Those threads would include a senior official stating that their current EMS station was moving toward the point of being in disrepair, providing little to no protection to those clinicians that were stationed there.

Another would say that their community had grown so quickly that their current station is unable to keep up with the demand of their citizens and another station needed to be built.

On the opposite end of the table, another agency stakeholder would state that he/she agreed with the evaluation of the situation; however, funding wasn’t going to be available for a while, and if the fuel prices continue to increase it may be even longer than previously predicted.

As a reader of this column, I would venture to guess that you too have had similar conversations with your personnel, which is one of the reasons you are here looking for ideas that will help your funding shortfalls.

When considering locations to obtain funding for EMS, the US Department of Agriculture is not somewhere I would immediately consider, but in the instance of building up the rural delivery of pre-hospital emergency medicine, the USDA steps up to the plate and hits a homerun with their Community Facility Grant Project.

By going to their website you will find more information related to this project.

The USDA Community Facility Grants program says it is designed to “assist in the development of essential community facilities. Grant funds can be used to construct, enlarge or improve community facilities for health care, public safety, and community and public services.”

There are several factors that are combined to determine the total grant funding that can be approved for a requested project.

For grant applicants, population and median income are two of the largest factors in determining qualified applicants. Based on the guidance for their document, towns greater than 20,000 have minimal chance of receiving funding under this grant program. “Grant assistance may be available for up to 75% of project costs. Grant funding limitations are based on population and income, economic feasibility, and availability of funds.”

This project will fund projects that also receive other USDA “CF financial assistance such as direct or guaranteed loan, applicant contributions, or loans and grants from other sources.”

Limitations to the USDA Community Facility Grant project include:
1. The payment of any annual recurring costs, including purchases or rentals that are generally considered to be operating and maintenance expenses.
2. The construction or repair electric generating plants, electric transmission lines, or gas distribution lines to provide services for commercial sale.
3. The payment of costs to construct facilities to be used for commercial rental where the applicant has no control over tenants and services offered.
4. The construction of facilities primarily for the purpose of housing State, Federal or quasi-Federal Agencies.

For those agencies that serve the rural populations that have minimal operations for healthcare delivery within their borders, this is an excellent opportunity to look at ways to fund the future of medical treatment to your citizens.

For more information about how to apply for this grant process you must contact your local USDA Rural Development office. You can find these resources here.

And while the thieves in these incidents probably didn't connect the dots, the victims — firefighters — did. These incidents seem to defy human decency.

The first story comes out of Sugarland, Texas, and involves an off-duty Houston firefighter who was standing guard over one of the four fallen firefighter's bodies at a funeral home. While inside, a thief broke into his vehicle and made off with more than $3,000 worth of computers, tablets, etc.

The second story comes out of Liberty County, northeast of Houston. The Moss Bluff Volunteer fire chief returned to the station to find that it had been completely stripped of all salvageable metal. The thieves had cut through the sheet-metal wall and made off with everything including hose couplings, vehicle batteries, fire pump, a generator, and even the air conditioning unit.

The Moss Bluff Volunteer Fire Department's station was uninsured and is out of commission. And as Chief John Wilson said, "It's going to take a lot of barbeques and fund raisers" to get the department rolling again.

The Houston firefighter faired a little better thanks to the responding police officer. The officer was so moved by the theft that he used Facebook to raise money to replace the firefighter's stolen belongings. When enough money could not be raised, the officer opened his wallet and kicked in the rest.

As firefighters, we often see people having one of the worst days of their lives. But those worst days are generally brought on by accident or negligence, and rarely by malice. The careless smoker or cook is probably not an inherently bad person.

It is easy for us to believe that people are inherently good — and most are. Yet it is incidents like these that remind us that there is no honor among thieves. How often have you heard of thieves who scour the obituaries to burgle the homes of the deceased during a wake or funeral?

The moral to the story is hope for the best and prepare for the worst. Take the time to check your fire station for potential security gaps, carry insurance, lock your POV doors at the station, and so on.

Even in times of great tragedy, there will always be those with no sense of decency.

Physio-Control based out of Redmond, Wash., unveiled its newest product, TrueCPR, a standalone CPR feedback device designed to provide rescuers with real-time feedback on chest compression depth, rate and quality. TrueCPR utilizes Triaxial Field Induction (TFI), a magnetic technology that overcomes erroneous overreporting of compression depth from devices currently on the market when used on a mattress or stretcher. Physio-Control expects to launch TrueCPR in Europe shortly and in the U.S. in 2013.

RhinoChill, a unique therapeutic hypothermia induction device, was on display by Benechill International, from Wallisellen, Switzerland. Designed for initial induction of therapeutic hypothermia in the pre-hospital environment, RhinoChill uses a nasal cannula like an intranasal cooling catheter to cool post-cardiac arrest victims rapidly. An inert coolant is delivered through the catheter while flowing oxygen or compressed air to facilitate evaporative cooling of the brain, effectively lowering core body temperature. BeneChill International currently markets RhinoChill in Europe and expects approval in the U.S. in the future.

The Corpuls CPR, a new automated CPR device, was introduced by Corpuls, Inc. of Kaufering, Germany. Expected to be released in Germany and the rest of Europe in 2013, the battery-operated device includes an integral long backboard and features adjustable depth and rate parameters. The manufacturer has no current plans to bring the device to the U.S. market.

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.

In speaking with fire and EMS agencies about the Assistance to Firefighters Grant program, there is a great deal of confusion about just how many applications each eligible agency may submit in a given year. Some say one, others two.

Very rarely is the correct answer given. According to the 2008 published guidance for the Assistance to Firefighters Grant, each eligible agency may submit one application for each "program area" for a total of three.

The 2009 AFG workshop has not provided any information which would lead one to believe that there will be changes in this area. The three AFG program areas are:

• Fire/EMS Operations & Safety
• Fire/EMS Vehicle Acquisition
• Regional Projects

Each individual application is scored independently of the others, and submitting multiple applications will not affect an application's score. One caveat to this is any agency hosting/participating in a regional application is prohibited from requesting the same equipment as part its own application. Doing so will result in both applications being made ineligible.

