BY CRAIG A. HAIGH
For volunteer, paid-on-call (POC), and combination fire departments, response time is one of the most difficult aspects of providing emergency services. Most such departments cover a relatively large geographical district, using volunteers or POC members who are required to respond to a single, centrally located station to pick up the apparatus and then respond to calls. Many such districts are rural and sparsely populated, thereby forcing responding personnel to travel long distances from their homes to the station. Once at the station, these members either join forces to make up a company, or in many cases a single member may simply drive the apparatus to the scene where he meets with other members who have responded directly to the incident.
Waiting for a sufficient crew to arrive at the station before responding increases the response time for the department. For those who expect a member to pick up the apparatus alone while dispatch redirects other members en route to the station to the scene, there can be confusion and inefficiency. For most departments using the latter system, all responding members head toward the station until they hear the unit “check en route,” at which point they redirect themselves and head to the location of the call. Although apparatus and personnel ultimately reach the scene, response times for many jurisdictions using this system can be 10 minutes or more.
In July 1996, the King (NC) Fire Department, then a strictly volunteer department managed by a career chief, elected to offer first responder EMT-defibrillation service as part of its overall first responder EMS operation. The district’s firefighter/EMTs were aware of the need for rapid defibrillation of cardiac arrest patients and understood that the sooner a patient could be treated the better his chances of survival. At the time, county paramedic ambulances responded into the district with King fire units first responding at the basic EMT level. King’s average response time ranged from seven to eight minutes, with many calls exceeding 10 minutes. Depending on the location and availability of the county ambulances, advanced life support care was arriving at between nine and 20 minutes after dispatch. The system needed some work.
BREAKING TRADITION
When faced with a problem, many organizations place more trust in the “expert” who carries a briefcase and lives 50 miles away than they do their own turnout gear-wearing members. Fortunately, the King Fire Department did not have the funds to hire an expert; so, in a stroke of genius, it asked the department members their opinions.
These newly recognized “experts” were asked, “How can we reduce response time to an average of four minutes without hiring paid staff or building more stations?” Ideas were rapidly provided, but the best one would allow an on-call EMT-D to take the squad home. The members felt that having all members respond to the station and then to the scene caused the real delays. If the squad were “on the street” 24 hours a day, response times would decrease. It sounded like a reasonable solution, but the predominant attitude was, “We’ve never done it that way.”
What would the citizens of the district say seeing fire apparatus sitting at a volunteer firefighter’s house and not in the fire station? Was it inappropriate to allow fire apparatus to sit outside and not be garaged? Would the apparatus be vandalized? What if the firefighter lived on one side of the district and the call was on the other side? What if the on-call firefighter needed to run to the grocery store or wanted to go to dinner with the family; could he drive the apparatus, or would it be deemed a waste of taxpayer money? After much discussion, the department decided the potential benefits outweighed the risks. The idea was sold to the medical director and the fire district board of directors.
At that time, the department responded to EMS calls with a 1985 Chevrolet Suburban equipped as a quick-response vehicle (QRV), as required by the North Carolina Office of EMS standards. The initial plan was relatively simple. The on-call EMT-D would drive this vehicle (referred to as Squad 30) and keep it with him for the duration of his shift. Changes in personnel or shift would occur at the station at an established time, at which point the incoming EMT would take the squad and the outgoing EMT would return to his personal vehicle.
The overall concept was great but, as with any new system, some minor bugs had to be worked out. Since the squad had always been parked in the station up to this time, the doors had not been locked in years. Eleven years of dirt and grime had rendered the lock cylinders inoperable. Also, during the winter months, the vehicle engine and medical supplies on board grew cold sitting outside, so a system for keeping them warm was needed. Finally, in the past, the squad had not responded to anything except EMS calls and did not carry any fire suppression equipment. Now that the squad would be answering calls 24/7, it was likely that the on-call EMT-D would be the first to arrive at fire scenes.
 (1) Photos courtesy King (NC) Fire Department. |
To resolve these issues, the department repaired the door locks and installed a 110-volt engine block heater and an electric interior compartment heater. Additionally, it equipped the unit with an SCBA and spare cylinder, a set of irons, a pressurized water extinguisher, search rope, a rechargeable hand-light, and two six-foot hooks. The department created SOPs for patient care and how the personnel would function at fire scenes and nonEMS calls (photo 1).
