It may seem a long time ago now, but it was a brutal summer, ending in the final week of September when Los Angeles posted an all-time record high temperature of 112 F. It was also around this time when the NFPA published the Loss of Life data for 2009, and the record shows a significant decrease in deaths related to fire rescue activities. We need to celebrate the success stories of decreasing fire rescue injuries and loss of life.

Incident rehabilitation was featured in dozens of local media pieces over the summer months on how workers were coping with the hot conditions, and many were accompanied by pictures of proud rescuers who were given the opportunity to briefly rest, cool, rehydrate, and be evaluated. This was occurring before they resumed work at that incident scene, or at the others that would occur before the shift ended.

I also watched this summer the rehabilitation that professional athletes utilize in hot weather during football, soccer, and baseball games. We should view ourselves and our operations as "more valuable." Why? Our job is actually much more difficult then theirs. Ours is completely unpredictable. The athletes know they don’t have to play another full game an hour from now. Our public safety personnel do not.

I witnessed an occasion this summer where five firefighters were brought from the same incident, fortunately none with life-threatening problems. What was the issue? Nothing particular to that individual fire scene, but due to the fact that three working incidents had been managed back-to-back by the crews, with the third being the most difficult, on the hottest day of the year.

And those crews were not even halfway through their shift yet! In extreme weather conditions, rehab must be diligently applied at the first incident, to enable our professionals to prepare for the incident or two or six that still may be coming.

Consider taking a picture of one of a group of your fire/EMS personnel rehabbing at a working incident or training, and pair it up with a photo of a football team cooling on the sidelines. Make sure everyone of your personnel understand the priority of team preparedness, and the physical benefits of optimal performance by every team member. Rehab is a vital part of professional sports, and of professional emergency operations.

In the agencies where I work, we had many hot weather incidents, and all were managed using an incident rehabilitation program that has evolved over the past few years.

What is notable is that we started with the process, and now we are moving to the "props" that will make it more effective and more professional. Agencies have invested in cooling systems, fans, shades, drink dispensers, icemakers, and other equipment that increase the effectiveness of the process. There are no "Gatorade" signs hanging around (and no commander gets a Gatorade shower at the end of the incident), but the rehab area is beginning to look more organized.

It is our opportunity at the end of summer operations to reinforce the benefits of incident rehabilitation within our organizations and with our members. Even as we prepare in many locales for cold weather rehabilitation, there is no time like the present to prepare for another hot summer starting in about six months.

Here's a five item list to consider.

• Have you cooperated with your mutual aid and other nearby organizations to establish a consistent rehab process? Maybe even develop a regional rehab unit.
• Have you extended your program to cover the law enforcement, utility, and media personnel who are sweating in the same sunshine as you are? This builds incredible positive public relations.
• Have you considered and applied local donations of equipment and supplies to enhance the rehab operation? For those of us with the tightest budgets, it is worthwhile.
• Is the rehab operation paperwork filed with the incident report? Does someone check the sheets to make sure all working crews received rehab, or is some other process in place to ensure compliance of all crews with the program?
• Have you begun to use the rehab program as a bridge to other physical (and mental) well-being programs for your personnel? Some agencies have used the development of the rehab program to initiate an interaction with local universities, sports medicine programs, and nutritionists. That interaction then extended to other programs that brought routine fitness evaluations, nutrition training, and wellness programs into the organization.

Our personnel deserve the time, respect and attention to detail. The incident rehabilitation process is a critical process that ensures that each emergency operation can be carried out as safely as possible. And that detail will allow us to produce healthy retirees.

Too many candidates get sucked into concentrating too much on the check-off list for their tactical without realizing it. In the process, they lose control of the fire and their score gets hammered.

What's your best tactic for rescue or knocking down the fire? An aggressive attack on the fire! Go fight the fire with your resources. In the process you will get the necessary boxes checked off on the rating sheet, could put out the fire and get a top score.

Yes, you want to cover all the bases to make sure the boxes are checked off on the rating sheet, but again, isn’t the best tactic for extinguishment and rescue an aggressive fire attack?

However, concentrate on a solid plan. Many candidates put too much into play out of sequence early on in the exercise and make the problem bigger than what the raters have actually given them. Often, candidates will give assignments to units to place positive pressure ventilation, a crew to pull ceilings, assign more than one unit to carry out search rescue and other tasks, call the canteen truck, and add a rescue problem that wasn't given to them.

This is before they have the first line on the fire, a RIT team assigned, utilities pulled and a crew sent to the roof for ventilation. The fire gets away from them and they are out of equipment and resources before they realize what happened. How long can you tread water?

These are major areas the raters will be checking off on your scoring sheet that can rack up big points. You must come out swinging. Once you have proven you can handle the call from the beginning, you're nailing it. As soon as the raters know you got it, they will help you over the top to that next badge. It's a beautiful thing when it happens.

Have a plan
Here's a simple example of a fire problem: You give an on-scene size up at a fire involving a residence with fire blowing out a bedroom window. You order your engineer to hook up as you and your firefighter start pulling lines. If you followed this sequence, you have just lost the fire!

The problem here is you went from size up directly into tactics. Most candidates start off on the right foot with a size up of the fire. Then they make a fatal mistake in going directly into tactics without a plan. They confuse tactics with a plan. Once given the fire problem, focus all your energies on developing a plan.

Without a plan, you are out of control. What was your plan on this fire problem? By just taking a few more moments, you would have one. When confronted, candidates that go immediately to tactics regroup and say, "My plan is to confine and put out the bedroom fire." O.K., but if you didn't say it, you didn't have a plan. Size up, plan, and then tactics.

Last week my fire department was dispatched to assist to a neighboring department with a house fire. I happened to be at the firehouse so I quickly proceeded to don my gear and grab a jump seat — for once I didn't have to drive! The rear of the ladder truck soon filled with four other members and we turned out down the street.

One of the members sitting across from me was a newly promoted lieutenant. As with many volunteer departments, a line officer is often found riding in the back seat when another line officer has already grabbed the front — we can argue that practice at a later time. I noticed that this new lieutenant was not wearing his seat belt. I immediately said "Dude, where's your seat belt?" Motioning at the retracted seat belt as he glared at me, he replied, "Right here."

My response? "How 'bout you put your seat belt on so that if we crash this thing you don't come across the seat and kill me?" Somehow I went from scoring a coveted jump seat en route to a working fire to the middle of a stand-off. Grudgingly, he put his seat belt on and we continued on our way.

As we pulled up to the scene, this newly minted lieutenant snidely plucked at his seat belt strap and said, "Is it all right to take this off now?" At that point, I felt I'd had enough. Having spent several years as a line and chief officer, this lieutenant for me was setting an extremely poor example for the younger and more impressionable members riding in the rig. I then proceeded to explain my feelings to this lieutenant — perhaps a bit harshly — until another senior member put the discussion to rest by simply stating, "At this station, we wear our seat belts." End of story.

Epitomizes problems
So why do I share this story? I do so because this 3-minute episode epitomizes the problems that we face in today’s fire service on many different levels. The title of this year's Safety, Health and Survival Week is "Committed to Long-Term Results." But how can we commit to long-term results if those in positions of leadership and power won't follow the rules themselves? How is it possible that a line officer can not only get away with not wearing a seat belt, but can then argue the issue with someone who tells him to put it on? Have we learned nothing from those who have given their lives before us?

Imagine this scenario: A fire apparatus rolls out the door with two young firefighters and a line officer. One of the young firefighters sees that his officer isn't wearing his seat belt and figures he doesn't need to wear it either. The truck crashes and the young firefighter is ejected and killed. Who is at fault? The reports and the scuttlebutt will all say that if this young firefighter had just put his seat belt on, he would still be here today. People will question his poor judgment and shake their heads at what they believe was a rookie mistake. But was it?

In reality, that same line officer who set a silent example by not wearing his seat belt is largely responsible for this hypothetical fatality. Like it or not, when you pin a fancy gold horn on your collar or put that shiny white front piece on your helmet, you’ve become someone that younger members look up to and follow. Even when you don’t realize it, these members are emulating you and following your example. Senior firefighters, line officers and chiefs all create a culture that younger and more junior firefighters will learn to live by. It is this culture that can save or cost a life.

