Rx4EMS

Wednesday, June 11, 2014

Wild World of Exposure Risk in Firefighting & EMS

Wild World of Exposure Risk in Firefighting & EMS

By Alan Perry

There are accepted inherent risk to firefighting and EMS that all providers in the industry should understand when they sign up. Fire will be hot, people and events can be very unpredictable, we know this and accept this as well as the injury and illnesses that can occur over the course of a career in this industry. These risks should be managed and reduced to the greatest extent possible given our limited knowledge of the full constellation of circumstances that contribute to both physical and mental harm to our providers. We are constantly improving our awareness of these processes and adapt and train in methods to reduce risk where it is possible. Cancer, heart attacks and physical trauma will still claim the lives and health of our comrades. We will still suffer strains, sprains, hearing loss and depression as a normal consequence of our professional choice. Can we improve these circumstances by changing the things we personally have control over? I think so.

We have a duty to ourselves, our co-workers and our families to take safety and health seriously. This means taking a personal stand in keeping your activities as safe and healthful as possible, as well as identifying & correcting health and safety concerns when we find them. These concerns need to be communicated and thoughtful solutions found within our organizations working cooperatively with all stakeholders. Do not depend on state or Federal law to protect you, merely complying with the law does little to minimize the risks and certainly does not cover every possible one that we encounter. Chief Officers need to evaluate compliance with existing regulations and SOP’s to assure that all members are following the guidelines meant to protect them. If compliance rates are low try to determine if there are obstacles or unreasonable requirements that make it difficult or inconvenient to do so. Unreasonable and half-hearted requirements will lead to low compliance and increased injury and illness among your people.

My gut feeling is that health and safety programs rely too heavily on mandates, are not easy and seamless for the user, and are not promoted with any degree of enthusiasm within public safety organizations. This leads to an atmosphere of apathy and poor compliance. Add to that a general lack of personal responsibility, and/or awareness of our own circumstances, and assumptions that we are already doing all that can be done and you can see how ineffective things can be. To test the theory, I took a walk around several facilities in my area and made a mental note of some reasonable concerns in four

major areas; cancer, heart attacks, traumatic injury and hearing loss.

Cancer

Cancer rates are significantly higher in emergency services when compared to the general population. Public Safety workers who develop lung cancer and/or heart diseases are generally have the cause attributed to exposure to products of combustion and diesel exhaust. What about the other forms of cancer? What about all the other toxic products we are exposed too? We have policies and recommendations that discourage carrying turnout gear in personal vehicles due to exposure concerns, but we place the same gear at our feet when we are riding around in the fire truck. We have policy and recommendations for washing turnout gear, but we have no spare gear to use or recovery time dedicated to cleaning it after a fire. These are two examples of the disconnect between policy and practice that do little to reduce exposure. Add too that our own self-exposure to cleaners, fuel, and tobacco and non-fire air-borne pollutants creates a recipe for tragedy. Cavicide and other germicidal products in particular are an example that may present an significant incidental risk over time to all providers, the label clearly states to avoid contact with the skin, repeated exposure may lead to damage of the thymus- an important immune system organ responsible for maturing and selecting T-cells.T-cells are responsible for the control of abnormal cell development like cancer.

Heart attacks

Cardiac events are another prime source of injury and death in emergency services. They are attributable to levels of physical fitness and dehydration primarily. Physical fitness is a no-brainer provided you attain it in a responsible manner. A good work out routine will promote flexibility, endurance and strength equally and not push the body to exhaustion or failure.We self-ingest caffeine, energy drinks and protein supplements in our efforts to remain awake and enhance our physical and mental performance; at what cost? Caffeine is a diuretic; it virtually guarantees a state of dehydration. Both caffeine and other substances present in energy drinks override the body’s protective mechanisms and can/do push your heart beyond its ability, occasionally causing chest pain and/or arrhythmia. Protein supplements require proper hydration to prevent kidney damage, in firefighting or any high heat, high stress situation you can easily cause yourself permanent damage, or even death when using these supplements while on duty.

Traumatic Injury

Most injuries do not occur on the fire ground. Look around your station; you will find wires, cables, rope, hose, wet floors, oily spots, and occasionally clutter both in the station and the apparatus bay. All of these can contribute to a slip or fall that will at a minimum embarrass you and could potentially cause a career ending injury. Examine your apparatus design; are the steps at a reasonable height? Could the height from the cab to the ground be reduced? Are there adequate hand holds? What if you are carrying gear? Are your driving habits in-line with the driving policy? Is your driving policy reasonable given that emergency response does not improve response times appreciably? Is the risk of having an accident, injuring or killing a civilian(s) and/or a crew member(s) worth it? Lift with good technique and body mechanics, don’t forget to stretch, warm-up and exercise moderately. A large number of workplace injuries have occurred while doing PT. Isn't that ironic?

