“Medical LODD Lessons? Screw it, who cares.”

When the fire service looks at changing culture, reading should be a priority.

Suppose for a moment you are a battalion commander in Afghanistan. You and your personnel have just been rotated in and your area of operation is composed of a mixed landscape of roads, trails, open spaces, mountain ranges, large villages and small hamlets. Last year, those who you are relieving suffered 100 KIA total during their deployment. 60 percent of those were due to improvised explosive devices. Hostile fire claimed others and close combat (hand-to-hand/close quarters) accounted for a smaller percent.

On the desk in the CP are the reports of the previous battalion’s KIAs. They are divided into the percentages just mentioned; IED (60%), Hostile Fire (30%) and Close Combat (10%).

You have made it your priority to ensure that all the young men and women under your command come home, that no one gets left behind.

So which stack of reports do you focus on the most for lessons learned?
The 60%?
The 30%?
The 10%?

This week so far, the NIOSH Firefighter Fatality Investigation and Prevention Program has released three line of duty death reports. Two involved deaths attributed to health and the third a fall. Of the main fire service websites only one had all three (guess). The others had just the fall fatality. One didn’t even report on any of them. It’s not as if other news simply pushed them down the list, but such a story should be easy to find if not on the news landing page by using specific key words in the search field.

The reports, in posting order from NIOSH, are:
Career Fire Fighter Dies from Fall off Fire Escape Ladder – Illinois
Fire Fighter-Paramedic Suffers Sudden Cardiac Death During Ice Rescue Training – New Hampshire
Fire Fighter Suffers Sudden Cardiac Death While Fighting Wildland Fire – Virginia

So why is this? Why is it that the ‘glamorous’ line of duty death report receives promotion and the medical ones are snubbed or play second fiddle? What was it about a 46-year old male and a 54-year old male, fighting fire and training, that didn’t get Facebooked and Tweeted for all to see? Maybe it was that the fall involved the Chicago Fire Department. Or maybe it was that the victim in the fall was at a ‘real fire.’ Ice rescue training and a brush fire aren’t as exciting as smoke and fire on the roof of a 4-story occupied structure are they?

In 2010 stress and overexertion accounted for 61% of the causes of line of duty deaths and heart attacks made up 56% of the nature of death. If we are serious about reducing the number of line of duty deaths, especially by sharing lessons learned from the fatal incidents, then shouldn’t we expect to see equal coverage? There is just as much to learn from a firefighter who died of a heart attack as there is a firefighter who died of a fall. What if the various organizations and initiatives only focused on firefighters who died actively participating in structure fires and ignored the rest?

If firefighting were combat, would we read the lessons on what was killing 60% of our soldiers?

By the way, of the 43 who have died in 2011 to date, five have died in structure fires and four in wildland fires. What killed everyone else?

“Year-To-Date Summary Statistics (Provisional) On-Duty Firefighter Fatalities in The United States Date Range 1/1/2010 to 12/31/2010”, USFA
Fire Fighter Fatality Investigation and Prevention Program, NIOSH

Photo courtesy JEMS.com/AP/Kevin Frayer

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  • John Vanatta says:

    I agree with you, really. It’s not that we don’t care, but because we can’t change much of that 61%.

    The Battalion Commander in AFG works under a whole different set of circumstances. First, his troops will have received a mandatory physical, medical, and drug screening before the deployment. Second, they will have passed a physical fitness test which is scored and weighted for promotion, therefore ensuring they all have the minimum fitness level required. Third, anyone who failed any of the screenings will have been removed from the deployment, and may be forced out of the military. Fourth, the Bn CO has control of them 24/7/365, and has the tools to force compliance with standards far more restrictive than any fire officer may implement.

    My point is, the fire service officer has little to no control over the physical or mental condition of his assigned crew when they report for duty. Few departments can afford to pay for annual physicals, and have no right to the results anyway due to privacy laws. Many of those who die are aging volunteers who shouldn’t be on the line in the first place, but are because there is no one to take their place or they refuse to quit. Career firefighters fear losing their paycheck and pension if found unfit for duty. The union fights to prevent restrictive standards that may be used to discriminate against or harass its members.

    We can save a few by working the margins with a by promoting good fireground rehab policies, the physical fitness program, and nutrition. However, unless we see wholesale changes in employee privacy laws, fitness evaluations, and new restrictions of civil rights, you will never see a fire service without this problem.

  • Nate Q. says:

    I would have to argue that we can change much of that 61%. I think the parallel to a military officer is applicable in this scenario, being that it’s used to strees how we view statistics. As for control, a fire officer does have control over his/her crew, and can force compliance to applicable policies. If a member doesn’t appear to be mentally or physically ready at the start of the shift, then the officer has the right to step in. While military standards may be more restrictive in some circumstances, the enforcement authority is the same.

    I will agree that there are some obstacles to overcoming this challenge, and more emphasis needed, but there are some resources for those who wish to change. Yes, unions try to keep their members from being harrassed and discriminated against, but they also promote a change in health culture as well. http://www.iaff.org/HS/Well/index.htm
    I believe the unions are just looking for fair implementation strategies.

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