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

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

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

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

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

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

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

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

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

By Bryan Jack

The Fire Prevention and Safety grant program (part of AFG) is officially in full swing. Guidance was released a week ago and the application process opened on January 3 and will close on February 4.

If you haven't done your homework, completed your pre-planning and reviewed this year's guidance, then you are already behind the eight ball.

To help prompt you into action I'll highlight some of the aspects of this year's program that you will need to focus on when preparing your grant application and narrative.

There have only been a few small changes to this year's grant guidance and priorities, so those of you that applied last year or read last year's guidance are one step ahead.

The most noticeable change is that last year DHS was required to appropriate $28 million to prevention and safety and this year they were only required to dedicate $19.5 million.

The good news for all is that this year's program is funded at $35 million ($15.5 million more than the $19.5 million it is required to be funded at).

This increase in funding reinforces the critical importance of designing, implementing and improving fire prevention and safety programs throughout the county.

Your agency should make fire prevention education and public safety outreach a priority. AFG is providing a means to assist you with your fire prevention goals, all you have to do is apply!

If you haven't read and reviewed this year's FP&S Guidance and Application Kit you should.

This document explains all of the requirements and details about applying for the grant.

It covers topics such as: funding priorities, eligibility, allowable projects, cost share, application review and selection, and administrative procedures.

Essentially, your first step after reviewing the guidance document should be to identify which portion of the program your agency will apply for — "Fire Prevention and Safety" or "Firefighter Safety, Research and Development." (Eligible applicants for the latter are restricted to public health, occupational health and injury prevention institutions.)

I will assume that the majority of you will be applying under "Fire Prevention and Safety."

Next, you need to identify the type of project that you want to fund.

Your identified project should be based on an identified issue and needs to have an achievable and measurable goal/outcome. Some eligible projects include:

• Smoke alarm programs
• Residential sprinkler awareness programs
• Public safety education programs
• Wildfire prevention programs
• Juvenile fire setter projects
• Code enforcement
• Fire and arson investigation
• Many, many more

After you have identified your project you should start the application process. This process is conducted through the federal firegrantsupport.com website.

The application includes standard fill-in-the-blank and check-box data and also requires a narrative statement.

Some of the data that you need to have compiled for the application includes: general department information (career or volunteer, how you are funded, number of personnel, apparatus), call volumes by type for the past several years, types of calls you respond to, etc.

The application will take several hours to complete and the narrative should be drafted and refined over several weeks.

From the narrative viewpoint here are some things to remember to include:

Trends and needs
The first steps in designing a successful program are to identify the trends and needs of the area that you serve.

The only way to determine what your needs are, is to identify and review local and internal data. Start by reviewing your internal call data.

What types of incidents do you respond to and which incidents do you respond to most frequently? Is there a reason these incidents are occurring, and is there a way to prevent them from happening?

You need to identify what the local issues are and then devise a plan to correct those issues.

Population and demographics
After you have identified the local issues, you need to identify the population group that these issues are impacting.

For example, do you serve a community filled with school aged children, young professionals, or a retirement community?

Chances are that you have some of all the categories, but if you look at the available data you may find one group that stands out.

Solutions
You have identified the issues and analyzed the call trends, population and demographics of your service area. Now it is time to brainstorm some solutions.

Remember, there are always multiple ways to achieve your goals, so don't get tunnel vision on just one solution.

Just pick a fire prevention or safety project that addresses your identified problem/need (based on local data) and can meet an identified goal or outcome and then apply for funding.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

If you asked Santa for a new EMT card, you'd better let go of that idea lest you join the 207 Massachusetts EMTs who thought they had recertified their cards without really trying.

That was, uh, until the Department of Public Health caught on. Not so good for them, and really bad for all of us who now contend with a very suspicious public and curious government officials. "No," I've said a hundred times, "I can't recert my paramedic card with two box tops from Kellogg's Raisin Bran."

Apparently these Bostonians weren't the only folks trying to pull the wool over our eyes. Clear across the globe, or the "pond" as some would say, the World Health Organization (WHO) was accused of exaggerating the dangers of H1N1 in collusion with drug companies to (gasp) increase their profits.

Some accused the WHO of making up the whole H1N1 Pandemic. "What, what, what…" you say? Well hindsight is 20:20; H1N1 gave us one of the mildest flu seasons we've ever seen — I'm not so sure that was entirely predictable.

Excepting a nasty predilection for kids, we're in for what promises to be another lightweight influenza season this year. H1N1 is definitely here to stay; hopefully you got your flu shot this year. WikiLeaks might spill the beans on WHO someday.

Health Care Reform was big on the 2010 agenda and it looks like some trickle down will hit us on New Year's Day 2011. That's right; EMS will ring in the New Year by recording loaded ambulance transports in tenths of a mile. Oh, and that's not all. Medicare ambulance fees will decrease annually as a "productivity adjustment" due to the wonderful efficiencies afforded by Health Care Reform. Get me some Zofran!

The FAA finally answered multiple wake up calls from the NTSB, proposing a slew of safety requirements affecting air medical providers. On the subject of transportation, the NFPA 1917 Standards for Automotive Ambulances squeaked under the wire after a series of false starts to push out a draft document for public comment (which closed December 15).

