our flags to display our convictions and affiliations as volunteer, union, career, urban, rural, suburban, custom, wild land, structural, suppression, prevention, offensive, aggressive, defensive, transitional, traditional, old school, progressive, east coast, west coast, and on and on.

Beer buddies
Our leaders let us down, our managers don't care about anything but the bottom line, our heroes are flawed, and we find it difficult to trust anyone who doesn't mirror our appearance and values.

In this environment risk-taking and safety-consciousness become occupational touchstones that drive operational behaviors. Lessons learned be damned and common sense too while we're at it.

If fiction is truth repackaged, I'd like to hang out with the characters from "Route 66," "Rescue 8," "Emergency!" and "Report from Engine Company 82." But I'd pass on having a beer with any of the mostly flawed and contrived characters who populate "Backdraft," "Ladder 49," "Rescue Me," and Chicago-whatever. No offense intended if you like those movies or shows, they're just not for me.

The human character qualities of honesty and humility are too rare today. For various reasons many see fit to repackage themselves so as to become the image that they find appealing or think others will be impressed by. Study photographs of firefighters from the past and the present to compare and see what you think.

Essence of virtue
The fire service as we know it is evolving, changing in huge leaps and by small steps, to meet new threats. Threats we know and more that we do not want to imagine will force society and thereby us as public servants to prepare for and respond to.

Fire protection, law enforcement, public works and libraries are public goods. The people who pay for those goods and services have a say in how those functions are executed and they deserve our respect. Our traditions and past practice are subordinate to the public good.

In so many ways we are our own worst enemies. Ego, pride and ignorance are in abundance overshadowing honesty and humility.

In the long distant past, colonial volunteer fire brigades organized and operated on the precept of manhood and public virtue. If those ideals even exist in today's fire service they are too often exhibited by perverse means. It is as if we are trying to do the right things, but how we do it is less than right and sometimes downright wrong.

We may have lost forever the true essence of our virtuous and heroic past, regaining it may be a lost opportunity. It will always be one boot planted in the past and one stepping into the future, what counts though is the heart and mind connected to those boots.

8 evolving trends to watch for

1. Dwindling full-timers
"Every minute counts" is valid for emergency planning and response, but deploying a just-in-case delivery model is increasingly coming under attack for its staffing and apparatus costs. Expect more use of per diem and part-time staffing arrangements to contain employee costs.

2. Cross training
Many if not most career firefighters must have some level of emergency medical training. Expect attempts to cross-train and use paid firefighters as law enforcement officers in small- and medium-size cities.

3. Cops in charge
History has shown that fire departments more often come under control of police departments than vice versa. Expect that law enforcement officers will be increasingly asked to cross-train in firefighting and EMS in small and mid-sized cities.

4. Data driven
More decisions involving public expenditures will come down to using data to save money. Expect more radical staffing and deployment models for EMS and fire units to meet changing needs throughout cities and peak demand times throughout a given day.

5. Expanded duties
An oath to save lives and property will mean more than fighting fires. Expect to be used during disasters in all-hazard (and some not so hazardous) roles that are not your regular assignment or mission.

6. Prevention will rise
The mindset that we fight fires first and thus put prevention in a secondary stance will increasingly come under scrutiny as costly and even (more importantly) that it really violates the so-called oath to save lives and preserve property. Expect the idea of the supremacy of fire suppression over fire prevention to wane and resistance to residential fire sprinklers to decline and with it the costly fire department staffing and deployment patterns as we know it now.

7. Increased zoning
Procedures for hazardous materials incidents stand as an example of how science and fact-based decision making can drive response to emergencies and threats. Expect to see increased application of the "cold zone, warm zone, hot zone" concept to threats and emergencies (even fires).

8. Threat response
Security threats demand a unified response. Expect to see more use of the rescue task force concept combining in varying ratio police, fire and EMS personnel.

The best tools for firefighter rehab sectors

Posted on Tue, 19 Jul 2011 10:21:35 UTC

By Ken Lavelle, MD, FF/NREMT-P

Anytime we need to do a job, we look for tools to help us do it more efficiently. However, these tools also need to help us do it reliably. If a tool causes us to get wrong information, then it is not a very good tool. This is particularly the case in medicine — and remember, EMS is medicine.

One of the challenges of the EMS provider in rehab is to quickly do intake and assessment as a company or group of firefighters enters the rehab area.

If the firefighters have to wait 10-15 minutes for anyone to see them, they very well may wander away. We need to engage them quickly, not only to make sure there is nothing life threatening occurring with their condition, but also to "get them in the system" and make sure they stay in rehab for the appropriate amount of time.

Usually one person will be getting their name, age and company. This "scribe" can be anyone — it does not need to be an experienced medical provider.

They could be a cadet, a new member to the organization, even a spouse or friend that got sucked into a major event because they were out with an EMS provider that had a responsibility to respond to the incident. Obtaining this information can occur at the same time other activity is going on.

I usually like to get the firefighter to sit down and get their gear off, so the cooling down process can start. Next, we need to get baseline vitals. This is a mildly controversial area.

My former Division Chief, a very experienced EMS and fire physician, prefers to wait 10 minutes and then get a set of vitals. His view is that it does not matter much what the initial vitals are at the start, and that it is much more important what the vitals are at the time that the firefighter may be released.

