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19 Posts authored by: jmontes Employee

As COVID-19 continues to steadily spread around the world, infection control has become a critically important topic. EMTs, paramedics, firefighters, and law enforcement officers are on the front lines of the coronavirus pandemic. The National Fire Protection Association (NFPA) released a tip sheet that highlights information within NFPA 1581, Standard on Fire Department Infection Control Program and guidance from the Centers for Disease Control and Prevention (CDC). Written for fire departments, NFPA 1581 can be easily translated to fit other responder needs during this unprecedented time when personal protective equipment (PPE) supplies are scarce. 

 

Key Takeaways from NFPA 1581 and the CDC Guidance

 

Designate an Infection Control Officer. According to NFPA 1581, departments should have a part- or full-time employee serving as the infection control officer (ICO) to manage all aspects of infection control, from guidance on personal protective equipment (PPE) to post-incident management and cleaning. The ICO must be knowledgeable and cognizant of infectious disease pathogens, from bioterrorism weapons like anthrax to emerging infectious diseases like SARS or COVID-19. It is critical that the ICO also maintains a strong relationship with local medical and public health officials. Per the U.S. Department of Health and Human Services, hospitals and healthcare facilities must notify department ICOs any time their members are exposed to a known COVID-19 positive patient. When notified of an infectious exposure, the ICO is responsible for notification, verification, treatment, and medical follow-up, as well as case documentation.

 

Keep Yourself and Your Gear Clean. The most important action responders can take to limit their exposure is to carefully clean themselves and their reusable PPE. Employees should wash their hands or use hand sanitizer that is at least 60 percent alcohol as an alternative only when hand washing is not available. For those who are looking for guidance as to when it is most important for responders to wash their hands, NFPA 1581 identifies the following times:

 

  • After each emergency medical incident
  • Immediately or as soon as possible after removal of gloves or other PPE
  • After cleaning and disinfecting emergency medical equipment
  • After cleaning PPE
  • After any cleaning function
  • After using the bathroom
  • Before and after handling food or cooking and food utensils

 

Use Personal Protective Equipment. PPE should be used appropriately based on agency policy, local protocol, and manufacturer recommendations. With the exception of a mask, any potentially contaminated PPE should be removed when operating a vehicle. NFPA 1581 requires departments to keep infection-preventing PPE, such as gloves, eyewear, and masks, onboard all department vehicles that support EMS operations. New PPE should be donned to assist (again) with patient care, if necessary. The level of PPE needed to prevent infection varies depending on the nature of the pathogen. For the COVID-19 virus, responders should be using droplet protection.[i] This protection includes the following:

 

  • Gloves
  • Respirators (N-95/P-100 or greater)
  • Eye protection
  • Splash protection (gowns, face shield, etc.)

 

Limit Your Exposure. Limiting exposure can reduce your need for PPE and assist with long-term staffing availability. As departments are looking for ways to conserve their available PPE, some measures that can be taken to reduce exposure include, but are not limited to, the following:

 

  • Add an instruction to your emergency medical dispatch protocols where after screening a 911 caller, call takers request that when safe and able, the patient await responders outside in the open air. This reduces responder exposure to contaminated surfaces and puts them in an environment where droplets are diffused more quickly. [ii]
  • Limit the number of members who interact with patients. Based on the patient’s presentation and medical needs have a minimum number of responders, who are necessary to provide care, don PPE and have direct contact with the patient.[iii]
  • Once a member dons PPE, they should stay in the PPE for the remainder of patient care activities. This may necessitate having an additional member drive the ambulance during transport when the patient requires two or more members to render care, but will reduce the donning and doffing of PPE mid-call, which is frequently highlighted as a high risk of exposure to responders. The member driving needs to only wear respiratory protection as long as the cab of the ambulance is sealed with a vapor lock barrier from the patient care compartment.[iv]

 

Expand Your Options in Times of Shortage. Because of PPE shortages, there is guidance from the CDC advising departments to either modify the protection levels of PPE being used for patient care and cleaning or reuse the PPE, after following disinfection procedures, if your levels run low. Here are some recommendations for departments to consider until adequate levels of PPE can be acquired (note that any of these procedures must only be used when there is no way to increase your PPE supply and when approved by your ICO, risk management team, and medical director):

  • Instead of going down a level in respiratory protection, consider going up a level, such as with a powered air purifying respirator (PAPR) with the appropriate filter or cartridge. PAPRs are frequently reusable and provide splash and eye protection at the same time. [v]It may be easier and more cost effective, in the long term, to invest and train your members about solutions such as these - while still providing baseline minimum droplet protection to your members.
  • Work with your ICO, agency risk management, subject matter experts, and your medical director to develop protocols that allow for triaging the use of remaining higher-level PPE. [vi]For example, based on the CDC guidance for reserving the use of N-95 respirators, only use them on calls where there is a high-risk exposure level and on lower risk calls, use an approved lower level of protection or perhaps an expired piece of PPE that has been tested to meet CDC guidelines that may be more readily available.  Examples of high-risk exposures include but are not limited to:
    • Aerosolizing procedures like nebulizer treatments, or endotracheal intubation
    • When a patient is actively coughing or generating sputum into the patient care environment
    • When a patient has a positive test and respiratory symptoms, like a productive cough
  • Increase your buying power by partnering up. In the current environment, leverage your contracts, mutual aid agreements, and memorandums of understanding to work with community partners and public health officials to try and acquire PPE together rather than competing against each other.  If that is unsuccessful, use the National Incident Management System and your emergency management partners to run resource and logistical requests up the incident management chain.[vii] Note that in many states, this requires a gubernatorial emergency declaration; if your state hasn’t made one, please encourage your leaders to consider making one

 

Learn More

Keep up with the latest COVID-19 news and information using the following resources below. As the world continues to grapple with this crisis, NFPA will continue to generate key resources and information that address responder safety, emergency planning, building, fire and life safety issues.

