By Anne Camaro, IPSA 911 Telecommunications Committee Member, Assistant Director of Administration and Training Cambridge Emergency Communications

As we gear up to celebrate another National Public Safety Telecommunicators Week, it is important to pave the way for new telecommunicators as they make their way from the classroom to the communications center. Whether working eight or 12-hour shifts, dispatchers know that no shift is ever like the last one. The uncertainty of the next call, the excitement of the next chase and the relief of the resolution are the only constants. The situations, the names and the people are ever changing in a web of stories that become the reason we choose to stay.

Ability to adapt

Having grown up in the boom of technology of the 1990s, I still remember the first time I sat down in front of a DOS based CAD. Having to adapt from mouse clicks to keyboard tabs was no easy task, however, that was the first of many different things I had to adapt to throughout the years. However, not everyone can adapt in the 911 telecommunications profession.

As communications supervisors recruit new talent and promote from within, one of the most desired qualities in a candidate is adaptability. Most supervisors will not hire or promote someone who demonstrates a resistance or fear to change. Individuals who are hired to work in this profession and then become unwilling or unable to adapt to the ever-changing environment in the communications center, rarely stay. No dispatcher, at least no successful dispatcher, can stay rigid and resist change.

So how can we become more adaptable? Jennifer Garvey Berger, author of “Simple Habits for Complex Times: Powerful Practices for Leaders” describes four steps we can take to become more adaptable. To face change successfully, she states that we must shift our mindset and highlights four tips on how to get started: (1) ask different questions; (2) accept multiple perspectives; (3) consider the bigger picture and (4) experiment and learn.

Further, Jeff Boss, an adaptability coach, describes an adaptable person as someone who is open to change, who has the will to face uncertainty, and who sees opportunity where others see failure. According to Boss, adaptable people are resourceful and think ahead; they don’t whine, or place blame; and they also don’t claim fame. Adaptable people stay current, are open minded and know what they stand for. A dispatcher who possesses these traits is desirable and will become invaluable to the agency they work for because they are willing and able to go the extra mile.

Change is scary and complex. It involves coming out of our comfort zone, but if we want to succeed as 911 telecommunicators we must understand that change is part of the job description. It is inevitable. From change, the best 911 telecommunicators learn and thrive. In a field that gets more complex by the minute, a famous quote attributed to Leon C. Megginson’s work regarding Darwin’s “Origin of Species” is valid, “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.”

By Ken Wallentine

In a recent survey, I asked for reader thoughts on meeting the challenge of the active shooter in schools. Thanks to the officers who sent thoughtful responses. Not surprisingly, several respondents suggested placing more officers in schools.

Here is a snapshot of some other responses:

• Creating an easier path for retired cops with degrees to become certified teachers.
• Hiring retired officers as part-time school workers in a variety of positions and co-locating neighborhood policing offices in schools.
• An adopt an officer program. This officer suggested pairing street cops and detectives with schools that would “adopt” the officer. The officer would be invited as a special guest to assemblies and other events and to eat lunch at the school on a regular basis.
• Better designs for physical security.
• Taking advantage of existing locks to provide a single point of entry.
• Additional training and emphasis on challenging unidentified or suspicious school visitors.

Virtual reality, active shooter scenario

I recently participated with dozens of school district executives, school resource officers, principals, vice-principals and counselors in a series of school shooting scenarios. The virtual reality system allowed us to experience an active school shooter scenario in penetrating virtual reality, using actual weapons and feeling the impact of gunfire. At the end of each virtual reality session, we gathered cops and educators to debrief. Ideas and questions flowed freely. Conversations that began in virtual reality will continue as partnerships strengthen.

Safety apps

I learned about programs that help students report concerns and/or reach out for help. The best of these is a smartphone app called SafeUT. It is a resource for students, parents and educators. Students and parents can submit tips, chat with a qualified mental health professional, make an immediate one-button call for help and monitor existing tips and helpful hints for safety and well-being. Other states are creating similar apps.

Just last week, a middle school student in my community threatened to shoot up his school. Classmates who heard the threat said something and used the SafeUT app. A cop went to the home and spoke with parents and the student. He and his partner searched the kid’s bedroom and found an AR-15 and a handgun. The app, powered by students willing to say something, worked. Mass shooting prevented? Probably.

Broadening the discussion

The conversations about safer schools and safer kids are happening across the country. These discussions need to include local public safety officers, teachers and parents. Those conversations need to be far broader than just hardening the targets. Let’s join the community in talking about prevention. Let’s be sure that our departments and schools are social media smart. Are we watching out for and reaching the kids who signal trouble? Are our schools fostering an emotionally healthy environment? Are there safe places and trusted people for kids who are bullied, abused or emotionally struggling?

Preparedness

As public safety servants, we prepare tirelessly for many events that will never happen in our community. With the violence at Parkland and Great Mills, the focus right now is on school shootings.

We must prepare the best we can. In our sheriffs’ offices and police departments, let’s talk about something that we know about: threat assessment. When we get a tip, do we have a system in place to quickly bring a school official, mental health professional, school resource officer, and—as appropriate—parent or guardian together for a risk analysis and intervention plan?

Our preparations will necessarily lead to deeper connections with educators, parents, kids and our entire community. Our preventive efforts will pay off, too. As we stretch our reach to kids on the fringe, we may or may not prevent a school killer, but we may just make life better for a lonely kid.

There is a genuine compassion and commitment among public safety officials to keeping our communities safe. Your communities need your critical conversation contributions.

