Rescue teams needed to save more than victims

Rescue teams needed to save more than victims

Byline: Bruce Evans

Recently USA Today ran a series of articles that once again reminded us of the lack of teamwork between EMS workers and firefighters in some communities. Nationally our trade has been muddied in the public eye, and in some instances rightfully so. So where do we start and how do we overcome the rift between EMS and the fire service?

Most people who consult on conflict resolution will tell you the first step in making the peace is to find a common ground. One possible answer might be to employ a rescue company as a link between services. Every department, big or small, should develop and employ the services of a rescue company. Many metropolitan departments have one or more rescue companies, but they may not understand how valuable those companies may be. The rescue company has the skills, attitude and experience of both firefighters and EMS workers. When the union or the department looks for the skills set to repair the bridge between fire and EMS, they should look to those company officers from the rescue company.

A hard look at typical rescue company crew experiences and psychology can teach management a lot about leadership and teamwork. Typically the rescue company firefighter is a self-starter who is action-oriented and constantly active. If you’ve ever looked at a rescue company schedule, you know the training is demanding and often requires a broader science-knowledge base coupled with the dexterity and precision to put things together and take things apart – some of the very same characteristics typical of EMS or paramedic crews. Very often rescue companies are involved with the patient for long periods of time, which demands a certain amount of patient care that’s very similar to an EMS crew’s actions.

Teamwork often is the unrecognized component of a rescue company. Some of the greatest accomplishments are the result of exceptional teamwork during a rescue operation. This is the skill that the fire service needs to convey to other parts of its operations. Engine companies show the necessary teamwork, but consider what happens outside that unit when the smaller team must embrace the actions of a larger incident. It’s in these instances that the lessons from the rescue company could assist the fire service in solving the problem. The very nature of the work environment involved with a complex or technical rescue often demands interface with outside agencies.

There are internal challenges that a fire department confronts when contemplating the development of a rescue company. Most chiefs won’t consider it because of risk management issues or cost. If a rescue company is not an option, then consider a strong automatic aid agreement. Departments opting not to invest in a rescue company should bring the rescue company from the neighboring jurisdiction, no questions asked, and triggered by the communication center as part of a pre-defined response matrix.

A rescue company is a costly proposition, and I would suggest a few strategies for justifying the cost and securing funding sources. A rescue company typically plays a strong role in vehicle extrication. Vehicle rescue that involves several different kinds of transport modes provides an opportunity to secure more funding resources. The National Highway Traffic Safety Administration grant program allots money for vehicle rescue equipment. If the service area includes a rail corridor or other regional transportation system, it’s only appropriate that those quasi-government agencies afford money for the equipment necessary to conduct rescue operations. Regional response has advantages when it comes to securing grant money from government and private sources. Most funding sources from private agencies like to see their money affect the largest area possible. The FIRE Act also can provide some financial assistance in securing vehicles and equipment.

Regional response has additional advantages when it comes to securing grant money. Another source for funding a rescue company and supplying equipment is the Local Emergency Planning Committee. Each state has several LEPCS, which often provide grants for the training and equipment associated with hazmat or industrial response. LEPCS tend to fund community-based resources and anticipate that jurisdictions will work together and share resources.

There sometimes is a perception that rescue companies are an expensive asset that are not used often. But as new roles emerge for the fire service, we can address job tasks and assignments by looking at the rapid intervention team function. Safety is of paramount importance on the fireground, and the fire service has seen a tremendous push toward rapid intervention training. Countless training hours have been spent teaching firefighters how to rescue each other. You could make an argument for a heavy rescue being deployed to every working structure fire.

In an analysis of fireground deaths over the last 10 years, entrapment has become a significant cause of firefighter fatalities. When firefighters are caught in a building collapse, you want a rescue company on scene that has the skills, equipment and ability to breach concrete and conduct complex search operations. It’s only prudent to teach firefighters self-rescue techniques, but it may be more appropriate to leave the rescue operations to the people who do it the most.