 

 

Points i-vi based on March 10, 2020 Covid-19 Interim Guidance for EMS Providers, Center for Disease Control and Prevention 

 

Point vii - based on NFPA 1600; Standard on Continuity, Emergency, and Crisis Management 

 

“We have an obligation to the customers we serve … But we also have to protect our members because, if we don’t protect them, who’s going to answer the call for 911?” Phoenix Fire Captain Rob McDade told a local news station during a recent report on the coronavirus or COVID-19.

 

Responders respond

 

Captain McQuade is not alone in his thinking. Emergency response departments everywhere are stepping up their service and capabilities in the wake of the dangerous coronavirus that is sweeping the globe. To reduce risk of exposure, emergency response organizations have been making adjustments to their protocol; and for most, the new normal consists of screening 911 callers, adjusting response tactics, donning more PPE than usual, frantically searching for more of that gear and elusive testing kits, self-quarantining because of potential exposure or confirmed infection, protecting their families and loved ones from being exposed to anything they may have exposed to, taking patients to alternative sites, and preparing for reduced resources and manpower.

 

911, what’s the nature of your emergency?

 

Dispatch has always played a critical role in emergency response, but now the men and women on the line are asking 911 callers whether the sick or injured party (and others in the home) have been outside the country, exhibiting signs of fever or flu-like systems, or have come in contact with anyone that has been tested. These are critical protection measures so that responders can protect themselves when they go into certain emergency situations. Rhode Island public safety dispatchers are taking things a step further by requesting, if at all possible, that patients meet them outdoors where they will have their temperature taken. Paramedics and EMTs then call ahead to hospitals so that health care professionals can prepare for patient intake and provide guidance on the best ways for responders to deliver patients once onsite. States are setting up testing sites in vacant hotels, cruise ships, other buildings, and mobile field units/alternative sites to allow for increased testing, more rapidly. If it is determined that a patient needs transport to a healthcare facility – family members will likely be unable to join them in the ambulance unless that patient is a child or has special needs. Loved ones are also directed to contact the hospital directly to determine if they can visit patients.

 

Changes in access


In some cases, the screening tables have been turned on responders JEMS reports that nursing homes and other care facilities are screening paramedics as they come in to pick up patients because they stand a strong chance of being virus carriers. Wes Ward, EMS Battalion Chief for Center Point Fire District in Alabama told JEMS, “We don’t want to be a route of transmission of the disease throughout the public. That was a problem with the SARS disease in Toronto and we learned a lot from that.”


Shortage of supplies persist


Enhanced 911 call intake procedures also inform the way that paramedics and others dress for certain calls. If a patient seems to be infected or at risk, responders are donning PPE including masks, goggles, gloves and gowns. There is an alarmingly low supply of protective gear available for hospitals and responders. Fire departments, labor unions and elected officials have voiced concerns over this sad and dangerous reality. Typically, departments overwhelmed by a disaster rely on mutual aid or an agreement to share first responders and resources, but COVID-19 likely won’t adhere to man-made boundaries - making it less likely to tap into neighborly assets.


Testing is still largely reserved for the elderly, individuals with underlying health problems, and those suffering from more severe symptoms. Vice President Pence recently recognized the importance of testing those working on the front line, President Mike Pence said, “It is important the tests are available for the people who are most in need, and our health care workers and first responders that are helping and supporting them.” On the very same day Pence spoke about the issue, a policy maker in Florida suggested that first responders “take one for the team” and build immunity by getting infected by the virus in a controlled setting.

 

The downside of delayed responsiveness


The list of responders affected by the virus continues to grow. The first confirmed case of coronavirus occurred over two months ago in Kirkland, Washington. More than 40 first responders in that community went through a 14-day quarantine period – some sheltered in place at home while others holed up at a fire station that re-opened last weekend after a thorough cleaning. Some firefighters remain in home quarantined there. The number of infected firefighters continues to jump in cities and towns all over America. Last week, 80 remained under quarantine in San Jose, California, and the city temporarily shut down two fire stations. Similar efforts took place in Brooklyn – and are increasingly happening in communities all over.


Community communications is key

 

There are a lot of positives to take away from this global pandemic and one, in particular, is the proactive way that emergency response organizations are communicating to the public about local emergency preparedness decisions, changing protocol, social distancing, and sharing the hazards that are occurring as a result of the coronavirus. We are seeing fire departments, EMS, and others working to minimize frustrations, provide best practices, and debunk misinformation via media outlets, social media channels, department communications platforms, and regularly scheduled press events. Leaders are addressing local exposure issues, reminding us to not mix disinfectants that can generate dangerous, toxic fumes, and sharing guideline from different organizations. Emphasizing the importance of social distancing, and getting the word out about local changes related to firehouses (station visits, tours, community events and any other interaction that might put the public and emergency response personnel at risk). All these changes and communication efforts go a long way in alleviating concerns, defusing misinformation, empowering the public, and keeping people safe.

 

For the latest COVID-19 information from NFPA visit this landing page - www.nfpa.org/coronavirus. As we navigate the evolving situation with COVID-19, we remain committed to supporting you with the resources you need to minimize risk and help prevent loss, injuries, and death from fire, electrical, and other hazards.

The growth and spread of the coronavirus (COVID-19) infection around the world has everyone on edge. Businesses, schools, and healthcare institutions are all breaking out their pandemic plans from H1N1 in 2009 or, if they didn’t have guidance in place, they are looking to establish continuity or strategic plans in case COVID-19 threatens to impact their operations.

 

According to news report, COVID-19 is spreading at a fast rate; and as more testing kits become available, there will be many more confirmed cases of the virus around the world. Those kits will also provide a much better epidemiological picture of where COVID-19 is spreading and how it is being transmitted. With measures being taken to slow its spread, hopefully, we will see the impact lessened and the threat thwarted, but, in the meantime, it is important to plan for the worst.


Maybe you’re thinking COVID-19 is a medical issue, not a fire incident or emergency response concern, so how can NFPA help us?


