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CAROLINA FIRE RESCUE EMS JOURNAL | PPRODUCT & SERVICE GUIDE | SUMMER 2022 | 23
The Attorneys at Chappell Smith & Arden, P.A. are committed to protecting the rights of First Responders and keeping their families safe. Chappell Smith & Arden, P.A. can help you with: • WORKERS
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A WORD FROM THE
EDITOR
A good HEART and TRAINING are not the only things firefighters need to get their job done. This is where Carolina Fire Rescue EMS Journal’s eBook Buyers Guide comes in. Within these pages you will find an array of solutions for the challenges you face on the fireground. Take a few minutes to peruse the offerings from top of the line fire industry providers. Unlike print-only publications, this eBook contains offerings with direct links that will connect you to the manufacturers pages for further information. Chances are that within these pages you will find something that will help you and your department save lives and protect property.
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These companies want your business. Check them out!
Gwen Shuford
Managing Editor, Carolina Fire Rescue EMS Journal
CAROLINA FIRE RESCUE EMS JOURNAL | PPRODUCT & SERVICE GUIDE | SUMMER 2022 | 3
STRENGTH TRAINING FOR FIRE FIGHTING … Jeff Casebolt
M
ore than 20 years ago, upon reflection as a Strength and Conditioning (S&C) Coach, I asked out loud to no one in particular, what was my job? The question was generated from the thoughts of developing a philosophical approach to proper strength and conditioning parameters when working with athletes and assisting professionals in the service industries: Fire, Police, Emergency Medical Services (EMS), etc. I realized that my job was to best prepare these individuals for day-today operations and ultimately improve longevity in their chosen careers. As I sat there with my cup of coffee, spitballing ideas during a “free-writing” session, it hit me. The thought that popped into my head, and has never left, was to strength train the service industry with the intent of minimizing injury potential, which in turn will improve performance and maximize availability for time spent on the job. The rationale behind my epiphany was if, as an Strength and Conditioning (S&C) Coach, I could properly strengthen all the muscles surrounding and supporting each of the major joints of the fire fighter’s body then the individual would be less prone to injury, be available to develop advanced movement skills, while minimizing the number of “sick days” taken each year due to on-the-job injury. This concept is now commonly referred to as joint stability. In order to promote true injury minimization among joints, the concept of mobility needs to be mentioned and explored. Joint mobilization is more than the flexibility of muscle and connective tissue – rather it is best summed up by addressing both the necessary movement patterns of the joint while increasing or maintaining the range of motion needed to move without compensation. Furthermore, improved muscle
ISOMETRIC
Strength
Speed
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quality and the movement patterns used in the weight room, not necessarily for the purposes of hypertrophy, but instead focusing on the increased tensile strength of the muscular and connective tissues would simultaneously affect joint stability, mobility, while improving metabolic efficiency. The separation of strength development and skill acquisition was one of the first major breakthroughs for me professionally when examining and philosophizing my contribution to condition those individuals who support their families while working a physically demanding job, such as firefighting. For the development of strength, I always start the conversation by referring to the Force Velocity Curve (FVC) and specifically to the Pure Strength portion of the curve on the concentric side of the graph – see graph. Within this portion of the curve, the velocity of movement is low and force production is high, with intentions of inducing neuromuscular fatigue. I am not a proponent of prescribing sets, reps, and load perse. Conversely, I prefer to educate my lifters to train to a “feeling” – psychological or physiological. What I mean is, depending on the need for
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recovery – I ask, how close can I take a lifter to full Momentary Volitional Fatigue (MVF): the inability to complete another repetition with “good” form in the concentric phase of the lift. When examining a training session, if a compensatory movement pattern is witnessed, due to previous or existing injury, or induced fatigue, a corrective verbal que is given and if faulty movement is still present the set is terminated. If the lifter does not have adequate recovery time post-strength session, then complete MVF style lifting is not advised given the lack of time prior to the next shift, then a different approach must be taken. I propose lifting to a percentage of MVF, which is not an easy proposition at first, but with persistence your lifter will learn the following: using a load for projected Repetition Maximum (RM) have the lifter work to within three to five repetitions of the RM and that should be enough to stimulate the need for recovery. For example, a load is used where the lifter can produce 15 repetitions; therefore, I ask the lifter to get within three to five reps of that projected 15RM, which has been shown to have been enough stimulus to force the muscle(s) into recovery and decrease the time needed for recovery. WWW.CAROLINAFIREJOURNAL.COM
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STRENGTH TRAINING FOR FIRE FIGHTING … Some professionals are referring to this concept as stimulating reps, but no matter the name, the concept is cemented in strength development and is an effective tool when working with lifters who need to be fully recovered in less time. Therefore, the induced stimulus must be enough to put the muscle into recovery for the purposes of adaptation. If the stimulus is not significant enough or recovery is inefficient then adaptation is less likely to occur. According to the latest research, three to five reps within an RM, on average seems to be enough stimulus to cross a mythical or magical threshold putting the targeted muscle into recovery. Proper recovery is recognized and acknowledged here as sufficient nutrition, hydration, and recovery returning the body to homeostasis in a timely manner. In conclusion, the development of muscular force production using the FVC as a guide happens in the Pure Strength – low velocity, high