Doing the right thing

I’m new to the blog writing thing. I found an issue i have passion, interest and concern about so here goes my 1st jump into the icy waters. Looking forward to all your feedback: My post starts by please reading the story in this link 1st.

http://www.firefighterclosecalls.com/news/fullstory/newsid/192207

This well-thought-out piece by Chief Billy Goldfeder is not new information nor a new point of discussion. It is a discussion that has been going on for quite a while but has been hidden from the mainstream discussions of the American fire service. I remember this topic as a class discussion in my first year in The Executive Fire Officer program, (EFO). The group of chief officers in that class recognized back in early 2003 that we, the fire service, made excuses for preventable deaths and took little or no responsibility for our actions in these events. I want to reiterate PREVENTABLE deaths — easily preventable deaths. However outside of the forum of the EFO program, very few in the fire service, including our leaders have wanted to address this issue.

What many knew back then is that the rest of the developed world took firefighter safety seriously, and due to that attitude have significantly lower Line of Duty Deaths, (LODDs) than the United States for quite a long time. And not in a way in negatively impacted their effectiveness. I want to make clear I am talking about fairly easy ways to prevent deaths: by driving slower, by not getting killed in a collapse during overhaul, by not dying from a heart attack when you are not physically fit to be performing active duty tasks. I’m not talking about events where brave firefighters died while making a grab, like Kevin Appuzio who died making a rescue in 2006.

I believe one of the major problems that leads to these unnecessary deaths is rationalizing our bad habits and behaviors all in the name of saving lives and property; when in fact very, very few of these unsafe activities positively impact patient survival or property conservation. An example of this type of uncorroborated rationalization is the following. The former OEM Coordinator for Hamilton Township, NJ, Hank Adams would regularly ask why we (fire service personnel) drive so fast to a call, with Red Lights & Siren. We would say, ‘We need to get there fast to make a difference, to save lives; and seconds count.’ Hank would say ‘Well I went to the same call you did, from about the same distance, following all traffic signals and got there one minute after you guys, or got there 30 seconds after you guys.’

My first impression was to myself: BS. My second one was, ‘So you’re telling me that what I believed to be important and making a difference doesn’t count?’ Quite frankly it made me feel less important as an emergency responder.

In EFO I was enlightened about research: why it is important to our decision-making process. I discovered it was important to base our decisions on facts based on true cause and effect, not just isolated facts, opinions, or anecdotal outcomes. What we need to clearly understand just because we observe or encounter a situation, correlation does not imply causation. A correlation between two variables does not necessarily imply that one causes the other, nor does one impacts the other. For example, just because you hear a rooster crow every time the sun comes up doesn’t mean the rooster caused the sun to come up. We naturally make cause-and-effect assumptions based on:

1. Things that happen when the same variables are connected to a certain action or outcome. Example, “every time Aaron works we get no fires. He’s a ‘white cloud.’” yet Aaron had nothing to do with that situation. (Ok, maybe he does, we just can’t prove it yet!)
2. 2. Our personal biases make a connection based on our perceptions. “The firefighters at Station 5 are the best. My parents were members, I’ve been there for 10 years, and in my experience we have it together better than any other department I know.” This belief is held although there is little factual comparison to substantiate that opinion.

