1. Emergency Services, LLC / Copyright 2007 / Volume 07-11 TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show in its entirety FIRE MEDICS Suicide Awareness Quiz EVOLUTIONS 2000 Kramer vs. Kramer Program Quiz Answers FIRELINE Multi-Fatal MVI Fall from High-Rise – or Jump? Discussion Questions HANDS-ON Train/Bus Crash Simulation (expanded segment)Train/Bus Crash Simulation (expanded segment) Quiz Working Fire Training 07-1 Training Materials

2. Emergency Services, LLC / Copyright 2007 / Volume 07-12 TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show in its entirety Working Fire Training 07-1 Training Materials All training methods and procedures presented in this Working Fire Training (WFT) video program and training materials are based on IFSTA, NFPA, NIOSH, OSHA and all other relevant industry regulations and standards and are presented as a part of generally accepted and acknowledged practices in the U.S. Fire Service. WFT should be used under the supervision of certified trainers in conjunction with national, state, and local training standards and protocols, and the standard operating guides and procedures of the Subscriber. WFT is intended to be an ancillary source of training information and should not be used as the sole source of training for any emergency service organization. WFT accepts no responsibility for how the Subscriber implements or integrates this program into the Subscriber’s own training program, nor does the use of this program by the Subscriber imply that WFT approves or endorses any specific training methods presented by the Subscriber to its own organization. WFT accepts no responsibility for the correct understanding or application of its training methods and procedures by emergency service personnel who view this program; nor for any performance or lack of performance by emergency service personnel who may view this program and use or apply these training methods and procedures incorrectly; nor does it accept any liability for injuries or deaths of emergency service personnel who may view this program and use or apply such training methods and procedures incorrectly. By presenting this program for viewing to its organization’s members, the Subscriber, and by viewing or reading materials presented by WFT, the members and students of the Subscriber, agree to hold harmless WFT, the University of Cincinnati, VFIS, and any persons or organizations who participate in the creation and/or presentation of this training material from any legal action which might result from any line-of-duty injuries or deaths of the Subscriber’s members or any other emergency service personnel who view this program and who may use or apply such training methods and procedures incorrectly. LEGAL DISCLAIMER

3. Emergency Services, LLC / Copyright 2007 / Volume 07-13 DISPATCH/SIZE-UP Three vehicles, all carrying teenagers, were traveling at high speed. –Two fatals, four severely injured, over hundreds of square feet. –Several jurisdictions had to respond. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

4. Emergency Services, LLC / Copyright 2007 / Volume 07-14 RESPONSE The first thing was to call for equipment and stay detached from the scene to concentrate on organization. –That's one of the main things that one has to do in any accident of this nature, or any large incident. We had to call in multiple EMS units. –Approximately 10-11 ambulances were on scene; the Justice of the Peace was called. –Kept scene organized with paper and pen and wrote down the units and the number of personnel who were responding. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

5. Emergency Services, LLC / Copyright 2007 / Volume 07-15 COMMAND EMS Supervisor and Incident Commander formed an incident command team. Try to keep firefighters and special teams working together. –I concentrated the firefighters with the paramedics into the most critical areas. Paramedics basically did triage and started working on some of those who were less critical. –DOSs, of course, were left in place. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

6. Emergency Services, LLC / Copyright 2007 / Volume 07-16 ACCOUNTABILITY Incident Command set up a command post so personnel knew its location. Beaumont Fire attempted to keep fire personnel with their unit. –Even if they are moved to different tasks, Command tries to keep the together as a group and chart their location. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

7. Emergency Services, LLC / Copyright 2007 / Volume 07-17 ACCOUNTABILITY (cont.) Personnel must also be accountable for their whereabouts. –Once, at a previous incident, a medical unit transported a firefighter to a hospital and no one knew it. –Keep a tight rein on accountability. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

8. Emergency Services, LLC / Copyright 2007 / Volume 07-18 SCENE SAFETY Beaumont Fire checked to make sure the scene was safe first. Amazingly, there were no fuel tanks leaking considering the number of vehicles involved. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

