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Thursday, November 20, 2008

No Time-Outs in Tactics, Responses

Here's a question for you: How long does it take to play a one-hour football game? The answer is that it depends on the number of time-outs. Football games start and stop so many different times that it seems like it takes an eternity to play the last quarter.

In firefighting there are no time-outs. Once a set of circumstances creates a threat to life and property, the clock starts ticking. It doesn't stop until someone, usually the member of a fire company, intervenes through the use of technology or technique to make that situation “all better.” We can't blow a whistle and ask the referee to stop things so we can adjust our game plan.

Nowhere is this truer than in understanding and explaining the curious phenomenon of response time. Over the last couple of decades, a lot of ink has been spilled on this particular topic. Interestingly enough, however, it still remains confusing and to a certain degree ambiguous to members of the fire service, our elected officials and the public at large. The fire service can't seem to agree on what to call things and how to measure them.

Unfortunately, this confusion and ambiguity continues to contribute to our lack of scientific credibility. Moreover, the data that we often use to justify our policy decisions are significantly lacking in both quantity and quality.

Perhaps it's time to revisit the basic concept. There are members of the fire service today who don't recall when we first began our discussions of response time. To reset that clock, most people need to go back to the 1970s and look at the work of fire protection engineer Rexford Wilson, who wrote Nine Steps from Ignition to Extinguishment. It's a classic little text that has been rewritten, regurgitated and reiterated by so many different people that it's often mistaken as being too old to matter. Nothing could be further from the truth. Wilson was on the right track.

Another element that contributed to the discussion of response times was the Utstein Criteria, which came to the forefront during the creation of paramedic programs in the '70s. Although there are large numbers of people in the paramedic business today who think that Utstein was a doctor, it was actually a place. The criteria explained and examined the time intervals that were integral to the handling of a cardiac-arrest patient.

In the fire service, the Commission on Fire Accreditation International played a part when it published “The Cascade of Events” in 1985. This examination of time intervals combined Wilson's work with the Utstein Criteria in an attempt to identify what could or should be measured as part of the total handling of an emergency event. To determine the cascade of events, Fire Chief Charlie Rule and a member of his staff contacted hundreds of fire departments to determine how they were keeping records and what kinds of time stamps were being kept and under what conditions.

What he found was somewhat troubling. Many fire departments were not keeping accurate time records, and moreover, nobody was looking at them. Therefore, in developing the standard of cover response methodology for the CFAI, one of the most important aspects was to look at the total elapsed time during the handling of emergencies in an attempt to establish consistent and standardized terminology.

So where are we today? Well, one might say we're better off because people now at least understand that there's a time element involved. On the other hand, we still have fire departments that don't keep accurate response-time records. We still have fire departments that use their own terms for what they think they're measuring. We also have fire departments using technology that doesn't help them do a better job.

Let's be more specific. For everyone to really understand what the element of time is all about, there are two very specific definitions that need to be agreed on. The first of these is a time stamp, which is a record of the actual time an event occurred. It's not a guess, and it's not an estimate. A time stamp is a documentation of the year, month, day, hour, minute and second when something happened. A classic example would be a phone ringing at a dispatch center, which then initiates an electronic record-keeping device that notes exactly when the first ring occurred. Another time stamp would be recorded when the phone is picked up by the dispatcher. Between those time stamps is a time interval, which is the next definition we need to know. A time interval is nothing more than the period of time between two time stamps.

You may think these terms and definitions seem simple; however, in the best fashion of the fire service, we manage to obscure both by a variety of techniques. The first thing that causes a time stamp and time interval to be suspect is when they're recorded manually. Sometimes time stamps and time intervals are hard data because a computer recorded them; there was no human intervention. Sometimes they're soft data, which means that a human wrote them down. The margin of human error can be significant, especially under the stress and strain of emergency operations.

Once we've accepted the concept of a time stamp, we must recognize that there are specific time stamps to be documented in the emergency response field. Unfortunately, there are highly expensive computer-aided dispatch providers that don't understand this basic concept. They've failed to build appropriate time stamps into their CAD systems so that this information can be analyzed later. While I don't want to single out any specific vendors, I do want to point out the lack of standardization in the CAD world.

