We Only Need One ICS

I came across an article yesterday posted on EMS1/AMU’s blog about EMS adopting an incident command system.  It’s an article that leaves me with a lot of questions.

I want to examine some individual statements within the article.

  1. “Many EMS providers lack training and awareness about implementing an incident command structure.”

 

This is 100% true, but I’ll also expand this statement across much of public safety and emergency management.  Aside from well-experienced practitioners of ICS, which there are relatively few compared to the greater public safety/EM community, most simply aren’t equipped to implement a significant incident management system.  The biggest reason is that ICS training sucks.

 

  1. “EMS organizations have only recently recognized the value and need for such a command structure as part of their response strategy.”

 

I would suggest that this is partly true, but in many parts of the nation, requirements and standards have been established by way of executive order, state and regional EMS protocols, and other means for EMS to use ICS.  Many of these have been in place since the 90s, before HSPD-5 and NIMS requirements, but certainly with the emergence of NIMS in 2003, this has largely been a standard of practice for EMS, if not a requirement in many places (and under specific circumstances, such as required through OSHA 1910.120).  While I understand that ‘standards’ and ‘requirements’ don’t necessary define value, they essentially dictate a need.

 

  1. There was a recognition that “EMS providers were having difficulty applying fireground incident command practices to EMS calls.”

 

While I agree with what I think is the spirit and intent of this statement and bring this back to my comments on item 1 above, I’m still cringing at the ‘fireground incident command’ phrase in this statement.  ICS isn’t just for the fireground. While it may have been born in wildfires, that was decades ago.  We are now officially in 2019 and should be well past this concept that ICS is only for the fireground.  Even if we disregard, for the sake of discussion, the requirements for all responders to use ICS, such as those in OSHA 1910.120, which predate NIMS, HSPD-5 was signed almost 17 years ago!  Nothing in HSPD-5 or the original NIMS document elude to the current implementations of ICS being a fireground system.  It was to be applied to all responders.

 

  1. “During a response, providers did not establish a formal command structure”

 

Totally true.  This applies, however, not just to EMS, but to most of public safety.  See my comment for item 1.

 

  1. “In 2012… they began to research various fire and EMS command models that were scalable and practical for all types of critical EMS calls.”

 

I’m not sure why there is a need to look past NIMS ICS.  Perhaps we are stepping back to my comment on item 1 again, but if you understand the system, you can make it work for you.

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It is absolutely not my intent to throw negativity on the author or the people who spearheaded the implementation of an EMS-specific ICS as cited in this article.  They clearly identified what they perceived to be a need and tried to address it.  I give them credit for that.  It should be seen, though, that they identified many of the same needs that ICS was developed to address in the first place.  They then created a system (which has many of the same qualities of ICS) that is focused on EMS needs during an incident.  The issue here is bigger than this article, and certainly more endemic.  Unfortunately, the article doesn’t really provide much detail on their ‘provider in command’ model, but what they describe can all be accomplished through NIMS ICS if properly utilized.  They even identify objectives of their model, which are really just pre-identified incident objectives.  They certainly don’t require a different model.  I think, however, what they largely accomplished was an audience-specific training program to show how elements of ICS can be implemented.  I just don’t think they needed to change the model, which is what the article seems to indicate.

Sadly, trying to make customized adaptations of ICS is nothing new.  For years, some elements of the fire service have dug in with certain models which are fire-ground centric.  Other disciplines have dome similar things.  It’s worth mentioning that FEMA had developed a number of discipline-specific ICS courses, such as ICS for Public Works or ICS for Healthcare.  While the intent of these courses is to provide context and examples which are discipline-specific (which is a good practice) rather than new models specific to these disciplines, I think that has inadvertently given some the impression that there are different systems for different disciplines.  ICS is ICS.

Once again, I put the blame on poor training curriculum.  When a system is developed and proven to work under a wide variety of circumstances and for a wide variety of users, yet users keep feeling a need to develop adaptations for themselves, this is not a failure of the system or even the users, it’s a failure of the training.

