BACK STEP TALKS

SERIES III ISSUE 3 APRIL 2024

Life Safety Initiative #9

Over the past decade, 2013 – 2023,

on average nearly 100 firefighters are

killed in the United States each year.

Firefighter injuries are estimated at

around 61,000 per year because not

every injury is reported or meets the

criteria of a reportable injury. And

the fire service has no idea of how

many near-misses (or near-hits)

occur each year even though there

was a firefighter near- miss website

established to record these.

The only way we can learn from our

mistakes is to perform a complete

investigation for every near-miss,

significant injury, or fatality. For the

latest Firefighter Injury report (2022)

please go to

https://www.nfpa.org/

education-and-research/research/nfpa

-research/fire-statistical-reports/

firefighter-injuries-in-the-united-

states.

In previous issues of Back Step

Talks, we have provided extensive

coverage of the line-of-duty deaths

of Nathan Flynn (Howard County,

2018) and Joshua Laird (Frederick

County, 2021). We applaud the

efforts of both Howard County

Department of Fire and Rescue

Services, and the Frederick County

Division of Fire and Rescue Services

for conducting a thorough

investigation of these LODD’s,

making life saving changes to their

operational procedures, and sharing

that information so that other

departments can learn from these

tragic events.

In this issue, we visit LODD and

injury reporting systems with an

encouragement for every department

to utilize these resources to learn

from others and to share their own

experiences so that everyone learns.

We also revisit some of the key

issues that are killing our firefighters

and what actions are necessary to

reduce injuries and deaths. Please

take the time to read these articles

and share with others.

written by Dave Reid

Pawtucket FD firefighter survives near-miss roof collapse.

Photo Credit: Tom Camody, Northeast Fire Photos

Firefighter Life Safety

Initiative #9: Thoroughly

investigate all firefighter

fatalities, injuries and near

misses.

Everyone Goes Home – More Than Just a Cute Slogan

When the National Fallen

Firefighters Foundation (NFFF)

hosted the first Firefighter Life

Safety Summit in March 2004, in

Tampa, Florida, more than 200 fire

service representatives convened to

identify the means of reducing

firefighter line-of-duty deaths

(LODDs) and line-of-duty injuries

(LODI’s). Some of the questions

asked were:

- What policies or procedures

need to be changed or

enhanced?

- What changes in equipment

need to be considered?

- What additional training

should firefighters have to

be safe?

Two major outcomes of the Tampa

summit were: the development of

the 16 Firefighter Life Safety

Initiatives, and the inauguration of

the Everyone Goes Home program.

The 16 Firefighter Life Safety

Initiatives are intended to serve as a

guide for departments to reduce

LODDs and LODIs. In this issue of

Back Step Talks, and every

preceding issue, we have focused on

one or more of the Life Safety

Initiatives with information that you

can use to improve safety in your

department.

The Everyone Goes Home program

provides an educational platform for

departments to use in implementing

the 16 Firefighter Life Safety

Initiatives. The program provides

free training, resources, and

programs to help departments

reduce preventable firefighter line-

of-duty deaths and injuries.

Training programs from the

Everyone Goes Home program can

be accessed through the FireHero

Learning Network -> Training

Firefighters | Fire Hero Learning

Network The learning network

contains 24 on-line training

programs that can be completed at

your leisure while sitting at home or

while on-duty.

To build a foundation for

understanding the 16 Firefighter

Life Safety Initiatives, every

department is encouraged to have

their members complete the

“Courage to Be Safe” training

program. This training can be done

in either an on-line format or a

classroom delivery.

Through the NFFF State Advocate

program, in-person training can be

provided at a department level that

allows a deeper concentration on

changing the safety culture of the

fire service. The MFCA Health and

Safety Committee Chairman, David

Lewis, is a NFFF Advocate and can

assist with bring these training

programs to your department.

By adopting the 16 Firefighter Life

Safety Initiatives in every

department and utilizing the

resources and training offered by the

Everyone Goes Home program, we

can reduce LODDs and LODIs and

truly live up to the slogan

“Everyone Goes Home”.