force – section of the curve with induced fatigue to full or near MVF without compensatory movement patterns for the purposes of muscular strength development. At the other end of the FVC continuum, still, on the concentric side of the graph, you have high-velocity movement coupled with low force production by the muscles. It is in this section of the graph we examine the concepts of skill acquisition or job requirements for the field. The development of skill occurs at the Pure Speed portion of the FVC – high speed, low force production – therefore, during the training process for the acquisition of skill, I tend to focus more on the specific development of job-related skills with the possibility of supporting low to highlevel plyometric movements paying close attention to compensatory or pathological movement patterns for the purposes of minimization injury potential with the intent of maximizing improved human motion. The intent is transferred under the SAID Principle – Specific Adaptation to Imposed Demand. If you want your lifters to become better at the utilization of developed strength and more efficient with their movement patterns it is best to install specific movement patterns needed for on-the-job training. The skill of strength development is an important part of working with novice or new to strength training lifters
in the weight room. Basically, there are two extreme schools of thought on the strength training continuum: 1. Movements that are required for the lifter’s profession – i.e., firefighting, or 2. Muscular strength in the safest way possible. No matter your professional philosophy teaching safe techniques while educating your lifters on proper form is essential for minimizing their injury potential. When initiating a training program, I lean towards the latter philosophy and tend to stay there for much of the time I spend working with said lifter(s), no matter the number of years dedicated to strength training. My intentions are to load the systems of the body: neurological, muscular, bone/ joint, and connective tissue – efficiently, properly, and safely with induced fatigue, while minimizing joint loads through appropriate load distribution. Simply teaching proper techniques for developing lifters in the weight room will go a long way in reducing injury potential. Conversely, the majority of strength training programs are loadbased utilizing the lifter’s competitive nature, with the objective resulting in 1RM – one repetition maximum – often producing compromised technique and tissue breakdown, as a result. Recently, I was privileged to the following advice, in reference to training athletes for the purposes of reducing injury – “move slowly for the development of muscle, and quickly for connective tissue condition”. This advice hit home because I have always examined strength as a healthy stressor of the neurological system to ligamentous structures via muscle, tendon, bone, and joint --- understanding each of these systems (tissues) necessary dose-response during strength training followed by the ballistic nature of on-the-job training goes a long way in preparing the firefighter for the necessary fieldwork. The combination of increased strength and improved skill acquisition will minimize both acute and chronic injury potential according to several literature reviews and anecdotal evidence. Moving external load ballistically can have benefits due to a large neurological impulse generated towards the muscles responsible for the movement, but once the movement has been initiated momentum becomes the byproduct
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resulting in significantly less muscle fiber activation until deceleration of the object is needed. In order to properly slow down, stop or reverse the generated angular momentum about a joint an antagonistic co-contraction is most likely utilized, which is a naturally occurring protective instinct and if transferred to the skill acquisition phase of training, reduced “athleticism” may result and can be witnessed. In other words, if you are going to use ballistic lifts in your athlete’s development, start with a base of strength, understand why you are programming ballistic lifting into your lifter’s workouts, learn to teach the lifts properly, and understand when, how, and why an injury is likely to occur. Even when a ballistic lift is performed to perfection, residual effects can result in accessory injury – injuries that were caused in the weight room, but do not present themselves until the lifter is physically active during a work-related incident. In addition, developing strength through the entire range of motion in all planes of motion, in which a joint move has shown to improve integrity through congruency, resulting in reduce injury potential and a reduction in recovery time if an injury happens to occur. Research suggests a safe strength development program – moving weight slowly - in combination with a proper firefighting specific skill development program – moving the body quickly - is as effective as a ballistic strength program for the purposes of developing on-the-job “athleticism” with less potential for injury. Jeff Casebolt has been associated with the fitness industry since 1991 working as a personal trainer, strength and conditioning coach, corporate fitness coordinator prior to going back to school to work on a Ph.D. in Biomechanics and as a professor. Jeff’s research interests include increasing function with strength training across all ages, occupations, and abilities, lower body power development, injury mechanisms among athletes and occupations, and fall prevention among the elderly. In addition, Casebolt is associated with Dynavec Resistance Systems and the Fire Fit Trainer assisting with research, development, marketing, and sales. WWW.CAROLINAFIREJOURNAL.COM
UPDATE FROM THE NC STATE FIREFIGHTERS’ ASSOCIATION Tim Bradley
T
