San Anselmo City Council
October 24, 2023

349
Crew Assignment
Crews from each department that regularly operated together were assigned to work as either engine or truck companies in each scenario. Both Fairfax County and Montgomery County crews participated in each experiment.

Crews assigned to each responding company position in one scenario were assigned to another responding company position in subsequent scenarios, with the objective of minimizing learning from one experiment to another. For example, crews in the role of engine 1 in a morning scenario might be assigned to the engine 3 position in the afternoon, thus eliminating learning from exact repetition of a task as a factor in time to completion.

Additionally, participating crews from both Montgomery County and Fairfax County were from three different shifts, further reducing opportunities for participant repetition in any one position.

Response Time Assumptions
Response time assumptions were made based on time objectives set forth in the NFPA 1710. Time stagger allocations were set by the project technical advisors in order to assess the impact of arriving unit time separation on task start and completion times, as well as the overall scene time.

Below are the values assigned to the various time segments in the overall response time. The total of the response time segments may also be referred to as the total reflex time.

1. Fire ignition = time zero

2. 60 s for recognition (detection of fire) and call to 9-1-1

3. 60 s for call processing/dispatch

4. 60 s for turnout10

5. Close Stagger = 240 s travel time FIRST engine with
60 s ladder-truck lag and 90 s lag for each subsequent engine a. Truck arrives at 300 s from notification
b. Second engine at 330 s from notification
c. Third engine at 420 seconds from notification

6. Far Stagger = 240 s travel time FIRST engine with 120 s ladder-truck lag and 150 s lag for each subsequent engine a. Truck arrives at 360 s from notification
b. Second engine arrives at 390 s from notification
c. Third engine arrives at 540 s from notification.

The design of this part of the experiments allowed firefighter entry into the burn building. The next part of the experiments required a modified methodology.
28 10 After the experiments were complete, the NFPA 1710 technical committee released a new edition of the standard that prescribes 80 seconds for turnout time.

ITEM 2.2 - ATTACHMENT 6

350
Part 3: Room and Contents Fires
As previously discussed,
NFPA 1403 prohibits
firefighters in a training
exercise from entering a
structure with sufficient fuel
load to result in room
flashover. But the value of the
data from the time-to-task
experiments lies not just in the
duration and
time-of-completion statistics
for tasks, but also in measuring
the tenability of the
atmosphere for occupants
urgently needing firefighter
assistance. Therefore Part 3 of
the experiments (room and
contents fires) used a larger
fuel load to focus on the seven
of the 22 tasks that cause a
change in the fire behavior
through ventilation or active suppression:

1. Forced entry of the front door

2. Water on fire

3. Second floor window #1 ventilated (burn room window)

4. Second floor window #2 ventilated (front window, near corner)

5. Second floor window #3 ventilated (front window, near front door)

6. First floor window #1 ventilated (window beside the fire room)

7. First floor window #2 ventilated (self-ventilated at flashover) Because the fuel load was sufficient for flashover, all firefighter activity was conducted outside the building. Tasks that in Part 3 required entry into the building, such as search or interior utility control, were factored into this part by delaying the next task for the average duration of the task from Part 2. Firefighters in full gear opened the door with a gloved hand or opened windows from the ground with a tool such as a pike pole or angle iron, again at the time specified by the averages from Part 2. Averages were derived from the three iterations of each scenario. The different number of iterations in Part 3 will be explained later in this report.

Because firefighters could not enter the building, a nozzle controlled from the instrumentation room was installed. The nozzle was placed in the room directly outside the burn room and oriented toward the burn room near the doorway in order to best emulate the nozzle location of live firefighter suppression (see Figure 22). The nozzle was encased with mineral wool and heavy-duty aluminum foil (bottom picture in Figure 22) to protect the electronics and wiring from the intense radiation energy emitted by the fire. Blocks were used to anchor the nozzle against the lateral forces exerted by the momentum of the water supply. The activation time for suppression was determined by the data from the time-to-task test results.

A 15o spray pattern was directed toward the seat of the fire and swept horizontally from side to side. While the remotely controlled hose line knocked down the majority of the fire, it was not as effective as a live firefighter with a better view into the room of origin. Therefore, after the fire was diminished, a supplemental stream was applied through the burn room window in order to control the fire (see Figure 23). All personnel on the hose line were in full turnout gear and self-contained breathing apparatus during the exterior application of water.

Fuel Packages for the Room and Contents Fires
In order to maximize the repeatability of the fire development, nominally identical rooms of furniture of identical manufacturer, style, and age were used for each test. A plan-view schematic of the furniture is shown in Figure 24 and pictures of the burn room prior to testing are shown in Figure 25. Key dimensions, mass, and materials for combustible furnishings are detailed in Appendix C.

The Tornado Remote Controlled
Monitor is Produced by Task
Force Tips, Valparaiso, Indiana,
USA. Permission to publish
courtesy of Task Force Tips
Figure 23: Supplemental Suppression Applied for Room and Contents Tests
Figure 22: Remotely Controlled Fire Suppression Nozzle for Room and Contents Fires
29 ITEM 2.2 - ATTACHMENT 6

351
The ignition source consisted
of a cardboard book of 20
matches that was ignited by an
electrically heated wire, often
referred to as an electric match.

The electric match was placed
near the bottom of a 21 qt
(19.9 L) polypropylene waste
container. The height of the
waste container was 15.5 in
(394 mm) with interior
dimensions at the top opening
of 14.5 in (368 mm) by 11.3 in
(287 mm). Approximately 0.7
lbs (0.3 kg) of dry newspaper
was added to the waste
container. The majority of the
newspaper was folded flat, and
placed on edge along the sides
of the waste container. Four
sheets of newspaper, 22 in (559
mm) by 25 in (635 mm) were
crumpled into “balls”
approximately 3.9 in (100 mm)
diameter and placed on top of
the electric match in the center
of the waste container.

Experimental Matrix for
Room and Contents Fires
Sufficient amounts of
furniture for 16 rooms were
available for the room and
contents fires, so eight
experiment scenerios were
conducted — each with a
replicate. Because the time to
untenable conditions was a
primary variable of interest in
the room and contents fires,
the arrival time of the first due
engine was a paramount
consideration. Because the
effects of the subsequent
apparatus stagger were
explored in the time-to-task
tests, the stagger was fixed at
the “close arrival” time.

Additionally, a baseline
measurement was required to
compare the effectiveness of
response to the absence of a
fire department response.

Therefore, a five-person, later
arrival combination was
eliminated in favor of a
no-response scenario (with
replicate). Table 3 summarizes
the 16 tests conducted.

The first due engine arrival
times were determined using
the following assumptions:
ignition of the fire occurs at
Figure 24: Configuration of Furnishings in Burn Room (Room and Contents Fires) Figure 25: Pictures of the Room and Contents Furnishings 30 ITEM 2.2 - ATTACHMENT 6

352
time zero. Smoke detector
activation and a call to 9-1-1
occurs at 60 seconds after the
fire starts. Call intake and
processing requires an
additional 90 seconds. The
firefighters take 60 seconds to
complete their turnout at the
station and begin travel to the
scene. Thus travel time begins

3.5 minutes into experiment.

The two levels of arrival time
are then determined by two
different travel times: early
arrival assumes a three-minute
travel time, while later arrival
assumes a five-minute travel
time. For all scenarios in the
room and contents experiments,
the close stagger (60 seconds)
between subsequent apparatus
times was used.

Procedure for Minimizing the Effect of Variance in Fire Growth Rate
Fires involving furnishings have inherent variance in burning behaviors. Factors such as humidity and minor variations in materials (particularly worn furnishings that may have different foam compression or fabric wear patterns), can result in uncertainty of 20 % or more, despite significant efforts to enhance repeatability. The early growth period of fire
development is often associated with the greatest variance, since minor factors (as discussed above) can influence the thermal environment more easily when the fire is small. Therefore, the room and contents fires were normalized to the 212 °F (100 °C) temperature near the ceiling in the burn room in order to minimize the variance of the room and contents fires. The time at which the burn room reached this temperature (usually in approximately 180 seconds) rather than the actual ignition time, was designated as the “zero time.”
Figure 26 shows the time-temperature curves before and after normalizing at 100°C. This approach was implemented during the experiments by watching the time temperature data in real-time from the instrumentation room and announcing the “zero-time” over the fireground radio system. The normalization procedure did not negatively affect tenability measurements in the target room because when the fire is small, products of combustion do not reach the room because of lack of momentum. Therefore, adjusting all room and contents tests to the same upper layer temperature was an appropriate way to minimize variance.

Milestone Times for Critical Tasks
As stated earlier, firefighters could not enter the burn building during the room and contents experiments because of the danger for potential flashover in an experimental scenario. Therefore, prescribed tasks were performed at specified times based on data from part 2. In this section we report on significant data gathered from instrumentation and describe an additional part of the experiments designed to extend our understanding of the effect of crew size and stagger on the tenability of the atmosphere in a burning structure.

Table 4 (page 32) identifies significant tasks selected as key milestones because of the way they affect fire behavior and atmospheric tenability inside the structure.

Crew Size First Due Arrival Time
2-Person Early Arrival of First Engine (6.5 min) – close stagger 3-Person Early Arrival of First Engine (6.5 min) – close stagger 4-Person Early Arrival of First Engine (6.5 min) – close stagger 5-Person Early Arrival of First Engine (6.5 min) – close stagger 2-Person Later Arrival of First Engine (8.5 min) – close stagger 3-Person Later Arrival of First Engine (8.5 min) – close stagger 4-Person Later Arrival of First Engine (8.5 min) – close stagger No Response (Baseline) N/A
Table 3: Experimental Matrix for Room and Contents Tests (Each Conducted in Replicate) Figure 26: Direct Comparison of Temperatures,
Before (Top) and After Adjustment (Bottom)
31 ITEM 2.2 - ATTACHMENT 6

353
Table 4: Tasks That Affect Fire Behavior and Atmospheric Tenability 32 ITEM 2.2 - ATTACHMENT 6

354
This section describes the analytic approaches used to
address the research objectives of the study. First the statistical methods used to analyze the fireground
time-to-task observations are presented. Then the time-to-task data and the room and contents data were combined to assess crew performance in relation to tenability within the structure.

Time-to-Task Analysis
Time-to-task data were compiled into a database and assessed for outliers and missing entries. Because all time-to-task experiments were conducted in triplicate, missing data were apparent and were reviewed via video and radio tapes. Missing data attributable to timer error were replaced by a time observed in the video. Where video and/or radio documentation was not adequate, missing data were recoded to the mean of the task times from the other two experiments.

Data Queries
The statistical methods used to analyze the time-to-task data were driven by a principal goal of this research project — to assess the effect of crew size, first-due engine arrival time, and subsequent apparatus stagger on time-to-task for critical steps in response and fire fighting. This research goal motivated the development of four specific research questions (see Figure 27) that in turn pointed to specific statistical analyses for generating inference and insight.

Statistical Methods – Time-to-Task
The analysis of the time-to-task data involved a sequence of multiple linear regressions using Ordinary Least Squares to generate and test the effects of staffing and stagger on timings.

The regressions were of the form:
where the xik reflect factors such as stagger and crew size, and the y represents our dependent/outcome variable.

Time-related outcomes (i.e., the dependent variables in the regression equations) could include task duration, elapsed time to start the task, and elapsed time until task completion, all measured in seconds. Table 5 (page 34) lists the time-related outcomes used to test the effect of crew size and stagger for the tasks in the field experiments.

The effects of crew size and stagger were explored using indicator variables in the regression analyses. The coefficient for a given indicator (for example, crew size of four relative to a crew size of two) indicated the number of seconds the larger crew size added or reduce the timing outcome of a task. Crew sizes were collapsed in some regressions to test whether the timings of “larger” crew sizes of four and five were significantly different than “smaller” crew sizes of two and three. Interaction terms were not assessed in these regression analyses because of the small number of experiments available for analysis.

Standard t-tests examined statistical significance (i.e., to see if the hypothesis of “no impact” could be rejected) to estimate the impact of several specific configurations:
 crew sizes of three versus two
 crew sizes of four versus three
 crew sizes of five versus four
 (occasionally) five versus two, and four versus two
 larger (four & five combined) versus smaller (two & three combined) and
 stagger
The specific tests for each task (regression analysis) are shown in the Appendix E. The actual coefficients of each regression and their corresponding standard errors are presented in Appendix F.

To infer impact, significant tests were conducted at the 0.05 significance level. Only statistically significant contrasts of crew size and/or stagger are included in this section of the report.

Graphic expositions of relevant time/task related findings are then presented as well. Where stagger was statistically significant, the effects are graphed separately. Where stagger was not statistically significant, the data for crew size were combined.

Analysis of Experimental Results
Time-to-Task Research Questions
1) How do crew size and stagger (i.e., timing of between first engine and subsequent apparatuses) affect overall (i.e., start to completion) response timing?
a. To what extent do variations in crew size affect overall response timing?
b. To what extent do variations in both crew size and
stagger affect overall response timing?
2) How do crew size and stagger affect the timings of task initiation, task duration, and task completion for each of the tasks comprising the suite of 22 tasks?
a. To what extent do variations in crew size affect timings across the suite of tasks?
b. To what extent do variations in both crew size and
stagger affect response timings across the suite of
tasks?
3) How does crew size affect elapsed times to achieve three critical events known to change fire behavior or
atmospheric tenability for occupants?
a. Entry into structure
b. Water on fire
c. Ventilation of each window (three upstairs and one
downstairs window and the burn room window)
4) How does the elapsed time to achieve the national
standard of assembling 15 firefighters at the scene
(measured using “at hydrant” as the start time) vary by crew sizes of 4 and 5?
Figure 27: Research Questions for Time-to-Task Experiments 33 ITEM 2.2 - ATTACHMENT 6

355
Regression analyses
Appendix F presents the
regression results for each task
and relevant outcome, along
with their corresponding
standard errors. The results of
conducting significance tests at
the 0.05 level of significance
are shown in Appendix E.

Rather than detailing each of
the lengthy lists of coefficients
found to be significant, only
the answers to the primary
research questions are
presented for each task.

Measurement Uncertainty
The measurements of length,
temperature, mass, moisture
content, smoke obscuration,
and stopwatch timing taken in
these experiments have unique
components of uncertainty that
must be evaluated in order to
determine the fidelity of the
data. Appendix G summarizes
the uncertainty of key
measurements taken during the
experiments. Importantly, the
magnitudes of uncertainties
associated with these
measurements have no impact
on the statistical inferences
presented in this report.

How to Interpret
Time-to-Task Graphs
Figure 28 presents a sample
time-to-task analysis, in this
case results for venting time.

Each crew size has a column
graphic showing the start time
and completion time for the
task. Visually, columns starting
lower on the graph depict
deployment configurations
that resulted in earlier start
times. The height of the
column graphic is a
visualization of the duration of
the task, taller columns
indicating longer times to task
completion. Time data are also
shown in a table below the
graph. Where stagger was
statistically significant, the
effects are graphed separately.

Where stagger was not
statistically significant, as in the
illustration, the data for crew
size were combined.

Table 5: Dependent Variables Used in a Regression Analysis of the Effect of Crew Size and Stagger on Time-to-Task Outcomes
Figure 28: Example Time-to-Task Graph
34 ITEM 2.2 - ATTACHMENT 6

356
Time-to-Task Graphs
Overall Scene Time (Time to
Complete All 22 Tasks)
The four-person crews
operating on a low-hazard
structure fire completed the
same number of tasks on the
fireground (on average) 7
minutes faster than the
two-person crews (see Figure
29). The four-person crews
completed the same number of
fireground tasks (on average)

5.1 minutes faster than the
three-person crew. The
four-person crews were able to
complete necessary fireground
tasks on a low-hazard
residential structure fire nearly
30 % faster than the
two-person crews and nearly
25 % faster than the
three-person crews. Although
on the low-hazard residential
structure fire, adding a fifth
person to the crews did not
show any additional decrease in
fireground task times, the
benefits of a five-person vs. a
four-person crew are significant
in other measurements,
particularly the “water-on-fire”
time. Additionally, the greater
need for five-person crews for
medium- and high-hazard
structures, particularly in urban
settings, has been documented
in other studies (Backoff et al.,
1980; Cushman, 1982;
McManis Associates et al.,
1984) and five-person crews are
required for areas that contain
medium and high-hazard
structures in fire protection
consensus standards.11
Figure 29: Overall Scene Time
11 NFPA 1710, Section 5.2.3.1.2 and Section 5.2.3.2.2: In jurisdictions with tactical hazards, high-hazard occupancies, high incident frequencies, geographical restrictions, or other pertinent factors as identified by the AHJ, these companies shall be staffed with a minimum of five or six on duty members. 35 ITEM 2.2 - ATTACHMENT 6

357
Figure 30 b: Overall Scene Time-Four Person Crew
Overall Scene Time and
Crew Sizes
The graphs in Figure 30 show
average times for each task by
crew size.

Figure 30 a: Overall Scene Time-FIve Person Crew
36 ITEM 2.2 - ATTACHMENT 6

358
Figure 30 c: Overall Scene Time-Three Person Crew
Figure 30 d: Overall Scene Time-Two Person Crew
37 ITEM 2.2 - ATTACHMENT 6

359
38 Advance Attack Line
Time (Hose Stretch Time)
Figure 31 measures the
interval from the start of the
task “Position Attack Line” to
the end of the task “Advance
Attack Line.” In comparing
four- and five-person crews to
two and three-person crews
collectively, the time difference
for this measure was
statistically significant at 76
seconds (1 minute 16 seconds).

In conducting more specific
analysis comparing all crew
sizes to a two-person crew the
differences are more distinct. A
two-person crew took 57
seconds longer than a
three-person crew to stretch a
line. A two-person crew took
87 seconds longer than a
four-person crew to complete
the same task. Finally, the most
notable comparison was
between a two-person crew and
a five-person crew, with a
122-second difference in task
completion time.12, 13
Figure 31: Advance Line Time (Hose Stretch Time) by Crew Size 12 Apparatus stagger was not statistically significant, so the data for crew size were combined. 13 Where subtracting the start time from the end time yields a result that differs from the duration noted in the chart by one second, it is the result of rounding fractional seconds to the nearest whole second.

ITEM 2.2 - ATTACHMENT 6

360
39 Time to Water on Fire
There was a 10% difference in
the “water on fire” time
between the two- and
three-person crews. There was
an additional 6% difference in
the "water on fire" time
between the three- and
four-person crews. (i.e.,
four-person crews put water on
the fire 16% faster than two
person crews). There was an
additional 6% difference in the
“water on fire” time between
the four- and five-person crews
(i.e. five-person crews put
water on the fire 22% faster
than two-person crews).