Everyone Goes Home resources and

information can be accessed via

Everyone Goes Home - Firefighter

Life Safety Initiatives

Written by David Lewis

National Fallen Firefighters Memorial Weekend, May 4

th

& 5

th

, 2024

During the weekend of May 4

th

&

5

th

, the Nation’s firefighters will

gather on the campus of the

National

Emergency Training Center (NETC)

in Emmittsburg to pay tribute to 91

firefighters that died in 2023 and

135 firefighters that died in previous

years. Among these firefighters are

19 having died from post 9/11

illness. The following Maryland

firefighters will have their names

added to the Memorial Wall during

the weekend:

· Firefighter Brice Trossbach,

Naval District Washington Fire

& Emergency Services (2023)

· Firefighter Rodney Pitts III,

Baltimore City Fire Department

(2023)

· Captain Dillon Rinaldo,

Baltimore City Fire Department

(2023)

· Battalion Chief Christopher

Morlan, Frederick County

Division of Fire & Rescue

Services (2021)

· Firefighter Henry Eckhardt, Jr.,

Reisterstown Volunteer Fire

Company (2021)

· Firefighter/EMT Bryan

Hamilton, Naval District

Washington Fire & Emergency

Services (2021)

· Firefighter Mark Fisher, Jr.,

Montgomery County Fire &

Rescue Services (2014)

Several thousand firefighters will

volunteer their time to support the

fallen’s families. Family escorts will

guide and support the families while

at the NETC. Honor Guard and

Pipes & Drums will render honors to

the fallen while a team of behind the

scene staff will feed the families and

ensure everything runs smoothly.

Representatives from the Maryland

Fire Chiefs Association (MFCA)

will be resident at the host hotels to

provide assistance to the survivor

families with transportation and

other needs. Both Saturday evenings

and Sunday’s ceremonies are

streamed live on www.firehero.org

and Sunday’s ceremony is open to

the public.

written by Dave Reid

National Fallen Firefighters Memorial Emmitsburg, MD

Photo Credit: Lt. David Bullard Columbia County Fire & Rescue, GA

What’s Killing Firefighters—5 Factors We Can Control

First Responder Center for Excellence

Firefighting has always been a

dangerous job. But our perception of

the danger doesn’t always align with

reality. Put another way: What’s

killing most of us isn’t fires or

explosions or technical rescue

operations gone wrong. Too often,

what’s killing us is our failure to

take steps that are entirely our

responsibility.

Recently I had the opportunity to

attend a forceful program on

firefighter health and wellness titled,

appropriately, “What Is Killing Us?”

This one-day program was created

and run by the Loveland-Symmes

(OH) Fire Department and was

emceed by Chief Tim Sendelbach of

the Loveland (CO) Fire Rescue

Authority. The speakers included:

· Dr. Sara Jahnke, director

and a senior scientist with

the

Center for Fire, Rescue &

EMS Health Research

at the

National Development &

Research Institutes

· Chief Bryan Frieders, CEO

and president of

the Firefighter Cancer

Support Network

· Ret.

Chief Patrick J.

Kenny

, international speaker

and author of Taking the

Cape Off: How to Lead

Through Mental Illness,

Unimaginable Grief and

Loss

· Dr. Kenneth Fent, team

lead on the

CDC/NIOSH

National Firefighter Registry

· Dr. James J. Augustine, a

medical director with fire

and rescue agencies in

Georgia, Florida and Ohio,

and a member of the EMS

Eagles Global Alliance

.

There’s a lot to share from this

packed day of presentations, but

let’s focus on five key themes that

emerged as factors contributing to a

health and wellness crisis in the fire

service — yet largely preventable.

#1: We’re afraid to talk

about firefighter health

and wellness.

The fire service has come a long

way in addressing

fitness, nutrition

and illness and injury prevention

,

but many of us are still afraid to

have open, honest conversations

about our health. How many

firefighters do you know who won’t

go beyond minimum-required

medical testing because they’d

“rather not know” or they’re worried

a diagnosis will put them on light

duty? How many officers are

reluctant to confront someone on

their crew who they know is

struggling with cardio

fitness,

alcohol use, or even just

working a second job to the point of

fatigue?

We must be willing to talk honestly

with our medical professionals about

our habits and our risks. And we

must work to create a culture where

medical issues aren’t shameful and

ignoring them isn’t glorified.

#2: We’re failing to take

personal responsibility for

what’s killing us.

When we’re not hiding from the

medical issues, we’re often

consciously ignoring them.

