Historical Foundations of Fire and Emergency Services PDF

CHAPTER 1 Historical Foundations of Fire and Emergency Services LEARNING OBJECTIVES After studying this chapter, the student will be...

CHAPTER 1 Historical Foundations of Fire and Emergency Services LEARNING OBJECTIVES After studying this chapter, the student will be able to: ∎ Understand the history of fire and emergency services (FES) and its impact o contemporary organizations (p 3). ∎ Examine the effect that the insurance industry has had on building and fire preventio codes (p 4). ∎ Examine the influence of the National Fire Protection Association (NFPA) on the fire servic (p 5). ∎ Explore federal involvement in regulation and funding of state and local FES (pp 6–10). ∎ Examine challenges in FES (pp 10–12). ∎ Examine progressive trends in FES (pp 12). Case Study Slow Progress in Fire and Emergency Services In 1994, a state fire marshal was in the process of reviewing plans for a new casino ship that would dock in his state and sail on the Mississippi River when he decided to make inquiries to find out if there was a fire safety standard that covered casino ships. He found that the NFPA did not have a standard at that time (subsequently, at the request of the U.S. Coast Guard, the NFPA did create a fire safety standard for these ships). The fire marshal then noticed that the permit applicant was the previous owner of the Beverly Hills Supper Club in Southgate, Kentucky. This nightclub was the location of a tragic fire in 1977 that took the lives of 165 victims. The marshal asked himself how this person, who was at least partially responsible for many fire deaths, could be allowed to own and operate a ship that needed to be safe enough to protect the lives of thousands. As he began to think about this situation, he remembered a more recent tragic fire that occurred. In 1991, a fire broke out at a meat processing plant in Hamlet, North Carolina; the fire claimed the lives of 25 workers. The owner was convicted of 25 counts of manslaughter, lost all his wealth in civil court action, and spent many years in prison. This sentence was in sharp contrast to the consequences encountered by the owner of the Beverly Hills Supper Club some 14 years prior. As this case exemplifies, there has been a great deal of progress in the FES, but because it is relatively slow and not always obvious to the casual observer, some might believe that these tradition-based services are unaffected by change. This is not true; the following examples demonstrate relatively recent progressive changes in the FES: ∎ Smoke alarms ∎ Seat belts and air bags ∎ Hurricane- and earthquake-resistant construction ∎ Paramedic services ∎ Professional firefighter and officer competency standards ∎ Federal grants for FES ∎ Compressed air foam ∎ National standards for emergency medical training and certification ∎ Higher education opportunities ∎ United States Fire Administration (USFA) and the National Fire Academy ∎ National incident management system ∎ Residential fire sprinklers ∎ Safety standards for firefighters and fire suppression operations ∎ Defibrillators  ∎ Federal support for disaster mitigation ∎ NFPA standard for the deployment and staffing of fire companies ∎ Thermal imaging cameras ∎ Hydraulic rescue tools ∎ National focus of emergency response to major disaster events ∎ Chem-bio detectors Discussion Questions 1. Identify and list three examples of progress for the U.S. Wildfire problem. 2. Name Issues with future progress hampered by lack of nationwide standards or regulations (for example: Occupational Health and Safety Administration [OSHA], emergency medical service professionals, NFPA, or insurance industry). 3. Identify and list protocols or techniques in need of progress for contagious diseases. Prologue to the Future FES administrators should always be thinking about the future and looking ahead. However, it is important to begin with a basic understanding of how we arrived at where we are today. Like any journey, you need to know where the trip began and where you are at present to plan the route to the future, including all the points along the way. The history of a profession is important because it explains many current policies and points to issues that remain unresolved. By examining the history of FES specifically, you can gain insight into the foundation of these organizations, avoid mistakes, and identify what worked in the past to serve as a guide toward a brighter future. Ultimately, your role in leadership, administration, and management can be enhanced with knowledge of the history and current status of the FES profession. Local Beginnings The first fire protection service on record in North America started in 1648 in the town of New Amsterdam, now part of New York City. Like other early fire departments that soon followed, it was an all- volunteer organization. However, it was not long before the public began to demand fire safety codes and paid fire departments to combat the massive fires that struck many large cities across the United States as a result of combustible construction and careless fire safety behaviors. In 1853, the nation’s oldest fully paid fire department was organized in Cincinnati, Ohio FIGURE 1-1. FIGURE 1-1 Early American firefighters. © Alpha Historica/Alamy Stock Photo. As demand for fire protection grew, other towns and cities developed their own independent fire departments. However, the need for communication and standardization across departments soon became clear. When a large conflagration consumed Baltimore in 1904, the mayor called on fire departments in Washington, DC, Philadelphia, and New York to assist. These agencies responded but were dismayed to find that their hose couplings would not fit the Baltimore fire hydrants, and the city continued to burn. These local origins also explain why there are now more than 29,000 fire departments across the United States. Most of these departments protect a population of fewer than 2,500 citizens, and only 16 departments protect more than one million people each (Evarts & Stein, 2020). Interestingly, the largest department—New York City Fire Department—is actually a consolidation of five counties (New York City is made up of five boroughs, each of which is also a county in New York State.) Emergency medical response also started out on a small scale. The first prehospital medical response system on record served with Napoleon’s army in 1797. This system was designed to triage and transport the injured from the battle field to aid stations. More modern field care and transport began after the first year of the Civil War. Civilian ambulance services in the United States began transporting patients to hospitals in Cincinnati in 1865 and in New York City in 1869. Later, funeral home hearses, which often doubled as ambulances, were eventually replaced by fire department, municipal, and private ambulances FIGURE 1-2. FIGURE 1-2 Vintage Ambulance 1934. At the