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Are We A Good Value?

     It still amazes me sometimes when I think about all the things we do, and are expected to do, as firefighters, emts, and paramedics.  We don't spend a lot of time thinking about these things, and neither does the general public, but every now and then we need to take a look at what we do and ask ourselves... "Are we a good value?"

     Some people still think we sit around the firehouse all day playing cards and drinking coffee.  Others ask "When do you work?" because they always see us when we are off duty (come visit us on duty).  Others may focus on our pay, or benefits, or vacation time, or the fact that many of us work second or third jobs on our days off to help pay the bills and take care of our own families a little bit.  Taxpayers have a right to know if they are getting a good value for their tax dollar, and as a rule, we in the fire service are historically poor at communicating just what it is that we do, how we do it, and how it benefits the citizen personally and as a community.  The bottom line to some is how much it costs them for us to do what we do.   It is easy for us to become defensive of what we do, because we know what we do.  Unfortunately, many of the people who run the towns and/or pay the taxes, don't know much about what we do and don't know if they are getting their moneys worth or if they are getting ripped off by the "public employees," unions, management, politicians, "the government" or some other "they or them" out there.  Some don't even care at all (another story). Facts and feelings are easily argued.  So lets look at a few and let her rip....

    First of all, firefighters are people.  Many of them do drink coffee...sometimes too much coffee...and some don't.  In times past, a good game of Poker, Hearts, Cribbage, or even Solitaire helped pass the time in many fire stations.  It was actually fun to play cards, competing with each other in a harmless way.  It taught strategy and tactics, it taught patience, it taught winning and losing, it taught working together, it taught decision making, risk vs benefit, and much more.  It taught a lot and enabled the guys working together to talk about their job, family, values, politics, sports, and everything else (like people used to do before TV and computers took that away). Unfortunately, many of the benefits of playing cards have been lost today.  You can't even find a deck of cards in most firehouses today, never mind find anyone who knows how, or wants to play.  Too bad, because that 'social activity' had purposes far greater than just passing the time. THINK ABOUT IT!

    When do we work?  Most people are expected to work roughly 40 hours a week in the 'real world' today... whether it is 8 am to 4 pm (5 eight hour shifts) Monday thru Friday, with the weekends off or some other equivalent shift work.  A 40 hour week is the common benchmark, although many work twice that.  Unfortunately, we have not yet been able to find a way to schedule our fires and medical emergencies more conveniently and cost effectively, so we have to be ready for whatever might happen, 24 hours a day, every day, just in case. To accomplish this, a schedule of (2) 24 hour shifts (48 hours), spread out over an 8 day rotation, was developed to get as close to a 40 hour work week as possible (actually an ave. is 42 hrs).  Two goes into eight four times, so you need four groups of firefighters, working (2) 24 hour shifts a week to cover 24 hours a day,/7 days a week, 365 days a year.  That means, there are two 24 hour days in eight when firefighters are working and six 24 hour days in eight when firefighters are technically not working.  So yes, you may see us 'off duty' when you may be working, but remember, we are also working at 3 in the morning when you are sleeping, and on holidays and weekends, etc... we are in the ambulance, fire truck or station.. Think About It.

    On days off, some firefighters may work other jobs (carpenters, plumbers, electricians, etc...) or they may simply be on call, willing and able to come back to duty when needed to respond to fires, ems calls, or to cover empty fire stations for overtime pay.  It is important and a good value to have off duty firefighters available to come back to duty when needed for large incidents, multiple incidents, or major emergencies.  We all wear pagers for this purpose and some guys go back to duty several times a day.  How many other jobs are there where off duty employees wear pagers and drop whatever they are doing, 24 hours a day, to go back to work? It benefits the firefighter to go back to work (for overtime pay), it benefits the fire department to have those extra resources (people) readily available when needed, and it benefits the taxpayer because many of the built in costs (overhead) of public employees are already being paid for (insurance, retirement, taxes, etc) and don't have to be duplicated. Unfortunately, there are some limits (economical, family, mental, physical, etc...) to what can realistically be expected of people (firefighters included) above and beyond the required work week.  

