This concept is used when discussing risk management, healthcare, and engineering. It is also a component in designing better systems under the Just Culture model. Reason points out that failure is an inevitable result of human systems—we are all fallible. Countermeasures are based on the idea that “we cannot change the human condition, but we can change the conditions under which humans work.” So, failure is seen as a system issue, not a person issue.

High-reliability organizations take this approach to failure awareness:

• Analyze every event, no matter how small, to implement system-wide changes
• Encourage and reward error reporting
• View near-misses as opportunities for improvement rather than proof of success
• Continuously learn from defects and develop failure-free processes

Two years before wildfires incineratedswaths of Los Angeles, the city’s fire chief, Kristin M. Crowley, identified “one significant area of weakness” in her department’s ability to contain wildfires. L.A. had no specialized wildland unit to respond to daily brush fires and scrape vegetation, dig ditches and do the other labor to ensure blazes did not spread or rekindle, she wrote on Jan. 5, 2023, asking for $7 million to assemble its own squad.

In a memo that has not been previously reported, she told city fire commissioners that L.A. relied almost entirely on overburdened “hand crews” from other jurisdictions to bring such muscle to its brush fire emergencies. Hand crews, the most elite of which are sometimes called “hotshots,” fight wildfires with chain saws, axes and shovels, setting containment lines and then sticking around to meticulously monitor smoldering fires, feeling by hand for heat and digging out live spots to make sure fires don’t relight.

High-reliability organizations resist oversimplification of explanations for successes and failures:

• Constantly question “why” and invite diverse opinions
• Avoid simplistic explanations for failures
• Recognize the complexity of their work and its potential to fail in unexpected ways

Forget “wildland-urban interface”

When catastrophic fires occur, experts often blame the so-called wildland-urban interface, the vulnerable region on the perimeter of cities and suburbs where an abundance of vegetation in rugged terrain is susceptible to burning.

Yet the fire disasters that we’re seeing today are less wildland fires than urban fires, wildfire expert Jack Cohen said. Shifting this understanding could lead to more effective prevention strategies.

“The assumption is continually made that it’s the big flames” that cause widespread community destruction, he said, “and yet the wildfire actually only initiates community ignitions largely with lofted burning embers.”

The belief was that urban fires no longer exist, but they’ve come back. “It’s like watching polio return,” he said. “It’s happening repeatedly.”

While the Bel-Air fire in 1961, which destroyed 484 homes, and the Mandeville Canyon fire in 1978, which destroyed 230 homes, are often cited for the scale of their destruction, the 1991 Tunnel fire in the Oakland and Berkeley Hills marked the start of the modern era of urban fires, destroying 2,843 homes.

More recently, fires devastated Gatlinburg, Tenn., in 2016, the towns of Superior and Louisville in Colorado in 2021 and Lahaina, Hawaii, two years ago.(Curwen)

High-reliability organizations maintain high awareness of the state of their systems and processes:

• Focus on preserving constant awareness by leaders and staff of factors affecting the mission
• Proactively identify and prevent defects and harm
• Use real-time data and insights to prompt action, learning, and outcomes

Officials said that the Santa Ynez Reservoir had been closed since about February for repairs to its cover, leaving a 117-million-gallon water storage complex empty in the heart of the Palisades for nearly a year. (Hamilton)

High-reliability organizations cultivate resilience by:

• Prioritizing safety over other performance pressures
• Developing the ability to assess and respond to unexpected situations quickly
• Continuously learning from both successes and failures
• Investing in emergency training for unlikely but possible system failures

Thirteen years ago, Los Angeles Fire Department officials were bracing for the kind of dangerous winds that could drive flames across hillsides and canyons and tear through neighborhoods from Malibu to the Pacific Palisades to the San Fernando Valley.

The National Weather Service had issued red flag warnings of doomsday gusts as fierce as 90 mph.  LAFD commanders ordered up at least 40 extra fire engines for stations closest to the areas where the fire hazards were greatest, including the Palisades, The Times has learned through interviews and internal department records.

Among the additional rigs were more than 20 that were pre-deployed to those stations and 18 “ready reserve” engines that supplement the regular firefighting force in such emergencies, the records and interviews show.

“We could not take any chances on this, because the risk was too great,” said former LAFD Assistant Chief Patrick Butler, now chief of the Redondo Beach Fire Department, who led the agency’s preparations in 2011. (Tchekemedyian & Pringle) (Image is from staging for a 2010 brush fire – Mike Meadows)

High-reliability organizations value insights from those with the most pertinent knowledge, regardless of hierarchy:

• Empower frontline staff to make critical decisions
• Recognize that those closest to the work often have the greatest situational knowledge
• Ensure leaders know who possesses specialized expertise within the organization

Davis, Aaron C.; Boburg, Shawn; Sacks, Brianna; Hennessey-Fiske, Molly: & Lee, Joyce Sohyun. (2025 January 18) A key ‘weakness’ in L.A.’s wildfire strategy went unaddressed for years, Post probe shows. The Washington Post. https://www.washingtonpost.com/weather/2025/01/18/2023-memo-la-fire-chief-warned-significant-gap-wildfire-defense/

