Carolina Fire Journal Redesign by William Ellis

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The First Responder’s Resource

THE FIRST RESPONDER’S RESOURCE

Like other populations, First Responders are at risk for depression, substance use disorders, and suicide. Here are some expert tips on the warning signs along with prevention tactics.

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CONTENTS VOLUME 37 | NUMBER 4 | SPRING 2022

FEATURES SPECIAL FEATURE SECTION:

First Responder Wellness & Support 2

Winning the Hidden War

Exposing the Mental Health Stigma Among First Responders

DENA ALI

CHIEF MICHAEL LANNING

Meditation: Sharpen Your Edge. Lose Your Edginess BRANDON K. DREIMAN

Building Resiliency in the Fire/EMS Service S C OT T A . R O B I N S O N

Update from the NC State Firefighters’ Association TIM BRADLEY

DEPARTMENTS Last Alarm | End of Watch 12

What Does It Actually Mean to “Never Forget?” A A R O N D I XO N

Retirement Planning 13

Retirement … It’s In Your Future DA L E R . F O LW E L L

Safety & Prevention 15

Know When to Hold ‘Em, Know When to Fold ‘Em DAV I D G R E E N E

Heat Risks Are Rising

N I C O L E R A N DA L L

Recruitment & Retention 19

Noise, Noise, Noise DAV I D H E S S E L M E Y E R

EMS 20 When Your Patient’s Glucose Reading is “HI” — Understanding and Managing Type II Diabetes A A R O N D I XO N

NC Medical Director Update 2022 D R . JA M E S W I N S LO W

Sixty-One Delta One 24 The Rigs We Ride — Hazmat Apparatus Design GLENN CLAPP

28 How It All Got Started B O B T WO M E Y

29 SUSPENSION TRAUMA SERIES CONTINUED: Suspension Trauma: A Lethal Cascade of Events (Part II)

STAFF

Policies & Procedures

Trudy H. Schneider Business Manager trudy@baxterknight.com

32 NFPA 3000 SERIES CONTINUED: Understanding the Recommendations of NFPA 3000

Bill Ellis Art Director advertising@carolinafirejournal.com

N O R M A N WO O D

DA N I E L M O R A N

Leadership

R.B. Knight Publisher rb@baxterknight.com Gwen Shuford Managing Editor gwen.shuford@carolinafirejournal.com

ADVERTISING Dick Murphy dick.murphy@carolinafirejournal.com Gwen Shuford gwen.shuford@carolinafirejournal.com

33 Generational Leadership

EDITORIAL BOARD

MARK RIVERO

Jim Bell — President Bobbitt Design Build, NC Division

Missions Rescue 34 The Guatemala Connection: The Journey Begins DAV I D P E A S E

Bill Carter — Director of Fire/EMS Business Development , Civic Federal Credit Union Glenn Clapp — Division Chief – Fuquay Varina Fire Dept. Doug Cline — President, International Fire Service

Health & Wellness 36 Strength Training for Firefighting … J E F F C A S E B O LT

Kent Davis — Consultant, Threat Suppression Dale Folwell — N.C. State Treasurer David Greene Ph.D — Ph.D Chief, Colleton County Fire Rescue

Equipment Purchasing 38 Evaluating Fire Equipment: Remove the Junk First … Then Calculate

David Hesselmeyer— President – On Target Preparedness, LLC Ricky Hesson — N.C. Hazmat Association Beth Krah — Krah Corporation Tracey Mosley - Program Manager, NC Association of Fire Chiefs

Know Your Gear

40 Inside Turnout Gear Technology

Ken Newell — Stewart-Cooper-Newell Architects

Fire Station Profiles

Richard Ray — Capt. Durham Fire and Rescue

TO D D H E R R I N G

42 Hope Mills Fire Dept Profile C U M B E R L A N D C O U N T Y, N C

43 North Myrtle Beach Fire Dept Profile H O R R Y C O U N T Y, S C

Lizzy Long — Billy Graham Rapid Response Team Mark Rivero — Public Safety Management Programs S. Illinois University Caroline Schloss — Crossword Puzzle Mark Schmitt — Captain, Greensboro Fire Department Matt Sloane — Skyfire Consulting

Air & Surface Decontamination

William Tatum - SC EMS Director

44 Upstream Strategies, Barriers & Runaway Bulls

Bill Webb — Ex. Director Congressional Fire Services Institute

Ask Mr. Bill

Published by KCI Media Group 10150 Mallard Creek Rd. Suite 201 Charlotte, North Carolina 28262 704-568-7804

46 Show Me the Money BILL CARTER

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Preserving History 49 The Firemen of Spencer Shops X AV I E R K LO N OW S K I

EXTRAS 51

26 Dressing for Cold Weather Search and Rescue Operations

52 Industry News

James Winslow — NC EMS Director

Dalan Zartman — President, Rapid Response

BETH KRAH

Search & Rescue B O B T WO M E Y

The First Responder’s Resource

Carolina Fire Rescue EMS Journal reserves the right to edit for clarity and content. Editorial opinions and products advertised do not necessarily reflect the views and opinions of the publisher. © 2022 KCI Media Group, LLC

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Cover STORY

Like other populations, First Responders are at risk for depression, substance use disorders, and suicide. Here are some expert tips on the warning signs along with prevention tactics.

ince 1999, suicide rates in the United States have climbed by over 30%. Researchers have discovered several factors leading to this rise and recognize that few populations are immune from its outcome. Troubling for researchers and those involved with prevention alike is the fact that there is no effective algorithm to predict a suicide. The Question Persuade Refer (QPR) Institute says that our ability to predict suicide today is not much better than chance or a coin toss. This is because most people who have the documented risk factors will never attempt suicide, and many people who die by suicide displayed few of the documented risk factors. While understanding risk factors are important in terms of prevention, it is now recognized that prevention by design can be more effective. This is achieved by

creating communities where it’s more difficult to die by suicide due to greater barriers between those at risk and their means to die. Moreover, protective factors can serve as a wall of resistance between risk and outcome. Effective protective factors include strong support networks, access to mental health resources, coping skills, sleep, and practice of mindfulness. Connectedness is one of the greatest protectors against suicide. Meaningful connection is an innate human need for all people, and there is no substitution. A method any layperson can learn to help prevent suicide is asking directly about suicide. If you are worried about a friend, coworker, or family member, you should ask them directly if they are thinking about suicide. Don’t worry, the question is not offensive to somebody considering suicide, and evidence has found that it will

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not implant the idea in a vulnerable mind. Those who have considered suicide reported relief when directly asked in an empathic and sincere fashion. By asking them directly if they are thinking about suicide, you give them permission to open up, share their struggles, and take the first step to heal — finding alternatives to suicide. You become their ally in finding solutions for their pain. Timing is also important because suicide intensity ebbs and flows, and, when suicide intensity peaks, a person is most at risk. Fortunately, we know this intensity is often short-lived. Any barriers that are present between a suicidal person and their means have a preventive value, and the conversation should lead to enhanced barriers. In a recent lecture, Sally Spencer-Thomas Ph.D. provided guidance on how to ask directly

about suicide. Here is some of the information that she provided. If you have any questions, comments, or concerns about the following, please reach out to me or go to workplacesuicideprevention.com. WORKPLACE SUICIDE PREVENTION Before engaging in a conversation about suicide, you should understand that there are no magic words that can take someone’s pain away. The most valuable thing you can do for them is to show up and truly listen to what they have to say. Ensure you truly show up by employing active listening skills. This means to tune into your body language: get on their level, face them, and lean in! Make eye contact, mirror their responses, and focus on what they are saying. Forget about problem-solving or crafting the perfect response. Your goal here is to help them feel WWW.CAROLINAFIREJOURNAL.COM

Special Feature Section connected and safe by conveying calmness and trustworthiness. In doing this, you provide them with an opportunity to open up and share their thoughts and feelings. Then and only then can they feel safe sharing their struggles. You can start the conversation with a simple, “I’ve noticed you don’t seem like yourself lately…” Then list the specific things you’ve noticed about their behavior, moods, and/or life circumstances. There is no script for this; you have to follow your gut. Make sure you explain your concerns, let them know that you are bringing the issue up because you care about them, and you want to be someone in their life they can talk to about hard times. Don’t hesitate to be honest and let them know that you, too, know how important it is to have somebody to talk to when things become overwhelming. If you have a similar experience, share briefly that you’ve walked a similar road. Be sure not to flood them with your experiences. They should be doing a majority of the talking in this conversation. Employ effective listening by creating a space that lets them know that they are being heard and their story matters. To keep them comfortably talking, use minimal encouragers such as “umm hmm,” “what else,” and the best prompt, “tell me more.” This lets them know that you are aware something is missing, and you not only care but are not burdened by this conversation. A great acronym I use is “Awe.” “And what else”. Awe reminds me to keep the conversation going by letting them know that I am invested, and I want to hear more. If you get silent, know it is ok. Silence is an opportunity for them to develop the courage to keep talking. Effective pauses in conversation are just that, effective. Savor the silence and try not to be the first to break it. Throughout the conversation, imagine you are holding up a mirror to the person, reflecting what they say to show that you understand. This sort of reflective communication helps to validate their concerns and thoughts. The best way to do this is by summarizing what you hear and adding emotional labels to their story. For example, after they explain a loss and you detect that they are sad, you could say: “Let me see if I got it right, you sound sad because you have lost…” Conveying your willingness to be present while another is in a dark and difficult place is more important than any advice you may have to offer. You don’t have to know the answers. Showing you are willing to provide unconditional support is what’s most important.

Don’t forget that finding the courage to open up and share your struggles is scary, and when people finally do it, it’s because they feel miserably trapped with no other option. More than anything, they are looking for connection and relief from their pain. Thoughts of suicide are common for people experiencing overwhelming hopelessness, selfhate, and disconnection. When talking to somebody going through a difficult time or major loss, it’s important to always assume that suicide is on the menu. Sally explains, “by assuming the suicidal thoughts are already there, you don’t need to wait to be given a big, red warning flag. Instead, you make what we call a pivot statement (2019).” A pivot statement occurs when you summarize the risk factors and warning signs you hear and then connect them to the possibility of suicide. An important part of the pivot is checking with the person to make sure you are hearing them correctly. Example: “Let me see if I’ve got this right. So, what I’m hearing is that you are going through a divorce, you are having a hard time concentrating at work, and you fear a personal financial collapse, yes? You know, sometimes when people are going through a divorce, having a hard time concentrating, and experiencing financial stress, they also think about suicide. I’m wondering, how many times suicide may have crossed your mind, even if it was just fleeting in nature. (Sally Spencer-Thomas, 2019)” By letting the person in crisis know that you understand why people think about suicide, you help the person feel validated and less isolated. With compassion and a willingness to walk with them, you can make a huge difference in their outcome. Asking, “are you thinking about suicide,” offers the best opportunity for an individual to open up and express themselves. Understand, a person who is thinking about suicide may respond with a “no,” especially if they are a fellow firefighter who may fear judgment, loss of job, discrimination, or forced hospitalization. If somebody answers no, but you note discrepancies between what you see and what you hear, just reflect it by telling them that, “you are telling me that you’re fine, but I am seeing and hearing somebody who is distressed, would you tell me more about what you are going through?” Follow your gut, stay calm, and don’t force conversation. Don’t forget, there is no script for this conversation.

First Responder WELLNESS & SUPPORT

Sometimes when asking about suicide, you might get a “yes.” How do you respond to “yes?” First, make sure you stay calm. Here are a few responses that will make a huge difference: Express gratitude: The first words out of your mouth should be, “thank you.” “Thank you for trusting me.” “Thank you for your courage to be vulnerable with me.” “Thank you for valuing our relationship.” When people admit thoughts of suicide for the first time, they fear judgment and anticipate a negative reaction. However, when they receive a genuine expression of gratitude, this helps to put them at ease. By responding calmly and with gratitude, you create a safe space to move to the next steps. Reassure your partnership with them. You are by their side and not planning on going anywhere! A significant fear for someone living with suicidal thoughts is rejection through judgment. Reassurance that you are not afraid and not planning to toss them like a “hot potato” can be very grounding for them. Your partnership ensures they know that they are not alone, and they have an advocate. A connection may provide a flicker of hope that keeps them alive. Provide hope through offering choice and empowering them to take the next steps. Hope is the antidote to suicide, and the best way to offer hope is through action. You provide action through resource sharing and tackling issues in a step-by-step method. We must remember that we can’t fix everything today, but we can start with the most pressing issue or the one thing we can tackle today. Small attainable goals are the key to change and success. Championing change with broad statements like, “you have so much to live for,” is not an effective means for building hope. Hope forms through an individual plan for healing. What you want to communicate to them is that they matter to you, to their family, and their organization. They are not a burden, and they are worthy. Remember, you are not the solution; you are the bridge to the resources. Your role is to remain in the passenger seat and share the best routes in hopes of eventually handing them off to professional resources. FOR ANYONE IN NEED OF IMMEDIATE HELP You can choose together to call the National Suicide Prevention Lifeline (1-800-273-8255) or to text the Crisis Text Line (text HELLO of 741741). Or you may reach out to a known mental health provider, peer support team, or first responder crisis line.

Even in the warm hand-off to professional care, you can be with them. Just ask permission or offer to join them for their first appointment. From this author’s experience, that first appointment is daunting, and having support can make a huge difference. Finally, before ending the conversation, make a plan to follow up. Ask for permission to check in next week or even offer a lunch/ coffee meeting. It’s ok to let them know that they may face challenges as they are common, but persistence will help them fade. By offering to follow up, you let them know that you are willing to walk in the darkness with them. When someone shares with you that they are having thoughts of suicide, they trust you and you must treat this with gratitude. Sally says, “This is a gift, they have invited you into a vulnerable part of their world, and you are a guest in this space.” There is no script for this conversation, and at any point, if you find the individual is an immediate threat to themselves or others, you must reach out to emergency resources. But, when they are not an immediate threat, your willingness to courageously walk through the darkness with them may be what leads them to heal. If you would like more education on asking about suicide, go to the QPR Institute, Living Works, American Foundation for Suicide Prevention (AFSP), or the International Association of Fire Fighters (IAFF) Peer Support program. Lastly, thank you to Dr. Spencer-Thomas for her help on this work. Please visit her website, https:// workplacesuicideprevention.com/ Dena Ali is a captain with the Raleigh, NC Fire Department where she has worked her way up the ranks. Ali has a degree from North Carolina State University and an MPA from the University of North Carolina—Pembroke, where her research focused on firefighter suicide. She received the NC Office of State Fire Marshal Honor, Courage, and Valor award in 2018 for her steadfast effort to bring awareness to firefighter mental health through her vulnerability. She is an advocate of awareness, education, and understanding of mental health disorders and suicidality. She speaks locally and nationally on these topics and is a QPR Suicide Prevention Gatekeeper Instructor and is the founder and director of North Carolina Peer Support where she helped to develop their statewide curriculum. She is also a founding member of the Carolina Brotherhood, a group of cyclists/firefighters in North Carolina who honor the fallen and their families annually.

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EXPOSING THE MENTAL HEALTH STIGMA AMONG FIRST RESPONDERS Chief Michael Lanning

ersonally, I find the stigma surrounding mental illness to be one of — if not the — most destructive stigmas affecting humans today. But this article is more specifically about how that stigma affects those who work in the emergency services industry. I believe the best place to begin is with my own vulnerability. After all, how can I expect others to follow my lead without some vulnerability re-counting my own experience and struggle with mental illness. I will be the first to admit that before my own experience with mental disorders, I did not give the subject much thought. In so few words, I was uninformed to the true epidemic that plagues so many people worldwide. Suicide was a word I had heard many times growing up, but it was often thought of as just a cry for attention. So naturally, I developed a very incorrect and damaging opinion of that word and those that complete the fatal act. That was until I lost my father on March 9th, 2013. Having been raised by a single father who was both a veteran in the US Navy and a firefighter, the loss I experienced was catastrophic, to say the least. My father allowed his darkness to overwhelm him, and it ultimately resulted in his completing the act of suicide. My father had previous diagnoses of Post-Traumatic Stress Disorder (PTSD) and Bipolar Disorder, but he was part of another generation that taught him to deal with

pain and feelings in private, which ultimately contributed to his demise. Naturally, the days and weeks to follow crept on, appearing today to have all been a blur. But I was told my father was “too weak for this world,” his actions were “those of a coward,” and that he was “selfish.” Of course, I contemplated whether these words from friends and loved ones were true. In the months that followed, I became consumed by my own darkness, which I feel must have been very similar to my father’s. I battled the thoughts in my head for as long as I felt that I could. After a few months of dealing with my own demons, I decided it was my time to leave this world. I will be the first to say, through the entire process of spiraling out of control, my loved ones never left my mind. I didn’t want to leave them behind and I certainly did not want to die, but I felt I had no other option. I believed that no one would understand what my mind was telling me and that I would not be looked at the same if I asked for help. So, one day, I sat on my bed and wrote my suicide note for my lovely wife and our infant son. I wanted to assure them that my suicide was not because of them, but that it was because I was exhausted from the continuous battle within my own mind. Luckily, my actions that day weren’t successful, and I was woken up that afternoon to see my wife’s face and hold my son. Since that day, I have transformed the feelings of shame and loneliness into a force to be reckoned with, a personal pledge to fight not only my

MEDITATION: SHARPEN YOUR EDGE. LOSE YOUR EDGINESS. Brandon K. Dreiman

irst responders are paying more attention to mental wellness than ever before. One frequentlyencouraged method

for improving mental wellness is meditation. While the benefits of meditation are at this point indisputable, some myths endure. One regularly mentioned concern is that a firefighter will lose his or her

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own demons but also to help all those who are struggling find positive ways to battle their demons as well. It is important to understand common myths about suicide. For example, the myth that those who take their own lives are cowards or weak. If anything, it is the exact opposite. An example is Meriwether Lewis, of the famed Lewis and Clark Expeditions. Using his story is especially important because it brings further light to the issues associated with mental illness. Just as an iceberg only presents part of itself to the human eye, the same was evident in Lewis. There were so many people who did not know about him, but more specifically, about his struggle with mental illness. Their two-year journey took them into a mysterious world, and they faced countless difficulties. The decision to do this took great strength and courage. So, one would unquestionably say these men were heroic and brave. But Meriwether Lewis is said to have completed suicide, and even was quoted as saying “I am not a coward, but I am so strong. So hard to die.” Another example that debunks these common myths is the account of Holocaust Survivors. Research has found that suicide rates in the concentration camps and amongst those who were liberated are arguably the highest in human history. One cannot rightfully argue that these victims were weak or cowards. They survived years of oppression and violence against their race, only to eventually fall by their own hand in some cases. I believe the myths associated with mental illness and suicide are a direct result of a lack of education and awareness. The reality is that those who attempt, or successfully complete suicide, often don’t truly want to die. Once a person becomes habituated to painful and fearsome events, they become fearless and less bothered by the idea of pain. A mixture of that fearlessness, along with the false perception of a burden they don’t want

to impose on others, accompanied with what they think of as the stigma in our society that undervalues a person suffering from mental illness, all combine to elevate the risk for suicide. The important thing to remember is that these are all falsehoods. They are just the individual’s misperception. All emergency services personnel are exposed to destructive events more often than the public. We are expected to return to the station and continue doing our duties as if nothing ever happened. Many believe that these issues can be compartmentalized and stored away to never be dealt with. Doing so results in maladaptive coping patterns such as substance abuse and often becoming disconnected from loved ones and reality. Our jobs and the things we see in the process of performing our duties aren’t going to change, and we have little control over what we will experience. However, what each of us do have control over is the way we react and process what our eyes and minds see and feel. We must learn positive coping strategies. The stigma associated with mental illness prevents help-seeking. We must not be embarrassed by an illness that can occur as naturally in the human body as cancer or heart disease. Agencies need to step forward and debunk the common misperception that admitting you’re struggling or need help is a career-ending move. If we avoid open discussion about mental health, we are further isolating individuals and helping them believe the lie that they are alone in their battle. It is time for us to break the chains and stigma associated with mental health concerns and mental health disorders. Vulnerability begins with us, and together we will bring forth change and raise awareness about the issue of mental health. We owe it to all the brothers and sisters we’ve already lost; we must honor and celebrate their lives. Who knows, the life you save by talking about mental illness may be one of your own brothers or sisters.

“edge” by meditating. The thought is that, by taking the time to slow down and calm oneself, a person may become more passive, thereby losing assertiveness and initiative. While this concern among socalled Type-A personalities is understandable, a distinction must be drawn between one’s “edge” and one’s “edginess.” Our edge is that quality within us that provides a decisiveness to take control, make decisions, and act. It’s hard to describe, but we all know it when we feel it. Despite these concerns over losing our edge, what one discovers is that meditation ultimately enhances focus.1 Thus,

far from losing one’s edge, a firefighter will discover that their initiative and assertiveness become more refined through meditation. In other words, their ability to focus and act calmly, swiftly, and decisively without being derailed by knee-jerk responses and emotion is improved. This translates to better situational awareness and less tunnel vision in times of chaos and stress. Someone who is “edgy,” on the other hand, is nervous, anxious, angry, and irritable. These traits are kryptonite to a sharpened edge, and meditation is an incredibly valuable tool for decreasing this edginess, reducing negative emotions, and WWW.CAROLINAFIREJOURNAL.COM

Special Feature Section increasing self-awareness.2 Let us examine some other benefits and myths of this ancient practice, each in its turn.

Benefits

Rivals antidepressants

A study at Johns Hopkins evaluated the relationship between mindfulness meditation and how well it worked to reduce symptoms of depression. “Researcher Madhav Goyal and his team found that the effect size of meditation was moderate, at 0.3. If this sounds low, keep in mind that the effect size for antidepressants is also 0.3, which makes the effect of meditation sound pretty good.”3 While meditation is not a magical cure for depression, neither are antidepressants. The results of the study are significant enough to warrant talking to one’s physician about how to incorporate meditation into a depression treatment program.

It can help with addiction

There is no doubt that substance use disorders abound among first responders.4 If one has decided to stop using an addictive substance, it is always wise to consult with a physician to determine how to stop safely and how to minimize withdrawal symptoms.5 With that in mind, one way to help ensure a long-term cessation of use is through meditation. One study, in particular, showed that even brief meditation training of two weeks showed “increased activity for the meditation group in the anterior cingulate and prefrontal cortex”, both of which are directly related to self-control.6

May improve immunity

When one evaluates the leading causes of firefighter deaths, it is clear that boosting our immune systems should be a priority. Studies suggest that meditation can provide a valuable link in the chain of enhanced immunity. One study noted that “countering a dysregulated or hypersensitive immune system profile with mindfulness meditation could theoretically function to improve organism fitness by enhancing immune defenses that protect against viral and bacterial infection, as well as various age-related disease conditions, including cardiovascular disease, osteoporosis, arthritis, type-2 diabetes, frailty, and some cancers.”7 In another study, it was shown “that the meditative practice enhanced immune function without activating inflammatory signals. This suggests that meditation, as

behavioral intervention, may be an effective component in treating diseases characterized by increased inflammatory responsiveness with a weakened immune system.”8 If meditation can impact heart disease and cancer, both of which are leading killers of firefighters every year, then it is worth our time to explore how we can implement it into our lives. While there are far more benefits to meditation than those described above, hopefully, this is enough to convince you that meditation has value and is worth your time to try. Still, though, there are some myths about meditation that must be considered. The next portion of this discussion addresses some of the more common myths.

Myths I can’t clear my mind

Meditation is not about clearing the mind. It is about watching the mind. Our everyday “monkey mind” is busy jumping from branch to branch (or topic to topic) all on its own without any thoughtful input from us. Meditation seeks to catch our mind as it is hopping around aimlessly, recognize those wandering thoughts, and bring our focus back to something definitive like our breath. “The goal isn’t to not think, it’s to not be so attached to your thoughts.”9 Far from being an obstacle to meditation, catching those wandering thoughts literally sharpens our ability to concentration every time we do it.

I don’t have time

Firefighters may believe that meditation requires one to sit in the lotus position in a dark, incensefilled room for hours on end. The reality is that just a few minutes of meditation can benefit us. Some meditation practices begin with three mindful breaths. That’s it – about a minute of meditation. Want to take it a step further? “Stop, pause and gently close your eyes. Count your breaths without trying to alter them, in and out, until you reach a count of five, then start over again.”10 After a few minutes of doing that, you will be able to feel the difference. Sure, some people meditate for 20, 30, or 60 minutes. But just like any new practice, you can begin by focusing on short meditations, and maybe your practice will grow from there.

I can’t sit still

Some folks have a hard time sitting still. It’s a fact. The good news is that one does not have to be seated to meditate. Walking meditation

First Responder WELLNESS & SUPPORT

is a deliberate practice of focusing on one’s breath while … walking. You can walk in a forest, down your neighborhood sidewalk, or even in a bustling downtown district. The key is to observe the world around you without judgment. This means that you don’t attach stories to the sights you see, the sounds you hear, or the things you smell. You simply observe and breathe. It gets easier to observe without judgment the more often you engage in the practice, but for our purposes, the goal is to recognize that you don’t have to sit on a meditation cushion to meditate.

I tried, and I just can’t do it

Meditation is a skill. It is simple, but it is not easy. Even people who meditate daily sometimes don’t get into the “zone” during their practice. That is 100% normal, and every meditator should expect those days to happen. Part of meditation’s subtle beauty is that it teaches us to accept those “bad” days without getting upset. It allows us to observe that, “Huh. Today’s meditation wasn’t what I expected. That’s okay. I’ll try again tomorrow.” Boom. You have learned about yourself and your practice without getting upset or judging yourself for it. That is tremendously empowering, and it is a stressreduction technique that you will automatically start to employ in your everyday life. You see, even when meditation “doesn’t work,” it is working exactly as it should. While this discussion only scratches the surface of a gigantic topic, the goal is to simply raise awareness about the benefits of meditation while hopefully dispelling some of the common myths. If you want to learn more about meditation you can look for books and articles that describe the various styles of practicing.11 Also, there are tons of meditation videos on YouTube and several meditation apps12 one can explore to find the style that suits him or her the best. See what’s out there and how you can explore this incredible wellness tool. With a little practice, you will see results. Brandon K. Dreiman

is a Captain and 20year veteran of the Indianapolis Fire Department where he serves as the Coordinator of Firefighter Wellness & Support. He is a Certified Addiction Peer Recovery Coach and a Certified Recovery Specialist with a Substance Abuse endorsement in the State of Indiana. He is also a Registered Yoga Teacher, meditation instructor, and the founder of the Naptown Yogawalla in Indianapolis, IN.

