
By Andrew Beck
You are called to a local gas station shortly after it opened on a cold morning. The staff and customers are complaining of an odor similar to natural gas. You respond to the business, bump test a four-gas meter, and head inside. You notice a slight odor of something, a little like natural gas, maybe even sewer gas. As you move through the building, you pick up two to three parts per million (ppm) of carbon monoxide (CO), but then it drops back to zero. You have 0% lower explosive limit (LEL) in the entire building, and you note a drop in oxygen from 20.9% to 20.1% in the utility area in the rear of the store. The meter reads 0.0 on all channels after you head outside, and the oxygen reading returns to 20.9%, so you are confident it’s not a faulty meter. You turn on and off all of the gas-fired appliances, but this seems to make no difference.
What do you do? There seems to be something there, although it’s a small concentration. Another substance could be stimulating your meter. It could be sewer gas, or it could be nothing. There isn’t enough CO to implement your department’s standard operating procedures. The gas station’s staff wants to know what to do, and you start to feel like you are a contestant in final Jeopardy. We can find ourselves in situations like this many times in our career, especially in the early stages of an incident.
The Occupational Environment
There are different types of occupational environments; some are more friendly than others. The fire service is what is known as a wicked environment. Wicked environments are characterized by a setting where decisions have open-ended feedback that’s not immediately available. The results of mistakes can also have severe consequences.
There is also a kind environment, one that has immediate, obvious feedback for decisions and less catastrophic consequences for mistakes. Picture a simple assembly line. Installing a part in the wrong place will become apparent pretty quickly when the next step in the assembly process isn’t possible. This error will be noticed quickly and corrected immediately. The error is contained quickly even if the people involved do not notice it. The fact that the next step will not work acts as a self-policing system.
In contrast, a wicked environment has a lot of open-ended decision points, and you are not immediately alerted if you miss a cue or make an incorrect decision. Imagine that assembly line again. After incorrectly installing a part, the next part fits just fine until some later time when the entire nearly finished device falls apart or explodes. This is the environment closer to a wicked environment.
Working in a wicked environment necessitates that you gain skills from experience. These so-called experiential fields require a balance between knowledge about and exposure to different situations. Our job, like any experiential job, is a combination of art and science. They both have to be present in the correct amounts for a practitioner to successfully perform the job in the wicked environment in which we work. We can learn the science, but the art is where experience pays off and where we can lose situational awareness.
The Science and Art of the Job
Initial rookie training or on-the-job training gives us the science behind our job. It consists of measurable, objective skills like donning a self-contained breathing apparatus (SCBA), deploying hoselines, and conducting a size-up. These skills can be taught and practiced to perfection. This proficiency is essential, and mastery of many of these skills can keep us alive in an emergency. Proficiency of these skills also gives us confidence and frees brain power to process other things that are happening. Many of these skills pass from veteran to rookie, and departments should strive to ensure that there is a process for passing along this knowledge. You can feel pretty good after finishing an academy or another training program and be excited to use the new knowledge you acquired.
When you first arrive at a working fire or another dynamic incident, it is difficult initially to know where to focus your attention. You may not know what to do immediately or how to process what you are seeing. You have the training and knowledge, but the situation doesn’t match what you imagined in training.
To apply your skills correctly and at the right time necessitates a dose of art—for example, the Yoda-like decisions made by the veterans with whom we work that cause us to wonder, “How did they know to do that?” As we gain experience, we start to be able to process what we see and integrate it to the point where we understand how to apply our skills. We have seen enough fire to know what nozzle pattern to use and when, even though the situation may not exactly match the one in burn training during recruit training. You do not feel as overwhelmed by everything you see on a call and begin to calm down and make sense of it.
Less Experienced
How do you get to this point? Interestingly, it’s not merely a matter of time. In some other professions with wicked environments, it depends on what experiences you have in that time that makes the difference. Pilots, professional ski patrollers, and smokejumpers all work in wicked environments. In each of these fields, there is a “danger zone” where a person becomes proficient with his skills and starts to feel comfortable but lacks the art needed to be safe.
In aviation, it’s just after pilots gain the instrument rating. They can now fly in any weather and have amassed a good amount of technical flying skills. The problem is, they may have only a small number of hours and have not experienced many situations, making it hard to apply the skills correctly. This can lead to overconfidence and accidents. Federal Aviation Administration (FAA) accident statistics bear this out: There is a spike in crashes in general aviation around the 300-hour mark.1
U.S. Forest Service (USFS) smokejumper bases across the western United States refer to second-year jumpers as “snookies,” or second-year rookies. The term isn’t a put-down but a recognition that a single season of jumping fires is not adequate to acquire enough experience to have the right balance of art and science.2
The International Association of Fire Chiefs (IAFC) National Near Miss Reporting System recently assisted Avalanche Worker Safety, a group working to keep professional avalanche workers safe, in implementing a near-miss reporting system. Avalanche forecasting and control operations is a job with many inherent dangers—explosives, remote areas, helicopters, and traveling in avalanche terrain, for example. Some veteran patrollers will tell you that being a second-year patroller is the most dangerous thing in the world.3 They have not experienced enough situations to understand the big picture and to keep themselves safe consistently.
