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PTSD in the Fire Service: Escaping a Personal War Zone

fire service ptsd

For generation after generation, fire service PTSD has been an unspoken and largely undiagnosed condition. However, understanding the circumstances that trigger fire service PTSD can lead to treatment, improved morale, and even save lives.

You don’t always get to choose your battles; sometimes they choose you. When that first call comes in, you don’t know what will be waiting on the other end; a burning building, a natural disaster, or an act of violence that requires prompt emergency medical services. But when the fires go out and the healing begins, the battles don’t always end. Compassion fatigue, burnout, and eventually post-traumatic stress disorder (PTSD) can manifest themselves out of the mental and physical trials of the everyday first responder.

Understanding the symptoms that compound into PTSD and learning how to manage them won’t only improve morale, but can also save lives, according to Paul Costello, FF/EMT-P, a 25-year veteran of the fire service.

COMPASSION FATIGUE

Defined as “an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper,” compassion fatigue serves as a common precursor to PTSD.

While largescale emergencies and rescue operations do contribute to compassion fatigue, oftentimes it’s the mundane tasks that have the strongest impact on first responders. Fires are at an all-time low, meaning primary care and mental health calls will take up a majority of first responders’ time. Think of each company member’s psyche as a personal barometer; with each passing call, those barometers will gradually inch closer and closer to the end of the dial, signifying an escalating growth of compassion fatigue. While every individual’s barometer is different, the lurking danger of burnout will inevitably set in.

BURNOUT

Occupational burnout is defined as “a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work.”

Developing a negative worldview as a result of burnout doesn’t only run the risk of adversely affecting your personal life, but it is dangerously contagious to your family and colleagues as well. Think about the bright-eyed and bushy-tailed rookie arriving for his or her first day on the job and immediately assimilates to the burnout of a 20-year veteran. Influenced by how the veteran reacts negatively to day-by-day nuances, pretty soon the rookie exhibits his or her own gradual tilt into compassion fatigue and a faster descent into burnout.

Being the dull tool in the toolbox doesn’t just affect you, but it also affects outcomes.

“It’s almost cancerous in a manner of speaking with how it can impact your employees,” said Costello. “One of the things I firmly believe is it affects outcomes but you have to override it. Realize that you’re there as an advocate whether or not a call is exactly as dispatch has described it. It’s still that person’s emergency. You have to accept it as a reality in our profession.”

EMERGENCE OF FIRE SERVICE PTSD

Like a wildland blaze at the height of fire season, PTSD will overwhelm first responders in the form of anxiety, depression, substance abuse, sleep deprivation, panic attacks, and violent or suicidal thoughts. While many cases compound through a linear ascension of compassion fatigue and burnout, single traumatic events, such as the recent shootings in Las Vegas, can profoundly accelerate the symptoms of PTSD.

Despite glaring warning signs, the fire service maintains a troubling track record of refusing to seek help. The idea that an individual will be seen as weak or passed over for promotion if they seek counseling are common concerns for the everyday firefighter, but this type of self-deprivation creates a vicious cycle of compassion fatigue which leads to burnout and eventually develops into the bottomless pit of fire service PTSD.

NEED HELP? GET HELP

Just as you rely on your crew when entering a burning building, you certainly don’t have to fight PTSD on your own. Some insurance plans in the fire service feature an employee assistance program that provides a certain number of free visits to a licensed clinical social worker or behavioral therapist. These sessions provide you an outlet to unload your feelings and emotions while receiving guidance on how to deal with them in the future.

Are you a chief? Sometimes the most powerful form of leadership is to lead by example. Dental visits are recommended twice per year; why doesn’t mental health carry the same weight? Normalizing annual “tune-up” visits to a cognitive therapist is a healthy way to stay on top of PTSD. When an effective leader can sympathize with what a company member is going through, crews will want to emulate that behavior.

“This is a tough business that’s a slog at times with daily wear and tear,” said Costello. “You’re dealing with other people’s problems and emergencies and trying not to let the process as a whole grind you down. Whether your career is 20, 25, 30 years, if you’re going to be successful you’re going to have to have these tactics to defend yourself.”

Fire Service Health and Safety Part I, the first installment of a two-part online training series from TargetSolutions, explores numerous topics pertaining to firefighter health and wellness, including a section dedicated to anxiety and fire service PTSD.  The course outlines the
concepts, science, and economics of fire service-related health and safety as modern firefighters need to understand these interconnected concepts.

Understand your limits, seek treatment, and then pass on that knowledge to future generations. You’re not in this alone.

If you or someone you know is contemplating suicide, please call the National Suicide Prevention Lifeline at (800) 273-8255.

ABOUT THFire Service PTSDE CONTRIBUTOR

Paul Costello is a veteran paramedic, firefighter, fire service instructor, and TargetSolutions subject matter expert who has assisted in the development of numerous fire-related training courses. He played a pivotal part in the direction and production of TargetSolutions’ award-winning 1410 Evolutions training bundle, a 14-course video-driven series that was shot on location with the St. Charles Fire Department in St. Charles, Missouri and Pasco County Fire Rescue in Land O’ Lakes, Florida.

