Fire and Rescue Training

Tough fire and rescue training produces more skilled fire and rescue personnel and safer communities.

Work has pulled me to the DC area during the week and home has pulled me to West Virginia on weekends and holidays. One of my tasks around DC is to provide medical support for a group of rescuers specially trained in structural collapse, confined space, trench, and ropes.  Simultaneously, I remain on the Beaver Volunteer Fire Department and dive team. It is the best of all worlds.

My primary field is medicine, and while I have helped pull victims from fires and entrapments, my primary usefulness comes once the patient is out. I admire people who risk themselves to rescue people and keep them alive until they get to people like me. Such work requires imagination, skill, intelligence, and courage, which was demonstrated at an exercise in northern Virginia in September of 2020.

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Understanding Problems

Ever feel like your problems are so big that you can’t even understand them, much less deal with them? Ever feel impotent to grasp others’ problems, much less help them with them? Approaching the topic first from a medical and then from a larger perspective, the attached article may provide some insight.

A fellow student from the public health program at Johns Hopkins came to me with a research idea many years ago. Performing publishable research is a requirement of the program, and we were struggling with the most fundamental issue; thoroughly understanding the problem that you wish to address. Our team wrestled with the possibilities, explored lots of dead ends, and sought guidance from more experienced researchers. Eventually a reasonable, although not groundbreaking, plan took shape.

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Checklist for Evaluating Articles in the Medical Literature

Clinicians face mountains of medical literature, and no one can keep up. Much of it is trash. Doctors and other health care professionals must know how to evaluate medical literature to provide the best possible care to their patients; but few know how. Here is some help:

Title and General

1.    Is the title appropriate?

2.    Are the authors appropriately identified?

3.    Does information on conflict of interest or other disclaimers appear in the article?

Abstract

1.    Does the abstract entice the reader to read the article?

2.    Does the abstract correctly summarize the study and its findings?

Objective

1.    Objective(s)

2.    Study type – observational (cross sectional, case control, cohort) or experimental (randomized controlled trial, vaccine trial)

3.    Are the objectives reasonable and worthwhile?

4.    Strengths and limitations of the objective and study type

5.    How could these affect the results or conclusions (biased, generalizable)?

Methods

Study design

1.    Study design –

2.    How conducted?

3.    Who conducted?

4.    Methods appropriate for objective?

5.    Strengths and limitations

6.    How could these affect the results or conclusions (internal and external validity)?

Study population

1.    Who are the study subjects?

2.    How selected?

3.    Who selected?

4.    Strengths and limitations –

5.    How could these affect the results or conclusions (biased, generalizable)?

Study maneuver

1.    What treatments/interventions planned?

2.    How administered?

3.    Who will provide the maneuvers (where and when)?

4.    Are these appropriate for the study objectives?

5.    Strengths and limitations of planned maneuver –

6.    How could these affect the results or conclusions (biased, generalizable)?

Study observations/measures and data to be collected

1.    What observations/data collection is planned (On whom, where and when; are they consistent)?

2.    How will they be made or collected (by what method, are they standardized, are observers blinded)?

3.    Who will make the observations and collect the data, where and when?

4.    Are these appropriate for the study objectives?

5.    What are the strengths and limitations of the planned observations (exclusion, masked or unmasked, sources of bias, likely to be reliable, valid)?

6.    How could these affect the results or conclusions (biased, generalizable)?

Analysis

1.    What is the planned data analysis (what methods will be used, how will the data be grouped, what tests will be used for each analysis planned, what will be considered statistically significant)?  Are assumptions based on prior studies?

2.    How will the data be analyzed?

3.    Who will conduct the analysis?

4.    Is the planned analysis appropriate for the study objective and the type and level of data collected (parametric or non-parametric tests, one-sided vs. two-sided tests of significance, stratification when appropriate)?

5.    What are the strengths and limitations of the planned analysis (what is the power of the planned data collection/analysis)?

6.    How could these affect the results or conclusions (failure to detect a true difference)?

Results

1.    What results/observations are presented/not presented (are all the findings presented for all subjects)?

2.    How were the results obtained (what analysis was used, was the planned analysis completed)?

3.    How were the results which are presented/excluded determined and why (data insufficient, poor response, not significant)?

4.    Are the results appropriate for study objectives, planned observations and analysis?  Are they correctly performed and interpreted, internally consistent and valid (arithmetic errors, what is considered statistically significant, appropriate comparisons)?

5.    What are the strengths and limitations of the analysis results (statistical vs. biologic/clinical significance, statistical power)?

6.    How could these affect the results or conclusions?

Discussion and Conclusions

1.    What are the conclusions?

2.    How or on what basis were they made (are they justified by the results and analysis, is that analysis sufficient to determine whether significant differences may be due to incomparability of groups or methodological considerations)?

3.    Are the above limitations under all other sections adequately addressed in this section?

4.    How do they affect the conclusions?  Is this adequately assessed?

5.    What are the strengths and limitations of the conclusions?

6.    What recommendations do the authors have for future study?

 

Taking Intelligence Threats Seriously

Knowing about a threat is the first step to avoiding it. Believing correctly about the threat is the second step. In our world in which the ordinary is expected, we sometimes miss extraordinary threats at our door. 

On 7 December 1941, Privates Joseph L. Lockard and George Elliot were at the Opana radar site on Oahu. They detected a large group of aircraft flying in from the north and reported the findings to Private Joseph McDonald at Fort Shafter. Lieutenant Kermit Tyler was the officer in charge and knew that a routine flight of B-17 bombers were expected that morning from San Francisco. He told his subordinates “Don’t worry about it.” Thus, the Japanese attack on Pearl Harbor was unopposed. Tyler had not taken the threat seriously.

The Joint Task Force National Capital Medicine (JTF Cap Med) recently completed medical support for the 57th Presidential Inauguration, involving hundreds of medical professionals providing health care and preventive services to thousands of military and civilian participants and hundreds of thousands of onlookers. Since the president, key members of government, and Washington DC itself are high profile targets, planners developed a careful intelligence estimate for the event. Military personnel in combat service support roles such as quartermaster, finance, chaplain and medical sometimes do not understand the importance of such estimates. In other cases we do not consider the breadth of threats to military operations such as the Inauguration.

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