The National Commission on Terrorist Attacks Upon the United States (the 9/11 Commission), recognized NFPA 1600 Standard on Continuity, Emergency, and Crisis Management as our National Preparedness Standard. Widely used by public, not-for-profit, nongovernmental, and private entities on a local, regional, national, and global basis, NFPA 1600 has been recognized by the U.S. Department of Homeland Security as a voluntary consensus standard for emergency preparedness. The standard is available on the NFPA website for free viewing, and offers key information for entities who want to conduct a risk assessment, business impact analysis, capabilities and needs assessments, and develop emergency and recovery plans. Healthcare decision-makers may also find NFPA 99 Health Care Facilities Code helpful; the document provides critical safety information and requirements for isolation spaces, emergency planning, IT and data infrastructure, and more.


So, what can you do today to better prepare and revise your plans?


First thing is to identify the event that you are planning for. Chapter 5 of NFPA 1600 states, “Crisis management planning shall address an event, or series of events, that severely impacts or has the potential to severely impact an entity's operations, reputation, market share, ability to do business, or relationships with key stakeholders.” In the case of COVID-19 that is easy to identify. What’s harder to put a finger on is the vulnerability of people, property, operations, the environment, the entity, and the supply chain operations.

 

Second is to conduct a business impact analysis. A key facet of this deep dive is evaluating the following: 

 

  • Dependencies
  • Single-source and sole-source suppliers
  • Single points of failure
  • Potential qualitative and quantitative impacts from a disruption

 

Third is to assess your resource needs. Here are some things to consider:

 

  • What do you have in place currently to mitigate potential disruptions?
  • What are the things you must do to maintain services, at a minimum?
  • What are your technological capabilities and how can they be leveraged to minimize impact?
  • What are aspects of your business or services that can be disrupted in order to re-direct assets to necessary activities?

 

Once you have a good picture of the threat, your capabilities, and what you need to continue operations, you can realistically plan. Businesses and communities will be well-served if they regard the coronavirus as an opportunity for self-evaluation and to either update or create plans that will be needed if the virus continues to spread. NFPA 1600 is a valuable tool for those who are focused on continuity of operations, but bear in mind that planning cannot and should not be done in a vacuum. Establish a planning team, and invite your stakeholders, vendors, and emergency partners to participate in the planning process, where appropriate. Evaluate your products or services, and prioritize the use and purchase of them. For a business, an example of prioritization might entail decreasing marketing efforts so that fulfillment capabilities can be increased. For a school, it may entail reducing or cancelling after school events and large gatherings, such as assemblies. Another thing to consider is your physical operations. Ask questions about what can be done remotely.


Healthcare gets a little trickier because facilities service patients; but do all operational aspects require workers to be physically present, perhaps unnecessarily putting them and their loved ones at risk? Or can you identify the biggest priorities? Do you know what your surge capacity is? How many additional PPE supplies can you store? What contracts do you have in place to acquire more supplies? Are you in touch with the local health department and discussing plans for any surges, how to get support or how to offer support? Do you have MOUs with similar facilities in case your physical operations are affected? Now is the time to ask these questions, and more, and to make the necessary connections.


As an all-hazards information and knowledge leader, NFPA has worked to help entities and communities address emergencies for a very long time. As you review or develop necessary plans, consult NFPA 99, NFPA 1600, and the NFPA 1600 handbook.You may also want to consult the NFPA Emergency Preparedness Checklist or contact NFPA to learn more about a facility planning workshop that walks parties through the process of developing emergency plans.  And, as always, if you have questions or need guidance on how to access or use codes and standards - we are here to help.

 

IT’S A BIG WORLD. LET’S PROTECT IT TOGETHER.

 

If you found this article helpful, subscribe to the NFPA Network Newsletter for monthly, personalized content related to the world of fire, electrical, and building & life safety.

Recently, two teachers’ unions joined forces with Everytown USA, a gun violence prevention advocacy group. They released a position statement against active shooter exercises, featuring realistic simulations, in schools; and highlighted the psychological and emotional impact on students that participated in those simulations. There have been reports of workplace exercises where occupants of buildings have also suffered harm as a result of realistic simulations.

 

The Everytown USA statement closely resembles one produced by the National Association of School Resource Officers and The Association of School Phycologists (NASRO/NASP with one big differentiation: NASRO/NASP made a distinction between exercises and drills. Why is this important? Because they are considered two very different things in codes and standards.


NFPA has several documents (NFPA 101, NFPA 99, NFPA 1600, NFPA 3000, and more) that talk about drills and exercises. Although the codes are different, they all recognize that drills differ from exercises. An exercise as defined in NFPA 1600 Standard on Continuity, Emergency, and Crisis Management is a process to assess, train, practice, and improve performance in an entity. It’s important to note that it says entity, not occupants.


None of the NFPA codes or standards currently define what the term “drill” means but the term “fire drill” has its own section in NFPA 101 Life Safety Code. In Chapter 4 of NFPA 101, and in its explanatory language in Annex A, it is clearly laid out that the intent of drills is to familiarize occupants with using different egress routes and practicing drills at different times. NFPA 101 advises to use simulated conditions, and the explanatory annex clarifies that this reference applies to using the emergency egress alarm to signal the drill; practicing at different times of the day or different days of the week; and to searching for a secondary exit, if the closest one is blocked.


Both drills and exercises are effective practices, and should be used to keep our schools and communities safe.
Drills focus on the occupants of a building and are meant to teach a skill or action by following and practicing a set of instructions. As an example, a fire drill is designed to teach occupants of a building to egress the building quickly and safely. During fire drills you can gain additional skills by learning to check for the nearest exit to you, by seeking an alternative exit, and moving to relocation areas. Most of us are familiar with drills because we have experienced them on a regular basis from kindergarten through adulthood.


School drills have proven to be historically successful. In fact, the last fire-related deaths recorded at a school were in 1958. What’s great about drills is you are learning a skill (egress or shelter in place) that can be applied in different scenarios. Egress knowledge, for example, is important during a fire but can also be applied during an active shooter incident. Shelter in place is key during a hostile event, but it can also be useful during natural disasters, air quality issues and other emergencies. The skills taught to occupants during drills can typically be applied when direction is given or when occupants are faced with decisions.


