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Learning to Be the Boss in the Fire Service

Blog by Alan Brunacini
Retired Phoenix Fire Chief and Author of “Functional Boss Behaviors”

I’ve studied bosses, and I’ve noticed that the best predictor of behavior in an organization is to look at the way the boss behaves. Often times, however, we lose sight of the fact that the relationships between bosses and workers have a direct impact on the level of service an organization provides.

If you ask anyone who has been a boss in the fire service, they’ll probably tell you a lot of stories about the road rash they experienced trying to get it right.

But I’d be willing to bet a lot of them would say, “I wish someone had told me this.”

After 50 years in the industry, making observations and learning by experience, I’ve put together some notes on what it takes to be a boss in the fire service. These notes, which I turned into my Functional Boss Behaviors book, which is available as a course through TargetSolutions, outline a set of 10 behaviors that effectively support and assist a worker in delivering standard service and added value:

1. Workers Must Take Good Care of Customers: A great deal of our focus is on customers. These are the people who receive services from us. When we are connected to the customer, we should deliver the best possible service to the customer.

2. Bosses Must Take Good Care of Workers: The relationships inside the organization are the launching pad for how we deliver services. The behavior of the boss is the most powerful thing in our everyday environment. If bosses don’t take care of workers, how can we expect the workers to take care of Mrs. Smith?

3. Build Trust or Go Home: Trust is a basic part of any relationship and is what connects the boss to the worker and to Mrs. Smith. Mrs. Smith trusts us because we respond quickly, solve her problem, and we’re nice. The workers trust Boss Smith because he responds quickly, solves the problem, and has a supportive relationship with them. Bosses must foster, develop, and then refine the trust relationship inside the system in order to provide the best service outside the organization.

4. Sweat the Big Stuff: The first priority for every boss is that “everyone goes home.” The routine stuff we do is important and ensures we are ready for the tough stuff; however, the boss’s focus should be on the critical stuff that allows us to deliver service and survive that service.

5. Set the Workers Free: When we become bosses, we gain authority and power that we use to create order, deliver adequate service, and take care of the workers. One of the best things a boss can do with that authority is to empower workers to be independent and self-directed.

6. Play Your Position: Organizations essentially consist of three levels strategic, tactical and task. For the organization to be effective, each level must be independently functional and capable, AND they must be interconnected. The challenge is to knit these three levels together in a way that connects the levels to each other, but points the organization toward the customer.

7. Keep Fixin’ the System: We are always operating within a model of continuous improvement. We follow procedures to deliver service and then constantly critique what worked and what went wrong. That model is necessarily boss driven. Bosses must continually look at SOPs, training, and, most importantly, themselves to improve organizational performance.

8. Create “Loyal Disobedience/Insubordination”: The firefighters the workers have the best set of perceptions, experiences, and connections to Mrs. Smith, and often they have ideas about how to improve service. A willingness to come forward with suggestions and bad news is a mature form of organizational commitment and respect. A good boss is accessible and will help solve the problem.

9. All You Got Is All You Get (Anatomy & Physiology): Every boss has different strengths and weaknesses. A boss’s personal effectiveness is dependent on how the boss uses his very personal skills and capabilities. Small improvements can produce big time results in the boss-worker relationship.

10. Don’t Do Dumb Stuff: This is pretty straight forward, but I bet we could talk all day about the dumb stuff we’ve done or seen others do. Workers can easily identify anything the boss does that is self-serving or stupid, which can be really destructive.

I’ve never figured out how to change somebody’s attitude, but I’ve noticed if you can change someone’s behavior, their attitude will change over time. And I don’t think you do that with leadership. You do that with an online, present, conscious, engaged boss.

About the Author
Retired Phoenix Fire Chief Alan Brunacini is one of the preeminent authors and pioneers of the fire service industry. Chief Brunacini is a 1960 graduate of the Fire Protection Technology program at Oklahoma State University and he earned a degree in political science from Arizona State University in 1970. He graduated from the Urban Executives Program at the Massachusetts Institute of Technology in 1973 and received a Master of Public Administration degree from Arizona State in 1975.

