Improving the Health & Safety of all Emergency Responders

How Do You Know What You Do Not Know?
Karl E. Ristow, CFO, MIFireE

As a young firefighter I was the “why” guy. Why do we do it this way? Why can’t we do it differently? As I morphed through the years I continued to ask those questions but also had to start answering them as well. Going through college as a young fire officer I became aware why I needed to ask these questions as it was to better understand the issue so I could make good decisions in the future.
On 17 June 2009, life changed for me as my neighboring department lost nine firefighters in a large furniture store fire. I was perplexed and concerned as a fire chief as to why this happened and how to prevent the next one. After we buried our nine brothers and after all the investigations and reports were released it became very apparent to me as to why this all happened. The fire department was the classic example of “How do you know what you do not know”.

Self-assessment has been a part of my DNA for years. I was first acclimated to it by serving on quality improvement teams while serving in the Air Force. I was asked to be a part of these teams, and later lead them, because of my sensational appetite to ask and understand why. This was an opportunity to make changes in our system and processes but most of all it allowed me to learn more from quality improvement gurus like Dr. Edward Deming.

Moving forward almost 20 years I have the proud honor to oversee a program that asks agency to ask why in everything they do. The self-assessment process asks a fire department to answer four important questions in all areas of the organization: What am I doing? Why am I doing it? How well am I doing it? How can I make it better? It is a continuous improvement process designed specifically to identify strengths, weaknesses, opportunities, and threats. It was designed with intent that if one self-assesses, they can apply mitigations to lessen the impact or in other words they could know what they do not know.
I have been meeting with groups of fire officers the past few months to discuss changes to the quality improvement model. The model is reviewed and updated every five years to ensure it remains contemporary and relevant to the fire service. A key inject to this update is getting stakeholder input. The recommendations I have been getting have been centered around adding performance indicators to address cancer and post-traumatic stress disorder (PTSD).

As we talked through their recommendations, I had to seek the “why” to their request beyond the obvious answer; I had to understand intent of the request. While cancer and PTSD are hot topics in the fire service today, I was wondering about tomorrow. Would they react or pro-act in identifying the next thing? How would they know what they do not know?
Criterion 7F asks agencies if their occupational health, safety, and risk management programs protect the organization and personnel from unnecessary injuries or losses from accidents and liabilities. The first steps to having a risk management program is to identify all risks to our employees. What does current research show and what possibilities are out there. We could go one step further and self-assess from within to see what specific issues our folks are having locally. The purpose here is to go outside of the box to consider issues that could also impact our responders down the road.
In the end the fire officer groups have felt it important to keep the performance indicators generic enough to ensure agencies can detect the next big thing and take up correct measures before trends push for change. From this dialog a recommendation to change one performance indicator from looking at communicable diseases to all health risks was identified. They felt this would set the stage for future findings (to know what you do not know) over the next five years.

Is this the end all be all, NO! It is a start of a process called quality improvement. Culture is a tough nut to crack in any career field. It has been identified as the number one item in the 16 Life Safety initiatives published by the National Fallen Firefighters Foundation. Many think this only applies to how we fight fires or respond to emergencies; I would offer this applies to all areas of the fire service career field. This applies to everything from Governance and Administration to External System Relationships. We need to embrace self-assessment and quality improvement in everything we do. We need to do this on a continual basis (process) rather than only conduct it when (or after) things go bad (project). The culture is, “We do not self-assess”! How are you going to know what you do not know? Continually self-assess and seek quality improvement in all that you do voluntarily and transparently. It works!


Karl E. Ristow, CFO, MIFireE

Karl Ristow is currently with the Center for Public Safety Excellence as Program Director for the Commission on Fire Accreditation International. He has 38 years of fire service experience having served as firefighter through fire chief. Karl is a retired United States Air Force firefighter having served throughout the world in defense of his country. He is a visionary, educator, mentor, and advocate. Karl holds a Master’s Degree in Public Administration, a Bachelor’s Degree in Interdisciplinary Studies, and Associate Degrees in Fire Science and Instructor of Technology. He is a graduate of the National Fire Academy’s Executive Fire Officer Program. He is also a Chief Fire Officer Designee through the Commission on Professional Credentialing and a Member of the Institute of Fire Engineers. Karl is married to his wife Barbara and they have 5 sons.