Firefighters have a deep fatalistic

streak. That’s not surprising, and in

fact it may help us cope with the

trauma of the job. But it works

against us when there are

health and

wellness issues

well within our

control.

Dr. Jahnke, a leader in identifying

behaviors that lead to firefighter

death, stressed that we each own our

health and wellness choices.

Specifically, she mentioned the need

to understand how vital good sleep

is to our health. The book Why We

Sleep by Matthew Walker, PhD, was

mentioned by several speakers as

required reading for all firefighters.

Beyond sleep, Dr. Jahnke laid out

the factors that are right in front of

us yet seem to elude capture. Really,

how many times will we have to

hear about getting a full

cardiopulmonary work-up so we

have a baseline and then setting

goals necessary for our survival?

What’s Killing Firefighters—5 Factors We Can Control

Other factors include:

· Getting to our target weight

· Achieving cardiovascular

fitness

· Using alcohol responsibly

· Eliminating tobacco

· Establishing work-life

balance

Going further, Dr. Jahnke

emphasized how much our negative

and positive health and wellness

behaviors impact those we lead, our

families and our friends.

#3: We’re not doing

enough to reduce our

cancer risk.

Chief Frieders shared several real-

life examples of firefighters lost to

occupational cancer in their 20s and

30s. These are cancers the general

population doesn’t usually have to

worry about until much later in life.

On an intellectual level, we all

know cancer is a health crisis in the

fire service. But Chief Frieders

emphasized that we’re not taking

that academic knowledge and

converting it to action. Every

department needs comprehensive

policies on turnout cleaning and

storage, required use of SCBA and

PPE, and understanding that the

IDLH environment exists during

overhaul.

But it’s not just about having the

policies. It’s about being a strong

enough leader to train on and

enforce those policies. As a

certified incident safety officer, I

took Chief Frieders’ message to

heart. When an ISO sees a ladder

truck about to tangle with live

wires, an IC setting an operation

that fails to consider flow path, or a

firefighter failing to take burn time

into account before going through a

door, the ISO notifies the IC, or

physically restrains the firefighter,

and calls a stop to the operation.

ISOs must have the same

awareness, and not hesitate to exert

their fireground authority, when it

comes to practices like strict use of

SCBA during all phases of interior

work, clean cab practices, on-scene

hose-down, and mandatory gear

washing after certain operations.

What kills us doesn’t always

happen in a split second. It happens

over time. It’s up to department

leaders, oftentimes, to save our

members from themselves.

I also can’t overemphasize the

valuable work that the

Firefighter

Cancer Support Network

performs.

Every probie, firefighter, line

officer and chief should be aware

of the information the network

provides on cancer prevention and

treatment, including good policy

and practice, expert advice for

those who are diagnosed, guidance

for how firefighters can assist a

brother or sister firefighter facing a

cancer diagnosis, and available

resources and referrals.

Another essential tool for fighting

cancer in the fire service is better

data collection and reporting. Dr.

Fent leads the

CDC/NIOSH

National Firefighter Registry

,

which was designed to monitor

occupational risk factors and cancer

outcomes among U.S. firefighters.

Every firefighter should participate

(testing has begun and the open

enrollment is planned in the fall).

The system will protect all data,

privacy, and maintain participant

confidentiality; no firefighter

should worry that information

provided can be tracked back to

them.

#4: We’re pretending

COVID is over.

It’s impossible to talk about what’s

killing firefighters over the past two

years and not talk about COVID.

More than half of line-of-duty

deaths in 2020 were

attributed to

COVID

. Further, many firefighters

who survived the disease may have

symptoms of long COVID, which

can contribute to other health risks.

At the time of the conference,

hospitalizations and deaths were

trending down, but since then, they

have started to pick up again.

Addressing the current wave, Dr.

Augustine advises that there is

What’s Killing Firefighters—5 Factors We Can Control

greater susceptibility to serious

impact among seniors and the

unvaccinated and that, while

greater numbers of vaccinated and

boosted individuals may get one of

the variants, the effects will be far

less severe. He also notes that

because we were isolated for an

extended period and now find

ourselves going out much more, we

are experiencing an immunity gap

with regard to other illnesses and

infections. For example, Influenza

A is occurring with greater

frequency, even though we would

normally be coming out of flu

season. The bottom line?

Responders should maintain

COVID PPE practices based on

local conditions.

