Top 3 products you can't get in the US — yet

Posted on Mon, 22 Oct 2012 23:40:56 UTC

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

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

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

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

How About a Culture of Prevention?

Posted on Mon, 29 Jun 2009 19:32:56 UTC

By Bill Delaney

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

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

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

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

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

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

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

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

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

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

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

4 EMS calls I used to wish for

Posted on Mon, 6 Oct 2014 22:51:48 UTC

One of the great paradoxes of human thought is the idea, “Be careful what you wish for; it might come true.”

We tend to associate the warning with great wealth or fame, but I think is has application in the EMS realm as well.

We often begin our careers with a flurry of training and activity. We attend classes and complete homework assignments. We study for tests.

We go on ride-alongs and fill out job applications. We interview and join organizations. Often there is a field internship and a probationary period.

As quickly as it all started, one day we look in the mirror and we’ve arrived. We iron our new uniform, place our new stethoscope in our cargo pants (It was a gift from mom after all) and arrive at the station ready to work. At this moment, it’s only natural to want to test our mettle.

I get it.

At the outset of our careers, we typically refer to them as “good calls,” the calls where our skills and training are brought to bear. We want to know what it’s like to be in the middle of the chaos. We want to feel the thrill of life and death hanging in the balance.

The calls I used to wish for
Stay around in this industry long enough and chaos and tragedy will find its way to your doorstep.

I don’t say this to admonish you. I was no different when I began my career.

I used to wish for challenging cardiac arrest presentations until the day a family called for their two-month-old infant who had stopped breathing in his crib. I don’t wish for challenging cardiac arrest scenarios anymore.

I used to wish for metal crushing car accidents and complex extrications until a group of four teenage girls pulled out in front of a van on a two-lane highway. The impact ripped the vehicle in half.

I don’t wish for car accidents anymore.

I used to wish that I could be a part of a large MCI that would make the national news and be remembered for years to come. Then two students at Columbine High School showed up one morning with guns and bombs. I was sipping my morning coffee at a street corner post a few miles away.

I don’t wish for MCIs anymore.

I used to wish for a prehospital delivery. I wanted to say that I had delivered a baby on my own.

Then a mother of five deep into her labor called 911 in a rural area 90 minutes from the closest hospital. Her meconium stained child was flaccid and struggled to breathe unassisted.

I don’t wish for prehospital deliveries anymore.

The price of experience
It’s worth remembering that when we wish for “good calls” and the opportunity to test ourselves, we are also wishing for fear and tragedy and pain and misery and grief and sorrow.

Often, in our wishes, we picture ourselves rendering care, but we fail to envision the screams of pain, the tears of family members and the horrible consequences of lives forever ruined.

I don’t want to discount the value of experience. I’m glad that I’ve responded to challenging calls and that I know what it’s like to rise to the occasion. There is a certain sense of satisfaction when the best within us rises to the occasion, even when the occasion happens to be the worst of human experience.

But there is a price.

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at steve@theemtspot.com or at Steve.Whitehead@EMS1.com.

Will they remember the 343?

Posted on Wed, 11 Sep 2013 16:45:03 UTC

Sept. 11, 2001 was a life-defining moment and as the events of that day became known, we got a sense of history coming into play. As 9/11 now recedes into history, future generations will come to see that day in different terms and we can only imagine how they will view what happened.

Very little is certain and it is safe only to assume that if history is any guide to the future, events unforeseen will occur and render our inadequate predictions meaningless.

Sept. 11 briefly unified firefighters and increased public respect for firefighters. Recall how frequently you heard, "Thank you for your service."

Now a dozen years past, we don't hear the "thank you for your service" much, perhaps because the event grows more distant in time. Firefighters I talked to in the dark months after 9/11 described an overarching new view of a world where only the polar extremes of black and white existed; any intermediate shading was lost in the collapse of the towers, the destruction at the Pentagon, and the charred hole in the ground in rural Pennsylvania.

Perspective shift
This "black and white" worldview incrementally transformed into an "us versus them" view as the recession cut into municipal fire budgets and angry taxpayers questioned firefighter salaries and pensions.

What I see now of 9/11 comes mostly from the metropolitan New York City and New Jersey area where there remains a steady, reverent and solemn memorializing of the 2,753 civilian victims and the 343.

Something has changed us since 9/11. Years of conflict, economic upheaval, and elected high-officials who place politics above leadership has tired us and almost demoralized us as a country. Cynicism and skepticism cuts a deep vein through public opinion forcing us to identify our tribe or faction, one group demonizing the other, with the fire service no exception.

The unity of 9/11 was fleeting and our collective cynicism seems poised to poison our views of everything, mixing the good with the bad. It is black and white; those not with us are against us.

Forward looking
In 40 or so years, Americans will number about 438 million. Nearly one in five will be an immigrant. In 12 years, the foreign-born share of the population will surpass the total from the last great wave of immigration seen over a century ago.

Latinos, now our largest minority group, will triple in size by 2050 and the non-Hispanic white population will become the minority. Our elderly will more than double by 2050, as the baby-boom generation enters so-called retirement.

The numbers of working-age Americans and their children will grow more slowly than the elderly population, shrinking as a share of total population and finding it more and more difficult to support the aging members of society.

