After Action Review

By: Rabbi Howard A Cohen (Deputy Chief, ret.) AFM Virtual Training Coordinator

An important, but often overlooked, training tool is the after-action review, sometimes called a debriefing.  An after-action review (AAR), or debriefing, is a discussion of an event for the purpose of examining what happened, why it happened, what, if any, improvements could be made, and who needs to know what was learned?  

After-action reviews were originally developed by the United States Army and are now used in many different industries, including the fire service, hospitals and sports teams.  Studies demonstrate that AARs have a demonstrable positive impact on the culture of organizations that utilize them.  They increase trust among team members; improve ability to deliver services; and improve safety on the scene.

The AAR is an important component in creating a culture of positive change within a department. AAR debriefs, whether structured and formal (appropriate after a large complex event) or informal, encourage a candid critique and evaluation of a crew’s strengths and areas in need of improvement.  The key to successfully using the AAR is that it is done after every incident, no matter how small or seemingly routine.  As we know, any call, no matter how routine it may seem, has the potential to turn into something life threatening.  Thus, something innocuous learned in one AAR, might very well be instrumental in avoiding something serious in a future incident.

One reason why AAR is so effective is that it takes the ego out of evaluating an incident.  AAR is not about finger pointing, judging, or critiquing individuals. There is no rank and everyone gets to speak.  While there are different ways to organize an AAR, the original model structured around five specific and open-ended questions is arguably still the best.  The five questions of the AAR are: What was our intention;  What went well;  What could have gone better;  What should we have done differently; Who needs to know.  Let’s take a closer look at each of these five questions.

What was our intention with our actions?  Was the call something we could have anticipated and planned for?  Did we have an action plan for this kind of call?  If so, did we follow it?  If not, should we develop one?  What were our expectations and how did we prepare ourselves for this kind of call?  Was what we expected different than what we encountered?

What went well?  What actually happened?  Consider the incident from all the different perspectives.  Who did what?  What tools were involved?  What outcomes were achieved?

What could have gone better?  What additional training do we need?

What should we have done differently?  Any unanticipated problems?  How was our situational awareness?  Were risks and hazards recognized?  Do we need to change our policies and procedures for this kind of call?

Who needs to know?  Who needs to know what was learned from the AAR?  How do you share what was learned?

If you are ready to institute AAR into your department there are six steps to take.  First, write standard operating policies/guidelines (SOPs/Gs) that document the purpose of AAR and how it is to be done. Second, make sure to provide training to department members who will most likely be the ones leading AARs.  Third, support open communication by providing a safe place where the firefighters can talk freely and without fear of judgment.  Fourth, make sure that there is time for an AAR.  Fifth, make sure that there is a process for recommending policy and training updates based on AAR feedback.  And the sixth and final step is to make sure that there is a way for communicating AAR findings to everybody in the organization.  This last step not only shows that the process has positive effects, but that the information gleaned from an AAR might also save someone’s life at the next call.

If your department does not yet have an AAR practice, this is the perfect time to start one.  AARs promote organizational safety and improve performance.  Every incident now becomes a learning opportunity. In the fire service, enhanced performance is measured by lives and property saved and the well being of the first responders.

Fire Prevention Activities Grow in Kenya

When Dave and Nancy , Co-Founders of Africa Fire Mission, went to Kenya in November 2012. One of the things that surprised them was the lack of knowledge around fire prevention and fire safety. In the US, children start to learn about fire safety in Pre-School and fire prevention messages and what to do in case of fire are integrated into school and work for many Americans. In most of Africa we have learned that there is very little education around fire prevention or fire safety.

As soon as Dave saw the gap he invited the Nairobi Fire Service to come to Missions of Hope International (AFM’s first partner) to teach the teachers a little about fire prevention. Stop, Drop and Roll, Crawling Under Smoke (Get Low and Get Out), how to call the fire department and how to use a fire extinguisher were among the first lessons taught. That first fire prevention session in Nairobi had about 30 participants - since then AFM has been growing our fire prevention program through curriculum and a train the trainer model through CHE (Community Health Education).

This October, Kenya participated in Fire Prevention week - at least 10 counties participated and more than 40,000 individuals received direct training in fire prevention! Children and adults conducted fire drills in their schools and businesses. Firefighters went into their communities and shared safety messages in churches, schools, businesses and anywhere that people gathered!

Indirectly, the impact was pretty great too! There were walks to raise awareness and media campaigns to share the work! Millions were impacted indirectly through these collaborations!

At Africa Fire Mission we are committed to continue to increase the impact of fire prevention and safety to save lives! It is important to our mission just as training firefighters. Our curriculum is available for free on our website - check it out here: Fire Safety Curriculum and we’d love for those using our curriculum to report their training experiences here: Report

To all the firefighters in Kenya that are spreading the message of fire safety - Asante Sana (thank you!) We can’t want to see the multiplication continue in Kenya and across all of Africa!

Incident Command: Coordinating with limited resources

By: Chief Mike Kull

In a perfect world, every time our Fire Brigade receives a call for service, we will have all the manpower we need and all of the necessary equipment available at a moment’s notice.  Of course, we don’t live in a perfect world and no matter where you are serving as a firefighter, there will be times that you will not have all of the resources you may need to properly respond.  So, what do we do to prepare for those times when we don’t have everything we THINK we NEED?

            The first step is for us to do an HONEST review of our available resources and manpower from our own fire station.  What is the lowest number of firefighters we have available to respond?  What equipment do we have that will be available and in good working order order for EVERY call?  This is where we start our preparation and training.  If we can only expect to have two firefighters available to respond to a call for service, we can make that work!  As we train at our stations, we train with only two firefighters performing tasks that we will be expected to do at an emergency.  We continue training and practicing as a two-person team until EVERYONE can complete all tasks with only two people.  Now, if we respond to an incident and we have more than two firefighters available, it will make the tasks go quicker and easier.  While we are practicing and training, we will be sure to use the equipment that we will have available and in good working order for every call.  We will be sure to properly MAINTAIN that equipment so that it is always available and in good working order.  If we then have other equipment available to us at an incident it will, again, make our jobs quicker and easier.

            Once we have become very good at working with low manpower and minimum equipment, our next step is to become familiar with other resources.  Is there another Fire Station or Brigade near-by that can bring more firefighters or other equipment?  If so, it is important to take the time to visit with those other firefighters and to practice and train with them as well. They may not always be available when you call them for help, but you will be familiar with them and their equipment if they do arrive to help.

            Now that we have become well trained with our own firefighters and our own equipment as well as with the available resources from nearby firefighters, we must look for other places to find the resources we need.  Are there police officers at the incident that can help us control the crowd or traffic nearby?  Are there members of the COMMUNITY that can assist us with tasks that do not put them in danger?  Is there a nearby business that may have tools or equipment that could be useful?  Are there hand tools that are not designed for firefighting that we may be able to use?  Can we build our own tools out of resources available nearby?

            All of this takes place BEFORE we are called to service.  It is important to identify the types of emergencies that we will be called to.  Then we must try to learn what equipment and resources we will need to help out at that emergency. We can PRE-PLAN what we will need so that we can practice those skills with our limited manpower and equipment and learn how to be successful. 

            In order to become a Fire Brigade that can perform well with limited resources we must practice and train often within our own Fire Stations and also those nearby.  We must utilize resources available in our community and we must find ways to use tools and equipment that are available to us to perform our jobs as firefighters. We must know the types of emergencies we will be called to and what resources we will need.  As we practice and train with very limited resources we become very good at our jobs and we can perform even better as more resources are found or arrive to help.

 About the Author:

Chief Mike Kull is a Fire Chief in rural Pennsylvania and successfully deals with limited resources on every call. He has been serving his local community for 25 years. Chief Kull serves as Fire Chief and Administrator of his local volunteer fire department as well as serving as a local elected official and has served in various government roles for his entire career. He is also a Forest Fire Warden with the PA Bureau of Forestry and serves on his church council.

Basic Troubleshooting for Petrol Powered Engines

By: Chief Mike Kull

Power tools can increase the ability of firefighters to perform their required tasks at emergency incidents and help to protect lives and property. Your petrol powered tools must be properly maintained. They must be started and run until the engine is warm on a regular basis. There will be times that you will not be able to get the engine started. Here are some basics to check when troubleshooting an engine that will not start.

Petrol powered equipment is very similar to the fires that we fight.  A fire requires three things in order to burn: Heat, Fuel and Oxygen.  In the same way, a petrol engine requires those same three things: Spark (Heat), Petrol (Fuel) and Air (Oxygen).  If a petrol engine will not run the first steps to fixing it requires checking those three things.

