The Unintended (But Cool) Consequences of Firefighting 3.0

Part 2 in a series on changes to the fire service to reduce 9-1-1 calls by taking a holistic approach to serving those in our communities most in need. It's good for firefighters, too.

If there’s such a thing as a firefighting gene, Darwin Shell’s got it. His great-grandfather, grandfather, father and “numerous” uncles and cousins were, or are, in the fire service. He jokes that until a couple of years ago, he’d been “living in a fire station since I was basically 5 years old.”

He spent the first 23 years of his career doing shift work with the Round Rock Fire Department, steadily working his way up the promotional ladder to the rank of Captain. The last two years he’s found himself in the brave new world of an 8 to 5 job on the administrative side of the department after then-Chief Robert Isbell, who we introduced to you in last week’s post on Firefighting 3.0, put Darwin in charge of the newly-formed Community Risk Reduction (CRR) program.

CRR is not his father’s fire service. It balances emergency responses with proactive, focused prevention efforts, driven by local data. It identifies fire and life safety risks for individual residents, prioritizes them, and then focuses energy on mitigation and prevention.

As noted last week, the most calls for service for fire departments are for medical issues; and most of those are for low-acuity medical issues. Often, it’s a call to someone who is elderly or disabled or poor — sometimes all three — who has nowhere else to turn. They need help, and CRR is about helping those good folks when their problems are still low acuity, i.e., before they turn into actual emergencies.

Firefighters are in a unique position to help because they are pretty much universally respected and trusted by residents. Helping these low-acuity cases takes a shift in mindset for firefighters who’ve been trained to handle heavy equipment and run into burning buildings to facilitate a rescue.

“When you’re working on the fire truck, you’re there for 15 to 30 minutes on a call, hopefully helping the family the best you could and getting them what’s needed for a medical emergency, a vehicle accident or a fire,” Shell said. “But with community risk, you’re there for a lot longer duration than just the average fire call. You’re building that deep relationship with them and really trying to navigate them to the appropriate resource.”

When Shell knocks on a resident’s door, it’s because someone else has identified them as being in need. And while folks do trust firefighters and are willing to open up to them, there’s a right way to do that, just like there’s a right way to perform CPR or lay a supply line.

“It’s all about your approach,” Shell said. “It’s about your demeanor, just positivity. As you first enter, it’s always introducing yourself and the polite and kind words of introduction and just being there and just being thoughtful, caring with every word. Get to know their names, their husband or wife’s names, do they have children? If so, getting to know their children’s names while you’re building that relationship ... It’s all about building rapport, making them feel comfortable with you, having them understand that you’re here to help.”

Of course, residents open up about their problems to this man. CREDIT: City of Round Rock, Texas

Shell recalls a particular a resident who was at risk of violating multiple code enforcement ordinances.

“She had some challenges with family members kind of coming and going and staying as they please in her home,” he said. “Her home was not as well maintained as it should be. She really didn’t know where to turn with her kind of financial hardship.”

Having a code officer write her up wasn’t going to fix the problem, so Shell reached out to the City’s neighborhood services division and local church leaders who have volunteers happy to help those in need.

“What was once a lot of code enforcement problems for this resident ended up being a three-hour cleanup of her home, inside and out,” he said. “And that kind of got her off on the right foot about making some other changes around the house. Before you know it, we’re connecting her with a couple resources where people were coming out and volunteering, replacing siding, some windows, painting. Within a month, two months, she was within normal code compliance as a homeowner. And the curb appeal of her house was just changed. Within a month and a half, it was just neat.

“I think the resident just needed that just one step of help for her to kind of get that ball rolling. And before you know it, she was self-motivated and was like, ‘Wow, I see some changes. It’s OK.” 

Coordinating with other departments and agencies is integral to CRR, according to Chief Isbell.

“I’m not talking about us being a social program to go in and pick them up and fix them, but we have these agencies all around us who can help,” Isbell said. “They exist in most communities. They’re all around us. And if (the fire department) is the tip of the spear going in and seeing them, then we ought to be also the one that reaches back and connects them to a resource.”

In Round Rock, that’s Williamson County EMS for medical and mental health needs; it’s the Austin Bridge Builders Alliance, a faith-based group that helps with volunteer cleanup efforts; it’s the Round Rock Area Serving Center, which runs a food pantry and assists low-income residents with utility payments; it’s the local Meals on Wheels program; it’s Round Rock Helpers, a group of Christian retirees who perform minor maintenance and repair services.

