Big Picture Blindness

By Wlliam Shouldis

A House Divided is a novel that examines the life of a military hero attempting to recover from a war injury. Blindness is the disability. For most of us it is impossible to imagine a life without sight, yet fire service supervisors sometimes make operational decisions “in the dark.” We often are not aware of our “blind-spots” that can distort our view of a situation or circumstance. A practical example is an incident which involved a towing company and responders. Each viewed the emergency scene from different standpoints. Each had a vested interest. Each had a right to be at the site, and each sought customer approval. Each also experienced difficulties and frustration. The lesson learned was that public and private sectors must work together. This type of incident is common in any size community and demonstrates the importance of including outside agencies in the preplanning process.

At the scene of a motor vehicle crash there is an ever-increasing need for command, control, communication, and safety. Yet effective service delivery has more than one perspective and providers do not work in a vacuum. In this incident profile, the fire department was the lead agency, but was last to arrive at the scene. Law enforcement responded to a 911 call to assess the situation. Police officers were charged with establishing a perimeter to reduce the chance of a secondary event. First-arriving police officials observed three vehicles involved in a motor vehicle accident. Injured victims were on a “special needs” bus and in automobiles. Tow truck drivers were dispatched via a radio message from their employer. The busy thoroughfare needed to be cleared before normal traffic flow was possible. Fire department responsibilities included extrication and pre-hospital care. Command understood that at any mass casualty incident, time, resources capability, and proper documentation are critical. Firefighters began to stabilize the vehicles and create access paths for patient removal. Paramedics began the triage process. The initial step was the proper packaging of patients with limited equipment and supplies. Sorting of the injured and determining the correct level of medical care was then addressed. Ultimately, based on the nature of injuries, transporting the victims to an appropriate medical facility completed the response phase.

Real-life conflict occurred when a tow truck operator approached a medic unit and requested the signature of a patient in order to remove a high-priced luxury vehicle to a secure storage site. Without proper written authority, the late-model car could not be a taken. leaving the vehicle on the side of the street would subject it to vandalism. The tow truck operator approached the medic unit, with the rear door to the patient compartment closed. The fire officer was concerned with privacy and HIPAA regulations. The fire officer asked the tow truck driver to “back off”, but the operator insisted that the medics cooperate. Law enforcement became involved to maintain order. The situation resulted in a formal complaint.

Difficulties and frustration are part of every emergency responder’s life. Disagreements can occur in the fire station, during training, and at an emergency scene. Supervisors must be aware of the “big picture”. Recently, during the preparation for the LIVE 8 charity concert in Philadelphia, Chief Lloyd Ayers, stated that major events can become a “madhouse” without proper planning and organization. The fire department’s role is to ensure the incident does not escalate into “madness.” As educators and emergency responders, we should strive to understand and appreciate everyone’s role, which will increase the odds of safety and success while working an accident scene. Have a structured system to update policies and define duties. Don’t let “big picture blindness” be an operational handicap in providing community service.

William Shouldis is a deputy chief with the Philadelphia (PA) Fire Department, where he has served for 32 years. He is an adjunct instructor for the National Fire Academy’s resident and field programs, teaching courses in fireground operations, health and safety, and prevention. Shouldis has a bachelor’s degree in fire science administration and a master’s degree in public safety. He is a member of the Fire Engineering editorial advisory board, and a frequent FDIC speaker.

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