Predictions: 6 things to look for in 2015

From the easy to the slightly outrageous, albeit needed, here's a look at what to expect in the coming year

Predicting the future is an interesting and risky proposition. If you get it right, folks think that you have some type of amazing insight into life, followed undeserved accolades.

If you completely miss the mark, well, perhaps you're not very smart or insightful at all. The truth is there are many factors that control what the next 12 months brings for the fire-rescue service.

What internal and external factors will have an unforeseen impact on what occurs next year? What root changes will occur that will affect the delivery of our service to our customers? Those are the $64,000 questions.

However, in the grand tradition of being a forecasting soothsayer, I will offer the following six predictions for the year 2015. I'll start with the easy items and move to the more far-out issues.

1. Ebola will rise
The Ebola outbreak is not over by a long shot. We will see more cases imported and transmitted in the U.S. and Canada over the next 52 weeks. Please, let's not panic, but let's do prepare for this dreaded disease's reappearance. 

During the lull in the action, it is time for the U.S. and Canadian fire services to get truly prepared for this outbreak and for all other infectious disease control issues. I was fortunate to be a member of the course-development team at the National Fire Academy to write the two-day "Infectious Disease Control Program for the Fire Service." 

It is time to revise our operational vision and stance on infection control. This includes rewriting and updating the operational infection-control procedures, providing on-going instruction, investing in proper protective equipment, and exploring what technology can be added to the protective steps.

When the Grady Ambulance crew was unloading Dr. Brantly at Emory University Hospital in Atlanta, it was obvious that the brave crew and the response vehicle was prepared to handle this difficult case. Dr. Brantly was diagnosed with Ebola in West African and was to be treated in the United States.

Next, the world watched the Omaha Fire Department ambulance deliver their patients to the University of Nebraska Medical Center using the same equipment and techniques. How many other EMS systems can provide the same level of risk management for this and other horrible killer disease? 

My sense is that not many agencies are prepared for such a high-level and low-frequency risk. My hope is that we are all getting ready for the next time, making the difficult situation a routine well-handled one.

2. More active shooters
It is not a question of if, but of when and where the next heavily armed coward will attack a group of unsuspecting and defenseless civilians. It doesn't matter whether you protect a small village or a large complex city or anything in between, your community is at risk. That needs to be embedded into all fire departments' planning.

The coming year will bring about some sweeping operational changes related to active-shooter response. We have leaned a lot about what to expect and how to react. We need to determine the best way to apply this information to best protect ourselves and save more victims.

I wrote an article after the Washington Navy Yard shooting event and another asking tough questions about firefighters and medics being assigned to go into the hot zone under police protection.

The reason for such a dramatic change in the operational mode is that most active-shooter situations are resolved in seven minutes or less. Innocent people are critically injured or killed and the threat is neutralized (by public safety response or self-inflected) in a very brief period of time.

To save more lives, immediate life-saving treatment (stop bleeding, fluid replacement and respiration support) must be provided before the patient bleeds out. This must be followed by rapid transportation to a hospital operating room.

No longer taking defensive positions at shooting events will require a major philosophy and policy change. The fire service will need to develop new policies, provide on-going training on these policies and better communications with police.

We will need to regularly conduct dress rehearsal training to practice the revised active-shooter procedures. Personal protective equipment procurement, distribution, maintenance and replacement plans will need to be developed for the mandated ballistic gear and other support items.

When all of the planning, training and equipping are completed, it will be time to implement the plan. Once deployed, constant evaluation and program improvement will be needed. 

3. Traffic incident management
There are three vehicle crashes in the U.S. every minute (180 crashes per hour and 4,320 crashes per day, which equates to 1.6 million crashes per year). On average, five firefighters, 12 police officers, 30 department of transportation highway accident response workers and a large but unknown number of tow truck drivers are killed in the line of duty at vehicle wrecks.