REFERENCES 1. Wallace, C. (July 28, 2014). Meditate to sharpen your assertive edge. Financial Times. https://www.ft.com/ content/3ff70a4c-13f1-11e4-b46f00144feabdc0 2. Mayo Clinic Staff. (April 22, 2020). Meditation: A simple, fast way to reduce stress. https://www.mayoclinic.org/ tests-procedures/meditation/in-depth/ meditation/art-20045858 3. Walton, A. G. (February 9, 2015). 7 ways meditation can actually change the brain. Forbes. https://www.forbes.com/ sites/alicegwalton/2015/02/09/7-waysmeditation-can-actually-change-thebrain/?sh=3192e6931465 4. “The National Survey on Drug Use and Health revealed that up to 29% of firefighters engage in alcohol abuse, and as many as 10% of firefighters may be currently abusing prescription drugs.” Hilliard, J. (October 22, 2021). The relationship between addiction and emergency responders. https://www. addictioncenter.com/addiction/emergencyresponders/#:~:text=The%20National%20 Survey%20on%20Drug,firefighters%20 than%20the%20general%20population. 5. Promises Treatment Centers. How to detox from alcohol: Is going cold turkey a bad idea?” https://www.promises.com/ resources/detox-information/detox-alcoholgoing-cold-turkey-bad-idea 6. Posner, M. I., Tang, R., & Tang, Y-Y. (August 5, 2013). Brief meditation training induces smoking reduction. Proceedings of the National Academy of Sciences of the United States of America. https://www.pnas.org/doi/abs/10.1073/ pnas.1311887110 Black, D. S., & Slavich, G. M. (June 2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4940234/ 7. Bermudez, M-L., Chandran, V., Koka, M., & Senthilkumar, S. (December 13, 2021). Large-scale genomic study reveals robust activation of the immune system following advanced Inner Engineering meditation retreat. Proceedings of the National Academy of Sciences of the United States of America. https://www.pnas.org/doi/10.1073/ pnas.2110455118#:~:text=We%20also%20 showed%20that%20the,with%20a%20 weakened%20immune%20system. 8. Resnick, A. (July 12, 2021). Meditation facts: why you don’t have to clear your mind. Verywell mind. https://www. verywellmind.com/meditation-myths-whyclearing-your-mind-is-a-myth-5179587 9. Sweet, J. (May 30, 2020). 11 meditation myths you should stop believing. Forbes. https://www.forbes. com/sites/jonisweet/2020/05/30/11meditation-myths-you-should-stopbelieving/?sh=12934bdc55b6 10. Some examples of meditation types are guided, mantra, mindfulness, qi gong, and tai chi. 11. A few available apps are Insight Timer, Mind Space, Calm, and Plum Village.

SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 5

BUILDING RESILIENCY IN THE FIRE/EMS SERVICE Scott A Robinson

hen I joined the fire service in 1995, I never imagined I would spend so much time advocating about resiliency in the fire service. In 2003, while assigned to the back step of Engine 4 for the City of Cranston, Rhode Island, we responded as a mutual aid company to the Station Night Club fire in West Warwick, Rhode Island where we assisted the Town of West Warwick in fighting the fire from around 11:30 p.m. until about 2:00-3:00 a.m. and then assisted with body recovery until after 7:00 a.m.. Afterwards, we were placed back in service and returned to our city for our reliefs. The tragedy of that fire yielded 100 fire fatalities and about 300 injuries. Little did I know the experience would affect me for years to come as well. Today, the word “resiliency” holds a much different definition for me than if I had been asked for the definition in 2003. In 2003, I would probably have said simply, “Resiliency means to withstand adversity.” Knowing what I know now though, I can safely say that that simple definition is a bit inadequate. The American Psychological Association (APA) defines resiliency as the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress — such as familial and/or relationship

problems, serious health problems, or workplace and financial stressors. Today, I would define resiliency as a process. Resiliency is one’s ability to face overwhelming stress, find a way to overcome that stress, and then thrive after having had the experience.

Seventy billion of that cost was spent on depression treatment alone. (APA, Lea Winerman March 2017, Vol 48, No. 3). The numbers have surely increased since then. Stress reactions are normal physiological responses and are our body’s way of maintaining homeostasis in the presence of a “threat”. When we respond to a stressor, our bodies trigger a cascade of stress hormones that produce well-orchestrated physiological changes. Our heart pounds, our breathing quickens, our muscles tense, and beads of sweat appear. Sometimes, we even experience nausea and vomit, as a reaction to the neurochemicals that are released into our system.

at increased risk for many health problems, including:

• Heart disease, heart attack, high blood pressure, and stroke (the number one killer of firefighters)

• Anxiety • Depression • Digestive problems • Headaches • Muscle tension and pain • Sleep problems • Weight gain • Memory and concentration impairment

Today, the word “resiliency” holds a much different definition for me than if I had been asked for the definition in 2003. In 2003, I would probably have said simply, “Resiliency means to withstand adversity.” Knowing what I know now though, I can safely say that that simple definition is a bit inadequate. In order to understand why resiliency is important, first, we have to understand what stress is and how it affects us. Stress is a non-specific physiological response that occurs in our bodies from either a real or perceived threat, challenge, or change. Imagine, 75% to 90% of all visits to physicians are stress-related (The Effects of Stress on Your Body, 2021) and in the U.S. alone we spent $187.8 billion on mental health conditions and substance use disorders in 2013.

These physiological responses happen to avert stress or protect our lives from the stress at hand; however, when stressors are always present and one is constantly exposed to stressful situations, like when the bell or tones go off for the next run, that fight-orflight reaction stays turned on. The long-term activation of the stress response system and the overexposure to cortisol and other stress hormones that follow can disrupt almost all the body’s processes. This long-term activation puts individuals

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(https://www.mayoclinic.org/ healthy-lifestyle/stress-management/ in-depth/stress/art-20046037) The mantra I heard while “growing up” in the fire service was: If it’s not broke, don’t fix it. Obviously, this advice was not related to unseen behavioral health issues but was formulated on the premise that if you were managing through something, you would be fine. That is not the case, however. Eventually, things that cause stress may, and often do, become unmanageable and when an individual lacks the skills necessary to handle that overwhelming stress, that person suffers. Of course, it’s not only the individual that needs coping skills but our organizations do also as well. When our organizations do not embrace developing and practicing skills that make our workforce resilient, we suffer. This is why, not only is individual resiliency important, but also building organizational resiliency is paramount. Unfortunately, there are not many studies on resiliency and coping strategies within the first responder community, but there are several studies that have been done within the nursing and physician workforce from which the first responder community can learn. For instance, inside the health care field, several common characteristics or traits contributing to resiliency have been identified within those workforces. A study that included 1554 nurses from around the Pacific rim found that regardless of culture, there were four characteristics most utilized for the purpose of healthy coping skills that contributed to WWW.CAROLINAFIREJOURNAL.COM

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resiliency: self-control, seeking social support, problem-solving and positive reappraisal (Lambert et al, 2004). In another study of nurses and their coping strategies, (Chang et al, 2007) researchers discovered several characteristics that seemed to be contributory factors found in less resilient nurses, particularly in those who practiced escape-avoidance, which is a maladaptive form of coping in which a person changes his/her behavior to avoid thinking about or doing difficult things. Another maladaptive coping skill found was distancing. This resulted when nurses distance themselves from the stress and treat work-related stressors as non-personal. Finally, the study also identified nurses who had a degree of self-control, which ultimately caused them to isolate their true feelings from everyone. Each of these factors, escape-avoidance, distancing, and self-control, were predictors of lessresilient staff. Based on these studies it is evident that there are several ways to identify a resilient person. Resilient people confront their fears, rather than isolate themselves from them. They maintain an optimistic outlook and have a supportive social network including great mentors, or role models. They practice emotional literacy, or the ability to listen to others and empathize with their emotions and manage those emotional reactions. This allows them to recognize the impact of their emotional state on their problemsolving. (Howe 2008). Ultimately emotional literacy teaches a person to express emotions productively. Additionally, they have great success in facing overwhelming stress in their lives because they not only accept what cannot be changed but recognize they can control how they respond to what cannot be changed. Our first responder professionals are some of the most resilient people out there and I have worked with many of them during my 28 years in the fire service. Typically, those individuals have great social networks and family support. They have an optimistic view of the job rather than a pessimistic view. They recognize what they cannot control and what they can control. When I think back over those 28 years in the fire service, the happiest assignments I had occurred when I was working in places with people like these individuals. Resiliency is important. It protects us against heart disease, potentially increases life expectancy by ten years, inoculates us against the daily grind and traumatic life-altering events, improves our job satisfaction and productivity, boosts the immune system, and lowers the risk of alcohol and drug dependency; however, resilience is not an innate, fixed characteristic. It can be developed through targeted interventions. (McAllister and McKinnon 2008)

To be resilient individuals must focus on several factors: 1. Find satisfaction attained through their work 2. Develop positive attitudes and/or a sense of faith 3. Recognize that they make a difference in the lives of those they serve 4. Utilize strategies such as peer support 5. Validating and self-reflection of emotional literacy 6. Accept support from colleagues, mentors, and crews

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7. Seek education on mindfulness 8. Maintain a work-life balance. Resiliency does not end with the individual. We are only as strong as the organizations that support us. We need to foster resiliency in our departments, starting in our recruit schools by encouraging curriculums that nurture reflective learning, emotional literacy, empathy, and self-awareness education. Recruits also need to develop narrative writing skills as students. Departments need to provide supportive supervision in the workplace by educating our supervisors to provide safe environments in which first responders can reflect on their reactions to events and they can disclose and discuss their emotional reactions. Fire Departments and Emergency Medical Services (EMS) agencies need to develop peer and mentoring programs to help develop supportive relationships. Without the adequate resources and support through the development of individual and organizational resiliency in our fire departments or EMS agencies, even highly resilient responders will be unable to survive, let alone thrive. Scott A. Robinson is a Lieutenant with the Cranston, RI Fire Dept and has been a firefighter for 28 years. He is one of the IAFF Union’s Behavioral Health Specialists in the Department of Occupational Health and Medicine. Scott is former President of IAFF, Local 1363, and former Vice President of the Rhode Island State Association of Fire Fighters. He established the Rhode Island State Association of Fire Fighters’ Members Assistance Program (MAP) which is available to all union firefighters, active and retired, throughout RI, as well as their families. Scott is a Peer Support Master Instructor for the International Association of Fire Fighters, where he teaches peer support to IAFF locals in the U.S. and Canada and has been deployed on behalf of the IAFF to disaster areas across the country including Hurricane Harvey and the Champagne Tower collapse in Miami.

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UPDATE FROM THE NC STATE FIREFIGHTERS’ ASSOCIATION Tim Bradley

he North Carolina State Firefighters’ Association (NCSFA) has been in existence for over 135 years serving North Carolina Firefighters. We’re called the Tarheel State, but you’ll find Duke, State, Clemson, and even East Carolina University (ECU) fans here as well, in addition to a host of others. Traveling around North Carolina, you can’t help but appreciate the subtle differences in communities, people, and even community names. Alabama has its Scratch Ankle, but we’ve got our Nags Head and Bald Head, also a Clarks Neck and Scotland Neck, not to mention a Sandy Bottom. We’ve got a Bushy Mountain, and a Flat Branch Fire Department, as well as a Silver Lake and Silver Valley. I don’t think anyone else has a Duck or a Bat Cave, except maybe Batman, but we do here. North Carolina is special and a lot goes into keeping it special but in the end, it’s our people that make the difference. There are many differences in communities across the state, but many more similarities. Just like our three Regional Firefighter Associations, we have three phases of barbecue: Eastern-WesternPiedmont, yet it all comes from a hog. If you’re eating at a restaurant and order “Catch of the Day”, it could be anything from Catfish to Flounder. Regardless, someone worked hard to catch it, cook it, and serve it. Life is about people and North Carolina has some of the best, especially our firefighters. In North Carolina, we have over 48,463 active career and volunteer firefighters, with 1,308 fire departments serving communities from Corolla to Cullowhee, or the coast to the mountains. Taking care of firefighters has and continues to be our most important job and our greatest challenge. Two issues that have challenged us in recent years, just as they have firefighters across the nation, are Mental health issues such as Post Traumatic Stress, depression, grieving, and suicide, and Firefighter Cancer. Mental Health. The North Carolina State Firefighters’ Association recognizes our responsibilities in providing support and assistance to our state’s fire service personnel related to mental health. To the Association, our State and local communities, as well as the fire departments themselves, our personnel are our most valuable resource to be protected. For their

families and their community, they need to come home safe and remain safe by eliminating life-altering stress caused by witnessing of and participation in traumatic events, as well as the culminating anxiety that comes from balancing a stressful career with other aspects of life. This

First Responder WELLNESS & SUPPORT

(NCFF) has developed a program of reimbursement of expenses for qualified counseling related to Mental Health and Post-Traumatic Stress issues. The program will provide reimbursement of therapy or counseling by a qualified physician or licensed counselor. Since the grant from Blue Cross Blue Shield is a limited amount, funding will only be provided as long as funds designated for this purpose within the NCFF remain. The program will provide up to $2,500 in reimbursement per individual for insurance copays, insurance deductibles, or direct

reducing cancer in the future, the problem still exists for those in the fire service who develop cancer, one of those being the financial issues involved with firefighter cancer. Cancer can become devastating not only on the physical well-being but on the financial side as well. Over the last several years unsuccessful attempts have been made to pass a worker’s compensation-based presumptive cancer law in NC for firefighters. NC workers compensation law is written such that once the issue is determined to be a worker’s comp claim, all costs, medical and disability, are paid out of the worker’s compensation

Taking care of firefighters has and continues to be our most important job and our greatest challenge. Two issues that have challenged us in recent years, just as they have firefighters across the nation, are Mental health issues such as Post Traumatic Stress, depression, grieving, and suicide, and Firefighter Cancer. means not only providing benefits but providing programs in areas such as mental health and assistance with individual cases of Post-Traumatic Stress (PTS). Mental health issues such as Post Traumatic Stress, depression, family conflict, grieving, addictions, and suicide are all becoming more commonplace in our service. North Carolina previously had two programs dealing with these issues already in existence. The first was First Responder Assistance Program (FRAP), which offers resources and referrals to first responders for these issues. This is an initial contact program to provide information and resources for those seeking assistance. The second, broader program is the North Carolina First Responder Peer Support Program. This program is defined as assistance provided by a trained individual or group of trained firefighters, law enforcement officers, or EMS personnel who answer the call to their brothers and sisters in need, regardless of the need. These two programs provide initial and peer support in an excellent manner, but the missing component was the ability to cover professional counseling services an individual may need beyond the service of these programs. Working with a grant provided by Blue Cross and Blue Shield of NC, the NCSFA and the North Carolina Firefighters Fund

8 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

counseling services not covered by the individual’s or department’s insurance. Travel expenses may be reimbursed if the services obtained are out of State. The application must be submitted and signed by the Fire Chief or Chief Officer of the department, and services must be performed by a licensed therapeutic counselor or doctor specializing in stress disorders and must be related at least in part to the individual work as a firefighter listed on the fire department roster. Reimbursement approval is at the sole discretion of the NCFF. Information and application information can be found at www. ncsfa.com. Firefighter Cancer. Firefighter Cancer has become an issue for firefighters across the country and internationally. Numerous programs for risk management of cancer are available, both from local, state, and national programs. In North Carolina alone we have the North Carolina Firefighter Cancer Alliance, which provides training and prevention programs. Numerous departments have initiated cancer prevention routines in their daily operational guidelines. Other programs such as those with the International Association of Fire Chiefs (IAFC) and the National Volunteer Fire Council (NVFC) are shared and available. While prevention holds the key to

fund and not health insurance. This led to difficulty in getting the law passed by the North Carolina General Assembly because of cost concerns. In addition, even with presumptive cancer laws, coverage is not guaranteed. A little over two years ago the NCSFA began working with the League of Municipalities to develop language for a firefighter cancer insurance policy that could be placed into law and provided to every firefighter in North Carolina. Prior to last year’s legislative session, this language was submitted to the combined legislative committee of the North Carolina Fire Service, including the NCSFA, North Carolina Association of Fire Chiefs, and the Professional Firefighters and Paramedics of North Carolina, and all agreed it would be the focus of the 2021/2022 legislative session. In May of last year, the NCSFA held its annual legislative day, and firefighter cancer insurance was the priority presented to every legislative representative. With COVID masks designed with a purple ribbon design, and handouts describing the issue of firefighter cancer and the defined benefit of firefighter cancer insurance, close to 200 hundred firefighters made their case to legislators in person. This, continued on page 10 WWW.CAROLINAFIREJOURNAL.COM

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Special Feature Section

continued from page 8 combined with calls and lobbying efforts of fire service organizations, let the elected representatives know this was the critical issue facing our service. In the closing days of the session, the Firefighter Cancer Coverage legislation was passed, providing cancer coverage for every rostered firefighter in North Carolina with more than five-year continuous service. The program was funded for two years at a cost of $16 million. The North Carolina Department of Insurance was tasked with finding the coverage for the policy and selected Volunteer Fireman’s Insurance Services, Inc. (VFIS) of North Carolina to provide the coverage. The policy provides the following benefits:

• $25,000 benefit per cancer with a maximum of $50,000 per individual

• $12,000 per diagnosis of cancer

videos concerning topics of current events in the fire service. Examples include legislation, relief fund, and other benefits or programs available to the fire service. As these are produced, they’ll be placed on our webpage and social media for viewing. Held to two to three minutes each, they will provide information to chiefs and firefighters on a host of topics. Production began January 14th, and hopefully, within a few months many of them will be available. NCSFA History: The NCSFA has continued work on documenting our history. Mike Legeros, from Raleigh, has begun formulating historical information working with our Statistician and Historian, Dennis Pressley. Some of this was displayed at the Annual Conference last year. The Board plans to have a history book ready for this year’s conference, and also have plans to provide copies to all North Carolina Fire Departments. Since our beginning in 1887, the

First Responder WELLNESS & SUPPORT

book will describe the development and growth of the Association and the North Carolina Fire Service as well. Complete with pictures and documents it will be inclusive of events that shaped our growth. The NCSFA has a history of providing and fighting for firefighter benefits, resources, and providing an opportunity to work together for the improvement of our service, and ultimately the protection of our citizens. We partner with other Associations in North Carolina, as well as other State Associations to share ideas on benefits and programs. We work with national and international organizations to bring relevant programs here. Close to 70% of the National Volunteer Fire Council membership consists of North Carolina Firefighters. Proud to serve the fire service, our nine Board members are elected and represent the three regions of the State. For more information visit our website at ncsfa.com.

Tim Bradley has a Bachelor of Science Degree in Fire and Safety Engineering Technology, an Associate Degree in Electronic Engineering Technology, and is a graduate of the National Fire Academy’s Executive Fire Officer (EFO) Program. Tim has been in the fire service for 47 years. He served as Chief for seven years, Executive Director of the North Carolina Fire and Rescue Commission, and Senior Deputy Commissioner of Insurance in charge of the Office of State Fire Marshal (OSFM), among many other positions. He was awarded North Carolina’s Firefighter of the Year Award in 2003, and in 2007 he was awarded Firehouse Magazines Heroism Award for the rescue of a five-year-old boy from a house fire. He is the author of “The Fire Marshals Handbook,” a book published to match the requirements for the NFPA Standard for Fire Marshals.

reimbursement for expenses

• Career Firefighters 75% of salary up to $5,000 per month for disability for 36 months

• Volunteer Firefighters $1,500 per

month for disability for 36 months

• The policy pays in addition to

any other policy except workers compensation

While this was a major success, our work is not done. The program was funded for two years and efforts will be necessary to make the funding permanent going into the future. For additional information on this policy go to: www.vfisnc. com or www.ncosfm.gov/risk-mgnt

South Atlantic Fire Rescue Expo (SAFRE): This year’s dates for the

SAFRE Conference are August 10th-13th, 2022. Online registration will be available in the next couple of weeks. Course selections have already been made and this year we will have some great classes. We have two great keynote speakers this year, one for Thursday during opening ceremonies and one for Friday, Dr. Denis Onieal, former Deputy US Fire Administrator and former Superintendent at the National Fire Academy will join us Friday for a presentation as well as teach some leadership classes, and Commander Rorke Denver, retired Navy Seal will provide us leadership thoughts based on his experience during the opening Thursday. Our vendor show, which is one of the largest covers over 150,000 square feet of space and will have free admission. Please mark your calendar for that week. We look forward to a great week of fellowship, education, and seeing what’s new and innovative in apparatus, technology, and equipment for the fire service and our first responders. Video Series: The Board and staff of NCSFA have begun production of an informal series of informational 10 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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Last Alarm | END OF WATCH

WHAT DOES IT ACTUALLY MEAN TO “NEVER FORGET”? Aaron Dixon, MBA, NRP

or the friends and immediate co-workers of a fallen hero, there are engrained memories. They will never forget because they can’t. But what about the others, the organization, the leaders? Never forgetting should be an action – not just a phrase that we repeat on the anniversary of a loss or tragedy. Why do we say “Never Forget?” Because we want their death to change us for the better. We don’t want to go back to doing the same things we were doing before we lost them. We want to show that we have learned something and have made changes. Their existence and their loss mean something to our future. On February 24th, 2021, Tyler Warfield, a 23-year-old member of Clear Spring Fire Rescue, left the station on his motorcycle headed to another shift at a different fire department. He did not make it. He was struck by a vehicle and killed. At my office in Downtown Greenville, I received a phone call from a fellow commissioner informing me of his death. I quickly canceled my meetings for the day and headed to the station. I figured, at a minimum, I could cover one of the trucks and let the on-duty personnel grieve. As I pulled into the station, staffed trucks from other departments were already there providing coverage. All the command staff had responded to the incident and the station was empty and eerily quiet. Within an hour of my arrival, a nondescript white trailer arrived that was filled with all the necessities to facilitate a firefighter’s funeral. Black bunting was placed on

the outside of the station and a small shrine with Tyler’s turnout gear was set up by the flagpole. Planning for the funeral, coverage for the next three days, and family support were provided by State Fire in a very methodical manner. They had even established an incident command structure. The day of the funeral was awe-inspiring: a miles-long procession of emergency vehicles, bridges, and overpasses filled with firefighters at attention, a massive church filled to capacity with members of the public and fellow emergency services members. It was an enormous and impressive showing of support, love, and respect for our fallen member. Tyler’s path in the fire service was nearly identical to mine. We started as young kids — explorers — filled with obnoxiously high energy. Like Tyler, I had incredible mentors who calmed me, focused my attention, and made me successful. Tyler benefited from an incredible group of mentors, and in turn, they benefited from him. I failed to experience what Tyler had to offer, and his sudden departure saddens me. He had so much more to do in this world. So much more to give. I don’t have a wonderful story to share about Tyler, and that’s what saddens me. I ran into Tyler frequently on calls and at the station. He was always energetic and so incredibly respectful. He would go out of his way to say hi, but I was always so busy — putting my gear back together, getting information for my report, heading on to the next thing. I didn’t greet him with the same enthusiasm. I could tell that he wanted more engagement — more training, more involvement — and I was someone who could have

easily provided it. But I didn’t. I was too busy. Tyler’s funeral service was one of nearly a hundred that I have attended over the past 26 years of service — some for close personal friends of mine. Each service is profound, inspirational, and very similar. We come to these funerals in miles-long processions, embodying a unified brotherhood and sisterhood of strength, cohesion, and mutual support. At the beginning of these ceremonies, we act as a single professional entity. But at the end of these services, we scatter. We go back to our individual departments, neatly defined by geographical boundaries, and the normalcy of working and running a department. Until another tragedy unites us again. We shouldn’t allow ourselves to return to normal. If we are to truly never forget, then we must learn from the past and make changes. In the past year since Tyler’s death, I am unsure if I have made enough progress. As an Executive Director of an EMS service, my overarching intent is to foster an environment where the team is happy, safe, and proud. I want to give the same attention and the same emotion to my team when they are alive and in the moment as I will expand if they die. But the practical challenges of the job, managing a team of nearly 400, seems to inhibit those very core values that are so essential to me. This haunts me as an Executive Director. What can we do as leaders and

members of individual organizations to celebrate our people when they are still with us? Why is it that a member of our service must die before we unleash the full power of our brotherhood and sisterhood? We must support our members with the same vigor when they are very much alive. I am fully aware that I do not have the answers, but Tyler’s memory inspires me to do better, to pay attention more fully, and to appreciate those coming behind us. Maybe because of his loss, I can be a better leader, a better person. Rest peacefully Tyler, we’ve got it from here. A huge thank you to my wife, Penny Couillard, who has attended numerous funerals over our two decades of marriage. She was a major contributor to the writing of this article. Aaron Dixon, MBA, NRP, is the Executive

Director of EMS for Prisma Health, Commissioner for Clear Spring Fire Rescue, and an Executive Board Member of the SC EMS Association. Prisma Health operates a large EMS department providing 911, ALS, Mobile Integrated Health, Emergency Medical Dispatch, and Critical Care services throughout the Upstate and Midlands of South Carolina. Dixon is a national speaker and has authored multiple articles. He can be reached at aaroncdix@gmail.com.

