On Robin Williams and Canada

 

 

 

 

 

 

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As the world reacts to the news that actor/comedian Robin Williams has passed in what is being reported as a possible suicide, the event is bringing renewed attention to the issue of depression. At the same time a recent article in the Global News, an on line Canadian news paper, highlights the recent spate of suicides among Canadian first responders. You could look at this post as having nothing much to do with you if you aren’t an extremely successful and well loved Hollywood celebrity or if you don’t happen to hail from the Maple Leaf. However, if you are here and reading this odds are you are a first responder, and it has everything to do with you.

Robin Williams had been very candid in the press with his on-going struggles with depression and drug and alcohol addiction. Williams claimed he had never been formally diagnosed with depression or bipolar disorder but that he would get extremely down and sad for periods of time, which usually resulted in him turning to drugs or alcohol as self-treatment. While the symptoms of depression and/or bi-polar disorder could have actually contributed to some of his success with his high-energy brand of comedy (the manic up-side), the downside of the disease(s) were clearly worse.

So what does this have to do with Canadian first responders? It just so happens that Global News published a report on July 17, 2014 discussing 13 suicides among police officers, firefighters, EMT/Paramedics, dispatchers and jail staff in 10 weeks. Many, if not all, of these suicides are being attributed to the effect of PTSD, associated depression and other mental illness in these public servants.  This is not just a Canadian issue, as we all should know. PTSD and depression know no international boundaries and the common job we all share make us very susceptible to the diseases.

Many of you know that I struggle with depression. If you did not you can read about my history and diagnoses in a post I wrote about it here. I am not ashamed to say this. More of us need to be unashamed about the fact that we need help with some of the things we witness due to this job. The stigma of mental illness needs to be crushed if any real progress will be made toward lowering the number of public servant suicides. Our brothers and sisters need to feel safe in coming forward with their struggles before help is sought. Looking weak, fearing further isolation from their co-workers, worrying about job security or re-assignment, and a feeling of needing to deal with it on their own because they deal with everyone else’s problems are just some of the reasons “we” don’t seek help and take advantage of the resources that are many times already available to us.

Discussing mental illness isn’t as sexy as talking about flow path. It isn’t as glamorous as rallying support for the brothers and sisters succumbing to the cancers killing them from working at Ground Zero. But it is killing us the same as any other danger we face. It is something we can do something about if we all just have the courage to bring it out of the darkness and into the light.

Making Things Safer at the Scene of a Traffic Incident

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At the end of June I was fortunate enough to attend the train-the-trainer program at the National Emergency Training Center at the National Fire Academy for the National Traffic Incident Management program. That’s a lot of nationals in one sentence! And that’s the idea of this program. One, unified approach to how we as emergency responders deal with traffic incidents no matter if you’re in Washington state, Oklahoma or Maine. The goal is to enhance responder safety by teaching the participant the major factors and causal affects of injury and fatality secondary accidents while operating at the scene of an incident on the roadway. This class is targeted at police officers, firefighters, EMS, dispatchers and towing professionals all across the country in order to give everyone the tools they need to operate in a more safe manner on any type of roadway, not just Interstates or super-highways.

Three injury crashes occur every minute in the United States, putting police, fire, highway workers, tow truck drivers, and other incident responders potentially in harm’s way every day. Congestion from these incidents can generate secondary crashes, increasing traveler delay and frustration. The longer responders remain at the scene, the greater the risk they, and the traveling public, face. Every minute clearing an initial accident increases the chance of a secondary crash by 2.8 percent.

The National Traffic Incident Management (TIM) Responder Training program is building teams of well-trained responders who can work together in a coordinated manner, from the moment the first emergency call is made. They learn the correct deployment of response vehicles and equipment, how to create a safe work area using traffic control devices, and techniques to speed up accident clearance.

The program is sponsored by the Federal Highway Administration, which designed the course as part of the second Strategic Highway Research Program (SHRP2) to improve highway safety and reduce congestion caused by crashes.

