Many of those who proudly serve in the brotherhood could think of no prouder day than the first in which they were granted the honor, to wear atop their breast, the foundational symbol of the fire service, the Maltese cross.  The right to wear this proudly is not only a right, but a tremendous responsibility, and that responsibility begins with understanding the origins of that cross.

In the early 1300’s band of crusaders known as the Knights of St. John (Later recognized as the Knights of Malta) fought the Saracens for possession of the holy land. During these battle warriors encountered a new weapon, one never before seen by European warriors. This incredibly simple addition to the military arsenal wrought excruciating pain and agonizing death upon the brave fighters of the Catholic cross. That weapon, utilized by the Saracen’s was fire.

As the Crusaders advanced on Saracen forces, they were struck by glass bombs containing naphtha, a powerful igniter.  When the crusaders were saturated with the highly flammable liquid, the Saracens hurled a flaming torch into their midst. Hundreds of the knights were burned alive, and countless others selflessly risked their lives to save their brothers-in-arms from death.

Thus, these men (for all intensive purposes) became the first firemen. Their heroic efforts were recognized by fellow crusaders who awarded each here a badge of honor – The Badge of Malta. Since the Knights of St. John lived, for close to four centuries, on a Mediterranean Island, the cross came to be known as the Maltese Cross.

Just as the profession itself, the Maltese cross is a symbol of pride, courage, and protection. It is a representation of the willingness of the men who serve in the Fire and Emergency Services to make the greatest sacrifice,  so others may live.

Note: The firefighters did include a disclaimer at the end of the video stating, “None of us express the views or opinion of the Milwaukee Fire Department.”

The news story and segments of the video can be found and viewed at http://www.wisn.com/news/19317937/detail.html
It certainly seems that in the digital age we have all moved into, we are all under the microscope in an entirely new way.  This has particularly hit home for me recently. I am currently actively involved in a background investigation with several fire departments as a part of the hiring process. This for me has involved more precautions than certainly my father when he was hired, and even my brother. That is to say that I had to take into consideration my past, but also my ‘digital impression’. For example I have a Facebook account, a blog, and a few you tube videos floating around out there, and before submitting my background investigation paperwork I had to go through all of this material and really take into consideration the image I was projecting.  For example on my Facebook I had over 500 pictures, and in many of them there was some form of alcohol. Now even though I rarely drink, and do so under normal circumstance, I had to understand that if the majority of my pictures had some form of alcohol in them, this could be misconstrued by a viewing agency.

As for this video, I certainly think that disciplinary action was appropriate, and furthermore may even support the termination (I would have to have more details to be definitive). The way I see it is this, we are all entitled to our own personal lifestyles that we keep separated from our professional image. However once material is published in a public forum such as YouTube, Facebook, MySpace etc. that falls outside of the appropriate division between personal and professional, especially when such media is filmed on duty. When you work for the fire and emergency services, you always represent that organization and thus have a personal responsibility to be conscious of your public image, and the use of the public domain eliminates your ability to keep your private (non professional life) private.  The only thing I can say in regards to the termination (given the detail provided) is that the content of the video may have been severe enough to demonstrate to the department that theses employees’ morals and ethics were poor enough to directly affect their ability to perform the essential functions of the job (in regards specifically to patient care). Remember that a huge part of the selection process for the position of firefighter is a job suitability assessment that gauges things such as morals and ethics. A representation of poor moral and ethical guidance, then, in the form of a publically available video, may have been sufficient to determine they did not meet the JSA criteria for their current position.  What I mean is that the video could have been as much a concern for the firefighter’s suitability for the job, as it was a concern for the image they were projecting and how that image would affect the department in the public eye.

Essentially this is what happened. On March 27, a captain with the Leadville/Lake County Fire Rescue was arrested and detained at the Lake County Jail for responding to a medical call at the jail. At the request of County Sheriff, Ed Holte dispatch was only to activate EMS for medical calls, not the fire department. Keep in mind that the deputies have only first responder medical training, while Captain Dailey was a EMT-B and able to respond quicker than EMS. Dailey responded to the jail with his crew and requested to see the patient. He was asked to leave by deputies and when he refused, he was placed under arrest. Charges are still pending at this time. Sheriff Holte now wants his deputies to become firefighters to increase his budget and take over other related duties from the fire department who currently works under a cooperative contract between Leadville and Lake County.