Recording these time stamps is critical. The following time stamps can be of great significance in analyzing the efficiency and effectiveness of emergency response units:

  • First ring to the dispatch center.
  • Phone picked up by the dispatch center.
  • Dispatch center enters the event into the system.
  • Information transmitted to a fire station or apparatus.
  • Apparatus initiates response, leaving the station or rolling wheels to the emergency.
  • First-due unit arrives on the scene.
  • Subsequent units arrive on the scene.
  • Chief officer arrives on the scene of a multi-company operation.
  • Emergency is declared under control and returned to a state of normalcy.
  • Units leave scene and become available for additional dispatch.
  • Last unit leaves and returns the emergency scene back to ownership of occupant.

Those are a lot of time stamps, aren't they? If you look at the cascade of events schematic in the CFAI's accreditation manual, however, you will quickly discover that these time stamps mark the beginning and ending of all the intervals that are critical to understanding a fire department's performance.

Alarm processing

The cascade of events recognizes that it takes time to process an alarm. Moreover, it needs to be recognized that depending on how an alarm-processing system is configured, there can be all sorts of reasons why a fire department is sitting in the station completely unaware that an emergency is in progress.

Imagine a fire in a hotel room. An individual runs out of the room into the corridor and pulls the fire alarm box. How long did that take? If the fire alarm box is hooked up to the office downstairs, someone has to acknowledge that the alarm is ringing. Then that person has to identify the appropriate action to take. I have heard hotel managers tell their personnel not to report an alarm to the fire department until it has been checked out by security. (People have died as a result of such a policy, by the way.) Of course, the alarm could be connected directly to a fire department alarm panel, which means that a light might go on in a dispatch center.

These different configurations can explain variations in alarm-processing times. It isn't good enough to just recognize alarm processing as a concept. If a department really wants to understand its performance, then it has to examine these elements and understand how simple or how complex they can make a situation. There's a wide variety of conditions that can complicate alarm processing. Imagine multiple jurisdictions without an adequate communications system. Imagine regional dispatch centers as opposed to individual dispatch centers. Imagine what happens with voice-over IP. Imagine what happens with cell phones.

In the examination of alarm-processing time, two factors should be considered: What time stamps are available, and exactly how long does it take before a fire department dispatcher notifies a fire company to respond? To me these factors are fairly straightforward, yet they have been complicated by departments sometimes accepting the simplest time stamps and not exploring the entire chain of events.

Turnout

Let's look at turnout time, which involves two time stamps and one interval: What time did the bells start ringing or the pager go off, and what time did the wheels start turning? Again, this sounds pretty simple; again, it's not. When Rule started examining turnout time during the CFAI research, he found that there were significant differences in such things as whether it was a full-time department or a volunteer organization that had to recall personnel to the scene. He also found significant differences in the design of fire stations. Those departments that were heavily involved in physical fitness programs and/or other types of activities also had some differences. These two time stamps are important because they allow citizens to feel that you care about what you're doing when you've been told to respond. But the clock is still ticking — remember, no time-outs!

The examination of turnout time has been underestimated by the fire community for many years. Moreover, people call it a lot of different things. I've seen probably at least a half dozen slang terms used for this time interval. I know one group calls it “getaway time.” Another calls it “out of the chute.” A rose by any other name is still a rose. It's the time interval between finding out you have an alarm and those lug nuts on the front wheels of your apparatus starting to revolve in the general direction of the emergency. Regardless of what you call it, that's what it is.

Travel

The next component is travel time, which the fire service has emphasized a lot. It's the interval between the time those lug nuts start spinning and the time they stop. It's not when you see smoke on the horizon, and it's not when you push a MODAT button two blocks away from the scene. It's the time interval between starting and stopping the first-due unit. Anything less than that is a perversion of what travel time is all about.

Of course, there are a million variables of that can affect travel time. I don't think anybody reading this column is under the impression that driving the same piece of road under different traffic conditions will always result in the same travel time. Try going down your main drag at 4 o'clock in the morning versus 4 o'clock in the afternoon and see if there's a difference, regardless of whether you're going Code 1 or Code 3.