Drills should be conducted in accordance with locally adopted codes, like NFPA 101. The proposed 2021 edition of NFPA 101 requires an emergency egress drill for each month that school is in session. Where allowed by the authority having jurisdiction (AHJ), those monthly egress drills can be changed from egress to another form of preparedness drill, twice per school year. This was done in order to give schools more flexibility and to not have emergency drills take up an exorbitant amount of time each month. These guidelines are minimum requirements; schools and AHJs may choose to do more, if they see fit.


An exercise applies to the entity. Exercises are designed to simulate hazards, conditions, and responses to dynamic threats. They give participants an opportunity to test preparedness measures, decision-making, and necessary skills, among other things. An exercise is much more dynamic and complicated than a drill and usually serves building and life safety authorities the most. By simulating a hazard and responding to it, the exercise creates opportunities to test procedures for access, way-finding, threat remediation, rendering aid, and relocating injured parties out of a building. For example, an active shooter exercise may be used to assess communication between school leaders and responders; determine responders’ abilities to navigate buildings; gage how aid is provided; examine the functions of unified command; and analyze the procedures for community notifications.


Like drills, exercises can improve an entity’s readiness and reinforce critical decision-making skills, while under pressure. Exercises help responders get familiar with the intricacies of buildings. They provide a means to practice communication methods and elicit feedback on what plans, policies, and procedures worked - and what didn’t go so well.


NFPA 3000 Standard for an Active Shooter/Hostile Event Response Program requires that facilities who have been deemed by their AHJ to be at risk for an active shooter or hostile event exercise all, or part of their emergency operations plan, no less than once annually. NFPA 3000 explains that the exercise is designed to be coordinated with community response partners. The exercise can be a tabletop or functional exercise; in other words, occupants don’t need to be involved in any way. NFPA 3000 further specifies that training the occupants of a building on their expected actions be part of an emergency plan (i.e. drills).


Understanding the differences between the terms drill and exercise can help re-frame modern day conversations about safety. Here are the key takeaways.

 

  1. There is a difference between drills and exercises!
  2. Keep the occupants of your buildings and your building’s community informed of your efforts!
  3. Follow the codes!
  4. Work with your AHJ!

 

And remember, NFPA codes and standards are designed to make our communities safer. If you have questions related to building and life safety, contact an NFPA staff member today.

 

IT’S A BIG WORLD. LET’S PROTECT IT TOGETHER.

 

If you found this article helpful, subscribe to the NFPA Network Newsletter for monthly, personalized content related to the world of fire, electrical, and building & life safety.

President Trump has declared the week of May 19-25, 2019 National EMS Week.  The theme for this year’s week is “EMS Strong: Beyond the Call.” Those words convey an incredibly powerful message about the EMS profession. EMS goes beyond the 911 call. Yes, EMS is about excellent patient care in an emergency, but it’s also so much more. It’s something that takes time, skill, practice, passion, and compassion far beyond the scope of a normal job. It’s a responsibility to care for your community and for your fellow responders that doesn’t end when your shift is over.  Every day they provide highly skilled medical care, but they do more, they are a social worker, a problem solver, a liaison to their community, and sometimes most importantly, the shoulder we cry on in our worst moments.   This year we are recognizing the continuously expanding breadth and scope of what they are providing and their importance as a valuable and equal responder group stakeholder.

Over the past 8 years, in concert with the changing face of healthcare, EMS has become an even more critical cog in the healthcare infrastructure of our communities.  Regardless of service type (fire based, third service, private, hospital based, non-profit, etc.) EMS is presently the #2 (law enforcement is #1) reason for 911 activation in the United States.  Today EMS providers are also part of specialized units like SWAT, technical rescue, and hazardous materials teams.  As a nation, we are currently in the process of growing and incorporating our EMS provider’s roles in public health and community based manner. This involves using EMS to divert people from needing to use medical facilities and providing medical care in a more streamlined fashion at the home.  These services will reduce the strain that growing numbers of hospitalizations are creating in our healthcare systems.  This may significantly reduce cost and wait times for services as EMS will assist in the maintenance of the patient care, not just in the acute and transport realms. EMS has always been considered the eyes and ears of the Physician, even the term paramedic means “next to the Physician” when you use the Latin routes of the word.  These community based healthcare programs or community paramedic programs, as they are commonly known, move EMS into the realm of other functions and Physician’s eyes and ears outside of the emergency world.  In 2019 we will release NFPA 451; Guide for Community Health Care Programs.  This document will help EMS Systems regardless of their service type with expanding their roles in the overall Health Care community.  States and authorities having jurisdiction, may also find the guide useful in the creation of scope of practice models and new regulations

In just the past two years the NFPA has focused on providing more informed support and service to our responder stakeholders as a whole.  Although many in law enforcement, 911 centers, and EMS aren’t necessarily as familiar with our efforts as the fire service is, the NFPA strives to make all responder’s safer and unified and has done so for many years.  In just the last two we’ve increased our non-fire based EMS participation in technical committees by a factor of 10.  In 2018 we released two new groundbreaking standards with the participation of the entire EMS community.  Those were NFPA 2400; Standard for Small Unmanned Aircraft Systems (sUAS) Used for Public Safety Operations and NFPA 3000tm; Standard for an Active Shooter/Hostile Event Response (ASHER) Program.

For EMS week 2019, The NFPA will post links to our different tools and resources, these provide information and knowledge that will help our EMS systems and providers.  Each day of EMS has a theme and below are each day’s theme and resources the NFPA provides that fit that theme:

MondayEMS Education Day Check out our free Alternative Vehicle Safety Training for EMS Personnel and use your 30% discount for the NFPA 3000tm Active Shooter Hostile Event Response Program, Plan, Respond, Recover badging program!

Tuesday - EMS Safety Day – Create a free account and view safety standards that can help keep you safe in your job every day like NFPA 1999, NFPA 1500, and NFPA 3000tm

Wednesday - EMS for Children day – A little known fact is that the facility design and safety requirements for acute care pediatric centers are found in NFPA 99, create a free account and check it out today!

Thursday - Save-A-Life Day (CPR & Stop the Bleed) – Our nation’s fire and EMS responders are key cogs in helping educate our communities.  The NFPA supports these critical efforts in our community healthcare and community risk reduction standards and guides. Separately, with the recommendations in  NFPA 3000tm, we are seeing more and more communities teach “Stop the Bleed” and have seen bleeding control kits spreading into the emergency planning for occupancies such as schools and airports (the picture I sent is from Nashville airport).

