Sarah J McCrea-Dameron

Choose the Hard Way to Breathe Easy

photo credit: https://from2005toeternity.wordpress.com/

Let’s face it, life is hard…if you’re living it right. The Austrian poet and novelist Rainer Maria Rilke said, “The easy path leads to the hard life, but the hard path leads to the easy life”. This has been my experience, most certainly. Seldom, if ever, has greatness come from any easy decision or easy chore in my life. Those things that mean the most to me and that have proven to be the most rewarding have taken great sacrifice and perseverance to achieve.

For example, getting into the fire service is no easy task but worth every minute of effort, I promise. Many fire departments are seeking candidates that have their EMT certification and fire science degrees. Better yet are the candidates that have survived a firefighter academy and have experience in first response either as an EMT or volunteer/wildland firefighter. This means that many of our candidates have already dedicated years of their lives to becoming a firefighter, in the hopes of being given the chance to go through our fire academy. It’s still no guarantee, but it’ll be worth it in the end.

The fire academy is no easy task, but worth every ounce of the blood, sweat, and tears sure to be lost during the experience. Ours is a twenty-two-week academy during which the recruit earns their state firefighter, hazardous material awareness, and advanced EMT certifications. They also learn about our values and culture, our strategies and tactics, and prove themselves time and again both mentally and physically. Twenty-two weeks of grueling tests and evaluations with the lingering and impending thought of potential failure and termination at every turn. It’s tough, but it’ll be worth it in the end.

Being a firefighter is no easy task, but worth every holiday away from family, every lost night of sleep, every sore back and stiff knee, every life lost for the chance to save another. It’s a career with purpose and honor, comradery and teamwork. It’s not easy to not only experience death and destruction, but to also be expected to stop the loss, save all viable life, and prevent any further injury or damage from happening, all within minutes. Firefighters are professional problem solvers and the pressure to always know what to do in every situation is enormous, especially because so much usually at stake. But it’s worth it in the end.

Being an administrator of a fire service agency is harder than I ever imagined it would be. As a firefighter, my focus was on the community and my crew. As an administrator, it is the community and the entire department, all divisions. With limited funding, aged resources, and political tensions, most days are littered with “no’s” and “not right now’s”, which are far better than the “never’s” and “what are you thinking’s”. It brings me great joy to know that my job is to serve the community through the hands and hearts of firefighters. Through it all, even though it has only gotten harder, it’s worth it.

The hard path has made my life easy, filled with purpose, pride, family, and security. And for that I am grateful, as I breathe easy.

Sarah J McCrea-Dameron

Courage in Innovation

We have a new program in our fire service, the Nurse Call Line. The Nurse Call Line exists to better navigate our community through the health and social service agencies of our community.

Without it, when people call 9-1-1, they are dispatched an ambulance, or more, maybe a fire truck or engine, depending on their complaints. Upon arrival, the EMS providers are straddled with two options: one, transport the caller to the hospital by ambulance; or two, the caller refuses medical treatment and transport. There is currently no in-between.

With the Nurse Call Line, we are able to connect 9-1-1 callers that have low acuity complaints directly with an emergency-medicine-experienced, registered nurse that utilizes a set of evidence-based, time-tested protocols and determines alternate care plans such as self-care, self-transport, the dispatching of emergent or non-emergent EMS resources, or maybe even a ride-sharing service.

Every time the Nurse Call Line doesn’t send an EMS resource, they save the callers, the insurance companies, and the community hundreds of dollars by reducing unnecessary EMS transports to the hospital. Every time the Nurse Call Line is able to address the needs of the caller without transportation to a health care facility and instead manages the needs of the caller through referrals to alternative resources or provides them with information for self-care, they save even hundreds more in prevented urgent care and/or emergency department costs.

Bottom line, the Nurse Call Line saves money and aligns callers with the most appropriate care for their needs.

We started the Nurse Call Line two years ago as a pilot program, wishing to evaluate the results before committing to permanent staff and funding. Two years ago, we recruited a team of nurses that were highly skilled and experienced in emergency medicine. We shared with them our dream, the intent of the program, the molds we were going to break, the uncertainty of the program’s future and invited them to join us on the journey. Each nurse that was offered the position accepted, despite this uncertainty and lack of sustainability. Each of the nurses that joined our team knew exactly what we were trying to accomplish, because they, as emergency medical nurses, had been experiencing the same frustrations we had. They also understood that the system was broken and that this new way of connecting with patients had great potential.

Hundreds of years ago, when captains recruited crew members for sailing exhibitions, they promised gold and riches, freedom and glory. This is what inspired men to travel into the great unknown, for near-certain death. Countless brave and courageous men lay at the bottom of the ocean, having lost the battle somewhere at sea and hundreds of miles from their intended shore and land of opportunity. Our nurses have that courage.

