Running head: PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 1

Transcription

1 Running head: PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 1 Providing Firefighter Rehab with Limited Staffing Paul C. Bearce Rio Rancho Fire Rio Rancho, New Mexico

2 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 2 Certification Statement I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotation marks so indicate, and that appropriate credit is given where I have used the language, ideas, expression, or writings of another. Signed:

3 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 3 Abstract Cardiovascular stress is the cause of firefighter deaths in over half of the cases reported, due to the fact that fire personnel perform arduous physical tasks in stressful environments. Providing incident rehabilitation services and medical monitoring has been shown to reduce the effects of physiological and emotional stress which creates a safer work environment for firefighters. The problem is the Rio Rancho Fire Rescue Department (RRFRD) has not been able to provide sufficient trained personnel to meet the national standards for firefighter s rehabilitation and medical monitoring during active fire suppression incidents. The purpose of this research project is to gain perspective on the options for providing this critical service to fire personnel, especially during difficult economic times. To address this issue, descriptive research was used to answer the following questions: (a. What criteria are fire departments using to create a firefighter rehabilitation system, (b. How do fire departments of similar size to RRFRD provide personnel and training to deliver critical rehabilitation services to firefighters on active fire scenes? (c. Among fire departments experiencing limited staffing levels, what volunteer resources are utilized to provide rehabilitation services on active fire scenes? (d. Are mutual aid resources from neighboring fire departments utilized to provide firefighter rehabilitation and medical monitoring to fire departments which have limited staffing levels? A review of contemporary literature, as well as original research incorporating surveys, interviews, and other correspondence were employed to investigate how other agencies coped with similar staffing challenges. It was determined that the utilization of call-back personnel, volunteer resources, and mutual aid agencies were common among fire departments needing

4 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 4 additional support services. Based on these findings, it is recommended that RRFRD develop a volunteer program using the existing Citizens Emergency Response Teams Program.

5 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 5 Table of Contents Abstract 3 Introduction 6 Background and Significance 7 Literature Review 14 Procedures 29 Results 31 Discussion 41 Recommendations 46 References 51 Appendices: A B C D E F G H I Organizational chart Fire department survey list Survey questionnaire Survey cover letter Regional fire department list Regional fire department questions RRFRD survey questionnaire CERT survey questionnaire Proposed volunteer organizational chart

6 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 6 Providing Firefighter Rehab with Limited Staffing Introduction Fire departments with limited staffing levels are held to many of the same standards as larger metropolitan departments. These standards, which are set by the National Fire Protection Association (NFPA), include the ability to provide rehabilitation and medical monitoring services to firefighters who are performing tasks associated with firefighting or other physically demanding tasks. The problem is the Rio Rancho Fire Rescue Department (RRFRD) has not been able to provide sufficient trained personnel to meet the national standards for firefighters rehabilitation and medical monitoring during active fire suppression incidents. The purpose of this project is to identify the means for providing staffing and the necessary training to deliver critical rehabilitation and medical monitoring services to firefighters who are involved in fire incidents, in accordance with these national standards. To address this problem facing RRFRD, research was conducted utilizing descriptive methodology with the goal of answering the following questions: (a. What criteria are fire departments using to create a firefighter rehabilitation system, (b. How do fire departments of similar size to RRFRD provide personnel and training to deliver critical rehabilitation services to firefighters on active fire scenes? (c. Among fire departments experiencing limited staffing levels, what volunteer resources are utilized to provide rehabilitation services on active fire scenes? (d. Are mutual aid resources utilized to provide firefighter rehabilitation and medical monitoring to fire departments which have limited staffing levels?

7 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 7 Background and Significance Fire Department History Rio Rancho Fire Rescue Department is an all-hazards response agency which serves the residents, visitors, and businesses of a medium-sized suburban area, located along the northwest border of Albuquerque, New Mexico. The results of the latest U.S. Census shows that Rio Rancho and the surrounding county has the largest percentage of population growth in the state, making it the fastest growing city in New Mexico (Rio Rancho Observe, 2011). RRFRD is a relatively small fire department with limited staffing. This shortage of personnel has created challenges in providing adequate resources to meet the increasing demands of nearly 88,000 residents who reside within the city s borders. According to Bassi (2008), in the early 1960 s, the arid desert northwest of Albuquerque consisted of vacant land and scrub brush. American Realty Petroleum Company (AMREP) had a vision to create a community on 103 square miles of sandy soil. They began to market residential lots to retirees who resided mainly on the east coast. Many of these retirees moved their families and furniture west to take advantage of the warm southwest climate. Population growth during the first decade of building homes was rather slow. It was not until 1981 that Rio Rancho celebrated the 10,000 th resident. However, during the early days of development, the need for a fire department became evident and the citizens formed the Rio Rancho Estates Volunteer Fire Department. With a donated 19-year-old fire engine and a former career firefighter at the helm, the volunteer fire department began to serve the fire suppression and emergency medical services (EMS) needs of the residents. The department quickly began to add to the fleet of vehicles and more volunteers signed up to help staff the apparatus. Funding was provided through state grants and the generous giving of the residents. Fundraisers were prevalent, including a department ladies' auxiliary who raised donations for the department to purchase a used ambulance. Calls for

