Social Media: Freedom of Speech or Verbal Abuse

TORONTO, ONT (August 27, 2013) -- Just 2 days ago, Toronto Fire Chief Jim Sales announced that 2 city firefighters had been suspended indefinitely for sexist remarks made about colleagues on Twitter. And believe me, these firefighters made some very nasty comments.

Toronto's top firefighter said,  'In the public domain it's important for all of us to demonstrate a positive image of the Toronto Fire Service.'  The same is true for fire departments throughout North America.

With the introduction of FACEBOOK and TWITTER (and other social media sites) what happens behind closed firehouse doors is no longer a well-kept secret. In the past, Fire administrators were very careful about what information was released to the public.  Today, they no longer have the ability to strictly control information flow about department activities.

 In today’s media environment, citizen journalists have the ability to instantly post commentary, images and video of emergency incidents without the necessity – nor the desire -- to interview participants or confirm details. Once a biased story is posted, the onslaught continues as no named commentators weigh in on tactics, staffing, equipment…even personalities of fire officers.

 The information – whether it’s accurate or not – is often available online even before companies take up. The SHARE button allows that same mismanaged story, complete with demeaning comments from arm chair Battalion Chiefs, to be published throughout the fire-rescue community...and seen worldwide. I see it happen every day.

 Fire-rescue agencies need to beat the “citizen journalists” at their own game. In many cities, department PIOs now publish working alarms as they happen, giving readers informed commentary thus heading off biased remarks. It is a wise practice to implement, because the citizen journalist is here to stay – and here to say!

It seems that larger departments are making the greatest strides in social media. But unfortunately, Volunteer agencies have been slow to adopt an effective social media reporting method. Dealing with social media in the volunteer fire service doesn’t require a by-law change or the addition of an elected officer.  Every station has young men and women who are extremely knowledgeable in the ways of electronic distribution, and their input should be sought when determining the best way to deal with social media.  

 The post 9/11 love affair with the fire service is over, and much of that break up can be attributed to negative information published via social media. Fire-Rescue-EMS organizations, union locals and individual departments and agencies need to take advantage of the positive aspects of social media, the most important being the ability to inform the public and influence opinion.  

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Toronto Paramedics and Firefighters at odds over Medical Calls

Toronto Paramedic and Firefighter - working as a team

TORONTO, ON (August 7, 2013) -- The Toronto Star's Rachel Mendleson reports that concern from Toronto firefighters over being removed from dozens of urgent medical calls is a “smokescreen” to protect jobs, when “what patients need are more paramedics,” according to Geoff MacBride, president of the Toronto Paramedic Association. 

Ed Kennedy, president of the Toronto Professional Fire Fighters’ Association, dismissed these assertions, calling MacBride “a broken record.”

Read the entire story -- what's your take?

Toronto Paramedics Union wants to change the city's Pre-Hospital medical service from Toronto EMS to Toronto Paramedics
Read why

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MVC's: SOPS for First Responders

By: Lou Angeli

Note: For the purposes of providing a guideline for this segment, the term First Responder refers to members of departments who are not full-fledged Firefighters, Paramedics or EMTs. Many of you are trained in basic level EMS or have taken First Responder courses through the auspices of your local emergency management agency. Now we're taking you to the next step, as we demonstrate how you can best interface with your trained colleagues.

The Goal: Quality Patient Care:

The Fire-Rescue-EMS Services have seen more change in the past twenty years then it did in the first two hundred. Delivery of emergency services has become much more diversified, and as providers, we are required to cross train in a number of disciplines, including Auto Extrication. With the move toward rescue-engines, quick response rescue apparatus and tactical service units, this installment of Rescue US outlines how thos who arrive on the accident scene should operate and interface with other agencies.

"All over the World, a report of an MVA sets into motion a multi agency response that includes Fire, EMS, Rescue and Law Enforcement. And in most jurisdictions the simple fact of the matter is that we respond to many more accidents than we do fires."

The Mission of Fire-EMS-Rescue is to save lives and limit property damage, and that holds true during MVc’s as well. Most serious accidents result in traumatic injury to the driver and passengers, so it’s imperative that fire/rescue personnel free trapped victims, so they can receive definitive hospital care. The goal - to begin advanced treatment within 60 minutes of the onset of life threatening injuries.

The Golden Hour
 
No, it’s not a religious TV show - it’s the buzz phrase that refers to the time frame from the point of time when an injuriy occurs - to the 60 minute mark. To call this the critical period is an understatement, because the earlier the patient is able to reach surgical intervention of their traumatic injuries, the greater their chances for survival.
 
