Hardly a week goes by when a story doesn’t pop up on my Facebook news feed or show up on some news agency page talking about the shortages of volunteer firefighter, EMS or rescue personnel. All these news agencies report the one thing we all know, volunteer firefighters are a dying breed, but very few reporters print any solutions. It seems the burden of finding new recruits always seems to fall on the shoulders of the department. We’ve all heard the reasons people don’t volunteer: It takes to much training…. I can’t afford to take time from work…My employer won’t let me respond…. I live to far from the station. Many of these reasons are valid and understandable. While I don’t think that lowering the training requirements is the answer, working together we can find solutions to the other reasons. It is well known that 69% of all Firefighters nationwide are volunteer and save taxpayers $140 billion annually. Many if not most communities cannot afford to provide fulltime paid responders. While the emergency services providers need to ensure that they do their part to provide professional and well trained responders they are not the only ones responsible for recruiting. I feel that the local community, state and federal government can all do their part to help fill those empty lockers.
There are things that local municipalities can do help give incentive for volunteering. While most department do not have the budget to pay responders the local government can things to show their gratitude to those that give up their time. Developing a property tax credit is one way they can help…. most everyone you talk to complains about paying taxes. Local municipalities can provide a tax credit to property owners who volunteer, after all those volunteers are saving the rest of the local taxpayers’ money.
The State government can do things to help provide incentives as well. They can reduce or eliminate vehicle registration fees for volunteers. In my state, they charge a higher registration fee for having firefighter, EMT or rescue plates. Lowering the registration fee will have a small impact on the State fund but will significantly help the volunteer. Providing tax credits to employers who allow their employees respond to emergencies during the work day is another way to help with department recruitment. It used to be a source of pride for companies to have their workers on the fire department but due to economic changes it is harder for those companies to be productive when being shorthanded. A tax credit could help soften that and encourage volunteering. Another potential idea to help volunteer departments is having the state set up retirement programs for long term volunteer responders. Wisconsin has a program where the state matches department contributions. Then after a predetermined number of years of service the volunteer becomes vested and upon reaching retirement age them money is played out.
I think the Federal government can step up and help the volunteer responder as well. A program like the GI bill could help provide incentive to volunteer serving the community. If a person dedicates a minimum number of years to the community the federal government could help pay for college via grants, interest free loans, etc. It would encourage young people to serve their local community and give them real life perspective. The federal government could also provide tax credits to people who buy homes in areas that have been identified as needing responders. I know there are already urban revitalization programs in existence but very few apply to areas protected by volunteers. Tax credits could also go to employers who encourage and allow employees respond to emergencies. The federal government already funds departments thru grants and other staffing programs but once again many volunteer organizations don’t qualify for staffing grants. Instead of funding the department to hire people we could encourage companies to have their employees volunteer.
I feel our society would be better off with a renewed sense of community and patriotism. I think you become more compassionate when you help someone from a different walk of life. Bringing more people into the fire services family will make for stronger, more understanding, healthier communities. Perhaps if we encourage young people to serve the community some of our countries other issues will work themselves out. I think that by the government investing in these ways it would be a win/win…. volunteer emergency services will be able to secure people and society would be better.
The title may be a bit ambitious but at this point in history, it is pretty widely accepted that Ohio has at least three cities with the highest rates of Heroin related overdoses and deaths. I happen to work in one of them.
What we have also experienced, as in most drug trends, is the repeat customer. Reviving the same patient several times in the same month before they finally die from the drug, get locked up or disappear. We know them by name or address and we say the same things to them when they wake up that we always do. In turn, they say the same things to us that they always do.
We have come across “Narcan Parties” where the addicts get together with a stock of Narcan and revive each other when they overdose. We arrive to find several patients that have already been given Narcan by someone. Usually that someone is long gone so we are left to finish what they started.
Our tactics for an overdose used to be a cruel joke. We used to wake the overdose patient up quickly so they would vomit. Then we would use the experience as an attempt to “teach them a lesson”. Then we started only giving them enough Narcan to keep them breathing and deliver them to the ED so they could get the supportive care they needed while they were slowly awakened, in the comfy ED bed surrounded by friends and loved ones. We also used to take their shoes before we transported them. That way if or when they signed out AMA and left the ED they would have to wait for the bus in their socks. All in a misguided attempt to “teach them a lesson”. All of that is gone now. (I sound nostalgic and I am just a little bit. Not about being mean to people but for a time when getting dispatched on an overdose was thrilling). We have so many overdoses now, the thrill is gone and we start hoping for a shortness of breath or a chest pain, simply to have some variety. It’s a sad day when the crew sits around the kitchen table and tries to remember when they last had a shooting or a stabbing. Those things are pretty common where I work.