In the first month the squad was on the street, four minutes were shaved from the average response time. Personnel soon experienced their first “save” with the new defibrillator, and the squad arriving prior to or along with the first-due engine greatly enhanced members’ overall effectiveness at fire scenes. In many cases, having the squad arrive ahead of the first fire apparatus allowed for a better size-up; the ability to locate hydrants; quicker, more efficient searches; and, in some cases, fire extinguishment or at least containment until the engine arrived. A few complaints trickled in from citizens, retired firefighters, and old board members; but, in general, the enhanced operational capabilities far exceeded any negative comments (photo 2).
ADDING PAID STAFF
The following November, the King Fire Department began hiring its first full-time firefighters. Staffing began with a paid driver Monday through Friday, 8 a.m. to 5 p.m., progressing to full 24-hour coverage. Because the squad program worked so well, it was maintained as career members were added. The department solicited donations and grants, which enabled it to purchase a second defibrillator. Career members were assigned to an engine company that was also equipped and certified as a QRV through the North Carolina Office of EMS. Since both units were now staffed 24 hours a day, there were now two first responder EMS units and a guaranteed available response of three firefighters (career firefighter and officer on the engine and a volunteer firefighter on the squad).
For a rapidly growing community and fire district protected by essentially an all-volunteer department handling more than 1,500 calls annually, this system made sense for several reasons. First, it provided a level of minimum staffing while guaranteeing a reduced response time. Second, it reduced the overall workload of the volunteers, since they were not required to respond to every call.
To make the system work, King established a protocol for the engine to respond alone to minor calls (e.g., routine medicals, illegal burns, assist the police), which left the squad available for the second or more serious call. Should an incident occur near the squad’s location, whether to respond would be at the on-call member’s discretion. For a more serious call or one requiring more than two personnel, both the engine and squad would respond, along with a duty officer and all available volunteers.
Although an extremely dedicated force of volunteers was maintained, it was becoming more and more difficult for them to handle the overall demands. In a world of two-income families, longer workweeks, greater training and certification demands, and enhanced citizen expectations from their emergency service organizations, it was and is extremely difficult to find the time to be a volunteer firefighter. This system relieved some of the burden from the department’s members and preserved their ever-dwindling family/free time.
EXPANDING SQUAD’S ROLE
With the advent of the two-in/two-out rule [Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard 29 CFR 1910. 134] and the fact that North Carolina is an OSHA state, the King Fire Department suddenly faced another dilemma. Since it used career employees, it was also subject to full compliance with this standard at all incidents involving an IDLH (immediately dangerous to life and health) atmosphere. A second and equally serious problem was that North Carolina exempts its volunteer firefighters from this rule unless they are part of a combination department. This issue placed King in a precarious situation. The department operates as part of a large mutual-aid system and frequently responds in districts covered by all-volunteer departments. Since these departments are not subject to OSHA rules, they generally did not establish rapid intervention teams (RITs) as part of their normal operating procedures. Since King’s department did use a RIT, OSHA still required it to comply with the standard even when responding outside its district. The OSHA penalty for noncompliance has been to cite the senior career member operating on-scene, no matter which district the call was in.
Under the OSHA standard, before a fire department begins an interior structural attack, it must ensure that at least two trained responders who can render immediate assistance to those inside, if needed, are standing by outside the IDLH atmosphere. Of the two stand-by responders, only one can be assigned an additional duty; the other is to ensure accountability of personnel and be ready to initiate a rescue if needed. Of the assigned duties to the first firefighter, none can be of a nature such that abandoning it would place any firefighter at an additional risk (i.e., the pump operator and, in some cases, the incident commander).
The question facing the King Fire Department was how to rapidly assemble and coordinate the necessary number of firefighters with only two career personnel on duty and an unknown volunteer response. The staffed squad helped in this area inside and outside the district.
The concept began in that on the squad’s arrival at fires or calls involving IDLH atmospheres within the district, the assigned member would team up with the duty officer to form the “two-out” part of the standard. This would allow the two on-duty career members and at least one responding volunteer to begin the attack operation. As additional volunteers or career members on callback arrived, they would either team up with the squad member to form a four-member RIT or be added to mitigation/suppression operational positions.
