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Take a hint. Repetition is good.
"We rarely do things the same way twice. Besides it always makes for an exciting morning..."
by Ronald Richards
You've just left the hospital after a round of pre-op tests. Within 48 hours you'll go under the knife to repair three arterial blockages. You're anxious. Will I make it through the surgery? Your palms are sweaty, your mouth feels parched. Your family comforts you by telling you everything will be all right. There is no reason to doubt them, is there? After all, the doctor has done this procedure thousands of times, with predictable and reputable results. He's told you that you'll be up and about in 24 hours and probably back home with your family in four days.
How can the doctor make this kind of promise with a straight face? Simple. He and his well trained team have done this same surgery the same way over a thousand times. All of of these highly trained professionals have a specific job. The operating room nurse, in concert with the OR technician, checks over the arsenal of tools that will be needed to complete the procedure. They've made sure there is ample blood supply on hand that matches the type, if it is needed. 

The anesthesiologist met with you after your stress test and put you through a litany of questions about your prior surgeries by asking about adverse reactions you may have had with anesthesia.

Like a well oiled machine, the health care professional awaits your arrival, ready to "dig in".  Again, you ask yourself, "Should I be nervous about this?"

Let's do a fast rewind here and make a few character changes. The surgeon arrives the day before your surgery, wreaking of booze, in a suit looking like he slept in it for three days. He says he's ready to do your surgery tomorrow, but he thinks he'll try "something different."

"Something different?" you ask.

"Yeah," says the Doc, "We rarely do things the same way twice. Beside it's always makes for an exciting morning."

By now you feel diarrhea coming on and you rush off to the bathroom. When you finally emerge, looking as white as a ghost, you have a chance to meet with the anesthetist. He doesn't ask you and questions, but says he has some "good stuff" and you "won't feel a thing..."

So far the only one missing is Harpo... and guess what.... here he comes. It's the nurse who asks what kind of blood you use? Unbelievable, yes. 

Drawing a parallel
As you are reading this article, somewhere someone is having open heart surgery. The doctor performing the procedure will do it the same way as the three he did yesterday and the 2000 he did over the past four years. Why? Because he had good results. Why change if it works?

This hasn't happened by chance. In reality this doctor has assembled a team of highly trained professionals who do the same thing day in and day out. The OR nurse monitors vitals. The technician makes sure all the hardware is working, in place, and available. The respiratory technician monitors the respiratory needs of the patient while the anesthetist makes sure the patient falls into a state of unconsciousness, remains there during the surgery, and awakens following the procedure.

Everyone has a job to do. Highly trained and ready to deal with the unforeseen-- should it arise.

What about the fire service? Do we operate this way? Is some areas of the country the answer is yes- highly trained, operating under the incident management system, tools in order, with a clear definition of the mission. In other areas, havoc exists, much like the half-cocked doctor who shows up to do the surgery.

How is this possible in this day and age? It's real easy. Many departments continue to operate in a vacuum. Company officers assign firefighters' roles when they arrive. Chief officers are busy informing the communication center of specific companies to call since they responded to an incident without automatic mutual aid.  Mutual aid companies that begin to arrive yell and scream in the radio, asking for directions and assignments.

Communications becomes a nightmare. Different frequencies, different bands, hose threads that are incompatible. One company uses a two tag accountability system, but most firefighters on the fire ground still have two tags attached to their gear. Other companies have no accountability at all.

What do you think the results are going to be? The building will burn, building occupants may get hurt or killed, and if all the firefighters are lucky they will return home. There is something I just don't like about the word lucky. Maybe that's because of friend of mine had a dog that had three legs and was blind in one eye named "Lucky".

Unbelievable, yes, but as you read this it is probably happening in many areas of the country. The sad part is that you may read about it in tomorrow's headline...."Fire goes three alarms, 4 firefighters hurt..." or "Toddler killed in fire, bystanders say firefighters missed him during search."  The media will focus a lot of attention on the incident, especially if a firefighter is killed.
 

How do we fix it?

Define the mission
What are we really trying to do? Save valuable lives. Save salvageable property. The house is fully involved. Chances are that those still inside are not savable and the effort to save the property will only result in additional costs to the owner to have it torn down once the fire is extinguished. The incident commander has to make it clear what the mission is. This will determine what mode the folks go to work in.

Determine the response
Who knows the demand for fire services better than the fire chief? Hopefully, you'll agree!  In a county-wide fire protection district, there is a "norm" as to how many pieces of apparatus respond on a specific type of incident. For example, on a report of a commercial building fire an acceptable initial response might be four engines, two trucks, a rescue and chief officer. Why send that amount of resources? Because based on the potential, the all of those companies may be put to work. Size of the building, occupancies, fire load have all been taken into consideration. What is the worse that happens? First arriving company arrives on scene and the incident is minor in nature. "Holding the first arriving engine and special services unit, return the rest...."

Yet, in many areas, the response may consist of two engines and if your're lucky a chief may show up. After all, if we need help we'll call a neighboring department. That's the only time you work together.... when you're knee deep in alligators! You know the drill. Mass hysteria. "Man, we gotta barn burner here!"

Wouldn't it be so much easier to have the first arriving engine company go to side one of the building, dropping its own supply line on the way in. (God forbid we drop hose and there is no fire...) and go to the fire floor with an appropriate sized line. The second due engine ensures the first arriving engine has a water supply established, charging the line dropped and its personnel report to the first arriving engine, pulling a second line to go above the fire. Before going to work, accountability tags are dropped off with command to insure all personnel are logged in. Maybe the third arriving engine goes to side three dropping a supply line with the fourth due engine picking up the line. Both companies will have specific areas to report to and specific tasks to complete once there.

The same drill applies to the truck company. First arriving truck goes to side one, gets good position and goes to work with ventilation, laddering, etc. Second due truck takes up position on side three. The rescue squad comes to side one and commences with search and rescue.

So what have we done here?  Hopefully that same thing that has been done on the last 1000 commercial building fires. We've done things the same way. Why, because if works. Why change? Repetition... is it boring? Yes, but it is time proven. Why try to assemble everything on the fly? Do what works.

About the author:Chief Ronald Richards has over 25 years of fire service experience, both career and volunteer. He rose through the ranks in the Forest City Fire Department, in Forest City, PA and became Fire Chief in 1995. He held that position through 2000 when he retired. He currently serves as the Chief for Training and Safety for Browndale Fire Company in Wayne County, PA. Chief Richards has over 24 years of service with the Commonwealth of Pennsylvania, having served as a Fire Marshal with the Department of Public Welfare, a Fire and Safety Specialist with the Pennsylvania Department of Corrections. He currently is the Assistant to the Superintendent within the PA Department of Corrections, responsible for media relations, litigation coordination, accreditation, and the writing of policies and procedures. Chief Richards graduated from the State University of New York with a Bachelor of Science Degree in Fire Service Administration.  Richards is a PA State Fire Instructor and an instructor with Command School, He is the founder of WithThecommand.com.