About the Author

Chief Ken Wallentine is a Special Agent who directs the Utah Attorney General Training Center, overseeing use of force training and investigation and cold case homicide investigations. He is also a consultant and Senior Legal Advisor for Lexipol. Ken formerly served as Chief of Law Enforcement for the Utah Attorney General, serving over three decades in public safety before a brief retirement. He also serves as the Chairman of the Peace Officer Merit Commission of Greater Salt Lake County.

By James Dundas, IPSA Memorial Committee Chair

Duty. Honor. Courage. Noble words to live and serve by. The epitome of those words was sadly reinforced recently as the public safety community of practice lost seven brave souls in the line of duty. In the one week from March 21 to March 28, 2018, the United States has averaged the loss one first responder per day.

Wednesday, March 21, 2018: Police Officer Andres Laza-Caraballo (age 31) of the Juncos Municipal Police Department in Puerto Rico was shot while off duty when attempting to intercede in a violent incident. Officer Laza-Caraballo confronted armed men when they entered a barber shop and began firing. Officer Laza-Caraballo was fatally wounded. He was a 10-year veteran of the department. He leaves behind two children.

Thursday, March 22, 2018: FDNY Firefighter Michael Davidson (age 37), a 15-year veteran, husband and father of four girls, died in a fire on a movie set in the Hamilton Heights neighborhood of Harlem. Part of an interior attack crew, FF Davidson became separated from the others when an evacuation was called. Search teams were quickly assembled and re-entered the building in a desperate attempt to locate FF Davidson. When found, FF Davidson was unconscious. He was transported to Harlem Hospital where he died.

Also on Thursday, March 22, 2018, in York City, Pennsylvania, FF Ivan Flanscha (age 50) and FF Zachary Anthony (age 29) perished in a huge multiple alarm fire in the former Weaver Organ and Piano Warehouse. FF’s Flanscha and Anthony were part of an interior crew dousing hot spots when a part of the structure collapsed, entrapping them and other members. The York City Technical Rescue team was brought in to lead the search, but unfortunately, both Flanscha and Anthony did not survive.  Two others, Assistant Chief Greg Altland and FF Erik Swanson received serious, but not expected to be life threatening injuries.

In what is becoming a more frequent and tragic consequence of exposure to hazardous substances, Special Agent Melissa Morrow (age 48) of the FBI succumbed to brain cancer on March 22, 2018, because of her search and recovery work at the Pentagon on September 11, 2001. She worked 10 weeks on site, and like many first responders, fell from continuous, long-term exposure to toxins. She is survived by her parents and one sister.

Friday, March 23, 2018: The Caldwell County Office of Emergency Management reported that FF Larry Marusik of the Ellinger Volunteer Fire Department succumbed to critical burn injuries sustained on March 10 while fighting a large wildland fire. He had been under treatment at the Brook Army Medical Center.  

Saturday, March 24, 2018: We saw the deaths of two Pratt, West Virginia, volunteer firefighters who died in a crash of their apparatus when responding to a severe multi-fatality traffic accident. Preliminary reports show that their rig left the roadway and crashed into a rock wall. Three other firefighters were injured, one critically.  

While it is premature to speculate on causal factors of these tragedies this past week, there are some practices that the public safety community may acknowledge that may help prevent a future tragedy from occurring. These recommendations were pulled from the IPSA’s 2017 LODD Report:

1.  Improve situational awareness. The key is situational awareness and the responder wearing the proper protective gear for the environment where he or she is responding. Situational awareness is enhanced when 9-1-1 dispatchers inquire about the circumstances and environment and report their findings to responding units.
   
   
2. Implement practices to reduce contamination. All agencies should assess their risks based upon their unique response profile and adopt policies that reduce the risk of contamination. This would include the adoption of operational practices such as mandatory post-fire decontamination, cleansing of PPE, carrying contaminated PPE in sealed bags and assessing personnel for exposure.
   
   
3.  Always wear a seatbelt. Empirical research shows that wearing a seatbelt will save lives. First responders need to buckle up, despite any temporary discomfort duty gear may impose.
   
   
4.  Enhance body armor by decreasing its weight and increasing flexibility, provide for more coverage, and enhance it ballistics, shielding capabilities. Body armor should protect vital areas against any form of penetration, whether a projectile from a firearm or a penetrating object intended to stab the officer. A proposed revision of NIJ Standard 0101.06, Ballistic Resistance of Body Armor is open for comment through May 23, 2018.
   
   
5.  Increase firearms training. Law enforcement officers are required to undergo a certain number of hours of firearms training. Unfortunately, the time allotted for training is generally very limited and does not correlate to the volume of gun violence in the U.S. Departments need to review their training hours and add training hours to keep their officers safe.
   
   

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IPSA's Report about 2017 Line of Duty Deaths

Join the IPSA’s Memorial Committee

 

First responders experience extreme physical demands, often in hazardous environments. Many tragedies occur suddenly and without warning. Gunshot wounds, building collapses, vehicular accidents, assaults and other causal factors contribute to untimely deaths in our emergency response community. Further, first responders face several threats to occupational related diseases such as cancer and cardiorespiratory related maladies. Law enforcement, firefighting and rescue activities are inherently dangerous occupations. Since the year 2000, the data reviewed accounts for the loss of 2,841 law enforcement officers, 1,937 fire and EMS personnel and 233 K9s.