Dr. Augustine provides regular

COVID updates on the

Center for

Fire, Rescue & EMS Health

esearch Facebook page. I

encourage you to tune in for

practical, up-to-date information

that’s provided in layperson’s

terms.

#5: We’re hiding behind

a “cape” that won’t allow

us to ask for help.

Drawing on his personal family

tragedies, including the loss of his

son to mental illness, Chief Kenny

gave the most emotionally stirring

presentation I have ever heard at a

firefighter conference. While his

story is unique, his message applies

to all firefighters. The personality

traits and self-image that make us

great firefighters can also work

against our relationships with

family, friends and other

department members. Chief Kenny

uses the cape as a metaphor — it’s

the part of us that struggles to

reconcile being a “hero” with the

understanding that sometimes we

can’t save everyone; we can’t make

everything OK.

It’s OK to need

help

. By taking the cape off, we

protect our physical and behavioral

health, bring ourselves closer to

those who love us, and strengthen

the bonds we have with friends and

our crews.

Wrapping It Up

With the data and information

available to us today, we have a

tremendous opportunity to

recognize and acknowledge the

factors that interfere with our

physical and behavioral health. We

have the tools to turn poor health

choices into good ones. We can

learn to spot warning indicators in

ourselves and others and access the

strength in ourselves to change

behavior or call on outside

resources without fear.

Throughout the “What Is Killing

Us?” program, participants

discussed the perceived stigma

associated with asking for help.

But rather than using this as an

excuse, presenters and attendees

concluded the only stigma is a self-

imposed one. Enforcing good

cancer prevention policies,

practicing heart healthy habits at

home and at the station, and

recognizing when we need help

and seeking that help — it’s all

within our control.

Article written by Scott Eskwitt.

Reprinted with permission

from Lexipol,

https://

www.lexipol.com. Lexipol provides

policies, online training, and

wellness resources to public safety

and local government

professionals.

Scott Eskwitt is the former director

of fire policy and training content

for Lexipol. He previously served

as chief of the Fair Haven (N.J.)

Fire Department, and was a

member of the Fair Haven First

Aid Squad and the Red Bank (N.J.)

Fire Department. Eskwitt is an

attorney and has spent his legal

career advising municipalities and

fire departments on risk

management, human resources and

labor relations issues. His

undergraduate degree in Industrial

& Labor Relations was received

from Cornell University and his

law degree from SUNY Law at

Buffalo.

Are You Prepared for a Line of Duty Death?

No one wants to experience a Line

of Duty Death; however, we know

that they can happen at any time.

And now that there are more

categories covered besides being

killed in the line of duty or dying

from a medical emergency at or

within twenty-four hours of a call.

The Federal Department of Justice

Public Safety Officer’s benefits

also cover some cancers and

suicides. At the present time the

Maryland State Firemen’s

Association Trustees coverage does

not include cancer or suicide

deaths. However, Maryland

Workman Compensation laws

cover some cancers with

stipulations.

So, how do we prepare ourselves

for a Line of Duty Death?

1. When onboarding a new

member have them complete a

PSOB Designation of

Beneficiary Form and have it on

file at the station.

This form be found at

PSOB

Designee Form-11-11-13.pdf

2. Have a copy of the members

birth certificate on file.

3. Have a copy of the members

marriage license, or divorce

decree(s).

4. Have copies of their children(s)

birth certificates, or adoption

papers.

5. Have the member complete an

Emergency Contact form and

keep it on file (readily

available).

Make sure it includes spouses

place of work incase

notification needs to be made.

6. Copy of a Military Form DD-

214. Documenting their military

service.

7. Keep good training records on

each member. Now that the

Federal PSOB pays LODD

benefits for firefighters in

training make sure that they

were authorized to be enrolled

in the class.

8. Ensure that the member has

passed an entry level physical.

9. Have the member complete a

form “In Case of Death.” This

form would be used by the

department so they would know

what the deceased would want

to be done in case they died.

10. Encourage your membership to

use the “Wills for Heroes”

program from the MSFA. This

is a no cost way to ensure that

your final wishes are carried

out.

11. Take annual pictures of

members in uniform. These

pictures can be used for

multiple things.

12. Have your Chaplain trained so

they will now what to do.

