Emergency Medical Services (EMS) agencies regardless of service delivery model have sought guidance on how to better integrate their emergency preparedness and response activities into similar processes occurring at the local, regional, State, tribal and Federal levels. The primary purpose of this project is to begin the process of providing that guidance as it relates to mass care incident deployment. The World Bank reported in 2005 that on aggregate, the reported number of natural disasters worldwide has been rapidly increasing, from fewer than 100 in 1975 to more than 400 in 2005. Terrorism, pandemic surge, and natural disasters have had a major impact on the science of planning for and responding to mass care incidents and remain a significant threat to the homeland. From the attacks of September 11th, 2001, the subsequent use of anthrax as a biological weapon, to the more recent surge concerns following the outbreak of H1N1 influenza, EMS have a real and immediate need for integration with the emergency management process, and to coordinate efforts with partners across the spectrum of the response community. The barriers identified from the literature review and interviews with national EMS leadership include: lack of access to emergency preparedness grant funding; underrepresentation on local, regional, and State level planning committees; and lack of systematic mandatory inclusion of all EMS provider types in State, regional, and local emergency plans. In December 2004, New York University's Center for Catastrophe Preparedness and Response held a national roundtable that included experts from major organizations representing the EMS system as a whole. The report from that meeting concluded that: "EMS providers, such as fire departments and hospital-based, commercial, and air ambulance services, ensure that patients receive the medical care they need during a terrorist attack. While EMS personnel, including Emergency Medical Technicians and paramedics, represent roughly one-third of traditional first responders (which also include law enforcement and fire service personnel), the EMS system receives only four percent of first responder funding. If EMS personnel are not prepared for a terrorist attack, their ability to provide medical care and transport to victims of an attack will be compromised. There will be an inadequate medical first response." In 2007, the Institute of Medicine in its landmark report Emergency Medical Services at the Crossroads issued a recommendation that stated: "The Department of Health and Human Services (DHHS), the Department of Homeland Security and the States should elevate emergency and trauma care to a position of parity with other public safety entities in disaster planning and operations." Since the time of these reports Federal progress to address these issues has included the creation of the Office of Health Affairs (OHA) within the Department of Homeland Security (DHS), the creation of the Emergency Care Coordination Center (ECCC) within HHS, and the creation of the Federal Interagency Committee on EMS (FICEMS) Preparedness Committee. In an effort to increase the level of preparedness among EMS agencies, the National Emergency Medical Services Management Association (NEMSMA) approached the DHS and OHA to engage them in a partnership that would provide a greater understanding of the shortfalls in EMS emergency preparedness and provide resources to fill those gaps. The primary objective of this project is to understand model policies and practices across a spectrum of disciplines and provider types that will lead to a better prepared EMS deployment to mass care incidents. This project should serve as a foundation for further development of EMS specific policies and templates that improve EMS readiness to manage the full spectrum of hazards that face their communities.

Homeland Security Presidential Directive - 7 (December 2003) established the requirement to protect national critical infrastructures against acts that would diminish the responsibility of federal, state, and local government to perform essential missions to ensure the health and safety of the general public. HSPD-7 identified the Emergency Services as a national critical infrastructure sector that must be protected from all hazards. The Emergency Management and Response-Information Sharing and Analysis Center (EMR-ISAC) activities support the critical infrastructure protection and resilience of Emergency Services Sector departments and agencies nationwide. The fire service, emergency medical services, law enforcement, emergency management, and 9-1-1 Call Centers are the major components of the Emergency Services Sector. These components include search and rescue, hazardous materials (HAZMAT) teams, special weapons and tactics teams (SWAT), bomb squads, and other emergency support functions. This Job Aid is a guide to assist leaders of the Emergency Services Sector (ESS) with the process of critical infrastructure protection (CIP). The document intends only to provide a model process or template for the systematic protection of critical infrastructures. It is not a CIP training manual or a complete road map of procedures to be strictly followed. The CIP process described in this document can be easily adapted to assist the infrastructure protection objectives of any community, service, department, agency, or organization.