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RETIREMENT … IT’S IN YOUR FUTURE

Dale R. Folwell, CPA | State Treasurer of North Carolina

he North Carolina Department of State Treasurer (DST) works hard to sustain pensions and funds for those who have dedicated themselves to a career of service in North Carolina. We also are committed to protecting these retirement benefits and payments for current and future public servants, as well as their beneficiaries and survivors. This is not an easy task, and takes commitment, dedication and requires a member-first mentality by DST, staff, and our Boards of Trustees. Each year, an annual report is prepared by an outside actuarial firm and serves to demonstrate the health, sustainability, and trends for each of the North Carolina Retirement Systems and Funds. This informs decisions and actions taken by DST, staff, and

the Boards. Recently, DST was presented with December 31, 2020, Actuarial Valuation reports for the Local Governmental Employees’ Retirement System (LGERS) and the Firefighters’ and Rescue Squad Workers’ Pension Fund (FRSWPF). As a firefighter or rescue squad worker, you may be a member of LGERS, contributing 6% of your monthly pay towards the pension. LGERS has consistently been wellfunded, and this is because of the steady participation by members, employers, and investment performance. Being well-funded means that the system is able to pay current and future benefits to eligible members. As of December 31, 2020, LGERS has a funded ratio of 87.8%. The FRSWPF is available to eligible firefighters and rescue squad workers who meet certain criteria and enroll in the fund. As of

December 31, 2020, the FRSWPF has a funded ratio of 95.8%. Enrollment in the FRSWPF is not automatic, but this additional pension provides valuable benefits for you, your beneficiaries, and survivors. Contributions ($10 per month) are made by you or on your behalf through your department or squad and go towards your lifetime monthly benefit of $170 once you have 20 years of creditable service as a firefighter or rescue squad worker and reached the age of 55. Retirement is inevitable for most of us. If you are a vested

member of LGERS, this potential monthly benefit may provide a solid foundation in retirement. The FRSWPF is an opportunity for additional support. But it is important to think about your future early and save often. Saving now means your assets may grow enough, and you will not be required to make further contributions in retirement, either by continuing to work or cutting back on your lifestyle. Starting early and saving often can help you achieve the retirement you envision.

Planning for your future is more than financial savings and funding.

It is also important to make sure

you have designated beneficiaries. If you are a member of LGERS, this is easy to do in your secure ORBIT account. Simply log in and click on the Maintain Beneficiaries tab. You can review your current designations for Return of Contributions and Death Benefits, if applicable. You may select as many principal and contingent beneficiaries as you like, but you must have at least one principal beneficiary. Updates made in ORBIT are effective immediately. As a member of the FRSWPF, there are also benefits for beneficiaries and survivors. This is a separate and important process. We recommend you complete Form 2FR (Designating Beneficiary(ies) for the Firefighters’ and Rescue Squad Workers’ Pension Fund) as soon as possible. This will help to ensure a potential line-of-duty death benefit is maximized. If a line-of-duty death occurs, and a single primary beneficiary is designated, they may be entitled to receive your monthly pension benefit. Beneficiaries for this fund can also be updated through ORBIT if you have an FRSWPF account that has not been refunded and you

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Retirement PLANNING are not currently receiving a benefit payment. ELIGIBLE FIREFIGHTERS To be an “eligible firefighter,” you must be 18 or older and belong to a fire department that: • is rated by the Fire Insurance Rating Bureau and is certified by the Department of Insurance as not less than a Class “9S” department, • files a roster annually with the North Carolina State Firefighters’ Association, which is forwarded to the Pension Fund by January 31 each year; and • holds training sessions at least 4 hours monthly for which members are required to attend at least 36 hours per year. Training sessions for firefighters are defined as sessions or drills that prepare firefighters for or increase their knowledge in, fire prevention, fire suppression, or protection of life and property. ELIGIBLE RESCUE SQUAD WORKERS To be an “eligible rescue squad worker,” you must be 18 or older and belong to a rescue squad that:

• is eligible for membership in the North Carolina Association of Rescue and Emergency Medical Services Inc.; and • files a roster annually with the North Carolina Association of Rescue and Emergency Medical Services Inc., which is forwarded to the Pension Fund by January 31 each year. • Eligible rescue squad workers must attend a minimum of 36 hours of training sessions each year. Training sessions for rescue squad workers are defined as any sessions or drills that prepare rescue squad workers for, or increase their knowledge in, rescue, emergency medical services, injury prevention, or protection of life and property. To become a member of this pension fund, you must: • complete an enrollment application (Form 350, Enrolling in the Firefighters’ and Rescue Squad Workers’ Pension Fund) through your department or squad; and • mail it with your first payment (contributions are $10 per month) to:

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Firefighters’ and Rescue Squad Workers’ Pension Fund Department of State Treasurer 3200 Atlantic Avenue Raleigh, NC 27604 Your enrollment date will be effective in the month in which the pension fund receives both your application and first contribution. As with enrollment, benefits are not automatically paid. To begin receiving benefits you must meet the retirement eligibility and complete and submit two documents: • Form 6FR, “Retiring from the Firefighters’ and Rescue Squad Workers’ Pension Fund” • Form 170, “Authorizing Direct Deposit” Planning for your retirement and taking action to make sure your future is secure are very important steps. We have a team on hand to assist with enrollment, discovering your available benefits, and planning for retirement. I encourage you to take advantage of the tools and resources available. Thank you for your dedication and service to the communities of North Carolina.

IMPORTANT INFORMATION

All monthly contributions for 2021 ($10/month, $120/year) are due to the FRSWPF by March 31, 2022.

Form 2FR (Designating Beneficiary(ies) for the Firefighters’ and Rescue Squad Workers’ Pension Fund) Form 350 (Enrolling in the Firefighters’ and Rescue Squad Workers’ Pension Fund) Fire and Rescue Personnel | My NC Retirement Dale R. Folwell, CPA

was sworn in for his first term as State Treasurer of North Carolina in January 2017. He was reelected in 2020 and is currently serving his second term. As the keeper of the public purse, Treasurer Folwell is responsible for the more than $117 billion state pension fund that provides retirement benefits for more than 950,000 teachers, law enforcement officers, and other public workers. Treasurer Folwell also oversees the State Health Plan, which provides medical and pharmaceutical benefits to more than 750,000 current and retired public employees and is the largest purchaser of health care in North Carolina.

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Safety&PREVENTION

KNOW WHEN TO HOLD ‘EM, KNOW WHEN TO FOLD ‘EM

M David Greene

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evacuated and was accounted for, a flashover occurred on the second floor. Fire vented from both eaves and I began planning on what I thought would be the proverbial parking lot that I would leave at the end of the night. Fortunately, the crews on the scene did an excellent job. They positioned several exterior hose lines and began to knock down the fire from the outside. They were even able to perform quite a bit of salvage that saved many of the contents on the first floor from the massive amount of water we were flowing on the second. Strangely, during one of my laps around the building during exterior suppression efforts, I found a firefighter had entered one of the bedrooms through a window. I ordered him out until we could knock the fire down enough to verify the structural integrity of the home. Once the fire was out, an investigation revealed a small second-floor layout was complemented by a tremendous amount of storage in the adjacent attic spaces accessible only by small panel doors. The storage areas contained couches, mattresses, and other combustibles with high heat release rates. There was simply no way that the interior crew could have reached these combustibles with an interior stream despite them trying until their helmets were nearly melting off their heads. At the end of the fire, the majority of the roof had been burnt off and we broke a load-bearing wall inside with the weight of the water we applied. Some of the firefighters were not happy about the decision to switch to defensive operations, as is often the case anytime that happens. However, there were no injuries, which is a win, all day, every day. Every incident we respond to brings with it a different set of circumstances. In many building fires, such as a stove fire, confining the fire to the room of origin is possible. In some cases, confining the fire to the building of origin is the only viable option. In urban areas with structures that are placed very near each other, confining the fire to the building of origin may not even be possible and of course, any life hazards present will further complicate or change our strategy. In the case of my fire, there were no immediate exposures

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any of you may not catch the reference, but the title of this quarter’s article refers to an old Kenny Rogers song. In it, Kenny stresses the importance of knowing how to play the card game poker. That is, you have to know when to “hold your cards” and “call” the other player when you suspect you have a better hand. Alternatively, and perhaps more importantly, you have to know when to fold and turn your cards in without betting anymore, if you suspect the other player has a better hand than you. When you fold, you accept that you will lose all of the money that you have bet up until that point. It is “folding” that I would like to discuss in this article. Many years ago, I was the Incident Commander at a twostory, 3,500 square foot house fire. The fire was on the second floor and heavy smoke was visible from both eaves. The family had self-extricated prior to our arrival. A crew of four entered the home and reported that on the second division there was high heat and zero visibility. I’ve often written in this column about how much easier it is to run into burning buildings than it is to command them from outside. Such was the case at this fire. There was little to no steam production and the smoke increased in both volume and turbulence. The crews reported on the radio that the layout was hindering their location of the fire. The frustration in their voices matched the frustration I was feeling outside. After a few minutes of continued lack of progress (and increased frustration), one of the crew came outside and met me in the front yard. The firefighter tried to talk to me but was hindered by his mask and the many foreground sounds. I put my ungloved hand on his helmet to pull his face next to my ear and it was like I had touched a hot stove. I instantly took my hand off his helmet, looked back at the house with its continued signs of fire progression, and thought, this is bad. I immediately ordered the firefighter to go get the rest of the crew off of the second floor, I had the engine on scene sound the air horns to evacuate the building and switched to defensive operations. Only a minute or two after everyone

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Safety&PREVENTION and evacuating the firefighters from the building removed all of the life hazards. Considering all factors, my fire was easy. Let’s examine a fire that was not easy. On December 3, 1999, a fire occurred at the Worcester Cold Storage Warehouse building in

old and had only one staircase at the center of the building. The fire started from an overturned candlelit by two homeless persons who were squatting in the building. After recognizing the fire, the two homeless persons left the building and did not call 9-1-1. The fire

two people living in that building.” Thirty-three minutes after the alarm, two firefighters from Rescue 1 reported that they were lost on the fourth floor and were running out of air. Four firefighters from Engine 3 and Ladder 2 attempted to find the crew from Rescue 1 but became lost

Thirty-three minutes after the alarm, two firefighters from Rescue 1 reported that they were lost on the fourth floor and were running out of air. Four firefighters from Engine 3 and Ladder 2 attempted to find the crew from Rescue 1 but became lost themselves.

Massachusetts. The building was a six-story, 15,000 square foot maze of connecting meat lockers with the walls and ceiling insulated by layers of cork, tar, and polystyrene or polyurethane foam. The building was 93 years

burned for 30 to 90 minutes prior to a passerby notifying the Worchester Fire Department. The first arriving engine found heavy smoke showing. Eleven minutes into the fire, a nearby business owner reported to a police officer that “there may be

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themselves. One hour and forty-five minutes into the fire, the Incident Commander made a decision that I hope and pray I will never have to make. Over the radio, the Incident Commander transmitted, “Command to all Companies, evacuate the building, sound the evacuation signal, evacuate the building.” Make no mistake, his decision to evacuate was nothing like mine, it was extremely difficult and painful. His decision to evacuate was made knowing that there were six firefighters still in the building that could not escape on their own. However, faced with a progressing fire, impossible interior conditions, and the potential for structural collapse from reports of cracked exterior walls, the Incident Commander decided to fold. He did so, knowing that he would lose everything that he had invested so far. What cannot be quantified is the number of firefighters’ lives that he saved by evacuating when he did. I am certain there was more than one firefighter at the scene that night that wanted to go into the building to try to locate their brothers. It took eight days to locate all of the firefighters in the Worcester Warehouse fire due to an interior collapse and fire damage. While this is one of our fire service’s greatest tragedies, it very well could have been worse if the Incident Commander had not evacuated the building and switched to defensive operations when he did. Tragically, Lieutenants Timothy Jackson, James Lyons, and Thomas Spencer as well as Firefighters Paul Brotherton, Jeremiah Lucey, and Joseph McGuirk gave the ultimate sacrifice that cold December night. The two homeless persons who

unintentionally started the fire were later located uninjured. I am not trying to draw a parallel or make a comparison between my fire and the Worcester Cold Storage Warehouse fire. There is no comparison. In Worchester, a very old, very large abandoned/ vacant building with limited access and egress, containing extremely combustible insulation with penetrations both vertically and horizontally allowing for rapid-fire spread and no sprinkler system was the hand that the Worcester Fire Department was dealt. Whether you are in the Southeast, Northeast, Midwest, Southwest, or West Coast, firefighters are built about the same. They do not like to lose and many views any kind of evacuation or transition from interior to exterior attack as a loss. I am certain that this view is exponentially worse when firefighters are still in the building when an evacuation occurs. However, our service is sometimes dealt a bad hand. When that happens, we have to know when to “hold ‘em” and know when to “fold ‘em.” Although we all hope that a decision to “fold” will occur early enough in the incident to leave with all of our firefighters, we have to be prepared to quickly evaluate our current investment, consider what our current conditions and resources are, and make a rapid decision to “hold” or “fold.” In the case of Worcester, the Incident Commander likely saved countless firefighters. Anyone taking command should be prepared to make a similar gutwrenching decision given similar circumstances. God bless the families of Lieutenants Timothy Jackson, James Lyons, Thomas Spencer, and Firefighters Paul Brotherton, Jeremiah Lucey, and Joseph McGuirk. Be safe and do good. David Greene has over 31

years of experience in the fire service and is currently the deputy chief with Colleton County (S.C.) Fire-Rescue. He holds a PhD in Fire and Emergency Management Administration from Oklahoma State University and an MBA degree from the University of South Carolina. He is a certified Executive Fire Officer through the National Fire Academy, holds the Chief Fire Officer Designation from the Center for Public Safety Excellence, holds Member Grade in the Institution of Fire Engineers, is an adjunct instructor for the South Carolina Fire Academy and is a Nationally Registered Paramedic. He can be reached at dagreene@ lowcountry.com. WWW.CAROLINAFIREJOURNAL.COM

Safety&PREVENTION

HEAT RISKS ARE RISING

Nicole Randall, Director of Marketing and External Affairs, International Safety Equipment Association (ISEA)

eat has always been an on-thejob fact of life for firefighters. But both climate data and occupational health trends are sounding alarm bells for heat’s impact on workers of all kinds, especially those laboring outdoors. The National Oceanic and Atmospheric Administration (NOAA) reports that the 10 warmest years on record have occurred since 2005. And while a new temperature record was set on average every 13.5 years from 1900 to 1980, a new record was set every 3 years from 1981–2019. Work-related deaths due to environmental heat exposure have also been trending higher, according to data from the U.S. Bureau of Labor Statistics (BLS). National Public Radio and Columbia Journalism Investigations analyzed BLS data going back three decades and found that “the three-year average of worker heat deaths has doubled since the early 1990s.” While the National Fire Protection Association’s (NFPA) stats on firefighter deaths by cause and nature of injury attribute only 2% to “exposure to heat” or “heat stroke,” respectively, heat stress could have played a role in fatalities counted under other causes, such as “overexertion/stress/medical” and “sudden cardiac death.” (The International Safety Equipment Association (ISEA) is officially represented on seven NFPA technical committees.) The International Association of Fire Fighters (IAFF) has emphasized that heat stress and heat stroke “can kill and cause debilitating injuries, as well as reduce a fire fighter’s physiological performance.” The IAFF added that heat also affects firefighters’ decision-making abilities. INCREASING FEDERAL EFFORTS ON HEAT PROTECTION The U.S. Fire Administration (USFA) devoted part of its June 2021 Firefighter Safety StandDown to mitigating heat stress. “Exposure to extreme heat situations usually occurs in limited, short doses for most firefighters but the effects of high heat on personnel are cumulative,” the USFA explained on its website. “Extreme heat from environmental conditions adds significantly to the risk of heat-related health emergencies.” In September 2021, President

Biden expressed his administration’s commitment to tackling workplace heat risks. “Rising temperatures pose an imminent threat to millions of American workers exposed to the

Occupational Safety and Health Administration (OSHA), had to turn their attention to developing COVID-19-related rules, according to reporting by Bloomberg Law. OSHA already had a Heat Illness Prevention Campaign dating back to 2011, offering education for employers and workers about the dangers of workplace heat. Its webpage links to training tools, videos, and infographics, as well as the agency’s latest regulatory moves on the subject. OSHA also formed a Heat Injury and Illness Prevention

develop recommendations for guidance materials, evaluate stakeholder input, and develop recommendations on potential elements of a proposed heat injury and illness prevention standard.” Nonetheless, OSHA did issue an advance notice of proposed rulemaking (ANPRM) on October 27, 2021, “to protect indoor and outdoor workers from hazardous heat.” The ANPRM invited input and “additional information about the extent and nature of hazardous heat in the workplace

While the National Fire Protection Association’s (NFPA) stats on firefighter deaths by cause and nature of injury attribute only 2% to “exposure to heat” or “heat stroke,” respectively, heat stress could have played a role in fatalities counted under other causes, such as “overexertion/stress/medical” and “sudden cardiac death.” elements,” he said in a statement. In tandem with the President’s statement, the White House issued a fact sheet on federal efforts to protect workers and communities from extreme heat. Despite the President’s concern, however, the people who would typically write the regulations at the

Work Group within its National Advisory Committee on Occupational Safety and Health (NACOSH). The announcement of the Work Group’s formation didn’t indicate a timeframe for its efforts, but explained that it “will evaluate OSHA’s heat illness and prevention guidance materials,

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and the nature and effectiveness of interventions and controls used to prevent heat-related injury and illness.” In December, it extended the deadline of that comment period to January 26, 2022. As often happens, another part of the government had already done some work that OSHA — and

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Safety&PREVENTION fire service professionals — might find useful. In 2016, the National Institute for Occupational Safety and Health (NIOSH) within the Centers for Disease Control & Prevention (CDC) published “Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments.” There’s more in the nearly 200-

page document than its title implies. NIOSH provides a comprehensive deep dive into heat stress. For example, it noted: “Re-education is needed in the workplace, especially about [heat stroke] symptoms. Many workers have incorrectly been taught that as long as they were still sweating they were not in danger of heatstroke.”

SAFETY EQUIPMENT INDUSTRY RESPONDS ISEA, which has become increasingly concerned about workplace heat risks, sent a written response in January 2021 to OSHA’s request for information about current and best practices for protecting workers in a variety of settings from heat exposure.

The American Society of Safety Professionals’ ANSI/ASSP A10 Committee has been working on a proposed heat stress management standard (ASSP A10.50), to provide guidance on how to create and sustain a program to keep workers safe from the exposures of hazardous heat.

ISEA’s letter outlined a number of best practices, including:

• Engineering controls. • Administrative controls. • Access to water, rest, and shade. • Cooling personal protective equipment (PPE).

ISEA also asked that OSHA update its record-keeping requirements to include heat stress. A copy of the letter to OSHA is posted on ISEA’s website. The American Society of Safety Professionals’ ANSI/ASSP A10 Committee has been working on a proposed heat stress management standard (ASSP A10.50), to provide guidance on how to create and sustain a program to keep workers safe from the exposures of hazardous heat. ISEA has an active committee that is planning outreach activities to coincide with OSHA’s heatstress prevention campaign to raise awareness in the workplace about the dangers of hazardous heat. ISEA’s committee is also considering organizing a day of Capitol Hill visits to raise visibility in Congress of OSHA’s heat-stress management activities. Because firefighters’ protective gear can itself create a microclimate between the body and the gear that might trap heat within the suit, a number of ISEA-member companies provide cooling vests for firefighters to wear under their turnout gear. Nine ISEA-member companies provide a variety of heat stress solutions, including Ansell Healthcare, Bullard, Draëger, Encon, Ergodyne, Honeywell, Protective Industrial Products (PIP), Magid Glove, OccuNomix International, National Safety Apparel, Lakeland Industries, and Radians. Nicole Randall is the director of marketing and external affairs for ISEA. Headquartered in Arlington, Virginia, the International Safety Equipment Association (ISEA) is the trade association in the U.S. for personal protective equipment and technologies. Its member companies are world leaders in the design, manufacture, testing, and distribution of protective clothing and equipment used in factories, construction sites, hospitals and clinics, farms, schools, laboratories, emergency response, and in the home. Since 1933, ISEA has set the standard for the personal protective equipment industry, supporting member companies united in the goal of protecting the health and safety of people worldwide.

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Recruiting&RETENTION

NOISE, NOISE, NOISE David Hesselmeyer

f you are like me, you stay very busy. I am sure most (if not all) of you would agree that alongside the busy demands of our work lives, devoting the time and energy to our families that they need and deserve must be our priority as well. I am blessed with a wonderful wife and three kids. We have jobs that drain us but are necessary to put food on the table and a roof over our heads. Many of us have to find time within our schedules for part-time jobs to supplement our full-time income. Then there are the odds and ends which for me include making any time I can squeeze in to participate at my volunteer firehouse. The previous paragraph probably tired you out just reading it, as I know it did me. The more we have on our plate, the more we lack focus. Today it seems there are more requirements and distractions than ever before. This can keep us from achieving all that we want to do — or more importantly — need to do. Certain obligations will always remain nonnegotiable. For example, we must work 40 hours or more per week at our full-time job. We cannot change that in an overwhelming majority of cases. However, the place where we can make some adjustments is in the “distractions” area of our lives. This week while I was exercising, I was listening to a podcast I love called the GaryVee Audio Experience, I was thinking about where I have been in my life, where I am at, and where I want

to go. I thought about how much I have been blessed. Then it hit me. There are many things that I want to accomplish which I have not done yet. Unfortunately, there are only so many hours in a day. This is compounded tremendously by so many other distractions. With all the

Emergencies and fires don’t wait, and neither should you.

at that moment. Schedule yourself from sunup to sundown. It is no secret that I have struggled with certain areas including exercising. “I do not have time for that,” was always my excuse. I do have time. I just did not schedule it in. Living the busy life I do, I decided to use my phone to an advantage. Using the Notes app, I write up my schedule for the day from the time I wake up until the time I go to sleep. I make sure that priorities like exercising are

“I do not have time for that,” was always my excuse. I do have time. I just did not schedule it in. priorities we have, how do we make these goals become accomplishments and why is it important in the emergency services world? It is important because the job we do as firefighters, rescue technicians, and Emergency Medical Technicians (EMTs) is not to be taken lightly. We are expected to be at the highest level of preparedness and be able to respond and act in that same manner every time the alarm goes off. Distractions impact us during our training, they impact us while we are sitting at the firehouse kitchen table, and I have even seen them impact us during responses, which can lead to injury or death for us, our colleagues, and the public. That is where the noise title comes in. Nowadays, there are more distractions than ever before. For example, you are absorbed in

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a task when a new email arrives. You stop what you were doing, completely lose your focus on that task, and transition your attention to the incoming email. You read the email and take the action needed to respond. Then you take the time to reset and begin focusing back on the task you were dealing with initially. This is an ever-increasing type of time and energy we expend daily on distractions that can quickly become ‘running in circles’ to accomplish a lot, but not getting

WHAT’S YOUR COVERAGE MISSING? Jay Howell

very much done at the end of it all. Now you may be saying, what’s wrong with answering emails promptly? That is not the issue. It is the focus lost due to transition and it is also the time that is lost. If this happens once a day, then you are not losing that much time. Let’s be real though. This happens to us over and over. Want another way to determine your level of distraction? Go to your phone, look at the screen time you have. I bet some of the numbers would astound you. I found that mine did. How do we go about reducing our distractions? This is something that each person would need to determine individually but here are some things I have started working on. I deleted apps on my phone that did not provide any use or benefit to me. This included one social media platform, a couple of games, and some news-type apps. These did not provide any benefit to me and honestly did not do anything but waste my time. I also went into my other social media apps that I do find beneficial, and I began looking at who I follow, who I am friends with, etc. When we look at all this, we realize that there is a lot more that we follow than we actually care about. So, I personally went on a terror run to remove all the things I did not feel strongly about or that I felt were not offering any real benefit to me. Screen time on my phone has greatly decreased. Reduce the ability of distractions. This is hard for some people including me. We must make a conscientious effort to be focused on what it is we are currently working on. This is where it gets hard. When we are training, we should not be on our phones. We most certainly should not be on them while on the scene. If you are working in your office and writing an article like this, turn off your emails for the time period. Be invested in your priority

scheduled during the day. Before we end, I want you to know that I am not advocating doing anything or skipping out on all the fun stuff in life. But our distractions get in the way of our goals. I know that I will lose time on some goals because of things like a sports game I want to watch. That does not help me accomplish any goals but it does refresh me to work harder and be less distracted against my goals. These are just some of the items that I have learned for myself. I can tell you that your distractions may be similar or different. However, time and focus lost leads to a lower understanding of the topics we should be learning and participating in. I encourage you to review what you do, what goals you have that you wish to accomplish, and then reduce your distractions. Who knows? You may just be able to conquer the world with the extra time you have! If you do make changes like this, I would love to hear from you. Please email me at dhesselmeyer@ ontargetprep.com and let me know how it is going! Until next time be safe! David Hesselmeyer began his emergency services career in 1997. He is credentialed as a firefighter, paramedic, rescue technician, North Carolina Executive Emergency Manager, an as an International Association of Emergency Managers (IAEM) Certified Emergency Manager. He graduated from East Carolina University with a Master of Public Administration (MPA). He owns On Target Preparedness, LLC, which is an emergency services consulting firm serving public and private agencies in preparing and responding to disasters. He is a member of the Buies Creek Fire Department in North Carolina. He writes for multiple emergency services publications.

SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 19

EMS

WHEN YOUR PATIENT’S GLUCOSE READING IS “HI” — UNDERSTANDING AND MANAGING TYPE II DIABETES Aaron Dixon, MBA, NRP

o understand diabetes, you must first understand hormones. Hormones are responsible for all basic bodily functions; they are not just the stuff coursing through your teenage children’s bodies, making them impossible creatures to deal with. Think of a hormone as a key that fits the lock on a particular type of cell. For each hormone (key), there is a matching receptor (lock) on the cell membrane of certain cells. Each cell has several hormone receptors that perform a specific function when activated. The same receptors can be found on multiple types of cells and cause different reactions. The function of a hormone is largely determined by the location and type of the cell that it interacts with. For instance, epinephrine, a very potent hormone, causes vasoconstriction of the blood vessels. Like the opening and closing of a nozzle on a hose, the smaller the opening in a blood vessel, the higher the pressure of the blood moving through it. When epinephrine is released, it binds to the cells on the blood vessels and the blood vessels constrict. Receptors for Epinephrine are also found in the lungs. When epinephrine binds to the receptors on cells in the lungs, bronchodilation occurs. Both mechanisms are the reason why epinephrine is given to treat anaphylaxis. Insulin is the primary hormone involved in diabetes. When blood glucose levels rise, the body secretes insulin. Insulin (the key) then binds with the correct receptors (the lock) allowing glucose into the cell. In Type I diabetes, the body does not produce insulin. As discussed in the last issue, the resulting disease processes cause Diabetic Ketoacidosis and death, unless treated with daily injections of insulin. In Type II diabetes, the problem is not with the production of the hormone, insulin, but with the receptors on the cells. While Type I diabetes is one of the oldest recorded diseases in history, Type II wasn’t really

recognized until 1936 when a British physician named Sir Harold Himsworth, recognized a condition of insulin resistance. The body produced insulin, but it could not utilize the insulin correctly. While Type II has been identified for 85 years, there has been a sharp increase in cases over the past 20 years – mostly attributed to the rise in obesity. Type II diabetes is now one of the most common chronic medical conditions found in the United States. Patients who have Type II diabetes produce insulin, but the appropriate receptors in their bodies are damaged. While Type I diabetics will die from Diabetic Ketoacidosis (DKA) without medical intervention, Type II diabetics will not. Because insulin is present in the body, fats are not broken down and ketones are not produced. With insulin being produced but unable to bind correctly to its receptors, blood glucose levels rise. Type II diabetics can run chronically high blood glucose levels resulting in a profound increase of risk for heart diseases, stroke, blindness, renal failure, and a myriad of other problems such as impaired wound healing. Glucose is abrasive and destroys the inner lining of the blood vessels. As the blood vessels get damaged, fat can deposit within the arterial walls and scar tissue can form. Both issues increase pressure within the organs increasing their risk for failure. Scar tissue in the vasculature prevents the movement of white blood cells from the blood to infected and injured areas reducing healing and clotting. A rare but fatal condition, Hyperosmolar Hyperglycemic Syndrome (HHS), can occur when prolonged extremely high glucose levels lead to profound dehydration. These patients can have glucose levels in excess of 1000 mg/dl. These patients will present typically as unresponsive, tachycardic, and hypotensive. Most prehospital glucometers will only read to 500 mg/dl. These patients will return a reading of “Hi”. The prehospital

20 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

treatment is ensuring a patient airway, oxygenation, and fluids to correct volume depletion. While HHS will cause an increase in respiratory rate, it is not as deep and rapid when compared to Kussmaul respirations seen with DKA since there is no acidosis. Unlike Type I diabetes which is treatable but not curable, patients with Type II can be completely cured of the disease. The treatment of Type II diabetes combines a mixture of behavioral changes including diet and exercise, and typically an oral diabetes medication, such as Metformin. Most Type II diabetes medications work on improving glucose metabolism and slowing the conversion of carbohydrates to glucose. One class of medication, Sulfonylureas (Glipizide, Glimepiride, and Glyburide), increases insulin levels. These medications can cause hypoglycemia. Eventually, a Type II diabetic will be prescribed insulin if diet, exercise, and oral medication do not sufficiently reduce glucose levels. Some of you may be thinking, what is the purpose of more insulin if the receptors are damaged? The answer is no, different than why we titrate any medication. Adding more hormone or medication increases the number of receptors stimulated, and for longer periods of time, thus increasing the effect. So how does this translate to your job in fire or EMS? First and foremost, Type II diabetes is preventable and curable, so take care of yourself. Actively manage your health, exercise, and eat correctly. Say no to those roller dogs at the 24/7 gas station-choose a bag of nuts instead. When a primary reason for line-of-duty deaths is attributed to heart disease, fix one of the main risk factors. Second, regarding your patients, even though hypoglycemia is

not common in Type II diabetes, you must check your patient’s blood glucose. Make sure you compare your result to their historical average. Most diabetics will know what their blood sugar typically runs. If your patient has a normal average of 300mg/ dl and it is currently 90 mg/dl, they will appear hypoglycemic. If and how you would treat these patients should be dictated by your local clinical operating guidelines. However, if you have what appears to be a stroke patient with a low glucose per their norm, I suggest correcting it before calling a stroke alert. Third, remember that Type II diabetics can run abnormally high glucose levels and present as normal. This is in stark contrast to a Type I who can be in DKA with a BGL of 275 mg/dl. Treat based upon the symptoms, vital signs, and patient presentation, not just the glucometer reading. You know the old saying, “treat the patient, not the monitor.” Diabetes is a very common disease and accounts for a high number of EMS responses. Hopefully, the last two articles provided a decent overview of diabetes and will help improve your patient assessment and development of differential diagnosis. Be safe out there. Aaron Dixon, MBA, NRP,

is the Executive Director of EMS for Prisma Health, Commissioner for Clear Spring Fire Rescue, and an Executive Board Member of the SC EMS Association. Prisma Health operates a large EMS department providing 911, ALS, Mobile Integrated Health, Emergency Medical Dispatch, and Critical Care services throughout the Upstate and Midlands of South Carolina. Dixon is a national speaker and has authored multiple articles. He can be reached at aaroncdix@gmail.com.

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EMS

MEDICAL DIRECTOR UPDATE 2022 Dr. James Winslow, Medical Director, NC Office of EMS

e’ve had a long pandemic. At this point, it’s been going on for roughly two years. We’ve all been through a lot, but we’ve also done a lot of good. In this column, I’m going to review some of the topics that I went over from the medical directors update in Wilmington in March. There are several topics I am going to touch on in this column.

• North Carolina’s experience with using prehospital ketamine since it was approved by the North Carolina medical board.

• How we are doing with drugassisted intubation

• The ongoing opioid epidemic • The COVID-19 global pandemic • Possible ways to address current staffing issues

• What lies ahead?

Ketamine — The North Carolina Medical Board added ketamine to the paramedic scope of practice in 2019. A key requirement of using ketamine is that all systems must report their data to the North Carolina Office of Emergency Medical Services (EMS). If you are currently using ketamine for anything other than drug assistant intubation and you’re not reporting your data to the state then please stop immediately and get in contact with your local regional specialist. They can assist you with the data reporting requirements. North Carolina has done well with its use of ketamine. In all of 2021, EMS used ketamine for sedation 236 times. From the data submitted to the state, there were only four unplanned intubations after the use of ketamine. This means that unplanned intubation only took place in 1.7% of the cases where ketamine was used for sedation. This is a very good safety profile. Please remember that only prehospital medical professionals

should be making the decision about whether to use ketamine for sedation. Drug-Assisted Intubation – Drugassisted intubation is an important skill. The evidence for whether it improves outcomes is quite mixed. Any system which performs drugassisted intubation must report its data to the state. Any system which is not reporting its data to the state should immediately inform its local regional specialist and stop doing this procedure. The regional specialist can help you with the data reporting requirements, but it is essential that you report data. Drug-assisted intubation is a high-risk procedure. It should only be done by very experienced paramedics who function under a very robust performance improvement system, receive the highest quality medical direction, and receive constant ongoing training. If the system cannot meet these requirements, it should not be performing drug-assisted intubation. Opioid Crisis – During the

pandemic the opioid crisis has gotten much worse. In 2018 the rate of unintentional overdose among North Carolina residents was approximately 25 per 100,000 residents. As of today, the rate is approximately 30 per 100,000 residents. That is about a 20% increase in deaths from opioid

overdose in North Carolina. EMS agencies are in a position where they can help more with this epidemic than any other organization. Prehospital professionals are at a person’s side as they are being reversed from an overdose. Prehospital professionals also visit people where they live. They do not wait for them to come to a hospital. Medics can implement harm reduction strategies such as needle exchange which have been proven to increase the number of people who get into treatment. North Carolina has also been a leader in helping patients gain access to medicationassisted therapy with Suboxone. Stanly County and Onslow County specifically are national leaders in this. Other counties such as Orange County have implemented needle exchange programs. Guilford county has also done a huge amount of work with local public health to address the opioid epidemic in their communities. Prehospital professionals have a huge ability to help their communities recover from this epidemic and save lives. I strongly suggest all EMS agencies try to implement harm reduction strategies for their patients and look at implementing medication-assisted therapy programs. There will very likely be a grant coming soon from the North County Office of EMS which can potentially help counties implement

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EMS medication-assisted therapy drug programs for their patients. Please contact your Office of Emergency Medical Services (OEMS) regional specialist for the details.

vaccinated. Please spread the word that vaccination is safe and effective. Staffing – Many systems are suffering severe staffing shortages. Often EMS

had over 100 years of experience in EMS. Even more recently an EMS crew made up of two paramedics brought me a patient. The two paramedics together had 65 years

Prehospital professionals have a huge ability to help their communities recover from this epidemic and save lives. COVID-19 Pandemic – As I am

writing this column it appears that the Omicron wave of COVID has passed. This latest wave of Covid has been bad. Please keep in mind that we will likely have more waves of COVID. Hopefully, they won’t be as bad as this last one. It is still extremely important for your staff and citizens that they get

systems blame this on the low pay that they can offer. Another reason given for staffing shortages has been the continued, long grind of the COVID pandemic. I think these are all valid reasons. There are still many systems, however who have been able to retain personnel for long periods of time. I visited one EMS system recently where three of their medics together

of experience. This got me thinking about what allows some systems to retain such seasoned medics. I think a big reason is that they don’t work their medics to death with high volume. In addition, I think they treat the medics like family and make them feel special. In order to create this type of environment, we need to train our leaders and make sure our leaders know how to lead.

There are many leadership training programs that are very inexpensive and sometimes even free that we can send our leaders to. In addition, I really think we need to look at how we use our paramedics. What good is it to have a twoparamedic crew respond to all calls if we can’t keep them for more than three or four years and they never become seasoned paramedics? I honestly do not think we need to send a paramedic on every single call. At the emergency medical dispatch level, we need to look at ways that we can only send paramedics to calls that are likely to be needed. If we continue to burn through our medics with such high call volumes we will not be able to retain them for the long term. If we want our systems to be able to perform advanced procedures like drug-assisted intubation or give ketamine we must retain medics so that they can have adequate experience to provide optimal care. Even more important than the ability to perform advanced procedures is the wisdom and experience that they need to make the complex decisions needed of prehospital providers. What lies ahead? We have

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hopefully made it through the worst of a global pandemic. We have risen to the challenge and dealt with stuff that none of the people who have come before us have had to deal with. You are all heroes. I think we can all legitimately breathe a big sigh of relief. I do want to caution everyone. I am very worried about the challenges that lie ahead. This pandemic has caused ruptures in our society. We are also facing an extremely worrisome international situation right now. We need to build relationships with each other. We need to concentrate on training. We need to take care of each other. Do not take anything for granted because it is very possible that worse lies ahead of us.

Thanks – Prehospital providers have a

very special job and do things that no one else can do. You are the last call and the last hope for many of your patients. Never forget that what you do is special. You make a difference.

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22 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

Dr. Winslow has worked

at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the North Carolina Office of EMS in 2011. This document contains all protocol, procedures and policies for all EMS agencies in North Carolina. WWW.CAROLINAFIREJOURNAL.COM

For over 37 years, the Carolina Fire Rescue EMS Journal has had the privilege of serving first responders in the Carolinas and beyond with specialized content they have come to know and trust for the Fire, Rescue, and Emergency Medical Services fields. The First Responder’s Resource

Through the years, our commitment to our readers has remained the same: to provide them with the expert-level resources that can help them perform their jobs more efficiently.

That same commitment and mission drives the improvements and enhancements we are currently making to every place where you can view our content. We encourage you to visit our newly redesigned website at www.carolinafirejournal.com to see some of the enhanced features, content updates, and tools. As always, we thank you for the job you are doing and look forward to serving you in new and better ways.

SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 23

Sixty-One DELTA ONE

THE RIGS WE RIDE — HAZMAT APPARATUS DESIGN Glenn Clapp CSP, EFO, CHMM, CFPS

s hazardous materials responders, we are well versed in certain topical areas such as air monitoring, personal protective equipment, product control, and many related others. One area, however, that hazmat responders do not often delve into is the design of the apparatus we ride to and from hazmat calls; and just as importantly employ operationally at incidents. Since hazmat apparatus do not usually receive the amount of wear and tear over time as other “traditional” fire apparatus we may only see them replaced a few times in our hazmat careers and due to this frequency of replacement, we may have very few opportunities to design such an apparatus. It, therefore, behooves us to discuss some of the elements of hazmat apparatus design due to the fact that our efficiency and effectiveness on the hazmat scene; and even our safety and well-being depend upon the development of a response vehicle tailored to our jurisdiction, team needs, and the hazards we face.

The first step that we should take when we determine that our hazmat team either needs to upgrade to a new apparatus or purchase our

procedures. The assessment will then allow us to develop the specifications for our apparatus to enable us to have the right “fit” for our needs. Our attention should then turn to the type of apparatus that will best suit our needs. One of the first questions that arise is in regard to the chassis upon which the apparatus is built, namely should we go with a commercial chassis or custom chassis. Commercial chassis are those that are manufactured by companies that produce truck chassis for many different types of

the specifications of the customer and although they are usually more expensive than commercial chassis the customer specifies all of the details of the chassis build and oftentimes such custom chassis provides the customer, with safety features specific to purpose-built emergency response vehicles. In any event, as the end customer, your team should ensure that the engine powering the apparatus meets the horsepower and torque requirements for the geography and topography of your

The first step that we should take when we determine that our hazmat team either needs to upgrade to a new apparatus or purchase our initial piece of rolling stock is to perform a needs assessment. initial piece of rolling stock is to perform a needs assessment. We should take into consideration the hazards that we face in our response territory, the equipment that we will be placed on the unit; and our response and on-scene operating

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24 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

applications. Commercial chassis can normally be purchased for less than a custom chassis (ideal for budget-conscious hazmat teams or those departments starting a team). Custom chassis are those manufactured by traditional fire apparatus manufacturers to meet

response district. Selecting the most appropriate rear axle ratio and transmission specifics is also imperative with respect to the nature of our response area (e.g., is our area flat with wide-open highway responses, or do we have a hilly topography with roads that rarely travel in a straight line?). The next major decision in our journey of hazmat apparatus design is that of whether our needs dictate that we utilize a straight chassis or tractor-trailer chassis. Each of the choices has its own benefits and drawbacks. Straight truck chassis are mechanically simpler than tractor-trailer chassis and do not ordinarily require special licensing or driver training beyond that for similar fire apparatus. Tractortrailer apparatus normally have more equipment storage area than straight trucks and are very maneuverable for their overall length, however, they require detailed driver training and special licensing (in North Carolina a nonCDL Class A License). Another detail driving the selection of your chassis is how your team responds to hazmat incidents, namely the use of a centralized or decentralized response model. A centralized response model consists of the hazmat team responding out of one station on an oftentimes larger apparatus (often accompanied by technician-level companies from other stations) whereas a decentralized model consists of WWW.CAROLINAFIREJOURNAL.COM

Sixty-One DELTA ONE multiple hazmat response apparatus responding from multiple stations. A decentralized model of response allows the use of smaller apparatus overall or even a primary hazmat response unit accompanied by smaller “satellite” units or smaller trucks towing trailers designed for various functions, resulting in

modern LED lighting can also greatly reduce the size of the generator needed. This portion of the discussion in turn leads us to the need for dedicated areas and equipment for auxiliary functions including a research area, weather data-gathering equipment, drone operations

As Research Group personnel have one of the most demanding roles on the initial hazmat scene with the Incident Commander, Hazmat Branch Director, et al. wanting to know what the team is dealing with in the initial stages of an incident, one of the most effective pieces of equipment in the research area is a

Another needed provision on modern hazmat apparatus is for weather data gathering. Hazmat teams can perform very accurate plume modeling in the field; however, that accuracy is dependent on the input of data that is correct for the incident scene.

In summation, if we put in our due diligence through conducting a thorough needs assessment of both of our jurisdiction and our departmental/hazmat team needs and then carefully develop the type of hazmat apparatus matched to those needs and the specifications thereof, we can realize huge benefits in our efficiency and capabilities at the hazmat incident scene; and our safety going to the scene, at the scene, and returning home to the station as we all look forward to doing after a successful hazmat incident. Doing so can also allow us to be stewards of our taxpayers’ money in maximizing our capabilities while keeping expenditures to a manageable level. As always, stay safe out there and be sure to visit the North Carolina Association of Hazardous Materials Responders website at www. nchazmat.com. Glenn Clapp is a past

overall savings to the team and department. If your team decides to select a straight truck for your hazmat unit a secondary decision arises. Hazmat units built on straight truck chassis are often modeled on fire service rescue apparatus in that they can be of the walk-in body type that can house additional personnel in the body area and allow for inside access to storage or they can be of the walkaround body type that offers more overall storage capacity. The next decision area is usually that of the accessories needed on the apparatus. Our hazmat team may need lighting, compressed air, and electrical power out in the field which dictates the need for an onboard generator and/ or air compressor. The use of

area, and personnel shelter areas for inclement weather each with their respective infrastructure requirements. Most hazmat units now include a dedicated research area that allows the Research Group to determine the product or products involved, their inherent hazards, and the personal protective equipment that is appropriate for the hazards encountered. Research Group personnel need to have a climate-controlled environment with sufficient lighting and supply of electrical power in which to perform their work. Although we normally use electronic sources for research in modern-day hazmat response, we also cannot forget the need for hard copy back-ups in the form of research books and the storage requirements that result.

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lock on the door that secures access to the area and lets the personnel attend to their duties (although I probably should not make that statement out loud). Another needed provision on modern hazmat apparatus is for weather data gathering. Hazmat teams can perform very accurate plume modeling in the field; however, that accuracy is dependent on the input of data that is correct for the incident scene. If we call for a weather report from communications or even the National Weather Service, the reporting location may be many miles away from our incident scene with vastly different weather conditions. An onsite weather station allows us to obtain the real-time weather conditions at our incident scene and hence increase the accuracy of our plume modeling. As the use of drones for reconnaissance and intelligence gathering at hazmat scenes has dramatically increased, we should not forget the need for drone storage, charging, and launch/recovery equipment storage area if your hazmat team has or wishes to develop that capability. In addition, response personnel needs a sheltered area in which to dress out prior to entry into the hot zone and to rehabilitate in after leaving the decontamination area. At a minimum, we should provide an awning and seating for those personnel or even ideally provide a storage area for a tent or other suitable shelter that could also include heating and cooling capabilities.

president of the North Carolina Association of Hazardous Materials Responders and has over 24 years of fire service and emergency management experience. He is currently an Improvement Specialist with the Industry Expansion Solutions Division of North Carolina State University and is a volunteer firefighter with the Fairview Fire Department. He is also a Technician-Level Hazmat Instructor, an Executive Fire Officer, a Certified Hazardous Materials Manager and a Certified Fire Protection Specialist.

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SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 25

Search&RESCUE

DRESSING FOR COLD WEATHER SEARCH AND RESCUE OPERATIONS Bob Twomey, Rescue Instructor, Pilot Search & Rescue

henever winter arrives, we respond to the normal search and rescues as in the many years past. While it may seem ridiculous to talk about proper dress and equipment issues utilized while you are in a cold weather search, it remains an important topic. How many times have you wished it was easier to access your needed rescue gear while dressed for cold weather searches and rescues? How much easier would it be to be able to wear your normal Search and Rescue (SAR) pack without having to put it on over winter-weight clothing? When changing elevations on that long search, how do you “dress in layers” yet remain capable of not getting overheated during exertion, or dress in layers in a cold rainfall yet be able to access your gear without getting soaked?

It may seem odd to think we need to consider these things…but these issues have belabored rescuers for many years. We want to stay warm and dry in cold or wet rescues, yet the very nature of a search and/or rescue dictates that we are able to perform the rescue in all clothing options and weather conditions. Take your SAR pack for example. First, it must be large enough to accommodate the likely needs of an extended SAR operation (See the National Association for Search and Rescue (NASAR) website for a list of suggested contents for SAR operations). While it is one thing to have all of these needed supplies, it’s an entirely different matter as to how you pack them for ease of access during bad weather. Some supplies, such as hand warmers, energy foods, initial-use first aid kits, spare batteries, or electronic gear (GPS units, radios, etc.) need to be more readily

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accessible from the SAR pack, such as from side storage pockets, rather than having to dig through the entire pack contents in a drenching rain. This requires planning and also comes from experience; as to what items will more likely be needed quickly or more frequently on an extended mission. Unfortunately, a lot of this is learned through trial and error …generally more error than trial. Your SAR pack MUST be comfortable. It must be adjustable, enough so that you can do it easily over multiple layers of winter clothing or tighten it securely enough to wear over your shirt in the warmer seasons. The SAR pack should be able to be secured easily with shoulder strap adjustments, waist/hip securing belts, and chest-level shoulder strap adjustment straps. To be comfortable during hours of wear in rugged terrain, the pack must fit properly on your body. If it rides too high on your back, your shoulders bear more weight than necessary, leading to fatigue in short order. If it rides too low, not only does it put extra weight on your shoulders, but it is not secure on the hips, which are easily capable of bearing SAR pack weight, hence the hip belts and padding on those belts. If the pack is resting on the mid to upper curvature of your back, it is not as secure or balanced on your back, thus it is more susceptible to lateral movement and instability. This is NOT what you need on a steep mountainside while working your way through dense vegetation. The pack must be secure and balanced. However, the pack must not be secured to your body so tightly as to hinder blood circulation or restrict ease of movement. The higher the center of gravity is on your back, the more likely you are to be unstable on steep terrain. Likewise, if the lateral balance of your pack is significantly unequal, your center of gravity (CG) will be to the left or right. This can cause early fatigue and difficulty when navigating steeper terrain. Many high-quality SAR packs come with an internal, adjustable frame that can be customized for the loads you need to carry. They “conform” to the curvature of your back and allow for some of the pack’s weight to be more evenly distributed across your shoulders, back, and hips. Remember that your pack must be adjustable for various clothing Personal Protective Equipment (PPE) configurations and layers for the seasons of the year. Rescuers love pockets and pouches. They are handy for carrying smaller items that will likely be needed frequently or on a more regular basis. Many rescuers like the packs that integrate “mollie” attachment configurations. The military learned years ago that the ability to quickly attach equipment specific to a unique mission, allows one to have what they

need and be ready for quick access. However, you do not want so many attached pouches that you look like a western pan wagon rolling through the prairie either. In general, uni-pocket packs are not the best choice for SAR. Contents must be placed into one large pack without the options for external compartmentalization, which means you open the entire pack to access each needed item. In a 35-degree winter rain on a mountainside, this is very inefficient. Rescuers like the SAR pack contents to remain dry, especially spare clothing articles. There is not too much more demoralizing than to need a dry change of clothes during a long, hard SAR mission, only to find out that when unpacked, all clothing is soaked (remember the cold winter rain you are searching in?). This can be dangerous as it relates to hypothermia and your ability to stay warm. Over many years in SAR, I learned that one CAN NOT waterproof a pack completely. When it rains or snows, the pack is going to leak some, especially if opened and closed in inclement weather. The solution? Waterproof the contents of the pack and not the pack itself! Plastic freezer bags that can truly be sealed, excluding water leakage, will work well. They are clear, so you can see the contents without unsealing them. Just be sure that when you place things in them that you squash out all the excess air as you seal them, lest they “balloon” and become susceptible to puncture. A better alternative is to utilize vacuum sealing plastic wrap. A simple food vacuum sealing unit that uses plastic wrap that is vacuum sealed for freezer food storage works very well to seal and waterproof SAR pack contents. Spare clothing, such as socks, underwear, t-shirts, insulated undergarments, etc. can be sealed, waterproofed, and shrunk down to the size of a tennis ball! Other items you may want to waterproof are fuel bars/pellets for your cooking unit, fire starter kits, first aid supplies, and food. They weigh the same as if sealed in plastic bags but take up less than half the space and are clear so you can see the contents. Anything that needs to be waterproofed can be vacuum sealed, so, let it rain or snow to the point your pack is saturated; the contents will be dry! A useful solution to being able to access readily needed gear is to NOT plan on all of it being on or in your pack. Pockets on your SAR clothing that are accessible AFTER you don your pack are good for dispersing gear across your body. This benefits ease of access and weight-balance distribution. As a minimum, heavyduty cargo pants should be considered as the standard for SAR. Newer versions of cargo pants are readily available today in various fabric weights and configurations … and they have lots of pockets. Another alternative is the use of flight suits. WWW.CAROLINAFIREJOURNAL.COM

Search&RESCUE They have pockets all over, including the lower leg areas, but they are onepiece articles of clothing. They can be various fabric weights and safety colors and can fit loosely enough to be comfortable. Remember, on a SAR mission, you are not there to make a fashion statement. You are there to perform a lifesaving rescue. All your clothing must do is be adequate for the mission, terrain, and weather conditions, and be waterproof, comfortable, durable, and efficient. Searchers need clothing that is waterproof yet breathable, such that evaporation from perspiration can leave the body but rain or snow cannot penetrate the fabric. Clothing must also be relatively wind-proof, as convection of body heat from a brisk wind blowing around your body will quickly cool your body. Evaporative cooling, especially when enhanced by convective winds around you, can quickly place you in a serious hypothermic condition. Likewise, undergarments also should have the ability to wick water or perspiration away from your skin yet maintain body heat when wet. Boots must be waterproof, comfortable, sturdy, and provide traction. They require proper maintenance…so that you can depend upon them. Does all this sound too complex or even expensive? Well, yes … it is. Common sense dictates that we care for ourselves so that we can care for our victim(s). It is not complex to

know that you dress in layers so that as weather conditions change, you can adapt accordingly for comfort and safety. Good, dependable outdoor gear and clothing are not cheap, but then, how important is your safety when out on a SAR mission miles from command when the weather takes a turn for the worse? You are no good to your team or the victim(s) if cold, wet conditions affect your ability to perform. No one ever said wilderness SAR would be easy or even inexpensive. Many things relative to your locations need to be carefully analyzed, like terrain, elevation, field conditions, weather norms, typical SAR missions you can expect, SAR duration, and so forth. But then, this IS rescue. Bob Twomey has been in the volunteer rescue service for 46 years, having served on five Rescue Squads from the coast to the mountains. He is currently a member of Transylvania County Rescue Squad, past Chief and Training Chief, an EMT for 45 years, and is an IFSAC and OSFM certified Rescue Instructor. Bob has been active in SAR, Mountain Rescue, and teaches high-level rescue. He is the chief pilot of Wolf Tree Aviation, and flies helicopter searches and rescue support locally. He is a Crew Chief for the NC Forest Service. He can be reached at 828-8847174 or at btwomey@comporium.net.