9. Emergency Services, LLC / Copyright 2007 / Volume 07-19 LESSONS LEARNED If he had to do it again, the IC would go back and push critical incident stress debriefing. –CISM was needed because there was one responder who had a son the same age as one of the teenagers who were fatal. It really got to him. –The members had a meeting among themselves and talked through the incident because the responder needed to talk. –We also talked about it at a medical station afterwards. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

10. Emergency Services, LLC / Copyright 2007 / Volume 07-110 LESSONS LEARNED (cont.) As an IC or company officer, the most important thing is to stay somewhat detached and factor out the emotions. See the School Bus vs. Train MCI in “Hands-On”. Fireline Incident: Multi-Fatal Motor Vehicle Incident 07-1 Training Materials

11. Emergency Services, LLC / Copyright 2007 / Volume 07-111 DISPATCH Dispatch sent a crew for a rescue of a man who had fallen from a roof. It was a five- minute response. On the way responders thought about the 16 inches snow they received the night before. As it turned out, the snow was one of the main reasons the patient lived. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

12. Emergency Services, LLC / Copyright 2007 / Volume 07-112 SIZE-UP Upon arrival, Medic One’s team assessed the scene. Deputy Chief met with the battalion chief in charge. –You could see the patient lying in the snow on top of the portico of the apartment building. –He had fallen or jumped from the 16th floor. It was unclear whether it was a suicide attempt or not. –It would have been unsafe for the paramedic to go out the window on to the portico. There was structural damage to the portico; its integrity was in doubt. Some lights and aluminum siding were bulging down from the impact of the body. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

13. Emergency Services, LLC / Copyright 2007 / Volume 07-113 EVENTS One firefighter attempting to climb on the turntable of the aerial ladder fell due to the ice and slid under the ladder, hurting his leg. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

14. Emergency Services, LLC / Copyright 2007 / Volume 07-114 STRATEGY/TACTICS They decided to split the paramedic crew; one crew responded to the downed firefighter and assisted with his leg injury, stabilized and immobilized him, and put him in the back of a waiting BLS unit. A paramedic from the other crew was sent to the second-floor window, with instructions not to go out on the portico awning, but to assess what they could from that location. He advised that the patient was alert and breathing but appeared to be combative. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

15. Emergency Services, LLC / Copyright 2007 / Volume 07-115 STRATEGY/TACTICS (cont.) Battalion Chief Hobin discussed a plan of action with the rescue squad to remove the subject on the roof. –They decided to use the 105’ ladder truck and bring him down the ladder on the Stokes basket. REMARKS Hobin’s concern was that the patient was already on the canopy for about 10 minutes and it was very cold and windy. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

16. Emergency Services, LLC / Copyright 2007 / Volume 07-116 RESPONSE A ground ladder was raised from the driveway up to the roof of the portico where a firefighter went to assist a police officer in holding the patient in place. –The firefighter notified Command that the patient was combative. Medic One crew called medical control and asked if they could sedate the patient while he was on the canopy so they could move him to the Stokes basket to the aerial ladder. –They prepared for that sedation using Haldol and Versed. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

17. Emergency Services, LLC / Copyright 2007 / Volume 07-117 RESPONSE (cont.) The rescue team advised Command that they could load the patient into the Stokes basket and remove him without sedating him. –Companies went up the aerial ladder with a cervical spine collar and backboard. –The subject refused the collar and board. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

18. Emergency Services, LLC / Copyright 2007 / Volume 07-118 RESPONSE (cont.) Responders decided to roll him and sweep him into the Stokes basket and bring him down the aerial that way. –The entire time he was he was grabbing the ladder rails and turnout gear of the crew. –A police officer handcuffed him to the Stokes basket for his own protection and that of the responders. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

19. Emergency Services, LLC / Copyright 2007 / Volume 07-119 LESSONS LEARNED It is important to coordinate with the incident commander so that everyone is on the same page. –There were four different agencies responding: Wilmington police and fire, New Castle County EMS, and a private agency for transport. –Everyone has to coordinate and work together and report to the Incident Commander what is occurring. Fireline Incident: Fall from High-Rise – or Jump? 07-1 Training Materials

20. Emergency Services, LLC / Copyright 2007 / Volume 07-120 Fireline Incident Discussion The departments involved in this month’s training pose some discussion questions that you can use as discussion-starters in your own department’s training sessions. How will your department handle these scenarios? 07-1 Training Materials

