When I started my paramedic career, it was self-serving. I was told: “If you want a fire job, get your medic,” by a fire chief who I looked up to. Obviously, it worked for him. He was a paramedic and a fire chief; it must be the way things are done. Getting my certification was probably the hardest thing I had done at that point (later, having kids was a lot harder).
The underlying theme that got me through was the dreaded acronym. There was an acronym for everything, from taking pulses to performing a patient assessment, establishing altered mental status, and even performing a size-up. It got to the point that there were so many acronyms, we were losing sight of what the real issue was: identify the problem, assign resources, execute, and reassess. Pretty simple, right?
I eventually secured a job in the fire service and, like any other brand new firefighter, wanted to prove my worth. I hit the street with every acronym I could find, believing that this was the easiest and most modern way to mitigate a problem. It wasn’t until several years later that I attended a lecture on putting book knowledge and street experience together to form a clear and concise plan–and the ASPN acronym was born. I am sure there are 504 other people out there who came up with this concept and take credit for it, but I first heard about it as it pertains to emergency medical services (EMS).
ASPN Definition
In the beginning, I started applying it to all EMS calls. It was a direct path to get to the root of the problem. The more I started exploring the concept, the more I started applying the “technique,” and the easier stressful situations became.
ASPN can have many different meanings, but the one that works best for me is associated signs/pertinent negatives. It’s a linear thought process to get straight to the problem and only ask/address the appropriate questions. To put it even more simply, it is identifying the problem and not getting swayed by the less important details. The more experience you gain in your profession, the easier it is to apply this concept. Some examples follow.
- There is a wildland fire approaching your district. You identify the associated signs (wind, moisture, fuel load, topography, structures threatened) and establish pertinent negatives (structure triage already performed, extended forecast, recent fire activity) to form a clear and concise Incident Action Plan (IAP) that is very basic–assign resources based on the problem identified.
- You arrive on scene as an initial company officer to a structure fire in your first due. You determine any potential associated signs of a flow path (air intake, exhaust hole, smoke velocity) and establish some pertinent negatives (ventilation-limited fire, smoke characteristics, erratic fire behavior) to form an initial attack plan on your 360à‚º view of the structure. Again, you have more tools to form an IAP that you can follow and manage in a manner that is appropriate to the resources at hand.
- You arrive on scene as a battalion chief to a commercial fire with a potential rescue in progress. You determine a rescue profile using associated signs (survivable environment, adequate staffing, hazard mitigation in progress) and recognize any pertinent negatives (staffing, resources, fire under control, extraordinary fuel loads) to form a risk assessment to commit your resources.
Now it is much easier to apply this concept to every medical scenario out there. However, it is much harder to think of it as a communication piece.
Communication
So what does ASPN have to do with communication? And how do we apply this to training?
Well, that’s where we need to think at the level of oversight and not operations. From a communication standpoint, we are always looking for ways to make our communication techniques better, whether it is on the fireground, on the radio, in training, or in answering an e-mail. If we look deeper into conditions, actions, and needs report, we all want the same thing: to figure out what the problem is and how we can fix it.
As an incident commander, we can ask the right questions with a clear decision-making model to ascertain what needs to be done next. As a training officer, we can ask what we are doing right, what is holding us back, and how we can get buy in to execute. As a company officer, we can get to the root of the problem and not be distracted by the drama when dealing with the troops.
Training
So how does this apply to training? When thinking about training, most of us have an uphill battle. Change in anything is difficult for members to embrace. It is uncomfortable to perform something new in front of peers and potentially be deficient. This is where the training officer can take that pressure off. By standing in front of a team, the training officer can look for possible group shortcomings (associated signs) with regard to training, show potential mistakes, and “flail” a little to set the precedence that it is OK to not be the best. The same training officer can point out all the potential problems that can develop (pertinent negatives) from not drilling on something new or old.
This sounds like material we have all heard before, but by having some sort of acronym in your head to apply, difficult situations become a lot easier–especially when the pressure is on.