Download the IPSA's Report about 2017 Line of Duty Deaths

The International Public Safety Association Memorial Committee was established to monitor line of duty deaths to honor the supreme sacrifice of our brave and heroic first responders and to review LODD data for trends, patterns and anomalies so the IPSA can develop recommended policies and changes that improve safety. If you are interested in getting involved with the IPSA's Memorial Committee, then apply to serve today.

By Dan Fish, Lexipol is an Official IPSA Supporter

How do law enforcement officers end up chronically stressed, burned out and suffering from compassion fatigue? Why do so many officers fail to take care of themselves mentally and physically? And how can we help them achieve better health and balance?

Questions like these are dominating public safety lately. Look at any law enforcement publication, website or conference line-up, and you’ll see topics related to physical and mental wellbeing, post-traumatic stress, peer support and other behavioral health issues.  (Full disclosure: The inspiration for this article was a presentation called “Keeping the Super Heroes Super,” presented by licensed psychologist and organizational consultant Kimberly A. Miller, Ph.D., at the FBINAA California Re-Trainer in August 2017.)

In part, this shift is driven by sheer economics—recruiting is getting more and more difficult for law enforcement agencies, so we need to find ways to retain good officers. But scientific developments are also driving the change. We’re learning more about the essential connection between mental and emotional health and performance. And that changes job-related stress from something we should just “deal with” to something that presents significant risks for law enforcement agencies.

What’s stressing out officers?

There’s no shortage of stressors in law enforcement. Depending on where you live and work, you may face media scrutiny or community distrust. Then there’s the grind of responding to call after call where people are exhibiting their worst behavior or are victims of someone else’s bad behavior. But let’s focus for a minute on two even bigger factors that underlie these specific stressors.

First, law enforcement officers are hard-wired to focus on the negative. We are always in threat assessment mode. All the way back in the academy, we were taught to focus on the bad things that can happen—because doing so could save our lives one day. This hard-wired approach to focus on the negative can take its toll and make it difficult to differentiate situations where we should be looking for the positive.

Second, law enforcement today is an all-encompassing, 24/7 career. There is a high level of responsibility that comes with being a protector of the public. Coupled with that, law enforcement culture expects officers to be stoic and strong in the face of adversity. We are taught to resist normal physiological responses to tragedies or critical incidents. This combination creates a perfect storm: The profession becomes all-encompassing, but at the same time we don’t provide officers with tools to deal with the effects of the profession.

How do officers know when they’re stressed?

The consequences of police officer stress pose a serious threat. Before we go further, let’s consider a few definitions:

• Stress is mental or emotional strain or tension resulting from adverse or very demanding circumstances.
• Burnout is the cumulative process marked by emotional exhaustion or withdrawal associated with increased workload or institutional stress.
• Compassion fatigue is the emotional residue/strain of exposure to working with those suffering traumatic events. It can encompass physical symptoms, such as difficulty sleeping, and emotional symptoms, such as loss of self-worth or anger.  

How does police officer stress manifest itself?

For many officers, law enforcement is their identity. They don’t leave much energy for their family, their friends or themselves. In turn, they can quickly feel isolated when dealing with the normal challenges of law enforcement. Once isolated, it’s a short step to despair and depression. Consider these possible signs and symptoms:

• Isolation and withdrawal
• Being disengaged or unmotivated
• Physical exhaustion
• Nightmares and flashbacks
• Poor hygiene or apathy about one’s physical appearance
• Loss of empathy or compassion
• Relationship issues, including divorce
• Substance misuse and abuse
• Recurrent sadness or depression
• Resistance to feedback
• Resistance to change
• Reduction in meaningful work product
• Reduced job satisfaction
• Increase in citizen complaints

Most of these signs and symptoms can be traced back to depleted energy.

How does self-care help?

The answer to the devastating consequences of police officer stress is self-care for mental health.

You may have heard this term tossed around, but what does it really mean? Self-care is not an exercise regimen or seeing a psychologist (although it could encompass those things). Rather, it’s a conscious process of considering our needs and seeking out activities and habits that replenish our energy—so that we can do our jobs better. This last part is often difficult to understand. Type A personalities often lead individuals to believe that they do their best when they commit all their resources to something, working harder and harder. But that’s simply not true.

We only have a finite amount of energy each day to expend. Just as taking a day off from the gym can help us train harder the next day, participating in activities outside law enforcement helps us refuel emotionally, which makes us more effective when we go back on duty. Combating the negative mindset also comes into play here. When you consider that negative emotion burns twice as much energy as positive emotion, the challenge and skill to remain positive makes its own case. We need to train officers to regularly assess their energy levels and focus on the positive.

One way to do this is by applying the “For vs. To” test to reframe an experience. Saying that something happened “to me” makes the experience negative and victimizing. Saying that something happened “for me” immediately turns the experience into a positive event and creates a challenge for officers to better themselves by developing their leadership and coping skills. Everything is a lesson and at minimum, in every tragedy/critical incident, there is a test of humanity. That test can develop good character if administered correctly, and should allow officers to feel relief instead of regret. The lesson is to not allow a temporary event to become a permanent state of mind.

Another important factor to understand about self-care: It’s a perishable skill, just like driving, shooting or arrest and control techniques. To be successful in maintaining good mental health, officers must practice. So let’s look at a few ways to do just that.

3 self-care tools

As mentioned above, Dr. Kimberly Miller presents frequently on the topic of self-care. She uses the analogy of “filling one’s bucket” with coping mechanisms that help officers stay positive, develop identity and self-worth outside of law enforcement, and be more in touch with their feelings and emotions. Here are three self-care tools she teaches.