21. Emergency Services, LLC / Copyright 2007 / Volume 07-121 Multi-Fatal Motor Vehicle Incident / Beaumont, TX Asst. District Chief William Horatio Ware, Beaumont (TX) Fire Dept. The composition of your Command post will change based on the incident. Do you train with your EMS response commanders in coordinating a medical response-oriented incident? The key is staying organized. If you start playing catch up, it's going to get worse. Keep your thoughts together and write things down. Inquire how other departments handle similar incidents. Learn from other departments, then adapt what they do to your own. Remember, that with teenage injuries and fatalities, parents will become involved at some point. Can you handle them if they show up on-scene? Fireline Incident Discussion 07-1 Training Materials

22. Emergency Services, LLC / Copyright 2007 / Volume 07-122 Fall from High-Rise…or Jump? / Wilmington, DE Battalion Chief John Hobin, Wilmington (DE) Fire Dept. It’s not often you come across someone so determined to kill himself. If a patient turns combative, get the police involved. As usual, our initial concern was for the safety of responders. Rescuing this patient meant assessing any damage to the portico he landed on. With safety in mind, always remind responders during inclement weather to watch out for unsteady footing due to water and/or ice. In this case, an injured firefighter meant dealing with two emergencies. Fireline Incident Discussion 07-1 Training Materials

23. Emergency Services, LLC / Copyright 2007 / Volume 07-123 OBJECTIVES/OUTCOMES After watching this segment, the student shall understand: more about the staging of such a simulation the response and coordination of responding to an MCI. CODES, STANDARDS & REGULATIONS NFPA 16, 1410, 1500; NFPA 471-473, Hazardous Materials Incident Response. All relevant local EMS protocols. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

24. Emergency Services, LLC / Copyright 2007 / Volume 07-124 PREPARATION The simulation was performed as part of a national conference given for transportation executives and was also opened to the public. Approximately 500 people attended. Assistance was received from a local school bus company who donated the bus and a construction company who provided equipment that prepped the bus into “wrecked” condition. The railroad provided engines and a track for the MCI venue. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

25. Emergency Services, LLC / Copyright 2007 / Volume 07-125 PREPARATION (cont.) Forty to fifty student volunteers were moulaged and placed inside the bus as passengers. Remember that many of the following functional areas and tasks are taking place simultaneously. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

26. Emergency Services, LLC / Copyright 2007 / Volume 07-126 DISPATCH EMS and Fire crews arrive, dispatched to a train wreck. All rail traffic is ordered stopped. Weather conditions and a low ceiling prevented some resources, such as a air-flight helicopters, from being used in this exercise. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

27. Emergency Services, LLC / Copyright 2007 / Volume 07-127 SIZE-UP A 360 size-up of the scene was conducted by first-in officers. –Additional EMS and ambulances were ordered. –First-in officers will establish initial command until a more senior officer arrives on scene. Simultaneously, crews work with the walking wounded in leading them to safety. –This is the beginning of a deeper triage. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

28. Emergency Services, LLC / Copyright 2007 / Volume 07-128 FIRE SUPPRESSION For the purposes of this exercise, no actual fire was involved. However, fire suppression crews were on scene for simulated fire attacks on the locomotives, applying foam to the diesel’s traction motors. Fire crews with charged hoselines were also in position if fire were to break out in any other location. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

29. Emergency Services, LLC / Copyright 2007 / Volume 07-129 HAZARDOUS MATERIALS Although hazardous materials weren’t simulated here, in a real event such as this, haz-mat may definitely be involved. –Diesel engine fuel, bus fuel, and possible contents of the train (especially if it were a freight train), could all be spilled, contributing to ground contamination. –If fire were in evidence, especially with petroleum-based fuels, airborne combustion contamination could also be an issue. –The tank car contents themselves, if discharged, could also present an airborne inhalation factor. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

30. Emergency Services, LLC / Copyright 2007 / Volume 07-130 INCIDENT COMMAND/COMMUNICATIONS Initial Command eventually is transferred to formal Incident Command. In an incident such as this, managing resources, both apparatus and manpower, will be critical. –Depending upon the degree of complication and the duration of the incident, a Logistics section should be set up. –The longer the incident lasts, the more need there will be for acquiring additional resources. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