Boiling Point Avoiding the Hypertensive Fallout

Blog by Todd J. LeDuc
Deputy Chief, Broward Sheriff Fire Rescue (Fla.)

A published study by the Institute of Medicine calls attention to a national epidemic that is particularly threatening to firefighters across the globe untreated hypertension.

With cardiovascular events one of the leading causes of firefighter morbidity and mortality, unrecognized and untreated hypertension and pre-hypertension must be more aggressively diagnosed and confronted.

More than 70 million Americans suffer from hypertension while an additional 50 million more are close behind with pre-hypertension.

Hypertension contributes to nearly one-third of all cardiac events and is the leading cause of stroke and renal failure. According to the International Association of Firefighters website, 75 percent of firefighters with hypertension do not have it controlled.

The United States Fire Administration has reported in a meta-analysis of firefighter line-of-duty reports that the leading cause of fire service deaths is heart attacks, which accounts for 44 percent of all firefighter deaths.

Furthermore, a Harvard study concluded that while only 5 percent of firefighter’s time is actually spent combating fire, they are 100 times more likely to have a heart attack.

This may be attributed to the extremely psychically demanding rigors of the service and environment that firefighters operate within. This, coupled with risk factors such as high blood pressure, obesity, heightened cholesterol levels and a sedentary lifestyle, creates an axis of risk.

Several factors were noted that fire service members should realize. First, only 2 percent of adults receive adequate amounts of potassium. This places a higher propensity to elevated blood pressure levels. A concerted effort must be made to eat foods high in potassium.

The recommended daily intake of potassium is 3,500 milligrams. Excellent sources are fish, fruit (especially bananas, apricots, cantaloupe, and grapefruit), peas, beans, and potatoes, among other foods.

Additionally, compounding the propensity toward high-blood pressure is the over consumption of sodium. In fact, the average adult unknowingly takes in 3,400 milligrams of sodium per day when the daily recommended allowance is 2,300 mg.

This is often a byproduct of processed, canned and prepared food son top of additional table salt added to meals to enhance flavor in preparation or at the dinner table. The study also reviewed contributory factors of excess weight and its effect of hypertension. The researchers concluded that modest reductions of 10 pounds in overweight adults through diet and modest exercise would result in an 8 percent decrease in cases of hypertension.

Of course, the first step in combating hypertension or pre-hypertension is identifying it. This can only be done by routinely monitoring your own blood pressure and sharing the results with your healthcare provider.

The Institute of Medicines findings show we can’t rely on our health care professionals to solve this problem. As the commander of your own ship, it’s imperative you take an aggressive role in managing your blood pressure.

As fire service professionals, your cardiovascular risks are greater than those of the general population and as such your diligence should be greater. Hypertension is not named the silent killer without good reason ignorance is not a panacea for wellness and heath.

Make a pledge to learn your pressure, modify your risk and contributory factors, and embark on a path of prevention. Your proactive imitative can prevent you from reaching a boiling point.

About the Author
Todd J. LeDuc is the deputy chief of department for Broward Sheriff Fire Rescue in Florida. With more than 25 years in the service, he lecturers and publishes frequently on fire service leadership, safety and wellness topics. He has worked extensively with fire departments in more than a dozen states with master and strategic plans, accreditation, department evaluations and consolidation studies.

The Paradoxical Commandments of Fire Service Leadership

Blog by Doug Cline
International Society of Fire Service Instructors, Vice President

It’s always good to remember what we were taught by our mentors. Listed below are The Paradoxical Commandments of Leadership, which I was raised on during my early years in the fire service. These commandments of fire leadership are right on, not only for those of us in the fire service, but every profession and in all areas of life.

