CRR: The fire service's next evolutionary step
The fire service has added medical, hazmat and mass casualty responses to its job description; here's why risk reduction is the next logical step
The American fire service is constantly evolving. In the last two decades, the role of the fire service has expanded to become literally America’s all-risk emergency service.
I, for one, still look for the loom-up or column of black smoke during a fire response. I’ve learned through knowledge and experience how to read a fire by the location, color and pressure of the smoke showing. And when off-duty, I still turn my head to hear and watch every passing siren.
I get it that for most of us, firefighting is still the prime motivation as to why we became, and are, firefighters. But the fire service must continue to re-invent itself to better serve its communities.
In the 1970s, this evolution was apparent when we moved from a certificate in advanced first aid to registration as emergency medical technicians. The evolution continued with the advent of paramedicine beginning in the Seattle and Los Angeles areas and then spreading across the country like a wildfire.
With advanced life support prehospital care, the fire service took a huge step toward assuring the health and well-being of its community.
In the 1980s, the fire service again expanded services by taking on the role of hazardous material mitigation. Ten years later, we added both technical rescue and urban search and rescue to our list of services.
Those services, along with mass-casualty and active-shooting training have become more important each year in the age of both foreign and domestic terrorism.
The next stage
Today, the fire service continues to take on more routine responsibilities in promoting a healthy community by becoming the primary agency in Community Risk Reduction, or CRR. While fire prevention, inspections and public education remain integral parts of CRR, the concept goes much further.
CRR takes a holistic approach to improving civilian and firefighter safety. For example, the tradition of October having emphasis on fire prevention remains, but CRR takes on a more year-round approach.
Often, the fire service and strategic partners can bring programs sponsored through grants, NGOs or other safety organizations to those needing specialized services. Here is a partial list of some additional programs that can be associated with CRR.
- Smoke alarm installation.
- Fall prevention.
- Child car seat installation.
- Elder care.
- Community paramedicine.
- Water safety.
- Emergency preparedness for individuals, families and the community.
- Heroin and opiate addiction.
Smoke alarm installation is more than handing out alarms to someone coming into the fire station. It is a door-to-door canvas that focuses on at-risk neighborhoods in the community.
How alarm programs work
Using fire reporting data, a department should be able to locate the neighborhoods that have had the most fires or the most civilian injuries and deaths. Looking at this data, it can also be determined if the residences involved had working smoke alarms.
Once selected, the department schedules a daytime or weekend blitz that canvasses the affected neighborhoods. Planning includes posting flyers with the day and time of the canvas two weeks beforehand at churches, community centers, social agencies, local stores social media and web sites and any other place the target audience is likely to gather.
It is possible that the neighborhoods in the most need for smoke alarms are also those where it will be the hardest to have residents participate.
Many departments canvas in three- or four-person teams. It provides both a quicker installation process and crew security.
One individual acts as the public educator, one is the scribe who obtains information on the residents for supporting data and at least one person is the smoke alarms installer. The public educator can also discuss other community services that one or more residents of the home might need.
If your local chapter of the American Red Cross sponsors a smoke alarm program in your area, they will provide the department with a partnership agreement that outlines how the distribution and installation process works. The Red Cross may also send someone to train and help, especially on your first neighborhood canvas.
While fall prevention and elder care are separate programs, both can be used primarily by senior citizens. Falls are one of the highest incidents needing your EMS, and one that can have devastating effects for seniors who wish to stay in their homes for as long as possible.
Working through senior and community centers and as a follow-up to runs where a fall injury has occurred, the fire department can contact the resident and see if they can help them through a home safety audit.
This audit looks for loose items such as carpets, throw-rugs, bannisters or steps where a person may be prone to fall. The visiting firefighter can also give the senior some information about programs designed to increase mobility in seniors; many programs come with little or no cost.
Finally, the firefighter can check to see that smoke alarms are properly functioning and not expired. The object for both programs is two-fold: to reduce further fall injuries, and to reduce the number of EMS responses for fall injuries.
We have all been to one or more auto crashes where an unrestrained child has suffered serious injuries or died due to the impact of the collision. Your department should investigate having one or more certified car seat technicians or installers on each shift or station.
Car seat installations should be scheduled at the station so the firefighter has a chance to gather their necessary equipment and safety materials to instruct the parents in the proper type of seat, installation, maintenance and future adjustments that need to occur as the child grows older.
This program is one of the most rewarding in CRR, and there are several grants by safety organizations and automobile manufacturers that may provide or pay the cost of child car seats for parents who can’t afford one.
This was a year of devastating storms and tornados that seemed to spawn flash floods and subsequent our need for water rescues. No matter what part of the country you may cover, fire departments are aware of the natural disasters that are more likely to occur in their area.
It is incumbent on us to help prepare our communities for these possible natural disasters. Using www.fema.gov/ready, a department can easily download and distribute preparedness literature to their community prior to the season when disruptions or weather-related disasters will most likely occur.
Health care issues
Wherever you are, you’ve responded to a growing epidemic of heroin- and opiate-related drug abuse. This epidemic is not just an urban problem, but is prevalent even in our most rural areas.
This is a problem that we own from an EMS point of view, while law enforcement owns the portion of the problem that includes the manufacturing, distribution and sale of these illegal drugs.
While the coma-reversing drug commonly known as Narcan has saved thousands of lives. It has also become a safety net for drug abusers, and is not a panacea when the heroin dosage includes much more powerful drugs such as fentanyl or the animal tranquilizer carfentanyl.
Some progressive fire departments are entering partnerships with their local law enforcement and addiction specialists to do follow-on visits with patients and their families immediately following their heroin coma.
In one case, a special unit called the quick response team, which is made up of a firefighter-paramedic, a police officer and a social worker who respond simultaneously with the medic unit on any call for an overdose, unconscious person, or non-breather.
If the run is confirmed as an opiate overdose, this team immediately begins to encourage the addict for consent to immediate addiction rehabilitation and treatment.
While legislation in some states hasn’t caught up with this trend, using fire department paramedics in partnership with local health care providers covering all or partial cost reimbursement has provided treatment before a condition has developed into a serious, even life-threatening, illness or injury.
A paramedic in a community paramedicine program may also visit after a hospital stay to see that the former patient is following the protocols suggested prior to their release. Again, the two-fold advantage to this program is that the hospital has less chance of a patient re-admission, and the fire department can replace emergency runs with scheduled visits.
Community Risk Reduction will be the next growth area for most fire departments. If properly implemented with strong partnerships, many or all cost associated with these services can be assumed by a third party.
Some will see this as another burden on the department. I see it as a chance to increase, not decrease, staff available for fire and EMS calls, while providing a needed community service between calls. And, it is a way to become more relevant to your community.