Why is Field of View Important?

Crew Resource Management

What is CRM?  

CRM is a global standard of training concepts that minimize human error to maximize safety and effectiveness. CRM breaks down into these specific behavioral skills: 

• Situational Awareness (SA): The ability to identify the source and nature of problems, extract and interpret essential information, and maintain an accurate perception of the internal/external environment. 
• Assertiveness (AS): The ability, willingness, and readiness to take action; including making decisions and having the courage to act. 
• Decision Making (DM): The ability to use logic and sound judgment to make decisions on available information. 

• Communication (CM): The ability to clearly and accurately send timely information, instructions, commands, and/or meaningful feedback. Active, easily interpreted communication is critical for an effective crew. 
• Leadership (LD): The ability to direct and coordinate the activities of all crewmembers to ensure that the crew works together as a team. 
• Adaptability/Flexibility (AF): The ability to alter one’s course of action contingent on another’s actions and/or as the situation demands. 
• Mission Analysis (MA): The ability to coordinate, allocate, and monitor crew and resources. 

In the industry’s current EMS continuing education scheme, we see CRM highlighted briefly in EMS Operations, but this is not enough. The overarching goal should be to make CRM a mandated mindset, instilling a culture of teamwork and safety. 

Instilling the CRM Mindset 

Many internal and external factors affect good CRM—stress, workload, distractions, fatigue. The crew must remain vigilant in recognizing these factors. However, the biggest factor is attitude. 

A CRM attitude starts with initial training and integration, and then improves and increases with annual training, a supportive environment, and improved CRM processes. At its core, CRM is a mindset, a thought-out process to keep our crews safe and efficient. 

It’s hard to introduce a new mindset (like not back boarding every trauma patient) when a community has never used it before. That’s why this is done over a period of time in the prehospital world. 

Every Team Member Counts 

By adopting CRM, everyone on the crew is equal to the completion of the team’s mission. In fact, a well-oiled CRM machine is not impacted by rank, which is present only to maintain structure, order, and positional authority.  

It is easy to say that you respect the probationary paramedic’s opinion, but do you foster a team environment where that individual is accepted? This is CRM: understanding that when working as a crew, rank is just a structure for leadership to help drive the aspect of equality and the basic CRM skills up and down the chain. All skills in CRM require a 100% buy-in and understanding from every individual regardless of rank in order to increase patient and provider safety. 

Each crewmember must take responsibility and work toward the following skills: 

• Evaluate the safety of the environment (situational awareness). 
• Take action or do what is right even when it means identifying your own weaknesses (assertiveness). 

• Make the best decision with the information you have (decision making). 
• Communicate clearly and freely with your team/crew (communication). 
• Understand leadership yet understand it can change based off any one of these skills (leadership). 
• Be ready to change and adapt at a moment’s notice (adaptability/flexibility). 
• Analyze best practices and continue to build off what works best for your system (mission analysis). 

Embrace the Change

 

Crew Resource Management Video 

Firehouse Magazine Close Calls Mayday Reality Check

https://www.firehouse.com/safety-health/article/21040224/close-calls-mayday-reality-check-firehouse-magazine

While searching for residents, two firefighters became trapped and called a mayday. One firefighter came down the ground ladder head first, and the second firefighter jumped.

Photo by Daniel Jasina

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I reached out to Chief (ret.) Don Abbott, my longtime friend and North America’s resident mayday expert, to get the most recent data from Project Mayday (projectmayday.net). Abbott and his team study maydays so those firefighters’ experiences become our lessons to learn. The latest facts are critical for us all to understand, train and prepare for these emergency events.In addition to some of the Project Mayday findings—typically presented as a percentage of occurrence—I offer in this article some key points and questions for departments to consider. Understand that these are not career maydays nor are they volunteer maydays. These are firefighter maydays. Maydays occur in all types of departments to all types of members, regardless of being paid or not, elected or appointed. And if you are a fire officer, the responsibility of being in command is a huge undertaking, and the related practical training must be initial and ongoing.

Trigger phrases

In listening to more than 5,000 audio recordings—repeated numerous times by a group of firefighters and fire officers—and transmitted over the fireground audio tapes, Abbott and his team identified 16 communication phrases that were heard more than 87 percent of the time in mayday incidents. In other words, if you hear one of these phrases, it should get everyone's attention, and a combination of these phrases should alert the incident commander (IC) that a mayday may be inevitable:
1.    “We have zero-visibility conditions” – 41 percent
2.     “We have fire above our heads” – 82 percent
3.     “We have fire below us” – 57 percent
4.     “We need more line, extend our line” – 34 percent
5.     “We have not found the seat of the fire” – 66 percent
6.     “We are running out of air” (low-air alarm in background) – 71 percent
7.     “This is a hoarder house” – 56 percent
8.     “We have had a flashover” – 35 percent
9.     “We have had a roof collapse” – 33 percent
10.  “We have lost multiple windows” – 27 percent
11.  “It’s really getting hot in here, we are backing out” – 45 percent
12.  “Our exit has been blocked” – 20 percent
13.  “We are sending a firefighter out with a problem” – 23 percent
14.  “We have a hole/or floor collapse” – 57 percent
15.  “Command has lost communications with multiple crews” – 18 percent
16.  “We have a lot of sprinkler heads going off in here” – 64 percent
These phrases are critical to identifying a problem, often before it happens. One of the Project Mayday findings that may underscore this best is that 37 percent of all mayday victims did not transmit the mayday when they should have.
For additional details about the trigger phrases, read Abbott’s feature “Communication Clues” at firehouse.com/12387578.