Firefighters and EMTs are

trained to do their jobs. The

person filling the role of

Chaplain needs to be trained as

well.

So, what do we do if we experience

a LODD?

1. Call the National Fallen

Firefighters Foundation 866-

736-5868. The Maryland Local

Assistance State Team

Coordinator will contact you

immediately. The Maryland

L.A.S.T. is made up of

volunteer from across the state

of Maryland and has a large

number of resources to handle a

LODD.

2. Contact one of the Maryland

State Firemen’s Association

Trustees. Paperwork must be

completed within 90 days of the

death for benefits to be

considered. The Trustees have a

Procedural Guide on the MSFA

website that will give you the

detailed information you need

to apply for benefits from the

MSFA.

3. Maryland Department of Public

Safety and Correctional

Services, Office of the

Secretary at 410-585- 3728.

4. Each County/City has their own

benefits, so you will need to

find out what they are and how

to apply for them.

Many jurisdictions have memorials

to honor the fallen heroes, the fallen

will have their name put on the

Maryland Fire and Rescue

Memorial in Annapolis. Fallen

Firefighters will have their name

added to the National Fallen

Firefighters Memorial in

Emmitsburg, MD. Fallen EMTs

and Paramedics will have their

name added to the National EMS

Memorial Foundation (physical

memorial pending).

Written by John Long, Jr.

Close Calls/Near Miss – A Learning Opportunity

The question really is what is Near

Miss Reporting? According to a UK

Health and Safety Executive who

states this as “an event, including

dangerous occurrences, not causing

harm, but which has the potential of

cause injury or ill health.”1 The

management of near misses should

be important within the fire and

EMS services. The Secret List an

independent newsletter started by

Chief Billy Goldfeder in 1998 that

has evolved to

FirefighterCloseCalls.com has

become the iconic method for near

miss reporting.2 Ideally, near misses

should also be reported within a

locally established framework within

the health and safety team of each

organization.

Accident pyramids as a basis for

fire service safety.

Near misses and unsafe acts form

the lower segments of what is

known as the

“Accident Triangle”,

from the 1960’s, which is based on

the original Henrich Model from the

1930’s. The theory is based accident

prevention – that the number of near

misses (unsafe acts) is reduced then

the potential for real injury or death

will shrink. As we know the

severity of near misses within the

Fire/EMS service is enormous.

Because of this factor Health &

Safety Officers need to Identify

hazards within risk assessments,

implement safety measures and raise

awareness in training. It is

imperative for all members of the

Fire/EMS service to be aware of

hazards and how to address them.

Vigilance for potential hazards

EMS Calls, Structure Fires, Motor

Vehicle Collisions, Special

Operations all have unique

hazardous environments which the

Fire/EMS service face every day.

Staying vigilant to the potential

hidden hazards, risks and

acknowledging of near misses are all

part of the accident prevention

process. The fact that the operation

was run hazardously, SOG’s not

followed, outside factor are signs

that the next time a real accident

could occur if proactive measures

are not taken. Near Misses are the

opportunity for Officers, Firefighters

and EMS professionals to take the

opportunity to learn and implement

improvements to prevent a

reoccurrence of a hazardous

scenario. An example is the

Wicomico County Fire Chiefs

Association and the Wicomico

County Emergency Management

have implemented additional

measures to ensure safety on the

roadways by changing dispatch

procedures on certain roadways.

This was implemented because of

the increase of near misses within

the county while operating on

roadways at 50 M.P.H. and greater.

Close Calls/Near Miss – A Learning Opportunity

This open dialogue within the

association gave a feeling of

involvement and a safer response

solution was created.

Near-Miss Reporting a Positive

Culture

It is a moral obligation to report

near-misses to improve operations

creating a safer work environment.

The problem is the fear of

punishment, or retaliation for a near

miss report, peer pressure, concern

about record and reputation.

Leadership needs to stress the

importance of reporting the near-

miss incident and create a positive

culture and staff feels free to report

these occurrences. Everyone can

make a mistake, no matter how well

trained or experience on the job.

The fact that an accident was close

to happening indicates, in most

cases, a human factor contributed to

the incident. Admitting a fault can

be very stressful and intimidating in

a culture as the Fire/EMS service.

This is another human factor of

safety management which some

organizations may need to address.

The fire service mut be encouraged

and the leadership approachable

regarding reports of near misses.