Part of the 2008 AFG guidance reads:

In FY 2008, you may submit one application per application period in each of the program areas, (i.e., one application under Operations and Safety, one under Vehicle Acquisition, and/or a separate application as a regional host). If multiple applications are submitted on behalf of one organization within one of these program areas, either intentionally or unintentionally, we will deem all of that organization’s applications in that program area to be ineligible. For example, if any applicant submits two applications for Operations and Safety, both applications will be deemed ineligible.

Fire departments or nonaffiliated EMS organizations that will benefit from a regional project may also apply for funding under the AFG, as long as they are not requesting the same items as the host applicant for the regional project. For example, if a host applicant applies for a multi-jurisdictional communications project, a participating organization that will receive some of the communications equipment can apply for other needs as long as it does not apply for duplicative communications equipment. Host applicants MAY NOT apply to address other needs beyond the regional project on the regional application; however, a host applicant may submit a request to meet its own, non-regional needs in a separate application.

While the 2009 AFG guidance has not yet been published, workshops for the 2009 AFG program are ongoing. I would encourage you to attend, get the facts, and increase your chances for success in 2009!

Best of luck!

Some agencies have developed a routine practice of triage skill testing using a defined period for use of process and props. This process is affectionately called "Triage Tuesday" in many communities.

The goals are several-fold. First, it allows EMS providers to use the basic tools of MCI management, like triage tags. Second, it gives providers the opportunity to discuss their patient evaluation skills with their officers, and importantly, the nurses and physicians at the Emergency Department. Third, it reinforces skills that will create confidence in the providers when the big incident needs to be managed.

The process of using "Triage Tuesdays" instills, and then cultivates, a culture of confidence in EMS providers and emergency department personnel.

Multiple casualty incident preparedness
EMS agencies and providers successfully use everyday operations to prepare for bigger incidents, including MCI events. The daily use of Incident Command Systems for incident management is one of the most important elements of preparedness.

Formal Incident Management System training is designed to prepare providers at all levels and in all disciplines for a multi-agency response. The use of patient triage principles occurs with each patient encounter, and is built around the use of ABCDE patient assessment (Airway Breathing Circulation Disability Exposure) and the differentiation of all types of patients around the basic decision of "sick" and "not sick."

But triage for multiple patient incidents requires another level of decision-making by emergency workers. Those incidents require the caregiver to determine who is sickest among a number of patients, and how sick are they versus the resources that are available to care for them. In the worst of MCIs, someone needs to be prepared to make decisions about who should or should not be resuscitated.

It is these decisions that can be developed using regular training like "Triage Tuesday."

Preparing EMS providers for multiple casualties
EMS providers accept that they practice patient assessment and determination of critical illnesses or injuries with everyday patient encounters. Many resist training for these incidents. There's a few reasons for this:

• EMS providers don't like to practice. They often have a bias toward actual delivery, and feel that everyday care is difficult enough to prepare for a big incident.
• It takes time and effort. It distracts from the most important role, which is day-to-day care.
• EMS professionals don't like "pretend games" at all, and get callused by daily interactions with patients and providers that "play too many games."
• When things don't go well in training exercises, it can be embarrassing.
• It costs money to use those materials like triage tags, and other props.

So how can EMS agencies develop a regular and routine practice of triage skill testing? First, use a defined period for use of process and props, like "first Tuesday of every month." Second, work with hospital(s) providers to set mutual goals, like "we are testing and updating processes to prepare for MCIs in our area, for the mutual benefit of the patient." Third, establish a routine practice to communicate the results in each direction, as in "we are identifying areas of weakness in our practice only by accepting suggestions and concerns from your personnel, and hope your agency will do the same."

In the simplest models, the agency's triage tags are applied to each patient who is transported on a given day of the week (or month) before arrival at the hospital. The tag may or may not be used for simple documentation, in addition to the routine patient care report.

The Emergency Department personnel, advised about the process, accept the patient and confirm the accuracy of the patient triage classification, providing simple and immediate feedback to the EMS crew.

Emergency Department personnel may take advantage of the opportunity to test their own triage skills, become familiar with the tagging systems, and use the ED's disaster patient tracking system.

There are more opportunities to expand the training, or add elements once a month to enhance the experience. More props can be utilized, including vests, caps, signage, management boards, and technology enhancements.

Those items that were purchased are dug out of the cabinets and closets, and used for the day. Some agencies will designate the first Tuesday of the month to use the expanded set of tools, designate what type and volume of incidents will utilize the props (every auto accident, or every injured patient incident), utilize field and ED supervisors to provide additional options for testing and management, and produce reports on use of all of the tools.

When agencies are using new tools for MCIs, like bar code devices, the monthly designation allows more providers to develop the skills in using the technology, in the field and in the ED.

An important element of these designated days is to practice the communication scripts. The EMS providers will be asked to use the MCI props, and also to communicate with the patient/family/ED personnel what the props would accomplish in a major incident.

For example: "Mr. Jones, we take care of people every day, and expand those principles when we have big incidents or multiple patients. This is one of the tools we use for big incidents, and we are using it today on all of our patients. We are also doing our regular documentation that is part of your medical record."

In a few places, the supervisors will take the day's incidents and add some elements that give providers some practice in MCI management. At each incident where there is a moment or two where critical patient care is not needed, the supervisor may inject a couple virtual patient encounters to manage, or test the providers on what they would do if this patient encounter was part of a multiple casualty incident that is common for the area. That way a simple patient encounter can be made into a more complex incident for the providers to manage.

Simple and technology enhancements for MCI training
Triage Tuesdays allow the development of MCI skills without moulage, fake patients, and contrived scenarios. It is noted that the skills of MCI management are not developed by moulage administration. Don't waste the money. It is advantageous to expand on real patient encounters, rely on day-to-day patient assessments to train providers on what patients look like, and use simple patient descriptor cards to allow the providers to triage multiple simultaneous patients.

An EMS system could almost develop "baseball cards" that have a descriptor of patient injuries, and have the EMS providers practice going through the cards and making an accurate triage decision. A sample patient descriptor is listed below.

IT applications to Triage Tuesday are very appropriate. Some EMS systems and Emergency Departments have new IT applications that are being utilized, sometimes with new equipment, communication processes, and software.

