Los Angeles Skid Row

Skid Row covers about 50 city blocks (0.4 square miles) in Los Angeles and has 12,000 to 14,000 residents. Approximately one-third are persons experiencing homelessness (PEH). The rest live in single-room occupancy (SRO) hotels, residential hotels, or apartments. 68.9% of Skid Row residents live below the poverty line (Ward et al., 2024). This may be the most extreme example of Fire-EMS challenges in high-poverty neighborhoods.

Graphic from: Collins, B., & Loukaitou-Sideris, A. (2016, July-August). Skid row, gallery row and the space in between: cultural revitalisation and its impacts on two Los Angeles neighbourhoods. Town Planning Review, 87(4)

A 1971 UCLA study of the Los Angeles City emergency ambulance system found that 13 of the 632 census tracts, small permanently established geographic areas, generated 10% of the total public emergency ambulance demand. (Aldrich et al. 1971). John Hisserich’s public health dissertation used the same 1964 to 1967 data to analyze the determinants of service in detail.

“Sick Calls” were highly correlated with variables describing census tracts with socioeconomically depressed populations. The 13 busiest census tracts included the city’s three Skid Row areas. Census tracts within the minority ghetto area south of the central city were the next highest-demand areas (1970).

In 1976, Los Angeles city planners created a ‘Containment Plan’, which relocated affordable housing and social services from elsewhere in the region to Skid Row, effectively concentrating the homeless population in one limited downtown area (Haas and Heskin, 1981; Goetz, 1992).

These socioeconomically depressed census tracts are persistent, defined as tracts with 20% or more of residents living below the poverty line for about 30 years (Benzow et al., 2023). The 13 Skid Row census tracts identified by Hisserich show that 79% of residents have lived below the poverty line for 38 years (Benzow & Fikri, 2020).

These tracts have experienced a major change in ethnicity while continuing to have high poverty. Benzow and Fikri (2020) describe what changed:

Hispanics now make up 73 percent of the population of Los Angeles’ high-poverty neighborhoods, even though they represent a little less than half of the city’s total population. Blacks saw their share of the city’s high-poverty neighborhood population fall from 43 percent in 1980 to just 12 percent in 2018, largely driven by their exodus from the city over that time. Los Angeles’ Black population declined by one-third from 1980 to 2018, while its Hispanic population increased by 139 percent. (p 20).

Fires in High-Poverty Neighborhoods

High-poverty census tracts face nearly six times the odds of experiencing multiple serious residential fires compared to the least deprived quartile (Wibbermeyer, 2025; Pae et al., 2025). Family poverty, unemployment, low education, and low household income are all independently associated with higher frequencies of residential fires (Wibbermeyer, 2025; Shai, 2026). In Philadelphia, low income and older housing interact to produce fire injury rates exceeding the combined effects of either factor alone (Shai, 2026).

Outside Fires

The Los Angeles Fire Department responded to 24 homeless encampment fires daily in 2020 (Smith et al., 2020). Most of these fires were within the same 13 census tracts that were the busiest for emergency ambulance calls between 1964 – 1967.

From 2018 to 2024, the unhoused population in Los Angeles grew by 44.6%, from 31,285 to 45,252 individuals, according to the Los Angeles Homeless Services Authority. Rubbish fires increased 475% from 5,541 to 31,964 between 2014 and 2024. “While not all of those have been documented as directly associated with a person experiencing homelessness (PEH), many have,“ the report states.

In 2024, rubbish fires involving PEH totaled nearly half of LAFD’s Rubbish Fire call volume at 46.84%. Meanwhile, fire calls involving homeless persons during that same period accounted for 32.91%, or nearly one-third, of all LAFD fire activity, the report states (Kurzwell, 2025).

Systemic Impact on Fire and EMS Operations

Citygate Associates LLC performed a Standards of Cover analysis for the Los Angeles Fire Department. In this Battalion 1/Battalion 11 cluster image, stations 4, 9, and 11 are among the 10 busiest, while stations 3, 10, 13, and 6 are among the 28 busiest in a department with 106 fire stations.