Personnel involved

Many chiefs interviewed stated that they could have predicted the crew having the mayday based on the number of crewmembers with “move-ups,” working out of assignment, and overtime/staffing issues, in other words, being outside the crew that normally worked together.
Crewmember having maydays
·       Move-up company officer (normally an engineer but filling in as officer) – 13 percent
·       Move-up engineer (normally a firefighter but filling in as an engineer) – 25 percent
·       Firefighter working overtime – 31 percent
·       Crew running short on staffing – 32 percent
What training and qualifications do your personnel have when working “out of position”? How often do your driver/engineers train as part of a firefighting crew?
Crew size
The size of the crew calling the mayday was represented in the Project Mayday studies as follows:
·       2-person crew – 27 percent
·       3-person crew – 39 percent
·       4-person crew – 34 percent

Communication and radios

According to Project Mayday, 36 percent of maydays transmitted were missed on the first call by anyone on the fireground or dispatch. The majority of missed maydays were called on portable radios, and most radios were not fully charged. Further, it was determined that only 53 percent of the agencies actually followed their communications-related standard operating procedures (SOPs)/department policies during the actual mayday event.
Some other communications-related findings from the Project Mayday studies:
·       Emergency activation (EA) buttons were activated in 32 percent of all maydays
·       74 percent of mayday victims did not completely understand how their radio’s EA button system worked and what functions/problems this may create
·       61 percent of fire departments change channels for a mayday
Considering the number of missed mayday calls, it’s important that communications be as clear as possible, with specific phrasing. For example, instead of saying “Engine 16” (said as sixteen), say “Engine one-six,” and instead of saying “A side,” say “Alpha side.” Some additional tips:
·       Keep radio cables from portable to lapel mic inside the coat or covered with a sleeve
·       Clean lapel mics regularly
·       Portable radios should be hard-charged at least every 48 hours
·       Portable radio batteries should be replaced every 3 years
·       All radios should be set up so that if you turn the channel selector all the way right or left, it is on the same channel
Consider these questions: What is your department’s mayday policy related to the above factors, including daily radio maintenance and checks, channels used, radio control, dispatch involvement, responsibility of the non-mayday companies on the fireground, radio discipline, and command managing that mayday? Do you train and therefore operate based upon your written policies, or are your policies one thing but how you operate on the fireground another thing? Does your department have a battery-management tracking system?

Mayday callers report

The experience of the mayday callers themselves cannot go unrecognized. Firefighters who called maydays reported the following:
·       Command offered reassurance/instructions – 63 percent
·       Frustration due to too much radio traffic – 47 percent
·       Not turning on/off PASS unit or muffling it, making communications difficult – 57 percent
·       Confidence in the IC (93 percent); company officer (84 percent) and rapid-intervention team (RIT, 20 percent)
Additionally, mayday-callers reported an inability to get radio air time after transmitting the mayday. The studies also showed an average time of approximately 79 seconds from the mayday transmission to the point the call was answered or acknowledged.
Radio discipline is a big deal. Many departments have adopted the policy of “no good news” on the radio. In other words, there is no need to advise anyone if you have water on the fire; after all, that's what you were told to do. On the other hand, if you are not making progress and things are getting worse, that is a valid transmission. As we have shared in this column before, a good term to remember is DIM-WIT: “Does It Matter What I'm Transmitting?” If not, don't transmit.
Further, can your dispatchers monitor and transmit on the fireground channels throughout the entire incident? Are there policies related to what the dispatchers are expected to do on those channels? When training, are your dispatchers training with you, on the radio, as they would operate in a real emergency? 

Mayday causes and survival

Firefighters involved in maydays reported the following contributing factors to their mayday:
·       Situational awareness – 77 percent
·       Disorientation – 65 percent
·       Decision-making – 64 percent
·       Individual actions – 71 percent
·       Communications – 36 percent
·       Not enough resources – 39 percent
·       Unsafe acts – 65 percent
Firefighters involved in maydays reporting the following methods for how they survived the incident:
·       Self-rescue – 36 percent
·       Assisted by their own crew – 26 percent
·       Assisted by another interior crew – 25 percent
·       RIT rescue – 7 percent
·       Other – 6 percent
Although RIT affected a rescue in only 7 percent of mayday incidents studied, their presence at the scene is important, as it provides a dedicated team to respond if teams already in the structure are unable to assist. In the cases studied:
·       RIT had been established prior to the IC’s arrival – 15 percent
·       IC established a RIT – 89 percent
·       When first RIT was activated, second RIT was immediately established – 18 percent
A key finding from Project Mayday: One out of every nine RITs that is put to work to conduct a rescue has their own mayday. It was determined that in many cases, the RIT went in too quickly without understanding the entire situation, most often because the IC did not define the actual problem prior to RIT’s entry.
Are all firefighters who respond to your fires fully qualified to be rapid intervention? What policy identifies who can serve in a RIT function? The RIT should be your best crew on the scene. Nobody wants to depend on crewmembers who are out of shape, have poor training habits, or are just lazy.