I think there is some validity to this, however I would prefer to know if there was a problem sooner rather than later. If a firefighter's heart rate is 200 because he is in a dangerous arrhythmia, I don't want to miss this, even for only 10 minutes.

If their blood pressure is extremely low or extremely high, I also need to keep a better eye on them. While in most circumstances they should have either a complaint or physical appearance that should clue us into this abnormality, this is not always the case.

I think both approaches are reasonable — discuss with your medical director which is better for your department.

I have found that obtaining vitals is often the bottleneck in the initial rehab evaluation. There are two vital signs I definitely want immediately — heart rate and blood pressure.

A third vital sign that I think is reasonable to obtain sooner rather than later is a carbon monoxide level. I am not concerned about the temperature because it is my opinion that getting an accurate core body temperature is not feasible in the field.

Doing so requires taking a rectal temperature, something neither I nor the firefighter are much interested in doing. The other, non-invasive methods of getting a temperature are not very reliable, and an elevated temperature is almost always associated with a significantly elevated heart rate.

So how can we get these vitals quickly?

The pulse can be obtained by the good old fashioned method of feeling a radial pulse and counting, but we can also use a number of other tools, such as pulse oximetry, a heart monitor or a carbon monoxide monitor.

have found that either feeling and counting the radial pulse, or using CO oximetry, is the most efficient in obtaining a pulse rate. Using CO oximetry allows us to get both a heart rate and a CO level with one action.

The concern is of course is whether it is truly reliable. I believe it is, but if you are concerned, feel for a pulse at the same time and compare the results. This will likely not add much time to the task.

The blood pressure also needs to be obtained quickly and reliably. Now I am generally a fan of automatic blood pressure cuffs. In the hospital, these work fairly well and allow us to trend the blood pressures — follow them over time.

However, in the field, I have found that they are becoming more and more of a problem. Too often the machine pumps up the cuff and then slowly goes down. And up. And down. And down some more. And then back up. And then down. And then fails to give a value.

EMS providers end up staring at the screen awaiting this important vital sign. So, I think the best way to get a BP in the field is the manual sphygmomanometer and stethoscope.

If a firefighter is found to have a significantly abnormal BP, and they become a patient, then using the automatic machine to confirm and trend is reasonable. But I bet most EMS providers can take a manual BP faster.

Once you have these vitals, and assess the firefighter's appearance and any physical complaints, they can then be sorted into the medical sector or just to the rest and refreshment area.

But we need to have these vital signs to do so, and we need them quickly and to be accurate. Remember we call them vital signs for a reason — they are important.

Stay safe (and hydrated!)

How we're changing the status quo

Posted on Mon, 20 Dec 2010 14:39:32 UTC

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.

What if EMS won the $800M Powerball jackpot?

Posted on Mon, 11 Jan 2016 15:52:01 UTC

I don't buy a lottery ticket often, but when I do I wait until the jackpot is over $400 million. If I am lucky enough to win I might as well win big. Once the ticket is in my hands I start daydreaming about how I would spend the massive windfall — pay off the mortgage, pay off mortgages of family, give generously to my favorite charities, take a glorious vacation — and then hunker down to enjoy life living off the miraculous earnings of compounding interest.

But what if it was EMS that won the jackpot instead of an individual? Here are my ideas for how $800 million could be spent to improve the EMS profession, make EMS providers safety, and ensure a bright future for EMS. Add your ideas in the comments.

1. Hands-on training on escaping violent encounters for every EMT, paramedic and medical first responder. These half- or full-day sessions would build off the EMS1 Escaping Violent Encounters video series.

2. Body armor for every EMS provider to wear on every call. But before we purchase the body armor we will complete research and design and pilot testing to come up with an EMS-specific vest that is slash, stab, and bullet resistant, easily cleaned and decontaminated, comfortable to wear while sitting, standing, kneeling or bending, and in color patterns that clearly differentiate an EMS provider from cops and soldiers.

3. Fitness equipment for every EMS station in the land. The EMS fitness equipment bundle could include a treadmill, stationary bike, elliptical machine, free weights and chin-up bar. Or maybe each station could be issued a fitness grant to purchase the exercise equipment of most interest to the people in the station, as well as an EMS-specific functional fitness training plan.

4. Send a chef and nutritionist to every agency to teach responders how to cook healthy meals and pack nutritious snacks for on-the-go eating. The nutritionist would also teach personnel how to track their calorie consumption, select healthy foods and bring their better eating habits home to their significant others and children.

5. Add a power-lift cot to every ambulance. Manual lifting patient-loaded stretchers should be a thing of the past for every EMT and paramedic using a stretcher or stair chair.

6. Stand-up peer support teams in every agency. A team of experts would be funded to create a peer support team training curriculum, field test and improve the curriculum and then diffuse that training across the land. In two years or less every EMS agency would have peer support counselors to respond to EMS providers in distress and refer those providers, as needed, to mental health professionals. Peer support is the lifeline that never fails.

7. Create, staff and permanently fund a 24/7/365 national peer support hotline for EMTs and paramedics to call. The hotline call takers will be knowledgeable of EMS (maybe even current or former medics) and have easy access to local mental health and social work resources to refer callers to. Funding for the national peer support hotline will include the capacity to follow up with callers, as well as resources for far and wide marketing of the peer support hotline's availability.