The committee will meet in February 2011 to review, revise, and respond to comments. If all goes well, we may see this document in 2012, at which point the feds will drop their KKK purchasing spec.

While you were out getting your flu shot, Emergency Cardiac Care (ECC) Guidelines 2010 rolled off the presses. As I predicted last year, procainamide is back! Truthfully, if you keep abreast of resuscitation research, nothing in Guidelines 2010 should have surprised you. 2010 saw the rollout of a brand spankin' new EMS Education Agenda, now gaining steam and slated to appear in textbooks publishing early 2011.

Despite all the supposed "efficiencies" afforded by Health Care Reform, EMS medications were in incredibly short supply during 2010. Many services ran out of preload epinephrine, 50% dextrose, naloxone, sublingual nitroglycerine, and several others.

The FDA is reporting that many shortages continue, and because shortages reached a seeming all time high with considerable disruption to patient care across the health care spectrum, four leading health care groups met in November with the FDA, manufacturers, and suppliers to discuss solutions. More to come on that front.

AED failures also peaked in 2010, prompting the FDA to call a special meeting this month with manufacturers to address the problem. Let's hope that Physio-Control, Philips and Zoll put their heads together with the rest of the manufacturers and strategize some industry standards that put an end to surprises like dead batteries, missing pads, and outright AED failures.

Fire equipment is designed and maintained to work when consumers need it to; AEDs should be no less battle ready than sprinklers, smoke detectors, and fire extinguishers.

So, what's in store for 2011? Well, firstly, you can dispense with all the overblown hype we were cajoled into believing was needed to protect against H1N1. Yup, the CDC finally acknowledged the science that clearly showed N-95 masks offered no benefits over simple surgical masks. Their whole infection control strategy was realigned to be more realistic: www.cdc.gov/flu/professionals/infectioncontrol/index.htm.

Unless you live in California, where either the germs are unique or lawmakers don't do science. Tantamount to a giant leap backwards, California implemented strict new requirements that not only fly in the face of science, but force Fire and EMS agencies to literally flush money down the toilet: www.dir.ca.gov/title8/5199.html. Be afraid; be very afraid…the backers of this bizarre legislation may well bring it elsewhere!

Next, EMS is getting its own version of an airport TSA full body scanner: ultrasound. That's right, portable ultrasound is finally making the leap from ED and ICU to the ambulance. Watch for this incredibly useful tool to play a big role in hypotension, cardiac arrests, line placement, trauma, fractures, OB and more.

I'm also betting that 2011 will see some decent prehospital data validating the accuracy of SpCO, the pulse oximeter used to measure blood carbon monoxide (CO) levels. The device, marketed by Masimo Corporation (Irvine, Calif.) has come under heavy attack in the blogosphere after a single in-hospital study reported differences between the device and blood gas measurements. It's amazing how quick some folks are to bash new technologies. CO is a major public health problem; SpCO is a new technology that can save lives when used properly. Nuf' said.

"Can you hear me now?" may be back for reruns in 2011. I'm betting thousands of public safety radio users will keep their heads in the sand for one more year until they wake up disconnected on January 1, 2013. The FCC has announced narrow banding until the cows come home. If your department hasn't started moving there, expect to be out of touch in 2013. Last call — literally.

Finally, we all have an obligation in 2012: remember September 11th. This year marks the 10th anniversary of the brutal attack on America. It is our responsibility as emergency responders to make sure the memory remains in the hearts and minds of all Americans.

Take a moment to visit the National September 11 Memorial site at www.national911memorial.org. The education tab links to some awesome resources for the classroom. Make certain that your schools are helping us to always remember 9/11. Happy New Year!

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

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

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

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

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

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

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

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

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

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

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

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

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

This discussion is very brief and to the point.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We've certainly seen plenty of negative stories about "firefighter-produced" video and still photos, so it's nice to see a positive example of how the prevalence of cameras (on helmets, in mobile phones, on dashboards, or in pockets) can help our fire departments tell their better stories.

Obviously, if the outcome of this incident had been different, the resultant video footage could be a great deal more sensitive.

In this case, it documented three rescues by skilled and dedicated firefighters — and that's undoubtedly a good thing.

Balancing the potential down- and up-side of onscene video (both official and unofficial) will likely continue to be a challenge faced by all our departments.

Like so many things we do: when it's good, it's really good; but when it's bad, it can be really bad.

Stay safe and remember to smile for the camera(s)!

In a previous article I discussed the development of a structural PPE risk assessment. In this article I will touch on what happens with the introduction of real data into the risk assessment process.

The use of department data can bring to light important considerations that may have been overlooked. This article will focus on threat recognition and prioritizing the threat.

Organizations must start the risk assessment with a serious and realistic reflection of the actual environments that the PPE will be expected to perform in, not just structural firefighting.

I separate this potential threat into two separate risk categories: thermal threat and non-thermal threat. These are not hard and fast, but should be considered templates and decisions should be based on data.

I recently worked with a metropolitan fire department to introduce data into the risk assessment framework with interesting results.

Data was collected from the fire department to determine when firefighters were actually wearing the structural PPE. The data that was compiled included not only structural fires, but also structural alarm soundings, vehicle fires, vehicle accidents, false alarms, and various other situations.