The top ten busiest engine, truck, and rescue ambulance companies are adjacent to each other, predominantly in two clusters. The individual unit-hour utilization (UHU) measures for these units significantly exceed 30 percent for long, consecutive hours at a time.

Based on this measure alone, the busiest unit crews are overworked and in need of relief units and/or strategies to decrease the quantity of non-urgent EMS incidents. The volume and simultaneous demand on the top 10 to top 28 LAFD stations is the highest Citygate has ever measured in a metro client. (Citygate, 2023, pp. 6-7)

The Battalion 1/Battalion 11 cluster falls within the same census tracts that were the busiest for emergency ambulance calls between 1964 – 1967.

LAFD Fire Station 9

“Skid Road” Fire Station 9 has the smallest first due area in the city, about 1.5 square miles. The station staffs two paramedic-staffed engine companies (Engine 9 & Engine 209), the city’s only stand-alone “paramedic assessment” truck company (Truck 9)¹, two paramedic rescue ambulances (Rescue 9 & Rescue 209), one 24-hour and one variable-hour EMT rescue ambulance (Rescue 809 & Rescue 900), and a paramedic/firefighter fast response vehicle (FR 9).

In the Citygate study, Rescue 809 (EMT) was the busiest LAFD ambulance, with 6,522 annual responses. Paramedic Rescue 9 and Rescue 209 responded to 5,221 and 5,090 calls, respectively. In the National Fallen Firefighters Foundation 2022 video about the Boyd Street Fire, the 19 on-duty members working a 24-hour shift at Station 9 averaged 100 responses every day; 90 percent were EMS calls.

SoCal Connected (2020) Fire Station 9. [Video] Season 10, Episode 1107. Public Broadcasting Service

Fast Response 9

The firefighter/paramedics assigned to the four Fast Response Vehicles (FRV) [deployed throughout the city] have a unique authorization from the Los Angeles County Department of Health Services to medically clear certain patients experiencing acute behavioral crises or chronic public inebriation for transport to either a Mental Health Urgent Care Center or Sobering Center, rather than to a traditional hospital emergency room. In addition, all LAFD FRV personnel certified Tactical EMS (TEMS) units and are available to support LAPD SWAT Team efforts. (LAFD, 2020)

This 2:19 minute video shows Fast Response 9 handling a homeless encampment fire in 2025. https://youtu.be/kLgR2QPGFH0

The 2020 Boyd Street Fire – Narrative from the LAFD “Green Sheet”

On Saturday, May 16, 2020, at approximately 18:27:00 hours, the Los Angeles City Fire Department (LAFD) responded to a structure fire at 327 East Boyd Street in the Skid Row [Toy District] area of downtown Los Angeles. The first arriving resources found a one-­story commercial occupancy with light, intermittent brown smoke showing from the top of two closed rolling steel doors. The subject occupancy was doing business as a wholesale distributor to dispensaries and smoke shops, and it had closed for the day prior to the time of alarm.

Conditions noticeably worsened over the next several minutes. Initially, members described a notable change in smoke emitting from the front of the occupancy, and then a rapidly increasing “freight train” or “jet-­like” sound, accompanied by rapid and escalating “popping-­like” noises. Subsequently, companies initiated a rapid retreat – both off the roof and out of the building. As firefighters began initiating their escape, a large volume of smoke ignited, and then immediately following, fire “blowtorched” out of the front of the occupancy, across the street, and out of the rear portion of the roof.

As a result of the catastrophic fire event, just eleven (11) minutes into the incident, twelve (12) firefighters were injured. The injuries were sustained when the firefighters were engulfed by a large volume of fire, some while retreating from interior firefighting positions, and others as they were descending the aerial ladder. All told, eleven (11) firefighters sustained minor to critical burns, and one (1) additional firefighter suffered a lower extremity injury.

The cab of the first-arriving Truck 9, with its deployed aerial ladder, sustained significant damage because both were in the immediate path of the flames. (LAFD, 2020)

This link takes you to the Green Sheet, an Informational Summary Report that is issued by LAFD as a safety/training tool: https://lafd.org/sites/default/files/Boyd_Green_Sheet.pdf

Captain II Victor Aguirre (Truck 9), the last remaining LAFD member to be hospitalized from the Boyd Street Fire, was released following 65 days of care in the burn unit of the Los Angeles County + USC Medical Center.