The reporting process must be

designed with a positive learning

opportunity for all objectives, to

gain the trust and confidence of the

staff.

Systematic Process for near-miss

reporting

Another step to get staff to report

near misses is to make the process

itself easy to follow and not time

consuming. Near-miss reporting is

usually completed on a self-

explanatory form. Remember to

keep this simple, clear and ask for

the critical information. Some

examples of questions to ask:

Location, date and time of near-

miss, should operation had stopped

immediately or paused because of

near-miss Yes or No, Suggestions

for improvement, basic description

of incident, type of near-miss;

unsafety act, unsafe equipment.

It should be clear in a SOG where

these forms are kept and how to

deposit them for review. If in a

digital form the link and processing

procedure should be provided.

Furthermore, the organization must

prove a positive culture by

including follow up communication

in staff training or meetings. Staff

will not report if they believe

management is not looking and

acting on forms completed.

Depending on reporting processes

and internal regulations near-miss

reporting can be Anonymous vs no

anonymous. Repeat near misses

may identify a shift issue, a process

change, further training which may

eliminate the near-misses or future

accident or injury.

Awareness, training and active

participation

Near miss training should become

part of your organizations culture

just like PPE training, CPR, Hose

Line Advancement or pump

operations. Explaining what a near

miss is and providing examples is

the first step. Highlighting past

occurrences and openly discussing

issues will help eliminate hazards

and operational risks while

improving safety while in the

station or operating at an incident.

Summary

Near Miss reporting has been a

slow cultural shift since 1998 with

Chief Goldfeder started the Secret

List. The fire and EMS service has

slowly picked up the concept that

this reporting is a Learning

Opportunity that increases safety

and yet improves operations.

Leadership needs to remember this

reporting regardless of Anonymous

or Non-Anonymous is for the

betterment of the organization and

should be treated as such with no

punishment or retaliation assigned.

Leadership needs to read and take

action on near misses so staff in the

field understand the message has

been received. The process for

reporting needs to be simple and

seamless to get buy in from the

firefighters and EMS providers

engaging in these activities. Lastly

this change in culture starts in the

indoctrination of new staff just like

Firefighter 1 or EMT-B class.

Written by Dave Black

Firefighter Close Calls

Just Culture: An Organizational Paradigm Shift for Near-Miss Reporting

According to data published by the

National Fire Protection Association

(NFPA) in December 2023, there

were over 65,000 line of duty

injuries and 96 line of duty deaths in

2022. While these numbers are

received through official reporting

channels, there is undoubtedly un-

reported events that have resulted in

injury. Furthermore, it is safe to

assume there are even more events

that go un-reported that did not result

in injury or death but had a

significant probability to result in

injury or death had the event

unfolded differently. The fire

service collectively refers to those

events as “near misses.” Near

misses are not mandatory reporting

events for most departments so it is

difficult to quantify their prevalence

in today’s fire service.

Many factors may contribute to why

these events are not voluntarily

reported but organizational culture

may play a role. Most people who

have been in the fire service for any

length of time can think instantly

think of superior officers they would

feel comfortable reporting issues to.

They can also recall officers who

they would rather not inform of

issues for fear of embarrassment,

retaliation, undesirable crew

assignments, or poor performance

reviews. At higher levels in the

department, a sign of organizational

culture that may dissuade personnel

from reporting near miss events

would be how the department

conducts formal and informal post

incident analyses (PIA). Do these

PIAs look to identify strengths and

weaknesses or do they look to place

blame on crews or individual

personnel? Are these PIAs

constructive and conducted with

mutual respect for participants or are

they one-sided criticisms?

A cultural shift the fire service

should look to adopt would be the

utilization of ‘just culture’. Just

Culture has its roots in the aviation

industry as a common safety practice

among flight crews. In the 1980’s,

the aviation industry looked at a

granular level to identify how they

could limit or eliminate aircraft

incidents and accidents. During this

assessment, “there was a systematic

review of the technology, the

training, and the culture in aviation.

