I enjoyed “Fires in Hospitals and Nursing Homes: Be Prepared for the Unexpected” by Dan Sheridan (Fire Engineering, February 2014). I would like to add some comments on a situation we had a number of years ago. Our area caught seven-plus inches of rain in about a four-hour period, causing massive flooding. Our local hospital had flood waters in the tunnels; all mechanical rooms were under water. The entire lower level of the hospital was under water, as were all standby power units. We had approximately 12 engine companies drafting water from the facility. We were within 30 minutes of closing the facility. Plans were initiated for evacuation of all patients and staff.
That was when we learned about all of the ramifications of closing a hospital. They included contacting all area hospitals for room availability and amassing a fleet of ambulances for transport. There were several ongoing surgeries that were about three to five hours from completion. The surgeons refused to leave, and the surgeries were completed using hand lights. There was also the problem of notification of next of kin and tracing the destination of each patient. Patients on life support were on the verge of being disconnected.
When it hit the news media, we were swamped with people who wanted to help and take patients to their homes and so on. Also, the next of kin began arriving, and not everyone spoke English. The pre-evacuation took a lot longer than anyone at that time ever thought it would.
Today, we have learned many lessons, especially after Katrina closed a number of hospitals and extended-care facilities. The logistic sector can rapidly be overwhelmed. These types of incidents require a massive amount of planning and logistics. Depending on the situation, the incident commander had better start thinking worst-case scenario and start the wheels in motion so if evacuation becomes a reality, responders will be ahead of the game instead of behind the eight ball.
Keep up the good work. I use much of the information in my fire science classes.
Richard J. Keyworth, CFPS
Lieutenant (Ret.)
Elk Grove Village (IL) Fire Department
Adjunct Faculty Instructor
Harper College
Palatine, Illinois
Capturing ideas on the fireground
Have you ever had a great idea while on the fireground but because of the emergent nature of fighting fire you lost the idea in the fire? Later, maybe even months later, you find yourself in a similar situation and you remember that wonderful idea on how to improve a technique or situation. Once again, you lose it because it gets buried in the activity and urgency.
My background has been in documenting software systems for more than 30 years. Once of the difficulties in the software development cycle is the loss of knowledge about why a decision is made. Unless the developer chooses to write down the reasoning behind a decision, the “why” gets lost. I became an advocate of “integrated documentation” quickly and sold the concept as a time and money saver.
In 2007, I began researching decision making in the fire service while working on my doctorate. One of the participants in my research was Battalion Chief David Rhodes of the Atlanta (GA) Fire Department. He is also “Smoke Daddy” of Georgia Smoke Divers (GSD). In November 2011, he invited me to attend GSD training to observe. I noticed that when instructors had ideas about how to improve the class, they quickly took a few seconds to write their idea on a little white index card. They stuck the card in their pocket and kept moving. Later, at the end of the day, the Planning Section chief would collect all the cards. The leadership would go through the cards and determine whether to implement the idea. I realized what I was witnessing was real-time “integrated documentation.” I’ve since been to six trainings. Ideas that surfaced in previous trainings have now been successfully implemented.
There is a fluidity to this process that comes out of training. This practice is not an add-on task for instructors. The expectation is set during morning briefings that ideas about improving the class are expected. This ultimately results in continuous process improvement of the class and empowerment of everyone as a contributor. Rank never enters into the picture. Anyone can have a valid idea.
But, how can this work on the fireground when decisions are happening quickly? Obviously, if you are pulling hose or knocking down the fire, you cannot take precious seconds to stop and write an idea on a piece of paper that might ignite in the environment. The way to capture these ideas is to have an immediate “hotwash” on the scene after the fire. Designate someone to write down any suggestions. Keep cards and pencils in the apparatus for this purpose. Spend some time when you get back to the station to fully develop these ideas. This process will work even if you are running lean-for example, with two-person crews.
If you are in a department environment that is resistant to change, make the changes for your own team as appropriate without going against standard operating procedures (SOPs). If you do this, be transparent about your decisions. Back up your decisions with real-live examples of why you chose to do things differently.
Design the card to be durable and easy to use and file. This could actually work very well as an app on your smartphone, but for now consider using preprinted 3 × 5 cards. At minimum, include space for the following information: name of submitter, date, time, incident, condition leading to the idea, and the idea. Include instructions on how and to whom to submit the idea. Also, include space for feedback from the reviewing officer or committee and the date rejected or accepted. If accepted, include information as to which SOP was changed to incorporate the idea.
The purpose of this process is continuous improvement. Everyone has valid ideas. This will improve SOPs over time. As structures and conditions change, new ideas will keep SOPs current. This process has the added benefit of instilling trust in the rank and file by recognizing and honoring the fact that the people on the front lines know best how to do their jobs. This is one of the tenets of effective high-reliability organizations.
Judith L. Glick-Smith, Ph.D.
President/CEO
MentorFactor, Inc.
Cumming, Georgia
Editor’s note: On page 77 of the March issue, the credit line for photo 1 should read: (Photo 1 by Steve Skipton; other photos by author.)
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