beginning of EMS, patients were just transported to hospitals without emergency medical treatment. © Margo Harrison/ShutterStock. National Development Efforts Development of the Modern Fire Service As of 2017, the United States had an estimated 29,819 fire departments. Because there are relatively few federal regulations for fire services in the United States, there could be 29,819 different ways to provide public fire protection. For example, NFPA Fire Service standards are voluntary unless adopted as law by a government. And for FES, they are written more as an outline and do not have specific educational, training, or testing criteria. Volunteer firefighters staff most of the U.S. fire departments, about 65%, and serve primarily small populations of 2,500 or less. Presently, all-paid or mostly paid departments protect 69% of the U.S. population, all-volunteer departments protect 19.0%, and the rest are protected by combination departments (Evarts and Stein, 2020). Even with the lack of federal regulation, the equipment and procedures of these departments are relatively uniform because of past initiatives, primarily the Insurance Service Office (ISO) Grading Schedule. Insurance Service Office Most of the uniformity among fire service practices and equipment that exists today is a direct result of the ISO Grading Schedule for Municipal Fire Protection (ISO, 2012). This document was created in the early 1900s by the National Board of Fire Underwriters, an organization whose members come from the insurance industry. The effort was undertaken after several insurance providers went bankrupt trying to pay claims from citywide fires that resulted in financial panic in the insurance industry. The insurance industry wisely realized that it needed to encourage fire departments to prepare for large-scale fires by giving them the ability to provide mutual aid to other fire departments that could not handle major fires on their own. The grading schedule surveyed public fire protection departments in urban centers throughout the United States and aimed to create uniformity. This generally resulted in increases in the number of fire stations and staffing of fire companies. Municipalities that did not adopt the ISO’s recommendations faced the prospect of higher insurance costs. As a result of improvements in public fire services, lower insurance rates primarily benefited commercial properties. For example, Highly Protected Risk buildings have their own insurance rates that are lower than the general class rates. These properties are primarily those protected by engineered automatic supervised sprinkler systems and are found in buildings owned by large corporations. Today, municipalities are graded with a numerical rating from Class 1 to 10, with 1 being the best rating. A community that has a Class 1 rating has lower insurance premiums than a community with a higher rating. Many fire chiefs (administrators) have justified budgetary increases for items recommended by the ISO to improve a community’s rating, thus lowering insurance costs. Unfortunately, this national standardization initiative has not been accepted completely by all departments because the numerous ratings have several levels of compliance. Some fire officials and municipal administrators have been openly critical of the grading schedule. To receive a high rating, a fire department has to invest heavily in many fire companies, including increased staffing levels. However, as the probability of large-scale fires has decreased, public officials have questioned the need for large crews (up to six firefighters per company) and close spacing for fire stations (sometimes as close as three-quarters of a mile apart). In addition, there have been complaints regarding the relevancy of the grading schedule. For example, in June 2007, a tragic fire in Charleston, South Carolina resulted in the death of nine firefighters. At the time, Charleston Fire Department was one of 38 departments in the country with an ISO Class 1 rating. In a December 2008 article in Fire Chief magazine, Charles Jennings, Ph.D., MIFireE, CFO commented: “Numerous studies have questioned whether compliance with the [ISO Grading] schedule is correlated with better fire services or lower losses. In the wake of the deaths in the Class 1 Charleston (SC) Fire Department, an embarrassed insurance industry trotted out proposed revisions to the schedule, which hasn’t been updated since 1980” (Jennings, 2008). Some of the potential revisions include increased reference to NFPA standards, additional emphasis on firefighter safety and training, and credit for adoption and enforcement of model building and fire prevention codes. Still, although complaints regarding the validity of this grading scale may be well-founded, it has helped fire departments from different areas fight fires together, and many departments rely on the grading schedule to justify and plan improvements to their departments. Commission on Fire Accreditation International As an alternative to ISO for planning, the International Association of Fire Chiefs (IAFC) and the International City/County Management Association have created a new accreditation program for fire and emergency rescue agencies. The Commission on Fire Accreditation International self-assessment process can be used to measure fire department capabilities, response times, and compliance with nationally recognized standards. Some criticism about this process indicates that departments receive accreditation even though they do not meet all of NFPA standards, especially staffing and response time criteria. As of August 2018, 247 fire departments have been accredited. The program is a comprehensive self-analysis of each agency’s ability to provide professional FES to the public. A committee of public fire protection experts appointed by the IAFC and International City/County Management Association evaluates the competencies using professional standards as guidelines. Although this effort is a step in the right direction, stricter requirements are still needed for accreditation and compliance with standards on firefighter safety, deployment, and staffing.  