The risks to the firefighter during each situation, and potential threats, were reviewed.

The data was reviewed and the numbers are as follows:

The department wore structural PPE more than 32,000 times in a year. Structural fires accounted for 3,989 structural fire responses. In addition, the fire department responded to 6,287 alarm soundings wearing structural PPE.

They also responded to 991 vehicle fires, 8,892 vehicle accidents and 11,885 false alarms in structural PPE. A key piece of data is that more 14,100 of the calls were "after dark."

"After dark" is from 6 p.m to 6 a.m. The fire department is also responsible for more than 3,000 miles of freeway and roadways.

What did we do with the data?
The risk potential was developed in Step 1 of the risk assessment and (previous article) was used to prioritize the data according to threat and occurrence as well as thermal and non-thermal threat to the firefighter.

The threat to the wearer was prioritized by the significance of the threat and how often they occur using the following chart:

Each of these categories is further divided into two groups — "Non-Thermal Threat" and "Thermal Threat" — to represent the actual environment that the firefighter will experience.

While structural PPE is primarily designed for structural firefighting, it provides necessary protection for other related fire service duties.

There are many times when firefighters will don structural PPE for a variety of reasons including use as protection from the elements.

The findings
The highest occurrence with a significant threat came from firefighter visibility. Firefighter visibility on the fireground and on the roadways is critical to firefighter safety.

Given the high frequency of exposure of fire personnel to low visibility/dark situations, research was conducted into possible solutions for trim configurations on the structural ensemble.

The goal of the research was to use various trim configurations and colors to enhance firefighters' visibility and increase their conspicuity when operating on emergency scenes wearing PPE in both daylight and low light/night scenarios.

Daytime visibility
Studies reviewed indicate that daytime conspicuity is improved by increasing the contrast between the wearer and the background scene through the use of trim with fluorescent color pigments.

The conclusion of a study by Ziegler and DuPont is that high contrast and high visibility are achieved in the daytime using lime-yellow or yellow.

Fluorescent yellow-green is included in NFPA 1971. As the daylight fades, the presence of low wavelength light (such as UV) enhances the brightness of fluorescent colored trims and leads to increased in the visibility and conspicuity of the wearer.

Afternoon and nighttime visibility
In low-daylight approaching nighttime situations, the fluorescent materials take on a much greater importance as they are recognized at greater distances with greater accuracy.

This lengthens the reaction time from when drivers see the wearer and increases safety. Several studies conclude that saturated colors are more conspicuous during nighttime operations than white.

Reflected white is very common during nighttime operations and the use of reflected color is important to firefighter safety.

Conclusion
The research indicated that fluorescent yellow-green retro-reflective trim provides increased contrast between the wearer and the scene background during daytime and low light operations and the saturated color increase visibility and conspicuity during nighttime operations. Drivers may not recognize reflected white as a person above the reflected visible white noise.

This led to a review of the current specification. The purpose of the risk assessment is to make sure that all of the situations that PPE is worn are considered. Visibility is just one such issue.

With training, all NFPA 1971 certified PPE will protect the firefighter in that "bad day at the office," but the PPE must also be practical and safe for other uses as well.

In the first part of this article, we outlined how standards on personal protective equipment establish minimum levels of performance that are intended to reflect firefighter needs.

Over the next two months, there are several standards under development or revision; these include each of the standards listed below.

NFPA 1851 - Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting

Work is toward a third edition. The most significantly considered topics are the qualifications for service providers on cleaning and repair and how these organizations are qualified, difficulties in implementing the complete liner inspection and the rigor of the hydrostatic test applied to liners after three years, and the mandatory 10-year retirement requirement for all ensemble elements.

The industry is debating how manufacturers can specify companies to provide inspection, cleaning, and repair of their clothing versus the verification of independent service providers that can offer care for any type of clothing.

The adequacy of current procedures for qualifying organizations is being reviewed and being extended from simply addressing repair to cleaning and inspection processes. The committee is considering whether cleaning procedures need to be validated.

There are also concerns for high levels of liner failure during hydrostatic testing noted by some departments that occurs as part of complete liner inspections. Proposals for changing the frequency of this testing or how the testing is conducted are open for consideration.

Lastly, some departments are advocating exceptions to the rule that all clothing and equipment covered by NFPA 1971 be retired 10 years from its manufacturing date.

NFPA 1852 - Standard on Selection, Care, and Maintenance of Open-Circuit Self-Contained Breathing Apparatus (SCBA)

The standard is considered relatively mature and only a few changes have been proposed. These include events and procedures for reporting failures of SCBA, specifying the number of spare cylinders on hand for a given organization, and providing editorial changes to make some requirements more consistent with NIOSH regulations. (Note – Pat, does this line seem OK to you? I'm also checking with the Stulls - Jamie.)

NFPA 1855 - Standard on Selection, Care, and Maintenance of Protective Ensembles for Technical Rescue Incidents

This is a new standard that is intended to establish the companion selection, care, and maintenance requirements for products certified to NFPA 1951, Standard on Protective Ensembles for Technical Rescue Incidents.

The standard has a number of similarities to NFPA 1851, but has some adaptations to address specific issues related to two principle ensembles covered in the standard – utility technical rescue (without barrier) and rescue & recovery operations (with barrier). NFPA 1951 also addresses requirements for a CBRN ensemble.