Curwen, Thomas (2025 Jan 11) Inconvenient truths about the fires burning in Los Angeles from two fire experts. Los Angeles Times. https://www.latimes.com/california/story/2025-01-11/fire-experts-asses-los-angeles-blazes-amid-changing-times

Hamilton, Mark. (2025 January 10) State to probe why Pacific Palisades reservoir was offline, empty when firestorm exploded. Los Angeles Times. https://www.latimes.com/california/story/2025-01-10/as-flames-raged-in-palisades-a-key-reservoir-nearby-was-offline

Tchekemedyian, Alene & Pringle, Paul. (2025 January 18) Amid dangerous winds in 2011, LAFD engines stood ready. That didn’t happen this time. Los Angeles Times. https://www.latimes.com/california/story/2025-01-18/amid-dangerous-winds-in-2011-lafd-engines-stood-ready-in-the-palisades-that-didnt-happen-this-time

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.

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.

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

Dunning, D. (2011) Chapter five – The Dunning-Kruger Effect: On Being Ignorant of One’s Own Ignorance. Advances in Experimental Social Psychology. 44, 247-296 https://doi.org/10.1016/B978-0-12-385522-0.00005-6

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

The creation of knowledge is the core of the activity of a research scientist or professor. The peer-review publishing process was started during a smallpox outbreak in the 1820s when the powerful Académie de Médecine medical institute in Paris published a weekly account of their discussions as they evaluated a new vaccine. (Tingley) This process of moving from private conversations to public papers was the foundation of peer-reviewed scientific journals.

Getting published in a peer-reviewed journal takes time, this graphic from Voight and Hoogenboom provides the details:

Once published, this new information becomes part of the on-going conversation in this field of study. Eventually, someone will build upon this new information to further expand the understanding of this field of study.

The Crisis of a Novel and Unknown Virus

In an earlier post, we described the situation facing medical staff and first responders:

At the start of this pandemic, medical, public health, and first responders were like a test pilot in an out-of-control experimental airplane. Transmitting a non-stop detailed radio commentary of what the pilot is observing, what the pilot is doing, and what are the results. Often factoids will pop-up out of context or be incompletely reported.  5 Tips When Commanding During A Time of Great Hazard and Uncertainty

The traditional peer-reviewed process would mean that what is being learned on the front lines of the coronavirus fight would not be shared in a peer-review journal for 6 to 12 months. 

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 a finding submitted to Science was publically 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.

This also means that many more people are following scientific journals. That means many factoids, cautions, or concepts are getting significant media attention without noting that this is a preliminary finding that has not been verified.

Awash in Stories

There are heartbreaking and amazing stories of loss and survival. From Dallas, a patient who was on a ventilator for 30 days:

The Texas Health Dallas team had already tried at least a half-dozen therapies.  … Then they turned to a treatment from the history books. Convalescent plasma, antibody-rich blood donated by survivors of infectious disease, was developed in the late 1800s to fight diphtheria. It was the subject of the 1901 Nobel Prize in Physiology or Medicine and has been deployed against measles, mumps, and the 1918 Spanish flu.

Texas Health Dallas obtained emergency permission from the federal government to administer convalescent plasma on a compassionate-use basis because Michael remained critically ill. (Kuchment)

That does not mean that every patient who is on a ventilator should immediately receive convalescent plasma. But it does add to the knowledge of COVID-19 treatment outcomes and needs further study.

Getting a Handle On The Work In Progress

There are efforts to keep track of clinical developments. Over 600 clinical trials have been registered at various clinical sites. A global coronavirus COVID-19 clinical trial tracker has been developed. https://www.covid-trials.org/

This remains a bumpy ride over unfamiliar terrain for fire and ems commanders. We are seeing some signs of a framework, not unlike the imposing of order on the chaos of a multiple alarm/multiple hazards incident. The situation remains deadly and fluid.

Stay safe, be smart, mask up.

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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 

Voight, M. L., & Hoogenboom, B. J. (2012). Publishing your work in a journal: understanding the peer review process. International journal of sports physical therapy, 7(5), 452–460.

Ward, M.  (2020 March 30) 5 Tips When Commanding During A Time of Great Hazard and Uncertainty CompanyCommander.com Reston, VA: Gold Badge Enterprises.

Kuchment, A. (2020 April 25) Dallas medical team rescues coronavirus patient after 30 days on life support: Doctors at Texas Health Dallas relied on their experience with Ebola — and a treatment from the history books — to help a Dallas man recover. Dallas Morning News. Accessed April 26, 2020: https://www.dallasnews.com/news/public-health/2020/04/25/dallas-medical-team-rescues-coronavirus-patient-after-30-days-on-life-support/

Thorlund, K., Dron, L. Park, J., et al (2020 April 24) A real-time dashboard of clinical trials for COVIC-19. The Lancet. DOI: https://doi.org/10.1016/S2589-7500(20)30086-8 Accessed April 26, 2020: https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30086-8/fulltext#articleInformation 

Featured image:

Humans Are Getting Restless and Sicker as They “Stay at Home”

Living in a chronically stressful situation makes humans forgetful, reduces hand-to-eye coordination, and slows reaction time to situations. Humans are more likely to have mood disorders or act out during a long period of stress.

