Carolina Fire Journal Fall 2021

Fall 2021 Vol. 36, No. 2

SINCE 1985

www.carolinaf irejournal.com

CONTENTS Features

Ask Mr. Bill

September 11 — 20 Years Later 4

A Perfect Elixir for Financial Stress — Drink Up Now and Sleep Better Tonight!

27

Dr. David Greene

Focused Discipline for Your Retirement

18

Bill Carter

Dale Folwell

Firefighter Hoods: Benefits of Particulate Blocking Technology

Lexington Fire Department

EMS

Vaccines Are Our Lifeline

6

FIRE STATION PROFILE — North Carolina

8

Raleigh Fire Department

James Winslow

When Your Patient is Too Sweet Aaron Dixon

Effectiveness of Pulse Technology and a Hybrid Hydrogen Peroxide Decontamination System for EMS

9

Bill Webb

Vince Battaglia

16

Dr. Norman Wood

21

30

38

Remembering Bill McCormick

39-41

31

Ken Newell

EDITORIAL BOARD

Ken Newell — Stewart-Cooper-Newell Architects

Jim Bell — President Bobbitt Design Build, NC Division

Civic Federal Credit Union Glenn Clapp — Division Chief - Fuquay Varina Fire Dept.

22

Active Shooter

Julie Downey —Fire Chief for Davie Fire RescueFlorida

Active Shooter: Is There Really a Problem?

Dale Folwell — N.C. State Treasurer

23

25

Ken Farmer

David Greene Ph.D — Ph.D Chief, Colleton County Fire Rescue

David Hesselmeyer— President - On Target Preparedness, LLC

Nicole Randall — International Safety Equipment Richard Ray — Capt. Durham Fire and Rescue Mark Rivero — Public Safety Management , S. Illinois University

Matt Sloane — Skyfire Consulting

William Tatum — SC EMS Director James Winslow — NC EMS Director Bill Webb — Ex. Director Congressional Fire Services Institute Charles Werner — President, Drone Responders

Ricky Hesson — N.C. Hazmat Association

Dalan Zartman — President, Rapid Response

Goosie Kennedy — D.R. Reynolds

Eye Protection: New Standard Addresses Spray, Spurt of Biological Hazards 26

Lizzy Long — Billy Graham Rapid Response Team

Bill Suthard — PIO, Huntersville Fire Department

Todd Herring — V. P. of Product Innovation and Strategy Fire-Dex

Barnyard Management

for Valkyrie Tactical Solutions, LLC

Mark Schmitt — Captain, Greensboro Fire Department

Kent Davis — Consultant, Threat Suppression

Chief Julie Downey

Corey Outen — Chief Medical Instructor

Caroline Schloss — Crossword Puzzle

Doug Cline — President, International Fire Service

Mark Rivero

On-The-Job Safety

Glenn Clapp

Dedication

Bill Carter - Director of Fire/EMS Business Development ,

Recruiting & Retention

Unanswered Prayers

29

Vince Battaglia — CEO of Pathogend of Georgia

Doug Cline

Baby Boomers and Generation Z Expectations, Differences and Understandings

Levels of Concern: What Are They and Why Are They Important? 37

Dena Ali - Captain of Engine 11 for City of Raleigh FD

Leadership

The 7 Qualities Fire Service Leaders Must Possess — Courage

Hazmat 2021

New Deliveries

Selecting the Architect for Your Public Safety Project

13

Bob Twomey

Suspension Trauma: A Lethal Cascade of Event

28

36

Dena Ali

The Station House

Rescue When the Ground Moves

34

Neha Pathak, MD

The Company Officer’s Role in Addressing Mental Health

Update from Capitol Hill

Advocating for the United States Fire Administration

Exercise Prescriptions: Working Out as Medicine

Behaviorial Health

FIRE STATION PROFILE — South Carolina

20

Todd Herring

Fitness

Karen Leatherman— President, Fitness Forum Tracey Mosley — Program Manager, NC Association of Fire Chiefs

Nicole Randall

STAFF Published by KCI Media Group 10150 Mallard Creek Rd. Suite 201 Charlotte, North Carolina 28262 704-568-7804 Vol. 36.2 • Fall 2021

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Carolina Fire Rescue EMS Journal reserves the right to edit for clarity and content.

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Fall • 2021 3

Feature

September 11 — 20 Years Later

There’s a storm brewing.

Unfortunately, I am not referring to a tropical cyclone or the development of a Dr. David Greene line of supercells.

I am referring to an incident that is vile. One that is incomprehensible.

One that will have a tremendous loss of life and will claim the lives of firefighters.

You are reading this after the 20year anniversary of the terrorist attacks on September 11, 2011.

However, I am typing this before the anniversary date. It is human nature to lose memories as time goes on.

Add to that the fact, that we are now hiring firefighters who were born after the September 11th attacks occurred, and it is easy to understand how it is harder to remember.The lack of a major terrorist attack over the last 20 years has lulled us into a false sense of security.

Let me remind you. On September 11, 2001, two commercial airliners hit the World Trade Center in New York City. Another hit the Pentagon in Washington, DC and a fourth crashed in Shanksville, PA while passengers fought terrorists for control of the plane. In New York City, a radio transmission was recorded early in the incident from the field communications unit to the FDNY communications center.“George, have them mobilize the Army. We need the Army in Manhattan.” How many of us have been the Incident Commander at a call where we have considered needing the Army to successfully prosecute the incident.Try to imagine that.

In response to 9/11, many of us focused our training on specialized types of responses. My department sent firefighters to radiological training in Nevada, nerve agent training in Alabama, initial response to terrorist bombing training in New Mexico, and hazardous materials life

4 Fall • 2021

support training in Arizona, just to name a few. However, that was years ago. Although it is possible that our brewing storm will evolve in the form of one of these incidents, it is also possible, and perhaps more likely, that our “storm” incident will involve a simpler means of attack. It could be an active shooter incident, a truck that strikes multiple people, or even a knife attack. From the perspective of someone who wants to cause us harm, firearms and knives are much easier to acquire than radiological sources and nerve agents. This is not to say that we do not need to prepare for a nerve agent

attack, but we should also prepare for mass casualty incidents caused by means that are easier to employ.

Moreover, we should prepare for a combination of attacks. Shortly after 9/11, we were warned that a plan was discovered to use crop dusters with organophosphates laced with radium.

The results of such an attack would yield a group of individuals showing signs of nerve agent exposure, as a result of the organophosphate. It would be a secondary thought to pull the radiation detectors off the hazmat truck, to identify the presence of radium.

It is not enough that we train for

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and consider what our brewing storm will look like. We also need something else.There are countless reports of what the FDNY firefighters faced when they arrived at the World Trade Center.

Although 343 FDNY firefighters made the ultimate sacrifice that day, there were countless others that survived, despite thinking that they were going to die as well. Fighting such a welldeveloped fire so high above the ground with the structural damage that had occurred was not something any of them had experienced. In one instance, an engine crew shook hands, acknowledged the honor it was to serve alongside each other, and said goodbye.They then proceeded into one of the towers to help rescue civilians and all of them believed they would perish while doing so.This is the “something else” that we will need. Courage. We need courage not just to prosecute the incident when it occurs, but we need courage to stand up against the nay-sayers. Make no mistake, we will have people that wonder why we need to purchase a nerve agent detector. We will have people wonder why we have to buy a ballistic vest for every firefighter. We will have firefighters wondering why we are “wasting our time” training on nerve agents or radiological sources.

We must have the courage to remind any doubters, that we must not forget why the training and equipment is important.

Why is it important? Several years ago, I was fortunate enough to visit the 9/11 memorial in New York City. I anticipated an emotional experience having watched the incident unfold

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“It is altogether fitting and proper that we should do this.”

— Abraham Lincoln that day in September 2001.

To say I was unprepared is an understatement. Before going inside the memorial, my family and I took time to observe the silence at the reflecting pools in front of the memorial. The walls of these pools are etched with the 2,983 people who were killed in the 2001 and 1993 World Trade Center attacks. We observed a man with a clipboard placing flowers in some of the etched names. There was no pattern to his flower placement and as he approached us, I asked,“Excuse me sir, what is the significance of the flowers you are placing?”The man replied softly,“The flowers are placed on anyone that has a birthday today.” I couldn’t speak to even say thank you. It set the stage for a very powerful visit inside the memorial. The deaths that the memorial honors have ripple effects well into a second generation today.

It is not just important that we remember 9/11 to honor those killed. It is equally as important that we remember 9/11 so that we are prepared for the future.Think for a minute of how many of our citizens rise and sleep without thinking about us.That is to say, that very few, if any, of our citizens lay down at night and think,“I’m going to sleep well because I know that if my house catches on fire in the middle of the night, or I have a heart attack or stroke, there is a group of people in a fire station somewhere that will come save me.” Many of our citizens do not think about us until they are actually experiencing the worst day of their lives. We cannot afford that mindset.

The more time that passes, the harder it will be to remember how painful that day in September was.

For our new people born after it happened, they have no frame of reference. It is incumbent upon us to remain prepared. We must train.

We must equip. WE MUST NEVER FORGET! In the words of Abraham Lincoln,“It is altogether fitting and proper that we should do this.”

Take time today to remember.

Remember the 343 FDNY firefighters who died in the line of duty on September 11, 2001. Remember the almost 3,000 civilians that died that day.

Remember that there is a storm coming and it is our responsibility to be ready to respond to it and prepare the generations of firefighters behind us to be prepared for it. Prior to 9/11, no one could have imagined an incident with such a loss of life.

Fires in 110 story buildings that cause both buildings to collapse in two hours was incomprehensible.

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We, those of us watching on television, were just as surprised as the brave FDNY personnel operating at the scene when the towers collapsed so quickly.

It was inconceivable. Today, we must consider the inconceivable, the incomprehensible and the unbelievable. That is how we will properly prepare for the storm brewing. We must train for the incomprehensible. We must communicate with our neighboring agencies, who will be tasked with assisting us should the storm strike our jurisdiction. Finally, we must never forget.

Never forget their sacrifice, their

courage, and never forget that fateful day in September of 2001.

Be safe and do good.

Dr. David A. Greene has over 30 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

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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.

Fall • 2021 5

EMS

Vaccines Are Our Lifeline

We have had a very tough last 18 months. All of us have worked extremely hard, dealt with a huge amount of stress, and James Winslow unfortunately, watched some of our co-workers get very sick and maybe even die. The personal stress that many of us have dealt with has been significant. Personally, I have sometimes woken up in the middle of night after coming home from a busy COVID emergency department with nightmares worried I had virus on me that I was going to give to wife and family. I know there are many other EMS workers and other healthcare providers who have been through much more than I have. We will get through this. The only way to

really make it end though is through vaccination. The COVID vaccines have been fully tested, they are safe and they are effective. We all need to get vaccinated to protect ourselves, our families, and our communities.

There are many rumors and incorrect information regarding the vaccines. Here are some answers to a few questions I have heard.

Have the Vaccines Been Fully Tested?

All the COVID vaccines currently being used in the United States have been fully tested and any adverse effects of the vaccines are being carefully monitored. We are not Russia or China where vaccines were approved without fully testing them.

The Pfizer, Moderna, and Johnson and Johnson vaccines went through full Phase 3 testing which required at least 30,000 participants. Since

then over 350 million doses have been given in the United States. We now know everything there is to now about any adverse effects of the vaccines and their effectiveness.

These are safe vaccines. Any adverse effects of the vaccines are outweighed by their benefit.

Do the Vaccines Work?

The vaccines are very effective. A recent article published in the New England Journal of Medicine looked at the effectiveness of the Pfizer vaccine against symptomatic disease.

It found that one dose of Pfizer vaccine provided about 30 percent protection against symptomatic disease and the full two dose regimen still provided 88 percent protection against symptomatic disease. Here is the link to that article: https:// www.nejm.org/doi/full/10.1056/ NEJMoa2108891?query=featured_ coronavirus If you do get COVID after vaccination it is normally nothing more than a cold and the infection

is not severe. A good illustration of this occurred at a recent COVID outbreak in Massachusetts. This took place at a resort community where 60,000 people came what was basically a big party. Among the people attending there was a 70 percent vaccination rate.

Three hundred forty-six vaccinated people got COVID. Of the 346 vaccinated patients who got COVID only four were hospitalized and two of those patients had significant comorbidities. None died.

Nationally we have seen that around 95 percent of COVID cases and all hospitalized patients with COVID were unvaccinated. Here is a link to Massachusetts data: https://www.cdc. gov/mmwr/volumes/70/wr/mm7031e2.htm

Do the Vaccines Make a Person Infertile?

The vaccines do not affect fertility. No vaccine has ever caused infertility. COVID infection is very dangerous for a pregnant woman.

A pregnant woman with COVID is 22 times more likely to die than a non-infected pregnant woman.

The baby is also more than two and one-half times more likely to have a bad outcome at birth including but not limited to intracranial hemorrhage, severe lung problems or hypoxic encephalopathy. There are many more severe complications that a COVID infection can cause for a pregnant woman. A really wonderful benefit of the vaccine is that it allows the mother to give protective antibodies to the newborn in her breast milk. The complete article can be found on the Journal of the American Medical Association website at this link: https://jamanetwork.com/journals/ jamapediatrics/fullarticle/2779182 There is also preliminary research showing a possible association between COVID infection and erectile dysfunction. One study found that after COVID infection men were more than five and onehalf times more likely to have erectile dysfunction. This could be due to general debilitation after the infection. It’s also possible that the

6 Fall • 2021

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erectile dysfunction could be due to the fact that the COVID virus infects many of the small vessels in the body and the male erection is dependent on the health of these small vessels. Other studies also seem to show the virus persists in the penile tissue and may cause a drop in testosterone levels. Here is a link to an article for the study looking at the association between COVID infection and erectile dysfunction: https://pubmed.ncbi.nlm. nih.gov/33742540/

Why Do I Still Need to Wear a Mask?

The vaccines are good, and you are about three and one-half times less likely to get an infection if you are vaccinated. There are some theories that very large exposures to virus are more likely to result in breakthrough infections. Wearing a mask will help reduce the amount of virus you are exposed to which could help reduce the chance of developing a breakthrough infection. In addition, if you do develop a COVID infection after vaccination wearing a mask will greatly reduce the chance of infecting others.

What Are Most COVID Infections Like in People Who Are Vaccinated?

Dr. Chris Ohl, an infection disease specialist at Baptist Hospital in Winston-Salem, has used the term

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“covid cold” to describe COVID infections in people who have been vaccinated. Most people who develop COVID are exposed to the virus in their nose. The virus then begins to multiply in your nasal mucosa. After about two or three days the virus has multiplied enough in your nasal mucosa for your immune system to take notice.

At this point you may develop a “COVID cold.” In vaccinated people the immune system is already primed and ready to attack the COVID virus. In most cases the immune system in a vaccinated person then rapidly wipes out the viral infection while you feel like you have nothing more than a cold.

In a non-vaccinated person, the virus continues to multiply and spreads through your body. The immune system then takes too long to react before the virus takes hold.

Are There Certain People at Risk for Breakthrough Infections?

The people at greatest risk for serious breakthrough infections are people over age 65, transplant patients, cancer patients and people with other types of immunosuppression.

Dr. Winslow has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the NC Office of EMS in 2011.

This document contains all protocol, procedures, and policies for all EMS agencies in North Carolina.

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Fall • 2021 7

EMS

When Your Patient is Too Sweet

Diabetes (Type 1) is one of the oldest diseases in recorded history. Egyptian manuscripts depicted children that “passed too much urine” and Aaron Dixon died.Ancient Indian physicians tested for “honey urine” by seeing if ants were attracted to the urine of specific patients. Before 1923 every patient who developed Type 1 diabetes died with a proximal cause of Diabetic Ketoacidosis (DKA). For the purpose of this article, only Type 1 diabetes will be discussed.

Insulin is a naturally occurring hormone produced by the pancreas and secreted to reduce blood glucose levels after eating. Glucose cannot freely enter most cells in the body and need insulin to cross the cellular membrane. Once glucose enters the cell, it gets converted to Adenosine Triphosphate (ATP) — units of energy.ATP powers all bodily functions.

In Type 1 diabetes, the pancreas stops secreting insulin.The pathophysiology of why the pancreas stops working is still not completely understood. But it typically occurs in children — hence the name, juvenile diabetes.