The National Fallen Firefighters Foundation produced a video about the Boyd Street incident. It includes a description of Station 9’s first due district. https://www.firehero.org/2022/11/18/boyd-street/

24 Hours at LAFD Station 9 (2019)

In December 2019, SoCal Connected, from the local Public Broadcasting System station, spent 24 hours responding to calls from Fire Station 9.

One of my students called the SoCal Connected video “apocalyptic.” https://www.pbssocal.org/shows/socal-connected/episodes/fire-station-9

The Invisible U.S. Fire Problem

A 2025 white paper from Kindling, Inc., sponsored by the National Fire Protection Association (NFPA), examined how human and shelter vulnerabilities intersect to shape fire risk in U.S. communities.

This scoping paper has shown that the US fire problem is not solved. Certain groups of people suffer disproportionately from fire and evidence indicates people experiencing homeless are particularly vulnerable to fire, as are those living in insecure and vulnerable shelter more generally.

These fire problems seem ‘invisible’ at the national level, but they are plaguing American cities, undermining the lives and livelihoods of affected populations, and having negative impacts beyond those directly affected (such as the fire services and neighbouring communities). (Antonellis et al., 2025, p. 44)

The paper identifies the gaps and challenges when looking at the fire safety of insecurely and vulnerably sheltered populations in the US.

(Antonellis et al., 2025, p. 39)

_______________________________

¹Los Angeles Fire Department “Light Force”

All but Truck 9 are “Light Forces” – a 100′ tiller aerial truck married to a 200 or 300 series engine (pumper) as a single six-person crew. 27 of the 42 light forces are “Paramedic Assessment”; the crew includes one paramedic/firefighter.

Light Force 73 operating in the San Fernando Valley (2015). Photo by Mike Peters. https://www.lafra.org/swift-water-rescue-results-in-medals-of-valor/

90210FireBuff (2025, June 1) catches Light Force 61 arriving at a recreational vehicle fire. 9:42 minute video. https://youtu.be/opMG_PUVZZo

References

Aldrich, C. A., Hisserich, J. C., & Lave, L. B. (1971). An Analysis of the Demand for Emergency Ambulance Service in an Urban Area. American Journal of Public Health, 61(11), 1156-2160.

Antonellis, D., Vaiciulyte, S., Meacham, B., & Jennings, C. (2025, November). The Invisible US Fire Problem. Kindling, Inc. https://kindlingsafety.org/wp-content/uploads/2025/11/The-Invisible-US-Fire-Problem.pdf

Benzow, A., and Fikri, K. (2020). The Persistence of Neighborhood Poverty: Examining the power of inertia and the rarity of neighborhood turnaround across U.S. cities. Economic Development Group. https://eig.org/wp-content/uploads/2020/04/Persistence-of-Neighborhood-Poverty.pdf

Benzow, A., Fikri, K., Kim, J. & Newman, Daniel. (2023). Advancing Economic Development in Persistent-Poverty Communities. Economic Development Group. https://eig.org/wp-content/uploads/2023/06/EIG-Persistent-Poverty-Report.pdf

Cali Fire Photo. (2025, December 16) (Small Explosion) LAFD FR9 Handles Rubbish Fire. [YouTube Video]: https://youtu.be/kLgR2QPGFH0

Citygate Associates LLC. (2023) Los Angeles Fire Department Standards of Cover Analysis. Volume 1 of 3: Technical Report. Citygate Associates LLC. https://ens.lacity.org/lafd/lafdreportarchv/lafdlafdreport1864172030_06012023.pdf

Collins, B., & Loukaitou-Sideris, A. (2016, July-August). Skid row, gallery row and the space in between: cultural revitalisation and its impacts on two Los Angeles neighbourhoods. Town Planning Review, 87(4), 401+. http://dx.doi.org.proxy-bc.researchport.umd.edu/10.3828/tpr.2016.27

Goetz, E. G. (1992), Land use and homeless policy in Los Angeles. International Journal of Urban and Regional Research, 16, 540-54. DOI: 10.1111/j.1468-2427.1992.tb00195.x

Haas, G. & Heskin, A. (1981), Community struggles in Los Angeles. International Journal of Urban and Regional Research, 5, 546-64.