Like all new programs, there are many unknowns. Like all new programs, we deliberated about the details and pontificated over the possibilities, but at some point, we had to launch. We expected much learning along the way, discovery in the journey, and we knew we would never reach our final destination as there will always be more opportunity or room for growth and expansion.

The Nurse Call Line was no different. We made many mistakes, especially along the lines of training both new and incumbent staff. We could have done better, especially as it pertained to existing employee buy-in and engagement. We did our best at the time, especially when it came to the IT programming and interface…we were building a plane in-flight and these were unchartered lands.

Fortunately, we had a great crew. They knew where we were heading and what we were trying to accomplish. They forgave and instead supported the weaknesses of their leaders, while displaying courage and commitment in the face of opposition and uncertainty. And while we have not crossed the finish line, we have made progress and have confidence we are heading in the right direction.

It takes courage to be innovative. I am grateful for the courage the nurses of our pilot program have demonstrated over these past two years! Their bleeding hearts of compassion are those of warriors.

Sarah J McCrea-Dameron

9-1-1 Dispatchers, the HEROES you don’t see

https://www.co.morrow.or.us/sheriff/page/communication-center-9-1-1

I’ve been in the fire service for over twenty years. A little over 6 years ago, I moved into an administrative role and started learning more about the various divisions of the department, other than Operations or Suppression, including but not limited to: Training, Administration, Logistics, Prevention, and Fire Communications. My first assignment was the Emergency Medical Services Quality Improvement Coordinator (EMS QIC). In this role, one of the many tasks and responsibilities included investigating customer/patient complaints or incident concerns and would involve reviewing the incident from time of 9-1-1 call through to final patient care disposition.

All those years in the field, I communicated with dispatchers on the daily. I would listen intently to their incident dispatch, where they provided essential information I needed to ensure I knew where I was going and what I was going to encounter. They were there for me when I needed to request additional resources, or help getting more information from the 9-1-1 caller, or provide telemetry to the receiving hospital. They were not only my lifeline if I ever needed help, but also the neural network that made the whole system work.

But it wasn’t until I was in administration that I began to gain a better understanding of the breadth of what they actually did every day. I would come to learn that the dispatching side of the house is actually fun for them, the part of their day that they look forward to. Until I started listening to the 9-1-1 calls in the EMS QIC role and privileged with the responsibility of the Fire Communications Division, I did not fully appreciate their knowledge, skills, and abilities…as well as their perseverance, resiliency, and compassion.

I thought I had it rough when I ran those tough calls as a firefighter/paramedic. You know what I’m talking about…they still haunt my dreams. There’s not a day that goes by that I don’t drive past that intersection, or that apartment building with the pool, or that highway offramp. They all hold the memories and ghosts of those I touched, some I helped and others I watched drift away, always doing my best. But it turns out, 9-1-1 calltaking is much harder and tougher than anything I have experienced.

The panicked caller drops into the 9-1-1 calltaker’s ear, fearful for their life or the life of a loved one. They need help right now. Over the phone, with the limited sense of hearing and the gift of talking, 9-1-1 calltakers gather the address, phone number, and general understanding of what the emergency might be within minutes. All the while, they provide reassurance that help is on the way and life saving instructions for situations such as but not limited to: cardiac arrest (dispatch aided CPR makes a HUGE difference in the outcomes of out-of-hospital cardiac arrest victims), allergic reactions (epi-pen administration), respiratory distress (inhaler administration), obstructed airways, drownings, baby deliveries, etc. etc. They save lives every single day…

The firefighters and EMTs that are dispatched arrive most often 6-8 minutes later, after the caller has been reassured that help is on the way and has been given instructions to help the person they are concerned for (themselves or otherwise). The firefighters and EMTs don’t realize that the person they encounter when they arrive on scene was actually MUCH more agitated, panicked, fearful, and anxious just minutes earlier. The firefighters and EMTs don’t realize the luxury they have in being able to SEE and physically TOUCH the patient to more accurately determine what is wrong and how to fix it. The firefighters and EMTs don’t realize the importance of the CLOSURE they experience when they treat and transport the patient to the hospital, transferring a potentially stable (or hopefully at least improving) patient. Even the closure of knowing they did all that they could is something…

The 9-1-1 calltaker? They’ve, in the meantime, taken 8 more calls, one after the other. The callers have vacillated between the nagging knee pain that has been going on for months to the panicked mother who just found her toddler face down in the pool. Sometimes, when they just can’t take one more call, they might find a quiet place to cry, to mourn, to release. Meanwhile, their teammates are busy taking call after call and so they hurry back to help with the load.