Biographical Drama ‘Only the Brave’ Refuels the Firefighter Film Genre

Blog by Greg Baldwin
Marketing Content Specialist at TargetSolutions

Films inspired by the fire service have a habit of settling their themes around the “Man vs. Fire” climactic battle, leaving the story and plot as a mild formality. The recently released Only the Brave, directed by Joseph Kosinski, completely rewrites the firefighter film formula and serves as a testament to the resilience of the human spirit in the eyes of danger.

Based on the true story of the Yarnell Hill Fire near Yarnell, Arizona in June 2013, the story follows superintendent Eric “Supe” Marsh (Josh Brolin) of the Prescott Fire Department and his Type 2 battalion (also known as “deucers”) as they strive to one day become certified Type 1 (also known as hotshots). Supe is wise beyond his years and his crew operates as a well oiled high-performance engine, but despite these credentials their certification is still four years in the making. Things get testy when rookie Brendan McDonough (Miles Teller) is given an opportunity to earn a spot in the company. McDonough has just been kicked out of his mother’s house, has a child on the way, and bears a history of substance abuse. Paired with his poor physical conditioning and limited intellect, he’s branded the nickname “Donut” and is nearly dismissed on multiple occasions.

In a way, Donut’s exile into the real world from the sanctuary of his mother’s house is synonymous with the film’s theme of marching into danger and being forced to create something out of nothing. Laziness and abuse make up the only world that Donut has known, but that all changes as he confronts the crossroads in his life: take his limited fire experience and put it to good use with Supe’s department or continue his path to eventual self-destruction. Both decisions are dangerous but only one is correct.

The film succeeds in generating tension between Donut and his new company while subtly constructing the bonds that will eventually bring them together as one unit: the Granite Mountain Hotshots. There is an instance where Donut can no longer handle the escalating hazing and stops short of punching one of his instigating comrades. In most other films, the punch would have been thrown and the team would be no less for the wear. In this case, Donut has too much to lose and the members of the company start to take notice when he refuses to give up despite his struggles. It’s the fact that he didn’t throw the punch (as he probably would have done as a junkie) that makes his colleagues start to respect him. Whether this particular altercation is based on fact or not, the traditional formula of the firefighter film genre would ultimately call for Donut to land the punch. No exceptions.

The landscapes of the film are nothing short of breathtaking and, at times, terrifying. Supe recalls an occurrence early in his career where he came across an engulfed bear fleeing from an inferno. “It was the most beautiful and terrible thing I have ever seen.” Utilizing a healthy blend of practical and CGI effects, the film brilliantly illustrates this contradiction in ways that no other firefighter film has ever done. To our protagonists, the intimidating panoramic landscapes aren’t comprised of beauty or nature; only fuel for the fire.

Sure to refuel the firefighter film genre, the emotionally supercharged Only the Brave has opened to unanimous fanfare with critics lauding its story, writing, acting, and stunning visual effects. While the epic is a work of fiction, the climactic event that it is based on is not, and that certainly hits home. As I sit behind my computer writing this, somewhere far away in another city, another state, another country, there is a cadre of brave men and women who are entering a fire zone right now and putting it all on the line. Sometimes we could all use a reminder about the realities of the dangers that the fire service faces every day. Today, Only the Brave is that reminder.

ABOUT THE CONTRIBUTOR

Greg Greg Baldwin Content SpecialistBaldwin joined the TargetSolutions team in June of 2015 and serves as the company’s Marketing Content Specialist. A graduate of San Diego State University with a degree in marketing, he played a key role in the development of the award-winning NFPA 1410 Evolutions series as one of two videographers on location in St. Charles, Missouri. Greg is a veteran volunteer of the local animal shelters, having won County of San Diego Volunteer of the Year honors in 2013 for his implementation of a digital marketing program.

Top 5 Fire Training Scenarios for the Effective Firefighter

Running specific fire training scenarios at your training complex will boost confidence, expand knowledge, and promote valuable teamwork when prepping your cadre for the real thing.

An ongoing debate endures over whether money buys championships, a concept that can be applied to many of life’s little nuances. But the reality is what good is having the best that money can buy if you’re not prepared to properly use it? The same could be said for a firefighter’s training program. Your training grounds may be packed with the most pristine resources available, but like a last-place ball club with a skyrocketing payroll, your gear is only as good as the plan you develop for using it.

Scenario-based training for firefighters is a must for preparing your battalion, executing successful operations, and saving lives. Paul Costello, FF/EMT-P and certified fire service instructor, recently sat down with us to discuss a few fire training scenarios that can help prepare your cadre for the real thing.

1) EMS Training: Commonly known as one of the Toxic Twins, hydrogen cyanide is a chemical compound found in most working fires that effectively blocks the body’s cells from accepting oxygen. Implementing EMS into your program is one of the most valuable types of fire training scenarios that will prepare your battalion for tackling chemical inhalation, injuries, burn wounds and more. Costello discusses this further while referencing cardiovascular incidents leading to line of duty deaths; “Cyanide and its other twin carbon monoxide become a cardiovascular drag. If you already have a degree of heart disease that you didn’t realize, now you’re suddenly further impairing it, which is one of the known triggers of these line of duty cardiac arrests that occur during or after a fire.”