8 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 8 service for these volunteers grew as the population increased. In 1970 the department responded to 62 calls and nearly a decade and a half later, the call volume had increased to over 1,000 calls in a year. As the calls began to burden the volunteer system, a petition began to circulate through the community asking the city council to adopt a paid firefighter system. In September of 1984, citing a need for increased fire and emergency medical personnel, the governing body came to the conclusion that the city had simply outgrown the volunteer fire department. Through an emergency ordinance the Rio Rancho Department of Public Safety (RRDPS) was created. With this new public safety model, the design called for law enforcement officers to be cross-trained as emergency medical technicians and firefighters. At this point, a small number of the fire department volunteers remained in their former position and continued to answer calls for service through a reserve program. Their positions were still unpaid. It was the hope of the city leaders that the new department would provide an increased level of service to the citizens by boosting law enforcement s presence on the street while making more productive use of a firefighter s time, all at a reduced personnel cost. The department continued to grow slowly over the next two decades, and the burden of being cross-trained in police and firefighter duties began to take its toll on the personnel. A larger population and the subsequent increase in the request for fire suppression and EMS resources led to the decision to split the police and fire into two separate divisions, while still remaining under the administrative direction of RRDPS leadership. Under this model minimal numbers of firefighters, usually one or two, were housed in four fire stations across the city and were required to respond to emergency incidents and meet crosstrained police officers who would fill the remaining positions in a fire company. However, it

9 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 9 became increasingly difficult for these responders to maintain critical certifications in firefighting and EMS while performing law enforcement duties every day. With a promise of inexpensive housing and good schools, young families flocked to Rio Rancho and the city began to experience explosive growth. It became evident that the public safety system would no longer be able to answer the calls generated by the residents. By 2007, it was estimated that the population of Rio Rancho reached 80,000, making it the third largest city in New Mexico. Change was on the horizon again for the fire department after the city councilors determined that the public safety system that had served the citizens and the budget for so many years was being overwhelmed. By a unanimous vote, the split of the police and fire departments became official. In July of 2007 the city formed two new departments from RRDPS system. Rio Rancho Police Department and Rio Rancho Fire Rescue Department were the two separate and independent agencies under the new city charter. However, the young fire department, which was tasked with protecting lives and property, started at a distinct disadvantage with limited staffing levels and minimal stations. A total of 62 fire personnel staffed the same four fire stations which had existed since 1998 (Bassi, 2008). Current Fire Department Status RRFRD provides fire suppression, technical rescue, and fire prevention educational and regulatory services, and is the sole provider of EMS to the residents, visitors, and businesses in Rio Rancho. All department rescue ambulances provide advanced life support care and are staffed with at least one licensed paramedic. Being a single-tiered EMS system requires that RRFRD rescue ambulances first respond to provide medical treatment and transport of the sick and injured. With limited hospital services within the city limits, department ambulances are often forced to transport patients to Albuquerque hospitals to receive a higher level of care. This

10 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 10 can take the ambulance and the personnel out of service for up to two hours. Additionally, several of the department s five staffed ambulances could be transporting patients at the same time. Effectively, this potentially removes them from being an available resource in the event of a fire, technical rescue incident, or other emergency which requires a multiple-apparatus response. In 2007, RRFRD had applied for a federal grant to help boost the on-duty presence of crosstrained firefighter/emts through the Staffing for Adequate Fire and Emergency Grant (SAFER) program, offered by the Federal Emergency Management Agency (FEMA). The City of Rio Rancho was awarded the funding for 24 new firefighters, who were trained through an on-site academy. Additionally, the city s governing body added several more positions in the budget to bring the department s total personnel roster to 98. This, however, included administration, fire prevention, and training staff. Also during this time, the department opened the city s fifth fire station in a new sub-division. Department leaders soon began to realize that the boost in personnel would be sufficient in the short term only. There were a number of large commercial projects on the city s horizon which would only add to the work load of the fire department. A year later, Rio Rancho, along with other municipalities across the country, began to feel the effects of an economic slow-down. Decreasing retail tax revenue, new housing starts, and commercial projects all began to negatively affect the city s financial stability. Hiring freezes, layoffs, pay-cuts, and furlough days for government workers began to be commonplace in government. The fire department was not immune to these economic woes. Although there was no loss of personnel positions, RRFRD leadership was forced to cut their operational budget by nearly $600,000.

