Part 16
By Mark Cotter
It’s hard to stay in front of the pack when it keeps changing directions. My first experience with an organization’s hesitancy to adapt was with the New Jersey First Aid Council (NJSFAC), a politically powerful consortium of volunteer ambulance providers. In the 1960s, while many other areas of the country were still relying on funeral homes to provide emergency patient transport, there were probably more trained ambulance personnel in the Garden State than most others combined, with at least as many “first aid squads” in both small and large towns as there were fire departments. The NJSFAC could be proud of the accomplishment this represented.
Then, in the 1970s, along came a new combination of letters: EMS. A freshly-appointed State Health Department director decreed that Emergency Medical Technician would be the minimum level of training for all ambulance personnel, replacing the Red Cross First Aid courses that had been the “standard,” and setting the stage for an epic battle in the legislature between progress and success; state mandates vs. voluntary standards; new vs. old. The late James O. Page, nicknamed the “Father of EMS,” told the story of his being thrown out of a meeting of the NJSFAC by its sergeant-at-arms when he attempted to argue in support of the higher standards. In the end, a compromise was reached, with a combination of courses (Standard and Advanced First Aid, CPR, Emergency Childbirth, Light Rescue, and Defensive Driving, collectively-termed “The 5 Points”) being accepted as equivalent to the Emergency Medical Technician-Ambulance certification, at least in New Jersey.
This is an old story, and it was repeated with similar themes in a number of states, but the point is that this organization, representing the best people, having the best intentions, and boasting (at the time) one of the best systems, went from leading the charge to defending its position. Although this occurred slowly, even subtly, it represented a substantial change in mission, brought upon in no small part by a clouding of the vision of both its leadership and membership. Instead of continuing to build a system that was the best it could be, they were consumed with arguing that the current system had already achieved that status, and any change would be disastrous.
In my emergency services career I have witnessed many similar examples of organizations, big and small, private and public, that reached the peak of their respective fields, only to become entrenched and intransigent in the face of proposed change. This is especially common if the pressure to reform or improve comes from outside of the organization. Leaders in their field face the risk of becoming complacent, and even arrogant, regarding their positions and policies, and can ultimately hasten their own replacement or extinction.
Similar hazards face departments, and even individual companies and teams. We invest a lot in becoming the best we can be, obtaining the latest training, equipment, and apparatus; crafting comprehensive SOPs; and trying to plan for every eventuality. Along the way, maybe we taste the success of quick fire knockdowns, reduced injuries, and the efficient performance of evolutions. The danger, though, is that we might become content about our state of preparedness, regarding both our actual abilities, and how those abilities stack up to those of other fire and emergency service agencies.
We need to prevent our past success from clouding our ability to see the need for change. I recall a fire company that had a tanker-pumper on which they had mounted a pre-piped deck gun (an innovation, and significant extra cost, at the time). They came upon a fully-involved garage fire shortly after accepting delivery of the apparatus and emptied their tank through their deluge gun, completely extinguishing the fire before it could extend to the attached home. It was a feat all of the local departments were talking about, and wishing they were able to do themselves.
Unfortunately, it was success that department could not readily replicate. Several subsequent fires were attacked in a similar manner, but none were as cooperative as the first. Either the garage doors were intact and deflected much of the water, or the fire had already extended to the attached structure and needed immediate ventilation and interior entry to cut off, or there was not a direct shot at the fire from the roadway. The company continued to attempt this attack at a number of fires, however, because of that initial positive experience–even though it ultimately was their sole victory with that tactic. It certainly did work well that one time.
Complacency has a tendency to sneak up on us, making it difficult to see. Sure, we all recognize the cocky rookie who, fresh out of the academy and feeling like he knows everything there is about firefighting, needs a dose of reality. We can usually provide this by presenting a “what would you do” scenario that will get him or her killed if he answers wrong – and they usually answer wrong. What about the veteran, though, who refuses to participate in drills (sometimes subtly, by being quiet and uninvolved, or by offering only sarcastic input), convinced that they already know more than the instructor? We all need to be vigilant in order to prevent ourselves from developing a malignant sense of contentment in an environment where the challenges allow no such luxury.
One difficulty in trying to stay at the top of our game is that the game is constantly changing. The rules change (recall the Occupational Safety and Health Administration’s two-in, two-out rule, and the regular introduction of new and revised National Fire Protection Association standards), the playing field changes (look at the synthetic building materials being used these days) and our teammates change (learn new things, forget old things, retire, transfer) continuously. Oddly enough, it is only through efforts at continuous improvement, a process that includes determining when and how to adapt, that we can best assure success in a constantly changing, and infinitely variable, environment. In fact, we need to keep up (read fire service publications, attend drills and meetings, network with other firefighters) just to know what to keep up with.
Addressing our shortcomings for even routine situations can be daunting, especially if we can’t see them, but we need to include re-examination and improvement as an integral part of all of our processes. You could hire a consultant to address this, but you could also hire one to design your new engine, or your training program, or any of those reams of SOPs you haven’t developed yet. As universal as it is, tackling the problems of matching our practices to our situations, and our theories to our reality (one definition of “planning”) should be a standard ability/function of all organizations and, indeed, all teams. We need to be sure that the way we perform fits both the applicable standards (that is, we do things they way they should be done) and the actual situation (that is, we can do what has to be done). Often, that means changing the way we operate.
The path to continuous improvement involves regular examination of our services. This is accomplished on a practical, daily basis by being open to questions and suggestions from all members. “That’s the way we have always done it” is never an appropriate, or at least not a complete, answer. Being able to explain why something is done a certain way has value for both the speaker and the listener, while an inability to provide an adequate explanation might be an opportunity to take a closer look at something that has become merely a habit or ritual.
Other self-examination methods include the reading of emergency service journal and news accounts of incidents, especially if it is done with an eye toward inserting your own department into the situation/procedure described in the reports. Asking “what would we do when (rather than “if”) that (plane crash, complicated rescue, natural disaster, etc) happens here” is a powerful motivator for self-analysis. Sending members to conferences, both regional and national, provides opportunities for discovering what you need to know, but don’t; or need to be able to do, but can’t–yet.
It is through continuous study and questioning, individually and as a team, that we can throw light onto the areas that need our attention for improvement. Only the cultivation of such an organizational attitude can prevent us from falling behind in the quest for excellence.
Mark Cotter joined the fire service more than 30 years ago, and is currently a volunteer firefighter/EMT-B with the Salisbury (MD) Fire Department. Previously, he served with departments in New Jersey and Pennsylvania as an EMT-paramedic, emergency services consultant, and fire chief. You can reach him at fromthejumpseat@comcast.net.