2) SCBA & PPE: Complacency is an all too familiar foe when it comes to reviewing and mastering the basics. How to don your gear with speed, the rules of air management, knowing how much air your body expends, and when to remove yourself from a fire are all fundamental necessities that every firefighter must review with a degree of regularity. “Regardless of discipline, going back to the basics is imperative and the fundamental knowledge could use a boosting from time to time,” commented Costello.

3) Truck Company Operations: Truck company operations are vital to any firefighting effort. Aerials and master streams, operated by specialists called “truckies,” offer the opportunity to maintain strategic holds on building fires and provide incident command with succinct control of the flow path into the structure through their ventilation efforts. It comes down to skillset, orders from incident command, and not getting trigger happy with those 1,000 GPM master streams. Said Costello, “One alarm fire means you’re going to have X amount of engines, we’ll say three; a truck company, aerial or ladder, rescue, battalion chief or two, an air truck. Everything complements one another.”

4) Live Fire Training & Flashover Simulator: Whether it’s live fire evolutions in the tower, a burn room or a flashover simulator, all three scenarios serve the invaluable purpose of prepping firefighters for the real thing. Thermal dynamics, fire behavior, reading and controlling a fire are all beneficial for rookie firefighters and veterans alike. When structures start to burn at 1,100 degrees and you’re surrounded by super-heated gas, relying on your training could save your life. Relayed Costello, “What it does is prepare the firefighter for the behavioral nuances experienced inside a burning structure. Adult learners master by doing, actually seeing that things are improving or getting worse and if they’re getting worse, what can they do?”

5) Tower Training: Physical agility, simulated high-rise drills, and live fire evolutions are just a few of the training exercises that towers provide. Each building takes on its own personality and unique architecture in providing important training exercises to battalions across the country. The ultimate game changer, Costello praised tower training for its versatility and value; “For the average firefighter who isn’t part of a specialized team doing high angle rescue, it’s a confidence builder in trusting your equipment and team and the basics of why we do this type of safety training.”

TargetSolutions offers a variety of interactive online training courses of the aforementioned fire training scenarios, plus a plethora of other topics. Manage your entire department’s training, simplify ISO, and stay on top of EMS recertification all from one centralized hub. For more information, please contact us today at (800) 840-8048.

ABOFire Training ScenariosUT THE CONTRIBUTOR

Paul Costello is a veteran paramedic, firefighter, fire service instructor, and TargetSolutions subject matter expert who has assisted in the development of numerous fire-related training courses. He played a pivotal part in the direction and production of TargetSolutions’ 1410 Evolutions training bundle, a 14-course video-driven series that was shot on location with the St. Charles Fire Department in St. Charles, Missouri and Pasco County Fire Rescue in Land O’ Lakes, Florida.

The Four Pillars of a Tactical Response Program

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Training on active shooter incidents is critical for all agencies. Author Ofer Lichtman provided these images of a recent training event held by the Rancho Cucamonga Fire Department (Calif.).

Blog by Ofer Lichtman

Rancho Cucamonga Fire Department (Calif.)

Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.)Editor’s Note: Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.) is an expert on numerous subjects impacting the fire service, including Tactical Emergency Casualty Care (TECC) and terrorism awareness. Last year, Lichtman provided TargetSolutions with an in-depth interview on best practices for emergency responders during an active shooter incident. To read the two-part series, please click here.

If a department from another part of the country was looking to emulate Rancho Cucamonga’s model for a rescue task force, where would I recommend they start?

I would start with the end in mind and with a simple incident objective: Save the most lives as possible with what you have available. It doesn’t matter if you are 20 deep or 2,000 strong; if you can train your personnel in unified command, put together just one RTF, enter a warm zone and treat casualties closest to the time and location of their injury, then they can make a significant impact on any scene.

Here are the four pillars of my department’s tactical response program:

1. Get Buy-in from Personnel at All Levels

You need to constantly get buy-in from floor personnel, administration, and your city officials when building a program like this. You need buy-in as threats evolve and change. Listen to your people who are going into warm zones and address their concerns.

2. Create the Right Working Relationship between Law Enforcement, Fire, and EMS

Sometimes we miss the unified command part in which we say an incident is a law enforcement incident alone, and no feedback from the fire department or EMS is needed. That couldn’t be further from the truth.  You must train together, build relationships and trust each other. These healthy relationships will lend themselves to a greater unified command structure with common goals and incident objectives.

3. Make Sure You Have Proper Gear and Equipment

If we don’t give proper gear to protect our personnel, then we will lose buy-in. If we don’t give them the proper tools they need to do the job, then they’re not going to be as effective.