he North Carolina State Firefighters’ Association (NCSFA) has been in existence for over 135 years serving North Carolina Firefighters. We’re called the Tarheel State, but you’ll find Duke, State, Clemson, and even East Carolina University (ECU) fans here as well, in addition to a host of others. Traveling around North Carolina, you can’t help but appreciate the subtle differences in communities, people, and even community names. Alabama has its Scratch Ankle, but we’ve got our Nags Head and Bald Head, also a Clarks Neck and Scotland Neck, not to mention a Sandy Bottom. We’ve got a Bushy Mountain, and a Flat Branch Fire Department, as well as a Silver Lake and Silver Valley. I don’t think anyone else has a Duck or a Bat Cave, except maybe Batman, but we do here. North Carolina is special and a lot goes into keeping it special but in the end, it’s our people that make the difference. There are many differences in communities across the state, but many more similarities. Just like our three Regional Firefighter Associations, we have three phases of barbecue: Eastern-Western-Piedmont, yet it all comes from a hog. If you’re eating at a restaurant and order “Catch of the Day”, it could be anything from Catfish to Flounder. Regardless, someone worked hard to catch it, cook it, and serve it. Life is about people and North Carolina has some of the best, especially our firefighters. In North Carolina, we have over 48,463 active career and volunteer firefighters, with 1,308 fire departments serving communities from Corolla to Cullowhee, or the coast to the mountains. Taking care of firefighters has and
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continues to be our most important job and our greatest challenge. Two issues that have challenged us in recent years, just as they have firefighters across the nation, are Mental health issues such as Post Traumatic Stress, depression, grieving, and suicide, and Firefighter Cancer. Mental Health. The North Carolina State Firefighters’ Association recognizes our responsibilities in providing support and assistance to our state’s fire service personnel related to mental health. To the Association, our State and local communities, as well as the fire departments themselves, our personnel are our most valuable resource to be protected. For their families and their community, they need to come home safe and remain safe by eliminating life-altering stress caused by witnessing of and participation in traumatic events, as well as the culminating anxiety that comes from balancing a stressful career with other aspects of life. This means not only providing benefits but providing programs in areas such as mental health and assistance with individual cases of Post-Traumatic Stress (PTS). Mental health issues such as Post Traumatic Stress, depression, family conflict, grieving, addictions, and suicide are all becoming more commonplace in our service. North Carolina previously had two programs dealing with these issues already in existence. The first was First Responder Assistance Program (FRAP), which offers resources and referrals to first responders for these issues. This is an initial contact program to provide information and resources for those seeking assistance. The second, broader program is the
North Carolina First Responder Peer Support Program. This program is defined as assistance provided by a trained individual or group of trained firefighters, law enforcement officers, or EMS personnel who answer the call to their brothers and sisters in need, regardless of the need. These two programs provide initial and peer support in an excellent manner, but the missing component was the ability to cover professional counseling services an individual may need beyond the service of these programs. Working with a grant provided by Blue Cross and Blue Shield of NC, the NCSFA and the North Carolina Firefighters Fund (NCFF) has developed a program of reimbursement of expenses for qualified counseling related to Mental Health and PostTraumatic Stress issues. The program will provide reimbursement of therapy or counseling by a qualified physician or licensed counselor. Since the grant from Blue Cross Blue Shield is a limited amount, funding will only be provided as long as funds designated for this purpose within the NCFF remain. The program will provide up to $2,500 in reimbursement per individual for insurance copays, insurance deductibles, or direct counseling services not covered by the individual’s or department’s insurance. Travel expenses may be reimbursed if the services obtained are out of State. The application must be submitted and signed by the Fire Chief or Chief Officer of the department, and services must be performed by a licensed therapeutic counselor or doctor specializing in stress disorders and must be related at least in part to the individual work as a firefighter listed on the fire department roster. Reimbursement approval is at the sole discretion of the NCFF. Information and application information can be found at www.ncsfa.com. Firefighter Cancer. Firefighter Cancer has become an issue for firefighters across the country and internationally. Numerous programs
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UPDATE FROM THE NC STATE FIREFIGHTERS’ ASSOCIATION for risk management of cancer are available, both from local, state, and national programs. In North Carolina alone we have the North Carolina Firefighter Cancer Alliance, which provides training and prevention
cost concerns. In addition, even with presumptive cancer laws, coverage is not guaranteed. A little over two years ago the NCSFA began working with the League of Municipalities to
Over the last several years unsuccessful attempts have been made to pass a worker’s compensation-based presumptive cancer law in NC for firefighters.
Firefighter Cancer Coverage legislation was passed, providing cancer coverage for every rostered firefighter in North Carolina with more than five-year continuous service. The program was funded for two years at a cost of $16 million. The North Carolina Department of Insurance was tasked with finding the coverage for the policy and selected Volunteer Fireman’s Insurance Services, Inc. (VFIS) of North Carolina to provide the coverage. The policy provides the following benefits:
• $25,000 benefit per cancer with a
maximum of $50,000 per individual
• $12,000 per diagnosis of cancer reimbursement for expenses
• Career Firefighters 75% of salary up to $5,000 per month for disability for 36 months
• Volunteer Firefighters $1,500 per programs. Numerous departments have initiated cancer prevention routines in their daily operational guidelines. Other programs such as those with the International Association of Fire Chiefs (IAFC) and the National Volunteer Fire Council (NVFC) are shared and available. While prevention holds the key to reducing cancer in the future, the problem still exists for those in the fire service who develop cancer, one of those being the financial issues involved with firefighter cancer. Cancer can become devastating not only on the physical well-being but on the financial side as well. Over the last several years unsuccessful attempts have been made to pass a worker’s compensation-based presumptive cancer law in NC for firefighters. NC workers compensation law is written such that once the issue is determined to be a worker’s comp claim, all costs, medical and disability, are paid out of the worker’s compensation fund and not health insurance. This led to difficulty in getting the law passed by the North Carolina General Assembly because of