The curriculum is based on extensive and detailed research conducted with TIM responders across the country and is based on a train-the-trainer approach. The FHWA-led 10-hour course builds a team of instructors within each state, region, or agency. They, in turn, train their colleagues using this innovative curriculum. Shorter, four-hour courses and one-hour training modules (which became available online in late spring 2014) are used to cascade the training and make it available to all responders. Training modules are flexible and can be modified to fit state and local regulations or practices.

The TIM Training program has been endorsed by key agencies involved in incident response, including the International Association of Chiefs of Police, State and Providential Divisions (IACP); International Association of Fire Chiefs (IAFC); American Association of State Highway and Transportation Officials (AASHTO); National Volunteer Fire Council (NVFC); and the Towing and Recovery Association of America (TRAA).
More than 40,000 responders have been trained across the country using this curriculum. The results have been very positive. Several states are now requiring their state police or highway patrol officers to take the training. To generate the strongest teams, representatives from all responder groups train together, including police, fire, sheriffs, emergency medical services, dispatchers, tow professionals, departments of transportation, and public works.

This class was some of the best training I have had in a while. The cause is also very personal to me. My response district includes 2 Interstate highways, 4 State highways and several large regional roadways. My department as well as the local police and sheriff’s department have had several close-calls, including me personally, and a few accidents as the result of secondary crashes while operating on the scene of a primary incident. Thankfully no serious injuries or deaths have resulted. If it was one thing I learned from this class, however, that could just be a matter of time unless we start employing some different tactics regarding to operating in the roadway.

If anyone is interested in hosting training for your department, group of departments or group of mutual-responders you can contact me through the website and I’d be more than happy to come and put a class on for you or TIMTraining@dot.gov.

Like Tiger Schmittendorf says, “The most dangerous job we do. The job we do most often.”

Until next time be safe out there,

Chris

Fire Behavior and Tactical Considerations UL/NIST

Some of you may have already seen this video talking about UL/NIST’s research into modern fires and ventilation. There are several out there regarding this particular subject so perhaps this is one you haven’t seen yet. We watched this for drill the other day at my job and while the information wasn’t particularly new to me some of the other guys were having it explained to them for the first time. The presentation is done a bit better than most of these types of research videos and there are plenty of pictures and videos to keep it going. I’ve it a watch and learn what all the talk has been about the last several months.

