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

“IT IS CHEAPER TO PAY OVERTIME THAN CREATE MORE POSITIONS”

There has been a long dance over what staffing a fire department needs to meet its operational requirements. Jurisdictions are resistant to creating new full-time positions, as they require 137% funding to cover salary, worker compensation, annual/sick leave, training, personal protective gear, and other human resource expenditures.

From my professional experience, the jurisdictional administrators and elected leaders struggle with the concept of having a workforce where there are more full-time equivalents (FTEs) on duty than the minimum required seats to fill.

As Steven Knight points out:

Using my old department as an example, the staffing was determined on a legacy basis and that legacy pre-dated most, if not all, of the institutional knowledge. For example, the department staffed five personnel for every seat on an engine, four for every seat on a truck company, and two for every seat on a rescue. While the daily minimum staffing was consistently applied, it had to overcome the inconsistency in staffing for each position. In fairness, these legacy-staffing strategies may have been compromises over the years and budget cycles, but to clearly articulate the strategy at a future moment in time proves difficult.

Knight, S. (2019 March 12) Full time, part time, overtime: How to fill fire department vacancies. firerescue1.com

LOOKING AT LOS ANGELES

In 1987 a Los Angeles County firefighter/paramedic made more money than the fire chief. That firefighter/paramedic got $59,673 in overtime pay along with his $38,811 annual salary. Firefighter/paramedic Wilson worked five consecutive 24-hour shifts a week, every week. That made the Los Angeles Times.

In the late 1990s, a single-role Los Angeles City Fire Department paramedic made significantly more money than the fire chief, working five to seven consecutive 24-hour shifts a week. At that time, Los Angeles City was losing paramedics quicker than they could hire them.

One reason was the “force hire” that ordered paramedics back to work during their scheduled time off. In 1999 there were 60 unfilled LAFD single-role paramedic positions, representing a 14% vacancy rate in the paramedic workforce. If you wanted to make sure that you could get off to take a vacation, enjoy a holiday, or attend a family event, you needed to work 96 hours of voluntary “assigned hire” overtime the previous month.

When I was looking at other fire departments pre-pandemic, the number of firefighters and paramedics willing to work overtime decreases when the number of authorized but unfilled positions exceeds 12%. This is usually when forced, or mandatory, overtime starts in earnest. After a few months of forced overtime, some departments see an increase in injuries, sick leave, retirements/resignations, and a decrease in the number of employees voluntarily signing up for overtime.

A 2015 audit of overtime resulted in the Los Angeles City Council approving the hiring of 48 additional firefighters. At that time, “420 LAFD employees earned more than $100,000 in overtime, and 19 earned more than $200,000. One Fire Captain made $311,316 in overtime on top of a $120,829 salary, for a staggering total of $448,594 in overtime pay. … a Commander at the LAFD informed the Controller’s office that the employee with $311,316 in overtime did obey all policies and procedures regarding overtime.”

Those 48 additional firefighter positions in 2015 did not end the overtime issue.

An audit of the Fiscal Year 2019 expenditures (July 2018 – June 2019) showed that “Eighteen employees of the Los Angeles Fire Department earned more than $200,000 in overtime pay last fiscal year, with one firefighter making $360,010 in overtime.”

The 2019 audit also observed that “More than 90% of sworn police and fire employees last fiscal year received overtime, earning an average of $27,737, while 40% of the city’s general employees, defined as other sworn and civilian workers, received such pay. That group earned an average of $7,528.”

Last week Company Commander posted an article that reported “A captain in the department made $434,394 in overtime in 2021, pushing their gross pay to $598,532 to become the highest-paid employee in the city that year. Another fire captain made $420,055 in overtime, pushing that person’s gross pay to $593,314 in 2021. That person was the second-highest paid employee in the city, according to city payroll records. A firefighter with a base salary of $129,638 made $411,606 in overtime, making that firefighter’s total compensation $554,056.

There were 86 employees in the fire department who made $400,000 or more in 2021. However, the highest ranking employee was not among those. The fire chief made $338,624, or nearly $250,000 less than the fire captain.”

AN ANNUAL DANCE OF MEDIA FUELED OUTRAGE

In many jurisdictions, this dance of overtime outrage occurs every year. Most of the media articles blame or shame the individuals that worked overtime, ignoring the elected officials and public safety leadership that developed and implemented policies that generate overtime. 

