National Safety Culture Change Initiative

1-15-2010 2-22-40 PM

National Safety Culture Change Initiative: Study of Behavioral Motivation on Reduction of Risk-Taking Behaviors in the Fire and Emergency Service

Developed by the International Association of Fire Chiefs through a partnership with the U.S. Fire Administration

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Controlling and extinguishing hostile fire comes at a great cost to human life and secondarily at great financial expense. Despite improvements in personal protective equipment (PPE), apparatus safety devices, more availability of training, greater emphasis on firefighter health and wellness, and decreases in the number of fires and dollar loss due to fires, the rate of on-duty firefighter death and injury has remained relatively unchanged in the past four decades. (NSCCI) project is a joint partnership of the U.S. Fire Administration (USFA) and the International Association of Fire Chiefs (IAFC) aimed at identifying both positive and negative culture and climate found in the American fire and emergency service community. NSCCI, through this study and its website, www. ffsafetyculture.org, and other project efforts, will identify adverse behaviors and recommend changes to both culture and climate for occupational safety and health within the fire and emergency service.

The National Fallen Firefighters Foundation (NFFF) has asserted that the culture of the fire and emergency service is a major contributor to the fatal trend in firefighter health and safety (Siarnicki, 2010). This culture has not been concisely defined, but literature suggests both that it exists as a stand-alone concept and that it has unique characteristics that are uncommon to nonuniformed professions. Soeters, a leading scholar in the organizational culture of military and emergency service units, states that the peculiarities of organizations, such as the fire and Emergency Service, “justify the special attention of researchers to the culture and identity of these organizations” (Soeters, 2000, p. 466). An understanding of the culture can be used to develop safer practices to reduce the number of firefighters killed and injured each year.

  • This effort is directly related to three of NFFF’s 16 Firefighter Life Safety Initiatives (FLSIs). FLSI 1, which states: Define and advocate the need for a cultural change within the fire service relating to safety; incorporating leadership, management, supervision, accountability, and personal responsibility (NFFF, 2011), is an overarching initiative, acknowledging that the organizational culture of the fire service must undergo a change to accept the other 15 recommendations. Without understanding the culture within a fire and emergency service organization, it is likely that changes called for in the other 15 initiatives cannot be successfully implemented or sustained.

Initiatives 2 and 6 are also very relevant to this project. Since 50 percent of line-of-duty deaths (LODDs) are attributed to cardiovascular events and one-third of these deaths are in people with known cardiac histories, health and safety of agency members is a controllable risk factor (NFFF, 2011, p. 13). Initiative 6 encourages implementation of and adherence to existing medical and fitness standards, while Initiative 2 focuses on empowerment of all members of a department to be involved and engaged with departmental health and safety while around the station, while responding to and returning from calls for service, and while operating at emergency scenes.

The initial research phase of this study was directed toward clearly identifying and defining the problem. There is widespread acceptance of the presumption that behavioral issues contribute to both firefighter injuries and LODDs and that some type of cultural change is needed to alter the perceptions of acceptable and unacceptable risks. The objective of the research effort is to narrow the focus to identify the particular behaviors that need to be addressed.

The NSCCI project is aimed at identifying the aspects of fire and emergency service culture that contribute to preventable occupational illnesses, injuries and fatalities and subsequently changing those cultural norms that either promote or tolerate excessive risk behaviors. The Project Team developed this document based on the perspective that the expansion of a more appropriate safety culture should not be seen as a challenge to the overall fire service nor contrary to the mission of saving lives and protecting property. This document focuses on integrating safety into the fire service culture without diminishing any of its existing positive aspects.

