Wake up call

Wake up call

By Alan Perry

October 11, 2015

The Fire department acknowledges that it’s EMS SOP’s largely have not been updated since the consolidation of its Fire & EMS Divisions nearly 20 years ago. The rapid changes to the practice of EMS, including high performance EMS, crew resource management and position assignments brought a group together to re-evaluate and create operating guidelines for EMS, as well as develop training, deployment and feedback mechanisms. Our current guidance comes from the old SOP’s, a handful of Medical Directives and the regional EMS Protocols. Most other departments rely on these same mechanisms locally, nationally, there seems to be a tendency to develop agency/system specific protocols and SOG/SOP’s by agencies that find this lacking. This Department is pushing into new territory with its EMS activities, rapidly adopting practices and methods that have proven success with the goal of saving as many lives as possible with the latest science and technology. The regional protocols have not kept up, and the complexity of EMS operations has increased as well. The field forces are expected to keep up with these changes and be prepared to apply these new skills without any additional training resources being made available. The Department hopes that developing their own resources (protocols/ SOP’s/etc.) will give those in the field the resources they require to reference and be prepared to use these new tools.

A quick internet search reveals that there are many good models of EMS and agency specific protocols/ SOP’s & SOG’s. What I find lacking is training plans for communication to, instruction of, and feedback for providers. In fact it seems many departments, while communicating the requirements of maintaining certification and/or licensure to their providers are quite forthcoming, there is no reciprocal statement defining the agencies commitment or responsibility for training to its providers. While I am happy to embark on that task, I feel it will be futile since any attempt to compel even a willing organization to commit funding & staffing at any defined level will likely not be supported.

So, before I attempt anything like that, I ask that anyone with a similar circumstance take a moment and reply with their experience (especially if successful) so I can at least move forward with reasonable expectations.

Thanks,

Alan

Hidden Fire

Hidden Fire

Unseen threats to Emergency Services

By Alan Perry

February 11, 2015

Many a life and countless millions in losses can be attributed to the effects of hidden fire. These fires spread undetected, concealed in walls, floors and utility chases, destroying the structure and spreading to remote locations with catastrophic consequences. It is a threat every firefighter should know well and aggressively seek to identify, locate and extinguish before declaring a fire under control. This principal is an easy one to understand but also easy to overlook in the heat of battle. Many emergency services have similar threats to their ability to achieve their primary purpose and mission due to hidden threats within and outside the organization. Many appear well on the outside only to collapse under pressure when the underlying structure fails due to these “hidden fires”.

 The structural integrity of your organization can be compromised by inadequate training, poor morale, lack of public or political support, overextended resources, poor communication or any number of other threats and weaknesses you can name. The critical needs of the organization can be overlooked while distracted by ancillary programs, new services and trying to keep up with new trends. Some organizations seek out new responsibilities, programs and stature, enticed by State or Federal funding, setting up new services at the expense of those critical needs. I will argue that emergency services should do more to prepare for large scale events, integrate with more effective healthcare or cultivate needed specialized resources. These are all part of the public expectation and our mission just as the core services we provide are, there must be a balance between these “nice to haves” versus the “must haves”.

Identifying the threat or existence of the hidden damage is not difficult if you are in-tune with your organization. Objective quality control monitoring of your resources, human and physical, will give you the best and quantifiable evidence. Structural collapse rarely occurs without giving some evidence or clues to a developing problem, that’s why we sound floors and look for smoke and heat where it should not be. Similarly, problems within your organization will reveal themselves if we use common management tools to evaluate failures in our equipment, processes and personnel. Long standing problems will compound and accelerate the damage, like a hidden fire in a structure already weakened by termites.

To locate the source of this insidious damage we have to look at data, ask questions, and sincerely want to improve the situation without fear, or presumption, of what will be found. How effective are your firefighting operations? How reliable is your apparatus? How frequently do your providers deviate from operational or EMS protocols and SOP’s? Are there training issues? Funding issues? Do your personnel have the right tools and resources? Do they function well as a team? Are all concerns heard without reproach? These questions may reveal the symptoms; the cause may be well removed and must be located before it can be corrected and the damage stopped.

Stopping the destruction will require correction of the identified fault. It may also involve correcting other faults propagated elsewhere secondary to the origin. As with hidden fires, there will likely be extension to other parts of your organization. Your organizational culture can help you manage these shortcomings, or it may be decayed and damaged by the process itself. As with structures that are hopelessly corrupted by fire, the only solution may be demolishing it and rebuilding.  That would be an extreme outcome that will permanently alter the persona of the organization, but it would certainly give it the opportunity to rebuild the organization as it should be and on a solid foundation. An alternative that may be more appealing would be targeted restoration of affected components, like remodeling a kitchen, retaining the existing structure while upgrading the area in need, taking care to carefully examine other parts of the organization for weakness. So what kind of "house" do you want to inhabit? One with a solid structure, but perhaps without the fancy kitchen and showers, or a showplace that has cracked walls and creaking floors. Choose wisely.

Be Safe,

Alan