I tested those types of theories early in my EMS career…not on purpose, but from doing stuff I thought I knew about (but really didn’t). As many of you know back in the early 80’s we gave Sodium Bicarbonate in all cardiac arrests. It was theorized to make the blood more neutral to improve the chances of resuscitation in these patients. Every time we gave “Bicarb” we believed we were giving the liquid jolt of life. One day we responded to a cardiac arrest. I called the hospital for orders, (back then you had to call for any advanced procedures, crazy-huh?), I gave the doc a patient report and asked for orders forBicarb. She said no. I was livid! ‘What do you mean, No, I said to myself. I continued to reason with myself that this fringe lunatic MD was refusing to provide orders that would in turn kill my patient. Well I did what any good medic who advocated for their patient would do; I gave the Bicarb against orders. It was just and right I rationalized. ‘How dare this Doc try to kill my patient by refusing to give orders. Where did they find her, under a rock?’ Well, we continue the “Code” into the hospital and the patient never regained pulses and was pronounced in the ER. After cleaning up after the call I had the opportunity to question the MD, who by the way was also a PharmD, about being denied orders that were standard practice in cardiac arrests. She advised me that recent research showed that Bicarb has led to increased swelling in the brain, which has significantly reduced the chance of successful resuscitation. I was a little taken aback, but I was still a bit defiant and still not completely convinced. However shortly after that, protocols for cardiac arrest standards were changed and Bicarb was removed; not just in Jersey, but around the whole world! The point is, I assumed—based on what I was taught and what I correlated with successful resuscitations—and yet was wrong, very wrong.

The fire service is starting to catch up to EMS in using evidence-based results. The evidence to substantiate what we do is by performing unbiased and objective research. While there is previous science to measure the effects of fire and the impact of our firefighting techniques, the tools and technology haven’t been as sophisticated as they are today. Also, times have changed. Building construction and materials changed, and continue to change daily. The sizes of our trucks & horsepower have changed. Traffic has changed. All of these changes impact us a bit differently than 30, 40 and 50 years ago.

With science and statistics being more accurate, our ability to measure what we do and the impact it has on how we operate, it’s time to reevaluate how we do business Time to begin to put a more critical eye on how effective we are. I am not saying we throw out the baby with the bath water. I am saying let’s base what we do now and moving forward on as much fact as possible. Let’s integrate research and science with our experience. Thirty years later, and we are still using Bicarb, but not nearly as much and only in certain situations . Are we saving more patients? Yes we are, due to better-performed basic skills such as better CPR and basic airway management.

In no time ever before was there so much change at such a fast pace. To comprehend it all is mind-boggling. And here’s a little hint: It ain’t gonna slow down anytime soon. The treadmill of change is starting to just ramp up. On the EMS side, I am doing more than ever with my brain and logic and less with technology and advanced skills. I see much the same in the fire service to move in this direction, using your brain more to control the game.

So how do we address this in our daily operations? Let’s start with our physical and mental well being. The number one LODD cause in the Fire Service is cardiovascular-related. In fact, we even provided a special federal regulation called the Hometown Heroes Act to give us a better ability to be classified as a LODD from cardiovascular disease. Our goal should be to not get classified in this category by staying & working healthy. Most heart-related LODD’s happen during or after exertion. In order to prevent this, here are some easy things we all can do in the physical fitness category.

1.Hydrate, and when you are hydrated, drink more. (And we’re talking about non-caffeinated, sugar-free drinks.)

1. Be in shape for the job. Exercise regularly. Believe it or not, diet isn’t as important as being in shape and being acclimated to the environment you work in. Don’t get me wrong, eating right is important, but not as critical as being physically prepared for the job.
2. Get regular physicals. Physicals aren’t there to put you off the job, they’re there to keep you on the job longer, in a healthy manner.
3. When on a job, rehab. It means rest, cool down and hydrate. Again, rehab isn’t to keep you out of the game, rehab is there to get you back to work as soon as you’re fit.

Apparatus operations: You know I used to get nuts when Bucky Bresnan used to drive our 58 Peter Pirsch Ladder in a cool, calm and collected manner, even-though that thing could get up and go like a bat out of hell. However, taking a page from Hank Adams’ playbook referenced above, going faster doesn’t always get you there quicker; and in most instances doesn’t make a significant difference. Additionally, there is strong evidence that responding with Lights and Sirens increases your heart rate, breathing rate and blood pressure—and what does that do to you when you have a heart condition, (hint: It’s not good)? Additionally, your focus narrows and your overall situational awareness decreases.