8. Long-term funding to train and support EMS researchers in a broad array of medical and nonmedical academic disciplines. We need EMTs and paramedics to bring their field knowledge, experience, and passion into other career fields, such as psychology, physiology, kinesiology, biology, biochemistry, pharmacy, statistics, accounting, information technology, law and litigation, health care administration, epidemiology, bioengineering, computer science, human resources, public health, marketing and communications.

9. Endow an EMS artist, musician, dancer, comedian and writer residency program. Each year 10 medics would receive a scholarship equal to or greater than their annual salary, plus benefits and their employer would receive funding to backfill their position. After the residency the artist will have a job waiting for them. During that year the EMS artists would be able to illustrate, paint, compose, write, perform or photograph full time and at the end of the year their art or performances would be displayed in an online gallery and exhibited at EMS conferences everywhere.

10. Develop the next and future generation of EMS leaders by providing scholarships for EMS officers and aspiring officers to become a NEMSMA credentialed EMS officer. In addition any field training officer in the land could complete the EMS-Field Training and Evaluation Program at no cost or heavily reduced cost.

11. Support legislation for combat medics transitioning to civilian EMS careers. The process and timeline for honorably discharged combat medics to become ready-to-work certified and licensed should be measured in days or weeks, not months or years.

What would you do for EMS with $800 million? Dream big and share your ideas in the comments.

Another great CFSI dinner in the books

Posted on Fri, 30 May 2014 13:47:41 UTC

Each year, the Congressional Fire Services Institute has the distinct honor of hosting the annual National Fire and Emergency Services Dinner and Seminars Program. The event brings together fire and emergency services leaders from across the country to our nation's capital.

During their stay, they meet with their members of Congress, attend the CFSI seminars program, and come together as one fire service for a special dinner program honoring the dedication and service of our nation's one million first responders.

The theme of the 26th annual program, which took place on April 30-May 1 in Washington, D.C., was "Cultivating Relationships." Upwards of 2,000 fire service leaders from across the country attended the program.

This was not a social gathering by any stretch, but a unique opportunity to learn and participate in the legislative- and policy-implementation processes. For veterans and neophytes of this program alike, important work is accomplished at the annual National Fire and Emergency Services Dinner and Seminars Program that has a far-reaching effect on federal programs that benefit our nation's first responders.

This is why CFSI continues to conduct this event and encourage a large turnout — to cultivate relationships with political leaders who determine the federal government's commitment to important fire and emergency services programs.

Getting educated
Before commenting on the dinner, I'd like to discuss the seminars program. No other event in the fire service covers such a broad range of important federal issues — nor does any other event feature such a broad array of distinguished and knowledgeable experts on national fire service issues.

Our seminar presenters included 32 association leaders, six federal officials, and eight members of Congress. They are experts in such areas as first responder communications, emergency medical services, building codes, leadership, public safety education, health and wellness, and lobbying.

Our federal presenters were there to listen how our government can be more responsive to the concerns and needs of the fire and emergency services.

While CFSI was delivering an educational experience for all attendees, there were separate meetings and business taking place by other organizations and individual groups. There is not another opportunity during the year for such meetings between leaders of so many diverse organizations.

Business cards were exchanged and new business relationships were formed. Industry leaders conversed with fire officials, while many of our participants were walking the halls of Congress and meeting with their elected representatives.

The best ever
This was my 19th dinner as CFSI's executive director and arguably the best one from my perspective. Five of our fire caucus leaders participated in the dinner program. Sen. Tom Carper (D-Del.) and Reps. Steny Hoyer (D-Md.), Peter King (R-N.Y), and Bill Pascrell (D-N.J.) all addressed the dinner attendees, while Sen. John McCain (R-Ariz.) once again addressed our board of directors reception.

Many members of Congress would relish the opportunity to address such a large and esteemed audience of fire service officials, but few deserve the time behind the podium — most notably these members in addition to our three other caucus co-chairs — Sens. Susan Collins (R-Maine), Jon Tester (D-Mont.) and Rep. Dave Reichert (R-Wash.), who addressed the opening session of our seminars program.

These are members who understand our issues, members who work with us on a daily basis to help the fire service become better prepared and trained. They understand our culture, our traditions and our language.

Grant programs aren't funded on their own, nor are federal agencies like the U.S. Fire Administration or the National Fire Academy. Positive changes to the Public Safety Officers' Benefits Program require support from the Capitol Hill, as do efforts to enhance first responder communications.

Recognizing excellence
To a large extent, we have our caucus leaders to thank for this work, which is why we always look forward to paying proper tribute to them at the dinner.

The dinner also provides an opportunity to acknowledge fire service leaders and organizations for outstanding leadership.

Since 1999, CFSI and Motorola Solutions have presented the Mason Lankford Fire Service Leadership Award to an individual for exemplary leadership at the local, state and national levels. This year's recipient was the Hon. James M. Shannon, president of the National Fire Protection Association who will be retiring shortly following an illustrious 23-year career with NFPA.

CFSI co-sponsor an award with the National Fallen Firefighters Foundation that recognizes organizations for outstanding leadership to advance the cause of firefighter health and safety. This year we honored a government agency (the Office of the Fire Commissioner for the Commonwealth of Pennsylvania) and a partnership between two organizations (the Oklahoma Council on Firefighter Training and Ingegris Heart Hospital). The central focus of the award is to recognize organizations that are helping to advance the 16 Life Safety Initiatives developed by fire service leaders at Tampa, Fla. in 2004.