Without insulin, glucose cannot enter the cell and it stays in the blood, causing hyperglycemia — high blood glucose levels.After blood glucose levels exceed 250 mg/dl, glucose is pulled into the urine for excretion.The resulting concentration gradient, from glucose being excreted, draws water into the urine.This phenomenon, osmotic diuresis, causes profound dehydration and eventually shock.While the body is

8 Fall • 2021

full of glucose, none of it can be brought into the cell and converted to ATP.This can be compared to being lost at sea, surrounded by water without a drop to drink. Since ATP cannot be produced through the normal glucose pathway, and free fatty acids can freely enter the cell — stored fat is metabolized to produce ATP. Eventually, the utilization of fat causes the creation of ketoacids.The beginnings of the Ketogenic Diet mirror what is occurring in DKA. In the presence of insulin, fat is not metabolized. By eating a diet comprised almost entirely of fat and some protein, the body doesn’t release insulin, and stored fats are utilized, allowing weight loss. People on the Ketogenic Diet consume small amounts of carbohydrates (glucose) that stop the body from creating large amounts of ketoacidis. However, in Type 1 Diabetes, insulin is never secreted and ketoacids are constantly created, leading to acidosis.

The body eliminates the acid by utilizing bicarbonate (a buffer).This is no different than consuming Tums when you have indigestion.The bicarbonate combines with the ketoacid forming a new acid, carbonic acid.The new acid is then converted to carbon dioxide and water. However, eventually all the bicarbonate is used and the body becomes overwhelmed with acid.

Ultimately, the body becomes acidic, cells break down and bodily functions can’t work.The combination of profound dehydration and acidosis leads to death.

When looking for the signs and symptoms of DKA, remember the processes that are occurring: 1. The body is profoundly dehydrated, causing tachycardia, hypotension and dry/pale skin.

2. K ussmaul respirations (rapid

and deep) due to increased CO2 levels from buffering the acid.

3. H yperglycemia — blood glucose levels greater than 250 mg/ dl 4. U nconscious or altered mental status — due to reduced ATP and shock.

5. F requent urination to get rid of the glucose.

6. Constant thirst due to dehydration.

Additionally, especially in adults, DKA is caused by an underlying medical condition such as sepsis.

Always fully assess your patient and don’t focus on just DKA.Always try to identify the underlying cause.

In 1922 Dr. Frederick Banting, a Canadian surgeon and Charles Best, a medical student, isolated the hormone utilizing dog pancreases for the first time in history. Eventually, they moved to cow pancreases donated by local slaughterhouses. In January 1923, a 14-year-old was the first patient to receive injections of animal insulin.With daily injections, the 14-year-old lived until he was 26 and died of pneumonia. Diabetes was no longer a death sentence.

Currently, insulin is synthetically created.Type 1 diabetics typically take two basal, long lasting, injections and bolus with short acting throughout the day to cover meals.

Hypoglycemia, low blood glucose, is the emergency we are typically used to seeing.A known diabetic found halfnaked, on a urine-soaked mattress, in a dimly lite room, with poor vascular.When treating hypoglycemia do not forget the basic at the expense of the obvious.

Airway, oxygenation, and ventilation if applicable are essential even if the proximal cause of the unresponsiveness is known.The treatment of hypoglycemia is simple — glucose. If the patient can swallow, a sign of an intact airway,

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provide oral glucose. If the patient is unresponsive or too confused, IV glucose either D10 or D50 is necessary. If unable to establish an IV, glucagon can be administered IM. However, glucagon may not work in alcoholics or brittle diabetics who do not have stored glycogen.

Diabetic emergencies are common.

With glucometers on every apparatus, identifying hypoglycemia and hyperglycemia is easy. Some of the more experienced medics will remember using chemstrips and giving the coma cocktail, Dextrose, Narcan and Thiamine, before glucometers were available for EMS.A basic understanding of the disease process will make recognizing DKA easier.

Aaron Dix, MBA, NRP, is the Executive Director of EMS for Prisma Health, Commissioner for Clear Spring Fire Rescue, Executive Board Member of the SC EMS Association, and a volunteer paramedic. 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. Dix is a national speaker and has authored multiple articles. He can be reached at aaroncdix@gmail. com.

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EMS

Effectiveness of Pulse Technology and a Hybrid Hydrogen Peroxide Decontamination System for EMS

Vince Battaglia

Emergency response organizations are a vital link to any community’s access to immediate medical response and care. During the COVID-19 pandemic and the resulting shortage of personal protective equipment (PPE), personnel of these agencies had a potential exposure level far beyond that of many other healthcare workers. Due to the high level of asymptomatic patients as well as the wide variety of COVID symptoms, many emergency responses thought to be for other causes, also led to exposure to SARS-CoV-2.

For the sake of first responders, as well as for that of the larger community, it is crucial to create an environment free of biological contaminates as a staging

Non-Porus Material #1 Pre Post Reduction 530 0 530 312 12 300 532 0 532 301 1 300 957 0 957 272 13 259 59 0 59 Non-Porus Material #2 Pre Post Reduction 200 13 187 21 0 21 64 0 64 22 12 10 167 0 167 231 4 227 282 0 282

Porous Material Pre Post Reduction 842 397 445 1276 287 989 1485 184 1301 1567 187 1380 746 413 333 1889 202 1687 2511 270 2241 These three tables show reductions in ATP readings of porous and non-porous material.

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Figure 1. HHP™ device orientation for treatment of cabin and cab of ambulance.

Figure 2. Validation Tools: Biological Indicators with tryptic soy broth medium, H2O2 Chemical Indicators, and ATP swabs with ATP meter.

ATP swab readings taken from the jump seat. Pre disinfection — 957 (Fig. 3). Post disinfection ‚ 0 (Fig. 4).

point for this vital work to occur. 1 Though cleaning and disinfection for ambulances is a routine part of emergency response, 2 these cleaning and disinfection protocols do not commonly have a consistent and reliable way to ensure a full disinfection has occurred.

In an environment prone to contamination, even the best efforts can still leave germs behind. For this reason, there is a need for high level disinfection which is not prone to human error and can be validated. In this study, a portable disinfection device was used to enhance existing cleaning protocol.

This automated device injects seven percent hydrogen peroxide to fill the interior space of the ambulance with disinfecting solution.

As a measure of an effective treatment, pre and post ATP swabs were collected, and both chemical indicators and spore-based biological indicators were used to test for a 99.9999 percent kill in even the hardest to reach areas of the ambulance.

This case study examines whether using this system significantly improves disinfection outcomes for emergency response ambulances.

Figure 5. Chemical indicators showing a color change indicating exposure to H2O2.

Figure 6. Biological Indicators (Geobacillus stearothermophilus 1 x 106) encased in a Tyvek/ myler pouch.

proprietary seven percent Hydrogen Peroxide (H2O2) solution which together are EPA registered for high-level disinfection. To calculate treatment time, the device is programmed for the cubic footage of the space being treated. As the target environment of this study was the interior of ambulances, the device was programed to treat the space of the forward cab and all compartments in the

Figure 7. Challenged chemical indicators showing the importance of opening cabinets, glove box, and other storage spaces to allow for complete migration.

rear cabin at one time.

The device can be programmed manually using an onboard screen or remotely via APP. Once started, the system engulfs the space with Hybrid Hydrogen Peroxide™, a combination of vapor (VHP) and aerosolized hydrogen peroxide fog.

Following the initial delivery, the device then intermittently injects solution via Pulse™ technology to maintain the

see PULSE TECHNOLOGY page 10

Methods Patented Pulse™ Technology The system used in this study is a mobile fogging device combined with a

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Fall • 2021 9

Pulse Technology Cont’d from page 9

concentration of H2O2 for a set dwell time. For this study, dwell times of both 20 minutes and 30 minutes were used. As hydrogen peroxide naturally decomposes to oxygen and water, no neutralization.

Disinfection of Ambulances Ambulances were parked in a large non-climate-controlled garage. The HHP™ device was placed inside the rear cabin and directed towards the window opening to the front cab (Figure 1). ATP pre-swabs were collected, and chemical and biological indicators were placed in challenging locations throughout the ambulance (Figure 2). The device was started, and the ambulance was closed for the duration of the disinfection cycle. Following the disinfection cycle, the ambulance was opened and allowed to air out.

ATP post-swabs were collected, chemical indicators checked, and all biological indicators were retrieved and processed.

ATP Swabs Adenosine triphosphate (ATP)

Biological Indicators

swabbing was performed pre and post disinfection treatment to measure the presence of microorganisms and residual organic matter. Swabbing was collected from a 4x4 square inch area of both porous and nonporous surfaces. Swabs were taken from frequently touched locations within the rear cabin, the jump seat, and the rear bench seat (Figures 3 and 4).

Chemical Indicators Hydrogen peroxide chemical indicators were used to validate that disinfecting fog reached all areas of the ambulance, including hard to reach spaces such as a closed glove box and inside closed cabinets (Figure 5).

Location Front Cab

Result Pass

Test 1 Jump Seat

Rear Bench

Pass Pass

Pass

Front Cab

Test 2 Jump Seat

Rear Bench

Pass Pass

Front Cab Test 3 Jump Seat

Rear Bench

Pass Pass Pass

Biological Indicators For validation of a highlevel disinfection, biological indicators of Geobacillus stearothermophilus strain 12980 1x106 were used (the same indicators used in EPA testing). The indicators consist of bacterial spores on a stainlesssteel carrier encased in Tyvek/ mylar pouches. Indicators were placed throughout the ambulance’s back cabin and forward cab (Figure 6).

Following decontamination,

In an environment prone to contamination, even the best efforts can still leave germs behind. For this reason, there is a need for high level disinfection which is not prone to human error and can be validated.

Table 4. Biological Indicators (Geobacillus stearothermophilus 1x106). Passing results indicate a complete 6 log reduction (99.9999 percent) of present pathogens for an achieved successful disinfection cycle. indicators were collected, placed in tryptic soy broth, incubated, and monitored for seven days.

Results and Discussion The disinfection cycle was simple to operate as the HHP™ device automates the process. Initial measurements of the ambulances were taken by measurements or from schematics. These measurements were input into the device

which automates the time necessary for treatment. For this study, measurements were manually input into the device through its control panel; however, operators can also input this information through a cloud-based system, storing the measurements for future disinfection cycles and eliminating potential future errors in measurement or input. For emergency response organizations with large fleets, this method would eliminate the need to measure each individual vehicle prior to disinfection.

ATP swab readings demonstrated a notable reduction in the presence of organic matter (viruses and live particles possibly including dangerous germs) from pre to post disinfection. Both porous and non-porous materials were swabbed. Non porous materials repeatedly demonstrated a complete or near complete reduction in organic matter.

Porous materials demonstrated a >50 percent reduction in organic matter, which is consistent with the known greater difficulty in disinfecting porous materials (Tables 1-3).

Chemical Indicators change color when exposed to hydrogen peroxide, indicating the disinfection treatment has see PULSE TECHNOLOGY page 12

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Carolina Fire Rescue EMS Journal

Pulse Technology Cont’d from page 10

reached the locations where indicators are placed. All 15 chemical indicators, located throughout the vehicle, demonstrated exposure to hydrogen peroxide, validating the ability of HHP™ to engulf a space and even migrate to hardto-reach spaces (Figure 7).

Biological indicators of Geobacillus stearothermophilus are used to demonstrate proof of disinfection. These sporebased indicators ensure a pathogenic presence within the space prior to treatment.

By introducing this inactive but difficult to kill pathogen to the environment, it becomes possible to measure the degree of disinfection which has taken

By enhancing disinfection with employment of the latest technology, those in the emergency management field protect themselves as well as their patients in the vulnerable time of transport. place. Indicators are processed in tryptic soy broth and monitored for signs of growth.

Growth of bacteria indicates a less than 6-log (99.9999 percent) reduction in present pathogens, conversely, lack of growth is a sign of a successful high-level disinfection (equal or greater than 6-log) of all treated spaces (Table 4). Notably, testing for this study occurred without environmental conditioning of either vehicles or the enclosing bay. This testing resulted in repeated demonstration of a complete 6-log reduction as indicated by the spore-based biological indicators.

These results indicate successful treatment is possible even when environmental conditions exceed that of the manufacturing specifications.

These results indicate a wide range of environmental conditions retain the potential for a successful disinfection cycle.

use in this application for ambulance disinfection. Given the crucial role of emergency services personnel, and the importance of a pathogenfree environment at every step of the care process, thorough disinfection practices are a critical foundation for emergency response.

By enhancing disinfection with employment of the latest technology, those in the emergency management field protect themselves as well as their patients in the vulnerable time of transport. As the target of disinfection is invisible to the naked eye, validation tools can be employed to verify and create records of successful disinfection cycles.

The results of this study clearly show a significant and measurable improvement in the ambulance environment following treatment with the seven percent Hybrid Hydrogen Peroxide™ System.

Conclusion

Vince Battaglia served over 35 years of active duty and guard service. Deployed to over five different countries and operated in 54 of the 57 US States and Territories. Experience in Army aviation medicine and HEMS operations. Emergency preparedness trained and experienced with highly contagious and commonly spread diseases overseas. Assisted in the containing and treatment of pathogens that affected 32% of the workforce. Aided in the Containment and treatment for Korean hemorrhagic fever. Perform DOD testing of prototype medical equipment from 2012-2015. VA Certified Service-Disabled VeteranOwned Small Business (SDVOSB) since 2015.

Hydrogen peroxide systems are increasingly being used in the hospital environment; however, there remains limited

REFERENCES 1. Andersen, B. M., Rasch, M., Hochlin, K., Jensen, F. H., Wismar, P., & Fredriksen, J. E. (2006). Decontamination of rooms, medical equipment and ambulances using an aerosol of hydrogen peroxide disinfectant.

The Journal of hospital infection, 62(2), 149–155. https://doi.org/10.1016/j. jhin.2005.07.020 2. United States Department of Labor, Occupational Safety and Health Administration (January 2011) Bloodborne Pathogens Standard (29 CFR 1910.1030) https://www.osha.gov/OshDoc/ data_ BloodborneFacts/bbfact01.pdf

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Rescue

When the Ground Moves

In the last few years in some sections of North Carolina, it seems as if the rainfall just won’t end.

At DuPont State Recreational Bob Twomey Forest in calendar year 2020, one of our rain gages measured 120 inches of rain from January 1 to December 31.

The two years before were wet years, and 2021 is on track to be a wetter than normal year.

Likewise, it seems as though hurricanes have lashed the southern United States severely over the last few years, as evidenced by Hurricane Fred in August of this year. One of the most devastating events from a tropical storm dumping many inches of rain, besides the damaging flooding, is that of landslides. In this article, I am going to explain what often triggers landslides, why they occur, and why they can be so dangerous and their impacts on flooding sometimes.

During my career with the Natural Resources Conservation Service, especially here in the mountains of western North Carolina, I saw many slides in different settings, and witnessed their awesome power. I was able to study why slopes slid and the underlying causes of these slides, and their contributing forces related to devastating flooding.

Most landslides occur on slopes, sometimes on slopes deemed flat enough that no one would expect the ground to slide. As such, we need to look at the more common reasons a slope could suddenly collapse.

Gravity, slope geology — that is the rock types, depth to rock, rock strike and dip angles — soil types and consistency, the cohesiveness of the soil particles, soil fill or undisturbed soil, vegetation (or the lack thereof) upon a slope and slope cuts — all are major contributing factors in slope stability.

Gravity First, all slopes are under the

natural effects of the earth’s gravity.

This is a constant. Gravity can play a very major role in whether a slope is susceptible to slide, given the other physical factors mentioned above.

The steeper the slope, in general, the greater the effect of gravity upon its stability.

Slope Geology Slope geology is the presence of the type of rock and its depth, consistency, and strike/dip angles relative to the angle or steepness of the slope, be they man made slopes or natural slopes, as on a mountainside.

Examples of man-made slopes include earthen dams, roads cut across a natural slope, where part of the road is “cut” material and the other part of the road is fill material. Many roads are thus partially “benched” (cut into the slope) and the other part of the road is the resultant fill material from the bench cut. Basically, a road of this type is built as 50 percent cut and 50 percent fill material, resulting in “two slopes upon a slope.” Here the cut bank generates a slope where the road was “benched into the hillside” and the fill slope — where this cut material was placed to create the other half of the roadway, creating its own slope. So, from top to bottom, you have the natural hillside slope, the cut slope, the road, the fill slope, and the rest of the natural hillside slope below the fill.Thus, you can begin to see a road that’s cut and filled on an existing slope.This is a very common way to build anything from a logging road to a major highway.

Step slope behind house slid, taking out retaining wall and uncovering house and deck footings.

on a slope tends to be more stable than soil on a slope that has been disturbed, such as through any type of construction activity.

Vegetation on any slope tends to make that slope more stable, as the roots from the vegetation tend to bind soils and rocks together.

Trees generally provide the greatest

stabilizing factors, but grasses or brush also help stabilize soils on a slope.

