Networking with individuals across the country and around the world can bring us a wealth of ideas, solutions and knowledge. This column began with an e-mail from my friend and colleague, Ozzie Mirkhah, formerly the fire-protection engineer for Las Vegas Fire & Rescue.

He was doing research on another related subject and came across a master's thesis entitled "Deciding Who Lives: Considered Risk Casualty Decisions in Homeland Security," written by Robert T. Mahoney and submitted to the Naval Postgraduate School at Monterey, Calif. Knowing my interest in what the military calls "acceptable losses," Ozzie sent me the link to the study.

This column cannot do justice to this nearly 200-page research study, but it is meant to be a starting point to think about how we, as fire chiefs, face the dilemma of deciding who lives — both in our daily decisions at an emergency scene, and even more so in the aftermath of a catastrophic disaster or terrorist attack.

In a three-page preamble, the author — an FBI agent assigned to the New York City office at the time of the Sept. 11, 2001, terrorist attacks — describes his thoughts, feelings and emotions as he and another agent walked toward the World Trade Center through the masses of ordinary citizens escaping the terror prior to the collapse of the first tower. This experience served as the author's impetus for the study. Here are a few excerpts from that preface:

We were not alone in our a southbound movement, for sharing the street with us was an endless line of fire engines, police cars, ambulances, and other official and emergency vehicles of every description, size, and purpose that the city of New York could dispatch. … There was only the sound of the sirens from these massing emergency vehicles, and it came from all directions simultaneously. No, I was not alone by any means in my movement toward the Trade Center, and although I did not realize it then, we were all moving towards decisions of life and death, both professional and personal, that would change our lives forever.

It is hard to imagine, but in the middle of all that movement, for a moment, a firefighter sitting in the jump seat of one of those trucks passing on my right locked glances with me. Possibly we sought each other out in some odd comradeship of those who were moving towards the problem as opposed to the thousands who are moving away from it, but nevertheless, at that moment we looked at each other and I saw that mixture of concern and commitment that would become a recognizable, universal expression in the minutes and months that followed. With that look, the thought came to me, "They're riding to their death and they know it," never thinking that I might also be walking towards mine.

I looked straight up over me nearly a quarter of a mile high at the huge hole in the face of the North Tower, at the raging fires and smoke, and at the people you could see at the windows on the upper floors, and thought about the risk to all those firefighters and others going to their rescue. Owing to a past relationship with the New York City Fire Department I knew that the previous single largest loss of life in their ranks had been 12 men killed in a 1966 fire. My second thought was, "They could lose three or four times that many here." In spite of the horror I was seeing, and even my inexplicable counting of the people falling down the face of those buildings, I, and the other hundreds of people heading towards that site, would have had to untie the bonds of civilization to imagine that the actual loss in emergency service personnel would be more than 30 times that previous record.

Mahoney's thesis introduces the term "considered risk casualties," or CRC, in a similar light to what those of us who served in the military know as "acceptable losses." Several critical differences exist between these two terms. "Acceptable losses" primarily describe the estimates of loss in terms of military personnel and equipment to achieve an objective. To a varying degree it may or may not also include the number of civilian casualties that could occur as collateral damage. Depending on whether the action is during an unlimited war such as World War II, or a more recent action that critically involves the civilian population such as in Iraq or Afghanistan, civilian casualties may be a deciding factor in whether an action is undertaken.

“Considered risk casualties,” on the other hand, are the injuries, deaths and destruction of property among the civilian population as an anticipated, but unintended, consequence of a decision that was based on the limited resources that were available in a homeland-security scenario. To get me thinking in these terms, I imagined the mass-casualty-incident concepts of triage, treatment and transport, and then tried to look at this through scenarios such as how to contend with limited dosages of vaccine to inoculate the population against a potentially lethal influenza or bioterrorism attack.

In this instance, the CRC concept contemplates the consequences of loss of life in philosophical, theological, bioethical and ethical contexts. The author devotes a chapter to each of these disciplines as he explores the distinction between “killing” and “letting die,” especially so others may be saved. The subsequent question then becomes: how does the decision-maker triage the value of the individual or the category of lives in order to decide who is to be saved?

In addition to the issues faced by the military in the realm of “acceptable losses,” Mahoney studied several non-military emergency incidents and planning processes that occurred between 2002 and 2007 and which required this type of thought process. These included the Canadian response to the epidemic of Severe Acute Respiratory Syndrome (SARS) that began in 2002 and the Center for Disease Control’s 2004 effort to prepare for an acute shortage of vaccine during a future pandemic. (We saw a glimpse of this in the 2009 H1N1 influenza season.) In both cases, healthcare providers, including EMS and fire-service first responders were placed at the top of the list, to help ensure that health services for the remainder of the population would continue. Fortunately, neither event developed into what might have been the first large-scale test for a CRC event.

To a degree, Mahoney also discusses the use of CRC in future terrorism attacks on the United States. With the emphasis now on attacks from “home-grown” terrorists or sleeper cells, reaction times to these events may be even further compressed. Having a plan in mind to fit the size, scale and complexity of the attack(s) may assist the fire chief in making critical decisions.

In his conclusion, Mahoney indicates that such CRC choices currently are made by individual or group decision-makers using their experience, integrity, instincts and intuition. He calls for an increase in the educational process through research in the multi-disciplines discussed earlier, in order to develop a guide or matrix to fit CRC conditions. Having such a risk-analysis tool in place would help to bridge any gap that may result in the decision-maker’s reluctance to choose or to augment their level of experience.

In the future, fire chiefs who are facing a critical decision, such as whether to deploy or hold firefighters and EMTs in reserve during an unfolding attack, might be able to use this research to evaluate the traditional concepts of service and response. Particularly, it may help them gauge the risk to first responders in relation to the chances for an immediate decrease in the projected number of civilian casualties and deaths. Failure to contemplate these troubling scenarios will result in a decision by default and become an abdication of responsibility. None of these decisions will ever lead to a win-win scenario, but this research may serve to help guide us, and certainly opens the door to a dialogue in which we all need to participate.

Chief Robert R. Rielage, CFO, EFO, MIFireE, is the chief of Wyoming (Ohio) Fire-EMS, a 78-member combination fire department bordering Cincinnati. He previously served as the fire marshal of the state of Ohio.