Section 2 | Executive Summary

In April 2006, the Department of Homeland Security awarded FIRE 20/20 a Fire Prevention and Safety Research Grant to study the growing safety risks for fire/EMS personnel and civilians in multicultural communities. As part of the Multicultural Health and Safety Research Project (MHSRP) grant, FIRE 20/20 conducted the first “Diversity by Rank” Survey with 108 U.S. Metro Fire Departments.

For the purposes of this research study, FIRE 20/20 defined the Multicultural Community as a reflection of the people in our world today and the range of variations including: age, race, ethnic background, gender, people with special needs, socio-economic status, sexual orientation, sexual identity, religion and country of origin.

Sixteen Metro Fire departments expressed a desire to participate in the MHSRP. The three case study sites selected were Seattle, Austin and Milwaukee. Calgary, Alberta served as an independently funded pilot, where the research team developed and tested the research methodology and data collection instruments.

The research hypothesis was: The “hero” culture of the fire service, as identified by the agenda of the Fallen Firefighters Symposium, increases the risk of injury and loss of life of both firefighters and community members when working within multicultural communities.

The MHSRP team attempted to answer the following five questions:

1. How do firefighters perceive the effectiveness of their emergency and non-emergency service delivery in multicultural communities?

2. How do people in multicultural communities perceive firefighters’ emergency and non-emergency service delivery?

3. How does the fire service “hero” culture increase or decrease the risk of injury and loss of life for firefighters and community members when serving multicultural communities?

4. What health and safety risks to firefighters and community members could be reduced if firefighters had greater multicultural awareness and better reflected the community?

5. What is the current multicultural make-up of firefighters in metro regions of the United States?

The research hypothesis called for a probability sampling procedure based on demographic data relating to firefighter and civilian injuries and loss of life in multicultural communities. FIRE 20/20 had identified the National Fire Incident Reporting System (NFIRS) as the source of that data.

Early in the project, the research team learned that although NFIRS provided fields for demographic data, those fields were not required. As a result, no reliable demographic injury or loss of life data was available.

In an effort to identify specific incidents, as well as gather qualitative data to answer the research questions, FIRE 20/20 conducted 63 focus groups in the three project cities. These included both fire personnel (N=197) and multicultural community members (N=529). The research team also collected data through 124 fire personnel and multicultural community interviews and 1,391 written and online surveys. The research team gathered more than 40 hours of video interviews from fire personnel and multicultural community members selected from the focus groups.

The research team conducted a descriptive and an inferential analysis of the data. This enabled the review and analysis of qualitative and quantitative data from each of the three cities individually and collectively.

This written report presents research findings in a case study format, organized by the first four research questions for each city. Six themes emerged from the data that were vitally related to the health and safety of fire/EMS providers and multicultural community members: Multicultural Capacity, Communications, Fire Service Culture, Leadership, Customer Service and Community Relations. These six themes addressed more than 80% of the findings.

Some key findings stood out:

1. Both multicultural community members and first responders at all study sites rated Fire/EMS service very high.

2. Online survey results showed a majority of first responders reported communication and cultural issues did not affect service delivery. However, a number of both firefighter and multicultural focus group and interview participants reported that communication and cultural issues delayed service and potentially put first responders and civilians at greater risk.

3. The majority of first responders reported that they provide excellent or good Fire Prevention and Safety Education Services in Multicultural Communities. They also reported, however, that customers misuse their services and lack basic fire prevention and safety knowledge. The vast majority of multicultural focus group members expressed that they were unaware of the array of fire/EMS services and especially lacked fire prevention and public safety information.

4. Multicultural community leaders expressed a strong desire to collaborate with their fire department to assist with language and cultural translation, multicultural training, prevention and safety education, and recruitment efforts. Some community focus group members said that in their culture it was inappropriate for them to take the initiative to reach out to authority figures. They preferred the fire department reach out to them, leader-to-leader.

5. The majority of online respondents rated “hiring a competent, gender and culturally diverse workforce that is representative of our community” as a medium or low priority. However, a number of first responders representing both genders and multiple races stated clearly that a diverse crew positively enhanced safe and effective service. An overwhelming majority of community focus group members reacted favorably to the hiring of members of their specific cultural community by the Fire/EMS agency.

6. Although somewhat evenly split, first responders tended to believe that the “Can Do” attitude increased safety for multicultural customers and decreased safety for firefighters/paramedics.

The Discussion section of the report proposes a number of recommendations presented by theme for the participating fire departments and the fire service in general. Three key recommendations include:

1. Require the completion of demographic data for NFIRS. If the fire service is committed to reducing firefighter and civilian injuries and loss of life in multicultural communities, both understanding the value of demographic data and taking the time and initiative to collect, analyze and use this valuable source of information is necessary.

2. Build partnerships with multicultural communities. The focus group process built relationships and opened lines of communication for the participating fire departments and their multicultural communities. Community members provided specific recommendations about how their fire departments could work more safely, effectively and respectfully with their communities. The FIRE 20/20 research team recommends the continuation of these kinds of dialogues on a regular basis. As a result, this will increase the impact and reach of prevention and recruitment efforts, and reduce safety risks for both first responders and civilians. For departments that want to replicate the focus group process, a systematic outline called Community Bridge Building appears in the Findings section of this report.

3. Move to a “safety and prevention culture.” NFFF has identified that the fire culture must change from a “response culture” to a “safety culture.” Based on the data collected in this study, the move to a “safety culture” is an important first step, but it leaves customers out of the equation. The Fire 20/20 research team advocates that the culture shift be toward “safety and prevention.” Including “prevention” mobilizes customers as partners and increases fire service efforts to reduce emergency incidents from the start.

In conclusion, the findings and discussions generated in the MHSRP provide career, combination and volunteer departments with practical insights and strategies along with a set of recommendations to increase the degree of safety and effectiveness of service provided in their multicultural communities.

Section 7 | Discussion of Findings, Commonalities and Recommendations

7.1 Introduction

The findings revealed six themes that had the strongest impact on the safety of firefighters and multicultural community members. These themes included multicultural capacity, communications, customer service, fire service culture, community relations, and leadership issues.

As the themes surfaced during the preliminary analysis, it became clear that they were closely interrelated. While each discussion focuses on an individual theme, this closeness results in some duplication (cross referencing of themes). The discussion of each theme culminates with pertinent study recommendations, some for immediate action and others for future research.

As depicted in Figure 7.1, leadership emerged as a central core theme reaching out into each of the other themes. The leadership discussion provides examples of formal and informal leadership actions from the fire departments in the three participating project sites.

7.2 Multicultural Capacity

VIDEO | Multicultural community members and firefighters/paramedics discuss cultural concerns that impact safe and effective service

7.2.1 Introduction Multicultural capacity emerged as one of the key themes in this research study. For the purposes of this discussion, multicultural capacity refers to the degree of proficiency and ease with which Fire/EMS personnel respectfully deliver emergency and non-emergency services to multicultural community members, as well as their willingness to learn about different community cultures. This includes knowledge of cultural practices, values, rituals, differences in expressing emotions, community priorities, etc.

Because the demographics of the United States, and specifically the three research cities, are constantly evolving and growing increasingly more diverse, a proportionate growth in multicultural capacity seems not only appropriate, but also necessary. For instance, firefighters in all three study sites acknowledged that multiple languages, cultural and religious traditions and generational differences present new and unique challenges to both fire departments and community members. These challenges require the integration of new knowledge and methods to continue to assure the delivery of safe and effective emergency and non-emergency services in multicultural communities.

The research team’s primary focus was to study the relationship between the fire departments and the multicultural communities they serve, and to explore multicultural capacity as it related to safety, prevention of injuries and loss of life of both firefighters and community members. In this domain, researchers gathered both quantitative and qualitative data.

7.2.2 Between the Fire Department and the Community

Research by Pitkin and Eisinger indicated that active representation, rather than passive representation, resulted in more opportunities for multicultural community members to access policy-making positions in the bureaucracy. Lipsky, Meier and Morgan, England and Pelissero found that local government employees who work directly with the public, such as teachers, social workers, police officers and firefighters have considerable discretion in the process of delivering services to their constituents, and are thus able to influence those with whom they interact. Three major studies in the education field with ethnic groups of students, African American, Hispanic and Native American found that multicultural teachers had a significant impact upon reducing discrimination toward all multicultural students. That significance carried over in the needs, opportunities and expectations of multicultural students. That is, multicultural community members benefited in significant ways from the presence of multicultural local government workers who delivered services to them because diversity facilitated increased communication, understanding and trust.

None of the three departments that participated in this study reflected the gender, ethnicity, religion, race or social class diversity ratios of the communities they serve. However, all three of the chiefs expressed the desire and commitment to have greater multicultural representation throughout the ranks of their departments.

Members of the multicultural community focus groups saw having firefighters from their communities as a way of ensuring someone in the department with whom they could identify, spoke their language and understood their culture. They saw this as a safety factor in emergencies and a positive influence in fire safety, prevention and public education efforts.

The figures presented in Table 7.2.1 reveal that more than 40% of firefighters and paramedics in all three cities acknowledged that they encounter cultural misunderstandings when delivering services to diverse communities. Of note, 13% expressed that they did not know if they encountered cultural misunderstandings. Multicultural service issues generally related more to medical calls and non-emergency interactions, rather than to fire suppression activities.

Note: The scale for computing the mean is as follows: Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point Don’t Know = 0 points

Anecdotally, a number of firefighters and paramedics expressed how important it was to have an African American on the crew when they went into an emergency, an inspection or an investigation in an African American community. They expressed that having a Hispanic firefighter was helpful when entering a Hispanic home or business. Numerous male firefighters and paramedics described the importance of having a female on the team and how often that significantly reduced tension (of both the customer and the male firefighters). Having a woman crewmember also improved service delivery when dealing with female related

emergencies such as rape, childbirth or in culturally sensitive situations, i.e., among Muslims who often consider the touching of a woman by a male firefighter disrespectful or inappropriate. Since the largest percentage of calls at all project sites are for emergency medical services, it makes sense, as some officers mentioned, to have personnel options.

A number of community focus group participants identified specific issues that might help firefighters and paramedics. The researchers caution that these suggestions from community members represent their personal opinions and should not be construed to apply to all members of their race, religion, gender or socio-economic group.

The Muslim focus groups identified the need for women to cover themselves as one area that could affect the safety of firefighters and customers. Focus group members said that a traditional Muslim woman might not leave a burning building until she was covered or she might rush back in to get a covering. The recommendation was that firefighters and paramedics be aware of this and in an emergency rescue be prepared with a blanket to offer the woman.

A few members of the Chinese focus groups discussed how some Chinese, especially elders, may not trust banks and will instead keep their money and jewelry hidden in the house. They suggested that in a fire, some people might run back into a burning building to try to reclaim their valuables; in some cases, their life savings. Their recommendation was that firefighters be aware of and watch for this type of behavior in an emergency.

