If it took less than 10 minutes to learn a scientifically proven way to save someone’s life in the event of a heart attack — and that lesson was free — would you take the time? Would you be willing to teach others the same technique?

Individuals experiencing a heart attack had a much higher survival rate if bystanders administered continuous chest compressions (CCC) rather than the traditional CPR of alternating compressions with mouth-to-mouth breaths until emergency medical service arrives or an automatic external defibrillator, according to research conducted by Gordon A. Ewy, MD, director of the University of Arizona’s Sarver Heart Center. Only 5% of cardiac-arrest victims survive if nobody performed CPR. For those receiving standard CPR (alternating between 30 compressions and two breaths), survival was marginally higher at 6%. In contrast, 11% survived if bystanders kept pumping on their chest and did not stop for mouth-to-mouth breaths until emergency medical services arrived.

I first heard about cardiocerebral resuscitation in 2007, when Bentley J. Bobrow, MD, medical director of the Bureau of Emergency Medical Services & Trauma System at the Arizona Department of Health Services, presented the statistics on CCC versus CPR administered by bystanders at a meeting of the Arizona Fire Chiefs Association. A year later, FIRE CHIEF published an article and a poster to introduce the method — then referred to as cardiocerebral resuscitation (CCR) — to a wider audience.

Bobrow has promoted CCC statewide. For instance, 1,800 middle and high schools received CCC-CPR instructional kits last year. The kits contained a letter from the governor and a nine-minute DVD instructional video of students teaching CCC.

Bobrow is encouraging public-information officers in Arizona to “[make] this message a priority in your community through your media channels. Also, this is a perfect message for your civic and community leaders to endorse. Simply put, this will save a lot of people in our state, and I am confident that you will know how to best promote this life saving message.”

The number of saves in the six years since Bobrow introduced the concept has been amazing. And fire and EMS departments in other states, including Wisconsin and Missouri, also have introduced the new CCC procedures to their communities.

On Sunday, Ewy presented the statistical data collected on CCC-CPR to the American Heart Association. The AHA is preparing to launch a public-information campaign across the country titled “Hands-Only CPR” and will include brief and ultra-brief television spots.

Next week, families and friends will gather to celebrate Thanksgiving. Why not take nine minutes to watch the report on Mayo Clinic’s CCC program? Teach yourself and others how to save a person’s life.

You never know when they may use CCR on you someday.

The past few weeks have been difficult for military personnel and their families, between the tragedy at Fort Hood and the high number of casualties overseas. Perhaps that’s why I was so taken by military-spouse Angela Smith’s link to “101 Ways to Thank a Veteran,” written for a military-support blog. Even though Veterans’ Day has passed, there is no expiration date on remembering servicemen and -women.

Firefighters who also are soldiers activated and deployed during war time is stressful enough for fire departments, but coupled with a flailing economy, fire chiefs across the country are struggling with severe staff reductions.

I spoke with Frankfort (Ky.) Fire Chief Wallace Possich after he submitted two of his firefighters’ names for our double-duty holiday greetings list. Frankfort Fire and EMS provides services to the state capital with 88 sworn personnel out of four fire stations. According to Possich, his department is currently down 11 personnel: nine retirees who will not be replaced and the two firefighter/paramedics serving overseas.

“Since 9/11, I’ve had about eight fire personnel who have been activated to serve,” Possich said. “I’ve had people in both Iraq and Afghanistan, and a drill sergeant who was gone two years training recruits close to Fort Knox.”

Frankfort firefighter/paramedics Steve Clark and Scott True also are members of the National Guard. They were sent to Kosovo last August. Clark and True are in the same unit, both serving as medics.

The Frankfort department is required by federal regulations to hold the positions for serving military.

“We would do that anyway, so we just count their absences as military-leave vacancies and back-fill with overtime,” he said. “The military activation combined with the economy that has implemented hiring freezes it hasn’t helped at all.”

Possich is hoping to get authorization from his city officials to apply for a SAFER grant this week. The city has not yet applied for SAFER funds; however, Possich is hopeful officials will reconsider.

In 2001, Frankfort implemented a policy on how they would handle military activation and the benefits program. In addition, the state of Kentucky training system requires firefighters be certified and maintain 100 training hours annually in exchange for $3,100 on top of their salaries.