As proposed, the standard provides detailed procedures for conducting a risk assessment to support the selection of the appropriate ensemble. It also establishes specific requirement for how ensemble elements (garments, helmets, gloves, and footwear) are inspected, cleaned, decontaminated, repaired, and stored as well as the responsibilities for ensemble care and maintenance for the department and individual responder.

NFPA 1975 – Standard on Work/Station Uniforms for the Emergency Services

The standard address clothing that is worn underneath protective clothing and includes an option for the clothing to be flame resistant. The committee is considering the scope of the standard to address some of items of clothing currently worn underneath protective clothing for moisture management and comfort purposes.

The committee is also examining the potential for including other performance properties in the evaluation of this clothing.

The public input period has passed, but any input for the revision of this standard can still be submitted for the committee's consideration. In addition, the same committee is working on a new contaminated water diving standard and a rope and harness selection, care, and maintenance standard.

NFPA 1981 - Standard on Open-Circuit, Self-Contained Breathing Apparatus (SCBA) for Emergency Services

The committee is addressing a number of changes for improving the performance of fire service SCBA. Among these are proposed tests for evaluating the integrity of the facepiece to high heat in response to some reported industry failures.

A new radiant heat resistance test has been put forward for consideration. The committee is also increasing the conditions of the high heat oven exposure prior to the fire exposure in the overall heat and flame test.

A number of other proposed changes have been considered that include new methodology for evaluating SCBA voice communications and changing the alarm level (amount of remaining air) for the end-of-service time indicator.

The standard is also being revised to provide for a range of certifications to address other applications, such as law enforcement, hazardous materials, and other non-fire fighting operations.

NFPA 1982 - Standard on Personal Alert Safety Systems (PASS)

Since its last overhaul in 2007 to address issues related to PASS problems in high heat and moisture conditions, the current revision is focusing on changes that encompass the performance of wireless or radio frequency PASS and their ability to communicate to base stations outside the operating location.

Consequently, a number of new design and performance criteria have been proposed to address various aspects of evolving electronics and their continued functionality for PASS devices. For example, wireless PASS devices are now evaluated for their ability to alarm at a distance that is considered out of range from the base station.

NFPA 1989 - Standard on Breathing Air Quality for Emergency Services Respiratory Protection

This standard covers the quality of breathing air for SCBA and how it is tested. The standard, which has been in existence for two prior editions, is undergoing only relatively minor changes for clarification of the existing procedures.

NFPA 1999 - Standard on Protective Clothing Emergency Medical Operations

The standard was significantly expanded in 2008 to include other categories of clothing and equipment. The majority of current revisions are aimed at improving current test methods or addressing the need for clarification for existing requirements.

A number of items covered by the standards are typically not certified by manufacturers, such as disposal garments, work gloves, and eye and face protection.

We would like to also point out that you can submit input on any standard at any time, whether in revision or not. The submission of specific suggestions or criticisms is always welcome and seen as a valuable part of providing feedback that enable enhancement of the current standards, which in turn help allow the development of better performing clothing and equipment.

We hope that if any of the standards are of interest to you that you take the time to communicate your concerns or needs to the respective committee. The NFPA process is only improved when the actual users of personal protective equipment provide their input.

In my previous column, I used the analogy of football. In this column, I want to take this a step forward. In October, the college football world was rocked by the news from Pennsylvania State University.

I am not going to get into the debate of rights and wrongs or analyze the situation; rather, I think we can take away many lessons from the events that occurred.

Rehab is slowly becoming a part of our incident scenes and training ground activities, and I say "slowly" as I question whether it has truly evolved to match the intent for which it was designed. As members of the rehab section, we have to make tough decisions. Should personnel return to the incident scene or continue with training? Are personnel being rehabbed to the level they need in order to return to the fireground or training ground?

We know that firefighters and emergency service personnel have a determined attitude, which is good but can also be deadly. None of us wants to deny fellow firefighters the ability to fight fires or improve their skills by training. But are we jeopardizing our personnel by allowing them to go back to duty if they are not physically able to perform the job?

This is a tough question. On paper, it is relatively simple as we know we don't want anyone to be harmed or in danger, yet it happens every day, and in some instances, officers command rehabbed firefighters to go back.

This column seems to be asking more questions than answering them. Quite frankly, when it comes to ethical situations, we need to ask more questions. The answers are not always clear and, in some cases, will put you in a difficult predicament.

You have to ask yourself the bottom-line question: Are your actions or inactions jeopardizing your reputation and putting you at risk of liability? You have to make some tough decisions if your officer is not handling the situation as you would expect him or her to.

A great activity for rehab-focused training is to talk about a few scenarios and how to respond to them.

Scenario
You are assigned as the rehab officer. You have a battalion chief who is sent to rehab. Per rank, she outweighs you. Her blood pressure is 190/110, and even though she appears to be symptomatic, she will not admit to any other symptoms. She orders you to release her back to the fireground. In addition, the incident commander agrees with releasing her. How would you handle this situation?

Situations like this are tough to deal with. There comes a point when you are not able to convince some individuals to seek medical help; we know this to be the case in EMS with the patients we respond to. The best defense in these situations is to provide as much information as possible about the risks. If they are still not convinced and you are overruled, you must document very thoroughly. Unfortunately, there will be adverse outcomes at times, and you need to do your best in presenting the risks and then documenting the events.