The victims of 9/11 were a diverse group demographically speaking and maybe that will improve the likelihood of future generations sharing at least a small sense of connection to those we lost on 9/11. For it is only a sense of connection that gives us a desire to remember the past.

Realistically though, it is more probable that they will come to see 9/11 solely as a historic event, similar to how we now view Pearl Harbor.

The near things
There will be commemorations and memorials to those who were murdered and those who sacrificed their lives to save others, but the depth of symbolic emotion will fade in time. Let us hope then, that there will always remain at the very least this lesson — that the firefighters of FDNY put their lives at risk for other people and more than 300 paid the ultimate price.

As new significant events capture the thoughts of future generations, life will go on, the memory of the 343 will recede, and that is the point where history takes over. Geographer Waldo Tobler stated that the first law of geography is: "Everything is related to everything else, but near things are more related to each other."

I frequently borrow Tobler's Law and use it to think about history, adapting it as: "The nearer people and events are to you in place or time, the more important they are to you all the time."

I am a firefighter and so I care about other firefighters. If you live in or near New York City, you likely care about New York City and 9/11 will always be somewhere within in that frame of reference. All that we can presume is that if you are a firefighter, or you live in proximity to New York City, your world will include 9/11 and the 343, and the memory will not fade with time.

The sacrifice of so many to uphold a commitment to save lives is never easyto understand fully or to forget entirely. History provides the opportunity for future generations to remember the courage and humanity of the 343.

Fire station DVR crashes, grief counselors called in

Posted on Tue, 1 Apr 2014 08:01:44 UTC

SLEEPY HOLLOW, N.Y. — It's being blamed on a lightning strike or possibly a surge from a ComVolt substation. Either way, the destruction of the station DVR has left agony and uncertainty in its wake.

"We just don't know where to turn," said Sleepy Hollow Firefighter Ted Riklyner. "In a split second everything was gone - all seven seasons of "Rescue Me" with outtakes and interviews plus the complete set of "Emergency!" You have any idea the time and commitment our guys put into recording those programs? Many came in on their days off to make sure the DVR was set and running."

The power surge hit about 8 p.m. Friday, setting off small popping sound followed by a flash and a wisp of smoke from the DVR.

"We were just in shock," Riklyner said. "We sat there staring at it; good thing it didn't catch fire as we'd have been goners."

Fire departments rely heavily on their equipment and few pieces are more important than a DVR. Without it, firefighters on low call-volume departments like Sleepy Hollow can go out of their minds with boredom.

Town officials wasted no time bringing in a team of grief counselors to help firefighters cope with this tremendous loss.

Following the counselors' advice, Sleepy Hollow firefighters are spending their time washing trucks and practicing firefighting skills.

"It's a way to keep our mind off the tragedy," Riklyner said. "Eventually, we'll get a new DVR and rebuild the collection; we're just not at that place yet."

The best firefighters know when to get extreme

Posted on Thu, 25 Sep 2014 19:05:30 UTC

It seems normal is no longer in our vocabulary. There are extremes in all areas of our lives — extreme heat, cold, flooding, snow, wildland fires, mud slides, you name it.

Then there is the "biggie size" when you order your food. A small is now what was once a large. Nothing is small any more. It has all becoming extreme.

Our lives are extreme. Maybe it is part of the American culture — biggie size everything, right? Make it the extreme experience.

If we are in the era of extremes, why don't we do extreme training?

What is extreme?
We may have pushed the envelope using the term extreme by pushing our limits to the utmost. Do we really need to go to the extreme?

The answer lies partly in how you define extreme. Extreme is defined as reaching a high or highest degree or being very great.

This definition does not sound like a bad thing. We want the very best. If individuals want to be the best at what they do, they should push the limits to make themselves better.

We can look at this topic in two ways.

First, we should not push things above our limits. We should push forward and always try to better ourselves, but we don't need to make everything a biggie size.

If we think about the extremes of food and the biggie size, we need to change our mindset. Extremes in food results in extremes in body size. Our culture has become the culture of obesity. As a result, disease is running rampant in our society. We need to bring our size back to reasonable servings.

Weather the weather
Second, in contrast to getting away from the extremes in our eating, we need to get back to the extremes of training. If we are going to be good at what we do then we need to get off our backsides and get back to training.

The mind set in the fire service seems to have changed: 'Let's do training, but when it is convenient, and by the way, can we do it online?' We need to get back to training the way it was intended.

Doing an online class is not training; it is education. Can't figure out the difference. Let me help.

Your daughter comes home from school and tells you she is going to have sex training this year in school. What was the first thing you visualized. We immediately think of the action not the process. Hence, we should be training not just educating ourselves.

Balancing act
There are times for education and times for training, but without a balance of both we'll not have the knowledge and skills we need to do our job, which in many cases is under extreme circumstances.

Incident scene rehab training is no different. You can't experience setting up and managing a rehab sector by only reading about it. Get out and do it.

You should be practicing establishing and managing rehab at every training event. Get personnel used to having to go through rehab. Every meal you eat, every shift you work, practice rehab. Eat right, exercise, hydrate, and get to know the limitations of your body.

Extreme training should be part of our culture. It does not mean we work so hard that we collapse. It means to work to the highest degree to be the best we can.