11 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 11 Many areas across the United States are still suffering from decreased budgets due to the poor economic climate, high unemployment, and declining home sales. Rio Rancho is among communities which are still feeling this pinch. Although the city s population has continued to grow, RRFRD has remained stagnant with only 98 personnel on their roster despite an increase in the calls for fire suppression, rescue, and EMS. In 2011, economic stimulus grant money was used to construct the city s sixth fire station in a high-call-volume area. However, no additional personnel were forecast into the department s annual budget, leaving the staffing for the new station a controversial subject at City Council meetings. Department leadership was faced with the possibility of utilizing existing staffing levels, spread across a wider area and more stations. There was fear and anxiety among fire personnel that they would face the additional burden of more calls for service with no help from the city in the near future. Current staffing levels at RRFRD require a minimum of 27 personnel on duty 24 hours each day to staff the six current stations. These positions are filled by an on-duty battalion chief, six captains, two driver/engineers, six firefighter/paramedics, and 12 firefighter/emts. Most fire apparatus and rescue ambulances are staffed with a minimum of two personnel. Operational personnel work a 48/96 hour schedule with two days on duty and four days off. Several administrative positions are filled during normal business hours. These include a training battalion chief, an EMS battalion chief, two administrative captains, fire prevention personnel, the deputy chief, and the fire chief (Appendix A). At any given time, one large incident can deplete the department s limited resources. In a consistent approach to meet national response standards, RRFRD attempts to utilize on duty personnel, as well as call-back administrative staff to fill the required positions at the scene of an emergency incident. However, only critical staff assignments, such as command, safety, accountability, operations, as well as fire suppression,

12 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 12 ventilation, search and rescue, and a rapid intervention crew (RIC) are filled. Often, support roles, like firefighter rehabilitation and the light and air unit remain unfilled due to personnel shortages. National Standards RRFRD, like the majority of fire departments across the United States, has protocols and procedures in place to follow recommendations and guidelines set by the NFPA. Many of these guidelines provide goals for the department aimed at protecting the health and safety of firefighters involved in active emergency scenes and training classes. Other standards set goals for response to emergencies. RRFRD attempts to meet most of the standards set by the NFPA, although limited staffing levels often affect the department s ability to meet or exceed standards with consistency. Some of the stated purposes of the NFPA 1710 Standard are to define the minimum requirement for the management of resources, and to provide for the health and safety of fire personnel, and to allow for efficient incident management for fire departments. According to the NFPA (2001), the standard can be utilized to address the effectiveness of fire department personnel when they respond to fire incidents, EMS calls, and special operations emergencies, and to accomplish necessary tasks in a timely fashion while maintaining the occupational safety of department employees. Additionally, 1710 sets minimum requirements of fire department personnel to meet the necessary deployment criteria (NFPA 2001). RRFR attempts to meet the 1710 Standards on all structure fires and other incidents which may require extended scene time operations. However, due to a limited staffing model, meeting these requirements has proven to be a challenge on a consistent basis. NFPA s minimum standard for a residential structure fire is to have 14 firefighters on scene within a nine-minute response time. In order to meet this, RRFR

13 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 13 would have to initiate a second-alarm assignment. This, in effect, would deploy four of the city s six engine companies, as well as three of the city s five rescue/ambulances for a single incident. Hence, fulfilling additional support roles has become problematic. NFPA has also defined standards for fire departments to provide for firefighter rehabilitation (rehab) and medical monitoring when they are deployed to an incident that requires sustained strenuous physical activity, often in austere conditions. According Ludwig (2009), providing for the well-being, safety, and health of firefighters is one of the most important responsibilities that a chief officer faces during an emergency incident. Following the NFPA 1584 Standard for the rehabilitation of firefighters should be a priority on these scenes in an effort to decrease the number of firefighter deaths (Ludwig, 2009). Rehab for firefighters can range from a formal approach with a specialized vehicle, equipment and supplies, to giving firefighters a short water break under the shade of a tree. Typically, RRFDR s approach to rehab on an incident consists of two cases of bottled water stored on the floorboard of the command truck driven to the scene by the on-duty operational battalion chief. The goal of this research project is to define creative and alternative methods for a department with limited staffing, such as RRFRD, to provide for the critical incident task of firefighter rehabilitation and medical monitoring without having to increase the financial burden of additional personnel. Additionally, the project will allow the researcher to utilize the adaptive challenge knowledge and skills acquired through the Executive Development course as part of the National Fire Academy s (NFA) Executive Fire Officer Program. To meet these objectives, the five stages of innovation and creativity (Federal Emergency Management Agency, 2011, pp. SM6-7, 6-8) were used to research the answers to the questions posed by this project. In addition, the project addresses several safety issues which align with one of the United States Fire

