It was quarter to one a.m., and I was wide awake in the shift leader’s office. I was the boss of Engine 28 and responsible for the safety of my crew.

The fire suppression books I memorized for the promotion exam were authored by big city chiefs who worked with fire companies staffed with four to six firefighters and supported by a rapid arrival of command officers. There was no way a two-person truck company could perform the initial fireground tasks that a heavily staffed Fire Department of New York (FDNY) truck company could accomplish.

The county was evolving from a coalition of rural/suburban volunteer fire companies to an urban county fire department, which would be accomplished years later.

When I was sleepless in Seven Corners, we had daywork career battalion chiefs, three or two-person fire crews, rudimentary SOPs, and the beginnings of an incident management system. It was a very different environment than FDNY.

As a fire officer candidate, you would respond to an assessment center scenario with everything you remembered. The sequence of factoids was not as important as it was to get every item ticked-off in the assessor’s checklist to get the highest score.

I struggled as a paramedic student. The “nice to know” trivia factoids interfered with what I needed to know to get credentialed, and I was having the same problem now.

As the boss of Engine 28, I needed to do the right things first when arriving at a structure fire with our three-person engine company. Ironically, I recalled something from a retired FDNY Chief of Department that provided focus.

Edward P. McAniff’s book Leadership in the Fire Service, was on our promotional exam reading list. The IAFF local hired McAniff and Associates to deliver a preparation class, as this was our first exam to use an assessment center.

Chief McAniff said: “The goal of the first arriving engine is to advance an attack line and gain control of the interior stairs.”

That worked for me. A couple of weeks later, I applied this concept.

At 8 p.m., we were dispatched to an “Across from …” structure fire. We arrived at a single-level home four blocks south of the fire station. Fire was showing from the roof. A car was in the driveway, and lights were on in the house. After no response to our banging on the door, we forced the door open and advanced the 1.5” attack line.

There was no smoke or heat in the house. The second arriving engine company got to the rear and reported a fire coming from the natural gas regulator that spread to the soffit. When we opened the attic stairs, we found the fire.

The attic was finished with a hardwood floor and jammed with a lifetime of items from international travel. Overhauling the attic took a couple of hours using two engines and a truck company. The occupants were having dinner at a restaurant.

Returning at 1 a.m. for a fire watch check, we watered down the pile of steaming international debris in the front yard. I slept well that night.

Featured image: Shutterstock

These situations provide opportunities and challenges for the front-line emergency service officer.

FIRE DEPARTMENT AS A SOCIAL SERVICES PARTNER

The San Francisco Fire Department Street Crisis Response Team (SCRT) is staffed with a community paramedic from SFFD, a behavioral health clinician from HealthRIGHT360, and a peer specialist with lived experience from RAMS, Inc. (Richmond Area Multi-Services) who together have a range of specialty skills to engage on the scene with a person in crisis.

In the first year of operation, November 2020 – November 2021, SCRT took more than 5,000 calls and engaged with nearly 3,000 people in crisis. In early 2022, the seventh team with six additional staff will launch.

The first six months of the program showed that 9% of the SCRT encounters have ended in a 5150, an involuntary mental health hold for those who are a danger to themselves or others. 18% were transported to a hospital and 18% to a program such as residential care or drug treatment. (source)

Demonstrating the program’s success as an alternative to law enforcement, SCRT diverted more than one-third of all 911 calls (38%) for “mentally disturbed persons” from law enforcement cumulatively during its first year of operation. With six teams launched, SCRT is now diverting over half (58%) of calls monthly for “mentally disturbed persons” from law enforcement. Once fully operational, SCRT seeks to divert 100% of calls.

City of San Francisco (2021 November 30) San Francisco Celebrates One-Year Anniversary of Street Crisis Response Team Press Release

RISING PROBLEM OF HOMELESS ENCAMPMENTS: FIRES, INFECTIOUS DISEASE, VIOLENCE AGAINST CAREGIVERS, AND EMS WORKLOAD

Lexipol provided a 2019 webinar on “Crisis in the Streets: Fire Department Response to Homeless Individuals” that was eye-opening. Click on this link to see the on-demand webinar.

Homeless encampments experienced a 1,000% increase from 2007 to 2017 and are occurring throughout the United States. Half of the encampments have 11-50 residents, 17% of the encampments have more than 100 residences. (NLCHP 2017) Fire departments are responding to calls for violence, fires and infectious diseases like typhus and tuberculosis (Gorman 2018)

Due to violence against first responders, some fire departments are sending two crews to any EMS event at an encampment, to have one company commander function as the scene safety officer while the others work at the task-level. (Goldfeder, Long & Schaeffer 2019)

Seattle Fire Chief Harold Scoggins reports that from Jan. 1 to April 10 of 2022 the department responded to 478 encampment fires – three to five encampment fires a day. In 2021 during the same time period, it was 327. The year before that, they responded to 168 encampment fires. They are also responding to 30 to 35 medical calls to homeless encampments every day. (source)

Los Angeles Fire Department, a city 6 times larger than Seattle, responded to 24 encampment fires a day in May 2021, many spreading to adjacent businesses and residences creating millions of dollars of property damage. (source) In downtown Los Angeles, fires from homeless encampments account for 80% of the blazes in the summer of 2021. (source)

WE ARE NOT TELLING OUR STORY: FIREFIGHTERS RESCUE A LOT OF CIVILIANS

Stunning results from the Firefighter Rescue Survey. They have been collecting information on rescues made by firefighters as reported in the media or by fire departments. In 2021 they found that 2,173 civilians were rescued by firefighters. They received 757 completed rescue surveys. 

As of April 5, 2022, Firefighter Rescue Survey has received reports of 300 incidents where civilians have been rescued by firefighters in 2022. Statistically, that equates to nearly 3.3 incidents per day where firefighters are making grabs. (source) You can get Chief Brian Brush’s “2021 Rescue Survey & The Culture Shift for 2022: People Before Water“ through this (source).

The goal of the Firefighter Rescue Survey initiative is to reduce civilian home fire deaths to under 2,000 per year. U.S. news media reported 2,264 civilian home fire fatalities for the calendar year 2021. Please visit their website http://www.firefighterrescuesurvey.com/

REFERENCES

Thadani, T. & Cassidy, M. (2021 May 17) S.F. finally has a new mental health team to respond to homeless people in distress. Is it helping. San Francisco Chronicle. accessed April 14, 2022. https://www.sfchronicle.com/local/article/S-F-s-new-street-crisis-team-is-helping-people-16180437.php

NLCHP (2017). Tent City, USA: The Growth of America’s Homeless Encampments and How Communities are Responding. Washington, DC, National Law Center on Homelessness and Poverty. http://nlchp.org/wp-content/uploads/2018/10/Tent_City_USA_2017.pdf

Gorman, A. and Kaiser Health News (2019 March 8). Medieval Diseases Are Infecting California’s Homeless: Typhus, tuberculosis, and other illnesses are spreading quickly through camps and shelters. The Atlantic. New York, Atlantic Media, Inc.  https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/

Goldfeder, B., A. Long and B. Schaeffer (2019 July 9). Crisis In The Streets: Fire Department Response to Homeless Individuals. Webinar. Irvine, CA, Lexipol.  https://info.lexipol.com/webinar-fire-department-response-to-homeless

Markovich, M. (2020 April 15) Seattle Fire Chief: Responses to daily encampment fires taxing already short staffed fire dept. Fox 13 Seattle. Accessed April 15, 2022. https://www.q13fox.com/news/seattle-fire-chief-reponses-to-daily-encampment-fires-taxing-already-short-staffed-fire-dept

Smith, D., Queally, J., & Molina, G. (2021 May 12) 24 fires a day: Surge in flames at L.A. homeless encampments a growing crisis. Los Angeles Times Accessed April 17, 2022. https://www.latimes.com/california/story/2021-05-12/surge-in-fires-at-la-homeless-encampments-growing-crisis

(2021 June 14) Homeless Encampment Fires Account For 80% Of Blazes Plaguing DTLA In Recent Weeks: ‘It’s So Sad.’ CBS Los Angeles. Accessed April 17, 2022. https://www.cbsnews.com/losangeles/news/rash-of-homeless-encampment-fires-continues-across-southland/

Feature image: Winthrop, C. (05 March 2021) One Dead Following Palms Homeless Encampment Fire in Possible Homicide. westsidetoday.com Accessed April 17, 2022 https://westsidetoday.com/2021/03/05/one-dead-after-palms-homeless-encampment-fire/

(2022 April 6) Year of the Rescue, FIREFIGHTER GRAB VIDEO, Reducing Civilian Fatalities Below 2000. County Fire Tactics. Accessed April 17, 2022. https://countyfiretactics.com/2022/04/06/year-of-the-rescue-firefighter-grab-video-reducing-civilian-fatalities-below-2000/

