Every 15 Minutes

By Aaron Dean

Every spring before proms and graduations, high schools around the nation put on a drinking and driving awareness program called “Every 15 Minutes.” The Every 15 Minutes (E15M) program is a two-day event targeting high school juniors and seniors that illustrates the devastating effects of the poor choice to drink and drive. This nationwide program takes eight to 10 months to plan and incorporates many local agencies. The fire department plays a vital role in planning, coordinating, and implementing this program.

The E15M program begins on Day 1 with students arriving to class as usual. Beginning in first period and continuing throughout the school day, students are randomly pulled from class by the “Grim Reaper,” dressed in a full black robe carrying a scythe. The “random” students are actually preselected; they become part of the “Living Dead” and are sequestered from their peer group, friends, and family until the next day. This requires a parental consent form and the obtaining of signed notification of event forms beforehand.

A team that may include chaplains, law enforcement personnel, and coroner representatives then notifies the parents of the “death” at their residence or place of employment. The scene is very emotional. Even though the parents’ supervisors and coworkers have received prior notice, the tension affects all present.

THE CRASH SCENE

During the morning, a scheduled mock crash scenario is demonstrated in real time before the assembled students (photo 1). Usually, the crash scene is staged on a football field, which also allows for the safe preparation of a helicopter landing zone (LZ). Before the students assemble, a towing company delivers two damaged vehicles on the field. If possible, the use of a helicopter is suggested; its presence contributes greatly to the crash scene’s realism (photo 2). This venue allows excellent scene visibility and acoustics.

1. Photos by Josh Yee.

The scene is comprised of one or two vehicles strategically located. Four students are preselected as crash scene participants. The injuries may vary, but one student must be the driver driving under the influence (DUI) and one must be the dead-on-arrival (DOA) victim. The other two students can be considered critical trauma cases and treated and transported appropriately. One of the two should be a paraplegic, and one should require extrication at the crash scene (photo 3).

The four crash scene students are transported to appropriate respective destinations: The police take the DUI driver to jail for booking; the coroner takes the body of the DOA to the morgue; and the two injured patients go to the trauma centerone by ambulance and the other by helicopter. These students will be “processed” through the normal routine of events associated with each facility. The parents of the trauma patients go to the emergency room, which is one element of the program that really affects the participants.

On completion of the demonstration, the assembled students are released to continue with their normally scheduled classes. Students continue to be removed every 15 minutes by the Grim Reaper, accompanied by the sound of a heartbeat that is broadcast over the school’s public address system. Tombstones are erected on campus to symbolize the losses. The school day ends with the remaining student body being released in the normal manner. The Living Dead at this point now number approximately 30. They will be shuttled to an off-campus location, such as an Elks lodge, where retreat facilities have been arranged.

THE RETREAT

The retreat is led by law enforcement personnel, firefighters, chaplains, counselors, teachers, or other designated persons. The crash scene students are retrieved from each of their respective locations (the morgue, the jail, and the hospital) and reunited with the Living Dead. The goal is that these students reflect on the day’s events and share those thoughts with their peer group. The entire group remains out of contact with their families. This aspect of the program requires confidentiality and understanding by all in attendance.

At the retreat, warm-up games and icebreakers are played. In bigger schools, students may not know every student in the room. When the time is right, two activities are performedletter writing and the passing of a candle. Although others may be included, these two components are very effective.

Each student writes a letter to his parents. The letter begins, “Every 15 minutes in the United States, someone dies or is seriously injured in an alcohol-related incident. Today, I died.” The student continues writing from the heart. The parents of the Living Dead students in turn write letters to their children. One or two letters will be read during the assembly the following day.

The passing of the candle occurs when all persons are seated in a circle in a darkened room. No one speaks unless they have the candle. A quiet uneasiness settles on the room. One can speak for as long or as short as he would like. The candle is passed around the circle until all persons have had the opportunity to speak. Some very troubling stories may be shared during emotional times at the retreat. Not all stories will revolve around alcohol. Emotional issues such as drug use, losing family members in a war, and abusive family situations are examples of what has been shared. If a student reveals that he or she is in danger or needs help, appropriate measures must be started.

Having 30 teenagers sit quietly in a room is unnerving in itself. When you can hear a pin drop in a room full of otherwise active, high-spirited high school students, it is obvious the message is being received. The evening concludes with the students spending the night.

Day 2 begins back on campus with an assembly for the seniors and juniors. The entire student body attends if space permits. A funeral-type procession commences with a focus on yesterday’s events. A casket is on stage. A video of the previous day’s events produced by the students is shown. The student who was a paraplegic can finally get out of the wheelchair he has been using since he was released from the hospital. A guest speaker, such as a local TV news personality, speaks. Counselors should be available. Closure begins.