One of the most important safety factors is being able to gather pertinent on-scene information quickly to do a risk vs. reward assessment. According to the figures presented in Table 7.2.2 a small majority (51%) of firefighter respondents indicated they are able to collect the information they need. However, 40% of the firefighters and paramedics reported they did not get the critical information from customers that they needed to do their job. This can put firefighters, paramedics and their customers at risk of injury or loss of life.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point Don’t Know = 0 points

Not only is acquiring key on-scene information critical for the risk vs. reward assessment, but being able to build rapport with the customer(s) quickly and being aware and sensitive to the issues at hand also impacts safety in emergencies. With whom to talk to gather information, male or female, how one addresses elders, and how the firefighter or paramedic positions and conducts himself/herself in the room are all culturally sensitive issues that can help or hinder gathering important data in an emergency.

Firefighters and paramedics identified the presence of language problems as impacting the ability to gather critical information. The research team discusses this further in the Communications section.

A number of community focus groups in all three cities identified trust issues with people in uniform and authority figures. These included first and second-generation immigrant groups, African American, LGBT and homeless/low income groups. Members of these focus groups expressed a feeling of being judged by some firefighters for their race, lifestyle and socioeconomic situation.

The figures presented in Table 7.2.3 show a majority of the respondents (67%) reported they know which behaviors are appropriate for each culture. However, more than 25% of the respondents reported confusion about appropriate behaviors in different cultures. This finding exemplifies the importance of firefighters having multicultural understanding and knowledge.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point Don’t Know = 0 points

Open-ended survey comments, focus groups and interviews reflected more confusion than the online survey findings indicated. Some firefighters expressed feelings of being overwhelmed with all of the cultures, customs and religious beliefs. Some wanted the community to change and others claimed that it was the fire department’s responsibility to take proactive, constructive action to assist first responders to become more culturally competent so they could safely and effectively serve all customers.

A number of community focus group and interview participants recommended that if emergency responders are confused or aware that there may be a cultural issue, the best practice is to respectfully ask. They consistently explained that a sincere desire to learn about someone who is different is not only respectful; it is also an effective way to increase one’s multicultural understanding as well as improve communication.

Having a competent, inclusive fire department is one way to be safer and more effective in working with all of the multicultural communities. Meier, Stewart and England report diverse groups bring gender and multicultural understanding to work.

The online fire department survey asked respondents in all three departments to prioritize the importance of a competent, gender and culturally diverse workforce that is representative of their community. The figures presented in Table 7.2.4 produce a mean of 2.13, indicating that the responses clustered in the Medium Priority option. The largest percentage of respondents (37%) answered with the Low Priority choice. A number of open-ended survey responses confirmed this response by commenting that competence was the only criteria for hiring and that race and gender were unimportant.

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

On the other hand, the figures presented in Table 7.2.5 indicated that community focus group participants expressed a great deal of interest and enthusiasm in having members of their respective communities work for the fire department or on an ambulance. Seventy-nine percent of the community respondents chose an affirmative response.

Yes = 2 points No = 1 point

Members of the multicultural community focus groups saw having firefighters from their communities as a way of ensuring someone in the department spoke their language and understood their culture. They saw this as a safety factor in emergencies and positively affecting prevention and public education efforts.

Some multicultural community focus group members and interviewees expressed two concerns about members of their communities becoming firefighters and paramedics: The first was that the fire department has never recruited in their community, so potentially qualified applicants don’t know about the jobs or about what they need to do to prepare for exams. The second was some concern about how the fire department culture would treat firefighters from their communities. One key question was whether current firefighters would respect their religious practices. For example, Muslims pray several times daily and Orthodox Jews do not work on the Sabbath.

Another method for expanding multicultural capacity is job relevant, cultural competency training. The figures presented in Table 7.2.6 reveals that 67% of online participants reported that they considered themselves effectively trained to serve people from all walks of life and diverse cultural backgrounds. Note that more than one in four reported that firefighters did not believe themselves effectively trained to serve members of a diverse community.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Don’t Know = 1 point

Based on qualitative data gathered from firefighters in focus groups, interviews and open-ended online survey questions, the research team believes that firefighters were responding to their technical training in dealing with people, rather than multicultural capacity training. In fact, most firefighters and paramedics reported that diversity training offered by the departments and municipalities was not effective in helping them to safely and effectively deliver services to multicultural communities.

Community focus group participants took a very different view from the Fire and EMS personnel online survey respondents. They identified the need for further first responder cultural training within all project sites and gave several examples of dishonoring religious and cultural traditions and disrespecting members of some multicultural groups. Participants in almost every focus group providing these stories offered to work cooperatively with the local fire department to develop, implement and conduct cultural programs to help first responders increase their capacity.

While firefighter focus groups and interviews identified a need for multicultural capacity training operationally integrated into their job, figures presented in Table 7.2.7 indicate that such an integrated approach was not a high priority. Fire and EMS personnel chose Medium Priority for the statement, “Integrate opportunities to learn about different cultures into regular training activities.” In fact, about two-thirds of the respondents selected either Medium Priority (40%) or Low Priority (26%).

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

Firefighters in some focus groups expressed the importance of a cultural assessment of the on-scene conditions and integrating that into overall on-scene assessment. The figures presented in Table 7.2.8 point out that a majority of online respondents (77%) view a cultural assessment as a Medium Priority (44%) or Low Priority (33%).

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

Some community focus group participants and a few firefighters identified cultural misunderstandings and miscommunications that occurred during the inspection of small businesses owned by multicultural community members. The figures presented in Table 7.2.9 reveal a majority of online respondents reported that such an inspection training program was of Medium Priority (37%) or Low Priority (24%).

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

Generally, first responders were aware that cultural misunderstandings happened and they were sometimes unable to obtain critical information from their customers. In the online survey, however, methods presented to help resolve barriers—particularly in providing service to multicultural communities—were consistently rated as Medium or Low Priority by the majority of firefighters and emergency medical services personnel who responded.

7.2.3 Summary

Based on studies of representative bureaucracy, the research team believes that fire departments with better representation would potentially experience more effective relationships and open communication with many of the multicultural communities. Although the demographics of the three fire departments researched in this study are not proportionately representative of the communities they serve, all three chiefs expressed a desire and commitment to increase that representation.

The qualitative, quantitative and anecdotal data presented a number of multicultural capacity-related issues between fire departments and the communities they serve. All three departments identified challenges in recruitment of multicultural community members, language and communication barriers, understanding culturally appropriate behaviors and encountering cultural misunderstandings. Some first responders also expressed the importance and advantage of having a culturally diverse team and a desire for receiving job-specific, cultural relevance training.

Most multicultural issues related to rescue and/or medical emergencies, and non-emergency situations, in which customers identified some emergency responders who did not respect their customs or religious beliefs. Some members of the LGBT, homeless/low income, special needs (deaf, blind) and African American focus groups in all three study sites identified issues relating to lack of respect.

Few multicultural issues directly related to fire suppression consistently emerged from the three cities. However, some community focus group members identified occasions when community members might put themselves at risk (by going back in or not coming out of a burning building) as a result of cultural norms or traditions. Firefighters and community members both agreed that there is a need for increasing knowledge of fire safety in multicultural communities.

7.2.4 Recommendations

Background

Study findings identified that first responder personnel encountered cultural misunderstandings when delivering services to multicultural communities. Focus group participants identified several cultural issues that had the potential for creating misunderstandings that could negatively affect and potentially delay service:

1. Gender to gender issues
2. Religious values and practices
3. Child birthing practices
4. Death and mourning rituals
5. Cultural cooking methods and use of fire
6. Cleanliness and modesty issues
7. Folk or non-traditional medical practices

Value Statement

Greater multicultural capacity increases respect and teamwork within the department and builds trust and mutually beneficial relationships with multicultural community members. It also leads to opportunities for shared learning, expanded prevention efforts and safer and more effective emergency services.

Recommendations

Between the Fire Department and the Community:

1. Develop and implement an operations-oriented multicultural competency training program for all first responders and dispatchers. Multicultural community members and fire department personnel should jointly develop and conduct the program to maximize the opportunity for shared learning. Initiate the training in recruit school as well as throughout the force. Integrate the training into regular company level training (i.e., staging/incident management systems) and maintain a company training focus on carrying out job responsibilities more safely and effectively.

Within the Fire Department:

1. Develop a Cultural Assessment Procedure and integrate it into SOP/SOG for all calls.
2. Revise all firefighter and paramedic job descriptions to include multicultural competencies. Align hiring and promotional requirements/standards for those positions with revised descriptions.
3. Create and implement incentives to encourage firefighters/medics to recruit young people with needed multicultural and language competencies. Inspired firefighters/medics are the best recruiters.
4. Develop a cadet program to target young people with multicultural and language competencies. Use the LBJ Academy operated jointly between the Austin Fire Department and Austin Public Schools as a model.

7.3 Communications

VIDEO | Firefighters/paramedics discuss language and other communications challenges that affect safe and effective service in multicultural communities.

For the purpose of this study, the research team defined communications as the accurate exchange of verbal, non-verbal and written information to, from and within the Fire/EMS agency. Communication topics discussed in this section include: communication with customers, language barriers, internal communications, interdepartmental communications and use of the Language Line.

7.3.1 Communication Barriers

The figures presented in Table 7.3.1 contain cumulative and individual project site online survey findings about communication barriers. Communication barriers generally referred to language issues, including accents, but could also be related to volume, interpersonal skills in situations with displays of anger or grief, sender/receiver messages, non-verbal communication, misinterpretations in English, and communication challenges related to lack of information provided by dispatch. Firefighter and paramedic online survey respondents reported that they experienced communication problems, but less frequently than was indicated in the qualitative data collected in the focus groups and interviews. The cumulative mean of 2.47 indicated a clustering of responses in the Disagree category, but in close proximity to the Agree option.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Community focus group participants, primarily first- and second-generation immigrants, identified language barriers as a problem. They identified a need for translators at emergency scenes and at fire safety presentations. They also requested that the fire departments provide fire prevention materials translated into their respective languages. A few focus group participants from the deaf community in Seattle also indicated a need for translators.

The figures presented in Table 7.3.2 identify how firefighters and paramedics view the adequacy of their crew’s language skills to meet the emergency needs of the community. A cumulative mean of 2.56 shows that the respondents in all three cities responded in the low end of the Agree response. Milwaukee had the highest mean, 2.87, with 60% reporting Strongly Agree (7%) or Agree (53%). Seattle had the lowest mean of 2.38, with 52% reporting Disagree (37%) or Strongly Disagree (15%).

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

The number of languages spoken in each of the three cities may be one possible reason for this variance.

7.3.3 Service Delays

Operationally, a larger question is: Does the challenge posed by communication barriers delay service delivery to the customer? Firefighters’ and paramedics’ responses in the online survey (N=739) to the statement “I am forced to delay services to a customer due to communication barriers” are reported in Table 7.3.3.