Here's a prime international example: In the case of Princess Diana, lost her life following a high-speed tunnel race with paparazzi along the Seine River. Diana's limo was forced into a guardrail, smashing from side to side until it stopped and the paparazzi grabbing one more shot.
 
Paris has no cetralized emergency response number, so citizens phoned police, after a hile police contacted SAMU (French EMS) who requested heavy fire brigade 20 minutes into the incidenr. From the time of the onset of her injuries, until she was released from her vehicle, one hour, ten and minutes had elpased. Subsequently, as EMS physicians attempted cardiac microsurgery aboard a slow moving ALS unit. They essentially served Diana with her death warrant as she bled out.  
 

The Process Begins: Rapid Assessment

In most areas of the country, Law Enforcement is often first on the scene of an MVA. After all, they’re already on the road. Trained police personnel can begin the vitally important “size-up” of the accident scene, even before EMS and Fire arrive.

Once Paramedics or EMT’s arrive on the fireground, their first task is to determine the extent of injury through “Rapid Assessment”. During the Primary Survey, First Responder Teams should consider the mechanism of injury, damage to the vehicle and the patient’s position in the vehicle.

Consider the “Collision Factor” - namely the accident itself, the collision of the patient against vehicular compartments, and the collision of the patient’s own organs against internal body components. It’s also important to recognize if the patient has received any “deceleration” injuries. It goes without saying that treatment should be initiated immediately, in order to stabilize life-threatening conditions, and provide transport without delay.

Simultaneous Rescue and Patient Care

And therein lies the rub. Since MVA’s are multi-agency responses, the “rules of the road” are sometimes unclear, with responders often wondering “who’s patient is it anyway?” There are still departments in North America who DO NOT subscribe to the theory of simultaneous rescue and patient care. I’ve found this to be especially true in those areas where fire/rescue is provided by a government, and EMS by a contract provider.

Wake up Gang! Turf Wars were part of the job a hundred years ago, but in this age of micromanagement and communication, responsibilities should be crystal clear. When the battle lines aren’t clearly marked, the only loser is the patient.

Primary or Initial Assessment
Rescue Teams should provide EMS with immediate access to patients by opening compartments and removing glass. The Initial Assessment by EMS and Extrication Efforts by Fire/Rescue MUST OCCUR SIMULTANEOUSLY in order to remove the victim(s) as quickly as possible.

As the assessment takes place, Paramedics and EMT’s can immediately begin management by maintaining airways, controlling bleeding and stabilizing the C-Spine.

Secondary of Focused Assessment

Once Fire/Rescue personnel are able to remove trapped victims, secondary or “focused” assessment can take place. This exposes the patient full body to providers and allows for complete head-to-toe examination to identify other injuries, and reassess any critical findings that were initially suspected.

Risk Management
 
Chances are that as a First Responder, you may arrive on scene before a heavy rescue or vehicle rescue squad. So consider using some of the basic hand tools that are carried on your first-due rig. In many cases you may be able to provide access to victims using a simple halligan tool or axe. Other first-in tools may include a pry-bar, center punch, porta-power or portable saw.

Following Size-Up, Company members should be instructed to perform duties that will limit risk to victims and rescuers alike, including:

· Initiating scene safety procedures
· Stabilizing the vehicle with airbags or cribbing
· Providing adequate access to the patient
· Deflating tires (check your SOP’s first)
· Removing glass
· Advance a charged inch and ¾ hoseline
· Prepare any additional hydraulic tools
- Install portable scene lighting

Rapid Extrication

Rescue Tools are highly specialized pieces of equipment. You and fellow members should have a thorough working knowledge of these devices, including all appropriate safety precautions and maintenance procedures.

Of course, Rapid Extrication is the key to any successful Vehicle Rescue. Extrication.Com is a wonderful resource for those of you who’d like to learn more about state-of-the-art extrication techniques, especially precautions that should be taken when working with automobile airbags.

I encourage you and your members to review your department’s SOP’s and any local regulations dealing with emergency activities at motor vehicle accidents. Remember, our primary job at any MVA is to deliver quality patient care, and at the same time, keeping our own teams safe.

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Photos used to illustrate this article were taken by the author during an MVC with the driver trapped near Wilmington, Delaware. The incident occured on busy I-95 northbound lanes during a holiday rush. Responders included New Castle County Paramedics, BLS crews from Christiana Fire Company and Wilmington Manor Fire Company, along with Rescue-Engines and Heavy Rescue from Christiana Fire Company, Minquas Fire Company, and Wilmington Manor Fire Company.