So, why all of this information just discussed? Because all of these factors will have a bearing on when, where and how a slope may slide under see GROUND MOVES page 14

Soil Type Obviously, the soil type present on an existing slope has a major effect on the overall long-term stability of that slope, be it an earthen dam, a road installed across a natural slope, a “cut out area” for a house or other building, and so forth. Sandier soils lack the ability to be as cohesive as clay soil.The stickiness of sand is far less than the stickiness of a clay type soil, thus the stability of the slope can be far less, and especially so under saturated conditions. Undisturbed soil

A steep fill slope on a highway that slid under saturated soil conditions.

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Fall • 2021 13

Ground Moves Cont’d from page 13

heavy rainfall events.

While I said above that vegetation on a slope usually tends to help stabilize a slope, be it a natural, undisturbed slope, or a vegetated constructed slope of some type, vegetation tends to hold or capture rainfall, causing slower storm runoff and therefore greater infiltration of rainfall into the soil profile.While a soil profile is considered a solid material, if it becomes wet enough during this infiltration process, soil can become a “flowable solid.” Once a soil profile on a slope becomes saturated enough to reach this supersaturation condition, under the effects of gravity, it can begin to move, or flow. If it suddenly moves fast enough, it becomes a landslide, occurring in seconds, and moving tons of slope material and everything on it, rapidly downhill.

Landslides can range from small sloughs (pronounced “sluffs”) to massive mountainsides sliding for thousands of feet downhill, taking

everything in their paths with them.

Homes, roads, culverts, bridges, vehicles, forests, anything can be destroyed in a matter of seconds.The depth of these slides can vary greatly, from a few feet, to many feet deep, and they can travel many feet per second.Average soil weighs 90 to 120 pounds per cubic foot.Thus, it is not uncommon for hundreds to many thousands of tons to be contained within the slide.

Slides can be from a few feet to many feet down into the ground surface, and the size of the slide can be from a few square feet to many acres in size.The shear volume and speed of a landslide can wipe out everything in its path.

One of the most devastating components of a landslide occurs when the slope gives way, sliding all the way down into a stream or river Mud and debris flow down a steep fill slope tearing out retaining wall. channel, usually blocking the channel flow temporarily.The slide forms an the runoff floodwater alone would within the channel overcomes the earthen dam, blocking the water flow have caused with no landslide dam. dam and a catastrophic wall of water down the channel. During the storm Water levels sometimes reach well is suddenly released down the stream and subsequent runoff into the blocked above normal flood levels, and this is channel.

This causes serious flash channel, the water forms a lake.At a flooding, creating higher water levels when houses, cars, trucks, factories, certain point, the force of the water in the channel and floodplain than infrastructure, buildings, bridges, and so against this saturated “landslide dam” forth are ripped from their foundations and washed down stream.This is also when the sudden loss of life occurs.

The other issue from a landslide reaching a stream or river channel is the tremendous added debris into the fast-moving flood water. Logs, whole trees, houses and other buildings and items now caught in the flood flow tends to block bridges and culverts. So, this already above normal flow now gets even higher, as the water coming down the channel tries to get around blocked bridges and culverts, thus causing even higher and deeper flood flows and doing even more damage.

Any human caught in this churning flow of debris and water is certain to die.

So, what is all of this to rescuers?

It is very likely you will be searching channels for deceased people, under debris, inside cars, inside destroyed houses or other buildings, people caught in strainers — in short, seeing things like you have never seen before.The magnitude and force of these events will not allow much in the way of rescue. Rescuers must be EXTREMELY CAREFUL around unstable slopes that have slid and in the channels below the slides. Go online and search for landslide videos.

I think that you will see that, when the ground moves, you can do nothing to stop it. Look in awe at these violent forces of nature, and then know that your rescue efforts will be just beginning when the ground stops moving!

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 highlevel 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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Rescue

Suspension Trauma:

A Lethal Cascade of Events (This is part one in a series on Suspension Trauma.)

In 2009, the Bureau of Dr. Norman Wood Labor Statistics estimated that there were over 212,000 industrial related falls that resulted in serious injury, 605 fatalities. That averages 48 falls per hour if considering a 12-hour work day and a work year of 365 days. Occupational Safety and Health Administration (OSHA) has stated that falls are the leading cause of construction death and the second leading cause of workplace injuries. The Consumer Product Safety Commission, CPSC, estimates that there are approximately 6000 treestand related injuries each year to hunters.

After a successful fall stop with a full body harness, a person will feel the obvious elation of still being alive.

But if immediate recovery back to a standing position is not possible, another less known lethal danger must be responded to very quickly; and it is called Suspension Trauma.

OSHA requires that a suspended worker be rescued “as quickly as possible,” presumably within 10 minutes. They further state, “Suspension in a fall arrest system can result in unconsciousness, followed by death, in less than 30 minutes.” ANSI Z359.2 states that contact with a suspended worker must be within six minutes.

In 2009, the Consumer Product Safety Commission (CPSC) stated in a letter to the Treestand Manufactures Association (TMA) that the use of a Suspension Relief Strap is not selfrescue. These decisions and rulings are not haphazardly determined; they are based on 40 years of research and studies conducted on harness safety and suspension trauma.

In 1972, during the Second International Conference of Mountain Rescue Doctors, an Austrian report was discussed in which 10 climbers had become suspended and had to be rescued. Some were using foot loops for suspension relief straps.

The rescues took anywhere from 30 minutes to eight hours. Two climbers died before help arrived, three died shortly after being rescued and the other five died over the next 11 days. None had any external signs of significant injury. They all died from suspension trauma but from different mechanisms of pathophysiology, which will be explained shortly.

The Innsbruck Mountain Rescue Service in Austria decided to do additional circulatory and renal testing after a review of the Austrian Report. They took 10 experienced rescue personnel and suspended all of them in their Sit harnesses and foot slings (suspension relief straps). They were instructed not to move.

The test was to proceed for a

16 Fall • 2021

minimum of 30 minutes. Three test subjects passed out before reaching 30 minutes and had to be revived.

The test was stopped shortly after 30 minutes for the other seven test subjects. All these test subjects survived without long term injury.

In concluding remarks on the papers of the Second International Conference of Mountain Rescue Doctors it was stated by the authors; “Orthostatic shock and typical respiratory obstruction may lead to death when hanging on a rope; the probability of survival after hanging two hours is small; death may occur during or after detachment from the rope when rescued.”

In 1987, at the request of OSHA, the United State Air Force conducted extensive harness suspension testing at the Wright Patterson Air Force Base, Ohio. Thirteen test subjects were given a comprehensive medical evaluation and screening before entry into the test group. Final test results showed that an immobile person suspended in a full body harness has an average physical tolerance limit of 14.5 minutes before exhibiting presyncopal or near fainting symptoms at which time the test was terminated.

Presyncopal symptoms included nausea, light headedness, peripheral vision loss, flushing and paresthesia of the extremities. The range of tolerance limits from five to 30 minutes was observed before testing was terminated. It was also noted that a person suspended in a vertical position is in danger of brain damage and eventual death within four to six minutes of fainting.

In 1997, NASA conducted a study on orthostatic intolerance in astronauts. During the study, one test subject became unconscious in three minutes. This study was the foundation for the article “Will Your Safety Harness Kill You?” by Dr. Bill Weems and Dr. Phil Bishop, OHS, March 2003.

For over 2000 years, man has known that being suspended in a vertical position with the legs immobile can cause death. In the Bible, references to the death of Jesus Christ indicate that he died between three and six hours. Crucifixion victims ultimately died of suspension trauma induced pathology, the customary breaking of the legs, only hastened the outcome.

Tilt table testing has confirmed that even in the absence of being suspended in a harness, hypotension, bradycardia and presyncopal symptoms can occur in 80 percent of healthy adults in less than one hour. These same symptoms have been recorded in EMS training exercises where a healthy subject was immobilized on a backboard and carried feet first down flights of stairs. It is very common for military personnel to pass out while

standing at attention. Gravity and immobility is all that is required for a syncopal event to occur in a vertically positioned person; being suspended in a harness allows fainting to occur quicker and it can be lethal.

It is very evident that body posture, health of the individual, immobility, gravity, body weight, vasovagal responses to pain, emotional stress, hypovolemia, hypotension, bradycardia, cerebral hypoxia, dehydration, exhaustion, confusion, panic, hypoglycemia, restrictive respiration and obstruction to blood Tilt Table Testing circulation all play important roles in the Suspension Trauma Cascade of companies in the past. Failure To injury and death.

Warn has been ruled negligence by Over the past 40 years, study the courts and multimillion dollar after study has confirmed that being suspended in certain types of harnesses settlements have been common.

“During your official capacity accelerate the onset of syncopal events and suspension trauma.A full body harness can allow for a life-saving experience, but immediately upon suspension, time can quickly run out in a matter of minutes due to the rapid activation of the suspension trauma cascade of events. If this cascade is allowed to progress, a suspended person will experience each and every one of these events, including death.

In an overall view of suspension trauma, one must mention the liability aspects of training, equipment and the personal safety of employees and consumers.“Failure To Warn” litigation has been Gravity and Immobility is all that is required for Blood Pooling to occur. a very costly endeavor for

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and in the course of instructing or advocating the use of any product, you MUST provide complete information and inform of ANY potential dangers in using that product if there is ANY possibility of it causing injuries.”This description of Failure To Warn, lays out the heart of the matter; there are moral, ethical and legal responsibilities that must be adhered to for personal safety, and if not stringently followed, the cost of litigation will only be outweighed by the cost in human life.

Harness Type and Suspension Trauma Factors A distinction needs to be made between a front-attached work harness similar to an Alpine, Climbing or an Arborist Sit harness, and a rear-attached safety harness that is used in construction and hunting from treestands.

A front-attached Alpine, Climbing or Sit work harness is designed for the user to be suspended in them while they work; the very design of these harnesses causes very little pressure against the femoral vein in the legs, the main vessel that returns blood from the legs. Also, while suspended in this type of harness, the upper sections of both legs are in more of a horizontal position helping to negate the gravitational pull on the blood.

Both of these qualities in conjunction with active movement of the legs and body allow for a comfortable suspension with less incidence of blood pooling and suspension trauma injury or death.

Even though blood pooling can occur, the length of time that one can be safely suspended without injury is greatly increased as long as there is active movement. The Hybrid Sit Harness while using the sternal-attachment does not provide the same level of safety as the waist-attachment location. A sternal-attachment is not intended for prolonged suspension and presents similar hazards to a rearattached harness.

A rear-attached safety harness commonly used in construction and by treestand hunters is not intended to provide long term suspension.

Its sole purpose is to provide a fall stop and then one must remove themselves from the harness as soon as possible. When suspended in a rear-attached harness, the Suspension Trauma Cascade begins immediately.

With this type of harness, there is direct pressure placed on the femoral vein and nerve from the leg straps, and the legs are hanging in a vertical position allowing for an increased effect of the gravitational pull on the blood.

While suspended, a restrictive force is also placed against the abdominal and thoracic areas increasing the difficulty in breathing and discomfort. A rear-attached harness is very difficult to move in and will drain all your energy to exhaustion very quickly. In personal testing and harness development over the past 10 years involving thousands of suspensions, my personal exhaustion limit in trying to recover to a standing position is

Carolina Fire Rescue EMS Journal

Front-attached sit harness design ensures very little pressure placed on the femoral vein.

reached in less than five minutes, and the presyncopal or Suspension Trauma symptoms of tachycardia, nausea, shortness of breath and a feeling of increasing anxiety are felt in less than 10 minutes. I do not believe that I could remain conscious for more than 20 minutes while suspended in a rearattached harness.

All of these factors result in immediate pooling of blood in the legs, a very rapid deterioration of overall blood circulation, decrease oxygenation of visceral organs, heart and brain and an increasing level of physical discomfort and emotional stress. These immediately combined factors support the progression of the Suspension Trauma Cascade which is responsible for a suspended victim becoming symptomatic very quickly and losing consciousness.

Suspension Trauma Cascade While 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 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 one-way 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 presyncopal 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 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 everprogressive rate.

The average human body contains 10 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 and the body has a decrease of 20 percent 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 percent (six pints) of a body’s total blood volume. As soon as the heart has pumped over 40 percent (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,

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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 dominate in an emergency unless reduced by an increasing 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 see SUSPENSION TRAUMA page 19

Normal Circulation

Blood Pooling

Fall • 2021 17

Feature

News From the N.C. State Treasurer

Focused Discipline for Your Retirement

Are you doing enough to reach your retirement goals?

In general, it is recommended you have 80 percent of your preretirement Dale Folwell income in retirement to maintain the standard of living to which you are accustom. How can you need less income in retirement?

There are several considerations, and it comes down to your expenses. By the time you retire, your home may be paid off, so you no longer have a mortgage payment. Child-related expenses and ongoing contributions to retirement savings will go down. Some people can do it with less, some people will have more, but we all will have a need for income in retirement.

Saving early and saving often will lead to better financial security, and a small amount can make a big difference.This simple strategy works because compound interest is applied to your initial savings

and reinvested earnings.Your savings will accumulate as the years pass and when you reach retirement you will see that, as the saying goes, time is literally money.

If you are a member of the Local Governmental Employees’ Retirement System (LGERS), the same concept applies.You contribute six percent of your income to your pension each month and your employer, on average, contributes 14 percent on your behalf.

This, combined with investment earnings — which reached 14 percent at the end of 2020 — provides the foundation for your potential lifetime pension benefit.

Not everyone starts early and continues working all the way through to retirement. Some people are not thinking about retirement in their 20s and 30s.

Others may stop working to take care of children and families. In these cases, the other adage rings true — there is no time to lose. Starting later and filling in the gaps takes effort and dedication because you have lost the power of compounding incremental savings over a longer period.

There are some things you can do: cut

expenses, start saving and save more.

If you are working for an LGERS employer, you may be eligible to participate in the North Carolina Supplemental Plans (NC 401(k) and NC 457 Plans) (Plans).These are some of the largest and lowest cost plans of their type and these supplemental retirement savings can help to increase your income.

And, unlike some plans, you do not have to leave the plans when you leave your job. In fact, you can roll money in and remain in the plans up to and through retirement, continuing to reap the benefits of high performance, low cost and one-on-one counselor support.

The plans have received over 15 awards for plan design, participant education and communication.This year the annual National Association of Government Defined Contribution Administrators (NAGDCA) Leadership Awards Program, designed to distinguish the brightest ideas and most innovative solutions from across the industry, recognized the Department of State Treasurer (DST), Board of Trustees (board) and staff with two Leadership awards for outstanding achievements in Technology and Interactive Multimedia and National Retirement Security Month awareness.

Being recognized with two leadership awards in high-impact categories is a testament to the good work and collaborative relationship between the board and staff, and individual employers and participants.

If you are volunteer firefighter who works full-time for a non-governmental employer, I would encourage you to participate in the retirement offerings at your workplace. No matter who your employer is, it is important to know and understand your retirement benefits including investment options, an employer match or additional contribution.

While some firefighters and rescue squad workers are contributing members of LGERS, all firefighters and rescue squad workers who meet specific requirements and contribute $10 per month are

members of the Firefighters’ and Rescue Squad Workers’ Pension Fund (FRSWPF).

Each of these benefit plans are governed by the LGERS Board of Trustees (LGERS Board) who actively serve with a member-first mentality.They work with DST staff to ensure the plans are working for the benefit of past, current and future members, including eligible firefighters and rescue squad workers.

By statute, there is a FRSWPF Advisory Panel (panel) that is responsible for considering the status and needs of the FRSWPF alone.There are times when this fund may diverge from the needs of other pension plans, requirements of state or federal law, or the policy goals of other stakeholders. Per statute, the panel consists of seven people, including: the Director of the Retirement Systems, a North Carolina Department of Insurance designee, one person representing the public at-large, and four paid and volunteer firefighters and rescue squad workers. In addition, one of the members of the panel must also serve on the LGERS Board.

DST supports, informs and provides advice to the panel.A Status and Needs Report for the Firefighters’ and Rescue Squad Workers’ Pension Fund is presented annually to the LGERS Board. In this report, the panel provides recommendations for funding and investment policies, administration and benefits and other items that may provide further efficiencies.

With the member-first mentality, the LGERS board, panel and staff at the Retirement Systems Division work together to find out what is right, get it right and keep it right on behalf of those that teach, protect and otherwise serve the citizens of North Carolina.The results of this effort have been significant and the FRSWPF has reached new heights in funded ratios.

As of Dec. 31, 2019, the FRSWPF had approximately $459 million in assets and over 55,000 members, with an actuarial valuation placed the funded ratio at 92.3 percent — significantly higher than 83.7 percent just eight years ago.