Here are The Paradoxical Commandments of Fire Leadership:

1. People are illogical, unreasonable, and self-centered. Love them anyway!

2. If you do well, people will accuse you of selfish, ulterior motives. Do well anyway!

3. If you are successful, you win false friends and true enemies. Succeed anyway!

4. The good you do today will be forgotten tomorrow. Do it anyway!

5. Honesty and frankness makes you vulnerable. Be honest and frank anyway!

6. The biggest men with the biggest ideas can be shot down by the smallest men with the smallest minds. Think big anyway!

7. People favor underdogs, but follow top dogs. Fight for the underdogs anyway!

8. What you spend years building may be destroyed overnight. Build anyway!

9. People really need help, but may attack you if you help them. Help people anyway!

10. Give the world the best you have and you’ll get kicked in the teeth. Give your best anyway!

Ironically, I was searching for something else in the office when I ran across an old text book that I utilized while going through the International Society of Fire Service Instructors Company of Development Series many years ago. One of the authors of the book, Fire Chief Dan Jones, wound up being my mentor. The book Managing People happened to fall to the floor during my search and randomly opened up to page 32 where these commandments were listed.

This just happened to be at an opportune time in my life when I was looking to clarify focus, create drive and provide sound direction for my future. These commandments were like a sign from above.

Over the past year, I’ve had many discussions with colleagues across the country about the issues and frustrations we encounter on a daily basis in the fire service. It can be depressing. And I’m sure it’s not just the fire service. The future holds so many uncertainties. I’ve watched friends with more than 25 years be laid off. We see fire stations closing, training centers shut down and good leaders cut at the knees by ram-rod political events.

I believe the book falling open to the exact page of The Paradoxical Commandments of Leadership is one of those events the kind that make you say, OK, I get it!

My frustration with the fire service is like riding a roller coaster. Many issues influence my feelings. I often find myself disheartened with current events that happen routinely in our business. Thankfully, The Paradoxical Commandments, which were written in 1968 by a 19-year-old Harvard student named Kent Keith, have given me, and will continue to give me guidance.

Keith’s commandments were part of The Silent Revolution: Dynamic Leadership in the Student Council, his first book for high school student leaders, which can be carried over to everyone in every profession.

I laid down the Paradoxical Commandments as a challenge, Keith is quoted saying. The challenge is to always do what is right and good and true, even if others don’t appreciate it. You have to keep striving, no matter what, because if you don’t, many of the things that need to be done in our world will never get done.

Thank you, Mr. Keith, for your wisdom. It’s as true today as it ever was.

About the Author
Douglas Cline is a student of the fire service serving as training commander with the City of High Point (N.C.) Fire Department and assistant chief of administration with the Ruffin Volunteer Fire Department. Cline is a North Carolina Level II Fire Instructor, National Fire Academy Instructor and an EMT-Paramedic instructor/coordinator for the North Carolina Office of Emergency Medical Services. Cline is a member of the North Carolina Society of Fire Service Instructors and the International Society of Fire Service Instructors where he serves on the Board of Directors as The First Vice President.

CDC Makes It Clear Vaccination Records are Your Responsibility

Blog by Katherine West
Author and consultant on infection control

In December of 2011, the Center for Disease Control published updated guidelines and recommendations regarding vaccine records. The document clearly stated that EMS personnel are indeed covered under these guidelines, stating Health-Care Personnel (HCP) might include (but not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students, trainees, contractual staff not employed by the healthcare facility.

It is very clear EMS is covered. It should also be noted that National Fire Protection Standard 1581 makes the very same statement and recommends following the CDCs recommendations.

Due to the outbreaks across the country for measles and Pertussis, it is essential that vaccination/immunization records be available to assist with prompt exposure follow up. Here are the CDCs statements:

– HICPAC and CDC have recommended that secure, preferably computerized, systems should be used to manage vaccination records for HCP so records can be retrieved easily as needed

– Each record should reflect immunity status for indicated vaccine-preventable diseases, as well as vaccinations administered during employment

Medical records belong to the individual, so it is your responsibility to request the information be sent to your department. A declination form should be signed if an individual fails to request records.