If the fire service truly wishes to bring about long-term results, it's time to start holding people responsible for their actions. It seems that every time one of us is injured or killed, the rest of us are hesitant to ask questions or pass judgment. As a result, this culture never changes. How do I know? Look at the number of firefighter fatalities over the past 20 years. Does anyone really see a difference?

So how should we hold people accountable? It's time to start wielding a big stick. Fancy posters and cute little stickers telling you to wear your seat belt haven’t worked. Every year there are still numerous line-of-duty deaths that are a direct result of someone not wearing their seat belt. Want to make a difference? Start randomly stopping your rigs and checking to see that everyone has their seat belt on. If someone doesn't, suspend them. More than three infractions, show them the door. Maybe it's time to have the cops start citing people who can't get the message through their heads. After all, not wearing your seat belt is against the law!

Until these types of attitudes change or people are held responsible for their actions, I don’t believe we will ever reduce the number of line–of-duty deaths, especially those that are a direct result of vehicle crashes. Unless those in charge begin to lead by example and create a culture in which reckless driving, poor attitudes and lack of seat belt use are no longer tolerated, the culture will never change and we will be doomed to repeat our mistakes over and over again.

To those who have already begun to move this ship in a positive direction, my hat is off to you. And to those that refuse to help the rest of us reduce the number of firefighter fatalities by continuing this reckless culture ... I say maybe it's time to go.

One of the biggest myths in fitness and in injury prevention is how to properly train the abdominal wall.

Think of your abdominal muscles like a corset or weight belt, and with that visual in mind get rid of the notion that crunches and leg raises make your abs stronger.

Your abdominals' primary job is twofold: to create trunk stability and core/spine stiffness. The key to strong abs is possessing the ability to maintain postural control with the abdominal wall engaged for the duration of an event.

In public safety, this directly affects patient handling and lifting. The exercises in this video — plank reach, lateral plank and core press — are simple and highly effective. They allow you to get stronger while on duty and in uniform.

The keys to the exercises are simple, perfect positioning and progressive hold of the positions. As you get stronger, the duration of the exercise will increase, which will directly affect the ease at which you do your job.

Since crunches actually increase your chance for back injury, and leg raises cause postural distortions that increase your chance for back and knee injury, it only makes sense to incorporate some very safe, effective and easy on-duty exercises into your training.

Train your abs 2-3 times per week for 2-3 sets of a progressive hold. Start out with 20-30 seconds and build up from there, but remember that form always trumps function. As with all your training, it's quality over quantity.

Let's look at the way we displace the side(s) of vehicles today. First off, be it a car, SUV or even a pick-up truck, most vehicles today have four doors (two on each side) more often than not.

When we "pop" doors today, the door materials often shred, tear and rip apart, leaving us to attack it another way or try to cut the door off.
Why does this happen? Well, think of doors of having "hard" points and "soft" points.

The lightweight door materials are coupled with high-strength latches and hinges by the door crash beam, and the whole ensemble is tied tighter together than before due to vehicle construction and design and its inherent ability to move crash energy throughout the vehicle structure.

So we know door "pops" have issues. But today's cutters can make short work of cutting hinges and latches. Why not just cut them in the first place?

Cutting hinges and latches to remove the door creates much less stress and strain on the vehicle, which eases stress on the patient and the tool operator.

The evolution actually goes faster and smoother, making it safer. The key for this cutting technique is the ability to "visualize what you seek" (i.e. observe the hinge and/or the latch).

We must ensure the cutter blades get completely around the hinge or latch. We do not want to place the tips of the cutter on the hinge, which will make the tool "tip loaded" and cause damage to the blades.

To do this, we must make space between the door and vehicle body so we can get the blades in and around the objects to be cut.

Watch tool reaction during this technique! Many times, we're cutting square or rectangular material, which will cause the cutter to "swing" or torque quickly.

Also, ensure you have hard protection in place between the tool work and the patient and interior rescuer. As with roof post cuts, when you find wires in your path, cut them with a hand cutter like medic shears or battery cable cutters.

Why? Because many vehicles feature side-impact airbags in doors and side curtains in roof edges; these devices are impacted by static electricity as well as pressure and shock. When you're using the cutters, static charges can back surge into the wiring.

As well as door displacements, side removals call for using cutters to make relief cuts into the B-post. These areas are usually well reinforced, so cuts can be difficult.

Displace trim at the base and top of the B-post to check for seat belt pretensioners, side curtain cylinders and the adjustable seat belt bracket.

However, you will find that in taking both doors and the B-post as one unit — i.e. the total side removal goes faster — gives us almost the same amount of space as a roof removal and makes instant access to remove the patient from the vehicle.

It also sets us up for a rapid dash lift if we need to displace the dash to make additional space for disentanglement. The total side removal evolution has a quite a few names and can be done a few ways.

However, I am going to describe to you how to perform a B-post tear or a maxi-door evolution.

These areas are usually well reinforced, so cuts can be difficult. We need to displace trim at the base and top of the B-post to check for seat belt pretensioners as well as side curtain cylinders and the adjustable seat belt bracket.

There are a variety of ways to facilitate a side removal, but one of the most effective ways is to perform a B-post tear.

We start off with forcing the latch on the back door. Open the door fully; in fact, hyperextend the door forward a little. Then, taking the power hydraulic cutter make a relief cut into the base of the B-post, key point as deep and as straight as practical.

Cut the top of the B-post as close to the roofline as possible. With the spreader, place one tip or arm above the relief cut on the base of the B-post and the other tip or arm against where the floor rises vertically to meet the rear seat.

Open the spreader. As the tool opens, the base of the B-post is pushed away from the vehicle's rocker panel and the relief cut tears forward.

As it does, the weakest points are the spot welds on the base of the B-post; they pop and the base of the roof post comes away.

Sometimes the tear isn't straight and might have bits of metal still connected. Take the cutter and cut them away. Then the entire side swings out on the front door hinges.

Once the entire side is out past 90 degrees, we can cut the hinges, displace the hinges with a spreader or push the entire side further back and tie it off.

This will facilitate disentangling our patient quickly and safely. Remember though, rescuers, ALWAYS place hard protection between our tool work and the patient and interior rescuer.

ALWAYS cut wiring with a hand tool and not power hydraulics due to static concerns and ALWAYS cover up sharp edges, as this evolution will create a lot and in close proximity with our patient.

Try this evolution. I have found it goes faster than a normal door displacement in our work today, is much safer to both the patient and tool operator and creates almost the same amount of space as a roof displacement but on the same side as the patient, so we can have immediate access and disentanglement pathway for our patient.

As always — be safe out there, rescuers!

We have written several times in the past stating the importance of specific standards for the fire service. The majority of these standards originate from the National Fire Protection Association.

Standards on personal protective equipment establish minimum levels of performance that are intended to reflect firefighter needs.

The process for creating and revising standards is fully dependent on the technical committees which are established with fixed size committees. These include a balanced membership from various interested categories including end users, labor unions, manufacturers, research and testing laboratories, and special experts.

However, these standards only become better when individual firefighters and other experienced end users outside the process provide their input to the committee to reflect the practical realities of personal protection.

This month we are writing to encourage you to consider providing proposals and comments on several standards that are in the process of being developed or being revised.

Before we address the current standards in revision, it is important to understand how anyone can provide input to the NFPA process. Unlike many standards development organizations, the NFPA provides two different phases for public recommendations.

Formerly known as public proposals, the first stage is public input. This phase permits individuals to put in suggested changes to an existing standard that are considered by the committee writing the standard in preparing their first draft of the revision.

Any topic is open for consideration, but the NFPA requests that the proposals be put forward in a format where a specific change is suggested and a statement for substantiation should be provided with the change.

The committee reviews each suggested change and either agrees to make the revision or disagrees by rejecting the proposal. However, the committee can also agree in principle by making a related change or accept part of the proposal.

While each suggestion is separately reviewed, the committee may react to a large number of proposals on a single topic and respond with a change that addresses each of the related proposals.

The NFPA is in the process of implementing new procedures where public proposals are viewed more as suggestions as the committee creates a first revised draft of the standard.

The second phase of public involvement is public comment. NFPA is also adapting the rules for how this part of the process is carried out, but for the current year the existing procedures will be in place.

Public comments are submitted after the NFPA publishes its report on proposals, which shows how each of the public comments are handled and an initial draft of the revised or new document.