1. Cultivate a life outside law enforcement. Good bucket-fillers create time for relationships and activities outside of the work environment. Don’t short-shrift your spouse, children or friends for work. Because it can be hard to let go of the job even when you’re off duty, you may at first need to schedule planned activities with family and friends. Otherwise, you may find that you spent yet another evening stewing over the day’s events while your kids played games on their tablets in the other room. Remember, too, that “alone time” is beneficial. Find activities—hiking, swimming, reading, bird watching, listening to music—that you enjoy and make time for them, too. Other tips: Disengage from technology whenever possible or at prescribed times of the day or week, and avoid energy “vampires” (people who demand too much of your energy).
2. Develop good physical health habits. Dr. Miller also suggests committing to an exercise regimen—one you can maintain. Consider whether you need to improve your diet, too. Law enforcement officers often find it difficult to eat healthy on shift, but preparing meals in advance can help. Cooking can also be a great way to spend quality time with your spouse and/or children. Finally, do everything you can to get enough sleep. Most people need between 6 and 9 hours. Lack of sleep is linked to many adverse health effects, even cancer, and can worsen the effects of post-traumatic stress. I know it’s not always possible, but when you can, plan for appropriate sleep time to avoid starting the day already low on valuable energy.
3. Practice meditation and mindfulness. Dr. Miller and I agree that visualization, meditation and mindfulness also have promise as a focused method of improving the mental health of officers. Visualization is a type of meditation about a specific activity or outcome and is widely used by professional athletes to focus on performance. Police officers are very much like professional athletes and this method should be considered as a part of any self-care program. Meditation is focused on trying to empty one’s mind of everything so that it can re-charge or clear the memory of negative thoughts. Mindfulness is a technique I’ve written about before; it involves paying attention to thoughts and feelings and how they are affecting you, then altering the thought process to deal more effectively and efficiently with the feelings.

Thinking long-term

Our society praises selflessness. That’s understandable; our natural inclination is to put ourselves first, and learning to push back against that impulse makes us better citizens and human beings. But like any habit, selflessness can become an addiction. What we often see in law enforcement officers is dedication to the job taken to an extreme. And like any addiction, over time, it begins to cause problems—physically, mentally, emotionally.

Law enforcement agencies have typically done a poor job of understanding police officer stress and helping officers cope. That needs to change. We need leadership role models who will demonstrate the important of actively choosing a balanced lifestyle. We need peer support and supervisors who show officers that it’s OK to feel pain and emotional distress—that doing so builds resilience over time.

We cannot give away what we don’t have; unfortunately, too many officers don’t understand this concept. Today’s officers require a new kind of bravery: The courage to change hard-wired habits and commit to self-care. This is not something we can put off to deal with in retirement—or we might never get there. When it comes to positive mental health, we simply can’t afford to trade the now for later.

About the Author

Dan Fish is Professional Services Representative for Lexipol. He retired from law enforcement in May 2017 after a 30-year career where he served in all ranks of the Petaluma (CA) Police Department including Chief of Police. Fish earned his bachelor’s degree in criminal justice from Sacramento State University and he holds a graduate certificate in law enforcement leadership from the University of Virginia. He holds several California certificates including the POST Management Certificate and the Phi Theta Kappa International Honor Society Leadership Development Program. Fish is a graduate of the POST Executive Development Course and Command College, the LAPD West Point Leadership Program and the FBI National Academy session #263.

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Why public safety professionals need to prevent, identify stress (and apply coping strategies)

By Dr. Michael Pittaro, IPSA Fitness/Wellness Committee Member

After nearly 30 years of serving in a variety of public safety positions, one common theme always emerged, the importance of mental and physical health/fitness. Even today, mental and physical health/fitness is still under-addressed in 911 telecommunications, law enforcement, corrections, fire/EMS, emergency management, public works, public health and all related public safety professions. In 2011, I transitioned from the field to the classroom as a criminal justice professor. I’m presently teaching the next generation of public safety professionals about strategies to prevent and reduce stress.

Consistently, medical research illustrates that stress contributes to a host of mental and physical ailments stemming from the public safety profession. This is not surprising given that the public safety profession represents some of the most dangerous, demanding and physically/mentally exhausting occupations. Here are some examples.

• According to the National Institute for Public Safety Health, the average age of a first heart attack in the United States is 66, whereas the average age of a first heart attack for a firefighter is 49.
• In comparison with the general population, law enforcement officers have higher blood pressure and cholesterol levels.
• 40 percent of law enforcement officers have a sleep disorder, which places those officers at a higher risk for depression, stroke, obesity and on-duty related accidents.

A profession that has been mostly neglected, as far as stress-related research, is that of correctional officers. Correctional officers have a suicide rate that is twice that of the general population and some studies suggest that the suicide rate is even higher than that of other law enforcement officers. Even more disturbing is that, on average, correctional officers will not live to see their 59^th birthday.

There is a need to provide information, education and awareness to public safety professionals. There is also a need to develop prevention and intervention strategies designed to address the physical and emotional wellbeing of all public safety professionals.

Below are some methods for coping with stress. This is not a complete list, and it is not a simple solution to a complex problem, but it is a good place to start.

Minimize unnecessary stress in your life: Stress is a part of life. There is truly no way to escape it, but everyone can minimize unnecessary stress. Unnecessary stress is often the stress that is created in our minds, whether real or perceived. For example, I would become so frustrated when I came home from work and my kids left the kitchen a mess. While I still get angry and frustrated, I have learned that teenagers are simply lazy and rebellious at times, so I do not allow it to upset me as much as it did in the past.