Facts and Figures Subzone Rating Factors When State Farm insurance company abandoned the ISO grading schedule in 2001 for homeowner’s single family dwellings insurance rates, it was uncertain what budgetary planning tool would be used as a replacement for funding local fire departments. State Farm changed to a system that determines insurance rates based solely on the loss experience in subzone rating factors. These factors include fire, wind, hail, water damage, theft, and liability. (This is the primary statistical tool U.S. state regulator agencies use to set insurance premiums.) For example, if the company pays out $20 million during a year, it wants to charge rates that recover the payouts along with a percentage profit. This loss data is collected at the state level since each state regulates insurance independently. State Farm has said that 70% of claims paid under its homeowner’s program are nonfire losses, although it has not produced hard data to support this claim. Therefore, in most jurisdictions across the country a better ISO rating will not provide lower insurance premiums for homeowners. Again, only commercial buildings not protected by automatic sprinklers receive the substantial benefit. National Fire Protection Association In the early 1900s, national and regional building and fire codes were developed in response to the loss of life and property occurring because of catastrophic fires plaguing many U.S. cities. The NFPA, which was formed in 1896 by insurance companies, was and still is the leader in national consensus fire, safety, and electrical codes. The first NFPA standard addressed uniform automatic fire sprinkler installation. Around 1913, in response to several fatal fires, the NFPA added a standard for Safety to Life in an effort to prevent fire- related deaths. To this day, NFPA continues to create, update, and adopt codes and standards using a consensus method from committees that represent the fire protection community and the general public. The NFPA uses subject matter experts, including local, state, and national officials and public input to create consensus standards for firefighter training and education, equipment, and emergency operations with an emphasis on safety and efficient emergency service. These standards are updated on a schedule of every 3‒5 years. The last step in approving a code or standard is a vote of its membership at a national meeting of NFPA. In addition, there is an appeal process to correct or add any justifiable changes. For a full explanation of this process, the NFPA provides a comprehensive description in detail at its web page (? https://www.nfpa.org/Codes-and-Standards/Standards-development- process/How-the-process-works). Anyone can participate, including the general public, either by attending the committee meetings in person or submitting in writing proposals and comments. America Burning Report In 1968, the Fire Research and Safety Act was created. This Act, which established the National Commission on Fire Prevention and Control, stated, “The [U.S.] Congress finds and declares that the growing problem of the loss of life and property from fire is a matter of grave national concern” (USFA, 1973). In 1973, the national effort to professionalize the fire service started with the Commission’s America Burning Report. The report influenced the development of several NFPA standards for training, safety, and professional qualifications of fire service members and hazardous materials response personnel. In total, the Commission formally listed 90 recommendations, including: Establish a national fire data system. Increase the research and medical facilities for burn treatment. Make fire prevention at least equal to suppression in planning priorities.  Use women for fire service duties. Increase the use of automatic aid. Recognize advanced and specialized education in hiring and promotions. Provide federal financial help for planning, training, equipment, research, and fire safety education. Provide ambulance, paramedical, and rescue services where they are not provided by other agencies. Create the USFA and the National Fire Academy. Enforce adequate building and fire prevention codes. Require smoke alarms to protect sleeping areas and automatic extinguishing systems for high-rise buildings. Implement fire safety education in schools throughout the school year. Annually inspect homes for fire safety. Develop technology for automatic extinguishing systems for all kinds of dwellings, including single family. Even though many of its recommendations have not been fully implemented, the report has been the basis for many of the changes in progressive FES organizations and continues to influence the modern fire service. Because of its continued relevance, the USFA updated and reprinted the report in 1989. Development of Modern Emergency Medical Services Modern emergency medical services (EMS) started with the 1966 publication of the paper Accidental Death and Disability: The Neglected Disease of Modern Society, by the National Academy of Sciences’ National Research Council (National Academy of Sciences, 1966). This document pointed out an injury epidemic that was the leading cause of death among persons between the ages of 1 and 37, and served as a blueprint for a national effort to improve emergency medical care. These deaths were primarily the result of motor vehicle and work accidents that were the incentive for U.S. OSHA and the U.S. Department of Transportation (DOT) National Safety Act. The report revealed that many ambulances and emergency medical treatment facilities were inappropriately designed, ill- equipped, and staffed with inadequately trained personnel. When the Highway Safety Act of 1966 established the Emergency Medical Services Program in the DOT, the DOT was given the authority to improve EMS through program implementation and development of standards for provider training FIGURE 1-3. States were required to develop regional EMS systems, and some of the costs of these systems were funded by the National Highway Traffic Safety Administration (NHTSA).  FIGURE 1-3 Paramedics in action. © Rawpixel.com/ShutterStock. Through this federal agency, funding became available for training, equipment, and planning. At about the same time, a number of military medics were returning from the Vietnam War. They had experience with specialized emergency medical training, organization, and equipment that had never before been seen in any other military operation. These medics brought that experience, which included the use of medical air transport for rapid evacuation, to the field of prehospital care. In addition, the war provided opportunity for trauma research, more effective tourniquets, chest seals, and bandages with clotting material. Even synthetic blood and intravenous solutions that can carry oxygen have now been field tested because of war experience. Prehospital care has benefitted from this improved equipment and the resulting procedures. In 1971, another phenomenon changed the general public’s attitude concerning the fire service and emergency medical care. When the television show Emergency! aired for the first time, there were only six regions in the country providing paramedic service: Seattle, Miami, Jacksonville, Los Angeles City and County, and Columbus. By 1978, a mere 7 years later, there were more than 300 regions providing EMS. The show Emergency! generated an increased interest in providing EMS and paramedic service by local governments and effectively launched the careers of thousands of fire and EMS personnel throughout the country. Television has a strong influence on the general public, including politicians, resulting in demand and funding for paramedic programs. This was especially true for