Brush, B. (2022 February) “2021 Rescue Survey & The Cultural Shift for 2022: People Before Water.” CountyFireTactics.com. Accessed April 17, 2022. https://countyfiretactics.com/2022/02/06/2021-rescue-survey-chief-brush-the-cultural-shift-for-2022-chief-isakson/

I have posed a similar question to hundreds of emergency service providers attending a university course, a fire officer credential program or Just Culture presentation. Very few of them elected to continue to wait for the ambulance. Neither did Major Corey Britt, the Senior Company Officer at Oklahoma City Fire Station 34, when they responded to this Christmas Eve burn incident. (Meyer)

The students are shocked when the correct response from the formal organization’s perspective is to continue to wait for the ambulance. Major Britt was in a disciplinary hearing last Friday for his decision to transport the child and mother to the hospital on fire apparatus. (Yager)

The Just Culture Approach

The “Just Culture” approach can assist high consequence organizations (airlines, healthcare, and 24/7 industries) in holding its system and staff accountable within a supportive environment that provides a non-punitive means of reporting errors, while demonstrating zero tolerance for risky behavior. (Woods and Dekker)

It is a system of justice – using investigatory and disciplinary actions – that reflects what we know of socio-technical system design, human free will, and our inescapable human fallibility. (Nance)

After A Bad Outcome Event Occurs

Professor Sidney Dekker, founder of the Safety Science Innovation Lab, describes two approaches to just culture. Retribution imposes a deserved and proportional punishment while Restoration repairs the trust and relationships that were damaged.

The investigation of the bad outcome event looks at:

• What happened?
• What normally happens?
• What does the procedure require?
• Why did it happen?
• How are we managing it?

During this inquiry, we check to see if there is alignment of the department’s mission and value. Is there a clear understanding of the duty, what is defined as a breach of that duty and what are the consequences of breaching that duty.

The inquiry conducts an analysis to identify failed or absent defenses that takes a hazard or risk and makes it a loss, using the human error concepts developed by Professor James Reason.

Designing A Better System

Analysis of earlier bad outcome events result in four areas where we can design a better system. Emergency services have made such changes based on experience.

Controlling Contributing Factors

Changing the pre-cursors to human error at at-risk behavior. Two examples are requiring responders stop at every red light intersection and wear seat belts.

Adding Barriers

Preventing individual errors. Requiring a spotter when backing up vehicles.

Adding Recovery

Catching errors downstream. An example is checking your colleagues personal protective clothing before entering a hazardous environment.

Adding Redundancy

Establishing parallel elements to ensure safe activity. Using more than one method to confirm proper endotracheal intubation.

Just culture is set up to learn from incidents and identify changes in design, procedure and reward systems to promote better behavioral choices.

Understanding Risk

After understanding “what happened?” and comparing it to “What does the procedure require?” we look at the behavorial choice made and the individual’s understanding of the risk involved. Just culture focuses on three behaviors:

• Human Error is an inadvertent action, slip, lapse or mistake.
• At-Risk Behavior is a choice where the individual did not recognize the risk or believed the choice is justified
• Reckless Behavior is a conscious disregard of a substantial and unjustifiable risk

Evaluating the behavior includes the impact of Imposers. Imposers are persons or organizations who set the standards and rules, determines the risk threshold and renders judgement. EMS operations are regulated by a state agency, usually the Health Department. They issue a permit to jurisdictions to provide out-of-hospital care. They issue a license to individual caregivers.

Failure to follow state EMS regulations could endanger the jurisdictional permit to perform out-of-hospital care. In jurisdictions that charge for transport services, losing the jurisdictional permit could result in losing the ability to bill for services. Transporting patients on fire trucks endangers the jurisdictional EMS permit. From the organization’s viewpoint, losing the state EMS permit is a high risk.

Meanwhile, In Oklahoma City

The Emergency Medical Services Authority (EMSA) is struggling with increased call volume, a workforce thinned by the pandemic, long waits to unload patients at the hospital and more time to disinfect ambulances after transport. This results in fewer ambulances on the road and more late arrivals to Priority 1 and 2 calls.

EMSA Chief of Operations John Graham states that with fewer ambulances on the street, more of the responses are coming from the hospitals instead of community posts. This may place the ambulance 15 to 20 miles further away from the incident scene. In December 2020 there were 40 ambulance responses that took longer than one hour for the ambulance to arrive. (Meyer)

An Area With No Pre-planned Guidance

It is not clear if Engine 34 received an accurate estimated time of arrival for the ambulance assigned to the burn incident. (Yager) They had been on the scene for 16 minutes and were told the ambulance was at least 10 minutes away. The Oklahoma City Fire Department regulations may not include guidance on this type of situation.

Dana Libby, a former firefighter/paramedic, police officer and executive with a faith-based international charity organization, observed that the Doctrine of Necessity, along with necessary safeguards, has long been recognized in civil and criminal law. (Christie)

Libby further states:

Every Standard Operating Procedure should start with a statement of policy, principle, or purpose. The enumerated procedures should provide guidance on fulfilling the policy, principle or purpose, under a set of circumstances.

If the circumstances and conditions differ, there is at least guidance concerning what you are supposed to be accomplishing . . . good training, creativity, experience and wisdom will then get you as close as possible to the goal.

Take-Away for All

Many jurisdictions and state medical agencies have made changes in clinical and operational guidelines in response to the COVID-19 pandemic. The transport of critical patients when no ambulance is available is no longer an obscure “what-if” but now a “what-when” scenario. What is a just procedure for the patient, family, emergency responders, and healthcare staff?

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Christie, George C. (1999 March) The Defense of Necessity Considered From The Legal and Moral Points of View. Duke Law Journal 48 (5), Accessed January 25, 2021 https://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1052&context=dlj&fbclid=IwAR10x3HC831W5BqI2pNo1pFzsWz17e48gzjw2qYBBt5uGa2kpKY59mI1Zug

Dekker, Sidney (2017) Just Culture: Restoring Trust and Accountability in Your Organization. 3rd edition. Boca Raton, FL: CRC Press, Taylor & Francis Group. ISBN 978-1-4724-7578-7

Meyer, Ali (2021 Jan 19) EXCLUSIVE: ‘The system failed us’ – Family disappointed in EMSA ambulance delay. Oklahoma News 4. Accessed January 23, 2021 https://kfor.com/news/local/exclusive-the-system-failed-us-family-disappointed-in-emsa-ambulance-delay/

Nance, John J. (2008) Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care. Bozeman, MT: Second River Healthcare, ISBN 978-1-93640-604-3

Reason, James (1990) Human Error. New York: Cambridge University Press. ISBN 978-0-521-31419-0

Woods, David D., et al (2010) Behind Human Error, Second edition. Burlington, VT: Ashgate Publishing Company. ISBN 978-0-7546-7834-2

Yager, Peyton (2021 Jan 22) Oklahoma City Fire Major faces punishment within the department after driving burn patient to the hospital after ambulance delay. Oklahoma News 4. Accessed January 23, 2021 https://kfor.com/news/local/oklahoma-city-fire-major-faces-punishment-within-the-department-after-driving-burn-patient-to-the-hospital-due-to-ambulance-delay/

Sequencing Concepts and Practices

The 4th edition of Fire Officer: Principles and Practice is a major update that separates Fire Officer I and Fire Officer II material into two separate sections. This moved many topics around and allowed integration of some concepts into larger themes. About 35% of the content is new.

“Crew Resource Management” was the last chapter in the second and third editions, a stand alone section that provided five textbook pages focused on the International Association of Fire Chief’s approach to the practice.

The editors and I worked with the 24-member 4th edition focus group to make sure essential concepts and ideas were appropriately placed under the new format. We placed Crew Resource Management completely within the Fire Officer I section of the book.

Crew Resource Management As A Core Fire Officer Leadership Activity

Chapter 2 “Understanding Leadership and Management Theories” provides an overview of 11 leadership and management concepts. When describing the Blake and Mouton’s Managerial Grid, crew resource management is used as an example.

Starting on page 56 with “Origins of Crew Resource Management,” Chapter 2 provides an 11-page description of the concept and application of Crew Resource Management, tying CRM activities back to the leadership and management concepts covered in the beginning of the chapter.

The fire officer application of communication skills, teamwork, leadership, mentoring, handling conflict, responsibility, self-assessment are described within the context of CRM.

We added information from task allocation (NASA and flight safety), recognition-primed decision making (RPD), and situation awareness (Dr. Gasaway). Twelve of the 31 references listed for Chapter 2 are related to crew resource management. CRM represents 41% of the content in Chapter 2.

Crew Resource Management came to the fire service through flight safety over 20 years ago. It is time to move it from a “nice to know” topic at the end of the textbook to a core element of fire officer preparation.