Advancing a Backup Line
Advancing a backup line to
the door and stairwell was
started 16 % faster and
completed 9 % for replicates
with shorter staggers between
company arrivals. Advancing a
backup line is typically a task
completed by the third arriving
engine on a full alarm
assignment and is critical to
the safety of firefighters already
in the building on the initial
attack line. For this task,
stagger of arrival was
statistically significant and is
an important consideration for
overall station location and full
alarm response capability. The
differences can be seen in
Figure 33, which shows the
time from the start for the task
“Deploy Backup Line” to the
end of the task “Advance
Backup Line.”
Figure 32: Water on Fire Time by Crew Size and Stagger
Figure 33: Times to Advance Backup Line by Crew Size and Stagger ITEM 2.2 - ATTACHMENT 6

361
14 Stagger was not significant, so data from close and far were combined to increase statistical power. 40 Figure 34: Times to Conduct Primary Search by Crew Size ITEM 2.2 - ATTACHMENT 6

362
Primary Search
Figure 34 summarizes the
times that crews took to start
the primary search. On the
low-hazard, two-story
single-family dwelling 2,000 sq
ft (186 m2) , the three-person
crew started a primary
search/rescue more than 25 %
faster than the two-person
crew. In the same structure,
the four- and five-person crews
started a primary search 6%
faster than the three-person
crews and 30 % faster than the
two-person crew. Note that
there is no end time included
in this figure. Primary search
end times were reliant upon
radio communication by
firefighters inside the structure.

On occasion this
communication did not occur
or was delayed. Therefore data
reliability was insufficient for
analysis of task duration and
end time.14
Laddering and
Venting Time
A four-person crew operating
on a low-hazard structure fire
completed laddering and
ventilation (for life safety and
rescue) 30 % faster than a
two-person crew and 25 %
faster than a three-person crew.

Ground laddering time
started with the removal of the
first ladder from the truck and
stopped at end time of the last
ladder put in place. A total of
four ladders were raised on
each experiment.

Truck operations ventilation
time is the time from the start
time of ventilation of the first
window until the last window
ventilation was complete.

The differences in start times
and duration of the tasks can be
seen in Figure 35 and Figure 36.

Figure 35: Laddering Time by Crew Size
Figure 36: Ventilation Times by Crew Size15
15 Stagger was not statistically significant, so the data for crew size were combined. 41 ITEM 2.2 - ATTACHMENT 6

363
42 16 Stagger was not statistically significant, so the data for far and near stagger were combined.

Figure 37: Industry Standard Effective Response Force Assembly Time Industry Standard
Effective Response Force
Assembly Time
NFPA 1710 requires that a fire
department have the capability
to deploy an initial full-alarm
assignment to a scene within
eight-minutes (480 seconds).

The number of people required
falls between 15 and 17,
depending on whether an
aerial apparatus is used, and/or
if two engines are being used to
provide a continuous water
supply. In these experiments,
the measurement for an
effective response force
assembly time started from the
first engine arrival at the
hydrant and ended when 15
firefighters were assembled on
scene. Figure 37 reveals the
differences in assembly times
between the four and
five-person crews. An effective
response force was assembled
by the five-person crews a full
three minutes faster than the
four-person crews. It is
important to note that (by
definition), the two-and
three-person crews were unable
to meet this standard at any
time during the experiments.16
ITEM 2.2 - ATTACHMENT 6

364
43 Part 4: Fire Modeling
I
n the room and contents
experiments conducted in
Part 3 of the study,
instrumentation measured
oxygen, carbon dioxide, and
carbon monoxide
concentrations. Data were
grouped by the type of
experiment conducted with
respect to crew size and first
due engine arrival time. As
previously shown in the
experimental matrix, each
group contained two replicate
tests. In each group of data the
results of the replicates were
averaged to simplify the data
for further comparison. Figure
38 and Figure 39 show the
typical concentration curves for
the experiments.

These two graphs show the
ranges representative of those
found in the experiments.

Charts of gas curves for the
remainder of the experiments
— for both the burn room and
the target room — can be
found in Appendix H.

Fire Modeling Methods
A primary goal of fire
department response is to
prevent civilian injuries and
deaths. Because the significant
majority of fire deaths in the
United States occur in
residences, a rapid fire service
response provides the last
line-of-defense against civilian
fire deaths. Further, because the
fire service is less likely to rescue
occupants intimate with the
fire (i.e., inside the room of
origin where conditions
deteriorate rapidly), tenability
measurements were taken in a
remote bedroom on the second
floor of the residential burn
structure. The gas and
temperature measurements were
taken at the 5 ft (1.5 m ) height
above the floor, 3 ft (0.9 m)
from the west wall in order to
simulate a nonambulatory
occupant (e.g, someone asleep,
under the influence of alcohol or
drugs, or otherwise mobility
impaired).

Figure 38: Representative Oxygen Concentration
Figure 39: Representative Carbon Monoxide and Carbon Dioxide Concentrations ITEM 2.2 - ATTACHMENT 6

365
Computational fire models used the average suppression timings obtained from the time-to-task experiments under specific deployment configurations as inputs to the model. This
quantitative approach eliminated the experimental variance of the fire. The resulting “computational” fire is repeatable, and therefore, any differences in occupant exposure to toxic gases will be due to the intervention times associated with a specific deployment configuration rather than the random variation that naturally occurs from fire to fire.

Fire simulations were completed using the NIST Fire Dynamics Simulator (FDS). FDS is a computational fluid dynamics model of fire-driven fluid flow. The first version of the FDS was released in 2000. FDS has been extensively verified and validated (USNRC 2007). Since the initial release, numerous improvements have been made and new features added. This study used FDS version

5.4.2 (Sub-version #4957), which was released on October 19, 2009. In order to calibrate the model, simulations were performed to replicate the experimental results observed in the Figure 40: Measured vs. Predicted Temperature at the 2.1 m (6.9 ft) Thermocouple Location in the Burn Compartment
Figure 41: Measured vs. Predicted Temperature at the 1.8 m (5.9 ft) Thermocouple Location in the Burn Compartment
Figure 42: Measured vs. Predicted Temperature at the 1.5 m (4.9 ft) Thermocouple Location in the Burn Compartment
Figure 43: Measured vs. Predicted Temperature at the 1.2 m (3.9 ft) Thermocouple Location in the Burn Compartment
Figure 44: Measured vs. Predicted Temperature at the 0.9 m (2.9 ft) Thermocouple Location in the Burn Compartment
Figure 45: Measured vs. Predicted Temperature at the 0.6 m (1.9 ft) Thermocouple Location in the Burn Compartment
44 ITEM 2.2 - ATTACHMENT 6

366
room-and-contents fires. Once
the ability of the model to
replicate experimental results was
established, the different fire
growth rates and deployment
configurations were simulated to
characterize the effectiveness of
different responses relative to
different fire growth rates.

The occupant exposure to toxic
gases was assumed to occur until
the occupant is rescued by the
truck crew (start time of primary
search plus one minute). Table 6
shows the “rescue time” for the
various crew sizes that correspond
to the test matrix for the room
and contents experiments.

Part 4 of the experiments used
fire modeling to correlate response
times to atmospheric tenability in
a burning structure. In order to
calibrate the computer fire model,
simulations were performed to
replicate the experimental
results observed in the
room-and-contents fires.

Model inputs include building
geometry and material properties, ventilation paths (doors, windows, leakage paths), and heat release rate of the fuel package.

While the building geometry is easily measured and material properties (such as the thermal properties of drywall and concrete) are readily estimated, the heat release rate was not directly measured during the experiments. The heat release rate of the fuel package is the primary determinant of the production rate of heat, smoke, and gas species (e.g., carbon dioxide, carbon monoxide).

Figures 40 through 45 compare the experimental and simulated burn room temperatures using the burn room thermocouple tree.

The tree contained thermocouples located at 0.6 m (1.9 ft),

0.9 m (2.9 ft), 1.2 m (3.9 ft), 1.5 m (4.9 ft), 1.8 m (5.9 ft), and

2.1 m (6.9 ft) above the floor. For additional information about the instrumentation type location, see Appendix C. The results for thermocouples located in the hot gas layer show excellent agreement. The temperature at the lower two thermocouples show an overprediction of the hot gas layer depth in the computer simulation. A small difference in the location of the interface height (the steep temperature gradient between the relatively cool lower gas layer and the hot upper gas layer), can result in significant predicted temperature differences with relatively little effect on the bulk heat and mass transport accuracy. This explanation is supported by the agreement of the temperatures in the remote bedroom.

Figure 46 compares the experimental and predicted oxygen concentration levels in the upstairs bedroom (measured at 5 ft (1.5 m) above the floor, centered above the bed). Figures 47 through 52 compare the experimental and simulated
temperatures in the upstairs (target room) bedroom. As expected, the temperatures are moderated by mixing (cool ambient air mixes with hot combustion gases during transport between the burn room and the target room) and by thermal losses to the (cooler) surfaces between the two rooms.

Once the model inputs were determined to agree with the experimental results, the input heat release rate was changed to represent three fire growth rates representative of a range of fire hazard development – slow, medium, and fast, which are
described in greater detail in the following sections.

Time to Untenable Conditions: Research Questions
In the real world, fires grow at many different rates – from very slow, smoldering fires all the way to ultra-fast, liquid fuel or spray fires. In order to extend the applicability of the findings of this report beyond the one fire growth rate observed in part 3 of this report (residential room and contents fires), computer fire modeling was used to quantify the effectiveness of fire department operations in response to an idealized range of fire growth rates (characterized as slow, medium, and fast). Based on the research questions shown in Figure 53, fire modeling methods were then selected to maximize the applicability of the times to task results.

Figure 46: Measured Versus Predicted Oxygen Levels in the Upstairs Bedroom at 5 ft (1.5 m) 1) How do performance times relate to fire growth as
projected by standard fire time/temperature curves?
2) How do these performance times vary by crew size,
first due arrival time, and stagger?
3) How do crew size, stagger, and arrival time affect
occupant tenability within the structure?
Figure 53: Research Questions for Time to Untenable Conditions 45 ITEM 2.2 - ATTACHMENT 6

367
Figure 47: Measured vs. Predicted Temperature at the 2.4 m (7.8 ft) Thermocouple Location in the Bedroom
Figure 48: Measured vs. Predicted Temperature at the 2.1 m (6.8 ft) Thermocouple Location in the Bedroom
Figure 49: Measured vs. Predicted Temperature at the 1.8 m (5.9 ft) Thermocouple Location in the Bedroom
Figure 50: Measured vs. Predicted Temperature at the 1.5 m (4.9 ft) Thermocouple Location in the Bedroom
Figure 51: Measured vs. Predicted Temperature at the 1.2 m (3.9 ft) Thermocouple Location in the Bedroom
Figure 52: Measured vs. Predicted Temperature at the 0.9 m (2.9 ft) Thermocouple Location in the Bedroom
Fire Growth Rates
Three fire growth rates were used in the computer fire modeling to assess the effectiveness of different fire department deployment configurations in response to fires that were similar to, faster growing, and slower growing than the fires observed in the room-and-contents fires. The slow, medium, and fast fire growth rates are defined by the Society of Fire Protection Engineers according to the time at which they reach 1 megawatt (MW). A typical upholstered chair burning at its peak would produce a 1-MW fire, while a large sofa at its burning peak would produce roughly a 2-MW fire.

The growth rate of fires is often approximated by simple correlation of heat release rate to the square of time. If a fire is not suppressed before full-room involvement, the probability of spread beyond the room of origin increases dramatically if there is nearby fuel load to support fire spread. If a nearby fuel load is available, the 12 ft (3.7 m) by 16 ft (4.9 m) compartment used in the fire experiments would become fully involved at
approximately 2 MW. Table 7 shows the time in seconds at which 1-MW and 2-MW (fully involved) fires in this compartment would be reached in the absence of suppression.
46 ITEM 2.2 - ATTACHMENT 6

368
A fire department rescue
operation is a race between the
deteriorating interior conditions
inside the structure and the
rescue and suppression activities
of the fire department. Each fire
growth rate was used as a
baseline heat release rate for the
simulation. Intervention times
(window and door opening times
and suppression time) from the time-to-task tests were
systematically input into the model to evaluate the effects on interior tenability conditions. The interior tenability conditions were calculated in a remote upstairs bedroom (above the room of fire origin on the first floor) in order to maximize the opportunity for differentiation among different crew configurations.

Fractional Effective Dose (FED)
In order to convert instantaneous measurements of local gas conditions, the fractional effective dose (FED) formulation published by the International Standards Organization (ISO) in document 13571 Life-threatening Components of Fire – Guidelines for the Estimation of Time Available for Escape Using Fire Data (ISO 2007) were used. FED is a probabilistic estimate of the effects of toxic gases on humans exposed to fire effluent. The formulation used in the simulations accounts for carbon monoxide (CO), carbon dioxide (CO2), and oxygen (O2) depletion. Other gases, including hydrogen cyanide (HCN) and hydrogen chloride (HCl), were not accounted for in this analysis and may alter FED for an actual occupant.

There are three FED thresholds generally representative of different exposure sensitivities of the general population. An FED value of 0.3 indicates the potential for certain sensitive populations to become incapacitated as a result of exposure to toxic combustion products. Sensitive populations may include elderly, young, or individuals with compromised immune
systems. Incapacitation is the point at which occupants can no longer effect their own escape. An FED value of 1.0 represents the median incapacitating exposure. In other words, 50 % of the general population will be incapacitated at that exposure level.

Finally, an FED value of 3.0 represents the value where occupants who are particularly tolerant of combustion gas exposure (extremely fit persons, for example) are likely to become incapacitated.

These thresholds are statistical probabilities, not exact measurements. There is variability in the way individuals respond to toxic atmospheric conditions. FED values above 2.0 are often fatal doses for so-called typical occupants. There is no threshold so low that it can be said to be safe for every exposed occupant.17 2-Person Early 12:47
3-Person Early 9:03
4-Person Early 9:10
5-Person Early 8:57
2-Person Late 14:47
3-Person Late 11:03
4-Person Late 11:10
Table 6: Rescue Time for Different Deployment Configurations Deployment
Configuration
(All times with
close stagger adjusted
for early and late arrival
of first due engine)
Rescue Time for
Deployment
Configuration
(Min : Sec)
Fire Growth Rate Time in Seconds Time in Seconds to
Reach 1 MW Reach to 2 MW
Slow 600 848
Medium 300 424
Fast 150 212
Table 7: Time to Reach 1 MW and 2 MW by Fire Growth Rate In the Absence of Suppression Where Ci is the concentration of the ith gas and (Ct)i is the toxic concentration of ith gas and Δt is the time increment.

Eq.1
47 17 See the following sections of ISO Document 13571:

5.2 Given the scope of this Technical Specification, FED and/or FEC values of 1,0 are associated, by definition, with sublethal effects that would render occupants of average susceptibility incapable of effecting their own escape. The variability of human responses to toxicological insults is best represented by a distribution that takes into account varying susceptibility to the insult. Some people are more sensitive than the average, while others may be more resistant (see Annex A.1.5). The traditional approach in toxicology is to employ a safety factor to take into consideration the variability among humans, serving to protect the more susceptible subpopulations.

5.2.1 As an example, within the context of reasonable fire scenarios FED and/or FEC threshold criteria of 0,3 could be used for most general occupancies in order to provide for escape by the more sensitive subpopulations. However, the user of this Technical Specification has the flexibility to choose other FED and/or FEC threshold criteria as may be appropriate for chosen fire safety objectives. More conservative FED and/or FEC threshold criteria may be employed for those occupancies that are intended for use by especially susceptible subpopulations. By whatever rationale FED and FEC threshold criteria are chosen, a single value for both FED and FEC must be used in a given calculation of the time available for escape.

ITEM 2.2 - ATTACHMENT 6

369
Results from Modeling Methods
Table 8 shows the FED for slow-, medium-, and fast-growth rate fires correlated to rescue times based on crew size and arrival time in the study. As with the room-and-contents fire in part 3, results in Table 8 included only the close-stagger rescue time data. The effect of far-stagger rescue times on occupant tenability should be investigated in future studies. Values above 0.3 are shown in yellow, and those above the median incapacitating exposure of 1.0 are shown in red.

Figure 54 shows that with slow-growth fires in the experimental residential structure, all crew configurations could achieve rescue time before FED reached incapacitating levels. Figure 55 illustrates the greater danger of
medium-growth fires, where
the FED at rescue time for
two-person crews is well above
the 0.3 level, and almost to that
level for the other crews.

Figure 56 (page 49) vividly
illustrates the extreme danger
of fast-growth fires. By the
time a two-person crew is able
to facilitate a rescue, the FED
has far exceeded the median

1.0 level. For other crew sizes,
the FED has exceeded 0.3,
which is a threshold level for
vulnerable populations.

Table 8: FED as a Function of Deployment Configuration and Fire Growth Rate Figure 54: FED Curves for Early Arrival for All Crew Sizes at Slow-Growth Fires
Remote Room Tenability for Slow Fires
Figure 55: Average FED Curves for Early Arrival for All Crew Sizes at Medium-Growth Fires
Remote Room Tenability for Medium Fires
48 results
ITEM 2.2 - ATTACHMENT 6

370
Interior Firefighting Conditions and Deployment
Configuration
The available time to control a fire can be quite small. Risks to firefighters are lower for smaller fires than larger fires because smaller fires are easier to suppress and produce less heat and fewer toxic gases. Therefore, firefighter deployment configurations that can attack fires earlier in the fire development process present lower risk to firefighters. The longer the duration of the fire development process without intervention, the greater the increase in risk for occupants and responding firefighters. Therefore, time is critical.

Stopping the escalation of the event involves firefighter intervention via critical tasks performed on the fireground.

Critical tasks, as described previously, include those tasks that directly affect the spread of fire as well as the associated structural tenability.

There are windows of opportunity to complete critical tasks. A fire in a structure with a typical residential fuel load at six minutes post-ignition is very different from the same fire at eight minutes or at ten minutes post-ignition. Some tasks that are deemed “important” (e.g., scene size-up) for a fire in early stages of growth become critical if intervention tasks are delayed. Time can take away opportunities. If too much time passes, then the window of opportunity to affect successful outcomes (e.g., rescue victim or stop fire spread) closes.

For a typical structure fire event involving a fire department response, there is an incident commander on the scene who determines both the strategy and tactics that will be employed to stop the spread of the fire, rescue occupants, ventilate the structure, and ultimately extinguish the fire. Incident commanders must deal with the fire in the present and make intelligent command decisions based on the circumstances at hand upon arrival. Additionally, arrival time and crew size are factors that contribute to the incident commander’s decisions and affect the capability of the firefighters to accomplish necessary tasks on scene in a safe, efficient, and effective manner.

Table 9 illustrates vividly the more dangerous conditions small crews face because of the extra time it takes to begin and complete critical tasks (particularly fire suppression). In the two minutes more it took for the two-person crew (early arrival) than the five-person crew (early arrival) to get water on the fire, a slow growth rate fire would have increased from 1.1 MW to 1.5 MW.

This growth would have been even more extreme for a
medium-or fast-growth rate fire. The difference is even more substantial for the two-person crew with late arrival as the fire almost doubled in size in the time difference between this crew and the five-person crew.

Based on fire modeling for the low hazard structure studied with a typical residential fuel load, it is likely that medium- and fast-growth rate fires will move beyond the room of origin prior to the arrival of firefighters for all crew sizes. Note that results in Table 8 included only the close-stagger rescue time data. The effect of far-stagger rescue times on occupant tenability should be investigated in future studies. Therefore, the risk level of the event upon arrival will be higher for all crews which must be considered by the incident commander when assigning firefighters to on-scene tasks.