4. Make Sure Training and Tactics Match Reality

Threats evolve so constant training is a must to ensure our tactics are correct. For example, our original model was built upon having two personnel enter a warm zone, but that’s just not practical or efficient. Having a large RTF (3 LE / 5 FF), where one person focuses on the command and control aspect, while the others operate on the rapid treatment aspect, lends to our objectives being met safely, quickly and more effectively.

About the Author:

Ofer Lichtman started out as a first responder in Israel and is currently the Terrorism Liaison Officer Coordinator for Rancho Cucamonga Fire Department (Calif.). Lichtman was instrumental in developing its Terrorism and Tactical Response Program. Lichtman is a member of the Joint Terrorism Task Force and is on the advisory board of the C-TECC.

What You Allow, You Ultimately Teach: A Lesson for Leaders

Blog by Peter Dove

Shared Values Associates

Stylish businessman choosing profile pictureI was in a Bank of America branch some time ago standing in line for the teller. There were about four of us in the queue when in walks this young man in his early 20s with purple hair, a gallery of tattoos on his arms, a pierced nose wearing a ball cap that read F*#@ YOU.

As it happens, this is the USA and we enjoy freedom of speech, so if an individual wants to be boorish there is a certain latitude allowed, a latitude that seems to be expanding, which is lamentable but that is for another article.

Of course, many in the bank saw exactly what I saw, but did anyone walk up to this nice young man and diplomatically explain that others might apprehend this slogan, as popular as it may be, is insulting? No, not even me and I’m an executive coach and have been in the training business for decades. So, what did I and the rest in the branch allow? It’s okay to tell strangers, including children, in the most vulgar and insulting way possible, exactly what to do. That’s what was taught, though none of us realized it and perhaps might not admit that fact.

Rather than ask, “What are we allowing in our society?” – though a good question to be sure – let’s ask what are we allowing in our company, department or team because that is what we are teaching whether good or ill.

Here are some examples of what we might be allowing that we may wish to reconsider.

  • Getting to work late or going home early.
  • Nervous laughter. They seem to punctuate every sentence with a giggle. Nothing’s that funny.
  • Foul language.
  • Taking God’s name in vain.
  • Questionable clothing.
  • Bad hygiene.
  • Failure to meet deadlines way too often and asking for more time.
  • More work piled upon more work creating work/life imbalance.
  • Untrustworthy boss or co-worker.

You get the idea.  All of us have seen this behavior at some point and the question is, do we tolerate it? Why? What can be done? Answer: the uncompromising truth.

The solution is to create a social contract now, beforehand. How about we all get together and make it okay for us to be straight with each other? The boss should promote this idea on an ongoing basis for it to succeed as well as it might.

Both his or her position power and referent power (earned respect) must be used to make this rule sustainable. The conversation might go something like this, “From time to time I think all of us are guilty of behaving in a way that is bothersome to someone else on the team. I’d like to create an understanding that should something like that happen, go ahead and take the accountability to have a respectful conversation with that person and get the issue out on the table.”

This is a simple thing, but perhaps a difficult conversation for most. But, what is allowed is ultimately taught.

What kind of behavior is allowed at home? Consider establishing a social contract within our families. What are the ground rules? What is OK behavior, what is not and what are the consequences? I think the adage, “you shall know the truth and the truth shall set you free” has broad application and is as true now as it was 2000 years ago.

About the Author

Peter Dove, is president of Shared Values Associates, a firm dedicated to corporate culture design. Learn more about Peter Dove at www.peterdove.com.

Sudden Cardiac Events in the Fire Service

sudden cardiac arrest in fire service

With a staggering 51 percent of all firefighting line of duty deaths caused by sudden cardiac events, the epidemic presents itself as the No. 1 firefighting fatality.

The dangers of the firefighting profession are never in short supply. Smoke inhalation, burn injuries, car accidents, collapses – just a few of the perils that routinely handcuff themselves to the day-to-day operations of the job.

But there’s another hazard that’s quietly lurking below the radar causing more damage but receiving substantially less attention: sudden cardiac events. With a staggering 51 percent of all firefighting line of duty deaths caused by sudden cardiac events, the epidemic presents itself as the No. 1 firefighting fatality, more than any other fire-related danger combined.

Denise Smith, professor for health and exercise science at Skidmore College in Saratoga Springs, N.Y., is leading the crusade against fire service-related cardiovascular diseases. Citing studies that suggest the cardiovascular disease risk factors in firefighting are similar to those of the general population, Smith poses the question: If a firefighter’s basic cardiovascular disease risk isn’t greater than the rest of the population, why are they so much more likely to die at work?

The answer may lie in the magnitude of the cardiovascular strain they experience during their jobs.

For example, a person not involved with the fire service may harness a similar cardiovascular risk but is unlikely to do work that is as strenuous as a firefighter. More importantly, Smith asks, “are we doing enough to prevent sudden cardiac events in firefighters?”

Smith believes there is an abundance of cases where firefighters are being cleared for duty following a medical evaluation that includes findings of cardiovascular risk. This is due in large part because of the physician’s lack of understanding of the physiological and psychological strain of the job.

