Firefighter CRM can reduce injuries and deaths

Here are eight steps to making "one for all and all for one" improvements to firefighter health and safety


Should a firefighter have a say in another firefighter's health or ability to perform on the fireground? What if that firefighter's health directly impacted your ability to perform on the fireground or your safety?

These are interesting questions and a possible direction for Crew Resource Management. There has been a lot of interest over the years in CRM as an approach to improving safety on the fireground.

The basic idea behind the paradigm is that every member of a crew has something to contribute and that the safest way to approach an incident is if the entire crew is empowered to voice their opinions and alert their company officer if they see something that will put the crew at risk.

According to one of the guys who wrote the book on the topic — Tom Lubnau — the basic tenants of the model include a focus on communication, teamwork, task allocation and critical decision making.

I recently attended the National CRM Symposium at Pflugerville Fire Department where I had the opportunity to hear the leading experts like Lubnau, Dennis Rubin, Alan Brunacini and Bruce Varner. They explained the construct and discussed applications of the CRM model.

We had a discussion about if the CRM model might be applicable to firefighter health. More specifically, are a firefighter's personal choices about health a crew resource management issue?

Through some discussion, we agreed that the goal of CRM is to improve safety. This is operationally defined as decreasing line of duty injuries and deaths on the fireground.

Root causes
A basic assumption is that injuries and deaths on the fireground do not happen at random — certain activities and practices lead to injuries and death and increased risk. It is through identifying these ahead of time and addressing them that risk is reduced.

If you look at what risk factors increase risk for injury and death on the fireground and in the line of duty, we know that risk is significantly related to obesity, poor cardiovascular health, chemical exposures (if you consider cancer a line of duty injury) and exertion.

If you look at what risk factors are modifiable that lead to poor outcomes, they are things like nutrition, fitness, sleep, behavioral health, alcohol use and exposures (both chemical and substance use).

If you follow that line of logic backwards, much of the injury and death that occurs on the fireground is predicted and increased by risk factors that occur before you even hit the scene. It also means that many of the injuries and deaths are preventable if the risk factors are addressed before you are toned out.

So, it seems that health behaviors are a crew resource management issue and several of the tenets on the fireground do have a direct applicability to health management of the crew. This is particularly true when you keep in mind that firefighters face shared risk factors — unhealthy behaviors by one puts the entire crew at risk.

The practices of CRM, when considered in relation to crew health and crew risk factors, could have a significant impact on decreasing risks to the crew. If you look at the eight steps of the process, all have applications to health.  

1. Empower individuals
Every member of the crew should feel empowered to engage their crewmembers on issues related to health and health behaviors. This is not just identifying problems, but capitalizing on the crew's strength and bonds to improve the health of each member.

Sometimes when a firefighter isn't willing to make a change for themselves, they are for the sake and safety of their crew.

2. Encourage communication
While it can be an uncomfortable conversation to get started, each individual's risk factors (positive or negative) effect the risk level of the crew. And it is not a secret even if no one is talking about it.

If a piece of equipment on the truck was broken and there was a good chance it wasn't going to work at the next fire, there would be discussion about the problem and how to fix it. Yet, when it is a firefighter who is putting everyone at risk, it's a taboo topic to discuss.

The ironic point that is often overlooked is that no one wants to be the liability who everyone else worries about carrying out of a fire if they go down. Once the discussion is started, that person is often the first to jump on board and ask for help to improve.

3. Identify risks, strengths, weaknesses
Each person brings their own liabilities and strengths to the crew. It's important to know not only your own risk factors but the risk factors for everyone else so you're aware of what liabilities each person holds.

Are there people at higher risk for a cardiac event you should be aware of? Who has high blood pressure? Do any of your crew members have a history of cardiac problems? Who is a smoker?

4. Recognize barriers
If improving health, losing weight, stopping smoking, and getting fit were easy, everyone would do it. Many things about the fire service can be barriers — SOGs/SOPs that don't support healthy practices, lack of time, lack of resources, complacency and high call volume.

There are a number of barriers to being healthier and it's important to recognize them so you can address them.

5. SOPs/SOGs
Even when departments profess to be supportive of healthy lifestyles, there are often SOPs/SOGs that actually go against the practices that improve health. Those need to be addressed at the crew and department level if real change is to occur.

6. Solicit solutions, make a decision
When it comes to health and health behaviors, some people are on top of the topic and know how to manage and improve health and others don't. The impact and influence of the crew cannot be overrated.

7. Everyone helps each other
There are very few motivators for firefighters that are stronger than the bonds they have with their fellow firefighters. Often firefighters who aren't willing to make a change for themselves will for the good and safety of their crew.

8. Training and education
Learning about anything in the fire service is a lifelong and evolving process. Improving health is no different — knowing how to improve readiness is not something that can be learned an implemented over night. Education and training for the crew has to be an ongoing process.

The take-home message from the CRM model is that there is a shared responsibility to improve safety for all firefighters, that this safety comes from capitalizing on all the resources the crew has to offer and that it is the responsibility of each crew member to engage in the process to improve the safety of all.

What research is increasingly showing us is that safety starts before anyone arrives on scene and that some of the best predictors of injury and death are risk factors that have to be addressed on a day-to-day basis. The logical extension of these facts means that modifiable risk factors are a CRM issue and improving safety starts long before the tones go off.

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