The management of several neurohormonal pathways is crucial to treating the progression of HF, in addition to improving the quality of life for patients diagnosed with HF. Stimulation of the sympathetic and retin-angiogensin-aldosterone systems begins the initial and primary neurohormonal stimulation associated with the progression of this disease. However, it is becoming increasingly evident that other systems, including the cellular immune, endothelin-NO pathway, kallikrein-kinin system, the arachidonic acid cascade, and the natriuretic peptides need to be considered by clinicians when treating HF.
Once treated solely with nitrates, diuretics, and morphine, the management of HF is becoming a more complex and intricate balancing act among several interdependent neurohormonal systems. Same bucket. Same gallon of water. Same fire. Different gallon per minute application. Different outcome. Granted, occasionally a company officer team leader must briefly drop down to the task level. This role reversal creates a dangerous situation.
Should a company officer seek the entertainment value of operating a nozzle or chainsaw, then suggest that the individual be demoted. Operating nozzles, tools and equipment is the role of a firefighter, not the role of a company officer. There is an invisible strategic chain that links task-level, to tactical-level, to strategic-level. At the task level the strategic chain is connected to the team. At the strategic level the chain is connected to a branch director, to the operations section chief or more likely during a single-address, square-foot-fireground operation directly to the command post.
There needs to be a strategic presence with the team. This strategic presence is the team leader. The team leader monitors progress, monitors conditions, monitors remaining SCBA air, monitors the radio and looks for alternate egress. When the team leader is at task level, nobody is looking out for the team. Everybody is focused on the task. Make sure your company officers know how to be team leaders.
Neurohormones and heart failure.
At the core of fireground span of control that is out of control is an incompetent incident commander. One indicator is a command post laboring to track each and every company or worse firefighter throughout the course of an incident Indiscretion 7. Get personnel accountability out of your command post! Yet another indicator is the designation of an "accountability officer" Indiscretion 7. Accountability is a contemporary component of competent incident management. Managing an incident means managing span of control. Another reliable indicator is the "Groucho Commander.
Picture a hunched-over Groucho Marx striding back and forth, one arm behind his back, the other holding a cigar to his mouth. Migratory incident commanders are too overwhelmed and emotionally attached to the incident to be anchored at a command post managing strategy, resources, and risk. When span of control is out of control, it is impossible for the Groucho Commander to keep track of who is there, what they are doing, where they are, when they entered the hazard area and why.
Closely related to Indiscretions 1, 2, 3 and 8, once a fireground operation is set in motion, it continues until something bad happens or the incident is stabilized. A reliable indicator is the absence of regular, periodic and structured status reports. Other indicators include offensive operations without a time limit see Indiscretion It is impossible for a migratory Groucho Commander to manage the clock, span of control, an incident action plan, regular status reports, mode confirmations and periodic situation assessments. Bottom line: It is impossible for an uninformed reactive tactician to be an informed proactive strategist.
How many of you have experienced a fireground operation where one or more of the "13 Fireground Indiscretions" were transgressed? I have no doubt that every firefighter reading this article will be honest now answer "yes.
The time has come for unintelligent and unsafe fireground operations to be considered unacceptable. Your challenge is to learn from the indiscretions of the past in order to prepare for your next alarm.
Then, when mistakes are made and they will still be made , these indiscretions will be identified and not repeated! Consider the following: When and where did four firefighters die during a fire at an unoccupied car dealership when unprotected steel bowstring trusses failed? How many of you answered at Hackensack Ford in New Jersey? Five Hackensack firefighters were killed when timber, not steel, bowstring trusses failed during a fire at an unoccupied car dealership. Ultimately, fire officers make decisions that place firefighters in the wrong place at the wrong time.
Until something changes, the most dangerous element on any fireground will continue to be the uninformed, inexperienced, overly aggressive fire officer. Do you remember the plan at the beginning of this article?
The Deep Space Nine Transcripts - Indiscretion
The next incident that you manage will not become the subject of a NIOSH fatality investigation report. When selecting a report for study, the focus was on fatalities and injuries that were the result of firefighters being at the wrong place at the wrong time. Being at the wrong place at the wrong time is manageable; fire officers have the responsibility for ensuring that firefighters are doing the right thing at the right place at the right time. Granted, these factors are also important; however, because they are not manageable by incident managers, these factors were not considered.
The drill went like this: I would read a fatality investigation report and make a list of what I believed to be strategic factors that contributed to the fatality. Over a period of years and the study of numerous reports, I would add additional strategic transgressions to the list. Eventually I could find nothing to add to the list. Did you catch the significance of the last statement?
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Because the same factors are happening over and over. He may be contacted at fci usa. Home Home 13 Fireground Indiscretions. March 31, Join Thousands of Fellow Followers Login or register now to gain instant access to the rest of this premium content! Risk Management A basic principle of "risk management" is that once a risk has been identified, it can be managed. The number 13 represents bad luck, but addressing each of the "13 Fireground Indiscretions" will dramatically improve your fireground "luck": 1.
Lack of pre-incident knowledge and information. Most significant problem not identified. Inappropriate operational mode. No plan formulated or communicated. Insufficient personnel. Absence of "tactical accountability. A tactical accountability system will proactively account for teams and companies: who, what, where, when and why: Who is there? Nobody watching the clock. Random, undisciplined communication. Journal of Pan African Studies, 1, Self and community in a changing world. Bloomington and Indianapolis: Indiana University Press.
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13 Fireground Indiscretions
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