Grand Jury Report on Fire Department EMS in Orange County

The recently published document by the Orange County grand jury regarding the deployment and response of resources by Orange County fire departments to emergency medical calls for service is both stunning, and concerning in the inaccuracies, opinions, and falsehoods presented as fact. The determinations made appear to be based on these failures or research, and lead to what may be a pre-ordained belief, without factual support. Because this document rehashes a 2012 effort of a similar matter, I am disturbed by the need for another review that fails to build on the earlier discussion.

Fundamentally, the local fire department deploys resources designed to respond to and to mitigate the unwanted effects of the environment on life, property, and the environment itself. Albert Einstein is quoted as saying that the environment is “everything but me,” referring to himself at the time. Except for specifically law enforcement related matters, unrelated to unwanted fire, this defines the responsibility of fire department emergency response. The two most time sensitive, or emergency responses, include fire suppression and emergency medical/rescue code-three (with lights and siren) response. The fire service is truly a multi-mission operation that serves to address many of the emergency needs of the community. The capability of the local fire department is only limited to the funding and leadership provided by the governing agency decisionmakers.

To fully understand the importance of emergency response it is necessary to carefully consider the concept of time, and the influence of time on the growth of uncontrolled fire and patients in extreme medical conditions i.e., coronary, stroke, blood loss et al. In all these situations the outcome is directly related to timely intervention. The sooner that trained personnel, operating efficiently, arrive at the scene and begin fire suppression or medical treatment the more likely that a desired outcome is probable. There are three components to the total response time of a fire department: call processing time, turnout time, and travel time. The only component that cannot be manipulated to a great extent is travel time as rescue personnel can only travel so fast through the city streets to arrive at the scene of an emergency.

The distribution of fire stations across the land mass of a city like Newport Beach serves to place fire department rescue personnel near potential fires or medical emergencies under static conditions. During times of fire department system stress due to uncontrolled fire i.e., Emerald Bay and Coastal Fire recently, in Orange County and specifically Newport Beach, a rapid and integrated system is employed to shift similar resourced into areas of reduced coverage. This was recently demonstrated and reported to the City Council in a timely fashion by the fire chief regarding the Coastal Fire in Laguna Hills. Rapid intervention serves the people you, and your fire department serve.

Of the two identified time sensitive functions of the fire department, fire suppression and medical/rescue, resource deployment should be considered for the need based on a timely response to the incident, or potential incident. Because the building stock of a community changes slowly over time, the deployment of firefighting resources and staffing at the local firehouse responsible for initial fire suppression efforts should be based on factors related to risk, occupancy type, and travel time to all areas of initial responsibility, or first due for the resources staffed at that firehouse. Earlier intervention of fire should equate a smaller fire that is extinguished faster, requiring fewer total resources from neighboring firehouses. This concept should result in a more efficient operation that has fewer fire stations assigned to a fire and committed to a fire outside the first due area.

Because the community will need the firehouses staffed for fire suppression needs, the use of these same firefighting personnel for emergency medical/rescue response was seen as a wise use of taxpayer funds. The report fails to understand the wisdom of this important concept, and in fact fails to consider this altogether. Fire apparatus, fully equipped to perform all the multi-mission functions, and available 24/7 unless committed to a prior emergency is the gold standard of the business. The idea presented to staff a two-person medic unit in place of a “second” engine at the Laguna Woods firehouse fails to consider the multi-mission functions of a fire station that protects a large hospital, a very busy complex of freeways, and housing with mature residents who will need additional support under emergency circumstances. That Laguna Woods firehouse is staffed in that fashion because it is the busiest firehouse in a densely developed county of over 3 million residents. Drawing broad conclusions based on a limited, and often false understanding, has resulted in a bad recommendation.

I found it unusual that Newport Beach in particular, with a somewhat unique deployment of resources only matched by the City of Orange, was not mentioned in text of this report. This was especially noteworthy as the thesis of the report was focused on resource deployment, city operated ambulance services, and the Orange County Fire Authority (OCFA). The limited investment by the OC grand jury into the research on this important subject only serves to support the idea that the effort was biased from the start and will provide ample information for those intent on diminishing the value of a future OC grand jury report on a similar subject.

On Communication: Words Have Meaning

A standard by which we as a society communicate and function is through a common understanding of language. This is especially important when operating at an emergency scene, in the expenditures of public funds, in matters of employment, and legal issues. How senior managers prepare themselves and their organizations for all of these challenges prior to expected and unexpected events will likely factor into a desireable outcome. 

The words we choose to use in oral and written communication can be used by others when evaluating our inner thoughts, beliefs, and feelings. The effective use of language is important when trying to convey understanding and attempting to influence others. This is illustrated by many of the historic speeches and writings of Prime Minister Winston Churchill, Activist Mahatma Gandhi, President John F. Kennedy, et al during times of crisis. When language is used properly to advance a noble cause good people will follow the leader, whether for an instant emergency incident, a crisis event or a chronic challenge that can only be managed to mitigate damage. 