Like proposals, comments provide recommendations for specific parts of the proposed standard or revision. These recommendations can take the form of adding or changing text, adding new language, or removing parts of the standard.

The committee again reviews each comment and decides whether to accept or reject comments. As with proposals, comments can also be accepted in principle or in part, but another option open to the committee is to hold the proposed change to the next revision.

The actual procedures for submitting a public proposal (now public input) or a comment can be found on the NFPA's website, under the tab for "Codes and Standards."

The forms appear to the right side of this page and include explanatory notes for submitting the respective change. In addition, draft documents can be reviewed by selecting the specific standard of interest from the list that appears to the left side of the same page under the heading, "Document information pages."

By choosing the respective standard, information on that standard will appear, including a full draft of the standard, notices and minutes of any meeting, and a list of members for the respective committee.

The pages for each individual standard also provide a list of specific deadlines for submitting input or comments for the particular standard.

The most important document to look at is the "Report for Proposals" on new documents. This document provides information on what proposals were submitted and how each proposal was addressed by the committee.

In the next part of this article, we'll outline several standards under development or revision – and what they could mean for you.

In a previous article I discussed the development of a structural PPE risk assessment. In this article I will touch on what happens with the introduction of real data into the risk assessment process.

The use of department data can bring to light important considerations that may have been overlooked. This article will focus on threat recognition and prioritizing the threat.

Organizations must start the risk assessment with a serious and realistic reflection of the actual environments that the PPE will be expected to perform in, not just structural firefighting.

I separate this potential threat into two separate risk categories: thermal threat and non-thermal threat. These are not hard and fast, but should be considered templates and decisions should be based on data.

I recently worked with a metropolitan fire department to introduce data into the risk assessment framework with interesting results.

Data was collected from the fire department to determine when firefighters were actually wearing the structural PPE. The data that was compiled included not only structural fires, but also structural alarm soundings, vehicle fires, vehicle accidents, false alarms, and various other situations.

The risks to the firefighter during each situation, and potential threats, were reviewed.

The data was reviewed and the numbers are as follows:

The department wore structural PPE more than 32,000 times in a year. Structural fires accounted for 3,989 structural fire responses. In addition, the fire department responded to 6,287 alarm soundings wearing structural PPE.

They also responded to 991 vehicle fires, 8,892 vehicle accidents and 11,885 false alarms in structural PPE. A key piece of data is that more 14,100 of the calls were "after dark."

"After dark" is from 6 p.m to 6 a.m. The fire department is also responsible for more than 3,000 miles of freeway and roadways.

What did we do with the data?
The risk potential was developed in Step 1 of the risk assessment and (previous article) was used to prioritize the data according to threat and occurrence as well as thermal and non-thermal threat to the firefighter.

The threat to the wearer was prioritized by the significance of the threat and how often they occur using the following chart:

Each of these categories is further divided into two groups — "Non-Thermal Threat" and "Thermal Threat" — to represent the actual environment that the firefighter will experience.

While structural PPE is primarily designed for structural firefighting, it provides necessary protection for other related fire service duties.

There are many times when firefighters will don structural PPE for a variety of reasons including use as protection from the elements.

The findings
The highest occurrence with a significant threat came from firefighter visibility. Firefighter visibility on the fireground and on the roadways is critical to firefighter safety.

Given the high frequency of exposure of fire personnel to low visibility/dark situations, research was conducted into possible solutions for trim configurations on the structural ensemble.

The goal of the research was to use various trim configurations and colors to enhance firefighters' visibility and increase their conspicuity when operating on emergency scenes wearing PPE in both daylight and low light/night scenarios.

Daytime visibility
Studies reviewed indicate that daytime conspicuity is improved by increasing the contrast between the wearer and the background scene through the use of trim with fluorescent color pigments.

The conclusion of a study by Ziegler and DuPont is that high contrast and high visibility are achieved in the daytime using lime-yellow or yellow.

Fluorescent yellow-green is included in NFPA 1971. As the daylight fades, the presence of low wavelength light (such as UV) enhances the brightness of fluorescent colored trims and leads to increased in the visibility and conspicuity of the wearer.

Afternoon and nighttime visibility
In low-daylight approaching nighttime situations, the fluorescent materials take on a much greater importance as they are recognized at greater distances with greater accuracy.

This lengthens the reaction time from when drivers see the wearer and increases safety. Several studies conclude that saturated colors are more conspicuous during nighttime operations than white.

Reflected white is very common during nighttime operations and the use of reflected color is important to firefighter safety.

Conclusion
The research indicated that fluorescent yellow-green retro-reflective trim provides increased contrast between the wearer and the scene background during daytime and low light operations and the saturated color increase visibility and conspicuity during nighttime operations. Drivers may not recognize reflected white as a person above the reflected visible white noise.

This led to a review of the current specification. The purpose of the risk assessment is to make sure that all of the situations that PPE is worn are considered. Visibility is just one such issue.

With training, all NFPA 1971 certified PPE will protect the firefighter in that "bad day at the office," but the PPE must also be practical and safe for other uses as well.

You are getting ready to clear your EMS unit from a fire standby when the Truck Captain asks you to check out Chuck, one of the members of his company.

He was walking around the side of the truck when he walked into an open cabinet door, striking his head pretty hard. He did not pass out but has been feeling dizzy for the past 20 minutes since the incident.

His fellow members of the company tell you he seems a little "dazed" and although you don't know Chuck very well, he does some a bit slower than normal. He tells you, "I think I just got my bell rung — I'll be fine."

So, what do we do with Chuck? In emergency medical services, we need to consider the worst case scenario. In the case of a traumatic head injury, the worst case scenario is bleeding in the brain.

Assuming he does not have a neck injury (which is always possible, but we have discussed that in previous columns), the next consideration is a concussion.

Let's take a look at both of those conditions so we can convince Chuck what to do and what to expect over the next few days and weeks.

Even surprisingly mild trauma such as a fall from standing can cause bleeding in or around the brain. There are some situations where the risk is greater than normal.

Patients that are elderly have an increased risk because the human's brain shrinks slightly with age. This means that there are blood vessels between the brain and skull that are somewhat stretched and have an increased tendency to be damaged and bleed.

In addition, this potential space between the smaller brain and the skull allows blood to accumulate before symptoms can be present.

A younger patient would have symptoms more quickly because of the pressure on the brain. In older patients it takes some time for this pressure on the brain to build up.

If Chuck takes any blood thinners, the risk of bleeding is also increased. These include warfarin (Coumadin), Plavix, heparin and possibly full dose aspirin (although aspirin is much less of a risk than the other three.)

While if he was taking these medications he probably should not be working as an active firefighter, that is a discussion for another time, and there is always the possibility that he is not completely honest with everyone — he may want to hide that he is on these medications so he can continue to work, so make sure you ask.

In Emergency Medicine, we try to figure out which patients need imaging such as a CT Scan and which patients do not.

We can't CT every patient with a bump on the head or we would be irradiating a lot of healthy brains and clogging up the emergency department.

It is beyond the scope of this article to discuss the specific rules that are sometimes used, but it is helpful to know some of the symptoms or conditions on the list so we can use that information to convince Chuck that he really needs to go to the hospital and likely will need a CT scan to rule out bleeding.

Some of these conditions include:

• Persistent headache
• Vomiting
• Age over 60
• Drug or alcohol intoxication (hopefully not applicable in this case but intoxicated patients are difficult to accurately assess)
• Persistent anterograde amnesia (They cannot remember new things)
• Seizures
• Not fully alert, or a Glasgow Coma Score 14 or less (15 is normal)

If these conditions are present in Chuck or any patient with a head injury, use this information to convince them to go and get checked out, as the risk of bleeding is higher.

OK, so let's assume Chuck does not have bleeding in his head. But he continues to be a bit dizzy and is speaking more slowly than normal. Thus, he likely has a concussion.

The definition of a concussion is controversial because of the implications for athletic activity, work and liability.

One feature often debated is if a loss of consciousness is needed for a patient to have a concussion. In general the consensus is now that loss of consciousness is not required.

So the best definition of a mild concussion is a transient alteration of mental status after a blow to the head that can include headache, dizziness, nausea and unsteadiness.

A more severe concussion includes a loss of consciousness and amnesia.