Every health-care worker should be aware of their immunity status and possible need for a preventive vaccine. Vaccination is critical to risk reduction and concern in an exposure situation.

For more information, please check online at www.ic-ec.com.

About the Author
Katherine West is an expert in the field of infection control. She’s worked in the industry since 1975 and has served as a consultant to the Center for Disease Control and the National Institute of Occupational Safety and Health. She authored Infectious Disease Handbook for Emergency Care Personnel and is a well-traveled lecturer and author.

A Case for Company Performance Standards

Blog by Bill Sturgeon
Retired Division Chief of Training for Orange County Fire Rescue Department in Florida

During the 1970s, the fire service became involved in Emergency Medical Services. Then, during the 80s, it was Hazmat. And in the 90s, it was technical rescue. After 9/11, Urban Search and Rescue (USAR) became the new service everyone wanted to provide.

We trained hard and became proficient at delivering these new services. But there may have been some unintended consequences.

I recently retired as the chief of training for a large metropolitan department in Florida. The department has its fair share of fires and I noticed numerous times that critical errors related to fundamental firefighting techniques were being made.

Pulling the wrong line (too short, too long), hooking up to an intake instead of a discharge, not properly using forcible entry tools, poor ground-ladder deployment. The list goes on and on.

If this sounds familiar, read on! This is how your department can develop a low-cost training program, set performance standards, improve basic skills and have some fun in the process.

To begin with, fire chiefs must use company performance standards to measure progress. These can be internally developed standards or you can refer to NFPA 1410 (Standard on Training for Initial Emergency Scene Operations, 2010 Edition) and use it as the standard.

The bottom line is that this training must be supported from the top. All officers must get up, get out, and participate with crews.

Find out who are your strongest players. Find out who are your weakest links. And determine who your top company is so they can mentor and teach others.

Company officers must train and challenge their crews to meet or exceed standards (measured in time and accuracy). Drivers can review basic hydraulic skills, or you can develop a scenario to solve that includes a basic pumping problem.

Finally, firefighters should strive to master each task. Why? Because it is their job. Because they are the future leaders of the fire service (drivers, officers, and instructors) and they need to be capable of passing down knowledge to the newest members.

It’s better to learn these skills in the beginning of your career. They will serve you well.

Developing the plan:
1. Identify special requirements for your jurisdiction. Are there special circumstances you must consider when developing your training outlines?

2. Determine what standard you are going to follow. Is it going to be the NFPA 1410, your own, or a combination of both?

3. Develop necessary drills and use your reference materials.

4. Break down each task into a separate drill. No more than one sheet.

5. Set a time limit to complete the task or refer to NFPA 1410. This will be your performance standard for initial training.

6. Enlist some of your senior people to test the drills out (chiefs, captains, and commanding officers). This is the alpha test. Get some photographs of them in action and post them prior to having the company perform the drills. This creates buy-in. Obtain their feedback on how the drills can be improved.

7. Identify facilitators (instructors and/or mentors) and have them master the drills while troubleshooting any problems. This is the beta test. Now they are ready to begin teaching!

8. Start the drills.

9. All drills should be performed in the appropriate PPE. You are trying to get crews comfortable in their gear when operating at the scene of an emergency. It also will assist in acclimatizing personnel for inclement weather. Do not forget rehab!

10. Have each company pair up with another company in an adjoining district to practice and master the drills. Your facilitator, company officer, or chief should set up these training sessions. If meeting on the line between districts, keep one unit in service for response or use a reserve apparatus.

11. Have your mentors and/or instructors meet during regular intervals to review the training and teaching points. This is continuous quality improvement.

12. Publish each company’s drill times in a public area (the TargetSolutions platform is a great tool for this). This builds pride and competitiveness.

