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:

1. Identify the value of the product for the customer
2. Map the process for creating the product and eliminate elements without value
3. Create a flow for the value-creating steps
4. Let customers pull value from that flow
5. 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 number 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.

Volume 2, Issue 1, hits the intertubes

Dear Blue Card Subscribers:

Check out B Shifter’s latest installment at http://bshifter.com/SelectMagazines.aspx.

Our latest installment features Joe Starnes discussing flashover causes and prevention. Some firefighting friends from Oz talk about the Australian fire service—complete with a lessons-learned tale of communications gone wrong. Bruno introduces two new reader-response columns, and Vincent Dunn discusses fire-supression techniques in single-family residences. Lots of free downloads! Take a look!

Mike "FossilMedic" Ward

When does William study?

William Patelis, a University of Maryland student and a live-firefighter at the Bladensburg Volunteer Fire Department, posted a picture from the station's status board on FaceBook last night:

With the help of Chief Randy Kuenzli, got the rest of the details of the first 28 days of 2012:

• 235 ambulance runs
• 154 Engine runs
• 71 Truck Runs
• 8 structure fires

Bladensburg 8 is one of the all-volunteer staffed fire stations in Prince George's County, Maryland, providing engine, truck and ambulance service since November 2004.

Bladensburg was an early provider of community ambulance service. "Rescue Squad 1" has been part of the department since 1927.

Mike "FossilMedic" Ward

Expected to Burn For at Least Two More Days

A LARGE, "FORTRESS-LIKE" WAREHOUSE IN ELIZABETH, New Jersey, has been burning since Wednesday, confounding the FD's attempts to get to the seat of the blaze.

Star-Ledger photo

The large complex is riddled with tunnels, compartmentalization and holes throughout the building making it impractical for FF's to find their way through the maze.  It is believed to have begun on Wednesday afternoon when someone set a junk car on fire inside the building.  It has since spread througout the entire structure and started into a second building where the FD was able to contain it.

The Star-Ledger reports this morning:

A sprawling warehouse fire in Elizabeth that has spewed thick black smoke across northern New Jersey for two days could burn through Christmas, and the structure may suffer several "catastrophic collapses" before the blaze is extinguished, officials said.

The fire swallowed the center section of the largely vacant facility around 6 p.m. today, according to city Deputy Fire Chief Lathey Wirkus. Fire officials say flames from the eight-alarm blaze are so intense they will have to let more portions collapse before they can launch another attack.

The fire has burned for two days as more than 250 firefighters from 35 fire agencies struggled to attack the flames. One firefighter suffered minor injuries Thursday afternoon, Wirkus said.

Elizabeth Fire Chief Tom McNamara said the maze-like design of the building is making it nearly impossible for firefighters to approach the base of the blaze, while the choking smoke and intense flames are stalling prolonged operations inside the structure.

The Star-Ledger also posted this video report on the fire that includes comments by the Elizabeth fire chief and the mayor:

The century-old building was first used as an automobile and airplane assembly plant and was more recently a large bakery that produced Girl Scout cookies until ten years ago.  Since then it has been subdivided and used by several occupants including a tire wholesaler who has 1,200 tires stored inside.  Another area is stacked with plywood panels.

Hospital Employees Reportedly Abandoned Patients

 A BASEMENT FIRE IN A KOLKATA (Calcutta), INDIA, HOSPITAL FRIDAY morning filled the multi-story institution with thick smoke.  According to reports, all the hospital staff fled the building, abandoning their patients and leaving them to die or suffer inhalation poisoning from the smoke.  Public bystanders began rescuing the patients using all means.

AP

AP

The basement where the fire was seated was stocked with gas cylinders and poisonous/hazardous chemicals.  NDTV reports:

Chief Minister Mamata Banerjee said this morning's tragedy was "an unforgivable crime" and vowed "the harshest punishment possible" for those found responsible. "As per my announcement that offenders will be arrested, six persons, including SK Todi, have been arrested," Ms Banerjee told reporters. "Law will take its own course. Those responsible for so many deaths will be dealt with seriously," she said. Ms Banerjee said the fire services authorities and the police had cautioned the AMRI Hospital authorities in September about its basement. "AMRI had given an undertaking, but did not keep it," she said.

The licence of the hospital has been cancelled. A First Information Report or FIR has also been filed, which launches a criminal case. "It was horrifying that the hospital authorities did not make any effort to rescue trapped patients," said Subrata Mukherjee, West Bengal state minister for public health engineering. "Senior hospital authorities ran away after the fire broke out."