Hisserich, J. C. (1970). Public Emergency Ambulance Service: Determinants of Demand. (Publication Number 7100637) [UCLA]. Public Health Doctoral Dissertation, Los Angeles. DOI: 10.1111/j.1468-2427.1981.tb00567.x

Kurzwell, T. (2025, April 16). Unhoused account for nearly one-third of fire calls: Los Angeles Fire Dept. KTLA5. https://ktla.com/news/unhoused-population-accounts-for-nearly-one-third-of-fire-calls-los-angeles-fire-dept/

LAFD. (2020) Informational Summary Report: Injuries/Commercial Structure Fire, May 16, 2020, Boyd Incident. CA-LFD-001073. https://lafd.org/sites/default/files/Boyd_Green_Sheet.pdf

LAFD. (2020, February 11) With the addition of FRV 82 in Hollywood, the LAFD now has FRVs assigned within all four of the department’s geographic bureaus. Los Angeles Fire Department. https://lafd.org/news/lafd-augments-fast-response-vehicle-deployment

NFFF. (2022, November 18) Boyd Street [Vimeo video: 1:08 hours] National Fallen Firefighters Foundation. https://www.firehero.org/2022/11/18/boyd-street/

Pae, G., Paulsen, A., Pothula, S., Galet, C., & Wibbenmeyer, L. (2025). Integrating spatial analysis with census data to unravel the complex interaction between socioeconomic variables, the built environment, and multiple house fires in a predominately rural state. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 31, 327 – 332. https://doi.org/10.1136/ip-2025-045691

Phillips, D. (2020, May 6). 11 Firefighters Escape Through Ball of Fire in Explosion at Downtown LA Building: Some of the LAFD firefighters injured in Saturday’s fire and explosion suffered critical injuries, but all are expected to survive. NBC4 Los Angeles. https://www.nbclosangeles.com/news/local/10-firefighters-injured-in-downtown-la-fire/2363892/

Shai, D. (2006). Income, Housing, and Fire Injuries: A Census Tract Analysis. Public Health Reports, 121, 149 – 154. https://doi.org/10.1177/003335490612100208

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

SoCal Connected (2020) Fire Station 9. Season 10, Episode 1107 [Video 27:57 minutes]. Public Broadcasting Service. https://www.pbssocal.org/shows/socal-connected/episodes/fire-station-9

Ward, J. M., Garvey, R., & Hunter, S. B. (2024) Annual Trends Among the Unsheltered in Three Los Angeles Neighborhoods: The Los Angeles Longitudinal Unumeration and Demographic Survey (LA LEADS) 2023 Annual Report. RAND. https://www.rand.org/content/dam/rand/pubs/research_reports/RRA1800/RRA1890-4/RAND_RRA1890-4.pdf?utm_source=perplexity

Wibbenmeyer, L., Paulsen, A., Pothula, S., Galet, C., & Pae, G. (2025). 608 Geomapping and Spatial Analysis to Examine Socioeconomics, the Built Environment, and House Fires. Journal of Burn Care & Research: Official Publication of the American Burn Association, 46, S183 – S183. https://doi.org/10.1093/jbcr/iraf019.237

Featured Image is from Lopez, S. (2021, April 21) Ending homelessness on skid row won’t happen just because a judge orders it. The Los Angeles Times. https://www.latimes.com/california/story/2021-04-21/column-a-federal-judge-ordered-a-skid-row-cleanup-but-is-this-progress-or-posturing

What Do Retired Firefighters Dream About?

A recently retired firefighter posted that question on a private social media account comprised of other retired members from the same department. Those who responded mentioned dreaming of being back in the fire station, interacting with the crew, and recalling the mundane non-emergency aspects of the job.