This plague makes up almost 70% of your EMS workload on many days. It has rewired our brains to think that every unresponsive patient that us under 40 or 50 years old is an overdose. We have gotten very good at spotting an overdose patient but the saturation of this social disaster has lead to us, on occasion, to not recognize some other causes of cardiac arrest and causing us to play “catch up” during the resuscitation. You holier than thou types will be looking down your noses at this point and saying “I wouldn’t let that happen to me or I wouldn’t miss that”. Well I can assure you, even if you fancy yourself as an EMS king or queen with your Star of Life tattoo, the 14ga needles in your pocket for that random chest decompression on the way home from work and the bulging pocket of para-medicine quick information guides, you will find yourself wondering how you missed the hypoglycemia or other cause of this unresponsive father of 2 in the parking lot of the TGI McFunsters restaurant. We are creatures of habit. Drug overdoses are our new habit. Our drug of choice right now is Narcan and our new favorite activity is atomizing it on everyone. It’s moved up the algorithm to be a front line drug in every cardiac arrest.
No one is immune. I have given Narcan next to dumpsters in alleys, in the upstairs bathroom of a suburban home, on the patio at the gulf club, in the high school parking lot and to an elderly patient at a nursing home. It is all around us. No one is that far from it and everyone is affected.
In our area, we have the option for the patient to refuse transport after Narcan if they are awake and alert and have a “friend” to watch for a relapse for a few hours. I know some of you out there are probably yelling at you computer or phone saying that it is a bad idea leaving those patients and not transporting them for evaluation. The problem that we have discovered is that the “patient” would sign themselves out AMA before we even got the cot made and the report finished. The hospitals don’t want them if they don’t want to be there. We don’t want to take them if they don’t want to go. It was a reluctant compromise that we have made to relieve the burden on the Emergency Departments and kept us from being tied up on a patient that did not want to be treated. Contrary to the belief of some of you, some of them don’t want the help; some of them can’t be saved.
In our area, we also have an EMS protocol system that has a “drug bag” exchange built in. If you use a “drug bag” on a run, you can exchange it for a freshly stocked one at the receiving hospital. It has been a system that has worked very well for our region as it spreads the cost of drug purchases over a larger area. We pay an annual fee to the protocol system which, in part, helps lower the cost for everyone. That being said, it is still easier for us to run to the ED and make a drug bag exchange instead of having to do a patient drop off. As good as the system is, we have run out of Narcan in our area a few times.
Back to the plague, the situation has affected every aspect of our business. The dispatchers have gotten so used to saying “respond on an overdose” that they frequently have to correct themselves when announcing a different call type. The addicts have gotten better at phoning in the overdoses. They use terms like seizure and trouble breathing because they know if they say overdose, the cops will come. Once our brothers in blue show up, they run everyone for warrants and someone usually gets hooked up and taken to jail. They are not worried about going to jail for the drugs because the jail won’t take them anymore. That’s how big the problem is, the jail and the courts don’t even want them. At least the cops have quit saying “go with EMS or go to jail”. We’ve got that going for us I guess.
I guess the real question is, how do we manage our role is in this public health crisis? Do we handle it as business as usual like we do most things and hope that it goes away? Do we try to give these lost souls the information they need to make a change in their lives? Do we use our political muscle to put pressure on the physicians groups to stop passing out opioid pain meds like they are Sweet Tarts on Halloween? Do we formulate a whole new strategy to fight this lion? For now, we each need to make a choice as an individual EMS provider to try to help each addict the best we can in hopes that it will make a difference.
We are fighting against a force that none of us saw coming. We have witnessed drug trends come through our area in the past but realized, only after the demon was unleashed, that we were in over our heads but we managed. I think this time is a bit different. It doesn’t help that the Mexican drug Cartels are very active in our area. It also doesn’t help that we have some of the highest rates of human trafficking in our area either because the two go hand in hand. Law enforcement has their hands full with all of this so we try to support each other as much as we can.