Firefighters Train With new Bell 412

Delaware State Police Aviation crew introduce Wilmington firefighters to Bell 412.

Trooper-4 (Heavy), a Bell 412 pictured in the foreground, with Trooper-2 (Bell 407) in the background, as aviation team members work with Wilmington, Delaware firefighters during a training evolution using the rescue basket. As part of its multi-mission mandate, The Delaware State Police Aviation Unit, provides search and rescue along the busy Delaware River and Bay, from Philadelphia area to the Atlantic Ocean.

You can view my documentary on the Bell 407 by clicking here! Many thanks to Master Cpl. Robert McMahon, now retired from DSP, for his assistance in producing the video.

More photos of DSP helicopters and operations on FLICKR.

(photo by Lou Angeli)

Hot Fun in the Summertime!

SOPs and Protocol for Warm Weather Firefighter Rehab

By Lou Angeli

Nation's Bravest.com

Phoenix, AZ (May 22, 2008) -- This past week, I visited with several fire-rescue agencies in the desert southwest, from the Grand Canyon to Tucson. Beautiful country, but oh so HOT. On Monday and Tuesday, temperatures in Phoenix topped out at 110 degrees (F), and it appears that the city may already be on its way to challenging last year's record of 100 consecutive days of plus 100 degree temperatures.

"But it's a dry heat Chief." Sure -- just mention that to the crew of Phoenix Station 7, who attended a working structure fire on Monday at high Noon. They'll tell you that 110 degrees, regardless of a humidity reading of 10%, is HOT! So how does the nation's most prestigious fire department protect its members in such unbearable heat? An agressive firefighter rehab protocol, which includes replacing first-alarm companies once they're out.

Simply stated Firefighter Rehab is designed to ensure that the physical and mental well being of members operating at the scene of an emergency (or a training exercise) don't deteriorate to the point where it affects the safety of any other members. After all, "stressed out" is not a good thing when you're working at America's most dangerous job.

Back in 1993, the US Coast Guard conducted a study dealing with the effects of interior firefighting on the human body. The results of the study are posted in the Coast Guard's Firefighting Initiative, but in short, researchers noted that our body core temperature (even for short exposures), often reaches 104 degrees (F) during the firefight.

(1) Primary Mission

The primary mission for fire command is to identify, examine and evaluate the physical and mental status of fire-rescue personnel who have been working during the emergency incident or a training exercise. Following a proper survey (see below), it should be determined what additional treatment, if any, may be required.

According to FEMA, "Any activity/incident that is large in size, long in duration, and/or labor intensive will rapidly deplete the energy and strength of personnel and there merits consideration for rehabilitation."

2. Launching The Rehab Operation

A specially designated Rehab Area, (or Group) remote from the fire or emergency incident, should be established at the discretion of the Incident Commander in consult with the senior Safety Officer. If the Incident Commander determines that Rehab is necessary, qualified EMPT-Ps or EMTs (assigned to the first alarm response) should be assigned to manage the Rehab Sector under the command of a fire or EMS officer or supervisor. Note the emphasis of the "first alarm response."

EMS personnel must be on scene and available to provide treatment to fireground personnel at a moment's notice. If EMS does not respond as part of the initial turnout, consideration should be given to the fact that OSHA will certainly ask why they weren't... especially if anyone is injured.

Because they work side by side with the front line troops, company officers play an important role in Rehab. In fact, the federal government suggests that the safety of the fireground rests here, at the supervisor level. If a company member shows signs of fatigue or illness, the company officer will likely be the first to recognize the problem. Anticipate Rehab needs early in the incident. During large-scale operations, Incident Command should consider augmenting existing resources by requesting additional EMS personnel or even another engine company or squad, to assist in the operation of the Rehab Sector.

(3) Locating the Rehab Sector

It is crucial for Command to establish The Rehab Sector away from any environmental hazards, or by-products of the fire, such as smoke, gases or fumes. During hot months, the ideal location might include a shady, cool area distant from the incident. In winter, a warm, dry area is preferred.

Regardless of the season, the area should be readily accessible to EMS-Rescue personnel and their equipment, so they may restock the sector with supplies, or in the event that emergency transport is required.

Rehab sites can also be established in the lobbies of nearby buildings, parking facilities, or even inside municipal buses. Misting/cooling systems, heating systems, SCBA refilling and canteen service should be stationed in or around this area as well. During large-scale incidents, like multi-alarm fires, Command should consider establishing Multiple Rehab Areas as the situation warrants.