The findings presented in Table 7.3.3 are consistent with the online responses presented in Table 7.3.2 relating to adequacy of crew’s language skills. A cumulative response mean of 1.97 identifies responses from all three cities in the Infrequently answer choice. Seattle identified the highest number of service delays due to communication barriers with 18% reporting delaysAll the Time (1%) and Frequently (17%). Milwaukee identified the lowest with 9% reporting All the Time (2%) and Frequently (7%).

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

Qualitative data collected from fire department focus groups and interviews in all three project sites identified that communication barriers do cause delays in service. Firefighters and emergency medical personnel acknowledged that it took more time because they had to locate a translator. People in translator roles often included a younger member of the family, a neighbor or someone looking on, another firefighter on the other end of a cell phone, or the Language Line.

Additionally, it took more time to obtain the necessary information through the translator. Online respondents reported that depending on the incident, confusion in terminology sometimes occurred. They also reported that using a translator through a cell phone often complicated and delayed service because they needed to pass the cell phone back and forth between themselves and the customer. Researchers present further explanation about this issue in the discussion below about the Language Line. Finally, firefighters and paramedics said that communication barriers created delays when attempting to inform non-English speaking family members about what was transpiring.

Some focus group and interview participants identified the language challenges as a safety risk for both customers and firefighters. When the response required additional time because of translation, customers did not receive immediate medical attention. They also said that adding time in an escalating emergency might result in greater risks for all parties.

One possible explanation for the difference between quantitative and qualitative data to the statement, “I am forced to delay services to a customer due to communication barriers” is that online survey respondents replied from a purely technical, rather than a communication perspective. From a technical point of view, response time and initiating medical treatment or fire suppression were rapid; however, their perception of service delays due to communication issues is not considered a delay, just part of normal incident mitigation challenges.

One of those options is reaching out into the community for assistance. Some community members shared suggestions to address communication challenges for emergency and non-emergency situations. Participating multicultural community organizations in each of the three cities expressed interest in providing both onsite and phone (translation and multicultural capacity) assistance their local fire departments and emergency medical service personnel. They also expressed an interest in receiving train-the-trainer fire prevention programs so that members of their own community could present fire safety programs.

For additional information about a successful partnership between the Seattle Fire Department and the International District Emergency Center, see Promising Practices in the Findings Section.

7.3.4 Language Line

The Language Line is one method for overcoming language barriers. It provides access to a variety of translators for a wide number of languages. Language Line services are available to both dispatchers and first responders. The process begins with a call to the Language Line from a dispatcher in the call center or from a firefighter or paramedic on a cell phone in the field. Callers provide a fire department password and billing number, and their request for a certain language. In a few moments, someone who speaks the requested language and English is on the phone. If the initiator was dispatch, they bridge the caller with the Language Line translator. If the initiator is at an emergency event in the field, the caller provides an explanation of the situation to the Language Line translator and then hands the cell phone over to the customer or, if the customer is too injured or unable to speak, another person who has additional information. The translator and the customer (or assisting person) discuss the circumstances. Data is gathered. The first responder takes the phone back and the translator relays the critical information to them. This “back and forth” process may continue for some time until the first responder gains the necessary information.

Firefighters and paramedics identified numerous challenges with the Language Line, including not knowing what language the customer was speaking so it was difficult to request a language; difference in dialects; new languages that Language Line translators did not speak; translator comprehension of medical terminology; and in the heat of the emergency, important information sometimes being lost.

The use of the Language Line varied widely by study site. The figures presented in Table 7.3.4 indicate that a significant majority of the respondents in all three study sites use the Language Line Infrequently (29%) or Never (51%). Seattle had the highest usage and Milwaukee had the lowest.

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

The responses of firefighters and paramedics were split on the effectiveness of the Language Line. Paramedics used it more frequently than firefighters and dispatchers who participated in focus groups and interviews were especially complimentary and found it very useful.

7.3.5 9-1-1 Communications

Complaints about the 9-1-1 system registered by multicultural community focus group participants were directed at 9-1-1 operators, who also serve as Fire and EMS dispatchers. Concerns included operators who: a) sometimes transferred their calls up to five times, b) asked too many questions, c) asked questions some residents did not know how to answer, and d) sometimes asked questions that did not make sense to the caller. Negative past experiences combined with anxiety about their English or what might happen to them for causing the emergency resulted in some multicultural community members not calling 9-1-1 at all. Language barriers in combination with a level of anxiety or fear often resulted in confusing communication between 9-1-1 operators and community members that created a ripple effect of confusing information to firefighters and paramedics in the field.

Firefighters speaking in focus groups expressed concern that they did not always receive sufficient information or the “right” information they needed, while some in other groups thought they were overloaded with information. Responding to the question about level of information in the online survey, cumulative findings showed a split almost down the middle. The figures presented in Table 7.35 show 51% of the respondents selected Strongly Agree (4%) and Agree (47%) and 40% chose Disagree (33%) and Strongly Disagree (7%). A mean of 2.53 showed a split slightly favoring agree.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

These communication issues increased risk for both firefighters/paramedics and customers, according to fire and EMS focus groups and interviews in all three cities. This was especially true when responding to domestic violence and gang-related emergencies in which different agencies may have provided additional information. For example, miscommunication sometimes increased with separate fire and police dispatchers and different dispatch protocols. To increase the safety of first responders and the effective and timely delivery of services to multicultural community members, the research team believes it is critical that fire departments address this cycle of communication.

7.3.6 Interagency Operations & Communication

Regarding the question of whether law enforcement is present when needed, the figures presented in Table 7.3.6 reveal that cumulative online survey responses clustered in the Infrequently category with a mean of 2.35. This was a bigger issue for Milwaukee where the mean of 2.51 indicates a clustering of responses just into the Frequently choice.

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

The anecdotal findings from the Milwaukee multicultural community and the Fire and EMS focus groups supported these findings regarding the communication challenges between MFD and MPD. However, that was not the case in either Seattle or Austin.

7.3.7 Summary

One-third to one-half of online respondents in all three cities reported experiencing communication problems when providing services to multicultural communities. The majority of both fire department personnel and members of the multicultural communities in all cities identified language as a barrier to communications. The three departments had varying opinions of whether they had adequate language skills to meet the emergency needs of the community, but they did agree—as the qualitative data shows—that communication barriers did cause service delays and safety risks. However, the cumulative quantitative data revealed that responders do not believe communication barriers caused a delay of services. This presents a discrepancy, which may be explained by the perception of the definition of “service delay” in a purely technical sense. The cumulative majority said they Infrequently used the Language Line as a way to assist with language barriers, but the individual cities’ use of the line ranged from 15% (Milwaukee) to 70% (Seattle) and was used more frequently by paramedics and dispatch.

Regarding communication with 9-1-1 and dispatch, multicultural focus groups expressed concern over too many transfers and/or questions, worry about language barriers, and anxiety and fear of calling. Slightly more than half of first responder online respondents believed they do not receive enough information from dispatch to safely respond to emergencies. Qualitative data in all three cities confirmed that these issues increased risk to both firefighters and customers.

7.3.8 Recommendations

Background

The findings identified that language and other communication issues between multicultural customers, 9-1-1/Dispatch and first responders created barriers that put firefighters, paramedics and multicultural customers at greater risk by:

1. Delaying service
2. Contributing to incident escalation
3. Creating confusion in an emergency, both at dispatch and on-scene
4. Inhibiting the exchange of critical information

The findings also identified that community organizations would like to provide support to the fire department as both language and cultural interpreters.

Value Statement

Proficiency in language and communication is an important skill-set to ensure the safe and effective delivery of both emergency and non-emergency services.

Recommendations

Within the fire service:

1. Conduct a formal inventory of personnel language capabilities and make it available to response personnel in both the Fire Department and 9-1-1/Dispatch. This skill inventory data could be associated at the Dispatch/CAD level as a resource capability (similar to other skills such as EMS, Haz Mat, USAR). The use of the daily personnel roster could be an alternate method of disseminating this data.

2. Pay multilingual incentives to firefighters/paramedics who proficiently speak the languages of their customer base (including American Sign Language).

3. Train department members in the most efficient and effective use of the Language Line, beginning in recruit school.

Within the community:

4. Work with multicultural community leaders to conduct an inventory of community organizations willing to assist with language issues to:
1. Identify needs (i.e., on-scene, telephone, written translation)
2. Identify key community contacts
3. Create a list of skills that these organizations can provide
4. Make the list(s) accessible by dispatch and/or responders
5. Invite community members to collaborate with the fire department and dispatch

 

9-1-1/Dispatch-Related Recommendations

The Seattle Fire Department Alarm Center was the only dispatch center of the three participating cities totally staffed by firefighters who understood on-scene emergency issues. For the other two project cities and for other fire departments whose dispatchers are not firefighters, greater operational knowledge of how first responders use and apply dispatchers’ data and information in the field would reduce the potential for miscommunication.

5. Create a Dispatch Ride-Along experience as part of Call Taker/Dispatcher Training. Real-life knowledge about the emergency response process and the kinds of challenges responders face with unclear information would help clarify job functions.


Recommendations for Future Research


Accurate and timely data collected at 9-1-1/Dispatch about language and communication problems would allow fire departments an opportunity to track and analyze data at the beginning of the information exchange cycle.

6. Collect accurate and timely data at 9-1-1/Dispatch about language and communication problems would allow fire departments an opportunity to track and analyze data at the beginning of the information exchange cycle.
7. Identify communication barriers during 9-1-1 calls and enter the data into the dispatch data system. Categorize data by communication issue, specific language spoken and location of the caller.

While the cumulative online survey findings indicated that service delays to customers were infrequent, the qualitative data indicated that communication barriers did cause delays in service. One possible explanation for the dichotomy in findings is that the online respondents reported from a purely technical point-of-view rather than a human perspective.

8. Conduct further study to more closely examine service delays due to language and communication issues.

7.4 Customer Service

VIDEO | Multicultural community members and firefighters/paramedics discuss customer service issues that influence safe and effective service.

7.4.1 Introduction For the purpose of this study, the research team defines customer service as satisfaction with the capability of and quality of safe and effective services provided by fire and emergency medical service departments to all communities. Customer service feedback can provide departments with both an internal and external perspective about how well and how safely they are serving their customers. In an attempt to move toward a safety culture, customer service ratings, like near-miss reviews, offer an opportunity to learn from errors, incidents and accidents.

They are also a way to identify areas where performance is exemplary, and provide opportunities to build on successes and promising practices. This knowledge can help the department to deliver services more safely and effectively.

Customer service encompasses a wide range of skills, attitudes and behaviors of both technical responses (response time, how quickly the emergency is mitigated, whether SOPs/SOGs are followed) and interpersonal responses (personal interaction with the customer, cultural awareness and follow-up with customers after the emergency).