“In my mind, every firefighter should have a medical evaluation by a physician who understands the stressful nature of the job. Sometimes firefighters go to physicians who say ‘you are kind of in normal shape’ and clears them for duty, but doesn’t understand how stressful the job is.”

Denise Smith, Professor for Health and Exercise at Skidmore College (N.Y.)

Therein lies the problem: Firefighters are being cleared for duty despite the detection of early signs of cardiovascular diseases.

“The firefighter hears ‘I’m cleared for duty, therefore everything is OK,’ but very often those medical evaluations are doing exactly what they should be by detecting early signs of cardiovascular disease or risk factors but the firefighter is failing to follow up because he’s cleared,” said Smith.

Further complicating the issue of medical evaluations are departments that operate in a very black and white manner when it comes to firefighters being cleared for duty. Because of this, physicians are reluctant to take a firefighter off the job because of something like high blood pressure. This results in leaving treatment in the hands of the firefighter and puts them at greater risk if something is not done.

Simply put: Firefighters should receive appropriate medical evaluations and aggressively address risk factors – and departments should provide a comprehensive wellness and fitness program to help them do so, Smith believes.

In some cases, firefighters should be placed on light duty until health issues can be properly addressed. But what constitutes justifiable risk to remove a firefighter from active duty?

Smith suggests that a proper annual medical evaluation is a great place to start, but emphasizes that findings of hypertension, obesity, or diabetes/prediabetes must be taken seriously with accompanied steps to reduce the risk of further progression. Sudden cardiac events account for half of duty-related deaths and close to 1,000 non-fatal events every year.

Ignoring the risk makes no sense, she said.

“I think the possibility of a guy coming off active duty in order to rehabilitate to get those risk factors down to do the job more effectively and safely is a very reasonable approach,” said Smith.

As for what initial health risk factors should take priority, Smith suggests that elevated or borderline cardiovascular levels, especially prehypertension and prediabetes, should be taken more seriously. Too often are these issues seen as minor when, in fact, they’re constituting an exuberant medical risk.

While some may be intimidated by mandated health programs that place greater emphasis on managing a wide array of cardiovascular issues, Smith says the goal should be to turn these programs into a positive message as a way to avoid devastating health incidents.

“Prevention is the most powerful thing that’s largely within a firefighter’s own control,” Smith said. “A firefighter who has good overall health and is exercising, maintaining a normal body weight and eating healthy is the one who’s most protected from cardiovascular disease and cancer.”

“These are largely solvable issues and can be addressed and mitigated by the actions of firefighters to keep themselves healthier.”

  • This article was written by Greg Baldwin of TargetSolutions after an in-depth interview with featured contributor Denise L. Smith.

About the Contributor

Denise L. Smith, Ph.D.

Denise L. Smith, Ph.D., is a Professor of Health and Exercise Sciences at Skidmore College where she directs the First Responder Health and Safety Laboratory, and a Research Scientist at the University of Illinois Fire Service Institute. Dr. Smith has co-authored an Exercise Physiology and an Advanced Cardiovascular Exercise Physiology textbook. Dr. Smith has published more than 50 scientific papers and has received funding from FEMA-AFG, DHS S&T, NIOSH and DOD to pursue her research agenda. She is a member of the National Fire Protection Association (NFPA) Fire Service Occupational Safety and Health committee, and she regularly conducts fatality investigations for the National Institute of Occupational Safety and Health (NIOSH).

Best Practices for Emergency Response During an Active Shooter Incident – Part 2

active shooter emergency response

Approximately 15 percent of fire departments have some type of active shooter response model, according to Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.). (Photo courtesy of Ofer Lichtman)

Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.) is an expert on numerous subjects impacting the fire service, including Tactical Emergency Casualty Care (TECC) and terrorism awareness. Earlier this year, Lichtman provided an in-depth interview to TargetSolutions on strategies for emergency responders during active shooter incidents. This is the second part of that interview. Please click here to view Part 1.

Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.)How can first responders prepare for active shooter threats?
The Rancho Cucamonga Police and Fire Departments have had an active shooter response program since 2003 and have conducted over 136 scenarios involving multiple law enforcement and fire agencies from all over our region in Southern California. Each one of our firefighters is trained in TECC, multiple rescue task force (RTF) tactics and ICS (Incident Command System) for tactical response scenarios. Every one of our apparatuses is equipped with full ballistic PPE and tactical medical gear for every crew member.

In the first few years of our program, we focused on the small unit skills and tactics. As we progressed, we maintained a high level of competency and accountability at the crew level of our firefighters but we have also addressed strategic-level operations that focus on the elements that must be in place for our firefighters to get into the warm zone as fast as they can to actually make a difference.

As a training cadre, we study both past and possible future trends for active shooter types of scenarios and use those trends to build realistic and achievable scenarios in our own target hazards. For example, after the Aurora Theater shooting, we had four days of late night/early morning drills at a local movie theater. In these drills, all our RTFs had to wear their respiratory PPE and perform duties in a smoky, low visibility and loud environment to simulate a respiratory irritant at a confined entertainment venue.