We also present two other prestigious awards: the Dr. Anne W. Phillips Award for Leadership in Fire Safety Education and the Excellence in Fire Service-Based EMS Awards.

With the support of the International Fire Service Training Association, we recognized Mary Marchone of the National Fire Academy with the Phillips awards. The EMS award, co-sponsored by the MedicAlert Foundation, honored three recipients from the volunteer, career and combination categories: the Cullman County (Ala.) Association of Volunteer Fire Departments, the Memphis (Tenn.) Fire Department and the Howard County (Md.) Department of Fire and Rescue Services, respectively.

These are competitive awards with formal application processes. It is indeed a distinct honor for the recipients to stand before national fire service leaders and receive these recognitions. They have worked hard to achieve these honors and by doing so, have made the fire service stronger and communities across the nation safer.

We extend our thanks and appreciation to our co-sponsors for their continued support of the awards program. Without them, this program would not be possible.

From the administration
Our keynote speaker was Secretary Jeh Johnson of the U.S. Department of Homeland Security. In his speech, the secretary pledge to grow the department's relationships with the fire and emergency service, stating that the department will continue to listen to the fire service to better understand our needs and concerns.

He spoke of the department's commitment to the SAFER and AFG grant programs, enumerating the many ways both programs have addressed the needs of fire departments across the nation. He also recognized our Fire Administrator Chief Ernie Mitchell and the leadership he continues to provide at the federal level.

Cultivating relationships is the mission of the Congressional Fire Services Institute. The fire and emergency services stand to gain when nearly 2,000 fire and emergency services officials from all disciplines can gather together in Washington, D.C. and present a unified image to our leaders on both ends of Pennsylvania Ave.

We thank those who attended for their support and encourage others to contact our office to learn how they can engage in our efforts not only at our 2015 program, but every day during the year. You can reach us at 202-371-1277 or

Fire Chief Digital: Why firefighters commit suicide, fixing PTSD in the fire service and more

Posted on Wed, 27 Jan 2016 20:42:44 UTC

Welcome to the fourth edition of the Fire Chief Digital Edition, a quarterly supplement to and the Fire Chief eNews that brings a sharpened focus to some of the most challenging topics facing fire chiefs and fire service leaders everywhere.

In the Winter 2016 edition of Fire Chief Digital, brought to you by California Casualty, Cathy Sivak looks at why firefighters take their own lives and gives steps to help prevent firefighter suicides. Also, we talked to a panel of firefighters and paramedics that are not only experts in mental health but have also gone through PTSD. They give their take on the state of firefighter mental health and how to make it better.

Sarah Calams talks to a firefighter-turned-psychologist about what strategies fire departments can put into place to prevent firefighter-specific crimes, Linda Willing discusses the fire chief's role in firefighter mental health and our sponsored content section address three things to know and three places to get help for firefighters suffering from PTSD or having thoughts of suicide.

Click on the cover below to open the Fire Chief Digital Edition:

PPE for firefighter psyche

Posted on Thu, 21 Jan 2016 18:42:29 UTC

Fire and EMS personnel — whether it is their career or they volunteer time to the community — are exposed to hazards that affect their physical and mental well-being far beyond the comprehension of most of the public that they serve.

We are just beginning to learn about the scope and magnitude of the impact that responding to the emergency needs of our fellow citizens has on our psyche.

Based on what we've learned thus far, I'm comfortable saying that the protection of our mental health is right there at the top of the list of threats to firefighter health and safety.

In particular, the daily or weekly exposure to the traumas and misfortunes of fellow human beings, and efforts to resolve their problems, can manifest itself in many ways. Some of those include failed personal relationships, substance abuse, domestic violence, suicide and feelings of loneliness and alienation.

But perhaps the greatest threat to our psychological well-being is the general reluctance to accept that these hazards exist and that their negative impact on our lives, our families and our organizations are real. In many respects, to quote the old adage, "We have met the enemy and it is us."

Combat veterans and firefighters
The military services of both the United States and Canada have been devoting an increasing amount of resources to understand the detrimental effects that the continuous combat rotations in Iraq and Afghanistan have had on the mental health of their men and women.

The mainstream media in both countries has also been doing a better job of searching out and writing stories that are shedding new light on the challenges facing these veterans when they return home and try to resume their civilian lives.

When it comes to mental health issues, there are many parallels between the exposures for the combat veterans and firefighters and EMS providers. Both populations are exposed to common mental health exposures — here are six of those.

  • Being thrust into chaotic, high-stress situations with limited information and the expectation for quick resolution of the problem.
  • Technical training that develops a highly specialized set of skills, along with an expectation that failure is not an option.
  • A strong sense for taking responsibility for both the problem and its outcome. Listen to the language we use. "We burned that house down." "I lost that that pediatric cardiac-arrest patient."
  • A strong sense of camaraderie and teamwork where there are great pressures not to let one's team members down in a critical situation.
  • A culture that rewards risk taking and quick decision making and has a negative view of self doubt.
  • Extended periods of separation from family and friends and other influences outside the job that creates a sense of a second family.