It should be mentioned that understanding fire and emergency service culture as it relates to fire prevention activities is also important, although this project does not include that perspective. Throughout the paper, the term fire and emergency service is used to broadly capture any type of emergency response organization that responds to fires or other crises that erupt in communities throughout the U.S. An effort was made to be inclusive of non firefighting areas, but there is little literature available that looks broadly at emergency services that are not directly engaged in firefighting. However, a study produced under a cooperative agreement between the National Highway Traffic Safety Administration (NHTSA), with support from the Health Resources and Services Administration’s (HRSA’s) Emergency Medical Services for Children (EMSC) program, and the American College of Emergency Physicians (ACEP) looks specifically at an “EMS Culture of Safety” and can be accessed at http://www.emscultureofsafety.org/wp-content/ uploads/2013/10/Strategy-for-a-National-EMS-Culture-of-Safety-10-03-13.pdf.

Understanding the Fire and Emergency Service Culture

From the origins of an organized fire and emergency service in the U.S. through the early 1970s, very little attention was directed toward firefighter safety (Granito, 2003); the inherent risk factors of firefighting and emergency operations were recognized and simply accepted as unavoidable occupational hazards. Generations of firefighters were subjected to extreme risks, in most cases because their mission was considered essential and there were few alternatives available to them. The image of the firefighter, which is the foundation of the fire and emergency service culture, was built around selfless heroism “” the firefighter is always ready to face any risk and, if necessary, to make the supreme sacrifice in order to save lives and property.

  • Serious efforts to address firefighter safety began during the 1970s and expanded significantly through the 1980s and 1990s, coinciding in part with major advances in protective clothing and equipment, as well as the development of more effective tools and procedures that allowed for fire suppression operations to be conducted with better calculated risks to the firefighter. During that time period, operational procedures began to incorporate firefighter health and safety as primary objectives, on a par with saving civilian lives and as a higher priority than saving property (Linke, 2008). National Fire Protection Association (NFPA) 1500, Standard on Fire Department Occupational Safety and Health Program was published in 1987 as the first consensus standard to address occupational safety and health for organizations delivering emergency services.

The NSCCI project is directed toward this particular aspect of the effort to further reduce LODDs, as well as decreasing occupational injuries and illnesses within the fire and emergency service. It is intended to identify and examine the factors that cause or influence firefighters to make decisions and engage in actions that involve unnecessary and avoidable risks, which often places their own lives, and potentially the lives of their fellow firefighters, in danger when there are less dangerous options available. Expressing the concept in terms of risk management, this would refer to situations where the potential gain is out of balance with the potential loss.

The paper and its proposed strategies for reducing risk-taking behaviors in the fire and emergency service are based on a literature review, focused discussions, and the experiences and collective knowledge of members of the Project Team and reviewers.

What Drives Firefighter Behaviors?

U.S. society as a whole may contribute to the risk behaviors that are demonstrated within the fire service. Communities expect an urgent and timely response to emergencies and disasters with fully trained individuals arriving on adequately staffed apparatus. However, public knowledge of the complexities and challenges of building, maintaining and delivering such service capabilities is often transparent or invisible to those funding the services until the system fails to meet public expectations. Some fire and emergency service organizations do not have the resources to implement advanced training programs or provide training beyond that which is minimally required for each position.

Firefighters who are questioned in relation to their high-risk behaviors often refer to either public or organizational expectations of selfless heroism. Such perceptions are consistent with the popular image of the firefighter as a daring individual who is willing to risk life and limb to save the life of a total stranger and who is lauded for doing so.

Those with a traditional outlook often express disagreement with the emphasis that has been directed toward “acceptable risks” and “rules of engagement,” claiming that they promote nonaggressive and ineffective operations. The opposing viewpoint asserts that there are times when it is appropriate to be boldly aggressive and times to be intelligently cautious. The focus of this paper is to seek out areas where the level of safety in the provision of a fire and emergency service organization can be improved without diluting or lessening the critical mission of service delivery.

Examples of Inappropriate Risk Behaviors

Firefighters are routinely called upon to deal with situations that involve risks that could result in their death or injury or contribute to an occupational illness or disability. Several of these risk factors are inherent to the nature of the work that firefighters perform; however, the level of exposure to those risks varies depending on decisions that are made and actions that are taken “” or not taken “” when faced with a particular situation and set of circumstances. A general risk management philosophy in the fire service is risk a lot to save a lot, risk a little to save a little, and risk nothing to save nothing (Linke, 2008).