When we have extreme weather it is the highest degree of heat, no pun intended, or the highest degree of flooding that could occur. Winter is fast approaching and we should not use that as an excuse to not train.

I know of a fire department that actually has it written in its collective bargaining agreement that they will only do training if it is below a certain temperature and above a certain temperature. Really? Give me a break. We function in extreme environments, we need to train in those environments so we know how we need to function when we are faced with those environments.

Be the best you can be at what you do. Go to the extreme and have the highest degree of trained personnel. It will pay dividends in the long run.

10 ways to better respond to special needs patients

Posted on Wed, 9 Jul 2014 17:59:06 UTC

Paramedics and first responders tasks are becoming increasingly challenging with the growing number of special needs patients. According to the 2010 census, 2.8 million school age children were reported to have a disability.

In order to minimize problems and have an effective response, EMS and fire must create a stronger partnership and network with the special needs community. Here are 10 steps to successfully do so.

1. Don’t assume the patient has a mental disability based on their looks.

“Approach a special needs patient as you would a colleague,” said Pete Kelly, EMT-B, medical staff coordinator for Special Olympics Michigan. Once you have established mental and physical ability, than treat accordingly.

2. Have a Town Hall meeting with citizens and all essential resources.

Have 30 minute panel discussion with fire, EMS, law enforcement, transportation and a special needs specialist followed by a meet and greet. This is a great way to hear special needs populations’ concerns.

3. Encourage caregivers to keep information up to date.

The American College of Emergency Physicians and the American Academy of Pediatrics created an Emergency Information Form (EIF). The EIF is a valuable tool for first responders. Click here to download the form.

4. Develop a Special Needs Registry.

Emergency management agencies are creating an online registry to locate citizens with a disability during an emergency. Ohio County recently launched their website ReadyAllenCounty.org. Sites are usually in the cloud and need to be secure.

5. Include people with disabilities into emergency response plans.

The U.S. Department of Justice provides an American with Disabilities Act Checklist for Emergency Shelters.

6. Don’t separate equipment from the patient.

During an evacuation or a transport to the ER, try to keep the equipment with and the patient. Separation from an object can create outburst in some patients.

7. Be familiar with the equipment.

First responders can’t always keep up with the latest wheel chairs and devices. Here are a few of the latest devices. Convaid offers a special needs wheelchair product line that has advanced design, seating and mobility combinations for a variety of special needs and physical disabilities.

A child with a TheraTogs Lower Extremity System might be a challenge to transport. The device is designed to address several alignment and functional deviations of the knee joints, developing femurs, and hip joints in a child.

8. Keep the routine.

Mary Porter, owner of Tri-Care, says when dealing with a patient that cannot verbalize a compliant, Tri-Care staff often knows there is a problem when a patient is not sticking to the routine.

9. Get trained.

In recent years there has been a surge in organizations that have created training for first responders. About 1 in 88 children have been identified with an autism spectrum disorder (ASD) according to estimates from CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network.

In addition, Autism ALERT’s mission is to educate first responders and health care professionals on how to recognize and interact with persons on the autism spectrum.

FEMA also suggests the independent study courses offered by Emergency Management Institute IS-197.EM Special Needs Planning Consideration.

10. Use the right communication.

Minimize distractions and use short explanations and use simple language, if the patient has trouble hearing. If you do not understand something the individual says, do not pretend that you do. Ask the individual to repeat what he or she said and then repeat it back. Be patient.

Creating a strategic plan before, during, and after an incident with special needs population is the most effective way to have a good response and recovery.

3 legal lessons to learn from 2011

Posted on Wed, 21 Dec 2011 00:26:29 UTC

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.

What are some cultural faux pas in firehouses?

Posted on Tue, 14 Oct 2014 22:26:47 UTC

Touching or tampering with any firefighter's turn-outs or safety gear is a definite no-no. Never move anything on a fire engine without a firefighter or the equipment operator present.

Walking into a firehouse, without knocking or announcing yourself could be a faux pas. Firefighters consider the firehouse as their house. They take pride in keeping it up and could be surprised if non-firefighters just walked in on their semi-private area. It's also good to remember that firefighters usually work twenty-four hour, or longer, shifts. After the first night they may be a bit worn out. Firefighters have to go from zero to 90 when the alarm sounds. If you are in a fire station when the alarm sounds, most firefighters would expect that you leave or get out of the way so they can quickly lock up and go. For everything else, just use common courtesy.

Firefighter rehab lessons from a triathlon

Posted on Thu, 25 Sep 2014 17:40:42 UTC

I recently had the pleasure of providing medical support at a New Jersey Ironman event. While working in the medical tent at the end of the 1.2-mile swim, 50-plus-mile bike ride and 12-mile run, it struck me how in many ways it was similar to a rehab sector at a major fire.

But upon further consideration, there were some significant differences as well.

First, I noticed how varied the participants were in terms of physical condition. I expected most or all to be in excellent physical shape to participate in the event. But there were many who were somewhat overweight — but they finished.

We experience the same at a fire scene. Some firefighters are in excellent shape and others could use a bit more diet and exercise. As medical providers, we need to be able to treat individuals of all shapes and sizes. But I will note that at this athletic event, the overweight participants were not the fastest, but they also in general did not need our medical services.

"I did not prepare"
The participants that did need medical evaluation had an almost universal statement: "I did not prepare or train as much as I should have."