Firefighters, emergency medical technicians (EMTs), and other emergency responders face many dangers daily from exposure to smoke, deadly temperatures, and stress to issues surrounding personal protective equipment (PPE), vehicle safety, and personal health. Although publicized firefighter fatalities are associated more often with burns and smoke inhalation, cardiovascular events, such as sudden cardiac death, account for the largest number of nonincident firefighter fatalities. Both the United States Fire Administration (USFA) and the National Fire Protection Association (NFPA) have been tracking firefighter fatalities since 1977. According to NFPA statistics, the number of sudden cardiac deaths has averaged between 40 and 50 deaths per year since the early 1990s. USFA statistics show that firefighters, as a group, are more likely than other American workers to die of a heart attack while on duty (USFA, 2002). Additional pertinent findings in the NFPA's 2005 U.S. Firefighter Fatalities Due to Sudden Cardiac Death, 1995-2004 include: Four hundred and forty firefighters out of 1,006 (or 43.7 percent) who died on the job experienced sudden cardiac death, typically triggered by stress or exertion; Fifty percent of all volunteer firefighter deaths and 39-percent of career firefighter deaths resulted from a heart attack; Ninety-seven percent of the victims had at least a 50-percent arterial blockage; Seventy-five percent of the firefighters who died of a heart attack were working with known or detectable heart conditions or risk factors, such as high cholesterol, high blood pressure, and diabetes. While sudden cardiac death is the leading cause of death among firefighters, other factors affecting firefighters' health, wellness, and safety result in multiple deaths and injuries each and every year. Through the collection of information on firefighter deaths, the USFA has established goals to reduce loss of life among firefighters (USFA, 2006). In order to achieve this goal, emphasis must be placed on reducing the risk factors associated with cardiovascular disease as well as on the mitigation of other issues affecting the health and safety of the Nation's firefighters. As part of another effort to determine the specific issues affecting firefighter health and wellness, the National Volunteer Fire Council (NVFC) Foundation developed a questionnaire to determine personal health, well-being, and safety practices among firefighters. A summary of findings from this study was shared with the NVFC and USFA for use in this project. The questionnaire was distributed to a study population of 364 firefighters, of which 149 were career firefighters, 165 were volunteers, and 50 indicated they were both volunteer and career. Results from the questionnaire revealed several trends in this sample firefighter population; however, the study population was not large enough to generalize these trends for all firefighters. Results from the NVFC Foundation's questionnaire are presented here. Based on these findings, it is clear that a structured personal health and fitness program, as well as safe operations to, from, and while at emergency scenes, become critical to firefighters' safety, well-being, and survival. As a result, we present this document on emergent health and safety issues for the volunteer fire and emergency services.

This report contains research on behaviors and other factors contributing to the rural fire problem; identifies mitigation programs, technologies, and strategies to address those problems; and proposes actions that USFA can take to better implement programs in rural communities. In the Spring of 2004, the U S Fire Administration (USFA) partnered with the National Fire Protection Association (NFPA) in a cooperative agreement project entitled Mitigating the Rural Fire Problem. The purpose of the project was to examine what can be done to reduce the high death rate from fires in rural U S communities. Rural communities, defined by the U S Census Bureau as communities with less than 2,500 population, have a fire death rate twice the national average. The objectives of the project were to a) conduct research on behaviors and other factors contributing to the rural fire problem, b) identify mitigation programs, technologies, and strategies to address those problems, and c) propose actions that USFA Public Education Division can take to better implement programs in rural communities. Research sources included a review of the published literature, some original statistical analysis, and information from national technical experts who have worked with NFPA.

Each year, approximately 1,100 Americans 65 and older die in home fires and another 3,000 are injured. These statistics, combined with the fact that adults ages 50 or more care for and will soon enter this high-risk group, inspired USFA to develop a new public education campaign targeting people ages 50-plus, their families and caregivers. People between 65 and 74 are nearly twice as likely to die in a home fire as the rest of the population. People between 75 and 84 are nearly four times as likely to die in a fire. People ages 85 and older are more than five times as likely to die in a fire. A Fire Safety Campaign for People 50-Plus encourages people ages 50 and older - including the high risk 65-plus group - to practice fire-safe behaviors to reduce fire deaths and injuries. The strategy is to inform and motivate adults as they enter their fifties so that stronger fire safety and prevention practices are integrated into their lives prior to entering the higher fire-risk decades. In addition, many Baby Boomers are currently caring for family members ages 65-plus and can encourage fire safe habits.

The United States Fire Administration (USFA) is committed to using all means possible for reducing the incidence of injuries and deaths to firefighters. One of these means is to partner with other people and organizations who share this same admirable goal. One such organization is the International Association of Fire Fighters (IAFF). The IAFF has been deeply committed to improving the safety of its members and all firefighters as a whole. This is why the USFA was pleased to work with the IAFF through a cooperative agreement to develop this revised edition of Emergency Incident Rehabilitation.