Skill maintenance is a real issue when it comes to complex operations. In a situation similar to EMS workers, crews that see the sickest patient are those likely to be the most proficient in the care of those patients. A tremendous amount of educational literature has been written on proficiency and repetition of the task. We may be setting engine crews up for failure by providing training for an event they may see only once and practiced only a few hours or days a year.

Contrast that to a busy rescue company that has been to several incidents, performed several rescues and spent the bulk of its time training on the skills needed to accomplish the mission. The rescue company’s responsibility, as one New York City firefighter put it, is to “take care of the firefighters.” The rescue company may be an answer to taking another engine company out of the first-alarm assignment that would typically be used for rapid intervention.

So how do you justify the cost of a rescue company to your superiors or the city/county managers? One solution is to work toward an ISO rating, which provides reduced insurance premiums to citizens based on the firefighting capabilities of individual communities. For example, if you were to look at the percentage of fire loss by water damage, a significant portion could be stopped by aggressive salvage operations. Historically many cities operated salvage companies that fit the description of a service company, and much of the equipment in the ISO rating is dual-use for salvage and rescue. So while it may look like and act like a rescue truck, consider funding a vehicle as a salvage company. Establishing a line item budget based on reduced fire loss and aggressive salvage operations should be a benefit to the community.

For departments wishing to step into the Advanced Life Support market, a rescue company also may be the ideal place to upgrade to paramedic-level care. This shouldn’t be a resource that is sent on routine EMS calls, but it does provide an opportunity to deliver ALS care to entrapped patients without jeopardizing ALS personnel not trained or equipped to be in hazardous circumstances. An ALS rescue company also provides an immediate resource for a firefighter who collapses at the scene or for those rescued from a collapse scenario.

Lastly, the fire service needs to take action on the development and standard deployment of rescue companies. NFPA 1006, Rescue Technician Professional Qualifications, is an excellent guide for training personnel. Slated for revision in 2004, NFPA 1710, Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, should be revised to include the deployment of a rescue company given a certain number of stations. Anecdotally, 10 stations appear to equate to a city of approximately 250,000 and could provide a benchmark. The standard also could identify regional agreements for towns fewer than 50,000 or with less than than 10 stations. The 1710 standard addresses special operations response and the need for appropriate resources, yet the benchmark is vague. It needs to define personnel standards for rescue companies and define the capabilities similar to engine companies and ladder/truck companies.

Another concept based on multiple fire fatality statistics and the complexities of a large area search is the idea of a rescue company being present on any emergency in a building over 5,000 square feet or some benchmarked, similarly sized building. In conjunction with the NFPA standard, ISO needs to revise its definition for a service company and add the equipment commonly carried on rescue companies to ensure that the community moves toward an all-risk role. Many of the capabilities of the rescue company certainly could have an impact on insurance actuarial tables and lessen the financial impact of the incident.

The original thought is that we should take more lessons from the rescue companies about how to accomplish the mission of the fire service and realize we play many roles: EMS, rescue and fire suppression. If we look back at the distinguished career of the late Bttn. Chief Ray Downey Sr. from FDNY, who came up through the ranks of a rescue company, we find our moral compass. For almost four decades, he answered the call and exemplified what real teamwork is all about. Downey showed us what real leadership and teamwork was. Just as we continue to remember our fallen brothers of the Sept. 11 attacks, let us renew our faith in teamwork and innovation found in the rescue company.

Bruce Evans is the fire science program coordinator at the Community College of Southern Nevada as well as an adjunct faculty member for the National Fire Academy’s EMS and injury prevention courses. A captain at the Henderson (Nev.) Fire Department, he has a master’s degree in public administration and an associate’s degree in fire management.

For further information

An NFPA interview with U.S. Fire Administrator R. David Paulson that foretells the role of the USAR teams.

Files and outline for the Urban Search and Rescue medical specialist, who may provide some guidelines and selection criteria for placing a qualified paramedic on a rescue company.

A historical reference of the salvage companies of the Los Angeles Fire Department.

The ISO Mitigation page for service company criteria. The chart includes several pieces of equipment common to rescue companies.

FDNY memorial homepage to Bttn. Chief Ray Downey Sr.

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