Expect the next standard on traffic incident management, NFPA 1091, sometime in 2015. This will require fire departments to obtain the skills, knowledge and abilities to properly handle any type of operation out on the streets at vehicle crashes.

The Federal Highway Administration will be hosting the second Senior Executive Transportation and Pubic Safety Summit in late January. This four-hour course is designed to meet the NFPA professional qualification standard with the focus squarely on keeping the responders safe.

Look for a lot more awareness about this standard and many more opportunities to get this training certification under your belt. Based on the horrible line of duty death and injury statistics, we all need to jump on this standard and training package.

4. Personal character standards
Could this be the year we see movement toward personal character standards and mandated background checks for our people?

The misbehaving that occurs in our industry, seemingly on a daily bases, is mind-boggling. Embezzlement, spousal and child abuse, illegal drug use, flat-out lying about academic credentials and even a few cases involving murder are among the crimes that fire fighters have been accused of committing in the recent past.

Fire service leaders must take appropriate control over every aspect of our industry or suffer the consequences. Failing to act on significant topics will precipitate someone (or a group) from the outside forcing us to change.

The steps to alleviate the most heinous and reoccurring issue seems to be simple. First, develop a minimum background check standard that everyone, without exception, who pins on a badge must pass.

Not to be exclusionary, but there are folks in society who if allowed to become members of a public safety service, it will not end well for anyone. It should not matter if the applicant is career or volunteer member; either meet the background check standard or move-on. 

Next, never hire or allow idiots, thugs or military misfits to join the department. If the person has already demonstrated he is not worthy to hold the public trust, why push the issue?

There needs to be annual or bi-annual background checks to make sure that our incumbents have been behaving properly. Most departments like to say they "hold folks accountable" for their actions — well it is time to put up or shut up. Finally, conduct training from recruitment throughout the entire career that points out what to do and what not to do on and off of the job. 

5. SLICERS won't stick
The acronym SLICERS (Size up, Locate the fire, Identify and control the flow path, Cool the space from a safe location, Extinguish fire, Rescue, Salvage) doesn't make it to the mainstream fire service vocabulary any time soon. The concept of scientifically validating strategy and tactics will continue to be explored and a better understood. 

What happens when manual suppression techniques are used to control a fire must continue to be explored. This work has been outstanding by all measure. To validate what we do at a suppression event and what the scientific outcomes actually are is brilliant work — no more folklore.

Further, this is invaluable to firefighter safety and survival as well as best practices for saving civilian lives and property.

I will not win many friends with this prediction, but it seems to me that RESCO-VS is not broke. However, to embed this new learning into what is a rock-solid concept is a much better process to change behaviors and beliefs of our industry.  

The tremendous work of this group will certainly continue and how the information gets placed into motion looks a lot more like policy and a lot less like science. So, it is time to update the concepts that were developed by Chief Lloyd Layman of Parkersburg (W.Va.) Fire Department. 

6. Community paramedicine
Alternative delivery systems for emergency medical services will become more popular.

In 2010, the British Broadcasting Corporation produced a film documenting health care in America. One not-so-surprising finding was that those in inner cities used the fire department EMS as the beginning, middle and end of the health-care cycle. Living in Washington at the time, I was not surprised that D.C. was a focal point of this report. 

Statistical data points to escalating EMS responses throughout the nation, and the concern exists that there is abuse or misuse of the EMS system. As the number of emergency responses continues to climb, and hospital emergency department wait times for incoming patients to be treated is also increasing. 

In most boarding cases, when there are no hospital beds available, the EMS personnel must stay with the patient, causing hospital drop times (patient care transferred to the hospital staff) to escalate. Hospital drop times tie up the EMS resources and become a direct causal factor in communities having no ambulances available for the next emergency.

The system is ready to explode, so changes are needed.

I can't wait to see what happens over the next 12 months. Keep a score card along with me and we can see how I did at looking into the future of fire and EMS. Be safe out there. 

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