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Risk a lot to save a lot is BS
Great article I just read. He talks about the "Risk a lot to save a lot" saying and how it really doesn't make sense. Some people pull up on a vacant building and say that they aren't going in because it's vacant. Well do you really know that without a search? NO. Homeless people could be squatting or children could be playing around. The fire had to start some how. Our job is very dangerous at times and some people don't realize that. They think they can just stand outside with a hose line spraying water into the building and everything is great. We shouldn't only risk a lot to save a lot; we need to risk a lot to do our jobs.(as said at the end of the article)
http://thetailboard.com/2011/12/risk-a-lot-to-save-a-lot-is-b-s/
Replies to This Discussion
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Permalink Reply by John Crabbe on
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I believe there is a medium somewhere between the gung ho, balls to the wall at any costs attitude and being a safety sally where we can still be aggressive/efficient firefighters and do our jobs while reducing the numbers of deaths we have every year. If we can find that medium then I think the fire service will be in a good place
I think we are at that medium. There will always be those who believe some are "too" aggressive and other who believe we are "too" safety minded. However, what stems true is the vast amount of those who don't comment, don't speak, aren't know and so forth who comprise that medium ground. Despite the comments with the extremes we seen about LODDs etc, the first few comments of this thread show that medium ground.
I disagree with the article's author and the notion of disagreeing with a simplistic saying. It appears the author seems threatened or offended by the phrasing and that it becomes a knock on how he operates. Such phrases are easy to remember to help with a size up. On the flip side, I disagree with those who use LODDs as a barometer of safety without accounting for the overall picture.
Let's face it it is called a fire "science" for a reason, because it means those working in it have to think. We are not robots, no fire is the same, buildings have changed, materials have changed, fires have changed, it does take thought to do the job. Another reality is the majority of firefighters are not running a fire every day they work, nor are the fires in the same buildings, such simplistic phrases are there to help with a size up as opposed to being the commandment.
For example, say you are first due for a house known and reported by the PD as a meth making drug house. On arrival you see some funky colored smoke and flames coming from the structure. As you pull up a neighbor says he *thinks* there may still be someone inside. It comes down to a risk/benefit. We should know the hazards associated with meth making, we should know the hazards associated with off colored smoke or flame.........I would bet most firefighters would want to know some more information too right now.
That is the simplistic point at hand and what such easy phrases help with, to do a good size up. On the flip side when it comes to LODDs, it is easy to once again become focused on the overall number as opposed to the circumstances involved. The article mentions LODD where "vacant" structures were involved....yet as on the first page, the circumstances justified a search.
Yes, we can and should strive for less LODDs and zero is a noble goal, but we know the realities and nature of the job. So despite those saying we need to achieve zero LODDs the "medium" masses understand the aspect of doing an inherently dangerous job and sometimes things happen. In the end the determining factor is to learn from these events and train on them, after all that is what you hear most from departments experiencing a LODD.....what can we learn from this and what can others learn from us so we don't have this happen again.
In the end, that is what it is all about, learning. Such simple phrases help with remembering the size up and to look for the overall picture.....not as some push to change operations. Besides, the fire service is so diverse, staffing varies, response times vary, equipment varies and so on. In the end a fire facing a big city crew with adequate staffing and resources can account for more aggressive operations as opposed to a small department facing a fully involved structure with barely enough personnel to staff a rig. It comes down to doing a size up.
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Permalink Reply by Lark Kent on
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So true I agree. As firefighters it's not only a job this is something that has to drilled in the minds and hearts!
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Permalink Reply by Ben Waller on
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Well said, John.
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Bill, I mostly agree with you, but there is a large amount of emerging evidence that indicates that medical screening will NOT necessarily prevent stress-induced LODDs.
For example, there are at least four types of "heart attacks" that affect firefighters. Only one of them is something that can be picked up by a NFPA 1582 annual physical, and even that one is iffy. The four types:
1) Stress -Induced Coronary Artery Clots, may be associated with either lifestyle, genetics, or both. That is the type that the 1582 is designed to catch, but even if a full exercise stress test is done, it may not catch a partial coronary artery blockage. This is the type associated with eating lots of fats, smoking, high cholesterol, and obesity - and it often isn't the one that kills firefighters.