I think the major problem here is a breakdown in agency cooperation. I could certainly see this being a situation where police were attempting to enforce their policy, and fire was acting on their ethical (and potentially legal) obligation of patient contact. The sad thing is, in the end of many of these situations, the police end up over stepping their bounds severely by arresting fire personnel for what is (in reality) a ‘workplace’ dispute or disagreement. Look at this clip of a similar conflict from the Hazelwood Fire Department (http://www.youtube.com/watch?v=khBMoZdwEmc) posted last week.

There are so many moral and ethical issues that come up in this situation. The fire department certainly has an ethical responsibility to deliver care as efficiently and quickly as possible. On the other hand (I suppose) that police have an ethical responsibility to adhere to employer policy. However shouldn’t their ethical obligation to the Pt outweigh their ethical obligation to workplace policy? The fact is it sounds as if the police are making an attempt to ‘muscle out’ the fire department. They are trying to limit their response scope, and they are trying to “become firefighters to increase his budget and take over other related duties from the fire department”. This is another ethical problem because the department is attempting to take on tasks outside their defined professional scope of responsibility. At the risk of sounding less than entirely professional this seems like a childish move being used by police to ‘prove’ their worth in comparison to the fire department. There is resonance in this story of the longstanding conflict that surrounds fire and police cooperation, and now its jeopardizing patient care, and ethical standards of conduct. The fact that Mayor Bud Elliott wants to create some sort of super fire-cop organization is ridiculous. To increase the scope of police officers to this extent is simply and completely irresponsible and inefficient. The appropriate action would be for these two agencies to work together cooperatively rather than just to separate them. Let me be clear here, COPS ARE NOT FIREFIGHTERS, they did not test to be firefighters, they were not trained as firefighters, and they were not evaluated to be firefighters. To think that you can just add this to their responsibilities is ridiculous, training or not, and it is a decision that will be detrimental to the community.

There are a number of implications in regards to this clip that could have been prevented, and even more that could lead to either future improvements or future failures. First of all the situation shows a clear breakdown of communication between cooperative agencies. I will make some policy assumptions here. Perhaps in this situation the officer was attempting to regulate traffic based on laws and departmental policies within the police force. On the same note, the Captain for the fire department was likely acting in accordance with departmentally established policy set to ensure firefighter safety. Had communication been better between police and fire personnel then policy would have been further understood between different agencies. This is where communication is essential.

I would like to know the stated legislative mandates for scene control for these agencies. I know that in Colorado the acting medical provider controls the scene, in most cases the EMT-P. If this is the case in the Hazelwood Fire Department then there is major implication created by the officer. If the police interfere with the acting medical provider’s ability to provide care (in this case by removing an assisting party) then that could lead to patient claims of negligence, or even abandonment. It seems almost as if there is a power issue at hand in this situation (one that was inappropriately addressed). In the end it all boils down to a unified understanding of scene control policies as well as an understanding of cooperative agencies policies and obligations.  If agencies work together to clearly understand that their respective policies, it will breed more effective and efficient scene management.

From a personal perspective I have to say that the police officer in this situation was 100% out of line, and doing nothing more than attempting to flex his ‘legal’ power.  There is no reason to ask for this apparatus to be moved. In the video it can be clearly seen that traffic was light, and there were still two accessible lanes for traffic.  Fire apparatus’ are placed on MVA scenes with very specific and particular intentions, safety. Whether you’re a police officer or firefighter, everyone knows that scene safety in the #1 priority. To go to the extreme of arresting an aiding medical professional on the scene of a medical call is not only inappropriate and unnecessary, but completely dangerous. As a direct result of this arrest not only was the patient jeopardized, but the entire service area of the apparatus was as well. If the officer was removed from the rig, it would have taken this engine out of service, or at the very best substantially inhibited the crew’s ability to go back into service as they would be short handed.

Are we Breathing Too Much?  That is the question the Aurora Fire Department has set out to answer with their new revolutionary EMS practice,  Resuscitation Choreography.

The Aurora Fire Department, who has found themselves at the forefront of emergency response EMS innovating such revolutionary programs as Cardiac Alerts and Stroke Alerts have again found themselves in the lead to improve the quality of EMS care across the country. According to a report first released by Channel 7 News, Colorado, the Aurora Fire Department has become one of the first departments to implement a new style of EMS known as Resuscitation Choreography.  Since the program has been initiated the number of CORE saves in Aurora has gone from an average of 10 per year to a total of 24 in 2010. According to Kevin Waters, EMS director for the Aurora fire department “Our paramedics once took care of these people and hoped for the best. Now they take care of these people and expect a complete recovery”.

Resuscitation choreography essentially works to collaborate the most essential methods of resuscitation in the most efficient way possible. This works to bring together early response, cardio pulmonary resuscitation (CPR), portable defibrillators, and advanced medications.