Figure 56: Average FED Curves for Early Arrival for All Crew Sizes at Fast-Growth Fires
Table 9: Fire Size at Time of Fire Suppression
Remote Room Tenability for Fast Fires
Deployment Time to Water Fire Size at Time of
Configuration on Fire Suppression for
Slow-Growth Fires
2-Person, Late Arrival 14:26 2.1 MW
2-Person, Early Arrival 12:26 1.5 MW
3-Person, Late Arrival 13:24 1.8 MW
3-Person, Early Arrival 11:24 1.3 MW
4-Person, Late Arrival 13:11 1.7 MW
4-Person, Early Arrival 11:11 1.3 MW
5-Person, Late Arrival 12:33 1.6 MW
5-Person, Early Arrival 10:33 1.1 MW
49 (Min : Sec)
ITEM 2.2 - ATTACHMENT 6

371
Reports on firefighter fatalities consistently document overexertion/overstrain as the leading cause of line-of-duty fatalities. There is strong epidemiological evidence that heavy physical exertion can trigger sudden cardiac events (Mittleman et al. 1993; Albert et al. 2000). Therefore, information about the effect of crew size on physiological strain is very valuable.

During the planning of the fireground experiments,
investigators at Skidmore College recognized the opportunity to conduct an independent study on the relationship between firefighter deployment configurations and firefighter heart rates.

With the approval of the Institutional Review Board of Skidmore College, they were able to leverage the resources of the field experiments to conduct a separate analysis of the cardiac strain on fire fighters on the fireground.

For details, consult the complete report (Smith 2009). Two important conclusions from the report reinforce the importance of crew size:
 Average heart rates were higher for members of small crews, particularly two-person crews.
 Danger is increased for small crews because the stress of fire fighting keeps heart rates elevated beyond the maximum heart rate for the duration of a fire response, and so the higher heart rates were maintained for sustained time intervals.

Physiological Effects of Crew Size on Firefighters
50 ITEM 2.2 - ATTACHMENT 6

372
Study Limitations
The scope of this study is limited to understanding the relative influence of deployment variables to low-hazard, residential structure fires, similar in magnitude to the hazards described in NFPA 1710. The applicability of the conclusions from this report to commercial structure fires, high-rise fires, outside fires, terrorism/natural disaster response, HAZMAT or other technical responses has not been assessed and should not be extrapolated from this report.

Every attempt was made to ensure the highest possible degree of realism in the experiments while complying with the
requirements of NFPA 1403, but the dynamic environment on the fireground cannot be fully reproduced in a controlled experiment.

For example, NFPA 1403 required a daily walkthrough of the burn prop (including identifying the location of the fire) before ignition of a fire that would produce an Immediately Dangerous to Life and Health (IDLH) atmosphere, a precaution not available to responders dispatched to a live fire.

The number of responding apparatus for each fireground
response was held constant (three engines and one truck, plus the battalion chief and aide) for all crew size configurations. The effect of deploying either more or fewer apparatus to the scene was not evaluated.

The fire crews who participated in the experiments typically operate using three-person and four-person staffing. Therefore, the effectiveness of the two-person and five-person operations may have been influenced by a lack of experience in operating at those staffing levels. Standardizing assigned tasks on the fireground was intended to minimize the impact of this factor, which has an unknown influence on the results.

The design of the experiments controlled for variance in performance of the incident commander. In other words, a more-or less-effective incident commander may have a significant influence on the outcome of a residential structure fire.

Although efforts were made to minimize the effect of learning across experiments, some participants took part in more than one experiment, and others did not.

The weather conditions for the experiments were moderate to cold. Frozen equipment such as hydrants and pumps was not a factor. However, the effect of very hot weather conditions on firefighter performance was not measured.

All experiments were conducted during the daylight hours.

Nighttime operations could pose additional challenges.

Fire spread beyond the room of origin was not considered in the room and contents tests or in the fire modeling. Therefore, the size of the fire and the risk to the firefighter may be somewhat underestimated for fast-growing fires or slower-response configurations.

There is more than one effective way to perform many of the required tasks on the fireground. Attempts to generalize the results from these experiments to individual departments must take into account tactics and equipment that vary from those used in the experiments.
51 ITEM 2.2 - ATTACHMENT 6

373
Conclusions
More than 60 laboratory and full-scale fire experiments were conducted to determine the impact of crew size, first-due engine arrival time, and subsequent apparatus arrival
times on firefighter safety and effectiveness at a low-hazard residential structure fire. This report quantifies the effects of changes to staffing and arrival times for low-hazard residential firefighting operations. While resource deployment is addressed in the context of a single structure type and risk level, it is recognized that public policy decisions regarding the cost-benefit of specific deployment decisions are a function of many factors including geography, available resources, community expectations, as well as all local hazards and risks. Though this report contributes significant knowledge to community and fire service leaders in regard to effective resource deployment for fire suppression, other factors contributing to policy decisions are not addressed.

The objective of the experiments was to determine the relative effects of crew size, first-due engine arrival time, and stagger time for subsequent apparatus on the effectiveness of the firefighting crews relative to intervention times and the likelihood of occupant rescue using a parametric design. Therefore, the experimental results for each of these factors are discussed below.

Of the 22 fireground tasks measured during the experiments, the following were determined to have especially significant impact on the success of fire fighting operations. Their differential outcomes based on variation of crew size and/or apparatus arrival times are statistically significant at the 95 % confidence level or better.

Overall Scene Time:

The four-person crews operating on a low-hazard structure fire completed all the tasks on the fireground (on average) seven minutes faster — nearly 30 % — than the two-person crews. The four-person crews completed the same number of fireground tasks (on average) 5.1 minutes faster — nearly 25 % — than the three-person crew. For the low-hazard residential structure fire, adding a fifth person to the crews did not decrease overall fireground task times. However, it should be noted that the benefit of five-person crews has been documented in other evaluations to be significant for medium- and high-hazard structures, particularly in urban settings, and should be addressed according to industry standards.18 Time to Water on Fire:

There was a nearly 10 % difference in the “water on fire time” between the two and three-person crews and an additional 6 % difference in the “water on fire time” between the three- and four-person crews (i.e., 16 % difference between the four and two-person crews). There was an additional 6 % difference in the “water on fire’” time between the four- and five-person crews (i.e., 22 % difference between the five and two-person crews).

Ground Ladders and Ventilation:

The four-person crew operating on a low-hazard structure fire can complete laddering and ventilation (for life safety and rescue) 30 % faster than the two-person crew and 25 % faster than the three-person crew.

Primary Search:

The three-person crew started and completed a primary search and rescue 25 % faster than the two-person crew. In the same structure, the four- and five-person crews started and completed a primary search 6 % faster than the three-person crews and 30 % faster than the two-person crew. A 10 % difference was equivalent to just over one minute.

Hose Stretch Time:

In comparing four-and five-person crews to two-and three-person crews collectively, the time difference to stretch a line was 76 seconds.

In conducting more specific analysis comparing all crew sizes to a two-person crew the differences are more distinct. A two-person crew took 57 seconds longer than a three-person crew to stretch a line. A two-person crew took 87 seconds longer than a four-person crew to complete the same tasks. Finally, the most notable comparison was between a two-person crew and a five-person crew — more than 2 minutes (122 seconds) difference in task completion time.

Industry Standard Achieved:

The “industry standard achieved” time started from the first engine arrival at the hydrant and ended when 15 firefighters were assembled on scene.19 An effective response force was assembled by the five-person crews three minutes faster than the four-person crews. According to study deployment protocal, the two- and three-person crews were unable to assemble enough personnel to meet this standard.

Occupant Rescue:

Three different “standard” fires (slow-, medium-, and fast-growth rate) were simulated using the Fire Dynamics Simulator (FDS) model.

The fires grew exponentially with time. The fire modeling simulations demonstrated that two-person, late arriving crews can face a fire that is twice the intensity of the fire faced by five-person, early arriving crews.

The rescue scenario was based on a nonambulatory occupant in an upstairs bedroom with the bedroom door open.

Independent of fire size, there was a significant difference between the toxicity, expressed as fractional effective dose (FED), for occupants at the time of rescue depending on arrival times for all crew sizes. Occupants rescued by crews starting tasks two minutes earlier had lesser exposure to combustion products.

The fire modeling showed clearly that two-person crews cannot complete essential fireground tasks in time to rescue occupants without subjecting either firefighters or occupants to an increasingly hazardous atmosphere. Even for a slow-growth rate fire, the FED was approaching the level at which sensitive populations, such as children and the elderly are threatened. For a medium-growth rate fire with two-person crews, the FED was far above that threshold and approached the level affecting the median sensitivity in general population. For a fast-growth rate fire, the FED was well above the median level at which 50 % of the general population would be incapacitated. Larger crews responding to slow-growth rate fires can rescue most occupants prior to incapacitation along with early-arriving larger crews responding to medium-growth rate fires. The result for late-arriving (two minutes later than early-arriving) larger crews may result in a threat to sensitive populations for medium-growth rate fires.” The new sentence is consistent with our previous description for two-person crews where we identify a threat to sensitive populations..

Statistical averages should not, however, mask the fact that there is no FED level so low that every occupant in every situation is safe. 52 18 NFPA Standard 1710 - A.5.2.4.2.1 …Other occupancies and structures in the community that present greater hazards should be addressed by additional fire fighter functions and additional responding personnel on the initial full alarm assignment. 19 NFPA 1710 Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments. Section 5.2.1 – Fire Suppression Capability and Section 5.2.2 Staffing.

ITEM 2.2 - ATTACHMENT 6

374
53 Summary:

The results of these field experiments contribute significant knowledge to the fire service industry. First, the results establish a technical basis for the effectiveness of company crew size and arrival time in NFPA 1710. The results also provide valid measures of total effective response force assembly on scene for fireground operations, as well as the expected performance of time-to-critical-task measures for a low-hazard structure fires. Additionally, the results provide tenability measures associated with the occupant exposure rates to the range of fires considered by the fire model.

ITEM 2.2 - ATTACHMENT 6

375
54 I
n order to realize a significant reduction in firefighter line-of-duty death (LODD) and injury, fire service leaders must focus directly on resource allocation and the deployment of resources, both contributing factors to LODD and injury. Future research should use similar methods to evaluate firefighter resource deployment to fires in medium- and high-hazard structures, including multiple-family residences and commercial properties. Additionally, resource deployment to
multiple-casualty disasters or terrorism events should be studied to provide insight into levels of risks specific to individual communities and to recommend resource deployment
proportionate to such risk. Future studies should continue to investigate the effects of resource deployment on the safety of both firefighters and the civilian population to better inform public policy.

Future Research
ITEM 2.2 - ATTACHMENT 6

376
55 Acknowledgements
Aproject of this magnitude extends significantly beyond the capabilities and expertise of the report authors. The
following individuals were instrumental in the success of the experiments:
 Technical Experts — Dennis Compton, Retired Chief from Mesa, AZ and consultant, IFSTA; Russell Sanders, Retired Chief from Louisville, KY and staff, NFPA; William “Shorty” Bryson, Retired Chief of Miami, FL and Past President of Metropolitan Fire Chiefs; David Rohr, Operations Chief from Fairfax County Fire and Rescue; Richard Bowers, Chief from Montgomery County Fire and Rescue Department; Vincent
Dunn, Retired from Fire Department of New York; Michael Clemens, Chief of Training from Montgomery County Fire
and Rescue Department; James Walsh, Battalion Chief from Fairfax County Fire and Rescue; Larry Jenkins, Captain I from Fairfax County Fire and Rescue; Doug Hinkle, Training
Captain from Montgomery County Fire and Rescue
Department; and Paul Neal, Safety Officer for Montgomery County Fire and Rescue Department.
 Montgomery County Fire Department – Former Chief Tom
Carr and Chief Richard Bowers — AND Fairfax County Fire and Rescue Services — Chief Ronald Mastin for supporting this study over a period of years to an unprecedented degree.  NIST experimental and modeling personnel - Michael
Selepak, Roy McLane, Anthony Chakalis, Andrew Lock, Marco Fernandez, Ed Hnetkovsky, Jay McElroy, Lauren DeLauter, Glenn Forney, Dan Murphy, and Craig van Norman.
 IAFF Staff/ Data Entry/ Timer Supervision/Heart Rate
Monitors– Nicole Taylor, Randy Goldstein, and Ron Benedict  Skidmore College – Denise Smith and Polar Heart Rate
Monitors for supplemental study to bolster the significance of the main study results.
 Timers — DeWayne Dutrow — Lead, Cliff Berner, Michael Fleming, Colby Poore, Chris Maple, Michael Thornton,
Robert Daley, Ryan Loher
 Montgomery County Support Services — Joey Fuller III — Lead, Chris Hinkle, Doug Dyer, Joey Fuller IV
 The dedicated Fire Officers and Firefighters from
Montgomery County Fire & Rescue and Fairfax County Fire & Rescue, who performed the difficult work of structural fire fighting safely and courageously.

ITEM 2.2 - ATTACHMENT 6

377
56 References
 Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE (2000). Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med
343(19):1355-1361.
 Backoff, R. W.; et al. (1980). Firefighter Effectiveness - A Preliminary Report. Columbus Fire Division, The Ohio State University.
 Barnard RJ, Duncan HW [1975]. Heart rate and ECG
responses of firefighters. J Occup Med 17: 247-250.
 Blevins, L. G. and Pitts, W. M. (1999). Modeling of Bare and Aspirated Thermocouples in Compartment Fires. Fire Safety Journal, Vol. 33, 239-259.
 Bryant, R. A., et al. (2004). The NIST 3 Megawatt Quantitative Heat Release Rate Facility - Description and Procedure. Natl.

Inst. Stand. Technol. NIST IR 7052
 Centaur Associates. (1982). Report on the Survey of Fire Suppression Crew Size Practices.
 Center for Public Safety Excellence. (2008.) CFAI:

STANDARDS OF COVER, FIFTH EDITION. Chantilly, Va.
 Center for Public Safety Excellence. (2009.) FIRE &
EMERGENCY SERVICE SELF-ASSESSMENT MANUAL.

Chantilly, VA.
 Chang, C. Huang, H. (2005). A Water Requirements
Estimation Model for Fire Suppression: A Study Based on Integrated Uncertainty Analysis, Fire Technology, Vol. 41, NO. 1, Pg. 5.
 Coleman, Ronny J. (1988). MANAGING FIRE SERVICES,
2nd Edition, International City/County Management
Association, Washington, DC.
 Cushman, J. (1982). Report to Executive Board, Minimum Manning as Health & Safety Issue. Seattle, WA Fire
Department, Seattle, WA.
 Gerard, J.C. and Jacobsen, A.T. (1981). Reduced Staffing: At What Cost?, Fire Service Today, Pg. 15.
 Fahy R (2005). U.S. Firefighter Fatalities Due to Sudden Cardiac Death 1995-2004. NFPA Journal. 99(4): 44-47.
 Hall, John R. Jr. (2006). U.S Unintentional Fire Death Rates by State. National Fire Protection Association, Quincy, MA.  Huggett, C. (1980). Estimation of the Rate of Heat Release by Means of Oxygen Consumption. J. of Fire and Flammability, Vol. 12, pp. 61-65.
 International Association of Fire Fighters/John’s Hopkins University. (1991). “Analysis of Fire Fighter Injuries and Minimum Staffing Per Piece of Apparatus in Cities With
Populations of 150,000 or More,” December 1991.
 ISO (2007). ISO 13571: Life-threatening Components of Fire — Guidelines for the Estimation of Time Available for Escape Using Fire Data, International Standards Organization,
Geneva.
 Janssens, M. L. (1991). Measuring Rate of Heat Release by Oxygen Consumption., Fire Technology, Vol. 27, pp. 234-249.  Jones, W. W. (2000). Forney, G. P.; Peacock, R. D.; Reneke, P. A.

Technical Reference for CFAST: An Engineering Tool for
Estimating Fire and Smoke Transport. National Institute of Standards and Technology, Gaithersburg, MD. NIST TN 1431; 190 p. March 2000.
 Karter, M.J. Jr. (2008). U.S. Fire Loss for 2007. NFPA Journal, September/October 2008.
 McGrattan, K. B. (2006). Fire Dynamics Simulator (Version 4): Technical Reference Guide. NIST Gaithersburg, MD. NIST SP 1018; NIST Special Publication 1018; 109 p. March 2006.  McManis Associates and John T. O’Hagan and Associates (1984). “Dallas Fire Department Staffing Level Study,” June 1984; pp. I-2 & II-1 through II-7.
 Menker, W.K. (1994). Predicting Effectiveness of Manual Suppression, MS Thesis, Worcester Polytechnic Institute.  Metro Chiefs/International Association of Fire Chiefs (1992) “Metro Fire Chiefs - Minimum Staffing Position,” May 1992.  Mittleman MA, Maclure M, Tofler GH, Sherwood JB,
Goldberg RJ, Muller JE (1993). Triggering of acute myocardial infarction by heavy physical exertion. N Engl J Med
329(23):1677–1683.
 Morrison, R. C. (1990). Manning Levels for Engine and Ladder Companies in Small Fire Departments National Fire Academy, Emmitsburg, MD.
 NFA (1981). Fire Engines are Becoming Expensive Taxi Cabs:

Inadequate Manning. National Fire Academy, United States Fire Administration, Emmitsburg, MD.
 NFPA (2007). NFPA 1403: Standard on Live Fire Training Evolutions. National Fire Protection Association, Quincy, MA.
 NFPA (2004). NFPA 1710: Standard for the Organization and Deployment of Fire Suppression Operations, Emergency
Medical Operations, and Special Operations to the Public by Career Fire Departments. National Fire Protection
Association, Quincy, MA.
 NFPA (2008). Fire Protection Handbook, 20th Edition.

National Fire Protection Association, Quincy, MA.

ITEM 2.2 - ATTACHMENT 6

378
57  Office of the Fire Marshal of Ontario. (1993). Fire Ground Staffing and Delivery Systems Within a Comprehensive Fire Safety Effectiveness Model. Ministry of the Solicitor General, Toronto, Ontario, Canada.
 Omega Engineering, Inc. (2004). The Temperature
Handbook. 5th Edition.
 Parker, W. J. (1984). Calculations of the Heat Release Rate by Oxygen-Consumption for Various Applications., Journal of Fire Sciences, Vol. 4, pp. 380-395.
 Phoenix, AZ Fire Department,” Fire Department Evaluation System (FIREDAP),” December 1991; p. 1.
 Purser, D. (2002). “Toxicity Assessment of Combustion Products.” In The SFPE Handbook of Fire Protection
Engineering, 3rd Edition. DiNenno (Editor). National Fire Protection Association, Quincy, MA.
 Rand Institute. (1978). Fire Severity and Response Distance:

Initial Findings. Santa Monica, CA.Roberts, B.
 Romet TT, Frim J (1987). Physiological responses to
firefighting activities. Eur J Appl Physiol 56: 633-638.  Sardqvist, S; Holmsted, G., Correlation Between Firefighting Operation and Fire Area: Analysis of Statistics, Fire
Technology, Vol. 36, No. 2, Pg. 109, 2000
 Smith DL, Petruzzello SJ, Kramer JM, Warner SE, Bone BG, Misner JE (1995). Selected physiological and psychobiological responses of physical activity in different configurations of firefighting gear. Ergonomics 38(10): 2065-2077
 Smith, D. Effect of Deployment of Resources on
Cardiovascular Strain of Firefighters.” DHS, 2009.
 Thornton, W. (1917). The Relation of Oxygen to the Heat of Combustion of Organic Compounds., Philosophical
Magazine and J. of Science, Vol. 33.
 TriData Corporation. The Economic Consequences of
Firefighter Injuries and Their Prevention, Final Report.