13. Document and share lessons learned. Explore new ideas and techniques.

14. Once all of the training is completed, develop the department performance standard and demand each company meet it. Require monthly training on the standards then supervisors should quarterly spot-check and regulate annual performance standard testing.

You will see dramatic improvement in basic skills if you use this approach. I sure did!

About the Author
Bill Sturgeon is a retired division chief of training for the Orange County Fire Rescue Department in Florida. Sturgeon was a 30-year veteran of the United States Fire Service. During his career, he served as a volunteer, military, municipal, and county firefighter and held many positions, including paramedic, EMS supervisor, company officer (special operations), safety officer, battalion chief, assistant chief and division chief. He is a graduate of the Executive Fire Officer Program at the National Fire Academy.

Celebrate Your Department’s Legacy

Blog by Battalion Chief Chris Hubbard
Hanover Fire & EMS Training Academy

I liken it to Tom Brokaw’s bestselling novel The Greatest Generation. That sparsely populated group of remarkable individuals who left a footprint on our profession without even knowing. You know whom I’m talking about. The old-timers. The ones who don’t come around quite as often anymore and take with them the tale of your department’s journey.

With their departure comes a lack of knowledge for the legacy of our fire service. We are left scrambling to put the pieces of the puzzle together and celebrate the impact they’ve had on today’s generation of firefighters.

As a battalion chief in the Hanover Fire & EMS Department in Virginia, I recognize a need to educate tomorrow’s industry professionals on the history and the legacy of the department. While the importance of fire behavior, streams, ladders and EMS skills are essential to the development of a firefighter, so too is the passing on of our history.

The past is a direct reflection of who we are as a department. The vision and mission is directly impacted by individuals who painted the canvas of our department and the footpath for those who will take ownership of it.

To tackle the lack of knowledge and respect for past generations – and their influence on the department – our training division established a program that both honors our veterans in the department and delivers an invaluable learning experience to the fire academy recruits.

Life members of the Hanover Fire & EMS Department were assigned to current academy students with an expectation to personally interview them. The result was to provide the students with a deeper understanding for the decades of services by the life members, as well as the history of the station. The students were held responsible for presenting their research in both a written report as well as an oral presentation to fellow recruits.

The challenge for today’s training department is providing quality programs on a tight budget. But at little to no cost, a similarly designed program will re-energize both the new recruits and officers alike. It engages that dwindling generation of fire service professionals and calls home the importance of celebrating our past to develop our future.

What are you and your organization doing to capture the history and legacy of your organization? Capture it now before its gone forever!

What’s the Best Way to Maximize My Personnel’s Training

Blog by Jacob Johnson
Pearland Fire Department in Texas

I’ts natural for fire service instructors to question whether they are training their personnel properly. They may wonder, am I training my people on the right things? The answer to that question is simple: Training coordinators should focus on what needs to be covered, as well as what personnel want covered. This can be accomplished by performing a needs assessment that centers on training needs vs. training wants.

This can be accomplished by performing a needs assessment within your department that centers on training needs vs. training wants.

The most important question instructors face is what type of training should they deliver? They may wonder, should I focus on the basics or should I focus on advanced training? Here is my stance: Are the basics of firefighting important? Yes, they are very important and much needed to survive in this profession.

The fire service, however, is prone to focusing too much on the basics and not nearly enough on the more challenging training or skills we need to improve. By completing a needs assessment, you can use those results to determine whether you should be focused on the basics, or pushing into the more advanced material.

My personal goal as an instructor is to give a training class that is challenging to my audience and makes a difference in their performance. If that goal is accomplished in every class, everyone is happy. Now, sometimes a simple building construction class is challenging to some members of the department. But at the same time, it is taken as a refresher for some of the other members and not really much of a learning experience. It’s important to remember training is all about learning and what new skills your students can extract and spread to the rest of their crew or department.