A Four-Pronged Approach

Those groups cover the four areas Isbell says are needed to help residents get and stay safe: the environmental health of their homes, physical health, mental health, and spiritual health, “the piece that we don’t talk much about in government,” he says.

“We can’t just fix their house and say, ‘We fixed their house up.’ Or, ‘We’ve cleaned up the hoarding situation,’ or whatever it may be, and expect it to stay there,” Isbell says. “It got there because of a reason, and it may be physical, mental, or spiritual that helped contribute to that. And if we make sure that we check those off, more than likely, almost 100 percent of the time, we’ve improved the quality of life for these folks and made their situation better. They’re less reliant on 9-1-1. I want to run less of those calls because we’re an emergency service, and so I’m trying to fix that so that we don’t have to do those.”

These kinds of programs do just that. In Dallas, one year after instituting its Mobile Community Healthcare Program, the number of calls from “frequent flyers” dropped from an average of 2 per month to practically none.

Says Capt. Shell: “It’s getting that person where they need to be and with the help that they deserve. But then, also, the city sees we’ve got a healthier, safer citizen and we’re not rolling equipment to that address as often.”

That’s certainly a great outcome, but Chief Isbell said there’s a “collateral benefit which is even more fulfilling and beneficial than anything else we do, is that we’ve improved the quality of life for someone. We don’t often get to say that. We rarely ever get to say that.” 

In the last GGF, Isbell said he found candidates for home inspections by analyzing consumer data sets, which pointed to residences likely in need of assistance. When he came to Round Rock, he discovered another avenue for identifying residents in need: neighborhood cleanups. Enter Joe Brehm, who started the neighborhood services program in Round Rock a dozen years ago.

Joe’s the kind of public servant you wish you had a thousand of: diligent, thoughtful, innovative, unfailingly polite and respectful, and with a true heart for public service. We’ll feature Joe in upcoming GGF because of the state-of-the-art neighborhood and community building program he’s built from scratch.

Joe worked with Round Rock’s solid waste hauler and faith community to conduct neighborhood cleanups, where residents can discard bulky trash and brush and have minor repairs and maintenance done on their homes and yards. When Isbell hit Round Rock, they added free fire inspections.

There’s never a shortage of volunteers willing to help a neighborhood cleanup. This is a group of City of Round Rock employees on their day off pitching in to help. CREDIT: City of Round Rock, Texas

And just like that, the fire department identified another cohort of residents who could use a little ongoing help to restore and maintain their health and their homes.

“I think one of the benefits of Darwin's team and what they do is that they have a system and it’s not just kind of like a one and done service,” Joe says. “They have an ongoing process where they’ll regularly touch base and check in with (residents in need). It’s great that my group can come into this neighborhood and help the people who live there. But if they have ongoing needs, Darwin’s team is much better positioned to help and touch base and follow up with them.”

Joe — who oversees code enforcement in Round Rock — works with Darwin on more than just neighborhood cleanups.

“You know, that’s been my favorite part of this process is that Darwin is boots on the ground, can find those needs and he has his set of resources, and my guys are boots on the ground and we have access to our set of resources,” Joe says. “So when we have those regular interactions with each other and those referral of residents and needs, we don’t have to be the one shop that solves it all. We’re the one city that solves it all.”

Joe offered an example of that kind of teamwork.

“We had a house that got damaged by hail recently, owned by a single lady, low income, and her skylight got damaged as well,” Joe says. “So, we’re in a position where it’s entirely on private property, and she’s physically unable to go up there and secure the skylight herself. Well, I’ve got volunteers that can help do repairs and stuff, but generally we keep them off roofs because that’s a danger for them. But I’ve got to get this roof secured first. So that’s where the fire department came in. They got on the roof, and they helped secure it.

“Now, I can bring in some of my volunteers that do skilled labor. And sure enough, once they get in, they start talking to her. They’ve done all sorts of things inside her house, like electrical and plumbing. In fact, my team’s worked with Home Depot to get her replacement flooring because she had a pipe burst that was in her foundation. So sure enough, we had somebody who donated thousands of dollars’ worth of labor to tear into the foundation, fix the pipe and reset the concrete. But now we're still trying to work with getting her some flooring other than the base concrete.”

If you’ve never had to get a quote for a pipe leak in your foundation, congratulations. It’ll make your eyes water.

Sometimes it’s the little things that make a difference — and thinking ahead. As Chief Isbell says, those fire alarm inspections and installations are fantastic for finding residents in need. Obviously, they are great tools in and of themselves. But if you’ve lived indoors in your life, you know fire alarm batteries die. And the fire alarm will beep to tell you the battery is dying. This typically happens in the middle of the night when you’re getting good sleep. But, no big deal, right? Just replace the battery.