The latest count, but probably not the last, records 89 patient mortalities and dozens more injured.  Compounding the anguish is the unsubstantiated claim that the fire department was not notified until an hour after the fire was discovered, and when they did finally respond, the streets were already so congested that they could not get to the location until well over another hour later.

This early video report from national tv station NDTV covers the onscene chaos as bystanders do their best to rescue the abandoned patients and infuriated relatives storm the hospital lobby and trash the place.  Kudos for the brave tv reporter who carries on while the floor starts giving way under her feet in the report:

As is the standard practice in the country, the six owners of the hospital were arrested and charged with culpable homicide while the fire was still burning.

Reportedly there were 160 patients in the hospital, but the actual number is not confirmed.  Seven hours later the fire was extinguished and the surviving patients had been transferred to other hospitals.  Rescuers pulled 73 bodies from the building, and another 16 succumbed to their injuries later, said Danayati Sen, a top Kolkata police official.

The AMRI Hospital, scene of the tragedy, is a private hospital and considered to be very "posh," receiving compliments as one of the best medical facilities in the city.

Reportedly three of the bodies pulled from the building were those of staff members. The remainder were presumably patients and relatives who were aiding in their care. The primary cause of death was smoke inhalation.

Bodies lined up outside a mortgue awaiting identification.  (AP)

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As tweeted by @Boston_FF_L29

UPDATE (6:33 am):

Pictures tweeted by @ProvFireVideos

Sad morning.

Incident timeline by @BOSTON_FF_L29

BOSTON & Needham, Ma., USA Boston Ma.Firefighter (L29). Tweeting Local, National Fire News & MY Opinions, NOT those of L29, L718 or Boston Fire. For Wx tweets follow me @L29_SNEWeather

BOSTON_FF_L29 Normally I would have gone to sleep, but this fire seemed different from the start…and got worse by the minute (7:15)

Pictures posted by Matthew Gregoire, Providence Fire Videos, @ProvFireVideos

Thanks to James for catching our headline typo.

STATter911 with additional video and media reports

Fox 25: Worcester firefighter dies in blaze (live helicopter feed ended)

ABC 5: Massive Blaze Destroys Apartment House

Mike "FossilMedic" Ward

Updates and pictures from @BostonFire

Response at 12:45am to Calumet St. in Mission Hill for a building fire.

Engine 37 reports fire showing and orders a 2nd alarm.

37-39 Calumet St. in Mission Hill. Now a 5th alarm. Large 3 story wood frame duplex. Heavy fire in rear.

Fire now extended to 41 Calumet.

Fire still out of control. Now through front of building. Ladder pipes and decks guns operating.

Tower Ladder 17 operating now

Right now at 2:24 am

About 130 firefighters, lots of medics & police on scene. Many deck guns operating. 6 in the front of building.

Front on building. 3 of 6 guns on Calumet St. Many more in rear.

Through the roof

The Chief of Department, Ron Keating, is the Incident Commander of the fire. He will be retiring on Monday after 41 + years.

Still going 3 hours plus into it.

37-39 Calumet St. Boston 5 alarms.

Rotating crews in Tower Ladder 17.

Fire now contained to original building. Chasing hot spots. Division 2 Deputy Chief now Incident Commander.

Right now at 4:22 am:

In the first few minutes of the fire, Ladder 4 had a report of a person trapped on floor 2. They kicked in a door and found a woman.

She was transported for smoke inhalation by EMS.

Incident Commander starting to bring in fresh firefighters to continue fighting the fire. 3 ladder trucks and 1 tower ladder coming.

Our helmets off again to the Boston Sparks members for hot chocolate, cookies & coffee. They continue to be true friends.

Snow is really picking up at 5:08 am. Firefighters will be here through the morning.

No idea on how many displaced. At least 9 apartments involved. Red Cross is on scene helping a lot of people.

Chief is giving a damage estimate of $1,200,000.00 for 37-39 Calumet, 41 Calumet St. & 35 Calumet St.

Several homes on Wait St. also had large amounts of water in their basements.

< <<<<<<<<<<<<< >>>>>>>>>>>>

Mike "FossilMedic" Ward

Instructor Meet-Up October at St. Charles, MO

It was my second trip to a national fire training conference in the mid 1980s. The organizers promoted a networking opportunity at the local fire museum. For the 2011 equivalent of $50 I could rub shoulders with movers and shakers of the fire training community.