14 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 14 Administration s (USFA) operational objectives of reducing the number of line-of-duty deaths and injuries suffered by firefighters by implementing the reduction of risk at the local level through prevention and mitigation (Federal Emergency Management Agency [FEMA], n.d., p. 18). Literature Review It can be assumed that government administrators, fire service officers, and firefighters agree that firefighting is inherently dangerous and involves heavy physical activity in austere conditions. This intense exertion can lead to a negative impact on the health and safety of firefighters involved in these scenarios. When the effects of strenuous activity are combined with existing medical conditions, the toll on a firefighter can be dramatic and may lead to disability or even death. To combat the physical and emotional effects of firefighting, fire department leaders have the responsibility of providing rehabilitation services and medical monitoring for their personnel operating on an emergency incident. Additionally, this service is defined by NFPA standards as a recommended practice for fire departments. This task, however, can often prove to be difficult, especially for smaller fire departments. When developing a system to address firefighter rehabilitation and medical monitoring, as well as providing the staffing of this program, there appears to be a significant number of considerations that fire departments must take into account. During a review of contemporary literature and research on this subject, it was discovered that numerous fire departments from across the United States have encountered many challenges to providing for firefighter rehabilitation and other support services to personnel on an emergency scene. Limited staffing, budget cuts, and shrinking volunteer resources are common barriers facing departments

15 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 15 attempting to provide adequate support services. This inability to provide for firefighter rehabilitation, medical monitoring, and other support services can lead to decreased levels of firefighter safety, and has contributed to an increase in the line-of-duty deaths of firefighters during active incidents. When a firefighter dies in the line of duty, the U.S. government investigates the cause of the fatality and will make recommendations to fire services across the nation on how to prevent future incidents. The USFA (2006) has tracked and monitored firefighter fatalities in an effort to find solutions to reduce the number of deaths. In addition, the data collected on these incidents help to establish the effectiveness of health and safety programs aimed at keeping firefighters safe. Ultimately, the goal is to reduce the number of fire ground deaths by 50% in the next ten years. During the evaluation of firefighter deaths, incidents involving accidental or intentional injury, as well as any occupational related fatal illnesses, were considered for inclusion (U.S. Fire Administration [USFA], 2006, pp. 1-4). Many of these reports have several common themes; the investigators often name physical stress combined with lack of health/fitness as contributing factors to these deaths, and the addition of an incident rehabilitation program as a recommendation for future management during an emergency incident. In July of 2006, a 43- year-old male firefighter responded to a fire and provided various physically demanding tasks on scene. It was a warm evening with high humidity and the firefighter, along with several others, was treated for heat stress on scene. He was later found unconscious and without a pulse at his home. Efforts to revive him were unsuccessful. Contributing factors to his death were reported as heat and physical stress, which triggered a heart attack. Institution of an on-scene rehabilitation program during structure fires was the top recommendation of the investigating agency (Baldwin, 2007). In November of 2005, a similar incident claimed the life of another 43-year-old

16 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 16 male who had performed exterior firefighting tasks at the scene of a residential structure fire. During an on-scene debriefing of the incident, the firefighter walked to the fire engine and collapsed. He was transported to the hospital, but later died. The National Institute for Occupational Safety and Health (NIOSH) report concluded that the physical exertion associated with firefighting contributed to his cardiac arrest. The addition of an on-scene rehabilitation program was among the six recommendations of the NIOSH investigator (Baldwin, 2006). During a training exercise, a 50-year-old male firefighter was assisting a recruit class during live fire burn training evolutions. He began to feel ill, sat down to rest, and was found collapsed and unconscious a few minutes later. He did not survive after efforts to revive him were unsuccessful. Stressful environmental conditions and the high levels of physical activities triggered his heart attack. Among the NIOSH recommendations was to create a wellness and fitness program for all firefighters involved in these intense physical activities (Baldwin & Hales, 2009). In another training incident, a 42-year-old female firefighter collapsed and was found not breathing during a physically demanding training exercise. She was pronounced dead after arrival at the hospital. Physical exertion which triggered her cardiac condition was the finding of the NIOSH investigator. Incorporating medical monitoring into a rehab program was the second listed recommendation from the report (Baldwin, Miles, & Hales, 2009). Despite the findings and recommendations of the investigators of firefighter deaths, fire departments across the United States are still experiencing about 100 deaths on the fire ground annually. According to Schaeffer (2011), firefighter work cycles, the limited air supply that firefighters carry on their back, dehydration, and fatigue are large contributors to firefighter injuries and deaths during fire suppression activities. The latter two factors have been shown to increase as the incident progresses, especially during the overhaul phase of the incident