this popular TV show. In 1999—more than 20 years after the show’s debut—Project 51, a website dedicated to the show and its cast, stated, “Who would have guessed that the humble beginnings of the Mobile Intensive Care Unit would evolve to one of today’s most recognized emergency based services, and one that is used most routinely by millions of people” (Project 51, 1999). The show had more to do with the fast adoption of advanced and basic EMS by the fire service, hospitals, and ambulance services than anything that had come before. However, although Emergency! was visionary, it was not a completely accurate portrayal of the state of EMS at the time. For example, it suggested that paramedics existed everywhere, which was not true in the 1970s. It also portrayed paramedics as having frequent success saving lives, which may have led to unrealistic expectations. Even today, portrayals of EMS in television, movies, and other media may create unrealistic perceptions and expectations regarding EMS, such as high success rates for heart attacks, etc. This causes problems with depression of EMS providers who expect to save every patient and with the public that expects emergency medical miracles on every call. FES Professional Standards To develop a professional service organization—one whose members are trained and qualified—FES professionals must rely on recognized national or international fire and emergency standards of competency. In the fire service, this effort is led by the NFPA. Fire Standards NFPA publishes voluntary codes and standards that cover fire department professional benchmarks for firefighter training, safety, and emergency operations, including planning tools for fire station location and response times. These codes and standards to be legally enforced must be adopted by a state or local government. In many cases, they are implemented locally by voluntary compliance. For example, in 2001, an NFPA committee finished work on a new standard—1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments—which measures fire and EMS deployment, response times, and staffing (NFPA, 2016). This standard is commonly used as a planning tool to help improve the professional and effective operation of a fire department that includes safety of firefighters. CASE STUDY The Need for National Standards In a tragic example of not learning the lessons of history, 25 people died and nearly 3,500 homes were destroyed in a large wildfire in Oakland, California, in 1991. Surrounding jurisdictions that responded to the mutual aid call were unable to connect their hoses to the Oakland fire hydrants, severely handicapping firefighting capabilities. Even today,  many FES cannot communicate with one another because of different radio channels and systems of communication. Progress in this critical area has begun with funding and radio spectrum allocation for a new nationwide system called FirstNet. ATT is the partner and contractor for the implementation. Further efforts are needed to standardize fire service equipment, training, and communication. Adherence to national standards is necessary to keep fire departments up-to-date with personnel, equipment, and training. Expert fire protection consultants can also be hired to study and make recommendations on any aspect of a FES organization; this practice is discussed in more detail in the chapter Public Policy Analysis. This can be a necessary step in policy analysis to implement these standards for a local jurisdiction. In most cases these changes would result in employee and officers altering existing policies, causing resistance. In addition, many need additional funding that can be justified by an outside expert consultant. EMS Standards Within the field of EMS, the path toward national unifying standards began with the nationally recognized EMT-A curriculum created by the National Highway Traffic Safety Administration (NHTSA) in 1969. The field of EMS quickly grew with the Statewide EMS Technical Assessment program initiated by the NHTSA in 1988, along with the Trauma Care Systems Planning and Development Act of 1990. These efforts provided guidelines for a trauma system to address the needs of injured patients and match them to available resources. Local EMS authorities were vested with the responsibility of establishing trauma systems and designating trauma centers in their areas, and states were encouraged and given funds to develop inclusive trauma systems. In 1991, the Commission on Accreditation of Ambulance Service began administering an EMS accreditation program that is still used today. This program is a comprehensive self-evaluation analysis with the main objective being to provide quality and timely EMS to the community. In 1994, the National Standard Curriculum, a national training model developed by the DOT, was developed and included examinations, skills sheets, and evaluation tools from the National Registry of EMTs, the entity that conducts testing for national EMS certification. This is still a work in progress as some states have their own EMS certification systems and do not recognize the national certifications or those of other states. Federal Involvement Federal agencies, such as the Federal Emergency Management Agency (FEMA), along with the Departments of Defense and Homeland Security and the Federal Bureau of Investigation, provide training, equipment, and resources to prepare local FES organizations for terrorist activities, weapons of mass destruction, and other extremist violence. The Environmental Protection Agency, a major regulator of hazardous substances, has created regulations for storage, use, and transportation of hazardous materials. OSHA has developed rules to protect fire and EMS personnel against the hazardous materials that they come into contact with in their jobs. The USFA and its National Fire Academy also provide valuable training and education for the fire service, although their impact has been limited as a result of insufficient federal budget support. However, the federal effort continues to expand as a result of the September 11, 2001 terrorist attacks on the United States, which led to increased national attention and prestige for FES. These federal programs continue to play an important role in creating a path to national uniformity by stressing curriculum, ideas, management, and leadership practices that prove to be successful, including providing a path to the interoperability between jurisdictions. Melding of Fire Service and EMS Over time, the role of the fire service has expanded greatly beyond fire suppression to include medical response, fire prevention, natural disasters, and public education. Citizens now depend on the fire department to protect them against the dangers of fire, entrapment, hazardous materials, emergency medical incidents, and explosion, and to come to their aid in any emergency event that might occur in the community. Domestic acts of terrorism, such as those in