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A Little Safety Parable

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You too could be roadkill. Photo courtesy of aanimalcontrol.com

You too could be roadkill. Photo courtesy of aanimalcontrol.com

So I’m walking from our house to the beach with my three daughters.  There’s a road we have to cross in between here and there that’s pretty busy.  On occasion tourists come flying around the curve, not realizing that there’s an area where you have to cross (although it’s not a marked crosswalk).  While no one has been hit at that spot in the 29 years I have been living on the Island (that I know of), I know it’s a bad section that you can’t see around.  It occurred to me today when I was making that crossing that it’s a lot like the risk we endure as firefighters.

I had the opportunity this weekend to read a recent article on Stat911, that seems to have created some serious wailing and gnashing of the teeth between people who call themselves brothers.  Honestly, it was pretty sad to me as I read these comments.  I admit, it is a little bothersome when a video comes out and a number of people point out the obvious mistakes made, but as I mentioned in an earlier article here on FHZ, we should be looking at things that go wrong and learning, and resolving to keep from repeating events that maim and kill our brethren.

Conversely, instead of saying how stupid some of these people are, perhaps we should offer some constructive criticism and offer suggestions on methods that would help solve the problems, rather than lowering the bar into that angry pit of accusatory language.  And when we generalize about whole departments or organizations based on a squirrely few, we aren’t doing anything other than trying to piss one another off.  I agree 100% that some of the repeated actions (or inactions) taken by other firefighters that endanger themselves and their their colleagues are a little infuriating (like refusing to wear a seat belt), but like the point I have also made over and over again, people aren’t going to learn when you rub their nose in it, they will learn when they see the logic in changing.

But back to my story.  There is, of course, risk in crossing the street, but we accept that risk when we go for a walk, don’t we?  As a pedestrian, we take a calculated risk every time we go out in the road, but it doesn’t stop us from doing it.  In fact, walking in the middle of a busy street is exhilarating.  There’s a certain adrenaline rush when you run out in front of moving cars.

As a responsible father, however, I’d advise against running in front of a moving car.  I’m sure I’d get in a little trouble with my wife, the law, and probably get a few death threats if I just let my children run out in front of cars.  If my four-year-old got struck by a car there, after having  just let her run out there, knowing the risks involved, wouldn’t that make me a little bit liable?  But given the logic espoused by a few of my more enlightened colleagues, I suppose I am overreacting when I tell my girls it’s a wise idea to look both ways at that intersection.  After all, no one has ever been struck or killed here.  If I insisted on having the street marked with lines and a sign, I might be construed as overreacting if you ask some of these folks.

I eat risk for lunch.  I eagerly chose to pursue a fire service career because it was exciting.  Even more so, I focused my whole career to concentrate on special operations.  I’m the Deputy Director of a US&R Task Force.  I used to teach high-line rope rescue, and hold internationally recognized instructor certifications in SCUBA and water rescue.  I hold NPQ and IFSAC certifications as a HAZMAT Technician.  Two of my favorite hobbies are mountain biking and skiing.  I’m not in the slightest bit worried about taking risks.

But there is a serious difference between taking stupid risks and calculated risks.  Firefighting isn’t Jackass.  We have a serious job to do that involves serving the public, and using our personnel as cannon fodder doesn’t do the job.  If you take a risk and die trying to save a life in our job, I’ll be the first one to sing your praises.  If you take a risk and die trying to save a burning trash pile, I’m sorry, I’m not impressed.  If you get burned because you failed to use the safety equipment we provide you, I guess my first question will be, why wasn’t it used?

I think some of the plastic vests and hard-hats are a little much sometimes, but I can understand the effort to make ourselves more visible and to avoid having something clonk us on the head.  But as a leader and chief officer, I also know what can go wrong, what can go seriously, seriously wrong, and to ignore it because I’ve never seen it first hand would be folly.  And to just turn my back on personnel who fail to use good safety practices, knowing what the outcome could be, would be negligent.

Quit the name calling and sand throwing and act like grown-ups.  You can argue that it’s just “ragging”, but it’s not.  The language some of you all out there are using is just plain wrong and malicious.  And it certainly doesn’t represent your side of the argument professionally at all.  I can give people crap all day long with the best of them, but that’s not what some of you are engaging in.  What you are engaging in is simply destructive behavior, and it’s one of the reasons why our profession isn’t always taken very seriously. The only people we are hurting here is ourselves.

Risk vs. Reward and Patient Advocacy

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An OLD shot of Savannah's LifeStar landing for a Hilton Head Island F/R medevac.

The SC-TF1 Director copied an article to our command staff that I found interesting.  It ran in Popular Mechanics titled Unacceptable Risk (I couldn’t find a direct URL for it, so here’s the pdf: HelicopterCrash).

Our organization allows paramedics on scene to request a medical helicopter evacuation with a minimum amount of oversight by the medical control physician.  Being a paramedic myself, I know when to call for a flight and when not to.  I am not about to call for a chopper to take a patient to a hospital for a broken foot, and likewise, I am intelligent enough to be able to assess a patient and opt to fly them to a hospital that has the resources to help my critically injured victim.  I am appalled at some of the case histories where someone was flown out for a routine (very routine) injury and consequently, I know of agencies who simply won’t call for a flight, regardless of the need for it.

How bad of a medic must you be that you can’t tell the difference between a potentially life-threatening injury and one that can be transported by ground to a hospital?  If I’ve got an altered patient with a potential head injury, I know they need to go to a trauma center.  So what if I have to go on an out-of-jurisdiction transport to the trauma center- it’s what we do.

Regardless of whether or not the aeromedical evacuation of a patient is risky and may or may not have tangible benefit, the decision must come to this: What do I need to do for the best interest of the patient? I don’t care if you don’t like the way they look, or they stink, or you are tired.  When you became a medical response professional, you probably took an oath that involved a statement like “Above All, Do No Harm”.  Our jobs involve making sure our patients not only get care, but that it is the right care, it is not care that is provided at a huge cost because we were too lazy to do our jobs, and that the patient’s rights are maintained in their treatment and transport to a medical facility (or not).

Just as I wouldn’t make you take a treatment that could possibly kill you in order to cover my ass, ordering a helovac for a finger amputation isn’t in my first line of thought.  And I know I curse and fuss when I DO call for a chopper and a spot of rain on the pilot’s windshield causes them to scrub the mission, but you know what? I’m a big boy- I’d MUCH rather you err on the side of keeping your crew and my patient safe and I’ll deal with the fallout otherwise.  But to just say, “All patients go by air” or much worse, “No patients go by air” is ridiculous.

Maybe like everything else, we need to stop applying a broad brush to a situation and do our jobs, by appropriately assessing our patient, determining their logical needs based on mechanism of injury, observable findings, and our experience, and make a good call as to what to do with them.  If we ca’t do this much, it’s no wonder we continue to have to convince people we aren’t just “ambulance drivers” but real, live, medical professionals.