    Years ago, it was very cost effective to operate a fire department with volunteers or call firefighters that only got paid when there were fires.  This is an ideal system and still works well in some areas.  You could have lots of people, at very little cost, to respond to and fight the occasional fires in town.  Unfortunately, it is hard to find people in some communities today that are willing to commit (long term) to the amount of time and effort required to be properly trained, certified, and recertified in all aspects of firefighting, ems, haz mat, technical rescue, etc... and then have them leave their family (often) or workplace (income) to give their time and risk their life for the community. (Those who do should be treated like gold and taken care of! ) If it was easy to operate this way, all fire departments still would.  Unfortunately, that is not the case when a department gets 'too busy' or is in a community that is expensive to live in. Or in a world where self comes before community. So, we have had to invest more money, in fewer people, to accomplish the mission today.  It is a real challenge for everyone involved, to balance the considerable expenses, with the need for sufficient people to perform the services, with the concerns of taxpayers, and the concerns of employees, with the needs of those who call 911 at all hours of the day.  We on the Cape have done pretty well over the years, with firefighters all trained as emts or paramedics as well (2/3 to 3/4 of all our calls are ems related these days). Each firefighter is expected to do the jobs of several people now, unlike years ago when there may have been 30 or more firemen to draw from to get the job done.

    A good value for their money.  That's what we as firefighters, officers, emts, paramedics, haz mat techs, dive team members, technical rescue specialists, dispatchers, and public servants need to be.  The fact that most firefighters are expected to do (to be) some or all of these things (and many more) in a professional and skilled manner is just a start.  We have to be trained to handle so many different possibilities. We never know what is coming next when that phone rings, and we all know how bizarre some calls can be. Is it a car fire, a brush fire, a house fire, a fire in a large commercial structure, or one of those less draumatic alarms, odors, or complaints. Or is it a medical call...a heart attack, a stroke, a diabetic, shortness of breath, a child birth, a juicy bleeding (BSI) wound, a psychiatric patient or a fighting drunk.  Is someone going to die?  Try to harm us?  Sue us? Bleed on us?  Puke on us or worse?

    Our world is constantly changing, becoming ever more technically complex, with tons of guidelines, regulations, protocols, procedures, laws, and the like to try to comprehend and follow.  We have to drive and operate expensive, complex, and important equipment including pumpers, aerial trucks, brush breakers, ambulances, boats, extrication tools, power tools, computers, defibrillators, thermal imaging cameras, SCBA, and so much more.  We have to attend lots of training and classes to be competent and skilled in all these things, yet training budgets are frequently the first thing to be cut.  We have to be mentally and physically capable of handling great responsibilities for ourselves, our co-workers, our management, our department, our community, our families, and our taxpayers... not to mention the regulators and lawyers who are out there waiting for us human beings to make a mistake. 

   When we respond to a fire on a fire truck, we need to wear approximately 30 lbs of equipment to keep us 'safe', then carry several heavy tools, a radio, a light, drag heavy hoses, put up ladders, force entry into locked doors; crawl into dark, smoky, strange places, in high heat, looking for victims, trying to put out fire and save someone's property.  We have to breath bottled air, that only lasts about 15 minutes under the work load at most fires.  If we get lost, trapped, or whatever, and our air runs out, we are screwed.  We get exhausted easily, particularly as we get older and are not as well conditioned as we once might have been. Being short handed adds to the problem.  We know if we make a mistake (and we often do) it can lead to an injury (sometimes career ending) or it could lead to the injury or death of someone we are responsible for.  We don't like to think of the fact that we could be killed, but we can be, just as about 120 guys do every year in the USA.  We are not immune.  We are not super heroes.  We are not simply an expense or a bottom line.  We are just people trying to do a job, we can make a living at, get some satisfaction from doing, and provide our 'customers' with our personal commitment to help them when the 'shit hits the fan' in their life. Our safety is also of major concern to a community.  If we are injured or killed, the financial loss alone to the community can be devastating, not to mention the loss of experience, skills, investments in training, and the emotional damage that always comes with such a loss.  That is why safety (and sufficient help) are always at the top of our list of concerns at every incident.