Psyche protection
We have made great strides in providing better equipment, protective clothing, and training to our people to better protect them from the physical hazards of firefighting and EMS delivery.

Our recognition of the hazards to our mental health, and similar efforts to successfully manage those hazards, has not been adequate. We have personal protective equipment to protect our bodies from physical injuries, but we lack PPE for the psyche.

In the mental health world, resilience is the capacity of an individual to recover quickly, resist and possibly even thrive in the face of direct or indirect traumatic events or adverse situations.

How can you develop resilience for yourself? How can you help the members of your team to develop resilience?

Share your thoughts and ideas here and I'll pull them together for the next article for this topic. I understand that some folks can be a bit shy about posting for the entire world to see.

So you can also send your comments to me using the e-mail address below. Anything I get through e-mail will be used anonymously unless you state otherwise.

Haiti earthquake: The role of geospatial intelligence during response

Posted on Wed, 20 Jan 2016 20:27:44 UTC

By Liam O’Brien, faculty member, Intelligence Studies at American Military University

Six years ago on January 12, 2010, a 7.0 magnitude earthquake hit Haiti. The devastation was extensive: It destroyed 75 percent of the nation’s schools as well as government offices, medical buildings, and other public infrastructure. More than 1.5 million people were displaced from their homes, and more than 220,000 people died and 300,000 were injured.

Role of NGA
Within hours of the Haiti earthquake, the National Geospatial-Intelligence Agency (NGA) set up a Crisis Action Team (CAT) and consolidated response oversight for geospatial intelligence (GEOINT) efforts. The CAT worked to ensure that all geospatial intelligence efforts conducted by NGA, as well as the greater National System for Geospatial Intelligence and the Allied System for Geospatial Intelligence, were coordinated and aligned to provide geospatial intelligence analytics and services in an integrated, collaborative, and effective manner.

?NGA staff in St. Louis and Washington, D.C., along with the NGA support teams at the U.S. Southern Command, helped provide immediate assessments. Within the first two days of the Haiti earthquake, they produced assessments of damage to critical infrastructure, conducted optimal travel-routes analysis for first responders, and provided a variety of up-to-date situational awareness products using a combination of government satellite imagery, commercial imagery (much of it provided at no cost by GeoEye and Digital Globe under the International Charter on Space and Major Disasters), and geospatial data.

Full story: Haiti earthquake: The role of geospatial intelligence during response

Fire chief saves child, earns F-16 ride

Posted on Mon, 9 Jul 2012 08:52:53 UTC

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.

How much do you know about fire trucks?

Posted on Tue, 10 Nov 2015 16:32:56 UTC

Fire cadets and fire departments

Posted on Thu, 22 Dec 2011 12:22:38 UTC

Fire cadets play an important role in assisting local fire departments. They also are a great way to encourage young people to go into firefighting careers and EMS programs. While cadet programs aren't considered direct recruiting tools, they are ways to expose students to the life of a firefighter so they can decide if it might be the right career path for them.

Many people aren't even aware that fire cadet programs exist. What are fire cadets and what are their duties? Here's a brief breakdown of how these young future firefighters contribute to local fire departments.

Generally, programs for fire cadets accept people between the age of 16 and 20. Some require that they be at least in the 10th grade. If they're still in high school, most programs require that students maintain at least a 2.0 grade average in order to remain active in the program. If they've graduated from high school, they should be in college and maintaining a good grade average.

Application acceptance for fire cadet programs can be ongoing through local fire departments, or it can be limited to once or twice a year. Applicants must have undergone CPA training and certification prior to applying. If accepted, cadets go through a training program.

The cadet basic training program teaches them introductory level knowledge of firefighting skills, tools, equipment and fire science. It also helps cadets develop positive mentoring relationships with firefighters. The cadet instructors evaluate the students during basic training to assess their ability to undertake duties and their commitment to becoming a fire cadet. Proficiency exercises take place at this level to assess the student's physical abilities.

Some fire cadet basic training programs also require that trainees participate in ride-alongs with firefighters and

Fire cadets generally spend about 100 hours or three to six months in supervised cadet training activities. After that, they are considered for ride-along certification, which gives them an opportunity to accompany firefighters to emergency calls. During this phase of training cadets can spend anywhere from 12 to 24 hours on a firefighting under the supervision of a mentor or instructor.

Although special instructors are responsible for fire cadet training, fire station personnel also sometimes assist with basic training.

Once they've been certified as fire cadets, inductees are allowed to assist fire departments in a non-hazardous capacity. Their duties might include cleaning equipment, restocking supplies and helping to clean up fire scenes.


Apparatus Advances in 2007

Posted on Fri, 28 Dec 2007 10:00:00 UTC

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

At the beginning of the year, the fire apparatus industry really seemed as if it would suffer because of the new 2007 EPA Guidelines for Diesel Engines. While it wasn't all smooth, it didn't turn out as bad as some had imagined. Admittedly, it did require a lot of redesign and engineering of cabs and bodies to have the new engines fit. But it seems that sales have increased in the second half of the year, with many large orders being placed despite the new designs.

This year brought us the PUC from Pierce Manufacturing, which is a new concept that provides ease of maintenance with easier access to the pump, engine and transmission as well as a Pierce Pump. The vehicle also has more compartment space, chest-high cross lays and easier access to the rear hose bed by an angled ladder.

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!