We are tired, frustrated, angry, annoyed, sad and weary but we will keep fighting because who else is going to do it?
Our area is getting some federal attention so I hope that will help. We are trying to get this lion back in the cage but it has proven to be a very fierce enemy. We will continue to fight and do the best we can until the next demon comes along.
Stay safe out there and watch each others backs!!
NEW YORK — Seven FDNY firefighters were disciplined for violating the FDNY’s “zero tolerance” hazing policy following a hazing incident of an African-American firefighter. Although the department withheld the identities of those involved, the New York Post (see this article for full story) reported that the incident involved a prank in which “they put the guy’s locker in the bathroom.”
Okay, so we all know where FDNY stands on “hazing”. Except that it seems to be a very vague rule. The word potential kind of is the catch all. Potential to demean a member? That could be anything if you didn’t like someone.
When I was in Boy Scouts, admittedly a long time ago, we always played harmless pranks on the new guys in the troop. Like sending them out at night for an imaginary snipe hunt or having them do all the dishes. I grew up with two older brothers so I had some experience in dealing with this type of chicanery. But I guess persons without older siblings never get a chance to experience this sort of thing.
So what is the right course? The “insider” who talked about the culture in the firehouse is right. But what harm is there in changing that culture? We certainly have changed as a fire service over the years. There was a time when you weren’t tough if you wore your SCBA into a fire. Now you belong in the dark ages if you don’t. So yes, fire service culture does change. Again, what’s the harm in changing the culture of hazing? I know some members just won’t be happy if they can’t play tricks on others. So we have to deal with those individuals. As a first step, we as fire service leaders have to let all personnel know where we stand on the issue and that violations will not be tolerated.
I can take a joke as much as anyone, but I had experience from an early age. Sometimes, however, some guys just go too far. And these are the ones the rules are made for. Much like in school where the teacher teaches at the lowest level so everyone can keep up. I think there are harmless pranks, but if we allow those (and how would you define them), then you have the guy or gal that goes too far. We are our own worst enemy more often than not. So we make a rule that seems vague (FDNY) but is actually there to protect everyone.
Just to be clear, I am not in favor of creating “safe places” within the fire house (like some educational institutions) where members can go and have quite time or just feel safe. If you are that sensitive then maybe the fire service isn’t for you. I don’t think anyone has suggested that, yet, but at some point I feel confident someone will.
The fire service is a great job, or institution, full of traditions and heritage. We also have a record of being flexible and recognizing the need for change. I think it is time to change the “hazing” culture and respect each other equally.
Remember, that guy or gal you are playing a prank on or hazing may be the one that has to pull You out.
Remember, Stay Safe, Everyone Goes Home, and a
Merry Christmas from Florida
There has been a lot of talk lately of privatization of either fire service, EMS, or both in some communities. The thing about this choice to do so is that communities will suffer if the choose to do so. Why, do you ask? Because firefighting and even EMS is not a sustainable business model. There is no money to be made from firefighting and really pretty little money to be made from EMS.
The problem I see with privatization of these crucial services within our communities is that they will hire people at a lower cost and what are you going to get? These people who will work for these companies and won’t make enough to support their family. Then they will have to pick up a side job or two to make ends meet. Do you see a problem with that?
It may not be a big deal to you, and yes many firefighters have second jobs, but they usually do so to have extra money. They can support their families without that side job. So theoretically these firefighters will focus on their full time job and be ready for that big call. Do you want an exhausted firefighter or paramedic showing up to your call?
Privatization can be helpful in other aspects of government, but not critical services. There is no profit to be made from critical services. We need public safety services to be a government function. You won’t hire a private eye or security guard to investigate your minor crimes, would you? Why should we allow our government representation do this to our communities?
Sometime our city counsel or trustees forget they work for the people and we the people can make sure they won’t have a job after election day. Let’s make sure we let our government know we don’t want privatization of critical services! We are turning back the clock on this issue and it’s not beneficial to our communities. In the 1700s people would pay private companies to protect their homes during a fire, we have evolved from then, right?
Next time you hear someone in your community talking about how privatizing your public safety services, make sure you think long and hard what your community will be giving up to save a few bucks on taxes.