Archive for May, 2013

Denis Onieal started his career in the fire service in 1971. If there is one thing the National Fire Academy’s esteemed superintendent has learned over the last 42 years, it’s this: Change is inevitable. “It really doesn’t matter what profession,” he says, “but without a doubt that tenant holds especially true for those in the fire service.”

“Take a fire chief of 1970 and put him in charge of a department today and the only thing that’s the same is the trucks are still red,” Onieal said Monday after wrapping up his session at Fire-Rescue Med titled, “The Future of the Fire Service.”

“We have to deal with change. It’s like the old expression goes, if you don’t like change you’re going to hate extinction.”

Onieal, who has been honored countless times for his leadership in the fire service, including the Lifetime Achievement Award from Fire Engineering in 2007, discussed how today’s solutions won’t be able to fix tomorrows problems. New challenges, however, will bring new opportunities.

Onieal raised several issues during the hour-long session that could all play significant roles in how the fire service evolves in the coming years.

An aging population, with baby boomers requiring more medical calls; building construction, which poses new threats to firefighters during fire suppressions; the media age, where every wrong move a public servant makes will be posted on YouTube within minutes.

“Training is another area that will continue to develop,” Onieal said. “With the advent of online technology, students are using Internet-based tools. The challenge is going to be in assessing how that knowledge acquired through digital means translates into practical use,” he said.

“To think the fire service is not going to be affected by all of this is to deny reality,” Onieal said. “The future will be different. Not easier, not harder, but different. It’s on us to adapt to the changes or someone else will.”

When the Memphis Fire Department hired Gary Ludwig as its new deputy fire chief in April of 2005, morale was at an all-time low. Ludwig was brought in with clear goals: Improving fire department culture and rebuilding the EMS portion of the department.

Eight years later, those goals have been met, he believes.

Ludwig spoke Tuesday morning at Fire-Rescue Med about the challenges he encountered after taking over the organization with more than 1,900 employees.

“When I first got to Memphis I thought it would be a couple years,” Ludwig said. “… It has been a fantastic opportunity to affect change and I haven’t looked back.”

To meet his clear-cut mission, Ludwig enacted a comprehensive plan that detailed everything the department needed to modify. At the heart of the mission was putting EMS on the same level as fire suppression with everyone inside the department.

“The reality is we are EMS agencies that sometimes go on fire calls,” Ludwig said.

You have to embrace the EMS mission or else it will fail. And it all starts at the very top. It can’t be EMS vs. suppression. We are all on the same team. So it was a cultural change of working together instead of us vs. them.

Ludwig went over numerous steps implemented that influenced the new vibe inside the department. One of the most impactful was the decision to put paramedics on equal footing as firefighters. That meant equal pay, equal titles and equal ranks. “There was no reason paramedics should be held to a lower standard than firefighters,” Ludwig said.

“This is a fire department, isn’t it?” he said.

Ludwig also installed a new policy, called the “12/12,” that mandated paramedics spend 12 hours each 24-hour shift in an ambulance and the second 12 hours on the engine. He also forbid what he considered rampant bad-mouthing and mistreatment of paramedics, hired a new medical director, reestablished his departments EMS training program, instituted marketing initiatives to spread the departments successes, and put together a recruiting effort to fill needed positions with new blood.

He even went so far as to change the color of ambulances to red so they would be the same color as the fire engines.

Every step taken was aimed at improving the working conditions for everyone in the department. But to do it, he needed to send a message that EMS was not second-class.

“Changing the culture took time,” Ludwig said. “It was a gradual improvement. It didn’t happen overnight.”

We all know how important training is to effective emergency response. That point was driven home again during Monday morning’s opening session at Fire-Rescue Med 2013.

Dr. David Zideman, the clinical lead for Emergency Medical Services for the London Organizing Committee of Olympic and Paralympic Games, spoke about his experience during the summer of 2012. “The event went about as smoothly as it could have,” Zideman said, “thanks in large part to the four years of preparation before the 14-day ceremony and the training rehearsals that were held in advance.”