We can all take a lesson here. We need to prepare ourselves for the task at hand, whether it be running a marathon or making a grab at a working structure fire.

Athletes have the advantage of knowing when they are going to compete. We do not.

Career firefighters' call to duty may be anticipated by shift, but in reality we need to be ready to go any time the bells go off. We need to train and prepare ahead of time so we can be of service to our community and not a burden to our fellow firefighters.

Guerrilla triage
Operationally, we found it quite valuable to station a couple EMTs at the finish line. Our tent was close, but these "triagers" were able to eyeball each participant and assess whether medical treatment was needed or if the runner was simply tired.

This is exactly the role I tend to assume on the fireground as a fire department physician. As firefighters are walking around, doing their assigned task or approaching the rehab sector, I look them in the eye and watch how they walk.

I am looking for a purposeful gaze, a steady gait and clear speech. They can be tired, but they should not have an alteration in mental status. Those that show these signs are engaged for further assessment.

Just as at a fire scene, the environmental conditions play a significant role in the number of individuals that presented for care. On this day, it was cloudy with temperatures in the 70s. This was ideal and certainly lessened the impact of the exertion.

On the fire scene we need to be aware of the conditions as well. A hot day with high humidity results in significant exertion even at a non-working fire scene. Awareness and anticipation allow us to be better prepared to care for those that need it.

Difference in focus
Again, there are a number of differences between the triathlon and the fire ground. Now I understand that what I describe below may not happen everywhere, but I have seen examples enough times that we must acknowledge they occur.

None of the triathlon athletes were embarrassed for needing medical evaluation and care. They did not try to minimize complaints or issues and they were honest with the medical providers, even if they had to stop in the middle of the race.

Too often I see firefighters (and tactical operators, law enforcement and other athletes) minimize their complaints with a goal of getting back in the fight. This is noble, but we must admit that it may be a bit selfish.

If you are hurt more than you let on, you could be a liability to your department, your mission, or your team. Be honest with us and let us help you get back on your feet to fight, even if it has to be on another day.

Perhaps this was a unique group of people, but these tri-athletes really seemed to work with us. As a result, we were able to effectively treat them and the number that had to go to the hospital during and after the event was very small.

What's in a name?
Obviously the other major difference was the overall situation. In one case we have a recreational athletic event, and in the other someone may have lost a home, occupants or fellow responders may have been injured or even killed. The stress level is inherently different.

This may explain the denial of complaints seen at fire rehab; rather than a conscious decision, firefighters may not realize how injured they are due to their focus. In addition, staffing can be an issue.

The athletic event was planned months in advance and staffing was known. The fire scene is unplanned, and staffing may be stretched on both the fire and EMS side, limiting our ability to be efficient in the rehab sector.

These two situations seemed similar, but in many ways were not. Even the name was different — we were medical or Athlete Medical Support.

I wonder if our thoughts (and sometimes prejudices) about the activities going on in a firefighter rehab sector would be different if we called it Firefighter Medical Support. Perhaps the term rehab has a negative connotation — implying that something is wrong with you that has to be fixed, like physical rehab, drug rehab, rehabbing an old house for example.

Stay safe.

Another great CFSI dinner in the books

Posted on Fri, 30 May 2014 20:47:41 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 update@cfsi.org

Use this analysis tool for a better EMS grant proposal

Posted on Tue, 14 Oct 2014 21:46:56 UTC

Building a strong argument for your grant proposal is not an easy task, but using a cause-and-effect analysis to determine which areas to focus on can make the process a lot easier.

First, determine what problem are you trying to solve. For some agencies this could be quicker response times, increasing cardiac arrest survivors, or reducing injuries for on-duty personnel.

When constructing a grant proposal, be mindful of every facet of the problem and how it affects your agency and the community you serve. There are many ways to accomplish this task; one that I find very useful is the fish-bone diagram.

This technique helps identify many possible causes for a problem, and can lead to great brainstorming for an individual or a group.

For example, here’s an example of the fish-bone diagram showing a problem of missed free throws in basketball.

As you can see, the diagram lists the possible causes that have led to the effect of missed free throws. The example above does a great job providing a broad range of specific causes, and this is exactly how you must approach a grant proposal.

Cause: Poor cardiac arrest outcomes

For our example, let’s say an EMS agency is experiencing poor outcomes for out-of-hospital cardiac arrests. What factors could be contributing to these poor outcomes?

Was bystander CPR done? Were AEDs available and used? What was the response time of EMS? How far was the incident from the nearest hospital?

Take a moment to construct your own fish-bone diagram and submit it in the comments below.

Effect: Poor cardiac arrest outcomes

Now that we have an excellent idea of what causes our problem, how do we develop this information into a grant proposal?

Through your fish-bone diagram, you concluded one cause was poor AED availability. To break this down even further to get to the root cause, we could do another fish-bone diagram for just poor AED availability. However, in this article we are going to keep it simple.

We will use this information for an extremely common grant application question: summarize the purpose of this request. In this case, the purpose of requesting funding for AEDs would be to improve out-of-hospital cardiac arrest for your community.

This is a clear and concise opening statement that leads the way for a great grant proposal.

The fish-bone diagram is a useful tool to dissect your problem and better highlight root causes of a problem that often have financial implications and can be addressed through grant funding.