Change the way you react, respond to stress: This is along the same line of thinking as the above.  How we react and respond to stress can be controlled with some time, patience, effort and practice. Everyone needs to learn how to recognize the physical and emotional signs and triggers. Know and identify when you are becoming stressed and learn how to self-calm.

Accept the things that you cannot change and are beyond your control: As a former Executive Director of an outpatient substance abuse facility, this is a phrase that became part of our daily mantra. It is also a common saying in both Alcoholics Anonymous and Narcotics Anonymous. It holds true here as well.

Adopt a healthier, happier lifestyle: Public safety professionals work with the public. This includes toxic individuals in toxic environments, which often leads to cynical and jaded thoughts. Given the reality and scope of the work environment, surround yourself (at least outside of work) with positive, supportive individuals. Engage in a hobby or do something that makes you happy. Make the time to exercise. Exercise helps reduce stress, depression and anxiety. It will help push negative thoughts aside.

Learn to say “No”: Several strong type-A personalities struggle with this one. Think before you commit to a new task. Take a day or two before giving an answer. Saying no helps keep your life in balance.

Take away something positive from a negative situation or event

Many individuals look at the glass as being half-empty as opposed to being half-full. However, if you sit down and evaluate your life, you will determine that the positive things in your life outweigh the negative. Redirect your negative thoughts to the positive.

Accept that there is both good and bad in the world

Despair, hate, bias and crime are world-wide problems. That’s a reality that will likely not change in the near-term. However, given that this won’t change, it is incumbent on us to focus on the positive achievements we perform every single day. Public safety professionals help people, save people and we protect people. That is what we do, we need to be proud and we need to focus on that.

Laugh more, criticize less: Humor and laughter helps to ward off stress. Avoid getting together with friends just to commiserate about your day. That is not healthy. Instead, hang out with friends and family members who enjoy a good laugh. Distance yourself from toxic friends and family.

Compartmentalize: One of the most helpful strategies that has worked well for me is to compartmentalize. Compartmentalizing is a psychological concept that can be used as a coping, defense strategy when dealing with conflicting internal events simultaneously. In other words, leave work at work and home at home. When the two carry over from one aspect of your life to the other, problems become compounded.

Change must be embraced: To change our thinking, behaving and acting, we must embrace change. Thinking about changing is not sufficient. Everyone must take daily action steps toward change. These steps often take us outside of our comfort zones. As the late Jim Rohn, an entrepreneur, author and motivational speaker, previously stated, "Your life does not get better by chance, it gets better by change."

About the Author

Dr. Michael Pittaro is an Assistant Professor of Criminal Justice in the School of Security and Global Studies (SSGC) with American Military University and an Adjunct Criminal Justice Professor at East Stroudsburg University. Dr. Pittaro is a criminal justice veteran, highly experienced in working with criminal offenders in a variety of institutional and non-institutional settings. Before pursuing a career in higher education, Dr. Pittaro worked in corrections administration; has served as the Executive Director of an outpatient drug and alcohol facility and as Executive Director of a drug and alcohol prevention agency. Dr. Pittaro has been teaching at the university level (online and on-campus) for the past 15 years while also serving internationally as an author, editor, presenter, and subject matter expert. Dr. Pittaro holds a BS in Criminal Justice; an MPA in Public Administration; and a PhD in criminal justice.

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By Julie Downey and Charles Kean, IPSA RTF Committee Members

By design, active shooter hostile events or mass casualty incidents are used to cause wounding and death on a large scale. As public safety agencies work toward appropriate responses to ASHE/MCIs, whether in the form of a shooters, bombers or any other hostile means, the MCI aspect of the response plan is often lacking. Law enforcement must continue working with their public safety partners to gain rapid access to an unstable and dynamic situation, and the medical community also needs to be included in the response model.

The rescue task force concept of providing immediate medical care to the injured during an ASHE/MCI is gaining traction. As the incidence of ASHE/MCIs rise in U.S., the evidence of RTFs saving lives is also growing. While many jurisdictions are implementing RTFs, as we saw in the 2017 Las Vegas shooting, several agencies have not adopted the concept.

This article examines two jurisdictions in the United States and highlight the common goals, problems and some unique situations present in various ASHE/MCI response models.

Springfield, Illinois

Springfield is the capital of Illinois and is in Sangamon County. In a city of 118,000 people and a county of 245,000, there are two different level-one trauma centers. With over 20 fire departments and EMS providers along with 25 law enforcement agencies, getting all of them on the same page is difficult. Complicating the ability to synchronize various agencies is the composition of the departments. Three private ALS EMS agencies provide the bulk of the transport in Sangamon County, and law enforcement agencies range from a two-member department to a 245-member agency.

Deploying RTFs

In Springfield, as the planning and training for implementation of the RTF concept has evolved, casualty triage has taken a more prominent position in the overall concept of operations.

In the Springfield program, the contact team is tasked with neutralizing the threat. This is common in most RTF plans. The contact team is directed to notify incident command about the location of victims, and if possible, the number and condition of the injured.

The first RTF to enter the crisis site and begin the treatment and evacuation of the casualties has a rather simple triage method, dead or not dead. As the RTF moves through the area, patients are treated and marked for evacuation, or if capable of movement, directed to exit the site through the same path the RTF and contact team entered. While some may argue it is dismissive to triage with the categories being dead or not dead, the purpose for the initial RTF is to quickly assess patients with easily correctable life threats and then move on to the next patient.