Does every concussion need to go to the hospital? Probably not — we see a number of protocols in the athletic arena that indicate that if the symptoms are very brief and there is no loss of consciousness, and the athlete is back to normal in less than 15 minutes, they may even be able to return to the field.

Now this varies significantly based on the level of play — a little leaguer would likely not return to play, but a pro hockey player in the Stanley Cup probably would.

How does this apply to our firefighters? Well, it does give us a number of cases to study to try and figure out what is the best course of action — a lot of athletes are experiencing concussions so there is a lot of money and research looking at them.

But the immediate issue is that we don't really know the risks of allowing patients who have had a concussion to return to play or work.

We believe that if a person who has had a concussion has another one while still symptomatic, it might be bad, but we don't know specifically why.

Based on a number of the classifications of concussion and the recommended actions, I believe that if our firefighters still have any symptoms that last longer than 15 minutes, or have any of the risk factors for bleeding listed above, then evaluation in the emergency department is definitely indicated.

What about long term? There is a "Post Concussion Syndrome" that is the constellation of symptoms that can continue for weeks or months after the initial trauma.

These symptoms can include headache, difficulty concentrating and dizziness. This syndrome is not often seen in children or in countries where there is little to no litigation and compensation issues, so maybe there are some exacerbating circumstances.

But one could see how a firefighter with these continued symptoms would have a hard time returning to work.

Back to Chuck. He has already had symptoms for longer than 15 minutes so he should be checked out at the hospital. He may or may not get a CT scan, but I think it is clear he has had more than just having his "bell rung."

The National Hockey League and the National Football League are finally realizing that concussions are a serious threat to their players so we should recognize the threat to our firefighters. I believe we do, so let's stay vigilant.

Stay safe.

By Jay Lowry

A great deal. Unlike 20 years ago, we live in a very connected world and the global market is influenced by local events with repercussions felt in cities and towns across the United States.

When Greece received a bailout from the European Union, stocks plummeted in the United States — and didn't stop dropping for a while.

Why should firefighters or EMS care?

There is a steady drum beat for financial reform including pension reform, eliminating deficit spending and reducing salaries. These are local effects of a national and even international problem. NFPA 1710 staffing is being attacked as wasteful and the financial crisis helps those who want to have barebones service.

Some firefighters state this was the worst budget year in history. Not hardly.

In many areas, the big bust will be the 2011-2012 and 2012-2013 budget cycles.

The mood of the country coupled with rising debt, deficit spending, massive entitlement programs and loss of investor confidence will combine to make the current situation look tame.

Warren Buffett is known as the "Oracle of Omaha" because of his financial acumen. Testifying before Congress last month, and in subsequent interviews, Buffett discussed rising concerns over municipal bonds.

He has divested, as have others, in muni-bonds because cities and counties are finding it very hard to make payments. This is very bad news.

All is not lost. Fire and EMS will survive but both must plan for tighter budgets while educating the public on the importance of the services performed.

The economy will rebound eventually but don't expect it to happen soon. Even so, the effects will have consequences for years to come.

In my previous column, I used the analogy of football. In this column, I want to take this a step forward. In October, the college football world was rocked by the news from Pennsylvania State University.

I am not going to get into the debate of rights and wrongs or analyze the situation; rather, I think we can take away many lessons from the events that occurred.

Rehab is slowly becoming a part of our incident scenes and training ground activities, and I say "slowly" as I question whether it has truly evolved to match the intent for which it was designed. As members of the rehab section, we have to make tough decisions. Should personnel return to the incident scene or continue with training? Are personnel being rehabbed to the level they need in order to return to the fireground or training ground?

We know that firefighters and emergency service personnel have a determined attitude, which is good but can also be deadly. None of us wants to deny fellow firefighters the ability to fight fires or improve their skills by training. But are we jeopardizing our personnel by allowing them to go back to duty if they are not physically able to perform the job?

This is a tough question. On paper, it is relatively simple as we know we don't want anyone to be harmed or in danger, yet it happens every day, and in some instances, officers command rehabbed firefighters to go back.

This column seems to be asking more questions than answering them. Quite frankly, when it comes to ethical situations, we need to ask more questions. The answers are not always clear and, in some cases, will put you in a difficult predicament.

You have to ask yourself the bottom-line question: Are your actions or inactions jeopardizing your reputation and putting you at risk of liability? You have to make some tough decisions if your officer is not handling the situation as you would expect him or her to.

A great activity for rehab-focused training is to talk about a few scenarios and how to respond to them.

Scenario
You are assigned as the rehab officer. You have a battalion chief who is sent to rehab. Per rank, she outweighs you. Her blood pressure is 190/110, and even though she appears to be symptomatic, she will not admit to any other symptoms. She orders you to release her back to the fireground. In addition, the incident commander agrees with releasing her. How would you handle this situation?

Situations like this are tough to deal with. There comes a point when you are not able to convince some individuals to seek medical help; we know this to be the case in EMS with the patients we respond to. The best defense in these situations is to provide as much information as possible about the risks. If they are still not convinced and you are overruled, you must document very thoroughly. Unfortunately, there will be adverse outcomes at times, and you need to do your best in presenting the risks and then documenting the events.

Conclusion
The dilemmas you encounter may not be the same magnitude as the events at Penn State, where criminal activity was involved; however, you might have to make ethical decisions that could be the difference between life and death. Based on the circumstances, you need to take the appropriate course of action. This may mean that you will need to call outside agencies to investigate.

Thorough documentation to protect yourself and the organization is paramount. Looking the other way just once could erase a lifetime of accomplishments.

As 2011 ended, we marked the 40th anniversary of one of the most influential pieces of legislation involving the nation's fire service. In 1971, the United States Congress appropriated funding to establish the National Commission on Fire Prevention and Control. Up to this point, subjects such as fire suppression, fire prevention and related topics were perceived not to be a national problem but a local issue.

After two years of work, the Commission released its report entitled "America Burning." The report was groundbreaking for its time. It called for a national fire academy, the development and enforcement of uniform building codes and the establishment of a national fire administration, along with other initiatives. The report estimated that 12,000 people were dying annually as the result of fires in this nation.

"America Burning" also recommended that more emphasis be placed on fire prevention, increased training of fire service personnel and educating the public about fire safety.

In 1987, the USFA convened a workshop to examine the changes that had taken place as a result of the Commission's recommendations and to develop plans for the fire service that would take us into the 21st century.

In 1999, President Clinton appointed a panel "to reexamine the evolving role of the fire services in the safety and sustainability of today's American communities." The commission's report reached two major conclusions:

1. "The frequency and severity of fires in America is a result of our nation's failure to adequately apply and fund known loss reduction strategies. The primary responsibility for fire prevention, suppression and action on other hazards dealt with by the fire services properly rests with state and local government. Nevertheless, a substantial role exists for the federal government in funding and technical support."

2. The panel's chair, George K. Bernstein, stated, "Until the USFA is empowered by funding and staffing to truly become the leader in our nation's firefighting efforts, unless the fire services are adequately funded, and unless local communities enforce known fire preventive and suppression measures, the establishment of this commission and its efforts to develop recommendations will have been an exercise in futility."

The reason I have given you this historical information is because it appears that the current congressional leadership is about to diverge from this four-decade-old policy. Recently the U.S. House and Senate passed the Fiscal Year 2012 Appropriations Plan.

The 2012 spending plan lowers the amount of funding for the AFG and SAFER programs to $337.5 million. This is a collective reduction of $135 million from FY 2011, when both programs were funded at $405 million. The USFA is cut by $1.5 million, and the program's budget is now more than 40 percent less than it was in 2002.

Congress further reduced the amount available to other Homeland Security Initiatives, including Urban Areas Security Initiative, the State Homeland Security Grant Program and Citizen Corps. These programs were cut by nearly 50 percent from their 2011 funding levels.

We have made substantial progress in the fire service in America since the National Commission on Fire Prevention and Control first issued its report. Civilian fire deaths have decreased by 66 percent, and firefighter fatalities have dropped from 157 to 87 in 2010.

At the same time, the number of calls answered by our nation's firefighters has continued to increase. Now a fire call is received every 1.18 seconds in our country. Also, the number of firefighters answering these alarms has been drastically reduced.

In particular, the number of volunteer firefighters in this country has dropped by 10 percent in the past 25 years. During that same time, the average age of volunteer firefighters has increased dramatically. In 2009, the percentage of volunteer firefighters over the age of 50 was 21.8 percent; this is nearly double the amount it was just 12 years earlier.