Greek tragedy for firefighters

Posted on Mon, 12 Jul 2010 21:35:47 UTC

By Jay Lowry

What does the Greek financial crisis that hit the headlines earlier in the summer have to do with fire stations being built?

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.

Rescue is a Thinking Person's Game

Posted on Wed, 8 Aug 2007 19:38:53 UTC


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.

Rescue lesson: How to 'read' vehicles before cutting

Posted on Wed, 10 Sep 2014 16:24:45 UTC

We know the importance of reading and discerning fire behavior. Analyzing the structure and the way it is burning allows us to make competent decisions to put the fire out.

The same is true for performing vehicle-extrication operations. One of the most common mistakes involves misplacement of tools when trying to move metal.

The first thing is to develop is an understanding of the anatomy and construction of today's vehicles. This falls into two basic categories: body panels and structural elements.

Body panels are the vehicle's skin. Generally, late-model passenger-vehicle body panels are thin and lightweight and provide minimal rigidity or resistance. Rigidity or resistance is greater where bends are present, particularly on fenders, quarter panels and deck lids.

These are somewhat reliable points to push against or establish capture points. The flatter body-panels surfaces are easily displaced and sheared unless they have significant reinforcement. Hoods, deck lids, and roofs will present a wide variety of reinforcement, but the only panel that may have substantial reinforcement is the roof.

These flat areas are unreliable push-and-capture points. If you have to use them as such, the reinforced areas should be identified so that you can focus your attention there. Here are two examples.

Case 1
You arrive on the scene of a SUV on its side. You want to stabilize the roof side with struts, but the roof does not provide a good capture point.

You can use simple hand tools to quickly shear the thin roof panel to make a pocket for the head of the strut, or if the strut has a piercing head, drive it into the panel.

It is important to position this capture point and the head of the strut as close as possible to the structural rail above the high-side window openings. If the strut head were placed in the middle of the roof panel and the vehicle shifted, the potential for the strut to shear the panel and become displaced is significantly increased.

Modern body panels are typically attached to inner construction or more structural elements with automotive adhesives and plastic retention pins or clips. Nuts and bolts are few and far between. This allows rescuers to easily peel and displace body panels.

However, this is often an undesirable outcome. Peeling body panels exposes inner construction but does not increase access to our objective. It also weakens the overall design of that vehicle component and makes the removal more difficult.

Case 2
When attempting to force a door by popping the Nader pin and door latch, you place the spreader tip on the edge of the door and quickly see separation between the outer layer of the door panel and the inner construction of the door assembly. This is commonly referred to as skinning or peeling.

If you continue to spread, the outer panel will separate but the Nader pin and door latch connection that you are attempting to pop will remain intact.

If you relocate your tips to the inner construction of the area you are trying to attack, the metal will displace rapidly and fold around the latch rather than popping. That is because you have weakened the overall resistance and rigidity of the door.

How they present
Once you understand these fundamentals about body panels, you can apply some methodology to your tool placement and extrication techniques. When forcing doors, look at how they present and read them.

The weakest part of a door is the middle. Using vertical spreads in the window opening to create purchase points for hinge or latch access make the most sense. It makes sense because it attacks the weakest portion of the door and develops an outward extrusion in the door. This will take the energy and movement of a door pop away from the victims inside.

The next objective is to spread the latch assembly and or spread or cut the hinges. It is easy to develop tunnel vision toward the latch assemblies and hinges and attempt to gain access to these by spreading the door at their locations.

These are the strongest points of connection between the inner door construction and the vertical posts or pillars of the vehicle. This misapplication of tool placement often results in peeling or skinning because the initial tip placement occurs on the outer panel.

Attacking the gap
If you assess the door presentation after the initial window spread, there is typically a purchase point or gap created between the window rails and the vertical posts of the vehicle. The window rails are a more structural steel that commonly runs down into the door assembly and is connected to the inner door construction.

Attack this gap and incrementally spread and relocate the tips. Work deeper towards the inner construction and progressively move down towards the latches or hinges. This maintains the integrity of the door and increases the likelihood of an effective displacement.

Once you have gained adequate access to the door's inner construction around the latch assembly or hinges, spread it out and pop the connection or cut it.

Take a moment to look at the body panels. Evaluate the inherent weak points and use those as well as the overall design and presentation of the panel to your advantage. Let the tools do the work.

Structural elements
The structural system is the skeleton and muscles of the vehicle, yet it does more than give it form. It has energy-absorption points known as crumple zones. These are segment breaks or weaker points in a structural member that allow it to withstand tremendous impacts and absorb or dissipate energy before it reaches the occupants.

We now have eye-popping collisions with tremendous vehicle damage with passengers that are entrapped but minimally injured based. The other facet to these engineering principles is that newer vehicles have incredibly rigid and strong structures around the passenger compartment.

This means high-strength steels that are difficult to cut or move. This translates to new tool requirements and a deeper understanding of what we can effectively cut and where we should cut.

By looking at the structure of a vehicle as a skeletal system, we can determine that isolated relief cuts are usually far less effective than multiple relief cuts. Rather than trying to remove an entire element, simply weaken the areas around that element and then move it. Here is an illustration.