National Institute of Standards and Technology, U.S.

Department of Commerce, Gaithersburg, MD. 2005.
 USFA (2002). Firefighter Fatality Retrospective Study. United States Fire Administration
 USFA (2008). Fatal Fires, Vol. 5-Issue 1, March 2005. USFA, Firefighter Fatalities in the United States in 2007. June 2008.

Prepared by C2 Technologies, Inc., for U.S. Fire
Administration, Contract Number EME-2003-CO-0282.
 USNRC (2007). Verification and Validation of Selected Fire Models for Nuclear Power Plant Applications. Volume 2:

Experimental Uncertainty. Washington, DC : United States Nuclear Regulatory Commission. 1824.

ITEM 2.2 - ATTACHMENT 6

379
58 ITEM 2.2 - ATTACHMENT 6

380
59 APPENDIX A: Laboratory Experiments
The fire suppression and
resource deployment
experiments consisted of
four distinct parts: laboratory
experiments, time-to-task
experiments, room and contents
experiments and fire modeling.

The purpose of the laboratory
experiments was to assure a fire
in the field experiments that
would consistently meet NFPA
1403 requirements for live fire
training exercises. The
laboratory experiments enabled
investigators to characterize the
burning behavior of the wood
pallets as a function of:

number of pallets and the
subsequent peak heat release
rate

compartment effects on burning of wood pallets

effect of window ventilation on the fire

effect on fire growth rate of the loading configuration of excelsior (slender wood shavings typically used as packing material)
Design and Construction
Figure A-1 shows the experimental configuration for the compartment pallet burns. Two identically sized compartments (3.66 m x 4.88 m x 2.44 m) were connected by a hallway (4 m x 1 m x 2.4 m). At each end of the hallway, a single door connected the hallway to each of the compartments. In the burn compartment, a single window (3 m x 2 m) was covered with noncombustible board that was opened for some experiments and closed for others.

At the end of test, it was opened to extinguish the remaining burning material and to remove any debris prior to the next test. In the second compartment, a single doorway connected the
compartment to the rest of the test laboratory. It was kept open throughout the tests allowing the exhaust to flow into the main collection hood for measurement of heat release rate.

The structure was constructed of two layer of gypsum wallboard over steel studs. The floor of the structure was lined with two layers of gypsum wallboard directly over the concrete floor of the test facility. In the burn compartment, an additional lining of cement board was placed over the gypsum walls and ceiling surfaces near the fire source to minimize fire damage to the structure after multiple fire experiments. A doorway 0.91 m wide by 1.92 m tall connected the burn compartment to the hallway and an opening 1 m by 2 m connected the hallway to the target compartment. Ceiling height was 2.41 m throughout the
structure, except for the slight variation in the burn room.

Fuel Source
The fuel source for all of the tests was recycled hardwood pallets constructed of several lengths of hardwood boards nominally 83 mm wide by 12.7 mm thick. Lengths of the individual boards ranged from nominally 1 m to 1.3 m. The finished size of a single pallet was approximately 1 m by 1.3 m by 0.11 m. Figure A-2 shows the fuel source for one of the tests including six stacked pallets and excelsior ignition source. For an ignition source, excelsior was placed within the pallets, with the amount and location depending on the ignition scenario. Figure A-3 shows the pallets prior to a slow and a fast ignition scenario fire. Table A-1 details the total mass of pallets and excelsior for each of the free burn and compartment tests.

Experimental Conditions
The experiments were conducted in two series. In the first series, heat release measurements were made under free burn conditions beneath a 6 m by 6 m hood used to collect combustion gases and provide the heat release rate (HRR) measurement. A second series of tests was conducted with the fire in a compartmented structure to assess environmental conditions within the structure during the fires and determine the effect of the compartment enclosure on the fire growth. Table A-1 presents a summary of the tests conducted.

Figure A-1. Compartment Configuration and Instrumentation for Pallet Tests Figure A-2. Pallets and Excelsior Ignition Source
Used as a Fuel Source
ITEM 2.2 - ATTACHMENT 6

381
60 Measurements Conducted
Heat release rate (HRR) was measured in all tests. HRR
measurements were conducted under the 3 m by 3 m calorimeter at the NIST Large Fire Research Laboratory. The HRR
measurement was based on the oxygen consumption calorimetry principle first proposed by Thornton (Thornton 1917) and developed further by Huggett (Huggett 1980) and Parker (Parker 1984). This method assumes that a known amount of heat is released for each gram of oxygen consumed by a fire. The measurement of exhaust flow velocity and gas volume fractions (O2, CO2 and CO) were used to determine the HRR based on the formulation derived by Parker (Parker 1984) and Janssens (Janssens 1981). The combined expanded relative uncertainty of the HRR measurements was estimated at ± 14 %, based on a propagation of uncertainty analysis (Bryant 2004).

For the compartment fire tests, gas temperature measurements were made in the burn compartment and in the target
compartment connected by a hallway to the burn compartment using 24 gauge bare-bead chromel-alumel (type K)
thermocouples positioned in vertical array. Thermocouples were located at the center of each compartment at locations 0.03 m,

0.30 m, 0.61 m, 0.91 m, 1.22 m, 1.52 m, 1.83 m, and 2.13 m from the ceiling. The expanded uncertainty associated with a type K thermocouple is approximately ± 4.4oC. (Omega 2004)
Gas species were continuously monitored in the burn
compartment at a level 0.91 m from the ceiling at a location centered on the side wall of the compartment, 0.91 m from the wall. Oxygen was measured using paramagnetic analyzers.

Carbon monoxide and carbon dioxide were measured using
non-dispersive infrared (NDIR) analyzers. All analyzers were calibrated with nitrogen and a known concentration of gas prior to each test for a zero and span concentration calibration. The expanded relative uncertainty of each of the span gas molar fractions is estimated to be ± 1 %.

Total heat flux was measured on the side wall of the enclosure at a location centered on the side wall, 0.61 m from the ceiling level.

The heat flux gauges were 6.4 mm diameter Schmidt-Boelter type, water cooled gauges with embedded type-K thermocouples (see Figure A-4). The manufacturer reports a ± 3 % expanded
uncertainty in the response calibration (the slope in kW/m2 /mV).

Calibrations at the NIST facility have varied within an additional ± 3 % of manufacturer’s calibration. For this study, an uncertainty of ± 6 % is estimated.

Table A-1. Tests Conducted and Ambient Conditions
at Beginning of Each Test
Notes: PAL stands for “pallet” and CRA (“Community Risk Assessment”) is the designator for the configuration of pallets burned in the compartment. Efforts were made to use the same amount of excelsior mass for CRA 2 (~0.8 kg), but the value was not measured.

Figure A-3. Fuel and Excelsior Source for Slow (top)
and Fast (bottom) Ignition Scenarios Figure A-4: Heat Flux Gauge with Radiation Shielding ITEM 2.2 - ATTACHMENT 6

382
61 Results
Table A-2 shows the peak HRR and time to peak HRR for the free burn tests and for the compartment tests. Figure A-5 includes images from the free burn experiments near the time of peak HRR for each of the experiments. Figure A-6 illustrates the progression of the fire from the exit doorway looking down the hallway to the burn compartment for one of the tests. Figure A-7 to Figure A-10 present graphs of the heat release rate for all of the tests. Figure A-11 through Figure A-15 shows the gas temperature, major gas species concentrations, and heat flux in the burn compartment and target compartment in the five compartment tests.

Table A-2. Peak Heat Release Rate During Several Pallet Tests in Free-burn and in a Compartment
Figure A-5. Free-Burn Experiments Near Time of Peak Burning ITEM 2.2 - ATTACHMENT 6

383
62 Figure A-6. Example Fire Progression from Test CRA 1 Figure A-7. HRR, Slow Ignition, Free Burn Scenario
Figure A-8. HRR, Fast Igntion, Free Burn Scenario
Figure A-9. HRR, Slow Ignition, Compartment Test
Figure A-10. HRR, Fast Ignition, Compartment Test
ITEM 2.2 - ATTACHMENT 6

384
63 Figure A-11. Temperature, Gas Concentration, and Heat Flux During Test CRA 1, 6 Pallets, Slow Ignition Scenario ITEM 2.2 - ATTACHMENT 6

385
64 Figure A-12. Temperature, Gas Concentration, and Heat Flux During Test CRA 2, 4 Pallets, Slow Ignition Scenario ITEM 2.2 - ATTACHMENT 6

386
65 Figure A-13. Temperature, Gas Concentration, and Heat Flux During Test CRA 3, 4 Pallets, Fast Ignition Scenario ITEM 2.2 - ATTACHMENT 6

387
66 Figure A-14. Temperature, Gas Concentration, and Heat Flux During Test CRA 4, 4 Pallets, Slow Ignition Scenario (Replicate) ITEM 2.2 - ATTACHMENT 6

388
67 Figure A-15. Temperature, Gas Concentration, and Heat Flux During Test CRA 5, 4 Pallets, Slow Ignition Scenario (Open Window Venting)
ITEM 2.2 - ATTACHMENT 6

389
68 Based upon the results of the laboratory experiments, the project team determined that four pallets would provide both a realistic fire scenario, as well as a repeatable and well-characterized fuel source. Varying the placement and quantity of excelsior provided significant variance in the rate of fire growth. Prior to finalization of the fuel package and construction specifications, modeling was used to ensure that the combination of fuel and residential geometry would result in untenable conditions throughout the structure without subjecting the firefighters to unsafe testing conditions. Therefore, CFAST (the consolidated fire and smoke transport model (Jones 2000)) and FDS (fire dynamics simulator model (McGrattan 2006)) were used to predict the temperatures and toxic species within the structure as a function of the experimentally determined heat release rates. The results summarized below confirmed that the building geometry and fuel package produced adequate variation in tenability conditions in the residential structure and ensured that the room of origin would not reach flashover conditions (a key provision of NFPA 1403). Meeting these conditions provided the foundation for experiments to meet the two primary objectives of fire department response: preservation of life and property.

APPENDIX B: Designing Fuel Packages for Field Experiments Figure B-1: Time-dependent temperature contours in field structure with fast growth fire Figure B-2: Time-dependent smoke density contours in field structure with fast growth fire Figure B-1 and B-2 show the thermal and smoke
conditions in the residential structure at different time periods using the fast growth, four pallet fuel package.

The results of the fire modeling indicated development
of untenable conditions in the field experiments
between 5 and 15 minutes, depending upon several
factors: fire growth rate, ventilation conditions, the total leakage of heat into the building and through leakage
paths, and firefighter intervention. This time frame
allowed for differentiation of the effectiveness of various fire department deployment models.

ITEM 2.2 - ATTACHMENT 6

390
69 Through the generosity of the Montgomery County (MD), an open space was provided to construct a temporary burn prop at the Montgomery County Fire and Rescue Training
Facility in Rockville, MD. The area had ready access to water and electrical utilities. A licensed general contractor was retained, including a structural engineer for the design of critical ceiling members, and the burn prop was constructed over a several month period in late 2008.

The burn prop consisted of two 2,000 ft.2 (186 m2) floors totaling 4,000 ft.2 (372 m2). An exterior view of two sides of the burn prop is shown in Figure C-1.

Additional partitions were installed by NIST staff to create a floor plan representative of a two-story, 186 m2 (2,000 ft.2) single family residence. Note that the structure does not have a basement and includes no exposures. The overall dimensions are consistent with the general specifications of a typical low hazard residential structure that many fire departments respond to on a regular basis, as described in NFPA 1710.

Further details about typical single family home designs are not provided in the standard. Therefore, a floor plan representative of a typical single family home was created by the project team.

Details and floor plan dimensions are shown in Figure C-2.

The black lines indicate load-bearing reinforced concrete walls and red lines indicate the gypsum over steel stud partition walls.

The ceiling height, not shown in Figure C-2, is 94 in. (2.4 m) throughout the entire structure except in the burn compartments, where the ceiling height is 93 in. (2.4 m). The purpose of the partition walls was to symmetrically divide the structure about the short axis in order to allow one side of the test structure to cool down and dry-out after a fire test with suppression while conducting experiments on the other side.

The concrete walls original to the burn prop were 8 in. (204 mm ) thick steel reinforced poured
concrete and the floors on the first
level and second levels were 4 in.
(102 mm) thick poured concrete.

The support structure for the
second floor and the roof
consisted of corrugated metal pan
welded to open web steel joists.

The dimensions of the joists are
shown in Figure C-3. The ceiling
was constructed from ½ in. (13
mm) thick cement board fastened
to the bottom chord of the steel
joists. Partition walls were
constructed from 5/8 in. (17 mm)
thick gypsum panels attached to
20 gauge steel studs fastened to
steel track, spaced 16 in. (407
mm) on center.

Additional construction was
implemented in the burn
compartments to address thermal
loading and hose stream
impingement concerns. Spray-on
fireproofing was applied to the
steel joists prior to fastening the
ceiling, as shown in Figure C-4.

The ceilings were constructed
with three layers of ½ in. (13 mm)
cement board, as opposed to one
layer construction in the rest of
the building. Each layer was
fastened in a different direction so
that seams of adjacent layers ran
orthogonally. The difference in
ceiling heights previously
APPENDIX C: Temporary Burn Prop Construction and Instrumentation Figure C-1: View of two sides of the burn prop
Figure C-2: Dimensions of the Burn Prop Floor Plan
ITEM 2.2 - ATTACHMENT 6

391
70 mentioned is the result of the two additional sheets of cement board. The burn compartment walls were constructed from a single layer of ½ in. (13 mm) cement board over a single layer of 5/8 in. (16 mm) gypsum board, attached to 7/8 in. (22 mm) offset metal furring strips. Particular care was taken so that all ceiling and partition wall seams were filled with chemically-setting type joint compound to prevent leakage into the interstitial space between the ceiling and the floor above. After construction of the ceiling was complete, a dry-standpipe deluge system was installed with one head in each burn room to provide emergency
suppression. During an experiment, a 2.5 in. (104 mm) ball valve fitting was attached and charged from a nearby hydrant. Figure C-5 was taken during the process of replacing “worn out” ceiling panels and shows the additional construction implemented in the burn room as well as the deluge sprinkler head.

Windows and exterior doors were constructed to be
non-combustible. Windows were fabricated from 0.25 in. (10 mm) thick steel plate and the exterior doors were of prefabricated hollow-core steel design. The windows on the first floor were 30 in. (0.76 m) width x 36 in. (0.91 m) height and 36 in. (0.91 m) width x 40 in. (1.02 m) height on the second floor. Exterior doors were 35.8 in. (0.88 m) width x 80.5 in. (2.03 m) height. There were no doors attached to the doorways inside the structure.

Figure C-6 shows the construction of the burn prop windows as well as the NFPA 1403-compliant latch mechanism. Figure C-7 is a picture of the interior of the burn prop taken just outside the burn compartment, showing the construction of the ceiling, interior doorway construction, gypsum wing wall and the joint compound used to seal seams in the ceiling and walls.

Instrumentation
After construction, the instrumentation to measure the
propagation of products of combustion was installed throughout the burn prop. The instrumentation plan was designed to measure gas temperature, gas concentrations, heat flux, visual obscuration, video, and time during the experiments. The data were recorded at intervals of 1 s on a computer based data acquisition system. A schematic plan view of the instrumentation arrangement is shown in Figure C-8.

Table C-1 gives the locations of all of the instruments.

Measurements taken prior to
the compartment fire
experiments were length, wood
moisture content, fuel mass
and weather conditions
(relative humidity,
temperature, wind speed and
direction). Gas temperatures
were measured with two
different constructs of type K
(Chromel-Alumel)
thermocouples. All
thermocouples outside the
burn compartments were
fabricated from 30 gauge
glass-wrapped thermocouple
wire. Vertical arrays of three
thermocouples were placed
near the front door on the
north side and south sides of
the stairwell on the first floor.

On the second floor, vertical
arrays of eight thermocouples
were placed near the center of
each target room. Inside the
burn compartments, seven 3.2
mm (0.125 in.) exposed
junction thermocouples and

0.76 m (30 in.) SUPER
OMEGACLAD XL® sheathed
thermocouple probes were
arranged in a floor-to-ceiling
array. Figure C-9 shows the
vertical array in the burn
Figure C-3: Structural Steel Dimensions
Figure C-4: Fireproofing added to structural steel Figure C-5: Additional construction of burn room walls and ceiling and deluge sprinkler head.

Figure C-6: Window & Latch Construction Figure C-7: Interior View of Burn Prop ITEM 2.2 - ATTACHMENT 6

392
71 compartment. Type K
thermocouple probes were
chosen because of their ability to
withstand high temperature,
moisture and physical abuse
resulting from physical contact
with hose streams and
firefighters. To protect the
extension wire and connectors
from the effects of heat and
water, through-holes were drilled
in the burn compartment walls
and the sheaths were passed
through from the adjacent
compartment. To prevent leakage
through the holes, all void spaces
were tightly packed with mineral
wool. Inside the burn
compartment the end of each
probe was passed through an
angle iron stand, and fastened to
the floor and ceiling to provide
additional protection from
physical contact with firefighters
and to ensure that the
measurement location remained
fixed throughout the
experiments. In consideration of
the risk associated with heating
the open web steel joists,
additional thermocouples were
placed above each burn
compartment to monitor the
temperature of the interstitial
space.

Figure C-8: Instrumentation & Furniture Prop Layout
ITEM 2.2 - ATTACHMENT 6

393
Gas concentrations were sampled at the same location in each target room. Both gas probes were plumbed to the same analyzer and isolated using a switch valve; gas was only sampled at one location during any given test. The gas sampling points were located in the center of the West wall (C Side) of both rooms, 1.5 m (5 ft.) above the floor. The sampling tubes were connected to a diaphragm pump which pulled the gas samples through stainless steel probes into a sample conditioning system designed to eliminate moisture in the gas sample. The dry gas sample was then piped to the gas analyzer setup. In all of the experiments, oxygen was measured using a paramagnetic analyzer and carbon monoxide and carbon dioxide were measured using a
non-dispersive infrared (NDIR) analyzer. One floor-to-ceiling thermocouple array was also co-located with each sample port inlet.

Schmidt-Boelter heat flux gauges were placed in the North burn room. One gauge was located 1.0 m (3.3 ft.) above the floor and was oriented towards the fire origin (waste basket). This heat flux gauge was placed to characterize the radiative heat flux at the face piece level that would be experienced by a firefighter inside the room. A second flux gauge was placed on the floor in order to characterize the radiative heat flux from the upper layer and to make an estimate of how close the room was to flashing over with respect to time from ignition (using the common criteria of flashover occurring at ~20kW/m2 at the floor level). The heat flux gauges were co-located with the thermocouple probe array.

All length measurements were made using a steel measuring tape. Wood moisture content measurements were taken using a non-insulated-pin type wood moisture meter. Fuel mass was measured prior to each experiment using a platform-style heavy duty industrial scale. Mass was not measured after each experiment because of the absorption of fire suppression water.