   It takes about 12 - 18 firefighters on scene to safely and effectively to do all the work that needs to be done at an average house fire. (An Incident commander, safety officer, 2 pump operators, 3 hosemen, 3 laddermen, 2 ventilation people, a search crew, backup crews, ems crews, a RIT crew, relief crews, etc...)  You need that help the most in the first 10-15 minutes of a fire if you are going to make a difference at all. We work in small teams (2-3 people) to accomplish various jobs...operating hose lines, putting up ladders, searching in smoke, opening up roofs or windows, ventilating heat, smoke and poisonous gases, overhauling charred materials, and then putting all the hose and tools back in service for the next run.  It is strenuous, difficult , but satisfying work that drains you mentally and physically.  If you try to do the job of the small teams without enough help (only 1-2 people) the probability of failure, injury, or worse increases considerably.  A minimum of (4) people on scene is the NFPA standard before making entry into a burning building or hazardous atmosphere... the two in two out guidelines.  A crew of (2) showing up on a fire truck (a driver-operator and one firefighter)  is supposed to wait until backup arrives, yet that is not always possible. Waiting is something firefighters hate to do, especially when a life may need to be rescued. Personal safety vs saving a life... risk vs benefit... make a decision and live with it... or maybe die by it.

    EMS Calls are similar.  If you consider all the things that we need to do today for a call like a heart attack...respond, locate the patient quickly, carry in all our stuff, get some basic information and history, a list of medications, allergies, take some vital signs...pulse, BP, pulse ox, respiration rate, skin quality, lung sounds... get a baseline EKG, a 12 lead EKG, interpret the rhythm, determine an appropriate treatment plan, put them on oxygen, give them some ASA and/or a nitro, get them down stairs using the stairchair, to the cot, carry them to the ambulance, setup and start the IV, retake a set of vitals, re-evaluate changes and adapt the plan, make the patient comfortable and conduct an MI survey to find out if the qualify for the cath lab, administer morphine or other medications as appropriate to relieve pain or treat conditions, get en route to the hospital, write everything you do down on a SARF while bouncing down the road, call the hospital by radio, explain in a concise and professional way, what we have, what we did, and what we need... keep the patient company... deal with family members...hold the bucket when they throw up... respond quickly when their heart rhythm goes life threatening (V-Tach or V-Fib)... check a chest compressions and start bagging them (breathing for them using a squeeze bag valve mask device)...put the pads on them, interpret the rhythm, defibrillate the patient once, twice, three times as necessary... more CPR...more meds... get an airway tube into them...intubating their trachea...check breath sounds...more meds...more CPR...write it all down...update the hospital...get 'em back?  Try to keep them that way... Get to the hospital...10, 15, 30, 45 minutes away... Get to the hospital, move the patient and all the attached equipment into the ER... transfer the patient, give report, write the SARF... replace the meds, clean up the rig, etc, etc... 

   Can one person in the back of the ambulance do all that?  NO WAY!  But many ambulances routinely are staffed with only (2) emts or paramedics.  You need 2 to 4 people in the back of the ambulance and a driver when someone goes into cardiac arrest if you are going to get it all done on a call like I just described.  And that crew is gonna be tied up for an hour or two. Who is back at the station?  Who is responding to the other calls in progress?  Let's get back quick so we can do the next 6 or 7 runs of the day.

   There are those who chose to become the "experts" in various aspects of what we do.  They may become instructors, leaders, rescue specialists, tech rescue specialists, haz mat techs, divers, etc...  Many of these people do this with little or no compensation, giving their own time and energy, to be able to benefit themselves and others when needed.  Some may join the elite teams that may go to incidents like occurred on 9/11, spending a week or more away from home under horrible conditions.  We all benefit from folks like that who are committed to excellence and truly represent a Good Value to their department, community, and country.

    Why do what we do?  Hopefully because we love what we do.  We need to in order to do it, to put others ahead of ourselves. Are we paid well?  Not bad.  Enough? Of course not.  Do we have a lot of time off?  Not bad. Is it all leisure time? Hah!  Do we have better benefits than some people?  I don't know, maybe...   Are we expensive to have around?  Yeah, I guess we are in a lot of ways.  Are we cost effective all the time?  Probably not.  Are we necessary? Are we good at what we do?  Are we serving the public well?  Are we giving them their moneys worth? Are we a good value? You decide.  THINK ABOUT IT! 


   Stay Safe.