31. Emergency Services, LLC / Copyright 2007 / Volume 07-131 INCIDENT COMMAND/COMMUNICATIONS (cont.) In this scenario, a recently implemented 700 MHz system was tested. –Multiple talk groups and agencies were assigned separate channels so many entities could communicate in a large incident such as this. –Working Fire Training will be demonstrating a similar system in an upcoming program. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

32. Emergency Services, LLC / Copyright 2007 / Volume 07-132 SAFETY Safety officers should be plentiful. Officers should be assigned to all functional areas such as fire suppression, haz-mat, and the medical control area, as they are needed. Based on the number of patients and responders and areas of operation, sufficient numbers should be appointed to cover inside and outside the bus and any specific work areas. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

33. Emergency Services, LLC / Copyright 2007 / Volume 07-133 EXTRICATION In order to gain access to the bus for medical responders, vehicle extrication crews must mobilize immediately. –As usual, always stabilize all vehicles and make them safe for crews and patients. –Methods might include cribbing and anchoring with chains, cables, and winches. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

34. Emergency Services, LLC / Copyright 2007 / Volume 07-134 EXTRICATION (cont.) Entry to the bus can be made in a number of ways, depending upon its position and condition. –In this case, access was made through the windshield, back door, and by cutting through the roof. –It might be a good idea to set up a traffic flow for responders and patients. For example, in through the roof and out through the back door and windshield. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

35. Emergency Services, LLC / Copyright 2007 / Volume 07-135 EXTRICATION (cont.) Removing the Windshield –Remove the insulation gasket from the edge of the glass. –Use a utility knife to cut the gasket and loosen it from the frame. –Use the pick end of a Halligan or an ax head to pry the gasket away from the glass. –Then strip out the gasket from around the edge of the windshield. –Finally, pop the window out of the opening. –Use a reciprocating saw, like a Sawsall, to remove the window support frame. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

36. Emergency Services, LLC / Copyright 2007 / Volume 07-136 EXTRICATION (cont.) Use of Tools –Typical hydraulic extrication tools and cutters won’t work on a school bus, with its insulation spaces between the inner and outer walls (sides and roof). –A reciprocating saw, like a Sawsall, is the tool of choice as it can cut both walls with one cut, including the structural supports in the sides or roofs. –An air chisel could also work, but it would demand cutting the inner and outer walls separately. –Lubricating saw blades regularly as you cut will extend blade life. If you can’t lubricate from both sides as the saw makes the double cut (inside and outside walls), be prepared to change blades frequently. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

37. Emergency Services, LLC / Copyright 2007 / Volume 07-137 EXTRICATION (cont.) Coordination – Communication – Cooperation –This is a system the Independence, MO Fire Dept. uses to determine where to make the cut. –It involves people on the inside and outside of the bus who determine where the purchase point for the saw blade should be. –Personnel on the inside act as a Safety Officer and monitor that area, making sure civilians are not too close. –They also make sure appropriate hearing and eye protection are deployed among patients, if necessary. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

38. Emergency Services, LLC / Copyright 2007 / Volume 07-138 EXTRICATION (cont.) Coordination – Communication – Cooperation –Both groups communicate back and forth regarding the saw cut entry, progress, and safety. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

39. Emergency Services, LLC / Copyright 2007 / Volume 07-139 EXTRICATION (cont.) Bus Construction –Bus construction is very unique compared to other vehicles. –Buses have three side rails or impact barriers that run the full length on each side of the bus: One is located where the seats attach to the side of the bus. One is located at the bottom of the windows. One is located just above the frame. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

40. Emergency Services, LLC / Copyright 2007 / Volume 07-140 EXTRICATION (cont.) Bus Construction –These rails are probably three to four times as strong as the regular skin of the bus, so they take side impacts well. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

41. Emergency Services, LLC / Copyright 2007 / Volume 07-141 PATIENT TYPES Different types of patients will have different needs and will have to be handled accordingly. –Children and teenagers will be much more frightened and will need more reassurance and psychological support. –Allaying fears will be a big issue. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