“If one person doesn’t get his 100 hours, the whole department loses their stipend,” Possich said. “Part of the rules on the stipend system is you have to be affiliated with the fire department. The state law is waived while serving in the military.” The fire department agreed to keep personnel serving in the military on their books as paid employees by paying $10 a week.

The city maintains the health-care payments for serving personnel and also covers the families; the city pays the insurance and the employee can pay it back upon his or her return. Pension and seniority are not affected. Possich said he has received three “Employer Support of the Guard and Reserve” awards for his support.

“We try to maintain our communication with our serving personnel and maintain contact with their families too,” Possich said. “One firefighter who was deployed for two years was concerned about his young family, so the department went over and painted his house and did the landscaping.”

So here is one more way to thank a veteran or soldier. Send me the name and mailing or e-mail address of a firefighter or EMS person serving in the military. Starting next week, the names will be available on the FIRE CHIEF Web site.

And a belated happy 234th birthday to the Marines.

Last weekend, I delivered a presentation on fire service trends at the Buffalo Trace Regional Fire Academy in Maysville, Ky. More than 400 firefighters — primarily volunteers with ages ranging from 18 to 70 — were signed up for the three-day academy.

Because Kentucky firefighters are required to meet certain hours for state certifications, State Fire Commissioner Ron Davis said the state provides the regional training at no charge. One of the most popular classes at the academy was a two-day basic firefighting course for new firefighters and seasoned firefighters who want to brush up on their skills. Also among the 16 classes being offered were highway crash–site management, occupant protection and an eight-hour firefighter survival course.

The evening before my presentation, I had the opportunity to meet several firefighters at a nearby pub. They shared with me a number of their concerns as volunteer firefighters who are trying to balance work and family, and over the need for more training in the current economy. One training officer explained that the lack of jobs has sent volunteers out of the region, some driving 50 to 60 miles each way to work. “There’s no time to train and even less time to respond to calls,” he said.

Recruiting and retaining members and balancing budgets are universal problems, and managing them can be very stressful. In fact, firefighter stress was one of the trends I identified in my presentation.

Recently I heard a fire chief say that volunteer firefighters are most susceptible to emotional stress because “when they respond to a call, they know the people they are working on in their town.” When I shared that comment with the volunteers, they nodded in agreement.

After my presentaion, a young firefighter came up to me and told me he once had to help cut his brother and a friend out of a car after a bad accident. The brother survived, but the friend was killed. I told him that he had a long career ahead of him and I hoped he would learn how to deal with the stress he would encounter.

Of course, support of family and friends goes a long way to relieving some of that stress. To that end, FIRE CHIEF once again will be gathering names and contact information of firefighters and emergency personnel who either are serving our country overseas or are veterans recovering back home.

If you know firefighter, EMT, paramedic or other first responder who would appreciate receiving a holiday card or package from fire departments or fire families here in the U.S., send his or her contact information to me, and we will post it on our Web site.

It’s time to remember those who are away from home for the holidays and let them know we care.

Once again, October has proved to be a busy month. My notebook is filled with interesting information and quotes from a wide range of sources across the country, some from group discussions and therefore unattributed. Here are my tricks and treats to think about this Halloween weekend:

Ergonomics. “We’re seeing Kevlar belts being worn with suspenders to help take the weight off of the shoulders,” said Ken Busch of Scott/Honeywell, during a turnout gear presentation.

Story-telling. “To be successful in the environment we are in, you have to be able to tell our story. The mantra we deal with over and over is efficiency, efficiency, efficiency,” Chief Adam Thiel, Alexandria (Va.) Fire Rescue, said.

Prescreening. “Why is the concept of mental health not in our curriculum at the entry level of our fire academies?” asked Deputy Chief Pat Kenny of the Western Springs (Ill.) Fire Department.

Safety. “Why don’t [manufacturers] build something to tell when gear is about to exceed the capacity to protect a firefighter?” asked Chief Alan Brunacini (Ret.).

Global outlook. “If we want to look for apparatus models that really work … look at the rest of the world and how they are doing it,” Thiel continued.

Common sense. “You can’t change without trust,” said one chief during a discussion about changing cultures, unions and consolidations.

Staffing. “Are city managers decreasing their personnel, too?” asked a cash-strapped chief.

Attention deficit. “You’re lucky if you have even five minutes of attendees attention,” quipped one chief.