Your pension is a part of your retirement income. But this typically must be combined with other savings and income sources, like Social Security.Your supplemental retirement savings (NC Plans) will help to build your retirement income to a level meets your expectations and where you want to be in retirement.

If you can, I would encourage you to save early, save often and utilize your employer’s benefit offerings.

Thank you for your dedication and support to the communities and people in North Carolina.

The FRSWPF provides benefits to all eligible paid and volunteer certified firefighters and rescue squad workers. For more information about the FRSWPF, enrollment documents, monthly contributions, and applying for retirement, visit: https://www.myncretirement.com/nonretirees/fire-and-rescue-personnel For more information about LGERS and the North Carolina Retirement Systems, visit: https://www.myncretirement.com/

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Suspension Trauma Cont’d from page 17

rate, blood pressure and cerebral perfusion. This can take a minute 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.”

(Next issue will discuss more about the 10 victims from the Austrian report.)

During his recovery and up to the present time, Dr. Wood has been working on safety products that make elevated work and treestand hunting safer. He has been awarded four U.S. Patents for fall safety equipment and is the owner of several U. S. Patent Pendings.

In 2010, Dr. Wood finished his long term project, The Rescue One CDS (Controlled Descent System) harness, a new revolutionary full body safety harness that eliminates serious injury or death from suspension trauma.

Dr. Wood is currently the lead physician for Kittitas Valley Healthcare Medical Clinic, Cle Elum WA.

Rear-attached safety harness leg straps exert direct compression of the femoral vein.

Dr. Wood was a member of the West Virginia WV State Police in 1985 and became a Special Agent for the Organized Crime Drug Enforcement Task Force, US Customs Service, San Francisco, CA. He later attended the West Virginia School of Osteopathic Medicine, after 16 years in law enforcement. He graduated with honors. In 1998 during his residency training, he fell 20 feet out of a tree while trimming a limb. He was not wearing a fall arrest harness.

Dr. Wood had to drag himself 100 yards, crawl onto his 4-wheeler and drive to his cabin to call for help. He was transported to the Trauma Center where he worked and was placed in the Intensive Care Unit for the first week. He broke his pelvis in two places, left hand and had internal bleeding. As Dr. Wood states, “when you cannot walk for almost four months it gives you a lot of time to think”.

Vasovagal Event (Fainting)

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Fall • 2021 19

Feature

Firefighter Hoods: Benefits of Particulate Blocking Technology The area around your jaw, face and neck is the most vulnerable spot when exposed to fireground contaminants from soot and smoke.

Todd Herring While standard knit hoods protect you from heat and flames, they do not provide the protection you need from hazardous particles. In recent years, improvements to firefighter hood designs have led to advanced particulate blocking protection. I encourage all fire departments to become educated on the importance of particulate blocking hood technology for the health and safety of their crew members.

4 Reasons Firefighters Need Particulate Blocking Hoods 1. Keep Up to 99 Percent of Contaminants at Bay Particulate blocking hoods act as a filter to reduce your exposure to persistent fireground carcinogens and other toxins.With innovative particulate blocking technology, these hoods can block particulates at 0.2 microns in size or larger! Envision this, there are approximately 25,400 microns in one inch, and a human hair is about 75 to 100 microns wide, so a 0.2-micron particulate is about 500x smaller than a strand of hair.

2. A Classic Knit 2-Layer Hood Only Blocks 27 Percent of Harmful Particulates Average hoods offer limited protection against toxic particles.The

20 Fall • 2021

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FAST Test Report demonstrated that particles at 2.5-micron size penetrated the standard knit hood and left a concentrated, heavy deposit on the participant’s neck, cheeks, ears and jaw.

3. Firefighters Are More Likely to Be Diagnosed with Cancer Than the General Public According to research from the Center for Disease Control (CDC) and the National Institute for Occupational Health and Safety (NIOSH), as a firefighter, you have a nine percent higher risk of being diagnosed with cancer compared to the general U.S. population.

4. You Control Your Level of PPE Protection Do not let your hood be the weakest link in your gear.With firefighting, many unpredictable elements come with responding to a call. So, take the time to research and find the right solution that will keep your crew safest on the fireground for years to come.

Today, firefighting PPE manufacturers continue to look at fire gear as a way to reduce your chances of succumbing to heat stress and exposure to carcinogens.

Todd Herring began his journey at Fire-Dex in September of 2015 as part of the acquisition of TECGEN. With over 20 years of experience in the protective textile industry, Herring was soon promoted to Director of Marketing and Product Development in August 2016. Gaining the title of Vice President of Product Innovation and Strategy in 2021, he currently leads the newly created Product Innovation and Strategy team. He holds a Bachelor of Science in Textile Engineering from NC State University.

Carolina Fire Rescue EMS Journal

Leadership

The 7 Qualities Fire Service Leaders Must Possess — Courage

During this series we have been examining the seven qualities that are necessary Doug Cline for a leader to be successful in leading the organization and the team.

You cannot be an effective team leader without courage. Part seven will focus on courage.

Courage is defined as “the ability and willingness to confront fear, pain, danger or uncertainty.”

Courage is a powerful word, especially in leadership.You can see why when you look back to its Latin origin, Cor, meaning heart and then consider today’s dictionary definition: mental or moral strength to venture, persevere, and withstand danger, fear or difficulty. Historically and not so long ago the word courage and courageous was often reserved for describing superheroes, Greeks Gods, cartoon characters and historical heroes like Martin Luther King and others.

It certainly wasn’t used until recently to describe officers or leaders in the fire service culture. In fact, historically emergency service leaders were seen and celebrated more for being stoic, powerful and with a more command and control approach. However, over the years the fire and emergency services have had leaders who demonstrated courage. Individuals who have fought for safety, progressive tactical changes and mental health understanding in our profession.

Courageous leaders are people who are able to push through uncomfortable situations.They are willing to make difficult decisions and do not back down when things get too hard. Courageous leaders take risks that go against the grain of their organizations and the profession.They make decisions with the potential for revolutionary change in their organizations and profession.

Their boldness inspires their members, energizes the culture and positions their organization as leaders in societal change.

These courageous leaders have five strong leadership characteristic traits that need to be noted.

empathize with others, overcome challenges and defuse conflict. Emotional intelligence helps you build stronger relationships, succeed at school and work, and achieve your career and personal goals. It can also help you to connect with your feelings, turn intention into action, and make informed decisions about what matters most to you. It is well known that top leaders in the emergency services have a high degree of emotional intelligence.

3. Resilience is the capacity to endure challenges and to gain strength in the navigation of these challenges. Leadership in its self can be challenging.When complex emergency services industry problems present themselves, you as a courageous leader must have a strong mind set and address them head on.

4. Self-discipline is the ability to push yourself forward, stay motivated, and take

action, regardless of how you’re feeling, physically or emotionally. Motivation and willpower contribute to it, as do persistence, the ability to follow through on your intentions and hard work. In addition to building self-awareness and a deeper understanding of your emotions, you need to exercise self-discipline and demonstrate poise — even in the most trying circumstances.

5.Authenticity is defined as the quality of being genuine or real.

Authenticity is foundational to courageous leadership. I have found that employees’ perception of authentic leadership serves as the strongest predictor of their job satisfaction, organizational commitment and workplace happiness. Research shows that organizations, which are comprised of leaders who are true to themselves, demonstrate improvements in both employee trust and performance.

In this seven-part series we have explored the seven qualities fire service leaders must possess. It is critical that all seven of these qualities be executed and practiced every day as a leader.

Douglas Cline is Chief of the Training and Professional Development Division with Horry County Fire Rescue. He is the Executive Editor for The Fire Officer and Executive Director for the Command Institute in Washington D.C. A 36 year fire and emergency services veteran as well as a well-known international speaker, Cline is a highly published author of articles, blogs and textbooks for both fire and EMS. As a chief officer, Cline is a distinguished authority of officer development and has traveled internationally delivering distinguished programs on leadership and officer development. He also has a diverse line of training videos on leadership, rapid intervention team training, vehicle fires, hose line management, and emergency vehicle operations and fire ground safety and survival.

1.Commitment to the Purpose or more commonly known in emergency services as the Mission,Vision and Values.

It is critical to understand that purpose is essential to individual, organizational and industry success. Commitment is known to build resilience and performance of our emergency services industry. It is imperative that we focus on being purpose-driven as we execute to accomplish all we do to meet our mission.

2.Emotional intelligence is the capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathetically. Emotional intelligence — otherwise known as emotional quotient or EQ — is the ability to understand, use and manage your own emotions in positive ways to relieve stress, communicate effectively,

Carolina Fire Rescue EMS Journal

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Fall • 2021 21

Recruiting & Retention

GENERATIONS IN THE WORKFORCE:

Baby Boomers and Generation Z Expectations, Differences and Understandings

In the arena of public safety, police, fire, emergency medical services and emergency Mark Rivero management administration, we are able to see that the generations of employees can range from the Baby Boomers to Generation Z.What comes to mind is not just the potential age differences but what does one see as the important difference between the two groups?

In discussing these phenomena and its interpretation, what are the expectations and the resulting actions either attitudinal/psychological or physically and also how do we expect each group to act with each other? Attitude is actually a subjective measurement that will depend on each person in each group. Physically, it’s measured simply as the ability to perform the strenuous activities on the fire ground and how well do you recover.The recovery becomes very important as we age and also as we attempt to train and keep up with the younger personnel.

However, what do the two generations expect of each other when it comes time to perform in actual firefighting skills on a live scene?

For those in the Baby Boomers era, age has now become an important factor as we have experienced drastic physical changes to our bodies.The mind says we can still run upstairs with the high-rise pack, extra air bottles and

22 Fall • 2021

ancillary equipment and then begin the firefighting activities.When the fire is out, now we face the reality that firefighting is really a young person’s game.

How do we meet the expectations of those in Generation Z? Do we recover physically as we did last year or even five years ago and when do we make that decision of potential retirement? Now when we look at the energetic Generation Z firefighter, we see that they can perform this same fire scenario numerous times and the recovery seems like hours for them and days for the Baby Boomers.

Attitude is always great on the fire scene as everybody wants to perform and get done as fast as possible.

Maturity, wisdom or aging for the Baby Boomers seems like it’s far off into the distance rather than just around the corner, but here we have that attitude that is trying to keep us young.

The Generation Z firefighter, looks at attitude and asks when you are going to call it a day and move on.This is an expectation that is natural but, the Baby Boomers grew up with the attitude of giving 110 percent. Does Generation Z know what giving 110 percent is like?

In recent discussions with individuals from multiple career fields and jobs, responses were all over the spectrum. In reality, Baby Boomers grew up in a time where computers were not the norm and cell phones were only thing seen on TV shows like Get Smart where the phone was in the shoe.

Expectations for the Baby Boomers was also to get a job early on in life and look

for one that has a future and retirement benefits. Expectations for Generation Z appears to be different in ways that one can ask if they understand what is meant by giving 110 percent.

Generation Z has experienced the ability to have instant results with modern technology and in reality that cell phone that is almost in everyone’s hands is really a computer with a phone application. Generation Z can seek answers to questions in seconds and demonstrations on how to do it on Youtube.With these differences in the workforce, one can see why there is a difference in the attitudes of the two groups.This is not saying it’s good or bad, its simply showing that technology has changed the expectation time frame and today its simply faster than what was available 20 to 30 years ago.

With the attitudes of the two generations what does one expect when working together?

Cooperation will always be the key.

For the two groups as in any training or work scenario, show me how to work smarter not harder.This brings us to the relationship of how do we work smarter and not harder together? Well, one way is to show respect for each other no matter what the skill level between the two groups. Respect will go so much further when working with each other because one person does not know everything and when one shows that attitude, maybe it’s time for a conversation on how are we going to complete the task at hand?

There will be times that training with these two groups can be enjoyable and when things are taught in a fun setting, all involved end up learning more and a positive outcome is achieved and the benefit is valued by all. Respect is also earned from both groups when they are able to understand what is expected

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from each other and also on how individuals of each group can cross train or educate each other on the skills that are lacking because of technology shortcomings.

What happens when two totally different generations work side by side when mitigating an emergency scene?

If the groups have trained together, they will know the expectations of their fellow worker and they can assign each person to a role that they know will be accomplished quickly and efficiently and to the expectation of the supervising officer. In the long run, these groups will be working with members of more than just the Baby Boomers and Generation Z.When training and/or working emergency incidents is done in compliance with the organization’s expectations the observing individuals, either the public or organizational leaders will see, not only coordination and progress but discipline that is needed to function in a positive manner to get the job done.

Mark Rivero worked for the City of Las Vegas, Nevada, Fire and Rescue from 1992 until 2011, holding positions as firefighter, training officer and, ultimately, professional development officer, creating degree pathways for fire service personnel and bringing in educational institutions to address higher education topics and degrees that were specific for the fire service. He currently serves as a program advisor/site coordinator for Southern Illinois University, and as the chairperson for the doctoral degree path committee for professional development at the National Fire Academy.

He also works with the American Council on Education, reviewing fire service courses at various institutions across the United States. Rivero received his doctorate from the University of Nevada, Las Vegas, in 2004.

Carolina Fire Rescue EMS Journal

Active Shooter

Active Shooter: Is There Really a Problem?

I am excited to join the Carolina Fire Rescue EMS Journal and introduce a new series, where Chief Julie Downey we will discuss Mass Casualty Incidents (MCIs) and Active Shooter/Hostile Events (ASHE) In this series we will discuss multiple considerations including: • Is there really a problem?

• History of MCI Response • The True First Responder to an MCI or ASHE • Stop the Bleed • MCI and ASHE Response • EMS and Law Enforcement integrated response/ Rescue Task Force (RTF) • Unified Command Best Practices •Patient Care for an MCI/ASHE •Patient Tracking •Training and Exercise •MCI/ASHE Documentation •Recovery

Is There Really a Problem?

Mass shootings are the most common mass casualty events and are the most studied type of mass casualty/active shooter incidents.

The FBI defines an “active shooter” as an individual actively engaged in killing or attempting to kill people in a populated area and Congress defines the term “mass killing” as three or more killings in a single incident.

According to FBI data (www. fbi.gov) between 2000 and 2018 in the United States there were 277 active shooter incidents. In comparison, according to the Congressional Research Service between 1999-2013 there 66 active shooter incidents recorded.

The number of mass shootings occurring in the past 10 years is almost two and half times greater than the decade prior (1998 to 2007). More than half or 57 percent of all recorded mass shootings occurred within the past 10 years, as reported from

the 2018 National Crime Victims’ Rights Week Resource Guide. The data does not include shootings because of gang or drug related incidents.

As we can see with the dramatic increase in Active Shooter/Hostile Event (ASHE) incidents, there is definitely a problem in the United States. The increase in ASHE has forced fire rescue, EMS, and law enforcement to reexamine how to respond to ASHE incidents, as well as how to rapidly treat and remove victims from potentially hostile environments as safely as possible for responders.

When we review the afteraction reports of ASHE incidents, there are several common challenges that have occurred.

These include the lack of unified command between fire rescue, EMS and law enforcement; communication issues with between fire rescue, EMS and law enforcement; difference in terminology or radio codes; reluctance to respond into an area that has not been deemed safe and secure from law enforcement; reluctance to respond into the “warm zones” with a properly trained and equipped rescue task force; and lack of asset/resource knowledge from neighboring jurisdictions.

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History of MCI Response That Has Led to Change On April 20, 1999, the Columbine High School shooting occurred. Twelve students and one teacher were killed and 24 were wounded. There were two shooters who had self-inflicted fatal wounds within 45 minutes from start of incident but there was no significant law enforcement entry for over an hour and no medical operations for four hours.

After this incident occurred, the law enforcement community had a paradigm shift and adjusted their procedures/tactics to quickly enter an area where shooters are

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Fall • 2021 23

Active Shooter Cont’d from page 23

suspected to be and make contact with the shooter(s). However, the incident had little to no change in the way fire departments or EMS responded into an ASHE incident. Fire rescue and EMS assets continued to stage until law enforcement determined the scene was secure — location determined to have no continuing threat and controlled by law enforcement — which can last hours. As a result, there was a significant delay in medical operations and the wounded continued to die.

In April of 2013, after the Sandy Hook Elementary School shooting in December 2012 that killed 20 children and six adults, members of multiple agencies — International Association of Fire Chiefs (IAFC), International Association of Police Chiefs (IAPC), Federal Bureau of Investigation (FBI) American College of Surgeons, Department of Homeland Security (DHS) and many other organizations formed a committee. The committee’s goal was to create a national policy to enhance survivability from intentional mass casualty and active shooter events. The committee’s recommendations are called the Hartford Consensus. The Hartford Consensus concluded that “integrated and coordinated

24 Fall • 2021

planning, policies, training and team building prior to any incident will ensure effective and successful response.”