Publicly accessible Davis Vantage Pro2 weather instrumentation (available via http://www.wunderground.com) located
approximately two miles from the experimentation site was used to collect weather data in five minute intervals for the each day that the experiments were conducted. Figure C-10 is a
photograph of the West wall of the North target room, showing the thermocouple array, the smoke obscuration meter, and a gas sampling probe used during the phase two experiments. The layout is identical to that in the South target room.

Non-combustible “prop” furniture was fabricated from angle iron stock and gypsum wallboard. The purpose of the furniture was twofold. The furniture was placed inside the burn prop to simulate realistic obstacles which obscure the search paths and hose stream advancement. The second use for the furniture was so that measurement instrumentation could be strategically placed within the frame of the furniture. This served to protect instrumentation from physical damage as a result of contact with firefighters and their tools. Figure C-11 shows an example of a table placed outside the burn room.

All instruments were wired to a centralized data collection room, shown in Figure C-12, which was attached as a separate space on one side of the building. This ensured physical separation for the data collection personnel from the effects of the fire, while minimizing the wire and tube lengths to the data logging equipment. Note that the roof of the instrument room was designed to serve as an additional means of escape for personnel from the second floor of the burn prop through a metal door. A railing was installed in order to minimize the fall risk in the event that the emergency exit was required.

Figure C-9: Burn Room Thermocouple Array Figure C-10: Target Room Instrument Cluster Figure C-11: Non-combustible “Prop” Table
72 ITEM 2.2 - ATTACHMENT 6

394
73 Figure C-12: Instrumentation Room
Outside Inside
ITEM 2.2 - ATTACHMENT 6

395
74 Time-to-Task Data Collection Chart
Date ______________Start Time __________ End Time (all task complete) __________ Timer Name ________________________________________________________________ APPENDIX D: Data Collection and Company Protocols for Time-to-Task Tests ITEM 2.2 - ATTACHMENT 6

396
75 Tasks/Company
Arrive on Scene
- Arrive/ stop at hydrant
- Position engine
______________
- Layout report
- On-scene report
- Conduct size-up – 360o
lap – incident action plan – offensive
– detail incident (situation report)
- Transmit size-up to responding units
- Transfer command to chief
Establish Supply line
- Hydrant-Drop line (wrap)
- Position engine
- Pump engaged
- 4” straight lay
- ----------------
- Supply attack engine
Position attack line
- Flake
- Charge
- Bleed
- ----------------
- Advance
Establish - 2 in – 2 out
(Initial RIT)
Establish RIT
(Dedicated)
Company Protocols: Crew Size of 2
(10 total personnel on scene)
PLUS 4 RIC – 1403 = total 14 needed
Engine 1/2
Driver
Officer
-
Driver/O
Driver/O
Driver/O
Officer – (Not
interior—just
front door)
Officer
Truck 1/2
-Arrive
- 360o lap
Position Truck
Officer
O/D
O/D (performs
all RIT duties)
Engine 2/2
-Dry Lay – 2nd
engine takes
hydrant
- Charged
hydrant
– Supply attack
engine
Driver
Battalion Chief/ Aide
- Arrives
- Assumes Command
- Evaluates Resources
- Establishes
Command post
- Evaluates exposure
problems
- Directs hose
positioning
- Coordinates Units
- Transmits
Progress reports
- Changes strategy
- Orders, records, and
transmits results of
primary and
secondary searches
- Declares fire under
control
Engine 3/2
ITEM 2.2 - ATTACHMENT 6

397
76 Tasks/Company
Gain/ Force Entry
Advance Line
- scan search fire room
- suppression
Deploy Back-up Line and protect
stairwell
Complete Primary Search
(in combo with Fire Attack)
Search Fire Floor
Search other Floors
Ventilation
(vent for fire or vent for life)
- Horizontal
- Ventilation
Ground Laddering – 2nd story
windows, front and side, for
firefighter means of egress and for
vertical ventilation – 24’/28’ and
roof ladder in case of vertical vent.

Control Utilities
(Interior and exterior)
Conduct Secondary Search
- Search Fire Floors
- Search other Floors
Check for Fire Extension
Open ceiling walls near fire on fire
floor
Check floor above for fire
extension
- wall breech
- ceiling breech
Mechanical Ventilation
Engine 1/2
Officer
(if officer commits
then he must pass
command)
Officer
Officer
Truck 1/2
O/D
Driver/Officer
Driver /Officer
Driver/Officer
Engine 2/2
Officer
Officer
Officer
Battalion Chief/ Aide Engine 3/2
O/D
O/D
Driver/Officer
O/D
ITEM 2.2 - ATTACHMENT 6

398
77 Tasks/Company
Arrive on Scene
- Arrive/ stop at hydrant
- Position engine
______________
- Layout report
- On-scene report
- Conduct size-up – 360o
lap – incident action plan – offensive
– detail incident (situation report)
- Transmit size-up to responding units
- Transfer command to chief
Establish Supply line
- Hydrant-Drop line (wrap)
- Position engine
- Pump engaged
- 4” straight lay
- ----------------
- Supply attack engine
Position attack line
- Flake
- Charge
- Bleed
- Advance
Establish - 2 in – 2 out
(Initial RIT)
Establish RIT
(Dedicated)
Company Protocols: Crew Size of 3
(14 total personnel on scene)
PLUS 4 RIC – 1403 = total 18 needed
Engine 1/3
Driver
Officer
-
Driver
Driver
Driver
D/RB
Truck 1/3
-Arrive
- 360 degree lap
Position Truck
O/RB
Engine 2/3
Dry Lay – 2nd
engine takes
hydrant
Charged
hydrant –
Supply attack
engine
Driver
O/RB— advance
by foot to get to
point of entry –
performs all RIT
duties
Battalion Chief/ Aide
- Arrives
- Assumes Command
- Evaluates Resources
- Establishes
Command post
- Evaluates exposure
problems
- Directs hose
positioning
- Coordinates Units
- Transmits
Progress reports
- Changes strategy
- Orders, records, and
transmits results of
primary and
secondary searches
- Declares fire under
control
Engine 3/2
ITEM 2.2 - ATTACHMENT 6

399
78 Tasks/Company
Gain/ Force Entry
Advance Line
- scan search fire room
- suppression
Deploy Back-up Line and
protect stairwell
Complete Primary Search
(in combo with Fire Attack)
Search Fire Floor
Search other Floors
Ventilation
(vent for fire or vent for life)
- Horizontal
- Ventilation
Ground Laddering – 2nd story
windows, front and side, for
firefighter means of egress and for
vertical ventilation – 24’/28’ and
roof ladder in case of vertical vent.

Control Utilities
(Interior and exterior)
Conduct Secondary Search
- Search Fire Floors
- Search other Floors
Check for Fire Extension
Open ceiling walls near fire on fire
floor
Check floor above for fire
extension
- wall breech
- ceiling breech
Mechanical Ventilation
Engine 1/3
O/RB
(if officer commits
then he must pass
command)
O/RB
Truck 1/3
O/RB
O/ RB
-
Driver
Driver
Driver (exterior)
O/RB (Interior)
O/RB
Driver
Engine 2/3 Battalion Chief/ Aide Engine 3/3
O/RB
Driver
Driver
Driver
(exterior)
O/RB
Driver
ITEM 2.2 - ATTACHMENT 6

400
79 Tasks/Company
Arrive on Scene
- Arrive/ stop at hydrant
- Position engine
______________
- Layout report
- On-scene report
- Conduct size-up – 360o
lap – incident action plan – offensive
– detail incident (situation report)
- Transmit size-up to responding units
- Transfer command to chief
Establish Supply line
- Hydrant-Drop line (wrap)
- Position engine
- Pump engaged
- 4” straight lay
- ----------------
- Supply attack engine (1 3/4”)
Position attack line
- Flake
- Charge
- Bleed
- Advance
Establish - 2 in – 2 out
(Initial RIT)
Establish RIT
(Dedicated)
Company Protocols: Crew Size of 4
Total on scene = 18
PLUS 4 RIC – 1403 = total 22 needed
Engine 1/4
Driver
Officer
-
Driver
Driver
Driver
RB/Nozzle
LB/Flake
Both advance line
for fire attack
Truck 1/4
-Arrive
- 360 degree lap
Position Truck
D/LB
Engine 2/4
-Dry Lay – 2nd
engine takes
hydrant
Charged
hydrant –
Supply attack
engine
Driver
O/LB/RB—
advance by foot
to get to point of
entry – performs
all RIT duties
Battalion Chief/ Aide
- Arrives
- Assumes Command
- Evaluates Resources
- Establishes
Command post
- Evaluates exposure
problems
- Directs hose
positioning
- Coordinates Units
- Transmits
Progress reports
- Changes strategy
- Orders, records, and
transmits results of
primary and
secondary searches
- Declares fire under
control
Engine 3/4
ITEM 2.2 - ATTACHMENT 6

401
80 Tasks/Company
Gain/ Force Entry
Advance Line
- scan search fire room
- suppression
Deploy Back-up Line and
protect stairwell
Complete Primary Search
(in combo with Fire Attack)
Search Fire Floor
Search other Floors
Ventilation
- Horizontal
- Ventilation
Ground Laddering – 2nd story
windows, front and side, for
firefighter means of egress and for
vertical ventilation – 24’/28’ and
roof ladder in case of vertical vent.

Control Utilities
(Interior and exterior)
Conduct Secondary Search
- Search Fire Floors
- Search other Floors
Check for Fire Extension
Open ceiling walls near fire on fire
floor
Check floor above for fire
extension
- wall breech
- ceiling breech
Mechanical Ventilation
Engine 1/4
RB/LB
Officer – not on line
(if officer commits
then he must pass
command)
O/RB
Truck 1/4
O/RB
Officer and RB
-
Driver and LB
Driver /LB
Driver/LB
(control exterior)
O/RB
(control interior)
O/RB
D/LB
Battalion Chief/ Aide Engine 3/4
O/RB
D/LB
ITEM 2.2 - ATTACHMENT 6

402
81 Tasks/Company
Arrive on Scene
- Arrive/ stop at hydrant
- Position engine
______________
- Layout report
- On-scene report
- Locate Fire
- Conduct size-up – 360o
lap – incident action plan – offensive
– detail incident (situation report)
- Transmit size-up to responding units
- Transfer command to chief
Establish Supply line
- Hydrant-Drop line (wrap)
- Position engine
- Pump engaged
- 4” straight lay
- ----------------
- Supply attack engine (1 3/4”)
Position attack line
- Flake
- Charge
- Bleed
- Advance
Establish - 2 in – 2 out
(Initial RIT)
Company Protocols: Crew Size of 5
D/O/LB/RB/CB Total on scene = 22
PLUS 4 RIC – 1403 = total 26 needed
Engine 1/5
Driver
Officer
-
Driver
Driver
Driver
RB/Nozzle
LB/Flake
CB/ Control
---------------
Advance line for
fire attack
----------------
The Officer
responsibility is
to supervise hose
stretch /monitor
safety and
continually survey
the scene
Truck 1/5
-Arrive
- 360 degree
Size up.

Position Truck
D/LB
Engine 2/5
-Dry Lay – 2nd
engine takes
hydrant
Charged
hydrant –
Supply attack
engine
Driver
Battalion Chief/ Aide
- Arrives
- Assumes Command
- Evaluates Resources
- Establishes
Command post
- Evaluates exposure
problems
- Directs hose
positioning
- Coordinates Units
- Transmits
Progress reports
- Changes strategy
- Orders, records, and
transmits results of
primary and
secondary searches
- Declares fire under
control
Engine 3/4
ITEM 2.2 - ATTACHMENT 6

403
82 Tasks/Company
Establish RIT
(Dedicated)
Gain/ Force Entry
Advance Line
- scan search fire room
- suppression
Insures first line flowing water—
Deploy Back-up Line and protect
stairwell (1 ¾”)
Complete Primary Search
(in combo with Fire Attack)
Search Fire Floor –
Search other floorsVentilation (vent for fire or vent for life) - Horizontal
- Vertical
Ground Laddering – 2nd story
windows, front and side, for
firefighter means of egress and for
vertical ventilation – 24’/28’ and roof
ladder in case of vertical vent.

Control Utilities after search, force
entry, venting and fire extinguished
(Interior and exterior)
Conduct Secondary Search
-Fire Floor
-Primary and secondary search of
entire floor above
Check for Fire Extension
Open ceiling walls near fire on fire
floor
Check floor above for fire
extension
wall breech
ceiling breechMechanical Ventilation
Engine 1/5

RB/LB/CB
Officer – not on
line (if officer
commits then he
must pass
command)
O/RB
Truck 1/5

O/RB/CB
Officer and
RB/CB
Driver and LB
Driver /LB
Driver/LB
(control exterior)

O/RB/CB
(control interior)
D/LB
Engine 2/5
O/LB/RB—
advance by foot
to get to point
of entry –
performs all
RIT duties
Battalion Chief/ Aide Engine 3/5

O/RB/CB
D/LB

O/RB/CB

O/RB/CB
ITEM 2.2 - ATTACHMENT 6

404
83 Appendix E: Statistical Analysis of Time to Task Test DataIdentifying Statistically Significant Differences in Crew Size and Stagger on a Number of Task Timings Using Regression Analyses of Times (Start, End and Duration) on Crew Size and Stagger ITEM 2.2 - ATTACHMENT 6

405
84 Appendix F: All Regression Coefficients
Regression Models of Time to Task (in Seconds) as a Function of Crew Size and Stagger (Standard Errors are in Parentheses underneath coefficients) ITEM 2.2 - ATTACHMENT 6

406
85 All Regression Coefficients (CONTINUED)
Regression Models of Time to Task (in Seconds) as a Function of Crew Size and Stagger (Standard Errors are in Parentheses underneath coefficients) ITEM 2.2 - ATTACHMENT 6

407
86 Regression Models of Time to Task (in Seconds) as a Function of Combined Crew Size and Stagger (Standard Errors appear in Parentheses)
ITEM 2.2 - ATTACHMENT 6

408
87 Regression Models of Time to Task (in Seconds) as a Function of Combined Crew Size and Stagger (CONTINUED) (Standard Errors appear in Parentheses) ITEM 2.2 - ATTACHMENT 6

409
88 The measurements of length, temperature, mass, moisture content, smoke obscuration, and time taken in these
experiments have unique components of uncertainty that
must be evaluated in order to determine the fidelity of the data.

These components of uncertainty can be grouped into two categories: Type A and Type B. Type A uncertainties are those evaluated by statistical methods, such as calculating the standard deviation of the mean of a set of measurements. Type B
uncertainties are based on scientific judgment using all available and relevant information. Using relevant information, the upper and lower limits of the expected value are estimated so that the probability that the measurement falls within these limits is essentially 100 %. After all the component uncertainties of a measurement have been identified and evaluated it is necessary to use them to compute the combined standard uncertainty using the law of propagation of uncertainty (the “root sum of squares”).

Although this expresses the uncertainty of a given measurement, it is more useful in a fire model validation exercise to define an interval for which the measurement will fall within a certain level of statistical confidence. This is known as the expanded uncertainty.

The current international practice is to multiply the combined standard uncertainty by a factor of two (k=2), giving a confidence of 95 %.

Length measurements of room dimensions, openings and
instrument locations were taken using a steel measuring tape with a resolution of 0.02 in (0.5 mm). However, measurement error due to uneven and unlevel surfaces results in an estimated uncertainty of ±

0.5 % for length measurements taken on the scale of room dimensions. The estimated total expanded uncertainty for length measurements is ± 1.0 %.

The standard uncertainty of the thermocouple wire itself is 1.1°C or 0.4 % of the measured value, whichever is greater (Omega 2004).

The estimated total expanded uncertainty associated with type K thermocouples is approximately ± 15 %. Previous work done at NIST has shown that the uncertainty of the environment
surrounding thermocouples in a full-scale fire experiment has a significantly greater uncertainty (Blevins 1999) than the uncertainty inherent with thermocouple design. Furthermore, while a vertical thermocouple array gives a good approximation of the temperature gradient with respect to height, temperatures cannot be expected to be uniform across a plane at any height because of the dynamic environment in a compartment fire.

Inaccuracies of thermocouple measurements in a fire environment can be caused by:

Radiative heating or cooling of the thermocouple bead
Soot deposition on the thermocouple bead which change its mass, emissivity, and thermal conductivity

Heat conduction along thermocouple wires

Flow velocity over the thermocouple bead
To reduce these effects, particularly radiative heating and cooling, thermocouples with smaller diameter beads were chosen. This is particularly important for thermocouples below the interface because the radiative transfer between the surrounding room surfaces will be significantly less uniform than if the thermocouple were in the hot gas layer. It is suggested in [Pitts] that it may be possible to correct for radiative transfer given enough sufficient knowledge about thermocouple properties and the environment.

However, measurements of local velocity and the radiative environment were not taken. Additionally, the probes were located away from the burn compartment walls in order to avoid the effects of walls and corners.

The gas measurement instruments and sampling system used in this series of experiments have been demonstrated to have an expanded (k = 2) relative uncertainty of ± 1 % when compared with span gas volume fractions (Matheson). Given the limited set of sampling points in these experiments, an estimated uncertainty of ± 10 % is being applied to the results.

The potential for soot deposition on the face of the water-cooled total heat flux gauges contributes significant uncertainty to the heat flux measurements. Calibration of heat flux gauges was completed at lower fluxes and then extrapolated to higher values and this resulted in a higher uncertainty in the flux measurement.

Combining all of component uncertainties for total heat flux resulted in a total expanded uncertainty of -24 % to +13 % for the flux measurements.

Prior to experimentation, ten of the wooden pallets used in the fuel packages were randomly selected for measurement. Two measurements were taken, moisture content and mass. Moisture content was measured using a pin-type moisture meter with a moisture measurement range of 6 % to 40% and an accuracy of <0.5 % of the measured value between 6 % and 12 % moisture content. Mass measurements were made with an industrial bench scale having a range of 0kg to 100 kg, a resolution of 0.1 kg and an uncertainty of ± 0.1 kg.

All timing staff were equipped with the same model of digital stopwatch with a resolution of 0.01 seconds and an uncertainty of ± 3 seconds per 24 hours; the uncertainty of the timing mechanism in the stopwatches is small enough over the duration of an experiment that it can be neglected. There are three components of uncertainty when using people to time fire fighting tasks. First, timers may have a bias depending on whether they record the time in anticipation of, or reaction to an event. A second component exists because multiple timers were used to record all tasks. The third component is the mode of the stimulus to which the staff is reacting: audible (firefighters announcing task updates over the radio) or visual (timing staff sees a task start or stop).

Milestone events in these experiments were recorded both audibly and visually. A test series described in the NIST Recommended Practice Guide for Stopwatch and Timer Calibrations found the reaction times for the two modes of stimulus to be approximately the same, so this component can be neglected. Because of the lack of knowledge regarding the mean bias of the timers, a rectangular distribution was assumed and the worst case reaction time bias of 120 ms was used, giving a standard deviation of 69 ms. The standard deviation of the reaction time was assumed to be the worst case of 230 ms. The estimated total expanded uncertainty of task times measured in these experiments is 240 ms.