Spark (Heat):

The first thing to check is if the engine has spark.  To check this, you must remove the spark plug.  A look at the spark plug will tell you something about the engine’s performance.  If the spark plug is wet and black, there may be too much fuel (Rich).  If the spark plug is brown, there may be too much air (Lean).  Clean and dry the spark plug and check the gap of the electrode.  The correct gap is usually about the thickness of a thin coin.  After cleaning and setting the gap, be sure the top of the spark plug is firmly set into the spark plug wire and hold the bottom metal end of the spark plug against the metal of the engine block.  Pull the starting rope of the engine and watch to see if the plug is generating a spark.  If not try cleaning and resetting the gap.  If it still does not spark, replace the plug.  If there is still no spark, this indicates a bigger problem with the engine than we are discussing in this post.  If there is a spark, it is time to move on to the next item to check.

Fuel (Petrol):

The first thing to check is how fresh the fuel is.  It is always a good idea to empty the fuel tank and replace with freshly purchased fuel.  While the fuel tank is empty, look to see if it contains any dirt or debris and clean the tank if necessary.  Next, it is important to check the fuel filter.  Some small engines may not have a fuel filter.  If there is a fuel filter, look at it’s condition.  Is it filled with dirt and debris?  Can the fuel flow through the filter?  If not, the fuel filter must be replaced.  If installing a new fuel filter, be sure to check if there is an arrow indicating the correct direction of fuel flow and install properly.  It is also important to check the condition of the fuel lines (hoses) to make sure there are no leaks or clogs.  A final, more advanced component to check is the carburetor.  Many times, an engine that has not run for a while will have varnish or clogs in the carburetor blocking the fuel jets and preventing fuel from flowing through the carburetor.  If you disassemble the carburetor, be careful not to damage any gaskets and count the number of turns that it takes to remove any components so that you can return them to the same settings when you reassemble.  Also check that the floats inside the carburetor can move freely and are not filled with fuel.

Air (Oxygen):

The final component required for an engine to run is air.  Check the air filter.  You should be able to see a light shining through the air filter.  If the filter is covered in dirt and debris, clean the filter by gently brushing it off, being careful not to damage the filter material.  If necessary, replace the filter.  If the air filter is made of foam and you can not purchase a replacement filter, you may be able to make a new one.  Foam can be cut to the size of the original to use if necessary.  Be sure that the foam is not too dense to allow air to flow through.  Also be sure that the foam you use is not falling apart, allowing pieces of the filter to be drawn into the engine.  The other item to check with air is the choke.  Be sure that the choke lever is connected and working properly to restrict the flow of air when starting a cold engine and opens to allow in more air when the engine is running.

Starting the Engine:

When attempting to start a cold engine, be sure to fully close the choke.  Set the engine’s throttle to the starting position and pull the starting rope.  As soon as you hear the engine try to start or sputter, open the choke.  The engine should start in the next few pulls.

Flooded Engine:

Sometimes when an engine will not start it is because the engine has gotten too much fuel (flooded).  This happens when the choke is left on after the engine first begins to fire.  There are two ways to tell if the engine is flooded.  The first is if you smell petrol.  A flooded engine will have a strong smell of petrol.  The second way to check for a flooded engine is to remove and examine the spark plug.  If the spark plug is wet with petrol, it is most likely flooded.  Dry the plug and try again.  

If the engine does get flooded, it can usually be started by opening the choke fully, opening the throttle all the way and pulling the starter rope until the engine starts.  (This may take many, many pulls.)  Sometimes a flooded engine can be started after sitting for a few hours to allow the excess fuel to evaporate.

Other Simple Causes:

There are two other simple things that should not be overlooked.  If the engine has an On/Off Switch, be sure the switch is set to the On position.  Second, some petrol engine’s have a low oil shut off switch.  Ensure that the engine has the proper amount of oil.

These were some of the most common causes of problems found in petrol powered engines and a quick overview of how to begin to get an engine running.  Proper care and maintenance of an engine will prevent many of these problems in the future. 

About the Author:

Chief Mike Kull has been serving his local community in rural Pennsylvania for 25 years. Chief Kull serves as Fire Chief and Administrator of his local volunteer fire department as well as serving as a local elected official and has served in various government roles for his entire career. He is also a Forest Fire Warden with the PA Bureau of Forestry and serves on his church council.

Five Traits of Good Leadership

by F. R. Montes de Oca, EFO, MESH, CPM

In October I am presenting  two back-to-back lessons simply titled “Leadership”. So, to kick it off, I thought I would submit a few words to give the sessions context and background.  Often we focus on the negatives associated with leadership, especially poor leadership. So here are a few traits that reflect on the positives of leadership for you to ponder.

Recognize People 

Those of us who aspire to be “good” leaders often recognize early on that their team members and direct reports are invaluable in the positive outcomes of almost all professional endeavors we undertake. Have we witnessed a leader thanking his or her members with a simple, hand-written note highlighting an action that exemplifies the “service to others”? I’m not talking about a rescue under adverse conditions or a save at a medical call – just a simple display of actions above and beyond, such as stopping to assist a stranded motorist.  Although the act may not rise to the level of a citation or medal, a short note citing the action written by the chief or commanding officer oftentimes is priceless.  

Respect Employees

I have had the honor of working with volunteer firefighters and support members in three departments throughout my career. Suffice it to say, I learned early on that although we normally can’t offer pay or raises to volunteers the alternative is to provide a healthy dose of respect for their selfless dedication to their community. Recognition and respect are integral in developing a loyal, committed response team. 

Communicate Effectively

My personal communication practice is to over-communicate until I start getting feedback that there is too much communicating.  In my career, I seldom received that feedback. It is often: “I don’t hear anything from the puzzle palace.”, or “We’re never brought into the loop until it’s all over!’ These complaints are present in large and small, volunteer and career organizations alike. The complaints are often based on employees and volunteers who wish to be involved, informed and have some control over their lives. There is no excuse for not keeping everyone informed by utilizing every medium you have at your disposal to the greatest extent possible. Without getting into too many details and notwithstanding the intricacies of departmental policies perhaps consider:

• Placing bulletin boards in all common areas – including bathrooms. 

• Establish and support internal communication committees.

• Open up your calendar for a weekly (monthly?) “Coffee (tea) with the boss”.

• Host a blog with contributions by staff members.

• Establishing shift and crew daily activity dashboards.

• Establishing shift and unit information officers to feed into the department blog.

Possess Integrity

Integrity is like trust.  You deposit into your integrity account regularly until you’ve built up a balance.  But the minute you violate this effort by act or omission, your integrity (and trust) balance drops to zero. Leaders who communicate and act in ways that attempt to undermine or control the rank and file, often possess integrity balances of zero.  Promise one thing and deliver another?  Zero integrity account balance.  Communicate an intention, but fail to deliver?  Zero integrity account balance. Making excuses that don’t add up?  Zero integrity account balance.

Provide Ongoing Feedback

This trait is closely associated with communicating effectively. A good leader would be hard-pressed to provide feedback without effectively communicating.  No matter how high we rise in an organization, as humans we all need and appreciate feedback – especially the positive kind.  But feedback of any flavor helps us to understand if we are accomplishing the wishes or needs of our manager, the community and our subordinates.  Providing feedback helps to highlight the roadmap that has been set out for us.  So, too is the regular, timely feedback we provide members that assists them in staying on track, on schedule and within the boundaries of our unit and/or agency.

I recall working for a manager who spent more time politicking and schmoozing his bosses than leading.  His method of feedback was, “I don’t give ongoing feedback.  I’ll just let you know when you screw-up.  Until then, you can assume you’re doing okay.” The balance of his integrity and trust accounts always ran in the red. Can you imagine running a fire agency that way? It happens more often that not. Often you can see it in the faces of the members and their actions. 

Utilizing the brief, and far from comprehensive list of ideas in the Communicating Effectively section above, providing feedback to all who report to you (and those who you report to) can and should become a ritual that is another tool in your leadership toolbox.

Fire departments are living, breathing organisms made up of those who wish to serve, have meaning in their lives and feel proud of their accomplishments.  Those who lead from a perspective of trust and integrity will witness their organizations becoming a vital and successful asset to their community.  

Go forth and lead!

About the author:
Frank Montes de Oca served as a firefighter/paramedic for over 38 years. Throughout his career he has been involved in training, managing and developing firefighter safety, leadership and organizational change. Chief Montes de Oca He can be reached at frm1@me.com or www.responder1.org.

My Tools

By Edward Collet, Jackson Township Fire Department Firefighter/EMT, Ohio; Ohio Fire Chiefs

In the fire service we use many different types of equipment to carry out our duties of protecting life and property.  It is impossible to know exactly which ones we will need on any given call, meaning every piece of equipment on the apparatus and in the station must be in good working condition. Part of having equipment in good working condition is knowing the important specifications like fuel type and blade speed for saws, lifting capacity for airbags, length of pike poles, and weight of axes just to name a few.  Not only will this level of knowledge allow us to properly maintain our tools but it lets us select the best tool for the job. 