Command issues

Strong and effective command is vital in mayday situations. Following are Project Mayday findings related to the experience level of those in positions of command during mayday events:
·       Average years of service – 16.7 years
·       Average years of IC experience – 6.6 years
·       Initial training time ICs receive related to running an incident – 4 hours
·       Continued in-service training annually for IC – 3 hours
Following are general findings related to incident command at mayday events:
·       Average response time for a chief to arrive on scene and assume command – 6 minutes, 39 seconds
·       Responding chief could hear all radio traffic while responding – 76 percent
·       Tactical priorities were established and announced by first-arriving unit – 64 percent
·       IC operated alone in command vehicle without an aid – 77 percent
·       IC reviewed or evaluated their incident action plan during the incident prior to the mayday – 67 percent
·       IC used a formal tactical worksheet – 64 percent
·       Tactical benchmarks were transmitted during the fire – 73 percent (face to face: 22 percent; radio: 82 percent)
·       Safety officer assigned for each incident – 22 percent
·       Automatic aid or mutual aid in use at the time of the mayday – 46 percent
·       IC served as a mutual-aid chief handling a mayday – 24 percent
·       No accountability management in operation at the time of the mayday – 68 percent
Additionally, Project Mayday found a nearly three-way split among the command options on scene:
·       IC ran both command and mayday rescue operations – 38 percent
·       IC ran the fire but was able to pass the rescue to another officer – 29 percent
·       IC ran mayday rescue and passed fire operations – 35 percent 
Some questions to consider: What is your area or regional policy for the initial and ongoing training to develop qualifications for an IC? How often are those who may someday be in command re-trained or re-certified as a fire commander? Is everyone from the chief of department to the newest company officer trained and qualified, at least annually in a classroom as well as during hands-on training programs, in addition to their field firefighting experience?

After the mayday

Learning from emergency incidents is vital to reducing future occurrences. Project Mayday found the following related to actions after a mayday incident:
·       Scene debriefing – 74 percent
·       On-site critique – 52 percent
·       Investigation into mayday/incident – 34 percent
·       Policies reviewed – 74 percent
·       Policies changed – 36 percent
·       Training changed – 56 percent

Final thoughts

Here we’ve covered the latest findings related to what actually happened during mayday incidents. Some issues that still need further research specific to firefighter survival include the impact of several additional factors:
·       Sleep
·       Energy drinks
·       Fitness
·       Behavioral health
·       Training specific to flow path

Abbott and his team continue to gather more data from those who have been in mayday scenarios and those who were in command at the time. It is incumbent upon all of us to use this information at our own departments, so we learn from what our brothers and sisters have already experienced.

Chief Billy Goldfeder

Firefighter Life Safety Initiatives # 13

Suicide Poster

Occupational Stress Exposure

As we all know there are 16 Firefighter Life Safety Initiatives. We are losing more and more firefighters every year to suicide and I do not think it’s going to stop any time soon and that hurts to know. Initiative 13 talks about Psychological Support and I think that we should be hitting #13 a little harder than we do.

Initiative 13 means that firefighters and EMS professionals and their families must have the resources to deal with the various complications that their jobs can bring to their lives, especially issues regarding emotional and psychological stress. They must also have help available to deal with the problems in living that all of us sometimes face, regardless of the work we do, especially regarding family, finances or even drug and alcohol issues. Health and safety standards (like the NFPA 1500 Standard on Firefighter Health and Safety) require that assistance programs be made available to ensure that such services are there when needed.

Understanding the new model for Initiative 13 dealing with firefighter behavioral health begins with an overview of the Protocol for Exposure to Occupational Stress. At the heart of the following flow chart or model is an understanding that firefighters and EMT's do not all respond similarly to traumatic events-thus, we have adopted the practice of calling them potentially traumatic events (PTEs). What’s different about firefighters and other first responders and why understanding their occupational stress is critical has to do with the “unfortunate regularity” of these workers to horrible, dangerous and stressful situations. The model and accompanying notes explain the components of determining who is impacted and who may need assistance. It recommends the use of the Trauma Screen Questionnaire as a widely accessible tool for individuals to understand if they are in need of behavioral assistance.

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7 things public safety officials need to know about Safe Haven laws

https://www.firerescue1.com/safe-haven-law/articles/393404018-7-things-public-safety-officials-need-to-know-about-Safe-Haven-laws/?NewsletterID=268544&utm_source=MailChimp&utm_medium=email&utm_content=Exclusives1RightTitle&utm_campaign=FR1Member&cub_id=usr_hsD7ZVgxBdBw5tJe

Atascadero Street Fire

http://www.subburndown.com/atascadero-street-fire
http://www.subburndown.com/atascadero-street-fire/