Practicing the MCI response plan

Posted on Mon, 23 Jul 2012 15:25:55 UTC

The multiple casualty incident (MCI) plan for Emergency Medical Services is as strong as the weakest link. There are a lot of links in the chain, so it is critical that every member of the EMS organization develop skills to manage his/her role in a major incident.

Some agencies have developed a routine practice of triage skill testing using a defined period for use of process and props. This process is affectionately called "Triage Tuesday" in many communities.

The goals are several-fold. First, it allows EMS providers to use the basic tools of MCI management, like triage tags. Second, it gives providers the opportunity to discuss their patient evaluation skills with their officers, and importantly, the nurses and physicians at the Emergency Department. Third, it reinforces skills that will create confidence in the providers when the big incident needs to be managed.

The process of using "Triage Tuesdays" instills, and then cultivates, a culture of confidence in EMS providers and emergency department personnel.

Multiple casualty incident preparedness
EMS agencies and providers successfully use everyday operations to prepare for bigger incidents, including MCI events. The daily use of Incident Command Systems for incident management is one of the most important elements of preparedness.

Formal Incident Management System training is designed to prepare providers at all levels and in all disciplines for a multi-agency response. The use of patient triage principles occurs with each patient encounter, and is built around the use of ABCDE patient assessment (Airway Breathing Circulation Disability Exposure) and the differentiation of all types of patients around the basic decision of "sick" and "not sick."

But triage for multiple patient incidents requires another level of decision-making by emergency workers. Those incidents require the caregiver to determine who is sickest among a number of patients, and how sick are they versus the resources that are available to care for them. In the worst of MCIs, someone needs to be prepared to make decisions about who should or should not be resuscitated.

It is these decisions that can be developed using regular training like "Triage Tuesday."

Preparing EMS providers for multiple casualties
EMS providers accept that they practice patient assessment and determination of critical illnesses or injuries with everyday patient encounters. Many resist training for these incidents. There's a few reasons for this:

  • EMS providers don't like to practice. They often have a bias toward actual delivery, and feel that everyday care is difficult enough to prepare for a big incident.
  • It takes time and effort. It distracts from the most important role, which is day-to-day care.
  • EMS professionals don't like "pretend games" at all, and get callused by daily interactions with patients and providers that "play too many games."
  • When things don't go well in training exercises, it can be embarrassing.
  • It costs money to use those materials like triage tags, and other props.

So how can EMS agencies develop a regular and routine practice of triage skill testing? First, use a defined period for use of process and props, like "first Tuesday of every month." Second, work with hospital(s) providers to set mutual goals, like "we are testing and updating processes to prepare for MCIs in our area, for the mutual benefit of the patient." Third, establish a routine practice to communicate the results in each direction, as in "we are identifying areas of weakness in our practice only by accepting suggestions and concerns from your personnel, and hope your agency will do the same."

In the simplest models, the agency's triage tags are applied to each patient who is transported on a given day of the week (or month) before arrival at the hospital. The tag may or may not be used for simple documentation, in addition to the routine patient care report.

The Emergency Department personnel, advised about the process, accept the patient and confirm the accuracy of the patient triage classification, providing simple and immediate feedback to the EMS crew.

Emergency Department personnel may take advantage of the opportunity to test their own triage skills, become familiar with the tagging systems, and use the ED's disaster patient tracking system.

There are more opportunities to expand the training, or add elements once a month to enhance the experience. More props can be utilized, including vests, caps, signage, management boards, and technology enhancements.

Those items that were purchased are dug out of the cabinets and closets, and used for the day. Some agencies will designate the first Tuesday of the month to use the expanded set of tools, designate what type and volume of incidents will utilize the props (every auto accident, or every injured patient incident), utilize field and ED supervisors to provide additional options for testing and management, and produce reports on use of all of the tools.

When agencies are using new tools for MCIs, like bar code devices, the monthly designation allows more providers to develop the skills in using the technology, in the field and in the ED.

An important element of these designated days is to practice the communication scripts. The EMS providers will be asked to use the MCI props, and also to communicate with the patient/family/ED personnel what the props would accomplish in a major incident.

For example: "Mr. Jones, we take care of people every day, and expand those principles when we have big incidents or multiple patients. This is one of the tools we use for big incidents, and we are using it today on all of our patients. We are also doing our regular documentation that is part of your medical record."

In a few places, the supervisors will take the day's incidents and add some elements that give providers some practice in MCI management. At each incident where there is a moment or two where critical patient care is not needed, the supervisor may inject a couple virtual patient encounters to manage, or test the providers on what they would do if this patient encounter was part of a multiple casualty incident that is common for the area. That way a simple patient encounter can be made into a more complex incident for the providers to manage.

Simple and technology enhancements for MCI training
Triage Tuesdays allow the development of MCI skills without moulage, fake patients, and contrived scenarios. It is noted that the skills of MCI management are not developed by moulage administration. Don't waste the money. It is advantageous to expand on real patient encounters, rely on day-to-day patient assessments to train providers on what patients look like, and use simple patient descriptor cards to allow the providers to triage multiple simultaneous patients.

An EMS system could almost develop "baseball cards" that have a descriptor of patient injuries, and have the EMS providers practice going through the cards and making an accurate triage decision. A sample patient descriptor is listed below.