After this is completed, then additional RTFs are tasked to evacuate casualties and re-evaluate patients using the more traditional START methodology. This includes reassessing patients marked as dead, unless there are obvious non-survivable injuries. In the revised MCI plans, the four-category START system is fully implemented at the warm-zone and cold-zone interface.

Working with hospitals

MCI plans need to include first responders (law enforcement, fire/EMS and 911 telecommunicators) and local hospitals. Many hospitals are unprepared, and if a MCI comes to their facility or if there is a potential for violence at the medical facility, they will simply call law enforcement to secure the facility.

Often the reality is that during an ASHE/MCI, law enforcement will be deployed to the crisis site. The agencies that are adjacent to the stricken jurisdiction will be involved in assisting their sister agency with response on site. In short, law enforcement resources will be scarce when it comes to the physical security of medical facilities.

Several recent ASHE/MCIs have occurred when key hospital administrators and management personnel were not on shift. Therefore, hospital administrators and managers need to have policies in place that allow the movement of less critical patients from critical care beds to waiting rooms or treatment by physician extenders such as nurse practitioners and physician’s assistants. Along with written and legally reviewed policies, charge nurses and unit managers need to be trained and empowered to make those treatment decisions, in consultation with the emergency department, attending physicians and where applicable, trauma surgeons.

Each of the level-one trauma centers in Springfield operates its own EMS system. To the benefit of the community, the EMS protocols are nearly identical which aids in reducing confusion in providing pre-hospital care. The MCI protocols for both systems are the same. They use the START triage system. However, there are some limitations with solely relying on the START system. For example, while it is designed for MCI situations, it does not address active threat environments. In the high stress and dynamic environment of an active threat, MCI is often the most overlooked aspect is the triaging and evaluating casualties.

Hospitals and patient transport

MCI planning must consider patient transport. During crisis, patients are arriving at medical treatment facilities by conventional EMS transport, law enforcement transport and/or self-evacuation. This model, while difficult to control during chaos, may create an unintended reverse triage. Patients that are capable of self-evacuation often are not severely injured, and they will likely arrive ahead of the patients who are in dire need of medical interventions, especially resuscitation and surgical intervention.

During an MCI and patients are being transported, there is a misconception that law enforcement will be available to secure medical facilities. There may also be a perception that the hospital’s internal security will be able and capable of controlling access to the hospitals, especially the emergency department. This is not typically the reality.

Training immediate responders

Another area for improvement is community resilience. In central Illinois, the HSHS St. John’s Hospital Trauma Team is using outreach education to teach Stop the Bleed to local fire and law enforcement agencies. The next goal is to implement a program like Davie, Florida and get bleeding control kits in the community with AEDs.

Davie, Florida

Davie is a highly populated town located in Broward County, Florida. Most agencies agree the public needs to get involved in rendering immediate care for someone that is severely bleeding. In October 2015, the Davie Fire Rescue was recognized at the White House/Department of Homeland Security for their innovation in developing Severe Bleeding Kits and distributing the kits to all their AEDs. In addition, they incorporated the severe bleeding training into all their CPR/AED classes. They have renamed the program to coincide with the DHS program – Stop the Bleed.

Early MCI management issues

Since the early 2000’s, several issues were identified regarding MCI management in Broward County. The biggest issue was that each of the 20 fire-rescue agencies in Broward County had adopted their own MCI plan. When mutual aid was provided from neighboring departments, as is frequently seen during MCIs, this led to multiple levels of confusion. The region identified the need to correct this problem with all agencies in Broward County agreeing to a single MCI protocol that consisted of common terminology, triage and tagging methods. This has greatly improved MCI management, which expanded state-wide.

In early 2004, Florida’s EMS Advisory Council approved and recommended a MCI procedure and a state-wide MCI triage tag. Funding was secured through DHS grants for the state to supply all ALS agencies with MCI equipment. This included a common field operation guide, field unit bags with personal triage fanny packs, MCI tags, colored tarps, identification vests and MCI trailers.

MCI management achieved, but RTF issues surface

To ensure all first responders were using the same guidelines for MCI management, the procedure was placed in the Florida Fire Field Operations Guidebook. This FFOG, funded by the State Fire Marshall’s Office, was provided to every first responder vehicle (law enforcement, fire and EMS) within the state.   

State-wide strides were made to prepare all first responders for MCI management, but equipment and procedures are not enough. There remains an on-going need to continually train, utilize and refine the procedures to ensure a constant position of readiness. Unfortunately, what was encountered 20 years ago with MCI management in Florida, is now occurring with the fire-rescue response to an ASHE/MCI. Law enforcement and fire-rescue agencies across the county and state are now developing their own sets of procedures and terminology.

The RTF concept is gaining in acceptance, but it is still not widely adopted. Some agencies fear that their personnel may get injured. Other agencies debate whether RTF personnel need to have full ballistic protection. Davie Fire Rescue has trained all personnel in RTF with classroom training followed by walk-through exercises and several full-scale exercises. The biggest obstacle we face is creating a true unified command. As we train more with law enforcement, we will see improvements.

Most fire-rescue agencies see the need to change our response to an ASHE/MCI. They see the need to get-in quicker to stop the dying, but there is no consensus on what this model looks like. Fortunately, there are several excellent resources now available through the International Public Safety Association, and even the National Fire Protection Association has a committee working on Active Shooter response (NFPA 3000).

As active threats continue to evolve, first responders, medical treatment facilities, community leaders and civilians must evolve their training and response.