The fire service in America needs to respond to related cuts in the federal budget, and we need to do it quickly. In the time it took you to read this article, fire departments in our nation responded to nearly 200 alarms.

We need to tell our federal legislators that the foundation laid by the Commission on Fire Prevention and Control needs to be supported and built upon rather than destroyed. We need to tell them that programs like AFG, SAFER and the Fire Prevention and Safety Grants are working and now is not the time to take steps backward.

Setting up a successful public access defibrillator (PAD) program should be on the forefront of every fire and EMS agency’s agenda. The American Heart Association notes that for every minute a person is in a cardiac arrest, their survivability decreases by 10 percent. Having easy-to-use PADs that are quickly accessible by the public increases the probability of delivering life-saving defibrillation sooner.

Here are the top five things to consider when starting a PAD program, along with some of the strategies I used to start a PAD program that has grown to more than 1000 PADs over just a few years.

Involve the stakeholders
With any successful startup program, getting the key players involved at the beginning is critical. Start by inviting those organizations and individuals who are the stakeholders – those with a vested interest in the success of starting a PAD program. This group should include fire, law enforcement, EMS, 9-11 communications, hospitals, cardiologists, the local American Heart Association, and other interested parties.

Start with regularly scheduled meetings and open discussions on the importance of PADs to the survival of cardiac arrest patients. You may begin the initial meeting by walking the group through the continuum of care that each member provides, starting at 911, through prehospital responders, to hospitals, and finally outpatient care. This helps everyone understand the many vital roles needed to help increase survivability. This group may grow and develop subgroups as other key tasks or steps are identified.

Funding
After the stakeholders have bought in to the program, one of the next steps is locating funding. Funding will be integral to starting and maintaining the program. A well connected stakeholder group may be able to tap into their individual networks to locate funding, and this task may also turn into a subgroup of the stakeholders. Funding may come from a variety of other sources, including community grants, endowments, fundraising events, matching funds, or other programs.

Hospitals may also have access to funding sources or use other methods to lower costs. For example, in one successful program, a hospital used its purchasing power to lower the costs for PADs. They did this by purchasing in PADs in volume at 100 units at a time, and also by helping to negotiate a lower price. This lead to a lower cost through a volume discount and lower shipping costs per unit. The hospital also offered to use their staff to help augment the program, store, and even tracking individual PADs. Their CEO was an early member of the stakeholder’s committee, and he quickly understood the importance of PADs to saving lives. He was used as part of the negotiating team to help get the lowest possible price for the PADs.

PAD selection and training
The team should determine whether the program will use a single model of PAD, or whether a variety of brands will be used. An argument for a single model is that as the program grows certain things become easier (and cheaper) due to economy of scale such as training, system upgrades, recalls, purchasing batteries and patches. Having one brand may also create a direct pipeline to the company for maintenance and support. Since CPR training includes PADs, if one particular brand of PAD is selected, then models for that particular device can be incorporated into training. This ensures realistic training based on the system.

The team should also ensure the PAD model integrates with the brand of device that prehospital responders are using. This will allow for similar defibrillation technology and protocols from PAD to responders, and ultimately the receiving hospital.

During this step, the team can also begin to focus on the location and placement of the initial PADs in the community. The team should consider sites where mass gatherings are common, areas with large populations over 50 years old, schools, and sites that take EMS longer to respond.

Marketing
This can be ongoing from the beginning of the process, and is important for creating “buzz” in the community. Once word is out, you may be surprised at the demand for the program from individuals and businesses.

Some marketing ideas can also be turned into fundraising opportunities. Two ways to get the word out and involve the community are mass CPR training days, and a contest to name the PAD program. The front of the PAD cabinet is also a prime marketing location and can be used to further market the program with contact information and logo placement.

The PAD program can also rely on local media for marketing. Depending on the situation, consider asking for coverage of successful cardiac arrest “saves,” or giving awards to citizen heroes for taking action.

System Integration
Early on, prehospital providers may be reluctant to embrace the program. Some may view it as encroaching on their turf and won’t fully understand the value PADs bring to increasing survivability. You should clearly explain that PADs will keep patients alive and offer responders a better opportunity to provide their skills to potentially survivable patients. Here are some integration considerations:

• The dispatching center should have a database that will notify the call taker if a PAD is located at the site, and also provide instructions for use. Some computer aided dispatch programs (CADs) have the capability to flag addresses with PADs located on the property.
• Some groups may not embrace the change because they may be required to perform new roles or change their operation, i.e. police may have to carry PADs in their patrol vehicles. It is important to overcome these arguments, as police often beat firefighters and EMS to the scene and can start defibrillation even sooner.
• First responders should understand the importance of PADs and also be able to transition from a PAD to their device for transport. There needs to be guidelines and training on switching from a PAD to a more advanced cardiac device, and also when should they continue using the PAD.
• This goes back to the importance getting key players from various agencies together so they can communicate the importance of the program back to their organizations.

Conclusion
These are only some of the areas to focus on prior to setting up a PAD program. These programs are easy to start and garner great success by increasing patient survivability from sudden cardiac arrest. If fire and EMS agencies do not step up and provide the necessary leadership to start a PAD program, some other organization will fill that role and take a significant new standing in your community. A successfully implemented PAD program is one of the only tools presently available for a city or EMS system to increase the rates of patient survivability from sudden cardiac arrest.

Feel free to contact me for any questions on PAD programs. I've helped start several programs, including one which received the national heart safe community award.

By Ken Lavelle, MD, FF/NREMT-P

Anytime we need to do a job, we look for tools to help us do it more efficiently. However, these tools also need to help us do it reliably. If a tool causes us to get wrong information, then it is not a very good tool. This is particularly the case in medicine — and remember, EMS is medicine.

One of the challenges of the EMS provider in rehab is to quickly do intake and assessment as a company or group of firefighters enters the rehab area.

If the firefighters have to wait 10-15 minutes for anyone to see them, they very well may wander away. We need to engage them quickly, not only to make sure there is nothing life threatening occurring with their condition, but also to "get them in the system" and make sure they stay in rehab for the appropriate amount of time.

Usually one person will be getting their name, age and company. This "scribe" can be anyone — it does not need to be an experienced medical provider.

They could be a cadet, a new member to the organization, even a spouse or friend that got sucked into a major event because they were out with an EMS provider that had a responsibility to respond to the incident. Obtaining this information can occur at the same time other activity is going on.

I usually like to get the firefighter to sit down and get their gear off, so the cooling down process can start. Next, we need to get baseline vitals. This is a mildly controversial area.

My former Division Chief, a very experienced EMS and fire physician, prefers to wait 10 minutes and then get a set of vitals. His view is that it does not matter much what the initial vitals are at the start, and that it is much more important what the vitals are at the time that the firefighter may be released.

I think there is some validity to this, however I would prefer to know if there was a problem sooner rather than later. If a firefighter's heart rate is 200 because he is in a dangerous arrhythmia, I don't want to miss this, even for only 10 minutes.

If their blood pressure is extremely low or extremely high, I also need to keep a better eye on them. While in most circumstances they should have either a complaint or physical appearance that should clue us into this abnormality, this is not always the case.

I think both approaches are reasonable — discuss with your medical director which is better for your department.

I have found that obtaining vitals is often the bottleneck in the initial rehab evaluation. There are two vital signs I definitely want immediately — heart rate and blood pressure.

A third vital sign that I think is reasonable to obtain sooner rather than later is a carbon monoxide level. I am not concerned about the temperature because it is my opinion that getting an accurate core body temperature is not feasible in the field.

Doing so requires taking a rectal temperature, something neither I nor the firefighter are much interested in doing. The other, non-invasive methods of getting a temperature are not very reliable, and an elevated temperature is almost always associated with a significantly elevated heart rate.

So how can we get these vitals quickly?

The pulse can be obtained by the good old fashioned method of feeling a radial pulse and counting, but we can also use a number of other tools, such as pulse oximetry, a heart monitor or a carbon monoxide monitor.

have found that either feeling and counting the radial pulse, or using CO oximetry, is the most efficient in obtaining a pulse rate. Using CO oximetry allows us to get both a heart rate and a CO level with one action.

