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Emergency Medical Services: An Adaptive Challenge

It seems that on almost a daily basis, we read about another firefighter or EMT/paramedic line-of-duty death. While we know that our profession is inherently dangerous, the fire and emergency service has taken significant strides in trying to reduce the number of injuries and deaths in our profession.

We now dedicate one week a year specifically to Safety and Health awareness, education and training with the goal of making every day a safety day. We’ve improved PPE, apparatus and tools. We wear gloves (and masks and gowns, if needed) when attending to patients, use safety needles to reduce needle-sticks when starting IVs and are working diligently to design safer patient care compartments for our ambulances.

Technology has improved many things for fire and EMS, yet for all we’re doing, we’re still losing people.

We need to continue to work on this from a different perspective. In my first year as an Executive Fire Officer student, I read Leadership on the Line by Ronald A. Heifetz and Marty Linsky. They write that we all have problems that we have the knowledge and processes to fix.

However, they go on to state that there are many problems that experience, expertise and SOPs/SOGs can’t fix. They refer to these problems as “adaptive challenges” because “they require experiments, new discoveries, and adjustments” from not only the organization itself, but also from the community, or in our case, the fire and EMS service. This involves “changing attitudes, values and behaviors,” and we know how difficult this can be in our profession.

They also suggest that leaders fail most often because we try to fix adaptive challenges by treating them as if they’re technical problems. While technical problems can be addressed by leaders using their expertise, experience and policies or procedures, adaptive challenges have to be addressed by “the people with the problem in learning new ways.”

In this vein, safety and survival should be viewed as an adaptive challenge. We need to change our mindsets and thought processes to continue to address this issue, and this change needs to come from within.

We have SOPS and SOGs that tell us how to drive, what to wear and when, how to operate on scene and how to train. We provide our members with the best tools and equipment we can afford, and we’re constantly training them on how to properly do every job they may encounter. These are all technical solutions to the problem, and while they have helped, we won’t be successful unless we begin learning new ways.

We have the opportunity to learn from everyone else and each other. There are many after-action and investigation reports available on fatal fires and incidents where technical solutions didn’t work.

In many cases, the decision-making process may have been flawed, due to either a lack of or poor information, which led to an injury or death. And we have seen this occur in all aspects of our jobs, but most prevalently in responding to incidents (driving), structure fires, EMS incidents and wildland fires.

Others in our profession have talked about the “duty to die” and how this may be acceptable in some circles. Yes, we have a dangerous profession, but we should never risk our lives when no other lives are threatened. We all know that we risk a lot to save a lot, and we should risk very little to save little. This is what we need to continue to learn and remember, and every day we should work to ensure that Everyone Goes Home.

We’re the ones with this problem, and we have to continue to change the mindset of our profession. As Heifetz and Linsky also say, “leadership requires disturbing people—but at a rate they can absorb.”

As fire and EMS leaders, we have started “disturbing people,” but we still have much to do. We need to recognize the issue of safety, health and survival for what it is, and it is indeed an adaptive challenge. Let’s make sure we’re treating it as such.

Norris W. Croom III, EFO, CMO, is the deputy chief of operations for the Castle Rock (Colo.) Fire and Rescue Department. He’s been a member of the EMS Section since 1998 and currently serves as the section’s director at large.

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