How equipment is kept is a direct reflection of the professionalism and pride of each fire department and firefighter.  One of my favorite examples of keeping equipment in good working condition is the saw.  Saws make firefighters more efficient and effective in serving the community, but only if they work.  Whether ventilating a roof, forcing a roll-up door, or cutting locks to gain entry there are other tools to accomplish the task but they are slower and require more physical exertion than saws.  When I am at work the saws on the truck are my saws.  I do not own the saws, the community provided them to the fire department, but when I am working they are mine to execute the duties the community expects of me.

 I make sure they are clean and in proper working condition.  It does not matter how other firefighters view the tools, I view them as mine and my responsibility for the time I have been trusted with them.  Have I come in to find filthy saws that would not start with blades not capable of cutting a newspaper, absolutely.  Just because someone else left it in poor condition does not give me permission to leave it that way.  It is about having pride in the job and ownership of your tools and actions.   Retired Lewisville, Texas Chief Rick Lasky wrote a book dedicated to having pride and ownership in the job.  For someone to invest the time and effort to produce a book on a topic it must be important.  Back to my saws.  The first thing I check is the fuel, without it the saw will not run.  Then I check the bar oil on the chainsaw and the condition of the blade.  If the blade is damaged I replace it.  Not only will a damaged blade not perform effectively, but it is also dangerous.  After that I clean the saw.  This give me the chance to have a close look at every part and identify damage which was covered by dirt and grime.   Finally, I start the saw to make sure it will run properly.   Over time, doing this has provided me with a great understanding of how the saws operate making me more effective at using them during fireground operations.   Did this take effort, yes.  Did I have to ask a lot of questions to senior firefighters and do research on my own, yes.  Did it take away time from holding down a recliner, again yes.  Most importantly did it increase my knowledge of the saws and ability to use them, absolutely. 

Keeping tools in good working order is not limited to power tools.  Hand tools must be inspected regularly.   Cleaning tools provides an opportunity to make a careful inspection to find damage.   Dirty tools are often broken tools since dirt hides damage.  Having hand tools in good working condition on the apparatus is a critical backup for our power tools.  Even with diligent maintenance and care, sometimes power tools do not start or work properly.  When this happens, it is time to grab the hand tools.  As the saying goes, an ax will always start.  The ax may start, but if the head flies off the handle it does little good at the emergency scene.  Simply making a policy to keep all the tools once a week makes sure they are ready for service and look good. 

Just as important as keeping tools in good repair is knowing when certain maintenance activities are beyond our skills.  I am able to work on a saw or secure an ax head to the handle, but when the heavy hydraulic extrication tools are not working properly I know the factory technical needs to be called.  Some of the tools we carry are very specifically engineered and complex, requiring them to be serviced by a trained technician.  We may have all the good intentions of getting a tool back in service and saving money by attempting repairs but in the end it may cost more to get it repaired properly or buy a replacement if it is not properly repaired.   Losing the use of a tool because it was not serviced by a properly trained technician is a disservice to the community.  It may cost more to get a tool properly serviced but it will save money in the long run and ensure the tool is functioning to serve the community.

A master craftsman would never imagine not having clean tools in perfect working condition.  As firefighters we are masters of our craft and must maintain our tools as such.  The most intelligent, strong, and skilled firefighter cannot proficiently service his or her community if tools are working and on the apparatus.

Introduction to the Principles of Emergency First Aid

By Howard Cohen

Not all firefighters are emergency medical technicians or paramedics, but often we are the first responders to scenes where it is necessary to provide life saving first aid.  Therefore, it is important for all firefighters to have at least a basic knowledge of first aid.  The purpose of this short article is to provide foundational principles for responding to trauma in situations where immediate life saving medical help is required.  In no way should this article be considered first aid training.  However, with the basic and limited information contained within, and no other training, you may still be able to save someone’s life.

Scene Survey: The First Task

Size up:  Regardless of your level of technical first aid training or medical knowledge, when responding to an incident that involves injuries your first task is to gather as much information as you can about the situation.  This is done through a careful size up.  It is critical that you assess the risks and dangers before rushing in to administer aid. Ask yourself, “What is trying to kill or harm me?”  Is it traffic, wildlife, fire, an unstable building, falling objects, or flooding waters? You do not want to become another casualty or cause further harm to the patient.

Number of patients:  Once you’ve made the scene safe and stable now is the time to determine how people are part of the incident.  It is easy to get fixated on patients who are calling out in pain, overlook those who are unconscious, or miss those who are not visible.  It is also easy to rush to aid a person whose injuries appear more life threatening than they are, for example someone who is bleeding from a superficial head injury, while someone else nearby has stopped breathing.

Primary Survey:  The Second Task

The primary survey is an assessment of the three main life supporting functions.  These are the respiratory, circulatory, and nervous systems, also known as the ABCDs.  Any problems involving one of these systems represents an immediate threat to the life of the patient and must be addressed immediately.   

ABCDs:  Once size up is completed, the scene is safe (or as safe as you can make it), and you have a sense of the number of patients needing aid,  initiate a primary survey of the patients by checking the status of the three conditions which represent an immediate threat to life.

Airway:  Check to be sure that the mouth and airway are cleared and air is actually going and out.

Blood is Circulating:  Check to make sure that blood is not pouring out and that it is circulating.

Disabled:  Check to see if the spine is stable and the central nervous system is operating normally.  Due to the limited scope of this article I will not be saying any more about injuries that involve the head, neck or spine.

Basic Life Support (BLS)

Basic life support is the immediate treatment of one of the three life threatening emergencies found during your primary survey.  The purpose of BLS is to provide temporary support to keep the patient alive while a secondary survey is conducted and/or until advanced treatment is available.

The simplest way to begin a primary survey is to ASK the patient, “How are you?” If he answers then you know that his airway is not obstructed (A), his heart is beating (B & C) and the brain is functioning (D).  If the patient does not respond or responds in an unusual way you will need to look more closely.  

Airway:

Airway problems are a result of an obstruction to the pharynx or larynx.  The obstruction can be complete or partial.  A complete obstruction is rapidly fatal, but can be effectively and dramatically treated by clearing the airway.  There are various ways an airway can become obstructed such as from vomit, a foreign object or swelling caused from trauma, an irritant or allergic reaction.  It is imperative that you clear the airway but you must do so without causing any additional harm to the patient.

Breathing:

It is possible for a person to have an open airway but still have difficulty breathing.  This can be the result of an injury to the brain, spinal cord or diaphragm.  The method for assisting a patient with breathing when more advanced medical care is not available is called positive pressure ventilation or artificial respiration (mouth to mouth).  The rate of inflation should be about 12 breaths per minute or one every 5 seconds.  Breaths should be about 1 to 1.5 seconds.  Faster breaths can force air into the stomach which can lead to vomiting.

Bleeding & Circulation:

Uninterrupted circulation of blood is essential to staying alive.  There are essentially two kinds of disruption to the circulation of blood that you can address as a first responder:  cardiac arrest and bleeding.  Cardiac arrest means the heart has stopped beating.  While doing your primary survey if you discover that the patient has no pulse it means her heart has stopped beating and she is in cardiac arrest.  It is important to note that under adverse situations, or if the patient is in shock, it can be hard to find a pulse.  The carotid pulse is the strongest to feel and easiest to access.  It is found on either side of the larynx in the neck.  If there is no carotid pulse, the heart is not beating. CPR (cardiopulmonary resuscitation) is the only treatment for cardiac arrest.  Even with hands-on training, it has limited potential to restore and sustain life.

The second kind of disruption to circulation is caused by a major loss of blood.  Blood loss must be controlled as a part of BLS.  Bleeding can be internal and both hard to identify and stop, or external, but not necessarily obvious.  Addressing internal bleeding is beyond the scope of this article and most first responders in the field.  External bleeding is controlled by direct pressure over the bleeding site with your hand, but preferably with a cloth or bandage.  This is not to absorb the blood.  It is to provide even pressure across the wound.  Expect to apply direct pressure for 10 or more minutes.  If the bleeding is not stopping, remove the bandage and check for the source of blood and then reposition your hand.  

There is no easy rule for deciding when bleeding is severe.  A rule of thumb is that if it looks like a lot of blood, then it probably is.  However, it is worth noting that severe  bleeding can be missed if the patient is wearing a lot of clothing or the blood is absorbed into the ground around the patient.

Conclusion:

When it comes to developing first aid skills, like all skills a firefighter needs to master, training and practice are essential.  At the same time, it is important to read about the principles and theories undergirding these skills.  However, there is no substitute for training and practice.

References:  

The Outward Bound Wilderness First-Aid Handbook; Jeff Isaac & Peter Goth.

The Field Guide of Wilderness & Rescue Medicine; Jim Morrissey & David Johnson.

Opening an Unconscious Patient’s Airway with a Manual Manipulation:  

https://www.youtube.com/watch?v=AifzmrpA7ao

https://www.redcross.org/take-a-class/cpr

About the Author

Howard retired from the Bennington Fire Dept as a deputy chief.  He spends a lot of time writing and teaching various aspects of firefighting.  He religiously works out every morning, doing a mix of high intensity interval training (HiiT), dumbbells, kettlebells, barbells and cycling. When he is not doing something for the fire service or working out he is the rabbi of two small congregations.