This Week’s Take Home: Fire Department Takes Over EMS due to Budget Shortfall

Torrance, California, voted 6-1 on January 12 to end its contract with McCormack Ambulance and bring 9-1-1 ambulance service in-house come July. The revenue from staffing 5 fire department ambulances is intended to offset a $2.4 million budget cut that could lead to the layoff of 10 firefighters and a loss of the ISO Class 1 rating.

For students of local government operations, the city posted a 232 page package of information and presentations leading up to this decision. You can access the 52 MB .pdf file from here: https://torrance.granicus.com/MetaViewer.php?view_id=8&event_id=7340&meta_id=321316

The current contract with McCormack calls for five 24 hour-a-day ambulances every day of the week. The Fire Department will be staffing two 24-hour-a-day ambulances and three “peak hour” units … along with a “surge” agreement with McCormack

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Feature Image: Camp Pendleton firefighters make their way up the Naval Hospital’s stairwell during a high-rise fire training exercise, May 19, 2012. Base and local units came together in a psuedo-scenario drill to test their communication skills with each other, as well as enhancing rapport for further incidents that may require the departments to work together. This Image was released by the United States Marine Corps with the ID 120519-M-6457B-002

Related Company Commander 4th edition post:

Like many, my plans and expectations continue to be rocked by the pandemic and the associated economic disruption. So, what will 2021 bring?

Research: Pandemic Impact on EMS Caregivers and Firefighters

One of the reasons to get a Ph.D. is to think about the “big questions.” That starts while honing skills and performing research as a student. I am part of a group looking at the pandemic’s impact on EMS caregivers in terms of PPE and worker compensation.

The first wave of the pandemic was an unscheduled major event that overwhelmed first responders. Like the 9/11 attack in New York City, there were assumptions and promises that crumbled months later as the magnitude of the World Trade Center illnesses were determined by state and federal authorities.

Worker compensation for COVID-19 is inconsistent. We are seeing the same pushback for COVID-19 infected EMS caregivers similar to last year’s Company Commander documentation of the Texas approach to firefighter occupational cancer claims.

There is a tremendous disparity in the protection of EMS caregivers based on their job classification and type of employer. Within the Fire Department of New York, firefighters get unlimited sick leave while single role EMS providers get 12 days a year.

Paul Cary, a retired Aurora, Colorado firefighter/paramedic, was working on a FEMA-deployed commercial ambulance in New York City. He gets infected on-the-job and dies of the coronavirus. Since he is not an employee of a jurisdictional emergency service organization when he was infected, his family will not get the same line-of-duty death benefits that a family of a volunteer rescue squad caregiver receives after a LODD coronavirus death.

Follow: Delivering Emergency Service During Austere Times

Last May the International Association of Fire Chiefs warned that the impact of the pandemic shutdown and quarantines could result in the loss of 30,000 fire department jobs because lost tax revenues will significantly reduce local government budgets.

These job losses come at a time when emergency service workload has increased, from both the pandemic as well as the increased number of residential cooking fires and fires in unoccupied businesses and office buildings.

EMS workload has skyrocketed, with many systems recording their “busiest days ever” that includes day-to-day workloads 50% higher than normal. This is driven by more patients and the fallout of overwhelmed hospitals during a COVID surge generating more interfaculty transports.

Some emergency service agencies have stepped up to help overloaded health care and public health colleagues by assuming additional roles and responsibilities.

Develop: Company Commander Supervision and Management During Times of High-Stress, Hyper-Partisanship, and Poor Quality Information

We are working in extraordinary times where we often encounter tsunamis of conflicting or confusing information that call for a response by a supervisor or manager. Beyond the arena of national politics, this affects our ability to command, supervise and train our team as these controversies can “… suck all of the oxygen (and energy) out of a room” and skew our decision-making process.

How can you maintain a non-hostile work environment when television, print and social media work every day to increase readership by promoting conflict, anger and angst?

Share: New and Recurring Voices

Opinion leaders, innovators and recognized experts drive emergency service practices. I continue to seek out the next opinion leader or subject matter expert that is working to make us better, safer and righteous. If there is someone or a team I need to know about, please send me an email.

This Week’s Take Home: Vincent Dunn’s Fire Battlespace Trilogy

On January 7, Chief Dunn posted an essay on his FaceBook page “Why I Wrote 7 Books.” https://www.facebook.com/VincentDunnFireBattlespace

I recall being a rookie engine company commander and reading the first edition of Collapse of Burning Buildings. It remains one of the most impactful experiences in my professional development.

The paramedic trained to the 2009 National EMS Educational Standard received a more intense medical education, especially pathophysiology. They have received training to respond to situations as a safe and effective critical thinker.

That same evidence and science based background will serve them well as they move into roles as evaluators, coaches and supervisors. Let’s see why.

History of EMS Credential Training

We have progressed through four versions of the federal EMS educational standards. Here is a summary of the timeline:

• 1977 National Standard Curriculum (NSC) for EMT-Paramedic. Published by the National Highway Transportation Safety Administration (NHTSA). 15 modules based in part on the University of Pittsburgh’s Freedom House training program.
• 1985 National Standard Curriculum revised. At the state’s request, lowered the requirements to obtain EMT-Ambulance credential, EMT-Paramedic curricula is reformatted into 6 divisions.
• 1994 National Standard Curriculum revised. EMT-Basic (1985) replaced with more comprehensive EMT-Ambulance. Other levels of caregiver training revised later in the 1990s.
• 2009 National EMS Educational Standards is a major revision. Stakeholder Task force established to implement standards by Fall 2014

2009: Expanded Depth and Breadth of Knowledge

The Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation.

National Emergency Medical Services Education Standards, Page 10

Pathophysiology was added to the EMT curricula to provide a basis for clinical critical thinking. An EMT who is a thinking clinician is able toidentify patients who are stable or unstable and require prompt transport. (Limmer)

This was such a significant change in the curricula that it took hundreds of leaders, educators, physicians, subject matter experts, regulators, publishers, medical writers and caregivers five years to get the 2009 National EMS Standards ready for implementation.

2014 Delivery Of The New Standard

The results of this massive multi-year effort is:

• 375 community/technical college paramedic certification programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP).
• 171 jurisdictional/private accredited paramedic certification programs that are CAAHEP accredited and have an academic partner in a consortium.
• The National Registry of EMTs initial paramedic credentialing procedure and knowledge exam adopted by 46 states

The Associate Degree Requirement

Much heat and angst were released when a position paper advocating a degree requirement for paramedics was published in Prehospital Emergency Care in 2018 (Caffrey, et. al.) The issue may not be as disruptive as feared.

A rumor started that said, if approved, every single paramedic would be required to obtain an associate degree. This was false, but created anger and anxiety for the hundreds of regulators, administrators and leaders that were credentialed long-before the 2009 standards went into effect.

In a study by Rivard, et. al (2020) that looked at the educational background of  nationally certified EMS professionals in the U.S. that re-certified through the National Registry between October 1, 2017 and March 31, 2018 and October 1, 2018 and March 31, 2019 showed that 28.5% of the paramedics rectifying had an associate degree.

The caregivers surveyed reported 3-7 years experience with 72% of the respondents working full-time. I anticipate that we will continue to see a rise in associate degreed paramedic caregivers taking recertification exams as those who were initially credentialed before Fall semester 2014 age out or let their EMS credentials expire.

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Limmer, D., et al. (2008) Beyond the basics, the art of critical thinking, Part 1. EMS Magazine 37(4) p. 87.

Caffrey, S. M., Barnes, L. C. & Olvera, D. J. (2018): Joint
Position Statement on Degree Requirements for Paramedics, Prehospital Emergency Care, DOI:10.1080/10903127.2018.1519006

Rivard, M.K., Cash, R.E., Mercer, C. B., Chrzan, K. & Panchal, A. R. (2020): Demography of the National Emergency Medical Services Workforce: A Description of Those Providing Patient Care in the Prehospital Setting. Prehospital Emergency Care. DOI: 10.1080/10903127.2020.1737282

CAAHEP (2019) Emergency Medical Services – Paramedic. Clearwater, FL: Commission on Accreditation of Allied Health Education Programs https://www.caahep.org/Students/Program-Info/Emergency-Medical-Technician-Paramedic.aspx Accessed November 15, 2019.

Featured Image: Wake County EMS, North Carolina. Mike Legeros

RE-IDENTIFICATION

The action items include:

• Activities to support risk reduction as well as medical and injury prevention efforts.
• Messaging strategies for clarifying and supporting the role of first responders in addressing risk reduction, medical and injury prevention and social services support.
• Strategies to reduce the number of 911 calls.

“Overcome By Events” is a military term used when a situation changes so rapidly that previously proposed courses of action are no longer relevant. It also shows up in long-term federal projects when the situation has changed the environment or requirements of a contracted service.

The coronavirus experience will accelerate the need to address Re-Identification as fire and emergency services continue to respond to the impact of the pandemic while in an economic collapse with a reduction of state and local funding along with mis-matched Medicare EMS reimbursement.