Oklahoma City, Orlando, El Paso, Parkland, San Bernardino, and New York City, have added a new mission of safe and effective response to terrorist events for the fire service. As such, the job of the chief officer is becoming more complicated and challenging every day. With the recognition that firefighters are dedicated to saving lives and are strategically positioned to deliver timely response, fire service–based EMS have gained popularity. Currently, four levels of EMS providers exist: (1) emergency medical responder, (2) emergency medical technician, (3) advanced emergency medical technician, and (4) paramedic. Firefighters may or may not be trained to an EMS level of certification, and fire departments may or may not provide ambulance transport. This varies considerably throughout the nation and is usually based on local policy. On a national level, nearly 60% of fire departments provide some EMS. Those that do not are mostly all-volunteer departments serving areas with small populations that do not have sufficient resources to provide EMS. In many areas, volunteer fire departments have trouble recruiting and retaining members, so there is concern that the additional demands of a volunteer’s time to train for and provide EMS might discourage membership. Unified Federal Emergency Response After a series of devastating fires in New Hampshire in 1803, the U.S. Congress passed a measure that provided financial relief to the affected New Hampshire residents. This measure is considered the first piece of legislation passed by the federal government that provided relief after a disaster. Over the years, the federal government created various other programs to fund recovery from disasters, including flood control by the U.S. Army Corps of Engineers. During the 1960s and 1970s, such major disasters as hurricanes and earthquakes brought focus to this fragmented approach to federal disaster assistance FIGURE 1-4. In 1979, FEMA was established to consolidate the federal disaster response, which at the time included the USFA and the Civil Preparedness Agency in the Defense Department. With the end of the Cold War, resources once allocated to civil defense were redirected to support disaster relief, recovery, and mitigation programs. FEMA started programs to prevent and reduce the risk before a disaster struck. Currently, the agency is focused on preparing and delivering training to mitigate and recover from terrorist incidents.  FIGURE 1-4 Hurricane damage. © Leonard Zhukovsky/ShutterStock. The U.S. Forest Service, under the Department of Agriculture, also played a crucial role in developing the ability to provide a unified emergency response through the help of two key initiatives: the development of the National Interagency Incident Management System—now called the National Incident Management System (NIMS)—and the red card system. The Forest Service developed the National Interagency Incident Management System in the early 1970s to ensure that fire protection agencies were prepared and organized to be able to fight destructive wildfires in southern California. In the red card program, firefighters who are assigned to a wildland fire managed by a federal agency (U.S. Forest Service, Bureau of Land Management, National Park Service, Bureau of Indian Affairs, or U.S. Fish and Wildlife) or by many state agencies are required to have a red card, which documents the current wildfire qualifications of an individual. In a sense, it is similar to a driver’s license. The credentials specify levels of competency, including firefighting and incident command, achieved by successfully completing training and testing to a national standard.  This credentialing system is remarkably effective and prepares firefighters from all over the country to work together, efficiently and collaboratively, on large wildfire firefighting efforts. For example, a wildland firefighter from North Carolina can travel to Wyoming and be assigned to a team made up of individuals from all over the country because there is a national system of competency credentialing. On November 22, 2002, the federal government took the effort for emergency response a step further with the establishment of the U.S. Department of Homeland Security (DHS). At the time, threats against the United States were growing in magnitude, and the DHS was created to protect American citizens from terrorist attacks. In 2003, FEMA became part of the DHS and continues to be the nation’s incident manager for all hazards and major disasters. This command system provides a direct line of authority and communications from the President of the United States—by way of the Secretary of Homeland Security—down to the local level. The number one priority of the DHS is to prevent the occurrence of a terrorist attack. The same goal is also very important to fire and EMS providers, because preventing problems has always been more effective than responding to an emergency in progress. Traditionally, however, prevention has not been a major priority with most emergency services. In December 2008, the DHS released its NIMS. This system supersedes all previous emergency management systems when the federal government is involved and is the default system in the United States. In responding to future disasters, a plan that details mutual aid across jurisdictions and state lines using the incident management command system will be a top priority. In addition, there are now more mutual aid agreements being signed to prepare for major emergency incidents that could result from terrorist actions and catastrophic natural disasters. National credentialing efforts for first responders are being developed with the support of the DHS. Although DHS has not implemented a national credentialing system at this time, several state, regional, and local government credentialing programs have been created to provide real world case studies. When large scale emergencies occur and first responders from distant jurisdictions respond to assist, the resources and staffing have to be identified, including skill and competency levels. This is especially true for a terrorist or major weather incidence. As successful as these efforts have been, greater standardization among fire departments is still necessary to ensure departments and individual responders are able to work together safely and effectively. The NFPA and DHS are continuing to develop standards and initiatives to improve the fire service’s ability to present a unified emergency response. These include NFPA 1500, Standard on Fire Department Occupational Safety and Health Program (NFPA, 2018) and NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments (NFPA, 2016). When many different emergency services departments come together to respond to national events, effective management is critically important. According to NFPA Fire Protection Handbook , “The absence of incident command at an incident scene puts firefighters at great risk and is