Hearing Loss

A federal Q-siren produces 123 decibels of sound pressure, according to most sources this is enough to cause immediate pain and permanent hearing loss within seconds, add a 140 decibel air horn too that mix and you create a dangerous situation for both your crew and the general public without substantial hearing protection. You have hearing protection on the engine. That is good, what about the medic and the other response vehicles? Does the guy in the convertible trapped in traffic in front of you have any protection? Does the small child playing in their yard? Warning devices are only one concern, there are many others; chain saws, power tools, PPV fans and pump panels are all dangerous too. Hearing loss occurs from brief exposure to intense sound pressure as well as routine exposure to levels as low as 90 decibels, that is the ambient sound pressure inside an engine or medic just driving down the road normally.

Conclusion

A genuinely effective health and safety program is one that is supported with spirit throughout the organization. These programs fit seamlessly into the workflow within the organization and are supported with unimpeded access to the correct resources. Event reporting is unfiltered, honest, and thoroughly documented with the objective of determining causality and circumstances to prevent future occurrences. Members of the organization recognize the importance of personal accountability for actions affecting their health and safety and that of others. The Recipe: Leadership Commitment, Engineering Controls, Education, Ease of use + Attitude.

Be Safe,
Alan

Saturday, May 10, 2014

Seeds of Change

Seeds of Change

By Alan Perry

May 10, 2014

Agriculture was the impetus for humankind’s evolution from hunter-gatherer nomad to community based civilization. The ability to cultivate, select and care for crops is, in itself, a lesson in management. The same principals can be applied to leading and managing an organization, the organization and its components; people, resources and assets all require thoughtful and deliberate actions to assure the organization’s success. The rules for agriculture rarely change, though the methods have evolved somewhat. EMS and Fire organizations have, and are still, seeing rapid change in the environment we operate in as well as the methods of management. This change requires us to constantly revisit, revise and improve our practices in the cultivation of our organization and the people who make it work.

When farming; the soil must be prepared, the seed planted at the right depth, the weather conditions must be good for the idea, and the change, to take root and propagate. Most people prefer consistency and predictability in their daily routines; change is frequently viewed as a negative. Change can come in the form of new schedules, protocols, a new philosophy or mission. Not all change has value. If it does not improve system reliability, performance, safety or some other desirable goal in a meaningful way, it will not be well received and will likely waste resources. Leaders are responsible for evaluating the need for change based on the organization’s mission, and communicate the need for, and the value of any proposed change within the organization.

Planting crops too early can easily result in complete losses if a late freeze comes along. Warm up your organization to new ideas before pushing headlong into any major changes. As a leader; your ability to accomplish work through the actions of others can be seriously compromised, if not impossible, if the workforce or organizational culture itself are resistant to change. Being an effective leader means recognizing this, and finding ways to overcome, or even use it to your advantage without becoming antagonistic. Even the best ideas require preparation and timing, occasionally preparation and opportunity. Impatience is destructive, but so is failure to deal with serious problems. This quandary often paralyzes leaders, effectively stifling the progress of the organization.

Research and data are useful and necessary when planting a new crop or experimenting with new methods of farming. When managing change in any organization research and data can be used to identify and quantify the need for change that can improve the performance and effectiveness of the organization in meeting its mission. Many leaders do not recognize that this must be a continuous process that looks at the entire organization. They frequently only address critical issues that have already resulted in a major loss, or bad public relations, using a reactive management style exclusively. Successful leaders and their organizations are pro-active, constantly looking for ways to improve and better meet their mission and goals. Plants evolve and adapt to change through natural selection. Those that out-perform others survive and multiply those that do not, fail to thrive and eventually become extinct.

Plants have one purpose; to propagate, grow and reproduce. People are the same on that basic level, but because we are human we have significant other needs for security, purpose, accomplishment and self-expression. Most people are rational, thoughtful, and want to do meaningful things for others and the organizations the work for. Occasionally exceptions occur when change is perceived by an individual or group as an attack upon their traditions or values. A leader must be clear, uphold the mission of the organization, and confront the change head-on. A charge unanswered gains both momentum and credibility while planting another type of seed that is difficult to remove. Doubt and weakness, like a weed infested crop, will draw away the vitality and strength of the organization. Removing the lack of commitment and support will destroy the good with the bad.

No part of a plant is “in charge” of the plant, the whole organism must function as a unit, each part doing what it was intended to do, or the plant will quickly perish. Organizations do differ on this point; however each part of the organization does have to function as intended to be successful. Leading in middle, lower or informal role within any organization can be challenging, requiring a harmonious integration of the needs of the organization, the unit and individuals. When challenges are discovered, or your unit finds ways to improve the value and quality of their product, you must find ways to effectively communicate this up the management tree to make it reality. The mid-level organization leader must effectively manage the needs of the organization, and those of its most important asset; the employees/volunteers. The front line leader may feel insignificant, in reality this is far from the truth. In that role the leader can have the most direct effect on presenting the public “face” of the organization. Leaders elsewhere in the organization should value the input from front-line leaders who deal with the public daily and best know the needs of the customer.