CULTURE

The action items include:

• Create a process that allows for goal setting, strategic planning, and periodic feedback by all stakeholders of the community and the members
  of the organization.
•  Adopt a philosophy that promotes seeking out the best industry practices of other professional organizations and establish a process by which organization can evaluate those practices and implement those that are relevant in their own organization to improve performance.
• Establish a process to continually assess the skills, knowledge, and abilities needed by the organizational workforce to meet the changing community demands for service, to meet the external challenges placing pressures on the organization, and to help address the changes and innovation that are occurring or will need to occur in the agency.

The experience of an international health crisis compounded by social justice issues – where emergency service workers have pinged-ponged from hero to enemy – presents an opportunity to evolve our culture that meets both the community and the emergency responder’s needs and expectations.

ROBUST USE OF DATA

The action items include:

• Champion a substantial update to NFIRS to become a more relevant and technologically robust system or replace it with another system capable of integrating with new innovative data systems to provide advance analytics, and support evidence-based decision making, built upon the receipt of quality data for local agencies.
• Employ advanced analytics to assist in making predictive and prescriptive decisions that are focused on the outcomes the agency is trying to achieve.
• Champion legislative changes to allow for sharing of patient data between hospitals and responding agencies and encourage interagency cooperation to promote the evaluation of patient outcomes based upon the entirety of the response to that patient.

An existing weakness in many emergency services agencies is the ability to use data to make smart decisions, define what is “good,” and explain it to our bosses and the public. Data analytics provides powerful decision-making tools.

HEALTH AND WELLNESS

The action items include:

• Conduct research on the impacts of current work cycles on the health of the workforce and the impacts of sleep deprivation and sleep hygiene on the longterm health of the individual and their cognitive abilities while on duty.
• Develop on-going mental health assessments for emergency responders to promote early recognition of developing mental health issues aligned with a mental health assistance process if issues are detected.
• Adopt physical performance and annual fitness testing requirements for fire and emergency services employees to ensure the responder can safely do the job without injury or risk to their health.
• Conduct continued research to develop a comprehensive approach to reducing exposures, the best method(s) for decontamination, and periodic testing to help ensure a safer environment for the workforce.

Occupational cancer and suicide are joining sudden cardiac arrest as the leading causes of death for emergency responders. The IAFC If You Don’t Feel Well, Don’t Make It Your Farewell initiative is one way to address this critical issue.

PARTNERSHIPS

The action items include:

• Inventory and leverage the allied services (law enforcement, health, social services, nongovernmental organizations) in the community to provide more effective and efficient services.
• Promote individual and neighborhood self-sufficiency though existing programs (e.g. community emergency response teams, the radio amateur civil emergency service, volunteers in patrol, and senior Medicare patrol volunteers) to create greater resiliency in the community.

Emergency services are the community’s focal point for neighborhood resiliency.

SUSTAINABILITY

The action items include:

• Develop a better understanding of community needs and their changing demands for services so as to modify the service delivery model(s) to meet them.
• Promote collaboration between labor groups, local government, and state government to ensure existing pension financial commitments are met ensuring adequate service levels within the communities being served.
• Adopt the concepts outlined in “Vision 20/20 – National Strategies for Fire Loss Prevention,” and incorporate these recommendations into the daily agency operation to minimize the impacts to the community and emergency responders.

States just have 71% of the assets needed to fund promised retirement benefits, as documented in the latest Pew Charitable Trust analysis.

Because growing pension debt leads to higher costs, states with poorly funded plans have had to increase their pension contributions. And the higher cost of paying for benefits may affect the states’ ability to fund other core government services and crowd out other important public investments.

Many fire departments are dealing with a crisis of underfunded pension liabilities. An October 1, 2018 commentary by Daniel DiSalvo from the Manhattan Institute described the issue:

In 2015, the Federal Reserve estimated that states’ and localities’ pension funds had accumulated $5.52 trillion in liabilities but had set aside only $3.7 trillion in assets.  To ensure that public employees receive the benefits promised by their plans, state and local governments are spending more every year on their pension systems. According to census data, those governments contributed $40.1 billion to their pension systems in 2000; by 2016, that number had skyrocketed to $140.5 billion. In addition, pension funds are making riskier investments in an effort to catch up.

That means more of the annual budget is committed to meeting the pension liability. In some fire departments, this represents up to 17% of a fire department annual budget in states that are mandating full funding of pensions by 2033 (or 2040 or 2050). Today’s pensions (and budgets) are suffering from earlier administrations that “skipped” a payment or raided the pension fund to meet a budget shortfall.

TECHNOLOGY

The action items include:

• Anticipate that artificial intelligence, smart technology, and robotics will shape future service delivery dramatically in the next 30 years and will change response methods requiring a new skill set and strategic processes for fire and emergency services agencies.
• Champion the United States Fire Administration, in concert with other national organizations, to develop a fire advanced research challenge to promote application of technology developments for use in the emergency services through proof of concept and competitive challenges, similar to the Defense Advanced Research Projects Agency (DARPA) challenge utilized by the Department of Defense.

INCLUSIVENESS

The action items include:

• Create pathways to attract, prepare, and hire underrepresented personnel into the fire and emergency services.
• Promote cultural understanding and humility within the workforce to increase the quality of interactions and the services provided to the community.

The late Honorable John Lewis, U.S. Representative from Georgia, addresses the 2010 IAFF Human Relations Conference (about 20 minutes)

Next Steps

If you have been working in local government during the last decade, you have experienced some of the most dramatic shifts in how it operates. Whether it’s the political dynamic, the elevated threshold for transparency, the lack of civility, or the demands placed on local government to provide more services, it has been a time of real change.

As we look to the future, those dynamics may continue, but other forces of change will emerge, making the leading and managing of tomorrow’s governmental system very exciting, very challenging, and very fast.

This white paper provides an excellent foundation to build the 2050 version of the Fire and Emergency Services leader. We face amazing opportunities and difficult challenges. We also have the talent and ability to build OUR future.

Please download the white paper and plan your path. https://cpse.org/projects/21st-century/

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Center for Public Safety Excellence website to view and download white paper: https://cpse.org/projects/21st-century/

IAFC Cardiac Arrest Toolkit. https://www.iafc.org/topics-and-tools/safety-health/cardiac-awareness-toolkit

Vision 20/20 – National Strategies for Fire Loss Prevention. https://strategicfire.org/crr

(2020 June) The State Pension Funding Gap: 2018. Overall debt at historic high after recovery, underscoring need to prepare for a downturn. The Pew Charitable Trusts. https://www.pewtrusts.org/-/media/assets/2020/06/statepensionfundinggap2018.pdf

DiSalvo, D. (2018 October 1) How Public Pension Boards Are Making a Crisis Worse. Because of the way they’re structured, they have incentives to ignore the retirement plans’ going term health. Governing.com

Petrella, D. (2014 June 2014) Rising police, fire pension costs squeezing city budgets. The State Journal-Register. https://www.sj-r.com/article/20140628/News/140619232

Feature Image: Screen shot from this animation of a gyroscopic firefighting vehicle.

A culture war is a cultural conflict between social groups and the struggle for dominance of their values, beliefs, and practices. It commonly refers to hot-button topics on which there is general societal disagreement and polarization in societal values is seen. Our current situation is summed up this way:

You’re either a liberal snowflake controlled by big government or a greedy conservative willing to sacrifice Grandma for the economy. It took less than two months for Americans to get here.

Lerer, L. (2020 May 7) The New Culture War (On Politics With Lisa Lerer) The New York Times.

1 – Keep Your Job By Guarding Opinions And Observations

A stunning number of emergency service executives, managers, and supervisors are losing their jobs because of what they post on social media. David Brooks talks about the actions by Social Justice activists:

The Social Justice activists focus on the cultural levers of power. Their most talked about action is canceling people. Some person, usually mildly progressive, will say something politically “problematic” and his or her job will be terminated. In this way new boundaries are established for what has to be said and what cannot be said.

Brooks, D. (2020 June 25) America Is Facing 5 Epic Crises at Once. (Opinion) The New York Times

Emergency responders getting fired over inappropriate or troubling posts on social media is not new. Former volunteer firefighter/medic and radio/TV Reporter Dave Statter coined the term “Social Media Assisted Career Suicide Syndrome (SMACSS)” in 2012.

Here are two take-aways from Statter’s recent coverage:

There are no “private” social media sites. Eventually someone will provide access or send screenshots or print-outs to an outsider. An example of a SMACSS MCI occurred last year in Philadelphia where 13 police officers were fired and 56 received formal discipline for making racist or offensive Facebook posts.

You cannot separate your emergency service affiliation with your social media activity. In the past some folks have gotten in trouble for posting while on duty or using images that can identify them as an emergency responder. Recent activities imply that you are always linked to your emergency service affiliation. A Harris County, Texas, firefighter lost 3 firefighter/EMS jobs over a Facebook post on his personal account about hunting immigrants.