Company Commander posts these articles not to pile on blame or shame, but to share examples of the staffing and budgeting issues that every jurisdiction faces. The ICMA and Center for Public Safety Excellence white paper on 21st Century Fire and Emergency Services identified two themes:

• First, the past strategies of deferring conclusive action on critical issues with short-term solutions and leaving them for the next set of leadership is not a sustainable strategy for the future. To continue to do so will worsen the eventual correction(s) that will have to be made.
• Second, we must begin recruiting talent with the mindset, skill sets, and resolve to help build a core organizational culture that can adapt and respond to rapid changes and that are not vested in a 20th century fire service paradigm or antiquated local government bureaucracy.

This white paper may serve as a starting point to change the conversation with jurisdictional leaders and elected officials. We need to develop a new narrative promoting appropriate organizational staffing to meet the expanded and complex role that a fire/rescue department performs in 2022.

AN OBSERVATION ABOUT THE FREQUENCY OF OVERTIME POSTS

Company Commander also posts articles that describe closed fire companies and reduced staffing that some jurisdictions are forced to do to stay within their authorized overtime budget. In terms of number of posts, there are about four times as many posts about closed fire companies, reduced staffing, or “browned-out” fire companies as there are about overtime earnings.

Featured picture: “Firefighters Defend Neighborhood Structures as Hollywood Theater Goes Up in Flames.” LAFD.org. 7/13/2022

Out-of-Hospital Cardiac Arrest Research

Dr. Peter Safar conducted a number of experiments at John Hopkins University using expired-air ventilation with closed chest massage on human volunteers in the late 1950’s. “Closed-chest massage should be preceded and accompanied by pulmonary ventilation,” noting that the Baltimore City Hospital’s technique involved one operator inflating the lungs every five seconds, followed by a second operator providing four sternal compressions at one second intervals.

Closed chest massage was endorsed as in the United States as a:

• medical procedure in 1962
• reclassified as an emergency procedure in 1965
• Committee of Cardiopulmonary Resuscitation emphasized the A-B-C-D formula for resuscitation in 1966.

Baltimore City Fire Department Battalion Chief Martin McMahon encouraged his “ambulance men” to volunteer to be sedated so lung air exchange volumes could be determined when looking at different artificial ventilation techniques at John Hopkins University – including expired-air ventilation.

Out-of-hospital cardiac arrest research + The Great Society + federal response to traffic trauma = United States Emergency Medical Services

City “emergency” hospitals often included ambulance service at the start of the 20th century. (Burgess) Public safety organizations – police/fire/ambulance – got more involved in ambulance service after World War II. There was uneven coverage and levels of service.

Vince Robbins writes in Management of Ambulance Services that Miami was the first “nonphysician, mobile, advanced medical treatment service in America.” This determination is based, in part, on articles published in medical scientific journals describing out-of-hospital cardiac arrest research results.

Doctor Eugene Nagel developed a 54-pound defibrillator in Miami that was as effective as John Hopkin’s original 1959, 200-pound, portable defibrillator. The first out-of-hospital resuscitation from ventricular fibrillation occurred in Miami in June 1969.

United States EMS is a child of the Great Society

The Great Society was an ambitious series of policy initiatives, legislation and programs spearheaded by President Lyndon B. Johnson (D) with the main goals of ending poverty, reducing crime, abolishing inequality and improving the environment.

The first federal funding for EMS was $16M from the newly formed Division of Emergency Medical Services within the Department of Health Education and Welfare (DHEW) in 1972 to create demonstration projects in five states.

Congress passes the 1973 EMS Systems Act that provided a 5-year $454M Great Society grant program that funded the creation of more than 300 regional EMS systems. Funding was also provided for EMS feasibility studies, planning, operations, expansion and improvement, and research. In 1974 there was also a $15M Robert Wood Johnson Foundation grant that supported development of 44 EMS systems. (Shah)

Traffic Trauma

The 1966 National Academy of Sciences report on “Accidental Death and Disability” results in federal funding to establish Emergency Medical Services (EMS) as a component of the National Highway Safety Act of 1966.

A component of the National Highway Safety Act of 1966 was the improvement of emergency ambulance and rescue service to traffic collisions. This was assigned to the mission of the National Highway Traffic Safety Administration (NHTSA) within the Department of Transportation. This component included the development of a national EMS education curriculum. (Institute of Medicine)

Pittsburgh’s Hill District

The Hill District is a Pittsburgh neighborhood that often would not get the police ambulance to respond to emergency calls.