These special tools require regular practice, especially near the introduction. Regular MCI drills allow practice using the tools, the hardware, and the software. It also helps define shortcomings and bottlenecks. It is likely to greatly benefit the staff of the EMS providers and the Emergency Department.

Regular drills, like Triage Tuesdays, enhance training for emergency providers. With that process, the EMS agency is taking care of people, to include your providers, your patients, and your support agencies. There is great benefit to having, practicing, and improving the EMS MCI plan. Having each member of the EMS agency and Emergency Department skilled in the props, process, and practice will benefit all of the appropriate elements, especially the rescuers.

Triage Tuesdays allow providers to use MCI props routinely. Vests, hats, signage all gets way too buried without regular use. So dust off the MCI kit, write and print a couple hundred patient descriptor cards, and take advantage of all special events. Understand what are high-risk events and use those as scenarios.

Sample MCI Patient Descriptor Cards

Patient 101
Chris Farmley, born on 8/2/88, SS# 123-45-6789, complains of abdominal pain.

Skin:

Cyanotic, cool, moist

Breathing quality:

Rapid, shallow, guarded

Pulse quality:

Rapid, weak, irregular

Neurological status:

Disoriented; feels pain; responds to verbal stimuli; pupils equal, react slowly

Medical history:

Not available

Further examination:

Abdomen rigid; no other injury evident

Patient 102
Jane Doe, approximately 13 year old Caucasian female with blonde hair, blue eyes, and a one inch scar on her left knee, is unconscious with no apparent injuries.

Skin:

Cyanotic, cool, moist

Breathing quality:

Absent

Pulse quality:

Carotid pulse weak, irregular

Neurological status:

Does not respond to verbal stimuli; pupils dilated, react slowly

Medical history:

Not available

Further examination:

Not applicable

Additionally, each boat will perform differently in the water as the loads within the boat change. I've observed two prevalent mistakes that novice boat operators and rescuers make.

First, they simply don't understanding the performance characteristics of their boat and motor. Improper operating techniques may result in rotational capsizing or sudden surges or losses in position in the river. Either of these actions can put rescuers in the water.

Second, they develop tunnel vision on a specific problem and forget about the river. The river never stops coming at you and losing sight of it can result in rapid loss of position and an ill-advised ferry angle.

For the purpose of this article, we will be discussing the most common river-based boats within the rescue service — 12- to 16-foot crafts including standard inflatables, tunnel hulls and jon boats. Before effectively operating these boats, we need to have a firm grasp of three basic factors:

1. Load capacity
2. Performance characteristics
3. Immediate actions

Load capacity
Boats may be equipped with a load-capacity placard that displays the max allowable weight and or persons that can be in the boat. This calculation is based on a standard U.S. Coast Guard formula that multiplies the length of the boat times the width of the boat and divides it by 15. For example: a 15-foot-long by 8-foot-wide boat would result in 120/15 = 8.

This formula is based on a 150-pound person, and I don't know many rescuers that weigh 150 pounds. So, use a coefficient of 20 to be on the safe side. This would result in a maximum person load of six as opposed to eight. You also need to consider the increased drag and weight that is generated as you approach the maximum load.

I am a strong advocate of keeping boat personnel to a minimum in swift-water applications to ensure optimal performance of the craft. The best layout for a boat rescue team is an operator or pilot, a primary rescuer and a secondary rescuer if absolutely necessary.

Performance characteristics
Once the load capacity is known, it needs to be applied on the river to analyze its relationship to performance characteristics of the boat. Generally, inflatable crafts are much more stable than jon boats. This allows more personnel to be placed in the boat with less concern for placement or position.

Jon boats can be highly unstable and require great attention to load positions in the boat to prevent taking on water and capsizing. This principle is particularly important when turning the boat or applying sharp ferry angles.

During these maneuvers, it is imperative that the crew understands how reactive the boat is to load placement near its sides. In unstable boats, crews should shift their weight to the downriver side when performing turns if the goal is to maximize boat stability.

However, the result is a wide turn radius. If a tighter turn is desired, the crews must be aware of their particular boat's reaction to inside loading to ensure that they do not overload it and allow water to rush into the boat and cause a rotational capsize.

Each of the primary boat types turn very differently. Standard inflatable boats typically perform a sliding motion across the surface of the water. Jon boats and V-bottom boats slide less and will naturally turn tighter. Tunnel-hull boats have two rails in the water that produce extremely tight turns that generate up to 4 Gs when performed at maximum operating speed.

Motor operations
When setting up a boat, the motor must be set at the appropriate angle with the appropriate prop to ensure that maximal water is drawn through the prop and not an air cavity.

It is often impractical to adjust the trim of the motor while on the river by any means other than load positioning. For example, many tunnel-hull boats need to have as much load in the rear as possible to generate enough initial torque to react with maximum propulsion. If a crew knows they are going to perform a peel out or a tight down river eddy turn, they should shift their weight just prior to performing that maneuver.

Bringing a boat to plane or maximum operating speed may also be impacted by load distribution in the boat.

The last component to be evaluated is overall capability of the boat as it relates to CFS or water movement. Boat crews must know the limitations of their boat — especially how much current is too much for the boat configuration. This will be based on the load in the boat, the drag of the boat design and construction, and the horsepower and prop setup of the motor.

When things go wrong
It is also important to know how to trouble shoot and take corrective actions when things don't go as planned. Know the motor inside and out. If propulsion is lost or the motor dies, have a systematic and rapid checklist that you progress through to correct the problem.

The crew should also have a course of corrective actions to try to maintain a safe boat position in the water with paddles. This is one example of immediate actions, which should be rehearsed and performed with great repetition to develop muscle memory.

Once the boat itself has been addressed, operators and crews need to understand the dynamics of swift water. Rescue sequences typically require a large array of boating skills from ferrying, hovering and peel outs to river reading, avoiding and identifying hazards and victim retrievals.

Divided attention
One of the hardest disciplines to develop in novice operators is the ability to keep the nose of the boat up river with no ferry angle and maintain position in the river while a victim is being loaded. This is commonly referred to as hovering.

Operators will naturally want to shift their focus towards the rescuers and victim during loading. This generally results in an accidental ferry angle being set towards the victim because the operator is staring at that receiving point on the boat as opposed to looking up river to hold position.