42. Emergency Services, LLC / Copyright 2007 / Volume 07-142 EMS RESPONSE In this incident: –EMS and ambulance service is provided by a third-party provider, American Medical Response. –the Independence Fire Department provides BLS/ALS service on their apparatus, and –mutual aid departments that responded also brought their EMS provider. As triage begins by medical personnel, triage tags will be distributed to patients. –Crews helping with walking wounded or very slightly injured patients on the bus will assign green tags. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

43. Emergency Services, LLC / Copyright 2007 / Volume 07-143 EMS RESPONSE (cont.) More experienced medical personnel should determine the triage level of more seriously injured patients and assign those colors accordingly. –Consequently, you want to get paramedics into the bus early on, even as extrication is being conducted. –Some seriously injured but trapped patients may need field treatment (IV drips, etc.) while they are being extricated. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

44. Emergency Services, LLC / Copyright 2007 / Volume 07-144 PATIENT TRACKING A tracking system kept track of all patients throughout the incident. –Hand-held bar code readers scan triage tags and with other inputted patient data combine to build a patient database that is communicated wirelessly to a laptop computer at the medical command post. –This database information can be updated and used to track patients as they move through the system. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

45. Emergency Services, LLC / Copyright 2007 / Volume 07-145 PATIENT TRACKING (cont.) This is extremely useful in an incident such as this as the school district and parents will have to be notified of their students’ disposition. This system can also communicate with receiving hospitals so hospital census and availability of beds can help determine transportation of patients. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

46. Emergency Services, LLC / Copyright 2007 / Volume 07-146 LESSONS LEARNED Should have called for more resources: ambulances and command officers The command structure has to be set up on the fly and assignments made with whomever is available at the outset. Additional command officers are a big help in an incident this size. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

47. Emergency Services, LLC / Copyright 2007 / Volume 07-147 LESSONS LEARNED (cont.) Good information was acquired by all departments and agencies involved as to what will be demanded of responders in a train-bus MCI. Hands-On: Train vs. Bus MCI Simulation 07-1 Training Materials

48. Emergency Services, LLC / Copyright 2007 / Volume 07-148 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ 1. True or False: Initial Command eventually becomes formal Incident Command. 2. True or False: In a train-bus MCI, if the engines aren’t on fire, fire suppression isn’t needed. 3. True or False: When triaging, fatals are usually assigned the color green. 4. True or False: In a simulated event, sometimes weather restricts training opportunities. 5. True or False: Logistics might be used in a large event in order to help with extrication. 07-1 Training Materials Quiz: Train vs. Bus MCI Simulation

49. Emergency Services, LLC / Copyright 2007 / Volume 07-149 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 6. Tools you should NOT use in working on school buses include: a. Air chisel b. reciprocating saw c. hydraulic cutters d. Jaws of Life e. One of the above f. Two of the above g. None of the above 07-1 Training Materials Quiz: Train vs. Bus MCI Simulation

50. Emergency Services, LLC / Copyright 2007 / Volume 07-150 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 7. Remove a bus windshield in this order: a. Cut gasket – loosen it from frame – pry gasket from glass – strip it from edge of windshield – pop out window b. Pry gasket from glass – pop out window – cut gasket – loosen it from frame – strip it from edge of windshield c. Loosen it from frame – pop out window – cut gasket – pry gasket from glass – strip if from edge of windshield d. Cut gasket – pry gasket from glass – loosen it from frame – strip it from edge of windshield – pop out windshield e. None of the above 07-1 Training Materials Quiz: Train vs. Bus MCI Simulation

51. Emergency Services, LLC / Copyright 2007 / Volume 07-151 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 8. Which of the following does bus construction NOT have? a. An impact barrier where the seats attach to the bus side b. An impact barrier located at the bottom of the windows. c. An impact barrier located just above the frame d. An impact barrier located just below the roof line e. None of the above. (Answers on Slide 70) 07-1 Training Materials Quiz: Train vs. Bus MCI Simulation