Attorney and retired Deputy Assistant Fire Chief Curt Varone provide an analysis of what the First Amendment rights mean for firefighters in Fire Law Blog: NC Facebook Post Results in Two Cybercasualties.

The impact of the current cultural conflict has resulted in more than 30 chiefs and company-level officers losing their jobs because of social media posts.

2 – Follow The Coronavirus Science

This one is difficult to accomplish because of two situations.

Politicization of Science

The politicization of science is the manipulation of science for political gain. It occurs when government, business, or advocacy groups use legal or economic pressure to influence the findings of scientific research or the way it is disseminated, reported or interpreted.

An example of this is the research linking lung disease to cigarette smoking. The debate between opening up businesses before the COVID-19 infections are under control is another.

Yale Senior Research Scientist Anthony Leiserowitz discusses the “Liberate America” protests:

… we’re seeing some of the same actors that have been denying that climate change is a serious problem. … much of this resistance is driven by the political ideology of radical individualism. These people are deeply suspicious of climate change because it’s the ultimate collective action problem. We can’t solve climate change by our own virtuous individual behavior alone … And that’s the same worldview that’s driving these protesters, who are basically saying, “You’re infringing on my individual freedom by telling me to shelter at home.”

Dennehy, K. (2020 April 21) Will Politicization of COVID-19 Crisis Erode National Consensus On Response? Yale School of the Environment.

A Tsunami Of 23,000 Unvetted Scientific Articles

Scientific publishers made life-or-death research available as quickly as possible by dropping paywalls and encouraging researchers to post their submissions on pre-print servers, where anyone can access them before they undergo a peer-review process.

This means that an article submitted to Science was available in days instead of months. Posting initial research findings on pre-print servers allows researchers to quickly share preliminary work and may help the scientific community to collaborate more effectively and efficiently.

The Atlantic science writer Ed Yong describes how peer-review and scientific knowledge works:

It’s less the parade of decisive blockbuster discoveries that the press often portrays, and more a slow, erratic stumble toward ever less uncertainty. “Our understanding oscillates at first, but converges on an answer,” says Natalie Dean, a statistician at the University of Florida. “That’s the normal scientific process, but it looks jarring to people who aren’t used to it.”

With over 23,000 non-peer reviewed scientific papers about the disease flooding the scientific community (Brainard), factoids and tidbits are grasped as “the solution” by news media. This creates contradictory comments and erodes the public’s confidence in scientific information.

3 – Be A Trustworthy Information Source

For weeks “Left Behind USA” was on social media promoting a flag-burning event at the Gettysburg National Military Park in Pennsylvania.

Dozens showed up, some heavily armed, to prevent the flag burning. There was no flag-burning event.

Officials at Facebook and Twitter shut down the Left Behind USA pages last week after The Post inquired about the accounts, saying the person behind them had manipulated the platform by creating multiple accounts with overlapping content in an effort to amplify their messaging. The officials declined to identify the other accounts.

Boburg, S. and Bennett, D. (2020 July 4) Militias flocked to Gettysburg to foil a supposed antifa flag burning, an apparent hoax created on social media. The Washington Post.

There is a constant drip-drip-drip of conspiracies, catastrophes and calamities that are right around the corner. Some of this is driven by the dozens of talking heads, “experts,” and writers filling-up a 24 hour, seven-day-a-week information beast. They are competing for “time spent watching” their items. More time on their items, more market share and ad revenue.

Others are purposefully creating chaos to meet a political or tactical need. Finally, some just want to have the equivalent excitement of pulling a fire alarm box in the South Bronx to watch the rigs respond.

SIFT Your Information

Mike Caulfield is a digital information literacy expert at Washington State University. His “four moves” SIFT methodology to information sources provide a valuable tool.

• Stop
• Investigate the Source
• Find Better Coverage
• Trace Claims, Quotes and Media to the Original Context

The infodemic.blog webpage will walk you through the procedures.

Why do we like conspiracies?

While some conspiracies are true – President Reagan selling weapons to Iran during an arms embargo and sending that cash to support rebels overthrowing the existing Nicaragua government – Graham Lawton looks at why we gravitate to conspiracy theories:

The human brain did not evolve to process complex information about global politics, economics or science. It evolved to survive on the African savannah where threats and hostile intentions were a daily reality.

Our brains have other cognitive biases that make us susceptible to conspiracy theories. One is proportionality bias, a belief that major events have major causes. Intentionality bias makes us assume that events are planned by somebody or something. Confirmation bias means we seek out evidence that supports our beliefs. And the illusion-of-understanding bias makes us overestimate our knowledge of how things work.

Lawton, G. (2020) Conspiracy theories: Belief in conspiracy theories is the product of normal human psychology, but can be extremely dangerous. New Scientist

Company commanders are trained to impose order on chaos over a wide variety of life-threatening, potentially catastrophic events with inadequate information during a dynamically changing environment. We have the experience, discipline and tools to be trustworthy sources of information to our crews and community. I recommend we start approaching these issues as we would a 55 gallon drum leaking a purple fluid and issuing a light haze.

4 – Be An Active Voter

The vote you cast in a local or national election has more power than a million words on social media or a $10,000 donation to a Political Action Committee. Generally, less than 2/3rds of eligible voters in a community are registered to vote. In the 2016 Presidential election, 58.4% of the registered voters cast a ballot. That mean each person that voted had the power of 2.5 voter-eligible citizens in that community.

The polarization of political discourse – with a widening gap between liberals and conservatives – has become personal and emotionally negative. A review of academic research by journalist Thomas Edsall highlighted the degree to which the political polarization has increasingly taken on an
emotionally negative tone:

“Hostility to the opposition party and its candidates has now reached a level where loathing motivates voters more than loyalty,” and “The building strength of partisan antipathy — ‘negative partisanship’ — has radically altered politics. Anger has become the primary tool for motivating voters.”

Anger and outrage motivates voters on the extremes and have left moderate voters politically homeless, with 40% of voters surveyed in a May 28-June 4 Gallop survey identifying as Independent, 31% as Democrat and 25% Republican.

That same anger fueled the social media posts that lead to the loss of jobs for dozens of our colleagues. Be the knowledgeable and trustworthy commander and participate in our purposefully messy and raucous election process to allow us to continue to serve our communities and country.

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Ayesh, R. (2020 July 4) Trump casts himself as chief defender of American history in divisive speech at Rushmore. Axios. https://www.axios.com/trump-casts-himself-as-chief-defender-of-american-history-rushmore-65d3d482-9eba-4b0c-9798-f99feeddef20.html

Liasson, M. (2020 June 20) As The Culture Wars Shift, President Trump Struggles To Adapt. National Public Radio https://www.npr.org/2020/06/20/881096897/as-the-culture-wars-shift-president-trump-struggles-to-adapt

Lerer, L. (2020 May 7) The New Culture War (On Politics With Lisa Lerer) The New York Times. https://www.nytimes.com/2020/05/07/us/politics/liberal-conservative-coronavirus.html

Dennehy, K. (2020 April 21) Will Politicization of COVID-19 Crisis Erode National Consensus On Response? Yale School of the Environment. https://environment.yale.edu/news/article/will-politicization-of-covid19-crisis-erode-national-consensus-on-protecting-public-health/

Tingley, K. (2020 April 21) Coronavirus Is Forcing Medical Research to Speed Up. The New Your Times Magazine. Accessed April 24, 2020: https://www.nytimes.com/2020/04/21/magazine/coronavirus-scientific-journals-research.html 

Yong, Ed (2020 April 29) Why the Coronavirus Is So Confusing: A guide to making sense of a problem that is now too big for any one person to fully comprehend. The Atlantic. Accessed April 29, 2020: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/  

Brainard, J. (2020 May 13) Scientists are drowning in COVID-19 papers. Can new tools keep them afloat? Science. doi:10.1126/science.abc7839 Accessed June 21, 2020 https://www.sciencemag.org/news/2020/05/scientists-are-drowning-covid-19-papers-can-new-tools-keep-them-afloat

Boburg, S. and Bennett, D. (2020 July 4) Militias flocked to Gettysburg to foil a supposed antifa flag burning, an apparent hoax created on social media. The Washington Post. https://www.washingtonpost.com/investigations/hundreds-of-armed-men-went-to-gettysburg-to-defend-it-from-a-phantom-antifa-flag-burner-created-on-social-media/2020/07/04/206ee4da-bb05-11ea-86d5-3b9b3863273b_story.html

Brooks, D (2020 June 25) America Is Facing 5 Epic Crises at Once. (Opinion) The New York Times. https://www.nytimes.com/2020/06/25/opinion/us-coronavirus-protests.html