Change. “When you have a downturn in the economy, it forces us to think differently — whether we like it or not — and it creates a lot of anxiety.”

CCR. “What kind of CPR are they going to do on you if [EMTs] do that on the public?” asked Deputy Chief Chuck Montgomery of the Glendale (Ariz.) Fire Department while explaining the increased benefits of cardio cerebral resuscitation over CPR.

Going the distance. “Why is it OK in a rural area to respond in 10 minutes, but it’s not OK in a suburban area?”

Opposites. “When things are going good, the authority having jurisdiction goes up, and when things are going bad, it goes down.”

Firefighting? “Nothing in the laws says we have to put it out.”

Volunteerism. “How do you cut a volunteer fire department? Citizens Emergency Response Training is filling the gap for police and fire….”

Agreement. “The classic answer to all public service officials’ questions about cutting budget or service is the same: ‘it all depends ….’”

Vision. “There’s a difference between a growth and a survival mode.”

Mind’s eye. “Mental health is a key component of overall firefighter safety,” Kenny continued.

Volunteer stress. “Mental wellness is critical for firefighters, and it’s worse for volunteer departments because they know the local people.”

Superheroes. “Take the cape off before it chokes you.”

Five keys to success. “Vision: Do you know where you want to go? Values: Will your values take you there? Will you be satisfied when you get there? Action: Do you act to insure success and eliminate failure? Attitude: Do you reject psychological blocks from the past or imposed by others? Connections: Can you establish strong ties and relationships with people?” By Dr. Joseph Mancusi

Reminder. Change your clock and change your batteries.

While doing some Internet research last week, I came across a U.S. Fire Administration firefighter fatality notice from Feb. 23. The notice read that 34-year-old Firefighter Derek North of the Stockton Fire Department in Lakeland, Ga., died while responding to a fire call. North’s brother was driving the department’s 1966 Ford Fire Knocker when he swerved to avoid a collision. The vehicle overturned and Derek North, who was in the officer’s seat, was killed while Chad North sustained serious injuries.

Several years ago, the Fire Apparatus Manufacturers Association issued a white paper that claimed that 50% of apparatus in the United States is older than 15 years and not in compliance with NFPA standards. But even if a fire truck might is old and non-compliant, if it is properly maintained and safely operated, no one should die.

The current economy is making it more difficult for fire departments to purchase new apparatus and the future is not looking much better. Fire chiefs across the country are looking closely at all aspects of apparatus specifications, leasing options and preventive maintenance.

In last week’s Command Post, I wrote about a fire chief roundtable at the recent FEMSA/FAMA meeting, where leaders from various size departments responded to questions about apparatus purchasing.

Chief Jeff Johnson of Tualatin Valley (Ore.) Fire & Rescue talked about how his department is considering “zippy” cars that would be placed on located on highways during rush hour for EMS response. Johnson said that such vehicles could save time and money, compared to dispatching a larger apparatus. The quick response makes sense when accidents add to traffic congestion and make it even more difficult for emergency vehicles — especially large vehicles that may not be needed — to get through.

Richmond (Va.) Fire Chief Robert Creecy said that he repeatedly reminds his staff that they are caring for other’s property. “We live in rental property and drive rental cars,” he said. “The buildings belong to the city and the vehicles belong to fleet services.” Right now, Richmond faces a monumental task of replacing a fleet of quints purchased in 1997.

Several fire departments are trying to extend the life of their apparatus and buying standard demo units to save money. Chief Don Oliver of Wilson (N.C.) Fire Rescue told me that when the department was purchasing new vehicles for officers, it chose a demo SUV and van from their local Chrysler dealership. Oliver said that they saved a good chunk of money by buying used.

Can you continue to cut your budget and not affect the safety of your community and your department?

The Fire and Emergency Manufacturers and Services Association and the Fire Apparatus Manufacturers Association held their annual joint meeting earlier this month. The event gave several fire chiefs the opportunity to speak up on issues facing their departments — and some of those chiefs pushed back on FEMSA/FAMA members.

Rob Brown, chief of the Stafford County (Va.) Fire Department and chair of the International Association of Fire Chiefs’ Economic Task Force, provided insight on fire department budgets. The IAFC created its economic task force following the economic downturn to provide fire chiefs with information and guidance. In his presentation, Brown encouraged the manufacturers and vendors to understand and work with fire-service leaders during a tough economy. “We need vendors to be our partners,” Brown said.