Also affecting the scope of customer service are issues relating to dispatch—the first step in the process of an emergency response. A miscommunication or a problem between dispatch and the customer (i.e., language problems, transferring calls, disrespect), or between dispatch and the first responder (i.e., lack of information, miscommunication), can lead to customer service challenges or risks for the first responders and the community member(s).

Four departmental services, fire service, emergency medical service, fire prevention/public safety and the 9-1-1/dispatch system are the topics developed in this discussion.

7.4.2 Fire Service Ratings

The figures presented in Tables 7.4.1 and 7.4.2 contain the frequency distribution of responses from first responders and multicultural community members regarding the quality of fire services delivered in the multicultural communities. The tables present each project site individually and also cumulatively (N=739).

The fire department service delivery ratings (Table 7.4.1) were very high in all three departments, and the frequency distribution was similar. While the multicultural community focus group participants (Table 7.4.2) rated the service slightly higher than the firefighters rated themselves, the cumulative means were very close—3.59 (multicultural community rating) and 3.50 (first responders’ rating). Responses in both ratings clustered in the “excellent” category.

Excellent Service = 4 points Good Service = 3 points Adequate Service = 2 points Poor Service = 1 point

The research team learned that collecting meaningful customer service ratings from firefighters and paramedics about their service presented a unique challenge. Qualitative responses in focus groups, interviews and open-ended survey questions indicated that some responded to the more technical aspects such as response time, how quickly the emergency was mitigated and whether SOPs/SOGs were followed. Others focused more on the interpersonal aspects of the services including personal interactions with customers, cultural awareness and follow-up with customers after the emergency.

When discussing safety issues, it was easier for most firefighters to deal with technological issues than it was to deal with people related issues. The research team believes the same parallels exist when measuring customer service and that its technical aspects are easier to measure and are more aligned with the fire culture norms.

The figures presented in Table 7.4.2 address customer service from the community’s perspective. The source of these findings is the community post-focus group survey (N=332).

Excellent Service = 4 points Good Service = 3 points Adequate Service = 2 points Poor Service = 1 point

Qualitative data from community focus groups and interviews generally supported the quantitative results, but with a few exceptions. Negative feedback originated from some members of the low income/ homeless, LGBT, African American and deaf focus groups. Their criticism was generally related to a specific past event in which they felt they were treated with a lack of respect, or an isolated event with the fire department in a situation unrelated to an emergency service call (for example, a family member or friend’s experience with recruitment or hiring). In all cases, community members shared suggestions for improvement. The figures presented in Table 7.4.3 show that 84% of all the online firefighter and medic survey respondents in all three departments Strongly Agreed (47%) or Agreed (37%) that firefighters provide services equally to all communities.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Don’t Know = 1 point

However, anecdotal data from some participants in both firefighter and community focus groups and interviews in all three cities produced contrary findings: indicating that certain neighborhoods were treated differently. Some multicultural firefighters and paramedics told stories about property being less respected in low income areas. One firefighter told a story about how the department placed greater emphasis on checking and replacing batteries in smoke detectors in higher socio-economic neighborhoods. Community focus group members told of a fire in an African American nightclub and one at a BBQ restaurant frequented by African Americans where dispatch delayed response. Gay and lesbian firefighters and community members talked about gay and lesbian clubs receiving different treatment during inspections.

7.4.3 Emergency Medical Ratings

The figures presented in Tables 7.4.4 and 7.4.5 contain the frequency distribution of responses from all first responders and multicultural community members regarding the quality of emergency medical services delivered in the multicultural communities. As with the fire service ratings, strong similarities emerged in the distribution as well as the means from all three departments. Unlike the fire ratings however, the multicultural community focus group participants generally rated the emergency medical services slightly lower than the first responders rated themselves, though the combined means were very close with 3.46 (multicultural community rating) and 3.54 (first responders’ rating).

Excellent Service = 4 points Good Service = 3 points Adequate Service = 2 points Poor Service = 1 point

As with fire services, the research team learned that collecting meaningful customer service ratings from firefighters and paramedics about Emergency Medical Services presented a unique challenge. Emergency service responses in focus groups, interviews and open-ended survey questions paralleled those for fire service; they displayed a division of respondents who related to either the technical aspects or the interpersonal aspects of emergency service.

The written and online survey questions did not go into depth about or separate the technical vs. the interpersonal aspects of emergency medical service described above. More objective measures can help departments to safely and effectively deliver a wide range of services to multicultural communities by providing data to assist with strategic planning, program development, budgeting and resource allocation.

Excellent Service = 4 points Good Service = 3 points Adequate Service = 2 points Poor Service = 1 point

Negative feedback came from some members of the low income/homeless groups in each of the three cities. Many in the lower socio-economic strata had no medical insurance or personal physician. These people often gained access to medical and mental health treatment and care through calling 9-1-1. As with the discussion about fire services, the interaction with dispatch (9-1-1 or private ambulance companies) influenced customer’s feedback about service emergency medical service in a number of cases.

The figures presented in Table 7.4.6 reveal that 87% of online respondents Strongly Agree (45%) or Agree (42%) with the statement “Emergency medical responders provide service equally to all people in our city.”

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Anecdotal findings from community focus groups and interviews generally supported the quantitative results with a few exceptions. Negative feedback originated from some members of the low income/homeless, LGBT, African American and special needs focus groups. Their criticism generally related to a specific past event in which they believed they were mistreated or dealt with disrespectfully. Additional events included those related to private ambulance companies in which the ambulance was late or the attendants inadequately trained.

7.4.4 Fire Prevention and Safety Education

Researchers found that all three participating fire departments delivered fire prevention services and safety education. However, each department had different organizational and operational structures to provide these services.

The figures presented in Table 7.4.7 contain the responses from firefighters and medics regarding the quality of fire prevention and safety education services delivered in multicultural communities. Seventy-five percent of all online respondents from the three study sites rated this delivery as Excellent (36%) or Good (39%). Of particular note, almost 1 in 4 rated this service as Adequate or Poor.

Excellent Service = 4 points Good Service = 3 points Adequate Service = 2 points Poor Service = 1 point

The research team asked questions about fire prevention and safety education in the multicultural community focus groups, but did not include specific questions on the community post-focus group survey, thus, no quantitative data is available.

Although many of the multicultural community focus group members spoke highly of fire prevention programs for their children in the schools, the majority was unaware of fire prevention and safety education programs for adults, and more specifically, for elders. Community participants expressed a strong need for adult and elder programs to be delivered in their communities.

The figures presented in Table 7.4.8 indicate the perspective of all first responder online survey respondents regarding the effectiveness of public education materials within multicultural communities. Study sites responded very differently on this survey question. One explanation may be the difference in each department’s allocation of staffing and resources committed to public education. Of particular interest to the researchers was the large percentage of Don’t Know responses that ranged from a high of 34% in Seattle to a low of 19% in Milwaukee. The research team believes that the high Don’t Know response is a strong indicator of the low level of involvement by first responders throughout the ranks in fire prevention and public safety efforts.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Multicultural community focus group participants identified the need for materials to be translated into the languages appropriate to the attendees and, if possible, to have a translator available. Some groups expressed that they would be willing to help with written and verbal translation services.

One aspect of public education identified in the community focus groups related to customer confusion about which services their fire department provided. This uncertainty was consistent across the board in all three cities. It was especially confusing if someone was a first generation immigrant, did not speak English or moved from another community where the organizational structure of fire and EMS was different.

7.4.5 Trust

A key element of the relationship between first responders and customers is trust. Lack of trust can easily create a ripple effect that potentially shapes the safety of both parties, especially in emergencies. When it comes to fire and EMS personnel providing services to multicultural community members, that topic becomes even more important. Anecdotal data from the community focus groups indicated that due to a lack of trust, community members sometimes gave incomplete or inaccurate data to first responders, which increased risk. The figures presented in Tables 7.4.9 and 7.4.10 focus on trust issues that potentially affect customer service and ultimately safety. Sixty-seven percent of the cumulative online respondents reported that they experienced customer misuse of emergency services All the Time (20%) or Frequently (47%). In other words, first responders believed customers could not be trusted to use the 9-1-1 system strictly for emergencies.

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

Qualitative data from first responder focus group participants referred to this misuse primarily with “non emergency” medical calls, also known as “aid calls.” Many firefighters and paramedics in the three cities also specifically spoke about the growing predicament involving people without medical insurance and proper health care using first responders as an alternative to a doctor’s treatment or as entry and free transport to the emergency room.

Two specific areas of confusion expressed by community focus group members included: why a fire truck responded when a community member had called for a medical emergency and which fire and emergency medical services cost money. In some cultures, people were averse to calling attention to themselves and their issues. They were embarrassed that they have caused an emergency. When a fire truck with a siren and blinking lights arrives, it brought a great deal of unwanted attention to them and their situation. Some multicultural community leaders who participated in the focus groups implied that this may be a reason some people do not call 9-1-1, and not calling has the potential to escalate the risk for all involved. Many community participants were also unaware that firefighters have medical knowledge and skills.

A number of community focus group participants in all three project sites expressed that they were concerned about cost of services. Some participants thought there was a charge for calling 9-1-1. Others believed that there was a charge if the fire truck responded. There was also confusion about cost of transport and the difference between a fire department ambulance and a private ambulance service. This confusion and reluctance also potentially placed both the customer and first responders at greater risk.

While no literature exists on measuring the effectiveness of fire prevention and public safety education programs in the fire service, the research team believes that increasing prevention and public safety education efforts will: a) enhance the development of trusting community relationships and partnerships; b) increase community knowledge and practice of fire and injury prevention; c) reduce confusion about services; and, perhaps most importantly, d) decrease the number of fire and emergency medical incidents. All of these can reduce the risk of injury and loss of life for both first responders and multicultural community members. The advantages to the fire department and the community of further emphasizing prevention have not been fully explored, but the potential outcomes for both parties appear positive. Further discussion of the community outreach effort appears in the Community Relations Discussion section and a highlighting of a prevention and safety culture may be found in the Fire Service Culture and Promising Practices Sections.

This issue impacts firefighter and civilian safety when firefighters and paramedics are put into service for a call that is not an emergency and are therefore “out of service” and not available to respond to a more urgent emergency. First responders expressed concern that this growing situation puts an added strain on resources, may result in a delay of service and/or cause incident escalation. While the preponderance of the findings supported these concerns, a few firefighters discussed the commitment to provide service to the community that they committed to when they accepted the job of first responder. The explanation—contributed mostly by veterans—was, when there is a need; we show up and do whatever is necessary.

No data was collected in this study about the number of non-emergency 9-1-1 calls or their impact on resources or delayed service.

Similar to firefighters’ lack of trust in customers, the figures presented in Table 7.4.10 reveal that many firefighters and paramedics reported customers did not trust them. Forty-four percent of the online respondents said they experienced lack of customer trust All the Time (6%) or Frequently (38%). The clustering of the responses, as indicated by the mean of 2.47, occurred very close to the midpoint between the Infrequently and Frequently categories.