Over the next three years the Hartford Consensus developed four additional reports. https:// www.facs.org/about-acs/hartfordconsensus. The four reports are: 1. I mproving Survival from Active Shooter Events 2. Active Shooter and Intentional Mass Casualty Events 3. Implementation of Bleeding Control 4. The Hartford Compendium on improving survivability from mass casualty events.

Across the country, we started to see fire department and EMS agencies begin to train with law enforcement for an integrated response. Fire, EMS, and law enforcement thus began to work together to save lives in an ASHE in the warm zone, but there still was no consensus standard in place.

On June 12, 2016, the Pulse Orlando nightclub shooting occurred, in which 49 people were killed and 53 more were wounded.

After that incident, the National Fire Protection Agency (NFPA) was requested to develop a standard, multidisciplinary program for preparedness, response and recovery to active shooter/ hostile events with 53 members appointed to the committee from a wide range of expertise. The

standard was developed and, in 2018, NFPA 3000 Active Shooter/ Hostile Event Response (ASHER) Program was released. The ASHER Program focused on bringing all facets of communities together to provide a unified prevention, response and recovery plan. The program offered comprehensive criteria for organizing, managing and sustaining a multidisciplinary ASHE standard based on an organization’s or community’s level of risk. NFPA 3000 2021 Edition was approved as an American National Standard on April 4, 2020.

The NFPA 3000’s main objectives are to prepare a single set of requirements to be used by a whole community addressing unified command, integrated response and planned recovery.

The standard explains these principles further: • Unified Command – How and why the unified command structure at an operations level needs to be in place, practiced and physically in the same location.

• Whole Community — Providing training and education to community members, preparedness information, bleeding control and emergency action plans for facilities.

• Integrated Response — All responding public safety agencies must have operational

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plans that incorporate the objectives of other agencies, and they must function as a cohesive, integrated unit.

• Recovery — There are several aspects of recovery — immediate, early, and continued recovery — that need to be planned for.

I hope this has been a good review of MCI/ASHE response that has created additional discussion and research. I look forward to the next magazine’s MCI/ASHE article where we will continue this discussion. – Stay Safe Julie Downey, Fire Chief for Davie Fire Rescue (Florida) certified firefighter/ paramedic for 40 years, and Chief Officer for 17 years. For over 25 years I have been involved with MCI training, and exercises and have conducted over 300 exercises throughout the state and across the country. I have been recognized by the White House for my initiatives in the Stop the Bleed program.

I am a Technical Committee member for the NFPA 3000 Standard for an Active Shooter/Hostile Event Response Program and am the Chair of the State of Florida Disaster Response Committee. I am also the author of the State of Florida MCI Procedure and MCI Field Operations Guides and have authored or coauthored over a million dollars in grant funding for MCI/ASHE related equipment and training.

Carolina Fire Rescue EMS Journal

Barnyard Management

Unanswered Prayers

In 1990 the popular country singer Garth Brooks released a song called “Unanswered Prayers.” Take a little journey Ken Farmer back in time to this song with me. The words to the song start with the following:

Just the other night at a hometown football game My wife and I ran into my old high school flame And as I introduced them the past came back to me A nd I couldn’t help but think of the way things used to be She was the one that I’d wanted for all times A nd each night I’d spend prayin’ that God would make her mine A nd if he’d only grant me this wish I wished back then I’d never ask for anything again Sometimes I thank God for unanswered prayers

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Remember when you’re talkin’ to the man upstairs T hat just because he doesn’t answer doesn’t mean he don’t care Some of God’s greatest gifts are unanswered prayers S he wasn’t quite the angel that I remembered in my dreams And I could tell that time had changed me In her eyes too it seemed We tried to talk about the old days There wasn’t much we could recall I guess the Lord knows what he’s doin’ after all And as she walked away and I looked at my wife And then and there I thanked the good Lord For the gifts in my life As you hear these words, I am confident that most of us have had many similar unanswered prayers.

You remember the job you always wanted, the car you had to have, and maybe even the guy or girl that you knew would make your

life complete and perfect!

Well, most of us, including me, have these bittersweet memories.

All the things we just knew we had to have to get our life in balance and promised to God that “if he would grant me this wish, I would never ask for anything again.”

Thank goodness that God knows more about our real needs than we do! As the words continue, it says “that just because He doesn’t answer doesn’t mean he don’t care” is so very true.

The Bible refers to the Book of Life eight times. This reference is found in both the Old Testament and the New Testament. The Book of Life assures that God knows his true followers, keeps and protects them during their earthly journey, and brings them home to him in heaven when they die.

I have always thought that once you get to heaven, they will let you read from the Book of Life, and you will understand clearly why things did and did not happen. Things like how you missed being in the bad wreck that happened right in front of you? Why you did not die in an awful fire that night? Why you did not marry that special girl or guy or even how your life ended up

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like it did?

You can’t help but wonder how things happened and how you were blessed in your life.

The words to this song can give you a lot of insight and hopefully some blessings when you stop and think about your life. I had a chance a few weeks ago to drive through my hometown. Things did not appear to have changed much to me. Many of the buildings were smaller now than what I remember as a child and most things had not changed that much.

My former high school had been added to with a nice new addition but the for the most part, time had been good to Yanceyville. Like all of us, I remember the good times and bad times in high school.

All the things you wanted and dreamed about and many which you never achieved.

As I enter the latter part of my life, I often think about my own unanswered prayers. Just like the song, I have learned to thank the Good Lord for the many gifts in my life.

Don’t ever forget to say thanks for the many gifts in yours. It is what makes life worth living in these ever-challenging times.

Stay Safe

Fall • 2021 25

On-The-Job Safety

Eye Protection: New Standard Addresses Spray, Spurt of Biological Hazards

By Nicole Randall Even before COVID-19, protecting first responders’ eyes from biohazards and bloodborne pathogens was an important priority, yet one that might be easily overlooked by an EMS crew rolling up on a chaotic scene.With the delta variant’s higher transmissibility, however, the need for proper protection is even greater.

The Herald Sun reported in August, for example, that “450 North Carolinians died of COVID-19 at home last year,” noting that Cabarrus County Emergency Medical Services alone received 198 COVID-19 emergency calls.“Most people in the grips of COVID-19 required advanced life support care, such as breathing tubes or masks hooked to oxygen supplies when paramedics arrived. In some cases, they were unconscious,” the article noted.

While the need for eye protection has grown, figuring out the best equipment to use hasn’t always been easy or straightforward.A new standard was recently released to help: ANSI/ISEA Z87.62 – 2021 American National Standard for Occupational and Educational Eye and Face Protection Devices for Preventing Exposures Causes

by Sprays or Spurts of Blood of Body Fluids.

ANSI/ISEA Z87.62-2021 sets forth criteria related to the general requirements, testing, permanent marking(s), selection, care and use of protectors to minimize or prevent exposure to the wearer’s eyes and/or face — mucocutaneous exposures, nose and mouth — caused by spray or spurt of blood, body fluids and/or other potentially infectious materials.This new standard is a first iteration and does not encompass every biological hazard.Within this context, test criteria specifically do not assess aerosolized pathogens, although they may be considered in a subsequent

26 Fall • 2021

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version.

The International Safety Equipment Association (ISEA) led the process of creating the new consensus standard, which represents the safety equipment industry’s first effort to standardize eye and face protectors used in occupational settings where spray and spurt biological hazards pose a risk.The new standard won American National Standards Institute (ANSI) approval in July 2021.

Spray and Spurt Protection Spray and spurt protection are assessed through a robust test method applied to a range of products categorized by their effective coverage area of the eyes, nose and mouth. Requirements for conforming products are similar to those in ANSI/ISEA Z87.1 for optical quality and some physical requirements. (ANSI/ ISEA Z87.1, the widely adopted American National Standard for Occupational and Educational Personal Eye and Face Protection, was updated in 2020.)

“Every day, millions of workers in healthcare settings, clinical research and testing facilities, veterinary services or first responder environments are exposed to bloodborne pathogens, and occupational health and safety regulations require employers to protect employees from these hazards,” said JP Sankpill, director of safety regulatory compliance at Essilor of America, and chair of the Z87 Committee.

Jim Harris, PhD, PE, National Institute for Occupational Safety and Health (NIOSH) and vice-chair of the Accredited Standards Committee on Safety Standards for Eye Protection, Z87, added that while new safety products quickly entered the market attempting to meet demand, there was no standard by which to evaluate how well these products performed on see EYE PROTECTION bottom of page 30

Carolina Fire Rescue EMS Journal

A Perfect Elixir for Financial Stress — Drink Up Now and Sleep Better Tonight!

Personal Finance Tips That Will Change the Way You Think About Money of the progress you’re making toward your financial goals — or warn you if you’re backsliding. I suggest doing this before the start of a new year so that you will be ready for the coming 12 months.

However, you should track medical expenses, car repairs and ANYTHING that you don’t track in your monthly budget under miscellaneous.

How to Budget Like a Pro

ASK MR. BILL

A column devoted to answering your questions on consumer, mortgage, small business and non-profit investments and lending programs to help you navigate the new financial landscape. Send your questions to bill.carter@civicfcu.org.

We’ve certainly amassed a wealth of knowledge over the years.Whether it’s the dozens of “I got out of debt” success stories we’ve been a part of to the scores of psychological studies we’ve covered linking better financial decision-making to behavior change.

There is no better time than now to review our top money tips into one juicy, super-helpful read. From the best ways to budget, to how to boost your earning potential like a pro, these nuggets of financial wisdom are as fresh as the day they were published.

First Things First: A Few Financial Basics 1. Create a Financial Calendar If you don’t trust yourself to remember to pay your quarterly taxes or periodically pull a credit report, think about setting appointment reminders for these important money to-dos in the same way that you would an annual doctor’s visit or car tune-up.

2. Check Your Interest Rates Q: Which loan should you pay off first?

A: The one with the highest interest rate and/or the largest monthly payment.

Q: Which savings account should you open?

A: The one with the best interest rate.

Q: Why does credit card debt give us such a headache?

A: Blame it on the compound interest rate. Bottom line here: Paying attention to interest rates on all accounts will help inform which debt or savings commitments you should focus on.

3. Track Your Net Worth Your net worth — the difference between your assets and debt — is the big-picture number that can tell you where you stand financially. Keep an eye on it, and it can help keep you apprised

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4. Set a Budget, Period This is the starting point for every other goal in your life.

Here’s a checklist for building a knockout personal budget.

• Create an Excel spreadsheet listing all known fixed expenses — mortgage, car loan, insurance payments, fixed loan payments.

• List all known variable expenses — utilities, food, gas, credit card minimum payments.

• Create a column for non-monthly recurring expenses such as medical bills or auto repairs.Although not in your monthly budget of expenses, you should record these larger unexpected expenses each month to obtain an estimate of what your annual expenses in these areas will be.Although not coming as a regular monthly expense each month, you will need to track and total each quarter to estimate how much you need to set aside in your monthly budget to save for similar expenses moving forward that you consider miscellaneous.

5. Take a Daily Money Minute Many of the top financial advisors recommend setting aside one minute each day to check on your financial transactions.This 60-second act helps identify problems immediately, keep track of goal progress and set your spending tone for the rest of the day! It’s just simply a matter of being aware of what’s going on in your accounts.

6. Allocate at Least 20 Percent of Your Income Toward Financial Priorities By priorities, we mean building up emergency savings, paying off debt and padding your retirement nest egg.

7. Budget About 30 Percent of Your Income for Lifestyle Spending This includes movies, restaurants, and happy hours — basically, anything that doesn’t cover necessities. By abiding by the 30 percent rule, you can save and splurge at the same time.

How to Get Money Motivated 8. Draft a Financial Vision Board You need motivation to start adopting better money habits, and if you craft a vision board, it can help remind you to stay on track with your financial goals.

9. Set Specific Financial Goals Use numbers and dates, not just words, to describe what you want to accomplish with your money. How much debt do you want to pay off — and when? How much do you want saved,

and by what date?

10. Adopt a Spending Mantra Pick out a positive phrase that acts like a mini rule of thumb for how you spend. For example, ask yourself,“Is this [fill in purchase here] better than Bali next year?” or “I only charge items that are $30 or more.”

11. Love Yourself Sure, it may sound corny, but it works.

Being the master of your own finances is a totally “freeing” experience. I don’t know about you, but it’s been the single greatest source of stress in my life. Love yourself, get rid of the stress.

12. Make Bite-Size Money Goals One study showed that the farther away a goal seems, and the less sure we are about when it will happen, the more likely we are to give up. So in addition to focusing on big goals — say, buying a home — aim to also set smaller, shortterm goals along the way that will reap quicker results — like saving some money each week in order to take a trip in six months.

13. Banish Toxic Money Thoughts Hello, self-fulfilling prophecy! If you psych yourself out before you even get started (“I’ll never pay off debt!”), then you’re setting yourself up to fail. So, don’t be a fatalist, and switch to more positive mantras.

14. Get Your Finances and Body in Shape One study showed that more exercise leads to higher pay because you tend to be more productive after you’ve worked up a sweat. So, taking up running may help amp up your financial game. Plus, all the habits and discipline associated with, say, running marathons or working out are also associated with the discipline needed with managing your money well.

15. Learn How to Savor Savoring means appreciating what you have now, instead of trying to get happy by acquiring more things. Be grateful.

Many are homeless and hungry.

How to Amp Up Your Earning Potential 16. When Negotiating a Salary, Get the Company to Name Figures First If you give away your current pay from the get-go, you have no way to know if you’re lowballing or highballing.

Getting a potential employer to name the figure first means you can then push them higher.

17. You Can Negotiate More Than Just Your Salary Your work hours, official title, maternity and paternity leave, vacation time and which projects you’ll work on could all be things that a future employer may be willing to negotiate.

18. Don’t Assume You Don’t Qualify for Unemployment At the height of the recent recession, only half of people eligible for unemployment applied for it. Learn the rules of unemployment. Do your research. It may bring you a few more

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dollars.

19. Make Salary Discussions at Your Current Job About Your Company’s Needs Your employer doesn’t care whether you want more money for a bigger house — it’s about about keeping a good employee. So, when negotiating pay or asking for a raise, emphasize the incredible value you bring to the company.

How to Keep Debt at Bay 20. Start with Small Debts to Help You Conquer the Big Ones If you have a mountain of debt, studies show paying off the little debts can give you the confidence to tackle the larger ones.You know, like paying off a modest balance on a department store card before getting to the card with the bigger balance. Of course, we generally recommend chipping away at the card with the highest interest rate, but sometimes psyching yourself up is worth it.

21. Don’t Ever Cosign a Loan If the borrower — your friend, family member, significant other, whoever — misses a payment, your credit score will take a plunge, the lender can come after you for the money, and it will likely destroy your relationship. Plus, if the bank is requiring a cosigner, the bank doesn’t trust the person to make the payments. Bonus tip for parents: If you’re asked to cosign a private loan for your college student, first check to see if your kid has maxed out federal loan, grant and scholarship options.

22. Every Student Should Fill Out the FAFSA Even if you don’t think that you’ll get aid, it doesn’t hurt to fill out the form.

That’s because 1.3 million students last year missed out on a Pell Grant — which doesn’t need to be paid back because they didn’t fill out the form!

23. Always Choose Federal Student Loans Over Private Loans Federal loans have flexible terms of payment if your employment dreams don’t exactly go according to plan after college. Plus, federal loans typically have better interest rates. So be smart about the loans you take out.

24. Choose Mortgage Payments Below 28 Percent of Your Monthly Income That’s a general rule of thumb when you’re trying to figure out how much house you can afford.And this is 28 percent of your gross income not your take-home pay. Just remember that few people can change their lifestyle to afford a higher mortgage payment.

How to Shop Smart 25. Evaluate Purchases by Cost Per Use It may seem more financially responsible to buy a trendy $5 shirt than a basic $30 shirt — but only if you ignore See PERFECT ELIXIR page 41

Fall • 2021 27

FSP

FIRE STATION PROFILE — South Carolina

Lexington County Fire Service

Department Name: Lexington County Fire Service County: Lexington Type Department: Combination Structure: County ISO: Class 3 Number of Stations: 25 Number of Apparatus: Pumpers: 23 plus (4 Reserves) Aerials: 3 plus (2 Reserves) Specialty: 5 What type EMS do you provide?