It was recognized that the conditions

for accidents were often known by

people in the workplace who were

afraid to speak up for fear of being

reprimanded or humiliated” (Allyn,

2019). People who have a fear of

reprimand, humiliation, or other

perceived untoward effect of

speaking out or reporting safety

concerns will not report them. This

prevents the organization from

gaining valuable insight into why

and how near miss events occurred

and disseminating those findings out

to the entire organization. This

intimidation or fear therefore places

other members of the organization at

risk of experiencing a similar event

without the knowledge of how to

mitigate or prevent it. Ultimately,

this cycle increases the likelihood

that an organization will have a

formal report of a line of duty injury

or fatality as their personnel will not

have gained the knowledge on

mitigation or prevention of the event

until it was too late.

The medical community has adopted

just culture as a foundation of their

day-to-day quality improvement

efforts. Dr. Nadja Kadom, an

associate professor and director of

pediatric neuroradiology at Emory

University School of Medicine in

Atlanta, provided several insights

about just culture in an article for

the Radiological Society of North

America. She stated, “shifting from

blaming individuals to looking at

the system as a whole in a just

culture leads to a more productive

organization and a more enjoyable

work environment” (Allyn, 2019).

Another commentator in the article,

Dr. Priscilla Slanetz from Harvard

Medical School, added “by

encouraging open communication

or error in a non-punitive

environment, just culture holds

institutions accountable for

actions” (Allyn, 2019).

A just culture is a behavior that is

not one that can be practiced at just

one or two levels of an organization.

Just culture must originate at the top

and be actively practiced by all

members of the organization.

“Leaders often have to unlearn their

whole approach to safety, because

the instinctive reaction to an adverse

event is to look for a single cause

and blame the person closest to the

event with the severity of the

punishment tied to the result of the

error” according to Dr. David

Larson, vice chair of education and

clinical operations at Stanford

University School of Medicine.

Leadership at all levels of a fire

department should strive to have

their members feel empowered to

report near miss events in a timely

and accurate manner. While no

universal reporting system for near

miss events currently exists, there

are several systems available for a

department to utilize, such as the

International Association of Fire

Chief’s (IAFC) collaboration with

National Near Miss (NNM) and

ResponderSafety.com on a national

database of near misses that can be

found at

www.firefighternearmiss.com. Fire

service leaders should advocate for

the safety of their personnel by

encouraging participation in near

miss reporting systems as well as

incorporate ‘lessons learned’ from

within their departments. By

empowering members at all ranks of

an organization to discuss near

misses and operational

shortcomings, all members of the

organization can improve and

implement positive change and

growth.

Written by Jon Johnson

Just Culture: An Organizational Paradigm Shift for Near-Miss Reporting

Firefighter Close Calls

Fatal Firefighter

Injuries

RSNA Just Culture

NFPA Firefighter

Injuries

Understanding Fiber: Health Benefits of a Fiber-Rich Diet

I find it interesting that the sound of

a sneeze elicits the words “Bless

You”, however, the sound of a fart

elicits laughter, and can cause

people to leave a room. Both are

natural body functions, yet they

bring about vastly different

responses. Farting can tell you a lot

about your digestive health. It is a

sign that you are getting adequate

fiber in your diet, or perhaps need to

include additional sources of fiber.

Fiber is a complex carbohydrate

found in plant cell walls. There are

two types of dietary fiber, soluble

and insoluble. Soluble fiber controls

hunger by slowing digestion and the

absorption of nutrients, increasing

satiety (feeling of fullness). Foods

containing soluble fiber tend to have

a low caloric content, helps maintain

healthy cholesterol levels, reduces

the risk of heart disease, regulates

blood sugar levels to reduce risk of

insulin resistance or diabetes,

reduces your risk of cancers such as

colorectal and breast, supports

bowel function and regularity,

reduces development of

hemorrhoids, increases immunity,

improves brain function, binds to

toxins such as lead and mercury so

they can be eliminated from the

body, assists in balancing hormone

levels by removing excess estrogen,

and bolsters gut health by increasing

the number and balance of healthy

gut bacteria, creating a healthy

microbiome. Foods containing

soluble fiber include oats, barley,

nuts, chia seeds, flaxseed, kidney

beans, black beans, lima beans,

garbanzo beans, peas, turnips,

Brussels sprouts, broccoli, sweet

potatoes, apples, carrots, avocados,

pears, apricots, and citrus fruits.

