What Are We Doing?
I am writing this because I feel there is an ongoing issue that the fire service is struggling with and that you may have insight on the topic. I am writing this a few days after the tragic deaths of three Baltimore firefighters and the injuring of a fourth. I am by no means a veteran firefighter, and I do not think that I know it all. I learn about the fire service as if I were to live forever, never being satisfied with the amount of knowledge that I have. I feel we should all strive to learn more. I am in no way being critical of what occurred but I am talking more along the lines of the fire service mentality.
I recently read a social media post showing an example of a “vacant” structure that had actually contained the living quarters of a squatter and that this is why the poster’s department goes into vacant structures. The following quotes was also used: “Victim profiling and risk vs. reward is bull@*#$,” “It’s a dangerous job,” and “We all take that risk.” The original photos of the fatal fire depicted heavy fire coming from all windows and the front door. My question is, What are we as a fire service doing?
- Vacant Buildings: Scourge of the Fire Service
- Survivability Profiling: Are the Victims Savable?
- Survivability Profiling: How Long Can Victims Survive in a Fire?
- Survivability Profiling: Applying What We’ve Learned
I will concede that I was never on scene and never saw what the rest of the building looked like, nor do I know what information the department was working with. However, if there was a victim inside, what is the probability of surviving unprotected in a fully involved fire? I will not say it’s impossible, as very few things in this career are an absolute certainty, but I will say that it is highly improbable.
Where do we draw the line? Do we take a serious risk to save that which is already lost? And is being killed an acceptable outcome to the risk of attempting to save a victim who has an extremely high probability of being deceased? There is a very fine line between a risk and being foolhardy. I believe that if there is any chance of rescuing a victim, even if it’s uncertain that there is one, yes, we should take that risk. I believe in always giving all to save a life. It’s about THEM. I understand that I will risk all that I am to save a victim, even if it costs me my life, and will risk as much as practical to save property. However, I do not feel as if my or other firefighters’ unwillingness to be foolhardy somehow makes us less “real” firefighters.
This culture needs to change. This career will NEVER have zero line-of-duty deaths. However, why shouldn’t we try as much as possible to keep ourselves alive? Why do fellow firefighters feel this is a “coward” mentality? Buildings can be rebuilt. The lives of those who perish can never be brought back. The lives of the families, friends, and coworkers of the fallen will never be the same. Let us no longer be foolhardy or despise fellow firefighters who are unwilling to make an unnecessary life risk for saving property, especially abandoned property.
With that being said, there should be no pointing of fingers. There should only be learning. May the fallen Baltimore firefighters rest in peace, and may their families and friends find peace and comfort.
Greg Sowl
Firefighter/EMT
Chippewa Twp. (OH) Fire Department
It’s Your Choice
There’s a lot going on right now. Some say morale is at an all-time low, blaming admin for what they did or didn’t do. Forced overtime is occurring regularly, and people seem to be leaving the job faster than we can hire them—so it’s easy to come to work with a chip on your shoulder.
But you don’t have to. It’s a choice. It’s your decision. Remember, it’s not things that upset us; it’s our judgment of things. You have control over your attitude and your reaction to everything you encounter daily. Think about responding to a cardiac arrest or a working fire. You can choose to be calm, cool, and collected, working together to get the job done efficiently; or, you can choose to panic, create chaos, and watch things spiral out of control. We all know what that looks like, and we don’t like when it happens.
The same theory applies to station life and morale. (Actually, it applies to all things.) You can choose to be positive while going about your daily routine, or you can perpetuate the negativity. You can complain to everyone and anyone who will listen, letting that toxic attitude spread like wildfire. It’s a feedback loop of negativity, and you’ve become part of the problem.
This goes up and down the chain of command. If officers complain in front of their crews, this gives everyone permission to do the same, once again lowering morale. The public cares about one thing: doing our job and doing it well while maintaining a positive and professional demeanor. This month, I challenge each of you to avoid the three Cs: Don’t compare, don’t criticize, and don’t complain (Jay Shetty’s Think Like a Monk, Simon and Schuster, 2020). These three behaviors are the root of all negativity. Avoid these three Cs, and you’ll be surprised how your outlook changes.
Shane Marstiller
Fire Apparatus Operator
Hilton Head (SC) Fire Rescue
Just an Old Guy
I am not a very smart person. I do not have numerous college degrees. I am overweight and out of shape. I am not in the prime, not even the first two-thirds of my career—what some would refer to as being on the back nine. What I have, however, is nearly 40 years of experience, watching, listening, anticipating, and being very opinionated. Beginning very young driving an ambulance with a small “mom and pop” private service running out of a yard barn, to one of the largest private services in our state, and then on to nontransport fire-based advanced life support (ALS) services, and then to the largest emergency medical services (EMS) provider in the state has allowed me to see many facets of the EMS systems.