BLS FR Specialty Operations: Swift water, High angle Rope,Trench Confined Space, Haz Mat Annual Budget: $25,073,739 Area Covered Square miles: 755 Population: 300,000

Total Runs: 17,267 Fire: 8142 EMS: 9125 Chief: Mark Davis Chief Officers: Deputy Chief Dean Anderson, Deputy Chief David Fulmer, AC Robert Risinger,AC Nathan Prouse, Planning Officer/BC Mike Vantroost Other Officers: Battalion Chiefs: Brad Amick, Cam Glover, Hall Miller, Mike Hannon, Chris Brewster, Martin Friar, David Dorroh, Justin Buck, Steve Cannon 44 Captains Number of Members: 310 Paid: 277 Volunteer: 40 Address: 436 Ball Park Road Lexington SC 29072 Website: Lex-Co.com Phone: 803-785-8141 Community Outreach:

Lexington County Fire Services works daily to provide a fire safe community through inspections, plan review and fire prevention efforts.We support all local

Chief Mark Davis

school districts and communities with events and routinely conduct smoke detector blitz and after the fire community canvassing.

Top Two concerns in your community: • Staffing • Growth What are you doing for fundraising? We do not fund raise for operational orpersonnel equipment.We do an Annual Boot Drive for the Jeffrey Chavis House in Augusta.

What upgrades will you make in your department this year?

• We are upgrading our Self Contained Breathing Apparatus (255 units) • We are purchasing a 100’Tower Truck and a 75 ‘ Quint and Engine • Hiring a Special Operations/Safety Officer • Additional Training staff • Additional 6 Captains for Operations What special hazards or unique businesses in your community?

We have many large manufacturing businesses in our response area: • Amazon Distribution center • 2 Michelin tire Plants • Nephron Pharmaceuticals • UPS / Fed EX Hub • US food Distribution center • CMC Metals Recycling Center • 3 Separate Interstate Highways • Rail Systems What problems in your department that you would like feedback from others?

We have seen a tremendous increase in call volume due to growth and the Pandemic.The ability to hire and train successful firefighters has been a challenge.

List any initiatives: Recently along with the four other fire departments in our county, we developed and implemented county-wide field operations to streamline and enhance our automatic aid responses. Presently we are in the process of moving to PURVIS dispatching.

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Carolina Fire Rescue EMS Journal

FSP

FIRE STATION PROFILE — North Carolina

Raleigh Fire Department

Department Name: Raleigh Fire Department County: Wake Type Department: Paid Structure: Conventional Org. Chart ISO: 1 Number of Stations: 29 Number of Apparatus: Pumpers: 29 Aerials: 9 Specialty: Heavy Rescue, (5) Hazmat units, (2) Mobile Air Units, (1) High Water Rescue Vehicle, (3) Rescue Boats, Bike Team, (3) Mini Pumpers What type EMS do you provide?

BLS ALS FR Specialty Operations: Special Operation Command Annual Budget: $71,000,000 Area Covered Square miles: 146 Population: 500,000 Total Runs: 62,725 Fire: 43%, EMS: 57% Chief: Herbert Griffin Chief Officers: Danny Poole -Asst Fire Chief/ Logistics, Ray Enoch – Asst.

Fire Chief /Professional Development, Lowell Smith – Asst. Fire Chief/ Operations, John Fannin – Asst. Fire Chief/ Office of Fire Marshall Other Officers: 110 Captains, 130 Lts Number of Members: 553 All Paid: Address: 310 W. Martin St. Raleigh, NC 27601 Website: Raleighnc.gov Phone: 919-996-6115 Community Outreach:

Carolina Fire Rescue EMS Journal

Chief Herbert Griffin

RFD Community Outreach Team canvass the lower socio-economic neighborhoods to install free smoke detectors, offers education and outreach services for children, schools, preschools, teachers and daycare providers.They also provide Hurricane Safety Awareness, Fire Prevention, Community Risk reduction initiatives, grilling safety, virtual live chats on fire safety topics for all age ranges.

Top Two concerns in your community: Covid-19 Pandemic, Potential Civil Unrest What are you doing for fundraising? Due to current pandemic, we have limited opportunities for fundraising events.

What upgrades will you make in your department this year? New Fire

Stations #14 & #22, implementing the department’s first Diversity Equity and Inclusion Officer, PIO, Recruiter, Staff Psychologist, Rehab Unit.

What special hazards or unique businesses in your community? State Capitol Building What problems in your department that you would like feedback from others? Chief Officer Development Course, Risk Management for Department Officers.

List unique initiatives that could benefit other departments.

• Implemented RFD Health and Safety Compliance Office.

• Created and Implemented Newly Promoted Officers (NPO) Course through Professional Development.

• 2021 All Chiefs and Newly Promoted Officers were giving the IAFC

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Courageous Conversation Course.

• July 2021 Implemented (3) Incident Safety Officers.

• 2021 Implemented department wide (DEI) Diversity Equity and Inclusion Training – 6hrs.

• Incorporated FEMA Field Force Extrication Course for Civil Unrest.

• Purchased Ballistic Vest for Civil Unrest and First Responder Protection.

• 2021 Created RFD’s Research and Development Team for formal testing and data analysis of all firefighting equipment.

• 021 partnered with Wake County to assist in the largest county wide vaccination initiative at PNC Park.

• Created and implemented RFD’s first ever community newsletter called the Raleigh Fire Times.

Fall • 2021 29

Update from Capitol Hill

Advocating for the United States Fire Administration

The year 2023 will mark the 50th anniversary of “America Burning,” the seminal report authored by the National Bill Webb Commission on Fire Prevention and Control that placed a federal focus on our nation’s fire problems. What impresses me most about the document is the two-year undertaking by commission members to study the problems and develop meaningful recommendations based on scientific data to address our nation’s fire problems.

Among the many recommendations was the establishment of a United States Fire Administration and National Fire Academy. Based on the strength of these two recommendations, the Carter Administration created both entities. First domiciled in the Department of Commerce, the Federal Fire Prevention and Control Administration and National Academy for Fire Prevention and Control — the original agency names — were eventually transferred to the Federal Emergency Management Agency when this agency was created in 1979.

While America Burning should be looked at from a historical

perspective, there is one recommendation in the report that continues to capture my attention: proposed funding for the new agency. Commission members recommended a starting annual budget of $124,800,000. That was 50 years ago. In today’s dollars, that figure would amount to approximately $770,000,000. Here we are 50 years later and USFA’s budget is approximately $50 million.

Believe me, the national fire service organizations have advocated for increased funding for our lead federal agency. We have delivered our message to members of Congress throughout the years and to previous administrations.

Part of the reason why USFA/ NFA’s budget remains inadequate compared to other agencies with similar-sized constituents can be attributed to being domiciled in FEMA. Initially, the idea of placing USFA under FEMA made some sense.

FEMA being the parent agency was established to bring a federallyunified approach to responding to natural disasters. But as someone mentioned to me during a recent conversation on this issue, the marriage doesn’t make sense. While the focus of FEMA is on disaster response, the same cannot be said of USFA/NFA. Their focus is on prevention, training and data collection.

Would it have been to keep USFA

in the Commerce Department?

That is a good question and I certainly do not have the answer.

It was originally placed there because of the economic loss of fire in the country and the fact that USFA’s mission was not focused on response — like FEMA’s — and more on education, training, and research.

But here we are 50 years later and the reality is that USFA remains a subsidiary of FEMA, lacking the funding, stature and recognition it deserves to be our voice at the federal level; the voice inside the White House when the President is briefed on large-scale disasters involving response from our nation’s firefighters and emergency services personnel; the voice at disaster scenes — including wildfires, major hazmat incident, and large scale natural disasters; delivering messages to the media about the deployment of firefighters and their roles in response and recovery operations.

Let’s hope that our next U.S. Fire Administrator is given a seat at the table during federal policy discussions with FEMA and DHS. Do you suppose Army generals speak on behalf of the Navy in meetings at the Pentagon? Of course not. Nor should we expect anyone but our fire administrator to speak on behalf of our firefighters and emergency services personnel.

And whenever we are presented with opportunities to speak to our members of Congress, remind them about our federal agency and challenge them to provide it more support. Upon your return from the National Fire Academy, send your members of Congress a letter discussing your positive experience and the knowledge you acquired from your classroom training.

We need to remain persistent, speaking up about our needs when the opportunities present themselves at the federal level. And sometimes we must present those opportunities ourselves.

Bill Webb has served as Executive Director of the Congressional Fire Services Institute since 1995. CFSI is a nonprofit, nonpartisan policy institute designed to enhance congressional awareness about the concerns and needs of the fire and emergency services. As Executive Director, he works closely with members of Congress and fire service leaders to sustain support on Capitol Hill for programs and legislation that benefit our nation’s fire and emergency services.

Before joining CFSI, Webb worked for the Firefighter Combat Challenge as the project manager for the competition. He currently serves as Vice Chairman of the National Fallen Firefighters Foundation and is an honorary member of the Vienna Volunteer Fire Department, the Delaware Volunteer Firefighters’ Association and the International Association of Fire Fighters Local 36.

Eye Protection Cont’d from page 26

tests simulating some spray or spurt situations. Now, Harris explained, Z87.62 provides specific performance criteria for protecting workers from potentially infectious bodily fluids.

It’s important to note that ANSI/ISEA Z87.62 focuses on coverage, but does not impose any protector impact criteria.

Users whose environments may require impact protection should select items that may be dual marked to ANSI/ISEA Z87.1 and Z87.62.

The standard can be purchased from ISEA for $65 at safetyequipment. org/standards or through any licensed resellers.

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.

Nicole Randall is the director of marketing and external affairs for ISEA.

30 Fall • 2021

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Carolina Fire Rescue EMS Journal

The Station House

Selecting the Architect for Your Public Safety Project

Many people do not personally know an architect — Ken Newell much less have ever hired and worked with one before. But as you move closer to requiring the services of a professional designer, you may begin to contemplate the best approach for finding and selecting the best option for your public safety project.

Architecture firms come in a variety of sizes and types.

There can be pros and cons to large firms and small firms.

This article will pose a series of common questions and answers regarding the selection of an architect.

When Should We Bring the Architect Into the Project?

Include the architect as early as possible! The architect should be able to assist you with many preliminary steps, often before they start charging fees. Many owners go through the property selection process before involving the architect. However, the architect can provide critical information that can help determine the appropriateness of considered sites – such as the necessary turn radius for the apparatus and if the site has adequate drainage. They can also help to ensure that you do not acquire too little or too much property. The architect can perform site studies, help secure planning and zoning approvals, and perform a variety of other pre-design tasks.

How Do We Find Suitable Firms to Contact?

Only interview firms that you feel can successfully accomplish your project because of their expertise and experience.

may not want to limit your choices to only “local” architects.

Local politics often drive who is chosen for projects.

This likely will not serve you well if the local firm does not have extensive public safety experience.

What Information Should We Request of Potential Architects?

Most project owners will send a solicitation to potential architects that requests qualifications to be submitted.

This will result in a prescribed Statement of Qualifications (SOQ) that you may use to evaluate the candidates. The request for SOQs should describe the parameters of your intended project to the best of your ability at this early stage.

At a minimum, ask prospective firms to provide data on their previous projects that are similar to your project. Ask them to indicate how they will approach your project and who will be working on it, including consultants hired by the architect. Ask for short or long

resumes of the firm’s “team” for your project. It is probably wise to consider only firms that have enough personnel that, should something happen to the staff assigned to your project, they have other qualified architects that could complete the project.

Ask for project data for similar projects that the firm has designed. Make sure the firm has more than just a few public safety projects similar to yours that were completed successfully. Ask specifically if see SELECTING THE ARCHITECT page 32

Consider the architects that support your associations.

They have already made an investment in you by providing financial support and resources. You can always find architects with fire station design experience at the state fire conferences as well as the national seminars like FIERO (always held in the Carolinas) and Station Design Conference.

You can also contact your local American Institute of Architects (AIA) chapter. They will have information about regional firms and their web pages may even link to firms with public safety experience. Be sure to ask other departments or municipalities who have completed projects that you have admired or that seem especially appropriate. For building types as specialized as public safety facilities, you

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Fall • 2021 31

Selecting the Architect Cont’d from page 31

the architect is involved in any litigation with owners on current or past projects, at least a 10-year history. If the answer is yes, find out details. Ask for the names of other clients you may contact and talk with those project owners to whom the firm has provided professional services for similar projects.

After the Statements of Qualifications, are “Face to Face” Interviews With a Potential Architects Desirable?

I’m guessing not many of you married your spouse without seeing them first! Now I’m not suggesting that you are going to Find an architect you’re comfortable working with, and that listens and responds to your design needs

marry your architect, but you are likely going to be dealing with them a lot over an extended period of time. No matter how good someone may look on paper there are a lot of issues that need to be addressed in person.

During the course of the project it will likely be necessary for the architect to make presentations to several groups that you answer to. You need to make sure that the architect has that ability. An interview addresses one issue that cannot be covered in brochures: the chemistry between the owner and designer. Without a good chemistry between personalities, it may be a long project for all!

How Many Firms Should We Interview, And How Should They Be Selected?

Interview between one and five firms. If you have great information, references and a preliminary meeting with one public safety architect that meets

32 Fall • 2021

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all of your requirements you may feel comfortable in selecting that designer if code or law allows.

Don’t interview so many that the process becomes “a blur” and wears out the selection committee. Make sure the selection committee includes the major end users of the facility.

Only interview firms that you feel can successfully accomplish your project because of their expertise and experience. Don’t give “courtesy” interviews. Insist on meeting the architect’s key people who will work on your project.

During the Interviews, What Are Some of the Questions We Should Ask? How much information will the architect need from you to provide the necessary services? Who in the firm will work directly with the client?

How does the firm provide quality control during design?

Carolina Fire Rescue EMS Journal

An architect is trained to listen to you –the client- and to translate your ideas into a viable construction project. Look for an architect who is a good listener and you’ll usually find a good architect.

What is the firm’s constructioncost experience? What is the firm’s history of performing projects on schedule? Usually, the two driving factors for most projects are time and money. It is imperative to determine that the firm has a good track record of bringing the project in ontime and on-budget. Who from the firm will be performing construction administration during the construction phase? How busy is the firm? Do they have the time necessary for your project now or when you need it?

Some organizations, boards or municipalities require that designer selection be based on qualifications and not fees. For those that don’t, you can ask for a fee proposal at any point that you think is appropriate. If you are considering soliciting fee proposals from more than one firm, you will want to make sure that you can provide enough information for definite proposals.

Each firm must be able to prepare proposals based on the same scope of services so that you can make an “apples to apples” comparison.

Should We Make “Pre-Design” A Condition Of Selection?

Bottom Line

Some owners request that all the potential architects present a schematic design of the new facility during the interview. This is not recommended for several reasons. It is usually unreasonable to request the architect to spend the huge amount of time necessary to develop a “legitimate” design without the ability to be compensated. This can lead to firms hurriedly presenting “eyewash” schemes that have very little thought and almost no serious programming behind them.

Therefore, a firm that can present a “pretty picture” may be selected over one that will ultimately design the better facility.

in over 300 of the firm’s 425+ Fire/ EMS and Public Safety projects. Newell has earned a national reputation for the programming and design of public safety facilities that are functional, practical, and budget-conscious. He has also consulted other architects on

the planning and design of over 125 public safety projects spanning 27 states.

Because of his extensive experience in Public Safety design, he has been invited to speak at many state, regional, and national Public Safety conferences since 2000.

Experience, expertise, and good references in public safety design should be the bare minimum required in a potential architect for your facility. An architect is trained to listen to you –the client- and to translate your ideas into a viable construction project. Look for an architect who is a good listener and you’ll usually find a good architect.

Ken Newell is a Principal and Partner with Stewart-Cooper-Newell Architects.

Since 1988, he has been directly involved

After the Interviews, HowShould We Follow Up? If you haven’t spoken with the architect’s past clients, do so now. Assess both the previous performance of the firm and the performance of the resulting facilities. If you have not visited some of the firm’s previous facilities similar to yours, now would be a good time to do so.

On What Should We Base Our Selection Decision?

Personal confidence in the architect is paramount. If you don’t trust them, don’t hire them.

The owner/architect relationship demands accountability. Seek a balance among design ability, technical competence, cost, and professional service. Once you’ve selected the architect enter into detailed negotiations of services and compensation. If you cannot agree, initiate negotiations with your second-choice firm.

What About Competitive Bidding Among Architects?

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Fall • 2021 33

FITNESS

Exercise Prescriptions: Working Out as Medicine

Neha Pathak, MD I’ve spent almost my whole life waiting for my first heart attack.

My dad had his first one in his early 50s. Then came quadruple bypass surgery. Four blood vessels in his heart had become clogged with thick, waxy sludge. Surgeons snipped parts of a vein from his left leg, stitching it around the blockages.