Driving Fire Apparatus to Preserve Life and Property

By Edward Collet, Jackson Township Fire Department Firefighter/EMT, Ohio; Ohio Fire Chiefs

Driving the fire apparatus is a great privilege and responsibility.  It is probably the least considered way firefighters protect lives and property.  Everyone has visions of a firefighter racing to the emergency scene, heroically rescuing victims and bravely dousing the inferno.  That is the way most people see firefighters saving lives and property.  Rarely does the image of a firefighter professionally and respectfully driving to an emergency scene, or anywhere for that matter, come to people’s mind when considering saving lives and preserving property.  In reality, it is driving where the fire service can have the biggest impact on the community. 

Think of how many fires and true emergencies a department responds to compared to the number of kilometers its apparatus drives in a year.  If your department is anything like mine, there are many, many more kilometers traveled than blazes fought. 

Property is preserved whenever a firefighter drives defensively and with due regard.  The fire apparatus entrusted to you by your community may be one of if not the single biggest investment it has made.  You are responsible for it being returned from your care in the same condition it was given to you.  It is possible to give it back in better condition by making sure it is clean, well maintained, and everything is working properly.  Showing the pride you have in the community’s property entrusted to you will help develop the community’s pride in the fire department. 

 Having an accident which damages the property of a community member and prevents the fire department from going to the emergency does not generate goodwill and pride for the fire department. It does just the opposite, the community will be mad at the fire department. Not only did they not do the job expected of them, they caused additional damage to the community.

As a driver you are entrusted with the lives of so many people: your brother and sister firefighter in the apparatus, every member of the community you pass, and your own.  I have talked and written about the responsibility a driver has to get his crew safely to and from an emergency scene and the responsibility not to harm the public as we go down the road on many occasions. We forget about ourselves.  As a driver we are responsible for getting ourselves back and forth to an emergency safely.  How would you feel if you could no longer perform your job and provide for your family because of a career ending injury caused by you driving less than professionally.  Or worse, you do not come home because you became a line of duty death statistic. Driving safely and professionally is a selfish endeavor, I want a long and fruitful career and to go home to my family at the end of every shift.  Unlike most things, everyone benefits from this selfish action. 

There are so many variables at an emergency we have little or no influence over, but getting there and back we have much more control over.  Drive with courtesy, respect, and professionalism and the community will see you are concerned for protecting their lives and property. Remember, if we become an emergency it is impossible to fix the original one we were called to. 

Firefighter Physical Fitness

By: Howard Cohen

I am not fitness trainer.  I am not an athlete.  I have not participated in any sort of organized competitive sport for nearly forty years.  I am just a person who unabashedly believes in the importance of physical fitness for everyone, but especially firefighters.

With that disclaimer out of the way, let’s face it:  firefighting is a dangerous and physically demanding job.  Firefighters operate in harsh and challenging environments, use heavy, hard to handle tools, and wear many kilos of protective gear.  To successfully do our jobs we need to keep ourselves in great shape.  This means that we must take care of ourselves through proper nutrition and hydration, physical exercise, and sufficient rest. This is what is minimally required to properly and safely perform our jobs.

If you stop and think about it, what is the one “tool” every firefighter uses at every call? It’s our body.  We depend on our bodies for all aspects of firefighting.  In this sense, fire fighters are like elite athletes.  While we may not have to jump, sprint or throw a ball, we are, however, often required to crawl, drag or haul awkward shaped heavy objects in extreme heat conditions that greatly tax our cardio vascular systems. But there are important differences too.  Elite athletes generally perform under optimal conditions. Firefighters respond to calls during the worse weather conditions. Elite athletes typically get a good night’s sleep before their big events. First responders are often woken up multiple times during the night.  Elite athletes eat a well balanced meal with regard to their upcoming sporting event.  First responders meals are often rushed, gobbled on the run or interrupted by calls.  However, the biggest difference is that for elite athletes it is all about winning or losing.  For firefighters, what’s on the line is often life or death; your’s, your fellow firefighter’s or a civilian’s.

The good news is that achieving a firefighter operational level of physical fitness is not hard. However, it does require a commitment to exercise regularly.  There are many great ways to hone your fitness level.  If you have access to youtube, search for a type of workout that appeals to you. You will discover many free options to choose from.  Ideally, your workouts will include strength training with weights or whatever heavy objects you have available to you and cardiovascular exercises, such as lunges, jumping jacks, running, climbing stairs, or any activity that gets your heart rate up. You don’t need a specific or fancy program to get in good workouts.  All you need is to make a personal commitment to move your body and get your heart pumping.  Any well rounded program will benefit you in all aspects of fitness.

There are no downsides to exercise and being physically fit, period.  Physical fitness has been shown to prevent or treat many chronic health conditions brought on by unhealthy lifestyles, it even counter acts some of the aging process.  Studies indicate that exercising regularly builds up a stronger heart and along with a healthy diet, can even reduce the risk of cancer and boost one’s immune system.  Being physically fit also helps to reduce injuries that can keep you from working.  Sometimes firefighters forget that physical fitness involves more than just working out. It also includes taking care of your body by eating well, keeping yourself well-hydrated, getting sufficient sleep, and avoiding or limiting ingesting harmful chemicals, such as alcohol, recreational drugs, or tobacco. 

The biggest obstacle to sticking with a fitness plan is boredom.  Therefore it is important for you find or create a routine that holds your interest.  Mix it up too.  Don’t do the same workout day after day.  Workout with a friend or your other brigade crew members.  Make it fun.  To the extent that your schedule permits, it is also helpful to make your fitness program a fixed and regular part of your daily routine.  Some people like to get their workouts in early in the morning.  This way no matter how the rest of the day unfolds it’s a good day because you got your workout in.  Other people like to workout at the end of the day.  This way they figure, no matter what kind of day they had they have something to look forward.  Personally, I get my workout in every morning after having two cups of black tea and reading the headlines in the paper. After my workout I’m ready for whatever is coming my way.

In conclusion, the purpose of this article is to inspire you to find and commit to a personal fitness program that excites and motivates you.  Honor your body.  After all, it is the home of your holy soul.  Now get moving and get your heart pumping!

Bio: Howard retired from the Bennington Fire Dept as a deputy chief.  He spends a lot of time writing and teaching various aspects of firefighting.  He religiously works out every morning, doing a mix of high intensity interval training (HiiT), dumbbells, kettlebells, barbells and cycling. When he is not doing something for the fire service or working out he is the rabbi of two small congregations.

Firefighter Mental Health

By Howard Cohen

Fire fighting is one of the best jobs around.  It is also one of the most dangerous.  As firefighters we train and prepare to run into burning buildings, mitigate hazardous materials, work car accidents on busy roads, and deal with angry, hostile citizens.  But we tend to not train or prepare for one of the greatest risks to our physical, emotional, and spiritual health:  Frequent exposure to traumatic events. Studies in North America show how over time the stressors associated with exposure to traumatic events pose a serious challenge to our emotional, mental, and spiritual health.  For example, a study of firefighters in the United States revealed that 46% experienced suicide ideation; 19% participated in suicide planning; and 15% attempted suicide.  In addition, studies conducted in other countries[1], including Kenya[2], also show that post-traumatic stress symptoms and illness rates among emergency services workers are significantly higher than in the general population. Firefighters every where face the same physical dangers and traumatic events.  Therefore, as studies show, firefighters worldwide also suffer higher post-traumatic stress symptoms and illness rates than the general population.  Fortunately, we have the tools to help us, and our brothers and sisters in the fire service, address the stressors that arise from encountering traumatic events.

What is a traumatic event?  A good working definition is that it is an incident that evokes a strong emotional reaction with the potential of interfering in our lives.  Unfortunately, as first responders we often hide our emotional responses to bad calls behind a mask of toughness. This means that sometimes the impact of a tough call unfolds over time.  This can make it harder for us to recognize a connection between what we experience on a call and its emotional, physical and spiritual effects on us.  It is also important to realize that not everyone’s emotional response to a call will be the same.

Stressful events produce a complex interplay of nervous, endocrine, and immune mechanisms responses.  In other words, our normal way of being is disrupted.  The fight or flight or freeze response is an example of this.  How quickly we regain our homeostasis and return to normal or typical functioning depends on how resilient we are.  Resiliency is our key to coping with stressful events.   The good news is that resiliency is a skill we can develop.  It doesn’t require any special equipment or hours of exercises.  In fact, it is the natural outcome of some very enjoyable and healthy activities.  Here are some ways to build your resilience for when you’ll need it. 