develop language for a firefighter cancer insurance policy that could be placed into law and provided to every firefighter in North Carolina. Prior to last year’s legislative session, this language was submitted to the combined legislative committee of the North Carolina Fire Service, including the NCSFA, North Carolina Association of Fire Chiefs, and the Professional Firefighters and Paramedics of North Carolina, and all agreed it would be the focus of the 2021/2022 legislative session. In May of last year, the NCSFA held its annual legislative day, and firefighter cancer insurance was the priority presented to every legislative representative. With COVID masks designed with a purple ribbon design, and handouts describing the issue of firefighter cancer and the defined benefit of firefighter cancer insurance, close to 200 hundred firefighters made their case to legislators in person. This, combined with calls and lobbying efforts of fire service organizations, let the elected representatives know this was the critical issue facing our service. In the closing days of the session, the
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month for disability for 36 months
• The policy pays in addition to
any other policy except workers compensation
While this was a major success, our work is not done. The program was funded for two years and efforts will be necessary to make the funding permanent going into the future. For additional information on this policy go to: www.vfisnc.com or www. ncosfm.gov/risk-mgnt
South Atlantic Fire Rescue Expo (SAFRE): This year’s dates for the
SAFRE Conference are August 10th13th, 2022. Online registration will be available in the next couple of weeks. Course selections have already been made and this year we will have some great classes. We have two great keynote speakers this year, one for Thursday during opening ceremonies and one for Friday, Dr. Denis Onieal, former Deputy US Fire Administrator and former Superintendent at the National Fire Academy will join us Friday for a presentation as well as teach some leadership classes, and Commander Rorke Denver, retired Navy Seal will provide us leadership thoughts based on his experience during the opening Thursday. Our vendor show, which is WWW.CAROLINAFIREJOURNAL.COM
one of the largest covers over 150,000 square feet of space and will have free admission. Please mark your calendar for that week. We look forward to a great week of fellowship, education, and seeing what’s new and innovative in apparatus, technology, and equipment for the fire service and our first responders. Video Series: The Board and staff of NCSFA have begun production of an informal series of informational videos concerning topics of current events in the fire service. Examples include legislation, relief fund, and other benefits or programs available to the fire service.
As these are produced, they’ll be placed on our webpage and social media for viewing. Held to two to three minutes each, they will provide information to chiefs and firefighters on a host of topics. Production began January 14th, and hopefully, within a few months many of them will be available. NCSFA History: The NCSFA has continued work on documenting our history. Mike Legeros, from Raleigh, has begun formulating historical information working with our Statistician and Historian, Dennis Pressley. Some of this was displayed at the Annual
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with the Griffon Association’s Annual Golf Tournament
Your sponsorship, product or monetary donation, or registration to play in the tournament itself all help make it possible to provide: • Financial help for families of deployed Soldiers • Assistance to Soldiers injured during duty • Scholarships for Army Reserve Soldiers and families
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Conference last year. The Board plans to have a history book ready for this year’s conference, and also have plans to provide copies to all North Carolina Fire Departments. Since our beginning in 1887, the book will describe the development and growth of the Association and the North Carolina Fire Service as well. Complete with pictures and documents it will be inclusive of events that shaped our growth. The NCSFA has a history of providing and fighting for firefighter benefits, resources, and providing an opportunity to work together for the improvement of our service, and ultimately the protection of our citizens. We partner with other Associations in North Carolina, as well as other State Associations to share ideas on benefits and programs. We work with national and international organizations to bring relevant programs here. Close to 70% of the National Volunteer Fire Council membership consists of North Carolina Firefighters. Proud to serve the fire service, our nine Board members are elected and represent the three regions of the State. For more information visit our website at ncsfa.com. Tim Bradley has a Bachelor
of Science Degree in Fire and Safety Engineering Technology, an Associate Degree in Electronic Engineering Technology, and is a graduate of the National Fire Academy’s Executive Fire Officer (EFO) Program. Tim has been in the fire service for 47 years. He served as Chief for seven years, Executive Director of the North Carolina Fire and Rescue Commission, and Senior Deputy Commissioner of Insurance in charge of the Office of State Fire Marshal (OSFM), among many other positions. He was awarded North Carolina’s Firefighter of the Year Award in 2003, and in 2007 he was awarded Firehouse Magazines Heroism Award for the rescue of a fiveyear-old boy from a house fire. He is the author of “The Fire Marshals Handbook,” a book published to match the requirements for the NFPA Standard for Fire Marshals.
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BUILDING RESILIENCY IN THE FIRE/EMS SERVICE Scott A Robinson
W
hen I joined the fire service in 1995, I never imagined I would spend so much time advocating about resiliency in the fire service. In 2003, while assigned to the back step of Engine 4 for the City of Cranston, Rhode Island, we responded as a mutual aid company to the Station Night Club fire in West
what I know now though, I can safely say that that simple definition is a bit inadequate. The American Psychological Association (APA) defines resiliency as the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress — such as familial and/or relationship problems, serious health problems, or workplace and financial stressors.
