By Steve Shupert
Published Saturday, June 2, 2012
Situational awareness (SA) is a lot like the weather: People talk about it a lot, but many people don’t prepare for it properly. We forget or forego things like sunscreen, umbrellas, hats or gloves because we’re in a hurry or because we’re not really convinced that we’ll need them.
The same can be said for our reaction to SA. Some people forget about it on the fireground at times because they think there are more pressing issues at hand, or they don’t think it’s important. However, the fire service has loads of data on how, when and where we get hurt. And many times, properly managed SA could have made a difference.
But how do we develop SA? How do we craft the technique? An even simpler question: What does “situational awareness” really mean? Is it something we can turn on and off? A lot of smart people keep telling us that we need to have it, and that we’ll function more efficiently on the fireground if we use it.
My crew and I have tried to make SA something we work into every call, so in this article, I’ll explain some workplace practices that my engine/medic company has adopted to make SA part of our everyday approach to incidents. What follows is centered on the company officer’s (CO’s) role on the fireground. These practices are built around a “normal” medic with engine assist responding first-due to “bread and butter” residential fires.
Why Do We Need SA?
To help understand why SA is so important, consider some fire/EMS statistics. NIOSH identifies five leading casual factors related to firefighter deaths:
- Improper risk assessment (poor size-up)
- Lack of incident command
- Lack of accountability
- Inadequate communications
- Lack of SOGs or failure to follow SOGs
The National Firefighter Near Miss Reporting System, using data obtained through the “Human Factors Analysis Classification System,” or HFACS, lists their top three reasons for accident/injury as:
- Lack of situational awareness
- Human error
- Poor decision-making
(Note: Wikipedia describes HFACS as a system that “identifies the human causes of an accident and provides a tool to assist in the investigation process and target training and prevention efforts.” It tries to identify active errors and latent failures, including unsafe acts, preconditions for unsafe acts, unsafe supervision and organizational influences.)
Further, according to data collected by the Department of Labor’s Census of Fatal Occupational Injuries, 1992 to 1997, and the National EMS Memorial Service, 1992 to 1997, EMS units are more than twice as likely as fire apparatus to be involved in transportation accidents while en route to a call; medic personnel are seven times more likely to suffer a back injury with time loss; the EMS assault fatality rate is seven times higher than other healthcare workers, and the non‐fatal assault rate is 22 times higher than the national average.
Although their data may prove it in different ways, four highly respected institutions are telling us that we’re getting hurt/killed because, many times, we fail to recognize where we are and what’s going on around us. We fail to develop and/or maintain a plan to mitigate events that, when you think about it, have a fairly narrow scope of difficulty or challenge.
Applying SA: An EMS Example
SA starts before a call comes in, and much earlier than the moment the engine rolls out. When the apparatus does leave the station, the CO is responsible for getting everyone there quickly and safely. The engine is also the biggest, noisiest thing going down the road, so it has the capability to clear intersections and cut a safer path for the medic.
En route, the CO reads a map, and the medic follows the engine and assembles a care plan based on dispatch information. As the engine approaches the address, it slows and pulls past the residence. The CO observes three sides and the roof of a residential structure. The engine is positioned as though it will need to stretch a hand line. This is an easy and convenient way to practice a couple of important fireground skills, such as size- up and fire apparatus positioning, while working a medic call, and it leaves the front of the structure open for the medic to help facilitate patient movement.
As the CO performs their size-up, they look for unusual circumstances that may indicate an unsafe scene: signs of dogs present, poorly lit areas, etc. All crewmembers also remain alert for any hazards as the medics make patient contact. Tip: To alert members to a potential threat, develop a simple, easy-to-remember phrase that can be used by any member of the crew and that can be said naturally, without raising suspicion. We use “Does anyone have an ink pen?”
The engine crew brings the cot and anything else the medics ask for. The CO watches over operations on the inside of the house. So while the medics are assessing the patient, the CO is watching everything else, making sure egress is not blocked and anticipating what-if scenarios.
The engine crew handles patient movement to the medic unit and pitches in with the medics’ patient care plan as needed. The CO monitors patient care quality assurance (QA). Both units clear the scene.
