The purpose of this handbook is to provide assistance to both new and experienced medical directors as they strive to provide the highest quality of out-of-hospital emergency medical care to their communities and foster excellence within their agencies. The handbook will provide the new medical director with a fundamental orientation to the roles that define the position of the medical director while providing the experienced medical director with a useful reference tool. The handbook will explore the nuances found in the EMS industry-a challenge to describe in generalities due to the tremendous amount of diversity among EMS agencies and systems across the Nation. The handbook does not intend to serve as an operational medical practice document, but seeks to identify and describe the critical elements associated with the position.

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.

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.

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.

This body of work provides detailed information on the nature of the Shenandoah Retirement Home Fire in Roanoke County, Virginia on December 14, 1989. It will assist policymakers who must decide on allocations of resources between fire and other pressing problems, and within the fire service to improve codes and code enforcement, training, public fire education, building technology, and other related areas.

This body of work provides detailed information on the nature of a fire in a Seattle Warehouse in January 1995 where four fire fighters died. This investigation will assist policymakers who must decide on allocations of resources between fire and other pressing problems, and within the fire service to improve codes and code enforcement, training, public fire education, building technology, and other related areas.

A fire originating in the compactor chute of a 35-story high-rise apartment building in the Harlem area of New York City caused the deaths of seven building residents. Several code enforcement and fire department operational problems may have contributed to the loss. The U.S. Fire Administration had planned to investigate this fire because of its many important lessons but would only do so with the express permission of appropriate authority. The Fire Department of New York (FDNY) requested that the investigation be delayed until a preliminary internal investigation was completed. When the preliminary FDNY report was issued, the Fire Administration found it to be of such high quality and candor that an additional investigation did not seem likely to add much to the lessons of interest nationally. This report summarizes some of the lessons learned on the FDNY report and discussions with members of the investigation team.

To develop a clear picture of the specific requirements of the rural arson control system, the IAFC conducted in-depth case studies of these systems in four rural counties. The results from visits to rural arson control programs in seven states are incorporated in this report..

This Orientation Manual provides practical information: both rescue techniques, and preparedness information for the first responder who will encounter people with visible and non-visible disabilities through their work. This publication can assist first responders in advance or make critical emergency decisions. This publication will help first responders to confidently work with the disability community toward the goal of protecting and saving lives and minimizing trauma.

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

As part of the second needs assessment of the U.S. fire service, a rough comparison was made between needs reported in the first needs assessment survey and resources requested and granted to the same fire departments in 2001-2004 under the Assistance to Firefighters Grant program.

This report continues a series of annual studies by the USFA of on-duty firefighter fatalities in the United States. The USFA is the single public agency source of information for all on-duty firefighter fatalities in the United States each year. The unique and specific objective of this study is to identify all on-duty firefighter fatalities that occurred in the United States and its protectorates in 2001, and to present in summary form the circumstances surrounding each occurrence. The study is intended to help identify approaches that could reduce the number of firefighter deaths in future years. In addition to the 2001 overall findings, this study includes assessments of trends over the past 6 years, as well as special analysis on actions that can immediately impact cardiac health and firefighter safety during emergency operations.

This report continues a series of annual studies by the USFA of on-duty firefighter fatalities in the United States. The USFA is the single public agency source of information for all on-duty firefighter fatalities in the United States each year. The unique and specific objective of this study is to identify all on-duty firefighter fatalities that occurred in the United States and its protectorates in 1996, and to present in summary form the circumstances surrounding each occurrence. The study is intended to help identify approaches that could reduce the number of firefighter deaths in future years. In addition to the 1996 overall findings, this study includes special analyses on violent firefighter deaths, physical fitness and its relation to firefighter deaths, and vehicle accidents.

The specific objective of this study was to identify all of the on-duty firefighter fatalities that occurred in the United States in 1995, and to analyze the circumstances surrounding each occurrence. The study is intended to help identify approaches that could reduce the number of deaths in future years. In addition to the 1995 findings, this study includes a special analysis of the use of personal alert safety devices at fatal structure fires and a special report on several fatalities that occurred during technical rescue operations.

This report identifies relationships between city characteristics and the causes of residential fires, with special emphasis on climate, demographic, and socioeconomic factors.

This report delineates the fire risk factors and presents the statistics regarding the fire problem among the elderly in the United States.

This study analyzed the use of sprinklered and non-sprinklered fire protection options in existing small Board and Care homes.

This guide outlines the essentials for establishing an arson strike force. It begins with a definition of the concept, presents a brief description of how such a unit might respond to an incident, proceeds through the planning steps for single and multi-jurisdictional strike forces, and outlines key elements in their organization and management.

This body of work provides detailed information on the nature of the fire problem for policymakers who must decide on allocations of resources between fire and other pressing problems, and within the fire service to improve codes and code enforcement, training, public fire education, building technology, and other related areas.

This document is intended to provide concise practical and technical guidance on arson prosecution. It draws heavily on state arson prosecutors' guides and other literature, and on presentations made at the first in a series of conferences for arson prosecutors at the Federal Law Enforcement Training Center in Clynco, Georgia in November 1985. This document also contains a guide to key literature on arson prosecution. This guide, found in Appendix A, suggests specific readings for prosecutors desiring additional information on the topics discussed in this document. Full citations to materials cited in the text and in the guide to sources by topic may be found in the references at the end of the report.

This report compiles the best practices and common problems of fire protection and criminal justice agencies in identifying, investigating, prosecuting, and preventing arson. Trends, current challenges, and best practices are discussed.

This body of work provides detailed information on the nature of the fire problem for policymakers who must decide on allocations of resources between fire and other pressing problems, and within the fire service to improve codes and code enforcement, training, public fire education, building technology, and other related areas.

This body of work provides detailed information on the nature of the fire problem for policymakers who must decide on allocations of resources between fire and other pressing problems, and within the fire service to improve codes and code enforcement, training, public fire education, building technology, and other related areas.

Self-Contained Breathing Apparatus (SCBA) are one of the most important items of personal protective equipment used by firefighters and rescue personnel. SCBA allow firefighters to enter hazardous environments to perform essential interior operations including offensive fire attack, victim search, rescue and removal, ventilation, and overhaul. They are also used at non-fire incidents involving hazardous materials and confined spaces where there is a threat of toxic fumes or an oxygen-deficient atmosphere. There have been several well-documented incidents during the past 10 years where SCBA failure may have been a contributing factor in the deaths or injuries of firefighters . These incidents, coupled with a recognition of the importance of self-contained breathing apparatus to firefighter safety, prompted the United States Fire Administration to undertake this study to address any operations trends associated with SCBA failure incidents, and to identify potential problems requiring correction or further study.

Three Pittsburgh firefighters died on February 14, 1995, when they ran out of air and were unable to escape from the interior of a burning dwelling. This incident illustrates the need for effective incident management, communications, and personnel accountability systems, even at seemingly routine incidents. It also reinforces the need for regular maintenance and inspection of self-contained breathing apparatus, emphasizes the need for PASS devices to be used at every fire, and identifies the need for training to address firefighter survival in unanticipated emergency situations.