Most of the discussion of risk exposure is written in the context of structural firefighting, where the concepts of offensive versus defensive strategy are easily defined. Offensive strategy places firefighters in close contact with the fire, inside the burning building, and involves a certain level of inherent risk. Defensive strategy keeps firefighters outside, in what should be safe exterior locations, to minimize risk. This concept requires some extrapolation to be applied to other emergency responses and scenes.

While the Incident Commander’s (IC’s) decisions establish a theoretical level of acceptable risk that applies to every individual involved in an incident, at times, individual firefighters knowingly or unknowingly expose themselves to higher levels of risk than the IC has deemed acceptable. This is a particular problem when individual perceptions of acceptable risk are different from the IC’s perceptions.

Fire and emergency service organizations should concentrate on implementing and demonstrating an effective and measurable model of firefighter training. This model supports and emphasizes the behaviors learned during initial firefighter training (recruit training) and continuously builds upon those experiences to build advanced skill sets throughout their service as a firefighter/EMS provider. This training should subscribe to the philosophy that health and safety are the capstone of any model. The focus areas of risk behavior modification are education, training, health and wellness.

With regard to vehicle operations for both personally owned and agency-owned vehicles, fire and emergency service organizations should concentrate on implementing and demonstrating an effective and measurable model of driver/operator training that advances skill sets throughout tenure as a firefighter, ensures quality, and provides for driver/operator accountability. The focus areas of risk behavior modification are driver capability, quality assurance and accountability.

Fire and emergency service organizations must also focus on moving toward compliance with national standards for health and wellness, fitness for duty, and emergency scene rehabilitation.

In each of these cases, scenarios can present themselves where emergency responders act without a full understanding of the potential scope and fallout from their actions, leading to illness, injury or death that is out of alignment with the potential value of the chosen action.

Leadership

Leadership is often mentioned as a key component in relation to implementing safety policies and programs. Change is unlikely to occur unless the leaders of an organization embrace the effort and demonstrate a commitment to the endeavor. This applies directly to the formal leadership, which includes labor as well as management, and it often includes informal but influential leaders within the organization.

Effective leadership must go beyond simply issuing directives and policy statements. The members of a fire and emergency service organization can generally differentiate between policies that are intended to satisfy a duty or responsibility and legitimate efforts to lead the organization in a specific direction. There are many examples of fire and emergency service organizations that have issued policies that are based on recommended safety and health standards and then failed to demonstrate a true commitment to those policies.

Health and Wellness

Almost half of all firefighter fatalities in the U.S. are cardiac-related (USFA), and the majority of those deaths are found to be related to pre-existing and preidentified medical conditions. These factors reinforce the message that all firefighters should be periodically evaluated to ensure that they are medically and physically fit to perform their expected duties. This message is incorporated within NFPA 1500.

  • It is also expressed in FLSI 6, which states: Develop and implement national medical and physical fitness standards that are equally applicable to all firefighters, based on the duties they are expected to perform.

Although the message is clearly stated and its importance is widely accepted, the American fire and emergency service community has been very slow to adopt mandatory policies to implement such requirements. The necessary standards have been developed and adopted, yet there are still fire and emergency service organizations without programs of this nature and tens of thousands of active firefighters who have not been medically certified for emergency duty.

The two primary factors that inhibit the adoption of mandatory medical and fitness standards are cost and the belief that a substantial percentage of fire and emergency service members would be unable to meet the requirements. This behavioral aspect reflects the determination of many individuals who join the fire and emergency service or who continue to serve in spite of their medical status and physical fitness limitations. Indeed, many fire and emergency service organizations would face a serious crisis if the recommended policies were immediately mandated, as they may lack the resources to medically screen all personnel and to recruit new members to replace those who are found to be ineligible for service.