The reality is that just like you can’t prevent every terrorist attack, you can’t be completely prepared for them either. You can, however, have a great response that will eliminate the threats and save as many lives as possible. One of the things that best highlights our preparation and reaction for the San Bernardino attack (in December of 2015) was during the incident, at the Unified Command Post we had a very strong suspicion that there were going to be other attacks in the county. We had to be proactive and prepare. Through good coordination, we deployed strike teams of RTFs from agencies that already had an RTF program in place to specific areas of the county where we thought the next attack could be. These RTFs that we had in staging around the region would have had very good response times if another incident would have happened and would have been able to save many lives.

Has anything changed as a result of these recent attacks?
Since the San Bernardino incident, we have personally trained 13 agencies in our county in the current RTF model that is used throughout the country. We have a very proactive, aggressive and practical program. In San Bernardino and Riverside counties we now have great coordination, not just with our law enforcement partners but with our mutual aid resources. If we speak the same language and understand each other’s objectives and what a specific resource can offer, then we will be prepared to help each other if a situation like this were to occur again.

One of the things we changed in the last year, and not specifically because of the San Bernardino incident, is that we now deploy our RTFs sooner than ever before. We want them to engage appropriately in a warm zone without necessarily making sure the ICS charts have been filled. In the past and in some cases still today, you see departments with RTF capabilities stage their RTFs while they wait to build an ICS chart, fill out the positions, wait to hear key words such as “Shooter is dead” and only then engage in treating patients. So you ask yourself, “have we really changed?” The reality is, we must treat casualties in the warm zone and provide care as soon as we can vs. spending time building an ICS chart. We have to allow the incident to dictate the ICS structure and not the other way around.

What would you like to see change in the future when it comes to these responses?
I believe that the golden standard for response to civilian mass violence should be redefining our trauma chain of survival followed by an aggressive data-driven first responder rescue program. Traditionally we looked at the trauma chain of survival as starting with the medical first responders (firefighters and paramedics; national average response time: eight minutes).

The problem with this concept is we are missing two significant groups of people that would always be on scene prior to most firefighters and paramedics. These groups are your non-medical first responders such as law enforcement (national average response time: three minutes). The second and most impactful group is your bystanders, who are on scene before anyone responds. Both of these groups can buy time for medical first responders by treating the injured when an event happens, especially if they are equipped with the means to do so. When these two essential links in the trauma chain of survival are in place then we will truly have a robust and successful trauma chain of survival that will potentially save more lives than ever before.

Additionally, I believe we must continue to focus on immediate-unified command between law enforcement, EMS and Fire. We must have a collective understanding that this is a multi-pronged response with multiple missions in these events and it’s imperative that we establish common incident objectives to meet all of them.

To read Part 1 of this two-part series, please click here.

About the Author

Ofer Lichtman started out as a first responder in Israel and is currently the Terrorism Liaison Officer Coordinator for Rancho Cucamonga Fire Department (Calif.). Lichtman was instrumental in developing its Terrorism and Tactical Response Program. Lichtman is a member of the Joint Terrorism Task Force and is on the advisory board of the C-TECC.

Why Effective Public Relations Is Important for the Fire Service in the 21st Century

Fire Service Public Relations

Fire departments need to be more proactive communicating with the public in order to connect with the community, says author and speaker Daniel Byrne of the Burton Fire District (S.C.).

When it comes to humility, fire service members usually lead the pack. You’re not going to find Joe Firefighter cruising around town boasting about his job to every Tom, Dick and Harry. In fact, it’s quite the opposite.

Daniel Byrne, who serves as Community Support Officer for the Burton Fire District in South Carolina, condensed a firefighter’s typical day down to a simple routine: come to work, do your job, go home.

Ask Byrne to add some flare to describe the line of duty and the result is almost glamorous: Respond to calls, fight fires, then go home.

But Byrne says that type of mindset needs to change. As an outspoken proponent of encouraging firefighters to be more enthusiastic about informing their community and neighbors about their occupations, Byrne urges enhanced public relations with those same communities and local media to spread the word and tell the firefighter story.

“Times have changed and so much focus is now placed on economic efficiency and transparency,” said Byrne, who has had numerous articles about effective public relations strategies published in Firehouse magazine and online at Firehouse.com.

“It’s all about ‘what are you doing for me today? What services are you providing for me today to warrant tax dollars?’ If they don’t truly know what we do in-between fires, what challenges we face, and what our needs are to meet those challenges – along with the consequences for not having those resources – how can they support us?”

The public is simply uninformed because no one in the fire service is informing them, Byrne believes.

“People in your community can tell you reams of information on the Kardashians and the latest story on the bathroom wars, but can’t tell you what the leading cause of fire in their community is or how many fires their department responds to,” said Byrne.

“People are asking why we pay firefighters to sleep. Managers and government officials are asking. Now the public is asking. The public want answers to these questions that we never had to provide.”