FridayEMS Recognition Day – Today we celebrate you! Our nations EMS Providers no matter your method of service (volunteer, private, fire based, etc.) we thank you for what you do for our communities and each other every day.  The NFPA also appreciates the efforts you make to improve and increase standards, your participation on technical committees, and you inputs and comments, are what drives our standards development process. (I recommend using the group pic with me in it)

Thank you for all that you do for our communities and for each other.  The efforts of our EMS responders, in my opinion, are the backbone of what make our communities strong.  The continued growth of the EMS role, the collaboration with other responder partners and Health Care community, and working with us at the NFPA to develop standards in order to support the profession is how we at the NFPA believe we support making EMS strong and we are stronger together at the call and beyond the call.

One year ago this week, NFPA released NFPA 3000TM (PS), Standard for an Active Shooter/Hostile Event Response (ASHER) Program – the world’s first guidance to help communities establish unified mass casualty preparedness, response, and recovery plans.


The impetus behind the development of this standard was the same disgust that we all felt this week when we heard that even more carnage had unfolded in California and North Carolina. Yet, with each horrifying incident, many still ask, “When will the insanity stop? What can we do to end these senseless events? Is anyone working on this? Am I becoming numb to these unforgivable incidents?”


The most important answer to the above is yes, people are working to effect change. BUT we can do much more to prepare cities, towns, campuses, and the many people it takes to safely manage these communities. In fact, we need to do a lot more. We need more people recognizing they can’t fight this fight alone. We need more people engaging with key stakeholders to define, communicate, and practice the steps outlined in NFPA 3000. We need more policymakers supporting legislation so that authorities have the manpower, money, and resources to make a difference. And we need the public to know what steps they can take to better protect themselves and loved ones.


Many organizations and outlets recognized this past year that they needed to learn more and share more about ASHER strategies. NFPA received requests from the media, industry influencers, first responders, school officials, emergency managers, members of Congress, state legislators, security professionals, facility managers, healthcare sources, and building security contacts who wanted to learn more about the standard. Engaging audiences via news coverage, webinars, podcast, trade articles, conference sessions, collaborations, and discussions was extremely important in year one of NFPA 3000. I can say with great confidence that this standard is serving as a springboard for different jurisdictions and authorities to holistically plan, react to, and survive man-made catastrophes.


One of the most memorable efforts this past year was a trio of events encouraged by Massachusetts Governor Charlie Baker. Three filled-to-capacity school active shooter symposiums were co-hosted by the state fire marshal and NFPA, just as the Baker administration was lobbying for $72 million in funding for hostile event and recovery resources. The symposiums brought together law enforcement, fire, EMS, school leaders, and policymakers to ensure that officials in different communities throughout the Commonwealth were proactively working together on ASHER strategies. Representatives from more than half of Massachusetts’ 351 cities and towns attended one of the symposiums. A similar free active shooter/hostile event program, with Michele Gay who lost her daughter during the Sandy Hook tragedy as the keynote, is being offered for school officials, responders, emergency management personnel, and facility professionals at the annual NFPA Conference & Expo® in San Antonio this June.


Over the last year, we have seen people who may have thought these incidents were unlikely taking proactive steps to prepare for potential events, as reported by The Wall Street Journal. NFPA 3000 can help with those preparedness methods because it sets the foundational minimums for developing or vetting a comprehensive holistic ASHER program. In ways large and small, individuals can also play a role in elevating safety. For example:

 

  • A member of the public may want to contact local leaders to see if NFPA 3000 safety benchmarks are being considered and applied in their communities, or to determine how things work at their schools should an unwanted intruder show up.
  • Adults and children can learn Stop the Bleed – so that they are empowered to administer critical care before a victim bleeds out. Run Hide Fight is also vital information for our world today; but it’s important to remember that this guidance is not necessarily reflective of the order of actions, but more about options based on the scenario.
  • First responders can refer to the standard so that they can train on the competencies for their role or help conduct risk assessments at facilities and venues.
  • Hospital staff can use the NFPA 3000 to coordinate with first responders and establish lines of communication that are regularly tested. The standard also provides a framework for recovery planning and victim identification planning - two critical elements that are often overlooked.
  • School leaders and their building staff can use information in the standard’s 20 chapters to facilitate conversations with law enforcement, fire, EMS, building contacts, emergency managers, and elected officials.


The point is, it’s a whole new world. We have to keep asking questions, learning and teaching to make a difference. NFPA staff and the Technical Committee that developed NFPA 3000 has done just that since last May; and those insights are currently being incorporated into the next edition of the standard, as we speak. For example, additional considerations for the standard on the table include guidance on types of medical equipment and the contents of medical kits for occupancies, the public, and responders; more detailed planning and risk assessment parameters; increased recovery planning including an annex with informational references and resources; and additional ASHER training and exercise considerations.

 

NFPA will continue to bring attention to active shooter/hostile event preparedness, response, and recovery. We hope that you will use the great videos, training, articles, fact sheets related to active shooter and hostile events that we have developed to help you engage audiences; that you will consider joining us next month in June at the free active shooter/hostile event program in Texas; and that you will submit your ideas for changes to www.nfpa.org/3000next.

 

We all play a role in keeping people, property, first responders, and ourselves safe. NFPA 3000 shows us that we can, and should, do more to protect against unwanted threats.

A national proclaimed recognition week (second week in April) was established in 1991 honor the 9-1-1 Public Safety Telecommunicators. This year, April 14 - 20 is dedicated to the men & women who serve as public safety call takers & dispatchers in our 9-1-1 centers. We at the NFPA thank all who stay on the line and help us in our times of greatest needs.  Many don’t realize the challenges our 911 telecommunicators face every day.  They are the first to know when something has happened and attempt to remotely make calm out of chaos, gather critical information; including information to help protect the safety of first responders, and then provide lifesaving instructions over the phone that could potentially save someone’s life.   