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

Community focus group members in the three cities generally concurred with the online survey findings. Some multicultural focus group members in all three project sites did not have a great deal of trust in emergency responders. The distrust generally resulted from three causes: 1) a person, group or someone they knew had a negative experience with firefighters, paramedics and/or dispatch, 2) an emergency-related event where the person experienced lack of respect or was dissatisfied with the service provided, or 3) a non-emergency related event such as an issue with a fire inspection or during the testing and hiring process in their local fire department.

Another primary reason for distrust of firefighters and paramedics was unrelated to the local fire department, but affected them. It was the distrust of anyone in uniform or wearing a badge. This was often the case with immigrants and refugees from other countries where military, police and even firefighters are corrupt. Community focus group participants at the lower end of the socio-economic scale and some immigrant groups also verbalized a similar lack of trust. It was with these focus groups that a set of customer service inconsistencies began to show-up; their concerns seemed to be associated more with firefighters than emergency medical service personnel, with the exception of the employees of some of the private ambulance services in Milwaukee.

It is difficult for those charged with protecting public safety to deliver services in communities where distrust exists on the part of the service recipients. Sir Robert Peel developed a set of principles that have served as guideposts for community policing projects. These principles, based on a continuing relationship of trust and cooperation with the public, are applicable to all service agencies whose responsibility it is to protect the public.

The findings that emerged from this study indicated that distrust exists among both service providers as well as recipients. Two-thirds of the first responders who completed the online survey reported that they could not trust the community members to use the 9-1-1 system in compliance with its emergency objective. When multicultural issues such as: language barriers; a lack of knowledge about fire prevention and safety; a sense that values, traditions and customs are not always respected; and a sense of distrust of authority are factored in, it is clear that a gap exists. It is at this point the safety and effectiveness of service delivery seems to deteriorate with, for example, lower socio-economic, homeless, recent immigrants, African Americans, LGBT groups.

7.4.6 9-1-1 System Ratings

The research design did not specify any data collection from dispatch or community focus groups about customer service of 9-1-1/dispatch in the three project sites. However, in reviewing qualitative findings from focus groups and interviews, a common theme emerged about customers’ experience with the 9-1-1 system. The quality of the initial interaction with dispatch (9-1-1 or private ambulance in some cases) often set the tone for how the department handled the emergency and the customer’s perceptions of the fire or the emergency medical response.

A miscommunication or problem between the 9-1-1 operator (dispatch) and the customer (i.e., language barriers, transferring calls, disrespect), or between dispatch and the first responder (i.e. lack of information, miscommunication), often resulted in unanticipated customer service challenges in multicultural communities. Such miscommunication often brings potential safety hazards for both the first responders and the customers.

Due to the differences in the operational organization of dispatch in each of the three project sites, it was difficult to identify commonalities between them.

7.4.7 Community as Partner

Community members openly shared their needs and ideas during focus groups and interviews. Many of the community focus group participants viewed researchers as an extension of their local fire department. They believed the research team conducted the focus groups and interviews on behalf of the fire department to find out what services the community wanted and needed. Many directly articulated their pleasure at being invited as well as their appreciation for the opportunity to enter into a dialogue where the contents would be shared with public safety agency leadership.

Study findings indicated that multicultural focus group participants in all three cities were motivated to assist the fire and EMS agencies to provide safe and effective fire, emergency medical, fire prevention and safety education services in their respective communities. Some focus group participants offered to assist with language and cultural translation, cultural competency/cultural sensitivity training, introductions to community leaders, logistical support for fire prevention, safety education programs and incident support.

7.4.8 Summary

In general, first responders in all three cities believed that they provide excellent and equal service to the multicultural communities they serve. Except for a few specific criticisms related to those areas where first responders believed customer service was lacking, the multicultural communities concurred, and considered the services provided excellent or good. However, a discrepancy between the quantitative and qualitative responses regarding firefighters providing equal service points to a gap in the perception of services provided and those actually provided.

Researchers found a possible discrepancy in the area of effective fire prevention and safety education. Though varied throughout the three study sites, the departments considered the effectiveness of their education materials excellent or good but also revealed a fair number of respondents who did not know. On the other hand, members from the multicultural community identified a number of areas in which they felt their knowledge was lacking, such as: which services the fire department provided, why fire trucks and firefighters came during a medical emergency, cost of services, and the difference between department and private ambulances.

A lack of trust appeared to exist between first responders and community members, some of which was a result of misuse of the 9-1-1 system by the community. First responders also believed that the members of the multicultural community did not trust them. The reasons for that distrust were related to a negative experience or general distrust of uniformed personnel. Despite a lack of trust in some cases, the majority of community members were quite willing to assist their local fire departments to provide safer and more effective services in their communities.

7.4.9 Recommendations

Background

Study findings identified a degree of interconnectedness between customer service, communications and community relations’ theme discussions, so there is some overlap in the recommendations. Language difficulties and multicultural capacity influenced how customers perceived service when calling 9-1-1 and on-scene during emergency events. Both language challenges and multicultural capacity issues sometimes resulted in service delays that potentially increased risk to first responders and civilians. The findings also identified customer dissatisfaction with the lack of translated public education and prevention materials.

Value Statement

A continuing process of assessing customer satisfaction with the delivery of services, identifying prevention needs and other service issues establishes open communication and allows the fire department to take early action when something unforeseen occurs. This represents a proactive safety-and-prevention orientation rather than a reactive approach.

Recommendations

The FIRE 20/20 research team recommends the following:

1. Conduct yearly surveys of multicultural customers to identify service issues and fire and injury prevention needs.
2. Conduct focus groups with members of a variety of multicultural communities to explore service issues and fire and injury prevention needs at a more in-depth level.

Recommendations for Further Research

1. The research team recommends further study of the multicultural and language issues between the 9-1-1 operators/dispatchers and callers.
2. The research team recommends further study to identify the frequency of and time devoted to non-emergency 9-1-1 calls and the impact of these calls on both department resources and delays in service.
3. The research team recommends further study of the quality of customer service provided by 9-1-1 operators/dispatchers and its impact upon the safety and effectiveness of emergency service response.
4. The research team recommends further study about the accessibility and effectiveness of fire prevention and safety education within multicultural communities.
5. The research team recommends further study and development of objective quantitative and qualitative measures that are meaningful and effective in assessing the degree of customer satisfaction with the delivery of fire and emergency medical services.

7.5 Fire Service Culture

VIDEO | Firefighters and paramedics discuss the fire culture, the “Can Do” attitude, and their bearing on safety issues.

7.5.1 Introduction The fire culture (also known as the “hero” culture) is the number one initiative from the National Fallen Firefighters Foundation 16 Life Safety Initiatives. “No advocacy point carries more importance and potential than the need to change from within—that is, the need for fire departments and the fire service as a whole to change its safety culture.” As was clearly articulated at the 2007 Everyone Goes Home Summit in Navado, California, it is difficult, if not impossible, to make a significant reduction in the number of injuries and line of duty deaths (LODD) without changing the culture.

Edgar H. Schein identified three basic levels of organizational culture: behaviors, values, and at the deepest cultural level, beliefs. For the purpose of this study, the research team defined “fire service culture” as related to the norms of the fire service that involve firefighters’ beliefs, values and behaviors such as a sense of belonging, teamwork, attitude, safety, camaraderie, heroism and tradition. Consistent with the literature, organizational culture affects not only the personnel working within the organization, it extends into the external community as well.

In an effort to further identify behaviors associated with the fire service, researchers used the terms “Can Do” or “Do Whatever It Takes” as synonyms for the hero culture.

This discussion section explores firefighters’ beliefs, values and behaviors about data reporting and data collection, safety initiatives and issues for first responders and civilians, risk taking and issues related to multicultural communities.

7.5.2 Data

The research team identified two data-collection challenges. The original plan called for the use of NFIRS data from the three project site departments to establish a baseline of firefighter and multicultural community member injuries and losses of life. During the pilot study, the researchers found that the NFIRS data was inadequate for this purpose due to incomplete entry of critical demographic information. The reporting fields regarding race, gender and age exist in NFIRS, but they are optional items rather than required reporting fields.

While the lack of demographic data precluded a complete response to the study’s research question #4, the identification of inadequate data to track the race, gender and age of firefighters and multicultural community members injured or killed during emergencies surfaced as one of the most important study findings. Without baseline data, it was not possible to determine whether strategies designed and implemented to reduce emergency event injuries and deaths were effective.

The second challenge related to accurately reporting injuries. Injury data is critical to collect and analyze because it is often a predictor of more serious injuries and even loss of life. Manning describes a mathematical relationship among the frequencies of unsafe behaviors, injuries and deaths, and states that almost every serious injury event is preceded by hundreds of unsafe behaviors which led to it.

7.5.3 Culture of Safety and Prevention

During the data collection phase of this study, the researchers heard a consistent theme in the Austin Fire Department (AFD) and Austin-Travis County Emergency Medical Services (A/TCEMS) focus groups about an effort to address the frequency of unsafe behaviors, injuries and deaths. Initiated by the training chief following a serious accident 5 or 6 years ago, the endeavor appeared to be gaining the acceptance of first responders and the leaders alike.

Following an interview with the chief officer, the research team discovered that this project was a concerted effort to shift the departmental culture toward greater emphasis on the practice of safety and prevention. Rather than repeat the detailed description of this AFD organizational change initiative to depict a culture of safety and prevention, the reader is referred to Promising Practices in the Findings section.

7.5.4 Reporting Injuries

The findings in Table 7.5.1 show that more than one-third of the online respondents (N=739) from all three project sites reported they Infrequently (31%) or Never (3%) accurately report all injuries, only 14% of the first responders indicated injuries were always reported.

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

Qualitative data gathered from firefighter and paramedic focus groups, interviews and open-ended survey questions indicated that injuries often go unreported due to fire culture-related issues. A concern about being labeled was a reason some female and minority male firefighters did not report injuries. Others indicated that reporting injuries had a financial impact due to reassignment to light duty, which meant giving up shifts and losing the opportunity of working overtime.

Some veteran firefighters reflecting back on their “rookie” experiences stated that injuries went unreported due to fear of earning a reputation that would negatively influence their careers. Interviews with personnel at the AFD Wellness Center confirmed that not reporting injuries actually began in recruit school. “If you don’t finish recruit school, you don’t get hired” was the rationale. Related directly to firefighter safety, the reluctance to report injuries while in recruit school could result in permanent physical damage later in one’s career. This learned and reinforced aspect of the fire culture was likely a contributing factor in the general under-reporting of injuries.

The non-reporting or under-reporting of injuries has a direct impact on the safety of firefighters in at least two modes. The training mode requires information about injuries and the conditions surrounding them, similar to that gathered by the AFD safety Field Training Officers. The lack of data precludes any assessment or evaluation of cause and any opportunity for others to learn from what happened or how they can avoid similar situations.