I emember the jagged slit: four cuts stretching from thigh to ankle where the vein had been. And the chest wound left by the bone saw that the surgeons used to pry open his sternum to reach the heart. That scar never fully healed. It puckered, darkened, and stood out to me like a harsh warning.

Dad wasn’t alone. Every few months, we’d visit friends who’d also had bypass surgeries. The men would unbutton their shirts to compare scars.

I knew a healthy lifestyle and medications might delay my heart attack. But I never really believed that I could prevent it. I felt at the mercy of my genes.

Someday, I would shift from being healthy to sick.

This was a big reason why I became a doctor: to help my patients (and myself) stay well for as long as possible. It was about holding off

34 Fall • 2021

disaster.

But in all my years in practice, I never really saw anyone get better from heart disease or diabetes just by taking my prescriptions. Their lists of medical problems, medications and side effects grew. And my frustration and disappointment deepened.

This hopeless feeling is something I had in common with Tim Kaufman.

He’s not my patient, but he calmly tells me his story via Zoom. He used to feel just like me. He saw an early death as inevitable, despite more than a decade of care from a host of doctors.

Until he didn’t.

In his 20s, Kaufman was diagnosed with a painful disorder. This led to a sedentary life and addiction to opioids, alcohol and fast food. By his late 30s, he took more than 20 prescription drugs to manage his chronic pain, blood pressure (BP) and cholesterol.

Still, his BP and heart rate were dangerously high. His blood pressure reached 255/115. (Normal is less than 120/80.) His heart rate clocked in at 125 beats per minute. (Normal ranges between 60-100.)

Kaufman weighed more than 400 pounds. He doesn’t know the exact number because his doctor’s office scale didn’t go that high.

“I had gotten real sick, real fat, and

real addicted really quick,” Kaufman says.

Eventually, he began to believe that this was the body he was given, this was his DNA, and he’d just have to accept the misery. When his doctor tried to add yet another medicine to the mix, Kaufman threw the prescription in the trash on his way out of the office.

Finally, at a breaking point, he felt that his doctor couldn’t help him.

Kaufman set a sobering goal: to delay his own funeral for as long as possible. And BEFORE: “I had gotten real sick, real fat, and real addicted, really quick.” AFTER: “I wasn’t running away from anything he wrote himself a anymore.” prescription:“Get up from the chair two Something as mild as a loud sneeze times tomorrow.” would dislocate his shoulder.

As an adult, newly married and Last-Chance Plan with a growing family, Kaufman had Kaufman has Ehlers-Danlos his first joint surgery. Afterward, his syndrome (EDS), a genetic doctor said the procedure had been connective tissue disorder. He’d very hard to do. Instead of tough always had flexible joints. As a kid, fibers that keep the shoulder in he did “circus tricks” to entertain his place, Kaufman’s tissue was loose, friends. weak, and stretchy, like chewing His condition got worse. gum.

To protect his joints and avoid more surgeries, Kaufman was told to limit physical activity. Get a desk job, he recalls his doctor saying.

That was when he got his first taste of opioids. The mild chronic pain he’d always had would fade for a few hours, only to roar back when the meds wore off. Working with his doctor, he upped his doses until he was on opioids 24-7.

With strict limits on activity and worsening chronic pain, Kaufman started to self-medicate with vodka and fast food. The diseases of a sedentary life (high blood pressure, high cholesterol, and high blood sugar) began to pile up. So did the medications to treat them. And he needed crutches and costly custommade knee braces.

But there was something even more painful than the physical suffering. It was seeing pity in the eyes of Heather, his wife and high school sweetheart.

His kids didn’t expect much from him. They just knew that “Dad’s sick.”

Every task he had to quit, like mowing the lawn, landed on Heather’s to-do list. Their kids didn’t expect much from him either. They just knew that “Dad’s sick.”

At 38, Kaufman was in such bad shape that his doctor wouldn’t OK gastric bypass surgery for weight loss. It was too risky for someone with so many out-of-control medical problems. It was too risky for

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someone with so many out-ofcontrol medical problems.

Desperate to not die, Kaufman only asked his muscles to pick him up out of his chair twice one day, then three times the next. After that became manageable, he started to walk on a trail near his home.

He couldn’t have dreamed up a better, more personalized medicine.

Kaufman found that the more he moved, the more movement his body craved. He set new goals to climb stairs, hike mountains, and run more races than he now remembers, a decade after his health crisis. Rows of medals hang behind him on Zoom as he tells me his story.

With every step, Kaufman pictured leaving a stamp of gratitude on the ground beneath his feet, thankful for each new day of life. It became such a powerful mental image that he had his “gratitude stamp” tattooed to his calf.

Slowly, his muscles could handle the work that his connective tissue couldn’t. As he grew stronger,

Carolina Fire Rescue EMS Journal

Kaufman could walk without his crutches and no longer needed his knee braces.

The weight he lost from a dramatically improved diet stayed off. He could finally sleep through the night without restless, painful tossing and turning. With his doctor’s blessing, his long list of prescriptions melted away.

Kaufman’s DIY transformation unwittingly hit on almost everything Collings recommends.

Switching to a plant-based diet provided energy to be more active.

No longer on any prescription drugs, he considers food and activity his medicine.

It didn’t happen overnight, and it’s not about being perfect.

Kaufman confesses that when he had cleaned up his diet and ramped up his activity, he still chewed tobacco. Tackling one habit at a time snowballed into other positive changes.

As we talk, I think about how my own habits slipped during the COVID-19 pandemic. Most of my day isn’t active. I’m eating worse

than I have in years. I feel anxious.

And yet, in the back of my mind, I wonder if I can still turn things around and prevent that heart attack I’ve always dreaded. My dad made some lifestyle changes in his 70s, including more movement, and is doing well at 84. It truly is never too late.

I share a little about this with Kaufman. He tells me to go out and just move my muscles and breathe the air and not to think of it as exercise. I envision thousands of chemical messengers flooding through my bloodstream, reaching every organ from my brain He reminds me,“All you have to do is move a little more than you did yesterday.”

For him, the weight loss wasn’t what transformed him. It’s his newfound sense of joy and adventure, which no pill or injection can deliver.

“It’s not about the before and after photo,” Kaufman says.“If I could make you feel how I feel ... you would switch in a minute.”

WebMD Health News © 2021

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Fall • 2021 35

Behaviorial Health

The Company Officer’s Role in Addressing Mental Health

Dena Ali Six years ago, I unknowingly began to travel down the path of addressing suicide in the fire service.Today, I am grateful for the experiences that led me down this path, but at the time, it was the most excruciating and alienating experience of my life.This was due to a negative firehouse atmosphere coupled with a company officer who turned a blind eye to the contributing factors.

Unintentionally, my company officer conveyed the message to me that I was not worthy of his energy.Among other personal factors, those feelings of worthlessness led me down the dark path of depression and suicidal ideation.

Luckily, they also led me down the path towards understanding suicide.

I quickly learned that thoughts of suicide often manifest from a feeling of insufferable emotional pain, disconnectedness and shame. Shame is the universal and primitive experience that tells us that we are defective or flawed to a point that we deserve our pain, and worse, cannot connect with others (Brown, B., 2018). In shame, you not only feel responsible for your pain, but you also feel humiliated to a point of silence because shame tells you that you are alone in your experience. Fear of judgment manifests from feelings of self-hate, self-blame and liability.These feelings are unbearably painful and found to be associated with not only suicide, but also depression, anxiety and addiction.

Early in a career, firefighters develop a sense of purpose and responsibility that leads them to believe that they should never show any sort of vulnerability.

The fear of weakness when one is experiencing thoughts of suicide or any other perceived weakness can become alienating and further intensify thoughts of suicide. Dr. Craig Bryan calls the circumstances that lead to suppressed emotions for first responders a catch-22, and says,“we train our warriors to use controlled violence and aggression, to

36 Fall • 2021

suppress strong emotional reactions in the face of adversity, to tolerate physical and emotional pain and to overcome the fear of injury and death … these qualities are also associated with increased risk for suicide.”This is because those virtues necessary to perform well in high stress incidents are also the same qualities associated with an increased capability for suicide.

According to the QPR institute, the majority of people who died by suicide were suffering from depression at the time of their death.The FSU laboratory for the Study and Prevention of SuicideRelated Conditions and Behavior has discovered that nearly 100 percent of people who died by suicide had a diagnosable mental health disorder at the time of their death. Mental health disorders are so common that they will impact nearly 50 percent of people in their lifetime, and due to the nature of firefighting, firefighters are more susceptible to certain ones.

Understanding the commonality and treatability of mental health disorders should become the norm for firefighters.

Through this understanding, we may shift towards a fire service that encourages help seeking behaviors among their members.

Mental health disorders commonly found among firefighters are associated with organizational stress — to include harassment and bullying — sleep disorders, sleep deficiency, posttraumatic stress symptoms, substance abuse, financial stress and relationship problems. Firefighters suffering stress from these often fear judgement, so they suffer in silence. Rather than addressing the underlying issues, they find themselves numbing negative emotions with maladaptive coping, such as alcohol. Sadly, numbing the negative also numbs the positive.The use of negative coping skills to address stress often interacts in a synergistic fashion and further builds into a crisis.The use of alcohol to manage stress often leads to poor choices and poor health, and if

unaddressed, can become deadly.

This is why it’s so important for leaders model the behaviors they wish to see in their people. Leaders must be willing to admit that they too need help sometimes, and it’s OK to reach out.Truly, the best-case scenario would be for a leader to have the courage to share their journey from struggle, through help seeking, to healing.This is because hope is the antidote to shame and suicide. Hope is a learned process that develops from understanding that the path ahead is possible.There are simple skills firefighters can learn early in their career to help them to become more resilient to stress.These include sleep hygiene, the power of meaningful conversation about difficult experiences and finally mindfulness. Each of these have been studied extensively, and all found to prevent suicide, depression and PTSD. Company officer training has the potential to yield the greatest impact for our firefighters. Emphasis must be placed on training officers to recognize changes in their employees, and to develop open relationships to where the employee always knows that he/ she can go to their officer. Company officers should notice when an employee is acting unusual and foster an environment that is supportive and inclusive to all members of the crew.

The officer must be aware of when an individual is being isolated, taunted, or simply ignored by the rest of the crew.Additionally, they must foster a safe environment that allows individuals suffering or struggling in silence to be able to open up and share their struggles.They are responsible for ensuring their members know they are available any time that the employee is in need. More importantly, the company officer must be willing to initiate difficult conversations when they notice changes in behavior.

Trust should be established early in relationships and nonjudgement about mental health and stress must be the norm.While many officers fear they are not equipped to deal with members dealing with overwhelming stress, they generally can make an impact. People suffering or struggling don’t always need the right answers, they often just need an opportunity to open up and be heard.

The most prominent researches in the field of suicide have found that a little intervention can go a long way in terms of healing. People simply need hope, and to know that their situation is not permanent.

Evidence-based intervention is used to prevent suicide by helping recognize people who are feeling suicidal, and to have the courage to ask them directly about suicide. Often, people in suicidal crisis don’t discuss their thoughts because they don’t want to worry or burden others.They may also feel humiliated, ashamed, or fearful of their thoughts, and dread the response they may receive from those who lack compassion and understanding.

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However, by asking directly about suicide, you give them permission to tell you how they feel. People who have felt suicidal will often say what a huge relief it is to be able to talk about their experience.

Once people are able to talk about suicide, they experience the first step toward healing — that is, discovering alternatives to suicide.A common interpersonal feeling of those who are suicidal is intense hopelessness, and an anecdote to this hopelessness comes from meaningful social connection. But remember, as long as judgement exists, meaningful social connection cannot.

The best-case scenario would be to ensure the company officer has the training, knowledge, and willingness to be the first line of defense for an employee in need of help. It is not enough to refer individuals struggling to mental health services. Experience has taught us that fear of referral is the main reason first responders suffer in silence.

Company officers must have the courage to be willing be there for their members and create an environment where the individual feels safe opening up about their struggles. Open disclosure through discussion is truly the best way to help an individual connect, understand their experience, and find solutions.

Every firefighter and every human should be able to share their struggles in a safe and supportive environment without fear of retribution.As long as our firefighters fear their careers and that their reputations will be in jeopardy, they will continue to suffer in silence.

In my years of researching this topic and searching for solutions, I have found that it is an absolute profound human tragedy that people die by suicide because it’s much harder for them to ask for help. If we truly want to see rates of suicide decrease, we must find a way to make it easier for people who are suffering to reach out.We rarely have to have the right answers if we are just willing to sit in the darkness with somebody until they can find the light.

As powerfully explained by Pema Chodron,“Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well, can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”

If you have been blessed by traveling down a dark path before finding your way to healing, you have the sacred opportunity to light the path for others by simply sharing your story and being courageous enough to sit in the dark with another.

Dena Ali is Captain of Engine11 for City of Raleigh Fire Department, Operations, B Shift.

Brown Brené. (2015). Daring greatly: how the courage to be vulnerable transforms the way we live, love, parent, and lead. New York, NY: Avery.

Washington, M. T. /. (2010, April 13). Is the U.S. Army Losing Its War on Suicide? Retrieved from http://content. time.com/time/nation/article/0,8599,1981284,00.html.

Carolina Fire Rescue EMS Journal

Hazmat 2021

SIXTY ONE DELTA ONE

Levels of Concern: What Are They and Why Are They Important?

The term “level of concern” is often used in the hazmat response world, however as a hazmat Glenn Clapp CHMM, CFPS responder have you ever really thought about what the term truly means and how we use the concept in real world responses? In simple terms, a level of concern is the concentration of a substance either established by regulation or that is derived through an educated decision process that if exceeded will detrimentally affect human life and wellbeing. In the hazmat response arena, we use levels of concern to determine the proper personal protective equipment — such as respiratory protection — for responders to use and to guide us in deciding the appropriate measures for protection of the public during hazmat incidents.

Levels of concern are usually expressed in units of parts per million (ppm). One part per million can be visually thought of as if you divided a room into one million equally sized boxes and one of those boxes was one hundred percent full of a substance. As can be seen, one part per million is a very small concentration. If we do the math, we can derive that it takes ten thousand parts per million to equal one percent concentration. Levels of concern are also sometimes expressed in units of milligrams per cubic meter (mg/m3). We can covert mg/m3 to ppm by multiplying the concentration in mg/m3 by 24.45 and then dividing the product by the molecular weight of the substance.

We would be remiss in our discussion if we did not address a few fundamental concepts relating to levels of concern prior to delving deeper into the subject.

Levels of concern are often expressed as a time weighted average (TWA) in which the concentration is averaged over a specified period of time (such as an eight-hour TWA). A short-term exposure limit (STEL) is stipulated as the maximum exposure over a short term — usually 15-minute time frame. Hazmat responders may also note levels of concern stated as a ceiling (C) that should never be exceeded for even a split second.

The first level of concern that we will discuss is the Recommended Exposure Limit (REL) that is defined by the National Institute for Occupational Safety and Health (NIOSH). The REL is — just as the name implies — a recommended level of concern that is not legally binding unless formally adopted. I personally remember the concept of the REL as personnel should not be exposed to concentrations in excess of the stated amount. An example of a published REL is that of ammonia at 25 ppm for a 10-hour TWA or 35 ppm STEL. Another level of concern that is not legally binding unless formally adopted but is a consensus recommendation is the Threshold Limit Value (TLV) published by the American Conference of Governmental Industrial Hygienists (ACGIH). The ACGIH is the representative body for industrial hygienists — professionals who monitor

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hazards in the workplace such as chemical exposures and noise. The TLV for ammonia is 25 ppm for an eight-hour TWA or 35 ppm STEL. One level of concern that is legally binding is the Permissible Exposure Limit (PEL) stated by the Occupational Safety and Health Administration (OSHA). The PEL of a substance is the maximum concentration a worker can be exposed to and can be thought of as the concentration that shall not be exceeded. Whereas the TLVs published by the ACGIH are regularly updated, OSHA’s PELs have not been updated for quite some time. The PELs can be found in Subpart Z of 29 CFR 1910 (OSHA’s General Industry Standards) in Tables Z-1, Z-2, and Z-3 (collectively known as the “Z Tables”). Table Z-1 lists the PELs for air contaminants,Table Z-2 lists substances with published ceiling values that also have established “peaks” or maximum allowable concentration excursions above the ceiling values with corresponding maximum exposure times; and Table Z-3 lists the PEL’s for mineral dusts. Although OSHA states that the use of personal protective equipment should be the last method selected for controlling exposures — with the elimination or substitution of the hazard; engineering controls, and administrative controls utilized in that order to alleviate the hazard prior to the use of PPE), in the hazmat response world the use of personal protective equipment is usually the only viable option. The PEL can also be practically thought of as the concentration above which respiratory protection shall be worn. By comparison, the PEL of ammonia is 50 ppm for an eight-hour TWA. NIOSH has also developed a level of concern titled Immediately Dangerous to Life or Health (IDLH), which is the maximum concentration a worker can be exposed to without incurring escape impairing symptoms or irreversible health effects. Prior to 1994 the IDLH value allowed for a 30-minute exposure time at the specified concentration to allow for an escape from the environment, however since that time the IDLH concentration has no associated exposure time and therefore applies to any length of exposure. Practically the IDLH concentration can be thought of as the concentration above which supplied air respiratory protection (such as an SCBA or Supplied Air Respirator [SAR]-also known as an airline respirator) shall be worn. OSHA does define what is termed the Maximum Use Concentration for each type of respiratory protection and in some situations a supplied air respirator is required to be utilized even below the IDLH concentration, however we will not muddy the waters with that discussion at this time. For the purposes of comparison, the IDLH concentration for ammonia is 300 ppm.