          • Eat healthy food

          • Develop hobbies and interests outside of work

          • Cultivate friendships with those whom you can speak openly and honestly

          • Nurture your spiritual life

          • Practice mindfulness such as yoga or meditation

          • Exercise

          • Relax, go on vacations

          • Be kind to yourself

          • Embrace change

          • Remind yourself that you have the most meaningful job in the world

          • Embrace healthy thoughts

          • Be open to getting help if you think you might need it.

There are many signs that we, or someone we know,  may be adversely affected by a traumatic event or an accumulation of unprocessed events.  These signs may include some or all of the following:

        •Fatigue                                            • Grief

    • Chest pains                                                   • Denial    

         • Loss of emotional control                              • Depression

        • Difficulty paying attention                            • Anger

          • Difficult making decisions                     • Change in appetite

          • Nightmares                                                   • Misuse of alcohol or drugs

          • Intrusive images                                            • Anger at God/Crisis of faith

          • Anxiety                                                         • Withdrawing from others

          • Guilt                                                            

When someone you care about is exhibiting some of the above signs gently bring your observations to their attention.  Be sure to let them know that you are coming from a place of love and concern. Though it isn’t always easy to approach a friend and colleague who is hurting, the price to pay for not to doing so could be very high.  As you know, a firefighter not performing at peak levels because of stressors is a potential risk to herself or other firefighters.  Hopefully, if we are ever exhibiting signs of not coping with the stressors in our life well or with a particularly bad call one of our friends and colleagues will let us know.  Awareness of these outward signs, whether as the result of self reflection or because it was brought to our attention, is critical.

Developing situational awareness on the fire ground is a critical skill taught to every firefighter.  Emotional and mental health situational awareness is a critical skill for building resilience; this skill should be taught to every firefighter because traumatic events and bad calls go hand in hand with the job  Whether it is a fatal car crash, burn victim, suicide or the death of a child, these encounters take a toll. It is no surprise that many firefighters are haunted by the tragedies they witness as a part of their job every day.  Fortunately, with increased awareness and resilience building skills firefighters today are better able to cope with the stresses that go with having the best job in the world.

[1] First Responders and PTSD: A Literature Review By Ashley Fitzpatrick, BSN, RN, EMT -

7.28.2020

[2] Rationale for Early Psychological Intervention Among Disaster Actors in Nairobi County, Kenya by Eunice K. Ndulu & Dr. Maragret Iyaya, Journal of Education and Practice; Vol. 10, No 32, 2019.

Firefighter Safety- Using your PPE

By Brad Banz, Retired Chief, Colwich, Kansas Fire Dept. and Retired Captain, Wichita, Kansas Fire Dept.

 Today’s firefighters are asked to do much more than just respond to fires.  In the modern world, we respond to automobile accidents, dangerous goods (haz-mat) incidents, various types of rescue calls, utility emergencies, EMS calls, and now add in terrorism and pandemic to the list, not to mention anything else that may occur.  

    Firefighters are exposed to a spectrum of hazards as a result of the wide variety of incidents that we respond to.  We are exposed to environmental heat from working around fire, as well as the excess heat our bodies produce from extreme exertion.  The fires today we are responding to burn hotter than they did even 30 years ago.  An example is burning a cotton mattress versus a modern sofa made of polyurethane foam and polyester fabric.  The cotton mattress when burned will release heat at a rate of 140-350 kilojoules per second.  The sofa will release heat at a rate of 3,210 kilojoules per second.  Ten times the amount of heat.  We are exposed to cold, falling objects and debris, blood and biohazards, suffocation hazards, and crushing hazards.  We are also exposed to a toxic assortment of chemicals, not only from the dangerous goods incidents we respond to, but from each fire, no matter what the contents.  

   The reason I share this is not to scare anyone from the job, but to hopefully educate everyone on the hazards that are there so they can better equip themselves to more safely do the job.  Because we respond to more incidents and are exposed to a wider variety of hazards, we must do a better job as firefighters of focusing on safety.  One of the most fundamental things firefighters can do is to wear their PPE.  

     Let’s talk a little about how PPE makes us safer.  Coats and pants are made of 3 layers of material.  The outer shell provides a first layer against heat and cold, and some protection against moisture.  The middle layer is the vapor barrier.  As the name implies, it provides a barrier against steam and some chemical vapors.  The inside layer is the thermal barrier.  The layering of it, along with the outer layers, create a stronger barrier against heat.  The level of heat protection is dependent upon the materials the coats and pants are constructed of.  They will give limited protection against some dangerous goods, but are not meant to be the primary PPE for all responses.  In any circumstance, to insure maximum protection, coats and pants should be fastened all the way.  Boots can be constructed of leather or rubber and must have steel toe and foot protection to protect from crushing injuries as well as penetrations.  Gloves are made of leather or other materials.  They are lined to protect our hands from thermal injuries and have wristlets to protect our wrists as well.  Hoods are made of Nomex or carbon fibers.  An adequate hood offers protection to our necks and overlaps down on to the tops of our shoulders, and protects our necks and all exposed skin on our heads from heat.  They should be pulled up whenever operating in a hazardous environment.  A good helmet should have an adequate face shield, chin strap and neck protection.  It should also be clean and not cracked.  The face shield should be in a down position when working in an environment where tools or equipment are being used or blood, biohazards, or other chemicals may be present.  

    Any time we are entering an environment that is filled with products of combustion, heat, fire, or unknown atmosphere we should be wearing a breathing apparatus.  This includes during the overhaul process after the fire is contained.  If your department/brigade does not have BA then you need to structure your firefighting tactics accordingly.  

    As I addressed earlier, one of the biggest hazards we face is responding to medical and trauma related emergencies, and the risk of biohazards.  We need to make sure to protect ourselves by wearing the proper gloves, protective glasses, masks, and if the situation calls for it, gowns and facial protection.

    I have briefly covered the hazards and the PPE we can use to lessen the risks that we face.  Firefighters need to consistently practice an attitude of safety every day, and watch out for each other.  Thank you, and let’s all stay safe out there.

The Importance of Firematics

by Nicholas Higgins

It has been said time and time again, "You can never train too much for a job that can kill you." As we are aware, firefighting has many aspects to it. Many of these are common to every fire department, no matter their location, size, or status (career or volunteer). Other aspects are specialized areas that not all departments focus on or specialize in, such as medical, hazardous materials or technical rescue. In any case, having a sound basis in the area of “firematics” is a stepping stone to success for yourself and for your crew. We will briefly touch on key areas every firefighter should have a sound understanding and strong knowledge of. Many of these areas are touched on briefly in probationary/training school and then oftentimes, pushed aside once graduated. However, these areas are the core foundation for everything we do as firefighters and lay the groundwork for everything else we do on the fire ground. The skills of understanding these concepts, terminology and definitions is in fact, simple in theory. The difficulty is understanding the strategies and tactics behind them in order to implement them. All good leaders and firefighters must understand these core areas of which everything else is built from. 

The areas I would like to briefly touch upon are: building construction, fire behavior, reading smoke and size-up.

Building Construction

In the American Fire Service, there are oftentimes six different types of building construction however this may be different in various parts of the world based on the materials used to build structures. As firefighters, it is imperative that we know our enemy and know everything we can about it. Without having at least an understanding of our enemy, it becomes difficult to defeat it. In almost every one of our cases, the enemy is the building structure. In order to be a successful firefighter in any capacity, on any apparatus, in any area, understanding and having a solid foundation of building construction knowledge is vital. Just as a world-class fighter studies their opponent in the months leading up to a fight, us as firefighters MUST study our buildings in our areas, so we too are prepared to fight…and WIN. 

The most vital piece of information I can provide here is simple. It makes a difference in knowing the different types of structures and how to identify the differences, however, what makes it even more important is the ability to identify the types and how they will react under fire conditions while in the moment! This leads us to fire behavior.

Fire Behavior

Fire behavior is the foundation on which all firefighter knowledge is built upon. Moreover it is our understanding of fire behavior from which we can gain an understanding of fire and how to suppress it properly. The lack of fire behavior knowledge creates an even greater risk for serious injury or death. Understanding fire behavior is truly being able to operate as a firefighter. The understanding of fire behavior is the basis for understanding fire suppression and the understanding how to properly perform other tactics such as ventilation, forcible entry on some occasions and overhaul.

As society changes or in many cases evolves, so does fire behavior. The reasoning behind this is simple - the introduction and presence of synthetic materials (also known as plastics). These materials in their solid form are petroleum- based products, therefore producing an increase in the output of thermal energy. This reasoning alone is a cause for a more rapidly spreading fire regardless of the type of structure it is in. More so than not, it is causing our enemy (the building) to have more fuel to hurt us. To understand fire behavior, it is important to understand the phases that come along with it and it’s attributes – ignition, growth, full development (flashover is present) and decay (back draft is likely). To understand these areas takes years of studying and training to become proficient but having the basic concepts down is a great start to proficiency in fire behavior for firefighters of all levels and experience.

With fire comes smoke.