With all these years of experience, what I cannot seem to understand is why the fire service in many cases makes EMS an evil necessity and, in the time of need, does not embrace EMS. In a time of personnel shortages, hospital overloads, retention troubles, and burnout in a pandemic such as no one in health care has ever seen, EMS remains, in many cases, an evil necessity.
The fire service drastically decreased the number of working fires and the number of fire fatalities with the development of a comprehensive and aggressive fire prevention initiative. By changing the culture once again, the answers to much of this battle can be found within the fire service. Since the development of National Fire Protection Association 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, there is a minimum staffing required for safe fireground operations. The dwindling fire responses have not eliminated the minimum staffing requirements. Now with the fact from the U.S. Fire Administration 2017 data, well over 65% of fire departments provide some level of EMS first response with a run load that is over 70% EMS, makes the fire service the perfect agency to build, protect, and enhance patient care.
As far back as the Spartans with Leonidas and the Roman Empire, we had battle cries such as “Nemo resideo”—which, in Latin, is “No one left behind”—shouted aloud while holding the Testudo formation to enrage and motivate those preparing for battle as well as make their enemy tremble in fear. This shield line was only as strong as the weakest legionnaire. In the fire service, we teach and use words such as honor, sacrifice, and courage. As the country reels from the pandemic and the overworked and overcrowed health care system, new concepts should be born as we continue to sacrifice through courage in an honorable manner.
As Nick Nolte graciously stated, “Birth is violent, and out of that violence is our only chance of rebirth.” Out of this pandemic, we have the opportunity of rebirthing the EMS system. Since the conception of the water pump in second-century Egypt and the 500-member fire brigade of Marcus Licinius Crassus in 60 AD Rome, the basis of the fire service has not really changed. We pump water on the fire to protect exposures, prevent expansion, and eliminate the fire. In contrast, the EMS scope of practice changes that have developed out of medication shortages and numerous other factors outside of the EMS providers’ circle of influence have created the perfect avenue for a hybrid prehospital care system that could prevent numerous patients from entering the emergency departments, filling beds that are needed for more serious patients, and provide relief to the hospital staff being overworked—preventing phrases such as “COVID Fatigue.”
Some could call this Mobile Integrated Health Care. I would prefer to just call this the fire service changing its culture and embracing the needs of the community by moving more toward prevention, changing the culture once again and creating crews that are clinicians, working with medical direction and individual state licensing boards in developing new protocols for treatment, transport, more appropriate transport destinations, more appropriate transport methods, and telemedicine for some of the more difficult or serious illnesses or injuries.
Development of an advanced practice paramedic program allows the paramedic to make an educated decision for patient care needs and appropriate treatments. Protocols can provide an avenue to refill certain prescriptions, provide certain prescriptions, and perform minor treatments in the home such as minor suturing and wound care—all with the oversight of medical direction either online with telemedicine or offline with new and aggressive protocols. Increasing the role of the emergency medical technician allows for certain medication administrations and emergency procedures that were once solely the purview of the paramedic. Create a culture that is no longer responsive but preventive.
In many cities, towns, and rural areas, this would have a huge impact on the number of patients seen in the emergency department. The load created on the individual fire department would be minimal. Looking at a single apparatus that is a “busy company,” making 5,000 calls per year or 13 calls per 24-hour shift is still only a call every two hours. This allows plenty of time for the apparatus to spend time on the scene to treat and identify if the patient needs to be transported and where or if he can be treated at home.
Obviously, there will be certain responses that do not meet these criteria, but a clear majority of our calls are not ALS and are dispatched basic life support because there is no other call type. Many of these could be treated at home. We are taught to be a patient care advocate even when the patients cannot advocate for themselves. No longer should we transport every patient just because they called 911.
I am not proposing to take over any ambulance service or incorporate all ambulances into the fire service. The public has always looked to the fire service when in need. The proverbial cat stuck in a tree, where the fire department rescues the poor kitty, has been an urban legend for generations. Now that health care in general is in need, shouldn’t the same fire service come to the rescue? Phrases such as “No one left behind” and “Taking care of our own brothers and sisters” should be expanded to all those who are in this fight, because they all matter!
The answer seems simple: Bring fire, EMS, and health care to the same table, at the same time. Just think what reducing the impact on the emergency department by only 5% would do for the overload. What would this same reduction do for the retention of ambulance personnel and prevention of burnout by allowing them to only transport those who need the emergency department? The solution from this old, noneducated guy on the back nine seems very simple: “Nemo resideo!”
Jeffrey S. Quinn
Captain-Paramedic
EMS Education Director
Indianapolis (IN) Fire Department