• Freedom House Enterprises was a community non-profit using grants to create African-American owned businesses
• Reached out to create a commercial ambulance service to cover the Hill and Oakland Districts
• Partnered with Presbyterian-University Hospital

Dr. Peter Safar, now working at Presbyterian-University Hospital in Pittsburgh, accepted 44 residents of the Hill district through Freedom House Enterprises in 1967. They took a 9-month training program at Presbyterian-University Hospital that included classroom and clinical rotations.

Twenty six students completed the paramedic-level training (EMT II). Paramedic ambulance service started June 16, 1968. Miami and Los Angeles County Fire Department paramedics started responding to emergencies one year later. Seattle two years later

There is a different focus between the Freedom House paramedics and the Seattle, Miami and Los Angeles programs. As a grant-funded community development project, the Freedom House paramedics started running calls as the primary caregiver from the very first day. The paramedics in Seattle, Miami and Los Angeles, because they were in a clinical research project, responded to emergencies with a nurse or physician on the unit during the first year or so. All of the paramedic programs included physician review of calls, with feedback on their clinical performance and case management.

Freedom House is the source of the National Standard Curriculum for Paramedics

The National Highway Transportation Safety Administration (NHTSA) developed the National Standard Curricula outline using University of Pittsburgh/Freedom House 300 hour “EMT II” training program as template. I recall pages of concept and practice bullet-point lists for each of the 15 modules.

University of Pittsburgh Presbyterian-University Hospital contracted with the National Highway Traffic Safety Administration in 1975 to write a paramedic textbook based on the outline. Nancy Caroline, M.D., was the primary author and Walt Stoy, Ph.D./paramedic, was the principal investigator.

NHTSA projected that a textbook to be available by late August 1977. Something happened. Instead of getting 25 textbooks I was buying a “blue line” pre-publication manuscript from the Government Printing Office. I needed the manuscript to develop study guides for a paramedic course. Emergency Care In The Streets was eventually published in 1979 by Little Brown.

Freedom House Ambulance 1967-1975

Freedom House Ambulance staffed five ambulances to serve the Hill and Oakland Districts, averaging 6,000 responses a year. A 1971 University Hospital study compared “inappropriate care” delivered by the two ambulance services. The police ambulances, staffed with Advanced First Aid credentialed caregivers, delivered inappropriate care 62% of the time, Freedom House ambulances, staffed with University Hospital trained EMT and EMT II’s, delivered inappropriate care 11% of the time. (Edwards)

Matthew Edwards is a physician who researches the intersection of medical history, ethics and public policy. His look into the history of Freedom House includes identifying the situations that lead to its demise:

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In 1975 the Freedom House caregivers were paid at a much lower rate than the police, firefighters and “superambulance” personnel. Few of the Freedom House caregivers were able to thrive as employees in the city-operated EMS system. They were required to be “retrained” as city ambulance attendants.

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Safar P, Brown TC, Holtey WJ, Wilder RJ. (1961) Ventilation and circulation with closed-chest cardiac massage in man. Journal of the American Medical Association. 176:574-576.

Safar P, Escarraga LA, Elam JO. (1958) A comparison of the mouth-to-mouth and mouth-to-airway methods of artificial respiration with the chest pressure arm-lift methods. New England Journal of Medicine. 258:671–7

Rasmussen, FN. (2005 February 13) Chief Martin McMahon, 94, first-aid pioneer. The Baltimore Sun. Accessed September 8, 2020: https://www.baltimoresun.com/news/bs-xpm-2005-02-13-0502130054-story.html

Burgess, G. (2018, April 30) Early Days of the San Francisco Emergency Service: From the Police Infirmary to Mission Emergency. Brought to Light, UCSF Archives and Special Collections. Accessed January 30, 2021: https://blogs.library.ucsf.edu/broughttolight/2018/04/30/early-days-of-the-san-francisco-emergency-service/

Robbins, V. (2015) “The History of Ambulance Services and Medical Transportation Systems in the United States” in Kirkwood, S., ed. Management of Ambulance Services. Boston: Pearson/Brady. ISBN 978-0-13-503829-2

Zeitz, J. (2018) Building the Great Society: Inside Lyndon Johnson’s White House. New York: Penguin Books. ISBN 9780698191594

Committee on Trauma and Committee on Shock (1966) Accidental Death and Disability: The Neglected Disease of Modern Society. Washington DC: National Academy of Sciences/National Research Council.