In a narrow shoot with fast water, even a 15-degree ferry angle can cause a boat to careen towards the bank and the operator may not be able to recover boat position in time to avoid further injury to the victim and damage to the boat and crew. Conversely, an operator who is completely honed in on a hazard in the river but has lost focus on his rescue crew and the victim may fail to respond appropriately to their needs.

We address this dichotomy during training by encouraging operators to divide their senses. They are instructed to keep their eyes on the water and their ears attuned to their rescuers.

Training tips
One of the best drills or events to apply this is in victim pickups. The boat will always approach the victim from the down river side. We require operators to maintain boat position and hover during a victim pickup as well as capture the victim and perform a down river peel out with the victim on the down-river side of the boat.

In more forgiving water conditions, operators should always bring their motors to neutral during victim pickups to negate the possibility of a prop injury to the victim. In swift water however, losing operational control of the boat by going to neutral could be catastrophic.

We train our rescuers to convey specific verbal commands to the operator when they grab, capture and pull in a victim or command a peel out. If the rescuer is losing the victim, he or she communicates to the operator to either "peel out" to come around and relieve current pressure on the victim or "kill it" to bring the motor to a neutral or zero energy state.

The key is to develop refined boat operating skills through repetition and exposure to different water conditions as well as strong situational and environmental awareness using all senses. Boat-based rescue operations can be tremendous assets or liabilities to rescue organizations.

Get the boats out of the bay and onto the water to insure they will be an asset.

Taking a quick look at historical trends in fire-service hiring may provide both insight and optimism for those looking for a fire service career.

When World War II ended, the United States saw one of its greatest economic booms across all industries. As people gravitated more towards urban areas, suburban homes were being built at an unprecedented pace throughout the nation.

This growth in suburban areas created a demand for many jobs including paid firefighters. Areas that were previously serviced by volunteer organizations now had the need and funding for paid fire departments. Urban cities also grew, creating a demand for even more firefighters in these already well established metropolitan departments.

This combination of a strong economy and urban and suburban growth created many fire service jobs during the post war era. From 1947 to 1960, the number of paid professional firefighters grew exponentially.

If the pants fit, wear them
The growth slowed slightly during the 1960s, but there was still an ongoing demand and need that was not being met with an overwhelming supply of candidates.

Since there were no requirements or classes one could take at that time, there was often a great deal of nepotism in the hiring practices. If family or friends were not interested in the job, it was often given to whoever best fit in whatever sized turnout coat they had on hand.

I know retired firefighters who walked into a firehouse to inquire about a job and were hired on the spot because there was an opening and the coat and bunker pants fit them.

Up until the late 1960s and early 1970s, most full-time fire departments operated on a two-platoon schedule. Firefighters often worked 24 hours and then had 24 hours off.

They were not only spending half of their life at the firehouse, they were also on call on their days off. They were required to live in the city they served and often required to remain in town on their days off. In fact, it was not uncommon to have to be granted permission from the fire chief to leave town on vacation.

Three-platoon system
As labor laws improved most departments were mandated to move to the current three-platoon system. Work schedules varied, but the most common was 24 hours on and 48 hours off. This is still a very popular schedule in the South and Southeastern United States. This transition occurred in the late 1960s and early 1970s in most paid fire departments throughout the country.

What this meant was that every fire department that made this move from a two-platoon system to a three-platoon system had to increase its staffing levels by 33 percent. Departments throughout the country conducted mass hirings to fill these positions.

Another reason there were so many firefighters being hired at this time was that the post-war firefighters were now nearing their retirement age. For these two reasons we saw a hiring boom again between the years of 1968 and 1976 that rivaled that of the post-war era.

Once these positions were filled, hiring returned to a slower pace and positions were filled mostly through attrition. Demand lessoned while interest grew.

This interest and popularity for the job was assisted by television shows such as "Emergency!" that glamorized the profession and brought national attention to the modern urban fire service. This increased the number of candidates looking towards the fire service as a career at a time when jobs were decreasing.

Competitive hiring
As fire departments began providing emergency medical services, new requirements for firefighters became mandated and educational programs were put into place. Requirements such as CPR, first aid, EMT and later paramedic licensure became minimum standards; many departments looked for candidates who already possessed a head start in this training.

Competition for the jobs began to increase and departments began to move away from nepotistic hiring practices to a more competitive hiring process. The trend of increasing standards and requirements continued to persist throughout the 1980s and into the 1990s making it a highly competitive process without a direct or clear educational path.

Since the career span of a firefighter is about 25 to 30 years, we saw another mass exodus of firefighters retiring in the late 1990s, which happened to coincide with another economic surge from the puffing up of the dot-com bubble.

Jobs in all fields were abundant; there was increased growth in many parts of the country, and the U.S. economy seemed to be unstoppable. For the first time in decades we saw entry-level firefighters being hired in mass numbers again.

The Great Recession
But unlike decades past, we saw an excess of qualified candidates lined up for these jobs. Despite the dot-com bubble bursting around the same time as the 9/11 attacks, this increased hiring trend lasted up until the housing and financial markets tanked and economy flopped into recession in 2006.

Since then we have returned to a slow hiring pace due to the economic downturn and cut backs in many parts of the United States. For the young candidate wanting to get hired, it is easy to get discouraged looking at the past several years and our uncertain future.

However, just like the stock market and everything else that has its ups and downs, one should try to see this downturn in hiring as only temporary. By preparing yourself now and staying committed you will set yourself up for success when things do turn around, which they inevitably will.

I am not making any timeframe predictions as to when we can expect this turn around to occur, or all the factors that will come in to play when it does, but I can tell you these four inherent truths based on the history of the fire service:

1. There will always be the need for professional firefighters and EMS personnel.
2. Firefighters will retire and fire service vacancies will arise.
3. The most-qualified, best-prepared and best-suited for the job are the most likely to get hired.
4. For those who possess the passion, firefighting will continue to be the best job in the world and well worth the wait and all the hard work one puts into it.