IT applications to Triage Tuesday are very appropriate. Some EMS systems and Emergency Departments have new IT applications that are being utilized, sometimes with new equipment, communication processes, and software.

These special tools require regular practice, especially near the introduction. Regular MCI drills allow practice using the tools, the hardware, and the software. It also helps define shortcomings and bottlenecks. It is likely to greatly benefit the staff of the EMS providers and the Emergency Department.

Regular drills, like Triage Tuesdays, enhance training for emergency providers. With that process, the EMS agency is taking care of people, to include your providers, your patients, and your support agencies. There is great benefit to having, practicing, and improving the EMS MCI plan. Having each member of the EMS agency and Emergency Department skilled in the props, process, and practice will benefit all of the appropriate elements, especially the rescuers.

Triage Tuesdays allow providers to use MCI props routinely. Vests, hats, signage all gets way too buried without regular use. So dust off the MCI kit, write and print a couple hundred patient descriptor cards, and take advantage of all special events. Understand what are high-risk events and use those as scenarios.

Sample MCI Patient Descriptor Cards

Patient 101
Chris Farmley, born on 8/2/88, SS# 123-45-6789, complains of abdominal pain.


Cyanotic, cool, moist

Breathing quality:

Rapid, shallow, guarded

Pulse quality:

Rapid, weak, irregular

Neurological status:

Disoriented; feels pain; responds to verbal stimuli; pupils equal, react slowly

Medical history:

Not available

Further examination:

Abdomen rigid; no other injury evident

Patient 102
Jane Doe, approximately 13 year old Caucasian female with blonde hair, blue eyes, and a one inch scar on her left knee, is unconscious with no apparent injuries.


Cyanotic, cool, moist

Breathing quality:


Pulse quality:

Carotid pulse weak, irregular

Neurological status:

Does not respond to verbal stimuli; pupils dilated, react slowly

Medical history:

Not available

Further examination:

Not applicable

4 key areas for firefighters strength training

Posted on Mon, 29 Oct 2012 08:55:36 UTC

Whether dragging victims from a building or simply humping hose around the fireground, firefighting demands certain types of physical training in order to perform the job safely and effectively.

Traditional firefighter conditioning has revolved around cardiovascular training such as jogging or treadmill work. But the real world dictates that firefighters must have cardiovascular function with nearly 50 pounds of gear on their bodies.

This changes the equation drastically when it comes to being in shape. It dictates that maximal strength and the highest level of anaerobic endurance must be obtained.

To some extent maximal strength can dictate how much endurance you have. If your maximum-effort dead lift is 200 pounds and you're asked to carry a 200-pound person, you won't be moving that person far before running out of energy.

On the other side, if your dead lift is 600 pounds, then a 200-pound person can be moved with relative ease because it only requires 33 percent of your maximal strength.

3 problem areas
Statistics show that most firefighters' physical injuries involve the lower back, knees and shoulders. This is where strength training takes a specific route to bring up strength and decrease injury.

Lower-back injuries often come from lifting heavy patients. Any firefighter who has run ambulance calls has come across residents who weigh between 300 and 500 pounds, or more in rare cases. Obviously firefighters need to be strong enough for that type of duty.

Injuries occur here due to weak lower back muscles, little-to-no hamstring strength and improper technique while performing a task. The first issue is to bring up the lagging muscle groups, then teach form in order to be mechanically sound.


  • Reverse hyper extensions – This builds important lower erectors and glutes while tractioning the lower back.
  • Glute ham raises – This strengthens the hamstrings, glutes, lower back and calves. Working them with this exercise teaches all the posterior chain muscles to work together as they do on duty.

Knee issues can be more complicated, but often firefighters beat their knees up by having weak hips and hamstrings. When jumping, jogging and carrying equipment at a fast pace, the hips and hamstrings must take their share of the work. If they are lacking in strength, the knee extensors attempt to complete the work. Over time this over use of the knee starts to take its toll.

Pain and injury occurs here due to weak hamstrings, hips, vastus medialus muscles and improper form. Once the hamstrings get stronger, knee pain and injury decreases.


  • Glute ham raises – This builds the hamstring in a functional environment.
  • Straight leg deadlifts – This strengthens the hamstrings in a way they will be required to work.

Shoulder pain, tendonitis and injury usually start with a weak upper back. The upper back — which includes the lats, rear delts, rhomboids and sub scapular muscles — needs to be strong in order to hold the shoulder joint in place under strain and to maintain correct posture while performing various tasks.


  • Rear delt row – This directly builds the rear delt and sub scapular muscles.
  • Bent over row – This builds the lats and also the rhomboids, traps.
  • Lat pulldown – This builds the lats, rear delts and most minor muscles groups of the back.

Cardiovascular endurance
Working on your cardiovascular endurance is important in maintaining your overall health and aiding your recovery. Many firefighters remain on the job well into their 50s; and some, especially volunteers, remain past 70.

High-impact activities, such as jogging, over time will increase injury and wear on the knees, back and hips. Therefore it is important to gain endurance with the least amount of negative impact on the skeletal system.

Sled dragging is one of the best overall tools to develop conditioning while building muscle in important areas. There is virtually no joint impact and with the proper weight can be just as intense as running is on your heart, lungs and lactic acid tolerance.

Dragging the sled backwards is similar to dragging people out of buildings.