one of five leading contributing factors of firefighter fatalities, as reported by the National Institute of Safety and Health” (NFPA, 2008). Therefore, incident scene management is critical to the successful mitigation of large- and small-scale emergencies and the health and safety of emergency responders. Critical to incident scene management is the ability to communicate to other responders and their dispatch centers using mobile two-way radios. Currently, there are around 10,000 different and incompatible mobile radio emergency services networks in the United States. A new effort by the Federal government, FirstNet, is the nationwide public safety communications system dedicated to America’s first responders. Congress allotted $7 billion and 20 MHz of valuable radio spectrum to build the network. This effort is a work in progress and does not incorporate voice communications at this time. Current Problems Facing Fire Service and EMS Although the fire service in the United States has come a long way from its local beginnings to create a system of national standards and unified emergency response, there are still many areas where further professional progress is needed. The modern fire service is continuing to work toward measurable outcomes for firefighter and fire officer training, certification, education, and physical fitness standards nationwide. There are still many challenges to be faced, including breaking down traditional ways of operating and getting officials to help set emergency management priorities. A few specific challenges are mentioned in the following sections. U.S. Fire Experience and Trends Trends on a yearly basis may be misleading so it is always helpful to look at a multi-year analysis such as: Trend from 2008 to 2017 FIRES 1,319,500 −6.2% DEATHS 3,400 +9.6% INJURIES 14,670 −15.8% $LOSS* $23.O billion +12.0% * Adjusted to 2017 dollars; includes $10 billion in losses from Northern California wildfires. Data from National Fire Protection Association for more statistics on U.S. fire loss. See: National Fire Protection Association for more statistics on U.S. fire loss. After looking at these U.S. statistics you may ask the question, “Why are fire deaths up 9.6% over this 10-year period?” This is a great observation and is something that should be investigated by NFPA and other national fire research organizations to determine a cause(s). Once a cause (not always just one) is identified, then appropriate fire prevention measures would be suggested. At the local level the fire administrator may want to strengthen or implement programs such as smoke detector battery replacement or installations, for example. This may also indicate that modern furnishings are more flammable and that residential sprinklers should be considered. We have solid statistical evidence that these smoke detectors have been very effective at lowering fire deaths historically. From 1980 to 2016 U.S. fire statistics documented a 63% drop in fire deaths. Smoke detectors are now installed in over 90% of homes. The other major contributor to this reduction was a sharp decline in fires started by smoking materials. This was the result of two factors: fewer smokers and, more recently, fire safe cigarettes. This trend is also supported by the present statistic that 51.6% of residential fires were caused by “cooking” in 2017 and that was the biggest cause. A more in-depth discussion of the use of trends and statistics can be found in Chapter 12, Public Policy Analysis. Challenges of the Modern Fire Service In 2016, the NFPA conducted research on fire-related trends and statistics and noted a number of issues relating to smoke alarms. To begin with, 38% of all home fire deaths reported occurred in households without smoke alarms. What is even more concerning is that, although most households in the United States have at least one smoke alarm, these alarms were found to operate correctly in only about half (40%) of reported home fires (NFPA, 2015). This is a trend that the fire service will have to continue to battle. A more recent NFPA study conducted in 2016 found the following additional concerns regarding the U.S. Fire Service’s needs and response capabilities. A few highlights are listed below:  Two out of five (43%) fire stations are at least 40 years old, up from 32% in 2001. There is an increasing need for additional stations in both the largest and smallest communities. Only one quarter (27%) of fire departments have a basic firefighter fitness and health program. Twenty percent of fire departments did not have anyone conducting fire code inspections in the community, down from 24% in 2010. Nine percent of departments reported that they could not communicate via two way radio with their response mutual aid partners at an incident scene, lower than 13% in 2010. Forty-nine percent of all fire departments in 2015 have not formally trained all of their personnel involved in structural firefighting, up from 46% in 2010. However, 67% of these formally untrained departments serve under 25,000 residents. Except for cities protecting populations of greater than 500,000, most cities do not assign at least four firefighters to an engine or pumper company and are probably not in compliance with NFPA 1710, which requires a minimum of four firefighters on an engine and pumper companies (NFPA, 2016). The greatest FES educational needs for the public were the following (NFPA, 2016): A wildfire safety program based on a national model (84% of the U.S. population without a program) Home fire sprinkler education (74%) Car seat installation (70%)  An older-adult fire safety program based on a national model (67%) Home safety visits (54%) A youth firesetter program (48%) Cardiopulmonary resuscitation instruction (42%) Free installation of home smoke alarms (37%) A school fire safety education program based on a national model curriculum (32%) Fire prevention week activities (14%) Challenges of the Modern EMS A common challenge of modern EMS is that some of the country still cannot access EMS by calling 911, and people place many unnecessary 911 calls. Fees charged for transport are paid by Medicare, Medicaid, and private health insurance, or not paid at all. Just like anything that is free, emergency transport is demanded more often than it is actually needed. As stated by Pratt, “Prehospital 9-1-1 emergency patient medical care is a major part of the safety net for the American healthcare system. They might be the provider of last resort for the needy, yet they can be one more mechanism for overloading the health care system” (Pratt et al., 2007, 14). The easy access of ambulance transport that is common in most densely populated areas results in high numbers of noncritical patients requesting medical care. Because emergency rooms cannot turn anyone away from medical care, they are overtaxed and may have to turn real emergencies away to an ER many miles away. At the present time, fees can be charged only for