17 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 17 (Schaeffer, 2011). During the overhaul phase, which involves firefighters searching for fire extension and continued burning in concealed spaces, they are often exposed to dangerous gases and other products of combustion. Firefighter rehabilitation, referred to commonly as rehab, is described by Bledsoe (2009) as: The means to restore to a condition of good health, to restore the ability to work, or the like. In the fire service, rehabilitation is an intervention designed to mitigate the effects of physical, psychological, and emotional stress of firefighting in order to sustain a member s ability to work, improve performance, and decrease the likelihood of an onscene injury or death. (Bledsoe, 2009, p. 3) According to Dobesh (2011), rehab has also been simply defined as firefighters taking care of firefighters in an effort to send them home as healthy as they were when they arrived. However, rehab is necessary for this to occur with any consistency. Some departments have an elaborate rehab protocol, while others have nothing (Dobesh, 2011). McEvoy describes firefighter rehab as containing nine key components: Relief from climatic conditions, rest and recovery, cooling or re-warming, re-hydration, calorie and electrolyte replacement, medical monitoring, medical care according to local EMS protocols, member accountability, and release from rehab (McEvoy, n.d.). The USFA further defines the need for firefighter rehab to include extended operations at the scene of a structure fire, as well as providing for the health and safety of wild-land firefighters, which also involves arduous physical labor. No matter the incident, the USFA recommends that firefighters have a process in place to receive rehab services when they have become injured, exhausted, exposed to extreme climate conditions, or are in need of fluid or food replenishment (Federal Emergency Management Agency [FEMA], 2009, p. SM 5-32).

18 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 18 Verfuss (2004) wrote that fire departments across the U.S. are giving firefighters all of the tools necessary to perform their job in the safest possible environment. This includes health and wellness programs to assist them combating he physical stressors experienced on the fire ground. However, he contends that the fire service has failed to recognize the importance of providing on-scene incident rehab for firefighters, leading to increased incidents involving on-duty injuries and deaths. Cardiac-related incidents account for nearly half of these deaths. It is not burns or falls or collapse that is killing responders, it is a combination of heat and cardiac stress (Verfuss, 2004, p. 43). In August of 2011, the volunteer firefighters from River Oaks (TX) Fire Department were dispatched to nearby Parker County to help with a grass fire which was uncontrolled due to extreme weather conditions. Texas had been experiencing an unprecedented drought and on that day, temperatures reached 112 degrees with humidity levels of under 10%. Volunteer firefighter David Bearce (personal communications, December 8, 2011) was among the responders who were given the task of breaking down bales of hay which were burning in the field. After 20 minutes of work, his crew reported to rehab, which consisted of bottled water for rehydration and wet towels placed around their necks. After another 20 minute work cycle, he again reported to rehab and had his vital signs monitored. His heart rate was elevated and he began to feel lightheaded. He had also stopped sweating. He was later transported to the hospital and after receiving intravenous fluids was told by the physician attending to him that he was on the verge of heat stroke, which is potentially life threatening. In retrospect of his experience, he felt that the lack of a more formal rehab procedure in his department, lack of adequate fluid replacement, the absence of medical monitoring, along with improper personal protective equipment, contributed to his medical issue.

19 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 19 Firefighter rehab has been shown to improve the health and safety of firefighters who are involved in physically demanding emergency scene tasks, or when the incident occurs during extreme weather conditions. Although the NFPA has set a standard for fire departments to follow in an effort to create a more consistent approach to rehab, many departments are providing this critical task through a minimalist approach. Or, the use of rehab has not been deployed on a regular basis and firefighters and incident commanders have been reluctant to realize the benefits of rehab during emergency responses. According to Evans (2008), the Norfolk Fire Department s (NFD) use of rehab was chaotic and unplanned. Providing this service was inconsistently applied and sometimes even forgotten. Additionally, firefighters in Norfolk did not accept the process of rehab, possibly due to cultural reasons. NFD firefighters even stated that they perceived rehab as being only for the weak, with some going as far as creating stickers that read rehab is for quitters. Staff officers who filled the role of incident commander often stated that the reason they did not create a rehab sector was the lack of personnel to fill the positions necessary to provide rehab services. NFD has a department trailer that is specifically designed and equipped to provide rehab on scenes, however, it is not utilized often for its intended purpose (Evans, 2008, pp. 6-7). Bledsoe (2009) wrote that there are several steps to creating rehab services on the scene of a fire incident. Firstly the incident commander must recognize the need for rehab and establish a rehab sector. The decision must be based on the incident type, weather, working conditions, or established guidelines. Next, those staffing the rehab sector must know what is expected of them and these tasks must be clearly defined by protocols. He notes that this is especially important when non-fire department personnel are providing the rehab services. There must also be a system of accountability of the firefighters who are entering and exiting the rehab sector. Safety