Chronic stress can lead to malignancy because of a suppressed immune system. The chronic “fight-or-flight” situation may keep the heart rate and blood pressure elevated. Depending on the underlying medical conditions, there is a possibility of cardiac arrhythmias that may lead to myocardial infarction. These factors affect first responders as well as citizens.

Humans may starve or gorge. Type 2 diabetes may develop due to a “stay-at-home” diet and lifestyle. The gastrointestinal (GI) tract is more irritable – that may lead to GI inflammatory diseases.

About 18% of Americans have some type of mental health issue that requires treatment, about 6.7 million receive counseling. The FaceTime or telephone counseling sessions during the “stay-at-home” era may not be as effective as the face-to-face sessions.

Social isolation may result in Substance Use Disorder (SUD) users getting high alone, resulting in overdoses that will not be witnessed by others and lead to death. Those in recovery will have difficulty getting peer-to-peer support and remaining sober.

All of these factors mean that we will encounter a higher number of 9-1-1 calls involving people dangerously acting-out, more patients presenting with serious pathophysiology and more people falling through the safety net of available services.

Local and State Governments Suffer Reduced Revenue

About half of the income that runs state government comes from sales taxes, personal and business income taxes, excise taxes. The rest comes from federal grants and charges.

Many state governments have not returned to the financial health it had in the late 1990s. The recession of 2001 and the “Great Recession” of 2007-2009 were different than earlier recessions. The decline in tax revenue was steep in both periods and the recovery has been slower than any earlier recession. For our colleagues in public health, there were 250,000 state and jurisdictional positions never restored after the “Great Recession.”

The Urban Institute pointed out that: “Even though 42 states had recovered their nominal 2008 tax revenue levels by 2013, only 24 experienced real revenue growth.” Alan Greenblatt, looking at the projected 2020 budget fallout, points out:

Cities from Santa Barbara, Calif., to Scranton, Pa., have furloughed workers. In Akron, Ohio, 600 city employees — a third of the total workforce — have been furloughed.

County-level governments rely on property taxes for 72% of their revenue. It is the most stable source of government revenue but when the tenants of commercial properties do not pay their lease or go bankrupt during the “Stay at Home” quarantine the amount of property tax revenue received plummets.

A decline in state revenue impacts local jurisdictions as 32% of local revenue comes through a transfer of state funds to local jurisdictions. In Las Vegas and Baltimore, the local government leaders are starting the reduction-in-force process.

Las Vegas Metropolitan Police Department laid off more than 100 part-time employees last week. The emergency created by the coronavirus has allowed local governments throughout the Las Vegas Valley to suspend more than 25 labor contracts.

Baltimore informed its labor unions it is considering pay cuts, furloughs, and layoffs to address an anticipated $103 million revenue shortfall for the next fiscal year that starts July 1. The city wants to make $11 million in personnel cuts.

Many jurisdictions are looking at significantly lowered revenues. For example, San Antonio, Texas, anticipates a 17% decrease in sales tax revenue.

I would anticipate local jurisdictions will impose a hiring freeze, provide no cost-of-living pay raises for Fiscal Year 2021 (generally from July 1, 2020, to June 30, 2021), and postpone or cancel major purchases – like replacement apparatus. That promotion we talked about in the opening paragraph … probably will not happen this year. 

Building Company Level Resilience 

Mike Taigman points out that resilience is the ability to advance despite adversity.

… people who are resilient tend to be more able to adapt to changes in the world, whether it’s having a baby or getting divorced… and they are less likely to be thrown off by little things, like getting cut off in traffic or dropping your phone in the toilet. They tend to be braver and more willing to take reasonable risks, therefore they accomplish more. And they’re much more effective at achieving goals they set for themselves.

Anthony Bourdain’s reflection on firefighters after visiting Detroit Squad 3 reflects our cultural approach to challenges:

Firefighters, in my experience, are a lot like the Marines I’ve met over the years. No matter how badly led, ridiculously underequipped, underappreciated, no matter how doomed their mission, they take a bizarre and quite beautiful pride in at least being screwed more than everybody else and doing it with style. They seem to do what they do for themselves. It’s not a job. It’s a calling

As pointed out last week, one of the best resiliency resources is a webinar hosted by Taigmen: “First Responders, Stress Management and Coronavirus.” Taigman provides a thoughtful presentation with a rich list of resources.

This 1 hour, 22-minute webinar covers the neuroscience of resilience.