The second mode is operational. Emergencies may call upon personnel to work safely at the peak level of performance. When a first responder is working injured, s/he is unable to safely reach those performance standards and this limitation places the firefighter and all other team members at risk.

“Operating near the edge of safety represents a conflict between two competing goals. The first is to provide effective service delivery, which means being able to rescue civilian casualties in a fire. The second is to provide for firefighter safety. Operational safety is a trade-off between an appropriate and acceptable level of risk taken by firefighters to extinguish fires and rescue or protect civilians and the level of safety required to prevent firefighters from becoming casualties themselves.”

Finally, while these study findings apply only to three project sites out of more than 100 Metro Fire Departments in the US, the results are a cause for concern. If this is a trend, these findings bring in to question the accuracy of both local and nationally reported injury data.

7.5.5 "Can Do" Attitude

The research team identified the “Can Do” or “Do Whatever It Takes” mindset as an important attitudinal component of the fire culture. The “Can Do” Attitude is a critical element of firefighting and is unto itself, neither good nor bad. It stems from the belief that one can solve the problem at hand safely and effectively. A major portion of this study was devoted to measuring the impact of this attitude on firefighter and multicultural community member safety.

The findings presented in Table 7.5.2 reveal that the “Can Do” attitude can increase risk to first responders when delivering services in multicultural communities. Forty-three percent of the online respondents from the three project sites (N=739) indicated that the “Can Do” attitude Decreases (37%) or Significantly Decreases (6%) first responder safety in multicultural communities. Twenty-eight percent of the respondents believed the “Can Do” attitude Increases (21%) or Significantly Increases (7%) first responder safety, and 29% of the respondents thought the attitude does not affect safety.

Significantly Increases Safety = 4 points Increases Safety = 3 points Decreases Safety = 2 points Significantly Decreases Safety= 1 point N/A = 0 points

The findings presented in Table 7.5.3 show that 74% of all online respondents Strongly Agree (13%) or Agree (61%) that firefighters sometimes go beyond their limitations. With a Mean of 2.91, the responses were clustered in the Agree category, indicating that firefighters were aware that they did take risks and went beyond their limitations in their job.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Qualitative data from first responder focus groups, interviews and open-ended survey questions indicated that the “Can Do” attitude increased risk when one or more of the following conditions were present: a) the drive from an “adrenaline rush” is especially strong; b) overconfidence about training and equipment; c) holding the belief that it is okay to die while saving another; d) the lack of effective and safety-oriented leadership making sound decisions; e) the internal or external push of peer pressure.

In addition, near-miss events also contributed to a sense of false confidence that a past practice was safe. In reality, what happened was unsafe and those involved were merely the recipients of good fortune. If that occurred more than once over a period of time, it could lead to flawed policy, procedures and training.

The findings presented in Table 7.5.4 raise an important point about the fire culture: that, in the name of customer safety, some first responders justify their risky “Can Do”, “Do Whatever It Takes” behavior. A plurality of 48% of the online respondents agreed that the “Can Do” attitude Increases (36%) or Significantly Increases (12%) the safety of multicultural community members, while 34% percent reported the attitude does not affect safety.

Significantly Increases Safety = 4 points Increases Safety = 3 points Decreases Safety = 2 points Significantly Decreases Safety= 1 point N/A = 0 points

These findings strongly support the perspectives Pessemier developed in his paper on Fire Safety Culture. “In the fire service, there is a perception that the higher the level of risk that is taken by firefighters, the higher the level of safety of those who might otherwise perish in a fire.” Pessemier continues, “The identity of the fire service could be described as one that includes a culture and image based on the values, beliefs, and practices that result from the idea that members are willing to risk their lives to save others. Because firefighters are willing to take this kind of risk, they receive a very positive social identity as part of the image that the public carries about firefighters and the profession.”

The findings contained in Table 7.5.5 highlight an interesting perspective about the attitudes and beliefs of the fire culture that potentially increase risk. Seventy-five percent of the online respondents reported that they Disagree (56%) or Strongly Disagree (19%) that they expect other firefighters and paramedics to do whatever it takes, no matter what the risk.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

At first glance these findings appeared in direct conflict with the risk-taking data presented in Table 7.5.3, where a similar percentage of the respondents reported firefighters sometimes go beyond their limits. However, further consideration of these two sets of findings indicated that both might exist simultaneously.

Schein identified a key tenet of organizational cultures as, “…a pattern of shared basic assumptions that the group learned as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think and feel in relation to those problems.” Applying this to the fire culture maxims of “covering one another’s back” and “risk a life to save a life,” they certainly qualify as ingrained cultural norms in the tradition of the fire service.

Thus, if firefighters are personally willing to go beyond their limits because it is a cultural norm, then it’s not necessary to expect others to do the same: it’s implicit. The researchers conclude that the basic assumption that I’m willing to risk, but I don’t expect that from others is a selfless feature of the “hero” culture of the fire service.

7.5.6 Risk

Becoming a firefighter today can be an especially daunting undertaking for a new recruit. Informal rites of passage exist to challenge the worthiness of the candidate even though s/he has completed recruit school. Rising to the challenge, recruits often feel pressured to prove their worth by taking risks.

The findings contained in Table 7.5.6 identified that a majority (70%) of the online respondents Infrequently (48%) or Never (22%) observed new firefighters taking unnecessary risks.

All the Time = 4 points Frequently = 3 points Infrequently = 2 points Never = 1 point N/A = 0 points

Qualitative data from first responder focus groups, interviews and open-ended survey questions revealed that each of the departments was concerned about this issue. Some veteran firefighters articulated that new firefighters might be at greater risk of injury because they did not feel comfortable speaking up when they perceived an unsafe situation or behavior. Others indicated they did not speak out as rookies because doing so might have given them a negative reputation that could have followed them for the rest of their career.

The research team noted a connection between the under-reporting of injuries and inability to speak-up regarding unnecessary risk taking. Departmental policies appeared clear regarding both activities. Yet, the practice seemed to override policy due to subtle peer pressure, in what could be identified as a form of silent complicity.

Informal mentoring is an ongoing and important function in the fire culture and critical to the safety of the team. Depending on the mentor and the situation, the experience can lead to either safer or riskier behavior. Interviews revealed modeling was a powerful element of the mentoring process. “Do as I say, not as I do” was expressed in terms of seat belt usage, entering an unsecured scene without police back-up, freelancing, (operating independently without being part of the overall strategic plan of managing an incident), hazing activities at the station, talking about other crew members behind their backs and demeaning a customer to team members after a response. Veteran firefighters discussed the importance of their mentoring experiences. The researchers observed that it was a process for passing on a tradition to the next generation. Some rookies, on the other hand, expressed a desire for someone in the department to help them bridge from recruit school theory to the practice of becoming a professional firefighter.

7.5.7 Impact in Multicultural Communities

The findings in Table 7.5.7 identify how the “Can Do” and “Do Whatever It Takes” attitude affected both first responder and civilian safety when working in multicultural communities. Although 49% of the respondents Disagree (38%) or Strongly Disagree (11%) that the “Can Do” attitude can cause first responders to miss important cultural issues during emergency events, a considerable number of respondents (38%) saw this as an area of concern.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Anecdotal data from focus groups, interviews and open-ended online survey responses indicated that the desire to “rush in” to mitigate the emergency without paying attention to situational cultural issues was more of a problem in medical calls than fire. Understanding how to show respect, with whom to speak and other cultural protocols were important in obtaining the information necessary to respond to a medical emergency. The Multicultural Capacity discussion section contains more information about this topic.

7.5.8 Summary

Exploring the issues and impacts of the fire culture on the health and safety of first responders and multicultural community members is both critical and complex. The “Can Do” attitude is an important element of firefighting and is, in itself, neither good nor bad. It stems from the belief that one can solve the problem at hand safely and effectively.

Researchers noted that a “Can Do” attitude increased risk when one or more of the following conditions were present: a) the drive from an “adrenaline rush” was especially strong; b) overconfidence about training and equipment; c) holding the belief that it was okay to die while saving another; d) lack of effective and safety-oriented leadership making sound decisions; and e) internal or external push of peer pressure. Near-miss events also contributed to a sense of false confidence that a past practice was safe. These, combined with high multicultural customer approval ratings and customers’ expectations that first responders will do whatever it takes to rescue them in an emergency, continue to perpetuate some unsafe attitudes and behaviors of the fire culture on a basic belief level.

The majority of first responders did not identify the “Can Do” attitude as the cause of missing important cultural issues during emergencies. However, anecdotal data indicated that the desire to “rush in” was a problem in some medical calls.

Accurately collecting and rigorously analyzing and using data is an important first step to creating a fire culture oriented toward safety and prevention. The research team identified a lack of both NFIRS demographic data and accurate injury data in the three project departments. First responders presented a number of reasons for not reporting injury data, some of which related to fire culture issues such as reputation, image and losing shifts. Some participants noted that working while injured affects a team from working safely at peak levels of performance in emergencies and puts both first responders and customers at greater risk.

Although online respondents reported that new firefighters generally did not take greater risks, a number of veteran firefighters related personal stories about the impact of peer pressure. They also told stories about the inclination of the fire culture to be unsupportive of rookies speaking up when they perceived unsafe situations.

Online respondents identified effective leadership as the best way to manage risk. Focus group participants identified “informal mentoring” as an important aspect of the fire culture where both safe and unsafe behaviors, attitudes and beliefs were learned and reinforced.

7.5.9 Recommendations

Background

Study findings and the subsequent discussion regarding the fire service culture explored firefighters’ beliefs, values and behaviors about data reporting, data collection, risk taking and safety issues for first responders and civilians in multicultural communities.

Value Statement

Departments that embrace a safety and prevention culture as their primary mission will: reduce the number of incidents; form partnerships with the community that increase the impact of targeted prevention programs and recruitment efforts; and decrease risk of injury and loss of life for both civilians and responders.

Recommendations

The FIRE 20/20 research team recommends the following to enable fire agencies to re-focus their efforts on pro-actively pursuing a culture of safety and prevention:

1. Embrace the concept of accurate reporting of injuries as a safety and prevention strategy at all levels throughout the organization—beginning in recruit school.
2. Make NFIRS demographic data fields concerning race, gender and age required entry fields in both the civilian and firefighter casualty reporting modules.
3. Encourage the use of the near-miss reporting systems and develop an internal review process to learn from all near-misses.
4. Develop policies and procedures to ensure the reporting and treating of injuries sustained by recruits who are attending recruit school.
5. Partner with NFFF and ask them to include disabled and disease survivors in their “Courage To Be Safe” program.

The "Can Do" attitude is an important and necessary element of being a successful first responder. This study attempted to identify a correlation between the "Can Do" or "Do Whatever It Takes" mindset and high-risk behaviors that increase injuries and loss of life of both first responders and civilians in multicultural communities. The findings were inconclusive due to the researcher’s operational definition of the “Can Do” attitude.