20 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 20 of firefighters should be the main focus of the rehab sector. In other words, the personnel who are providing staffing for rehab must assure that firefighters are being properly cared for and are rested and ready to return to duty prior to being released from the rehab sector (Bledsoe, 2009, pp. 3-4). After rehab has been established at an emergency scene, it then becomes a priority of the incident command staff to determine how and when a firefighter must cease performing operational tasks and report to the rehab sector to rest and rejuvenate. According to Schaeffer (2011), firefighters who are involved in strenuous scene situations must share the heavy workload through the rotation of personnel through the various work tasks and through the rehab sector. The use of personal protective equipment (PPE) and the wearing of self-contained breathing apparatus (SCBA) can take a heavy toll on the firefighter through additional cardiovascular stress and increased body temperatures. This creates significant risks on the health and safety of fire personnel which rehab can address. It then becomes necessary to provide this critical period of rest and recovery. He contends that most fire departments adhere to the twobottle-rule, which requires a firefighter receive some form of rehab after having exhausted the compressed breathing air available in the SCBA cylinders. It would be at the change-out of the second bottle/cylinder that the firefighter should be required to rest for at least 10-minutes and have a quick mental awareness check and ask if they are prepared to re-enter the scene. Additionally, they should receive rehydration fluids and food if necessary (Schaeffer, 2011, pp ). With the release and update of the NFPA 1584 Standard in 2008, many fire department leaders became acutely aware of the importance of and the need to provide rehab and medical monitoring for their personnel involved in active incidents. The question that many had was how to accomplish this goal. The resources involved in providing this service to fire personnel can

21 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 21 include a vehicle, personnel, equipment, and supplies. Depending on the size of the incident and the number of firefighters involved in the active scene tasks, Bledsoe (2009) states that some departments opt for having an apparatus dedicated to this purpose. The personnel necessary to provide staffing for any rehab services may require department administration to pre-plan for their resource needs. This may include the use of personnel from the Salvation Army, the American Red Cross, or even a fire department auxiliary. He warns, however, that agreements must be in place for the type of food and hydration fluids that these agencies provide as doughnuts and coffee are not appropriate for rehab, (Bledsoe, 2009, p. 12). Evans (2008) wrote that 70% of the departments he queried acknowledged that they participated in some form of rehab for firefighters. Of those, there were only 20% were completely compliant with the NFPA Standard. Slightly more than 10% of these departments did not have any formal rehab program in place. Within the departments which were actively providing rehab, most utilized personnel and apparatus from the local ambulance provider, while 40% of the departments had a dedicated rehab vehicle to transport personnel and supplies to the scene (Evans, 2008, pp ). In another survey of fire departments and their approach to firefighter rehab, Irr (2008) discovered that 56% of the departments involved in his research stated that they had a dedicated rehab apparatus, while 31% utilized an available on-scene department apparatus to provide the rehab services; fewer still relied on private ambulance providers to staff the rehab sector (Irr, 2008, p. 17). Schaeffer (2011) suggests that rehab may be approached through a two-tier system. In a quick residential fire, rehab may only consist of hydration and removing PPE for active cooling. A more complex fatality fire, however, may necessitate additional support teams, including mental health professionals, (Schaeffer, 2011, p. 47). The contention by fire department leaders

22 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 22 tends to lean towards the necessity of providing their personnel with these rehab services, especially since it has been shown as a contributing factor in maintaining the health and safety of firefighters during the active phase of emergency operations. However, one of the questions that remains unanswered by many departments across the United States is how to find dedicated personnel resources to provide this critical service. Many fire departments, when responding to a reported fire, are utilizing their on-duty personnel to fill roles necessary to meet the demands of NFPA The NFPA standard defines response time criteria, and also creates a template for assigning firefighters to tasks associated with providing fire suppression, search and rescue, incident command, and other fire-ground priorities (NFPA, 2001, pp. 7-8). However, for smaller, minimally-staffed departments, meeting these criteria for firefighting operations can tax their personnel, leaving no unassigned firefighters to perform support services such as rehab and medical monitoring. The challenge then becomes how to staff for these fire-ground support functions, when sufficient resources are unavailable. Even considering a minimalist approach of providing just rehydration fluids and a cooling station would require an employee to staff it. Tight budgets, reduced personnel, and increased calls for service have been facing fire department leaders for the past several years. Requests for additional personnel are likely to address staffing levels on apparatus or boost manning level in the firehouse, leaving ancillary functions unmanned. Even though rehab may be considered a critical fire-ground task, it has taken a back seat to the more pressing needs of daily department operations. The sluggish economy in the United States has created difficult times for fire departments across the nation. Governing bodies are looking at fire department budgets with closer scrutiny and fire chiefs are being asked to justify their staffing levels. An unfortunate result of the