Conclusion
The dilemmas you encounter may not be the same magnitude as the events at Penn State, where criminal activity was involved; however, you might have to make ethical decisions that could be the difference between life and death. Based on the circumstances, you need to take the appropriate course of action. This may mean that you will need to call outside agencies to investigate.

Thorough documentation to protect yourself and the organization is paramount. Looking the other way just once could erase a lifetime of accomplishments.

By Kenneth Heard
Fairfax County, V Radio Center

When Izard County (AR) Judge Rayburn Finley's grandson was injured in a four-wheeler accident last summer, Finley instinctively dialed 9-1-1 on his cellular telephone. But instead of reaching his county's dispatch center some five miles away, Finley spoke with a dispatcher in neighboring Sharp County more than 25 miles away.

Photo 9-1-1 Magazine
Izard County dispatcher Shane Farmer uses Google Earth on his computer to pinpoint locations of 9-1-1 callers using cellular telephones. Access to online sites like that, in addition to the inherent capabilities of the agency's new Vesta Pallas 9-1-1 system, give dispatchers an information edge they can pass on to responders.

Because Izard County didn't have Enhanced-9-1-1 service, cellular telephone calls were diverted to surrounding counties that have the service. Rayburn's grandson was not seriously injured, but the response time was delayed as Sharp County dispatchers had to call Izard County to send emergency help.

Now, the rural county has joined the legion of other Arkansas counties in upgrading its emergency services. It will be the first time the county has any 9-1-1 service. In the past, emergency calls were fielded by dispatchers for the sheriff's office, assessed by priorities and then sent by radio communications to whichever deputy was patrolling the closest to the call. Izard County officials have installed the AT&T Vesta Pallas 2.3 system and hope to be fully operational by the first of 2009, enabling dispatchers a way to handle cellular calls. The PBX-based system provides such services as mapping, incident tracking, Computer Aided Dispatch, digital logging, and third-party applications.

The system can also handle administrative duties such as receiving faxes, voice mail, prerecorded messaging, and routing. Dispatchers began training in the first week of October after the system was installed in September; AT&T representatives conducted brief, but successful, field tests to try out the new system a week later.
A majority of emergency calls come from cellular telephones, Izard County Sheriff Tate Lawrence said, because the county's rural roads are well traveled.

"We're a very rural county," Lawrence said of the 13,249 who live there. "We're challenged to protect the lives of everyone here. This will help us do that."

The county hopes to add landline telephones to the system in early 2009. Horseshoe Bend, a town of about 2,500 in eastern Izard County is a retirement community; Lawrence said a 9-1-1 system for home telephones in that town will assist those with medical emergencies. The county received the Vesta system with a $100,000 grant from the Arkansas Commercial Mobile Radio Services/Emergency System Telephone Board.

Cellular telephone customers in Arkansas pay a 50-cent surcharge on their monthly bills to help fund such grants. The money is disbursed based on needs to counties which apply for the grants, said Renee Pressler, a spokesman for the Arkansas Department of Emergency Management.

"The grants have helped a lot of counties who couldn't otherwise afford such services," she said.

In a move to help strengthen the fund, Arkansas Attorney General Dustin McDaniel ruled in November 2007 that prepaid cellular telephone services had to pay the monthly fees for its customers as well. He ruled that "commercial mobile radio service included any wireless two-way communication device, including ... cellular telephone service, personal communication service, or a network radio access line."

Of the 75 Arkansas counties, only two now do not have the Enhanced-9-1-1 system in place. Calhoun County in southern Arkansas plans on installing one in 2009; Newton County, one of the most rural Arkansas counties in the northwest portion of the state, has no plans for such a system.

In Izard County, four dispatchers rotate 12-hour shifts. A part-time employee and a jailer help during busy times, said Dispatch Center Administrator Cathy Schaufler.

The center averages only seven to 10 calls per shift, she said. But each call could be a life-and-death situation and time is critical, she added. "In the past, we've had people call and say, 'I don't know where I'm really at,'" Schaufler said. "They may be nervous, or hurt, or excited. We can pinpoint their calls without them stuttering around."In Izard County, cellular telephone calls were picked up by Sharp County to the east, Independence County to the south, Stone County to west, or Fulton County to the north.

"Our system was nothing more than a telephone system with caller ID," Lawrence said. "This system will give us mapping capabilities, and we'll send that information to our deputies' computers in their patrol units."

The Izard County dispatch room is located in the center of the sheriff's department and the detention center. There are two terminals at a work station along with several video monitors that's how scenes of the jail cells.

Dispatcher Shane Farmer worked at one terminal during a day shift recently and showed the locations of recent calls. The system incorporates Google Earth, a satellite mapping system that allows computer users to see actual aerial photographs of land. He zoomed in on the detention center and showed the winding roads that traverse through the county.

Dispatchers have already received some cellular telephone calls through the system. Cellular telephones that have service with AT&T and Cingular Wireless are already online, Schaufler said. Other services such as Sprint and Verizon are expected to be accessible by early 2009, she said.