The causes for the reduction in LODDs are not readily measurable. Although the number of deaths is down, the statistics do reflect a status quo or even regression in some ways. Statistics through November show that 68 percent of LODDs occurred away from the incident scene, or responding to the incident scene. Heart attack was the cause of 58 percent (46) of the deaths, vehicle collision 14 percent (11). Twenty-one firefighters who died were over the age of 61. The oldest was 86. Two firefighters were under the age of 21.

The National Fallen Firefighters Foundation's Everyone Goes Home Firefighter Life Safety Initiatives call for the certifications of firefighters. Perhaps the fire service is implementing and adopting this Initiative. The training required for certification may be a factor in the reduction of fireground deaths. However, 8 percent (6) of the LODDs involved firefighters losing their lives due to building collapse, being overtaken by advancing fire conditions or becoming disoriented.

The FDSOA, NIOSH, the IAFF and the IAFC all worked to reduce the number of LODDs in 2010. The FDSOA through safety officer training certification, NIOSH by investigating LODDs and making remedial recommendations and the IAFC's Rules of Engagement and the IAFF's Fire Ground Survival Program both show a commitment to reducing firefighter fatalities.

Technological improvements may be another LODD reduction factor. Several firefighters report "new" use of seat belts because of the strong reminders that come in the form of warning lights and buzzers in newly delivered apparatus.

Increased awareness of air management has changed the way departments treat low air warning alarms. Changes in roadway operations is apparent in most photos and videos, in the form of roadway safety vests on most (if not all) responders.

All of these improvements in safety operations and awareness may be contributing factors in the relatively low number of LODDs in 2010. Perhaps the "no fear" culture of the fire service is changing and we are entering a time when risk management prevails and we employ intellectual aggressiveness.
We still must address our biggest cause of LODDs — heart attack. We must look at age as a factor that increases risk. The Fire Service Joint Labor Management Wellness-Fitness Initiative should receive a renewed effort.

The fire service is committed to reducing LODDS, but the efforts must seriously review the statistics and make the necessary changes.

Those in the fire service are not well known for their writing abilities. The individuals who we place on pedestals tend to be those of action, but just as importantly not individuals who are likely to place their actions into written words.

There's a great deal of recognition that this lack of writing ability hampers some of our larger efforts, particularly in comparison to our partners in public safety.

I, however, see an additional shortfall — the loss of the art of stories. And it is not confined to written stories; it extends to oral story telling.

The new kitchen table
In today's age of sound bites and limited space on whatever social media page you're using, we lose the fire service story. Our hectic lives can make time at the kitchen table both limited in time and attention span.

So when does the rookie learn? And when I say rookie, I mean everyone who hasn't faced the scenario you faced.

Often, we shy away from story to not look like braggers — sometimes because were not sure we did the right thing and sometimes because we simply want to forget what occurred. But others within our organizations need to know that what we all do is important, that sometimes we fail and that sometimes we hurt.

If, as I believe, fire suppression is a science, then it's a science of collective consciousness. I've written about and studied the outstanding work being done by Underwriters Lab and NIST.

The data they've quantified is not only interesting, but also applicable to what we do. But I also have learned from the "lab work" of firefighters from my own and other communities.

Context of firefighting
I believe in learning through bruising. Ours is a tough business where the rubber meets the road. Drilling on the tasks that we must carry out is a continuous process to achieve more than mere proficiency. We work ensure that we will carry out the task flawlessly.

And although I don't mean to take anything away from the value of the task, it's the task as part of tactic that matters, and tactic as part of strategy pulls the dance together.

If we're participating in a ventilation drill, starting and using the saw and knowing how it works are all incredibly important skills. But the story at the table gives the skill context.

The stories about the how, when, why and what we do, give members a better understanding of the science and art of fire suppression. I am concerned that the art gets lost with the lost art of the story.

I've discussed with pride our success and have had individuals share in my sorrow and moments of doubt. These discussions are educational and helpful, both to myself and I know to those listening and sharing.

So, the next time you're at the station, put away your electronic device for a while and start talking.

Many people aren't even aware that fire cadet programs exist. What are fire cadets and what are their duties? Here's a brief breakdown of how these young future firefighters contribute to local fire departments.

Generally, programs for fire cadets accept people between the age of 16 and 20. Some require that they be at least in the 10th grade. If they're still in high school, most programs require that students maintain at least a 2.0 grade average in order to remain active in the program. If they've graduated from high school, they should be in college and maintaining a good grade average.

Application acceptance for fire cadet programs can be ongoing through local fire departments, or it can be limited to once or twice a year. Applicants must have undergone CPA training and certification prior to applying. If accepted, cadets go through a training program.

The cadet basic training program teaches them introductory level knowledge of firefighting skills, tools, equipment and fire science. It also helps cadets develop positive mentoring relationships with firefighters. The cadet instructors evaluate the students during basic training to assess their ability to undertake duties and their commitment to becoming a fire cadet. Proficiency exercises take place at this level to assess the student's physical abilities.

Some fire cadet basic training programs also require that trainees participate in ride-alongs with firefighters and

Fire cadets generally spend about 100 hours or three to six months in supervised cadet training activities. After that, they are considered for ride-along certification, which gives them an opportunity to accompany firefighters to emergency calls. During this phase of training cadets can spend anywhere from 12 to 24 hours on a firefighting under the supervision of a mentor or instructor.

Although special instructors are responsible for fire cadet training, fire station personnel also sometimes assist with basic training.

Once they've been certified as fire cadets, inductees are allowed to assist fire departments in a non-hazardous capacity. Their duties might include cleaning equipment, restocking supplies and helping to clean up fire scenes.

References
http://www.sandiego.gov

That is even more relevant for first responders who, with the ever-growing use of fire, EMS and police apps, are becoming increasingly dependent on these pocket-sized computers to do their jobs.

For civilians, a broken smartphone means an interruption in their quest to defeat Angry Birds. For first responders, a broken smartphone could mean a lost life or a hamstrung investigation.

OtterBox, with their heavy-duty Defender Series cases, has created a level of smartphone protection that will keep your mobile device well protected through month after month of heavy-duty daily use.

OtterBox sent me a Defender Series case to try out with my new iPhone 4, but they also manufacture models for Blackberry, Motorola, Nokia, Samsung, HTC, and LG smartphones, as well as the Apple iPad.