23 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 23 economic downturn is that many low-income residents are increasingly relying on fire departments to provide them with basic medical care due to a loss of adequate primary healthcare. This places an additional burden on an already taxed system (Lewis, 2010). Hrustich (2009) stated that the Endicott Fire Department has lost one-third of its uniformed personnel due to the city s financial shortfalls. The loss of firefighters to answer calls for service has placed the residents in that city at an increased risk of losing their property to fire and has potentially placed firefighters in danger of injury. Additionally, there is no agreement between the city and the labor union to provide the citizens with minimum staffing levels of firefighters to respond to fires and medical emergencies. Monetary limitations imposed by the city have disallowed the use of overtime to staff apparatus and stations. Unfortunately, staffing cuts, budget restraints, and negotiated union contracts have created a large variance in the staffing of fire departments, despite the recommendations of NFPA 1710 (Hrustich, 2009). In 2004, the International Association of Fire Chiefs (IAFC) conducted a survey of over 7,000 members, asking them to identify the problems facing their departments. Overwhelmingly, the majority of respondents stated that budget cuts and staffing issues were creating significant challenges in their departments. Many of those who responded to the survey stated that they had experienced layoffs, compounded by the increase in calls for service and growth of their communities (IAFC, 2004). The current economic climate across the U.S. has forced many fire departments to look at creative solutions in an effort to provide for the increasing needs of their customers. These resources are also being utilized to help fulfill roles that benefit firefighters health and safety through rehab. The NFPA 1710 Standard defines automatic aid as identifying personnel and equipment resources which are predetermined to be deployed to a neighboring community when an

24 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 24 emergency incident is reported and dispatched simultaneously to each agency. A further definition of mutual aid states that the personnel and equipment would respond to the emergency in a neighboring community based solely on a formal request funneled through the dispatch center (NFPA, 2001, p. 13). To meet the demands of providing for emergency response under limited resources, Lewis (2010) stated that almost all fire department jurisdictions rely on mutual aid resources from surrounding departments, even if it occurs only on a limited basis. However, some departments use mutual aid assistance on routine calls and to provide for support services. Staffing can be problematic, and emergency response agencies cannot provide adequate staffing levels to meet the potential surge of emergency calls that face departments daily (Cahill, 2011, p. 16). With shrinking staffing levels to meet this surge capacity, fire chiefs are increasingly relying on these creative sources, such as mutual aid, to provide for personnel to perform the demands of emergency response and to provide for the safety of their personnel. Larger fire departments usually have greater depth in which to absorb the impacts of personnel reductions, but smaller agencies tend to feel the effects of tight financial restraints and are more likely to resort to finding alternative methods to maintain services. Verfuss (2004) writes that large metropolitan fire departments, such as Phoenix, Arizona, provide rehab to firefighters during extended incidents by utilizing paramedics rescue trucks and fire personnel assigned to a dedicated department rehab apparatus which was designed specifically for that purpose. Conversely, smaller, rural fire departments may not have sufficient personnel for support services, so they rely on mutual aid compacts with neighboring communities to provide rehab services by using volunteers to staff a shared apparatus. Departments within Yates County (NY) have even offered the use of their personnel and rehab trailer to the county sheriff s department when they have an extended operation (Verfuss, 2004, p. 46).

25 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 25 Adequate staffing at the scene of a structure fire allows department leaders to utilize proven tactics aimed at mitigation of the emergency. It has been shown that these tactics increase the likelihood of firefighter safety and survival. In an analysis of on-duty firefighter deaths, Parker (2010) found that 43% of these incidents showed that lack of adequate staffing was considered a factor in the poor outcome and that there were not enough firefighters to accomplish the necessary tasks. The lack of properly trained personnel often forces fire departments to overly depend on mutual aid resources (Parker, 2010). Although effective fire suppression, life safety, and property conservation are among the priorities of any firefighter, fire departments are also faced with a legal obligation to provide sufficient staffing levels to accomplish these tasks while maintaining safety for their personnel. It is the responsibility of the locality or fire department to ensure staffing at safe levels. This can be accomplished through minimum staffing of apparatus, having extra apparatus respond, requesting mutual aid, or requesting aid from bystanders for exterior activities away from fire hazards. Additionally, there is a certain amount of liability that a department assumes if it can be proven that lack of staffing contributed to the occurrence of an accident (Reeves, 2006, p. 106). Although, asking a bystander to help with fire-ground operations may be an unnecessary risk, fire departments have considered the use of volunteer resources and internship programs to help them augment their firefighters efforts. When faced with a personnel shortage that affects the efficiency of firefighters working at the scene of an emergency incident, fire department leaders may have to look for resources beyond the neighboring fire agencies to help with these tasks. This may involve employing volunteers to the response protocol to augment career firefighters efforts. With the prospect of having volunteers arriving on a fire incident, safety, training, and reliability are concerns that are immediately brought forth. However, there are many volunteer personnel across the United