For fires or calls involving IDLH atmospheres within the assist areas, the squad responded along with the assigned apparatus and established the RIT team just as it would if the call were within the jurisdictional boundaries of King fire district.
 (3) King Fire Department members practice removing an injured firefighter as part of RIT training. |
Before beginning this process, the department decided, however, that two areas needed to be addressed. First, King needed to send a representative to each of the neighboring departments to explain and obtain imput on the new policy. Second, specialized RIT training was needed for all squad personnel, for all members subject to callback, and for those officers who responded and operated as duty officers. More importantly, a departmentwide training program that taught members how to stay out of trouble was needed so that the RIT team would never need to operate in any other mode except standby (photo 3).
The department created a 12-hour “Firefighter Safety and Survival” class for King Fire Department members and also those in the neighboring departments. The class focused on “staying out of trouble,” not on how to get out of trouble once you get there. Topics included size-up, what tools members should carry in their pockets, how to read fire behavior and its relation to building construction, tactics for maintaining good health and its relation to safety, and an in-depth study of turnout gear and its inherent strengths and weaknesses. Intertwined throughout the entire program was the underlying fact that efficient nozzle tactics and an adequate fire stream (flowing the required gpm) normally eliminate the need for members to “bail out.” Members were also taught how to perform forcible exit, SCBA emergency procedures, and ladder bailouts/ hoseline slides, should they find themselves with no alternatives.
Personnel functioning as RIT members received specialized training. The department developed a 40-hour course that combined classroom and practical drills, focusing on the principle that “prevention is better than reaction.” It was drilled into the students that their primary focus as RIT members was to act as on-scene safety officers who also were prepared to make a rescue should something go wrong. Class topics included the following:
- an overall review of the OSHA two-in/two-out standard;
- the leading causes of firefighter deaths and injuries;
- knowing your enemy—an in-depth study of fire behavior and its relation to building construction;
- a study of the different types of building construction including loads, structural elements, and construction materials characteristics and their rates of heat release;
- when a rescue is required, analyzing options based on CRC (challenges, resources, and choices); and
- numerous techniques/options for firefighter rescue, ranging from basic “grabs” to prolonged extrications.
With the training complete, it was time for the implementation and testing phase.
CURRENT APPARATUS AND EQUIPMENT
As the department progressed into implementing the plan, several areas of concern arose. First, several pieces of equipment needed to be added to the squad so that it could truly be used as a self-sustaining (or as reasonably close as possible) RIT vehicle. Fortunately, King had replaced the Suburban and had begun operating with a 1998 Chevrolet one-ton truck with a utility body. This vehicle design allowed easier access to equipment and greater payload capacity.
Second, the question arose about the likelihood of both EMS-equipped vehicles being out of the district on “assist calls” and how they could maintain EMS coverage at home. The department as a result equipped a second engine, the heavy rescue, and both chiefs’ vehicles as QRVs.
Overall the system has worked well, and the goal of providing high-level EMS service along with a designated RIT has greatly served the department. The system continues to grow and periodically changes to continue meeting the challenges of the department.
As departments across the nation face continued budget cuts, tax caps, unfunded mandates, and a general lack of volunteerism, we must become creative in continuing to provide the services needed. We cannot stick our heads in the sand and pretend that the standards do not apply; we must become creative in how we deliver our services, thinking outside the box while still preserving the great traditions of the fire service. The above system is one of many methods for offsetting the existing situation while still meeting the professional standards established for our protection and ultimately serving the citizens and visitors of our communities.
CRAIG A. HAIGH is a 20-year veteran of the fire service and chief of the Hanover Park (IL) Fire Department. Previously, he served seven years as chief of the King (NC) Fire Department. Haigh began his career as a volunteer firefighter with the Hampton (IL) Fire Department and later joined the Rock Island (IL) Fire Department, serving as its first EMS coordinator. He has a bachelor’s degree in fire and life safety engineering technology and is a nationally registered paramedic, a certified fire officer and fire investigator, and a field staff instructor at the University of Illinois Fire Service Institute.