The effectiveness of the Defender Series comes from its layered design. Instead of a simple plastic or rubber case that clips around your phone, the Defender has several layers of protection to keep the phone safe from drops and scratches.

The first layer is a polycarbonate shell that clips snugly around the phone. A plastic membrane on the front of the shell offers durable screen protection, making an adhesive screen protection film unnecessary.

Installing the shell took less than a minute and, once in place, it felt totally secure; pulling on the front and back of the case didn't offer any give.

Surrounding the base shell is a silicon cover that smoothes over the base layer's hard edges and creates another level of shock protection. The silicon layer has flaps that cover all the iPhone's ports and clip securely shut, but can easily be pulled open for access to the charging port, headphone jack, and volume buttons.

With the first two layers in place, the protected iPhone then clips into a polycarbonate holster that holds the device face in or face out.

The holster is, essentially, a case for your case, and with the phone clipped into all three (polycarbonate shell, silicone layer, and holster), the phone feels extremely secure.

It's bulky, but not overly so, and for the day I wore it clipped to my belt it never felt intrusive or uncomfortable. Firefighters, Medics or cops — who are used to having gadgets hanging from their utility belts — won't notice the added bulk.

But the real question when it comes to smartphone cases is: How far can you drop it?

I tested it for myself, dropping my Defender-wrapped iPhone from waist height, and then chest height. No damage whatsoever. I was tempted to drop it off our balcony, but the memory of replacing the glass backing of my iPhone a few months ago stopped me.

I asked OtterBox' Public Relations Specialist Kristen Tatti about the case's dropping capability, and she said their rule is "Three feet to concrete," meaning you can drop it from your pocket without risk of damage.

Tatti added that local firefighters in Fort Collins, Colo., (OtterBox' home) have been outfitted with the cases, and all have raved about the Defender's durability.

"They say it's nice to have something sturdy so they don't have to worry about their phones," she said. "With more and more firefighters getting emergency pages on their smartphones, a broken device can really ruin your day."

OtterBox also makes lines of cases more sleek than the Defender, including the "Commuter" (a simpler polycarbonate and silicone combination) and the "Impact" (just a silicon shell). Visit OtterBox' website to learn about all their smartphone and tablet cases.

With that in mind, let's learn a bit of history about building hazards.

Wooden shingles have "been the cause of incalculable loss of property because of its susceptibility to ignition from sparks and through its efficiency in communicating fire it has been the known culpable factor in the rapid spread of most of the largest conflagrations on record."

That is a quote from the 1926 NFPA brochure called "The Menace of the Wooden Shingle." Obviously, the fire service has known about the hazards wooden shingles represent, but hasn't been able to change the minds of builders at large, since wooden shingles still represent a fire problem today.

Modern fire load
The home furnishings industry has been changing the furnishings in our homes from a natural-based material to plastic-based material. We knew the dangers that were inherent by adding plastics in large quantities to homes, but again, we were unable to change the minds of the manufacturers.

We pushed for legislation that would put residential sprinklers in all new homes, but again we were beaten down by the home builders in most cases. While these battles need to be waged for the safety of civilians and firefighters, we have to realize that we must also prepare ourselves for living with the changes that are being thrown at us.

Let's take a look at how today's furnishings burn, compared with those of a just a few years back. This is a major wake-up call to firefighters that fires burn differently today than they did a generation ago. Today's fires burn hotter and faster.

Learn from the video and pass it on to others in your department to learn from as well.

The fire service was not a big fan of the engineered I-beam, but it didn't make much difference. Today, they are out there in large numbers and it will continue to grow. We need to learn about how quickly these beams can fail when exposed to fire. A number of studies have been done on just this topic, so learn from them.

The NIOSH website includes many LODD reports that can be reviewed for learning. The site is easy to navigate and search, so spend some time reviewing past incidents and be better prepared because of it.

As a fire service, we need to be involved in standing up for what we know is right. We also have to realize that many battles will not be won. The best things we can do is to make sure we are aware of the hazards that exist, and try to prepare for the battle ahead with this information in mind.

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.

But, sometimes left out in our regular training is the common fires that are perceived to pose less risk and are seemingly simple to handle. These are dumpster or trash fires.

The past few years we have read about serious injuries to firefighters and even death while operating at fires in trash receptacles or dumpsters. Although these fires are normally "routine" and without incident, we cannot let our guard down when responding to and operating at these calls.

We need to occasionally brush up on our tactics and share information with our crews about fighting dumpster fires.

Whether the fire is in a residential trash receptacle or a large commercial dumpster, we need to have a constant approach to these incidents. I like to tell firefighters that each of these fires needs to be considered a hazardous materials fire.

They are not hazmat fires in the sense that we pull off the Level A suits and call in the team, but that we use a cautious approach that recognizes the fact that we never know what is in those containers. Operating with that frame of mind will help you slow down and maybe survey the situation just a little more conservatively.

Here are some keys and considerations for operating at dumpster fires.

Location
By knowing the occupancy that the dumpster is serving may assist in knowing what the contents might be. An auto parts store could have brake cleaner, parts cleaners and other flammables. Use what you know and can identify to prepare accordingly.

An abandon house could have anything in it including remodeling materials, old carpets, synthetic flooring and even asbestos.

Industrial locations can have just about anything and everything, including combustible metals, materials that are reactive to water or both. Use extreme caution at industrial sites and try to secure the site's hazardous materials data book.

On commercial buildings, look for the NFPA hazard diamond to identify any significant hazards kept on the property. It is very likely they are also in the dumpster.

Personal protective equipment
SCBA should be more than weight on your back. Wear your air! It's free and can save your life. I can't tell you how incredibly important it is to wear your pack and mask.

Flash fires and for small explosions from aerosol cans in these containers is common. Don't forgo wearing your hood and buttoning up your collar. Again, wear your air.

Use structural firefighting gloves, not extrication or work gloves. Your work gloves on any fire are structural firefighting gloves. Protect your hands.

As you can see, you need to be buttoned up for dumpster fires just like you would for a structural fire. Don’t take shortcuts!

Fire attack
Like any fire or incident, try to attack from the up-wind side. This is not always possible, but it helps with visibility and staying out of the "junk."

