Engine Company EMS and Diligence

Know your Equipment 

By: FF/P Robert Balkun, FF/P Tom Corrone, and Lt. Frank Ricci City of New Haven Fire Department

Failure to be aware of your service’s medical capabilities and equipment can lead to a reduced quality of care in respect to cardiac arrest care in pediatric patients.

In departments that provide both basic and advanced life support services, personnel need to remain aware of the differences in equipment when delivering electrical defibrillation to pediatric patients.

Most AED manufacturers now make both pads for ALS and BLS. These BLS pediatric AED cables can be easily confused with pediatric therapy electrodes for ALS care. To the left are AED pediatric cables manufactured by Physiocontrol.

AED pediatric electrodes have a built in resistor in the cables, reducing the amount of joules provided from an adult setting (typically 200J) to an dosage appropriate for a pediatric patient; cables for ALS monitors like the Lifepak 15’s do not have this built-in resistor.

Defibrillation electrical settings are weight-based for pediatric patients in reference to advanced care, allowing ALS providers to change defibrillation settings via their monitor to the correct amount therefore not requiring this resistor in the cables.

On the packages to these therapy cables, it does state these ALS cables should not be utilized on AED’s, but if providers are not aware of the differences, this can be easily missed.

Refer to your services EMS director and/or local protocols for recommendations and how this may affect care in your service area.

Customer Service Doesn't Matter

Customer Service Doesn’t Matter

By Frank Ricci “Politics & Tactics”

Your fire department is missing the mark. We have failed to understand the game and we have paid a political price for our lack of vision.

Stand back and watch what happens the next time a stranger walks into your firehouse. Chances are the watchmen or firefighter will stay seated and ask how can I help you.

Even if they stand and are helpful we still fail as a service. The customer service era that started in the late 80s focusing on the tangible was the foundation for our current mindset. The meaning was to do the best job possible for our customers, but fell short of exceeding expectations. It was about providing the best service and not providing the best experience.

To be clear your department can provide great customer service and still not deliver on creating a great experience. Experience is based on emotion, etiquette and execution.

Lets go back to our friend (boss, citizen) entering the firehouse. Would the experience of our friend improve if the firefighter walked toward the visitor, made eye contact, introduce him or herself, and shook their hands, all while smiling?

Simon Cooper past CEO of the Ritz-Carlton Hotel Company mastered providing an experience. He ran a chain where the customers could go down the street and stay for a lower rate with similar amenities. However where the other top hotels fell to the Ritz was by failing to provide consistency with the intangibles. The greetings, attention to detail and the simple smile, ironically these are the things that are not affected by budget cuts and cost nothing.  

As the fire service we need to move from the customer service model and move to a customer engagement model. 

It comes down to the perception of our customers. I tell my members at each alarm we can have a choice to leave the customer with one of three impressions.

1.                     The meeting results in indifference where nothing in gained and only an opportunity is missed.

2.                     The experience is poor and they leave the meeting thinking you are an ass.

3.                     You master customer engagement and provide the best experience possible while making a new friend.

Number three is more than a great introduction. It is about wrapping our friends in cotton. First and last impressions matter to our friends.

Take the time to hold a hand of an elderly customer letting them know that the medic crew is going to take great care of them.

Take the time after the call to answer questions and put the neighborhood kids on the fire engine. Remember you are there on our customer’s worst day. It is up to you to make the difference.

These customers are the friends who will write letters to the editor, attend government meetings and come out to fight the closing of a station.

Engagement is the key to the lasting impression that will ensure and bypass customer service. We can and must do better. Our core values and the work in the late 80s will serve as the foundation, yet we can not rest. Now is the time to build and move our service to the front.   

"Trust but Verify"

By Frank Ricci                                       Trust but Verify

President Reagan used the Russian proverb "doveryai, no proveryai" to communicate America's position in negotiating with the Soviet Union.  This was one of our nations most important nuclear arms reduction agreements know as the Intermediate-Range Nuclear Forces Treaty (INF). He used it at every meeting!

No less important we utilize the proverb to raise our kids and firefighters. We have all heard it " what, you don't trust me." Remember if everyone made great choices all the time there would be little need for officers.

That is why there is redundancy built into our ranks. This ensures critical tasks don't get missed. However it is critical that the fire officer doesn't micro manage and we balance oversight.

Keep in mind your own reaction when a heavy hand from the rank above comes down, stays on your back and not only tells you what to do, but how to do it. This demonstrates a break down in command and a total lack of trust. This should not be confused with communicating a vision through expectations and training.

As a officer I strive to communicate expectations through training. This is one of the keys to achieving tactical excellence. Your team will excel if they understand their value and are proficient at a task level.

The goal for a good boss on the fire ground is to communicate the task that fits into the operational objectives and let your team do what they do best. In another words tell them what to do, not how to do it and than verify that it was done. 

This strategy will ensure that you do not get overly tactically involed loosing valuable perspective of the big picture. You will be able to recognize your own weakness in your training program. 

President Reagan left the legacy as the great communicator. When our actions can lead to injury or death it is imperative that we all strive to be better communicators.  Always communicate expectations, trust but verify.
 

Safety Officer & the Libertarian

Safety Officer & the Libertarian

By Frank Ricci

On issues of public policy the wise seek counsel, gather facts and always include a libertarian in deliberations.  The Demarcates and the Republicans will debate how a policy should be funded, implemented, and when it should take affect. The reason for the libertarian is simply to ask why is the government implementing the policy in the first place.    

The Safety Officer servers in the same role they must ask why. Why are we taking these actions in the first place? Will this structure end up in a landfill at the peril of the wrecking ball? As Anthony Avillo so eloquently states “is this operation going to conclude with a dumpster overhaul.”

A willingness to make your wife a widow and your kids fatherless for the community you serve is a noble notion. However this should not be blind dedication. History and Vincent Dunn has taught us that collapse zones matter. As a service we have paid a high cost for buildings that were almost preordained to collapse. If the safety officer just asked “Why” would the outcome be different.

Safety Officers act as an arm of command. That should not be confused with being in command. While short staffing has made our profession more dangerous by dictating that company officers become more tactically involved.  Safety officers who believe they are there to give orders, contradicts the very propose of their function. 

The Safety Officer must not lose perspective! One of their key roles is to ensure that collapse zones are established and maintained. Now that is the tricky part firefighters are like bugs to a flame they will creep closer and closer till they are in the danger zone. Collapse zones should not just be marked with tape they should have a firefighter or officer assigned to manage them.

Firefighters think Fire-line tape is for the public not for them. I have witnessed this with downed power lines. Someone needs to be stationed on the outside of the tape to warn of the hazard.

To head off the reader comments, not enough help is an excuse for poor leadership and failed management not a reason for failing to call more recourses to the scene.

Remember that it is the month of our country’s founding. The birthday of the greatest experiment in world history. Keep our troops in your heart and on the next big decision lets hope there is a libertarian in the meeting and a safety officer on scene.