Wise, Jenna (2020 July 5) Dozens, some armed, come to Gettysburg to guard against rumors of Antifa violence. Pennsylvania Real-Time News. https://www.pennlive.com/news/2020/07/dozens-some-armed-come-to-gettysburg-to-guard-against-rumors-of-antifa-violence.html

Caulfield, M. (2020) Sifting Through The Pandemic: Information Hygiene for the Covid-19 infodemic. infodemic.blog https://infodemic.blog/

Lawton, G. (2020) Conspiracy theories: Belief in conspiracy theories is the product of normal human psychology, but can be extremely dangerous. New Scientist. https://www.newscientist.com/term/conspiracy-theories/#ixzz6RMShYuWK

Statter, D (2020) Social Media Assisted Career Suicide Syndrome. STATter911. https://www.statter911.com/tag/social-media-assisted-career-suicide-syndrome/

Palmer, (2019 July 18) Philadelphia Police Department to fire 13 officers over offensive Facebook posts. The Philadelphia Inquirer. https://www.inquirer.com/news/philadelphia-police-officer-firings-facebook-posts-database-20190718.html

Varone, C (2019 July 4) NC Facebook Post Results in Two Cybercasualties. Fire Law Blog. http://www.firelawblog.com/2019/07/04/nc-facebook-post-results-in-two-cybercasualties/

Woodwell, WH (2019 November) Voting Rights Under Fire. New York, NY: Carnegie Corporation of New York. https://production-carnegie.s3.amazonaws.com/filer_public/bc/46/bc469634-87fd-4233-bc93-d9a89bfc9c00/voting-rights-fin.pdf

Smith, H (2016 Nov 16) Turnout in the 2016 Presidential Election. FairVote. https://www.fairvote.org/turnout_in_the_2016_presidential_election

Newport, F (2019 December 5) The Impact of Increased Political Polarization. Gallup https://news.gallup.com/opinion/polling-matters/268982/impact-increased-political-polarization.aspx

(2020) Party Affiliation (trend since 2004) Gallup. https://news.gallup.com/poll/15370/party-affiliation.aspx

Featured image: Jedd Meddaugh, Dallas Morning News (2018 December 4) “Meet the new culture war (not the same as the old culture war): The anti-culture armies realized it was smarter to buy in to pop culture than to howl against its encroachment on everyday life.” https://www.dallasnews.com/arts-entertainment/books/2016/12/05/meet-the-new-culture-war-not-the-same-as-the-old-culture-war/

As communities transition from lock-down to a phased opening, fire and ems commanders are facing unique and challenging situations as we continue to be on the front line of public safety, public health and medicine.

Revisiting the Hammer and the Dance

Tomas Pueyo created a great visualization, “The Hammer and the Dance,” to look at lockdown and reopening. “The dance” is the period we’re entering now. The period where we need to think about our movements like the ebb and flow of a complicated dance.

Pueyo says that “It’s called ‘the dance’ because it is a much more fluid phase. You might have outbreaks, so you need to react to that. It’s much more technical, too.” More testing, more contact tracing, masks and social distancing are elements of the dance.

“What I will say is life will never go back to what people have in mind as normal,” Pueyo said. “Once you change your habits as a society for months, it is likely that many of these habits will remain afterwards, so the world we knew until February 2020 is gone.”

KGO-TV (2020)

How Long Will We Dance?

Michael Osterholm, Ph.D., MPH, is the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He advises both Republican and Democratic presidents and was the interim Director of the Centers for Disease Control (CDC). His 2017 book Deadliest Enemy, foretold a global pandemic.

Blue Zones founder Dan Buetner interviewed Osterholm and calls him “… one of the most dependable, non-political sources for straight answers for COVID-19.” Here are some of the bullet points, you should read the entire interview. (click here)

• If you’re under age 55, obesity is the #1 risk factor.
• Wearing a cloth mask does not protect you much if you’re in close contact with someone who is COVID-19 contagious. It may give you 20 minutes, instead of 10, to avoid contracting the disease.
• We can expect COVID-19 to infect 60% – 70% of Americans. That’s around 200 million Americans.
• We can expect between 800,000 and 1.6 million Americans to die in the next 18 months if we don’t have a successful vaccine.
• There is no guarantee of an effective vaccination and even if we find one, it may only give short term protection.

We have to learn not only how to die with this virus, which tragically we’ve had to do, but we also have to learn how to live with it. If we’re not going to lock up and we’re not going to open up willy-nilly, then what is the approach? What are the things that we can do to change society that will help us maintain society to the best we know but at the same time also reduce transmission? That’s a key activity right now that public health needs to be playing a very important role in. (Osterholm)

The 1918 Influenza had a second wave in the fall that was made more severe by a mutated virus spread by wartime troop movements. (Roos 2020) There were three waves of infections in the two years that the 1918 Influenza was active.

In Chapter 19 “Pandemic: From Unspeakable to Inevitable” Osterholm describes a tabletop pandemic scenario that starts in April, gets hammered down by late July, second wave begins in late September and continues through June.

I speculate that the current spike of new cases in western and southern states are from the first wave perking up after lockdown ended. The second wave comes with the fall flu season and COVID-19 will continue well into 2021.

COVID Clusters

With each subsequent week of patient data we get a clearer pattern of who is getting sick. (Lu) This includes work places where there is no ability to socially isolate and conditions that facilitate the transmission of the coronavirus through aerosol transmission.

Nursing homes and assisted living facilities are COVID clusters, representing 42% of U. S. deaths. (Roy)

New data from CDC shows that the death rates among Black and Hispanic/Latino people are much higher than for white people, in all age categories. (Brookings)

Not long after the virus started spreading, counties with relatively larger black populations faced higher case counts, higher COVID-19-related mortality, and a faster pace of progression compared to counties with a lower share of black people. The 681 high-concentration black counties account for only about a third of the U.S. population but 53 percent of the cases and 63 percent of the deaths nationally. (Zephyrin)

More than 28% of people diagnosed with COVID-19 are Hispanic. (Zarefsky)

In New York City communities with large Hasidic populations experienced some of the highest infection rates in the city. (Stack) This situation also infected most of the firefighters working Brooklyn Park’s FDNY Engine 282/Ladder 148 that were responding to crowded “places of worship, schools and mikvahs,” or ritual baths, in the ultra-Orthodox enclave, an FDNY employee said. (Balsamini)

The reasons for these racial differences are driven by essential workers in high-risk medical and service jobs, inadequate infectious disease resources, poverty, and community practices.

Emergency Service Exposures From Community Infection

The first COVID-19 San Jose firefighter was infected off the job and asymptomatic. He infected 15 of his colleagues, 10% of the fire department, by March 6.

He covered a shift for a buddy at another firehouse, exposing colleagues there. He attended a career development course at the department’s training center — and the disease spread further. … From March 6 to March 12 the number of infected San Jose firefighters increased to over 50.

Kelliher 2020

The first FDNY EMT diagnosed with the coronavirus was infected off-the job from a person who recently travelled overseas (Maisel 2020).

Both of those examples occurred at the beginning, when the Hammer was coming down. With communities opening up again, we are looking at the Dance and the continuing challenge of off-the-job infections.

Last week provides a great example of our current situation, with 8 Greensboro, North Carolina, firefighters getting infected after a four-fire station golf outing. (Fox 8 WGHP)

Battalion Chief Tom Bouthillet, Hilton Head Island Fire Rescue, points out “This is the new challenge. Previously, we were worried about exposure on medical calls. Post-shutdown, off-duty exposures are more likely. Kids are getting exposed in daycare, spouses are getting exposed in their jobs, and then there’s daily life, whether a golf outing, wedding, or some other thing. Test, trace, isolate.“

Face Masks As A Political Issue

Prior to some governors requiring face masks as part of the phased opening up of states, less than half of the population were voluntarily wearing masks.

“Attitudes about masks have become politicized,” said Robert Kahn, a University of St. Thomas Law School professor who has been following the mask debate. “I don’t think they were always that way, like in, say, March, early on in this.” (Vetterkind 2020)

Surveys in May showed that 75% of Democrats and 53% of the Republicans are wearing facemarks (Pepinsky 2020)

The conflict and confusion of mask usage comes from the mixed messages, as pointed out in this June 2 Washington Post 4-minute video, showing Dr. Anthony Fauci saying on March 8 that citizens should not be wearing masks – in part to keep the too-small inventory of masks available for medical staff – and then saying that citizens should be wearing cloth face masks on April 2:

https://www.washingtonpost.com/video/politics/as-states-reopen-coronavirus-masks-symbolize-a-cultural-divide/2020/06/02/60900f1d-3f37-4241-b218-c3f905ab30ad_video.html

A long article in the June 19th Washington Post looks at the face mask battle:

Mask-wearing for some people is an identifier of broader beliefs and political leanings. Like so many issues rooted in science and medicine, the pandemic is now fully entangled with ideological tribalism. This has played out before: helmets for motorcyclists, seat belts in cars, smoking bans in restaurants.