Shah M. N. (2006). The formation of the emergency medical services system. American Journal of Public Health, 96(3), 414-23.

Committee of the Future of Emergency Care in the United States Health System, Board on Health Care Services (2007) Emergency Medical Services at the Crossroads. Washington DC: Institute of Medicine of the National Academies Press. ISBN 978-0-309-10174-5

Staresinic, C. (2004 February) Send Freedom House! Nobody has seen ambulance attendants like these before. PITTMED Vol 6, No 1. pp 32-34 Accessed September 14, 2020: https://www.pittmed.health.pitt.edu/Feb_2004/PittMed.pdf

Edwards, M. L. (2019) Pittsburgh’s Freedom House Ambulance Service: The Origins of Emergency Medical Services and the Politics of Race and Health. Journal of the History of Medicine and Allied Sciences 74(4) pp. 440-466. doe: 10.1093jhmas/jrz041

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

George is dying of cancer and under hospice care. His wife wanted those that worked with George to sent a short positive and upbeat memory or message. One of her adult children would assemble the videos into a loop for George to see and hear when he was awake.

Kübler-Ross: The 5 Stages of Grief

Emergency service workers learn about the five stages of grief as defined by Elisabeth Kübler-Ross, MD. She identified these stages after spending two-and-a-half years working with dying patients, The stages are:

1. Denial and Isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

A follow-up book took those five stages of loss to help the survivors find the meaning of grief.

We share grief – our story, our loss, our feelings.

Shared and witnessed grief is grief abated.

Our Emergency Service Family

Our emergency service family provides a unique structure when we are confronted with an unexpected death. For example, there was a rookie firefighter who suffered a line of duty death. His spouse, their parents, and their network of regular friends and work colleagues were not aware of how we take care of our own.

It starts with a fire department member staying with the body from the hospital to the cemetery. Continues with providing a single-individual as the fire department or union representative that worked with the family on all of the details. One of the parents said, “… they just came in and started doing things. They took care of our every need.”

The other factor with our tribe is a deep understanding of disease pathophysiology, recovery/rehabilitation, the mixed quality of medical care, human behavior under crisis, and end-of-life reality.

We know death on an intimate level.

Our Digital World

Every Sunday visit to my elderly parents used to start with the sick and dead report. They would tell me who in their wide circle of friends was sick or had died. A lot of that information came from a breakfast ritual of reading obituaries in The Washington Post. That reporting ended when the number of their friends could be counted on one hand.

Within a private social media retirement group, I know about two-dozen fire department colleagues who are dealing with serious medical issues. Some will not have a great resolution.

I have a lot of digital friends and work colleagues. Our face-to-face meetings often start with a comment or question about their latest Facebook status update or crisis.

Through programs like CaringBridge (https://www.caringbridge.org/) and GoFundMe (https://www.gofundme.com/), I am able to financially support friends and colleagues and get detailed updates.

Is Too Much Information Creating Compassion Fatigue?

I wonder if this constant information flow becomes too much. Compassion Fatigue is described as a condition that develops over time, but it is not PTSD. When we are consistently hearing vivid stories of traumatic occurrences it can spur feelings of empathy and suffering in us. Over time, those feelings can invade and result in many waking hours without sleep, and lessen our ability to feel “optimism, humor, and hope.” (Figley)

I was sobbing after recording the video because someone that I worked closely with is in pain and dying. I cry for his family and their loss.

I also cry for my loss. A chunk of my fire department history will fade when George is gone. I feel my mortality.

Update May 20, 2020: retired Captain II George L. Sisson has died. Godspeed ….

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Kübler-Ross, E. (1969, 2019) On Death & Dying: What the Dying Have To Teach Doctors, Nurses, Clergy & Their Own Families. New York: Scribner.

Kübler-Ross, E. and Kessler, D. (2005) On Grief & Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. New York: Scribner

Kessler, D. (2019) Finding Meaning: The Sixth Stage of Grief. New York: Simon & Schuster.

Figley, C. R. (ed) (2002) Treating Compassion Fatigue. New York: Brunner-Routledge.