Brown suggested focusing on the increasing costs associated with NFPA standards, lower-cost options for equipment and apparatus, and renewable resources and the environment. “It’s a lot easier to ask for a piece of equipment that is environmentally friendly,” he said.

Brown also encouraged the fire service to break from tradition thinking and be more open to technological advances. Citing the changes in pilots’ helmets from World War II designs to the high-tech helmets fighter pilots wear today, Brown suggested that the fire service hasn’t moved far from the leather helmets of 60 years ago.

During the buyers’ roundtable, moderated by CFSI Executive Director Bill Webb, six metro, urban, suburban, volunteer and Canadian fire chiefs shared their opinions with the FEMSA/FAMA members.

“We’ve been cutting for so long there’s nothing left to cut,” Richmond (Va.) Fire Chief Robert Creecy said. “We’re browning out on a day-to-day basis. It’s the leanest of times. Richmond has been recession-proof, and now it’s worse than during the Great Depression.”

Conversely, Jeff Johnson, chief of Tualatin Valley (Ore.) Fire & Rescue and current IAFC president, said based on the government structure, TVFR controls its own money and currently is involved in $77 million worth of fire-station construction.

The chiefs on the panel all agreed that they are more involved in the purchasing process because of current economic conditions.

“It’s very important that we are closest to the work,” Alexandria (Va.) Chief Adam Thiel said. “My role is to really show everybody where the box is and stay within.”

Chief Tim Beckett from Ajax, Ontario, Canada, said his department is running its trucks a lot longer, and his council has suggested buying standard apparatus or even buying demo units. “We’re looking at practical versus bells and whistles,” he said. “We’re seeing an increase on our maintenance side, too.”

Chief Joseph Chornock, Germantown (Md.) Volunteer Fire Department, also has had to rethink apparatus purchases. “By purchasing all the apparatus alike our maintenance and mechanical costs are reduced. We don’t have to stock all kinds of parts,” he said. “It’s good for our firefighters, too, because different pumps operate differently.”

The chiefs on the panel all agreed that the fire service needs to re-think the business of emergency response and manage public expections. The chiefs anticipate more mergers and consolidations and more cooperation and collaborations on equipment purchases.

“Local money will be used to solve local problems, but local money will never solve national problems — a lot of fire chiefs need to learn to share,” Johnson said. “We have got to continue to think better about our business and use data and science to solve our problems. Apparatus and radios got better in my 32 years. What’s going to change our fire service is science and technology.”

The meeting gave FAMA/FEMSA members a lot to think about: smaller apparatus, leasing vehicles and response to routine calls and activated fire alarms. Lack of money changes everything.

When selecting the judges for the Station Style Design Awards, we try to find fire chiefs or officers who have hands-on experience in designing fire stations. We also include architects from different geographical areas. This year’s judges included three fire-department personnel who also have experience in architecture and engineering.

And the judges — first time and returning — could all agree on one thing: the competition was tough this year.

The first design awards in 2000 had 23 entries in four categories; this year’s program had 87 entries in six categories. Judges reviewed each entry on their own before meeting with the other judges. Each brought his or her top three choices in each category to the final judging. Discussions were intense as the choices were whittled down to gold, silver and bronze — or none at all.

Returning judges had noticed significant changes in this year’s entries:

• “More training within the stations.” And another quickly added, “So much so that I expect it now.”

• “Many of our clients are volunteers, and their training facility is 50 miles away. They hold their breath when anyone sends them away for training. It’s a lot easier to bring in one instructor to teach rather than send off your firefighters.”

• “Functionality is the key in the fire station.”

• “Operations comes first.”

• “LEED is expected in all architecture. It’s soon approaching the code level would be sustainability. A lot of cities are funding LEEDs buildings.”

One seasoned judge explained the initial criteria for each entry. “The first thing we look at if it is operationally sound. You can have good design with a small amount of money or a large amount of money.”

Another judged added, “I don’t think square foot cost has a big impact on my decision. You look at it and say it’s an expense.”

“Far more important is matching the client’s budget than what it is and more important what is it for that community.”