The most radical of the changes, as a result of the program, is continuous compressions. Current guidelines as established by the American Red Cross dictate that CPR be performed by doing 30 chest compression to every two breaths given to the patient. However Resuscitation Choreography teaches paramedics and EMT’s to do compressions uninterrupted.  This is because (according to DR. Gilbert Pineda, EMS director for the City of Aurora) when doing compression it takes a minimum of one round of compressions to begin to effectively deliver oxygenated blood to the vital organs. This is reset every time compressions are interrupted. By doing continuous compression rescuers are now finding themselves able to more effectively supply the brain with oxygenated blood asystole.

Another major innovation is the use of a CPR feedback device (PUCK) that monitors the rescuers compression rate, depth, and effectiveness actively during CPR.

Finally there is the utilization of therapeutic induced intravenous/exterior hypothermia. This is a process in which a patient’s body temperature is deliberately decreased in order to prevent damage to the vital organs by slowing the body’s anatomical functions, consequently reducing the amount of oxygen needed to sustain vital organ life. Studies have indicated that therapeutic induced hypothermia has been associated with improved functional recovery and reduced cerebral histological deficits follow ROSC (restoration of spontaneous circulation).

However, I personally believe that nearly 5x increase in CORE saves in Aurora may be largely attributed to the professionalism and quality of the Paramedics they employ. It seems that there are a number of people who are quick to say that Fire/Medics are less competent than Ambulance Medics, especially in a city utilizing private ambulance companies. However this data works to prove that these fire/medics are unquestionably some of the best medics in the state, and quite possibly, the best paramedics in the country.  In fact Aurora, CO (as a direct result of their paramedics) had the most medical and trauma CORE saves in the country in 2009.  The level of training and service expected of these paramedics have forced them to proudly work towards higher and higher levels of excellence, certainly speaking highly of their commitment to improving the quality of life for the people they serve. An example of this can be seen in Aurora’s standards of data analysis.  Nationally the standard for a CORE save is restoration of spontaneous circulation prior to transferring care, however Aurora Fire Chief Mike Garcia informed me that they do not document any CORE save unless the patient leaves the hospital neurologically intact, he referred to this as a “true save”.  Even their data reflects a higher quality of expectations from their EMS employees, and statistics show that they are more than happy to rise to the challenge of the administration.

All opinion aside it is simply remarkable how far emergency services have come. Only 12 years ago when I acquired my first CPR certification we were taught to 10 compressions to every 2 breaths, and now Aurora is on the brink of redefining the standard so that continues compression are used nationwide.

Curtis Mitchell lost his life waiting for help to arrive, he lost his life hoping for a miracle, and in his case (after 10 911 calls) his miracle was too lazy to get off their asses and walk through the snow…

It is rare that I find myself ready to say that I am completely ashamed with the performance of a fire and emergency service professional; however that is exactly how I felt after I read this article (and saw the video). When I made the decision to become a firefighter it came after a 911 call I was involved in as a student.  The call involved a child that had hit his head. There was nothing wrong with the boy; however the sheer relief that was evident in the mother’s eyes when we arrived was nothing short of amazing. It was this moment that I realized that what makes emergency workers incredible is simply there reliability.  Let me elaborate. I have always been taught that 911 responders will do whatever it takes to get to a patient. Sometimes this is as simple as missing a meal, and other times as complex as driving in your personal truck and snowshoeing the rest of the way because the engine can’t navigate through hazardous or extreme road conditions. The reason they do this, the only reason, is that no matter what they think they know, the person calling IS having an emergency, and they are looking for you to be their miracle, their comfort. That is why we all do what we do. We do it because we want to help people, and because we legitimately care about the people we have committed to serve.  No one, under any circumstances should EVER be led to believe that they are inconveniencing the professionals that have made the commitment to come whenever you call, and that is precisely what these employees did when they told the RP that if her boyfriend wanted a ride to the hospital he would have to walk to them.  I am truly disgusted by the actions of these EMT’s and Paramedics and hope that the general public understands and recognize that these morals and ethics are not representative of the majority of EMS and fire employees.  A dedicated firefighter and paramedic once told me that compassion is rooted in an understanding that no one is ever better than someone else, they are simply luckier. This is an ethical philosophy that certainly fell short in the standards of theses responding medical providers.  On this day they decided that their personal comfort was more important than that of patient Curtis Mitchell’s life, and that is simply and completely unacceptable.  This is made even sadder by the fact that (in this particular case) Mitchell lost his life expecting help to arrive. These actions prove that these responders to not possess the ethics and morals that comprise a competent and compassionate EMS provider and I personally hope to see their positions terminated and criminal charges brought against them for negligence and abandonment under the National Registry’s Duty to Act.