The Vesta system was delivered to Izard County on September 11. It was fitting, Schaufler said, because the date and the service they added shared the same digits – 9-1-1. "I thought that was really appropriate," she said.

The Vesta system is stacked on a six-foot-high metal rack in a storage room near the center of the facility. Schaufler's office is nearby. She hopes to add digital recording equipment by the end of the year. The extra equipment needed to handle landline telephones can be added to the rack easily, she said.

Meanwhile, County Judge Finley is overseeing the county's conversion to physically addressing every street and road in the county to be ready for the full 9-1-1 conversion.

"We'll put every address on our Global Positioning Systems," he said." A lot of people have lived in [rural] areas here all their lives and they've never had street addresses.

"This is going to be a huge benefit for every person in our county," he said. The county has more than 2,500 miles of gravel road, Lawrence said. There are only 10 deputies working for the sheriff's office who protect nearly 550 square miles.

The county is diverse in its topography, too, he said. The White River, which is prone to dangerous flooding in the spring, edges the county on the west and south. Hilly terrain and lonely, curvy roads make up most of the county, making it rife for vehicle accidents. Deputies were delayed early this spring when responding to a vehicular accident because the caller did could not pinpoint where the incident occurred. A car traveling on Arkansas Highway 56 left the road one night in April, Lawrence said. A woman spotted the accident and dialed 9-1-1 on her cellular telephone.

The woman saw a road sign indicating the Izard County town of Franklin was ahead and mistakenly thought she was already in Franklin. Her emergency call went to Sharp County where dispatchers forwarded it to Izard County.

After searching near Franklin, Izard County dispatchers finally found that the accident occurred across the county line in Sharp County and notified authorities there again with the correct location. The vehicle's driver was not seriously injured, but had he been, the time it took to sort out the accident location would have been critical, Lawrence said.

The new system would have greatly benefited Izard County deputies last February when a devastating tornado packing winds in excess of 100 miles per hour ripped through the center of the county.

Two people were killed when the twister struck Zion, about five miles south of Melbourne and the county's dispatch center. A second twister ripped through Ash Flat and Highland in Sharp County, tying up dispatchers for hours.

"It was total confusion," Finley, who lives in Zion, said of the emergency response. "It was awful. A lot of the [cellular telephone] towers were downed, but some people could call out."

He said he drove the rural roads around Zion with a chainsaw, cutting toppled trees out of the way so ambulances and emergency personnel could drive to the scene.

"We were hauling people out of house one after another. Sometimes ambulances took two or three at a time," Schaufler said. "With this system, when people call in trouble, we can find them," Finley added. Lawrence said deputies' computer terminals in their patrol units will be equipped with a program to help locate callers' locations once the system is fully incorporated. The terminals will use both mapping and Google Earth.

"We'll be able to pinpoint people now," he said. "It will be one step further in helping our people.

"It will eliminate a lot of confusion," he added. "Before, when someone called in, we would try to get them to describe their location as best they could. The problem was enhanced at night when everything looks the same.

"Now we can get there quicker and we'll definitely save lives," he said.

Kenneth Heard is the Jonesboro News Bureau chief for the Arkansas Democrat-Gazette.

This article first appeared in the January/February 2009 issue of 9-1-1 MAGAZINE. 9-1-1 MAGAZINE is the magazine for the emergency communications and response industry, serving law enforcement, fire, and emergency medical services. 9-1-1 MAGAZINE provides valuable information to readers in all aspects of the public safety communications and response community. Visit 9-1-1 MAGAZINE online at www.9-1-1magazine.com.

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!)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As always — be safe out there, rescuers!

As I sat down to write this article, I was called by one of my co-workers to inform me that two of our friends had been caught in a house explosion while responding to a natural gas leak.

It appeared, as of a few hours later, that both will be well, though they suffered burns and got knocked around quite a bit.

Having seen both these men in action in the past during training, I know their ability and their level of safety is beyond reproach. I shudder to think what might have happened to more "casual" firefighters.

This event doesn't take me far from the original idea of this month's piece. I spent much too much time watching NFL playoff games.

Actually that's a lie, as you CAN'T spend too much time watching football, but I digress. There were lots of opportunities to see the fact that football, unlike many other sports, is a team sport from beginning to end.

We watched as individual players would fail, and bring down the whole team. And although the press likes to focus on singular members (particularly quarterbacks), the reality is that if the whole offense isn't doing its job, the quarterback will be out on a stretcher fairly quickly.

If the defense doesn't do its job, the offense waits a long time to get its hands on the ball.

Seldom wants the chief's buggy
The fire service is like this. We joke that when Mrs. Smith calls 911, she seldom asks for the chief's buggy — she wants the big red vehicles with the tools and personnel prepared to overwhelm her particular problem.

When the whole team performs, then we tend to "win." Win means we make the situation better for the property owner, or at least the community.

As I've written before, our priority for a win must be OLTL/TSOS; Our Lives, Their Lives/Their Stuff, Our Stuff. Its OK to lose (break) our tools/equipment to save their property. It's not OK to lose our lives on the un-savable.

Although it's much too early to tell what happened to our friends, I am sure that they were wearing the appropriate PPE, and clearly they maintained team integrity. They were being good team players.