7.6 Community Relations

VIDEO | Firefighters/paramedics and multicultural community members discuss how to better connect with one another in non-emergency situations.

7.6.1 Introduction The research team defined community relations as Fire/EMS’ ability to build and maintain quality, ongoing relationships with all aspects of their multicultural community. Effective community relations builds bridges into the community and improves communication between first responders inside the firehouse and those who reside in the neighborhoods that surround them. Fire and EMS personnel can reduce risk to themselves and multicultural community members through increased interaction with the community, expanded fire prevention and safety education efforts and strong partnerships with community groups and organizations.

7.6.2 Fire Department Community Relations Efforts

All three fire departments had a variety of formal and informal community relationships throughout all levels in their respective departments. All three departments had at least one public information officer (PIO) who was responsible for formally communicating with the media, handling press conferences and press releases. The PIOs also helped to coordinate department public events. All of the fire chiefs were active, visible presences in their community, attending public functions and serving as the face of their respective fire departments. Chief officers also represented their fire departments at community functions and events.

Many firefighters, paramedics and company officers also participated in and enhanced their department’s community relation efforts by building both professional and personal relationships in their communities. On-the-job activities included safety talks, prevention programs, hosting events at the fire station, follow-up with emergency victims, helping elderly in the fire station neighborhood, taking fire apparatus to a community event, recruiting at high schools and career fairs, joining elementary-school children for lunch, making presentations during fire prevention month and offering blood pressure checks. Off-the-clock community outreach included coaching sports, volunteering with non-profit organizations, tutoring students, or being a members of local service clubs. Through these formal and informal community relations activities, the fire departments built trust, strengthened community relationships, built partnerships, informed their communities about fire department services, educated community members about fire prevention and fire safety and recruited future firefighters.

7.6.3 Lack of Knowledge Increases Risk

In terms of awareness about fire department services, multicultural community members evenly cover the spectrum, according to firefighters surveyed. The figures in Table 7.6.1 reveal 40% Strongly Agree or Agree and 40% Strongly Disagree or Disagree with the statement, “Multicultural community members I meet are aware of the services we provide.” Of note, 20% of the firefighter respondents reported they did not know if community members were aware. That firefighters might not know their customers’ needs and baseline knowledge of fire and prevention services could increase risk for both firefighters and community members.

Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Table 7.6.2 reveals that 53% of online respondents Agree (45%) or Strongly Agree (8%) that customers they meet in “emergency situations” lacked basic fire safety knowledge. Lack of knowledge about safety issues increases the chances of dangerous emergencies occurring.

*The means were very similar for the three cities, however the “Don’t Know” response percentage is skewed. The “Don’t Know” percentages ranged from a low of 7% to a high of 18% but do not directly affect the mean.Strongly Agree = 4 points Agree = 3 points Disagree = 2 points Strongly Disagree = 1 point

Community focus group qualitative findings in all three cities differed, by degree, from the online survey findings. A majority of multicultural community focus group participants acknowledged being uninformed about fire prevention, safety knowledge and the range of services provided by their local fire department. That was especially true of immigrant and elderly groups. Specifically, many of the participants were unaware the fire department provided medical support as well as fire and injury prevention services. A number of community focus group participants also expressed confusion about how and when to use 9-1-1.

7.6.4 Two-Way Learning

Based on the research findings, the research team believes that effective community relations is a two-way opportunity for the fire department to teach the community about fire safety and injury prevention and to learn from them about multicultural issues that potentially increase risk for both firefighters and civilians.

For example, community focus groups informed the researchers about potentially dangerous issues as well as prevention opportunities related to the cultural use of fire (i.e. candles, incense):

1. Hispanic participants talked about the fire hazards with home altars and suggested that the fire department work through the church with smoke detector and fire prevention programs. One focus group member said that some members of her community were placing altar candles in dishes of water so if they tipped over they would go out. The focus group member suggested that the fire department promote this fire safety technique in prevention talks.
2. Orthodox Jewish participants explained that if a Sabbath or holiday candle tips over, they could not put it out. They also said they will not use the phone during the Sabbath or other Jewish holidays to call 9-1-1 unless someone’s life is at risk. One focus group member explained that Orthodox Jews burn their leavened products before the Passover holiday (in the spring) and they usually do it inside or outside of their home. They suggested that the fire department have a community burn site that would bring the community together and create a safer environment to burn the leavened products.



A number of community focus groups informed researchers about cultural cooking issues. Among them:

3. Many immigrants from African countries have a special coffee ceremony where they cook coffee on a charcoal burner inside the house or apartment. This creates fire and carbon monoxide hazards.
4. Some Chinese focus group members disclosed that woks get very smoky and often set off smoke alarms, frequently prompting people to disconnect them or remove the battery.
5. A number of first-generation immigrants in all three cities talked about their difficulties in cooking on an electric stove because they cannot see a flame. Community leaders noted that this was an important fire safety educational opportunity.
6. Focus group participants explained why some people from their community might not leave the house immediately if there is a fire or other emergency
1. Members of the Muslim focus groups explained that some women might not leave a burning house right away if they are not covered. They suggested that firefighters and paramedics bring a blanket to offer as covering.
2. A community leader in the Chinese focus group explained that some elderly Chinese do not believe in banks and may go back into a burning building to get their life savings or jewelry.
3. A number of community focus group participants told researchers about why they or members of their communities may not call 9-1-1 during an emergency:
1. Cultural shame and embarrassment for creating the emergency
2. Language and communication barriers
3. Fear of uniforms and authority figures
4. Concern about cost of services

The research team believes this kind of information will help fire departments in both prevention and emergency response efforts. This study served as a vehicle for such exchanges and many focus group members viewed the groups as proactive community outreach initiatives by their fire department.

7.6.5 Building Partnerships

Members in many of the community focus groups expressed interest in working more closely with their fire department. They offered to help to translate and distribute fire safety and prevention materials, provide space, and arrange for safety presentations at a community centers, elderly activity centers, regularly scheduled meetings or community events.

Most community participants thoroughly enjoyed the times when firefighters brought fire trucks or firefighting equipment following some of the community focus groups in each of the study sites. Multicultural community leaders who participated in the focus groups said that they would welcome a fire department presence at their cultural events and festivals, but did not know who to contact or how to arrange such an activity. They said firefighters could learn about their culture at such events, as well as reach many members of their community to hand out prevention and safety materials, to recruit future firefighters, and to build trusting relationships that would help ensure safe and effective delivery of emergency services should such event occur.

Effective community relations programs can create partnerships with community organizations that cost-effectively extend the services of the fire department directly into some of the higher-risk populations. As an example, the Seattle Fire Department’s long-term partnership with the International District Emergency Center (IDEC) is an excellent model. The Promising Practices section of this report describes this program.

7.6.6 Leader to Leader

Hierarchy is important in many cultures (including the fire culture). A number of community focus groups in the three cities discussed the need for “leader-to-leader” conversations. Community members viewed this as a sign of respect. Community focus group participants reported these conversations would be most successful if initiated by a fire chief’s invitation. Of note, the word “invitation” was important. Some cultures (Arab, African, Asian, South Asian) viewed it as inappropriate or rude for members of their community to initiate a new relationship with authorities.

Community focus groups expressed that the appropriate community leader may be either a formal or an informal leader. Participants offered to help to identify the right person in their respective communities.

A number of community focus groups in all three cities said that the police department had reached out to their community leaders by asking them to serve on a task force or citizen advisory board. The fire department had not issued such an invitation, which focus group members said would be most welcomed.

7.6.7 At the Station Level

Although leaders often establish formal partnerships, community relations should be practiced through out the ranks and at the station level. The relationships between firefighters and people who live and work in the neighborhoods surrounding the fire station establish and maintain trust. Some firefighter participants talked about the metaphor of the “open bay door” to let community members know they were welcome. In Milwaukee, firefighters talked about how they had created events like a back-to-school fundraising BBQ at the neighborhood firehouse to raise money for local children’s school supplies. Another firefighter described how he and his team went to the local school cafeteria on a monthly basis and spent 45 cents to have lunch with the kids. More about Milwaukee’s outreach is in the “Best Practices” section of this report.

7.6.8 Strategies for Connecting to the Community

Creating culturally relevant fire prevention and safety radio and TV public service advertisements would be an excellent strategy to help the multicultural community gain knowledge about fire safety, firefighters and community members agreed. With a mean of 2.63, Table 7.6.3 shows that 58% of the firefighters and paramedics who responded to the online survey rated culturally relevant public service ads as a Top Priority (19%) or High Priority (39%).

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

Some firefighters as well as some community focus group members suggested that fire stations would be good community gathering places. Some fire stations in each of the three cities have community rooms or spaces outside of the living quarters where people can meet. However, as the figures presented in Table 7.6.4 reveal, firefighters in all three cities who responded to the online survey overwhelmingly disagreed. Seventy-three percent indicated that they were not in favor of opening their fire station to the community by ranking this as Low Priority. Some firefighters expressed in focus groups, interviews and online survey open-ended questions that many of their stations were old and crowded, with insufficient space for their own accommodations, let alone for hosting community meetings.

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

The figures presented in Table 7.6.5 indicate more than 60% of firefighters who participated in the online survey placed a Top (16%) or High Priority (45%) on involving community members in the development of educational materials.

Top Priority = 4 points High Priority = 3 points Medium Priority = 2 points Low Priority = 1 point

With the proper staffing, including firefighters with high multicultural capacity, this kind of a partnership could develop meaningful training for members of the community, increase cultural competency in the fire department and build effective partnerships that reduce the number of emergency incidents.

7.6.9 Summary

Community relations is a two-way path. It not only alerts the public to fire department programs, but it also proactively seeks out and builds relationships and partnerships that benefit both the community and the fire department. The multicultural communities in the three study sites expressed appreciation for the invitation to participate in the research study. They saw the focus groups as an invitation from the fire departments to learn about them and to listen to their input. The analysis of all the quantitative and qualitative data indicates that through effective community relations, fire departments will enhance the safe and effective delivery of both prevention and emergency response services.

7.6.10 Recommendations

Background

Study findings indicated that the three project fire departments lacked well-established, non-emergency relationships with many of their multicultural communities. Fire prevention materials used in the three cities, for the most part, appeared in English and perhaps one or two additional languages. All three cities had public safety education programs in the schools, but consistent programs for adults were absent, even though many multicultural community members lacked knowledge and understanding of their fire department’s services. Cultural norms and fear of authority precluded many multicultural community members from initiating non-emergency relationships with their fire departments. This was especially true within the elder, first- and second-generation immigrant populations.

Value Statement

In order to have effective fire and injury prevention and safety programs, there must be good working relationships and open dialogue and communication between the fire department and the multicultural communities they serve.