In the Wake of Tragedy

Image     In the beginning stages of a news-worthy story there are generally a few things that happen that have become common place in our society today. First, there is a storm of information that crashes onto the internet. These early reports are usually from scanner listeners and people near the scene of whatever is going on. The reports are usually short and to the point, perhaps not yet grasping the severity of the situation or being extremely limited in facts. “Boston Fire working a fire in a brownstone.” “Reports of victims trapped.” Or, “Huge fire by my office!” are blasted out across Facebook, Twitter, Instagram and other social media outlets. This usually sparks some interest from those of us in the fire service community and we may begin to take notice on a professional curiosity level. Many lay people just go on about their business, perhaps seeing a cubicle-dweller’s picture out of his office window and giving it casual look, thinking “Oh, thats pretty cool.” Second, as the incident may escalate, the local media is drawn to the scene. Often their first information is also drawn from scanner feeds or social media outlets. This piques some reporters interest and he or she may grab a mic, a camera man and a van and head down to the scene. This may turn into something and their station/paper/magazine needs to be the first to break it in the name of ratings and advertising dollars (because if there are no ratings there are no advertising dollars and then they all lose their jobs). These reports initially consist of very little substance and even fewer facts. They are generally what we in the job would refer to as “fire porn.” A live TV shot from the ground, or a helicopter, or some remote cam showing a bunch of smoke and fire. The long lines of apparatus parked along the street. The sound of Q-sirens wailing. This draws in viewers and again piques interest among people. After all, most people are enthralled at the site of a huge header and blowing flames. Next comes the erroneous or mis-information. This is usually as the result of two different reasons. Firstly, uneducated people making statements about something they know little to nothing about or, secondly, a rush to try and get “facts” out to the public without the needed vetting of sources and corroboration. One need only think back to 9/11 to remember this. How many reports of more planes being hijacked were there? Reports of terrorists running around Manhattan with guns. Eye-witness accounts of missiles being fired at the towers and the Pentagon. The same thing happens on smaller scales at every major incident. Some are embellishments by lay people and reporters alike, “Firefighters are doing their best to keep this entire block from becoming a conflagration” when those of us with any kind of knowledge and experience can see it’s a room and contents with a window failure that might get the neighbor’s house going if left alone long enough. Some are inadvertent inaccuracies based on pieces of information from many different sources. And still others you just have to laugh at wondering where the talking-head pulled that little gem from? Then, mercifully, comes the wind-down. When the incident is all but over and the live-shots from the scene involve a couple aerial pipes and a whole bunch of steam. Facts are corrected. Some reporters may even admit to mistaken reports earlier. Public interest is now all but gone and the story fades into history. But, in the wake of tragedy, this sequence of events is kicked into hyper-drive. Huge fires draw viewers. Huge fires draw hits to social media pages. Huge fires draw fame to those that were previously unknown. Firefighters dying in the line of duty does that ten-fold. And this is where I am ashamed of so many of our own. In the wake of tragedy there are those that seek to exploit the situation in one form or another. Memorial t-shirts, hats, stickers are all available to order within hours by unscrupulous vendors looking to cash in on our collective grief and traditions of remembering our fallen. Still others look to gain notoriety in some fashion or other. The guy from next door giving his eye witness account. The retired so-and-so on TV called in to provide commentary as an “expert.” And then there is the lowest of the low, in my opinion. There are those that call themselves brothers and sisters who take to their keyboards and the internet and immediately begin the Monday morning quarterbacking. Each and every one of these belly-crawlers would have never been in “that” situation. They would have had that fire out by the time this event could have happened by using this technique or that. They throw out buzzwords and hot topics to prove what salty Jakes they are and that everyone should listen to them. It’s a grab at feeling self-important or respected by their peers. Some do it in the name of “education.” “Hey! I’m just trying to prevent this from happening to someone else!”, is their rallying cry. Playing the part of the selfless champion for today’s fire service our brave brother or sister points out every last flaw they noted on the 15 seconds of film they saw on their local news station. Or pin points the exact thing that caused the whole operation to go South from the one radio transmission they perceive to be the most important. Yes, in the wake of tragedy we should all bow down before these pillars of fire service knowledge and stalwarts of tradition. Or, in the wake of tragedy, we should shut the fuck up. We should come to grips with our own individual mortality and realize that in an hour, tomorrow or in a month that could be you or I. We should offer support and prayers and encouraging words to one another. In the wake of tragedy we should be still and let things develop as they will. Allow investigations and reports to be completed. Let the facts come out. Not speculation. Not supposition. Not your own goddam commentary based on the three fires you’ve been to in the last three years. In the wake of tragedy we should come alongside our brothers and sisters who have had huge, gaping holes torn in their lives and assist them in any way that we can, not add to their grief. In the wake of tragedy we support the loved ones left behind. We become surrogate mothers and fathers, uncles and aunts, friends. We play catch in the yard. We cut the lawn. We pick up groceries. We let them know that they are part of the biggest, most dedicated and most loving family in the world. In the wake of tragedy we continue to do what we have all sworn to do; we serve. In the wake of tragedy we honor, in actions and in words. Romans 14:8 For if we live, we live to the Lord, and if we die, we die to the Lord. So then, whether we live or whether we die, we are the Lord’s. Rest in eternal peace Lieutenant Ed Walsh and Firefighter Michael Kennedy, we’ve got it from here.

Mayday

Chris Sterricker:

Melina does an outstanding job honoring the memory of Captain Jeffery Bowen, Asheville, NC Fire Department. Her perspective and emotion reminds us that there are others out there who hurt with us, who bleed with is.