And although I haven't talked to the officers in the department yet, I'm sure the fact that they had good team players made it possible to stay focused on the bigger strategic picture and make faster order out of the chaos of a building explosion.

Pushed inside
At another recent event in the Northeast, at a large complex fire, reports are flowing out that teams continued to push inside for interior attacks LONG after command had made the clearly communicated decision to go exterior/defensive.

Command had to get on the radio and order units out of buildings or off of roofs several times. Actually as I write this, it dawns on me that I shouldn't call them teams as they weren't acting team-like.

All of this is to point out how necessary it is for company level units to stay focused on the "little" things and stay on task. When you're standing on the second floor of the charlie side, it's a little difficult to know what's happening at the "front door."

When command knows we will stay in control, then they tend to give us the room to do what needs to be done.

But that trust is earned by them seeing us drill, seeing us care for our equipment, provide conversations other than what we like to eat, and ultimately by how we've acted on the fireground in the past.

Just like not being able to see through the building, we can't see ahead in time. We don't know what the "routine" call will bring.

But if we're prepared, if we do the right thing, then our friends get to tell us to "get well soon" rather than "goodbye."

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

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

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

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

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

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

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

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

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

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

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

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

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

Last week my fire department was dispatched to assist to a neighboring department with a house fire. I happened to be at the firehouse so I quickly proceeded to don my gear and grab a jump seat — for once I didn't have to drive! The rear of the ladder truck soon filled with four other members and we turned out down the street.

One of the members sitting across from me was a newly promoted lieutenant. As with many volunteer departments, a line officer is often found riding in the back seat when another line officer has already grabbed the front — we can argue that practice at a later time. I noticed that this new lieutenant was not wearing his seat belt. I immediately said "Dude, where's your seat belt?" Motioning at the retracted seat belt as he glared at me, he replied, "Right here."

My response? "How 'bout you put your seat belt on so that if we crash this thing you don't come across the seat and kill me?" Somehow I went from scoring a coveted jump seat en route to a working fire to the middle of a stand-off. Grudgingly, he put his seat belt on and we continued on our way.

As we pulled up to the scene, this newly minted lieutenant snidely plucked at his seat belt strap and said, "Is it all right to take this off now?" At that point, I felt I'd had enough. Having spent several years as a line and chief officer, this lieutenant for me was setting an extremely poor example for the younger and more impressionable members riding in the rig. I then proceeded to explain my feelings to this lieutenant — perhaps a bit harshly — until another senior member put the discussion to rest by simply stating, "At this station, we wear our seat belts." End of story.

Epitomizes problems
So why do I share this story? I do so because this 3-minute episode epitomizes the problems that we face in today’s fire service on many different levels. The title of this year's Safety, Health and Survival Week is "Committed to Long-Term Results." But how can we commit to long-term results if those in positions of leadership and power won't follow the rules themselves? How is it possible that a line officer can not only get away with not wearing a seat belt, but can then argue the issue with someone who tells him to put it on? Have we learned nothing from those who have given their lives before us?

Imagine this scenario: A fire apparatus rolls out the door with two young firefighters and a line officer. One of the young firefighters sees that his officer isn't wearing his seat belt and figures he doesn't need to wear it either. The truck crashes and the young firefighter is ejected and killed. Who is at fault? The reports and the scuttlebutt will all say that if this young firefighter had just put his seat belt on, he would still be here today. People will question his poor judgment and shake their heads at what they believe was a rookie mistake. But was it?

In reality, that same line officer who set a silent example by not wearing his seat belt is largely responsible for this hypothetical fatality. Like it or not, when you pin a fancy gold horn on your collar or put that shiny white front piece on your helmet, you’ve become someone that younger members look up to and follow. Even when you don’t realize it, these members are emulating you and following your example. Senior firefighters, line officers and chiefs all create a culture that younger and more junior firefighters will learn to live by. It is this culture that can save or cost a life.

If the fire service truly wishes to bring about long-term results, it's time to start holding people responsible for their actions. It seems that every time one of us is injured or killed, the rest of us are hesitant to ask questions or pass judgment. As a result, this culture never changes. How do I know? Look at the number of firefighter fatalities over the past 20 years. Does anyone really see a difference?

So how should we hold people accountable? It's time to start wielding a big stick. Fancy posters and cute little stickers telling you to wear your seat belt haven’t worked. Every year there are still numerous line-of-duty deaths that are a direct result of someone not wearing their seat belt. Want to make a difference? Start randomly stopping your rigs and checking to see that everyone has their seat belt on. If someone doesn't, suspend them. More than three infractions, show them the door. Maybe it's time to have the cops start citing people who can't get the message through their heads. After all, not wearing your seat belt is against the law!

Until these types of attitudes change or people are held responsible for their actions, I don’t believe we will ever reduce the number of line–of-duty deaths, especially those that are a direct result of vehicle crashes. Unless those in charge begin to lead by example and create a culture in which reckless driving, poor attitudes and lack of seat belt use are no longer tolerated, the culture will never change and we will be doomed to repeat our mistakes over and over again.

To those who have already begun to move this ship in a positive direction, my hat is off to you. And to those that refuse to help the rest of us reduce the number of firefighter fatalities by continuing this reckless culture ... I say maybe it's time to go.