Cost is a significant problem for the various types of fire and emergency service organizations; however, the potential loss of active members may be a more critical concern for many volunteer fire and emergency service organizations that are already dealing with recruiting and retention issues and don’t have the added incentive of pay to bring new recruits in. In addition, volunteer fire departments face additional barriers, such as the fact that they typically do not provide health insurance for their members, they typically don’t have access to a department doctor, and departments in rural areas may not have easy access to medical resources. Within the career fire and emergency service, the concern tends to be associated with the fate of career employees who are determined to be unfit for duty.

The individual determination of many fire and emergency service members to remain active in physically demanding positions in fire and emergency service organizations, in spite of risks to their own health, is evident from the half of LODDs that result from medical causes. This behavior may be driven by dedication to the fire and emergency service mission, as well as the sense of membership within the fire and emergency service community.

Training

While training is often viewed as an essential component to accomplish any type of positive change in firefighter behavior, it is also frequently noted that inappropriate training is encouraging or reinforcing high-risk behaviors. This suggests that the problem may not be limited to inadequate training; it may also involve applicable training that establishes inappropriate attitudes, actions, beliefs and behaviors.

Fire and emergency service training organizations must be conscious of the behavioral influences that are incorporated within the content of their training programs, as well as the manner in which training is being delivered. The attitudes, beliefs and behaviors of the instructor may be more influential than the program content itself.

In addition to ensuring that the intended content is delivered and the desired attitudes and behaviors are developed, it is essential to ensure that training activities are conducted with a high degree of safety. The annual reports of firefighter fatalities almost invariably include deaths associated with training activities, whether from traumatic injuries or medical causes. The latter category often includes overexertion, heat stress, and a variety of known and unknown medical conditions.

Fire Officer Training

Training for COs (NFPA 1021, Standard for Fire Officer Professional Qualifications) should include educational components, such as health and safety, leadership, and tactics for new building construction features, in addition to those changing components for firefighters. Back to basics for COs is not simply more leadership classes “” it also includes the principles of reading smoke, adequate size-up with a declaration of strategy, understanding fire behavior, building construction, victim survivability profiling, and using the Incident Command System to help manage the incident with safety as the overarching, guiding principle. COs should be asking themselves:

  1. “Am I training on the types of incidents to which we actually respond?”
  2. “Do we have experience or training on this type of incident?”
  3. “Is another company better trained or equipped to handle this incident?”

Training for chief officers (NFPA 1021) should also include educational components related to budgeting (execution and understanding) and maximizing partnerships to improve service delivery. Back to basics for chief officers who operate on the fireground should include skills needed for proper apparatus placement, managing multiple divisions/groups, and managing personnel accountability, in addition to those new skills being learned at the CO level.

Officers who have responsibilities for overseeing a fire and emergency service organization’s health and safety program should be meeting the requirements of NFPA 1521, Standard for Fire Department Safety Officer. Training for such officers should include educational components, such as health and safety program management, workplace safety compliance, fireground tactics, hazard recognition, and Incident Safety Officer’s responsibilities. While not every department has a designated Health and Safety Officer, it should be every officer’s responsibility to function as a “safety officer” both on and off the fireground.

Summary

The culture of the American fire and emergency service community is rich and time-honored. The culture has aspects that provide superior protection for life and property, while it also has portions that contribute unnecessarily to firefighter and emergency worker injury and death. The culture can be changed at national, state and local levels without diminishing the quality of services provided by enhancing firefighter competencies needed at emergency scenes. Both the culture and climate can be moved toward a common sense, safety-oriented approach to balance the risks and rewards of questionable behaviors better.

This report generates important ideas that can be implemented to address culture and climate in an effort to change behavior in the American fire and emergency service community, which will lead to fewer injuries and deaths.

This document provides a foundation for future work in this area that will involve developing enhanced online educational materials and outreach. fire and emergency service organizations and individual responders can begin to engage in this move toward positive cultural change by visiting www.ffsafetyculture.org.

Full Access to the REPORT: HERE