The concern is of course is whether it is truly reliable. I believe it is, but if you are concerned, feel for a pulse at the same time and compare the results. This will likely not add much time to the task.

The blood pressure also needs to be obtained quickly and reliably. Now I am generally a fan of automatic blood pressure cuffs. In the hospital, these work fairly well and allow us to trend the blood pressures — follow them over time.

However, in the field, I have found that they are becoming more and more of a problem. Too often the machine pumps up the cuff and then slowly goes down. And up. And down. And down some more. And then back up. And then down. And then fails to give a value.

EMS providers end up staring at the screen awaiting this important vital sign. So, I think the best way to get a BP in the field is the manual sphygmomanometer and stethoscope.

If a firefighter is found to have a significantly abnormal BP, and they become a patient, then using the automatic machine to confirm and trend is reasonable. But I bet most EMS providers can take a manual BP faster.

Once you have these vitals, and assess the firefighter's appearance and any physical complaints, they can then be sorted into the medical sector or just to the rest and refreshment area.

But we need to have these vital signs to do so, and we need them quickly and to be accurate. Remember we call them vital signs for a reason — they are important.

Stay safe (and hydrated!)

A box truck fire in Athens, Ariz., last month put firefighters in a dangerous situation because of poor initial size-up and rig placement.

We are taught early on in the academy that size-up starts when the call goes out. We are taught to practice continual size-up and have situational awareness.

Without these critical components and a basic understanding of fires we will continue to place ourselves in compromising situations.

En route, continue your size-up and plan a safe attack method and approach. Typically on arrival, vehicle fires are a total loss.

Unless the vehicle is occupied there is absolutely no reason to put firefighters in a position of unnecessary dangers and risks. Vehicle fires are not the fires in which to play hero at.

On arrival, remember the importance of rig placement. Understand the ramifications of wind on vehicle fires as well as changes in elevation.

Changes in elevation at vehicle fires can be dangerous for the following reasons:

• Fuel spills compromising firefighters or apparatus
• Hazardous liquids compromising firefighters or apparatus
• Vehicle can lose brakes or not be in park, compromising firefighters or apparatus

Wind direction can impact:

• Smoke direction
• Exposure Risks
• Fire spread

Knowing the changes in elevation and the wind direction can assist you in allowing the apparatus to be positioned in a safe location.

This placement will also allow firefighters to advance the line downwind and downhill to help limit inhalation and spill hazards.

The firefighters in the video above are punished for not following the basics, but were thankfully not hurt. Use this video as a training tool to limit unnecessary risk and exposure in your department.

Beeping noises are designed to get our attention. Whether they come from alarm clocks, cooking timers, telephones, car horns, washers or dryers, they all cry out for us to stop what we are doing and focus our efforts on the beeping noise.

The beeping noise that smoke alarms emit is also designed to get your attention when they need a new battery, but why wait?

Most U. S. homes have smoke alarms, but most Americans don't test them as often as they should. The National Fire Protection Association recommends testing smoke alarms at least once a month.

However, when more than 1,000 adults were randomly surveyed by phone, fewer than half said they tested their smoke alarms every few months or sooner.

Further, only 42 percent had two to three smoke alarms in their residences, and most of them lived in single-family homes.
We have to drive home the message that our families should have at least one smoke alarm on each level of the house, including the basement and outside of sleeping areas.

We also have to make our community aware that smoke alarms have an "expiration date." The alarms tend to be more prone to malfunctions and false alarms when they are more than 10 years old.

The year of manufacture should be clearly listed on the smoke alarms, and if they are not, they are probably more than 10 years old and in need of replacement, as the requirement for manufacture dates on smoke alarms took effect in the year 2000.

To find out just how important smoke alarms can be, you can look at the circumstances of a Joe Stevens from last year in Lancaster County, South Carolina. On a Friday morning, Mr. Stevens said he woke up at 5 a.m. and started fixing breakfast.

He heard a smoke alarm on the other side of the house and went to investigate. He walked to the other side of the house and saw the bedroom on fire.

Just two weeks earlier, Mr. Stevens went through the house with his granddaughter, who is a firefighter. Upon seeing no smoke alarms in the home, they went to the store, purchased three smoke alarms and installed them.

Mr. Stevens believes that without the smoke alarms, he and his family may not have been able to get out of the house before the fire consumed it.
This would seem to be a perfect time to spend a few minutes making sure your citizens have enough smoke alarms in their home, and remind them to test them all to make sure they work.

Remind the adults to make sure the battery has been replaced in the past year. And to take them down or open them up and find the manufacture date, and make sure the alarm is less than 10 years old.

Finally, they should spend a few seconds dusting the inside of the alarm with a feather duster to keep it clean. Let's learn the lesson on having several working smoke alarms from Mr. Stevens' story.

AP/Minnesota Daily, Stacy Bengs
Firefighters size up the scene after the bridge collapse in Minn. last week.

Years ago, when I took my first search and rescue class, the instructor talked about the six-sided review of a building or incident. "Look up, look down, and make sure you look all around before committing yourself," he told us.

Over the years, I have thought of that simple saying on many emergency incidents and have passed it on to thousands of my students during training. The bottom line: Don't get sucked into something before you give it the old once over.

It's easier said than done sometimes, especially when lives hang in the balance and quick action will affect the outcome of an incident. But what about all of those other occasions when you may have the time to do it right?

What is your approach and thought process when you come across a technical rescue or any type of rescue for that matter? Is it a well executed series of steps or a fly by the seat of your pants operation?

Good team members, the right tools and practical training shouldn't be under valued, but that doesn't replace mentally being on your game.

To do that, you have to do something that most people hate or are too lazy to do Rescue is a thinking game you need to play the "what if" game. "What if a car goes over that edge, what if that building falls down, what if that place blows up, what if I have to cut that guy in half to get past him, what if I have to crawl in that hole to get that victim?"

It's not enough to just know how to use the tools, or be well practiced or to have a cohesive team. Rescue is a thinking game, and the people who can plan ahead, see something coming and be ready for it are worth their weight in gold.

Organized chaos
You're always behind before you get there, that's a given. But how far ahead of the incident are you when you arrive? I used to work for a battalion chief who would say, "You don't bring a crisis to an emergency." Sure it's organized chaos at some scenes, but your level of organization and the ability to achieve the required levels under the most impossible circumstances is the real key.

How many of us can say that we are "masters" of our craft and how many want to be? Chances are, if you're reading this column, you're already a student of the trade, which makes you a cut above the rest. But there is a lifetime of learning to be done and every day is a school day in our profession.

If you think that you know it all, have seen it all or have it done it all, we're all in trouble and chances are you're probably a liability at a significant incident. Confidence should never be replaced by arrogance.

Rescue is a thinking game. The best people who have seen a thing or two tend to mostly be humbled by the experience — they don't say much, but when the going gets tough they often get going.

I love watching new firefighters, they have so much energy and so much enthusiasm, and they're great to be around. It's also fun to watch them expend all of that energy to no successful end sometimes. But with age and experience comes wisdom!

The veteran firefighter may not always be as enthusiastic, but that tempered approach, years of real world experience and knowledge of the tricks of the trade often carry them through most calls.

But to be in the class above, you have to love it a little more to be really, really good at it. Superstars train harder, practice longer and are very, very focused.

So what does it take to be a master of disaster? Out of the box thinking, the ability to write down your first 20-30 moves on any type of rescue with a twist and a constant desire for perfection. And don't forget the lifetime of learning, listening and talking about the "what ifs" of our job.

By Bryan Jack

The Fire Prevention and Safety grant program (part of AFG) is officially in full swing. Guidance was released a week ago and the application process opened on January 3 and will close on February 4.

If you haven't done your homework, completed your pre-planning and reviewed this year's guidance, then you are already behind the eight ball.

To help prompt you into action I'll highlight some of the aspects of this year's program that you will need to focus on when preparing your grant application and narrative.

There have only been a few small changes to this year's grant guidance and priorities, so those of you that applied last year or read last year's guidance are one step ahead.

The most noticeable change is that last year DHS was required to appropriate $28 million to prevention and safety and this year they were only required to dedicate $19.5 million.

The good news for all is that this year's program is funded at $35 million ($15.5 million more than the $19.5 million it is required to be funded at).

This increase in funding reinforces the critical importance of designing, implementing and improving fire prevention and safety programs throughout the county.