Rescue Professionals across the Carolinas have trusted Mountain Tek with their equipment needs since 1995.

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Darrell Newton 1943 - 2022

Founder and President of Newton’s Fire & Safety Chief of Swepsonville FD for 50 Years

Carolina Fire Rescue EMS Journal remembers our dear friend Darrell Newton upon his passing. We are honored to have known and worked with him for many years. SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 27

Search&RESCUE SUSPENSION TRAUMA SERIES

SUSPENSION TRAUMA: A LETHAL CASCADE OF EVENTS (PART 2) Dr. Norman Wood

hile suspended in a safety harness, the leg straps cause a tourniquet effect on the femoral vein and pressure on the femoral nerve, causing blood to pool in the lower extremities, and considerable discomfort and pain. The venous return from the legs has very little pressure behind it, approximately one-fifth of the arterial pressure going into the legs. During ambulation, the normal venous pressure in the feet of 25 mm Hg can be increased to 90 mm Hg in just a few minutes due to gravitational pull on the blood and immobility. To assist the body in the movement of blood against gravity, the venous return from the legs has one-way valves to help the transfer of blood back to the heart. To provide the pressure needed to overcome the gravitational pull on the blood, active leg muscle contractions must be used. As the leg muscles contract, pressure is exerted on the veins in the legs forcing the blood through the oneway valves and back to the heart. Unfortunately, while suspended in a harness, the “muscle pumps” of the legs may be inadequate to overcome the compressive forces placed on the femoral veins by the leg straps and blood pooling occurs. Even with active leg movements, which can prolong the onset of presyncope

exhaustion, pain, hypoglycemia, muscle failure due to hypoxia and aesthesia of the legs, or the Suspension Trauma Cascade has progressed to the point of unconsciousness. The longer the suspension, the less mobile a person will become and the Suspension Trauma Cascade of events will begin to proceed at an ever-progressive rate. The average human body contains ten pints of blood with two pints normally in the legs at any one time. As soon as a person is suspended in a rear-attached harness, those two pints of blood are trapped in the legs

Normal Circulation symptoms, they ultimately may be ineffective against the rapidly progressing chain of events that cause increasing immobility and unconsciousness. There are many reasons why a suspended person would become immobile; a lack of understanding of Suspension Trauma, injury, confusion, physical and emotional

28 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

and the body has a decrease of 20% of its total circulating blood volume, and Class II Hypovolemic Shock is present. The heart is powerful enough to push the blood past the leg straps via the arteries and as long as the heart continues to beat, more blood will be pushed into the legs where it will be trapped. The lower extremities can hold 60% (six pints) of a body’s total blood volume. As soon as the heart has pumped over 40% (four pints) of blood into the legs, the victim is now in Class IV Hypovolemic Shock, the most severe level of Hypovolemic Shock with impending death if no immediate medical care is rendered. There is no Class V. This is the same as cutting both wrists and bleeding out half of the body’s blood. Blood pressure and oxygen levels drop to a critical point where it causes unconsciousness and then death. If the body is placed in a horizontal position, survival is possible; however, being suspended by a harness in a vertical position, there is little chance of survival without immediate suspension relief. A Vasovagal syncopal event, fainting, while suspended in a

vertical posture can end in the same catastrophic result. The Autonomic Nervous System (ANS) controls our “Fight or Flight” responses as well as our “Normal Relaxation State”. In an emergency, similar to having a harness fall stop, the sympathetic or “Fight or Flight” component of the ANS quickly prepares us to physically respond by increasing the heart rate, breathing, and blood pressure through catecholamine release and blood vessel constriction. This sympathetic control will remain dominant in an emergency unless reduced by an increasing

Blood Pooling parasympathetic tone. The parasympathetic or “Normal Relaxation State” component of the ANS creates the opposite effect on the body by decreasing the heart rate and blood pressure. The 10th Cranial Nerve, the Vagus Nerve is part of the parasympathetic ANS. The Vagus Nerve can be stimulated by pain, emotional stress, and hypovolemia. While suspended in a harness the body can be experiencing all three stimulants and the longer the suspension, the more intense the vagal tone will become. Contributing to this vasovagal event is the Bezold-Jarisch Reflex which is initiated when ischemic hypoperfusion or hypovolemia is sensed by chemoreceptors and mechanoreceptors in the left ventricle of the heart. This reflex causes a marked increase in vagal tone causing immediate bradycardia and dilatation of blood vessels by decreasing the sympathetic input. When the vagal tone becomes significant enough, a vasovagal syncopal event will occur due to the rapidly decreasing heart rate, blood pressure, and cerebral perfusion. This can take a minute WWW.CAROLINAFIREJOURNAL.COM

Search&RESCUE with Suspension Trauma. Either hypovolemic shock when excessive blood pooling in the legs or a vasovagal syncopal event occurred. With either, blood pressure and brain oxygenation will drop to a critical level where the victim becomes unconscious and death quickly follows. The three victims that died shortly after being rescued may have died of sudden cardiac arrest or pulmonary emboli. This can

be caused by hypoxic injury to the myocardium while suspended and by the blood which was once pooled in the legs becoming a toxic sludge which consists of low oxygen levels, blood clots, and high potassium (hyperkalemia). The third and final injection during a Lethal Injection Execution is potassium, it stops the heart. While suspended in a harness, the extent of stasis that the blood is exposed to will determine the degree

Vasovagal Event (Fainting)

or two where the victim feels the symptoms of presyncope, or it can be instantaneous as in a person fainting over the sight of blood or being stuck by a needle. A victim will never know how soon this event will occur, but it will be very rapid. Elements of the Suspension Trauma Cascade can present so suddenly that the suspended victim may have little opportunity to respond in an effective manner. One of the earliest symptoms of Suspension Trauma is cognitive impairment or confusion which makes the suspended victim much less likely to be able to assist in their own self-rescue. As soon as the Suspension Trauma Cascade progresses to the victim’s limits of physical or emotional tolerance, unconsciousness will occur by hypovolemic shock, vasovagal event, or both. During unconsciousness, the respiratory rate will slow, oxygenation of the brain

and heart will diminish, thus causing a greater drop in respiration and blood pressure which causes a further drop in oxygenation and the cascade spirals downward. There will be permanent brain damage in a few minutes. The heart will stop shortly after that when it sustains a global myocardial infarction, a “massive heart attack” from the lack of oxygen and death occurs. All of this can happen in “less than 30 minutes”.

Blood Clot Formation Beginning in Pooled Blood after 10 minutes

HOW THE 10 VICTIMS FROM THE AUSTRIAN REPORT POSSIBLY DIED Recall that these victims had prolonged suspensions anywhere from 30 minutes to eight hours before being rescued, some of whom had Suspension Relief Straps. All of them were in frontattached harnesses or rope slings. The two that died before being rescued may have succumbed to the classic cascade of events associated

Well-Formed Blood Clot in Pooled Blood after 20 minutes

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Blood Clot completely formed in Pooled Blood after 30 minutes SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 29

Search&RESCUE of pathological changes that occur to that collection of blood. If the venous return is only slowed as in a sit harness with increasing immobility, the pathological changes in the pooled blood of the legs will take longer to occur, perhaps hours. If the venous return is stopped or near so as in a rear-attached safety harness, the pathological changes will begin to occur immediately. As blood pooling continues in the legs, increasing hypoxia within the stasis blood triggers anaerobic

of time of suspension, over half of a person’s total blood volume may become incompatible with life. Once the tourniquet effect of the leg straps is removed, this blood can rapidly return to the heart, causing it to go into a fatal arrhythmia, and/or clots can be shed to the lungs, either of which can kill a victim very quickly. The victims that died shortly after being rescued may have been laid down in a supine position, which is considered the standard of care for trauma victims; however, this can

by blood pooling while hanging suspended in a harness. Renal tubular necrosis is the kidney “rotting from the inside out” and is caused by hypoperfusion while suspended. The kidneys can also be damaged by myoglobin, a large muscle protein released in the blood when muscle cells begin to break down in a low oxygenated state and from leg strap compression injury, a condition called Rhabdomyolysis. These bulky proteins obstruct the fine membranes of the filtration system of the kidneys

It can take a day or two before acute kidney failure becomes significant enough to make the victim ill.

pathophysiological effects on the body, a person will never know how much time he will have to survive and even if rescued after being suspended for a prolonged period of time, that victim is still in very grave danger of serious injury or death. Suspension Trauma can be quickly lethal and anyone using a rear-attached full body harness must be aware of the dangers and use all precautions. That being said, if you do not wear a full-body harness and fall, your odds of survival may be zero. Even if you survive, you may still sustain catastrophic injuries where any further employment is impossible for the rest of your life. Always wear a full-body harness and use all available safety measures. Dr. Norman Wood

metabolism in the muscle cells. Lactic acid, a byproduct of anaerobic glycolysis, causes the pooled blood to become increasingly acidotic. During an acidotic state, an ionic shift will occur between the hydrogen ions in the blood and potassium ions in the muscle cells causing the pooled blood to become hyperkalemic. Damaged Red Blood Cells will also release their own potassium. As the pooled blood becomes more hypoxic and stagnant, micro blood clot formation will begin very quickly which can lead to Deep Vein Thrombosis (DVTs). When the movement of blood, circulation, is stopped this imitates death to that section of the body. Anyone that has harvested a game or farm animal and then immediately cleaned that animal has observed the clot formation that has already accumulated. This same process of pathological change occurs in the stasis blood of the legs while suspended. Clot formation is easily observed in this instance, what cannot be visually observed is the pathological changes of the chemical composition of the blood to an acidotic state with high potassium and low oxygen content. At ten minutes, the pooled stasis blood is already starting to form clots. The scattered dark spots are the micro clot formation and the thickened area is more advanced clot formation. Although troublesome, a person would have a good chance of survival if this blood was allowed to circulate back to the heart and lungs. At 20 and 30 minutes, these clots are well-formed and are potential killers and if allowed to circulate back to the heart and lungs, death can occur in less than one minute. The pathological chemical changes occur at the same time and for the same reasons that clot formation begins and depending on the type of harness suspended in and the length

be detrimental if the conscious and alert victim has been suspended for a prolonged period of time. It must be remembered that a suspended person is not a typical trauma victim. They have not fallen to the ground, they have been suspended, a very unique circumstance. On-site, EMS care must be adjusted and is discussed later. The final five may have died over the next few days of hypoxic damage sustained by the heart, pulmonary emboli, or acute kidney failure. The kidneys cannot tolerate low blood flow and low oxygen levels caused

causing acute kidney failure. It can take a day or two before acute kidney failure becomes significant enough to make the victim ill. A short period of no symptoms may precede the acute onset of kidney failure which can quickly lead to death. Fifty percent of all acute kidney failure victims die. CONSIDERATIONS It is very clear from all available reports and studies conducted on Suspension Trauma and from the medical knowledge of the

graduated with honors from the West Virginia School of Osteopathic Medicine after 16 years of working in law enforcement for the WV State Police. In 1998, he fell 20 feet from a tree while trimming limbs and sustained injuries that immobilized him for almost 4 months. During his recovery, he began inventing new technology for fall prevention, and he continues his work through the present day. Dr. Wood is the owner of 4 U.S. Patents and several U.S. Patent Pending inventions for safety products that make elevated work and tree stand hunting safer.

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30 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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Search&RESCUE

HOW IT ALL GOT STARTED

Bob Twomey, Rescue Instructor, Pilot Search & Rescue

few months ago, while just hanging out at the station, a new probationary member and I were talking about rescue, volunteerism, and what motivates a person to want to be a rescuer. The longer we talked, the more he became interested in why normal people want to place themselves in harm’s way, as rescuers, to assist others in a time of peril. Of course, I gave him the TR definition of rescue (the safe removal of a person or persons from a place of danger and injury/death to a place of safety, for the continued immediate administration of medical care and transport to appropriate advanced care). Then he asked the proverbial question: “what made you want to do rescue or be a rescuer 48 years ago”? I told him and then got to thinking about how I could explain this to Carolina Fire Rescue Journal (CFRJ) readers in a way that would still be instructional, or at least inspirational. So, here goes. It was May 1973. I was a senior at Christ School, and it was during our final exam week just before graduation. I was in my room studying for the next day’s exams. It had been a normal weather day, except as evening approached, rain began falling. During the evening, it rained harder, then harder still, until by, 10 p.m., the areas out in front of our dorm were flooded due to so much rainfall and runoff that the storm drains were simply overwhelmed. Having been working on the school farm for four years, I became concerned about the fields and the school’s dairy livestock, I decided to make a run around campus and the farm. But in doing so, I saw heavier runoff occurring, so I decided to drive down to check the lake above the farm fields to see if the dam was holding up ok. I got three other classmates to go with me. Two were to take one truck and check campus and farm areas. One went with me to check the dam. As we approached the dam, we could see by the brilliant and constant flashes of lightning that the lake was not just full, but that the runoff was going through the emergency spillway and overtopping the entire dam! As we rushed back to notify the farm director, we saw emergency vehicles coming down the road running emergency traffic, so we decided to follow them to see where on the property they were responding. As we topped a hill

overlooking Roberson Creek, we could see that the entire floodplain was under swift, debris-filled floodwater. (if you recall, I wrote an article for the Summer 2017 CFRJ on dams and problems that can arise with earthen dams, and the Fall 2021 article “When the Ground Moves” about how rainfall and landslides occur for the knowledge of CFRJ readers). The local Rescue Squad had been summoned for victims in the floodwater. As the rains continued earlier that night, debris had lodged against a small bridge upstream of the school. For hours, an ever-increasing volume of runoff collected upstream of that bridge, forming a massive reservoir of floodwater. Finally, the bridge and the saturated roadway approaches to the bridge gave way under the pressure, releasing a massive volume of floodwater into the Roberson Creek valley. The floodwater inundated a mobile home park, knocking a mobile home off its foundation, carrying it rapidly downstream, crushing open the home, throwing six people into the water. According to a local paper article on the flood, two families had gotten into the mobile home that the occupants thought was high enough to have been above the normal floodwater elevations already flooding the rest of the park. But when the bridge failed, the sudden release of the floodwater created a surge of water powerful enough to have carried boulders the size of cars down the channel, as well as trees, other buildings, and infrastructure. Parts of the destroyed mobile home were carried for several miles down the channel, ending up on school farm property. Four of the six people in that home were killed in the floodwater. Three were found on school property and the fourth victim was another half-mile downstream. We followed the Squad down to the creek, which was now more of a raging river. The two surviving members of the original six were clinging to small trees along the creekbank, with only their heads and shoulders barely visible through the rain. The Squad was unfamiliar with the lay of the floodplain topography and was not equipped to perform floodwater rescues (remember, this was in the early 1970s) They had no boat with them, which would have been essentially useless in the debrisfilled floodwater, and rafts were not yet considered as rescue crafts like they are today.

Fearing the exhausted victims could not hold on much longer, we got a farm tractor to serve as an anchor for the rope used to pull the victims to safety. The Squad gave us rope (manilla rope back then). Two of my classmates did a ferry swim out to the victims, tied the running end of the rope to a small tree, and we retrieved them from the floodwater back to the bank, using the tractor to tension the rope which served as a handline. The Squad took charge of the victims once at the edge of the floodwater. Knowing the other four victims were still in the water, we assisted the Squad for the rest of the night searching the channel and floodplain for them. The next afternoon, after exams, we returned to assist the Squad, and three of the four victims were located. The fourth was found two days later. This was my first ever search of any kind. It was also my first experience seeing deceased victims of any kind of disaster. Apparently, it made an impact on me. In the fall of 1973, I joined Transylvania County Rescue Squad, beginning the now 48-year tenure as a Rescueman. And that’s my story. I am sure you have something in your past that made you feel volunteering in the rescue was the right thing for you to do. Perhaps you should share it with your new rescuers.

So, rescue-wise, what are some of the main points of this story as they relate to rescue? As I have said in previous articles over the years, the study of moving water, its powerful forces, the relationship of rainfall, flooding, and landslides is important to know in your communities. Training and certification in Swiftwater rescue and Incident Command Systems (ICS) is critical, no matter where you live. Each year we should all study, learn, practice, and deploy the Knowledge, Skills, and Abilities (KSA’s) in our communities. And over time, practical, hard-earned experience helps, too. It’s who we are. We’re Rescuers! Bob Twomey has been in the volunteer rescue service for 46 years, having served on five Rescue Squads from the coast to the mountains. He is currently a member of Transylvania County Rescue Squad, past Chief and Training Chief, an EMT for 45 years, and is an IFSAC and OSFM certified Rescue Instructor. Bob has been active in SAR, Mountain Rescue, and teaches high-level rescue. He is the chief pilot of Wolf Tree Aviation, and flies helicopter searches and rescue support locally. He is a Crew Chief for the NC Forest Service. He can be reached at 828-884-7174 or at btwomey@ comporium.net.

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SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 31

Policies &PROCEDURES NFPA 3000 SERIES CONTINUED

UNDERSTANDING THE RECOMMENDATIONS OF NFPA 3000 Daniel Moran, Davie Fire Rescue

he National Fire Protection Agency (NFPA) 3000 Active Shooter/Hostile Event (ASHE) standard’s main objectives are to provide a single set of requirements to be used by the whole community addressing Unified Command, integrated response, and planned recovery.

• Unified Command – When and

why a Unified Command needs to be in place, practiced, and institutionalized by the Authority Having Jurisdiction (AHJ).

• Whole Community - Providing

training and education to community members, preparedness information, bleeding control, and emergency action plans for facilities.

• Integrated Response – All

public safety agencies that may be involved in a response collaborating to develop common operational plans to function as a cohesive, integrated unit.

• Recovery – Planning for each of

the Recovery Phases (immediate, early, and continued recovery) is essential.

In this month’s article, we take a deeper dive into “Whole Community” preparation and response for an ASHE and provide recommendations for best practices. Who is the real first responder for an ASHE incident? Police, Fire, EMS, Security, Special Weapons and Tactics (SWAT) (the list of sworn and private responders could continue,) but the real answer is the members of the public (uninjured or minimally injured) that are already at the location of the ASHE incident are the first to respond and are the “immediate responders.” It is imperative that these immediate responders be educated on how to initially respond to these emergencies. There are also several steps that the public safety community should consider helping the public get prepared. Let’s break down the whole community approach into three stages – Community Preparation, Response, and Facility Management. Preparation – Training the public in severe bleeding control techniques is incredibly important, in fact, an entire campaign was built around that

topic known as Stop the Bleed®. By teaching everyone the challenges of uncontrollable hemorrhage and the basic principles of stopping bleeding, lives will be saved. A best practice would be to incorporate the Stop the Bleed® training into all Cardiopulmonary Resuscitation and Automated External Defibrillator (CPR/AED) courses. If you’ve already incorporated bleeding control training into all CPR courses, great! But the next question is, how do the public gain access to the equipment needed during the emergency? A best practice is to create a city/county ordinance that requires a bleeding control kit located in each AED cabinet that is required by code. Just as it is commonplace to see fire extinguishers and AEDs required by code, the future should be to require bleeding control kits in the same establishments as AEDs. Response – Stressing the public’s safety and using the Federal Emergency Management Agency (FEMA) Run, Hide, Fight® approach to ensure their safety will always be the first step in an ASHE. After the threat has been eliminated, the focus for the public and first responders is saving lives through treatment. The number one preventable cause of death in an ASHE is uncontrolled external hemorrhage. The focus for bystanders should be the application of a tourniquet, pressure dressing, and/or a hemostatic agent until transport and definitive treatment can be implemented. All of the myths around tourniquet application (losing the limb, loosening the tourniquet, etc.) have been proven to be false. The second preventable cause of death is respiratory/cardiac arrest from a tension pneumothorax. Education should be provided on occlusive dressing application “chest seals” to seal the chest wound. Finally, we should teach wound packing, a skill that is often not covered in-depth for EMS providers. Performing this skill fast and accurately will slow bleeding in junctional locations where most tourniquets cannot be used. Facility Management - Facility emergency action plans should be reviewed by their local public safety agencies. Vulnerability assessments

32 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

may be required for certain facility types, but whether completed or not, the public safety agencies that will respond to those facilities need to be aware of their plans, this is extremely important for identified target hazards. Hospital facilities have added challenges for emergency action plans, they need to develop a plan for an Mild Cognitive Impairment and Active Shooter/Hostile Event (MCI/ASHE) internal to the hospital as well as victims arriving unannounced at the ER. It would be important for responding agencies to know where the hospital incident management team will be located is an important part of planning for an MCI/ASHE or any other critical incident. The hospitals need to be prepared to be overwhelmed by private vehicles or police bringing victims to the hospital many times arriving prior to ambulances and maybe before even hospital notification of an MCI/ASHE has occurred. Hospital staff should be trained in rapid triage of victims at the hospital ER entrance/ambulance ramp. Mass bleeding control kits should be located at hospital main entrances, triage entryways, and the ambulance ramp. Having to retrieve tourniquets and bleeding control products from an inventory system will waste precious time. Hospital staff needs to be ready to enact their plans and treat large quantities of injured. During an ASHE a best practice that has been identified is to have a Fire/EMS liaison(s) report to

the hospital(s) victims are being transported to. The liaison(s) can keep the hospital(s) staff up to date on the anticipated victim counts (once established the transport officer or medical communications will provide updates on the victim count and conditions). The liaison can also assist with the victim tracking that arrives from private vehicles or police transports. A gap identified by many fire/EMS agencies is following up from the hospitals after receiving a hospital capability report on how many victims they will receive. The hospital liaison will be able to close that gap and provide real-time information. For more information on the Stop the Bleed program, visit www.stopthebleed.org For sample ordinances requiring bleeding control kits, visit https://www.davie-fl.gov/1080/ Stop-the-Bleed Daniel Moran is the Assistant Fire

Chief for Davie Fire Rescue (Florida). He has been a firefighter/paramedic for over 20 years. For the last 7 years as a Chief Officer assigned to administration, he has functioned as a lead judge and evaluator for dozens of MCI exercises. He manages the ASHE and RTF drills between Davie Fire Rescue and Davie Police and is currently developing a training platform on MCI response for all of Broward County. He is also the CoChair for the Fire Chiefs Association of Broward County EMS Subcommittee.

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Leadership

GENERATIONAL LEADERSHIP Dr. Mark Rivero

eadership is known to create great discussions among people and public safety is no different. Leadership can be defined in the simplest terms as doing the right thing even when no one is looking. But what does that really mean, and how does that affect the generational differences that can be present for a discussion either at a career or a voluntary department? Leadership is an art that is built from experience as well as learned from the educational process. Not too many years ago one could qualify for a chief position with just their experience in fire and ems. Today, some chief positions are requiring a Master’s degree in public administration. Many people can and will state that everyone has an opinion and everyone is right in their own mind. Let’s look at the fact that multiple generations can be in the workforce at any given time and how does one attempt to create leadership from the top down and also from the bottom up? One way is to remember that rank does not always mean you are a leader. Genuine leadership is supportive to all levels of the workforce and is not coercive. In this statement, we need to look at the 18-year-old who

EMS

is just starting their career. Do we demand that they always listen to the fact that it’s always been done like this before or do we show them the way things were and how they are today. When we think about shaping future leaders, are we looking toward creating a workforce well-equipped with skills and education? Are we being proactive in developing the youth that will replace us as we move up through promotions and retirement, so that they will have what they need to best serve the communities that will be counting on them? How are we doing when it comes to succession planning? Who in your organization is well-prepared to take over responsibilities if something tragic happened to a company officer (up to and including the chief)? Leadership building for the youngest generation of employees should not be a challenge of authority but instead a development effort for this group to gain experience and understanding of the expectations that will be asked of them during the years ahead in their career. In discussions with some coworkers that I went to the fire academy and graduated with some 29 years ago, I asked what is different today when compared

to when we went through fire training. Collectively, it was stated that attention to minor details and discipline were the most discussed topics. In today’s world of firefighting and EMS, where does leadership development come from? Ironically, most of the suggestions were in the education and on-the-job training outside of the academy. While it does not require a college degree to put out a fire, one needs to stay actively engaged in the creation of policies, practice collective bargaining, and effectively deal with the city and county managers. As we mentor our youth in critical thinking and training to do the right thing, are we demonstrating the need for leadership in the above-mentioned areas? The discipline and attention to detail required while donning personal protective equipment is just as important as that required during the use of universal protection equipment at a medical scene. This is really the beginning of teaching leadership skills to the youth of our career field because this is where techniques are known to become potentially lifesaving. This is also a demonstration of who is doing the right thing even when no one is looking. These techniques build confidence and confidence is what develops leaders. Education in the fire and ems world has become a valuable avenue and many agencies even provide tuition reimbursement to those enrolled in college programs. Leadership courses can lead to a certificate and even to a degree on multiple levels. Leadership

development is best demonstrated when an employee goes above and beyond their skill level and performs at a level that is unexpected of them and they in turn continue to be a humble individual. An example would be when the youngest person in your workforce comes to the station or firehouse on their day off to do something for the job while off duty, and a company officer recognizes them for their outstanding effort. This isn’t to say that it can’t happen while on duty because that happens as well. Remember what President John Kennedy said at his inauguration, “Ask not what your country can do for you. Ask what you can do for your country.” In closing, “Leadership is an art, to be learned and applied sensitively. It is not to be confused with mere position.” -The Art of Leadership, Donald Walters Mark Rivero worked for the City of Las Vegas, Nevada, Fire and Rescue until 2011, as firefighter, training officer and ultimately professional development officer, creating degree pathways for fire service personnel. He currently serves as a program advisor/site coordinator for Southern Illinois University and as chairperson for the doctoral degree path committee for professional development at the National Fire Academy. Rivero also works with the American Council on Education, reviewing fire service courses at various institutions across the United States. He received his doctorate from the University of Nevada, Las Vegas in 2004.

