From “leather lungs” to SCBA, from fire suppression alone to all-hazards response, from primary response to proactive community risk reduction (CRR), the evolution of fire services has been an ongoing paradigm shift, whether by choice or choice. forced due to changes in science and society.
Today, from the pandemic to social unrest, our nation has entered unprecedented times that further test our ability to protect property and save lives. Unstable large-scale natural or man-made incidents, combined with increased risk to staff, whether from virus, violence or personnel, underscores the fact that we cannot be everywhere at the same time. time and that we cannot be on time everywhere.
The paradigm shift
In previous columns of this space, my premise has centered on two key points:
1) Today’s fire service must view and approach its service delivery not from the perspective that it is a community service that responds to random acts of misfortune, but as a service of homeland security that protects America’s front doors and main streets; and 2) To increase and maintain community value, fire departments must have a seat at the table to offer solutions to their community’s perceived risks, support solutions or, at the very least, show concern for these. risks.
I now submit that it is crucial to add a third premise to my main points: the fire service must redefine the meaning of first responder, reinvent its purpose and approach to CRR, and usher in another paradigm shift. in our profession.
Arguably, this paradigm shift began in 1999 in Columbine High School in Littleton, CO. Two students who became gunmen roamed freely throughout the school and killed 13 students and injured 21, as law enforcement, firefighters and emergency medical services personnel followed protocols of the time and waited helplessly outside.
Major shifts in violent scene operations have swept away not only first responders, but also communities and school systems. From the creation of what we know today as rescue task forces, to school threat assessment teams and internal school policies, the focus has been on the initial charge of the system to reduce response times to minimize damage and loss of life. However, most of the focus has been on the actions of professionals, namely school administrators and emergency responders.
In 2012, the paradigm shift intensified with a violent event in Aurora, CO that left 12 dead and 70 injured. A TriData after-action report of the event credited firefighters, emergency medical service providers and law enforcement officers with making excellent, sometimes “unconventional” decisions that saved lives. lives, namely the use of police vehicles to transport the injured to hospital due to the inability of ambulances to reach the scene. According to the report, the 27 victims transported by law enforcement all survived. The after-action report further stated that the use of tourniquets and mass drills that prepared hospitals for the influx of casualties were key to saving lives. That said, once again, the paradigm shift has focused on professions that hold an event upstream.
In 2013 and 2017, in Boston and Las Vegas, respectively, mass casualty events again shifted our paradigm, resulting in a new frontal charge that redefines first responders and our theory and approach to CRR. The respective after-action reports credited civilians for saving lives, both by administering bleeding control measures and helping to clear crowds to help emergency vehicles get in and out. In Boston, the report says the scene was cleared of casualties within 22 minutes and all those transported survived. In Las Vegas, civilians transported many injured people in their personal vehicles.
Evolution of CRR programs
So what does all of this tell us? As we continue on this path of social and environmental change, we must also change to adapt and save lives. Whether it’s because of a still actively violent or unstable scene, because of multiple incidents occurring at the same time, or because of mass chaos delaying professional response, it takes us longer and longer to reach the victims and bring them to the hospital. The end result is that potentially salvageable lives are lost. A growing number of after action reports are highlighting and celebrating unconventional rescue methods and approaches, from police and civilian vehicles used to transport victims, to bystanders performing immediate actions, such as CPR and Stop the Bleed. For us to be “everywhere at the same time and on time everywhere”, we obviously have to reinvent our approach and change the paradigm.
Currently, CRR programs are viewed and approached as an additional service to the public, a nicety, constantly understaffed PR department that hopefully reduces calls and saves lives. However, this is no longer enough. The CRR should be seen as a program to improve emergency response capability and increase the chances that essential life-saving measures will be carried out everywhere at the same time and on time.
CRR programs must go beyond simply educating citizens on how to be safe. They must educate and train entire communities, those who will truly be the first to respond, as a cadre of responders capable of providing immediate lifesaving skills before the professionals arrive.
Israel credits the universal military training of a significant portion of its citizens (i.e. compulsory military service) with the country’s success in national defense. When a crisis occurs, ordinary citizens become responders who are prepared and trained to do so.
“Boston Strong” has come to symbolize the city’s ability to react and recover from large-scale unstable events. A Harvard report on the 2013 Boston Marathon bombing said Boston Strong “is much more than a phrase” but encompasses the city pride that inspired the successful response, from the pizza chef who knew how to use his apron as a tourniquet, to doctors and nurses at the hospital. “Boston Strong is an expression of resilience.”
Citizens at heart
For your community to be AnyTown Strong, it must be resilient. When an event occurs, it is the citizens who will be the first responders, and citizens who are prepared and trained to do so will increase the savings of life and property and help the community recover quickly.
Although many emergency response agencies have plans in place to deal with large-scale volatile events, the heart of a community’s strength lies in the citizens themselves and their ability to resist, react and recover. In other words, the ability of any community to be strong depends on a strong and refocused CRR program and effort.
It’s time to change the paradigm.