Link to the webinar: https://info.lexipol.com/webinar-coronavirus-stress-management-ty

Link to the research page: https://info.lexipol.com/coronavirus-stress-management

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Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480   Accessed April 11, 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/

(2020) Mental Health in America. Peoria, Ill: Bradley University. Accessed April 11, 2020:  https://onlinedegrees.bradley.edu/blog/mental-health-in-america/

Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020; [Epub ahead of print 2 April 2020]. doi: https://doi.org/10.7326/M20-1212. Accessed April 12, 2020: https://annals.org/aim/fullarticle/2764313/collision-covid-19-addiction-epidemics

Wilson, R. T., Troisi, C. L. & Gary-Webb, T. L. (2020 April 5) A deficit of more than 250,000 public health workers is no way to fight Covid-19. STATnews.com Accessed April 12, 2020: https://www.statnews.com/2020/04/05/deficit-public-health-workers-no-way-to-fight-covid-19/

Francis, N. & Sammartino, F. (2015 September) Governing with Tight Budgets: Long Term Trends in State Finances.  Washington, DC: The Urban Institute. Accessed April 11, 2020:  https://www.urban.org/sites/default/files/publication/66046/2000376-long-term-trends-in-state-finances.pdf

Greenblatt, A. (2020 April 9) State Budget Fallout: ‘A Hurricane That Hits All Over the Country’ The revenue drop from COVID-19 is barely starting to show up in official figures, but already furloughs and major shortfalls are common in state and local governments around the country. The pain may be sudden, but it could last for years. Governing.com. Folsom, CA: e.Republic. Accessed April 11, 2020: https://www.governing.com/finance/State-Budget-Fallout-A-Hurricane-That-Hits-All-Over-the-Country.html

Greenblatt, A. (2020 March 19) States and Cities Face the Prospect of Severe Budget Shortfalls. No one knows how deep or long the pandemic-triggered recession will be. But nearly every type of government revenue, including income, sales and gas taxes, will take a hit. Well-funded rainy-day funds should help. Governing.com. Folsom, CA: e.Republic. Accessed April 11, 2020: https://www.governing.com/finance/States-and-Cities-Face-the-Prospect-of-Severe-Budget-Shortfalls.html

LaFerney, D. (2020 April 10) Las Vegas police announce layoffs in wake of coronavirus struggles. Las Vegas Review-Journal. Accessed April 11, 2020: https://www.reviewjournal.com/news/politics-and-government/las-vegas-police-announce-layoffs-in-wake-of-coronavirus-struggles-2004337/

Davisdon, M. S. (2020 April 10) Coronavirus emergency allows for rare union contract suspensions. Las Vegas Review-Journal. Accessed April 11, 2020: https://www.reviewjournal.com/post/2004073 

Anderson, J. & Richman, T. (2020 April 10) Baltimore unions told there could be pay cuts, furloughs and layoffs because of coronavirus budget shortfall. The Baltimore Sun. https://www.baltimoresun.com/coronavirus/bs-md-ci-police-personnel-cuts-20200410-kabfx5ybkvhl3mkluasdg323re-story.html

Hellgren, M. (2020 April 11) ‘Slap In The Face’ | Firefighters Union Says City Shouldn’t Be Discussing Layoffs, Furloughs During COVID-19 Pandemic. WJZ Baltimore CBS 13. Accessed April 11, 2020: https://baltimore.cbslocal.com/2020/04/11/slap-in-the-face-firefighters-union-says-city-shouldnt-be-discussing-layoffs-furloughs-during-covid-19-pandemic/

Garnham, J. P. (2020 April 2) Local governments, already hard hit by the coronavirus, are facing a fresh budget threat: economic recession. KSAT.com Accessed April 12, 2020:  https://www.ksat.com/news/texas/2020/04/02/local-governments-already-hard-hit-by-the-coronavirus-are-facing-a-fresh-budget-threat-economic-recession/

Staff (2019 October 14) How Improving Resilience Can Make You Healthier, Happier and More Effective. JEMS. Accessed April 12, 2020: https://www.jems.com/2019/10/14/improving-resilience-healthier-happier-effective/

It is a marathon – manage your energies

We are hard-wired to work until a problem is solved. That is what makes us great as an emergency responder. Unfortunately, this situation will be impacting us for weeks, so we should consider lessons learned from wildfires, USAR deployments, and other calamities

1. Critically Evaluate Clinical and Operational “Facts”

At the start of this pandemic, medical, public health and first responders were like a test pilot in an out-of-control experimental airplane. Transmitting a non-stop detailed radio commentary of what the pilot is observing, what the pilot is doing and what are the results. Often factoids will pop-up out of context or be incompletely reported.

One of the sharpest paramedics I know, Tracey Loscar, describes the process she used in exploring the statement “… don’t use Advil for fever because it turns COVID-19 into pneumonia.”

Without context, it implies a warning with substance. It promotes fear and can even create dangerous conditions for people who may misread it and then apply that information without legitimate guidance. … in seconds you can see that this recommendation currently has absolutely no basis in science. All you would have to do is type, “Advil in COVID” into Google.

If you dug into it at all, like, less than ten minutes of your time, you would see that it’s based off a combination of a single letter, published in a French journal two weeks ago (The Lancet, March 11), and a Tweet from one French doctor in the Health Ministry suggesting Advil could aggravate the infection, make it spread faster. It’s not an actual study, it’s a theory.   Tracey Loscar   (March 28)

A 2001 RAND conference on protecting first responders after terrorist attacks looked at the difficulties in managing information during the anthrax incidents – issues that ring familiar today:

Especially in the case of anthrax, keeping up with changing information being provided by numerous agencies was a serious challenge for front-line responder organizations.