In agriculture we learn to work with nature, the sun, moon and position of the earth in its ellipse. Cooperation within the organization leadership structure is essential to the health and performance of any organization, a hierarchy must be established and followed to assure a concerted effort in reaching objectives. Discussion of opposing points should be encourage to assure that all possible opportunities are exploited, but once a decision is made with the best information available all must focus on obtaining a positive outcome regardless of personal preference. This extends beyond mere performance, loyalty to the organization and its mission is a necessary ingredient for all employees, but especially of the organizations leaders.

Ornamentals and potted plants are temporary, usually only for show, and in the end are usually just for looks with no real useful product. Don’t settle for short term appearances when cultivating your organization. Real progress and lasting success rely on good preparation, planning and learning to work with the forces of nature to coax a solid performance. Successful organizations must produce, wasting time, money and human capital on projects that only produce a public relations facade without adding any real value or performance is irresponsible and borders on fraud. Public safety organizations can’t afford to “fake it”, your personnel will know the truth and it will hurt morale. Fertilizer will make nearly any plant look pretty for a while, but it is no substitute for good soil management.

Like a farmer, you are trying to grow a product. In public safety that product is an effective organization that provides value to the public and those who make up the organization. Thinking like a farmer can be useful, helping you reconcile the needs of the organization, the forces of nature and the environment in such a way that you and the organization can be productive.

It’s always a good time to prepare

Thursday, March 6, 2014

Where We Make a Difference

Where We Make a Difference

By Alan Perry

March 6, 2014

There are times when riding in the back seat is desirable, such as being a jump seat firefighter. But it really chaps my parts when I continually see the Fire Service, Major Fire service publications and Fire training divisions focus nearly exclusively on Fire related items while placing EMS training and discussion in the backseat. EMS has been acknowledged as being at least 80% of our job. Are we in denial? Are we uncomfortable with the subject? Do we find it Boring? Is it less important, or is the Fire service culture still resisting the change that has already occurred?

While the data appears somewhat subdued and hard to find, most large fire departments that provide EMS services report an average of only 3% actual fire calls. Yet their persona and training programs remain largely centered around the fire service. Certainly not all present themselves in this way, but it has been my experience that EMS is still viewed as a necessary evil by most. According to the IAFC[i] career firefighters provide EMS services to 85% of the population overall, and 97% in the 200 most populated communities. So why the resistance? Even among a minority it makes no sense.

Fire and EMS represent two distinct personality types in my view which may largely explain these circumstances. Firefighting represents bravery in the face of danger, care of the sick and injured represents compassion. Ideally both of these should exist in the Fire-based EMS system; the reality is that we seem to attract one or the other. It is apparent in older departments that the entrenched old-guard firefighter mentality is enshrined in the administrations and leadership, this alone could explain some of the resistance, but most of these veterans are retiring now, so why does it persist? They left us a gift in the form of training their replacements, all the while instilling their old outdated views of firefighting and EMS. Dinosaur Eggs. Some have gone as far as to suggest that the value of EMS calls to the fire service is that these calls can be used as fire training[ii], as if that somehow makes them more worthwhile.

According to the IAFF [iii] “No other organization, public or private, is capable of providing pre-hospital emergency response as efficiently and effectively as fire departments”. For this to be true every Fire-based EMS system must also provide effective EMS training and quality control measures to assure that they are actually “capable” of providing this service better than any other organization. Also, merely being “capable” does not necessarily equate to actual performance. It appears to me that in many cases the administration and training components appear to have misread the data and believe 80% of their calls are fires and 3% EMS. The result being a lopsided training and public information based on that model.

The IAFC asserts that “ ⁱIf EMS is the intersection of public safety, public health, and medical care…. The U.S. Fire Service is uniquely qualified to be at that intersection” If this is a serious statement then why do the majority of fire departments still qualify promotions by assessments that evaluate fire tasks that are only performed 3% of the time? I realize that the duties of an officer include much more than the wrote skills involved in firefighting and/or EMS, and that the management and command components apply equally regardless of the service, but these same officers, chiefs & administrators must understand equally well what is going on at the street level in both Fire and EMS before we can make statements like this. So why don’t we make EMS management skills a greater part of that assessment to insure we kill the “dinosaur eggs” and promote EMS competence throughout the chain-of-command?

I am not an enemy of Fire-Based EMS, it is my career, a career I love and want to see be the best it can be. What I cannot tolerate is apathy, failure and hypocrisy. A white paper promoted by the IAFF states “[iv] The fire service has become the first-line medical responder for critical illness and injury in virtually every community in America”. This is an awesome responsibility, one we must take seriously; we have the opportunity to save lives. Lives cannot be rebuilt once lost; damage usually cannot be fully repaired. If we are to live up to our billing we will meet this obligation by responsibly representing the value of EMS services, conduct serious and frequent EMS training, and promote those that take the EMS mission seriously and display a continuous desire to improve our services in all areas relative to their public impact.

Be Safe,

Alan