I recommend at least a 1¾-inch hand line for suppression. It really depends on the size of the container. But, I can flow more water and fill the container much faster with the larger line as opposed to a 1-inch booster line. In the end, follow your department guidelines.

If the dumpster is threatening an exposure, then the booster is not an option.

When approaching and deciding what type of stream depends on personal preference, department guideline and location of the container. If the container is not threatening anything else, a straight stream can be directed into the container to get penetration.

If you have a lot of smoke with a container that is not threatening an exposure a narrow fog can be used to push the smoke away from you as you approach the container and then put to a straight stream or very narrow fog pattern once at the container.

If the container is threatening an exposure, a straight stream is recommended to avoid moving smoke and heat into the exposure. In some instances foam can be used to increase extinguishment in stubborn dumpster fires.

Not to be taken lightly
Don't take dumpster and container fires lightly. They can be just as dangerous as a structural fire in certain circumstances. The problem is that we have no way of knowing what or when those circumstances are. So, approach each one as if they are dangerous.

Don't take shortcuts with PPE. The only reason not to be fully protected is pure laziness. Ensure that you and your crew are geared up and ready for battle. That means being on air and wearing proper gloves and attire.

Finally, discuss these fires and identify occupancies that may pose an especially dangerous situation should one of their containers have a fire. This can help determine what type of tactics will be deployed before the fire happens.

These are not all of the options and considerations that can be discussed with trash and dumpster fires, but merely the high points. Be sure to follow your department's operational guidelines and keep training hard.

I'll see you next month from the fireground.

So are we really surprised when fire department members drive fast?

I once worked in a department that handed out so-called "CAD tickets" when your response time exceeded a set goal. You had to explain why it took you so long to reach the scene of an emergency, which, given this particular jurisdiction's legendary traffic, could take awhile even on a good day. Guess what type of driving behavior this practice not-so-subtly encouraged?

How fast is too fast? How slow is too slow?

As this story demonstrates, these can be difficult questions to answer. We know that when our residents call 911 for the fire department they generally don't want to schedule an appointment for later that day; they want us right now, or even better, five minutes ago.

Have you ever rolled up on a fire-EMS incident, called it in, and waited for help to arrive? I have, and it gave me a renewed sense of empathy for those we serve.

The fact is, response times are ultimately related to broader public policy decisions about fire station locations, resource deployment and unit availability. All other things equal, if you want to reduce or sustain response times in your community, then add more stations, response units or both. It really is that simple, in theory at least.

Otherwise, firefighters at all levels will do whatever they can, including driving fast, to close the gap between available resources and response-time expectations (official or otherwise); this will likely occur regardless of policies, procedures or sanctions.

Now I'm not saying that excessive speeding is OK, because we all know better. The challenge is defining what constitutes "excessive" for any given place, time, road, traffic and weather condition. Frankly, I've responded to calls when driving 25 mph, or even 10 mph, was probably excessive due to road, traffic, or weather conditions in that location.

In my 20-plus years of fire and emergency services work have I ever driven more than 100 mph? Yes. Would I do it again? No.

While I consider myself an excellent driver, I'm probably not that good. But then, in my current role there's generally nobody waiting on me to make a critical tactical decision, take command, or go inside. On those now-rare occasions when I am actually needed on scene, I drive as fast as I can safely go. (I still stop at all the stop signs and red lights.)

Whatever your department's policy, and practice, is for emergency vehicle operations, this is an important discussion to have with your peers, leadership, and ultimately your community.

Drive safe!

E-One had an extremely busy year, with several new products being launched including a new ARFF Vehicle, the Titan Force 6, with a five-person cab, exterior pump panel, multiple roof and bumper turrets, 3170 gallon poly water tank and a 437 gallon poly foam tank.

Also designed was the urban pumper, with a low ergonomic hose bed and a hybrid energy command vehicle for homeland security use. At FRI in Atlanta, it introduced a new SUV command vehicle — Comms-One — which promotes command interoperability in radio communication.

In more recent months, KME introduced the Challenger pumper line. The Challenger family features 36 different body configurations in steel, aluminum or stainless with 29" deep body compartments for added storage. It has numerous hose bed and compartment configurations including high capacity and low, easy-access hose beds. All can be built on KME Custom or commercial chassis.

Meanwhile, Ferrara's main launch in 2007 was the Heavy Duty 5 section Midmount ladder, which touts a shorter wheelbase and a lower overall height.

In addition, Crimson has built a new pump panel — ControlXT — in conjunction with Fire Research Corporation. It incorporates a more easy-to-read panel with engine information, water and tank level gauges, pressure governing systems and other customer-selected controls and displays. ControlXT will be standard or optional on all Crimson product lines.

Finally, Rosenbauer America debuted the T-Rex in 2007. In conjunction with Metz, the new articulating platform sets up in 25-30 seconds, has an aerial height of 102' equipped with a 2000 gpm pump and room for 115' of ground ladders. It also features a platform collision avoidance feature and a 1400 lb tip capacity.

All of the manufacturers are building and designing with firefighter safety in mind, which in my book is something that should continue in the coming years. More attention is being placed on larger cabs with more room for firefighter comfort and safety, lower hose beds and increased storage space as well as multi-tasking vehicles because we are all trying to do more with less in this day and age.

Just when you think nothing else could be possible, the fire apparatus engineers come out with another new idea that takes the industry by storm. With all of these new innovations that were introduced this year, I can hardly wait for the offerings in 2008. It should prove to be an interesting year. If that is not enough, newer stringent EPA Diesel Engine requirements crop up again in 2010. Oh well!

The Halligan is a firefighter tool that dates back to the mid 1900s. The tool has its origin in the FDNY; it was designed by former First Deputy Chief Hugh Halligan and local blacksmith Peter Clarke made the first actual working model.

Halligan was a city firefighter for years and worked first hand with the Halligan's predecessors, which were called the Claw Tool and the Kelly Tool. The Claw tool was the original and was problematic in its design. It was dangerous to use because it was very heavy and had an off-centered striking surface.

Later came the Kelly tool, which was designed by a FDNY Ladder Capt. John Kelly. The tool resolved some of the previous issues of the Claw, but still was deemed too heavy and not substantial enough in its welded assembly.