The desire to have accurate information was of particular concern to commanders, who were making decisions about what level of risk their personnel would face.

Finally, an EMS panel member observed that post-event information can be just as important: Sometimes responders were not told whether the test on the suspicious substance they responded to turned out to be positive for anthrax or not. The responder assumed that they would have been informed if it was positive, but the lack of certainty caused stress anyway.  RAND

Providing prompt and accurate feedback on the results of the patient (and caregiver) COVID-19 testing is vital to the caregiver’s sense of well-being.

2. Help every member of your crew to avoid contaminating their family and loved ones

A Dublin Firefighter/Paramedic describes a ritual he worked out with his wife on the times he responded to a chemical incident, water rescue, or fire with asbestos. He would call ahead to have her prepare the home. With the pandemic, this coming-home ritual occurs every night:

When we return our crew have finished and it’s back to the showers and the scrubbing , the uniform is kept at work and washed and I head home. I have two children, boys, who crave their fathers attention and after the day I have had I crave theirs, but before that happens I walk down the side of my house and take off  my clothes at the back door and I pick up the towel my wife has left me and I head straight to the shower.    SIPTU – Dublin Fire Brigade  (March 27)

3. Create time and space to decompress and rest

Some practices a company commander can perform while on-duty include:

• Informational briefings at the start of every shift.
• Maybe some time periods with the TV talking heads turned off – interrupt the constant drone of crisis, fear, and controversy.
• The daily broadcast from the White House provides national updates (and political theatre).
• When possible, rotate members from high-stress to lower-stress activity during the work shift.
• Make sure your team hydrates, take breaks and safely maintain energy levels.
• Discourage the use of caffeinated energy drinks as they are linked to cardiac problems and dehydration. Click on the link below to Dan Bodin’s evaluation of caffeinated energy drinks on firefighters.
• Establish a “quiet” area, like the bunkroom, for decompression.

4. Be a reliable source of information and administrative support

Every emergency service agency is struggling with worker compensation, sick leave, and related workforce questions when it comes to self-quarantine, defining what an “exposure” is and how caregivers will be handled. This remains a work-in-progress with a different pathway taken by every state.

• Make sure you have the forms and procedure in place when a caregiver is exposed, injured or needs to leave work for a family emergency.
• Be assertive in resolving the “I do not know” responses from Human Resources, Worker Compensation or your bosses.
• Keep a journal of what the people under your command are doing (ambulance, fire company, battalion or division) – especially the battlefield workarounds. Document the situation, what was done, what was said and who said it.
• The journal will also be important for the after-action report.
• The journal also provides the work-hour documentation needed when applying for federal reimbursement through the Stafford Act. Find a colleague that worked on a USAR deployment for guidance.
• Memorialize every accommodation and deviation from the published procedures and protocols in an email from your agency’s email system to the person that made the decision. Include a carbon copy (cc) or blind cc back to you. In the rapidly changing conditions, what was agreed to do about health coverage, injury compensation or quarantine arrangements on March 30th will be forgotten when the issue comes up for resolution months later.

5. Use multiple media to get the administrator’s message out.

Even during a crisis period, some emergency service members do not check their departmental emails or website. A short video is an excellent method to send updates and share your concerns with your team members that learn visually.

This 3:14 video from Virginia Beach EMS Chief Ed Brazle provided an excellent example:

This remains an unprecedented time in the world, possibly more disruptive than World War II in a much shorter timeline.

Be safe

Stay clean

Work smart

+++++++++++++

Jackson, B.A., Peterson, D.J., Bartis, J.T., LaTourette, T., Brahmakulam, I., Houser, A. & Sollinger, J. (2002) Protecting Emergency Responders: Lessons Learned from Terrorist Attacks (Conference Proceedings December 9-11, 2001, New York City). Santa Monica, CA: RAND Science and Technology Policy Institute. Accessed 3/29/2020: https://www.rand.org/content/dam/rand/pubs/conf_proceedings/2006/CF176.pdf 

U.S. Department of Health and Human Services. (2005) A Guide to Managing Stress in Crisis Response Professions. DHHS Pub. No. SMA 4113. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Accessed 3/29/2020: https://store.samhsa.gov/product/guide-managing-stress-crisis-response-professions-2/sma05-4113

Bodin, Dan. (2018 August) The Effect of Energy Drinks in the Fire Service. Ann Arbor, MI: Fire Department Safety Officers Association.  Accessed 3/29/2020: https://www.fdsoa.org/wp-content/uploads/2018/08/The-Effects-of-Energy-Drinks-1.pdf

Fire Department Safety Officers Association website:  https://www.fdsoa.org/

Featured image: An FDNY medical worker wears personal protective equipment outside a COVID-19 testing site at Elmhurst Hospital Center on March 25 in New York.(John Minchillo/AP)  https://www.nydailynews.com/coronavirus/ny-coronavirus-911-calls-spiral-out-of-control-20200327-jaioo6lmnvdcfeeg6lkfxexnua-story.html

World War C’s enemy is a novel virus that, if not controlled, can exponentially (geometrically) expand and infect a significant percentage of the population and overwhelm the healthcare system.

