John, a veteran of the Fire Department of New York had “retired” to his southeastern home several years ago. Unable to sit and fish all day, John soon joined the county fire service and became a resource for his department and his community. Loved by everyone for his jovial nature John was admired by the rookie firefighters.
One bright summer day, a chemical tanker truck caught fire in front of the regional trauma center. The trauma center was upwind and in no direct danger when fire and hazmat teams arrived. The fire was quickly contained and the hazmat team set about the work of clean-up.
As operations began, John’s first duty was to establish contact and coordination with the hospital. Smiling he turned to the rookie assigned to him for training and said,
“This will be fun, watch their reaction when we ask to speak with their Liaison Officer. They won’t have a clue what I’m talking about.”
John and the rookie walked into the hospital still smiling and asked the security officer at the front door to contact the Liaison Officer. Much to John’s surprise, the security officer immediate called for the Liaison Officer to come to the front lobby. Moments later, a young woman arrived and introduced herself to John.
Unfortunately, John’s experience is still the exception rather than the rule when community response services interact with hospital services. Too often these interactions are seen as either a threat to hospital autonomy or as a public relations exercise. As with most problems of culture and communication, the fault lies on both sides of the relationship.
Hospitals are for the most part private businesses with the duel mission of providing care and delivering a profit. Unfunded mandates and social pressures have created a complex web of regulation and oversight that is largely resented by those in the healthcare professions. Any aspect of the business that is not regulated is seen as an opportunity to distinguish oneself from the competition and is thus jealously protected. Until this year, that included hospital command structure during a disaster.
Fire/Rescue has been steeped in a system of command and control born of the need to ensure that lives and property are not placed at undue risk. Unlike healthcare professionals, Fire/Rescue professionals know that a breakdown in command decision making will cost their life or the life of one of their colleagues. There is no room for individuality or customization of the system in the mind of the Fire/Rescue professional.
These worlds collide in the modern era of disaster preparation and response. By mandate, hospitals and healthcare facilities are now required to use the same incident command system that Fire/Rescue has used for decades. The relationship is further complicated by the fact that this mandate reverses the traditional lines of authority and knowledge in which Fire/Rescue has always taken instruction and guidance from healthcare as regards Fire/Rescue’s medical operations. Now healthcare must take instruction and guidance from Fire/Rescue.
As with any realignment of a relationship, the integration of hospitals and healthcare institutions with the larger community response will ultimately strengthen the system and the nation’s preparedness. Until then professionals on both sides will do their best when their worlds collide.
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