The media by which modern society gathers, records, and documents our individual communication has changed rapidly in the 21st century and this has proven to be somewhat of a double-edged sword.  Because of the advancement of recording technology, the concept of private communication is no longer assured.  Images and edited recordings of audio and video can be manipulated so as to advance an idea without complete context. The use of advanced monitoring devices such as laser microphones, directional microphones, and highly advanced camera systems can capture information without the knowledge of the subject. This not only eliminates private conversations and actions but leaves out the context of prior understandings between communicators. 

In the business environment individuals should be aware of their communication styles and make every effort to be as effective and respectful as possible while still maintaining fidelity to the mission.  Common words specific to a discipline can sometimes shortened into an acronym, and are commonly seen in military, public safety, and healthcare applications.  Any acronym that may be construed to have an unintended negative meaning should be avoided, as the unintended consequences may prove to be a distraction from the organizational mission. 

Recognizing that people have individual personalities, and that these characteristics may surface in a comfortable work environment is critical for the supervisor or manager of any business. The workplace can be a controlled environment, to some degree, and the people who are authorized to manage that environment are responsible that to the extent possible the workplace is free from many forms of discrimination.  How those in charge care for the individual freedoms, limitations, and corrective actions employed will have significant influence on the morale and productive behavior of the workforce.  

Individual business disciplines involve varying levels of education, and the level of education can influence the size of the commonly used vocabulary. If the intent is to effectively communicate information in a workplace environment, it will be important to use words in the language that will be understood by the receiver. The objective is to achieve a desired result, and when multiple minds develop a common understanding the likely of success is enhanced. 

To add emphasis, foul language may be used in oral communication, most notably in military and public safety environments. This may be due to the inherent nature of timeliness of a needed action so as to prevent injury or death commonly found in those professions. While this may be uncomfortable for someone reviewing a body camera recording involving a subject and a police officer, it can be argued that it is used to achieve a successful outcome in critical use-of-force activities.  The Los Angeles Police Department (LAPD) argues for the use of “tactical language” when dealing with potentially violent subjects as a method to emphasize the seriousness of the officer during critical situations. 

Law enforcement officers operate in an environment where, at virtually anytime, a potential need to report critical information via radio for officer safety exists at virtually all times when on patrol. This speaks to the need to be exceptionally brief when possible.  The use of ten-code radio communication, intended to add brevity and covertness to the verbal communication, is not universal nationwide and can lead to a misunderstanding

Fire departments also routinely operate in in an uncontrolled workplace environment and under stressful conditions. Because most emergency calls for service for a fire service organization are “consequence mitigation/management” in nature a timely, efficient and competent response is mandatory. Much of this involves oral communication on the incident scene is between the individual(s) performing scene management, supervision, tasks and resource dispatchers.  Because this communication can be over portable radio only the most important information is spoken via radio during the emergency phase of an incident. 

In degrees of ascending importance, radio traffic can be described as routine, priority, and emergency, and it is necessary to recognize how to properly and efficiently communicate on the channel/frequency.  “Emergency traffic” via tactical radio channel is reserved for communication limited to information involving the immediate life safety of a firefighter; “priority traffic” is radio communication reserved for important information about the direction of critical tactical activity on the incident scene; and all other radio traffic is designated as “routine traffic.” 

When writing in the business environment on a work computer or device, it is important to limit the communication to that which is accurate, proper, fair and fact based.  Any electronic communications involving specific subject matter may be open to discovery in a claim and the employee/supervisor/manager will want to be seen as professional as possible.  Interpersonal communication between employees and the proper supervision of the healthiness of the workplace communication is a supervisory and management priority. How the supervisor handles her/his subordinates and understanding when to engage and at what level to engage will determine the success of those charged with this duty.  The volume and tenor of your voice, the environment chosen to have a discussion, and the perceived fairness and adherence to stated policy are important factors in these critical discussions. Modeling proper communication techniques is very important, as the standard is established by the supervisor. Giving license to subordinates by behaving contrary to the established organizational policy can lead to failure

Public Safety Officer Response Best Practices in The Age of COVID-19

Due to the highly contagious nature and potentially deadly outcome of exposure to COVID-19, and the need for first responders to adequately serve the public, modifications to the standard emergency response practices need to be designed and implemented by those charged with public protection. The purpose of a streamlined procedure is to ensure that all task and tactical operations achieve the intended benefits of a competent emergency response agency and provide adequate protection for the employees as well as those they serve.  

Because the public safety community has not experienced such a catastrophic event as the COVID-19 pandemic, a model of best practices does not currently exist on the numerous issues relating to the specifics of this disease including contagion, protection and prevention.  Further issues related to the management of labor contracts, treatment guidelines, and psychological issues outside of the normal business of daily emergency management serve to add to the complexity of a workable solution.  