In the Sacramento area, we like to close the assembly with Roll Call. Roll Call illustrates the ripple effect. You or someone you know will be affected by a drunk driver. The speaker asks specific groups of people to stand, such as those who responded to the crash scene or those who performed patient care. The questions broaden in nature until ultimately every person in the assembly is standing. The point: Drunk driving affects us all.

In California, the state Office of Traffic Safety (OTS) provides minigrants of $10,000 to develop the program. The California Highway Patrol (CHP) works closely with OTS, funding and coordinating each program. Outside of California, minigrants are available through the national E15M.¹ Local agencies assist where needed. For instance, fire department jurisdictions may differ from EMS response areas, local law enforcement boundaries may vary as to location, or helicopter and hospital capabilities may need to be addressed. Coordination is the key to a successful program. The CHP has a great procedures manual available at www.chp.ca.gov/pdf/manual.pdf.

HISTORY

Although there is some debate as to the origin of this program, it is reported the E15M program originated in Spokane, Washington,² 1990, under the direction of then Sergeant Mark Sterk of the Spokane (WA) Police Department (SPD). The traffic unit of SPD assisted Gonzaga Prep High School in producing a skit revolving around a traffic collision resulting from drunk driving. This is believed to have been the start of the E15M program. The first high school program was produced in 1991, funded by a grant from Safeco Insurance for the purchase of a sound system. The program continued, and many agencies came to see what was happening in Spokane.

Sterk was elected sheriff of Spokane County and continued to build the program. He named it “Every 15 Minutes,” which represented the approximate frequency of drunk-driving related deaths.³

It has been reported that Canada was performing a similar program to the north around the same time. After attending a Problem Oriented Police (POP) conference, the Chico (CA) Department hosted a program in January 1996.⁴ Reportedly, the Chico Police Department also played an integral role in strengthening the program. Again, since very little documentation of these events was formally recorded, the exact history has been difficult to establish. One aspect is very clearmany dedicated people have contributed and continue to contribute to this powerful program.

In 1997, the national Every 15 Minutes organization was formed. Dean Wilson of the Bethlehem Township (PA) Police Department is the training coordinator and has spent countless hours developing the program. “We want to further grow this [program] … it has come so far already over the years,” he explains. Wilson says that an online format will be available at www.every15minutes.com early this year to help coordinators administer their local program.⁵

In the years since, this interactive, preventive program has influenced numerous high school students, parents, and faculty. In 2005, the 16,885 alcohol-related crashes in the United States represent an average of one alcohol-related fatality every 31 minutes.⁶

DOES IT REALLY WORK?

Two studies are worth noting regarding the effectiveness of the E15M program. The first, from Springfield, Missouri, was published in the American Journal of Health Studies in 2000.⁷ It was based on the Greene County (MO) DWI Task Force, which presented the E15M program in 2000 for the third time to the 1,700-student Kickapoo High School. The Task Force wanted to determine the effectiveness of the program. The abstract reveals, through the use of a survey-based format, “The intervention program had a favorable impact on attitudes but not behavior. Survey and focus group data suggested there would be no sustained behavioral change without combining the intervention with stronger DWI law enforcement, community support, and educational programs.”

Another study, published in the California Journal of Health Promotion in 2003, had as its focus group 1,651 students from 81 California high schools who participated in the E15M program as the Living Dead. Data were collected in the form of pre- and post-incident surveys. Results suggested lasting program effects were congruent with other drinking- and driving-prevention programs. The following was noted: “However, one of the goals of the program is to prevent alcohol-related driving mishaps during prom and graduation months, so short-term intervention may be successful.”

Also, an indirect aspect emerged. “Parents whose children participated as Living Dead … were significantly different in their attitudes and behaviors about alcohol use among their children. Following their participation in the program, parents also reported being more likely to discuss drinking and driving, more prepared to control or prevent alcohol problems, and more confident that their teenager would not drink and drive.”⁸

THE FIRE DEPARTMENT’S ROLE

The fire department can play an integral role in the E15M program. As the fire department coordinator, your planning is critical. Depending on your local geographical area of 911 response, various forms of service delivery may be performed. If your fire department has ambulances and transports, continuity of care and coordination may assist in the logistics of the agencies involved.

As we in the fire service know, the plan is ever dynamic. Therefore, it is imperative to give chief officers as much advance notice as possible so that resources can be scheduled. Send, as needed, follow-up e-mails to ensure everyone is informed. Since different personnel or actors may fill certain positions because of promotion or vacation, multiple notifications ensure companies will be where they need to be at the proper time. The worst scenario is telling a firefighter on arrival at the firehouse to get ready to go do a “dog and pony” show in 10 minutes.