The levels of concern that we discussed above generally apply to workers — or in our case hazmat response personnel since we fall under OSHA’s General Industry Standards.

When we encounter an incident in which

the public is impacted by exposure to hazardous materials we should look at other levels of concern that are more appropriate. These levels of concern include Acute Exposure Guideline Levels (AEGLs) developed by the Environmental Protection Agency that represent concentrations of airborne chemicals above which health effects will occur.

The AEGLs are designed to protect the elderly, children, and other civilians susceptible to the effects of hazardous chemicals.

Another group of similar levels of concern are the Emergency Response Planning Guidelines (ERPG’s) developed by the American Industrial Hygiene Association, which estimate the concentrations at which average members of the public will begin to experience health effects if exposed for one hour. A third group of such levels of concern are the Temporary Emergency Exposure Limits (TEEL’s) developed by the U.S. Department of Energy Subcommittee on Consequence Assessment and Protective Actions, which are similar to the ERPGs in that they estimate the concentrations at which most people will begin to experience health effects if they are exposed to a hazardous airborne chemical for a given duration.

The AEGLs, ERPGs, and TEELs all have three levels of categorization, with Level 1 (e.g.AEGL-1) corresponding to the concentration at which mild health effects will occur, Level 2 corresponding to the concentration at which irreversible or other serious health effects leading to the inability to take protective action will

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occur, and Level 3 corresponding to the concentration at which life-threatening health effects will occur. The accepted level of hierarchy for the use of the three aforementioned levels of concern is the use of AEGLs first, ERPGs second, and TEELs third.

The question that then begs to be answered is “Which level of concern is used for emergency responders and which is used for the public in terms of exposure to hazardous chemicals?”

The reality is that there is no one “magic answer” for all situations and each level of concern is but one tool in your hazmat toolbox. We should use our training, education, and experience along with the published data and situational details to determine the correct level of concern to use for any given hazmat situation.

As hazmat responders we need to be thoroughly familiar with the concepts discussed above to ensure that we can provide the highest level of safety and protection for ourselves and our citizens.

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 president of the North Carolina Association of Hazardous Materials Responders and has over 23 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.

Fall • 2021 37

Dedication

Remembering Bill McCormick

It is our genuine gratefulness and warmest regard that we dedicate Mountain View Fire Department’s newest AnchorRichey EVS built Tanker (126) to the memory of William “Bill” Ray McCormick (June 1937 – March 2021).

Bill McCormick was one of the founding fathers of Anchor-Richey EVS, Inc. alongside his business partner W. Matthew Richey. Prior to the formation of Anchor-Richey EVS, Bill and Matthew both owned and operated their own businesses while doing work for each other at separate locations in neighboring counties. In 1996 they decided to bring their two businesses together and form a corporation that would repair and manufacture fire apparatus, Anchor-Richey EVS, Inc. Bill and Matthew worked together to grow the corporation during their 14 years in business before Bill retired in 2010 at the age of 73. Bill had a love for fire trucks, talking about fire trucks

and selling fire trucks. It wasn’t uncommon for Bill to try to sell a fire truck to even the delivery drivers at the shop. His passion for fire trucks and customer service showed with his innovative and creative thinking to help design and build trucks to suit a customer’s need.

Bill’s passion didn’t stop there, he also had a special place in his heart for his hometown fire department, Mountain View Fire Department (Hickory, N.C.) where he was (recently) a member of the board. Bill was very proud to have several Anchor-Richey EVS brush trucks serving his hometown community. Bill also had an intricate part in the decision for Anchor-Richey to start manufacturing tankers as well and had always hoped that one day he would have one at his hometown station. That dream became reality in March of 2021 just a couple weeks before his passing, when the truck was delivered.

Recently, at the 2021 Annual Community Meeting of the Mountain View Fire Department, they unveiled their two new pieces of equipment and there was a special ceremony held to dedicate this tanker truck to the memory of Bill for his love and dedication to the Mountain View Fire Department and Anchor-Richey EVS, Inc. Bill’s wife, Barbara, children, and grandchildren were present for the dedication and the acknowledgment of this plaque.

Bill is greatly missed by everyone including those of the fire service and his legacy will live on for many years to come with this plaque displayed on the Tanker for its lifetime of service to the Mountain View community.

(From L to R): Chip Duncan, Shayla Nelson, Barbara McCormick (Bill’s Wife (Spouse), Matthew Richey

38 Fall • 2021

Front Left to Right: Shannon Hayes (Daughter), Isabella McCormick (Granddaughter), Barbara McCormick (Spouse), Mary Abernathy (Daughter-in-law), JR McCormick (Grandson). Back Left to Right: Rob Hayes (Son-in-Law), Diana Strickland (Daughter), Jimmy McCormick (Son), Bobby Abernathy (Son).

Matthew Richey (sitting), Bill McCormick (standing).

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Carolina Fire Rescue EMS Journal

Wallace Fire Department Pierce Enforcer Heavy Duty Rescue w/Cummins L9 450 HP engine, side roll and front impact protection, TAK-4 front suspension, 45,000 GVWR, 26” extended front bumper.

Delivered by Atlantic Emergency Solutions

Wallace Fire Department Pierce Kenworth T370 Tanker w/Paccar PX-9 380 HP engine, Darley PSP 1000 GPM single stage pump, 2100 gal. tank, Husky 3 single stage foam system, HiViz LED lighting.

Delivered by Atlantic Emergency Solutions

City of Suffolk Fire Department Pierce Enforcer Tanker w/Cummins X12, 500 HP engine, Waterous CSU 1500 GPM single stage pump, 3000 gal. tank, side roll and front impact protection 19”Chicago style bumper.

Delivered by Atlantic Emergency Solutions

Prince George County Fire Dept.

Pierce Enforcer Pumper w/Cummins L9 450 HP engine, Waterous CSU 1500 GPM single stage, 48” Control Zone pump house, Husky 3 single agent foam system, 45,000 lb. GVWR. Delivered by Atlantic Emergency Solutions

Prince George County Fire Dept.

Pierce Enforcer Pumper w/Cummins L9 450 HP engine, Waterous CSU 1500 GPM Single stage pump, 750 gal. poly tank, 48” Control Zone pump house, 19” extended bumper.

Delivered by Atlantic Emergency Solutions

Cool Branch Volunteer Fire Dept.

Pierce Enforcer Pumper, Cummins L9 450 HP engine, Hale QMAX200, 2000 GPM single stage pump, 1000 gal. poly tank, Husky 3 foam system, 52” top mount pump house w/19” walkway.

Delivered by Atlantic Emergency Solutions

Weyers Cave Volunteer Fire Company Pierce Enforcer Pumper w/Cummins L9 450 HP engine, Hale QMAX-150, 1500 GPM single stage pump, 750 gal. poly tank, New York style hose bed, 45” side control pump house.

Delivered by Atlantic Emergency Solutions

Deerfield Volunteer Fire Department Pierce Enforcer Pumper w/Cummins L9 450 HP engine, Hale QFLO Plus-125 single stage pump 1000 gal. poly tank, New York style hose bed, 45” side control pump house.

Delivered by Atlantic Emergency Solutions

Camden-Wyoming Fire Company Pierce Saber Pumper w/Cummins L9 450 HP engine, Waterous CSU 1500 single stage pump, 1000 gal. poly tank, New York style hose bed, 45” side control pump house.

Delivered by Atlantic Emergency Solutions

Glenmore Volunteer Fire Department Pierce Freightliner Tanker w/Cummins L9 350 HP engine, Waterous CXPA 1000 GPM single stage pump, 3000 gal. poly water tank, 28” side control pump house, 46,700 lb. GVWR. Delivered by Atlantic Emergency Solutions

Fayetteville Fire Department Pierce Enforcer Pumper, Cummins L9, 450 HP engine, Waterous CSU 1500 GPM Single stage pump, 1000 gal. poly tank, 52” side control pump house, New York style pump house.

Delivered by Atlantic Emergency Solutions

New Hanover County Fire Service Pierce Enforcer Pumper w/Cummins L9 450 HP engine, Waterous CSU 1500 GPM single stage pump, 45” Side Control Zone pump house, 1000 gal. poly tank, 46,500 lb. GVWR. Delivered by Atlantic Emergency Solutions

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Fall • 2021 39

KME Retail Unit AVAILABLE FOR IMMEDIATE DELIVERY 2021 KME Panther MFD pumper w/ Cummins L9 450 HP engine, Waterous CSU 1750 pump, 980/20 gallon poly tank, Challenger WB body, FireTech scene lights, Whelen light package, Bostrom seating with Secure-All brackets. Delivered by Safe Industries

C&B Fire Department 2021 E-One Typhoon Custom Pumper w/ Cummins L9 450 HP engine, 2000 GPM Hale Q-MAX pump, 1030 gallon poly tank, 5 person 67.5” long cab, low hosebed.

Delivered by Safe Industries

Cherokee Springs Fire Department 2021 E-One Typhoon Rescue Pumper w/Cummins X12 500 HP engine, 2000 GPM Waterous pump, 1010 gallon poly tank, FireTech Scene lighting, front bumper crosslays, FoamPro 2001 System. Delivered by Safe Industries

Clarendon County Fire Rescue 2020 5500 HD FES Rescue w/Cummins I6 6.7 engine, Whelen warning & scene light package, Command light tower, FES custom shelving package.

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Hilda Fire Department 2021 FES M2 106 Rescue w/Freightliner chassis, Cummins L9 engine, Whelen warning & scene light package, Wil-Burt Night Scan, smart power 25K generator, electric awning system.

Delivered by Safe Industries

Isle of Palms Fire Department 2021 E-One Typhoon Custom Pumper w/ Cummins L9 450 HP engine, 1500 GPM Waterous CSU pump, 1030 gallon poly tank, FireTech 12 V scene lighting, low hosebed.

Delivered by Safe Industries

City of Fayetteville, TN Fire Department 2021 KME Panther MFD w/KME chassis, Cummins L9 450 HP engine, 1750 GPM Waterous CSU pump, 980/20 gallon poly tank, Challenger WB body, FireTech scene lights, Whelen light package.

Delivered by Safe Industries

Providence Fire Department 2020 FES F550 Super Duty Single Brush Truck w/Ford chassis, 375 GPM Hale B18 pump, 400 gallon poly tank, Whelen warning & scene lights, FireTech pole lights, remote control turret & fogger system.

Delivered by Safe Industries

Town of Ridgeland Fire Department 2021 E-One Typhoon Rescue Pumper w/ Cummins L9 450 HP engine, 1500 GPM Hale QMAX pump, 780 gallon poly tank, FireTech Scene Lighting and Federal Signal Warning Lights.

Delivered by Safe Industries

To Advertise With

Call: 704-995-1029 Vineyards Fire Department 2021 KME Challenger Wide Bed Body Pumper w/Freightliner chassis, Detroit DD13 450 HP engine, 2000 GPM Waterous CSU pump, 1000 gallon poly tank, top mount pump module.

Delivered by Safe Industries

40 Fall • 2021

Barnwell County Fire Department 2021 FES M2 106 Tanker w/Freightliner chassis, Cummins L9 engine, 250 GPM Hale CBP pump, 2000 gallon poly tank, Whelen warning & scene light package, Newton dump on rear.

Delivered by Safe Industries

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Email: advertising@carolinafirejournal.com

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OTHER NEW DELIVERIES

Virgilina Fire Department

2021 Body Remount T370 Model, Kenworth chassis, custom paint by Anchor-Richey EVS, remountec customer’s body and pump onto a new chassis, additional custom compartmentation, extendable scene lights, new warning lights, extended front bumper. Delivered by Anchor-Richey EVS

Perfect Elixir Cont’d from page 27

the quality factor! When deciding if the latest tech toy, kitchen gadget, or apparel item is worth it, factor in how many times you’ll use it or wear it. For that matter, you can even consider cost per hour for experiences!

26. Spend on Experiences, Not Things Putting your money toward purchases like a concert or a picnic in the park — instead of spending it on pricey material objects — gives you more happiness for your buck.And remember that material items are basically housing your cash, and in a financial crunch cannot typically be quickly sold to recoup the cash.

27. Shop Solo Ever have a friend declare,“That’s so cute on you! You have to get it!” for everything you try on? Or have a buddy egg you on to go ahead and purchase that shotgun that you know you can’t afford? Save your socializing for a walk in the park, or a sporting event, instead of a stroll through the mall.You should begin to treat shopping with serious attention.

28. Spend on the Real You—Not the Imaginary You It’s easy to fall into the trap of buying for the person you want to be: chef, professional stylist, triathlete, Rock Star.

How to Save Right for Retirement 29. Start Saving ASAP Not next week. Not when you get a raise. Not next year.Today. Because money you put in your retirement fund now will have more time to grow through the power of compound growth.

Carolina Fire Rescue EMS Journal

Newport Fire Department 2021 Midwest Fire All Poly Series Tanker-Pumper M2 106 w/ Freightliner chassis, Cummins engine, 1000 GPM Hale pump, 2000 gal. all poly tank, Kussmaul air and battery conditioner.

Delivered by Midwest Fire

City of Raleigh Monterra 6x6 Acela High Water Rescue, 22” ground clearance & 50” of water fording capability, safety side ladders, 3,000 lb. capacity removable tuck-a-way lift gate w/built-in tie downs.

Delivered by General Truck Body - First Responders Group

30. Do Everything Possible Not to Cash Out Your Retirement Account Early Dipping into your retirement funds early will hurt you many times over.

For starters, you’re negating all the hard work you’ve done so far saving — and you’re preventing that money from being invested. Second, you’ll be penalized for an early withdrawal, and those penalties are usually hefty. Finally, you’ll get hit with a tax bill for the money you withdraw.All these factors make cashing out early a very last resort.

31. Give Money to Get Money The famous 401(k) match is when your employer contributes money to your retirement account. But you’ll only get that contribution if you contribute first.That’s why it’s called a match, see?

32. When You Get a Raise, Raise Your Retirement Savings, Too You know how you’ve always told yourself you would save more when you have more? We’re calling you out on that. Every time you get a bump in pay, the first thing you should do is up your automatic transfer to savings and increase your retirement contributions.

It’s just one step in our checklist for starting to save for retirement.

I know these things seem simple but doing them continuously everyday will keep you from getting behind the financial eight-ball. Set up a spread sheet, change some behaviors and this will become second nature to you. I guarantee you will sleep better at night!

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 41 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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Fall • 2021 41

Advertiser’s Index 911 Fleet & Fire Equipment 42 AB Tech Air Cleaning Specialists

30 32

Anchor-Richey EVS, Inc. 25,41

Atlantic Emergency Solutions 15,20,39,IFC Blanchat 7

CIVIC BC Code 3 Insurance

19

21

Columbia Southern University 24

CCPA 36

CURIS 10,18

Bobbitt Design Build

C.W. Williams

23,35

DR Reynolds

33

4

Mountain Tek

13

NAFECO 14 20

NAFI 2021

NC Sheriffs/Procurement 18 12

NCAREMS 2021

Easy Lifts

7

NCSFA 42

Fire Hooks Unlimited

8

Newton’s Fire Safety

Fire Station Outfitters

32

Fox Manufacturing LLC

37

North Greenville Fitness & Cardiac Rehabilitation Clinic 34

General Truck Body

IBC

PS TRAX

6

Gerald Jones Ford

26

Reyco Granning

9

Insta Chain

22

Roll N Rack

Kimtek 35

42 Fall • 2021

Minerva Bunker Gear Cleaners

28

29 5

Safe Air Systems

Krah Health Solutions

12

Safe Industries

Magnegrip Group

22

Stewart Cooper Newell

Marion Body

26

Syntex Industries

MedCenter Air

8

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11,40 31 6

Temptime 19 This End Up Furniture

33

TLC Tri State

41

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