Unfortunately, many instructors don’t train enough themselves. They become so confident and comfortable teaching the basics, they become lazy and even begin to think they will look bad if they teach outside of their comfort zone. They may be afraid they won’t have all the answers to all the questions, or they may be challenged by someone more up-to-date, making them look bad.

We can’t let ourselves become paper-stack instructors. Meaning, we can’t become an instructor who piles up certifications (aka: a paper stack) and then forgets what we were taught, and even worse, didn’t bother to learn more.

In order to give a challenging training class, which will truly benefit our students, we must take classes that challenge us and make us better; giving us the confidence and knowledge we need to be effective. After all, it’s on us, as instructors, to make training as impactful as possible.

About the Author
Jacob Johnson is a driver/operator for the Pearland Fire Department in Texas. He has been in the fire service for more than 10 years. He has taught at extrication schools, recruit academies, and several suppression schools over the last decade. His certifications include: FF Intermediate, Driver/Operator, Fire Officer 1, Fire Instructor III.

Stop the Entertainment During Fire Suppression Operations

Blog by Christopher Naum
Chief of Training, Command Institute, Washington D.C.

There’s an often overlooked factor contributing to unsafe practices during fire suppression operations, one that we rarely talk about. In short, we need to stop entertaining ourselves during operations and instead focus on comprehending and reacting to evolving risks.

Rather than practicing appropriate risk management, some individuals employ adverse behaviors that occur on a tactical level while incident commanders and company officers believe firefighters are completing their assigned tasks. This compromises accountability. Here’s the short version of something I came up with a few years ago and have discussed during a number of my training programs:

Tactical amusement: Engaging in any practice or tactic during fire suppression, support tasks or operations that place personnel at risk for the sake of entertainment.

Tactical diversion: Diverting from an assignment while engaging in fire suppression, support tasks or operations in such a way that places personnel at risk.

Tactical circumvention: Deliberately getting around an assignment or disregarding risk assessment and incident action plans.

If we’re going to reduce firefighter injuries and deaths, we need to do the right thing, at the right time, for the right reasons, and in the right place. We must stop the entertainment.

The demands and requirements of modern firefighting will continue to require the placement of personnel within situations and buildings that carry risk, uncertainty and inherent danger. Fire suppression tactics must be adjusted for the rapidly changing methods and materials impacting all forms of building construction, occupancies and structures.

The need to redefine the art and science of firefighting is nearly upon us. Some things do stand the test of time, others need to adjust, evolve and change. Not for the sake of change only, but for the emerging and evolving buildings, structures and occupancies being built, developed or renovated in our communities.

It’s no longer just brute force and sheer physical determination that define structural fire suppression operations. Aggressive firefighting must be redefined and aligned to the built environment and associated with goal-oriented tactical operations that are defined by risk assessed and analyzed tasks that are executed under battle plans that promote the best in safety practices and survivability within know hostile structural fire environments, while maintaining the values and tradition that defines the fire service.

Remember one thing. Don’t ever underestimate what you might encounter on any structure fire, or what might change in a second. Focus on the occupancy risk not the occupancy type. And know your buildings, your team, and your capabilities. Here are some valuable links that can help you meet this mission:

 Remembering FDNY Black Sunday … Multiple Firefighter LODDs  
 Chicago: Anatomy of a Building and its Collapse 
 Chicago: Anatomy of a Building and its Collapse-PDF Download 

Also, if you have not had a chance to look over the emerging website,  Buildingsonfire.com , take some time to explore the rich content. It’s still under construction, with an expanding wealth of information, research and data that today’s firefighter, company officer, and command officer need to know.

The authoritative and informational site that provides leading insights on fire service issues related to building construction for the fire service, firefighting operations and command risk management for operational excellence and firefighter safety.

Buildingsonfire.com, coupled with its companion sites CommandSafety.com and TheCompanyofficer.com, will continue to provide prominent and timely information to support the continuing traditions and missions of the Fire and Emergency Services.

