Ruminations on outcome based research
Spent time as a first-line supervisor on a haz-mat rescue company, when being a "glo worm" was new and cool.
The first response with the rescue was weird. A box alarm dispatch to a mid-rise senior facility was sending four engines, two trucks, an ems unit and the rescue … and my crew was S-L-O-W-L-Y walking to the rig.
Was this a test for the new officer?
Welcome to the Toast Patrol
The chauffer explained that they ran this address two to four times a day. The first due company is a few blocks away.
On almost every incident the first engine is returning the box alarm assignment within a few minutes.
It would be the first of hundreds of times the rescue would pull out into traffic, with me wailing the 2QB and stuttering the air horns. We drove the length of the shopping center parking lot next to the fire station before going in service.
Pretty dumb – why not just send the first engine and truck?
Apparently, we used to … until a 1+1 dispatch during a severe winter storm became a two alarm fire with rescue of an occupant in the fire apartment.
Looking at the details
The mid-rise facility was constructed in 1973, before fire sprinkers were required by the code to be installed within the apartments.
Built in an "in-field" property, truck company access to the rear of the building is tight.
The facility has almost 300 bedrooms.
A smoke detector is mounted in the kitchen, near the refridgerator. Every extra crispy toast and overbrewed teapot generated an alarm … breakfast, lunch and dinner.
Lean Manufacturing Model
Dylan Scott, writing in the February 2012 issue of Governing magazine, described the application of best practices by Patricia Gabow, MD, to improving Denver Health operations.
The lean manufacturing model is based on five principles, according to the Lean Enterprise Institute:
- Identify the value of the product for the customer
- Map the process for creating the product and eliminate elements without value
- Create a flow for the value-creating steps
- Let customers pull value from that flow
- Begin the process again and seek perfection.
Put more simply, it’s about eliminating wasteful actions. Anything that doesn’t add value for the ultimate customer is considered wasteful. “The philosophy is that waste is disrespectful to humanity because it squanders scarce resources, and waste is disrespectful to individuals because it asks them to do work with no value,” Gabow says. “We’ve added that waste is disrespectful to our patients because it asks them to endure processes with no value.”
Denver Health Becomes Profitable After Using Toyota As A Template
It it valuable to send seven fire companies two to four times a day for extra-crispy toast?
Wonder what the cost comparison and risk analysis would be if we placed a fire-rescue person at the facility to immediately respond to activated fire alarms? Maybe an ems credentialed responder with AED?
An example from Denver Health Medical Center:
Lean also inspired a restructuring of the Denver Health Medical Center’s rapid response system for patients who go into cardiac arrest. At most hospitals, a dedicated team is on call 24 hours a day, seven days a week for rapid response, and temporarily assume care of those patients from their primary nurses and doctors.
But in applying the lean principles, the medical center’s staff recognized an opportunity to cut costs while ensuring continuity of care. A regular assessment schedule was established for nurses to monitor their patients, and criteria were developed for nurses to determine if a patient was at risk. Then a specific protocol was outlined for staff to follow if a nurse made that determination, providing guidelines for moving up the chain of command if the immediate attending physician is not available or the patient’s condition did not improve.
An analysis by Denver Health staff found that the numbe
r of non-ICU cardiac arrest incidents decreased significantly following the implementation of the new procedures. And it bestowed rapid response responsibilities on staff members who were already working, rather than requiring an entirely separate team.
Mike "FossilMedic" Ward
This post dedicated to Technician Mark Baban, Rescue 401, B-shift. You left too soon.
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Shock … followed by purposeful action
Comments OffA brilliant and terrible Tuesday morning
Fourteen months into retirement I am teaching a Fire Officer II class at the Reagan National Airport fire station. The classroom is also their kitchen. The kitchen has a television.
The acting battalion chief steps in, apologizes for the interruption, and turns the television on.
As the news camera focuses on the entry hole, many of the experienced air-crash-rescue guys are speculating on what type of plane hit the tower and the issues facing FDNY.
After a dozen minutes I try to restart the class. Agree to leave the television on with the sound turned down. I get one or two sentences out when we see the second plane hitting the tower.
Class over!
You do not need a Formal Announcement to Mobilize
As FDNY Firefighter James Hanlon (Ladder 1) points out in the opening of the Naudet Brothers documentary 9|11:
When the civilian editors of Fire-Rescue Magazine and Journal of EMS were vetting my article, Attack on the Pentagon: The Initial Fire and EMS Response (April 2002 issue), they struggled with the concept that hundreds of emergency responders initiated action without receiving a formal notification.
The Metropolitan Washington Airports Authority Fire Department never expected a 757 to be used as an assault weapon against the Pentagon. When the second plane struck in New York, the dozen off-duty members attending the Fire Officer class joined the 16 on-duty members preparing for the unknown.
Most of the senior staff and urban search and rescue commanders in my department started purposeful action when they heard of the second plane in New York City. The information came through radio and television, informal digital networks and word-of-mouth.
Rapidly deploying 72 USAR members and 75 tons of equipment
It takes dedicated action by dozens of staff, support and non-USAR firefighters to make a deployment happen.
A point of pride is the ability to assemble the team well within the response deadline for domestic and international response. A deployment represents an administrative five alarm event.
A small role I had while assigned as a company officer at the Fire and Rescue Academy was to respond from home to get the facility unlocked on evenings, weekends and holidays. The Academy, with six classrooms and a large training bay, is the point of staging and assembly for the team.
Far from high tech. The tasks included moving apparatus out of the bay, properly configuring the "quad" – a large space with movable walls to create smaller class spaces, and powering up the facility.
Have to do Something
Ten years ago I also had a part-time job as a civilian Fire Instructor III at the Fire and Rescue Academy.
American Airlines Flight 77 struck the Pentagon shortly after I left the airport.
I was stunned. What could I do? No fire gear in the car, not in uniform, my "retired" fire department ID card did not provide KardKey access to headquarters or communications.
Headed for the Academy. Maybe they are assembling a fire crew with Engine 407. I was at the Academy in 1982 when we loaded up a Suburban with EMS gear and responded in near-blizzard conditions to the Air Florida 90 crash at the 14th Street bridge.
Not this time. All of the on-duty uniformed staff are away, either responding to the Pentagon or the anticipated USAR deployment. None of the remaining staff experienced a USAR deployment.
I looked up in time to see the South Tower collapse on live TV.
Purposeful Action – Setting the Academy for USAR deployment
No more wondering what to do.
Without asking for authorization, started moving academy apparatus out of the high bay building and up the hill. Configured the quad. Tried to set up the communications equipment, but no one had the key to the cabinet.
Before the 11 am official federal mobilization notice, the academy was ready …
… and I was on my way home, satisfied that I did something worthwhile in reaction to the unthinkable.
An Inherent Orientation to Action
Emergency service folks are hard-wired to take action.
To validate the impact of our Citizen CPR program we tried to identify the background of every person who performed CPR prior to the arrival of the department. More than half of the citizen responders were off-duty or former police, fire, ems and health care staff.
The same orientation that motivated Jeff Simpson, a Dumfries-Triangle Rescue Squad volunteer EMT who was near the World Trade Center.
From the National EMS Memorial:
Mike "FossilMedic" Ward
Earlier 9/11 essays:
2011: Remembering 41 EMS responders who died at WTC, including a hero from Prince William County, Virginia
2010: A Terrible and Brilliant Blue Sky Morning
2008: Reprint "The Anger Never Dies"