I showed up early, along with a handful of others. The organizer of the conference showed up, made sure that the food and drinks were present, and rushed off in his customized Escalade for a private dinner with the conference headliners.

The networking opportunity was like a freshman mixer … without girls  … or beer. Did not meet any of the scheduled instructors at the conference. 

We know how to run a meet-up!

The folks at Go>Forward have been arranging fireems blogger meetups at national shows for a couple of years. You have followed the meet-ups on Twitter, and read the stories from STATter911, Command Safety, The Fire Critic, Brotherhood Instructors, Life Under The Lights, Iron Firemen, Pink Warm and Dry, Ambulance Driver, Fire Daily, Green Maltese and others.

Gateway Midwest expands the meet-up and incorporates high quality fire and ems training.

Saint Charles, Missouri   October 21 – 23

go to http://goforwardtraining.com/gateway/ for more information and to register..

Put ffw10 or STATTER in the promotion code for a discounted registration.

How Mike will spend $50 at Gateway Midwest

Read

Meet me in St. Charles! October 21-23 Gateway Midwest

to find out.

Hope to see you in St. Charles!

Mike "FossilMedic" Ward

When Wagon Drivers Ruled the World

Long before GPS and Google Earth, Wagon Drivers held the secrets of quick response.

In my department they were the informal leaders of the fire station. They sweated the details and enforced the rules.

Woe be it to the the firefighter driving the pumper while the Wagon Driver had to cover as the acting fire officer. You could never be smooth enough.

From 4th expected to 2nd arriving

Part of their sweating was refining the details of a response route.  This residential road, off a main highway, held value to one group of Wagon Drivers 

To get to the far northeast corner of the fire company's box alarm district, the engine should be proceeding east on the highway another eigth of a mile to a major intersection.

Turn north and proceed up another highway that arcs west. Then turn east on a primary road.

Following those directions, the 3rd due engine would often be 4th arriving due to traffic and topography.

Cutting up this residential road would consistently result in arriving second to the box alarm.

It was more than the straighter road. The intersection was wide with excellent line-of-site. At the top of a hill.

Much easier to turn north here than down the hill at the major traffic-light controlled intersection.

The other side of the cut-through was also better, coming down a slight hill allowed drivers on the primary road to see the pumper sooner. You were turning on the primary road that took you to the incident.

Shaved more than a minute during rush hour responses. 

The cut through is not as valuable now, the maximim width 2010 pumper restricts manuverability. The cut through was great with narrow 1970 era rigs.

21st Century Wagon Drivers

A colleague from a large city was lamenting the over-reliance on technology. The city used map books that were created at each fire station. Each rig has a set of maps covering their box alarm district.

He noticed that the ambulance was taking longer to get out on dispatches. The rookies were entering the dispatch address into their smartphone and could not leave the station until the phone processed the address.

The kids said it took too long to look the address up in the map books. My colleague responded by increasing the number of street drills for the younger firefighters.

There are situations where technology makes a big difference:

Chicago Fire Department placed GPS devices on all of their front-line and reserve ambulances. Each device pre-loaded hospitals and fire stations into the database. They have prepared additional GPS units that are provided to EMS units that are coming into the city to assist with special event standbys.

How do newer members learn your response district?

Mike "FossilMedic" Ward

A 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. 

Good Morning America (ABC) is covering the breaking news of a plane that has hit the World Trade Center.

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:

… there were days we would go to the Trade Center five times in a single shift. My point is, we knew those towers as well as anybody. But nobody, nobody, expected September 11th.

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.

They were not alone.

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:

"I have no doubt whatsoever that, while I was stricken with disbelief and inaction, Jeff was figuring how he could help.

It was clear in the few minutes we were in the plaza that thousands of people had and would continue to be injured. There were many police, fire and EMS squads arriving at the scene and it was toward these and the injured that Jeff was headed the last time I saw him.

Frankly, there was no other reason for him to go towards the World Trade Center. His hotel, work site and safety were in the opposite direction.

With the second plane hitting the tower, Jeff would have been thinking about the increased number of casualties. I believe Jeff was caught in the collapse of the towers.

I do not know if he was inside the towers or working at one of the triage stations that had been set up close to the towers. In either case, he was doing what he was trained to do and spent his final hours helping the victims," stated Joseph T. Finnegan.

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"