We often use the term “all-hazards approach” in fire and EMS management, but what exactly is the definition of all-hazards?
Let’s start by what it doesn’t mean. The biggest take-home message: It doesn’t mean that you must be everything to everyone all of the time. Rather, the all-hazards approach means that you built an operationally flexible framework that’s adaptable to the newest event at hand.
It does require planning and understanding of risks that are in your community. It does involve training for different skill sets and capabilities. It does involve defining who (personnel and organizations) is responsible for specific aspects in an event.
What follows is the Columbus, OH, Division of Fire’s experienced evolution in the all-hazards approach as a fire-based EMS service.
Rescue to EMS
2022 marks the 200-year anniversary of the department that today is known as the Columbus Division of Fire (CFD). As is the case for many departments, the evolution to involvement in EMS for the CFD can be seen in steps in response to requests for help—essentially, a step-wise approach to all-hazards long before the term was invented.
One of the more visible and public moments of that transition occurred in 1933 with an electrocution on a pole. The CFD’s response to a request for help received very positive coverage in a local newspaper and created an environment in which calls for help and rescue became more regular. An evolution of a need, or a new hazard, developed in real time.
In 1934, a vehicle was retrofitted to become a squad car, and International Red Cross donations outfitted it with first-aid supplies and an H&H inhalator. By 1935, first-aid kits were placed on all fire apparatus and in chief cars, and 117 members were trained in standard first aid. By 1941, the increased medical aspect increased to 1,858 squad runs, and an iron lung was donated to the CFD.
The next big leap for emergency medical care occurred on April 8, 1969, when the CFD and the Ohio State University Hospital partnered to launch the “Heart Mobile.” Original staffing was a physician and three off-duty fire members. In 1970, the city placed the entire responsibility of emergency medical service with the CFD.
Unique operations
The all-hazards approach and response naturally grew over the years as new challenges and events occurred.
Consistent with the mission of many large cities, the CFD maintains a hazmat response capability that consists of a Level 1 hazmat unit (the first in Ohio). In addition, the CFD has active water-rescue capabilities and a dive team, which consists of two public safety divers and tenders, who are trained in cold-water and ice dives. Similar to many organizations, the department supports high-risk police responses via the use of a set of medics who have specialized training operating as tactical EMS providers.
Somewhat unique compared with traditional fire departments, the bomb squad for the city of Columbus resides within the CFD. This includes support and disposal equipment and six specially trained K-9s.
Other more unique CFD capabilities that evolved directly from the needs (hazards) that are encountered include the RREACT (Rapid Response Emergency Addiction Crisis Team), which was organized in response to how the opioid epidemic is compounding health care and challenges of patients. The team does follow-up and facilitates entry into treatment programs.
A similar program, SPARC (Specialized Program Assessing Resource Connectivity), evolved as a co-responder/secondary responder program. Its aim is to address quality-of-life issues and to meet the needs that otherwise lead to frequent 9-1-1 utilization.
In 2019—and in conjunction with the department’s three adult health system partners—CFD operationalized the Mobile Stroke Treatment Unit (MSTU), which put Columbus in the company of 14 other cities in the United States that have an EMS-based mobile stroke treatment program (firehouse.com/21137597).
Revisiting all-hazards
The 2019 edition of NFPA 1600: Standard on Continuity, Emergency, and Crisis Management defines the all-hazards approach as “An approach for prevention, mitigation, preparedness, response, continuity, and recovery that addresses a full range of threats and hazards, including natural, human-caused, and technology-caused.”
Inherent in this definition is a need to begin to plan and prepare, or as Centers for Medicare & Medicaid Services states, “planning that focuses on capacities and capabilities that are critical.” As noted above, an all-hazards approach doesn’t mean that you must be everything to everyone all of the time. It does require you to consider every hazard.
What you really are required to do is a risk analysis—or, in operational terms, a size-up. For many departments, when viewed as a size-up, the task becomes manageable. More simply, the department created an actionable item to accomplish.
Departments need a size-up on what might happen in the community and the effects that a hazard would have directly or indirectly on the department: With what role would the department be tasked? What capabilities does the department have available? What holes exist?
Once an assembled list of hazards is created, the department can prioritize what enhancements must be made to reduce overall risk to the community and to the department. This likely starts with the hazards that are unique to the department’s community. Often, a review of call volume and call types can be a good first step. What happens frequently? What’s new but is becoming more frequent? Of the latter, autonomous vehicles, electric vehicle fires, vacant structures, new structures, population shifts, and medical or fire risks are relevant starting points.
As a department begins to expand on preparation for the next hazards, it must begin to build bridges with those who have insight and expertise. Sharing with similar communities is a start but remember your emergency management and public health partners. They have great insight into data that normally aren’t collected in fire-based EMS. For example, the hazard vulnerability analysis is a matrix that often is available from a city’s emergency management agency. The most likely events for a community often are divided into natural, human-made and threat-based. From here, the all-hazards approach involves determining the relative effect of each on the organization. That relative effect might involve request for aid, effect to service delivery or staffing and/or resource availability.
Once a department begins to develop an understanding of a specific hazard’s likelihood and its relative effect, current capability and capacity can be assessed to determine a relative need for incremental allocation in planning and preparation. Repeating at regular cycles (yearly or biannually, for example) builds an organization in constant mode of all-hazards preparation. Through reevaluation, new hazards might be identified, and changes in relative effect can help to determine priorities in preparation.
Also, a department’s public health partners have vast amounts of data and insight into health risks and response capability and capacity. Pandemic preparations and disease outbreak obviously have been at the forefront in response capability recently. However, many other public health hazards might be identified (e.g., seasonal disease outbreak, substance-abuse risks, infant mortality and healthcare resources). These factors can be vital to a department’s planning to respond to events that affect the community directly. However, the indirect effects can be substantial, too. For example, does the department know the risks in its community and to its citizens should an evacuation be required or a utility disruption occur?
Operational flexibility
The key is to begin with a hazard then develop a reasonable plan and modify as members of the department learn through training, collaboration and real-life response. As the department addresses each new hazard, it likely will find that the process gets easier, partly by experience but, more importantly, because the responses begin to have similar aspects and demand similar knowledge or operational approaches. When this is found to be happening, the department truly has begun to tap into the all-hazards approach—the ability to respond, manage and mitigate an emergency hazard response by applying the knowledge and experience that already was amassed. This operational flexibility allows incremental growth with each response and builds on the collective knowledge—built by experience, study, preparation and information-gathering of the department.