Travel time is a multidimensional variable that's extremely important to the understanding a very simple concept: Time and distance can be the enemies or allies of a fire department. That's what Wilson wrote 30 years ago and what still holds true today. Fire station locations are important, but they aren't nearly as important as a fire company's performance on travel time.

Now comes the big rub. There are fire departments that only report travel time and call it response time. There are fire departments that only report travel time and turnout time and call that response time. There are some fire departments that are recording alarm processing, turnout and travel time and call that response time. Which one is right? Which one is a true reflection of the art and science of fire protection?

I would submit that the only legitimate, scientific response time includes all three. I base this conclusion on the simple fact that the person experiencing the emergency doesn't give a hoot about theoretical definitions. When he or she dials that emergency number and hangs up the phone, there are no time-outs. Whatever the emergency, it's in progress and will remain so unless one of two things happens. The first is if the event terminates itself. The second is if someone on the scene terminates it before the fire department arrives. Both of these conditions happen more often in the field than we would like to acknowledge.

The only legitimate definition of response time that belongs in the evaluation of a response standard is the combination of alarm-processing, turnout and travel time intervals based on accurate, credible and constant time stamps. This definition in the cascade of events represents the true sequence of an emergency.

Intervention

The time interval of intervention is becoming increasingly important. In the standard of cover methodology there's a term called “critical tasking,” which is when the fire department is requested to validate its ability to perform in a certain time frame so that a more routine emergency can be mitigated in a more reasonable time frame.

Isn't this what a fire department is really there for? We aren't there to burn down buildings systematically by taking a long time to put out fires. Contrary to the fact that most of the morale in a fire department emerges when we have a barn-burner, the reality is that citizens want us to put that fire out in the shortest time possible.

The initiation and completion of an emergency event also has another dimension. I have become exposed to this as a result of working with multiple firefighting agencies attempting to deal with the differences between a police and fire dispatch center and a fire-only dispatch center. I am liable to start a lot of arguments with this contention, but I believe it to be reasonable true. My contention is that dedicated fire dispatch centers are better at processing events than combined dispatch centers are. Law enforcement personnel in charge of dispatch centers often say that their workload is four to 10 times greater than the fire services workload; therefore, their 911 priority is processing their calls. If you're counting wickets that might be true but not if you're counting emergencies.

If you look at what's processed by a fire dispatch center alone, almost every time that phone lights up on the console, somebody's life or property is in danger. If you go to the law enforcement side, you'll find that nine out of every 10 requests for emergency services could be handled by a Good Samaritan or somebody with a clipboard to take a report.

Law enforcement does go on emergencies. Let's not make any mistake about that. For example, a bank robbery in progress is an emergency, especially when you consider those that have ended in massive shootouts. A traffic collision with injuries is an emergency for the cops as much as it is for us. If you don't think so, go take a look at the number of police officers who have been killed or injured attempting to set up a traffic protection zone around a traffic accident.

As long as we're using a football metaphor, there is another emergency response phenomenon. We don't have a group of referees dropping flags that result in time-outs at any of our incidents. The only way we're refereed is when we look at the outcomes over a period of time in our community. That leads to an issue of great significance to the fire service: the quality and quantity of our data. In conducting reviews of many fire departments, one of the things I find somewhat startling is that many fire departments do not have anybody responsible for quality control over response time data. It's assumed that the data is accurate. Consequently, it's assumed that conclusions drawn from inaccurate data is appropriate. Neither of these cases is true.

Response time information is a big part of the statistical science that we need before we can establish our credibility with the community. Anything less than an accurate and consistent portrayal of response time will continue to add to the confusion of both the public and the policy-makers who must approve our budgets.


With more than 40 years in the fire service, Ronny J. Coleman has served as fire chief in Fullerton and San Clemente, Calif., and was the fire marshal of the State of California from 1992 to 1999. He is a certified fire chief and a master instructor in the California Fire Service Training and Education System. A Fellow of the Institution of Fire Engineers, he has an associate's degree in fire science, a bachelor's degree in political science and a master's degree in vocational education.


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