Communications:

On May 22^nd, 2008 sometime between 11:27 and 12:30pm MST six tornados were reported between Larimer county and Greely, Colorado. The storm carried through Wyoming where it finally dissipated. The largest tornado of the storm was classified by the Enhanced Fujita (EF) scale, developed by the national weather service, as an F3 tornado carrying 150 to 160 mile per hour winds, initial reports depict the tornado as “nearly one mile in diameter” (Channel 4 News CBS Colorado).

The Weld County after action report noted that the “jurisdictions of Gilcrest, Greeley, Johnstown (unincorporated), Platteville, and Windsor [were involved], with Windsor receiving the most extensive damage” (AAR pp 1).

Communications where an intricate player in the response to the tornado disaster and a great deal can be learned to improve and adapt as a result of this incident.

The first communications issue I would like to highlight in regards to this situation is the activation and utilization of the State Emergency Response Operations Center. The SEOC is the location in which “representatives from other state departments and agencies come together to coordinate the state response to an emergency situation” (SEOC 2009).  When the SEOC (State emergency operations center) activated at level I “Multiple members of the Division of Emergency Management (DEM) staff were working at the Centennial office when the activation was called. State agency Emergency Response Coordinators we notified and requested to come to the SEOC.  However, other members of the DEM staff were out of the office. There appears to have been no effort to notify these members of this activation” (After Action Report pp 9).  This created a major failure of the system in the sense that it created a delayed response within the Department of Emergency Management and caused a breakdown in the ability of the state to coordinate interdepartmental/interstate response. The State Emergency Operations Center later noted that policies in regards to this type of notification were in place at the time of the incident; however, they were not used.

It is now imperative that education on contact policies be further implemented within the department so that an unexpected disaster does not cause an omission in response actions. This however seems to be (for the most part) an isolated incident.

The next item I would like to examine is form tracking system response communication. Through the Incident Action Plan in conjunction with the ICS 213-RR form tracking system response communication was very effective in the Windsor Tornado. ICS213-RR is “used to track resource requests (to be paid for out of the State Disaster Fund). Most of these requests were processed by the Division of Fire Safety. The positive aspect of this was the establishment and continuation of a numbering system as an administrative system to keep track of these requests. This assisted the Admin/Finance Section when they created their spreadsheet of costs (estimated/ actual)” (AAR pp 9). This in cooperation with two established and coordinated mobile command stations allowed for very efficient and active communication and incident tracking.

The next aspect of communication I would like to examine, as it pertains to the tornado disaster, is communication towards the general public. Communication and information delivery was carried out in a number of different ways throughout the incident.

Initial notification was relayed in three different ways, radio emergency notifications systems, television notification systems, and cellular notification systems. According to Colorado State University the text message notification system “will send a text message alert to all enrolled cell phones in the event of an emergency” (CSU 2007). The major implication with this type of community notification is that it reaches a relatively small percentage of the overall population. This is true based on the fact that at the time the system was only available to college students, and those students had to activate the service in order for it to work. Therefore this system was able to address one specific subgroup of the general public, but fails to incorporate a global audience. However additional subgroups where notified of the approaching disaster via radio and television broadcasts.

In order for response and recovery to be carried out effectively it was imperative that communication efforts where made with the public to aid in response, this could include providing information regarding road closure and travel detours etc. in an effort to elevate civilian congestions that could potentially interfere with response efforts. The same reporting could also be used to communicate shelter locations and other means of customer aid.  In an effort to reach the greatest majority of the general population the state chose to turn to its established media partnership. According to Emergency Management “The media plays a primary role in communicating with the public. No government emergency management organization could ever hope to develop a communications network comparable to those networks already established and maintained by television, radio, and newspaper outlets across the country” (Haddow 2008).  Immediately following the disaster in Windsor, local television stations suspended all operations to exclusively cover the tornado. While media coverage was carried out by each individual network, public affairs officer and departmental public information officers worked together to coordinate and release vital information such as road conditions, shelter locations, business closures etc. This information was used to reach a very large amount of people and help resolve panic and organize recovery efforts. Overall I felt that the operating organizations did an excellent job balancing the necessity to warn the citizens of danger and reducing the potential for panic. Also throughout the evening press conferences where held to inform the general population of progress in recovery and response efforts. These conferences which where cleared by the state public information officer helped keep the public informed to avoid panic or a sense of abandonment from the emergency services. It is very important when holding press conferences to avoid program specifics or policy issues; this is why all media releases in the event of a disaster must be cleared by the public affairs office. In addition of clearing information FEMA also utilized a singular spokesperson. This tactic helps coordinate all information and gives the public a sense of familiarity with representative personnel. Essentially this helps generate active rather than passive listening in the public.