26 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 26 States that assist career fire departments through a combination system that can be an effective method of creating additional manning with little or no increase in funding. It then becomes the responsibility of the sponsoring agency to provide the training and oversight for these personnel in order to create a useful resource that contributes to the safety of the incident, rather than cause concern for injuries or accidents. Scott and Windisch (2006), contend that although training and qualifications of volunteer resources can be a concern, the management of the relationship between career staff and volunteers can be a difficult task for department leadership (Scott & Windisch, 2006). Additionally, it could prove to be a difficult to recruit volunteer resources to fulfill these critical task roles. With the current economic climate in the U.S., many families are struggling to pay their bills and keep their children clothed and fed. This can create situations in which the principal money earner in the home may have to hold down several jobs in an effort to earn wages sufficient to provide for the family s needs. As a volunteer for a fire department, Simpson (1996) states that members must have the ability to leave work or home to answer an alarm that is received by the department. In rural areas, volunteerism in the local volunteer fire department has become a tradition for many families and it is somewhat expected to be active in the community. However, middle class suburban neighborhoods may find the availability of volunteers to be scarce (Simpson, 1996). The Community Emergency Response Team (CERT) is a national program aimed at training residents in the basic tasks of taking care of themselves and their neighbors in times of a natural or man-made disaster. According to the CERT website, the training program is delivered in twoto three-hour blocks over a seven-week period, and involves teaching disaster preparedness, basic fire suppression, first aid medical care, light search and rescue operations, and team organization and management. One of the tenets of the CERT program is people helping

27 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 27 people, and aims at training citizen responders to help make a positive impact during the initial phase of a disaster, when local first responders are likely busy. Additionally, CERT recommends that these trained citizens can partner with their local response agencies to take an active role in disaster preparedness and emergency response (Citizens Emergency Response Teams, n.d.). Dean (2003) wrote that any fire department can experience a natural or man-made disaster which can deplete their resources. During these times, it may become necessary to consider the use of volunteer resources, such as a CERT program. He contends that people have an inherent desire to help out when their community is in need during an emergency incident, and this desire to help out can provide a benefit to fire departments (Dean, 2003). However, this volunteer assistance does not necessarily require a disaster to become useful for the fire department, as there are more routine incidents in which CERT resources can be beneficial. The Los Angeles City Fire Department utilizes CERT volunteers to help them provide necessary emergency response on a regular basis. The Los Angeles program follows the national CERT program of presenting the training curriculum in a seven-week format to their students. They teach classes throughout the year and allow graduates of their program to sign up for call-out team status. This program allows those who pre-register through the fire department to be notified of official requests for assistance from CERT responders. In order to qualify for this program, the CERT graduate must be pre-qualified, be a sworn in as a disaster service worker, attend regular training sessions, and follow the fire department s CERT Code of Conduct. Members of the call out team are strictly prohibited from self-dispatching, and agree to stay only within their scope of training. The Code of Conduct also states that members of the CERT response are not firefighters and are not to present themselves as such. There are also rules that regulate members' conduct and professionalism while deployed to an emergency (CERT Los Angeles, n.d.). In addition to CERT,

28 PROVIDING FIREFIGHTER REHAB WITH LIMITED STAFFING 28 there are other national volunteer programs available for consideration as a fire department resource, including U.S. Fire Corps. Departments with minimal staffing have also considered creating an internship program through the fire department that may also provide additional resources for fire ground operations and support services. College students can be considered a valuable resource for smaller fire departments as they can be integrated into the emergency response model in a way that they can become indistinguishable from regular response personnel. Successful internship programs have been developed in Davis, California, and Fairbanks, Alaska. By providing free dorm housing and firefighter training, these programs have been shown to reduce the need for paid staff by supplementing the department s resources. Additional benefits include the students' ability to gain valuable experience working with trained fire personnel, while providing motivated responders who can provide emergency response at a greatly reduced cost (Bliss, 2010). This can also help students with the overall cost of education by reducing their housing costs during the school terms. However, a drawback to consider is that during semester breaks, students will be unable to provide a response service to the department and lose valuable training time when they return to their homes while school is not in session (Hrustich, 2009). It has been shown through research and common fire department practice that firefighter rehab and medical monitoring of personnel who are working at the scene of an emergency is a valuable tool to help prevent fire ground injuries and deaths. The reduction in physical and emotional stress has been a proven factor in the overall health and safety of firefighters. As many fire departments are facing difficult economic times and staff shortages, many fire chiefs and city administrators are looking at the valuable alternatives of mutual aid compacts, volunteerism, and even college internship programs to help augment their systems.