An additional component of uncertainty exists for the time measurement of the application of water on the fire. In order to measure this time, timing staff were required to listen for radio confirmation that suppressing water had been applied by the interior attack crew. This process required a member of the interior crew to find and manipulate their microphone, wait for the radio to access a repeater, and transmit the message. Because of the lack of APPENDIX G: Measurement Uncertainty
ITEM 2.2 - ATTACHMENT 6

410
89 knowledge about the distributions of time it takes for each part of this process, all parts are lumped into a single estimate of uncertainty and a rectangular distribution is assumed. This is most reasonably estimated to be 2.5 seconds with a standard deviation of ±2.89 seconds and an expanded uncertainty of ± 5.78 seconds.

Weather measurement uncertainty was referenced to the
published user’s manual for the instrumentation used. The weather instrumentation has calibration certificates that are traceable to NIST standards. A summary of experimental measurement
uncertainty is given in Table G-1.

Table G-1: Summary of Measurement Uncertainty
ITEM 2.2 - ATTACHMENT 6

411
90 APPENDIX H: Charts of Gas and Temperature Data
Examples of Gas and Temperature Data for Time-to-Task Tests Burn Room Data
ITEM 2.2 - ATTACHMENT 6

412
91 Target Room Data
ITEM 2.2 - ATTACHMENT 6

413
92 Temperature Near Front Door (Couch )
ITEM 2.2 - ATTACHMENT 6

414
93 Gas and Temperature Data for Room and Contents Tests Examples of Gas Data in Target Room
ITEM 2.2 - ATTACHMENT 6

415
94 Gas and Temperature Data for Room and Contents Tests Examples of Gas Data in Target Room
ITEM 2.2 - ATTACHMENT 6

416
95 Temperatures in Burn Room
ITEM 2.2 - ATTACHMENT 6

417
96 Temperatures in Target Room
ITEM 2.2 - ATTACHMENT 6

418
97 Temperatures Near Front Door (Couch)
ITEM 2.2 - ATTACHMENT 6

419
98 ITEM 2.2 - ATTACHMENT 6

420
99 NOTES:
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ITEM 2.2 - ATTACHMENT 6

421
100
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ITEM 2.2 - ATTACHMENT 6

422
101
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ITEM 2.2 - ATTACHMENT 6

423
102
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ITEM 2.2 - ATTACHMENT 6

424
103
ITEM 2.2 - ATTACHMENT 6

425
ITEM 2.2 - ATTACHMENT 6 Page 104 of 104
426
Lori Moore-Merrell
Rob Santos
Doug Wissoker
Ron Benedict
Nicole Taylor
Randy Goldstein
Greg Mears
Jane Brice
Jason D. Averill
Kathy Notarianni
ITEM 2.2 - ATTACHMENT 7

427
2 ITEM 2.2 - ATTACHMENT 7

428
3 September 2010
Report on
EMS Field Experiments
Lori Moore-Merrell
Rob Santos
Doug Wissoker
Ron Benedict
Nicole Taylor
Randy Goldstein
Jane Brice
Greg Mears
Jason D. Averill
Kathy Notarianni
ITEM 2.2 - ATTACHMENT 7

429
4 Certain commercial entities, equipment, or materials may be identified in this document in order to describe an
experimental procedure or concept adequately. Such
identification is not intended to imply recommendation or endorsement by the partner organizations, nor is it
intended to imply that the entities, materials, or equipment are necessarily the best available for the purpose.

ITEM 2.2 - ATTACHMENT 7

430
5 Produced with the Cooperation of
Montgomery County, Maryland
Fire and Rescue, Department
Chief Richard Bowers
Produced with the Cooperation of
Fairfax County, Virginia
Fire and Rescue Department
Chief Ronald Mastin
Funding provided through DHS/FEMA Grant Program Directorate for FY 2008 Assistance to Firefighters Grant Program – Fire Prevention and Safety Grants (EMW-2008-FP-01603)
ITEM 2.2 - ATTACHMENT 7

431
6 ITEM 2.2 - ATTACHMENT 7

432
7 Table of Contents
Abstract ......................................................................................9 Executive Summary ................................................................10 Primary Findings ....................................................................11 Background ..............................................................................13 Problem ....................................................................................14 Literature Review ....................................................................15 Purpose and Scope of the Study ............................................17 A Brief Overview of an EMS Response ..................................18 The Star of Life ......................................................................18 EMS Response to Time Critical Events ................................19 The Relation of Time-to-Task Completion and Risk ..............19 Standards of Response Cover ..............................................20 Experiment Planning and Methodology ................................20 Department Participation ..................................................20 Crew Orientation................................................................20 Cue Cards ........................................................................20 Tasks ................................................................................20 On Scene EMS Tasks........................................................20 Radio Communication ......................................................21 Task Timers ......................................................................21 Video records ....................................................................21 Crew Assignment ..............................................................21 Props ................................................................................21 Safety Protocols ................................................................22 Response Time Assumptions ............................................22 Part 1: Patient Access and Removal from Incident Scene ..24 Incident Scene ......................................................................24 Tasks ......................................................................................24 Part 2: Trauma Patient ........................................................25 Incident Scene........................................................................25 Tasks ......................................................................................25 Part 3: Cardiac Patient ............................................................27 Incident Scene ......................................................................27 Tasks......................................................................................27 Analysis of Experimental Results ..........................................29 Time-to-Task Analysis ............................................................29 Data Queries..........................................................................29 Statistical Methods ................................................................29 For Access and Removal ..................................................29 For Trauma and Cardiac scenarios ..................................29 Measurement Uncertainty......................................................32 How to Interpret the Time-to-Task Graphs ............................32 Time-to-Task Graphs................................................................33 Part 1- Patient Access and Removal ....................................34 Access ..............................................................................34 Patient Removal ................................................................33 Part 2- Multi-System Trauma ................................................34 Individual Task Times ........................................................35 Patterns in the Trauma Scenario ......................................39 Part 3- Chest Pain and Witnessed Cardiac Arrest ................40 Individual Task Times ........................................................41 Patterns in the Cardiac Scenario ......................................43 Conclusions..............................................................................44 Patient Access and Removal ................................................44 Trauma ..................................................................................44 Cardiac ..................................................................................44 Summary ..................................................................................46 Study Limitations ....................................................................47 Future Research ......................................................................48 Acknowledgements..................................................................49 References ................................................................................50 Glossary ....................................................................................52 Acronynms................................................................................54 Appendix A: Time to Task Measures ........................................55 Appendix B: Trauma Patient Assessment and Interview Form 58 Appendix C: Medical Patient Interview Form............................59 Appendix D: Medical Patient Assessment/Interview Form ......60 Appendix E: Statistical Analysis of Time to Task Data Patient Access and Removal............................................61 Appendix F: Statistical Analysis of Time to Task Data Systemic Trauma Patient ....................................................62 Appendix G: Statistical Analysis of Time to Task Data Cardiac Arrest Patient ......................................................63 Appendix H: All Regression Coefficients ..................................65 Notes ........................................................................................70 ITEM 2.2 - ATTACHMENT 7

433
8 ITEM 2.2 - ATTACHMENT 7

434
9 The fire service has become the first line medical responder for all types of medical emergencies in the majority of the United States. Fire departments typically deliver
first-on-scene, out-of-hospital care services, regardless of whether or not they provide transport. The design of fire
department-based Emergency Medical Services (EMS) systems varies across communities. Some departments deploy only Basic Life Support (BLS) units and personnel, some deploy a mix of BLS and Advanced Life Support (ALS) units and personnel, and a few departments operate solely at an ALS level. Additionally, the number of total personnel dispatched on an EMS call also differs.

This number is dependent on factors such as the type of system resources, the nature of the EMS incident, and the number of simultaneous and concurrent incidents.

For the first time, this study investigates the effects of varying crew configurations for first responders, the apparatus assignment of ALS personnel, and the number of ALS personnel on scene on the task completion times for ALS level incidents. This study is also unique because of the array of stakeholders and the caliber of technical experts involved. Throughout the experiments, all industry standards and safety protocols were followed and robust research methods were used. The results and conclusions will directly inform the NFPA 17101 and NFPA 1720 Technical
Committees, who are responsible for developing industry operational and deployment standards.

This report presents the results of more than 102 field experiments designed to quantify the effects of various fire department-based EMS deployment configurations for three different scenarios—-1) patient access and removal from the incident scene, 2) a victim of systemic trauma due to a long distance fall and 3) a patient with chest pain leading to a cardiac arrest. In addition to systematically controlling for arrival times of units, first responder crew size was varied to consider two-, three-, and four-person staffing. ALS personnel configuration for both the first responder unit and ambulance transport unit were also varied for purposes of the experiments. In each deployment, personnel performed a series of defined tasks consistent with the scenario being evaluated. Report results quantify the effectiveness of crew size, ALS configuration, and the number of ALS personnel on the start, duration, and completion time of all tasks delineated in the three scenarios. Conclusions are drawn from statistically significant results.

Abstract
NFPA is a registered trademark of the National Fire Protection Association, Quincy, Massachusetts.

ITEM 2.2 - ATTACHMENT 7

435
10 Executive Summary
I
ncreasing demands on the fire service, including the rising number of EMS responses, point to the need for
scientifically-based studies on the effect of first responder crew size, Advanced Life Support configuration, and the number of Advanced Life Support (ALS) personnel on scene on the safety of responders, as well as the operational efficiency and effectiveness of fire departments responding to emergency medical incidents.

To address this need, a research partnership of the Commission on Fire Accreditation International (CFAI), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Institute of Standards and Technology (NIST), and Worcester Polytechnic Institute (WPI) was formed to conduct a multiphase study of firefighter safety and the deployment of resources. A portion of that study, as reported here, includes an assessment of time-to-tasks for EMS incidents.

Beginning in FY 2005, funding was provided through the
Department of Homeland Security (DHS)/ Federal Emergency Management Agency (FEMA) Grant Program Directorate for
Assistance to Firefighters Grant Program-Fire Prevention and Safety Grants. In addition to the EMS field experiments described in this report, the multiple phases of the overall research effort include development of a conceptual model for community risk assessment and deployment of resources, implementation of a generalizable department incident survey, and delivery of a software tool to quantify the effects of deployment decisions on resultant firefighter and civilian injuries and on property losses.

The first phase of the project was an extensive survey of more than 400 career and combination (both career and volunteer) fire departments in the United States with the objective of optimizing a fire service leader’s capability to deploy resources to prevent or mitigate adverse events that occur in risk- and hazard-filled environments. The results of this survey are not documented in this report, which is limited to the EMS experimental phase. The survey results will constitute significant input into the development of a future software tool to quantify the effects of community risks and associated deployment decisions on
resultant firefighter and civilian illnesses and injuries.

The National Fire Protection Association estimates that 10,380 EMS workers were exposed to infectious diseases in 2008 (Karter, 2009). Another study noted that almost 10 % of Emergency Medical Technicians (EMTs) and Paramedics miss work at any given time due to job-related illness or injury (Studnek et al, 2007).

Another study noted that injury rates for EMS workers are higher than rates reported by the Department of Labor (DOL) for any other industry in 2000 (Maguire et al, 2005) and another study noted that EMS providers have a high risk for occupational injury, with approximately 25 % of workers reporting at least one work-related injury in the previous six months. Many of these injuries were the result of falls or lifting patients (Heick, 2009).

Funding and additional research are critical to further defining the high risks to firefighters during EMS responses and developing interventions to mitigate this serious problem.

In order to address the primary research questions using realistic scenarios, the research was divided into three distinct, yet interconnected parts.
 Part 1 — Time-to-task experiments related to gaining access to a patient and removing the patient from the
incident scene.
 Part 2 — Time-to-task experiments related to the care of a victim with multi-system trauma.
 Part 3 — Time-to-task experiments related to the care of a victim with chest pain and witnessed cardiac arrest.

These parts included the most basic elements of an overall EMS response, which are — access the patient, conduct patient assessment, deliver on scene patient care, package the patient, and remove the patient from the scene to a transport-capable vehicle.

Scope
The EMS portion of the Firefighter Safety and Deployment of Resources Study was designed solely to assess the personnel number and configuration aspect of an EMS incident for
responder safety, effectiveness, and efficiency. This study does not address the efficacy of any patient care intervention. This study does however quantify first responder crew size, i.e., the number and placement of ALS trained personnel resources on the time-to-task measures for EMS interventions. Upon
recommendation of technical experts, the investigators selected trauma and cardiac scenarios to be used in the experiments as these events are resource intensive and will likely reveal relevant differences in regard to the research questions. The applicability of the conclusions from this report to a large-scale hazardous or multiple-casualty event has not been assessed and should not be extrapolated from this report.

EMS protocols pertaining to the treatment and transport of patients vary by departments. For the purpose of this study, apparatus arrival times and on scene tasks were standardized by technical experts. Individual performance times were recorded for each task. Response data from more than 300 United States Fire Departments show that when dispatched simultaneously, a first responder arrives prior to an ambulance in approximately 80 % of EMS responses, (IAFC/IAFF, 2005). Therefore, arrival times of the first responder engine and the ambulance were staggered.

Additionally, in real-world situations, as in this study, many of the tasks can be performed simultaneously based on the number and training level of responding personnel. Attempts to generalize the results from these experiments to individual departments must take into account response and patient care protocols and equipment that may vary from those used in the experiments.

ITEM 2.2 - ATTACHMENT 7

436
11 Primary Findings
The objective of the experiments was to determine how first responder crew size, ALS provider placement, and the number of ALS providers is associated with the effectiveness of EMS providers. EMS crew effectiveness was measured by task
intervention times in three scenarios including patient access and removal, trauma, and cardiac arrest. The results were evaluated from the perspective of firefighter and paramedic safety and scene efficiency rather than as a series of distinct tasks. More than 100 full-scale EMS experiments were conducted for this study.

Hundreds of firefighters and paramedics are injured annually on EMS responses. Most injuries occur during tasks that require lifting or abnormal movement by rescuers. Such tasks include lifting heavy objects (including human bodies both conscious and unconscious), manipulating injured body parts and carrying heavy equipment. Several tasks included in the experiments fall into this category, including splinting extremities, spinal immobilization (back boarding) and patient packaging. Similar to the lifting or heavy workload tasks, larger crews were able to complete the labor intensive tasks using multiple crew members on a single task to assure safe procedures were used reducing the likelihood of injury or exposure.

A number of tasks are also labor intensive. These tasks can be completed more efficiently when handled by multiple responders.

Several tasks in the experiments are in this category. These include checking vital signs, splinting extremities, intubation with spinal restriction, establishing I.V. access, spinal immobilization, and patient packaging. During the experiments larger crews completed these tasks more efficiently by distributing the work load among more people thereby reducing the likelihood of injury.

Finally, there are opportunities on an EMS scene to reduce scene time by completing tasks simultaneously rather than sequentially thus increasing operational efficiency. For the experiments, crews were required to complete all tasks in each scenario regardless of their crew size or configuration. Therefore, patterns in task start times and overall scene times reveal operational efficiencies.

When enough hands are available at the scene to complete tasks simultaneously, this leads to overall time reductions relative to smaller crews that are forced to complete tasks sequentially.

Patient Access and Removal
With regard to accessing the patient, crews with three or four first responders reached the patient around half a minute faster than smaller crews with two first responders. With regard to completing patient removal, larger first responder crews in conjunction with a two-person ambulance were more time
efficient. The removal tasks require heavy lifting and are labor intensive. The tasks also involve descending stairs while carrying a patient, carrying all equipment down stairs, and getting patient and equipment out multiple doors, onto a stretcher and into an ambulance.

The patient removal results show substantial differences associated with crew size. Crews with three- or four-person first responders complete removal between 1.2 – 1.5 minutes faster than smaller crews with two first responders. All crews with first responders complete removal substantially faster (by 2.6 - 4.1 minutes) than the ambulance-only crew.

These results suggest that time efficiency in access and removal can be achieved by deploying three- or four-person crews on the first responding engine (relative to a first responder crew of two).

To the extent that each second counts in an EMS response, these staffing features deserve consideration. Though these results establish a technical basis for the effectiveness of first responder crews and specific ALS crew configurations, other factors contributing to policy decisions are not addressed.

Trauma
Overall, field experiments reveal that four-person first responder crews completed a trauma response faster than smaller crews.

Towards the latter part of the task response sequence, four-person crews start tasks significantly sooner than smaller crews of two or three persons.

Additionally, crews with one ALS provider on the engine and one on the ambulance completed all tasks faster and started later tasks sooner than crews with two ALS providers on the
ambulance. This suggests that getting ALS personnel to the site sooner matters.

A review of the patterns of significant results for task start times reinforced these findings and suggests that (in general) small non-significant reductions in task timings accrue through the task sequence to produce significantly shorter start times for the last third of the trauma tasks.

Finally, when assessing crews for their ability to increase on-scene operational efficiency by completing tasks
simultaneously, crews with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks

2.3 minutes (2 minutes 15 seconds) faster than crews with a BLS engine and two ALS providers on the ambulance. Additionally, first responders with four-person first responder crews completed all required tasks 1.7 minutes (1 minute 45 seconds) faster than three-person crews and 3.4 minutes (3 minutes and 25 seconds) faster than two-person crews.

Cardiac
The overall results for cardiac echo those of trauma. Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks (from at-patient to packaging) more quickly than smaller first responder crew sizes. Moreover, in the critical period following cardiac arrest, crews responding with four first responders also completed all tasks more quickly than smaller crew sizes. As noted in the trauma scenario, crew size matters in the cardiac response.

Considering ALS placement, crews responding with one ALS provider on both the engine and ambulance completed all scene tasks (from at-patient to packaging) more quickly than a crew with a BLS engine and two ALS providers on the ambulance. This suggests that ALS placement can make a difference in response efficiency. One curious finding was that crews responding with a BLS engine and an ambulance with two ALS providers completed the tasks that follow cardiac arrest 50 seconds sooner than crews with an ALS provider on both the engine and ambulance. As noted, this counter-intuitive difference in the results may be attributable to the delay of the patient arrest time based on the arrival of the 12-Lead ECG monitor with the two-person ALS Ambulance crew. The 12-Lead ECG task end time was the arrest start time. In this scenario, there were instantaneously two ALS providers present at the arrest rather than the one ALS provider placing the 12-Lead ECG device in the ALS engine /ALS
Ambulance crew.

ITEM 2.2 - ATTACHMENT 7

437
12 A review of the patterns of significant findings across task start times showed mixed results. An ALS on an engine showed an advantage (sooner task starting times) over an ALS on an ambulance for a few tasks located earlier in the cardiac response sequence (specifically, ALS Vitals 12-Lead through IV access). A first responder with four-person crew also showed shorter start times for a few early tasks in the cardiac response sequence (initial airway, breathing and circulation (ABCs), and the ALS Vitals 12-Lead and expose chest sequence). More importantly, a sequential time advantage appears for the last three tasks of the sequence (analyze shock #2 through package patient).

Finally, when assessing crews for their ability to increase on-scene operational efficiency by completing tasks
simultaneously, crews with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks 45 seconds faster than crews with a BLS engine and two ALS providers on the ambulance. Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks from the ‘at patient time’ to completion of packaging 70 seconds faster than first responder crews with three persons, and 2 minutes and 40 seconds faster than first responder crews with two persons. Additionally, after the patient arrested, an assessment of time to complete remaining tasks revealed that first responders with four-person crews completed all required tasks 50 seconds faster than three-person crews and 1.4 minutes (1 minute 25 seconds) faster than two-person crews.