I used to be that firefighter that took the 9-1-1 calltaker/dispatcher for granted, it was out of ignorance. Now, I respect them more than my words can express and I try to protect and provide for them with the limited resources we are granted. Perhaps, if people understood their value and worth, we would be able to hire enough staff so they didn’t have to work overtime or so they could take a breather between tough calls. Perhaps, if people could acknowledge and appreciate the Heroes you don’t see, the FIRST First Responders…?

Sarah J McCrea-Dameron

Lawnmower Leadership

https://gigazine.net/gsc_news/en/20181006-lawnmower-parent

I recently attended a new student orientation program at the college that my oldest child will be attending this fall. I was impressed with the event, specifically the portion during which they separated the parents from the students. While the students were touring with breakout groups specific to their majors, they provided parent-specific material and expectations.

Sitting there in the lecture hall with other parents going through a similar experience, many of us sending a child off to college for the first time, I listened to the professor describe what to expect in the coming months. There was a portion of the programming during which they encouraged us to reflect on our parenting styles, the examples provided were helicopter and lawnmower parenting. I had heard of helicopter parenting and was sure I hadn’t parented in that style, but lawnmower parenting? I hadn’t heard of it, and instantly became fearful I might have done just that.

Picture this, there’s a large area with high grass, a parent pushing a lawnmower, a child walking easily behind them in the neatly mowed grass path. The parent is doing all of the work, the child walks carelessly and effortlessly along. In a state of personal reflection, I acknowledge that as a parent and leader, I intentionally remove obstacles and attempt to set my children and subordinates up for success. A fellow team member on the executive staff with a similar leadership style likens himself to a bulldozer, leading his team down the road and removing obstacles along the way. What could possibly be wrong with this style? Isn’t this just advocacy and support? Isn’t that what I’m supposed to be doing?

Apparently not. Apparently, people are supposed to struggle a little. They have to experience hardship and challenges, failures and setbacks. It’s in those moments that they learn how to cope and overcome. They learn about innovation and perseverance. They might fall down, stumble, toss about, but they get up stronger. And most importantly, they learn how to get up and try again. We hear this all of the time, as individuals. Don’t give up! Try again! Believe in yourself! How do we practice this in leadership?

I asked my children if I was in-fact a lawnmower parent and they proceeded to laugh and say no. I pressed them a little, “then what kind of parent am I?”. They thought for a moment and then my son said, “maybe a weed-wacker”. He explained, “you get the big stuff out of the way and we know you are there for us, but you make us do most of it ourselves”. I’ll take that, while also making sure I am giving people ample opportunity to clear their own paths to success and personal growth.

Sarah J McCrea-Dameron

Turn It Down

Throughout most of my adult life, I have been known for my tenacity, brazenness, and passionate advocacy. I have a competitive personality which I have come by honestly after years of competitive sports and being a woman in the fire service. Throughout my career, there hasn’t been a day that has gone by that I didn’t have to prove myself to somebody. Unlike my male counterparts, seniority and rank don’t grant me anything. It doesn’t bother me, it’s just a fact. I have adjusted to the environment by actively attempting to earn the respect of those with which I work. I never back down from a challenge and aim to work as hard or harder than anybody else in the room or on the team.

This perspective requires balance. I don’t need to be better than anybody else. I don’t need to make a fool of anybody else. My goal is to be good enough to earn the trust and respect of my team so they know they can depend on me to do the job. I am also sensitive to the individual needs of my teammates and recognize the importance of their personal confidences. Effective teams work together by building each other up to maximize their strengths and minimize their weaknesses.

During the first few years of my tenure in administration, I was fortunate enough to have a mentor that provided regular feedback. Whether a written report, difficult decision, presentation, or otherwise, I looked forward to his constructive criticism in my continued professional development. One day, after one of our committee meetings during which I did my usual “leaning in” – speaking up, advocating, and articulating, his feedback was a motion of his right hand, index finger and thumb, simulating the turning down of a knob.

Believe me, I know I am imperfect, I have many “spirit breaks”, but this I did not expect. I thought I was in-check, in control, and effectively walking the line of respectful courage. I thought it was what I needed to do in the moment, all moments, and now I was being told to “turn it down”.

Like all constructive criticism should encourage us to do, I reflected on this feedback. I still think about it often. It hasn’t changed who I am or where I come from, but it does give me pause and encourages a greater sense of awareness. It has increased my sensitivity to the room, to my team, and to the way in which I communicate. It has humbled me and empowered me. I have a knob, I have control, and I turn it down, or up, when appropriate.