Also, consider alternative plans. For instance, the initial helicopter may not be able to attend because of a mission in progress. If a secondary agency has not filed a flight safety plan of the high school prior to the event, a “no go” will result. Weather may also disrupt flights, requiring additional ground ambulances. Programs usually continue as planned regardless of the weather.

The exact number of companies needed depends on your level of staffing and standard operating procedures. If participation will require overtime, chief officers may be less likely to permit full involvement. Generally, this program will need one engine company for patient care, one truck company for extrication, one engine company for LZ support, and one medic company for ground transport. A second medic unit may be needed if weather prevents the use of a helicopter. Although a battalion chief and a dispatcher add to the realism of the event, they are not necessary. The fire department coordinator can assume those roles if necessary.

The keys to the crash scene are choreography and safety. As the fire department coordinator, you are responsible for the crash scene, ensuring all students can see all action and that all action is timed appropriately. Remember, whatever happens was exactly what was supposed to happen. The audience will not know if you depart from the script slightly because of game-time difficulties, such as a delayed helicopter arrival.

In addition to extrication and transport, law enforcement will perform field sobriety tests on the DUI driver when planned. The officer, the DUI driver, and generally one firefighter are wired for microphones. Radio traffic can be transmitted over the public address system for the audience to hear. Occasionally, the paramedic radio report to the trauma center will be broadcast to the audience. It provides a chilling effect.

Safety is paramount! As fire department coordinator, you also assume the role of safety officer on-scene. From student participants to firefighters, everyone should be safe and injury-free at the end of the demonstration.

Don’t overlook basic principles such as using all appropriate personal protective equipment, including eye protection and full turnouts with gloves during extrication; appropriate crash scene and LZ isolation; and entrance/egress of apparatus, for which a traffic plan is highly desirable. Typically, “patient” extrication goes well if normal safety precautions are taken, such as covering the patient with a salvage cover and keeping a firefighter with the patient during cutting operations.

Videographers, usually students, will be present. It is easy for them to get tunnel vision when behind a camera; they must be accounted for at all times. Often, they will accompany the first-arriving company and the transporting medic to the hospital. However, the helicopter does not generally take the videographer because of weight restrictions. The fire department coordinator is responsible for the videographers’ safety.

A safety briefing for all crash scene participants is imperative. High school students want the program to be successful and will typically listen to your directions. Administrators and principals may be a problem; they must know that your word is final on all safety matters, including where they stand at the crash scene.

Your fire department’s involvement in this community event can be very rewarding and also serve as a training evolution for the incident command system (ICS), multiple casualty incident (MCI) protocols, EMS, and extrication tactics. Probationary firefighters can learn much from a simulated incident such as this one. Often, after the student body has exited the bleachers, fire companies can finish cutting up the vehicles before the towing companies arrive.

LESSONS LEARNED

Control access to the crash scene location and LZ, and keep them free of spectators, including civilian onlookers.
Crash scene participants should wear old clothing that can be cut. This includes at minimum long pants, closed-toed shoes, and appropriate undergarments.
Ensure camera crew members know where it is safe to film and where it is not. Make frequent eye contact with them during the incident if possible.
If the scene will include a partial ejection of a passenger through a windshield as in photo 3, the towing company is to cut the appropriate sized hole before delivering the vehicle and cover the edges of the hole with duct tape. Also ensure that the towing company double-checks the vehicle, making sure it is free of glass and other debris prior to delivery at the high school.
Preferably, use older model cars without air bags or complicated safety devices for easy extrication. Confirm that the towing company is bringing the vehicles specified. Using a more contemporary model could hamper extrication efforts.
After vehicles are positioned, photograph the scene with a digital camera to show fire companies during a pre-event briefing, so the captain can discuss possible operations with the company.
Demand to have in hand a photocopy of the helicopter flight crew’s filed flight plan to confirm that the helicopter has every intention of participating.
Confirm that radio communications with the helicopter on a nonemergency tactical channel are possible. Lack of interoperability can hinder operations. Generally, fire dispatch will not allow the use of emergency-designated tactical channels for a nonemergency community event.
Carry a cell phone, and have all attending agency representatives’ cell phone numbers in case there are last-minute information changes.
Preestablish a safety plan in case anyone should be injured during the “incident.” Create an incident action plan for the crime scene.
Do not use tarps or other ground covers, which the high school staff may want you to use to protect the field. They are trip hazards and can become airborne during helicopter operations.
No invasive support procedures are to be performed. Simulate IVs and airways. Do perform basic life support measures such as spinal immobilization, splinting, bandaging, and oxygen therapy.

Endnotes

1. Every 15 Minutes Web site, http://www.every15minutes.com/Mini-Grant%20Application%202007-2008%20Every%2015%20Minutes.pdf.