Featured Image: Engine 18 (1967 Seagrave 1000 gpm/300 gwt) photo probably by Clark Martin

Looking in the bay I saw an exhaust hose gently swinging from the ceiling. A blinking yellow light was announcing the imminent closure of the bay door. Engine 8 was on a run. All I could smell was a faint diesel exhaust. I mumbled “Medical Local” and continued home.

A pumper responding with purpose leaves a unique sound print, even if the siren and air horns are silent. There is the growl coming from a huge diesel exhaust pipe, the clinking of the automatic snow chains, groaning as the cab and hose body flex over the uneven roadway.

The electronic siren makes a slight whine, reminding me of sitting in a concert hall with the speakers powered-on and waiting for input. Sitting in the front of the cab, you hear the spinning of the Roto-Ray light and the pulsing of a strobe light transformer.

This square metal box of tools, talent, and hope pushes a lot of air while going down the road. I heard none of that as Engine 2 approached Lee Highway. I did hear the staccato of an engine brake and rude blat of the air horns.

My mirrors and interior filled with explosions of red and white as Engine 2 turned onto Lee Highway. Then that distinct “GE Powercall” style siren as Engine 2 passes me.

Right behind Engine 2 was the battalion chief. As soon as they drove past me they turned right into a single-family subdivision. So did I.

A community that was built between the World Wars, the hilly neighborhood had narrow, winding streets with single-family dwellings sitting on 1/3rd acre lots.

Hearing more sirens, I did not want to get stuck in a fire truck parking lot. I turned left. At the next intersection down, Engine 8 was hooking up to a hydrant.

I followed the supply line up the hill, where Engine and Truck 6 had lit up the front of a cape cod house like a movie set. I could see smoke coming from the eaves.

A crew was using a halligan and a flat-head ax to force open the front door. I felt every strike in my chest. My heart sang when I heard the saws rev-up. Opening the front door, the neighborhood filled with the odor of Class A smoke.

It has been a long time since I was that close to a first arriving company at a structure fire. My god do I miss it.

Elements, identifiers, and sequence of events may be altered in “war stories” to protect the innocent or work better as an example.

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.

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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.

Christmas Eve fell on a Saturday and the fire station was noticeably empty that evening. There was minimum career staff working and most of the volunteer Saturday night duty members would be “monitoring their pager” from home. Frank was gone, pulling his first overnight ED Tech shift at the hospital. The career county firefighter assigned to drive the ambulance decided we would use the Cadillac instead of the Ford.

It was unusually warm that day, almost getting to 60. I started what would become a career-long tradition by wrapping my Christmas presents at the fire station. The ambulance made a handful of responses with 3 trips to the hospital by the time I hit the bunkroom at 11 pm.

The Red Phone Rings

She woke up to her husband gurgling in bed around 2 am. When he did not respond to her shouts, she called the county emergency number 691-2233. The Red Phone rang in the fire station bunkroom and we were headed out for a “trouble breathing” call.

There were no dispatcher CPR instructions, no paramedics, no defibrillators, few EMTs and a rare fire company response with an ambulance for a medical call. Just an 18-year-old volunteer EMT/firefighter and a 24-year-old county firefighter in a Cadillac ambulance with a 472 cubic inch motor.

If we needed assistance once we arrived, I would need to call dispatch on a telephone or run out to the ambulance to use the fire radio. We were still responding when the engine company was dispatched to “… assist the ambulance with a cardiac arrest.”

Suction, Oxygen, CPR, and Gasoline

We took oxygen, suction, and the ambulance aide bag into the house. Her husband was still face-up in bed, but now his face was purple. We pulled him off of the bed. We rolled him on his side and suctioned his airway. He was not breathing. Rolled him back onto his back, inserted an oral airway, and started 2-person CPR with demand valve ventilation.

The next clinical intervention would be gasoline. Rapid transport to the emergency department was all we had left to offer. I was so happy to hear the wail of the engine’s Federal 2QB siren getting louder.

“The Latest in Resuscitation”

The volunteer fire department purchased a Heart-Lung Resuscitator (HLR) to be used while transporting CPR patients. The firefighters became proficient in setting up this oxygen-powered plunger and ventilator.

An early lesson learned was that using a Reeves stretcher with the HLR machine made it easier to move the patient to the ambulance.