2) Cardiac Arrythmias, usually genetic, often missed by an annual physical. A cardiac arrhythmia can kill a firefighter who has normal body weight, is a non-smoker, has minimal body fat, and who has healthy cholesterol levels.
3) Dehydration-Induced Coronary Artery Clots, caused by losing lots of body fluid while working hard in turnout gear in high heat conditions. The fluid loss thickens the blood and makes it more prone to clotting. More study is needed on this one, but there is emerging evidence that this may kill more firefighters than 1) above.
4) Cyanide-Induced Heart Attacks, caused by unhealthy cyanide levels in smoke. This problem is getting worse, with the increasing amount of plastics and other polymers in modern household and office furniture and other structure fire fuels. SCBA can protect from cyanide inhalation, but there is mounting evidence that cyanide seeps through and under our turnout gear and poisons us via skin absorption. Cyanide kills in two ways - it blocks oxygen from being carried by red blood cells and it can also cause severe coronary artery vasospasms that "clamp down" coronary arteries and block blood flow to heart muscle without any clots or coronary artery disease being involved.
Items 2), 3), and 4) are why we see young, fit firefighters die of stress-induced heart attacks, sometimes during normal activities such as working out, aerobic exercise, or even in their sleep at the station.
Obviously, being in good physical shape and maintaining a healthy lifestyle is a good choice, but when it comes to LODDs, it may give one a false sense of security.
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Permalink Reply by FETC on
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Ben I never said medical screening will prevent "stress induced cardiac events" I clearly said medical screening will reduce cardiac line of duty deaths by probably 50% by weeding out the firefighters who shouldn't be there in the first place.
Your first and second category are identifiable by an NFPA 1582 standard. Have seen it first hand. Between a good history, evaluation and thorough lab work along with comparing these results with a 12 lead EKG, things are concernable. If the doctor is truly on top of their game, I have seen some who look healthy get flagged with a potential condition, unconfirmed arrythmia, have to go see cardiologist and/or complete an echocardiogram or cardiac stress test. Then others who were easily identifiable with certain arrythmias not allowed to be a (or) remain being a firefighter even with a medication-controlled condition. My point is many reported LODD's the victim had no NFPA medical screening to begin with. With the state of medicine today, if you are walking and talking, unless you have something grossly noted by your personal MD, your the minority and they send you out the door. Most personal physcians have no clue about what you and I are talking about with fire service specific occupational hazards.
So I tend to look deeper into LODD reports and always want to know what the victim was doing before the event. People who already have serious cardiac disease, are going to die from the disease... some probably on their couch with no stress, and others mowing the lawn (minimal stress). But these firefighters whether paid or volunteer shouldn't be there to begin with. Same goes for a 20 year old, 400 lb firefighter or the 80 year old veteran. Cardiac related LODD's are far from all being HCN induced, (and I preach the PPE is not protecting us from absorbtion) I understand those. But come on most of the cardiac deaths are not fireground related, like dying in your sleep, (no alarm, no response) or the stress related from the alarm alone? (like chest pain post false alarm response) that is usually a huge "red flag" for an underlying medical or cardiovascular disease confirmed post autopsy. I mean they didn't physically exert themselves getting out of bed or onto the truck did they?
Many fire departments choose to not medically screen, (claim the costs) and if they do, seen some find doctors to customize the screening to allow certain illness or underlying conditions that would deny other NFPA 1582 firefighters the opportunity to work. Even DOT truck drivers have parameters and are allowed conditions that the firefighter may be denied.
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Bill,
I didn't say that you made that claim, I was just pointing out that medical screening isn't perfect.
I'm aware of cases in which firefighters that had a current (< 1 year) NFPA 1582 clearance died from events related to 1) and 2).
SOME of them may be caught at the physical, but it is possible (in the case of arrythmias, maybe probable) that there will be false negatives.
No medical testing or screening is perfect.