depression treatment alone. (APA, Lea Winerman March 2017, Vol 48, No. 3). The numbers have surely increased since then. Stress reactions are normal physiological responses and are our body’s way of maintaining homeostasis in the presence of a “threat”. When we respond to a stressor, our bodies trigger a cascade of stress hormones that produce well-orchestrated physiological changes. Our heart pounds, our breathing quickens, our muscles tense, and beads of sweat appear. Sometimes, we even experience nausea and vomit, as a reaction to the neurochemicals that are released into our system. These physiological responses happen to avert stress or protect our lives from the stress at hand; however, when stressors are always present and one is constantly exposed to stressful situations, like when the bell or tones go off for the next run, that fight-orflight reaction stays turned on. The long-term activation of the stress response system and the overexposure to cortisol and other stress hormones that follow can disrupt almost all the body’s processes. This long-term activation puts individuals at increased risk for many health problems, including:
Today, the word “resiliency” holds a much different definition for me than if I had been asked for the definition in 2003. In 2003, I would probably have said simply, “Resiliency means to withstand adversity.” • Heart disease, heart attack, high blood pressure, and stroke (the number one Knowing what I know now though, I can safely say killer of firefighters) that that simple definition is a bit inadequate. • Anxiety
Warwick, Rhode Island where we assisted the Town of West Warwick in fighting the fire from around 11:30 p.m. until about 2:00-3:00 a.m. and then assisted with body recovery until after 7:00 a.m.. Afterwards, we were placed back in service and returned to our city for our reliefs. The tragedy of that fire yielded 100 fire fatalities and about 300 injuries. Little did I know the experience would affect me for years to come as well. Today, the word “resiliency” holds a much different definition for me than if I had been asked for the definition in 2003. In 2003, I would probably have said simply, “Resiliency means to withstand adversity.” Knowing
Today, I would define resiliency as a process. Resiliency is one’s ability to face overwhelming stress, find a way to overcome that stress, and then thrive after having had the experience. In order to understand why resiliency is important, first, we have to understand what stress is and how it affects us. Stress is a non-specific physiological response that occurs in our bodies from either a real or perceived threat, challenge, or change. Imagine, 75% to 90% of all visits to physicians are stress-related (The Effects of Stress on Your Body, 2021) and in the U.S. alone we spent $187.8 billion on mental health conditions and substance use disorders in 2013. Seventy billion of that cost was spent on
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• Depression • Digestive problems • Headaches • Muscle tension and pain • Sleep problems • Weight gain • Memory and concentration impairment
(https://www.mayoclinic.org/healthylifestyle/stress-management/in-depth/ stress/art-20046037) The mantra I heard while “growing up” in the fire service was: If it’s not broke, don’t fix it. Obviously, this advice was not related to unseen behavioral health issues but was formulated on the premise that if you were managing through something, you would be fine. That is not the case, however. Eventually, things WWW.CAROLINAFIREJOURNAL.COM
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BUILDING RESILIENCY IN THE FIRE/EMS SERVICE that cause stress may, and often do, become unmanageable and when an individual lacks the skills necessary to handle that overwhelming stress, that person suffers. Of course, it’s not only the individual that needs coping skills but our organizations do also as well. When our organizations do not embrace developing and practicing skills that make our workforce resilient, we suffer. This is why, not only is individual resiliency important, but also building organizational resiliency is paramount. Unfortunately, there are not many studies on resiliency and coping strategies within the first responder community, but there are several studies that have been done within the nursing and physician workforce from which the first responder community can learn. For instance, inside the health care field, several common characteristics or traits contributing to resiliency have been identified within those workforces. A study that included 1554 nurses from around the Pacific rim found that regardless of culture, there were four characteristics most utilized for the purpose of healthy coping skills that contributed to resiliency: self-control, seeking social support, problem-solving and positive reappraisal (Lambert et al, 2004). In another study of nurses and their coping strategies, (Chang et al, 2007) researchers discovered several characteristics that seemed to be contributory factors found in less resilient nurses, particularly in those who practiced escape-avoidance, which is a maladaptive form of coping in which a person changes his/her behavior to avoid thinking about or doing difficult things. Another maladaptive coping skill found was distancing. This resulted when nurses distance themselves from the stress and treat work-related stressors as non-personal. Finally, the study also identified nurses who had a degree of self-control, which ultimately caused them to isolate their true feelings from everyone. Each of these factors, escapeavoidance, distancing, and self-control, were predictors of less-resilient staff. Based on these studies it is evident that there are several ways to identify a resilient person. Resilient people confront their fears, rather than isolate themselves
from them. They maintain an optimistic outlook and have a supportive social network including great mentors, or role models. They practice emotional literacy, or the ability to listen to others and empathize with their emotions and manage those emotional reactions. This allows them to recognize the impact of their emotional state on their problemsolving. (Howe 2008). Ultimately emotional literacy teaches a person to express emotions productively. Additionally, they have great success in facing overwhelming stress in their lives because they not only accept what cannot be changed but recognize they can control how they respond to what cannot be changed. Our first responder professionals are some of the most resilient people out there and I have worked with many of them during my 28 years in the fire service. Typically, those individuals have great social networks and family support. They have an optimistic view of the job rather than a pessimistic view. They recognize what they cannot control and what they can control. When I think back over those 28 years in the fire service, the happiest assignments I had occurred when I was working in places with people like these individuals. Resiliency is important. It protects us against heart disease, potentially increases life expectancy by ten years, inoculates us against the daily grind and traumatic life-altering events, improves our job satisfaction and productivity, boosts the immune system, and lowers the risk of alcohol and drug dependency; however, resilience is not an innate, fixed characteristic. It can be developed through targeted interventions. (McAllister and McKinnon 2008) To be resilient individuals must focus on several factors: 1. Find satisfaction attained through their work 2. Develop positive attitudes and/or a sense of faith 3. Recognize that they make a difference in the lives of those they serve 4. Utilize strategies such as peer support 5. Validating and self-reflection of