Let’s look at New York state with 15,783 COVID-19 cases on Sunday afternoon March 22nd: 2,178 patients may require hospitalization and 742 of those patients may need an ICU bed. New York has 3,157 ICU beds – 2,136 of them in the New York City region. Governor Cuomo says they will need somewhere between 18,600 and 37,200 ICU beds to meet the coming wave of COVID-19 patients.

Without COVID-19 the national ICU bed occupancy rate is around 67%. Imagine the impact of a flood of feverish COVID-19 patients with trouble breathing entering the hospitals.

What happens if you have a heart attack but the ambulance takes 50 minutes to come instead of 8 (too many coronavirus cases) and once you arrive, there’s no ICU and no doctor available? You die. (Pueyo 2020b)

Lack of Personal Protective Equipment

Just like the start of World War II, we are dramatically short of vital materials. There was just 1% of the facemasks needed to protect all of the U.S. healthcare providers. We need facemasks, gloves, gowns, and eye protection.

JEMS executive editor emeritus A. J. Heightman provides a Facebook tutorial on making facemasks out of pleated “MERV13” air conditioning filters, a Maxi-Pad and a yellow towel.

Others are repurposing construction and industrial facemasks. Fire-based services have SCBA as a last resort.

Inconsistent Organizational Response to COVID-19 Exposures

The challenge with COVID-19 is that infected people do not initially show symptoms. Throughout March we received a non-stop flow of research information on how COVID-19 is transmitted, how long it remains infectious (in air and on surfaces) and how long emergency service caregivers should be quarantined when exposed. While we know more than we did in February, information is inconsistent and unverified.

While most agencies are doing the 14-day self-quarantine or isolation of emergency service caregivers, New Orleans, Louisiana, took a dramatically different approach.

Exposed New Orleans firefighters will now be required to wear medical masks and closely monitor themselves for any potential symptoms, including taking their temperature twice a day. All EMS workers, meanwhile, will wear masks and take their temperature regardless of exposure.

New Orleans EMS Spokesperson Johnathan Fourcade said that five EMS workers who were originally quarantined have been called back to work. The fire department has been dealing with the lowest staffing numbers in the department’s history. As a result, it is dealing with excessive mandatory overtime demands. Many firefighters work 96-hours each week.

New York City (FDNY) firefighters and EMS providers received new directives Wednesday night:

… they would be required to work even if they had been exposed to the coronavirus — as long as they were asymptomatic. The guidance was in line with what the New York State Department of Health had suggested in recent days for health care facilities, the Fire Department said in an announcement to its staff. All those currently under quarantine would remain so.

FDNY accelerated the graduation of 309 probationary firefighters by 10 days as the department moved to a strict system of 24-hour shifts that change at 9 am to reduce firefighter COVID-19 exposure. Taking mutuals in other companies is halted.

FDNY EMS is making two-caregiver partner assignments to reduce the number of different employees working together. About 107 firefighters, 47 EMS providers, and 4 civilians are under home quarantine.

Field Operations in Austere Environments – Shelter in Place and closed businesses

California, New York, Illinois, Ohio, Delaware, and Louisiana governors issued a “stay-at-home” directive. So has Philadelphia. Most other states have closed schools, gyms, “non-essential businesses” and prohibited sit-down dining at restaurants.  The goal is to flatten the curve or reduce the growth of COVID-19 until a treatment plan is in place.  Tomas Pueyo’s “The Hammer and the Dance” article provides an explanation of how such a plan works.

Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way.

For on-duty emergency service workers, that means a challenge in finding food, vehicle repair, and supplies when they are on-duty. Many crews find empty grocery store shelves. Imagine weeks when every day is a national holiday with no food available except in the Qwick Mart/Gas Station.

Overwhelmed and Understaffed Health Care Staff and Facilities

In the last dozen days, we have seen the equivalent of a firefighter telling a crowd in a smoky theatre to “leave the building in a quiet and orderly fashion” and, a few minutes later, the firefighter is screaming “Get. Out. Now!”

The numbers are staggering and the implications are grim. Even if we could build hospitals as fast as China did, we do not have the medical staff or the specialized equipment to fully operate. How long would it take New York state to establish, equip and staff 16,000 additional ICU beds?

When the USNS Comfort arrives in New York City that will add 80 intensive care beds and 280 intermediate care beds.