Kettlebell swings are a very tough cardiovascular drill and very quickly improve the conditioning level of firefighters. I have seen U.S. Army Rangers buckle to the floor with 60 pounds in less than 5 minutes while doing swings, while it was no biggie for these guys to run more than 10 miles.

A strong lower back and abdominal base must be built before using this exercises with anything more than 25 pounds. The benefits of using a kettlebell is no joint impact and a great workout for the cardiovascular system and much of the entire muscular system.

Training on the job
It is important for firefighters to train at an optimal level of volume and intensity when on duty or scheduled for duty within 24 hours.

Firefighters must still be able to perform their job at any moment while on their shift. Totally wrecking the crew will not be optimal for a possible fire or other emergency. This is why training must be individualized for each person.

These issues are 90% of the problems I have seen in the four years of working with a large fire department. The variety of ages and body types means that training will require different starting points and constant revision to keep individuals progressing.

Unnoticed door locks increase firefighter risk

Posted on Tue, 17 Sep 2013 09:17:42 UTC

For many departments, the first-due engine is staffed with three to four firefighters, in some cases even fewer. There are five key job functions that must occur: size up, action plan, water supply, the initial stretch and forcible entry. These items will quickly tie up a short-staffed rig.

Luckily, in many parts of the country forcible entry is fairly simple. In many communities key-in-knob locks are the primary, if not the only device keeping the "bad guys" out of peoples homes. A short throw on the locking mechanism combined with wooden doorjambs means a very basic forcible-entry effort is all that's needed.

Recent UL studies — as well as years of studies from overseas, particularly Northern Europe — all point to the importance of door control on fire progression. Smooth forcible entry not only allows us to put the line in the right place, but also provides for better door control.

For many departments, the forcible-entry team will also be on the initial hand line. Quick and easy forcible entry allows for the team to still have the energy needed to make the attack.

Barring the way
It doesn't take more than a stroll through the local big-box home store to see that are several off-the-shelf devices to make door harder to force. These cheap and easy contraptions not only sell to homeowner's fears of invasion, but also require no skill to install.

The most prevalent are bars to buttress inward-swinging doors closed. And because they don't require additional hardware on the door or jamb, you won't necessarily know it is buttressed when sounding the door.

During a recent structure fire at a center hall colonial, after performing my 360 with no visible flame or smoke on the interior, it became clear that the unlocked side door gave the easiest, most direct line of attack for the first-due engine. The homeowners weren't home yet, but luckily the fire remained external due to a lightning strike. While walking through the house we discovered a store-bought device on the locked front door.

As we discussed the event later, some things became clear. Had the fire progressed to the interior, I would likely have placed the initial line through the front door.

The likely outcome
Our first-due engine would have begun forcible entry on that door and would have met with more resistance than seemed appropriate. The front door didn't have sidelights that would have made it possible to view the device from the exterior.

These slow downs would have likely led to a change in tactics, such as heading to the side door, and possible even a change in strategy given my team would have wasted time and energy on the front door.

Worse yet, had they headed in the side door, our truck crew would have begun to soften egress points incase the interior teams had to escape. Naturally the interior teams would consider the front door at the base of the stairs a natural exit, only to find it barricaded.

A quick web search of home door security bars will show the myriad of devices out there for the general public. Don't get me wrong; we can overcome these devices.

However, the standard size up isn't going to see the device and command is likely going to create an action plan that doesn't fit the tougher forcible-entry profile these devices create.

Add that to short staffing and everything slows down except the fire growth.

Fire trucks, flags and the law

Posted on Mon, 5 Oct 2015 20:03:26 UTC

Coming at a time when we are raw from its association as a symbol of hate in the massacre of nine worshippers at a historic South Carolina Church, discussions about the history, meaning and display of the Confederate battle flag are passionate and divisive.

In July, a Minnesota firefighter was suspended pending an investigation arising from flying the Confederate flag alongside the Stars and Stripes on a department truck in a 4th of July parade. He was removed from the department, supposedly following an investigation into the incident.

What does this have to do with your department?

Unless your jurisdiction has an ordinance prohibiting it, display of the Confederate flag is legal. So is burning the U.S. flag.

But your department would not tolerate on-duty burning of the U.S. flag as free speech. Do you equate the two? Would your taxpayers?

Conduct that does not fit snuggly into a specific policy forces an analysis of policies on unbecoming conduct or conduct that reflects negatively on the department.

If your department has a Confederate flag policy, let me know. I'd like to see it.

Tensions increase and the analysis can be more troublesome with off-duty conduct. How would you address a firefighter who displays the Confederate flag at his home, or a firefighter who has a Confederate flag sticker on her vehicle?

Three considerations
Here are a few points to consider in the discussion of firefighter conduct absent a specific policy.

First consider the department's culture. Examine your department's code of conduct and conduct unbecoming policy.

When were they last reviewed and updated? Also look at whether or not they have been applied in the past. And ask if they accurately reflect the culture your department strives to maintain.

Next consider public trust. It is important to weigh the impact and potential impact on the community, the taxpayers who support the department.

Finally, consider the context. Are you curious about the connection, if any, between a Minnesota department and the Confederate flag? Would a historic connection make a difference?

Additionally, the federal flag code contains rules for displaying the U.S. Flag. Your state may have additional statutes and penalties related to display of the U.S. Flag as well as your state flag.