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emotional literacy 6. Accept support from colleagues, mentors, and crews 7. Seek education on mindfulness 8. Maintain a work-life balance. Resiliency does not end with the individual. We are only as strong as the organizations that support us. We need to foster resiliency in our departments, starting in our recruit schools by encouraging curriculums that nurture reflective learning, emotional literacy, empathy, and self-awareness education. Recruits also need to develop narrative writing skills as students. Departments need to provide supportive supervision in the workplace by educating our supervisors to provide safe environments in which first responders can reflect on their reactions to events and they can disclose and discuss their emotional reactions. Fire Departments and Emergency Medical Services (EMS) agencies need to develop peer and mentoring programs to help develop supportive relationships. Without the adequate resources and support through the development of individual and organizational resiliency in our fire departments or EMS agencies, even highly resilient responders will be unable to survive, let alone thrive. Scott A. Robinson is a Lieutenant with the Cranston, RI Fire Dept and has been a firefighter for 28 years. He is one of the IAFF Union’s Behavioral Health Specialists in the Department of Occupational Health and Medicine. Scott is former President of IAFF, Local 1363, and former Vice President of the Rhode Island State Association of Fire Fighters. He established the Rhode Island State Association of Fire Fighters’ Members Assistance Program (MAP) which is available to all union firefighters, active and retired, throughout RI, as well as their families. Scott is a Peer Support Master Instructor for the International Association of Fire Fighters, where he teaches peer support to IAFF locals in the U.S. and Canada and has been deployed on behalf of the IAFF to disaster areas across the country including Hurricane Harvey and the Champagne Tower collapse in Miami. WWW.CAROLINAFIREJOURNAL.COM
MEDICAL DIRECTOR UPDATE 2022 Dr. James Winslow, Medical Director, NC Office of EMS
W
e’ve had a long pandemic. At this point, it’s been going on for roughly two years. We’ve all been through a lot, but we’ve also done a lot of good. In this column, I’m going to review some of the topics that I went over from the medical directors update in Wilmington in March. There are several topics I am going to touch on in this column.
Ketamine — The North Carolina
Medical Board added ketamine to the paramedic scope of practice in 2019. A key requirement of using ketamine is that all systems must report their data to the North Carolina Office of Emergency Medical Services (EMS). If you are currently using ketamine for anything other than drug assistant intubation and you’re not reporting your data to the state then please stop immediately and get in contact with your local regional specialist. They
During the pandemic the opioid crisis has gotten much worse. In 2018 the rate of unintentional overdose among North Carolina residents was approximately 25 per 100,000 residents. As of today, the rate is approximately 30 per 100,000 residents.
• North Carolina’s experience with
using prehospital ketamine since it was approved by the North Carolina medical board.
• How we are doing with drugassisted intubation
• The ongoing opioid epidemic • The COVID-19 global pandemic • Possible ways to address current staffing issues
• What lies ahead?
can assist you with the data reporting requirements. North Carolina has done well with its use of ketamine. In all of 2021, EMS used ketamine for sedation 236 times. From the data submitted to the state, there were only four unplanned intubations after the use of ketamine. This means that unplanned intubation only took place in 1.7% of the cases where ketamine was used for sedation. This is a very good safety profile. Please remember that only prehospital medical professionals should be making
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the decision about whether to use ketamine for sedation. Drug-Assisted Intubation – Drugassisted intubation is an important skill. The evidence for whether it improves outcomes is quite mixed. Any system which performs drug-assisted intubation must report its data to the state. Any system which is not reporting its data to the state should immediately inform its local regional specialist and stop doing this procedure. The regional specialist can help you with the data reporting requirements, but it is essential that you report data. Drug-assisted intubation is a high-risk procedure. It should only be done by very experienced paramedics who function under a very robust performance improvement system, receive the highest quality medical direction, and receive constant ongoing training. If the system cannot meet these requirements, it should not be performing drug-assisted intubation. Opioid Crisis – During the pandemic
the opioid crisis has gotten much worse. In 2018 the rate of unintentional overdose among North Carolina residents was approximately 25 per 100,000 residents. As of today, the rate is approximately 30 per 100,000 residents. That is about a 20% increase in deaths from opioid overdose in North Carolina. EMS agencies are in a position where they can help more with this epidemic than any other organization. Prehospital professionals are at a person’s side as they are being reversed from an overdose. Prehospital professionals also visit people where they live. They do not wait for them to come to a hospital. Medics can implement harm reduction strategies such as needle exchange which have been proven to increase the number of people who get into treatment. North Carolina has also been a leader in helping patients gain access to medication-assisted therapy with Suboxone. Stanly County and Onslow County specifically are national leaders in this. Other counties such as Orange County have implemented needle exchange programs. Guilford county has also done a huge amount of work with local public health to address the WWW.CAROLINAFIREJOURNAL.COM
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MEDICAL DIRECTOR UPDATE 2022 opioid epidemic in their communities. Prehospital professionals have a huge ability to help their communities recover from this epidemic and save lives. I strongly suggest all EMS agencies try to implement harm reduction strategies for their patients and look at implementing medication-assisted therapy programs. There will very likely be a grant coming soon from the North County