In my back-on-the-job dreams, a feeling returned that I was an integral part of something bigger, something important in a group that makes a difference in the community. I felt calm, competent, and connected. A feeling that has not shown up in any of my endeavors after retiring from the fire department.

Robert McCarl spent 18 months embedded with the Washington, District of Columbia, Fire Department (1978-1979) to conduct an ethnographic study of urban firefighters. An ethnographic study is an immersive, qualitative research method where a researcher embeds themselves into a specific community or social group to understand their culture, behaviors, and everyday practices from the participants’ own perspectives. McCarl explained his presence to firefighters this way, “I was hired by the union to document how information is passed from one guy to the next, say from an experienced man to a rookie” (McCarl, 1985, p. 21).

McCarl’s interviews with firefighters reinforce the concept of the fire department as a second family:

It’s hard to describe the closeness you felt with the guys in the fire house. I don’t think my wife has ever really understood it. I just used to love coming to work – especially on those long Saturdays when we’d have a big roast or ham or something and sit around and talk or play cards. … It’s a group of men with unique brotherhood feeling – they’ll never let you down (McCarl, 1985, p. 97)

A theme that will be repeated in the EMS section, “After the first few months in the house and on the fireground, however, this formal education (recruit school) has been shaped by the informal culture of the company and the officer, and the rookie has begun to reflect the attitude and techniques of those he has chosen as a model” (McCarl, 1985, p. 39).

Where’s My Gear?

I was surprised to find I was not the only retiree searching for my gear (fire coat, bunker pants/boots, helmet, portable radio) while dreaming of firehouse life. Probably something hard-wired from the recruit school/rookie year.

Emergency Medical Services (EMS) Is Different

Ethnographic studies of U.S. 9-1-1 ambulance service focused on private providers (Prener, 2022; Seim, 2020; Mannon, 1992; Metz, 1982). In these organizations, EMS caregivers arrive already credentialed as EMTs or paramedics. New employees receive orientation and, usually, a skills checkoff. Then they are sent out to work as part of a two-caregiver team.

Supervision may be remote and infrequent. They may spend a lot of their time between responses parked at an intersection or parking lot. This is a very different team environment from that of a fire station, with a larger fire suppression crew that includes a supervisor and a home base with a kitchen, bathrooms, bunkrooms, and dayroom to relax and recover. Caregiver annual turnover for United States EMS staff in 2022 is 25-30% (Zarei et al., 2026).

In The Ordinary Hours, James Weber uses the business fable storytelling technique to illustrate the EMS caregiver retention problem at a fictional four-station EMS 9-1-1 agency. The descriptions are vivid and valid. Following the retention improvement journey from Station 4 to the challenging Station 7 – with a 71% turnover in one year – is engaging.

Weber shows that EMS has 90 days to develop a new hire. It is a three-phase process.

• Month 1 is stabilization: provide psychological safety and agency orientation, using one consistent person as a mentor.
• Month 2 is to deepen agency integration and skill building,
• Month 3 is caregiver autonomy and organizational commitment, where the new hire’s mentor evolves into one of many resources the new hire has within the agency.

If the new hire is not anchored to the EMS agency by the 90th day, they will decide to leave.

References

Country Callbacks. (2026, June) Country Roads Went Viral at the FIFA World Cup – Here’s Why Soccer Fans are Obsessed! [YouTube] https://youtu.be/1-vSER43-GY

Mannon, J. M. (1992). Emergency encounters: EMTs and their work. Jones and Bartlett Publishers.