Recommendations

1. Develop a community relations/community liaison strategic plan including vision, goals, projected outcomes, staffing and an evaluation plan.
2. Develop a Community Liaison Position(s) to work proactively with the multicultural communities. The documentation for the Bridge Building Model employed during this study is located in the Findings section of this report.
3. Implement a “Breaking Bread Project” where the fire chief hosts a special invitation, monthly luncheon at different neighborhood fire stations with leaders/members of local multicultural communities. The goals of the luncheon may include: building relationships with community leaders, identifying community needs and input, providing educational information to the multicultural community about fire department services, and promoting the local fire station as a friendly and inviting neighborhood resource.
4. Send formal invitations to local multicultural community groups, community leaders and school principals in the neighborhood for a tour of a fire station.
5. Develop and launch a joint PR campaign with multicultural community leaders and multicultural media outlets (radio/newspapers) in their audiences’ languages. The purpose is to inform respective community members about the services offered by the Fire Department, cost related issues, how and when to use 9-1-1 and safety and prevention messages. The media would be willing to translate these materials, according to local representatives.
6. Work with multicultural media to develop a list of all multicultural events and festivals in the community. Talk with multicultural leaders about attending these events and festivals. When possible, bring apparatus and do a fire or EMS demo, a safety lecture, or blood pressure checks.
7. Explore the potential for constructing public meeting space in new fire stations and develop a plan to publicize this space for community meetings and fire prevention and safety training programs.
8. Develop and implement a “mini” fire academy or recruit school day specifically targeted at multicultural community leaders during which they would go on calls, learn and practice CPR, darn gear, and fight a controlled fire. Houston, TX has a successful model that they recently conducted for politicians and community leaders.

7.7 Leadership

VIDEO | Firefighters/paramedics and multicultural community members discuss how to better connect with one another in non-emergency situations.

7.7.1 Introduction The importance of good leadership, both at the top of the organization and within the ranks, was a consistent theme relating to the safe and effective delivery of services in multicultural communities. Manning, in his white paper for the NFFF 2007 Summit, supports this premise, arguing that leadership at all levels of the organization is necessary to shift to a safety culture. For the purpose of this study, the research team defined leadership as the process of influencing others; in this case, taking actions that ensure the health and safety of civilians and first responders, planning strategically, allocating resources and managing the overall direction of the Fire/EMS agency. Positive leadership inspires, motivates and directs the organization to come together for greater effectiveness.

The three participating chiefs unequivocally stated their willingness to address safety issues within their respective departments and improve their safe and effective delivery of services to multicultural communities. The chiefs demonstrated their commitment with active participation in this study and through the allocation of time and staff resources. In addition, all three chiefs plan to apply the results of this study to increase their community outreach and improve the effectiveness of their safety and prevention programs.

The content of this discussion focuses on leadership-related issues, both in the departments and in the community. These include collecting and using data, mentoring and role modeling, and enrolling stakeholders.

7.7.2 Valuing and Collecting Accurate Data

Valuing, collecting and using accurate data to support the safe and effective delivery of services in multicultural communities are leadership responsibilities. Two specific areas, identified in the study, where additional information is needed are: injury data and available demographic data (race, gender, age) relating to 9-1-1 calls, near-misses, injuries and loss of life.

The three participating departments recommended that personnel report all injuries. Yet, respondents to the online survey (N=739) indicated that they observed only 14% of firefighters accurately reporting all injuries all the time. Based on observations of Manning, Pessemier and other fire service leaders, the lack of accurate injury data was most likely a challenge that plagued the fire service as a whole rather than just being unique to Seattle, Milwaukee, or Austin.

In this study, firefighters identified reasons they did not report all injuries. These included financial reasons (giving up a shift, not meeting the requirements of the fire academy) and image concerns (perceived as weak, accident prone). The research team believes that leadership throughout a department must clearly articulate the importance and value of accurate injury reporting and then enforce policies that require all injuries be accurately reported at all levels of the organization.

All three departments lacked valuable demographic data relating to 9-1-1 calls and about firefighter and civilian near-misses, injuries, and loss of life. Although the demographic fields exist in NFIRS, they are not required fields. This unreliable data source precluded the research team from being able to accept or reject the study hypothesis.

Collection and analysis of demographic data provides a rich foundation of understanding about the complexities of first responder and civilian safety in multicultural communities. It gives department leadership a baseline from which to measure the effectiveness and value of prevention programs in multicultural communities and important information for strategic planning, training and resource allocation decisions.

7.7.3 Enrolling Stakeholders

A key to the fire chiefs’ success was their ability to enroll stakeholders who influenced, developed, implemented and/or were impacted by fire department policies and services.

Although each of the three fire departments involved in this study had unique reporting structures in their respective departments, a common element was the need for the fire chief to enroll, influence and work with stakeholders, both outside of their department and within the ranks. Some of the stakeholders included multicultural community leaders and union leadership.

Research findings indicated that the leadership in the three project sites possessed few ongoing working relationships with many of their multicultural communities or their respective leaders. One of the unexpected outcomes of this study was that the community focus group process initiated new relationships for the fire department and some of their multicultural communities. Qualitative data from community focus groups and interviews identified that the messenger, the message and the process were all important in building successful relationships and partnerships with multicultural communities.

Findings showed how ‘culturally’ important it was for the fire department—specifically the leadership—to take the initiative to reach out ‘leader-to-leader’ in the multicultural communities. Focus group participants expressed that for some communities it was viewed as inappropriate, and even rude, for community members to initiate relationships with government leaders without an invitation. A South Asian focus group in the pilot study clarified this in their response to the question, “Have you ever visited a fire station?” The response was simple—“We have never been invited.” They went on to say that in their culture, it was unacceptable to go to someone’s home without an invitation, and the firehouse was where the firefighters lived.

During the course of this research study, labor and management worked cooperatively with FIRE 20/20 in the three cities. They jointly signed letters sent to all personnel encouraging participation and personally participated in focus groups and interviews. When labor and management work together in this way, opportunities increase to achieve desired outcomes for safe and effective service in multicultural communities.

7.7.4 Mentoring and Role Modeling

A second unexpected result of this study was anecdotal data gathered about mentoring and role modeling and their effect on firefighter safety. Although these points were not identified in the Findings section, the research team thought them sufficiently important to mention in this discussion on leadership and ensuing recommendations.

Informal mentoring is an integral part of the fire culture tradition. The mentoring process assists younger firefighters to learn and refine their firefighter skills and helps to integrate her/him into the culture of the station and crew.

Veteran firefighters reported they often took new recruits ‘under their wing.’ They explained that someone had done the same for them and it had meant a lot. It was a way to give back, teach the job and pass along department knowledge and traditions.

A number of firefighter focus group and interview participants in each of the three project sites reported that seniority and experience were highly revered by new recruits. They said ‘rookies’ were hungry to ‘learn the ropes’ and desired acceptance as members of the team. Some reported that veterans’ stories were powerful vehicles for young firefighters and paramedics to learn about the job, policies and procedures, the department, and the fire culture.

Influences from informal mentors may encourage both positive and negative behaviors, attitudes and values. Some focus group and interview participants reported that not all mentors reinforced departmental policies and procedures. ‘Near-miss storytellers’ often became role models for impressionable, young recruits. The research team identified this type of informal connection as an example of how the fire department culture taught, modeled and reinforced unsafe and risky behaviors.

A number of firefighters reported that the informal mentoring process often took place between people of the same race/gender. If senior firefighters (of all races and both genders) had had a negative experience or believed they had been unfairly treated, they often warned new recruits who may potentially suffer the same circumstances. The researchers observed that this aspect of mentoring contributed to preserving tradition and keeping the culture the same, rather than confronting negative behavior and encouraging change.

A formalized mentoring program can act as an effective strategy to help realign the organization toward becoming a safety and prevention culture. Such a program can also serve a department as an intentional effort to develop future leaders. Identifying, selecting and acknowledging mentors who ‘walk the walk’ are keys to a successful mentoring program. Training mentors in active listening, and coaching and counseling skills is critical. Developing cross-gender and cross-racial mentoring relationships builds multicultural capacity and promotes the development of a caring and compassionate firehouse culture. Designing a mentoring evaluation component provides a gauge to measure growth and progress.

7.7.5 Recommendations

Background

The findings identified that all three fire chiefs saw the value of better connecting with their respective multicultural communities, but none of the departments had unified strategies to accomplish this goal. None of the departments collected consistent demographic data about firefighter or multicultural community member injuries and loss of life. While informal mentoring is a tradition in fire service and fire department culture, none of the three departments had a formal mentoring program.

Value Statement

The research team believes that the key to increasing the effectiveness of current and future fire service leaders lies in their efforts to promulgate actions that ensure the health and safety of multicultural community members and first responders.

Recommendations

1. Develop a Fire/Multicultural Community Task force that meets quarterly to discuss fire department/multicultural community issues. Possible topics include: Community and Fire Department Prevention/Public Education needs analysis, joint projects (e.g., translation of materials, smoke detector campaigns), 9-1-1 issues and community disasters.
2. Initiate a pilot study collecting a baseline of demographic data from near-misses, injuries and loss of life of both fire personnel and civilians. These findings serve as a level against which to measure the effectiveness, value and results of prevention programs, training activities and strategic planning efforts and allocating resources.
3. Develop and launch an intentional, structured mentoring program. The program should include: a selection process for mentors, mentor training, a reward/recognition element for both mentors and mentees and an evaluation component that measures the mentoring program’s effectiveness for the mentees, mentors and the department.
4. Encourage the National Near-Miss Reporting System to add demographic data fields to their online reporting module.

Section 8 | Summary

FIRE 20/20 greatly appreciates the opportunity to gather and share the knowledge gained in this study to help the fire service improve the safety and effectiveness of the delivery of fire and emergency medical services to multicultural communities.

The National Fallen Firefighters Foundation has done an incredible job of initiating the Sixteen Life Safety Initiatives, identifying behaviors, values and attitudes within the fire service that contribute to high risk behavior, and helping to change the paradigm from a “response culture” to a “safety culture”.

The Sixteen Life Safety Initiatives had not identified multicultural communities or their related issues as either a part of the problem or part of the solution. That is, until this study. The Multicultural Health and Safety Research Project identified that multicultural related issues such as language barriers and cultural misunderstandings can directly affect safe and effective service delivery.

The real contribution of this research is the understanding that multicultural communities want to be part of the solution and possess the resources to significantly contribute. After spending more than a year talking with firefighters and multicultural community members in the three project sites, the research team proposes that NFFF and the fire service consider taking the “safety culture” one step further to include “safety and prevention.”

The benefit is that ‘prevention’ expands the sphere of influence to include multicultural customers. It asks both first responders and civilians alike to take responsibility and be part of the solution. Firefighters will always be seen as heroes for saving lives and property, but they can also be courageous and heroic prevention role models by partnering with their multicultural customers to reduce neighborhood circumstances that have the potential to escalate to emergency levels.