Reading Smoke

An important aspect on the fireground for many reasons is understanding smoke and smoke behavior. Many clues from the smoke alone can help identify the location and status of the fire. Command and company officers, as well as firefighters, need to be able to read and interpret all of the clues while conducting their size-up upon arrival and throughout the incident. 

Here are some clues to take into consideration: potential fuel, density, color, velocity, and volume.

Smoke is fuel. In today's world and the modern-day fire service, the products of combustion are highly toxic, flammable and potentially explosive. The smoke’s chemical composition is different at each fire due to the different fuel sources yet, one thing remains the same; smoke contains high levels of carbon monoxide.

Density identifies the thickness of the smoke, it’s level of energy and if there is a potential for a flashover or for fire spread.

Color tells you how flammable the smoke is and what is burning.

Velocity tells us how fast or slow the smoke is moving and by doing so helps determine the location and its flow path.

Volume on the other hand doesn’t speak to firefighters about smoke or fire but it does give firefighters the amount of fuel that is burning. By knowing how much fuel is burning, provides insight to the size and intensity of the incident.

Understanding smoke provides the fundamentals for reading and identifying changes in fire and smoke conditions in the interior or exterior of a structure, along with identifying and possibly preventing flashover or fire spread.

Size-Up

The size-up is for all intents and purposes, our game plan or battle plan, if you will, against the structure we are working at. The size-up is where firefighters and fire officers gather information in order to make safe, efficient, and effective fireground decisions. Fireground decision making, as we know, is meant to be quick, but with an emphasis on safety and ensuring the tactics are done efficiently and effectively. This is done in three phases; the pre-incident size-up, the on-scene size-up and the after action review. All three of these have their purposes.

Pre-incident size-up allows firefighters to gather as much information as we can about the structure and contents inside and helps guide our on-scene strategies and tactics.

On-scene size-up is where firefighters utilize our pre-incident size-up and put it to work. This size-up is where more information is provided specific to the incident and can now confirm our findings from the pre-incident size-up. Further, this is where company operations are assigned and take place.

After-action-review is the final stage in the pre-planning process. This is the time for firefighters and officers to discuss and share the information obtained and to discuss the success and failures experienced at the incident. It is also a time to ask a few key questions. 

What did we expect to happen?

• What actually occurred?

• What went well and why?

• What can we improve upon and how?

The benefit of asking these questions allows for strengths to be easily identifiable and make it easier to uncover areas of weakness. By uncovering areas of weakness, you can develop ways to improve them!

In closing, I’d like to leave you with this piece of advice. If we think of firematics as an orchestra and each piece getting broken down into sections, we can identify each area as its own unique piece yet, an integral piece to the orchestra as a whole. With practice, each section sounds in harmony and sync with one another, but without practice or even a section missing, the harmony and synchronization doesn’t happen. This is the same for firematics, you cannot have one without the others.

For further information on these topics, you can refer to my book, “The 5-Tool Firefighter” where these concepts are laid out in greater detail along with other areas of interest to guide all firefighters on their journey to success.

About the author
Nicholas J. Higgins is a firefighter and district training officer for Piscataway Fire District #2 in Piscataway, NJ. He is a New Jersey State Level 2 Fire Instructor, a National Fallen Firefighters Foundation state advocate and a member of the Board of Directors for the 5-Alarm Task Force Corp. a 501 (c) (3), non-profit organization. Nick is the founder and contributor of The Firehouse Tribune website.

Advocating For The Needs Of Your Fire Service

by Chief Robert R. Rielage

When I was a much younger firefighter, my Chief once said, “He who doesn’t speak up, is never heard”.  These words really sum up the topic of “Advocating for the needs of your Fire Service”.  You need to make others, such as your governing council, know what you need to effectively do your job.

This is certainly not as easy as it sounds, but it is part of the job especially for the Chief and your officers.

First, no one understands your needs better than you. You are the officers and firefighters of your department.  You see every day what you need to make your service better.  The people you serve expect you to respond to countless types of emergencies, give timely safety advice, and perform your duties with dedication, professionalism and without hesitation.  

Basically, that type of department requires four things: people, training, equipment and facilities that are all properly maintained and at the ready for you to respond.

Your job is to make sure that there are an adequate number of properly trained firefighters to handle whatever the emergency; that they have the proper personal equipment to safely perform these tasks; and a budget that provides and maintains the personnel, equipment, vehicles and facilities to support your emergency operations.

Is it easy to ask for all of these things?  No, but once again, no one but you understand better the needs of your department.  So how and who do you contact to express these needs?  

The Chief, especially, must know the “politics” involved.  Note that this word has a small “p” politics in the sense of how your governing council, mayor, trustee or board of supervisors operates, not  the Politics with a capital “P” meaning the dealings of a certain political party affiliation.

We are fortunate in that in the United States, there is a class at the National Fire Academy entitled “Politics and the White Helmet” which clearly teaches the right way to express the needs of your fire department to those individuals or governing body that provides the funding to allow a department to get things done.  But at the same time, I’ve never seen a fire department that got everything it wanted – so the Chief or the officers need to prioritize their needs and requests.

In addition to this, I think it is equally important to have a working relationship with the news media: those newspapers, radio or television reporters who come out when there is a large fire, explosion, or a natural disaster that occurs in your response area.  Standing in front of a camera or a reporter with a microphone may not be comfortable for everyone.  Again, in their absence, the Chief should delegate someone in the department to be a Public Information Officer (PIO).

The PIO is a firefighter or officer authorized to discuss releasable information at the scene of an emergency.  Why is it so important?  Because a picture or a video with a story about the emergency is worth more than 100 requests for new equipment.  There are guidelines that we can discuss in another article or an upcoming training session.

The reporters can also give you some tips on how you should approach an interview, especially when the camera is on.

Some suggestions may include:

: Being in uniform or in your turnout gear – helmet, and coat which tells everyone you are an official representative of the department.

: Having the key points of what you want to say clearly in your mind, e.g. What you saw on arrival (the volume of fire, or the number of vehicles or victims involved) Were there any rescues performed?  

: Keep it brief but let the public know what your department did to make resolve the emergency and how quickly that took to bring the incident under control.

The purpose of my article is not to answer all of your questions on how to be an advocate for the needs of your department, but rather to give you a starting point.  The first lesson being, if you don’t advocate for the needs of your department, who will?

Stay safe!

About the author  Chief Robert R. Rielage, MPA, CFO, EFO, FIFireE, is the former Ohio fire marshal and has been a chief officer in several departments for more than 35 years. A graduate of the Kennedy School's Program for Senior Executives in State and Local Government at Harvard University, Rielage holds a master's degree in public administration from Norwich University and is a past-president of the Institution of Fire Engineers – USA Branch. 

AMBULANCE SERVICES AND THEIR IMPORTANCE IN SOCIETY

By Kelvin, Seru Kenya EMR

An increase in medical ailments has led to the rise in hospitals and emergency medical services. These services assist patients who require emergency medical assistance at critical moments, helping them to reach the hospital on time and thus saving their life.

Private and public ambulance transportation services are operating in large numbers today to serve patients in critical condition.

Ambulance operating centers are set up at every hospital and private EMS. These operating centers function with adequate ambulance transportation services to offer immediate medical care for patients. Private ambulance transportation services depict a consistent rise in the growth curve each year offering non-emergency services, unlike hospital ambulance transportation services which primarily function for emergency needs.

Some of the non-emergency protocols include shifting patients from one hospital to another, transporting patients for any scanning or laboratory services to the relevant facilities, and having patients with traveling disabilities ride in normal vehicles to hospitals for treatments.

Emergency ambulance services are usually equipped with adequate medical equipment and paramedical professionals. Sometimes, non-emergency ambulance transportation services are also equipped with some basic medical aids and paramedical staff to cater to the needs of immediate medical care to patients.

HERE ARE A FEW THINGS TO KNOW ABOUT PARAMEDICS, WHO ARE THE BACKBONE OF AMBULANCE TRANSPORTATION SERVICES.

1) Paramedics or paramedical professionals are the first to treat patients, even before doctors. They save patients through immediate medical procedures ensuring the vitals are stable before reaching hospitals for further treatments.

2) Paramedics are trained healthcare professionals and sometimes have equivalent training to doctors. They can be authorized to assist patients with required medications and procedures.

3) Paramedics roles were established before World War I and their services were mostly rendered to soldiers on the battlefield. In those days their function was closely associated with the military. Later, ambulance services with paramedics were put into function to offer immediate medical care for civilians as well.

4) Education level, standards, functions, and skills of paramedics vary by country. However, certain standard functionalities remain common. Such as being trained to practice CPR, procedures for cardiac arrest patients, usage of defibrillators, certain analgesic, paralytics, sedative medications for pain control, first aid to treat burns, fractures, childbirth complications, spine injury, airway management, blood control, etc.