52. Emergency Services, LLC / Copyright 2007 / Volume 07-152 SUICIDE PERSONALITY Ninety percent of all suicides are by people who have a diagnosable mental illness. –The most common of these is depression. Nearly everyone who calls a hotline has at least some situational depression, if not a true clinical diagnosable depression, but there are psychiatric issues at work. The remaining ten percent have situational pressures that are overwhelming or things coming up in their future they can’t bear to face; for example, long-term or chronic debilitating illnesses. Fire Medics: Suicide Awareness 07-1 Training Materials

53. Emergency Services, LLC / Copyright 2007 / Volume 07-153 SUICIDE IDEATION A person who has been depressed for a long period of time feels that: – they will never get better –their problems will never go away –they can’t continue the way they’ve been going. This leads to a process called Suicide Ideation. It starts with the thought, “if it gets too bad, I can just check out.” Or, “my family and friends would be better off if I’m not here.” Fire Medics: Suicide Awareness 07-1 Training Materials

54. Emergency Services, LLC / Copyright 2007 / Volume 07-154 SUICIDE IDEATION (cont.) Those thoughts start potential suicide attempters thinking about a plan and they’ll think about the plan for a long time. –They may consider the possibilities, then maybe reject it, then reconsider. –They “court” the idea and in an insidious way, the idea becomes self-soothing – they see it as an alternative that’s always out there. Sometimes people call when they first get the thought of suicide and it frightens them. Other people call later after they have a plan and a timeframe but want to reach out one more time. Fire Medics: Suicide Awareness 07-1 Training Materials

55. Emergency Services, LLC / Copyright 2007 / Volume 07-155 MAKING A CONTRACT The next step is to get the person to agree to a contract. –One might be to get the person to agree not to hurt themselves while you’re talking with them. –Or later it might be to get the person to agree to talk to you again before he/she tries to hurt or kill him/herself, to encourage more conversation. Fire Medics: Suicide Awareness 07-1 Training Materials

56. Emergency Services, LLC / Copyright 2007 / Volume 07-156 MAKING A CONTRACT (cont.) The next step is to get the person to agree to a contract. –The key is building rapport and a relationship; that is the primary goal for forestalling suicide. Fire Medics: Suicide Awareness 07-1 Training Materials

57. Emergency Services, LLC / Copyright 2007 / Volume 07-157 BUILDING RAPPORT Some of the ways that rapport can be built are as simple as just listening, understanding, or validating a person’s thoughts and feelings. –Sometimes just saying things like, “I’m really glad you asked me to sit here with you.” Or, “I really want to talk to you, I really want to help you” can open the door to better rapport. Fire Medics: Suicide Awareness 07-1 Training Materials

58. Emergency Services, LLC / Copyright 2007 / Volume 07-158 BUILDING RAPPORT (cont.) If you can build some trust and a relationship on this basis, you have a good chance of a successful intervention. Fire Medics: Suicide Awareness 07-1 Training Materials

59. Emergency Services, LLC / Copyright 2007 / Volume 07-159 IMMEDIATE HIGH RISK If you respond and catch someone in the act of attempting suicide, this is an immediate high risk: they have a plan and are intending to carry it out. At the point, the responder should say, “Well, since I’m here, let’s talk about it first.” –If the responder can open the door and get 15 minutes of time or forestall the potential suicide long enough to get additional help, the responder might be able to get the suicide attempter the kind of assistance he/she needs. Fire Medics: Suicide Awareness 07-1 Training Materials

60. Emergency Services, LLC / Copyright 2007 / Volume 07-160 IMMEDIATE HIGH RISK (cont.) Potential suicides see the suicide act as the solution to all their other problems. –If you can buy some time through diversion to get the person some help, you have a good chance of making those other problems diminish. Fire Medics: Suicide Awareness 07-1 Training Materials

61. Emergency Services, LLC / Copyright 2007 / Volume 07-161 SILVER BULLET? There is no silver bullet for getting a potential suicide NOT to act. –Telling the person that there are people who depend on him/her, there’s a job where he/she’s responsible, those things only reinforce the notion of suicide. –The closest thing would be to get the person to tell YOU what they have to live for; what makes them feel good (“Maybe my sons WOULD miss me...”). –If you can get the potential suicide to talk about what’s good about their life, that will forestall action. Fire Medics: Suicide Awareness 07-1 Training Materials