Summary
While resource deployment is addressed in the context of three basic scenarios, it is recognized that public policy decisions regarding the cost-benefit of specific deployment decisions are a function of many factors including geography, resource
availability, community expectations as well as population demographics that drive EMS call volume. While this report contributes significant knowledge to community and fire service leaders in regard to effective resource deployment for local EMS systems, other factors contributing to policy decisions are not addressed. The results, however, do establish a technical basis for the effectiveness of first responder crews and ALS configuration with at least one ALS level provider on first responder crews. The results also provide valid measures of total crew size efficiency in completing on-scene tasks some of which involve heavy lifting and tasks that require multiple responders to complete.

These experimental findings suggest that ALS provider
placement and crew size can have an impact on some task start times in trauma and cardiac scenarios, especially in the latter tasks leading to patient packaging. To the extent that creating time efficiency is important for patient outcomes, including an ALS trained provider on an engine and using engine crew sizes of four are worth considering. The same holds for responder safety – for access and removal and other tasks in the response sequence, the availability of additional hands can serve to reduce the risks of lifting injuries or injuries that result from fatigue (e.g., avoid having small crews repeatedly having to ascend and descend stairs).

ITEM 2.2 - ATTACHMENT 7

438
13 I
n recent years, the provision of emergency medical services has progressed from an amenity to a citizen-required service. Today more than 90 % of career and combination fire departments deliver emergency medical care services, making fire departments the largest group of providers of prehospital EMS in North America. Fire department operations are geared to rapid response, whether it is for EMS, resuce, or fire suppression. In many jurisdictions, EMS responses equate to over 75 % of a fire departments call volume. EMS deployment decisions are
therefore a critical driving factor for any department considering both short and long term resource deployment decisions.

The National Fire Protection Association estimates that 10,380 EMS workers were exposed to infectious diseases in 2008 (Karter, 2009). Another study noted that almost 10 % of EMTs and Paramedics miss work at any given time due to job-related illness or injury (Studnek et al, 2007). Another study noted that injury rates for EMS workers are higher than rates reported by the Department of Labor (DOL) for any other industry in 2000 (Maguire et al, 2005) and another study noted that EMS providers have a high risk for occupational injury, with approximately 25 % of workers reporting at least one work-related injury in the previous 6 months. Many of these injuries were the result of falls or lifting patients (Heick, 2009). Funding and additional research are critical to further quantifying the high risks to firefighters during EMS responses and developing interventions to mitigate this serious problem.

Much discussion and past research has focused on ambulance transport services, largely ignoring the impact of critical interventions that can be provided prior to ambulance transport unit arrival. Ambulances are important for the transport of patients needing more definitive medical care (Pratt, 2007).

However, based on the number and the geographic distribution of apparatus stationed for “all hazards” response, a more rapid response is typically provided by fire department baseline units carrying medical supplies and EMS trained personnel
(IAFC/IAFF, 2005). As fire departments continue to enhance their roles in EMS, it becomes important to examine how different deployment configurations and initiation of specific medical interventions may change the long-term outcome for the patient. Consequently, community planners and decision-makers need tools to optimally align resources with their service commitment for adequate emergency medical care for citizens.

Background
ITEM 2.2 - ATTACHMENT 7

439
14 Despite the role played by the fire service in the provision of emergency medical services, there are no scientifically based tools available to community and fire service leaders to assess the effects of EMS crew size and deployment on firefighter safety. More and more individuals, including the indigent, the working uninsured, and the underinsured, rely on prehospital medical care, which continuously increases the need for EMS resources in fire departments. The continued lack of comprehensive community health services and comprehensive health care reform means addressing this issue is a critical step in the evolution of the fire service and public safety.

Presently, community and fire service leaders have a qualitative understanding of the effect of certain resource allocations. For example, an increase in the number of fire houses, medically equipped apparatus, and EMS trained personnel would lead to a decrease in the time citizens spend waiting for EMS resources to arrive. Consequently a decrease in the number of fire houses, medically equipped apparatus, and EMS trained personnel would likely lead to an increase in the time before critical medical interventions can be provided. However, decision-makers lack a sound basis for quantifying the overall impact of enhanced emergency medical resources and the number of EMS-trained personnel on the timely provision of life-saving procedures.

Studies on adequate deployment of resources are needed to enable fire departments, cities, counties, and fire districts to design an acceptable level of resource deployment based upon community risks and service provision commitment. These studies will assist with strategic planning and municipal and state budget processes. Additionally, as resource studies refine data collection methods and measures, both subsequent research and improvements to resource deployment models will have a sound scientific basis.

Problem
ITEM 2.2 - ATTACHMENT 7

440
15 Literature Review
Within the past four decades, the range and structure of services provided by firefighters have broadened and
changed dynamically as an ever-increasing amount of
department resources are used to respond to emergency medical calls. Expanded activities and increased expectations bring advantages, as well as challenges for both communities and fire departments in terms of providing optimal protection during emergency situations, while quantitatively assessing objective systems performance.

Studies documenting engine and ladder response times and crew performance in diverse live and simulated fire hazard
environments, show a relationship between apparatus staffing levels and a range of important performance variables and outcome measurements such as response time, time-to-task completion, fire growth status at the time of attack, and occupant toxicity levels (Averill et al, 2010). Recent analyses of EMS crew staffing configuration have suggested that both the number of personnel dispatched per unit and the level of emergency medical certification of that crew may influence similar standards of measurement in the realm of medical response by multi-role firefighters. (Brown et al, 1996)
The rapid evolution of emergency service delivery and the growth of fire-based EMS systems correspond with an increase in literature that has detailed both the need for careful outcomes evaluation and continued innovation in terms of establishing performance variables that accurately assess the effectiveness of prehospital care provided by emergency medical technicians (EMTs). Investigators from government, professional
organizations, and academia have described the progress made in the field of prehospital care and the challenges that EMT’s and multi-role firefighters face in an expanding body of literature (Moore, 2002).

Publications to date have continually reached towards
ascertaining the performance measures, operational protocols, and dispatch configurations that optimize outcomes across diverse communities. Many of the currently established EMS benchmarks and obstacles identified in recent literature hold particular importance for multi-role firefighters. Far-reaching studies of EMS response have demonstrated how response time, scene time, transport time, crew size, equipment, and the level of crew staffing and certification levels have influenced patient survival (Cummins et al, 1991). While studies have continued to demonstrate the impact of these factors with increasingly sophisticated methods, the need to improve understanding of EMS delivery persists. Existing standards of care need to be reevaluated so current systems can adjust and progress in response to ongoing research findings.

Historically, total response time has been measured from the time a responding unit leaves a fire station until the time the unit arrives at the incident. However, anecdotal evidence suggests that total response time should include the time to locate and access the patient (time to patient side). Previous studies have shown a substantial time difference between the time the first responder arrives on-scene and the time of patient access. One study noted that the patient access time interval represented 24 % of the total EMS response time interval among calls originating less than three floors above or three floors below ground and 32 % of those located three or more stories above ground. (Morrison et al, 2005) Early literature on out-of-hospital cardiac arrest (OHCA) sought to uncover the effects of patient characteristics and location of initial collapse on survival to hospital discharge, with researchers then beginning to quantify the importance of response time. A paper by researchers from the EMS Division of King County, Washington and University of Washington
Departments of Medicine and Biostatistics found significantly higher survival rates for patients who arrested outside the home, noting that of those 781 patients, most were more frequently younger, male, and more likely to be witnessed at the time of collapse and had received bystander cardiopulmonary
resuscitation (CPR). (Litwin et al, 1987)
A growing number of defibrillation effectiveness studies began to demonstrate that response time, EMT training and practice, and population density influenced the effectiveness of this type of EMS delivery. (Olson, 1989; Kellerman, 1992; Hallstrom, 2004; DeMaio, 2005) For an urban environment exceeding three
million, at least one study noted that over a period of one year, survival rates were lower in urban environments than those reported for smaller cities, but reaffirmed that the single factor most likely contributing to poor overall survival was a relatively long interval between collapse and defibrillation. In their conclusions, the authors recommended the use of standardized terms and methodology and stressed that “detailed analysis of each component of the emergency medical services systems will aid in making improvements to maximize survival of
out-of-hospital cardiac arrest.” (Becker, 1991)
Researchers studying patient outcomes following traumatic brain injury (TBI) were employing the specific anatomic, physiologic, and age characteristics of patients to formulate methods that would evaluate the effectiveness of trauma care.

The “Trauma and Injury Severity Scores” (TRISS) method was one such system that generated scores for patients based upon systolic blood pressure, capillary refill, respiratory rate, and respiratory expansion. These scores provided a means of accurate analysis for EMS performance for cases of TBI, just as situational characteristics for OHCA, such as location of collapse, collapsing rhythm, and time to initial call were being used to gauge the effectiveness of emergency medical interventions for patients in distinct crisis scenarios. For instance, the correlation between age and predicted mortality for patients with comparable Trauma and Injury Severity Scores in an early study of the TRISS method suggested that a significantly narrower margin of effectiveness exists for seriously injured patients age 55 years or older. (Boyd, 1987)
Fire departments have long grappled with the most appropriate dispatch and notification configurations for EMS systems in different communities. Analyses have focused on comparisons of “one-tier” versus “two-tier” notification systems. “One-tier” systems require ALS units to respond to and transport all calls. In 2 “Multi-role” is a term given to firefighters cross-trained in a number of related emergency services fields, such as EMS, hazardous materials response, and technical rescue.

ITEM 2.2 - ATTACHMENT 7

441
16 a “two-tier” system, ALS units are allowed to delegate varying degrees of responsibility for response and transport to BLS units.

Two studies appearing in the Annals of Emergency Medicine in the same year examined the response capacity and performance measures for a broad sample of urban EMS systems with regard to dispatching protocols and notification systems. (Sweeney, 1998; Chu, 1998) Reviewing previously published studies on 39 emergency medical services programs from 29 different locations from 1967 to 1988, researchers focusing specifically on cardiac arrest and resuscitation outcomes noted survival rates to be higher for two-tiered systems where both a paramedic and either an EMT or EMT-D were dispatched to calls, as compared to survival rates for one-tier systems where dispatches were exclusive for an EMT, EMT-D, or paramedic. This analysis also showed rates of survival to hospital discharge to be slightly higher for patients with a collapse rhythm of ventricular fibrillation, which suggested that the earlier CPR initiation possible in two-tier configurations was a primary means to the higher survival rates in these systems (Eisenberg et al., 1990).

In an article that plotted responses to an EMS system
configuration survey against Code 3 (“lights and sirens”) response times to emergency calls, investigators identified three different types of “two-tier” configurations. In the first two-tier system, ALS units responded to all calls but once on-scene could turn a patient over to a BLS unit for transport. In the second two-tier model, ALS units did not respond to all calls and BLS units could be sent for noncritical calls. In the final two-tier configuration, a non-transport ALS unit was dispatched with a transporting BLS unit with ALS personnel joining BLS personnel for transport on all ALS calls. After reviewing survey responses from EMS systems in 25 mid-sized cities with populations of 400,000 to 900,000, researchers suggested that a two-tier response system that permitted dispatch of BLS units for noncritical calls would allow a given number of ALS units to serve a much larger population while still maintaining rapid Code 3 response times (Braun et al, 1990).

The emergence of the “chain of survival” concept in the prehospital treatment of cardiac arrest merged the effectiveness of specific EMS interventions for individual patient characteristics and the level of qualification of staffing on emergency apparatus as standards of measurement within a system-wide scheme of performance evaluation. In a statement explaining the chain of survival and detailing its components, researchers argued that time to recognition of OHCA, EMS system activation, initiation of CPR, defibrillation, intubation, and intravenous administration of medications were successive, distinct factors that directly influenced outcomes of sudden cardiac arrest and should therefore be used inclusively as measurements of overall performance for EMS systems. The authors presented a thorough review of past literature and noted that while a small number of urban EMS systems approached the then-current practical limit for survivability from sudden cardiac arrest, most EMS systems in the U.S. and other countries had defects in their chain, as demonstrated by a near universal preponderance of poor
resuscitation rates. This paper was notable for describing the research supporting each “link” in the chain or performance measurement of EMS system effectiveness and recommending specific actions to improve each area, thereby strengthening the chain of survival. Moreover, researchers suggested that communities implementing two-tier, double response systems might show optimal improvements in survival rates, as reports on EMT-D systems showed small response times but restricted intervention methods while ALS-only systems recorded longer response times with more advanced treatment options (Cummins et al, 1991).

Time-to-task measurements that have more recently been
formulated into the “chain of survival” model for sudden cardiac arrest have been widely accepted as measurements of fire crews’ performance. The continuous patient care and vigilant
monitoring of vitals advocated in most EMS models are duties that multi-role firefighters are distinctly well-equipped to perform, especially in emergency situations requiring both fire suppression and emergency medical response. Critical thinking, strategic teamwork, and ongoing, immediate priority assessments during emergency situations are all skills taught and regularly instilled by training and routine evaluation for multi-role firefighters.

In light of the existing literature, there remain unanswered questions about the relationship between resource deployment levels, in terms of first responder crew size and EMS training levels, and the associated task performance during EMS incidents.

For the first time, this study investigates the effects of varying crew configurations for first responders, the apparatus assignment of ALS personnel, and the number of ALS personnel on scene on the task completion for ALS level incidents. This study is also unique because of the array of stakeholders and technical advisors involved. All industry standards and safety protocols were followed, and robust research methods were used. The results and conclusions will directly inform the NFPA 1710 Technical Committee, who is responsible for developing industry standards associated with the deployment of fire suppression operations, emergency medical operations, and special operations to the public by career fire departments.

ITEM 2.2 - ATTACHMENT 7

442
17 This project systematically studies deployment of fire department-based EMS resources and the subsequent effect on the ability to provide an efficient and effective response.

It will enable fire departments and city/county managers to make sound decisions regarding optimal resource allocation to meet service commitments using the results of scientifically based research. Specifically, the EMS field experiments provide quantitative data on the effects on varying crew size
configurations, ALS personnel placement, and the number of ALS personnel available on ALS level incidents.

The first phase of the multiphase project was an extensive survey of more than 400 career and combination fire departments in the United States with the objective of optimizing a fire service leader’s capability to deploy resources to prevent or mitigate adverse events that occur in risk- and hazard-filled environments.

The results of this survey are not documented in this report, which is limited to the experimental phase of the project, but they will constitute significant input into future applications of the data presented in this document.

In order to address the primary research questions using realistic scenarios, the research was divided into three distinct, yet interconnected parts.
 Part 1- Time-to-task experiments related to gaining access to a patient and removing the patient from the incident scene.  Part 2- Time-to-task experiments related to the care of a victim with multi-system trauma.
 Part 3- Time-to-task experiments related to the care of a victim with chest pain and witnessed cardiac arrest.

These parts included the most basic elements of an overall EMS response and included time for personnel to access the patient, conduct patient assessment, deliver on-scene patient care, package the patient, and remove the patient from the scene to a transport-capable vehicle.

The EMS portion of the Firefighter Safety and Deployment of Resources Study was designed to assess the labor aspect of an EMS incident necessary to ensure safe, effective, and efficient operations. While studies have shown a relationship between response time and efficiency of patient care intervention, this project has no direct measures. This study does however quantify the effects of first responder crew size and ALS trained personnel resources on time-to-task for EMS interventions. The
applicability of the conclusions from this report to a large-scale hazardous or multiple-casualty event has not been assessed and should not be extrapolated from this report.

EMS protocols pertaining to the treatment and transport of patients vary by departments. For the purpose of this study, tasks were standardized by technical experts and individual times were recorded for each task. In real-world situations, as in this study, many of these can be performed simultaneously based on the number and training level of responding personnel. Attempts to generalize the results from these experiments to individual departments must take into account protocols and equipment that vary from those used in the experiments.

Purpose and Scope of the Study
ITEM 2.2 - ATTACHMENT 7

443
18 Considering the setting and the circumstances of emergency medical care delivery, the prehospital 9-1-1 emergency
care patient should be considered a distinct type of patient in the continuum of health care. These patients not only have medical needs, but they may also need simultaneous physical rescue, protection from the elements and the creation of a safe physical environment, as well as management of non-medical surrounding sociologic concerns (Pratt et al., 2007).

Interdependent and coordinated activities of all personnel are required to meet the priority objectives.

NFPA 1710: Standard on Fire Department Operations, Emergency Medical Operations, and Special Operations to the public by Career Fire Departments specifies that the number of on-duty EMS providers must be sufficient relative to the level of EMS provided by the fire department, and be based on the minimum levels needed to provide patient care and member safety.3 NFPA Standard 1710 also recommends that personnel deployed to ALS emergency responses include a minimum of two members trained at the emergency medical technician-basic level and two members trained at the emergency medical technician-paramedic level, arriving at the scene within the established time frame of two hundred and forty seconds (four minutes) or less for BLS units and four hundred and eighty seconds (eight minutes) or less for ALS units provided that a first-responder with Automated External Defibrillator (AED) or BLS unit arrived in two hundred forty seconds (four minutes) or less travel time, or at the minimum levels established by the authority having jurisdiction.4
During each EMS experiment, a first responder unit and an ambulance transport unit was dispatched to the scene. Crew size for the first responder unit and ALS configuration for both the first responder unit and ambulance transport unit were varied for purposes of the experiments. There were three specific scenarios to which personnel responded.
 Patient access and removal from incident site
 Systemic trauma/fall victim
 Chest pain/cardiac arrest
Important time intervals typically not measured by EMS systems are “time to patient access” and the “time to patient removal” intervals. These intervals include the time it takes personnel with equipment to locate and access the patient and the time it takes personnel to remove the patient and equipment from the incident scene to the ambulance for transport. These intervals are critically important to calculating overall scene time, particularly in scenarios where the patient is not immediately accessible (high-rise buildings, commercial complexes, schools, etc.).

The Star of Life
The elements comprising an EMS incident are symbolized by the Star of Life.5 The six branches of the star are symbols of the six main tasks executed by rescuers throughout an emergency medical event.

Figure 1: The Star of Life
The six branches of the star include the elements listed below.  Detection: Citizens must first recognize that an emergency exists and know how to contact the emergency response
system in their community. This can be done using several different methods such as dialing 9-1-1, dialing a seven digit local emergency number, using amateur radios, or call boxes. Reporting: Upon accessing a call center, callers are asked for specific information so that the proper resources can be sent. In an ideal system, certified Emergency Medical Dispatchers (EMDs) ask a pre-defined set of questions. In this phase, dispatchers also become a link between the scene and the responding units and can provide additional information as it becomes available.  Response: This branch identifies the response of emergency crews to the scene. The response may include an engine with firefighters trained as EMT’s followed by an ambulance
carrying additional firefighter/EMT’s or it may be a fire engine first responder crew followed by an ambulance
carrying single role EMS personnel.
 On scene care: Definitive care is provided on the scene by the emergency response personnel. Standing orders and radio or cellular contact with an emergency physician has broadened the range of on scene care that can be provided by EMS
responders. A long algorithm of procedures and drugs may be used before the patient is removed from the scene.
 Care in Transit: Emergency personnel transport the patient to the closest appropriate medical care facility for definitive care.