For the purposes of this article I refer to first responders as those whose employment is designated as a safety member by the State of California. Specifically, I will speak to peace officers, police officers, firefighters and ocean lifeguards. These employees constitute the lion’s share of those public safety members who respond to emergencies for service via 911 call or other notification avenue. Privately employed security, emergency medical service (EMS) or other initial emergency responder may benefit from this information as well.  

The understanding and nature of Novel COVID-19 virus is developing rapidly on a daily basis. Each new understanding serves to challenge previously known information and can influence the belief of the public and first response personnel that officials charged with public safety are sufficiently able to meet the demand. The larger legal, economic, and policy issues will be determined over a spectrum of time but the procedures related to emergency response and protection of the public should be focused on all of the safety related components. This includes call taking at the public safety answering point (PSAP), resource assignment, and tactical operations when arriving at the scene as well as patient treatment and transport to a hospital or other care facility.

Time, Distance, Shielding 

The primary consideration of public safety operations is force protection. This is consistent with the need to have a functional force capable of performing their sworn duty to protect the public. It does not suggest that first responders will not enter into harm’s way to take a calculated risk to protect a victim from harm. There is a tenet in the hazardous materials response discipline that applies to virtually all aspects of emergency response management. Time, distance, and shielding speaks to the three components of protection to be employed when dealing with a substance, or situation of known/unknown nature that could pose a health hazard to the public or responders. 

The concept of time seeks to address the influence of time of exposure to activities that are, or could be, hazardous to human health. The more time a first responder is exposed to the hazard the greater the chances of harm to that rescuer.  

For firefighters the concept of time is intended to limit how long of an exposure to toxic hazardous chemical substances, or poisonous biological agents in the immediately dangerous to life & health (IDLH) environment. For a lifeguard it could include operating a water rescue in open water at night, subsurface activities, or high surf rescue operations. In law enforcement it may include a felony car stop, high risk felony search warrant, or domestic violence response for service.  

Distance refers to the distance between the hazard and the rescuer. A firefighter may increase the distance from a hazardous chemical fire liberating toxic smoke, or simply increase the distance from the radiant heat from a structure fire to limit injury. A lifeguard may modify open water rescue tactics away from the surf line and choose to place a victim into a rescue boat off-shore to avoid the challenge of dragging a victim through heavy surf.  A police officer, when faced with overwhelming human force may add distance between criminal subjects to buy time to consider alternative solutions.  

Shielding speaks to the personal protective equipment (PPE) used and provided by an employer for the purpose of protecting the wearer from the damaging effects of a specific insult. This can be as simple as a helmet to provide some form of protection to the head, gloves providing protecting to the hand(s), boots to protect the feet, etc… Firefighters wear structural protective coats and pants for thermal protection from fire, law enforcement officers don ballistic vests to provide protection from bullets projectiles, and knife attacks, and lifeguards use a personal flotation device (PFD) to help them stay afloat in open water. 

Whatever the discipline it is likely that all first responders will come into contact with people during the course and scope of their work. It is also believed that some degree of these people will be carriers of COVID-19, and some will be symptomatic and others asymptomatic. Because we believe this disease to be highly contagious significant procedures, behaviors, and policies will need to be trained, practiced, and enforced for the safety of the public and first responders. 

Recent information indicates that a significant number of people are silent carriers of COVID-19 and because of this all patients will need to be treated as a potential carrier. Further, awareness on how to disinfect the protein involved in the virus should be understood by all first responders so that efficient and effective measures are developed and learned properly by those who are expected to have public contact. Additionally, the life expectancy of the virus in all mediums that first responders are expected to operate should be known and understood so that the confidence of the health & safety of the force is well established. 

Standard behaviors when operating in a confined space should recognize that the COVID-19 virus can stay atomized in an unventilated environment for hours.  Because of this EMS care providers should take measures that would either minimize exposure time in that environment or remove the patient to a more controlled environment such as the outdoors or inside an ambulance where the air is constantly changed. 

The treatment of a patient often involves intimate contact that enhances the potential for human-to-human transmission. Because of this distance becomes impossible for the patient woman/man. However, other EMS care providers can support the person providing treatment and still maintain six feet of distance. The use of a single EMS care provider entering a home so that the entire pre-hospital medical crew is not potentially exposed may hold promise, but fails to account for the realities of where all emergency medical calls occur and a stair-step approach should be considered so as to ensure adequate scene safety for responders.  

Providing proper PPE, and the consistent use of adequate protective equipment on each EMS call will be necessary to prevent the transfer of the COVID-19 virus from a known, or unknown patient. This is the only shield that we currently have to prevent human-to-human transfer via personal contact. Because the protection of the force of first responders is paramount to the safety employee these measures are necessary in the near term until effective anti-viral, vaccines, and other solutions are developed for common use.  

Fire Station Location and Travel Times