To many people, masks represent adherence to civic duty and a willingness to make individual sacrifices for the greater good of public health. To others, masks symbolize government overreach and a violation of personal liberty.

Within the work environment, company commanders have the employer directives for use of personal protective equipment. Delivering clinical care best practices provides infection control directives. Caregivers may encounter patients that fight them when deploying a facemask.

COVID Conspiracies and the Infodemic

Along with the pandemic there has been an infodemic – an overabundance of information – including false or misleading stories. Nature provides an example of a false story:

On 19 March, the website Biohackinfo.com falsely claimed that Gates planned to use a coronavirus vaccine as a ploy to monitor people through an injected microchip or quantum-dot spy software. Two days later, traffic started flowing to a YouTube video on the idea. It’s been viewed nearly two million times.

The idea reached Roger Stone … who in April discussed the theory on a radio show … The interview was covered by the New York Post, which didn’t debunk the notion. Then that article was liked, shared or commented on by nearly one million people on Facebook. “That’s better performance than most mainstream media news stories,” says Joan Donovan, a sociologist at Harvard University in Cambridge, Massachusetts.

Nearly 8 in 10 surveyed by Gallop/Knight between April 14-20 say misinformation about the virus is a major problem. Asked to identify the common sources of mis-information, 68% said social media and 54% say the Trump administration. (Jones 2020)

In addition, 36% of the respondents saying that they feel overwhelmed by all of the COVID-19 information.

23,000 Non-Peer Reviewed Articles

Kim Tingley, writing for The New York Times Magazine, describes two actions taken by peer-reviewed publishers to make potentially life-or-death research available as quickly as possible:

1. Dropping the paywalls of Science, The Lancet, Journal of the American Medical Association (JAMA) and The New England Journal of Medicine to make coronavirus content free online.
2. Encouraging researchers to post their submissions on pre-print servers, where anyone can access them before they undergo a peer-review process.

This means that an article submitted to Science was available in days instead of months. Posting initial research findings on pre-print servers allows researchers to quickly share preliminary work and may help the scientific community to collaborate more effectively and efficiently.

The Atlantic science writer Ed Yong describes how peer-review and scientific knowledge works:

It’s less the parade of decisive blockbuster discoveries that the press often portrays, and more a slow, erratic stumble toward ever less uncertainty. “Our understanding oscillates at first, but converges on an answer,” says Natalie Dean, a statistician at the University of Florida. “That’s the normal scientific process, but it looks jarring to people who aren’t used to it.”

With over 23,000 non-peer reviewed scientific papers about the disease and the novel coronavirus that causes it flooding the scientific community (Brainard), factoids and tidbits are grasped as “the solution” without follow-up studies. This creates contradictory comments and erodes the public’s confidence in scientific information,

The Dunning-Kruger effect

There is a phenomena known as the Dunning-Kruger Effect. Coined in 1999 by then-Cornell psychologists David Dunning and Justin Kruger, the Dunning-Kruger Effect is a cognitive bias whereby people are unable to recognize their own incompetence. And not only do they fail to recognize their incompetence, they’re also likely to feel confident that they actually are competent. (Murphy)

ZDoggMD – Doctor Zubin Damania – provides a 7 minute video explaining this: “From antivaxxers to moon landing deniers to poorly-trained medical folks, our idiocracy is often fueled by the so-called Dunning-Kruger effect.”

A person can counteract this effect by questioning what you know and pay attention to those who have different viewpoints. Seek feedback from people you trust who are knowledgeable in your area of interest. Be open to constructive criticism. Keep learning.

Some people will cherry-picking factoids from non-peer reviewed research to justify an ideological tribalism that supports a conspiracy theory. It is not the company commander’s role to dissuade a person’s belief. We are there to provide a service.

Unfortunately, as the pandemic continues to disrupt normal life, it builds frustration, anger and rage in some people. Fire and ems providers may find themselves in harm’s way.

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Pueyo, T. (2020 March 19) Coronavirus: The Hammer and the Dance.  What the Next 18 Months Can Look Like, if Leaders Buy Us Time. Medium.com Accessed June 18, 2020 https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

Kreutz, L. (2020 May 20) SF author’s viral ‘Hammer and the dance’ gives new perspective amid COVID-19 pandemic. ABC 7News KGO-TV. San Francisco. Accessed June 18, 2020 https://abc7news.com/hammer-and-the-dance-update-tomas-pueyo-coronavirus-article/6199923/

Buettner, D. (2020 June 6) COVID-19: Straight Answers from Top Epidemiologist Who Predicted the Pandemic. Bluezones.com. Minneapolis, Minnesota Blue Zones LLC. Accessed June 18 https://www.bluezones.com/2020/06/covid-19-straight-answers-from-top-epidemiologist-who-predicted-the-pandemic/

Roos, D. (2020 April 29) Why the Second Wave of the 1918 Spanish Flu Was So Deadly: The first strain of the Spanish flu wasn’t particularly deadly. Then if came back in the fall with a vengeance. History.com. New York: A+E Television Networks. Accessed June 19 https://www.history.com/news/spanish-flu-second-wave-resurgence

Lu, M. (2020 April 15) The Front Line: Visualizing the Occupations with the Highest COVID-19 Risk. Visual Capitalist. Vancouver, CA: Visual Capitalist Accessed June 18, 2020: https://www.visualcapitalist.com/the-front-line-visualizing-the-occupations-with-the-highest-covid-19-risk/

Roy, A (2020 May 26) The Most Important Coronavirus Statistic: 42% Of U.S. Deaths Are From 0.6% Of The Population. Forbes.com. Accessed June 20, 2020 https://www.forbes.com/sites/theapothecary/2020/05/26/nursing-homes-assisted-living-facilities-0-6-of-the-u-s-population-43-of-u-s-covid-19-deaths/#16bfbb3b74cd

(2020 June 7) COVID-19 Nursing Home Data. data.CMS.gov. Baltimore, MD. Centers for Medicare & Medicaid Services. Accessed June 20, 2020 https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/

Ford, T., Reber, S. & Reeves, RV. (2020 June 16) Race gaps in COVIS-19 deaths are even bigger than they appear. Brookings.edu. Washington, DC: The Brookings Institute. Accessed June 20, 2020 https://www.brookings.edu/blog/up-front/2020/06/16/race-gaps-in-covid-19-deaths-are-even-bigger-than-they-appear/

Zephyrin, L., Radley, D.C., Getachew, Y., Bumgartner, J.C., & Schneider, E.C. (2020 April 23) COVID-19 More Prevalent, Deadlier in U.S. Counties with Higher Black Populations. To the Point (blog), Commonwealth Fund, Apr. 23, 2020. https://doi.org/10.26099/y3xs-qr19 Accessed June 20, 2020 https://www.commonwealthfund.org/blog/2020/covid-19-more-prevalent-deadlier-us-counties-higher-black-populations

Zarefsky, M. (2020 May 21) Physicians detail COVID-19’s impact on Latinx communities. AMA. Chicago, IL: American Medical Association. Accessed April 20, 2020 https://www.ama-assn.org/delivering-care/population-care/physicians-detail-covid-19-s-impact-latinx-communities

Stack, Liam (2020 April 21) “Plague on a Biblical Scale “: Hasidic Families Hit Hard by Virus. In the New York area, the epidemic has killed influential religious leaders and torn through large, tight-knit families. The New York Times. Accessed June 20, 2020 https://www.nytimes.com/2020/04/21/nyregion/coronavirus-jews-hasidic-ny.html

Balsamini, D., & Edelmann, S.(2020 April 11) NYC firehouse crippled by coronavirus as 11 firefighters test positive. New York Post. Accessed June 20, 2020 https://nypost.com/2020/04/11/brooklyn-firehouse-crippled-by-covid-19-as-11-test-positive/

Kelliher, F. & Debolt, D. (2020 April 6) ‘The threat from within’ : How the coronavirus spread through San Jose’s fire department. As the pandemic reached the Bay Area, first responders quickly realized that they were facing a threat on multiple fronts. The Mercury News. Accessed June 17, 2020 https://www.mercurynews.com/2020/04/05/first-coronavirus-cluster-san-jose-fire-department/

Maisel, T. (2020 March 9) FDNY confirms that first EMT has been diagnosed with coronavirus. AMNY. Accessed June 17, 2020 https://www.amny.com/coronavirus/fdny-confirms-that-first-emt-has-been-diagnosed-with-coronavirus/

Digital Desk (2020 June 17) 8 Greensboro firefighters test positive for coronavirus after 4-station golf outing, Fox8 WGHP. High Point, NC. Accessed June 17, 2020 https://myfox8.com/news/8-greensboro-firefighters-test-positive-for-coronavirus/