transportation of a patient and not for emergency medical care provided by first responders. As a result, there are many private ambulance companies providing EMS care for free along with transport. The Patient Protection and Affordable Care Act of 2010, which is reforming the nation’s healthcare system, does not have any specific requirements for EMS but contains regulatory authority for a federal agency to write rules affecting EMS providers. Many of the specifics of this legislation have not been implemented or are not fully understood. This Act is evolving and might be changed or repealed in the future. The Trump administration is supporting a legal constitutional challenge to this act and it has been found to be unconstitutional by a lower federal court. At the present time it is in an appeals court for review. More to follow. Financial Challenges The financial pain of the recession that started in December 2007 continued for many years. The U.S. economy is just now experiencing a substantial comeback. In the aftermath of this recession, a wave of political action with a distinct antitax and antigovernment sentiment swept the country. One leading example of this backlash occurred in Wisconsin in 2011. The state passed legislation that limited bargaining rights for public employee unions. The legislation also increased state employees’ contributions to retirement and health insurance. Numerous other states are in economic peril and will have to take similar actions in the near future. There are many persistent sources of concern for the U.S. economy, such as unprecedented deficits. Although the unemployment rate is falling to record lows and the gross national product is very healthy, the federal deficit keeps rising, with the total cost per taxpayer of more than $189,000 at this time (to access the latest numbers, go to https://usdebtclock.org/). The danger that inflation and increasing oil prices might cripple the economy is always present. And, finally, a worldwide pandemic is causing substantial damage to the United States and world economies. The overall extent of this pandemic, COVID-19, is not known at this time but has and will affect operations and funding of FES departments.  Unions will face several dilemmas in the future. Issues that are part of this discussion include: Union bargaining rights Supreme Court limits public sector unions from collecting fees from non-members Employees’ salaries and benefits Revenue from EMS transport service Consolidations Reducing either staffing or stations (or both) The only thing that is for certain is that change will happen. Today’s Fire and Emergency Services What is the status of today’s FES? Often, there is a large gap between the public’s perception and the reality that many FES leaders encounter. Veteran chief fire officer Dr. Harry Carter states, “The fact is these leaders do not have the staffing, equipment, or most importantly, the financial support to back up their claims. Sadly, far too many of our folks in positions of leadership use their education and training to weave an intricate web of falsehoods and deceit. These folks are unwilling to face reality and provide a true assessment of their agency’s capabilities to their citizens and their local governments” (Carter, 2005). Dr. Carter points to many departments that run fire companies with one, two, or three firefighters. This does not meet the minimum requirement of four firefighters as listed in several national standards, a requirement that was validated by a 2010 scientific-based study at the National Institute of Science and Technology (NIST) that showed that the size of firefighting companies largely affects the company’s ability to protect lives and property (NIST, 2010). Dr. Carter also cites the example of Hurricane Katrina’s aftermath, which exposed numerous issues involving mutual aid response, including failures of local, state, and national plans for catastrophic incidents. As is true in any profession, there is always room for improvement; however, a number of positive trends should be recognized. For example, although careless smoking habits are a leading cause of fire deaths, these deaths are decreasing thanks to the increased effectiveness of smoke alarms and a decrease in the number of smokers (from 42.4% in 1965 to 15.5% in 2016). In addition, the Coalition for Fire-Safe Cigarettes has worked to save lives and prevent injuries and devastation from cigarette-ignited fires through state passage of fire-safe cigarette legislation. A report released by the NFPA on July 2013 stated that “the long-term trend in smoking-material fires has been down, by 73% from 1980 to 2011, helped by the decline in smoking, the effect of standards and regulations that have made mattresses and upholstered furniture more resistant to cigarette ignition, and more recently, the adoption of fire-safe cigarette requirements throughout the country” (Hall, 2013). Furthermore, fire departments are now placing more emphasis on fire prevention, specifically through the use of modern building and fire codes. Automatic sprinklers, long used for property protection, are very effective tools for reducing or preventing loss of life or property (Evarts & Stein, 2020). In addition, fire safety education, which was started in the 1970s, has now become part of many schools and fire departments. Public safety education by fire departments includes information about vehicle accidents, swimming pool and water safety, and other common accidents that cause injuries and deaths (Evarts & Stein, 2020). There is also the trend of departments adding new services, such as rescue, hazardous material response, emergency preparedness, and EMS. Still, the chief officer should never underestimate the difficulty of making changes. Preparation is the key to success. Remember to review the beginning of this chapter to provide background to contemporary issues. If we do not study history, we are doomed to repeat the same mistakes or discount successful solutions. Useful solutions to common FES issues, and techniques to implement change, can be found in the following chapters. The first step in preparation is being informed and educated in identifying a problem FIGURE 1-5.  FIGURE 1-5 Fire chief talking to firefighters. © Jones & Bartlett Learning. Photographed by Glen E. Ellman. Wrap-Up CHAPTER SUMMARY There are many lessons to learn from the history of fire and emergency services. Consider the famous quotation by William Shakespeare that “the past is the prologue to the future” as really good advice. From many organizations and individuals, numerous progressive changes have been discovered and adopted to make up the present day FES. More changes are sure to be discovered by analyzing problems, including solutions in the FES. No FES organization is an island unto itself. Look to the FES community at-large to coordinate and identify problems and solutions for common issues.  