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SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 33

Missions RESCUE

The Guatemala Connection:

extrication and rope rescue and be flexible enough in their teaching to conform to whatever might get thrown at us. It also needed to be a group that could get along, as we would be spending nine

THE JOURNEY BEGINS David Pease

t is interesting how we sometimes find ourselves involved in things we would have never imagined ourselves in until we are there. That is exactly what happened back in 2009 when I received an email from an organization called Paramedics for Children, run by Rodger Harrison. Paramedics for Children is a non-profit group that works with children on the medical side in Guatemala and Honduras. They ran clinics and were sending down donated ambulances. They would also ask for medics to volunteer to go down and help as well. The email I got was slightly different though, it was asking for Instructors to go to Guatemala and train a group of their rescue folks. They were hoping to acquire a used rescue truck to be donated, and equipment to go on that truck. I emailed that I may be interested,

along with my resume, and waited to see what would happen. Several months later I was contacted by Woody Sullivan of Pender County EMS and Rescue. He was donating their used rescue truck and had become the mission team leader. After several conversations and emails, he asked if I would serve as co-leader. I graciously accepted the position. My job was to put together the training program and outlines. He would work on assembling the

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team and we would both work on getting equipment donated. I was also looking to secure several slots on the mission team from our rescue team. We had several conversations and then it was time to look at when we would go. It was soon established that the time frame would be in late July or August, rather than in early June as once thought. This was going to put a major wrench in the trip for Woody, as school and work were going to be a problem. After much thought and deliberation, Woody realized he would not be able to make this mission trip. With much regret, he called me and asked if I would take over as team leader for the mission. I accepted, and soon the “real” fun began. I now had to put together my team and get as much rescue equipment donated for the truck as possible before we left in August. I put several emails out for equipment along with several articles. After Woody had talked with me, he advised Rodger of his situation. I soon got a call from Rodger, and he gladly welcomed me as the new Team Leader. I ascertained from him what training they needed, what they already knew, and how many folks we would be training. He informed me we would be training about 50. Now came the real challenge. First, I needed to put together a team of at least 12 Instructors that would be qualified to teach vehicle

days together. The first place I looked was my own rescue team, as I know we had a great bunch of qualified Instructors. I also knew we would not have enough Instructors to make up the mission team. I put the word out to my folks and within a fairly short time had eight of our members willing to go. Using our resources, we were able to gather an additional four instructors. I now had our mission team put together, although it did take a little longer than I just made it sound. Next, I put together a list of equipment I felt we needed to get by with for the truck. Knowing they had virtually no extrication equipment and very little rope equipment, the list was not hard to put together. I put some feelers out, but things were still slowly coming back. Having been in rescue for quite a while, (and I shall leave it at that), I have made a lot of contacts and friends, so it was time to start making some calls. Rescue Jack was the first to come on board with some stabilization struts. Turtle Cribbing followed with a set of plastic cribbing. Sterling Rope helped with ropes and accessory cords. REI and Southeastern Emergency Equipment

donated pulleys, carabiners, descenders, and brake racks for the rigging pack. Agri-Supply donated a set of high-lift jacks, a 60” pry bar, and a come-along. Loop Road Auto Parts gave us two hydraulic bottle jacks. Mac Tools donated hand tools and an air wrench. Lowes gave us power cords, quartz lights, sledgehammers, screwdrivers, pry bars, and hacksaws. Bosch put in 100 reciprocating blades, and Hudson’s Hardware of Garner threw in a 36inch pair of bolt cutters. Rocky Mount Fire rounded up some air pack frames, power cords, lights, gloves, hand tools, and several helmets. The Reds Team kicked in two stokes baskets, four stainless steel pulleys, (four) ½” lifelines, webbing, two corded reciprocating saws, one cordless reciprocating saw, one cordless impact wrench, an airline, a halligan tool, a WWW.CAROLINAFIREJOURNAL.COM

Missions RESCUE Paratech tool, fire ax, (five) 2.2 old Scott air packs, and purchased a new battery for the truck. We also acquired a used Phoenix hydraulic combination tool, a cutter, and a portable power unit. We now had some good basic equipment to put on the donated rescue truck and train them

with. This was way more equipment than anyone department had. Our time was drawing near, and we needed to get the truck to our station so we could get the equipment on it and ready for the “drive” to Guatemala. That’s right,

brought it back to Garner. We spent the weekend putting all the donated equipment on the truck. Once the equipment was loaded and mounted,

the truck was going to be picked up in Gastonia, North Carolina, and driven to Guatemala. A fellow from Guatemala would be picking it up and making the long and tedious drive to Guatemala City. The truck was delivered to Gastonia, where we picked it up and

we returned the truck back to Gastonia on that Monday, now ready for the trip to Guatemala. The truck was finally on its way there, and we were now ready to make the trip. It was only a week

before we were scheduled to fly out when I got an email from Paramedics for Children. They informed me that the truck had transmission problems and was stranded in Mexico. This now became a problem, not knowing if the truck would make it to Guatemala by the time we arrived. We were asked if the truck didn’t make it, could we change our flights. However, this was not going to be an option, so plan B was to have a pickup truck go to Mexico and get the equipment off the truck and take it back to Guatemala. Luckily, they got the truck repaired and it was now on its way to Guatemala. We arrived at Raleigh Durham Airport at 6:15 a.m. on Sunday, August the 1st, ready for our 7:30 a.m. flight to Atlanta, then on to Guatemala. Stay tuned for upcoming journals, as I take you on a journey that has, and continues to make a huge difference in the Fire/Rescue/ EMS services in a small thirdworld country. We do continue to take donations of equipment and vehicles to send down as well. David Pease, Chief

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SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 35

Health&WELLNESS

STRENGTH TRAINING FOR FIRE FIGHTING … Jeff Casebolt

ore than 20 years ago, upon reflection as a Strength and Conditioning (S&C) Coach, I asked out loud to no one in particular, what was my job? The question was generated from the thoughts of developing a philosophical approach to proper strength and conditioning parameters when working with athletes and assisting professionals in the service industries: Fire, Police, Emergency Medical Services (EMS), etc. I realized that my job was to best prepare these individuals for day-to-day operations and ultimately improve longevity in their chosen careers. As I sat there with my cup of coffee, spit-balling ideas during a “free-writing” session, it hit me. The thought that popped into my head, and has never left, was to strength train the service industry with the intent of minimizing injury potential, which in turn will improve performance and maximize availability for time spent on the job. The rationale behind my epiphany was if, as an Strength and Conditioning (S&C) Coach, I could properly strengthen all the muscles surrounding and supporting each of the major joints of the fire fighter’s body then the individual would be less prone to injury, be available to develop advanced movement skills, while minimizing the number of “sick days” taken each year due to on-the-job injury. This concept is now commonly referred to as joint stability. In order to promote true injury minimization among joints, the concept of mobility needs to be mentioned and explored. Joint mobilization is more than the flexibility of muscle and connective tissue – rather it is best summed up by addressing both the necessary movement patterns of the joint while increasing or maintaining the range of motion needed to move without compensation. Furthermore, improved muscle quality and the movement patterns used in the weight room, not necessarily for the purposes of hypertrophy, but instead focusing on the increased tensile strength of the muscular and connective tissues would simultaneously affect joint stability, mobility, while improving metabolic efficiency. The separation of strength development and skill acquisition was one of the first major breakthroughs for me professionally when examining and philosophizing my contribution to condition those

individuals who support their families while working a physically demanding job, such as firefighting. For the development of strength, I always start the conversation by referring to the Force Velocity Curve (FVC) and specifically to the Pure Strength portion of the curve on the concentric side of the graph – see graph. Within this portion of the curve, the velocity of movement is low and force production is high, with intentions of inducing neuromuscular fatigue. I am not a proponent of prescribing sets, reps, and load perse. Conversely, I prefer to educate my lifters to train to a “feeling” – psychological or physiological. What I mean is, depending on the need for recovery – I ask, how close can I take a lifter to full Momentary Volitional Fatigue (MVF): the inability to complete another repetition with “good” form in the concentric phase of the lift. When examining a training session, if a compensatory movement pattern is witnessed, due to previous or existing injury, or induced fatigue, a corrective verbal que is given and if faulty movement is still present the set is terminated.

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If the lifter does not have adequate recovery time poststrength session, then complete MVF style lifting is not advised given the lack of time prior to the next shift, then a different approach must be taken. I propose lifting to a percentage of MVF, which is not an easy proposition at first, but with persistence your lifter will learn the following: using a load for projected

five reps of that projected 15RM, which has been shown to have been enough stimulus to force the muscle(s) into recovery and decrease the time needed for recovery. Some professionals are referring to this concept as stimulating reps, but no matter the name, the concept is cemented in strength development and is an effective tool when working with lifters who need to be fully recovered in less time.

ISOMETRIC

Strength

Speed

(+)

Repetition Maximum (RM) have the lifter work to within three to five repetitions of the RM and that should be enough to stimulate the need for recovery. For example, a load is used where the lifter can produce 15 repetitions; therefore, I ask the lifter to get within three to

(0) (0)

(+)

Therefore, the induced stimulus must be enough to put the muscle into recovery for the purposes of adaptation. If the stimulus is not significant enough or recovery is inefficient then adaptation is less likely to occur. According to the latest research, three to five reps

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Health&WELLNESS within an RM, on average seems to be enough stimulus to cross a mythical or magical threshold putting the targeted muscle into recovery. Proper recovery is recognized and acknowledged here as sufficient nutrition, hydration, and recovery returning the body to homeostasis in a timely manner. In conclusion, the development of muscular force production using the

with low force production by the muscles. It is in this section of the graph we examine the concepts of skill acquisition or job requirements for the field. The development of skill occurs at the Pure Speed portion of the FVC – high speed, low force production – therefore, during the training process for the acquisition of skill, I tend to focus more on the specific development of

If you want your lifters to become better at the utilization of developed strength and more efficient with their movement patterns it is best to install specific movement patterns needed for on-the-job training. The skill of strength development is an important part of working with novice or new to strength training lifters in the weight room. Basically, there are two extreme schools of

Recently, I was privileged to the following advice, in reference to training athletes for the purposes of reducing injury – “move slowly for the development of muscle, and quickly for connective tissue condition”. FVC as a guide happens in the Pure Strength – low velocity, high force – section of the curve with induced fatigue to full or near MVF without compensatory movement patterns for the purposes of muscular strength development. At the other end of the FVC continuum, still, on the concentric side of the graph, you have highvelocity movement coupled

job-related skills with the possibility of supporting low to high-level plyometric movements paying close attention to compensatory or pathological movement patterns for the purposes of minimization injury potential with the intent of maximizing improved human motion. The intent is transferred under the SAID Principle – Specific Adaptation to Imposed Demand.

thought on the strength training continuum: 1. Movements that are required for the lifter’s profession – i.e., firefighting, or 2. Muscular strength in the safest way possible. No matter your professional philosophy teaching safe techniques while educating your lifters on proper form is essential for minimizing their injury potential. When initiating a training program, I lean towards the latter philosophy and tend to stay there for much of the time I spend working with said lifter(s), no matter the number of years dedicated to strength training. My intentions are to load the systems of the body: neurological, muscular, bone/joint, and connective tissue – efficiently, properly, and safely with induced fatigue, while minimizing joint loads through appropriate load distribution. Simply teaching proper techniques for developing lifters in the weight room will go a long way in reducing injury potential. Conversely, the majority of strength training programs are loadbased utilizing the lifter’s competitive nature, with the objective resulting in 1RM – one repetition maximum – often producing compromised technique and tissue breakdown, as a result. Recently, I was privileged to the following advice, in reference to training athletes for the purposes of reducing injury – “move slowly for the development of muscle, and quickly for connective tissue condition”. This advice hit home because I have always examined strength as a healthy stressor of the neurological system to ligamentous structures via muscle, tendon, bone, and joint --- understanding each of these systems (tissues) necessary dose-response during strength training followed by the ballistic nature of on-the-job training goes a long way in preparing the firefighter for the necessary fieldwork. The combination

of increased strength and improved skill acquisition will minimize both acute and chronic injury potential according to several literature reviews and anecdotal evidence. Moving external load ballistically can have benefits due to a large neurological impulse generated towards the muscles responsible for the movement, but once the movement has been initiated momentum becomes the byproduct resulting in significantly less muscle fiber activation until deceleration of the object is needed. In order to properly slow down, stop or reverse the generated angular momentum about a joint an antagonistic cocontraction is most likely utilized, which is a naturally occurring protective instinct and if transferred to the skill acquisition phase of training, reduced “athleticism” may result and can be witnessed. In other words, if you are going to use ballistic lifts in your athlete’s development, start with a base of strength, understand why you are programming ballistic lifting into your lifter’s workouts, learn to teach the lifts properly, and understand when, how, and why an injury is likely to occur. Even when a ballistic lift is performed to perfection, residual effects can result in accessory injury – injuries that were caused in the weight room, but do not present themselves until the lifter is physically active during a work-related incident. In addition, developing strength through the entire range of motion in all planes of motion, in which a joint move has shown to improve integrity through congruency, resulting in reduce injury potential and a reduction in recovery time if an injury happens to occur. Research suggests a safe strength development program – moving weight slowly - in combination with a proper firefighting specific skill development program – moving the body quickly - is as effective as a ballistic strength program for the purposes of developing on-the-job “athleticism” with less potential for injury. Jeff Casebolt has been

associated with the fitness industry since 1991 working as a personal trainer, strength and conditioning coach, corporate fitness coordinator prior to going back to school to work on a Ph.D. in Biomechanics and as a professor. Jeff’s research interests include increasing function with strength training across all ages, occupations, and abilities, lower body power development, injury mechanisms among athletes and occupations, and fall prevention among the elderly. In addition, Casebolt is associated with Dynavec Resistance Systems and the Fire Fit Trainer assisting with research, development, marketing, and sales.

SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 37

Equipment PURCHASING

EVALUATING FIRE EQUIPMENT: REMOVE THE JUNK FIRST … THEN CALCULATE Gary Wilkins

t some point in your life, you probably owed one of your teachers an apology for muttering, “I’ll never use that in the real world,” only to later discover your teacher was right. Many learnings have real-world applications — only sometimes do they come later in life. When I think back to my own-owed apologies, I recall another statement — “junk in is junk out” — as it relates to the use of calculators. That “junk” is exactly what this article is about. As a firefighter in today’s world, you’re conducting more math and science than you ever thought possible. When speaking with firefighters, the most hot-button calculation across the country is friction loss and gallons per minute (GPM). Manufacturers publish data knowing that fire departments can easily confirm those figures. In fact, most firefighters have probably spent money on fancy water flow meters that send realtime data to their mobile phones, and if not, many can recall using the ever-reliable pitot gauge to catch manufacturers in the occasional lie. Unfortunately, data from other parts of the fire industry remains unchecked. Take for instance ventilation. There are no real measures to properly (and fairly) evaluate fans while in the field. Flashing back to our “junk in … junk out” statement, if you’re basing your training on uncertified data, then the result is junk out. Looking at ventilation at its most basic level, the measurement of CFM (cubic feet per minute) can be used to approximate the amount of time it takes to effectively ventilate a structure. But how can you trust the manufacturers’ published CFM? There are no readily available gauges that firefighters can carry in their pockets to confirm this reported data. So that’s where third-party airflow certification comes into play. The Air Movement Control Association (AMCA) has become recognized as the authority for the development and measurement of

airflow. Specifically, the ANSI/ AMCA 240-14 was developed to measure and compare effective airflow of positive pressure ventilation (PPV) equipment. This test was developed in 1996 to provide end-users with trusted and repeatable airflow measurements

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that include the effects of entrained air. And recently, the AMCA 240 Committee developed the first method of testing the performance of a battery-operated PPV. This new standard is scheduled to be released in 2022. Structure Volume = Length Width Height

Generally, it’s accepted that it takes 10 complete air exchanges to ventilate a room (or structure). Time to Ventilate = 10(

Structure Volume ) CFM

But standards and data are only good if departments look for this information (and demand that all manufacturers provide

these important numbers). The manufacturer must label their numbers as “AMCA Certified.” If they fraudulently make this claim, AMCA can take action against the manufacturer. And if the manufacturer uses AMCA Setup,” “AMCA Accredited” or any other phrase, their numbers are not verified and a field test should be executed. Again, the numbers shouldn’t be junk. AMCA’s reputation extends to the NFPA, where this organization has leaned on the association when creating NFPA building codes pertaining to ventilation, like the following codes: • NFPA 80 • NFPA 90A • NFPA 90B • NFPA 92 • NFPA 101 • NFPA 105 • NFPA 204 • NFPA 5000 And while this article could dive deep into the depths of AMCA, we’ll simply reference one of AMCA’s most recent webinars, bit.ly/amca240-webinar, and instead, focus on what you can do in the field to evenly compare airflow when this data isn’t readily available. Most major (and reputable) brands of positive pressure ventilators have taken the extra steps to provide the fire industry with certified equipment, but in the instances where you’re evaluating uncertified equipment, you can take measures to standardize your department’s own evaluation process.

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Equipment PURCHASING

You’ll notice we said, “compare airflow” — not “certify airflow.” Without the proper setup, equipment, and knowledge, it’s impossible to fully certify positive pressure airflow in the field, but a simple wind meter (commonly used for landing a helicopter or to get a weather update on wildfire incidents) can be used to provide a few decent, comparable measurements. Again, though, these readings are not the “most accurate.” They’re simply a means of providing “comparable results.” The importance of the evaluation cannot be understated, and for ventilation evaluation, the following recommendations allow you to evenly compare ventilation equipment across every manufacturer. Here are some stepby-step guidelines: 1. Set up equipment according to manufacturer recommendations, as is recommended in the 7th Edition IFSTA Manual.

a. For instance, manufacturers offer various guards, which allows the fan’s setback to vary based on the department’s needs. As such, the fan’s position (based on manufacturer guidelines) becomes extremely essential. Moreover, AMCA scientific results show that proper setup can increase entrained airflow, which in turn can double the effective airflow when the equipment is used properly. 2. Evaluate all fan manufacturers during the same day, within the same environment, roughly the same time. a. Humid air is less dense than dry air. Crazy as it may seem, it’s true. As the time-of-day changes, the humidity in the air also actively changes. In most cases, slight variables will

only affect the results by a few percentage points, but major changes can impact your evaluation. For instance, if you were to evaluate Fan A at 800 with 20% relative humidity and then evaluate Fan B at 1600 with 80% relative humidity with an impending rainstorm, the results will be drastically different. b. The same can be said for wind speed and direction. 3. Use the same test structure with the same entry point and exit point per your department’s operating guidelines for proper ventilation. a. If possible, when using a portable wind meter, try and secure it to a stationary point in the center of the exit point, allowing you to receive consistent measurements and remove the human variable from the results.

To that end, it’s important to try to eliminate as many variables as possible during the evaluation, focusing on maintaining the same setup — or a near-identical setup as possible — and removing as many external factors as possible, like wind speed and fan direction. Also, be sure to measure the exit speed winds at the same exit point between the different brands. Performing this kind of evaluation can provide you with some knowledge of how much wind is moving through the structure. However, please note this wind meter measurement is only MPH and does not account for the amount of air moving throughout the structure, so the ventilation calculation mentioned earlier does not apply to this result. In the end, a detailed equipment evaluation of features and benefits along with verified data is critical in the selection process, ensuring that some fast-talking salesperson doesn’t persuade your department with too-good-to-be-true numbers. Take a moment to confirm reported airflow numbers at amca.org/ certify/#certified-product-search, and when all else fails, break out your own meter. Gary Wilkins has spent the

last three years focusing on all-things ventilation, working for Super Vac, one of the world’s most experienced ventilation companies. Prior to that, he worked in North Carolina as a distributor sales representative in the piedmont. Additionally, he notched 14 years with the Northeast Stokes Volunteer Fire Department and currently serves as a resource and advisor to the department and community in equipment evaluation and purchasing.

SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 39

Know Your GEAR

INSIDE TURNOUT GEAR TECHNOLOGY A closer look at how composites are constructed Todd Herring

irefighters spend a lot of time in their turnout gear from completing academy training to serving in the line of duty. They know what makes a good-fitting garment, but how many know what process goes into coats and pants that can withstand harsh conditions and wear? As a manufacturer of head-to-toe protection apparel. Keep reading to get acquainted with the materials and methods that matter in an emergency—factors that allow firefighters to lunge, climb, or crawl smoothly through the fireground while eliminating their exposure.

TURNOUT GEAR ELEMENT

FUNCTION

Outer Shell

Flame, heat, & abrasion resistance

Moisture Barrier

Resists liquid, chemical, and blood-borne pathogen penetration

Thermal Liner

Heat barrier & garment lining

Manufacturers engineer fabrics by blending the fibers to achieve the desired result. For the end-user, it is important to identify what characteristics are most important as garment weight, comfort, protection, durability, and cost are all impacted by the fibers and yarns used in its construction. Fabric Yarn Comparison

THREE MAIN LAYERS Turnout coats and pants are constructed with three main layers: an outer shell, a moisture barrier, and a thermal liner (this three-layer combination is known as a “composite”). The various properties of these layers work together to protect firefighters from heat, flames, and other occupational hazards. Garment design and performance requirements are set by the National Fire Protection Agency (NFPA). OUTER SHELL The outer shell is the first layer of protection. Turnout gear is constructed using several textile layers, each being engineered with a blend of different fibers and yarn to provide the desired performance attributes. A typical flame-resistant outer shell is constructed using spun yarns or a combination of spun and filament yarns. Spun yarns are short fibers crimped and twisted together, whereas filament yarns are composed of continuous, cable-like fibers. Spun yarns tend to provide softer, more flexible fabrics while filament yarn, being one continuous strand, is typically stronger and smoother to the touch. A mill then weaves fibers into the finished outer shell fabric. To enhance the fabric’s tensile and tear strength, many products on the market today use filament yarns in

This chart outlines the main function of each element of the composite.

A lot goes into every stitch, seam, liner tab, and water well that make up a protective ensemble, making quality materials and construction paramount to dependable performance. novel ways to provide robustness and abrasion resistance. Other fabrics utilize special filaments such as KEVLAR® in a twill weave (a pattern of diagonal parallel ribs) to give the fabric a softer feel and improved flexibility. Each fiber brings different characteristics to the equation be it enhanced thermal stability, improved strength, and resilience, or better maneuverability and comfort. Manufacturers engineer fabrics by blending the fibers to

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YARN

STRENGTHS

LIMITATIONS

Spun

Economical Easy to dye Better wicking

Lower strength vs. fil. Higher coef. of friction Higher piling propensity

Filament

Higher strength High lubricity Low shrinkage

Difficult to dye Seam slippage Low wicking

achieve the desired result. For the end-user, it is important to identify what characteristics are most important as garment weight, comfort, protection, durability, and cost are all impacted by the fibers and yarns used in its construction. Notable is that the outer shell also provides limited protection against water penetration. Fabric mills add a durable, water-resistant finish to the woven outer shell materials. The NFPA 1971 standard requires all outer shell fabrics to maintain a minimum performance level after five launderings of no more than 15% absorption of water (formerly 30% absorption or less; American Association of Textile Chemists and Colorists (AATCC) 42-Spray Rating). Most outer shells far exceed this requirement. MOISTURE BARRIER The moisture barrier is an integral part of the turnout composite as it serves two purposes: 1) to prevent liquid penetration of water, blood, body fluids, and common fireground chemicals and 2) to alleviate heat stress allowing

moisture vapor to escape from the garment. A moisture barrier both protects the firefighter from extreme hazards and keeps the wearer as cool and comfortable as possible. Moisture barriers are engineered using a membrane film laminated to a lightweight, flame-resistant fabric. Various fabric substrates give strength to the barrier and may contribute to the thermal protection

ABOUT NFPA TESTING The NFPA requires Thermal Protective Performance (TPP) and Total Heat Loss (THL) testing for turnout composites. TPP simulates a flashover condition to determine how quickly heat passes through clothing materials causing a second-degree burn, while THL measures the composite’s ability to let both body heat and vapor escape. Gear manufacturers work hard to strike the right balance between thicker, heavier garments that protect and thinner, lighter garments that also provide comfort.

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Know Your GEAR of the composite. The membrane component provides a breathable and liquidresistant property while allowing moisture vapor to escape. The moisture barrier also protects against liquid penetration. The NFPA requires moisture barrier fabric and seams to be tested for liquid penetration resistance to common chemicals identified as battery acid, gasoline, hydraulic fluid, aqueous film-forming foam (AFFF), and a swimming pool chlorine solution. The moisture barrier and seams cannot show any penetration of the test chemicals for at least one hour. Seam construction is also critical in maintaining the durability and protection offered by the moisture barrier. These barriers require the second step of manufacturing construction—seam sealing—that is critical in preventing liquid penetration through the seam stitch holes. Seams are sealed using a sealing tape designed specifically for the barrier itself. The seam tapes are applied using barrier manufacturerprovided seam-sealing equipment. THERMAL LINER The third layer, the thermal liner, provides both insulation and moisture management. The layer closest to the wearer is the facecloth. This is made from a thin but durable layer of flameresistant cloth— either an aramid fiber like NOMEX (a class of strong, heat-resistant synthetic fibers) or a para-aramid fiber such as KEVLAR (offering even higher strength than aramid fibers). Facecloths may also use a blend of NOMEX, KEVLAR, and other fibers that enhance the strength or moisture management capabilities of the fabric. The THOROUGHLY TESTED

The NFPA 1971 standard requires all moisture barriers to undergo a series of stringent testing, more so than thermal liners and outer shells. This includes: • Flame Resistance • Heat and Thermal Resistance • Tear Resistance • Cleaning Shrinkage Resistance • Water Penetration Resistance • Liquid Penetration Resistance • Viral Penetration Resistance • Resistance to Light Degradation • TPP (composite testing) • THL (composite testing)

Turnout gear materials and construction can be as varied as the needs of first responders who also come in all shapes and sizes. NFPA TESTING FOR THERMAL LINERS—WHAT TO KNOW

As required by NFPA 1971, thermal liners must be evaluated for flame resistance, heat, and thermal resistance, tear resistance, seam breaking strength resistance, and cleaning shrinking resistance. When procuring gear, it is the composite testing that is most important to note. Along with the moisture barrier, the thermal liner is a key contributor to TPP and THL results. Heavierweight thermal liners may provide higher TPP while reducing THL. Conversely, lighter-weight thermal liners may provide higher levels of THL while reducing radiant heat protection.

facecloth is then quilt stitched to a batting material, similar to a blanket. The batt is also made from nonwoven, spunlaced, flame-resistant fibers (Basofil or Polybenzimidazole (PBI) for example) and can vary in thickness or have multiple thin layers that provide varying degrees of thermal resistance. The batting creates a layer of air that functions as a heat barrier. Thermal liner facecloths can also provide a wicking property that draws perspiration away from the wearer, allowing sweat to be absorbed and spread out into and through the batt where it can be transported out by the moisture barrier. Wicking not only allows the wearer to cool down but keeps liquid sweat from building up on the body, thereby reducing the chance for steam generation and a resulting burn. Some thermal liner facecloths are woven with filament yarns and may be referred to as high-lubricity facecloths. These facecloths are smoother and therefore easier to don and doff or to maneuver in. However, they may not wick perspiration as easily as nonfilament facecloths. Nonfilament facecloths and filament facecloths provide different properties when used with different batting.

provide adequate heat and thermal protection. The test requires that the shoulder reinforcement areas be tested under a pressure of two psi, which simulates a firefighter wearing an SCBA. Knee reinforcement areas are tested under a pressure of eight psi, representing the amount of force applied by a 180-pound firefighter when kneeling. To provide maximum protection in these potential danger zones,

extra layers may be added to the inside of the thermal liner:

• Beneath the trim at the cuff of each sleeve, reducing the risk of burn due to moisture under the trim.