Metz, D. L. (1982). Running Hot: Structure and Stress in Ambulance Work. Cambridge, MA: Abt Books. https://doi.org/10.1525/maq.1983.14.3.02a00210

McCarl, R. (1985) The District of Columbia Fire Fighters’ Project: A Case Study in Occupational Folklife: Smithsonian Folklife Studies, Number 4. Smithsonian Institution Press. https://repository.si.edu/server/api/core/bitstreams/10e84cae-cc7f-4b6b-aea8-f02c2ad9208a/content

Prener, C. (2022). Medicine at the margins: EMS workers in urban America. Fordham University Press. https://doi.org/10.5422/fordham/9781531501075.001.0001

Reliable Source (2013, October 4) Bill Danoff on how ‘Country Roads’ became a German Oktoberfest hit. The Washington Post. https://www.washingtonpost.com/news/reliable-source/wp/2013/10/04/bill-danoff-on-how-country-roads-became-a-german-oktoberfest-hit/

Seim, J. (2020). Bandage, Sort, and Hustle: Ambulance Crews on the Front Lines of Human Suffering. Oakland, CA: University of California Press.

Weber, J. (2026) The Ordinary Hours: Why Your Best People Leave – And The Small Things That Make Them Stay. Oak Street Press. https://www.amazon.com/Ordinary-Hours-People-Leave-Things-ebook/dp/B0FQTNKY2Y/ref=sr_1_2

Zarei, E., Safari, M., Zamani, Z., & Kakemam, E. (2026). Turnover intention and its predictors among Emergency Medical Services (EMS) professionals: a systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 34. https://doi.org/10.1186/s13049-026-01567-8

I collect items that may show up in the sixth edition of Fire Officer: Principles and Practice, which comes out after NFPA Standard 1020 is updated around 2030. The St. Lucie County Fire District in Florida has provided a climate survey example. The fire district employs 523 firefighters operating out of 19 fire stations. Three Battalion Chiefs and a Deputy Chief on duty for each shift. 2025 Annual Report.

Fire Station 1 at Fort Pierce is the busiest station, with the 8 employees responding to 11,044 incidents in 2025 while staffing an engine and two rescue (ALS ambulance) trucks. The department responded to 71,203 incidents.

Severe Hazing Results in 3 Terminated and 2 Suspended

Senior firefighters, including acting supervisors, severely hazed rookie firefighter/paramedics at Station 1A, including using a modified bug zapper to administer shocks in 2024. The fire district obtained the videos in March 2026. The 17-page media advisory released by the fire district on July 18th provides extensive details and can be accessed through this link.

In-Station Behavior

The law firm that conducted the investigation included the July 2025 Susan Gainey Workplace Culture Analysis. Those findings include:

• Overly aggressive banter, mockery, sarcasm, and personal questioning unrelated to job performance, including 1A firefighters asking recruits in front of a group about drug usage.
• Mocking or public correction of apprentices, which some described as humiliating or going “overboard.”
• “Light hazing,” “playing jokes,” or “horseplay” that blurs the line between camaraderie and misconduct. One employee noted that such behavior would not be accepted at other stations.
• A sentiment among multiple firefighters that certain individuals were “not welcome” unless conforming to unspoken social norms.
• An environment that is “cliquish” such that new employees or employees on short-term assignments do not feel part of the team and may feel isolated.
• More than one employee stated that 1A is composed of “cowboys” who “do their own thing.” One employee stated that he was told by someone from 1A that they “did things their way, not the department way,” suggesting that they do not follow District policies and procedures.
• Multiple employees stated that the workplace culture at 1A was not inclusive.
• Firefighters had requested transfers or expressed discomfort due to the 1A environment.
• One firefighter stated that the environment at 1A “made it tough to come to work.”
• Loyalty among existing crew members can result in the informal exclusion of newcomers.
• One firefighter reported there appeared to be favoritism or bias in advancement at 1A.

My experience on the job and as a consultant is that while the formal fire department may have a specific way or philosophy of doing things, each fire station creates its own version of “the fire department way.” Station 1A behaving like cowboys is an observation I have heard in earlier bad-outcome investigations at other jurisdictions.

The decentralized nature of fire departments makes effective emergency response, but diffuses fire headquarters directives. I spent a year as a relief Fire Lieutenant, filling C-shift vacancies in all six battalions in a department with 36 fire stations. Every station was different. The fire company commander and the battalion chief have a profound impact on crew behaviors and task competencies.

If you are a supervisor, manager, or administrator, you should read the St. Lucie County Fire District media advisory. The culture described in this report is troubling, but not unique. How would you handle it in your department?

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.