Case 3
You have removed the side and roof of a vehicle in which the dash is impinging on a passenger. You prepare to lift the dash by making one relief cut in the A pillar between the dash and the rocker.

You then place your spreaders into the cut and attempt to lift, but the dash reaction is minimal and the A pillar that you are spreading starts to shear apart and displace in an undesirable way. If you continue to spread, you may start to shear the floor pan, separate the rocker and push the floor down.

This may get you what you need, but the travel is contained to the gap between the original position of the floor and the ground or cribbing. If you take the time to add a relief cut to the fender rail between the front wheel suspension hub and the firewall, you will free up the dash so it can freely displace with minimal resistance.

Fold the B post
The weak points within the structural system are generally connections between members or the crumple zones. Understanding the structural system and its relationship with the body panels will pay dividends when extricating.

I apply this frequently with side-out techniques. Instead of always making two initial cuts on an intact B post, I often make a single high-side cut and fold the B post down by spreading the cut, or placing a ram between the roof rail and the door at the bottom of the window opening and pushing.

When folding a B post, the spot welds that attach the B post to the rocker usually breakdown and allow the entire side to be walked to the ground or sheared with greater ease.

If I am performing a rip and blitz or a side-out technique where I am opening the entire side like one big door, I ensure that I am shearing the partial cut at the bottom of the B post by spreading against the rocker and a point very close to the lower hinge on the door.

This uses the structural resistance of the rocker rail and the inner construction of the door and hinge to my advantage. This also helps pull the B post out and away from the passenger.

It is easy to get overly focused on the task at hand and not take the time to really look at what the vehicle is giving us. Here are the take away points.

  • Attack the gaps that give you structural or inner construction access.
  • Don't pull on the skin and expect the body to move.
  • Bend the joints and connections or create joints with cuts to move components efficiently — It's easier to move the leg if you bend the knee.

Every extrication event is different, but every passenger vehicle is fundamentally the same. Rely on the constants to overcome the variables. If we take the time to read the vehicle, we will be much more effective at accomplishing our objectives.

How communication centers can aid incident commanders

Posted on Tue, 13 Jul 2010 21:03:09 UTC

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."

The best tools for firefighter rehab sectors

Posted on Tue, 19 Jul 2011 17:21:35 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!)

Funding Opportunities: What's in Your Backyard?

Posted on Mon, 11 Aug 2008 20:36:01 UTC

With most grant programs becoming more competitive, I've noted more emphasis being placed on applicants providing thorough vulnerability assessments of their area. These are intended to identify vulnerabilities in the jurisdiction requesting the funding and how the approval of your grant application would address them. Often, these vulnerability assessments can be crucial in the ultimate award decision. So how does one conduct a thorough vulnerability assessment? At the outset it would appear to be a daunting task. However, if the individual conducting the assessment utilizes the proposed systematic approach, it may be easier than you think.

The first step in conducting the assessment for your jurisdiction is to identify the risks, both natural and technological, that could have an impact on your community. Natural risks include weather phenomena such as hurricanes, earthquakes, tornadoes, blizzards, flooding, etc. I think that these vulnerabilities are often overlooked when assessments are written. A query of the local National Weather Service office will often yield a substantial quantity of data for inclusion into your assessment. This portion of the assessment does not need to be lengthy – but a few sentences that describe the natural risks to your community does provide the grant review team with a sense of your community and it shows that you have performed a thorough assessment.

Technological risks are much broader and can be more complex. I like to look at components of the infrastructure first, beginning with utilities. Examine the power grid of your community. Contact the local utility provider and arrange to meet with them. Ask them to describe the components of the power grid that provides electricity to your community. Where is the power generated? How many sources of power generation are there within the grid? What plans are in place to provide for supplemental power should portions of the grid be compromised? How many substations are within you community? How long will it take to repair or replace a damaged circuit or switch within the station? You will find that the power grid is more complex that most might think.

Water supply is the second most important utility component. Again a meeting with your water utility company might be warranted and again there are three many components that you should be interested in. Where are water supplies located? The supply sources may be reservoirs, wells, streams or rivers. These intakes are critical and sensitive components of the infrastructure and should be discussed within your assessment. Other components to identify are storage locations of treated water and the location of valves that serve distribution grids.

Communications (telephone), dams, natural gas supply and sanitary sewer infrastructure should also be investigated and discussed within your assessment. However, should your jurisdiction contain power generating facilities, major power transmission infrastructure or sources of water supply always mention it in your assessment. These are crucial components your community’s infrastructure.

After reviewing utility infrastructure, I then focus upon transportation vulnerabilities. Interstate highways and the bridges that connect these highways between jurisdictions are always listed first in my assessments. Not only should you identify these transportation arteries and how many miles are within your jurisdiction, you should also obtain traffic count data and list it as well. This data is often obtained from the state department of transportation or highways. Most of these agencies provide this data electronically. Find it and include it in your assessment.
I list railways next. Determine which railway companies have tracks within your jurisdiction and how many miles they operate. Passenger railways should also be included and remember to include the number of passengers that utilize the railway annually.

In the case of both highway and railway, I include commodity flow analysis data. This data is easily obtained from railways, though often more difficult for highway transportation. Most of the major railways will provide public safety personnel with a list of the most frequently shipped hazardous materials from the previous calendar year. This data is obtained by writing the railway and asking for it. This data, which may fluctuate a little from year to year, will provide you with you with the quantities and hazard class of the materials being transported through your community.