Sometimes I wish we recorded the eight-hour judging process. The discussions and arguments about various aspects of facilities, locations and creativity are valuable lessons. The pros and cons from everything aspect of a facility from the drive-through bays to location of decontamination rooms are learning opportunities.

Watch for the November issue and see if you agree with the 2009 Station Style judges.

Wilson (N.C.) Fire Rescue often has served as a beta-test agency for new GIS technology. On a recent road trip, I visited Wilson and found that GIS isn’t the mid-sized suburban department’s only innovation.

Chief Don Oliver offered to let me stay in the fire department’s VIP suite, a new concept to me. Oliver said that when the central fire station was flooded several years ago during a hurricane, the department turned an office into a small guest suite. The suite has given Oliver an economical way to invite instructors and chiefs from all over the country to visit and teach a course. Staying in the station also offers informal time with department personnel. The suite’s guest book includes signatures of Chief Billy Goldfeder, NFFF Executive Director Ron Siarnicki and Chief Ron Coleman.

Staying in the station also gave me a chance to see for myself exactly how Wilson’s GIS technology works for the department. The department first showed interest in GIS after a hurricane flooded many areas of the city. Department leaders were surprised to hear that the city’s planning department knew ahead of time what areas would flood. They began discussing options to share the information among the city’s agencies; consequently, ESRI became involved and began using Wilson as a test site.

I noticed a couple things during my tour of the station that I had not seen in other stations: a round conference table (“Works better for staff meetings,” Oliver said), signage on doors prohibiting turnout gear in living quarters; and security systems on doors to both living areas.

Another purpose of my visit was to see Wilson’s new Fire & Life Safety Adventure House for a future article. The department purchased a small house next to its central station and converted it to a multi-purpose education facility. Firefighters did the work themselves, and the facility offers a broad range of instruction for youngsters, senior citizens and the community at large. In fact, Oliver had local businesses visit the house, including members of a homebuilders association, and said they were blown away by the live-fire demonstration that is extinguished by a working sprinkler head.

Wilson runs a tight training program in conjunction with a local college and offers students an opportunity to stay in fire stations and attend classes to continue their education. He told me they have students from across the country attending the training programs.

Dinner in the station with the B shift also offered an opportunity to talk to the firefighters about their work. No visit to a fire station is complete without a firefighter prank. This one involved an unsuspecting baker’s pineapple cake and liquid soap. The frosting, however, was perfect.

While I have my own scanner and I’m used to the tones, I must admit I did a good job of falling back asleep after the tones went down for several calls during the night.

There is a 30-minute overlap in shift change and for morning checks of each vehicle and the equipment, including the testing of each saw on the rigs. “If we don’t test each one, how can we trust it will start when we need it on a call?” a young lieutenant said.

On a tour of the other four stations and the training facility, I asked the firefighters if they realized how progressive Wilson really is? Based on their response, I don’t think they knew. I do.

Verna Wilson intently rubbed a piece of paper over a large brass plaque, while Elizabeth Desideri held the paper in place.

Wilson’s son, 30-year-old Shawn Patrick Blazer, was one of eight Forest Service contractors killed in a helicopter crash on Aug. 5, 2008. His name was among those listed on the 2008 fallen firefighters’ plaque unveiled at the NFFF’s memorial weekend.

I attended my first memorial weekend this year. I had shied away from going in previous years because I cry easily and I feared the sadness — when I hear the Last Alarm or bagpipers playing Amazing Grace, I crumble. But when I finally went, it wasn’t the sound of bells or the bagpipes that touched me — it was the overwhelming compassion from volunteers who want to make a difference to the families who had just lost loved ones.

Anita Reynolds, who works for the Fairfax County (Va.) Fire Department, has volunteered for four years. Her tasks ranged from spraying for the annoying bees to passing out tissue packets to drying the chairs before the early morning ceremony. “We try and make [the families’] weekend as smooth and problem-free as possible,” Reynolds said.

Chief Bob Dipoli first volunteered in 1990, serving as an escort or caretaker for a family. “I was coming for the Executive Fire Officer program, and they were looking for uniformed escorts to assist a family from upstate New York,” Dipoli said. He became the escort coordinator and eventually became one of the presenters of the American flag, medal and a red rose, given to each new family during the ceremony.

At the ceremony, 457 motorcycles led by a police escort rode up from Fredericks, Md., under a large American flag suspended from two aerial ladders to place a wreath at the memorial.