Originally posted on Our Front Door:

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I remember it like it was yesterday, the sights, the sounds, the smells, the tears. It was all so real, so painfully real. I could never forget.

At first they just called to tell us that 445 Biltmore was on fire, this building, for those of you who don’t know, is directly connected to our hospital, our home, our place of safety. Everyone was out and there were no known injuries, Awesome, everyone is safe! From an ER standpoint we should be in the clear, now the firemen could get to work, put the fire out, and the long clean up could begin. However, in the end, that is not how this day played out.

A couple of hours passed and we got a very different phone call. “We need to call a code triage, there is an unknown number of people coming that way from the fire, get ready.”…

View original 623 more words

Extraordinary

Extraordinary.

Ladies and Gents, Brothers and Sisters, do yourself a favor and go read this very emotional and well written piece by an active ED RN. Although she is writing from that perspective and commenting on her co-workers this could easily be applied to so many of our co-workers in the Fire/EMS Service. Simply replace your mental image of a hospital Emergency Department with the scenes you have responded to and the co-workers you serve with while reading.

OH MY ACHING HEAD

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Concussion. It’s been a huge concern and media buzzword over the last couple years. Much of the discussion and attention has been brought about by several high-profile athletes having taken their own lives after dealing with what they believed were the side-effects of numerous concussions they had suffered during their playing careers, most notably Junior Seau and Dave Duerson. Both former NFL stars shot themselves in the chest so that their brains could be studied after their deaths in the hope of preventing or treating others with chronic traumatic enchephalapothy (CTE). CTE is being categorized as a degenerative disease caused by repeated brain trauma over a period of time, usually years, that results in a list of symptoms that leads many of its victims to live lives that are almost unrecognizable as compared to their lives before CTE. The most common cause of CTE is repeated concussion.

I think I was about 10 years old or so. Fifth or sixth grade, maybe. We were playing floor hockey in P.E. class in the poured-concrete with (probably asbestos) tile over the top gym. I remember having the puck and moving up the left side of the court, heading towards the goal. I think I was tripped by some other sticks, or maybe a leg, and falling head-first to the floor, bouncing my forehead off the concrete and tile. I also remember a class-mate named Randy was running behind me, trying to catch me on the play. Randy was the biggest kid in the school, no matter what grade. Over six-feet tall and over one-hundred pounds already, he wasn’t able to hold-up after I fell. He tripped and fell on top of me, bouncing my head off the floor split-seconds after it had already struck it the first time. I don’t remember getting from the floor of the gym to the principle’s office. I barely remember being told my step-dad was on his way to pick me up and take me home. The ride home, about a mile and a half, was fuzzy at best. Getting home I remember my step-dad had to half-carry me inside to our small den, where he laid me down on the loveseat, covered me with a blanket and told me to take it easy. I have sporadic, disconjugated memories of the next two days. I slept the whole time, waking briefly to hear bits of conversation coming from the other room or to see my mom or step-dad leaning over me saying something. That I remember I didn’t eat or get up to go to the bathroom, although I’m guessing I must have at least done the latter at some point. My parents never took me to the doctor. It was the mid-eighties and not much was known about concussion or traumatic brain injury. Certainly not by parents of the time, unlike today. Concussion was just another way of saying, “he got his bell rung”, and didn’t warrant anything more than a little time to recover, a slap on the butt and a “get back in there” from your coach. Today, of course, we know much more about the causes, symptoms and cumulative effects of concussion. But back then it just wasn’t a big deal. So I slept for two days and when I was either forced or felt well enough to get up (I don’t remember what the circumstances were), I resumed life like nothing had happened. Back to school. Back to basketball and baseball. Back to playing with friends. That was the first of what I’m guessing to be six or more concussions I’ve suffered over the years.

According to the Mayo Clinic concussion is, “a traumatic brain injury that alters the way your brain functions. Effects are usually temporary, but can include problems with headache, concentration, memory, judgment, balance and coordination.” Concussion occurs when the head is struck violently or shaken very hard and the brain slams into the skull, causing injury. Contrary to popular belief losing consciousness is not necessary to suffer a concussion. The brain can sustain a severe enough injury to be concussed without the patient actually losing consciousness. This is the least severe of the three grades of concussion. While there is no universal consensus on the grading of concussions there are two scales that are most commonly used in the United States; the Cantu scale and the Standardized Assessment of Concussion.