Public Relations Fire Service

Byrne cites the problem coming down to fire departments assuming what the public wants, but never actually asking. In reality, departments need to be more proactive in order to close the disconnect between themselves and the community, he said. This can include teaching classes, writing articles about the firehouse, providing guest speakers for schools and other social groups, and generally do everything possible to engage the public. The fire service’s perceived value can no longer be taken for granted.

Breaking out of the traditional persona of staying quiet is a role the fire service can’t afford to play anymore. For example, for many people sprinklers aren’t seen as a necessity because not enough speakers going out into the community to explain the benefits.

“Going out into the community and doing blood pressure checks and talking about fire extinguishers and smoke detectors is just as effective, if not more so, than any large scale fire program,” Byrne said.

Daniel ByrneUltimately, as Byrne states, prevention is a major part of fire protection and taking the proper steps to communicate this to the public and ensure safety can save lives and keep the damage to a minimum.

About the Author

Daniel Byrne is an Engineer/Paramedic and Community Support Officer for the Burton Fire District in Beaufort County, S.C. He is also an Assistant Chief of Training for the Georgia Air National Guard 165th Fire Department. Byrne is a third generation firefighter and holds both an associate and bachelor’s degree in Fire Science, and a Fire Officer and Fire Instructor III certification.

 

Why Sleep Deprivation Is a Serious Threat to Firefighters

Serving in the line of duty results in an abundance of health risks for firefighters, though perhaps none more silent or threatening than the constant onslaught of sleep deprivation.

David F. Peterson, a retired fire chief and current fire training coordinator of Blackhawk Technical College in Janesville, Wisc., has made it his mission to expose the ongoing dangers of sleep deprivation and establish guidelines to ensure firefighters are getting the quality rest they need.

Firefighter Sleep Deprivation

David F. Peterson

Although the fire service’s line of work has become synonymous with a lack of rest, Peterson scoffs at that notion.

“To me, that’s a hollow acceptance,” Peterson said. “I think we can do much better.”

Typically, the human body goes through four to five cycles of sleep every night, with each cycle lasting roughly an hour and a half to two hours. Toward the end of each cycle, the body goes through rapid eye movement (REM), a crucial stage for repairing brain cells, DNA, and allows the brain to cleanse itself of waste that it produces during the day.

Over the years, however, this crucial stage of sleep has considerably shrunk for firefighters.

Peterson cites an exponential increase in 911 responses to an aging population as the primary reason for an elevation in call volume. “While I’m retired now, I can’t tell you how many calls I went on that were not emergencies,” recalled Peterson. “People lack the education of when to call 911 but also lack transportation so they use emergency services as a clinic-type service.”

The result of Peterson’s theory is an increased amount of calls and longer work hours, with many firefighters working 24 and, occasionally, 48-hour shifts.

Although it varies from person to person, most experts suggest that the human body needs seven to eight hours of uninterrupted sleep to allow the brain to rid itself of waste and repair DNA. Long-term damage from a lack of quality sleep can turn into chronic problems later in life, including an increased chance of diabetes, cardiovascular disease, and weight gain.

Although there is no conclusive data yet, Peterson points out a link between Alzheimer’s disease and lack of sleep. Sleep deprivation robs the brain of a crucial protein called amyloid beta, which results in a plaque buildup that’s similarly seen in cat scans of patients with Alzheimer’s.

Contrastingly, studies show that the short-term effects of REM-lacking sleep begin with a decline in cognitive skills.

“After 18 hours of no sleep, you’re operating on .05 percent alcohol level as far as cognitive ability and that goes up to .1 percent after 24 hours. After four to five days of no REM sleep, you start to develop psychosis.”

David F. Peterson, Retired Fire Chief

Fixing the issue long-term, Peterson suggests, begins at the core of the problem: shift times.

“Some departments change shifts at 6 a.m., but if you live out of town and have to drive two hours, you’re going to be up at 4 a.m. and into the day and up all night. If you shift change at 8 a.m. then you could get two more hours of sleep.”

Check Out Fire BlogsOne solution that Peterson recommends for the short-term is a sentiment that’s echoed by many experts: naps.

Some departments don’t allow their staff to nap, which Peterson argues is detrimental to getting quality rest. Darkened dormitories and a flexible napping schedule are critical first steps for departments when it comes to solving the issue of sleep deprivation.

Although change can take time, Peterson’s advice remains simple and sound: “In other words, try to catch your Z’s when you can.”

About David F. Peterson
David F. Peterson is a 35-year veteran of the fire service and a retired fire chief. He is currently an EMS and fire training coordinator for Blackhawk Technical College in Janesville, Wisc. He served as a Level A regional HAZMAT team coordinator and instructor for 20 years and holds a bachelor’s degree in fire service management from the University of Southern Illinois and a master’s degree in executive fire leadership from Grand Canyon University.