6) Paramedics and physiotherapists have one of the noblest professions in Kenya Africa and the world at large. Earlier physiotherapy did not gain as much recognition as today where physiotherapists are looked at as saviors offering treatments as an alternate to surgical procedures in most of the cases and post-surgery maintenance for a quick recovery to a normal lifestyle.

7) One should respect the noble service of pre-hospital providers who form an integral part of ambulance services.

8) The youth of our nation should get involved in such noble services by joining community life-saving teams and getting careers rather than wasting their resource and potential indulging in unwise activities.

9) Moreover, the government should take initiatives to support the volunteer first responders at the community level and to empower them to continue saving lives at the scene, before qualified personnel arrives.

WHY SHOULD BOTH A FIRE TRUCK AND AN AMBULANCE ALWAYS SHOW UP FOR A MEDICAL EMERGENCY?

When a call comes in, dispatchers often are not given precise or complete information.

As such, units are dispatched ready for the worst-case scenario. To ensure the highest level of care, the closest fire engine station is dispatched, and EMS sends an ambulance (staffed with two paramedics).

No medical call is “routine.” At a minimum, most emergencies require assessing the patient, obtaining their vital signs, providing oxygen therapy, and moving them.
EMS may also need to place an advanced airway, administer drugs intravenously, or monitor cardiac conditions. All of these procedures are completed more efficiently when the appropriate amount of help is on the scene.

Efficient care is our goal, and it is often the difference between life and death.

Unfortunately, units have no way of knowing what they will encounter on a call until they arrive. They work in a “what if” and “all-risk” business.

Responding to the unknown is public safety.

Emergency hotlines are your instant go-to when the need arises. That’s why it is important that you keep a copy of each of the important ones with you.

What's in Your Pockets?

by Chaplain Howard A Cohen, deputy chief (ret.), Bennington Fire Department

 It is very important for us, as firefighters, to be as effective, efficient and fast as possible on the fire ground. One good rule is to never enter the fire ground without a tool in each hand.  The situation will determine whether you grab an axe, halagan bar, thermal imaging camera, rescue rope, flashlight, gas meter or some other tool. Just make sure you have one in each hand.  It’s a waste of precious time if you have to run back to your truck to get a tool.

 Another good rule is to carry small tools like a screwdriver, wire cutter, prying tool, extra chocks, webbing, rope, carabineer, and a knife in the pockets of your turnout gear.  One of my favorite conversation starters when I meet a new firefighter is to ask what they carry in their pockets.  I’m often amazed by what they tell me.

 For me, it was learning the value of multi head screwdriver that persuaded me to pay attention to what I carry in my pockets.  It was late one evening when an air vent on the roof of a nursing home malfunctioned and started filling a wing with smoke.  We needed to ladder the building to access the vent.  No big deal except that it was about 100 yards from our truck to where we needed to get on the roof.  We got the ladder up and clamored up on the roof. We needed to loosen six screws to get the malfunctioning vent off. Alas, no one had a screwdriver on them.  So back to the truck someone had to run.  Fortunately, there was no longer a fire risk because the power was shut off. 

When he returned, the firefighter climbed back up the ladder and onto the roof.  Oh no! He grabbed the wrong kind of screwdriver. Once again, down he went back to the truck, then back up the ladder to us on the roof.  If only one of us was carrying a screwdriver! What should have been a five minute task took thirty minutes!  Ever since, I carry a multi head screwdriver with me. I’m glad to say I’ve used it many times since.

 Here is a very simple, educational and fun “drill”.  Ask one another what they carry in the pockets of their turnout gear.  There is no right or wrong answer.  I guarantee you’ll learn something in the process.

Making a Size-up – the Most Critical Factor on an Emergency Scene

By: Robert Rielage, Retired Chief Fire Officer

A very wise former fire chief named Alan Brunacini once stated, “The first five minutes of a fire (or emergency) determines the next five hours on the incident scene”.

The size-up is performed by the officer of the first arriving company and helps provide and maintain a steady, adequate and timely stream of the resources needed to control and extinguish the fire, or handle the medical needs of patients on an emergency medical scene.

On every incident, the size-up begins with the information received by the call taker from the person reporting the emergency.  This information is then given by the radio operator to the fire crews as they dispatch the fire trucks or ambulances to the scene. With that information, the first arriving officer has a basic mental picture of what to expect – e.g. a house, apartment or commercial building on fire; or an automobile accident with one, two or more vehicles involved.

As they arrive on the fire truck, the officer should look at the scene and make a brief radio report confirming what they see, hear, or touch.  Is there smoke or fire visible?  Are there people screaming for help in a danger zone that need immediate rescue? Or is nothing visible?  The officer then makes the brief radio report telling the radio operator they have arrived on scene, giving them their exact location, and a brief description of the type of fire including the construction and number of floors of building if its involved.

As the firefighters get off their truck, the officer should try to walk around the building or accident scene, if possible, to determine such things as - is there fire or smoke in the rear or side of the building that may not be visible from the street?  Or how many vehicles are involved in the motor vehicle crash with an estimate of how many victims need medical attention?

After looking at all sides of the fire or accident, the officer makes a second brief radio report telling the radio operator the conditions they see, e.g. heavy smoke or fire from a rear window, whether the crew is going to enter the building with a fire hose (an offensive fire attack) or cool down the fire first from the outside (a defensive fire), and finally the officer tells the radio operator that he is in charge i.e. Fire Officer Kongi is in Command.

If it’s a fire, how big is it? Can it be controlled by your company alone? Or perhaps with yours and another company?  Or is it already too big for the initial assignment, and you need to start additional units to the scene?  If there are rescues to be made, are these people in immediate danger or is it better to begin putting out the fire – which may take these people out of the immediate danger to them – or it better to begin rescue and let the next company handle the fire? In either case, more resources are going to be needed because three or four firefighters on one truck aren’t going to be able to do both at the same time.

What about water?  Is there enough water of the truck to put out the fire – the water carried on your truck in most cases may be able to knock down the fire, but you will probably need a water tender or an adequate source of water from a lake, river or pond to finish the extinguishment.  Again, the size-up is intended for the officer to make that decision and get other fire trucks started to the scene so there is no interruption in extinguishing the fire or rescuing people.

At a medical scene, the officer needs to decide if the injured can receive adequate medical treatment from one or more ambulances coming to the scene, and immediately request more help, if needed.

I know that for some of you, the size-up may be more difficult to communicate to others.  I realize that some departments do not have reliable radios on their vehicles. Many of you have cell phones. While it’s not as direct, you might get together with the other fire companies to devise a way to briefly send a text message to other responding units about the type of fire and conditions you are facing.  Then they will know that you will give them an assignment that will support the strategy (offensive or defensive) when they arrive.

This is a brief description of “Size-up” and we should continue this discussion at some future time, but talk it over among the officers and decide if it is worthwhile to try, even if you have to resort to a brief text message.

Remember, it is always better to have more resources coming and turn them back if they are not needed, than being able to do very little while waiting for other companies to arrive.

Cancer in the Fire Service

By: Brad Banz-

Retired Fire Chief, Colwich Fire Dept., Retired Captain Wichita Fire Dept.

Unfortunately, as firefighters we are learning that a serious challenge we all face is cancer in the fire service.  As time and research progress, we are starting to learn how serious that threat really is to our health and wellbeing as firefighters.

A comprehensive study was conducted by the U.S. National Institute for Occupational Safety and Health, also known as NIOSH.  This study was conducted on nearly 30,000 firefighters who were employed by the Chicago, San Francisco and Philadelphia fire departments over a period from 1950-2009.  These fire departments are some of the largest in the U.S.  The study compared cancer rates of their firefighters in specific age groups and by race to the same age groups and race to comparable civilian populations in the same regions.  The study concluded that the firefighters had greater rates of digestive, oral, respiratory, and urinary cancers than their civilian counterparts.  According to the International Association of Firefighters, the labor union which represents many career firefighters in the U.S. and Canada, 66 percent of all firefighter line of duty deaths between 2002 and 2019 in the U.S. and Canada were cancer related.

This evidence shows that cancer is a concern among firefighters.  Over our careers we are repeatedly exposed to many known cancer-causing agents and unknowns which evolve in the combustion process.  Since we can’t avoid being around these contaminants, I would like to discuss ways of lessening exposure, and perhaps decreasing our cancer risk. 

The first thing we can do is to keep ourselves clean.  The chemicals in the grime that ends up on our skin are the chemicals that can cause cancer.  The sooner we wash, the better.  While on the scene, rinse hands and face upon completing work.  Some firefighters have wipes.  If so, use them.  Upon returning to quarters and having all equipment readied for service, shower or wash as soon as possible.  Concentrate on face, throat, armpits and groin area especially.