About the Author
Christopher J. Naum is a 36-year fire service veteran and a nationally recognized and highly acclaimed fire officer, instructor and author. Chief Naum is an authority on building construction, command management and firefighter safety. Chief Naum is the executive producer of buildingsonfire.com. Chief Naum has developed and delivered training to more than 200,000 personnel nationally and internationally throughout his career. He can be followed on Facebook (facebook.com/buildingsonfire) and twitter (@buildingsonfire).

The Power of CRM: Collective Situational Awareness

Blog by Paul LeSage
Author of ‘Crew Resource Management: Principles and Practice’

The trauma call was going smoothly. Emergency responders Kyla and Nick were communicating well with the paramedics, and the 46-year-old male patient had just been successfully intubated based on all clinical and technical indicators.

The veteran Nick asked Kyla if she wanted to take over care of the patient while he drove. Kyla felt confident, but wary. She would be in the back with a very senior fire medic named Jeff, who was known as a demanding, but excellent clinician. Giving Nick a nod yes, the care was verbally transferred and Kyla climbed into the back of the ambulance with Jeff for the 12-minute trip to the Trauma Center.

Within three minutes, the patient began bucking the ET tube, and Jeff, who was managing the patients airway, called Kyla to give 2.5 of Versed. As Kyla drew up the Versed, she became distracted by her hospital report. Pulling out one vial of Versed, she grabbed a 3cc syringe and pulled the entire 2 millimeters into the syringe.

Dropping that vial, she quickly grabbed a second one and drew up another 0.5 ml, wiped off the IV port, and pushed the meds. The patient quickly became quiet and stopped fighting the ET tube, and as she prepared to put the syringe into the sharps container Jeff blurted out, “How much Versed did you just give?”

“2.5, as you requested,” she stated, suddenly self conscious.

“2.5 milligrams, or 2.5 millimeters?” asked Jeff.

“Well, I guess I gave 2.5 millimeters,” Kyla said, suddenly realizing she gave several times the therapeutic dose.

When the agencies involved in this particular incident conducted an analysis of the events, there were several surprises.

In teaching Crew Resource Management (CRM), one of the most powerful lessons that can be communicated involves the responsibility that every team member has to speak up if they perceive a discontinuity in how events are unfolding.

Several studies have demonstrated that good teams are always striving for coherence, described as clear communication where everyone is on the same page.

An important component is the realization that every team member sees things a little differently. It turns out that regardless of the uniformity of your training and education, it’s our experiences that form the basis of our interpretations about how events unfold and what actions to take when compressed for time.

This means team members are constantly striving for common ground, which can be defined as those cues, signs, symptoms, and strategies that are easily agreed upon within the team. However, when we see a team member diverge from what we believe is appropriate, there is a sudden rift, or tear on the fabric of common ground. Often, our response is one of anger or frustration. Why can’t they see they are taking the wrong action? What is wrong with them?

Studies on human behavior demonstrate our level of assertiveness will be predicated on how comfortable we are within the team, how much perceived expertise the person making the decision has, whether they outrank us in the official agency hierarchy or by experience (novice vs. veteran), and our own intrinsic comfort with managing conflict.

Surprisingly, in a study of several hundred clinical, dispatch, and technical errors, more than 74 percent of the time a team member (or members) observed a problem or overt error at the moment it occurred. But unfortunately, no one spoke up to try and correct the situation. In CRM, we know this as there are two ways to say yes, and only one way to say no.

Essentially, if you say nothing, even when you suddenly lose common ground, you have said, Yes, I agree to the actions taken by a team member.

One goal of CRM is to help us overcome the barriers associated with speaking up, and learn how to intervene effectively, which involves respectful behavior and assertive engagement.

During the incident outlined above, the veteran medic Jeff realized that when he saw Kyla pull out a 3cc syringe, it bothered him. He had been taught to minimize just this type of error with Versed by using a one cc syringe. He wasn’t paying close attention when she drew up the Versed, and Kyla admitted that she lost concentration when distracted by the radio report.