Your agency should make fire prevention education and public safety outreach a priority. AFG is providing a means to assist you with your fire prevention goals, all you have to do is apply!

If you haven't read and reviewed this year's FP&S Guidance and Application Kit you should.

This document explains all of the requirements and details about applying for the grant.

It covers topics such as: funding priorities, eligibility, allowable projects, cost share, application review and selection, and administrative procedures.

Essentially, your first step after reviewing the guidance document should be to identify which portion of the program your agency will apply for — "Fire Prevention and Safety" or "Firefighter Safety, Research and Development." (Eligible applicants for the latter are restricted to public health, occupational health and injury prevention institutions.)

I will assume that the majority of you will be applying under "Fire Prevention and Safety."

Next, you need to identify the type of project that you want to fund.

Your identified project should be based on an identified issue and needs to have an achievable and measurable goal/outcome. Some eligible projects include:

• Smoke alarm programs
• Residential sprinkler awareness programs
• Public safety education programs
• Wildfire prevention programs
• Juvenile fire setter projects
• Code enforcement
• Fire and arson investigation
• Many, many more

After you have identified your project you should start the application process. This process is conducted through the federal firegrantsupport.com website.

The application includes standard fill-in-the-blank and check-box data and also requires a narrative statement.

Some of the data that you need to have compiled for the application includes: general department information (career or volunteer, how you are funded, number of personnel, apparatus), call volumes by type for the past several years, types of calls you respond to, etc.

The application will take several hours to complete and the narrative should be drafted and refined over several weeks.

From the narrative viewpoint here are some things to remember to include:

Trends and needs
The first steps in designing a successful program are to identify the trends and needs of the area that you serve.

The only way to determine what your needs are, is to identify and review local and internal data. Start by reviewing your internal call data.

What types of incidents do you respond to and which incidents do you respond to most frequently? Is there a reason these incidents are occurring, and is there a way to prevent them from happening?

You need to identify what the local issues are and then devise a plan to correct those issues.

Population and demographics
After you have identified the local issues, you need to identify the population group that these issues are impacting.

For example, do you serve a community filled with school aged children, young professionals, or a retirement community?

Chances are that you have some of all the categories, but if you look at the available data you may find one group that stands out.

Solutions
You have identified the issues and analyzed the call trends, population and demographics of your service area. Now it is time to brainstorm some solutions.

Remember, there are always multiple ways to achieve your goals, so don't get tunnel vision on just one solution.

Just pick a fire prevention or safety project that addresses your identified problem/need (based on local data) and can meet an identified goal or outcome and then apply for funding.

The tones drop and your company is dispatched to a working fire. The job is in your still area and the dispatcher says he has received multiple calls on this fire. You and your crew know you have work and everyone has their game face on.

Thoughts start racing through your mind and as you expeditiously get your PPE on, your size-up has already begun.

When teaching classes and attending classes on the subject of size-up, many start with the company arriving on the scene. It's obviously an important part — but our size-up begins before the call comes in.

I have asked classes when the size-up begins and many will give the typical answer of "when you arrive on the scene." But we should be pulling information about the call before we ever get on the truck.

The company officer should know as much as possible about their still area, or first-in area. They should have a good knowledge of what type of occupancies are typical, water supply issues and the best direct route to any call.

This information is learned and remembered over time and experience. Information of this nature is a responsibility of the company officer and the members of the crew.

We have received the call and we now know the address and area that the call is in.

That alone should give us a good impression of what we are likely dealing with. We should know if that area is primarily single story, two story, basements or no basements, or mostly commercial.

Are these single family or multi-family buildings? Is there a high percentage of elderly or young children in these households? Information that we need to know and should know as soon as we get the address.

We also have to consider that if we were awakened from sleep it is very possible that the occupants are either still inside or had been awoken as well. Are there kids still sleeping or could there be someone with a disability who was not able to exit?

Waking out of a deep sleep requires us to get sharp fast and we have to ensure that our crew is ready to go and in the right frame of mind.

While responding, have a brief discussion to make sure everyone knows their assignments. They have the proper tools and we know what we are going to do when we get there.

The officer is going to take the thermal imaging camera and do a 360-degree survey very quickly. The other firefighters split duty between pulling the line while the other is forcing entry if needed.

This discussion is very brief and to the point.

The company officer has to take into consideration the weather along with the vehicle operator. Poor road conditions can make our response delayed, in turn making any tenable spaces untenable and allowing fire growth to increase. Seconds can make a difference and we have to take that into account.

There has to be some discussion about water supply and if a pre-connect is going to be used or if we need to lead off. In some instances we lay to the hydrant, depending on how we attack the fire and how long our additional resources will take to arrive.

The operator and the officer should have a good idea of hydrant locations and how reliable the water supply is.

Is this an area that has newer, larger mains or are they as small as 4 inches and old? It all plays a part in our planning.

As we pull up to the fire building, we are identifying the type of occupancy, approximate size, special features like additions, multiple levels and approximate age of the building.

The type of occupancy will determine how many possible victims we are accounting and searching for, and possibly the age of potential victims. The size could dictate how much fire hose we need to stretch and will determine our deployment choice.

The age of the building will help us with looking for fire spread, balloon frame versus platform, and types of roof systems, floor systems and interior finishes.

We want to look for what I like to call the "character" of the occupancy. Are there cars in the driveway and nobody out front? Are there kids' toys in the yard or other indications of youth like basketball goals or skate boards laying around?

One thing to remember is that young kids, preadolescent, will hide under a bed, in a closet or under the blankets.

An older child will try to hide in a bathroom or shower. So, it is important that we identify these possibilities. Are there window coverings in the basement windows, maybe identifying a living area? These are just a few but not all of the "character"
factors.

Finally, we have to look at the fire conditions and the condition it is currently in and where it is going to be in five or 10 minutes. What is the smoke doing? What color is it?

Is it forcible or lazy? Do we have flames showing from one window, no windows or is it through the roof? We start to get into the tactical side of things at this point.

The point is to be prepared for any call in your area before you get. There should be a general knowledge of the area that you cover and sound decision-making comes from that knowledge.

Don't over think your size up and make sure you consider all of the factors and information being presented. Don't discount something because it has never happened before.

These are not all of the factors that need to be considered during a size-up, but a short list of basic examples that will lead to additional information for you to base decisions on.

As always, train hard, be persistent in gaining and passing along knowledge, and I'll see you next month From the Fireground.

By Dr. Kim Alyn
FirePresentations.com

It gets more and more difficult to find principle-based leaders in today's society. Passing the buck is commonplace as everyone points the finger at someone else. Society is starving for quality leadership, and it’s no different in fire departments all over the world.

Firefighters want leaders who will actively engage in the leadership process as they work to develop exceptional leaders for the future of the fire service. I have a leadership acronym for what I consider some of the more important traits of an exceptional leader:

Love what you do
Excel in competency
Act with integrity
Demonstrate accountability
Empower others
Respond humbly

Love what you do

People want to follow leaders who love what they do and show some passion for it. You don't have to love every aspect of your job or everything that transpires in the department, but you should at least love being a firefighter, a company officer or a chief officer. I have yet to meet a firefighter who didn't have a passion for being a firefighter when he or she started out. But as the years go by, apathy sets in for some people for a variety of reasons: Department politics, the promotion process, boredom, burnout, personality conflicts and disillusionment.

Too many firefighters let their external circumstances dictate their love for the job, which is reflected in low-quality performance. I read a great quote once that said, "Above all, be true to yourself, and if you cannot put your heart in it, take yourself out of it."

Exceptional leaders are defined by the level of excellence for which they strive regardless of their external circumstances. Average people need to be in a great job to excel. Average people need to work with great people to excel. Average people need to have a great boss to excel. Average people need things to go right to excel.

But exceptional leaders don't settle for less than the very best from themselves regardless of their circumstances. You won't hear an exceptional leader say, "Why should I give everything I have to this job? My boss doesn't appreciate me!" You won't hear an exceptional leader say, "I am going to come to work, give the absolute minimum and go home. Why should I give any more than that to this department?" You won't hear an exceptional leader say, "I hate my job. I work with imbeciles. How can I possibly excel in these conditions?" You won't hear an exceptional leader say, "No one will let me reach my full potential."