As for dying in your sleep, I'm aware of several firefighters (including a friend and a member of one of my former departments) that have died within 24 hours of an alarm response, but very, very few without a recent alarm as an added stress factor. Both of the ones with which I'm familiar died within 4 to 12 hours of fighting a fire.
As for exerting yourself getting out of bed or on the truck for an alarm, recieving the alarm is itself a stressful event, particularly for the departments that have the old school klaxons, gongs, or heavy duty bells as their station alarms.
Also remember that stress is not just an acute condition - it can be a chronic condition as well. Cumulative stress that doesn't show up on an annual physical can kill someone predisposed to an arrythmia six months after the physical from something as relatively innocuous as the station alarm for a call.
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Permalink Reply by Nathan Henderson on
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I agree with you 100% on that John. Well put.
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Response from acute stress triggers the "Fight or Flight" mechanism for which the body has a spike in HR and BP due to the delay in the brain telling the blood vessels to dialate at the rate for which the heart increases, therefore the user feels BOOM BOOM BOOM like your heart is going to jump out of your chest. Then seconds later while usually walking to the apparatus the boom subsides. This is when the vessels dialate and the spike in backpressure or increased BP is reduced to match the HR. Homeostasis. During this response, the "Healthy" firefighter has no problem dealing with the fight or flight mechanism's response.
Now for the "Unhealthy" firefighter who has hypertension, high cholesterol or cardiovascular disease, this is when their plaque build up breaks off from the rapid dialation and causes restricted or blocked blood flow to critcal areas of the heart or brain. This is the reason people say they are not feeling well post alarm or response. Therefore, the unheathy firefighter has a greater possibility of dying from just "acute stress" of the alarm notification. The underlying medical condition or disease should and "can be" identfied in a thorough medical screening and if they are not healthy enough for the alarm stress, I would not want them working in an extertion situation post notification.
Many who die from this type of mechanism are non-diagnosed because they do not go through a complete industrial athlete type medical physical. We have had firefighters here on FFN who argued they know they have cardiac disease and their department does ZERO medical screening, and if they drop on the department's time, "at least my family is covered for the benefits" This is BS and if the world is going in that direction, the PSOB will eventually dry up and the legitimate LODD will eventually get nothing when the federal money is gone.
Chronic stress can show on a medical screening, chronnic stress is linked to diabetes, hypertension, high cholesterol, fatigue, general weakness, and if the doctor thoroughly interviews the patient, they can identify things that mark the illness like lack of sufficent sleep hours to regenerate cells during time of rest, poor sleep patterns, poor eating habits, living a high chronic stress lifestyle, (work, relationships, kids, money) thus are markers for many of the underlying medical conditions listed above.
I agree with you Ben, not all is identifiable and therefore the medical screening process is not perfect. My point is the process itself needs to "Happen" for it to have a chance to work. I would like to see NIOSH report in their final report, who in the "Stress and Overextertion" category actually had annual medical screening, what was the standard being used, and did they meet the NFPA 1582 standard before the event. No different than them telling a department, lack of ICS, Poor Communications, 2 in 2 out, RIT, Safety Officer, NFPA Training, etc.
I would bet money the annual medical screening process in the fire service is in the minority accross the country.
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The reason I brought up my points is that a great many "heart attacks" happen to firefighters with no coronary artery disease or the other unhealthy problems of which you spoke. That's why LODDs should have complete autopsies, but not all LODDs get them.
Also, in the cases of the firefighter LODDs of my acquantance, all of them had a current NFPA 1582 physical, as stated.
The other thing is that even previously healthy firefighters can die from acute CO and/or CN exposure as well as chronic exposures. Ditto for arythmias - some of which show up for the first time when they kill a firefighter.
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Permalink Reply by Firemedic on
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I would have to disagree with you. I personally do not want to orphan my family because I did not do my job correctly. I believe that before you decide to run into a structure, all avenues need to be addressed. Is the structure safe to enter? How long and how far has the fire developed? Could the habitants survived? I can not risk my firefighters lives for something that would not gain a lot. Have you ever had to go up to a spouse and tell them that their significant is dead for nothing? Every scene is going to be different and using this motto could very well ensure that you firefighters alive for the next call.
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Good videos. Thanks for posting them.
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