In 2009, I had major back surgery that would limit my ability to work on an ambulance for a significant amount of time. For the better part of the next two years, I worked as a dispatcher, 911 call taker, and C-Med radio operator (coordinating regional ambulance to hospital communications).  In the center where I worked, we averaged processing approximately 140,000 calls for service a year. I can honestly say, the time I spent in dispatch made a huge difference in my life and career. It opened my eyes to other divisions of my department and other things I could do to serve my community.  It afforded me the opportunity to learn different operational and managerial roles that would benefit me later on. But most importantly it taught me to use other senses and critical communication and thinking skills to process information and emergency scenes without being able to see or touch the patients. In the long run this improved my leadership, communication, and organizational skills.

While in dispatch I managed many major multiple casualty incidents from the dispatcher chair. I also took calls from women in active labor and coached them through what to do until help arrived, I talked members of the public through Hands-only CPR, and even talked with many people who were contemplating suicide and tried to keep their attention and focus on staying with me until help arrived.  I always thought being an EMT and going through the emotions of the challenges we face every day was hard.  I didn’t know how good we had it until I went into dispatch!  It’s all the same challenges and feelings, but you can’t see or feel them for yourself. You have to hope that people are following your instructions and learning the results of your efforts is extremely rare. This puts an incredible mental strain on you because while most don’t realize it, our dispatch professionals are there with all other first responders on the very same front lines trying to help other in need. Their ability to quickly multi-task, get resources moving, and provide guidance in a fog of confusion, is a most admirable and critical skill for the safety of the public.

One of the things I’m most proud of in our work at the NFPA, is that long before I ever came along, the NFPA has been working with the dispatch community to incorporate them into the codes and standards we develop. This is indicative of the critical nature of the work of our dispatchers and the absolute fact that they too are first responders.

Through NFPA 1221; Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems we set the minimum standard to which our dispatch centers and Public Answering Points are designed and used. Through NFPA 1061; Standard for Public Safety Telecommunications Personnel Professional Qualifications we set the training and educational minimums that telecommunicators must demonstrate in order to perform their jobs. More recently, we have looked at the expanded role of our dispatch centers and personnel play in active shooter and hostile event incidents them having their own chapter in NFPA 3000; Standard for an Active Shooter/Hostile Event Response (ASHER) Program and their expanded medical screening role in order to reduce the burden of non-emergent medical calls in our 911 EMS systems in NFPA 451; Guide for Community Healthcare Programs.  Today and every day, we at the NFPA thank and appreciate those professionals on the other side of the line from all of us who stand ready to help complete strangers in their times of need.  Happy Public Safety Telecommunicators Week!!!!

The NFPA has released the third and final training module in a series of  learning programs surrounding the new NFPA 3000: Standard for an Active Shooter/Hostile Event Response (ASHER) Program. The Recover program provides registrants with the critical knowledge and information needed to maintain business continuity, coordinate with hospitals, and establish key benchmarks so that communities can rebound quickly if a mass casualty event unfurls in their area.  
Participants can choose to take one of three distinct modules (Plan, Respond and Recover) and earn a single badge; or complete all three modules of NFPA 3000 training for a comprehensive overview. Those opting for the latter, will receive an NFPA 3000 Program Specialist badge, signifying that they have been trained in the content and implementation of the new standard. 
The four main components of NFPA 3000 are: whole community; unified command; integrated response; and planned recovery. These themes are woven throughout the fabric of the first-of-its-kind standard. The  training covers each of NFPA 3000’s 20 chapters so that different stakeholders have a strong understanding of what needs to be done before, during and after an incident to reduce harm. Throughout the document and the training, the importance of working together is accentuated. 
With hostile events dotting our news feeds on a regular basis, we are reminded almost daily that our world is different and we need to be well-prepared for new challenges. NFPA 3000 and NFPA’s 3-part  learning program were designed to help communities deal with new threats. 
Do you have a unified ASHER plan in place in your city or town?

 

We, at the NFPA, work closely with EMS providers whose dedication to their patients and their colleagues often goes unrecognized every day. As we celebrate another EMS Week, we want to thank each of you, your families and all the people who make it possible for you to help people day in and day out.

 

The theme of EMS Week this year is "Stronger Together," which recognizes not only the bonds we form with our fellow EMS providers, but also the importance of collaboration. Whether working with colleagues in your organization, partners within your community, or agencies in neighboring jurisdictions, we truly are stronger EMS communities when we do things together as a team.

 

At the NFPA, we know this firsthand - thanks to our work with many organizations supporting EMS efforts across the nation. As members of Technical Committees on EMS, Cross Functional Emergency Preparedness and Response, Small Unmanned Aerial Systems, Ambulance Design and Construction, Hazardous Materials Response, and many more relevant topics, the EMS community helps to prescribe and inform NFPA's life safety efforts every day.  This year we have completed the draft of NFPA 451; Guide for Community Healthcare Programs, which will help EMS systems evaluate and partner with organizations so that, together, they can expand services and provide community paramedicine/ mobile integrated healthcare programs.  The EMS community was also incredibly vital in the creation of NFPA 3000 (PS); Standard for An Active Shooter/Hostile Event Response (ASHER) Program.  This first of its kind body of knowledge is already helping authorities every day - and EMS providers are very much a part of this planning, response and recovery process!

 

We encourage you to embrace this year's theme, "Stronger Together".  We believe that our EMS providers play a vital role in society; and our association is grateful for the insight and input that is so readily offered by the EMS community when it comes to updating existing documents and creating new guides and standards that increase coordination, safety, and the capability of our emergency responders.

 

From all of us at the NFPA, thank you for everything you do every day.