2. City of Santa Rosa, California Web site, http://ci.santa-rosa.ca.us/default.aspx?PageID=740.

3. Personal communiqué, Kim Thomas, Spokane (WA) Police Department, November 20, 2007.

4. http://www.csuchico.edu/chld/CD292/interns/e15min.html.

5. Personal communiqué, Dean Wilson, November 27, 2007.

6. Traffic Safety Facts, 2005 Data. National Highway Traffic Safety Administration Web site: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2005/810616.pdf.

7. American Journal of Health Studies Web site, http://ajhs.tamu.edu/16-4/hover.pdf.

8. California Journal of Health Promotion Web site: http://www.csuchico.edu/cjhp/1/3/01-06-bordin.pdf.

References

Every 15 Minutes Web site, http://www.every15minutes.com.

California Office of Traffic Safety Web site, http://www.ots.ca.gov/Grants/Program_Information/Case_Study_3.asp.

California Highway Patrol Web site, http://www.chp.ca.gov/programs/15min/.

National Highway Traffic Safety Administration Web site, http://www.nhtsa.dot.gov.

AARON DEAN has been a firefighter/paramedic for the Sacramento City (CA) Fire Department since 2001 and began his career as a volunteer firefighter in 1990. He has a master of science degree in emergency services administration from California State University-Long Beach and received his paramedic training from the Stanford Prehospital Care Program in 1994. He is the coordinator for the Every 15 Minutes program at Sacramento City Fire Department, which teaches high school students the consequences of drinking and driving.

Every 15 Minutes Duties and Checklist

Preplanning

Determine the number of students participating in crash scene. Usually, there should be at least a DUI driver, a DOA, a head injury/comatose patient, and a paraplegic patient.
Establish the time of day at which the crash occurs and what type of crash scenario it will be: head-on, rollover, T-bone, etc.
Obtain the schedule of events from the planning committee.
Make it clear to the planning committee that the fire department has the final say on scene specifics regarding safety. Do not compromise safety at any time!

Site Inspection

Determine the most appropriate locations for the the crash scene, the helicopter landing zone, and the audio setup, including AC power and a good visual aspect of the crash scene.
Ensure there is adequate entrance/egress to the crash scene and for all apparatus.
Ensure the safety of the entire scene, including the crash scene, the students, spectators, and fire and police personnel. Pay particular attention to the approach of apparatus, extrication, the landing zone, and video crew locations at all times.
Obtain towing company contact information (contact person and phone number) and discuss the vehicles involved (color, make, model, year) and possible safety issues with vehicles: air bags, “stuff” left in vehicle when towed to site, removal of broken glass in seats prior to placing students in vehicles, etc.

Company Assignments

Contact/e-mail fire department superiors for assignment of the following personnel and vehicles:

a battalion chief on location for the event;
a truck for extrication and two engines for patient care and LZ support;
an EMS unit for transport, possibly a second unit if weather prevents helicopter participation;
a medical evacuation helicopter; and
a dispatcher.
Remain in touch with the police department contact for up-to-date information.

One Week Before the Event

E-mail all members of all companies assigned program information specifics, including site-specific information, program details, and any necessary miscellaneous information. Identify the personnel projected to participate in the program.

The Day Before the Program

Follow up with the towing company to confirm:

the vehicles to be used,
that a hole has been cut in the passenger side of the vehicle’s windshield for the DOA patient and that the hole’s edges have been taped, and
the arrival time of the vehicles.

Confirm each participating fire department company’s attendance and time of arrival.

The Morning of the Event

Arrive at the site approximately three hours before the start of the program.
Position the vehicles on arrival of the towing company.
In the morning, obtain a tactical channel to use from the fire dispatch supervisor (usually D6). Call and confirm the helicopter’s availability. If unavailable because of logistics or weather, immediately request a second medic unit.
Meet with crash scene students to explain incident events/procedures.
Meet with audio/visual crewemphasize safety.
Get mic’d up, if needed.
Have a briefing with the fire companies and law enforcement arresting officers (bring doughnuts/snacks from the food committee to give to the companies during the briefing). Hold the briefing approximately 40 minutes prior to the time of the crash.
Get two handheld radios from a company for your use on-scene.
Remind the police department arresting officer to leave the audio microphone behind prior to departing for jail.

During the Event

If there is no dispatcher on-scene, you will become the dispatcher. Dispatch the “incident” and fill the role of fire dispatch or command as needed, using only the one tactical channel.

After the Event

Thank the participating companies.
Determine if the companies want to continue to train on extrication after the audience has cleared the bleachers.
Return mics to the audio crew.
Call Fire Dispatch and release the TAC channel.
Call the tow company and request that the vehicles be returned to the towing yard.