There are several research papers that show an overwhelming number of incidents didn’t not require emergency response based on the outcome and the actions taken. A conservative number is 77% of incidents did not benefit from Red Lights & Siren response; yet motor vehicle crashes are the second leading killer of firefighters. Not only are we killing firefighters, we are killing more civilians by driving unsafely. The reason—get this—saving lives. More and more Fire and EMS agencies are responding to a certain subset of calls in non-emergency mode. No one’s telling you not to go, no one’s telling you not to be combat-ready. What I am saying is get there safely so you can make a difference. And those who argue ‘seconds count’, prove it. Don’t give me your opinions, prove it. I’m always willing to listen and learn.

Lastly in firefighting operations: We are fighting fires in buildings that are being built with less material and much more prone to failure with faster fire-spread. The materials inside these structures are burning much faster. Additionally, you are responding with less manpower than ever before. The buildings and fire dynamics are not the same today as I and other firefighters encountered 36 years ago. It appears more firefighters are being caught in flashovers than in the past. Is this because they are using old tactics in a new environment?

The tactics I was taught and practiced back then are not as effective as they used to be in today’s structural fire environment. Just as we have been retooling and refining our auto extrication techniques due to new auto construction and materials, it’s time we retool our structural firefighting tactics and practices.

There is quite of bit of science based on work done by UL, NIST, ISFSI & the Kill the Flashover project. They have developed modeling that recreates the environments we are working in today. They also have extremely sophisticated monitoring equipment to evaluate and measure what’s happening in those environments, as well as evaluate our tactics for effectiveness. What is becoming more compelling about their work is each of these groups are replicating some of the research the others are doing, and coming up with the same results. This is no different than my Bicarb incident. More information is available to allow us to make better evidenced-based decisions. We must critically analyze our ventilations practices, our initial suppression tactics. Controlling airflow, initiating attack from the outside (I did not say fighting fire from outside, I said starting from there), limiting ventilation. These tactics should be additional tools in the toolbox.

We in the Fire Service pride ourselves (and deservedly so) for “making the grab”, “the quick knock”, holding the fire to room of origin…all the positive benchmarks of minimizing the number of people dying in fires and minimizing property damage. Taking pride in being the best we can be. So if by being in shape, being physically prepared for the job, by driving safer, and by utilizing the most effective tactics you are more effective, why not do it?

I’m not asking you to be the poster child for physical fitness. I’m not asking you to drive like you’re in a funeral procession. I’m not asking you to be a yard-breather, wimp or lawn jockey. What I am asking is, to be fit for the job. Drive in a manner that gets you there in one piece in a timely manner. To utilize the tactics that will be the most effective in saving lives and holding fire damage to a minimum.

Just remember, career or volunteer: you don’t work for yourself. You are the fire “Service”. You are hired and allowed to provide service to your community. They want you to do the best job possible, not what suits you the best. If you get hurt or killed, someone else pays for that, not you. Lastly if you don’t come home tonight, you’re not the biggest loser, your family is. It’s your family that needs to find a way to pay the bills without you, it’s your family that doesn’t have you to help them with their homework or see them graduate high school. It’s your family who says ‘why was he so selfish not to think of us when took chances he didn’t have to cause he didn’t want to feel he was a wimp’.

So I close this out with. Who do you have a responsibility to? To those who look up to every day as a hero in their communities? To those who are looking for the best outcome possible when they suffer an emergency? To the families of the brothers and sisters you work with who expect you to send their loved one home after every call, every shift? Or is to your own selfness need to push it, to act the way you believe you’ll look cool in front of your peers? Or to your peers who berate when you do the right thing instead of the tough guy macho thing? Only you can answer these questions, I’ve just provided you some moral and ethical points to ponder. In the end, you don’t have to answer to me, to your chief, to your brother & sister firefighters It’s only your conscience you have to answer to if you did the right thing that saved “that kid” or you did what you liked to do that the outcome went in the opposite direction.