• To the elbow area, helping

to ensure blockage of liquid penetration due to compression.

• At the knee area (an extra layer

of thermal liner and moisture barrier), providing additional heat and moisture protection when kneeling or crawling.

• At the shoulders, reducing heat

transfer when compressed by the straps of an SCBA.

FIND YOUR FIT Behind every filament and fiber that firefighters wear into the heat of the action is an industry striving to ensure that the next generation of coat and pant composites works even harder for them. If you have questions about turnout gear, ask your equipment supplier to arrange a look at the latest technologies including how garments are designed and manufactured. Todd Herring is V.P. of Product Innovation and Strategy at Fire-Dex. FireDex.com offers more information about turnout gear composites built for today’s changing needs.

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ALSO, PAY ATTENTION TO HIGH-COMPRESSION AREAS A high-compression area is anywhere constant pressure is applied to a composite. For instance, shoulders — when wearing a Self-Contained Breathing Apparatus (SCBA) and knees (when crawling) — become highcompression areas. Compression reduces the protective qualities of a garment and as a result, NFPA 1971 requires these areas to be evaluated for Conductive Compressive Heat Resistance (CCHR). CCHR testing ensures that when compressed, the turnout gear will SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 41

Hope Mills Fire Department

North Carolina

Cumberland County, NC

FIRE STATION PROFILE Type Department: Municipal ISO: Class 2 Number of Stations: 1 Number of Apparatus: Pumpers: 4 Aerials: 2 Specialty: 5 Do you provide EMS? Yes What type: BLS Specialty Operations: • Extrication • Land Search • Water Rescue • Underwater Search & Recovery • The department also operates a dedicated Traffic Incident Management System (TIMS) unit. Annual Budget: $2.8 million Area Covered Square miles: 10 Population: 20,000 + Total Runs: (2021) 2,136 Fire: 573 EMS: 1,362 Chief: Charles L. Hodges, Fire Chief Chief Officers: Charles S. Lopez, Deputy Chief / Justin B. Smith Asst. Chief / Wayne E. Dutterer, Asst. Chief Other Officers: 1-Fire Marshal / 3Captains / 3-Lieutenants Number of Members: Paid: 37 Volunteer: 10

• • • •

14-Screen Movie Theater 400+ -Businesses 95-acre Recreational Lake. 45,000 sq. ft. indoor Trampoline Park • 97-acre Greenway Recreational Area Chief Charles L. Hodges

Address: 5788 Rockfish Road Hope Mills, NC 28348

• Future plans are to implement first aid and CPR training to the public and a Kids Fire Academy

Web site: townofhopemills.com

Top Two concerns in your community: Rapid Growth / Traffic

Phone: 910-424-0948 Community Outreach: The department attends a variety of community events to spread the Fire and Life safety message including but not limited to: • Fire & Safety education in schools, daycares, civic organizations, and the general public. • Neighborhood canvassing for smoke detectors (with a focus on low income and senior populations) • Fire Extinguisher training for businesses and residents. • Citizen’s Academy

What upgrades will you make in your department this year? The department will be moving into a new 46,000 sq. ft. Public Safety Center (fire & Police) at the end of 2022. What special hazards or unique businesses in your community? • Railway for both Passengers & Freight • The flight path for both Military & Civilian Aircraft • 16-Shopping Complexes • 71-Restaurants • 7-public Schools • 30-Apartment Complexes

List anything else you are proud of and would like the readers to know about, are you doing anything special in Recruitment, Retention, or anything unique other departments could benefit from: The Hope Mills Fire Department is the second oldest, continually operating fire department and 1 of 3 municipal departments in Cumberland County NC. Due to our proximity to Fort Bragg, our population is made up of approximately 63% active-duty military. The department operates 2-Engine Companies, 1-Ladder Company, and 1-Fire / Rescue Squad 24/7/365. Through mutual and automatic aid contracts, the Hope Mills Fire Department responds to assist other agencies anywhere in Cumberland County including the City of Fayetteville, Town of Spring Lake, and Fort Bragg; due to our geographical location, our department also responds into portions of Robeson and Hoke Counties to assist as well.

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North Myrtle Beach Fire Department Horry County, SC

South Carolina

FIRE STATION PROFILE

Type Department: Fire Rescue

What problems in your department that you would like feedback from others? How to effectively handle growth (of your Department and Community)

Structure: Traditional Fire Department Organizational Structure ISO: 2

List anything else you are proud of and would like the readers to know about, are you doing anything special in Recruitment, Retention or anything unique other departments could benefit from:

Number of Stations: 5 Number of Apparatus: 10 Pumpers: 5 frontline and 2 reserves

Chief Gary Spain

Aerials: 1 frontline and 1 reserve Specialty: 1 Rescue and 2 Beach Unit ATVs Do you provide EMS? We are EMTs and provide first responder services Specialty Operations: (list all) Technical Rescue Team (Confined Space, Rope Rescue, Search and Rescue Operation and Trench Rescue) EMT Bike Team

Other Officers: 15 Fire Lieutenants, 3 Deputy Fire Marshals, and 1 Health and Safety Officer Lieutenant Number of Members: 68 Paid Members: 68 Address: 1015 Second Avenue South North Myrtle Beach, SC 29582

Annual Budget: $5,741,504.00

Web site: https://www.nmb.us/194/ Fire-Rescue

Area Covered Square miles: 21.71

Phone: 843-280-5512

Population: 19,000

Community Outreach: We assist with smoke detector giveaways and installs for the underprivileged and elderly. We do a tremendous amount of outreach in the schools as far as home safety and family safety. We are also a Fire Safe South Carolina Community. We also do a lot of social media outreach and videos to promote fire safety. Booths are set up at events to pass out literature and talk to the public about fire safety as well

Total Runs: 5936 Fire: 2295

EMS: 3641

Chief: Garry Spain Chief Officers: Deputy Chief Billy Floyd, Division Chief Training Charles Full, Division Chief Fire Marshal Greg Frazier, Battalion Chiefs Dustin Overholser, Mike Davis, and Todd Davis

so that we can be out in the public as much as possible. Top Two concerns in your community: Growth and Staffing What are you doing for fundraising? Several local businesses make generous donations to purchase equipment. What upgrades will you make in your department this year? Continue Planning for the construction of two new fire stations with one housing a state-of-the-art EOC. Purchase of a new engine and heavy rescue What special hazards or unique businesses in your community? Special hazards include unpredictable weather due to being a beach community. Also, we have an influx of tourists with our population going from 19,000 to well over 100,000 during tourism season daily. As far as unique businesses, we have several unique tourism venues.

We are currently providing signing and referral bonuses. Within all the different committees that we have in our department, we work to ensure that every rank has representation. This ensures that everyone has a voice and a say based on his or her level. We are also in the process of performing a Department pay study. We have a great group of individuals currently serving in our Department. We work to provide our Company Officers with the resources they need to effectively handle both the emergent and non-emergent duties they are responsible for completing. We strive to maintain a family-style atmosphere for our personnel to ensure they understand they are an integral part of the success of our department. We encourage our personnel to present new ideas and offer feedback on what we can do better as a Department that allows us all to grow both personally and professionally.

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Air& Surface DECONTAMINATION

UPSTREAM STRATEGIES, BARRIERS & RUNAWAY BULLS

Beth Krah

hen you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.” Dan Heath, Upstream –The Quest to Solve Problems before they Happen. “So often in life, we get stuck in the cycle of response. We put out fires. We deal with emergencies.”1 But the whole purpose of a first responder is to serve his or her community by responding to emergencies and putting out fires, right? Would you put out the fire as opposed to preventing it in the first place? There’s a good chance you can keep your crew and community safer by preventing issues before they turn into out-of-control situations that warrant a larger response. While attending a leading healthcare conference for C-suite professionals, we were challenged to adopt “Upstream Healthcare” measures and focus on mitigating risks before they become life-altering issues. Whether the topic is ensuring firefighter safety, the latest outbreak, or mitigating the nasty effects of carcinogens and cancer, prevention is critical in your mitigation efforts. Training our minds to think in terms of preventative measures takes time - and thinking through things instead of reacting after the fact. Coach and teacher Toby Sinclair gives an example of children caught in the river.

You and a friend are having a picnic by the side of the river. Suddenly you hear a shout from the direction of the water – a child is drowning. Without thinking, you both dive in, grab the child, and swim to shore. Before you can recover, you hear another child cry for help. You and your friend jump back in the river to rescue her as well. Then another struggling child drifts into sight…and another…and another. The two of you can barely keep up. Suddenly, you see your friend wading out of the water, seeming to leave you alone. “Where are you going?” you demand. Your friend answers “I’m going upstream to tackle the guys who’s throwing all these kids in the water.”2 BARRIERS AND RUNAWAY BULLS Heath mentions three barriers that often come into play:2 I don’t see the problem (problem blindness). When we’re blind to the problem, we treat it like the weather. If someone left the gate open and the bull escaped, would you laugh as you finish your hamburger or alert someone else and get on your horse and go catch that thing? Or do you just accept the fact that bulls escape and that’s life? The concern with not paying attention to smaller issues, or saying “that’s just how it is,” is that they’ll turn into all-out war if you’re not careful. Maybe not immediately, but by the time it happens, it’ll slap you upside the head and you’ll wonder how you got there. It’s not mine to fix (lack of ownership). The runaway bull wasn’t your problem – you didn’t leave the gate open, but you can only ignore the bull so long as it doesn’t charge at you. Are you willing to get out of your comfort zone and go after it? Doing nothing allows the problem to fester and reach unintended consequences thereby

creating a bigger problem. Help pull together a solution instead. I can’t deal with that right now

(tunneling). Are you overwhelmed juggling many other issues that you’ve had to just let the bull go? What you don’t realize is that (out of your purview) the bull is charging toward a group of kids and wreaking havoc in a nearby playground. How did it get this bad? Find out why the bull escaped. Train the ranch hand, fix the gate, insert the nose ring – whatever it takes to make sure this doesn’t happen again and you’re not unintentionally putting children or others at risk. STARTING YOUR UPSTREAM JOURNEY Three suggestions when embarking upstream:3

1. Be impatient for action but patient for outcomes. Implementing

the change from reacting to preventing will come with plenty of resistance. It’s much easier to react. Keep your goal in sight and take one step at a time when tackling such changes, knowing that in the long run, it will be cheaper, it will save more lives, and you will be

44 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

mitigating unwanted outcomes. If you need to rebuild the fence that was responsible for letting the bull out, it’s going to take time, but start now – it’s only going to get worse the longer you wait. 2. Macro starts with micro. It’s easy to get overwhelmed when looking at lofty goals and wanting to tackle the big things right away, but if you break it down and help one person at a time, or tackle one small thing at a time, the results will start to build on each other. In time, you will begin to see just how much has been accomplished on a grand scale and marvel about how you got there. One small step at a time in the right direction, and don’t quit, it will be worth it. Keep the goal in mind and keep plugging away. When you stand at the other side of the gate as you finish your fence, you’ll be exhausted, but satisfied that you did everything you could to keep those children safe from the runaway moo. 3. Favor scoreboards over pills.

Don’t focus so much energy on the perfect solutions (i.e. the pill) that you ignore the little victories that have been made. How can you make

progress each week that is within reach? Celebrate the little victories. Thank the neighbors that helped you build the fence, the team that refused to let you quit, the spouse for putting up with you during this time. First step is identifying the problems. If you can’t think of anything, in particular, ask your team. What are you complaining about when you get home? What keeps you up at night? Is there anything boiling underneath the surface that needs attention before it flares up into a full-blown catastrophe? THE LONG RACE In the long run, if it will help save lives, or even release funds back into the constraining budget, you must travel upstream and see where the issues stem from. Preventative measures take a good amount of planning, strategy, and forethought. It’s easy to purchase something to solve a problem after the fact, but challenge yourself to think ahead, be on the lookout for simmering issues, and concentrate on mitigation strategies before they grow into something uncontrollable. WWW.CAROLINAFIREJOURNAL.COM

Air& Surface DECONTAMINATION

2. Sinclair, T. (2021) Book Summary: Upstream Initially, prevention sounds Control group, her passion to serve is Beth Krah is founder by Dan Heath | How to solve problems with like it willis take too much time and CEO of The Krah of utmost importance for her and her Educate Key Systems Thinking. Retrieved from https://www. away from your job and serving Corporation (dba Krah tobysinclair.com/post/book-summary-upstreamteam’s role in serving their customers Whether it’s bringing in a consultant, tapping knowledge of a colleague who’s been around by-dan-heath-how-to-solve-problems-withthe community, but it will cost Health Solutions).into She the and keeping them healthy so they can systems-thinking#viewer-2035c time,times, money, and has servedout the healthcare theinfinitely blockmore a few or reaching to thecommunity Fire Dept.focus Safety Officers’ Association (FDSOA), on the pressing needs of saving the lives, in the long run, to react on 3. The Growth Faculty (2020) How to solve for over a decade providing non-toxic lives of others. strategies, She can be reached at educating yourself and your infection team prevention is key. measures Gatherwithinfo, evaluate pick the best fortheyour problems beforeoption they happen from bestselling the back end of an unanticipated beth@krahcorp.com. author of Made to Stick. Retrieved from https:// tragic event. The sudden and a special focus on EMS, Disaster situation, then implement that solution. www.thegrowthfaculty.com/blog/ immense impact of COVID-19 Preparedness/Response, Medical Care 4. Sage Publishing. Problem Solving. Figure 11.1 REFERENCES showed us that preparing for when Rational Problem-Solving Approach. Adapted Facilities and the Military. Previously 1. Heath, D. (2020) Upstream: The Quest to Solve from Dewey, J. (1910) p. 208. Retrieved from these events happen is much wiser Just don’t be the bull, for Pete’s sake! employed by Solvay Pharmaceuticals Problems Before They Happen. Avid Reader https://www.sagepub.com/sites/default/files/ than preparing for if they happen. in their Quality Assurance/Quality upm-binaries/54196_Chapter_11.pdf Press/Simon & Schuster; Illustrated edition Be serious about your strategies. Unforeseen circumstances are a [1] part of life – view them as training Heath, D.how (2020) Upstream: The Quest to Solve Problems Before They Happen. Avid Reader Press/Simon materials. Learn to prepare and respond effectively. Illustrated edition & Schuster;

[2] RATIONAL PROBLEM-SOLVING

Sinclair, T. (2021) Book Summary: Upstream by Dan Heath | How to solve problems with Systems APPROACH Above is a chart adapted by John Thinking. Retrieved from https://www.tobysinclair.com/post/book-summary-upstream-by-dan-heath-howDewey (1910) recommending a to-solve-problems-with-systems-thinking#viewer-2035c six-stage process that individuals can use to solve a problem.5 Don’t [3] rush it, think it through carefully, The Growth Faculty (2020) How to solve problems before they happen from the bestselling author of devise a plan, and start mitigating Made to Stick. Retrieved from yourself into a better position for life’shttps://www.thegrowthfaculty.com/blog/UpstreamDanHeathsummaryconcepts unexpected turns. [4] EDUCATE IS KEY

Sageit’sPublishing. Whether bringing in a Problem Solving. Figure 11.1 Rational Problem-Solving Approach. Adapted Dewey, J. (1910) consultant, tapping into the p. 208. Retrieved from https://www.sagepub.com/sites/default/files/upmknowledge of a colleague who’s binaries/54196_Chapter_11.pdf been around the block a few times, or reaching out to the Fire Dept. Safety Officers’ Association (FDSOA), educating yourself and your team is key. Gather info, evaluate strategies, pick the best option for your situation, then implement that solution. Just don’t be the bull, for Pete’s sake!

from

SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 45

Ask MR. BILL

SHOW ME THE MONEY

Credit resources you should consider to improve your financial well-being Bill Carter

onsumers would like nothing better than to return to something “normal” but even as increases in credit usage appears likely, the specter of inflation is among the factors adding uncertainty to the picture. Consumer credit across the board is expected to rise in 2022. According to projections from TransUnion, it’s still behind prepandemic levels but in other cases, they’re exceeding it. Some of the growth will result from credithungry lenders offering more credit to non-prime borrowers, notably in auto lending, credit cards, and unsecured personal loans. Massive increases in home prices are driving major growth in home A_MB16-1020 2021 FE Print Ad-FullPg_Final2.pdf

12/8/20

PUMPERS

equity that consumers could tap into for secured personal borrowing, potentially waking up a credit category that has been very quiet for years. Overall, TransUnion cites the increasing normalization of the economy as a factor in growth anticipated for 2022. A potential influence will be increased interest rates. The Federal Reserve has indicated there will likely be at least three quarter-point hikes in 2022. Wild cards include ongoing inflation, as well as the impact the Omicron COVID variant (and others) will have on the economy. Meanwhile, the last elements of pandemic debt forbearance measures will be running out.

12:25 PM

RESCUES

TA N K E R S

OUTLOOK FOR THREE KEY CONSUMER CREDIT CATEGORIES In 2021, Fed Chairman Jerome Powell told a press conference “There’s a real risk now, I believe, that inflation may be more persistent and the risk of higher inflation becoming entrenched has increased.” Lenders’ strategy of increasing relationships with non-prime customers could backfire if not managed carefully. Inflation often hits lower-income borrowers harder than higher-income consumers, according to Charlie Wise, Head of Global Research and Consulting at TransUnion. Four out of five consumers surveyed by Transunion say they are highly concerned about inflation. Another uncertainty will be the ripple effects of major spending through the buy now, pay later programs during the 2021 holiday season. “Growth in that sector continues to be enormous,” (TransUnion is working with Buy Now Pay Later (BNPL) providers to add the plans to its database. In December 2021 Equifax announced it would add certain “pay in four” plans to its records and Experian is working on expanding its coverage of the payment plans.) In the following sections, organized by credit type, the figures reported are the latest available from TransUnion.

CREDIT CARDS: RECORD NEW ACCOUNT ORIGINATIONS MAY DRIVE SUCCESS — OR DIFFICULTY Credit card balances are projected to continue to increase in 2022, on top of a rise in 2021. This represents a continuing comeback from 2020 when many consumers paid down their credit card balances with savings resulting from working from home and with government stimulus payments. Outstanding credit card balances stood at $726.2 billion at the end of the third quarter of 2021, up slightly over the year earlier, but still nearly 10% lower than the level in the third quarter of 2019, prepandemic. PRIMING THE CREDIT CARD PUMP: Originations of new credit card accounts hit a record 19.3 million in the second quarter of 2021, reflecting card issuers’ desires to begin growing balances after tightening credit standards early in the pandemic. The share of accounts extended to non-prime borrowers is forecast to reach 41% in 2022, about even with 2021’s 42% and above the 38% level seen before the pandemic. TransUnion says that lenders are attempting to build market share and become “top of wallet” for more consumers. There is an upper limit to this strategy, apparently. The

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Show Me the Money Credit resources you should consider to improve your financial well- Ask MR. BILL being. Consumers would like nothing better than to return to something “normal” but even as increases in credit usage appears likely, the specter of inflation is among the factors adding uncertainty to the picture. Consumer credit across the board is expected to rise in 2022. According to projections from TransUnion, it’s still behind pre-pandemic levels but in other cases, they’re exceeding it. Some of the growth will result from credit-hungry lenders offering more credit to nonprime borrowers, notably in auto lending, credit cards, and unsecured personal loans. Massive increases in home prices are driving major growth in home equity that consumers could tap into for secured personal borrowing, potentially waking up a credit category that has been very quiet for years. Overall, TransUnion cites the increasing normalization of the economy as a factor in growth anticipated for 2022. A potential influence will be increased interest rates. The Federal Reserve has indicated there will likely be at least three quarter-point hikes in 2022. Wild cards include ongoing inflation, as well as the impact the Omicron Covid variant (and others) will have on the economy. Meanwhile, the last elements of pandemic debt forbearance measures will be running out. Outlook for three key consumer credit categories

Another uncertainty will be the ripple effects of major spending through the buy now, pay later programs during the 2021 holiday season. “Growth in that sector continues to be enormous,” (TransUnion is working with BNPL providers to Despite the affinity that Millennials and Gen Z have for BNPL financing, their use of was credit cards continues to grow. As of 14% share a major spike over add the plans to its database. In December 2021 Equifax announced2022* it would add certain “pay in four” plans to its the second 2020 quarter of 2021, Millennials are2019 the largest generationlevels among cardholders now, at 32.7%, and when 2021** earlier in 2021. records and Experian is working on expanding its coverage of the payment plans.) combined with Gen Z has become almost half of the market, according to TransUnion. Gen Z’s 14% share was a major Credit Product (millions) (millions) (millions) (millions) spike over levels earlier in 2021. RISING HOME EQUITY COULD In the following sections, organized by credit type, the figures reported are the latest available from TransUnion. Rising Home Equity Could Bring the Return of a Once-MajorBRING Credit Source THE RETURN OF A Auto 28.9 28.3 26.8 28.4 Credit Cards: Record New Account Originations May Drive Success — or Difficulty ONCE-MAJOR CREDIT SOURCE The median sales price of existing single-family homes increased by 16% — $50,300 — in the third quarter of 2021 in the Credit cardBank balances are projected top of a rise in 2021. This represents credit card to continue to increase in 2022, on67.8 69.8 a continuing183 markets51.9 69.3 The median salesallprice measured by the National Association of Realtors. Price levels rose in virtually marketsof andexisting the increases comeback from 2020 when many consumers paid down their credit card balances with savings resulting from working were in double digits, four out of five areas. single-family homes increased from home and with government stimulus payments. Personal loans 20.0 17.9 14.2 18.8 by 16% — new $50,300 — in the in 2022. The National Association of Realtors expects price increases to decelerate as more homes come to market Outstanding credit card balances stood at $726.2 billion at the end of the third quarter of 2021, up slightly over the year third quarter of 2021 in the But in the meantime, those price increases have boosted home equity values, and potentially demand home183 equity earlier, but still nearly 10% lower than the level in the third quarter of 2019, pre-pandemic. loans and lines of credit. markets measured by the National Inthe 2021, Fed Chairman Jerome Powell toldincrease a press conference “There’s a realto risk now, I believe, thatto inflation will result from a return cards continues grow. may As ofbethe says the surge in account Primingcompany Credit Card Pump: Association of Realtors. Price levels Home as an ATM? more persistent theoffrisk higher inflation entrenched originations willand level inof 2022. largerbecoming card purchases, suchhas as increased.” for second quarter of 2021, Millennials rose in virtually all markets and the Originations of new credit card accounts hit a record 19.3 million in the second quarter of 2021, reflecting TransUnion estimates thatgeneration the median home equity available per consumer reached $123,747 in the third The company projects that in travel entertainment, the timing are the largest among card issuers’ desires to begin growing balances after tightening creditand standards early in the pandemic. increases were digits, four quarter of 2021. Significantly, this is many times the average non-mortgage debtinofdouble $10,151 per consumer. the first strategy quarter of 2022 credit card Lenders’ increasing relationships nonprime customers could42% backfire if not managed Inflation The share of accounts extendedof to nonprime borrowers is forecastdependent towith reach 41% in on 2022,COVID about eventrends. with 2021’s cardholders now,carefully. at 32.7%, and out of five areas. balances will increase as muchharder as and above the 38% seen before the by pandemic. often hitslevel lower-income borrowers than higher-income according to Charlie Wise,with HeadGen of Global Despite the affinityconsumers, that when combined Z has

10% year-over-year and will then Research and Consulting at TransUnion. Millennials and Gen Z have for

become almost half of the market, according to TransUnion. Gen Z’s

stabilize. By the end of 2022, the BNPL financing, their use of credit firm project’s balances will reach Four outbillion. of five This consumers by Transunion say they are highly concerned about inflation. $805.7 would surveyed be a 3% year-over-year increase and would be the highest level since the pandemic started. However, card balances would still not come back to pre-pandemic levels. Consumer liquidity remains relatively high, according to TransUnion, which may be reducing potential growth in card balances. However, another factor in this may be the increasing use of buy now, pay later financing. WHAT CARD LENDERS MUST WATCH Many buy now, pay later programs don’t charge interest. Even a small increase in credit card rates may boost the perception that BNPL is a bargain. Wise points out that inflation will pose the biggest challenges to credit cards, and unsecured personal loans, which are often used for debt consolidation. Inflation eats into income levels, affecting consumer mindset and their ability to repay past charges. Credit card delinquencies are projected to rise during 2022, though still at levels below prepandemic marks. Part of the

The National Association of Realtors expects price increases to decelerate as more new homes