Best Practices for Emergency Response During an Active Shooter Incident – Part 1

Best Practices for Active Shooter Incident

Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.)Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.) is an expert on numerous subjects impacting the fire service, including Tactical Emergency Casualty Care (TECC) and terrorism awareness. The terror attack in San Bernardino (Calif.) in December of 2015 has heightened domestic concerns over violence and against civilian populations. Lichtman recently provided TargetSolutions with an in-depth interview of his thoughts regarding effective strategies for first responders during an active shooter incident. This article is Part 1 in a two-part series. Please click here for Part 2.

Here is the Q-and-A:

TargetSolutions: What are the current protocols that are commonly taken during an active shooter incident?

Lichtman: As a country, about 85 percent of fire departments have an archaic type of response that is traditional in the sense of waiting for law enforcement to declare a scene safe. Then firefighters would proceed to enter a cold zone environment and begin treating patients in a traditional EMS fashion. The other 15 percent of fire departments have some type of active shooter response model. These proactive fire departments have identified the best way to increase survivability in these situations is to treat preventable death injuries as close to the time and location in which they took place. Fire departments around the country are identifying this as a standard model that needs to be developed and practiced.  Entering a warm zone environment and treating patients is one of the best things we can do as an industry for our community.

TargetSolutions: What are the characteristics of preventable death injuries during active shooter incidents in civilian environments?

We traditionally fall back on the military model of what’s killing our soldiers overseas. Our theory was that the injuries killing our soldiers overseas are the same injuries that are killing our civilians here at home. There was this notion that “a bullet in the Middle East does the same damage as a bullet in San Bernardino.” Massive extremity hemorrhage is known to be the No. 1 cause of preventable death injury in our soldiers, so it’s probably the No. 1 cause of preventable death injuries for civilians here at home during active shooters, but the reality is that it’s just not true! A recent study done in cooperation with the Committee for Tactical Emergency Casualty Care(C-TECC)  shows that civilians do not have a way to defend themselves in active shooter situations and the proximity to shooters is much closer than it would be if they were in a gunfight as soldiers engaged in combat.

The issue of body armor in the civilian population is non-existent, whereas in the military it’s very advanced. When you consider that most soldiers have a ballistic plate on their torso and a helmet, you realize why there is a very high injury pattern to the extremities. That is the reality in the military. In the civilian tactical environment, we must be data driven and recognize the differences from true combat. For example, applying a tourniquet isn’t the No. 1 treatment we should be focusing on anymore when we are treating civilians with no body armor. Applying a tourniquet is still a very high priority but the data shows that torso injuries result in the highest amount of preventable death injuries in the civilian environment. If we don’t train our people on how to identify and treat that, then we’re negligent as first responders. We have to ask difficult questions like are we really doing everything we can to give these people the best chance for survival?

TargetSolutions: How can the community help first responders during an active shooter scenario?

Lichtman: We know there are plenty of civilians who are trained or can be trained to provide care, information, and even eliminate a threat if they can. The reality is that the response time for a bystander is truly zero minutes. We can never come close to that as first responders. So why not empower the community and correctly train them to not only survive an active shooter incident but what they can do to save themselves, family and friends. Second, teach them treatment options for preventable death injuries that are more specific in the civilian environment and not the military. Trained community members give us the time we need from injury to when advanced care can enter the warm zone. We need to treat this with a whole community-wide approach and decrease the time it take patients to get treated. We can achieve this with bystanders who are actively participating in treatment and not afraid to take action during these disasters.

TargetSolutions: What can first responders do to help train the community should such an event occur?

Lichtman: One of the most effective and inspiring programs around is called the First Care Provider program (FCP). It’s a non-profit organization that identifies the concepts and approach needed to be done by civilians during these environments we have been talking about. It draws from the TECC guidelines that we as firefighters use and adapts them to civilians. In essence, it empowers civilians how to ACT (Actions, Communicate, Treatment) in an active shooter situation, what actions and options are appropriate in different situations, including treatment of preventable death injuries in the civilian populations.

As firefighters, we’re missing a golden opportunity to impact and prepare our community if we do not engage with them on this topic. As firefighters, we are becoming more comfortable and proficient with TECC and must use what we have learned to prepare our community for what they can do to increase all around survivability. Just as we have done in the past with respect to fire prevention and community AED programs, this should be no different.

You might have already heard of some communities attempting to implement this in reaction to the San Bernardino incident. In Rancho Cucamonga, we have trained all city employees and more than 2,200 civilians in that same model. We put on a three-hour course that consists of first care provider training and surviving an active shooter event which focuses on TECC and what they need to do in that type of environment. We have to give the community the tools they need to do a good job so that we can do ours. Further, in Rancho Cucamonga and cities across the country, we’ve employed community trauma kits. We have placed these kits in every city-owned AED compartment throughout the community, these kits include the equipment necessary to manage injuries in a mass type of civilian shooting.

To read Part 2 of this two-part series, please click here.

About the Author:
Ofer Lichtman started out as a first responder in Israel and is currently the Terrorism Liaison Officer Coordinator for Rancho Cucamonga Fire Department (Calif.). Lichtman was instrumental in developing its Terrorism and Tactical Response Program. Lichtman is a member of the Joint Terrorism Task Force and is on the advisory board of the C-TECC.