You had to use cravats (triangular bandages) to tie the plunger to the Reeves stretcher handles. This kept the plunger from traveling from the sternum to the throat during ambulance transport. The automated ventilation feature was never utilized – it was designed for intubated patients. We used a bag-valve-mask or demand valve resuscitator.

With thin staffing Christmas Eve, the three-person engine company immediately set the ambulance up for a fast departure and brought the HLR and Reeves into the house.

None of us had training in customer service or crisis counseling. We rocketed out of the house with the HLR thumping on his chest. We left the wife with a medical mess in the bedroom and no updated information on the condition of her husband. The police officer at the scene helped her get to the hospital.

No Clinical Change In The Patient

Beyond the skin color going from purple-to-gray, there was not much else that changed during the high-speed 16-minute transport. We probably exceeded 90 miles an hour on Interstate 495. I was glad that we were using the Cadillac instead of the Ford modular rig.

I sat in the captain’s chair operating the demand valve resuscitator and monitoring the HLR plunger position. His pupils remained fixed and non-responsive to light.

It was cumbersome getting the HLR unattached to move the patient onto the emergency department stretcher. When I stepped up on the stool to start chest compressions in the emergency department I could see the soft tissue damage done to the patient’s chest by the plunger as it walked around the sternum. The patient remained in cardiac arrest. The physician looked into the patient’s eyes and said “I see boxcars” and stopped the resuscitation.

Boxcars refer to a pattern that occurs in vascular stasis with the segmentation of the venous column—of blood in the retinal vein—after central retinal artery occlusion. It was used as an early indicator of brain death. (1979)

A Devastating Night 

A 16-year observational study that looked at holiday-related triggers for acute myocardial infarction showed that Christmas Eve poses the highest risk in Sweden. (2018) .

Frank did not know that when he started his first overnight shift as an emergency department technician. Since 11 pm most of Frank’s work has been processing patients who have died in the emergency department.

That includes inventorying their belongings, putting the corpse in a body bag and moving the corpses to the morgue.

Frank processed 1 trauma, 1 suicide, and 2 cardiac arrests between 11 pm and 3 am. Like the fire department, the hospital was thinly staffed.  The emergency department manager told Frank that his EMT experience should make it easy for him to process the dead without a lot of hand-holding.

Our patient was declared dead at 3:07 am on Sunday. This was going to be the 5th corpse Frank would have to process and transport over to the morgue. He was starting to get that two-thousand-yard stare.

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Feher, J. & Antal M. (1979 June) Ischemic retinal alterations in cardiac arrest.  Annals of Opthalmology 11(6):909-13.

Mohammad Moman A, Karlsson Sofia, Haddad Jonathan, Cederberg Björn, Jernberg Tomas, Lindahl Bertil et al. Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998-2013 British Medical Journal 2018; 363:K4811 https://www.bmj.com/content/bmj/363/bmj.k4811.full.pdf 

Ward, Michael (2018 December 31) The Two Thousand Yard Stare: 4 ways to Improve your Resiliency. CompanyCommander.com Reston, VA: Gold Badge Enterprises LLC. http://companycommander.com/2018/12/31/the-two-thousand-yard-stare-4-ways-to-improve-your-resiliency/

Feature photo is a representative of the type of high-top Cadillac ambulance used.

Elements, identifiers, and sequence of events may be altered in “war stories” to protect the innocent or work better as an example.

Our battalion chief was a strict chain-of-command boss. As we were picking-up from a commercial box alarm after dinner, the chief motioned me over. “Mike, your Sergeant is still not inspecting activated alarm bell incidents. He did it again while covering Engine B on Saturday. This behavior has to stop now.”  This was the boss’s second notice to me. I did not want a third notice. The bitter cold and the wind kept both units running calls well after midnight.

At 4:30 am the engine and truck responded together first due to an activated fire alarm at a trucking company garage in our industrial district. As we arrived, dispatch reported that the fire alarm system reset. I held the first engine and truck and returned the rest of the assignment. On the direct unit-to-unit radio channel, I told everybody to stay on the rigs, the sergeant and I would make a lap of the garage.

Unwanted Fire Alarms

This allowed me to have face-to-face time with the sergeant. While walking around the garage I repeated the chief’s expectations and concern about Saturday’s response. The sergeant responded that most of our activated fire alarms turn out to be false and he did not want to miss a real fire while inspecting a non-fire.