In my recent NFPA Live I discussed the upcoming release of NFPA 3000; Preparedness and Response to Active Shooter and/or Hostile Events. The purpose of NFPA 3000 is to identify the minimum program elements necessary for organizing, managing, and sustaining an active shooter and/or hostile event response program and to reduce or eliminate the risks, effect, and impact on an organization or community affected by these events. 
I talked about the purpose for developing the draft, who is involved, what it contains, and how you can get involved in its further development.
The document addresses the following areas and others:
• Risk assessment
• Planning
• Resource management
• Organizational deployment
• Incident management
• Facility readiness
• Finance
• Communications
• Competencies for law enforcement
• Competencies for fire and EMS
• Personal protective equipment
• Training
• Community education
• Information sharing
• Readiness of receiving hospitals
• Recovery
Public Input Closing Date is February 23, 2018. If you'd like to participate in the process by submitting a public input, you can do so here.
John Montes is an Emergency Services Specialist at NFPA, and Staff Liasion for NFPA 3000.  NFPA Live is an interactive video series in which members of NFPA staff address some of the most frequent topics they receive through the Member's Only Technical Question service. If you are currently an NFPA Member you can view the entire video by following this link. If you're not currently a member, join today!
 

 

In my recent NFPA Live I discussed the release of the 2018 version of NFPA 1582; Standard on Comprehensive Occupational Medical Program for Fire Departments. Specifically I talked about the layout of the document, some of the requirements that have been updated, and I debunked some of the myths surrounding it.

 

One of the myths I often hear about this standard is:  If you're not a firefighting candidate, 1582 requires you to be held to the same standards as a firefighting candidate. This is false. Watch the video clip above to see my full answer!

 

John Montes is an Emergency Services Specialist at NFPA, and Staff Liasion for NFPA 1582.  NFPA Live is an interactive video series in which members of NFPA staff address some of the most frequent topics they receive through the Member's Only Technical Question service. If you are currently an NFPA Member you can view the entire video by following this link. If you're not currently a member, join today!

 

Since 1986, the NFPA has been publishing NFPA 1403, Standard on Live Fire Training Evolutions. As we prepare for the release of the 2018 version of the standard I'm often asked what has changed since 2012 and how best to apply the standard to ensure a safer training environment.  

 

A few weeks back I covered these topics during my NFPA Live, an exclusive for NFPA Members. During the live event I got this follow-up question.  I'm now sharing it with you. I hope you find some value in it.

 

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NFPA Live is an interactive video series in which members of NFPA staff address some of the most frequent topics they receive through the Member's Only Technical Question service. If you are currently an NFPA Member you can view the entire video by following this link. If you're not currently a member, join today!

October 3rd marks my 1year anniversary at the NFPA.  It has been incredibly rewarding to work in a place where the mission is to help responders perform their work in a safe and organized manner.  I am grateful for the opportunities afforded to me and to the technical committee volunteers who have helped me along the way.  One of my biggest and most rewarding challenges has been to work on the development of NFPA 3000, Standard for Preparedness and Response to Active Shooter and/or Hostile Events.  On Friday the 29th I wrote the following blog, but so much has happened since that I want to acknowledge some things first:

 

  • The tragedy in Las Vegas was a stark reminder these types of hostile assailant attacks are on the rise and will continue. There is a need for our communities to prepare and our responders to be safe, organized, well-practiced, and unified in their handling of this incidents.
  • Having a member of our technical committee from Las Vegas Fire and Rescue, I know there will be many lessons learned, but the Las Vegas responders have been preparing for this day and they did an amazing job.
  • As already chronicled, the responders will need the support of their community and fellow responders for many years to come after what they have experienced.

 

Before moving on, I want to share the sentiment from one of the Orlando responders that was sent to the Technical Committee members for NFPA 3000 yesterday: “After waking up to the horrific news of another record-breaking mass shooting to our public in Las Vegas, it just solidifies, even more, the great work the NFPA 3000 TEAM is creating. Thank you for all for your insight and professional experience to the active shooter standard. We all work quickly to resolve each and every potential that this new standard should cover for a purpose much greater than anything else we have worked on in the Public Safety sector. To protect our responders and the citizens we serve, the concise standard that will evolve and will help many prepare for their worst day. Not everyone can be part of this assemblage, the group that creates the Standard or the group that has "been through this hell"...some can claim both. This is a club that wants no new members. Thank you for the work you do, the profession you support, and our shared goal to make the worst day safer and more prepared for.”

 

I couldn’t have said it better myself! Now on to what I wrote about last week’s experience:

 

During the week of September 25th, a Technical Committee of over 50 experts and guests from across the country met in Orlando, Florida to continue the development of the draft for NFPA 3000, Standard for Preparedness and Response to Active Shooter and/or Hostile Events.  

 

During the meeting the Technical Committee reviewed various active shooter/hostile events, using a 30,000 foot perspective, to determine what communities absolutely need to properly prepare and respond to, and eventually recover from these events. The committee formed task groups and developed over 20 chapters that address different components of preparedness, response, and recovery. Comprised of representatives from law enforcement, fire, and other impacted response agencies, the committee focused on the need for interoperability using common language, clear and open communication, safety among peers, and resolving the incident in a unified and effective manner. What it is not, however, is a tactical or strategy document. There is too much variation to standardize local tactics, and frankly, no one wants the bad guys to know what our tactics are. 

 

The group broke the draft down into chapters that started with how communities prepare, what should be in their plans, and what they should teach to their residents and responders. Then they moved to leading to incident management requirements, competencies for responders, training and recovery components. One of the strengths of this Technical Committee is its experience. Having responders present who were part of the responses to recent occurrences of these incidents really was beneficial in that they were able to tell us where the gaps are that could be filled and the things that they wish they had in place ahead of time.

 

 

After each day’s meeting adjournment, our gracious hosts from the City of Orlando and Orange County, Florida, arranged for different non-meeting related activities for the group. One day, they received a presentation from the fire chiefs detailing the attack at the Pulse Nightclub. They took almost 3 hours out of their time to detail the incident and take questions from the group.  A big take away was that they identified the absolute need from the command level for NFPA 3000.  They feel having something that is cross-functional insures that they are on the same sheet of music as law enforcement and emergency management and would have helped them immensely with their response to the incident. This isn’t to say that they weren’t that night, but it is to say that there were many instances of confusion and lack of cohesion where compliance of the potential components of NFPA 3000 will (and can) help mitigate those occurrences from happening in the future. 