Our healthcare colleagues are working in difficult circumstances. Hubei, China, and Italy provide previews of an overwhelmed healthcare system:

Healthcare workers spend hours in a single piece of protective gear, because there’s not enough of them. As a result, they can’t leave the infected areas for hours. When they do, they crumble, dehydrated and exhausted. Shifts don’t exist anymore. People are driven back from retirement to cover needs. People who have no idea about nursing are trained overnight to fulfill critical roles. Everybody is on call, always.   (Pueyo 2020a)

(Title changed and grammar corrected 3/26/2020)

+++++++++++++++++

John Hopkins University (2020 March 22 @ 2:13;55 PM) Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Accessed 3/22./2020:  https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Pueyo, Tomas (2020b March 19) Coronavirus: The Hammer and the Dance: What the Next 18 Months Can Look Like, if Leaders Buy Us Time. medium.com Accessed 3/22/2020: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56 

Pueyo, Tomas (2020a March 10 and 19) Coronavirus: Why You Must Act Now
Politicians, Community Leaders and Business Leaders: What Should You Do and When? medium.com  Accessed 3/22/2020: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

Esposito, Frank (2020 March 18) Here’s how New York City and suburbs will tackle the potential shortage of hospital beds. lohud.com. Accessed 3/22/2020: https://www.lohud.com/story/news/local/new-york/2020/03/18/hudson-valley-nyc-coronavirus-hospital-bed-shortage/5068189002/

Halpern, NA, & Pastores, SM (2010) Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010 Jan;38(1):65-71. doi: 10.1097/CCM.0b013e3181b090d0.

Wallace-Wells, B. (2020 March 18) The Coming Coronavirus Critical-Care Emergency. The New Yorker.  Accessed 3/22/2020: https://www.newyorker.com/news/news-desk/the-coming-coronavirus-critical-care-emergency 

Stein, M. I. (2020 March 16) Fire department, EMS no longer quarantining first responders exposed to coronavirus patients.  The LENS.  Accessed 3/22/2020: https://thelensnola.org/2020/03/16/fire-department-ems-no-longer-quarantining-first-responders-exposed-to-coronavirus-patients/

Watkins, A. (2020 March 20) Last Week One Paramedic Was Infected. Now Over 150 Are in Quarantine. New York City’s ambulance crews, which are stretched thin, have been told to work even if exposed to the coronavirus — as long as they are asymptomatic. The New York Times. Accessed 3/22/2020:  https://www.nytimes.com/2020/03/20/nyregion/coronavirus-nyc-emergency-response.html 

Steier, R. (2020 March 20) FDNY Adopts 24-Hour Shifts for Firefighters As Virus Safeguard. The Chief-Leader.  Accessed 3/22/2020:  https://thechiefleader.com/news/news_of_the_week/fdny-adopts–hour-shifts-for-firefighters-as-virus-safeguard/article_f4e3b454-6a27-11ea-9513-eb8ae9097bc2.html  

Khell, R. (2020 March 18) Navy hospital ship deploying to New York to help with coronavirus crisis. The Hill.  Accessed 3/22/2020:  https://thehill.com/policy/defense/488235-cuomo-navy-hospital-ship-deploying-to-new-york

Featured image: Patient care area created last week in a Vanderbilt University Hospital parking garage. Nashville, Tennessee. Georgia Lynn via Twitter

Professor Neil Postman’s book Amusing Ourselves to Death: Public Discourse In The Age of Show Business pointed out that visual communications, inspired by television, has made our world more like Aldous Huxley’s Brave New World – a population too amused by distractions like entertainment, leisure, and laughter to realize they have been made powerless – rather than George Orwell’s 1984 – a tyrannical state that bans information to keep the public powerless.

The larger point that Postman made was that societies are molded by technologies atop which they communicate. :

• Oral cultures teach us to be conversational.
• Typographic cultures teach us to be logical. Fire departments operate as a typographical culture – paper empires of logic and procedures.
• Televised cultures teach us that everything is entertainment and emotional.

I wonder how Postman would evaluate FaceBook memes, YouTube, and social media algorithms that are built to maximize the time users spend within the application. (Derakhshan 2016)

Nicholas Carr, the author of The Shallows: What the Internet is Doing to Our Brains, argues that the rise of the Intenet intensifies the move away from print culture. This move away from print even affected Carr as he confesses his own inability to concentrate after switching from physical books to online reading:

I’d sit down with a book, or a long article, and after a couple of pages my brain wanted to do what it does when I’m online: check e-mail, click on links, do some Googling, hop from page to page…the more time we spending surging, and skimming, and scanning…the more adept we become at that mode of thinking.  (NPR interview of Carr on 2010 June 2)

Conflict Drives Eyeballs

When I am “curating” items to post on the Company Commander Facebook feed in the early morning I am looking for items that evoke the type of reaction Chicago columnist Mike Royko went for – his daily columns took about two sips of coffee to read, sometimes ending with the reader exclaiming “!#%$!! Chicago.”

I was late getting on-board about Atlanta Captain Danny Dwyer. On Thursday I linked a post to the Wednesday editorial from the Atlanta Journal-Constitution.

The post quickly reached 1,309 people, getting 405 Facebook “engagements,” 117 emoticons, 16 comments, and 15 shares.

This is a “!#%$!! Fire Service” article.  High outrage, anger at the fire chief and some over-the-top responses. The Fire Atlanta Fire Chief Slaughter Facebook page was already up and this issue is “viral.”

Headline Readers

Most readers will not click to read the article attached to a Facebook post. They react to the headline and the picture. I try to put enough information in the FaceBook comment to describe the story, but that is not always done.