Two Key Elements: AOR & QA
During the above call, the CO performed a size-up, supervised the crews and acted as a safety officer. In short, they were responsible for the overall scene, but in our department, each member of the teams has an area of responsibility (AOR), and each member must know their AOR, as well as the AORs of everyone else responding to the scene. That way, if someone falls out of position, another team member can fill in for them. For example, if the CO gets stopped by a neighbor while walking into the house, the engine driver/officer can take their place and serve as the safety officer until the CO relieves them.
In addition to establishing AORs, we’ve built SA into our standard response through the use of QA. The CO is responsible for getting everyone on scene, as well as getting everyone out, and that includes overseeing patient care. The CO must own these actions and balance this responsibility with allowing all members to own their actions within their AOR.
Important: In order for AORs and QA to be successful, all team members must be briefed on the expectations at the scene and how AORs, QA and SA all fit together. Some of the benefits we’ve achieved by using these strategies include shorter scene times, more timely and proper patient interventions, fewer injuries during patient movement and a greater sense of teamwork and accomplishment. We move in a deliberate, measured fashion during size-up, assessment, treatment and transport, which allows us to be better prepared for the next call in a shorter timeframe.
SA During a Structure Fire
For structure fire responses, our department uses pre-incident assignments, or seating assignments, for which each firefighter is assigned a tool and an AOR. Like EMS calls, the AORs need to be flexible, because we must able to adapt to dynamic situations. We expect the seating assignments to last for the first five minutes of a fire, which as we all know, can be the make or break the rest of our response.
As an engine company in our first-due, we get a line down and make access to the fire. The pre-incident assignments support this goal. And just as with EMS calls, every team member must know their AOR and everyone else’s to maintain scene flexibility.
An example: Our engine arrived on the scene of a structure fire right behind the ladder truck, with light smoke showing and report of an entrapped person. As the truck forced the front door, a line was stretched to the fire. Due to the narrow entryway, the truck officer found himself on the outside helping to push the hose in. Because the person who watches the door wasn’t there (they were pulled out to help establish the supply line), the officer knew this critical task still needed to be done, so he picked it up, and another team member picked up his duties on the inside. This helped keep the entire operation moving forward. (See “From Size-Up to Extinguishment: A refresher on organizing and executing the fire attack,” July 2009 issue, for more details on fire pre-incident seating assignments.)
For my department, the engine crew seating assignments and their tools are as follows:
- Officer: Striking tool/thermal imaging camera
- Engine operator
- Nozzle firefighter: Attack line
- Door firefighter: Hook and Halligan bar
During a structure fire, the officer must be aware that their actions and decisions should be coordinated with other fireground activities, such as ventilation and search/rescue. Always be prepared to force entry and check for heat.
Statistics from the USFA suggest that most fireground injuries occur during the stretch of the first attack line. The CO is in the best position to limit these injuries by knowing the district and building, and having a well-trained crew.
The “nozzle” pulls the hoseline off the engine and carries it into the burning building, flaking it off as needed. Tip: In the morning, make sure the nozzle is working and if it’s adjustable, set it to straight stream.
This is the most vital position of the hose advancing team. The “door” has available hands to ensure a smooth advance of the hose. They help the officer with forcible entry, clear all hose kinks and make sure that the hose advances freely around obstacles. When positioned further back on the line, they can also observe the fire/smoke conditions.
If the line doesn’t get charged, nothing else will matter. It is the engine operator’s job to make sure that the hose clears the hose tray and to anticipate when to send the water, or for the officer to call for it. Setting the proper engine pressure depends on nozzle type, hose diameter/length, desired gpm and elevation. Depending on order of arrival, the engine operator will support attack lines, secure a hydrant/water supply and perform other exterior assignments.
According to Wikipedia, SA “involves being aware of what is happening in the vicinity to understand how information, events and one’s own actions will impact goals and objectives, both immediately and in the near future. Lacking or inadequate situation awareness has been identified as one of the primary factors in accidents attributed to human error. Thus, situation awareness is especially important in work domains where the information flow can be quite high and poor decisions may lead to serious consequences.”
However you wish to word it or apply it, SA is something we could all use more of, given our line of work. Our world, and therefore our job, is becoming more and more complex with the advent of new technology, WMDs, new construction materials, etc. In a fast-paced environment, such as a structure fire or motor vehicle collision, where firefighters must remain alert with, at times, little sleep, developing a way for SA to become part of your everyday routine will not only help keep firefighters safe, it will also make operations more efficient and make for a better performing department overall.
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