There are facets of public safety and emergency management that are generally not using ICS as well or as often as they should.  EMS is one of them.  As an active EMT for over a decade (including time as a chief officer), I can attest that (in general) ICS training for EMTs is abysmal.  The text books tend to skim over the pillars of ICS and focus on the operational functions of triage, treatment, and transport.  While these are important (for a mass casualty incident… not really for anything else), they fail not only in adequately TEACHING the fundamental principles of ICS (which can and should be used on a regular basis), but they fall well short of actually conveying how to IMPLEMENT ICS.  Further, much of the training provided includes a concept of ‘EMS Command’, which is opposed to what is in ICS doctrine.  We shouldn’t be encouraging separate commands and ICS structures at the tactical level of the same incident.

A few years ago I had started a crusade of sorts to get a better ICS curriculum developed.  There was a lot of support for this concept across the public safety and EM community, not only in the US but other nations as well.  Perhaps with the coming of the new year that effort needs to be reinvigorated?

© 2019 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC

EMS is in Trouble

If you’ve worked in or with Emergency Medical Services (EMS) over the past couple of decades, you probably know it’s in trouble in many areas around the nation.  As with many organizations, finances are the culprit.  Many EMS organizations simply can’t make ends meet.  Costs for equipment, insurance, fuel, training, and facilities often can’t be balanced in the black against recovered income.  It’s not to say it can’t be done – some are doing it, and successfully.  But many are having a difficult time.  Staffing is another problem.  Volunteer services must constantly recruit and work to retain staff.  Volunteer fire services are experiencing similar recruitment and retention problems.  Even with diligent efforts, day time coverage in some areas is a challenge while many of these volunteers are working at their primary jobs.  Paid services struggle with staffing as well.  It’s no mystery that EMTs and Paramedics don’t get into this business to make good money.  According to a study posted by Monster, the highest paid states provide pay in the $20-$35/hour range, but it slides quickly, with not only the lowest paying states paying in the teens, but the average also sitting in the teens.  Yep, you could be out saving lives and someone working at McDonald’s makes more money than you do.  It’s a rather depressing valuation.

When you couple these two big factors – volunteer staffing and finances – it gets even more difficult.  Paid and volunteer services alike are kicking calls over to mutual aid providers because of being short staffed, which means they miss revenue, which continues to make matters worse.  Many volunteer EMS services, as well as volunteer fire services, are hiring day-shift staff so they can continue to meet needs in their communities during these more difficult timeframes.  For those of you keeping score at home, that’s more cash out.  It might pay off for a busier provider, but certainly not for a provider whose call volume doesn’t balance the checkbook.  Yes, it continues to provide a service to the community, but it’s not sustainable in the long run.

How are the private paid services doing?  Many aren’t doing so well, either.  We see service areas shrinking all around the nation, with paid services seeing diminishing revenues from less dense population areas.  Quite a few paid services make ends meet from interfacility transfers, which are low cost but require volume to make reasonable revenue.

Municipal services are another category which generally have a poor income statement.  I think it’s great that some municipalities provide EMS transport services.  Financially, these services are underwritten by tax payers, with some cost recovery possible through billing insurance companies.  The costs of most municipal services, however, are generally higher, as EMTs and paramedics are government employees, often unionized, and with benefits.  It’s great for them, but not good for the municipal comptroller.  That said, it’s one of the most sustainable models since the underlying financing is spread across all the jurisdiction’s tax payers.  Still a challenge, though, when you consider the tough financial constraints many jurisdictions are facing.

So what’s to be done?  We will eventually need to see a shift in how EMS is provided across the nation.  It is an absolutely necessary service, just as important as roads, fire protection, or law enforcement.  While we won’t see a sudden change, I believe the way forward will be municipal services, or municipally-funded services (those being private or volunteer, but under contract with one or more municipalities).  EMS, similar to other disciplines in public safety, is a public service, and foundationally will need to be publicly funded in order to sustain.  This is nothing new, as there are a number of EMS providers already following this model – that being the maintenance of a contract with one or more municipalities to provide EMS services, for a fee, while also gaining revenue from third party billing, as well as fees for stand-by services for sporting events and other mass gatherings.

What trends do you see in EMS organizational models where you are?  Are the current models sustainable?  Do you view EMS as a public safety endeavor similar to law enforcement and the fire service?