Another thing we can do is keep our PPE clean.  Brush off loose debris at the scene and rinse away excessive grime on the scene.  Thoroughly rinse PPE at the firehouse to remove as much debris as possible.  Although many fire brigades may not have gear washing machines, for brigades which are fortunate enough to have a gear washer, launder gear according to manufacturer’s recommendations.  Whether laundered or rinsed, gear should never be dried in the sun.  Something that is often overlooked is our helmets, and admittedly, mine is dirty.  Helmets should be cleaned with soap and water only, as other cleaners could harm the shell.

Let’s talk about some rules for storage and transport of PPE.  Many firefighters like to keep PPE in sleeping quarters to have quick access during nighttime hours.  This is an unsafe practice.  When not responding to emergency calls, PPE should be stored in outside apparatus compartments while travelling.  Passenger compartments should also be cleaned after responding to a fire to remove all products of combustion. 

Cancer is an unfortunate reality of our careers in the fire service.  Because of the substances we are repeatedly exposed to, we need to do whatever we can to lessen the risk.  Hopefully these ideas for personal and PPE cleaning, and safe storage and transport of PPE will be valuable.  Stay safe out there.   

Personal Protective Equipment

“Helmets, Turnout Coat, Pants, Gloves and Self-Contained Breathing Apparatus”

- Robert Rielage, Retired Chief Fire Officer

The use of personal protective equipment (PPE) such as helmets, coats, pants, gloves, boots and self-contained breathing apparatus (SCBA) may not be available to your department or especially not to every firefighter of your department.  It is one of our priority goals at Africa Fire Mission to ensure that every firefighter is as safe as possible on the job and that each firefighter is utilizing all of the PPE available, whether fighting a fire, working at an automobile accident, or rescuing a person in an industrial accident.

Your PPE such as your pants, coat and gloves are designed out of very tough material to keep you safe from several things such as from being cut by broken glass, wood or metal.  They are also designed to protect you from the heat of the fire so you can get closer to where those who may need to be rescued are located.  Your helmet and eye shields are to protect both your head and eyes from falling or flying objects, much the same as your hands and feet are protected by your gloves and boots.

All of your PPE is designed to be worn on every call. Every piece is needed to be worn every time to  protect you.  It also provides better protection should your fire truck be involved in a traffic accident. 

There are also hidden dangers that you may not realize.  The smoke and hot gases released by a fire also contain contaminates – hazardous or poisonous chemicals like cyanide or carcinogenic particles released by the foam in burning furniture can cause you over time to develop cancer – one of the leading causes of death among firefighters.  Unfortunately, while PPE can help protect you, these chemicals produced by the smoke and fire can also cling to your PPE causing an indirect exposure that can also make you sick.

What can you do?  The best thing is to briefly wash down your PPE with water at the fire scene.  This is called “gross decontamination” and it washes off the majority of the bad chemicals, soot and smoke from your PPE.  Washing your PPE afterwards with a brush, soap and water is even better at keeping it clean. 

If your department has self-contained breathing apparatus (SCBA) you should wear it anytime there is fire and smoke present – even on an automobile fire.  This protects your lungs from these same deadly chemicals.  After using your SCBA, the face piece needs to be cleaned, again with soap and water, and the bottle and harness at minimum needs to be hosed off to keep it clean.

If you do not have SCBA, then always try to approach a fire with the wind at your back to blow the smoke and hot gases away from you.  Remember, your health and safety as firefighters are very important. You protect the citizens of your district from harm.  Wearing your full PPE is one of the most important things you can do to not only protect yourself, but also everyone in your community.

The Privilege to Drive the Big Red Truck

by Edward Collet

Jackson Township Fire Department Firefighter/EMT, Ohio; Ohio Fire Chiefs Association Water Supply Technical Advisory Committee Co-Chair

Safe Driving in the Fire Service

It seems not a day goes by without there being news of fire apparatus being involved in an accident.  Often firefighters and civilians are injured or killed.  The apparatus is always damaged to some extent either requiring minor repairs or putting it permanently out for service.   Some of these are truly accidents were the apparatus driver had not fault in the accident, yet many times the driver and officer have control of factors leading to an accident. 

Firefighting is one of the most trusted professions.  The day you earn the privilege to drive the big red truck, or whatever color the rig might be painted, your department entrusts you with very expensive and critical piece of equipment.  Your fellow firefighters and their families entrusts you to get them to the fire and back home safely.  The public entrusts you to get to the emergency without causing other crisis to address.  As the driver you have a huge responsibility.   How do you keep this trust and fulfill your responsibility?  Easy, check your apparatus and drive with due regard.

Anyone who has taken my class has heard my soapbox about safe driving, so here we go again.  There is absolutely no reason for firefighters to be injured and killed in accidents involving excessive speed and running through intersections.   Getting to the fire is not a race to see who gets there first.  Many have argued “we must drive fast because seconds count”.   Well what happens when seconds turn to minutes, turns to hours, turns to no one shows up because the fire department was in an accident.  Not much was gained by driving fast was it?  Speed is also the responsibility of the officer.  If the driver is going faster than you feel is safe make him slow down, you are the boss and ultimately responsible for the actions of your crew. 

Think about how you would feel if you had to visit the family of you brother or sister firefighter in the hospital, or worse, because your driving caused an accident.  Heavy things to think about, but it is the reality of being a driver.  If you do not drive carefully and defensively this could happen.  So how do we prevent this?  First is being familiar with your apparatus.  Engines and tender have a higher center of gravity than cars.  This means you cannot go around corners fast and they behave differently as you stop.  Fire apparatus are heavy and do not stop quickly.  Drive your apparatus when it is not an emergency to become familiar with how it handles. 

It is not enough to know your apparatus, you must drive like you are invisible to other drivers.  The fact is most drivers are distracted; listen to loud music, talking to passengers, talking on mobile phones, and even texting.  This means they will not see or hear you even with flashing lights and sirens.  We must drive like no one sees us and will not stop or get out of our way.  When you come to an intersection, stop until you make sure all traffic sees you and is stopped.  Even if you have the right-away, slow down before going through the intersection.   Even if cars pull over for you assume they will do something unexpected like pull out in front of you at the last second.

It is a great honor and responsibility to drive a piece of fire apparatus.  Do everything in your power to keep the trust given to you.  Know your apparatus, slow down, drive defensively, and pretend no one see you. 

Oh, I almost forgot.  When other drivers do not behave as they should in the presence of an emergency vehicle, stay calm and do your job in a professional manner.  Do not yell and gesture at other drivers.  I had an officer early in my career that would lean out the window and yell at drivers not getting out of the way.  Embarrassing, yes.  Unprofessional, yes.  Great way for the public to be mad at the fire department, yes.  Firefighters are supposed to embody what is best in society, so reflect that.

Stay safe and keep those in your apparatus safe.

Wildfire Preparedness Starts at Home

by Josh Bardwell

Texas A&M Forest Service Regional Fire Coordinator; West Mountain Volunteer Fire Department Firefighter/Emergency Medical Technician

Wildfires occur on almost all of Earth’s continents (with the exception of Antarctica) affecting people no matter their culture, language, and social status. With humans living in rural and interface areas where wildfires occur, it is not a matter of if, but when the need to be prepared will be tested.

Firefighters can have all the funding, water, training and staffing in the world, but still encounter challenges with preserving life and property from wildfires. Unlike a structure fire or rubbish fire relegated to a specific area and under limited environmental effects, wildfires can have unlimited fuel and oxygen which can cause them to grow large and move under their own weather which can be challenging to combat. Firefighters stand a better chance of saving lives and property when the public has made the effort well in advance of a fire even occurring. Prevention and preparedness programs are critical to educating and encouraging the public to take some responsibility in being part of the wildfire solution. Preventing fires is critical, but the public’s knowledge and ability to make their homes and communities less susceptible to wildfire damage is equally crucial. https://www.nfpa.org/Public-Education/Fire-causes-and-risks/Wildfire

Basic things that can be done now can make all the difference in the world.

·      Create defensible space around homes/buildings

·      Use fire resistant construction

·      Improve access for emergency responders

·      Have an action plan: 

o   https://www.iafc.org/docs/default-source/pdf/rsg-eag-v9.pdf

Sometimes it takes a friendly face or mascot for people to form an emotional bond with, which helps get the message across. In 1944, the United States Forest Service created the beloved Smokey Bear as a charismatic mascot that captured the attention of children and adults. His message has had minor verbiage changes over the years but nearly every American adult and child can recite his motto of “Only YOU can prevent wildfires.” Smokey Bear’s website is chocked full of wildfire prevention and safety tips for adults and children that is pertinent to people globally: https://smokeybear.com

As firefighters, we are mission driven to put fires out and save the day, but we must recognize our limitations. In my area of rural East Texas, 90% of our firefighters are volunteers and the expectations of the public we serve expect prompt and professional service. In order to maximize our effectiveness, we have to engage our communities with education and resources. 

The better prepared the residents of our community are before a wildfire occurs, the better our chances of success in combating a wildfire are with minimizing losses. When the community takes a proactive approach to wildfire mitigation and personal planning, the more effective we all are a cohesive team!