When you adopt that attitude and perspective, you render yourself powerless and ineffective. You give others the authority to dictate your level of excellence. You take the easy way out when you use your boss, your coworkers or your environment as an excuse not to do your best.

Exceptional leaders give everything 100 percent. They draw from their internal drive and excellence, not their external circumstances. That's what separates average leaders from exceptional leaders. Exceptional leaders love what they do because they choose to.

Excel in competency

Competency ranks high on the list of desirable traits followers want to see in their leaders. Competency instills confidence in followers, and it transcends the fireground. Of course firefighters want their leaders to be absolutely competent when taking incident command, but it doesn't stop there. Firefighters also want their leaders to be competent in communication skills, conflict resolution skills, interpersonal skills, administrative skills, negotiation skills and a variety of others.

On average, across the United States, firefighters spend 4 percent of their time on emergency calls, and 1 percent of that is fire suppression. The remaining 96 percent is spent back at the station dealing with a host of other issues that require competency in many areas.

Exceptional leaders in the fire service recognize that their first call to competency is in leadership. There is a great proverb that says, "He who thinks he leads but has no followers is only taking a walk."

Leaders need to focus on their ability to truly lead and improve this critical competency. When this area of competency is the focus, many other areas tend to take care of themselves.

Exceptional leaders never stop improving. They continue to take classes, read books, learn from others and look for ways to make themselves and their departments better in every way possible. They take input from followers, other leaders, other departments and anyone who can teach them something new. They are not too arrogant to think they can't learn from everyone.

Exceptional leaders excel in competency through continued education, training and experience.

Act with integrity

Integrity has been defined as doing the right thing when no one is looking. Exceptional leaders will make the choice to do what is right, even if no one else is doing it. They will make the unpopular decision if they know it's the right decision.

Having integrity as a leader is a challenge in what I call our current "morally negotiable society." It seems as if anything goes and anything can be justified or blamed on someone else.

Thomas Jefferson once said, "In matters of style you can swim with the current, but in matters of principle you stand like a rock." Great leaders may change in style, but they don't compromise principles. That kind of leadership is hard to find.

A man attended a leadership conference and listened to a powerful message on integrity. He went home and tossed and turned all night, unable to sleep. He began to take inventory of all the areas of his life that lacked integrity. One in particular stood out: He had been cheating on his taxes. So he sat down and wrote a letter to the IRS. It said, "Dear IRS, I am trying to become a man of integrity. I have not been claiming all of my income and have therefore not been paying all of the taxes I owe. As a result, I have not been able to sleep at night. Enclosed is a check for $2,000. If I still can't sleep at night, I will send you the rest."

You cannot practice behaviors that demonstrate integrity halfway. Exceptional leaders will do the right thing for their followers, their leaders, their departments and most importantly, for the public they serve.

Demonstrate accountability

Are you willing to make yourself accountable to people above you, below you and beside you? Most people are willing to make themselves accountable to the individuals above them because they know they are responsible for their performance evaluations. Some will even make themselves accountable to their peers, but few will actually make themselves accountable to their subordinates.

I met an exceptional leader, a chief officer, who understood this concept. He allowed his subordinates to give him feedback when he was curt with a member of the public, inconsistent with policy enforcement, or not setting a role-model example when it came to his attitude and work ethic.

Many leaders become indignant at the idea of a subordinate calling them to carpet on an issue. Exceptional leaders recognize that this builds trust, respect and a culture of mutual accountability.

Unfortunately, I have met far too many leaders in the fire service who look down their nose at people down the chain of command. They act as if they have all the answers and that's why they are in their position. The truth is we all need to be accountable up, down and across the chain of command if we hope to develop outstanding leadership throughout the organization.

Exceptional leaders demonstrate high levels of accountability because, as Stephen Covey so aptly put it, "Accountability breeds response-ability."

Empower others

Empowering others means establishing, defining and educating people on the expected results and boundaries in which to operate and then setting them free to make things happen. Or, as Theodore Roosevelt put it, "The best executive is the one who has sense enough to pick good men to do what he wants done, and self-restraint enough to keep from meddling with them while they do it."

Many leaders feel threatened by empowering others with authority, decision making or process determination. They are afraid the employee may fail and it will make them look bad. Or they are afraid the employee will succeed and it will make them look bad. A lack of empowerment is usually rooted in insecurity.

When you empower people, you communicate that you trust them to use their own best judgment. If you can't trust them to do that, you probably haven't provided adequate training. If you have provided adequate training and coaching and a firefighter still isn't using good judgment, discipline needs to follow. If the discipline does not change the behavior, the firefighter may need to consider a different line of work.

Unfortunately, because most fire departments have a few dense firefighters who refuse to use good judgment, every other firefighter is punished by being denied the opportunity to be empowered in any way they can be. Company officers and chief officers need to step up and discipline firefighters who need it, and the union needs to back that discipline so the other firefighters can have confidence that management and labor share the desire to have the highest levels of excellence in the department at every level.

Empowerment increases morale and allows firefighters to take ownership of their departments. People find it very difficult to buy into missions, visions and goals that they didn't help create. Empower your firefighters to become part of the process, and you will be amazed at the increase in participation and buy-in. Exceptional leaders empower others.

Respond humbly

Humility is a highly desirable trait in a leader. Many leaders in the fire service mistakenly think that if they are to exhibit confidence, they can't exhibit humility. You can be both highly confident as a leader and still humble. In fact, those are the easiest leaders to follow. No one wants to follow a humble leader who is insecure or unsure. No one wants to follow a confident leader who is arrogant, either.

Humility is best exhibited in your ability to listen and take input from others. If you invalidate them, people will view you as arrogant. If people come to you and point out an area you could improve, respond humbly. If people come to you and praise your abilities, respond humbly. If you have offended someone or acted like a jerk and you know it, swallow that pride and respond humbly.

When you maximize your mistakes, people want to minimize them. When you minimize your mistakes, people want to maximize them. When you exalt yourself, people want to humble you. When you humble yourself, people want to exalt you.

Humility covers a wide variety of areas as a leader, and exceptional leaders will respond humbly. Just remember the words of Ezra Taft Benso: "Pride is concerned with who is right. Humility is concerned with what is right."

If you want to become an exceptional leader, start with these key areas. Love what you do, excel in competency, act with integrity, demonstrate accountability, empower others and respond humbly. Society is absolutely starving for exceptional leaders. and you have an opportunity to step up in your department and be the leader your fellow firefighters need.

Dr. Kimberly Alyn is a best-selling author and an international fire service speaker. She is the owner of Fire Presentations (FirePresentations.com), a company dedicated to keynote presentations and training workshops for the fire service. Dr. Alyn has conducted the largest known fire service study on the topic of leadership and works with fire departments across the country on firefighter and officer development. She is the author of 11 books and a variety of CD/DVD productions. Dr. Alyn holds a bachelor's degree in management, a master's degree in organizational management and a doctorate in management with a specialty in leadership. Dr. Alyn can be reached at 800-821-8116 or email Kim@FirePresentations.com.

Personally, I was very pleased to hear about this proposed program to help get our veterans employed as firefighters in their local communities.

In my experience hiring numerous firefighters and medics through the years, I've found members of the armed forces to be outstanding candidates.

Whether retired from active duty, or still serving in the Guard and Reserve, our veterans have demonstrated many of the same competencies we expect in our fire departments.

I know that some fire chiefs are concerned about Guard members and Reservists potentially being deployed for extended periods of time, and I certainly understand the hardship that can place on departments that are already suffering from budget cuts and staffing shortages.

It's also true that returning veterans sometimes need additional support to address what they've experienced in the course of their service. (Although our departments should already be providing substantial access to behavioral health services for incumbent firefighters and other responders.)

But in my opinion, the benefits of hiring our veterans far outweigh any potential costs.

Discipline, commitment, service, flexibility, physical fitness, and the expectation of continual learning are characteristics shared by our veterans that translate very well to the civilian world.

Certainly those members of our departments who did not serve in the armed forces bring their own, highly valuable, public service commitment and skill sets to the table.

I tend to think that, as with so many things, combining the best of our civilian and military workforces holds great promise to positively shape the next generations of the fire and emergency services.

And I can't help but wonder, if this program is successful, how the fire and emergency services culture might change in the future?

Please join me in thanking all our veterans for their service and stay safe!