Related Content

International Public Safety Association’s Rescue Task Force Best Practices Guide

International Public Safety Association’s InfoBrief: Stop the Bleed

International Public Safety Association’s Position Statement supporting Stop the Bleed

 

The beginnings of one emergency number in the United States can be traced back to the driving force of the coordinated efforts of members of public safety moved to service. Professional firefighter and law enforcement associations went to Congress on behalf of the citizens they serve requesting one nationwide emergency number, spanning the course of decades.

Download the Interational Public Safety Association's InfoBrief 9-1-1 Emergency Communications Celebrates Golden 50 Year Anniversary in the United States on February 16, 2018.

By Michael Yatsko, IPSA Health and Fitness Committee Chair

If you are struggling with your New Year’s resolution of enhancing your health, wellness or fitness levels you are not alone. It is estimated that 80 percent of people struggle with, or even quit, pursuing their New Year’s resolutions before the end of the year. Most individuals give up by the third week of January. Behavioral change is not easy, without a plan you are playing the odds.

The goal of this article is to help you develop a plan, so you can create healthy habits which are sustainable. This article will give you some tips that will empower you by taking small, incremental and purposeful steps toward achieving your goals. To form a habit, it generally takes up to two weeks, and in some cases up to 90 days.

Start by using a three-day commitment plan. By using a three-day plan, it will enable you to take small bites out of your overall goal instead of trying to everything at once. This article provides you three items to consider for all three-days of your plan. Program design is not the scope of this article as you likely have been on one since the beginning of the New Year.

Strategy one: Healthy intake

The first step for healthy intake is to prepare your food intake for three full days. This takes some preparation; however, it is manageable by having a list prepared prior to visiting your local grocery store. Give your grocery list some thought and identify what foods should you eat throughout the day to stay healthy and create a three-day menu around them, and steer clear of all unnatural sugar goods.  

This leads into the second step toward your three-day healthy intake, and that is to prepare with portion control in mind. While I am not licensed to give in depth nutritional advice, stick to the basics and drink plenty of water, eat clean fruits, eat vegetables at every meal and include protein. If you need help with what your caloric intake should be, do some ancillary research on basal metabolic rate. 

The third step is to not deviate from your three-day menu. Sticking to your plan creates a positive sense of accomplishment thereby enhancing your chances of creating long-term healthy habits.

Strategy two: Physical readiness

Similar to nutrition, physical readiness must also be planned out. Use the three-day plan approach to create a behavioral change that will be lasting. The first step of creating a physical readiness plan is to consider your own personal goal. This is a very individualized approach, and should be treated as such. Your focus must be on obtaining your goal, not the goal of others.

Once your goal is determined, the second step is to take the time to write out a three-day plan that you can use as a reference when you get to the gym, or wherever you chose to complete your workout. Not only will it be used as a reference, but it creates a sense of accountability.

The third step toward physical readiness is to have a set time to workout and do it. Be sure to reference strategy one when planning your post-workout snack or meal prepared. A post-workout snack helps restore glycogen levels, which is critical for first responders.

Strategy three: Sleep patterns

There is enough empirical evidence that should convince anyone that sleep is a critical component to health, wellness and performance. I know every first responder reading this article is shaking their heads and thinking good luck with that. Shift work, court and stress will always exist in first responders’ lives, so we must have a plan in place to preserve health.

The first step is to create that plan and stick to it. Have a definitive bed time and stick to it. Equally important, have a regular wake-up time and stick to it. Everyone should aim for seven to nine hours of sleep every night.  

The second step is to design your nutritional intake around your bed time. Do not have caffeine, do not take stimulants or other disruptive elements at least five to six hours prior to going to sleep. Do your best to make sure you are finished eating for the day at least three to four hours before bed time to enhance your body’s ability to focus on sleeping, not digesting.

The final step to sleep is to shut everything down. Make sure you turn off (or silence) all disturbances. This includes anything remitting blue light, computers, TV’s and any major appliances.

Documenting your goals into a three-day plan will help ensure you stay on track. Having realistic and achievable timelines will lead to positive behavioral changes. Finally, take the fourth day to get prepared for the next three-days. This does not mean you go off your plan, it just gives you a day for light activity, refresh the meals for the next three-days and make any corrections to you sleeping environment.

About the Author

Michael Yatsko served 25 years with the Phoenix (AZ) Police Department, and honorably served 13 years in the military. Mike holds a Master’s degree in Human Movement (Kinesiology), and a post-grad as a Performance Enhancement Specialist. He also holds the prestigious certification of Certified Strength and Conditioning Specialist (CSCS) from the National Strength and Conditioning Association (NSCA). He served as the Physical Fitness Coordinator at the Arizona Law Enforcement Academy for the last 8 years of his career where he assessed, designed, developed, implemented, and evaluated the Recruit Physical Readiness Training (PRT) program that is still in use today. He also designed thousands of programs throughout the years, specializing in first responder PRT, as well as Mixed Martial Arts (MMA) Strength and Conditioning. He is currently on Hiatus from his Doctorate degree in Applied Sports Psychology as he fishes, works out, and golfs at his local club enjoying his retirement!

   

By Sean W. Stumbaugh, Battalion Chief (Retired)

When I was a supervisor in the fire department, my crews had a nickname for me: The Red Man. I embraced the moniker to some degree and I would joke with them, “Don’t make me take out the Red Man.” This was a term of endearment (at least that’s what I liked to believe) in many cases, but I knew it was born from numerous times that I led with anger. In hindsight this is not a great way to lead.