Of several valuable findings, two stand out as being common in these types of incidents. One, medication, once given, cannot generally be withdrawn. Once in, it’s in. This means we must pay close attention, particularly if we are veteran operators, to every step of the administration process.

Clearly state doses out loud, use specific language, and repeat. Secondly, when there is a tear in the fabric of your common ground, you have a responsibility to speak up respectfully and assertively. When Jeff saw the 3cc syringe, he should have said something.

Remember the power of CRM is collective situational awareness and there are always two ways to say yes, and only one way to effectively say I disagree.

About the Author
Paul LeSage worked for 29 years at Tualatin Valley Fire & Rescue in Oregon, and for seven years at Life Flight in Portland, Ore. He retired as the Chief of Operations in January, 2010, and has more than 33 years of experience as a firefighter, paramedic, and flight paramedic. Paul has co-authored a popular new book on Crew Resource Management, along with several Fire and EMS Field Guides.

Great Attitudes Lead to Great Things

Blog by Tim Holman
Chief, German Township Fire & EMS

There are many books and studies that say attitude is the most important element of an individuals success. This is especially true for those of us in the emergency medical services. It doesn’t matter how skilled an EMS provider might be, if they have a bad attitude, the care they deliver will suffer.

Ask yourself a question, would you want to be treated by a surgeon that has a bad attitude? Of course not.

Some may argue it doesn’t matter what type of attitude a person has, as long as they are skilled nothing else matters. But consider the fact that negative feelings determine our outlook on situations.

If a surgeon responds to a severe trauma victim with a negative attitude, should they be looking at the victim with an optimistic or a pessimistic view? Don’t fool yourself into thinking it doesn’t matter. It does matter and it matters a great deal.

Negative thinking, spawned by negative attitudes, leads to negative behaviors. The EMS providers’ behavior at an emergency scene is first impacted by the attitude, then the behavior. The behavior is the type of care he/she delivers to the patient.

Have you ever heard someone say, “he is a great paramedic, but he has a bad attitude?” The truth is there is no way a paramedic can be great if they have a bad attitude. The bad attitude cancels out the skills the individual may possess.

Great paramedics have great attitudes to go along with great skill. Most EMS systems will tell you the majority of complaints from patients have to do with the EMS providers’ attitude and seldom with patient care.

Every day EMS providers have an opportunity to make a difference in the lives of others. No, it is not pleasant to be called out at 2 a.m. for a patient who has been sick for three days. Drunks, overdoses and uncooperative patients are difficult. But if they are approached with a positive attitude, the interaction will go much smoother for both the patient and the EMT.

Remember in EMT class when they told all of us we would have these types of patients? Well, we chose to be EMTs anyway. Now we have a responsibility to be the best EMTs we can. The only way to do that is to perfect our skills and our attitudes.

Don’t let negative people around you determine your attitude. Attitude is a choice. Choose a good one. It means you look at each patient and ask yourself, how can I make things better for this person? Do I really care? Great EMTs care. They care about the patient, the community in which they serve, their co-workers and the organization in which they work, and their attitude reflects it.

As an EMT you are a role model. You are there to serve your community, provide the best care possible for the sick and injured, and meet adversity with a positive outlook. You have a responsibility to reflect confidence and compassion. You are a problem solver and people listen to you because you have a positive attitude.

Recently an EMT transported an elderly patient to the hospital. He said the patient appeared frightened and lonely. She had no family and was being admitted for treatment and tests. The EMT went down to the gift shop, purchased some flowers and took them back to the patient. The woman smiled for the first time during the transport and thanked the EMT repeatedly. His attitude made a difference for this patient. Sometimes the best treatment doesnt come from needles and medication. Sometimes the best treatment comes from a caring attitude. Great attitudes always lead to great things!