For example, it is clear that many of the 107 commenters responding to “Catastrophic Fires in Mid-Rise Multifamily Dwellings Under Construction – 5 Considerations” that was posted last Monday were only reacting to the dramatic picture and headline without the benefit of reading the article.

That commenter behavior may be a function of boosting the Catastrophic Fires item as a week-long Facebook Ad to a group of Facebook members that identify as fire or ems. Reached 14,000 additional people beyond the usual group of Company Commander readers, so …  eyeballs.

Monetizing Content

Controversy, over-the-top activities, and conflict increase online views. I like YouTube videos from automotive-themed personalities and wonder how much money they are making. (… and if Company Commander can do the same.)

In 2015 Garrett Mitchell was working for 1320Video. He created a character “Cleetus McFarland” in a motel parking lot late one night. He got over 100,000 views.

Cleetus McFarland became its own youtube site, with 1.87 Million subscribers as of this week. Revenue must be great, as the 24-year-old Garrett just purchased an abandoned racing track on 63 acres in Manatee County, Florida. The “Freedom Factory” will be used to create additional content and sponsored events.

Tyler Hoover, with 904K subscribers, pointed out that his routine of buying “the cheapest version of a luxury or exotic car” for Hoovie’s Garage and then trying to fix them get many more views than the videos of fixing up a car without much drama or problems. In fact, the videos without drama do not bring in enough revenue to justify Hoover making any more of them.

What to do when you get outraged?

Being in a constant state of outrage over real or imagined issues that are well beyond your sphere of responsibility is as unhealthy on your emotional condition as a steady diet of caffeinated drinks have on your cardiac physiology (Bodin FDSOA).

When we add energy drinks on board we have increased our risk of a cardiovascular event to happen even sooner. Over 38 countries around the world have either banned these drinks due to the detrimental side effects or placed age limitations on them according to Quartz Media. Studies world-wide have proven the dangers of regular intake of these drinks. (IAFC Cardiac Awareness Toolkit)

I like what Bill Carey posted in “I Don’t Think It’s What You Think It Is” on Backstep Firefighter.

So instead of memes and live Facebook rants, review your department’s disciplinary procedures, appeals, grievances and the like.

Be prepared for when a bit of bullying – which is what is happening in Atlanta – happens to you. Be better than a chief with nothing more than an ax to grind.

A fire in June 2019 suddenly gets a disciplinary review? No, it’s not about the fire.

+++++++++++++++++++++

Parts of this column were originally published in the August 5, 2019, Company Commander column: “Fire Officer Supervising In The Age of Show Business – 3 activities to stay on top”

Neil Postman (1931–2003) was chairman of the Department of Communication Arts at New York University and founder of its Media Ecology program. He wrote more than twenty books.

Postman, Neil (1985/2005) Amusing Ourselves to Death: Public Discourse In The Age of Show Business. 20th-anniversary edition. New York, NY: Penguin Books.

Silvestre, Dan (2018 Sept 11) Lessons from Amusing Ourselves to Death by Neil Postman. Medium.com.  Accessed August 3, 2019.  https://medium.com/@dsilvestre/lessons-from-amusing-ourselves-to-death-by-neil-postman-962221ee622tk 

Derakhshan, Hossein (2016 Nov 29) Social Media is Killing Discourse Because It’s Too Much Like TV: We need more text and fewer videos and memes in the age of Trump. MIT Technology Review.

Carr, Nicholas (2011) The Shallows: What The Internet is Doing to Our Brains. New York, NY: W. W. Norton & Company.

Athitakis, Mark (2015 February 26) Reading the Midwest: Mike Royko. Belt Magazine. Cleveland, OH: Belt Publishing. Accessed February 15, 2020. https://beltmag.com/reading-the-midwest-mike-royko/

Adams, Rick (2020 January 31) YouTube star Cleetus McFarland buys Desoto Speedway in Manatee County. WWSB. Sarasota, FL: Gray Television. Accessed February 15, 2020. https://www.mysuncoast.com/2020/02/01/youtube-star-cleetus-mcfarland-buys-desoto-speedway-manatee-county/

Riedl, Matt (2018 July 05) Wichitan becoming an online celebrity thanks to his crazy car collection. The Wichita Eagle. Wichita, KS: Kansas.com Accessed February 15, 2020. https://www-1.kansas.com/entertainment/ent-columns-blogs/keeper-of-the-plans/article213617609.html#

Bodin, Dan (2018 August) The Effects of Energy Drinks in the Fire Service. Ann Arbor, MI: Fire Department Safety Officers Association.  Accessed February 16, 2020. https://www.fdsoa.org/wp-content/uploads/2018/08/The-Effects-of-Energy-Drinks-1.pdf

Carey, Bill (2020 February 14) I Don’t Think It’s What You Think It Is. Backstep Firefighter. Trumbull, CT: Clarion UX. Accessed February 15, 2020.  http://www.backstepfirefighter.com/2020/02/14/i-dont-think-its-what-you-think-it-is/

Feature photo: Page from a 1962 Fire Education book that has appeared on threads discussing Captain Dwyer’s discipline.