Vicarious Learning

March 29, 2010
Over the past 3 months I have had the opportunity to be in a lot of different regions of the United States and I have taken that opportunity to conduct a study of just how well we have the basics of our job down. This was accomplished by asking what areas firefighters, company officers, chief officers and instructors thought we needed to focus our training efforts on. There was an overwhelming number of responses of be need to go back to the basics. In asking further what they thought the basics included they focused on hose line operations, search and rescue, utilization of tools, forcible entry and ventilation. I received this information in an email and felt it was relevant to share with others. Please take time to read this and compare to your department’s operations. Near misses are something we don’t like to admit. However, the information contained below and in the links is most likely occurring with your organization but never admitted, addressed or shared. 
This week's report of the week involves an officer that becomes disoriented when he stumbles into a store room adjacent to the fire area. The tasks he is performing are routine and the conditions are moderate. He is working with other crew members when the incident occurs, and the event sets itself up to create this near miss. Everything about this incident points to a likely situation that could be easily envisioned every day in the fire service. There are currently 41 reports in the system that mention the word "disoriented" in the event narrative and 1,438 reports that identify situational awareness as a contributing factor in the cause of the reported near miss.
This excerpt from report 09-1129, 'Disoriented officer neglects mayday protocol,' gives a feel for the overall situation:
The truck company, my firefighter and I, and another firefighter made our way into the building. I began checking for extension in the ceiling with a TIC and using my axe to push up the drop-ceiling tiles. I was only a few feet away from the rest of the crew members when I reached an area that had a higher ceiling. I asked a nearby firefighter to grab a longer tool so I could continue to check the remaining ceiling. I reached a doorway and there was an object in front of it. I pushed the object out of the doorway and stumbled into the next room a couple of feet.
During this event, the officer described the original conditions with low visibility and no heat; however the conditions changed at the most inopportune time. Right when he stumbled into the other room, he became disoriented and was working alone.
At this point, visibility had worsened. I turned to ask the firefighter (who had been right behind me) if he had the tool yet, and got no answer... I called the Truck officer on the radio, no answer... I called my firefighter and my engineer/operator, no answer. Finally, I began to follow the wall, surely, I would run into the crews again, but I did not...
This type of situation is not unusual. Frequently, we have found ourselves in need of tools that we did not bring with us, and we may also find out conditions change rapidly. After reading09-1129, and the related reports, consider the following:
  1. During an event like this one, what do you believe are the contributing factors?
  2. One of the pitfalls of using a TIC is the reliance on what the camera shows you with no regard for the bigger picture. In a sense, you invite a tunneled vision of the fire scene by using the camera exclusively. Discuss some of the things you can do to avoid losing situational awareness while using a thermal imaging camera.
  3. In a small building with a heavy smoke situation, how would you have reacted to this disoriented state (i.e., self-extricate; call for a mayday, etc.)?
  4. Discuss your department policies that are intended to prevent misplacing your officer. Look at this event from the perspective of the other personnel on the fire scene.
  5. What are some of the factors that could contribute to the failure of the officer to contact other personnel on the scene by radio?
Related Reports - Topical Relation: Disorientation
05-049
06-583
07-773

08-090
If you have had a near-miss share what happened to you with the rest of the fire service. Log on to www.firefighternearmiss.com and place your report into the system. Your report can then help train the rest of the fire service.
***The information in this piece was taken from the Firefighter Near Miss Reporting System Program

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