So, what was really going on here? I hadn’t been brought up in some military academy where I learned to be a drill sergeant when things didn’t go my way. Was there something else at work? Something I couldn’t really put my finger on? After retirement, I realized some of this behavior was born out of stress I was feeling, at work and at home.

I was confident retirement would fix this issue and my life would be a breeze. I soon found out that retirement was something I wasn’t fully prepared for. I went through a two-year transition that was more difficult than being at work. Fortunately, I had some support mechanisms that helped see me through.

This experience made me want to know more about the stress we face as firefighters. So I reached out to an expert in the field, Jeff Dill, founder and CEO of Firefighter Behavioral Health Alliance (FBHA). In this article, I’ll share some insights Jeff opened my eyes to, with the hopes that they might be eye-opening for you, too. And in a future article, I’ll share three steps all fire service professionals can take to combat the negative effects of work-related stress.

1,100 and counting

One of my goals when I was a training chief was to design training programs that reduced the risk of line-of-duty deaths by targeting the root causes of LODDs. We commonly use the number 100 to explain how many of us die on the job each year. This number is an average, and the actual figure fluctuates, but unfortunately the deviation is small.

Jeff Dill stresses an entirely different number: 1,102—the number of confirmed firefighter and EMS suicides he has validated since he began studying the issue. “These are not merely numbers, they are the names and faces of brothers and sisters who have left us behind,” Jeff says. “That’s always been our message at the FBHA. We never want to forget them.” Jeff now dedicates his professional life to helping reduce this growing number.

Call it by name

So, what is it we are struggling with? We can—and should—call it Post-Traumatic Stress (PTS) or Post-Traumatic Stress Disorder (PTSD). We’re hardly alone in being at risk for PTS; military personnel, police officers and other first responders face it too—not to mention anyone who experiences a traumatic experience, such as being assaulted or witnessing death or abuse.

Although the general public is familiar with post-traumatic stress, firefighter PTSD is different. “I’ve studied it for 20 years, and PTS is different in firefighters than in, say, a girl who is molested by a relative,” Jeff says. The differences extend to military and police as well. They generally face more violence, death and threats to their own lives.

While firefighters see their share of suffering, they may go months, or even years, before they are really scared or see a seriously traumatic event. Generally, the first few calls, or even the first few years do not affect them. I know I saw some horrific things early in my career, but they didn’t seem to bother me. Because PTS is often gradual in firefighters, we’re less primed to be on the lookout for it. In some people, symptoms don’t start until retirement—after the exposure to the trauma has ended.

PTS affects our behavior and our emotional state. There are different terms we can use to describe it, but some come with negative connotations. No one wants to be labeled “mentally ill” when something less than that (but still real and serious) is going on. Firefighters have concerns over these labels, particularly when it comes to job stability and promotion.

The struggle with PTS is real, however, and we need to move beyond the days where we just buried the problem or masked its symptoms. When we as individuals are struggling, we need the freedom to seek help. Our colleagues, and our departments, need to understand and provide support. We need to pay attention to the warning signs of behavioral health issues and their causes. If we don’t, we face the real risk of adding to the growing number of firefighter suicides.

One call or many

• While PTS in firefighters is typically the result of an accumulation of stressful calls combined with the regular stresses of life, Jeff explains that the circumstances are changing. Large tragic events are nothing new, but we are seeing different types of incidents. “Mass shootings, bombings, vehicles being used as weapons, and other terror-related incidents seem to be increasing in frequency—and these are traumas we would never have expected when I started in the fire service,” Jeff says.
  
• In addition to these dramatic events, firefighters are running “routine” calls daily. Each call has the potential to affect a responder. Each responder will react to the stress input depending upon their situation. “It can be one call,” Jeff says. “You can respond to a child drowning, and one firefighter is extremely upset and disturbed because he has a small child, while his partner doesn’t suffer any emotional distress. Then you go on a cancer call, and the roles are reversed. The cancer patient who just passed away may remind them of their father who only has weeks to live.”  
  
• Much of what we see and respond to is out of our control. As firefighters, we may struggle with this; we are firefighters and we fix things. We are here to help. When we “fail,” we tend to be very hard on ourselves. This can add to the effects of PTS.
  

Time for change

One of the biggest problems facing the fire service in the realm of behavioral health is what Jeff calls “cultural brainwashing.” We as a profession tend to instill in our members that feeling pain over stressful calls and events is weakness. We need to “suck it up” and stuff our emotions. This has been our tradition for a long time.

Some traditions are ridiculous. We need to move the culture to one of awareness and assistance when a member is struggling. They need a confidential place to seek help for PTS and other behavioral health issues.

With this new and growing knowledge, what should we do? We need to employ strategies that can help us not just cope, but overcome. 

About the Author

Sean Stumbaugh is a professional services representative for Lexipol. He retired in 2015 after 32 years in the American fire service, serving as battalion chief for the Cosumnes Fire Department in Elk Grove, Calif., as well as the El Dorado Hills (Calif.) Fire Department and the Freedom (Calif.) Fire District. Sean has a master’s degree in Leadership and Disaster Preparedness from Grand Canyon University, a bachelor’s degree in Fire Science from Columbia Southern University, and an associate degree from Cabrillo College in Fire Protection Technology. In addition to his formal education, he is a Certified Fire Officer, Chief Officer, and Instructor III in the California State Fire Training certification program. Sean has taught numerous state fire training courses and has been an adjunct professor with Cosumnes River College in Sacramento. Sean is now continuing his career by serving as the volunteer Para-Chaplain for the Daisy Mountain Fire District in Anthem, AZ.