But what if you’re elderly or disabled? The last thing you want is to risk a fall when you climb a step ladder to replace that cheap 9-volt battery. Falls can be devastating for the elderly. How devastating? Here’s what Dr. Peter Attia¹ says:

“Fifteen to 30 percent of people over the age of 65 who fall and break a hip will be dead within one year of that fall,” he says. “Of those who survive, 50 percent of them will experience a reduction in class of mobility, meaning: People who walked normally will walk with a cane; people who walked with a cane will walk with a walker; people who walked with a walker will be wheelchair bound. This is a profound change in quality of life.”

So Darwin sought and received additional funding to get sealed batteries in the smoke detectors the fire department installs. They last 10 years. That’s 10 years of falls averted, which is only huge.

Firefighter, heal thyself

There’s one more not insignificant thing to love about this approach to delivering fire and rescue services, Isbell says. It’s good for firefighters. Though, for some, it takes a little getting used do.

“It’s not exciting, swinging from the vine, saving people,” he said. “It’s just getting them out the door and doing it. Once they've done it, it’s infectious.”

Isbell shares a couple of stories. The first is from his time in Midland, Texas. The community paramedics would meet once a week for case management. As he’s heading into the meeting one day, the conversation had already started.

“As I walked into the meeting room,” he says, “I had two very seasoned firefighter paramedics, and they’re just elated, and they’re holding court, and they’re telling the story about one of their cases, about how Mrs. Smith (not her real name) over here that they had helped, they drove by her place the other day, and they saw her on the front porch, and she was waving at people as they went by. She was sitting on the front porch in a sundress, and she was waving at people, and they were excited because they said, ‘You know, that would have never happened if we hadn’t been involved.’ She hadn’t been out of the house in two years when they got to her. And now she’s sitting on the front porch waving at people that go by. She had a totally different disposition, and they were excited and elated about it.”

Story two came from his colleague, Chief Danny Kistner, who served in McKinney, Texas. Two of his community paramedics took off together during the week. He asked what they were up to, and they said there were going fishing. He didn’t think much about it.

“Well, he found out later that one of their clients was a terminally ill cancer patient that they had been taking care for a while, and they found out that he used to fish,” Isbell says. “(The patient) had an upswing in his condition and was doing better. So, they took off, went by and picked him up and they took him to the lake and took him fishing.

“That’s old crusty firemen, because of the difference they’re making, that fulfillment you get from improving the quality of life and giving someone that one more day of enjoyment of something that you knew that they liked doing. That’s the direction I’d like to see the fire service take.”

Isbell says transitioning to Firefighting 3.0 will keep more good people in the fire service longer.

“You hear burnout mentioned a lot in the fire service, and it’s not really burnout, and this is my observation only, but it’s disillusionment,” he says. “We train them to go out and fight fires and do rescues and save people. And then we put them on a truck and 75 percent of the time they’re seeing low acuity, very low acuity, calls, and very few fires. And if they do see a fire, it’s out by the time they get there.

“So, you've got kids that go years without using those skills that they were trained to do and that they thought in their mind that they were going to know how to do, like Chicago fire stuff. And so, they get ‘burned out.’ But it’s disillusionment. So, you take this work and we say, hey, we’re going to go see Mrs. Smith. Let’s see if we can get to where she’s managing her own healthcare, and maybe just make her life a little better. And they get to go, and they see the results. The fruits of their labor just bloom right in front of them. They see those results and it’s very satisfying. I think that’s one piece that makes it enjoyable work.

“But two is this: Man, there is not another endorphin release like helping someone else and knowing you made a difference. It’s a very specific high. It’s a biological thing that happens. We do have a chemical release when we help someone. So, I think that helps.”

You can see it in Capt. Shell. Scroll back up and look at the picture of that man and tell me he’s not loving his job.

“It’s a beautiful program,” Shell says. “It really is.”

Onward and Upward.

Bonus Health Content: Do You Even Lift?

1. Bonus material on preventing falls from Dr. Attia above. If you read last week’s post, you know Dr. Attia is all about the practice of medicine that extends healthspan. He calls it Medicine 3.0, and it focuses on prevention and taking care of a potential health issue before it becomes an actual health crisis. Never shy about stealing good ideas, I dubbed this emerging trend of community risk reduction as Firefighting 3.0.