(4) Coordination and Staffing

Command of the Rehab Area should be assigned to a chief or company level officer, who is designated as the Rehab Officer under most Incident Command structures. The incident itself will determine just how many people you'll need to do the job, however a minimum of two trained EMS personnel should initially be assigned to monitor and assist firefighters in the Rehab Sector. Utilize volunteer canteen or auxiliary members to assist EMS personnel in making "working" members as comfortable as possible.

(5) Evaluation of Fire-Rescue Personnel

It is important for command and company level officers to continually monitor personnel for telltale signs of exhaustion, stress, and or physical injury. Individual members are encouraged to report to the Rehab Sector at any time that he or she feels the need to do so. Symptoms may include weakness, dizziness, chest pain, muscle cramps, nausea, altered mental status, difficulty breathing, and others.Regardless of physical well being, all fireground personnel should report to the Rehab Sector immediately following:Strenuous Activity - Forcible Entry, Advancing Hoselines, Ventilation, etc

• The use and depletion of two SCBA bottles


• Thirty (30) minutes of operation within a hazardous/dangerous environment


• Failure of SCBA

(6) Examination of Arriving Personnel

Arriving personnel should be examined by qualified EMS, who should check and evaluate vital signs, and make proper disposition, i.e. return to duty, continued rehabilitation, or transport to medical facility for treatment. The workup should include:.

• Scoring for Glasgow coma trauma scale.


• Checking Pupils


• Checking Vital Signs, such as blood pressure, pulse, breathing rate


• Checking lung sounds


• Administration of a 2-lead EKG, when chest pain or irregular heartbeat is presented


• Skin condition and color Body core temperature

Heart rate should be measured as early as possible in the rest period. If the firefighter's heart rate exceeds 110 beats per minute, it is recommended that an oral temperature be taken. If body core temperature exceeds 100.6F, the firefighter should not be permitted to wear protective equipment or re-enter the active work environment, until temperature has been reduced and heart rate decreased. It is recommended that re-examination occur at ten minute intervals. Using standing orders or existing protocol, Rehab Team Members should record examination results on medical evaluation forms as indicated by the local jurisdiction.

(7) Treatment During Rehab

Upon completing the physical examination, the following steps should be taken to minimize further risk to fire-rescue personnel: Turnout gear, helmets, masks and hoods should be removed immediately. Prior to ingesting anything orally, fluid or solid, it is recommended that the firefighter clean his/her hands and face with water and a cleaning agent, as provided by Rehab Sector personnel.

• The firefighter should rehydrate


• Oral rehydration and nutrition is recommended in the form of 1-2 quarts of fluids
  
• Body core temperature should be reduced by cooling the body


• Cool body temperatures gradually using misting systems, fans, etc


• Individuals should be offered Oxygen therapy via nasal canulla or O2 mask.


• Standing rest before reporting for further assignment

The firefighter will only report to manpower staging when, presentation is deemed normal by the attending EMS personnel.Note: According to FEMA, Water is the best rehydration agent, however some agencies suggest a rehydration solution of 50 / 50 mixture of water and a commercially prepared activity beverage administered at about 40F. Avoid cooling the body using ice packs or hosestreams. Cooling should be gradual, limiting further shock to the body.

In the event that presentation appears abnormal, the Firefighter should immediately receive additional treatment, especially if conditions persist following fifteen minutes of rest. As is appropriate in most locales, those complaining of chest pain, difficulty breathing and altered mental status must receive immediate ALS treatment and transport to definitive health care. Follow your local jurisdiction's ALS protocols in this event.

(8) Accountability

Members reporting to the Rehab Sector / Group should enter and exit the Area as a team. Their company designation, number of personnel, and the times of entry to and exit from the Rehab Area should be documented. This can be done either by the Rehab Officer or his / her designee on a Company Check-In / Out Sheet. Keep crews together, and don't allow overanxious members to freelance the event.

(9) The Vital Importance Of Firefighter Rehab

Very few firefighters who wear the badge are athletes. But, from the moment the alarm is sounded, and that first surge of adrenaline reaches the heart, we're asking our bodies to work triple overtime. Couple that with 55 pounds of business suit, 1200 degree temperatures and another 50 pounds of hand tools and equipment, and the importance of effective rehabilitation at the fire scene becomes crystal clear.
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Originally published in Fire Chief Magazine -- written by Lou Angeli

A Bittersweet Commemoration and FEMA’s Bitter Mandate

by Lou Angeli

New York, NY (September 11, 2007) -- Today I joined thousands of Ground Zero responders in Lower Manhattan to commemorate the 6th anniversary of the attack on the World Trade Center. Of that group, two hundred of us were were invited to read the names of those who perished 6 years ago, the first time that emergency personnel were offered such a privilege. Needless to say, the event was bittersweet.