Insoluble fiber does not dissolve in

water. It adds bulk to stool,

assisting the passage of food and

waste products through the digestive

system, reducing constipation by

improving bowel regularity and

transit time. Insoluble fiber is found

in whole grains, wheat bran, high

fiber breakfast cereals, high fiber

breads, whole wheat pasta, barley,

nuts, seeds, beans, green beans,

carrots, celery, cauliflower,

zucchini, corn, dark green leafy

vegetables such as kale and spinach,

kiwi fruit, grapes, raspberries,

blackberries, raisins, and prunes.

As fiber passes through the large

intestine, it encounters normal

bacteria that aid in digestion. As

bacterial metabolism occurs, gas is

produced as a byproduct. If too

much fiber is consumed it can cause

bloating, cramping, and flatulence

causing discomfort to first

responders during calls, training

exercises, workouts, and while

performing work-shift

responsibilities. In addition,

undigested fiber increases stool

mass and volume, as well as pulling

water into the large intestine. The

feeling of heaviness, and possible

complications with diarrhea or

constipation result in discomfort,

decreasing optimal work

performance. Foods high in fiber

are good for your health, however

adding too much fiber too quickly

can promote intestinal gas, bloating,

and cramping. Fiber should be

increased slowly over a few weeks.

This allows the natural bacteria in

your digestive system to adjust to

the change. It is important to drink

plenty of water as fluid is necessary

to assist in pushing fiber through the

digestive tract.

Suggestions on how to increase

fiber in your diet:

1. Include a high fiber cereal (5 or

more grams per serving) for

breakfast. Add nuts and berries to

further increase the fiber content.

Choose cereal with “whole grain” as

the first ingredient, and 20% or

higher of the Daily Value (DV) for

fiber.

2. Consume at least half of your

grains as whole grains (oatmeal,

brown or wild rice, bulgur, quinoa,

barley, buckwheat, corn, millet).

3. Choose whole grain bread or

tortillas with at least 3 grams of fiber

per serving.

4. Snack on fresh fruit (include

edible skins), raw vegetables,

popcorn, nuts, whole grain crackers,

dried fruits. Monitor your portion

size when choosing nuts and dried

fruits as they are high in calories.

5. Add fiber to baked goods

(berries, nuts/seeds, dried fruit,

whole grain/wheat flour, oats, oat

bran or wheat bran).

6. Add leafy greens and the edible

skin on fruit when making

smoothies.

7. Add beans, legumes, and

vegetables to salads, soups, stir

fries, chili and stews.

8. Sprinkle ground flaxseed on

cereals, salads, grains, vegetable

dishes.

9. Add fruit and nuts to cereal,

salad, yogurt, or cottage cheese.

Due to the fact that the amount of

fiber varies in different plant foods,

it is important to eat a wide variety

of high fiber foods to maximize the

health benefits. The American

Heart Association recommends an

intake of 25-30 grams of fiber a day.

Use the % Daily Value (DV) to

identify a high or low fiber food.

20% DV or more dietary fiber per

serving is considered high. 5% DV

or less dietary fiber per serving is

considered low. Do your best to

include fiber with every snack and

meal.

Summarized and Written by:

Rhonda Cohen MFF, EMT, RDN,

LDN, CSN

Understanding Fiber: Health Benefits of a Fiber-Rich Diet

Try these energy bites for high fiber

snack on the go, to make you go.

Ingredients:

2 cups rolled oats

½ cup unsweetened coconut

¼ cup ground flaxseed

¾ cup peanut butter

½ cup honey or maple syrup

½ cup mini chocolate chips

Hand mix all ingredients in a bowl.

Scoop out one tablespoon of the

ingredients and roll into

approximately a one-inch ball.

Continue until all ingredients are

used. Store bites in a sealed

container and refrigerate until ready

to eat. If too sticky, add more

rolled oats.

Nutrition facts per serving

(one inch rolled bite):

Calories: 150

Fat: 7 grams

Saturated Fat: 2 grams

Fiber: 5 grams

Sugar: 9 grams

5

Firefighter Behavioral

The number of 1st responder

suicides through

March 31, 2024.

The number of fallen firefighters

through March 31, 2024.

15

US Fire Administration

Save the Dates

First Responder

Center for Excellence

Contact Us!

Email: [email protected]

Web Site:

www.mdchiefs.org

Chairman: David Lewis

Editor: Dick DeVore

Contributing Authors:

David Reid

Rhonda Cohen

Dave Black

Jon Johnson

John Long, Jr

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