however who have been able to retain personnel for long periods of time. I visited one EMS system recently where three of their medics together had over 100 years of experience in EMS. Even more recently an EMS crew made up of two paramedics brought me a patient. The two paramedics together had 65 years of experience. This got me thinking
Prehospital professionals have a huge ability to help their communities recover from this epidemic and save lives. Office of EMS which can potentially help counties implement medicationassisted therapy drug programs for their patients. Please contact your Office of Emergency Medical Services (OEMS) regional specialist for the details. COVID-19 Pandemic – As I am writing this column it appears that the Omicron wave of COVID has passed. This latest wave of Covid has been bad. Please keep in mind that we will likely have more waves of COVID. Hopefully, they won’t be as bad as this last one. It is still extremely important for your staff and citizens that they get vaccinated. Please spread the word that vaccination is safe and effective. Staffing – Many systems are suffering
severe staffing shortages. Often EMS systems blame this on the low pay that they can offer. Another reason given for staffing shortages has been the continued, long grind of the COVID pandemic. I think these are all valid reasons. There are still many systems,
about what allows some systems to retain such seasoned medics. I think a big reason is that they don’t work their medics to death with high volume. In addition, I think they treat the medics like family and make them feel special. In order to create this type of environment, we need to train our leaders and make sure our leaders know how to lead. There are many leadership training programs that are very inexpensive and sometimes even free that we can send our leaders to. In addition, I really think we need to look at how we use our paramedics. What good is it to have a twoparamedic crew respond to all calls if we can’t keep them for more than three or four years and they never become seasoned paramedics? I honestly do not think we need to send a paramedic on every single call. At the emergency medical dispatch level, we need to look at ways that we can only send paramedics to calls that are likely to be needed. If we
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continue to burn through our medics with such high call volumes we will not be able to retain them for the long term. If we want our systems to be able to perform advanced procedures like drug-assisted intubation or give ketamine we must retain medics so that they can have adequate experience to provide optimal care. Even more important than the ability to perform advanced procedures is the wisdom and experience that they need to make the complex decisions needed of prehospital providers. What lies ahead? We have hopefully
made it through the worst of a global pandemic. We have risen to the challenge and dealt with stuff that none of the people who have come before us have had to deal with. You are all heroes. I think we can all legitimately breathe a big sigh of relief. I do want to caution everyone. I am very worried about the challenges that lie ahead. This pandemic has caused ruptures in our society. We are also facing an extremely worrisome international situation right now. We need to build relationships with each other. We need to concentrate on training. We need to take care of each other. Do not take anything for granted because it is very possible that worse lies ahead of us. Thanks – Prehospital providers have a
very special job and do things that no one else can do. You are the last call and the last hope for many of your patients. Never forget that what you do is special. You make a difference. Dr. Winslow has worked at Baptist Hospital in WinstonSalem for the past 11 years. He was appointed as the Medical Director of the North Carolina Office of EMS in 2011. This document contains all protocol, procedures and policies for all EMS agencies in North Carolina. WWW.CAROLINAFIREJOURNAL.COM
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KNOW WHEN TO HOLD ‘EM, KNOW WHEN TO FOLD ‘EM
M David Greene
any of you may not catch the reference, but the title of this quarter’s article refers to an old Kenny Rogers song. In it, Kenny stresses the importance of knowing how to play the card game poker. That is, you have to know when to “hold your cards” and “call” the other player when you suspect you have a better hand. Alternatively, and perhaps more importantly, you have to know when to fold and turn your cards in without betting anymore, if you suspect the other player has a better hand than you. When you fold, you accept that you will lose all of the money that you have bet up until that point. It is “folding” that I would like to discuss in this article. Many years ago, I was the Incident Commander at a two-story, 3,500 square foot house fire. The fire was on the second floor and heavy smoke was visible from both eaves. The family had self-extricated prior to our arrival. A crew of four entered the home and reported that on the second division there was high heat and zero visibility. I’ve often written in this column about how much easier it is to run into burning buildings than it is to command them from outside. Such was the case at this fire. There was little to no steam production and the smoke increased in both volume and turbulence. The crews reported on the radio that the layout was hindering their location of the fire. The frustration in their
voices matched the frustration I was feeling outside. After a few minutes of continued lack of progress (and increased frustration), one of the crew came outside and met me in the front yard. The firefighter tried to talk to me but was hindered by his mask and the many foreground sounds. I put my ungloved hand on his helmet to pull his face next to my ear and it was like I had touched a hot stove. I instantly took my hand off his helmet, looked back at the house with its continued signs of fire progression, and thought, this is bad. I immediately ordered the firefighter to go get the rest of the crew off of the second floor, I had the engine on scene sound the air horns to evacuate the building and switched to defensive operations. Only a minute or two after everyone evacuated and was accounted for, a flashover occurred on the second floor. Fire vented from both eaves and I began planning on what I thought would be the proverbial parking lot that I would leave at the end of the night. Fortunately, the crews on the scene did an excellent job. They positioned several exterior hose lines and began to knock down the fire from the outside. They were even able to perform quite a bit of salvage that saved many of the contents on the first floor from the massive amount of water we were flowing on the second. Strangely, during one of my laps around the building during exterior suppression efforts, I found a firefighter had entered one of the bedrooms through a window. I ordered him out until we could
