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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.

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.

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!

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.

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.

Read more

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.

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!

Blog by Brian Ward
Officer with Gwinnett County Fire Department in Georgia

One of the most essential things we do as firefighters is Train for Adaptation. This helps us be ready for any situation.

Keep in mind, firefighters never really encounter identical incidents. Its true some have similarities, but each has its own unique twist. Thats why its critical we are capable of adapting spontaneously when a new challenge presents itself.

I recently spent several days with Chief David Rhodes of the Atlanta Fire Department during the Georgia Smoke Divers Course, which is based on a few items I believe are pertinent to any firefighter wishing to survive. The first item is paying attention to details. If we neglect the details, we can find ourselves in serious trouble.

As the accident triangle shows, small acts of omission today turn into major injuries and fatalities tomorrow. Examples of these small things include inspecting your turnout gear and SCBA and ensuring your tools are safe. As the saying goes, failing to prepare is preparing to fail.

Once on scene, paying attention to details will give you clues where the fire is or may be going. In addition, looking for details should be applied to all incidents regardless of nature.

The second item heavily covered was the topic of knowing your own limitations and your equipments limitations. Do you know the length of time you can perform a strenuous level of work in gear and breathing air? Could this dictate your decisions on scene? Absolutely.

Ask yourself, if I was trapped inside a structure, would I give up because I am tired or would I dig as deep as I could to self extricate? One might argue they’d never give up when it’s concerning life or death, but how many people die 5 feet from the door trying to get out?

So, how do you truly know what you are capable of? Have you ever prepared for this type of mental and physical test? The greatness of this type of training is testing your limitations and not just hoping you can rise to the occasion.

All of the training that took place during the courses six days was based on the concept of Training for Adaptation. The first two items discussed, were meant to build a foundation. The third item was making decisions in different training scenarios. Hands on training with heat, fire, smoke and chaos impacting decisions.

The major factor for me was answering the question, can I do it when I’m mentally and physically exhausted? The training scenarios were beyond any training program I’d ever attended.

It’s important to remember when training, you need to train for what you are going to face. Do not allow yourself to become complacent with your skills. Practice picking out details by conducting simulations and pay attention to the minute nuances of a building. Inspect your gear, tools, and equipment on a daily basis. Discuss this with your crew. Once your gear is inspected, drill wearing all of your gear. And know your limitations.

One of the training items at my station is based around gear acclimation and simply developing a tolerance for the change in temperature from winter to summer. There is an absolute noticeable difference when a firefighter is acclimated to an environment. It’s important to know how your body works.

Try to practice drills that require you to think about how you would mitigate a situation. If you practice extricating a down firefighter, change the location and situation each time. It will require you to think. As with any training, critique afterward on how to perform more efficiently next time.

About the Author
Brian Ward is an engineer/acting officer with Gwinnett County Fire Department in Georgia. He is a past training officer, chairman of the Metro Atlanta Training Officers and currently serves on the Honeywell Advisory Council. He is a State of Georgia Advocate for “Everyone Goes Home” and the Membership Task Force Co-Chair and Live Fire Instructor for ISFSI. Brian was recently awarded the National Seal of Excellence from the NFFF/EGH.

Ward has an associates degree in fire science and a Fire Safety and Technology Engineering Bachelors Degree from the University of Cincinnati. He is the founder of the website, FireServiceSLT.com and Georgia Smoke Diver #741.