For those of you who served at Ground Zero, you’ll recall that we were isolated from the rest of the World in our emergency village. There were no TV's, no newspapers at the disaster site, so we never saw the faces of the missing nor heard the pleas from their friends and families.

But today, 9/11 responders finally came face-to-face with the hundreds of families who lost loved ones during the collapse of the twin towers. When it was my turn to walk onto the stage to stand behind the podium, my reading partner and I were overwhellmed by the thousands standing before us holding out photos of their loved ones and waving so many signs of thanks.

Following the collapses, there were 20 rescues by official count -- perhaps one hundred others that were never recorded. Such rescues, especially those of Port Authority Police Sgt John McLoughlin and his partner Officer Will Jimeno, did a great deal to bolster the spirits of the thousand working at Ground Zero. Unfortunately, only one other rescue was made. Rescue turned to recovery within 48 hours.

In the years since 9/11/01, some fire-rescue personnel still feel that they had failed at their mission. One of them, Jeff Johns, a Transit Authority foreman and Ground Zero rescuer, ended his reading by apologizing to the families saying that, “We wish we could have done more. We tried” Failure is something firefighters, paramedics and law enforcement officers don't take to very well. Neither does Jeff Johns.

70,000 emergency and volunteer responders answered New York City's call for help during the ten day period following the disaster. They came from every state as well as Canada, Mexico, the UK, Germany, Italy, Israel and France. It was a nation coming together -- the world coming together in the spirit of volunteerism.

Some say that we've lost that spirit, but Americans proved again during Hurricanes Katrina and Rita, that they were up to the challenge. As Americans, it is one of those things we do best -- Helping our neighbors in time of need.

Feds Attempt to Break That Spirit

However, the federal government has taken a bold step to esnure that volunteer responders, like most of us who were assembled at Ground Zero, won’t be able to respond to America’s next disaster. And that was the buzz at the World Trade Center site following this year’s commemoration ceremony.

Please take note that my definition of a volunteer responder has nothing to do with a person’s avocation. It includes professional firefighters, paramedics, law enforcement officers, building trades, and medical professionals, who respond to offer their skills during a disaster.

There’s a second equally important tier of responders, those who I refer to as support volunteers. They are the students, housewives, retired folks and church groups who are drawn to the disaster site to help in whatever way that they can. Without them, the crews at the WTC disaster site would not have been nourished or provided supplies.

But FEMA says – NEVER again!

To coincide with the 6th commemoration of the World Trade Center attacks, FEMA announced an ambitious ID program for rescue workers to keep SCUVs from swarming to a disaster scene. SCUV is FEMA’s acronym for self responders – Self Convergent Unafilliated Volunteers.(1)

According to an AP report, The Federal Emergency Management Agency came up with the idea after the World Trade Center attack and Hurricane Katrina in 2005, when countless Americans rushed to help — unasked, undirected, and sometimes unwanted.

Volunteers and front line professionals who I’ve spoken to are livid. Even professional organizations, like the Disaster Research Center disagree with FEMA’s move to eliminate volunteers from disaster response.

“The rescue effort at the World Trade Center reminded us of the important role that emergent groups and volunteers have during major emergencies and disasters.” says DRC’s Patricia Smythe. (2)

Others aren’t as polite as Dr Smythe.

Popular internet journalist, Lew Rockwell suggests that FEMA is simply trying to enhance its credibility by discrediting the volunteers. “FEMA hates volunteers,’ Rockwell says, ‘since they do the actual rescuing and rebuilding, as in Katrina.” (3)

Oddly enough, following 2003’s Hurricane Isabel, FEMA’s issued a report that was clearly very favorable to the volunteer response to that disaster. (4) The headline reads, “Volunteers Perform Vital Function in Disaster Recovery.”

In the next edition of “Rescue Us” we’ll examine FEMA’s Volunteer Embargo with more detail, review the agency's track record and discuss what all of this will mean to the unlucky American community, which will play host to the nation’s next major disaster.

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(1) Feds To Restrict Volunteers From Helping During Disasters - MSNBC

(2) Disaster Research Center (University of Delaware)

(3) “Fema-nists Hate Volunteers” Lee Rockwell

(4) FEMA Release Number:1490-60 (October 20, 2003)