There were about 1,400 volunteers working medical, including doctors, nurses and first responders. They were all put through general training, role training, venue-specific training, daily scenario training and test event training.

“We trained our team to know exactly what was going to happen,” Zideman said. “We wanted to make sure everybody knew what they needed to do.”

Zideman delivered a comprehensive overview of the planning, implementation and execution of emergency response during the 2012 games. “In an event of this magnitude, no detail can be spared,” he said.

In total, there were 38,362 medical “encounters” reported during the 2012 Olympics. Encounters encompassed everything from a headache to a major cardiac event (of which there were only two).

“Interestingly, there was a great deal of planning for things that never happened,” Zideman said. Terrorism is a major concern for organizers of major sporting events and Zideman said there were numerous threats, including an anthrax attack, shootings, bombings, etc.

“Terrorism was a major concern. We had a huge security presence. We had the sites locked down for a year before the games began,” Zideman said. “Every spectator was searched, all the athletes were searched. … We were prepared for the threats.”

After spending four years preparing for an exhilarating event that lasted just two weeks, Zideman admitted he was a bit “sad” when the Olympic flame was dissolved.

“The Olympic experience was amazing,” Zideman said. “Having lived through amazing four-year experience and I came out different. Experience was truly amazing.”

Mike Metro didn’t waste any time Monday during his session at Fire-Rescue Med. Only a few seconds had gone by when the deputy chief with the Los Angeles County Fire Department let everyone attending know the Affordable Care Act (ACA) is going to dramatically change the fire service.

“If you don’t pay attention to the climate around us, in five years your fire department might not be around,” Metro said. “This will have a profound impact on all of us. … It’s a new game. We never had to compete before, but let me tell you what; we’re going to have to compete now. We have to prove we are more efficient, prove we have a better product and prove we offer a better customer experience.”

Metro, a 37-year veteran of the fire service, broke down some serious challenges the ACA presents. With 32-34 million more people having access to health insurance, the ACA will demand increased efficiency from everyone. He discussed how municipalities will be forced to consider doing things they’ve never done before – like privatizing America’s fire service. Not just EMS, but emergency response entirely.

“We need to make sure we’re on our game,” said Metro, imploring EMTs to deliver better services with better customer service because of the oncoming competition from private entities like American Medical Response and Falck.

“We need to start looking at it as what can we do for Mrs. Smith, instead of what can we do to Mrs. Smith,” Metro said.

The fact is, less than half of 911 calls require paramedic intervention. A large percentage of patients just need access to medical care, not expensive trips in ambulances to emergency rooms. “If Mrs. Smith isn’t seriously ill or injured,” Metro asks, “does she really need to go to the ER?”

Metro says the fire service needs to be forward-thinking. As the industry evolves, evolve with it. Possible suggestions include making EMS visits available through scheduling and potentially partnering with Accountable Care Organizations.

“We’re at a similar crossroad as we were in the 1970s,” Metro said. “Remember when guys said, ‘we aren’t going to put needles in the hands of my firefighters. We’re just going to put the wet stuff on red stuff.’ What happened? Many of them are not here today. We’re at the same crossroad now. … We need to design our future rather than become a victim to it.”

The IAFCs Fire-Rescue Med starts tomorrow in Las Vegas and will run through Tuesday, May 7. The conference for leaders of fire-based EMS is known as one of the premier events for educational sessions and hands-on training exercises. TargetSolutions will be attending the conference to cover the exciting and informative sessions that will be held on Monday and Tuesday.

Please follow us on Twitter and Facebook for updates and articles on the sessions. You can also follow @FireRescueMed for updates from the event’s organizers.

The entire program is filled with informative sessions, but here are three that are gaining buzz and were definitely planning to attend:

Monday, May 6: EMS at the London 2012 Olympics (Dr. David Zideman)

Tuesday, May 7: How Can We Survive With What the Future Holds? (Chief Kelvin Cochran)

Tuesday, May 7: PulsePoint Citizen Responder CPR/AED Mobile App (Chief Richard Price)

Please check back for updates and on social media for coverage of the event.