The Cantu Scale was developed by Dr. Robert Cantu in 1986 and was adopted by the American College of Sports Medicine. In 1991 the Colorado Medical Society developed its own guidelines after several deaths of High School football players after suffering brain injuries. These guidelines were more restrictive than Dr. Cantu’s and were then adopted by the NCAA for evaluating college athletes. Whether it be the Cantu scale or the CMS scale they share four general evaluations. 1) presence or absence of loss of consciousness, 2) duration of loss of consciousness, 3) duration of post traumatic memory loss, and 4) persistence of symptoms including headache, dizziness and lack of concentration. When the results of these evaluations are determined the concussion can then be graded.

Grade I:  concussions are not associated with loss of consciousness, and post-traumatic amnesia is either absent or      less than 30 minutes in duration. Athletes may return to play if no symptoms are present for one week.

Grade II:  concussions in which the patient loses consciousness for less than five minutes or exhibits posttraumatic amnesia between 30 minutes and 24 hours in duration. They also may return to play after one week of being asymptomatic.

Grade III:  concussions involve post-traumatic amnesia for more than 24 hours or unconsciousness for more than five minutes. Players who sustain this grade of brain injury should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week.

Post-concussive Syndrome can occur in the days, weeks, months and even years after a patient suffers a concussion. PCS is the presence and on-going problematic occurrences of the signs and symptoms of concussion after what should have been the “normal” healing time. Symptoms include memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia and excessive drowsiness. While no one knows for certain it is thought that the symptoms and problems associated with PCS contributed to the suicides of both Seau and Duerson. Dealing with these symptoms on a day-to-day basis became too much for them to bare and the only way they saw to be at peace was taking their own lives. But they were football players with lengthy careers in one of the most violent sports played. What could they possibly have in common with us?

I think we would all agree that the profession of firefighting and the delivery of EMS care has countless opportunities for us to suffer head injuries. From collapses at structure fires, to falls off the rig or a ladder, to encounters with violent patients there is ample opportunity for us to suffer a concussion. In the span of my career I can think of at least three times I personally believe I have suffered a concussion as a direct result of the job. I’m sure there are many of you who firefighter c-collarcould think of one or more times when you “had your bell rung” hard enough that you saw stars, became unsteady or even lost consciousness. These occurrences are severe enough to cause a concussion and warrant an evaluation. If you are suffering from the continued symptoms of what you believe to be a concussion suffered in the past you can still be evaluated presently despite the length of time since the injury. The exam will be subjective and based upon the history of the event and the symptoms you suffered or are continuing to suffer from. According to the United States Fire Administration report Fire-Related Firefighter Injuries Reported to NIFRS released in 2011, 15% of the 81,070 injuries suffered by firefighters between 2006 and 2008 (the time-period of the study) were head injuries. That’s 12,160.5 head injuries suffered. Divided by the three years of the study equals an average of 4,053.5 head injuries per year. That’s a lot in my book. Are all of them concussions or possible concussions? Probably not. But I’d be willing to bet that a large enough number of them warrant an evaluation for concussion and the possibility of on-going problems after.

As with Junior Seau and Dave Duerson repeated concussion, or a single severe enough event of concussion, can lead to a life time of disabilities and mental health issues. Depression is just one such mental health issue associated with concussion injuries and its associated syndromes. As we all know the issue of firefighter depression and firefighter suicide has been a significant topic of late and one which needs to be talked about openly and honestly. The days of “just suck it up and deal with it” are long over. The days of shrugging off the splitting headaches and continued dizziness because “you’re tougher than that” need to be left in the past too. We have enough on this job that can kill or lead to permanent disability, don’t let this be added to your list too.

Until next time,

Be safe.

Chris