Overall I feel that communication efforts in regards to the Windsor tornado disaster where carried out very effectively. Cooperative coordination was addressed promptly and public information was excellently delivered through media partnerships and advanced technology.  The use of interstate aid and federal aid would not have been nearly as effective without adequate response provisions.

My initial reaction to the Article “Who’s Killing New Orleans” by Nicole Gelinas was, so what? While I found the information presented in the text to be both disturbing and intriguing I was struggling to draw connections between our roles in the fire emergency services and the crime presented in New Orleans both prior to and during Hurricane Katrina. However upon further interpretation of the text I found a question that was immensely intriguing. What is the extent of our responsibility to improve or alter existing conditions of a particular region during reconstruction efforts?
In 2008 following a public outcry for revisions of disaster standards following mitigation and recovery failures during Hurricane Katrina, FEMA in conjunction with the federal government, introduced the Nation Response Framework (NRF), a document that outlines, in detail, the responsibilities of a variety of different response organizations on an “all hazards” level.

The NRF handles situations varying from small scale local incidents to national catastrophic events including (but not limited to) natural disasters and manmade attacks. The National Response Framework is different from the National Response Plan in the sense that it is a detailed plan of action rather than a set of guidelines. Essentially it outlines an actual and more structured plan that can be cooperatively utilized more efficiently than the original NRP (the pan in place during the Hurricane).

The question I have following reading this article is, how well adapted is the National Response Framework to the idea of the New Public Service, specifically in regards to recovery? The recovery section of the NRF (National Response Framework) is revolved around provisions for assisting individuals, households, critical infrastructure, and business’ to returning to a state of self sufficiency. Recovery is divided into two main categories; long term and short term recovery. Immediate short term recovery overlaps with response while long term recovery falls outside the provisions of the National Response Framework. I feel that short term recovery is addressed fairly well within the national framework, however long term recovery leaves much greater room for interpretation. For example, the article places a great deal of emphasis of the preexisting crime present in New Orleans prior to Hurricane Katrina. Essentially the article notes that the disaster was a means of highlighting an already existing problem. So then the question becomes, should recovery efforts be utilized to help improve conditions present prior to the disaster that initiates such efforts. According to the New Public Service, the public interest, as described by the text, should be “goals on which there is a consensus and/or things that are good for the community as a community” (Denhardt pp 68/73). By this definition then, recovery should not simply set out to rebuild in the wake of disaster, but to utilize the opportunity to improve overall. This is a question that had not occurred to me until reading this article. I understood that recovery helped to return a region affected by disaster to a state of operation, but it never occurred to me that it could be used as a “reset” button so to speak.

Gelina’s notes in her article that “no one addresses the city’s most obvious, and intractable, problem, the one that has kept New Orleans from thriving for years…every dime that the federal government spends on “community development will be wasted unless the feds, in conjunction with state and local officials, tackle first things first: making the city safe enough to encourage the middle-class and working-class tax base, black and white, to return” (Gelina pp 6/14). In this light the author creates a sense that even basic recovery efforts may potentially fail if underlined issues are no conjunctively addressed. Perhaps then it is time the FEMA’s long term recovery committees began to plan for disaster recovery with a mindset that is similar to that of mitigation. While short term recovery has immediately aparant necessities, long term recovery has the potential to be utilized to correct and prevent pre existing regional, state, or national complications in conjunction with disaster recovery. This could potentially become the next great stride in federal disaster planning as a result of Hurricane Katrina; after all in the New Public Service we have taken on the responsibility of serving the community and further “exploring the idea of the public interest” (Denhardt pp 68).

In the early hours of the morning Aurora Fire Crews were dispatched to reports of an explosion. Upon arriving on scene, crews realized there was no explosion, but rather a major MVA. The patient’s car reportedly struck multiple concrete barriers (the source of the ‘explosive’ sound) before traveling airborne for approximately 150 feet and rolling onto its roof. Upon rolling the driver of the vehicle was ejected at which point the vehicle landed on top of the patient dragging him and additional several feet.  Aurora Fire Crews were able to extricate the victim and transport to the hospital in under twenty minutes.  Within days of the response, the victim of the major MVA and extrication effort was released from the hospital with no permanent/long term injuries. This is a perfect example of the importance of well executed scene management and rescue operations. Furthermore this works to highlight the importance of the ‘golden hour’ of EMS.