Compounding the situation is that rookies and more experienced people, by and large, make another type of mistake as well. A newcomer makes mistakes in the science or skills areas, such as incorrectly donning SCBA, improperly heeling a ladder, or incorrectly using an extrication tool. These errors are usually quickly noticed, have relatively immediate feedback (providing others are paying attention), and can be rapidly corrected.
Veterans
Veterans, on the other hand, tend to make mistakes in the art area. These types of errors can have much more significant consequences. Rescue profiles or decisions about tactics and strategy can put many people in danger, and the mistake likely will not be realized until the operation is well along that path. In a 2016 study of mountain guides in Canada, the causes of missteps were similar to what we see in human error in the fire service.4 They included impatience, trying to outthink a situation, information overload, acting on emotion, not being vigilant to changing situations, underestimating consequences, lack of communications, and underplaying uncertainty.
The point where someone becomes safer is an elusive mark that depends on their experiences over a period. If you work in a comparatively quiet environment that does not have a high number of incidents, it can take much longer to hone your art. All years of experience are not the same, however. Within an organization, there can be vast differences in levels of experience. If a new practitioner is exposed to a severe event, it can serve to speed the process. In a 2005 paper, Paul Chamberlain from the USFS smokejumper program referred to this type of experience as a portal.5 Just like in science fiction, the individuals come through this portal changed. They now realize the importance of safety procedures and have experienced firsthand the consequences of mistakes.
Today’s Fire Service
Looking at the fire service in America, it’s not hard to see that we have a problem. Experienced workers are retiring at a rapid rate. Delayed retirement programs are attempting to retain those senior people who have honed the art so that they can pass these skills along. At some point, the older workers will retire, and the next generation will have to get up to speed with fewer fire incidents from which to learn. More people will work in a comparatively quiet environment, but they will be depended on to master their art nonetheless. Does this mean we are doomed to repeat the mistakes of the past?
We’re not doomed if we can tell stories. Humans have told stories for eons, and we have relied on this method of sharing information longer than we have used written histories. Humans are hardwired to both listen to and tell stories. Storytelling is a standard way to pass along information in experiential jobs, as there is much you can’t write down when it comes to the art of applying the science you have learned. In apparatus bays, in ski patrol locker rooms, and at kitchen tables in fire stations, shared stories pass along the art and traditions from one group to another. These stories, no matter how valuable, can impact only those who are present to listen. Discussion of a lesson learned cannot travel outside of earshot.
The IAFC National Near Miss Reporting System provides a way to increase the number of people who “listen” to a story by providing a virtual platform for sharing near-misses and lessons-learned stories. Founded in 2005, the Near Miss Reporting System operates as a platform to collect, analyze, and distribute near-miss and lessons-learned stories. An individual with a story can impact thousands of brother and sister firefighters. You can read a story that other firefighters entered, put yourself in their shoes at those moments, and learn the lessons vicariously. The key to making the memory last is to feel emotion while reading the story. Emotion will make the story stick and turn the story or experience into a memory. Put yourself in the person’s shoes, and focus on the why, not the who. What did the firefighters see? What options did they feel they had? What emotions were they feeling? Simply assuming you would never make the same mistake and moving on won’t allow you to have an emotional reaction, and you likely won’t form a reliable memory.
Now, we can develop the art side of our trade at a faster, more rapid rate. Searching reports provides a way to pull stories for various topics for use in training or safety presentations. Annual statistics can give another view of trends in the American fire service besides line-of-duty death reports and injury statistics. By sharing our stories, we can learn from one another to prevent mistakes. We can share not only stories but the satisfaction that comes when you have contributed to making the job safer for the next generation.
References
1. “Predicting Accident Rates from General Aviation Pilot Total Flight Hours,” William Knecht, FAA, Feb 2015; https://libraryonline.erau.edu/online-full-text/faa-aviation-medicine-reports/AM15-03.pdf/.
2. Personal interview with USFS Smokejumper Staff, Missoula Smokejumper Base.
3. Personal Interview Scott Savage, Sawtooth Avalanche Center.
4. Todd Guyn’s 10 Common Missteps of Avalanche Practitioners ISSW 2016. Lou Dawson; https://www.wildsnow.com/21017/10-list-avalanche-mistakes-safety. Oct 7, 2016.
5. “Portal,” Paul G Chamberlin, International Wildland Safety Summit, April 26-28, 2005.
Andrew Beck is the training officer for the Mandan City (ND) Fire Department and manages the training program, including live fire operations. He is a staff member for the International Association of Fire Chiefs’ National Near Miss Reporting System. Before moving to structural fire, he worked in wildland fire from 2002-2006 for the U.S. Fish & Wildlife Service and U.S. Forest Service. Beck has training in crew resource management and flight physiology.
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