After multiple trials, Chief Halligan developed a tool that was lighter, efficient, perform well, and would not fail when in use. There are many versions and alterations to the bar since, but the main concept is still present.

Andrew Brassard of Brotherhood Instructors states that the bar's original design was "made of cross-drop forged from one piece of No. 4140 (high carbon content) steel, and weighed 8 ½ pounds. Comprised of an adz, pick, and fork, the standard-issue bar is approximately 30 inches long, with a 15/16-inch shaft shaped into a hexagon for grip. The fork is a minimum of 6-inches long that taper into two well-beveled tines.

Spacing between the tines allows for a gas valve to be shut off. The adz has a gentle curve for additional leverage, with a beveled end. In addition to being used to break something, the pick and adz — only when properly used — provide protection to the user's arms, hands and body during forcible entry operations.

Although one would think the tool would take off in FDNY, there were initial thoughts from the department that this would be a conflict of interest. This is why Boston was the first major fire department to purchase the tool. It took FDNY firefighters buying it on their own for some time before the city of New York eventually purchased them for firefighters.

You often see the Halligan paired with an ax. These tools are quite complimentary in forcible entry and are often referred to as a "set of irons". Over the years people have designed straps and kits for carrying the two items together as a pair.

As mentioned earlier, there are three components of the Halligan Tool: adz, pick and fork. All parts of the tool can be used in various types of forcible entry. The tool can be used for breaching walls, forcing doors, ventilation, and search and rescue.

When purchasing a Halligan Bar be on the lookout for the following:

• Once-piece forged tool. Do not settle for welded, pinned or threaded connections
• Tool should be 30-inches long
• Adz and forks should be both 6 inches long and slightly beveled
• Forks should be thin

If you are not familiar or equipped with a Halligan Tool, get familiar online, speak with your officer and train. When training, train under the supervision of a professional or experienced officer. Communicate, and always remember your safety basics

Midway through the lecture, I asked the participants to describe his tie, thereby emphasizing the importance of observation to patient assessment. Most participants could not describe the tie or my assistant with any degree of accuracy. About 15 to 20 percent gave a fairly precise description of the tie, generally including the term 'ugly,' and a few must have been asleep as they wanted to know, "What assistant?"

The term for this aptly demonstrated phenomenon is 'inattentional blindness' because while we look, we don’t see. The information doesn’t register because our brains are focused elsewhere and ignoring the visual input. This may not pose a huge problem during a lecture, but can prove to be quite a predicament in the field.

How does our vision work?
Light waves (electromagnetic waves) are continuously bouncing off every object around us. Those light waves in the visible range (we can’t process ultraviolet or infrared waves) that get past the cornea and pupil then hit the retina in the back of the eye. The retina creates electrical signals that are transmitted to the brain, which in turn interprets the information and produces the vision that we 'see.' Don’t believe me? Close your eyes. What do you see?

Signal interpretation
Do we 'see' all the visual signals we receive? From where you are right now, stop reading and take a 180-degree or half-circle view of your surroundings, then close your eyes and recall what you just 'saw.' Now repeat the scan slower, paying attention to details and taking note of what you do not 'see.' All of the light waves bouncing off the objects in your visual field hit the retina and produce visual signals for the brain. Why did your brain fail to give you the total picture of what you saw? Information overload in any system can decrease performance, including your brain. To a significant degree, you determine what you see by the extent of attention you apply to what you are looking at or looking for. A lot of the visual input from the eyes to the brain never gets to perform on your brain's visual screen because you do not pay attention to the content. This can be both a blessing and a curse.

Blessing
Can you imagine trying to start an IV in a nice fat vein but as you start to insert the needle your vision is overwhelmed with mental images of surrounding objects such as the patient’s clothing, the cot, the blood on the floor, etc., etc., etc.? You would likely be hard-pressed to hit the vein. Our ability to concentrate visual signals on the task at hand helps us select the visual information we need to get the job done.

Curse
But what happens when we fail to recognize important visual input? Think about the last time you were providing patient care and asked yourself, "Where did THAT come from?" It might be when the visual input about your patient’s cyanotic lips and weak respirations were sidelined by the visual input of the bloody, deformed open femur fracture, or when you did not 'see' that large pool of blood on the floor before you kneeled down. Or perhaps you found yourself in such a situation after your failure to notice a weapon on the ground. All these events occurred within your field of vision, but failed to register with your brain.

Inattentional thinking
Inattentional blindness has a partner called 'inattentional thinking.' Dispatch sends you to the third intoxicated, unresponsive individual of the day or to the chronic back pain patient that you have visited too many times before. The danger is thinking that the problem is going to be the same as before, or that the scene is as safe as it was the last time you were there. If we fail to consciously evaluate the scene every time, or assess the patient every time regardless of presentation or how many times we have previously seen the patient with the same complaint, we may miss scene hazards or fail to benefit from an accurate patient assessment. What if the intoxicated patient noted above is not just drunk this time, but has a subdural hematoma that occurred from an unwitnessed fall, producing a dilated pupil that we did not think to check? What if the chronic back pain patient on this trip has an expanding abdominal aortic aneurysm that we failed to find because we did not think to examine the abdomen for a pulsatile mass? How many other 'what if' scenarios could feasibly exist?

Summary
We all fall victim to unwanted inattentional blindness and thinking. Decreasing the frequency of its occurrence requires awareness, and awareness is fueled by knowledge. If this is your first look at inattentional blindness, I would encourage further study. Resources include Blink, a book on this topic by Malcolm Gladwell, as well as print and video resources readily available by searching the Internet. In the mean time, keep your eyes open and pay attention out there.

References
1. Rensink RA, O’Regan JK, Clark JJ. To See or Not to See, The Need of Attention to Perceive Changes in Scenes. Psychological Science. 1997:8; 368-373.
2. Simons DJ, Chabris CF. Gorillas In Our Midst: Sustained Inattentional Blindness For Dynamic Events. Perception. 1999. 28; 1059-1074.
3. Rensink RA. When Good Observers Go Bad: Change Blindness, Inattentional Blindness, and Visual Experience. Psyche. 2000:8.
4. Rensink, RA. Seeing, Sensing, and Scrutinizing. Vision Research. 2000:40; 1469-1487.