As I previously mentioned, highway commodity flow analysis is more difficult to obtain. However, some states do compile this data and will provide it to public safety personnel. In my jurisdiction, the local emergency planning committee commissioned a local university to develop a commodity flow analysis for the several interstate highways that traverse the region. Another method that I have used to collect the data is a simple windshield survey of placards and trailer types conducted over a period of several hours at different times of the day. While not ideal, I’m always able to identify the hazard class and I usually try to extrapolate the number of shipments over a 24 hour period using the number of bulk shipments identified within peak and non-peak travel times.

I next focus upon industrial vulnerabilities. These often include facilities that store extremely hazardous substances (EHS) or hazardous chemicals. The local emergency planning committee is the primary source of obtaining this data for your jurisdiction. With respect to EHS facilities, I list the number of facilities, the types of chemicals stored and the area (in terms of square miles) of the jurisdiction that are included within each facility’s area of vulnerability. The area of vulnerability is the portion of the community that could be impacted by a release of an EHS. Don’t forget to mention EHS facilities within your assessment.

Finally, remember to analyze other industrial, commercial and large population residential occupancies that are an integral part of your community. I list the top five employers of my jurisdiction to provide some perspective of the economic impact of natural and technologic disasters. I also list a large retail hub (15 square miles of commercial occupancies) within my jurisdiction that provides economic benefit to the entire region. Does your jurisdiction contain multi-family (large population) residential developments? Do you serve retirement or assisted care facilities? While you may not think that these facilities are critical, they are a significant component of your community and should be included in your vulnerability assessment. Don’t forget government facilities. Be sure to list any federal, state, county and local government facilities within your jurisdiction. One of the most frequent hazardous materials responses for our regional HazMat team has been to a federal government facility.

Once completed, the vulnerability assessment of your community should provide the reader with a thorough review of the risks to your community. Divide the assessment into the components as described above and the process will be easier. Remember to keep the document current and revise it annually. You will find that once completed, it is easy to cut and paste the data into any grant application and will allow you to focus upon other portions of the application – such as how funding your application will address one or more of those vulnerabilities.

Assembly buildings: 6 safety items for your civilians

Posted on Mon, 26 Aug 2013 16:49:13 UTC

How many of your residents would drive a car down a mountain road without making sure the brakes worked or would jump out of an airplane without making sure the parachute is securely attached to their backs? The answer, I hope, is not many of them.

However, many people placing themselves in more dangerous situations everyday without even knowing it. I am talking about the life-safety risks in assembly occupancies.

An assembly occupancy is defined by the National Fire Protection Association as "An occupancy used for a gathering of 50 or more persons for deliberation, worship, entertainment, eating, drinking, amusement, awaiting transportation or similar uses."

Since many people enjoy going out, they encounter assembly occupancies on a regular basis. This could include going to a school play, attending a church service, dining at a favorite restaurant or watching a band at a nightclub with friends. In these cases, how often do our community members take the time to stop and consider:

  • Where are the exits?
  • How would I get out of here in a fire?
  • Are there enough exits for all of these people?

If they are like most people, the answer is not often enough.

History of tragedy
Each year, there are tragic news reports of fire and non-fire events in assembly occupancies with shocking death and injury tolls. Some recent incidents include:

  • Fire in the KISS nightclub in Brazil, on Jan. 28, killing 233.
  • Fire in the Cromagnon Republic nightclub, Buenos Aires, Argentina, Dec. 30, 2004, killing 180.
  • Fire in the Ycuá Bolaños Botánico Supermarket, Asunción, Paraguay, Aug. 1, 2004, killing 400.
  • Fire in The Station Nightclub, West Warwick, R.I., Feb. 20, 2003, killing 100.
  • Panic evacuation in the E2 Nightclub, Chicago, Feb. 17, 2003, killing 21.

As you can see, the issue of emergency exiting of public assembly occupancies is not unique to the United States. Here are six suggestions that can be easily performed and help your residents decide if the building may be safe.

Six steps

  1. Note the location of emergency exits when they enter a building and ensure that there is an adequate number. If the place has only one way in and out, use it at once.
  2. Ensure that exits are accessible and not locked or blocked. A business owner that allows an exit to be locked or blocked does not deserve anyone's business.
  3. See if the building has emergency lighting. If they think the room is dark during the performance, wait until the lights go out in an emergency.
  4. Gauge the size of the crowd. If the place is packed, they may want to go somewhere else — restroom lines alone can be hazardous.
  5. Be aware of their surroundings. Many assembly occupancies have dim lighting, and in a fire or power failure, it is a good idea to know where they are.
  6. Watch the alcohol consumption. Too much alcohol can impair judgment and motor skills, which can endanger one's ability to get out of a building in an emergency.

Teach your community that the few minutes needed to scan the building are well worth the time and effort. No one ever heads out thinking tragedy may lie just ahead.

Those who make plans in advance are much better prepared than those who do not. Share these thoughts with your community members at your next speaking engagement.

Fire service has a leadership crisis

Posted on Mon, 7 Apr 2014 22:05:54 UTC

After my last article, I received emails from various people around the country. Some offered thanks and support for continuing to carry the message on the importance of a diverse workforce.