Sarah J McCrea-Dameron

The Decision of Indecision

I’ve never really been one for indecisiveness and not because I always know what to do or have the right answer. Instead, my choice to make a decision stems from an understanding that not making a decision is a decision and likely the option I have less control over. I found the following quote from Bill W. that sums it up nicely, “Indecision with the passing of time becomes decision”.

Being decisive is a multifaceted state. You’re faced with a decision. You consider the facts, the outcomes, the consequences. You choose. Life goes on. It has been my experience that opportunities to make decisions never stop coming. They’re not like the items on my Monday To-Do List, whereas once I cross it off it is done, gone, I don’t have to worry about it anymore. Opportunities to make decisions keep coming, and they aren’t going to stop. It takes confidence to make decisions, and making decisions builds confidence. Sometimes, it might even take courage to make a decision.

Some decisions are significant and come with great consequences. They require time and patience: time to work through the problem to find the Simplicity on the Far Side of Complexity, and patience to allow facts to surface and conclusions to formulate. Often though, especially with significant decision-making moments, there will be several smaller decisions to be made after the fact, providing ample opportunity to make subtle corrections if needed or to address certain aspects not directly impacted by the initial decision. Overthinking the situation can lead to Paralysis by Analysis, or indecision.

Yes, making a decision can be scary or worrisome. Nobody likes to be wrong or make bad decisions. But like Maimonides said in his quote, “The risk of a wrong decision is preferable to the terror of indecision”, or Aaron Burr in his, “Error often is to be preferred to indecision”, indecision is even worse than being wrong. Even Berhard Langer agrees, “Be decisive. A wrong decision is generally less disastrous than indecision”.

After all, like John Ortberg said, “Greatness is never achieved through indecision”. Be great, start by making a decision!

Sarah J McCrea-Dameron

Recruiting for the Fire Service, do you have what it takes?

Image from https://exactsports.com/blog/building-grit/2016/04/11/

The fire service is hiring. Across the country, courageous men and women with a commitment to a life of service are needed to fill the rank of firefighter.

Firefighters are professional problem solvers that must be able to mitigate emergencies of all types and sizes. We have kept the title of firefighter because it defines the foundation of our response model and service, but we do it all. We have training in vehicle extrication, emergency medical response, swift water rescue, fire suppression, hazardous materials, and more. Obtaining skills in such a variety of disciplines requires constant training and unending devotion to your craft.

Firefighters are occupational athletes that must be able to swing heavy tools, drag and control water-filled hoses, break down doors, tear out walls, and move unconscious patients. These tasks are often completed while wearing a “human sauna suit” (aka turnouts), SCBA (self-contained breathing apparatus), and carrying tools totaling anywhere from 60-100 lbs. Physical fitness, both strength and endurance, is a necessity not a luxury.

Firefighters are team players that must be able to work with others to accomplish their mission in stressful situations. They must respect authority and be dependable. They must earn the respect of their teammates so that their teammates know they can trust them even in the hardest, darkest, and most dangerous of circumstances. They must be resilient because they will “see it all” over the course of their career. They are their “brothers’ keeper” and must watch over each other to ensure they all make it home safely at the end of every shift, both physically and mentally.  

Finally, firefighters are public servants that must be empathetic and compassionate to their customers, the community, at every interaction. They will see their neighbors and friends in their most vulnerable moments and must demonstrate absolute professionalism and confidence at all times.

Firefighters have grit, “unyielding courage in the face of hardship or danger”, do you have what it takes?

Sarah J McCrea-Dameron

Simplicity on the Far Side of Complexity in the Fire Service

https://www.planplusonline.com/simplicity-side-complexity/

“I would give a nickel for simplicity on the near side of complexity, but I would give my life for simplicity on the far side of complexity” – Both Einstein and Oliver Wendell Holmes, Jr. have been credited with some variation of this quote.

In the fire service, it is very applicable. We, without hesitation, trust and follow the incident commander that can effectively manage an emergency with a calm confidence. We breathe easier, no matter the situation, when we hear their voice on the radio. They have earned this respect and following through a demonstration of their skills and competence over time and throughout experiences. It wasn’t the run-of-the-mill-room-and-content fire, or the typical MVA-MCI, it was the this-could-go-south-at-any-moment or walking-the-line-between-offensive-and-defensive calls where they made the right call at the right time, everybody went home safe, there were no fatalities, and all-the-while, they were “cool as a cucumber”.

These leaders respect the incident, respect the risks, respect the unknowns, respect their people…understand them all and their relative complexity due to their dedicated training and discipline…and then make the resolution of the emergency appear as a simple exercise in the basics.

This is simplicity on the far side of complexity, and it’s the only place where simplicity belongs in the fire service.