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How Good is Good? Improving Emergency Operations Through Performance Analysis

  • Dave Donohue

 

The Fire Chief has approached you following a recent fire. She states that the crews took too long to deploy the first hose line, causing the fire to burn longer. She also noted that, in general, it takes too long for fire-ground operations to take place, including entry into the building, raising ground ladders, and beginning ventilation. She is tasking you with developing a training plan that will address these issues and improve your departments’ fire-ground operations.

Over the course of a fire and EMS career, organizations may spend over $250,000 in total costs, training responders. And this holds true whether the responders are career or volunteer. With funding for government services expected to drop over the next twenty-years, coupled with demographic and hiring changes in the emergency services trades, fire and EMS organizations need to work to ensure that personnel are well trained while using funds wisely. Analyzing performance and determining the cause of performance failures allows departments to apply solutions to improve performance and community outcomes and balance training with other causes of performance failure.

Performance Analysis

Fire and EMS personnel are expected to perform tasks in order to meet the mission of the organization. Successful performance is defined by the standards that the organization has set for itself. Departments may use legal standards, which are common in EMS, industry standards, such as National Fire Protection Association Standards, or develop defensible standards which meet the community’s unique needs. Regardless of the standards origin, the adoption by the organization is critical to establishing minimum performance. Without an adopted standard, any performance at an emergency incident meets the established standard set by the organization.

Standards may be based on set procedure, outcomes, or a combination. For example, EMS standards tend to be procedure-based where certain activities and procedures are performed in sequence and based on previous findings or actions. Performance on fire-grounds tends to either be outcome-based or a combination of outcome and procedure, such as determining whether to operate offensively or defensively based on the findings during size-up.

Performance may be assessed at the emergency scene or during training evolutions. The actions taken are measured against the department standard. If the performance does not meet the standard, there is a performance gap. Frequently, the initial reaction is to apply training in order to address the gap. This is premature as additional assessment should be conducted to determine if the performance gap is a training issue or is caused by some other issue. In fact, training is frequently not effective in addressing many performance gaps.

 

Causes of Performance Failure and Gaps

There are many causes of performance failure, some of which are organizational issues and some individually based. Equipment failure is a common cause of performance failure. Maintenance of equipment is cited as a frequent cause of performance failure. Equipment that is not properly maintained, that is subject to breakdown, or that is no longer able to perform its assigned role can lead to performance failures and delays at emergency incidents. Fire and Emergency Medical Services frequently attempt to use equipment for purposes that are not within the design specifications, such as using ladders for horizontal access or using apparatus in unique and novel ways. While this is done with the best of intentions, the equipment cannot be expected to perform at peak efficiency and may not be able to perform to the level desired. These actions may also impact future performance as the equipment has been damaged in some way.

Organizational support for operations may also impact performance. Organizations are responsible for staffing, providing support equipment such as personal protective equipment, work-load, and incentives for behavior. If any of these are lacking, the ability to perform will be affected. For example, as the crew size has changed, the ability of crews to perform tasks in a timely manner has also diminished. Organizations balance crew size, station location, and department size against community expectations, needs, and resources. If expanding crew size or increasing the number of stations can be justified against the competing priorities of the community, then changes may be made. However, if support does not match the standard of performance, then the performance standard must be adjusted to recognize the organizational reality.

Individual capability also impacts performance and must be addressed within the standard of performance. Emergency responders, whether fire or EMS, are tasked with physical performance while under physically demanding conditions. Fire fighters routinely operate while wearing half their body weight in equipment that diminishes the ability to shed excess heat, which limits movement, and diminishes the body’s ability to sense its surroundings. EMS personnel carry equipment that is bulky and poorly balanced and then are expected to lift and move patients and perform both fine motor skills, such as starting IV’s and physically demanding skills, such as performing CPR. The ability of the human body to perform, both cognitively and physically, is limited with age, genetics, and personal history all playing a part. Similarly, individual motivation will play a role in individual capacity. Emergency responders have different priorities, time commitments, and interests. These will all play a part in how well they are able to prepare themselves, how they manage stress, and how quickly they recover from physical and mental loads placed on them. Time management, personal obligations and interests, and off-duty activities and preparation serve as the critical components to individual motivation for task success.

Finally lack of training, either initial or currency, may be the cause of performance failure. If personnel have not been trained, or more importantly, the training has not been reemphasized through follow on training, feedback, and mentoring following the initial period of training, then performance will suffer. Training is key to individual performance, but it is not the only, or even primary, cause of poor performance.

Fixing the Problem

Once the root cause of the performance failure has been identified, strategies can be developed to address the cause and improve performance. The following chart identifies causes of performance failure and methods for addressing the issue.

Cause

Remedy

Failure to maintain equipment

Develop and implement a maintenance schedule

Repair equipment

Provide job aids to help with equipment maintenance

Equipment broken

Repair or dispose and replace

Equipment obsolete

Dispose and replace if equipment is needed

Identify equipment in other organizations that can be called on

Assign task to agency/organization with appropriate equipment

Equipment not appropriate for task

Do not use equipment that is inappropriate for the assigned task

Develop a list of equipment that is available from other organizations and that may be called for

Develop memorandums/agreements for unique equipment

If feasible, purchase appropriate equipment

Assign task to agency/organization with appropriate equipment

Lack of safety equipment

Provide safety equipment

Assign task to agency/organization with appropriate equipment

Inadequate staffing

Delay task until appropriate trained, qualified, and competent staff can be assembled

Seek additional staffing if justified

Assign task to agency/organization with adequate staff

Individual capability

Ensure that personnel are trained, qualified, and competent

Ensure work-rest cycles

Ensure physical capabilities of personnel

Ensure that spiritual/mental capabilities of personnel are addressed

Provide adequate off-duty recovery

Ensure overall health of individuals

Return sick or injured personnel home

Training

Ensure initial training meets expected performance

Provide follow on training that ensures minimum performance levels are met

Provide mentorship opportunities to reinforce training

Provide feedback on performance and expectations on a regular bases

Address any training gaps when identified

Develop a training plan that assesses expected levels of performance and corrects deficiencies when they are identified

 

Conclusion

Establishing performance standards for any organization is the first step to determining effectiveness. Once the standards are established and personnel are capable of meeting those standards, regular assessment will allow leadership to determine priorities for performance improvement, support requests for funds, and describe the importance and impact of the fire and EMS organization on the community.

After reviewing the Chief’s issues, you discover that the engine that responded has had significant issues with engaging the pump, the crew size has been reduced by one due to budget cuts, and that the ventilation fan is prone to flooding due to lack of familiarity. With these findings, you work with the Chief to move forward proposals to fund the purchase of a new engine and increase staff and develop a short training class and job aid on how to properly start and operate the ventilation fan. Based on your research, the City Council funds your requests for a new fire engine and a phased approach to increase staffing over the next three years.

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