62. Emergency Services, LLC / Copyright 2007 / Volume 07-162 APPROACHING A SUICIDE Speak slowly and softly, as if talking to someone you cared about. –“Softly” means without authority. Don’t give orders. –For example, ask permission if you can sit down next to them on that building ledge. Give them control over some of the little pieces that they can control. Make eye contact with them. Engage the person in conversation with an intention of slowing down the conversation. Fire Medics: Suicide Awareness 07-1 Training Materials

63. Emergency Services, LLC / Copyright 2007 / Volume 07-163 APPROACHING A SUICIDE (cont.) Potential suicides may be tense, or intense, or “wired up”; try to de-escalate the situation. Let the person tell his/her story. This will take time – exactly what first responders are trained NOT to do. The whole incident must slow down and wait. The overall effort is to make the rest of the world go away for a while. The first responder will also have to fight his/her own anxiety about whether he/she’s doing the job well enough to succeed with this person. Fire Medics: Suicide Awareness 07-1 Training Materials

64. Emergency Services, LLC / Copyright 2007 / Volume 07-164 APPROACHING A SUICIDE (cont.) The next step would be to offer help and to let them know there are people or agencies who can help them. Fire Medics: Suicide Awareness 07-1 Training Materials

65. Emergency Services, LLC / Copyright 2007 / Volume 07-165 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 1. True or False: Most of the people who try suicide are not really sick. It’s just a passing weakness. 2. True or False: Get the potential suicide to agree to a contract. 3. True or False: Telling the person that you are really glad they are willing to talk with you is a good start toward building rapport. 07-1 Training Materials Quiz: Suicide Awareness

66. Emergency Services, LLC / Copyright 2007 / Volume 07-166 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 4. Steps for approaching a suicide DON’T include: a. Speak slowly and softly. b. Give them some control over what’s happening. c. Make eye contact with them. d. Tell them all the things they have to live for. e. All of the above 07-1 Training Materials Quiz: Suicide Awareness

67. Emergency Services, LLC / Copyright 2007 / Volume 07-167 Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____ Select the best answer: 5. Steps for approaching a suicide include: a. trying to de-escalate the situation b. letting the person tell his/her story. c. calming your own anxiety as a responder d. letting the person know there is help available. e. All of the above (Answers on Slide 70) 07-1 Training Materials Quiz: Suicide Awareness

68. Emergency Services, LLC / Copyright 2007 / Volume 07-168 1. How should fire fighters and EMTs, who are in the business of saving lives, deal with potential suicide victims who are intent on ending a life? 2. Explain any mental dilemma or conflict that might arise among rescuers as they demonstrate empathy and understanding for suicide victims. 3. Write a brief protocol describing how your agency should handle victims who are threatening suicide or who have tried and failed. If you’re enrolled in the Open Learning Fire Science Program at the University of Cincinnati, complete written responses to the following three essay questions to earn one college credit hour for watching Working Fire Training. Kramer vs. Kramer Suicide and Saving Lives 07-1 Training Materials Evolutions 2000 – Continuing Education

69. Emergency Services, LLC / Copyright 2007 / Volume 07-169 ENROLLMENT INFORMATION: For more information on enrolling in the Open Learning program to gain college credit, call Working Fire Training at 800-516-3473 for a brochure or, to register directly, call the University of Cincinnati at 513- 556-6583. Associates and Bachelors programs are available. Call to have your transcripts evaluated. Send your responses to: Professor Bill Kramer University of Cincinnati College of Applied Science 2220 Victory Parkway, ML #103 Cincinnati, Ohio 45206 07-1 Training Materials Evolutions 2000 – Continuing Education

70. Emergency Services, LLC / Copyright 2007 / Volume 07-170 Thanks so much for viewing Working Fire Training! See you next month – stay safe! Answers: Hands-On – Train vs. Bus MCI Simulation: Quiz on Slides 48-51: 1. True 2. False 3. False 4. True 5. False 6. f 7. a 8. d Fire Medics – Suicide Awareness: Quiz on Slides 65-67: 1. False 2. True 3. True 4. d 5. e TRAINING Working Fire Training 07-1 Training Materials