 

On the last day of meetings a group formed a makeshift caravan and traveled to the Pulse Nightclub site. I have been privy to several presentations and briefings on the events of that night. I have seen videos and heard the 911 calls and radio traffic. I can also most assuredly tell you that none of it does justice to what is still there at the site. The messages of hope, loss, and love at the site left some very burly battle hardened operators a little choked up out there. Coincidentally we even met the owner who took time to speak to us and really touched all of our hearts with her dignity and strength. NFPA 3000 will truly be a standard that not only serves as a tool for response, but a tool for our communities.

5 things a facility manager should consider when preparing, responding, and recovering from a major hurricane
We have just experienced two major hurricanes here in the United States over the last several weeks, and are sure that there will be more natural disasters in our future. The responsibility for preparedness is a whole-community approach that rests on the shoulders of many stakeholders.  Each segment of the community has a role in prevention, mitigation, response, continuity and recovery that can be addressed in a holistic manner.  Facility managers are a vital cog in this chain. NFPA 1600, Standard on Disaster/Emergency Management and Business Continuity Programs, one of NFPA’s most widely implemented standards, establishes a common set of criteria that sets a foundation for disaster management, emergency management, and business continuity programs using a total program approach (plus the PDF version of this standard is free to download!). 
Here are five things to consider as you prepare, respond, and recover from a major hurricane:   
1) The most important thing to do is prepare and know you are part of a larger community and you need to help each other.  As outlined in chapter 5 of NFPA 1600, Standard on Disaster/Emergency Management and Business Continuity/Continuity of Operations Programs conduct a risk assessment, business impact analysis, and resource needs assessment before the event occurs. This will give you an idea of what you are facing and what you will need prior to the event.  
2) Know your stakeholders; These are the people that utilize your facility every day. Poll them to know what their plans are and let them know what yours are. Keep track of those that are staying and make sure to account for anyone with access and functional needs. 
3) Talk to your neighbors; keep track of local emergency management’s instructions and follow them. If you have capabilities and services to offer, let them know. Also, if you have resource needs, let them know. Being a good neighbor for others may save the life of one of your stakeholders or that of one of your neighbors in the event of a disaster. 
4) Communicate;  As early as possible, activate your plan and make sure that your stakeholders are aware of it.  Assure that they know their roles and expectations if any.  If you are operating a facility that is a critical infrastructure location, make sure that your on-duty staff have (to the best of their ability) secured the safety of their family and pets so that they can focus on the tasks at hand. Be sure that your support of this effort is communicated to them.  For more see NFPA 1600 Annex K.
5.) Trust the plan, but don’t let it hold you back; Even the best and smartest emergency preparedness planner can’t think of everything, and we know that mother nature isn’t interested in their best intentions.  Your plan may be a script, but you will need to be flexible and make decisions and improvisations based on the need of the event.   
At the end of the day remember:   
  • The time of the emergency is not when you should be exchanging business cards for the first time with your local partners. 
  • Take care of you and your own first, so you can focus on the rest. 
  • All plans and activities are fluid and dynamic based on the needs of the event.    

 

Photo courtesy of the United States Navy.

FEMA recently posted an article pointing to a report on violence against EMS practitioners. It shows what EMS are up against in the field; yet as a 16-year EMS veteran I can’t help but think no matter how thorough the report is, it only tells half the story.

 

EMS professionals often don’t report the violence they encounter on the job. Physical abuse can take many forms. Assaults can be minor or may not result in injury to the provider. Some are downright deadly like an incident in Arkansas last year when a volunteer firefighter was fatally shot while on an EMS call. Others are fatal for the assailant, as was the case in 2016 when a Boston Police officer shot and killed a mentally unstable man that was assaulting officers and the EMS workers who were trying to help him. The same day that FEMA posted their article about EMS violence, the district attorney in Boston ruled that the police officers were justified in killing that man.

 

In my experience riding the ambulance, managing emergency services for large municipalities and as the NFPA liaison responsible for engaging with stakeholders about EMS best practices and health and wellness, I’ve learned that many providers do not report instances of violence for many of the same reasons that I didn’t. During my career, I was assaulted several hundred times by patients but only reported about 15 incidents (because I suffered some form of injury) and only went to court six times when charges were pressed.

 

It is believed, although it has not been studied yet, that not reporting violence against EMS is widespread throughout the United States. Providers don’t report assaults to law enforcement or supervisors, so oftentimes administrators are unaware of the magnitude of this problem.  There are many individual factors why EMS workers don’t report violent incidents. Here are the ones that influenced my decisions:

  •  I felt sympathetic towards the sick and impaired, and didn’t want to get them in trouble 
  • I was assaulted by patients who were suspected to be under the influence of some controlled substance, and law enforcement was hesitant to charge them because they wanted them to be medically cleared
  • I may have not had a visible injury
  • There was no injury
  • I felt peer pressure to act like I was tough and that the assault didn’t affect me
  • I simply accepted it as “part of the job”

 

The EMS violence study is a tremendous starting point - although it only focuses on EMS workers employed by large, urban fire departments. This is likely due to lack of data. There are some noteworthy observations from the study including:

  • EMS workers are more likely to be assaulted by patients than their firefighter colleagues
  • Gender does not determine who gets assaulted
  • There is a disconnect between EMS workers in the field and the dispatchers who collect information about the medical emergency
  • There is a general lack of knowledge about preventing violent EMS attacks. Free online training opportunities, like this National Institute for Occupational Safety and Health course, can help
  • Signage in the back of ambulances stating “it is a felony to assault a first responder” may deter patients from assaulting EMS workers. These are used in Canada and the United Kingdom. They show support for EMS workers
  • Computer-aided dispatch (CAD) systems should utilize a flag system so that dispatchers can alert EMS workers about prior patient-initiated violence at the location. Urban departments in Dallas and Montgomery County, Pennsylvania have this feature
  • Fire departments can reduce provider stress levels by looking into more personnel to ensure that EMS workers have breaks during their shifts to encourage occupational recovery
  • Management should support EMS providers during legal proceedings after an assault occurs

 

The strength of the data out there clearly demonstrates a need for further and deeper exploration into this subject.  Another consideration is encouraging EMS workers to report violent incidents to programs such as the CLIR EMS self-reporting tool so that more robust data can be collected.

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