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Ask MR. BILL come to market in 2022. But in the meantime, those price increases have boosted home equity values, and potentially demand home equity loans and lines of credit. HOME AS AN ATM? TransUnion estimates that the median home equity available per consumer reached $123,747 in the third quarter of 2021. Significantly, this is many times the average non-mortgage debt of $10,151 per consumer. While the rate of home price increases will likely slow in 2022, TransUnion expects the level of home equity that homeowners will be able to tap in to launch new projects, finance other spending or pay down other debt to increase to as much as $129,528 by the end of 2022. Total home equity available for borrowing is projected to hit nearly $21 trillion by the end of 2022. Complicating the picture is mortgage refinances aren’t quite done. TransUnion estimates that 20 million consumers could still benefit from a rate and term refinance despite the surge of refinances in 2021. Even if rates went up by a full point, the company says about 10.5 million people could still benefit from this type of refi. In the second quarter of 2021 rate and term refinances represented 27.2% of mortgages. Over the last few years, cash-out refinancing, an alternate reason for refinances, has been a substitute for home equity loans and home equity lines of credit, representing 19.5% of total mortgages in the same time period. (53.2% of mortgages were for purchases.) Notably, while in other areas of credit covered by the TransUnion

report lenders are reaching into riskier categories, it’s been the opposite in mortgages. TransUnion research found that the distribution of mortgage balances has been trending towards less risky consumers. Mortgage delinquencies have been low, but the company points out that they could rise a bit as mortgage forbearance programs wind down in 2022. AUTO LOANS: STRONG CREDIT DEMAND HAMPERED BY SUPPLY ISSUES Inventory challenges, chiefly due to shortages of the chips that are so vital to today’s vehicles, will continue to plague auto lenders through 2022, TransUnion projects. As a result, growth in originations will most likely remain relatively flat. TransUnion predicts there will be 28.9 million auto loans originated in 2022, up only 2% from the expected level of 2021 sales. Testimony to the trend is that the use of dealer and manufacturer incentives has fallen to a trickle. Rising auto prices will increase origination levels in dollars. New vehicle prices set new records through November, according to Kelley Blue Book, with average transaction prices up 13% over the year before. A seller’s market, in which high prices and limited choice stymie purchases, will continue for some time, according to Kelley. New SUVs showed the smallest increase, 4.8% year over year — but average transaction prices for these autos were north of $73,000. Used auto prices have also been reaching record levels, according

to data from J.D. Power and Manheim. Average auto loan balances were up 6.6% as of the third quarter of 2021 over the year before, according to TransUnion. “As we see inventory increase, this will likely influence origination growth,” says Satyan Merchant, SVP and Auto Business Leader at TransUnion. “However, consumer demand for vehicles has not waned, and as we see inventory increase, this will likely influence origination growth.” Merchant says that lenders want to increase lending and as a result will expand into non-prime credit, especially sub-prime borrowers, to meet consumer demand. WHAT TO WATCH: Even given the flat trend, a significant change TransUnion sees is the slowly growing portion of the auto loan market attributable to Millennial and Gen Z borrowers. The two groups represent almost half of the auto loan market now — 33.5% for Millennials and 12.3% for Gen Z. Delinquencies among auto borrowers are expected to rise slightly in 2022, as lenders reach further down the credit scale. However, low delinquency rates suggest to TransUnion that the increase should be small and that delinquencies will generally be stable. RISING HOME EQUITY COULD BRING THE RETURN OF A ONCE-MAJOR CREDIT SOURCE The median sales price of existing single-family homes increased by 16% — $50,300 — in the third quarter of

2021 in the 183 markets measured by the National Association of Realtors. Price levels rose in virtually all markets and the increases were in double digits (or nearly so) in four out of five areas. The National Association of Realtors expects price increases to decelerate as more new homes come to market in 2022. But in the meantime, those price increases have boosted home equity values, and potentially demand for home equity loans and lines of credit. $21 million. Now that’s a LOT of equity sitting untapped that could be used to consolidate debt, make a major purchase, college expenses and obtain a lower rate than those on unsecured loans. So, I’ve shown you where the money is. Now it’s up to you, with your detailed knowledge of your budget, to seek out some of these products and services and move forward. And if you haven’t looked at mortgage rates over the past three years, you should do so. Refinancing your first mortgage if rates are now lower could save you thousands in interest and lower your monthly housing expense. And rates will be going up soon. Get busy. Bill Carter is Director

of Fire/EMS Business Development for Civic Federal Credit Union in Raleigh. He has been in the financial services industry for 42 years and serves on the Advisory Board of the North Carolina Fallen Firefighters Foundation. You can send your questions to him at: bill.carter@ civicfcu.org.

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48 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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Preserving HISTORY

THE FIREMEN OF SPENCER SHOPS

Xavier Klonowski

outhern Railway opened Spencer Shops in 1896 to perform maintenance on steam locomotives at the halfway point between Atlanta, Georgia, and Washington, D.C. Built just north of Salisbury, North Carolina, this massive industrial complex would continue to grow for the next 50 years, employing over 3,000 people who helped create the adjacent towns of Spencer and East Spencer. Spencer Shops, as with all industrial sites, was not without its dangers. The Shops were in

operation 24 hours a day with locomotives and electric generators using coal as their main fuel source, a foundry, blacksmith shop, and many wooden structures that littered the site, so the threat of fire was always present. And with a large site, over 70 acres, Southern Railway decided the best way to combat any potential fires at the new shops were with their fire department. The Spencer Shops Fire Department consisted of three-reel teams of eleven men each, operating 2,000 feet of two and a half inch fire hose. These

The Spencer Shops Fire Department reel team poses for a photo, in position for a race, circa 1920s.

men, a team of which would be stationed around the clock, were charged with keeping Spencer Shops safe from fire. But with many of the Southern Railway employees living in the adjacent towns, the Spencer Shops Fire Department’s paid firefighters also responded to the calls of the nearby community, lending a hand to the

local fire departments, who relied on volunteers and might not be available to fight fires at all hours of the day. This way the Spencer Shops Fire Department kept both the Shops and the community safe so that work could continue uninterrupted day in and day out. Fire hose reels were common firefighting equipment at the

A hose reel used in competition by the Spencer Shops Fire Department team on display at the North Carolina Transportation Museum. beginning of the 20th century, especially at industrial sites such as Spencer Shops, which were required by law to have them on hand to aid firefighters in case they were needed. The fire hose reels were just that, large reels for storing and distributing fire hoses. They often were built with large wheels and handles to assist firefighters in pulling the reel to where it was needed most, and sometimes were even outfitted to be attached to a horse for longer trips. The fire hose reels provided not just a way to fight fires but were also a source of recreation. Competitions were common in the early 20th century between teams and featured two events, the hand reel contest, a competition to see who could unravel up to 150 yards of hose, attach a nozzle, and produce water from the end of the hose in the least amount of time, and the grab reel race, a competition to see who could move their equipment the fastest between two points. Spencer Shops first started fielding competitive reel teams in 1899, made up of volunteers of the white workers of SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 49

Preserving HISTORY

The Spencer Shops Fire Department reel team poses for a group photo, circa 1920s.

A 1949 Mack Firetruck, which gave the Spencer Fire Department the ability to take on the role as primary firefighters of the Spencer Shops, on display at the North Carolina Transportation Museum.

A hose reel shed at the North Carolina Transportation Museum was used to store the hose reels when not in use.

The Shops were in operation 24 hours a day with locomotives and electric generators using coal as their main fuel source, a foundry, blacksmith shop, and many wooden structures that littered the site, so the threat of fire was always present.

the shops. These teams would travel throughout the state and beyond to compete and were even allowed to keep any winnings they won from the competition. But in 1906 the Spencer Shops Fire Department started to field a competitive team made up of professionals. The Spencer Shops Fire Department claimed to be able to produce water

anywhere on-site in just 45 seconds, and these competitions were the perfect chance for them to receive accolades for their skill. This new Spencer Shops team quickly set records in both events. They were crowned the North Carolina Champions of the hand reel contest from 1906 until 1920 but would continue to be strong competitors,

setting a record low of 17 seconds flat in 1928. They were crowned North Carolina Champions of the grab reel race from 1916 until 1927 and set a record low of 16.4 seconds. Unfortunately, with the costsaving measures enacted by Southern Railway due to the Great Depression, Spencer Shops was

no longer able to field competitive reel teams. The Spencer Shops Fire Department continued to watch over the site, but their days were numbered. The Town of Spencer began purchasing more modern firefighting equipment, including trucks and turn-out gear, giving them better abilities to fight any potential fires at the Shops. The reel teams of the Spencer Shops Fire Department had become obsolete and would become victims of Spencer Shops’ downsizing after the dieselization of Southern Railway. While the Spencer Shops Fire Department is no longer in service, the North Carolina Transportation Museum, housed in the former Spencer Shops, still has mementos from the Department for viewers to see, including the brick and slate, shed used to store the hose reels when not in use, a hose reel used in competition, as well as an early Mack fire truck used by the Spencer Fire Department. All photos are courtesy of the North Carolina Transportation Museum and the NC Division of Historic Sites and Properties.

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50 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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Caroline M. Schloss

Crossword PUZZLE

CarolinaFireEMS March2022 1 2 3 4

7 8

11 12 13

17 18

20 21

23 24 25

www.CrosswordWeaver.com

ACROSS

DOWN

4 GPM Gallons per ___ 6 Depending upon what is burning, the smoke can contain Carbon Monodixe/dioxide and/or ___ cyanide/choride 8 Gathering of intelligence prior to and during a hazmat incident often sets the tone of the ___ of our actions on scene 9 Any area where it is not safe to locate firefighters or civilians is considered a ___ area 11 Demobilization Unit Leader (abbr) 13 SFFO Order 10 and it falls under the heading, Overall ___ 14 National Ambient Air Quality Standards (abbr) 17 Rural Fire District (abbr) 19 National Fire Academy (abbr) 20 When approaching fixed winged aircraft it is usually safest to approach from the ___ 21 Eighty percent of people who do develop post trauma stress disorder will ___ 22 When parking multiple engines in an area it is vital to ensure there is ample ___ between equipment to allow for backing up and turnarounds 24 Have a 360-degree perspective; "___ up, ___ down, ___ all around" 25 Smaller hose lines may limit GPM's by virtue of the friction loss associated with their ___

1 Standard Fire Fighting Orders (abbr) 2 This fire behavior is the highest level of problem fire behavior and is characterized by ROS, intense burning, spotting and crowning 3 Revruitment and ___ should be a priority for all departments 5 Fuel Moisture Content (abbr) 7 Ground Support Unit Leader (abbr) 9 Modern construction now sees roof trusses that are glued together and that glue will turn back to ___ under exposure to heat and flame 10 Black smoke often indicates a burning ___ such as fuel oil, tires, or creosote treated rail ties, or poles 12 An intentionally set fire is also known as an ___ fire 15 SA-situational ___ 16 When approaching helicopters one should ___ down and carry tools below the waist 17 Fire can burn down to the bottom of the canyon and then cross over to the other side; this is known as slope ___ 18 Before driving any vehicle/apparatus across bridges it is critical to know the ___ limits and any height restrictions if posted 23 Step 1 of the risk management process is being ___ of the situation youʼre going to be working in

Answers on page 56

Caroline M. Schloss is a current member of the Knotts Island Volunteer Fire Dept.,

Currituck County Fire/EMS, Virginia Beach CERT VA., Currituck County CERT, National Association of Search and Rescue, Project Lifesaver VA. SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 51

Industry NEWS

KIMTEK Corporation Builds Custom FIRELITE® for Interior Fire Protection at the Tesla EV Auto Manufacturing Plant in Fremont, CA Randy Larson

ORLEANS, VT; March 9, 2022— KIMTEK Corporation announced today that it has delivered a custom-designed FIRELITE® firefighting truck skid for Tesla’s EV auto manufacturing operations in Fremont, California. The custom build was a cooperative effort with Tesla, KIMTEK, and Tropos Motors of Morgan Hill, California, a cuttingedge producer of EV truck chassis. To adhere to California’s stringent indoor emissions regulations, the Firelite was fitted with a Darley 1.5 AGE 13HX pump which was

reconfigured to run on propane. With custom storage options, crosslay trays, a 125-gallon water tank, and a 5-gallon foam system, the FIRELITE is designed to not only respond to fires inside the plant but is built to take on fire threats outside the plant as well. KIMTEK founder and president, Kimball Johnson, said of the Tesla custom firefighting skid unit, “New applications for our skid units are found nearly every week, as are ways we can adapt them for use in the field. We’re very pleased to work with our fine vendor partners like W.S. Darley

and Tropos Motors on custom builds like this, and the final results show the quality of those efforts”. ABOUT KIMTEK CORPORATION KIMTEK Corporation is the largest producer and marketer of ATV/UTVspecific skid units for public safety agencies in the U.S. KIMTEK’s FIRELITE® fire and rescue skid units and MEDLITE® medical skid units are now in service in all fifty U.S. states and across Canada, all branches of the military, the National Park Service, numerous NASCAR tracks, sporting complexes, schools,

universities, and in several countries worldwide. KIMTEK Transport skid units are made in the USA. Founded in 1984 as a research and development company dedicated to advances in life safety technology in the fire sciences, KIMTEK Corporation manufactures and markets a full line of FIRELITE and MEDLITE Transport skid units for emergency service UTVs and pick-up trucks. For more information, please contact KIMTEK at 888-546-8358 or visit www.kimtekresearch.com.

KIMTEK’s New Website Offers Faster, Simpler, and Easier Access to UTV and Brush Truck Rescue Transport Products Randy Larson

ORLEANS, VT; February 23, 2022—KIMTEK Corporation today announced that its newly updated website, www. kimtekresearch.com, is fully operational. Improvements specifically targeted the streamlining of searches of the company’s growing product line and its numerous existing and emerging applications. KIMTEK’s prominent line of slip-in FIRELITE®, MEDLITE®, and LEOLITE® transport skid units, engineered to fit utility vehicles and pick-up trucks used for first response in off-road, remote, and urban areas, are custom equipped for fire and medical rescue and law enforcement personnel. Featuring easy-to-find links to the KIMTEK products that coordinate with the various manufacturers of these vehicles, the new website simplifies and expedites users’ navigation among the many custom options available to first responders. KIMTEK founder and president, Kimball Johnson, said of the new

website, “New applications for our skid units are found nearly every week, as are ways we can adapt them for use in the field. We’re very pleased our website users may now find exactly what they need, as well as links to what they may want in the future, even more quickly and intuitively at http://www. kimtekresearch.com “. ABOUT KIMTEK CORPORATION KIMTEK Corporation is the largest producer and marketer of ATV/UTVspecific skid units for public safety agencies in the U.S. KIMTEK’s FIRELITE® fire and rescue skid units and MEDLITE® medical skid units are now in service in all fifty U.S. states and across Canada, all branches of the military, the National Park Service, numerous NASCAR tracks, sporting complexes, schools, universities, and in several countries worldwide. KIMTEK Transport skid units are made in the USA. Founded in 1984 as a research and development company dedicated to advances in life safety technology

in the fire sciences, KIMTEK Corporation manufactures and markets a full line of FIRELITE and MEDLITE Transport skid units for

emergency service UTVs and pick-up trucks. For more information, please contact KIMTEK at 888-546-8358 or visit www.kimtekresearch.com.

Contact: Randy Larson | 508-347-5961 | info@larsongroup.com KIMTEK®, MEDLITE®, FIRELITE®, and LEOLITE® are registered trademarks of KIMTEK Corporation.

52 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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Industry NEWS

Technimount EMS Introduces the Most Flexible Mounting System for Air Critical Care Transport Lorena Ruelas

Quebec, QC, (February 15th, 2022) – Technimount EMS (“Technimount”), an affiliate company of Technimount System and leading provider of mounting solutions for medical devices, is proud to introduce the Xtension ProTM Assistant – LP, a unique and innovative mounting system to secure multiple medical devices during Air Critical Care Transport. The Xtension Pro Assistant – LP is a flexible mounting system for the management of multiple medical devices on cots which improves Air Critical Care Transport operations. It integrates Technimount’s universal mounting system widely used among Emergency Medical Services in North America, ensuring a seamless transition from air to ground emergency transport up to hospital environments. Designed in compliance with the highest industry standards for air transport, this system significantly improves the safety of patients and crews. The Xtension Pro Assistant - LP was developed by Technimount

Engineering (Technimount Design Inc.), Technimount System’s affiliated division responsible for new product development and product improvement. This

innovative mounting solution integrates important features highly appreciated by Critical Care Transport teams, such as a two-sided open structure that facilitates lateral patient transfer from bed/stretcher to cot, while the medical equipment remains installed. It improves interchangeability between medical devices as configuration can be customized according to the type of transport or protocol. With the use of

Technimount’s Red Quick Release Mechanism, the mobile structure can be easily removed from the cot, allowing the critical care team to be more efficient in managing equipment and to concentrate on what matters most, patient care. “We had the opportunity to work closely with Air Critical Care Transport teams from the early stages of this project, which provided Technimount with firsthand insights that are essential in the development of innovative solutions that make a difference in their everyday practices,” said Carl Bouchard, President, and CEO of Technimount System. “We were able to integrate all these insights to the expertise we have gained over the years working with emergency ground transport services and the result is the first mounting system that can transition from one application to the other, improving patient care and safety during transport.” Compliant with FAA, 14 CFR 23, the Xtension Pro Assistant -

LP has been successfully certified on Pilatus PC-12 aircraft, and clearance for several deployments in North America is in process. ABOUT TECHNIMOUNT EMS Technimount EMS offers a wide range of mounting systems for medical devices, addressing the safety needs of patients and staff during ground or air emergency and Critical Care Transport, establishing itself as a standard in the Emergency Medical Services industry. ABOUT TECHNIMOUNT ENGINEERING Technimount Engineering supports and collaborates with healthcare professionals, EMS organizations, and medical device manufacturers, applying design and engineering into innovative and effective solutions to respond to their needs. Technimount Engineering transforms concepts into final products, ensuring their functionality brings value and improves the end-user experience.

Contact: Lorena Ruelas, Global Marketing Director | lruelas@technimount.com | +1 581.998.9820 ext. 103 Twitter: @TechnimountSyst | Facebook:@technimount | LinkedIn: Technimount System

ZICO Offers Improved SCBA Storage Experience Ryan Glover

YARDLEY, PA – Ziamatic Corp, a worldwide leader in Self-Contained Breathing Apparatus (SCBA) bracket technology, introduces two new solutions for reducing firefighter exposure to toxic particulates without having to sacrifice speed, comfort, and efficiency on the fire scene. “Now more than ever, departments want to reduce firefighter exposure to harmful chemicals and carcinogens,” said Keith Creely, Ziamatic Vice President. “But they’ve found that moving SCBA from the crew seats to the side compartments often meant trading away operational speed and personal comfort in the process. With our two new brackets, firefighters are no longer forced to choose. They can protect themselves and still do their jobs efficiently and effectively. Everybody wins.”

The QUIC-SWING Flip-Down 180°, Model QS-FD-180, stores SCBA away from the door to minimize snags, then slides out and flips end over end for easy access. “With the Flip-Down 180°, the SCBA faces the rear of the compartment.” said Creely, “So all your straps, all your hoses are stored tucked away from the compartment doors, the roll-up doors, and you reduce the risk of pinching or damaging the equipment.” The QUIC-SLIDE SwingDown, Model QSSD, allows donning from two different heights, providing more comfort and flexibility for personnel of varying body types. “The Swing-Down is different in that you can access your SCBA from two different heights,” said Creely. “You can release the lever

and bring the SCBA down to a lower level, or if you’re a taller firefighter, you can just slide out and don the SCBA as is. You don’t have to deploy the swing. It gives a department that bit of added flexibility.” Available now. For more information please call 1-800-711FIRE. View a video demonstration at www.ziamatic.com

Ziamatic Corp. (ZICO) was founded in 1958 with the intention of providing the men and women of the fire services industry with products that make their profession safer and easier. Over 50 years later Zico remains a leader in SCBA bracket and ladder rack technology. For more information, please call 1-800-711FIRE or visit www.ziamatic.com

Contact: Ryan Glover – Marketing | 215-493-3618 | rglover@ziamatic.com SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 53

New DELIVERIES

New Deliveries by Atlantic Emergency Solutions

Garner Fire Rescue Department Pierce Velocity 100’ Ascendant Aerial Tower with DDC DD13 525hp 1850 lb-ft w/OBD; Waterous S100 2000 GPM Single Stage Pump, 300 gallon water tank, (2) Akron 3487 Stream Master II Monitors, 15” extended front bumper

Chesterfield Fire & EMS (VA) Pierce Enforcer 107’ Ascendant Aerial Ladder with Cummins X12, 500hp, 1695 lb-ft w/OBD; Oshkosh TAK-4 front and T3 rear axles, 22’ extended front bumper, 70” cab with 10” raised roof

Town of Clayton Fire Department Pierce Arrow XT 100’ Ascendant Aerial Towerbumper, 70” cab with 10” raised roof and DDC DD13 525hp 1850 lb-ft w/OBD; Waterous CMU 2000 GPM Two Stage Pump, 300 gallon water tank, (2) TFT Monsoon Monitors, Oshkosh TAK-4 front and T3 rear axles

Bethlehem Fire Department Pierce Enforcer Pumper with Cummins L9 450hp 1250 lb-ft w/OBD; New York Style Host Bed, Oshkosh TAK-4 front axle, Waterous CMU 2000 GPM Two Stage Pump, 1000 gallon “L”shaped water tank

Suffolk Fire Department (VA) Pierce Enforcer Tiller wit Cummins X12, 500hp, 1700 lb-ft w/OBD; Waterous S100 1500 GPM Single Stage Pump, 200 gallon poly water tank, Oshkosh TAK-4 front axle, 13” extended bumper

Chesterfield Fire & EMS (VA) Pierce Velocity 100’ Ascendant Aerial Tower with Cummins X15 605hp 1850 lb-ft w/OBD; (2) TFT Monsoon Monitors, Oshkosh TAK-4 front and T3 rear axles, 15” extended front bumper, 70” cab

Blackstone Volunteer Fire Department Pierce Enforcer Pumper with Cummins X12 455hp 1700 lb-ft w/OBD; QMAX-150, 1500 GPM Single Stage Pump, 750 gallon poly water tank, Husky 3 Single Agent Foam System, 19” extended front bumper

Galax Fire & Rescue (VA) Pierce Arrow XT 100’ Ascendant Aerial Tower with Cummins X15, 605hp, 1850 lb-ft w/OBD; Waterous S100 2000 GPM Single Stage Pump, 300 gallon poly tank, (2) TFT Monsoon Monitors, Oshkosh TAK4 front and T3 rear axles

Appomattox Fire Department Pierce Enforcer Pumper with Cummins X12, 500hp, 1700 lb-ft w/OBD; Waterous CSU 1500 GPM Single Stage Pump, 1000 gallon poly tank, Husky 3 Foam System, New York Style Hose Bed

Odell Fire Rescue Pierce Enforcer Heavy Duty Rescue Pumper with Cummins L9 450hp 1250 lb-ft w/OBD; Waterous CSU 1500 GPM Single Stage Pump, 750 gallon poly water tank, Oshkosh TAK-4 front axle, 26” extended front bumper

54 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | 55

Advertiser INDEX A-B TECHNICAL COMMUNITY COLEGE

AIR CLEANING SPECIALISTS, INC

ANCHOR RICHEY EVS, INC ATLANTIC EMERGENCY SOLUTIONS, INC

42, 55 IFC, 11, 54

IFC= Inside Front Cover; IBC= Inside Back Cover; BC=Back Cover

FIRE HOOKS UNLIMTED

FIRE SEMINAR (NAFI)

FIRE STATION OUTFITTERS

GERALD JONES FORD

KIMTEK CORPORATION

BLANCHAT MANUFACTURING

KRAH HEALTH SOLUTIONS

BOBBITT DESIGN BUILD

LIBERTY ARTWORKS, INC

BULLDOZERFIRE, INC

MAGNEGRIP GROUP, INC

MARION BODY WORKS, INC

MATJACK

MED CENTER AIR/ATRIUM HEALTH

MOUNTAIN TEK

27 15

CITY OF CHARLOTTE – CCPA

CIVIC FEDERAL CREDIT UNION

CODE 3 INSURANCE, INC

COLUMBIA SOUTHERN UNIVERSITY

NAFECO

C.W. WILLIAMS COMPANY, INC

NEWTON’S FIRE & SAFETY EQUIPMENT, INC

DAVIDSON-DAVIE COMMUNITY COLLEGE D.R. REYNOLDS COMPANY, INC EASY LIFTS, LLC

22 17 26

NORTH CAROLINA SHERIFFS’ ASSOCIATION

NORTH CAROLINA ASSOCIATION OF RESCUE & EMS

NORTH CAROLINA STATE FIREMENS ASSOCIATION

NORTH CAROLINA TRANSPORTATION MUSEUM

NORTH GREENVILLE FITNESS & CARDIAC REHABILITATION CLINIC

PEACEFUL ROADS, LLC

ROLLNRACK, LLC

SAFE AIR SYSTEMS, INC

STEWART COOPER NEWELL ARCHITECTS

SUPER VAC, INC

SVI TRUCKS, INC

SYNTEX INDUSTRIES

TECHNIMOUNT SYSTEMS, INC

THIS END UP FURNITURE

TLC TRI STATE LAUNDRY COMPANIES 12

This index is provided as a service. The publisher does not assume any liability for errors or omissions.

Crossword ANSWERS

ENJOYING THE CAROLINA FIRE JOURNAL?

We publish this journal to serve the first responders who serve us in our communities, and we always appreciate feedback from our readers. Drop us a line and let us know your thoughts and any suggestions you might have. You can visit us online at carolinafirejournal.com, or facebook.com/carolinafirejournal and send us a message. We would love to hear from you and we look forward to finding new and better ways we can serve you. As always, we thank you for your service to us.

CarolinaFireEMS March2022

E X M I N U T E R E M L E T H I Q U I N T E R F D E L V O E S P A C R D S A L

56 | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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U N T N A A Q S F W T R N F A O I R E C O E A E P N W N D I A M E T E R L R S Y E S

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SPRING 2022 | CAROLINA FIRE RESCUE EMS JOURNAL | c

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d | CAROLINA FIRE RESCUE EMS JOURNAL | SPRING 2022

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Articles inside

When Your Patient’s Glucose Reading is “HI” — Understanding and Managing Type II Diabetes