The International Association of Fire Chiefs sponsored a “Fire Alarm Response and Management Summit” in May 2011

In 2009, fire departments went to 16 false alarms for every 10 fires, and 45 false alarms for every 10 structure fires. In 2009, almost half (45%) of false alarm responses were to unintentional activations, one-third (32%) were due to system malfunctions, 8% resulted from malicious or mischievous false alarms, and 15% were due to other false alarms. The ratio of smoke alarm activations to actual fires is even higher in surveys of the public than it is in fire department responses.

In follow-up research, The Fire Protection Research Foundation developed a risk-based decision tool to manage unwanted alarms. This included a literature review on addressing non-household unwanted alarms.

In the fire departments that collected data, between 0.3% to 0.7% of the activated fire alarms in commercial and business occupancies result in a fire event (Hall 2013). The risk-based decision support tool requires the community to determine what type of responses are appropriate for activated fire alarms.

Street Firefighters Focusing on 0.3% to 0.7% of Incidents That Are Fires

The battalion chief’s policy of proceeding to and visually inspecting the occupancy – unwritten and not part of the department’s official regulations – came from his risk evaluation of two unfortunate incidents.

The jurisdiction experienced two large-loss commercial/industrial fires where the fire department responded three different times over a couple of hours to an activated fire alarm in a non-sprinklered occupancy.

In both incidents, the engine crew reset the alarm panel but did not inspect the source of the alarm. On the third activated fire alarm response, the fire had broken through a window or roof. Both events grew to greater alarm incidents.

I explained this to the sergeant and made it clear that he needed to inspect every activated fire alarm occupancy. Continued failure to do this may result in a work improvement plan.

The Keyholder is En Route

Our walk-around the garage showed no evidence of smoke or fire when looking through the truck bay doors or front office windows. I released the truck company and told dispatch we will wait for the keyholder. I knew that the owner was coming and wanted to again try to get a lockbox installed so we could gain access to the building without the owner needing to drive back to work in the middle of a nasty winter night.

Two things were not right when the owner and I entered the garage. The 1970-era fire alarm system was showing a trouble light and we smelled smoke.  There was a driver’s lounge in the garage, added like a mezzanine. It had bathrooms, a kitchenette, a big-screen TV, a dining table and two couches.

Thick black smoke rolled out of the room when the owner opened the lounge door. As the smoke lifted I could see a dull orange glow and a snoring body on a couch.

I radioed in the fire, requested EMS and removed the deeply asleep driver from the room. A primary search found no one else. A tipped-over kerosene heater was the cause of the smoke.

Fire Cause Sequence

The bad weather made this driver hours late returning to the garage. He decided to sleep in the lounge. He used alcohol and a kerosene heater to keep the chill at bay. At some point, he kicked over the kerosene heater. When the smoke detector activated the central fire alarm station, a connection failed. That failure was reported to the central station as an alarm reset.

Not sure if the truck driver’s headache was carbon monoxide poisoning or a hangover, probably both. The garage fixed the fire alarm system. I finally got a lockbox when I explained we would need to force open a door to get into the building on future alarm activations to avoid a repeat of this event.

The sergeant would occasionally remind me that, even following the chief’s directive, we missed the incipient fire in the lounge. What would have happened if nobody entered the garage until work started at 8 am?

In the times when I am awake in a frigid winter pre-dawn, with brightly twinkling stars in a violet-blue sky, I shudder at the still-vivid memory of “… what could have been.”

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Aherns, Marty (January 2013) Development of a Risk-Based Decision Support Tool to Assist Fire Departments in Managing Unwanted Alarms. Task 2 Deliverable – Literature Review. Final Report. Quincy. MA: The Fire Protection Research Foundation

Hall Jr., John R. (2013 January 17) Development of a Risk-Based Decision Support Tool to Assist Fire Departments in Managing Unwanted Alarms. Task 5 Deliverable – Model and Tool for Assessing Policies. Final Report. Quincy. MA: The Fire Protection Research Foundation

Ahrens, Marty (2016 June). What’s going on with unwanted alarms? Summary of NFPA’s June 3, 2016. C&E Educational Session. Quincy, MA: National Fire Protection Association

Featured Image: Western Ocean City Business Fire – Caliber Collision  (14 January 2019)   http://www.co.worcester.md.us/fmo-news/west-ocean-city-business-fire-caliber-collision 

Elements, identifiers, and sequence of events may be altered in “war stories” to protect the innocent or work better as an example.