© 2016 – Timothy M. Riecker, CEDP

Emergency Preparedness Solutions, LLCYour Partner in Preparedness

 

 

Kansas City Changing the Paradigm In Shooter Responses

Despite some discussions going back to late last year about changing they way we respond to mass shootings, I’ve not heard of any major municipalities actually make these changes – until now.  Responders in Kansas City, MO (KCM) have exercised their new plan regarding early insertion of EMS personnel into an active shooter scenario.  The exercise appears to be very early stage, using it as a learning experience from which to further develop plans.  (another great use of exercises!)

I commented on the discussed changes back in January and I still have the same concerns today that I did then.  I had posted some discussion threads similar to my blog post onto LinkedIn discussion boards which prompted some very spirited discussion.  Most people agreed that getting EMS into an active shooter area early can save lives, but it needs to be done the right way.  KCM seems to be going in the right direction by developing plans and protocols jointly with law enforcement and working out the kinks and questions via drills and other exercises.  Carrying the preparedness cycle further, I’m sure they will work toward training and equipping EMTs appropriately for such a situation.  Constant practice of these protocols by all parties will be very important.  Responder safety needs to be the utmost concern.  While there have been incidents to the contrary, we as responders and we as a society are not used to EMTs and firefighters being shot at, much less killed in action by an aggressor.  Certainly the first EMT fatality in an incident such with an early insertion protocol will result in the protocol being aggressively questioned – as it should.  I just hope that those doing the questioning keep the appropriate context.

Just as there is no easy answer on how to stop mass shootings, there are no easy answers on how best to respond to them.  I’m hoping KCM is willing to share their worked out plan and protocols with the responder community so we can learn from them.  Such sharing will be very important to the evolution of responses to these types of incidents.

© 2014 Timothy Riecker

EMS Under Fire?

First off, I’d like to give a greeting to all of you.  I’ve been absent from blogging for quite a few months now.  I spent much of last year working in New Jersey as part of a team managing waterway debris removal as the result of Hurricane Sandy.  It was a great experience and often challenging – but I had an opportunity to work with some outstanding people and do some good for the people of New Jersey.  I’m sure in future posts I’ll reflect on some lessons learned from that assignment. 

Since my return I’ve been spending time with family and getting my own business back up and running.  I’ve also re-started the pursuit of my graduate degree.  With all the writing I’ve been doing, I’ve found it challenging to get back into blogging, but have thought about it often.

Earlier this evening I had some inspiration in reading the most recent (January/February 2014) edition of Emergency Management Magazine, in which Jim McKay’s Point of View article (which I could not locate online) spoke about ‘Medics entering the warm zone’ during mass shootings.  This is a topic I’ve had some mixed feelings over for the last couple of months. 

While I understand the urgency to enter the area and save lives – which is the main goal of public safety – we’ve always been taught to do so SAFELY.  This new concept of EMS personnel entering a non-secure active shooter environment is in serious conflict with what we’ve been taught about responder safety.  Are we being too hasty? 

Most times I’ve seen this new concept referenced, it is noted that the medics are outfitted with ballistic vests and helmets and escorted by law enforcement.  A great idea – but is this equipment being made readily available to EMS?  Not to the folks I’ve been speaking to.  Most law enforcement don’t regularly travel with riot gear, aside from their ballistic vests which they usually wear when on duty.  Additionally, are there law enforcement resources available to escort medics so early on in a mass shooting incident?  Often times not.  It seems this concept is not well thought out. 

What about training?  Tactical medic classes have been available for the last few decades, but most medics are not trained as such.  I’ve heard of no movement in EMS training to include information on how to make entry into an unsecured shooting incident, or in law enforcement training regarding providing escort duty to unarmed EMS personnel.  In fact one of the only ‘doctrinal’ references comes from the US Fire Administration, although it doesn’t provide much information.  This entire concept, to be effective, efficient, and safe needs to be prepared for – planning, training, and exercises. 

I’m not alone among my EMS colleagues having experienced looking down the barrel of a shotgun when responding to a call.  It must be considered that responding to an active shooter is NOT that.  It’s much more serious.  I understand that this idea can save lives – but what happens when the first medic loses their life after making entry?  Let’s start with that thought in crafting this new approach.  A dead responder can’t save any lives.