In 2010, the Incident Emergency Medical Subcommittee (IEMS), operating under the authority of the National Wildfire Coordinating Group (NWCG) - Risk Management Committee, completed the document, Interim Minimum Standards for Medical Units Managed By NWCG Member Agencies. The document was the first of several to be developed that will address the need for uniform standards and safe delivery of medical care provided by Emergency Medical Services (EMS) personnel at wildland fire. It focused on recognizing current practices and recommending standards to medical units for; promoting the use of licensed personnel within their scope of practice, state EMS office notification, applicable rules and jurisdictions, medical direction, communications, patient transportation and medical equipment, medication and supplies used. The IEMS also committed to developing wildland fire specific protocols and this document, Clinical Treatment Guidelines for Wildland Fire Medical Units, PMS 551, is the finished product. A task group of physicians with diverse backgrounds in wildland fire medicine, wilderness medicine and emergency/ clinical backgrounds reviewed this document and provided valuable input. These guidelines where developed with the expectation that the typical appropriate Basic Life Support (BLS) or Advanced Life Support (ALS) EMS interventions will be provided as needed so we did not include detailed protocols for EMS medical or trauma patient care, which already exists. Rather, we focused on guidance for the unique differences and challenges associated with remote sites and expanded evaluation skills needed for patient care issues such as: 1) assisting a patient with first aid and self-care health management; 2) triaging conditions for recognition of appropriate self-care assistance vs. need for transport to clinical medical care; and 3) initiating urgent/EMS care using appropriate and predetermined transport modes.

The Agency Administrator's Guide to Critical Incident Management is designed to assist Agency Administrators in dealing with critical incidents. A critical incident may be defined as a fatality or other event that can have serious long-term adverse effects on the agency, its employees and their families or the community. Although fire incidents inspired this document, it also has application to other types of incidents. The Agency Administrator is the highest-ranking agency line officer with direct responsibility for the personnel involved in the incident (for example, BLM District Manager, Park Superintendent, Forest Supervisor, Refuge Manager, BIA Agency Superintendent or State land manager). Through effective, efficient, and timely leadership, Agency Administrators are responsible for the overall management of critical incidents within their jurisdiction. This document includes a series of checklists to guide an Agency Administrator through those difficult and chaotic days that follow a death, serious injury, or other critical or highly visible event. The time to use it is now This document needs to be reviewed and updated at least annually. The availability of Critical Incident Stress Management (CISM) teams and related resources varies constantly - it is imperative that local units pre-identify in this plan the CISM resources that can support local unit needs. This guide was designed as a working tool to assist Agency Administrators with the chronological steps in managing the incident. It also provides a detailed overview of Agency Administrators' responsibilities before a critical incident occurs, during the actual management of the incident, and after the incident activity has taken place. It is not intended to take the place of local emergency plans or other detailed guidance. It should be used in conjunction with other references as well as the attached appendixes. This guide can also be used as a worksheet (both in preparation for and in management of a critical incident) by Agency Administrators and others with oversight responsibilities during a critical incident.

In the summer of 2004, the U.S. Fire Administration (USFA) launched its most comprehensive and intensive public fire education campaign for elderly Americans. A FIRE SAFETY CAMPAIGN FOR PEOPLE 50 PLUS provides detailed fire prevention information to assist fire departments and other USFA partners in mitigating the risk of fire fatalities and injuries among the 50 and over population. This report, Fire and the Older Adult, analyzes the fire risk to persons aged 65 and older as a complement to that campaign. The report provides an extensive review of the fire situation for older adults in the United States and evaluates fire risk factors and risks of fire injury and fatality among that population group. On average, more than 1,000 Americans aged 65 years and older die each year in home fires and more than 2,000 are injured. In 2001 alone, 1,250 older adults died as the result of fire incidents. Moreover, the elderly are 2.5 times more likely to die in a residential fire than the rest of the population. With the U.S. Census Bureau predicting that increases in the senior population will continue to outpace increases in the overall population, the elderly fire problem will undoubtedly grow in importance. After offering an overview of the U.S. demographics of the 65 and older population, this report discusses how physical, emotional, social, economic, and residential factors have unique impacts on seniors.