KEY TERMS Accidental Death and Disability: The Neglected Disease of Modern Society 1966 publication that serves as a blueprint for the national effort to improve emergency medical care. America Burning Report A compilation of 90 recommendations issued in 1973 by the National Commission on Fire Prevention and Control that began the national effort to professionalize the fire service. Commission on Fire Accreditation International A self-assessment process that measures fire department capabilities, response times, and compliance with nationally recognized standards. Federal Emergency Management Agency (FEMA) The nation’s incident manager for all hazards and major disasters, run by the Department of Homeland Security. Fire Research and Safety Act 1968 legislation that established the National Commission on Fire Prevention and Control. FirstNet The nationwide public safety communications system dedicated to America’s first responders. Insurance Service Office (ISO) Grading Schedule A document that grades municipalities from Class 1 to 10 based on 1 being the best and 10 indicating long response times and no water supply. International Association of Fire Chiefs (IAFC) “The International Association of Fire Chiefs (IAFC) represents the leadership of firefighters and emergency responders worldwide; our members are the world's leading experts in firefighting, emergency medical services, terrorism response, hazardous materials spills, natural disasters, search and rescue, and public safety policy” (https://www.iafc.org/about-iafc). National Board of Fire Underwriters “The National Board of Fire Underwriters was a group established in 1886 with the aim of preventing loss from fire and to protect property and lives from fire-related harms. It gathered statistics from fire incidents across the United States to provide a template for fire insurance” (https://www.insuranceopedia.com/definition/3060/national-board- of-fire-underwriters). National Fire Protection Association Group that uses fire service experts and public input to create consensus standards for firefighter training and education, equipment, and emergency operations with an inclusive emphasis of safety and efficient emergency service. National Highway Traffic Safety Administration The NHTSA is responsible for keeping people safe on America’s roadways. Through enforcing vehicle performance standards and partnerships with state and local governments, NHTSA reduces deaths, injuries, and economic losses from motor vehicle crashes (https://www.nhtsa.gov/about-nhtsa). National Incident Management System (NIMS) The default emergency management system in the United States. REVIEW QUESTIONS 1. Describe how the fire in Baltimore in 1904 led to most fire department’s interagency cooperation that we see today. 2. Look up the ISO Grade for your municipality. How do you think this affects individual homeowners, corporations, and fire departments in your area? 3. The chapter describes how the TV show Emergency! affected Americans’ perception of EMS. Describe how a TV show or movie you’ve seen has influenced your perception of the FES. 4. List and briefly describe at least four government agencies that oversee FES as well as what kind of standards they control or influence. 5. What do you think is the greatest challenge facing the modern FES? Explain. CHAPTER ACTIVITY #1: AN EXAMPLE OF PROGRESS— MAYBE? When the DHS promulgated the NIMS (command and control at large scale emergencies), there were those in the FES community who opposed it. Some noted that it was not designed to address the multialarm fire command system that was typically used in parts of the country. Another problem identified was that no common terminology for fire and EMS resources existed. One simple example is the definition of the basic unit of a fire department: the engine company. The name of this unit can vary by department, such as engine, pumper, wagon, or unit. One state plan has the following definition of a Type I Engine: 1,000 GPM (3785 L/min) pump, 750 gallons (2838.75 L) of water, 1,200 feet (365.76 m) of supply hose, 200 feet (60.96) of handlines, and four firefighters. Each firefighter on a Type I Engine must be state-certified as a FireFighter II. Even in this state, many departments do not conform to this standard.  The NIMS currently does not specify minimum qualifications and certifications for personnel, and no consensus or consistency exists in the fire service for determining competency of fire personnel. Although a few states have mandatory firefighter certification systems, most fire departments operate independently, and each decides how to train its members. Discussion Questions 1. Do all FES organizations have to comply with the federal emergency management plan? 2. Would your department’s engine companies measure up to the Type I Engine requirements listed previously? If not, would your department change, or do you think that the requirements are not realistic and should be changed? Please provide a complete justification for your answer. 3. Are there any major differences between the plan outlined in the DHS document and your department’s standard operating procedures for incident management? If so, please list the differences. 4. After reading the FEMA document, what challenges do you see in your fire or emergency services agency’s ability to respond to a large catastrophic event? Please provide a detailed point-by-point analysis. CHAPTER ACTIVITY #2: A SECOND EXAMPLE OF PROGRESS In 1976, the U.S. General Services Administration identified minimum requirements for new EMS ambulances, and medical equipment companies began catering to the prehospital EMS market. As a result, patient care devices became smaller, lighter, and more efficient. Local governments standardized patient care protocols within their jurisdictions based on state and national requirements and recommendations. Original patient care protocols were based on what little research had been done at the time. Data collection from paper patient care reports was difficult to understand, and the information acquired was incomplete and often inaccurate.  In the mid-1990s, electronic data collection systems, made possible by advances in medical equipment, came into use. With the ability to collect good data and the emergence of quality improvement programs to evaluate data, EMS providers learned that some accepted patient care practices were not only ineffective, but potentially harmful. Today, decisions concerning diagnostic and therapeutic equipment and patient care protocols are based on research showing accurate, definitive conclusions about the effectiveness of a product, drug, or treatment protocol. This practice is known as “evidence-based medicine.” Discussion Questions 1. Evidence-based medicine has changed long-held beliefs in patient care treatment. How has evidence-based medicine changed EMS protocols in your community? 2. Are the EMS protocols the same in adjoining cities, the county, or the state? If no, why not?