McCarthy, N. (2020 May 12) The States Most & Least Likely to Wear Face Masks. Statista.com. New York: Statista. Accessed June 19 https://www.statista.com/chart/21687/share-of-the-public-who-have-worn-a-face-mask-in-public/

Pepinsky, T. (2020 May 13) Yes, Wearing a Mask is Partisan Now. tompepinsky.com. Ithica, NY: tompepinsky.com Accessed June 19 https://tompepinsky.com/2020/05/13/yes-wearing-a-mask-is-partisan-now/

Vetterkind, R. (2020 May 20) Face masks becoming a political symbol of the COVID-19 era. Wisconsin State Journal. Accessed June 19 https://madison.com/wsj/news/local/govt-and-politics/face-masks-becoming-a-political-symbol-of-the-covid-19-era/article_0f3b0379-23c6-54da-a424-c2fd7360fe28.html

Rozsa, L., Janes, C., Weiner, R., & Achenbach. J. (2020 June 19) The battle over masks in a pandemic: An all-American Story. The Washington Post. Accessed June 20, 2020 https://www.washingtonpost.com/health/the-battle-over-masks-in-a-pandemic-an-all-american-story/2020/06/19/3ad25564-b245-11ea-8f56-63f38c990077_story.html

Ball, P. & Maxmen, A. (2020 May 27) The epic battle against coronavirus misinformation and conspiracy theories. Analysts are tracking false rumours about COVID-19 in hopes of curbing their spread. Nature 581, 371-374. doi: 10.1038/d41586-020-01452-z Accessed June 18, 2020 https://www.nature.com/articles/d41586-020-01452-z

Jones, J F. (2020 May 11) Americans Struggle to Navigate COVID-19 “Infodemic”. Gallup. Washington DC: Gallup. Accessed June 19, 2020 https://news.gallup.com/poll/310409/americans-struggle-navigate-covid-infodemic.aspx

Tingley, K. (2020 April 21) Coronavirus Is Forcing Medical Research to Speed Up. The New Your Times Magazine. Accessed April 24, 2020: https://www.nytimes.com/2020/04/21/magazine/coronavirus-scientific-journals-research.html 

Yong, Ed (2020 April 29) Why the Coronavirus Is So Confusing: A guide to making sense of a problem that is now too big for any one person to fully comprehend. The Atlantic. Accessed April 29, 2020: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/  

Brainard, J. (2020 May 13) Scientists are drowning in COVID-19 papers. Can new tools keep them afloat? Science. doi:10.1126/science.abc7839 Accessed June 21, 2020 https://www.sciencemag.org/news/2020/05/scientists-are-drowning-covid-19-papers-can-new-tools-keep-them-afloat

Murphy, Mark (2017 Jan 24) The Dunning-Kruger Effect Shows Why Some People Think They’re Great Even When Their Work Is Terrible. Forbes.com Accessed June 20, 2020 https://www.forbes.com/sites/markmurphy/2017/01/24/the-dunning-kruger-effect-shows-why-some-people-think-theyre-great-even-when-their-work-is-terrible/#5ae2c84a5d7c

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Feature Image: New Jersey Turnpike: Exit 15. Photo credit: Rob L. via  Henry Cortacans et al #NJEMSTASKFORCE1

1. Compliance with Rules and Regulations

The company commander represents the formal fire department within the fire station when transmitting the rules and regulations as well as assuring firefighter compliance. In large or bureaucratic jurisdictions it may not be possible to assure 100% compliance.

Let’s look at a fictional example. General Order 2020-039 was issued last week that describes complex changes in infection control practices due to shortages in personal protective clothing. It is in conflict with Standard Operating Procedure 2.3.1 that is built upon a federal regulation that carries a penalty for non-compliance.

If this was a question on a promotional exam, the candidate may (1) Describe how to comply with both GO 2020-039 and SOP 231 to the best of the crew’s ability – with emphasis on firefighter health and safety and delivering the maximum possible level of community service, (2) Notify the battalion chief of the conflict in directives, (3) If this is a resource issue, describe an innovative resolution, and (4) Prepare a document for the chief’s review describing the conflict with a recommended solution.

Is the new fire officer “by the book” and believes every single sentence that comes from headquarters as accurate gospel? That officer will believe the downgrading of the quality and level of infectious disease personal protective equipment below the federal minimum is just fine.

If this was real-life, the experienced Lieutenant will have a brief discussion with the battalion chief to look at options. The Lieutenant will then do the tasks that protect the firefighters/public and keep the supervisor out of federal court.

2. Firefighter Satisfaction

When new fire officer is tested by the crew, many stumble at the REQUEST stage. They will be asked to allow or do something that is clearly not allowed in the rules and regulations.

Rookie officers often want the crew members to like them. It is difficult to improve fire company performance once you have given away your formal authority so you can be like “… one of the guys.”

Respect is based on being trustworthy and authentic. Likeability is subjective, people often like people who are similar to themselves, or have a certain charisma. Being likable or popular does not always earn you the respect.

Being a respected supervisor is different than being their buddy. Many of the officers Hugh Caulfield assisted struggled with this.

You cannot manufacture respect. You cannot become something you weren’t or aren’t. Firemen will see through it in a second.

Don’t try to gain respect by doing the things you think will make you look ‘salty’ or bad ass. Gain it by doing your job. Gain it by having strong core values and instilling them in your organization.

Bastinelli, Brian (2017 Winter) #RESPECT. The Art of Firemanship. 02(1) https://static1.squarespace.com/static/5668c7042399a34df12fe70b/t/58c0a0cebf629ab8bacd5a81/1489019112067/AOF+Journal+Winter+2017+Single.pdf

How important is for you to be Beloved … or Respected?

3. Productivity

Fire company productivity includes performance at emergency incidents as well as completion of routine assignments such as hydrant inspections or fire station maintenance.

One of the features of the Blue Card Incident Management certification program is the use of “sets and reps” to hone muscle memory and mental cues when commanding an incident. It is a term used in physical training:

A Rep (repetition) is one complete motion of an exercise. A Set is a group of consecutive repetitions. For example, you can say, “I did two sets of ten reps on the chest press.” This means that you did ten consecutive chest presses, rested, and then did another ten chest presses.

Our goal is to be highly skilled to the point that the evolution (throwing a ground ladder, advancing a 2.5″ smooth bore) appears natural and easy. Firefighters are Unconsciously Competent.

Becoming unconsciously competent requires a lot of sets and reps. Officers will get resistance when increasing the training tasks. In doing Caulfield’s assessment, how important is company productivity to you?

4. Risk

Taking care of your crew is a sacred trust. We are in an environment that requires the company-level supervisor to be a vigilant and consistent advocate for the team.

This becomes a challenge when a chief officer or administrator asks “… how well do you like working here?” The officer may be warned that continuing to advocate for an issue – even those affecting the safety of the crew – may hurt the fire officer’s career.

Some of you may recall the “Career Dissipation Light” phrase from Backdraft

You may be planning to move upon the career ladder to become a command officer or senior administrator. That may be hard to do if you get formal discipline designed to stop or discourage your advocacy. What level of professional risk are you comfortable with?

5. Leader Satisfaction

What is a great work day for you? Is this the rank and assignment you plan to retire at? Where do you see yourself when you retire?

I have a long-gone fellow firefighter/paramedic that said “I do not want to be staring through the windshield of an ambulance when I am 40.” At 40 he was running the EMS side of the Academy.

Winning The Leadership Game

Caulfield said that the company officer wins the leadership game when the fire station runs on the company officer’s terms. The officer is satisfied with

• Firefighter Productivity
• Their Own Feelings About Being a Leader
• How They Are Meeting the Formal Organization’s Expectations of the Company Officer as a Leader

Caulfield provided leadership tools and different point of reference to help FDNY lieutenants and captains get through the War Years and significant economic crisis during a time of great cultural upheaval.

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Caulfield, Hugh J. (1985). Winning the Fire Service Leadership Game. Saddlebrook, NJ: Fire Engineering. ISBN 0-912212-09-8

Blue Card Command Training and Certification: http://www.bshifter.com/about_01.aspx

Curtiss, PR and Warren PW (1973) The Dynamics of Life Skills Coaching: Life Skills Series. Prince Albert, Saskatchewan: Training and Development Station, Department of Manpower and Immigration.

Adams, L. (no date) “Learning a New Skill is Easier Said Than Done“ Gordon Training International. Accessed February 16, 2019, from http://www.gordontraining.com/free-workplace-articles/learning-a-new-skill-is-easier-said-than-done/ 

Ericsson KA, Roring, RW and Nandagopal K. (2007 June) “Giftedness and evidence for reproducibly superior performance: an account based on the expert performance framework.” High Ability Studies. Vol. 18, No. 1, pp. 3–56.

Featured image: U Street Firefighters, Washington DC (2018) Facebook

Pictures are to illustrate concepts and DO NOT imply that the personal or organizations pictured are doing improper or unsafe activities