I also met Frank and Stephanie Thompson, whose son Brandon Thompson was killed in the Charleston Sofa Super Store Fire. “Last year was a blur for me,” Frank Thompson said. “I bought my tickets several months ago and told [the NFFF] I was coming back.”

Stephanie Thompson said that being able to talk to other survivors made a big difference in her ability to get through the grief.

“Two of our sons are police officers and we worried about their safety,” she said. “Being a firefighter, we thought Brandon would be fine.”

During the candlelight program, Dennis Compton addressed the 2,000-person gathering. “We will help in any way to help you to re-build your lives,” he said. “We are here to help and support you — it’s that simple.”

In the benediction of the candlelight service, Chaplain Ted Wilson, Oklahoma City Fire Department offered, “The amount of pain corresponds with the love that we have.”

And there was no shortage of love at the memorial. The survivors of fallen firefighters returned to share, this year’s new families came for healing and firefighters came for the remembrance.

“You are now part of our fire-service family and we are here to support you,” said Helen Worthen, whose son Eric Reiner died in 1998. “The light is a symbol of light and hope and we share that with you.”

I found inspiration in the memorial weekend’s spirit of unity. But I still struggle to understand preventable line-of-duty deaths. I propose that that the fire chief of each line of duty death be present at the Memorial weekend and escort to the family of the fallen firefighter. Watch the family members sign the remembrance banner, do a rubbing of the brass plaque or brick with their loved one’s name and escort them to receive the tri-fold American flag, the medal and the long stem rose.

“We can sleep because they do not,” Rep. Steny Hoyer said. “We don’t hope they are; we know they are.”

Is firefighter safety important? Ask Verna Wilson, Frank and Stephanie Thompson, and Helen Worthen. Buckle up, slow down and leave call response to the physically fit.

Earlier this week, the International Association of Fire Chiefs’ EMS Section sent a letter of protest against the new NBC television show, Trauma.

In the letter to the chairman of NBC Universal Television Entertainment, EMS Section Chairman Gary Ludwig expressed “deep and sincere displeasure” with the show, particularly with scenes depicting paramedics having sex in ambulances, making sexist remarks against women and performing medical procedures outside the standard of care. Ludwig requested NBC cancel or modify the series “accurately portray the sacrifices of those who perform emergency medical services to comfort and treat those who have suffered a serious trauma or illness.”

When I spoke with Ludwig, who also serves as deputy fire chief in Memphis, Tenn., he called the program “totally irritating.”

“It does an injustice to our profession, and the legal concerns impact the viewers,” Ludwig said, referring to a scene where a paramedic misuses drugs for a patient by one actor. Ludwig said he turned the program off after 20 minutes.

Are Ludwig’s concerns justified? How much does television influence the public’s perception of a profession?

Dragnet showed viewers a respectful police force in the fifties, while Hill Street Blues began to show a grittier side in the eighties. Medical professionals have been popular on television since the beginning, from the first soap operas to Marcus Welby, M.D., to shows like Grey’s Anatomy and Scrubs today.

Are firefighters and EMS personnel above being portrayed as human and vulnerable on television? Is that portrayal necessarily a bad thing?

“There are so many of us in our profession who went into this profession because of Johnny and Roy from Emergency!” Ludwig admitted.

Former JEMS publisher Jim Paige was an advisor to Emergency! and didn’t hesitate to put his foot down if something was not accurate.

“Jim didn’t want firefighters or paramedics being portrayed negatively,” Ludwig said. To this day, Johnny and Roy still come up at national conferences.

But it seems Emergency! was a far cry from Trauma or its sensational firefighting counterpart, Rescue Me.

As luck would have it, the show’s premiere coincides the National Fallen Firefighters Memorial Weekend and the start of Fire Prevention Week across the United States and in Canada. The fire service has worked hard over the past 30-plus years to raise the level of professionalism with education, certification and diversity. Likewise, EMS has raised to unimaginable levels with certified paramedics and advanced ALS. Still the emergency services still wrestle with issues of sexual harassment, drug abuse and politics.

Maybe we aren’t ready for programs like Trauma and Rescue Me to show the vulnerabilities of human beings working in the emergency services because those vulnerabilities touch raw nerves. But maybe that’s what television producers find so appealing about firefighters, paramedics and EMTs — they are sacred!