How many times have you been involved in a critique of an incident or training exercise and listened to participants complain about our number one issue in the fire service, communications?

Regardless of technological breakthroughs and the latest in digital communications, we still are plagued with communications issues. We have attempted to draw attention to this drawback in the acronym LCES:

Lookouts
Communications
Escape Routes
Safety Zones

While initially adopted in the wildland firefighting world, the acronym was quickly adopted by structural firefighters. While this is commendable, we still suffer with communications issues on all incidents, and our personnel, while well trained, still hit their heads against the communications wall.

There are various reasons, some simple, some more complex. Let us explore basic communications issues along with potential solutions.

Communications basics
Do you train your personnel to recognize communications blocks? Many fire academy classes utilize the old basic communications exercise where we whisper a message in one student's ear, and transfer to the next student and so on by whisper until we get to the last student and ask them to state what the message was.

You would be surprised by what comes out after going through 20 or 30 students. Is this an example of real world issues? Absolutely!

In the wildland fire world, we teach the 10 Standard Fire Orders and 18 Situations That Shout Watch Out.

These form the basis for LCES, and offer valuable insight to activities not just on wildland incidents, but other emergencies as well. Two of my favorite Fire Orders are:

1. Maintain prompt communications with your forces, your supervisor, and adjoining forces.
2. Give clear instructions and ensure they are understood.

This demonstrates our clear understanding of how important communications is to emergency services personnel. In the 18 Situations That Shout Watch Out, we have more examples of the need for communication:

1. Uninformed on strategy, tactics, and hazards.
2. Instructions and assignments not clear.
3. No communication link with crewmembers/supervisors.
4. Cannot see main fire, not in contact with anyone who can.

Out of the 28 total Fire Orders and Watch Out Situations, six cover communications, hence the "C" in LCES.

Training
We train our personnel to don and doff SCBAs in the dark, tie knots behind their back, couple and uncouple hose blindfolded, and perform a myriad of what we consider essential tasks in the dark.

Yet do we truly prepare them to COMMUNICATE? I fear not, and this is what is going to pose one of the most significant threats to our staff.

When you mention communications, the first thoughts revolve around radios, cell phones, microwave links, narrowband compliance, and other technical aspects.

What about BASIC communications. I have met and worked with individuals that can be characterized as poor communicators at best in the non-emergency world. This can translate to disaster on the fireground.

You may be surprised to learn how few of your firefighters know emergency communications signals such as evacuation signals or rope tugs during a structural search.

We all have portable radios, right? Wrong! I am still submitting grant applications for departments that lack sufficient portable radios and there are other departments struggling to meet narrowband radio requirements.

Have you ever had a portable radio malfunction? Have a battery go dead? In the industrial fire world, we struggle with communications during refinery fires or pipeline release due to loud noises that block communications.

Your firefighters and responders need basic communications training, or you are doing them not only a disservice, but you are risking their lives.

Take a few minutes at each training session to practice a form of communication. Instructors are taught to read body language of students, so you should be able to see if your students are uncomfortable or do not understand. Practice "OATH" rope signals:

One tug = OK
Two tug = Advance
Three tug = Take Up Slack
Four tug = Help

Practice hand signals used by your department, and evacuation signals and be sure that everyone understands what they mean.

Talk about emergency procedures of what to do when a portable radio fails, and review department SOPs.

Read, memorize and understand the 10 & 18, and how they apply to all firefighters, and the relationship between them and LCES. After dinner, in lieu of watching TV, take 10 minutes to review communications and discuss how your crew will adapt and overcome.

Communications do not need to be a negative aspect of emergency services. Think of the sense of accomplishment at your next critique when you get to say, "Well, when everything else went badly, our communications was GREAT!"

Does your department have exercises that you use to improve communications? If so, share them so others can learn.

Until next time, stay safe!

There are a number of different personal tools that can be carried in your pocket to make your job easier. Tools such as shove knives, screwdrivers, and various types of cutters are among the most popular.

It's always an interesting question to ask a firefighter what they carry in their pocket and why. There is usually a good story associated with the choices, and the discussion becomes a great learning opportunity.

The problem is that if you are not careful how these tools are stored in your pockets, you may end up damaging you bunker gear. The photo below shows a damaged pocket due to personal tools poking through the pocket.

The concern is that the tools could eventually puncture the actual outer layer of the gear, possibly compromising the thermal protection abilities of it.

A piece of out-of-service fire hose can be used to create an effective pocket protector. Simply cutting a pocket sized section of hose creates a protective sleeve for your tools in your pocket.

Shown in the photo above are sections of 1 3/4" hose folded over and secured with either duct tape or zip ties.

The folded over version creates two separate compartments to help organize your tools. The 1 3/4" version works well in smaller coat pockets, or the larger divided style found in some bunker pants pockets.

Larger hose like 2 1/2" or 4" can be used in a similar fashion in traditional full size pockets.

One thing to keep in mind when using the larger hose is that folding it over tends to make the pocket protector a little bulky.

One option is to remove the outer jacket of the hose (if possible) to make it more low profile. Another option is to make it into a single compartment protector by simply securing one end with duct tape, as shown below.

Taking a few moments to make a simple pocket protector can not only help prevent damage, it can keep you more organized.

More importantly, it can help you work smarter not harder on the fireground.