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knock the fire down enough to verify the structural integrity of the home. Once the fire was out, an investigation revealed a small second-floor layout was complemented by a tremendous amount of storage in the adjacent attic spaces accessible only by small panel doors. The storage areas contained couches, mattresses, and other combustibles with high heat release rates. There was simply no way that the interior crew could have reached these combustibles with an interior stream despite them trying until their helmets were nearly melting off their heads. At the end of the fire, the majority of the roof had been burnt off and we broke a load-bearing wall inside with the weight of the water we applied. Some of the firefighters were not happy about the decision to switch to defensive operations, as is often the case anytime that happens. However, there were no injuries, which is a win, all day, every day. Every incident we respond to brings with it a different set of circumstances. In many building fires, such as a stove fire, confining the fire to the room of origin is possible. In some cases, confining the fire to the building of origin is the only viable option. In urban areas with structures that are placed very near each other, confining the fire to the building of origin may not even be possible and of course, any life hazards present will further complicate or change our strategy. In the case of my fire, there were no immediate exposures and evacuating the firefighters from the building removed all of the life hazards. Considering all factors, my fire was easy. Let’s examine a fire that was not easy. On December 3, 1999, a fire occurred at the Worcester Cold Storage Warehouse building in Massachusetts. The building was a six-story, 15,000 square foot maze of connecting meat lockers with the walls and ceiling insulated by layers of cork, tar, and polystyrene WWW.CAROLINAFIREJOURNAL.COM
or polyurethane foam. The building was 93 years old and had only one staircase at the center of the building. The fire started from an overturned candlelit by two homeless persons who were squatting in the building. After recognizing the fire, the two homeless persons left the building and did not call 9-1-1. The fire burned for 30 to 90 minutes prior to a passerby notifying the Worchester Fire Department. The first arriving engine found heavy smoke showing. Eleven minutes into the fire, a nearby business owner reported to a police officer that “there may be two people living in that building.” Thirty-three minutes after the alarm, two firefighters from Rescue 1 reported that they were lost on the fourth floor and were running out of air. Four firefighters from Engine 3
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and Ladder 2 attempted to find the crew from Rescue 1 but became lost themselves. One hour and forty-five minutes into the fire, the Incident Commander made a decision that I hope and pray I will never have to make. Over the radio, the Incident Commander transmitted, “Command to all Companies, evacuate the building, sound the evacuation signal, evacuate the building.” Make no mistake, his decision to evacuate was nothing like mine, it was extremely difficult and painful. His decision to evacuate was made knowing that there were six firefighters still in the building that could not escape on their own. However, faced with a progressing fire, impossible interior conditions, and the potential for structural collapse from reports of cracked exterior walls, the Incident
Commander decided to fold. He did so, knowing that he would lose everything that he had invested so far. What cannot be quantified is the number of firefighters’ lives that he saved by evacuating when he did. I am certain there was more than one firefighter at the scene that night that wanted to go into the building to try to locate their brothers. It took eight days to locate all of the firefighters in the Worcester Warehouse fire due to an interior collapse and fire damage. While this is one of our fire service’s greatest tragedies, it very well could have been worse if the Incident Commander had not evacuated the building and switched to defensive operations when he did. Tragically, Lieutenants Timothy Jackson, James Lyons, and Thomas Spencer as well as Firefighters Paul Brotherton,
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KNOW WHEN TO HOLD ‘EM, KNOW WHEN TO FOLD ‘EM Jeremiah Lucey, and Joseph McGuirk gave the ultimate sacrifice that cold December night. The two homeless persons who unintentionally started the fire were later located uninjured. I am not trying to draw a parallel or make a comparison between my fire and the Worcester Cold Storage Warehouse fire. There is no comparison. In Worchester, a very old, very large abandoned/ vacant building with limited access and egress, containing extremely combustible insulation with penetrations both vertically and horizontally allowing for rapid-fire spread and no sprinkler system was the hand that the Worcester Fire Department was dealt. Whether you are in the Southeast, Northeast, Midwest, Southwest, or West Coast, firefighters are built about the same. They do not like to lose and many views any kind of evacuation or transition from interior to exterior attack as a loss. I am certain that this view is exponentially worse when firefighters are still in the building when an evacuation occurs. However, our service is sometimes dealt a bad hand. When that happens, we have to know when to “hold ‘em” and know when to “fold ‘em.” Although we all hope that a decision to “fold” will occur early enough in the incident to leave with all of our firefighters, we have to be prepared to quickly evaluate our current investment, consider what our current conditions and resources are, and make a rapid decision to “hold” or “fold.” In the case of Worcester, the Incident Commander likely saved countless firefighters. Anyone taking command should be prepared to make a similar gut-wrenching decision given similar circumstances. God bless the families of Lieutenants Timothy Jackson, James Lyons, Thomas Spencer, and Firefighters Paul Brotherton, Jeremiah Lucey, and Joseph McGuirk. Be safe and do good.
David Greene has over 31
years of experience in the fire service and is currently the deputy chief with Colleton County (S.C.) Fire-Rescue. He holds a PhD in Fire and Emergency Management Administration from Oklahoma State University and an MBA degree from the University of South Carolina. He is a
certified Executive Fire Officer through the National Fire Academy, holds the Chief Fire Officer Designation from the Center for Public Safety Excellence, holds Member Grade in the Institution of Fire Engineers, is an adjunct instructor for the South Carolina Fire Academy and is a Nationally Registered Paramedic. He can be reached at dagreene@lowcountry.com.
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