Some gave me even more material to use in future columns about issues that women are confronted with. And some asked permission to reprint the article, which was nice recognition and another avenue to expose the issues women face across more audiences.

I have had the good fortune of meeting some amazing people in the fire service, from firefighters to chiefs, to magazine editors, to leaders of affinity organizations, to scholars, to political leaders, to vendors, and to members of other public safety professions confronting the same challenges we have in the fire service.

Throughout these brief interactions, I have met few brave enough to stand in front of a crowd and voice their heartfelt support on the issue of diversity in the context of their own failures. It has been a long haul of shaking my head wondering when the fire service would finally "get it."

Reason for hope
Why is it still an issue bringing women on the job, promoting women to front-line officer positions, or considering women in chief officer positions? Women lead Fortune 500 companies, women are in high-ranking positions in the military, two women have run for vice president, and we have real potential for a woman running in the next presidential election.

Recently, I received reason to hope that maybe some fire service leaders are finally getting it. IAFC President Bill Metcalf and Tucson Fire Chief Jim Critchley spoke at a conference hosted by the International Association of Women in Fire & Emergency Services.

President Metcalf admitted that the fire service has failed in promoting diversity. I could not believe my ears when I first heard the words.

I made eye contact with various people sitting around me, and all of us had the same look of shock on our faces.

Then, Chief Critchley said that he had been confronted the day before by someone who challenged him to do more for women. He was told that it was not enough for fire chiefs to say they supported women, and that they were behind us and ready to be there for us.

Changing mindset
Instead, Chief Critchley was challenged to take the forward position on this issue, and lead from the front. Chief Critchley spoke clearly in admitting that there was more that he could, and should, do more for women in the fire service.

Standing before an audience of more than 200 conference attendees, two white male fire chiefs admitted failing women in the fire service. A truly cathartic moment for those of us who have been trying to represent and advocate on behalf of women for what seems like a lifetime.

President Metcalf offered two more issues that relate specifically to diversity. The first was that the fire service is in the midst of a leadership crisis due to the pending retirements of some of our most experienced leaders.

The second was the issue of behavioral health and the importance of fire departments offering programs to mitigate this latest industrial "hazard" that we are experiencing. I agree with the importance of these issues, but, pardon the interruption; we have a bit more to discuss regarding these two issues.

Leadership crisis
I would propose that in tandem with the inability of the fire service to sustain and grow diversity in the industry, we have had a leadership crisis for the last 30 years, starting when women first broke the barriers of entering the fire service.

How can I back up such an assertion?

Because I still hear and receive emails of the issues women confront. For example, two women who are in high-ranking positions in metro-size fire departments have recently been exposed to unethical management practices.

These unethical acts will significantly influence the ability of these two women to reach the highest-ranking position in their department. Both are highly qualified, highly educated, highly respected women. Both are being held back by other ranking chief officer making false accusations on performance issues or just frankly keeping women down.

And these women are defenseless. Their fire chiefs will not step in and correct the issues. If the women file an EEOC claim, their careers and reputation will take a beating. This is simply another failure in leadership.

Champions needed
The issue of behavioral health for women has been around for the same 30 years that we have been exposed to failed leadership. Women who are harassed, mistreated, shunned, discriminated against, etc … have been talking about behavioral health issues (like depression) for years. Yet, no one has been paying attention or admitting the significance of these issues.

Many women have left the service due to behavioral health issues. Respectfully, women are keenly aware of the failed leadership and behavioral health issues in the fire service. We are thankful that these issues are now being addressed on a broader scale.

Yet, our recruitment and retention numbers are diminishing. Women are leaving the service, retiring, and many, many departments do not have one woman on the job.

Have we missed our opportunity for women to reach critical mass in the fire service? Is it worth it for women to continue battling the same issues over and over? Will we overcome?

A universal problem
The good news is that the failure of leadership in the fire service is consistent with the scholarly opinion on leadership in general. Leadership development programs are failing across many industries.

You do not have to be a rocket scientist to make the connection that more leadership development programs — degree and otherwise — should equate to better leadership. However, many agree this is not the case.

An interesting perspective on leadership development was recently promoted through a TED talk by Roselinde Torres, senior partner and managing director of the Boston Consulting Group.

Torres offered up the following: the reason leadership development programs are not producing 21st century leaders is because many of these programs are designed around a traditional leadership model that was effective 20 years ago.

Today's leaders need to be prepared to deal with complexity and information flow at levels never seen before, she said. Leaders must be more global, digitally enabled and transparent.

You can watch the TED talk to fill in the gaps, but the final analysis comes down to leaders answering three questions for themselves.

Making change
First, where are you looking to anticipate change? Who are you spending your time with; what are you reading; and how are you distilling this into understanding where your organization needs to go?

Second, what is the diversity measure of your personal and professional stakeholder network? Who do you spend your time with — people like you or people different from you in any way possible so that you learn to establish trusting relationships that lead to the accomplishment of a common goal? Who are you listening to?

And last, are you courageous enough to abandon a practice that has made you successful in the past? Good leaders dare to be different.

Yes, President Metcalf and Chief Critchley, the fire service has failed. You both have shown tremendous courage in speaking to that failure and women do appreciate your support.

We will follow your lead. We will continue to be patient … for a little while longer.