During transport, patient care/treatment is continued.
 Transfer to Definitive care: Emergency crews transfer the patient to the appropriate specialized care facility. Transfer includes providing a detailed written report of the patient assessment and care provided on-scene and in-transit.

A Brief Overview of the EMS Response
3 NFPA 1710, Section 5.3.3.2.1: On duty EMS units shall be staffed with the minimum personnel necessary for emergency medical care relative to the level of EMS provided by the fire department.
4 NFPA 1710, Section 5.3.3.3.4: Personnel deployed to ALS emergency responses shall include a minimum of two members trained at the emergency medical technician-paramedic level and two members trained at the emergency medical technician-basic level arriving on scene within the established travel time. 5 Designed by Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration (NHTSA) in 1977.

ITEM 2.2 - ATTACHMENT 7

444
19 EMS Response to Time Critical Events
In a statement explaining the chain of survival and detailing its components, researchers argued that time to recognition of OHCA, EMS system activation, initiation of CPR, defibrillation, intubation, and intravenous administration of medications were successive, distinct factors that directly influenced outcomes of sudden cardiac arrest and should therefore be used inclusively as measurements of overall performance for EMS systems. This paper was notable for describing the research supporting each “link” in the chain or performance measurement of EMS system effectiveness and recommending specific actions to improve each area, thereby strengthening the chain of survival (Cummins et al., 1991).

A typical EMS event, regardless of the nature of the incident, follows a basic script. The first arriving unit performs a scene size-up and initial life safety assessment. The crew then gathers the appropriate equipment from the unit based upon patient injury, illness and location, and accesses and treats the patient.

In an analysis of data from more than 300 U.S. Fire
Departments, first responder units arrived prior to ambulances in approximately 80 % of responses (IAFC/IAFF 2005). This
response capability is likely attributed to the strategic locations of fire stations housing the engines and the fact that engines are often more densely located than ambulance transport units. In some cases, as is the case with motor vehicles accidents with entrapment and some structural collapse incidents, initial responding personnel may need to perform patient treatment and stabilization while performing patient rescue. For these types of incidents, it is necessary to have additional personnel on scene to assist with patient care and removal from the incident scene.

However, even without these major impediments, additional crew members assist with patient care and movement. In the experiments, crew members were used to assist with patient treatment, packaging, removing the patient from the incident location to the ambulance transport unit, repositioning the ambulance transport unit, and other tasks that streamlined the on-scene activity.

The Relation of Time-to-Task
Completion and Risk
Delayed response, combined with inadequate personnel
resources exacerbates the likelihood of negative patient outcomes.

While rapid response is critical to patient survival, the personnel who respond must also be highly competent in patient assessment and stabilizing treatment delivery.

Figure 2 illustrates a hypothetical sequence of events for response to a cardiac arrest (heart attack). A rapid response to an EMS incident is effective only if the personnel arriving on the scene can initiate appropriate emergency medical interventions.

This requires adequate numbers of personnel, as well as appropriate equipment and prior training. Early advanced cardiac life support (ACLS) provided by paramedics at the scene is another critical link in the management of cardiac arrest.

According to industry standards EMS systems should have sufficient staffing to provide a minimum of two rescuers trained in ACLS to respond to the emergency. However, because of the difficulties in treating cardiac arrest in the field, additional responders should be present (AHA, 2005).

The delivery of prehospital care is complex requiring both interpersonal and clinical skills. Firefighter/Paramedics must be able to communicate with patients, bystanders, on scene safety personnel, and hospital personnel. A lack of cooperation in any of these interactions could have a detrimental effect on the patient.

Figure 2:

Hypothetical
Timeline of a
Fire
Department
Response to
an EMS
Incident
ITEM 2.2 - ATTACHMENT 7

445
20 Standards of Response Cover
Developing a standard of response cover (SORC) related to service commitments to the community is a complex task. A SORC includes the policies and procedures that determine the distribution, concentration, and reliability of fixed and mobile resources for response to emergency medical incidents (CFAI, 2009). Fire departments that provide EMS must evaluate existing (or proposed) resources against identified risk levels in the community and against the tasks necessary to provide safe, efficient and effective emergency medical services. EMS risks that must be considered include population demographics such as socioeconomic status, age, ethnicity and health insurance status, as well as population density, community type (urban, suburban, or rural), access to healthcare, and traffic patterns and congestion. In addition to community risks, leaders must also evaluate geographic distribution and depth or concentration of resources deployed based on time parameters established by community expectation, state or local statute or industry standards.

Recognition and reporting of an emergency medical incident begins a chain of events that occur before firefighters arrive at the scene. These events include call receipt and processing, dispatch of resources, donning protective gear, and travel to the scene. NFPA 1710 defines the overall time from dispatch to the scene arrival as total response time.

The standard divides total response time into a number of discrete segments, shown in Figure 2.

Arrival of emergency crews on scene is then followed by a sequence of tasks. Depending on the availability of resources available, tasks may be completed simultaneously or sequentially. Knowing the time it takes to accomplish each task with an allotted number of personnel and equipment can be useful in planning resource deployment. Ideally crews should arrive and intervene in sufficient time to prevent patient brain death, excessive blood loss, and minimize pain and suffering with the goal and expectation of transporting and delivering a viable patient to an appropriate medical facility.

Decision-making regarding staffing levels and geographic distribution of resources must also consider times when there are simultaneous events requiring multiple resource deployment into multiple areas of the jurisdiction. There should be sufficient redundancy or overlap in the system to allow for simultaneous incidents and high volume of near-simultaneous responses without compromising the safety of the patient, the public, or firefighters.

Policy makers have long lacked studies that quantify changes in EMS scene performance based on crew sizes and configuration. These experiments were designed to observe the impact of first responder crew size and ALS configuration on the time it takes to execute essential EMS tasks. It is expected that the results of this study will be used to inform the threshold performance objectives to the NFPA 1710 and 1720 Technical Committees.

Experiment Planning and Methodology
The EMS field experiments consisted of three distinct parts:
 Part 1- Time-to-task experiments related to gaining access to a patient and removing the patient from the incident scene.  Part 2- Time-to-task experiments related to the care of a victim with multi-system trauma.
 Part 3- Time-to-task experiments related to the care of a victim with chest pain and witnessed cardiac arrest.

Following is a detailed description of the overall methods used throughout the experiments. Specific information pertaining to each part is presented separately.

The following research questions guided the experimental design of the EMS field experiments documented in this report:
 1. What is the effect of first responder crew size on EMS task times?
 2. What is the effect of ALS personnel placement on EMS task times?  3. What is the effect of the number of ALS trained personnel on EMS task times?
Department Participation
The experiments were conducted in Montgomery County, MD at the Montgomery County Public Safety Training Academy and in Fairfax County, VA at the EMS Simulation Center. Experiments took place during the months of April and May 2009. All experiments took place in daylight between 0800 hours and 1500 hours.

Montgomery County (MD) and Fairfax County (VA) firefighters and paramedics participated in the field experiments. Each day, both departments committed one ALS engine, one ALS ambulance and the associated crews. Firefighters and paramedics were identified and oriented to the experiments. Participants varied with regard to age and experience. The allocation of resources made it possible to conduct back-to-back experiments by rotating firefighters between field work and rehabilitation areas.

Crew Orientation
Daily orientations were conducted. Orientations included a description of the overall study objectives, as well as the actual experiments in which they would be involved. Crews were also oriented to the site layouts and specific scenarios to be conducted.

Cue Cards
Task procedures were standardized for each experiment/scenario.

Technical experts worked with the study investigators to break down crew tasks based on crew size. Task flow charts were then created and customized for the various crew sizes. The carefully designed task flow ensured that the same overall workload was maintained in each experiment, but was redistributed based on the number of personnel available for work.

All tasks were included in each scenario and cue cards were developed for each individual participant in each scenario. For example, a four-person first responder crew would have a cue card for each person on the crew including the driver, officer, and two firefighter/EMTs or paramedics. Cards were color coded by crew size to ensure proper use in each scenario.

Tasks
Tasks were completed specific to each scenario (patient access and removal from incident scene, trauma, and cardiac). Meticulous procedures gathered data to measure key areas of focus such as individual start times, task completion times, and overall scenario performance times. Each task in each scenario was assigned a standardized start and end marker, such as retrieving the key from the Knox Box6 or patient secured with straps to stretcher/cot. All tasks, with the events for measuring start and stop times, are shown in Table 3 through Table 5.
6 A Knox Box, known officially as the KNOX-BOX Rapid Entry System is a small, wall-mounted safe that holds building keys for firefighters and EMTs to retrieve in emergencies. Local fire companies can hold master keys to all such boxes in their response area, so that they can quickly enter a building without having to force entry or find individual keys held in deposit at the station.

ITEM 2.2 - ATTACHMENT 7

446
21 On-Scene EMS Tasks
The on-scene tasks focused on the activities firefighters perform after they arrive on the scene of an emergency medical incident.

A number of nationally recognized EMS experts were consulted during the development of the on scene EMS tasks in order to ensure a broad applicability and appropriateness of task distribution.7 The experiments compared crew performance and workload for typical medical response scenarios using two-, three-, and four-person first responder crews, along with a two-person ambulance crew. In total, 102 experiments were conducted to assess the time it took various crew configurations to complete the overall tasks in Parts 1, 2, and 3. In addition to first responder crew sizes, the experiments assessed the time necessary to access the patient, conduct a patient assessment, deliver on scene patient care, package the patient, and remove the patient from the incident scene to the ambulance. Two scenarios were selected as the basis of Parts 2 and 3. The scenarios included a patient with systemic trauma and a patient with chest pains leading to cardiac arrest.

The experiments also assessed the placement and number of responding ALS-trained personnel. There were 15 crew
configurations considered during the experiments. These included the first responder crew being varied from two-, three-, and four-person crews. Additionally, the first responder crew configuration was varied to include either an all BLS crew or a combination crew containing one firefighter trained at the ALS level. The ambulance crew was held constant at two-persons.

However, the ambulance crew configuration was varied to include two BLS crew members, one BLS and one ALS crew member, or two ALS crew members. Table 1 shows the crew configurations used throughout the experiments.

During the experiment crews dispatched to various scenarios included a first responder crew and ambulance transport unit or a single ambulance transport unit. For those experiments where both an engine company and an ambulance were dispatched, a three-minute stagger time was imposed for each of those trials.

The three minute stagger time was determined from an analysis of deployment data from more than 300 fire departments
responding to a survey of fire department operations conducted by the IAFC and the IAFF (2005). Each experiment containing a specific crew configuration was conducted in triplicate and completed in a randomized order (determined by randomization software) before a test configuration was repeated.

Radio Communication
Interoperability of radio equipment used by both participating departments made it possible to use regular duty radios for communication during the experiments. Company officers were instructed to use radios as they would in an actual incident.

Montgomery County Fire and Rescue Communications recorded all radio interaction as a means of data backup. Once all data quality control measures were complete, the records were then overwritten as a routine procedure.

Task Timers
Ten observers/timers, trained in the use of identical standard stop watches with split-time feature, recorded time-to-task data for each field experiment. To assure understanding on the observed tasks, firefighters were used as timers, each assigned to specific tasks to observe and record the start and end times.

To enhance accuracy and consistency during recording times, the data recording sheets used several different colors for the tasks (see Appendix A). Each timer was assigned tasks that were coded in the same color as the recording sheet. All timers wore high-visibility safety gear on the incident scene.

Video records
In addition to the timers, video documentation provided a backup for timed tasks and for quality control. Cameras were used to record EMS scene activity from varied vantage points.

Observer/timer data were compared to video records as part of the quality control process.

Crew Assignment
Crews from each department that regularly operated together were assigned to work as either a first responder crew or ambulance transport crew in each scenario. Both Fairfax County and Montgomery County crews participated in the experiment.

Crews assigned to each responding company position in one scenario were assigned to another responding company position in subsequent scenarios, with the objective of minimizing learning from one experiment to another. For example, crews in the role of first responder in the morning scenario might be assigned to the ambulance transport crew in the afternoon, thus eliminating learning the exact repetition of a task as a factor in time to completion. Additionally, participating crews from both Montgomery County and Fairfax County were from three
different shifts, further reducing opportunities for participant repetition in any one position.

Props
Crews were assigned specific equipment lists to bring for this scenario. All equipment used was actual working equipment from the units assigned to the scenario. Specific items included in all scenarios were an airway bag, medical bag, oxygen cylinder, ECG monitor defibrillator, cot, and clipboard. Items specific to a particular scenario will be listed in that section of the report, including manikins and a live individual acting as a patient. 7 Technical experts included Greg Mears, Michael McAdams, and Philip Pommerening. More information about the experts is presented in the Acknowledgements later in this report.

First Responder
Engine Company
Ambulance
Transport Unit
ALS Personnel
On-Scene
Total Personnel
On-Scene
N/A 2 BLS 02
N/A 2 ALS 22
N/A 1 BLS/1 ALS 12
2 BLS 2 ALS 24
3 BLS 2 ALS 25
4 BLS 2 ALS 26
1 BLS/1 ALS 1 BLS/1 ALS 24
2 BLS/1 ALS 1 BLS/1 ALS 25
3 BLS/1 ALS 1 BLS/1 ALS 26
2 BLS 1 BLS/1 ALS 14
3 BLS 1 BLS/1 ALS 15
4 BLS 1 BLS/1 ALS 16
1 BLS/1 ALS 2 BLS 14
2 BLS/1 ALS 2 BLS 15
3 BLS/1 ALS 2 BLS 16
Table 1: Crew Configurations for Time-to-Task Experiments ITEM 2.2 - ATTACHMENT 7

447
22 Safety Protocols
Participant safety was a primary concern in conducting the experiments. All participants and experiments complied with guidelines and recommendations as outlined in NFPA 450: Guide for Emergency Medical Services and Systems, NFPA 1500: Standard on Fire Department Occupational Safety and Health Program, and NFPA 1999: Standard on Protective Clothing for Emergency Medical Operations.

A safety officer from the Montgomery County Fire and Rescue Department was assigned to oversee all experiments.

The safety officer ensured all protocols concerning participant safety, under both real and experimental conditions were followed. This included wearing the correct personal protective equipment, vehicle maneuvering, and overall scene safety. The safety officer participated in all orientation activities and daily briefings. The safety officer had full authority to terminate any operation if any safety violation was observed. Radio
communication was always available.

A closely related concern to firefighter safety and readiness to repeat experiments with equivalent performance was adequate rehabilitation. Each “team” of participants had ample time between experiments to rest and rehydrate.

Response Time Assumptions
Response time assumptions were made based on time objectives set forth in NFPA 1710. Time stagger allocations were set by project technical advisors in order to assess the impact of arriving unit time separation on task start and completion times, as well as overall scene time. Table 2 shows the values assigned to the various segments in overall response time.

Figure 3: Safety Officer
Event Occurrence = time zero
60 seconds for recognition and call to 9-1-1
90 seconds for call processing and dispatch
60 seconds for responder turnout
Travel time = first responder engine = 420 seconds post event Ambulance = 600 seconds post event
Table 2: Response Time Assumptions
Figure 4: Ascending Stairs to Access Patient
Figure 5: Carrying Patient Using Stair Chair
Figure 6: Trauma Patient Assessment
Figure 7: Trauma Patient Spinal Immobilization
ITEM 2.2 - ATTACHMENT 7

448
23 Figure 8: Trauma Patient Packaging Figure 9: Loading Patient on to Stretcher for Transport Figure 10: Cardiac Patient Assessment Figure 11: Cardiac Patient Intubation Figure 12: Cardiac Patient I.V. & Medication Admin. Figure 13: Moving Patient for Transport ITEM 2.2 - ATTACHMENT 7

449
24 Historically, total response time has been measured from the time a responding unit leaves a fire station until the time the unit arrives at the incident location. However, some studies suggest that total response time should include the additional time to locate and access the patient. Previous studies have shown a substantial time difference between the time the first responder arrives on scene and the time of patient access.

One study noted that the patient access time interval represented 24 % of the total EMS response time interval among calls originating less than three floors above or three floors below ground and 32 % of those located three or more stories above ground (Morrison et al., 2005).

This study quantifies the time interval from arrival at the incident address until the crew begins the patient assessment, known as “at patient arrival time.” The experiment assumed the patient was on the 3rd floor of a garden style apartment complex with stair access.

This is representative of a typical structure to which firefighters respond in many residential neighborhoods. Patient assessment and treatment were not performed during the patient access and removal experiment. The primary purpose of this part of the experiment was to ascertain patient access and removal times. This part of the experiment was conducted separately from the patient care scenarios in an effort to establish distinctive timelines for patient access and removal separate from the patient care scenarios where on scene time can vary widely based on patient illness or injury.

Incident Scene
Garden Apartment Complex Scenario:

Firefighters from Fairfax County (VA) and Montgomery County (MD) simulated an initial EMS response for a patient with difficulty breathing in a garden style apartment building, represented by Simulation Lab #1 on the grounds of the
Montgomery County Safety Training Academy in Rockville, MD.

Simulation Lab #1 is a seven-story building, consisting of concrete scissor stairwells leading to the top floor of the building. The front of the building was equipped with a Knox Box, which firefighters accessed before entering the building. This task was typical of security access at any apartment complex.

Apparatus and crews were staged approximately 500 ft (150 m) from the Montgomery County Simulation Lab #1. Apparatus responded to the incident location, personnel dismounted and assembled equipment. Equipment included a defibrillator, airway bag, oxygen, and drug bag. Additionally, ambulance crews were required to bring the stair chair for patient packaging and removal. A crew member obtained an access key from the Knox Box and gained entry. Once crews entered the building they proceeded with the equipment to locate the patient on the third floor stairwell landing.

Patient assessment and treatment were not performed in this part of the experiments. In each experiment, the patient was packaged onto a stair chair, and then the patient and equipment were carried down three flights of stairs and out of the building.

The patient was then transferred to a stretcher and loaded into the ambulance for transport.

Tasks
Tasks for the garden apartment scenario for patient access and removal are delineated in Table 3.

Part 1: Patient Access and Removal from Incident Scene
Table 3: Time-to-Task Measures for Garden Apartment
Scenario/Patient Access and Removal
ITEM 2.2 - ATTACHMENT 7

450
Part 2: Trauma Patient
The trauma scenario involved time-to-task experiments focusing on a labor intensive traumatic scenario. In the experiment, a patient had fallen from a 25 ft (7.5 m) ladder at a construction site. This part of the experiment quantified the time intervals for different crew sizes and configurations responding to this event.

Incident Scene
The gymnasium at the Montgomery County (MD) Public Safety Training Academy was used for the trauma experiments. A classroom at the facility was also used for crew orientation and staging. Prior to the start of the experiments, participants were provided with the scenario background. Specifically, the call originated from a construction site that was only accessible by foot.

When cued, crews entered the gym and walked approximately 40 ft (12 m), carrying an airway bag (including suction), oxygen, spinal mobilization equipment, a trauma bag, and a radio and clip board.

The “patient” was a 150 lb (68 kg) training manikin “voiced” when prompted by one of the timers. The patient could answer basic questions until the point in the sequence where the patient lost consciousness. During the scenario, when it became clear that the patient needed to be transported, a backboard was brought into the scene by the ambulance crew. After packaging the patient onto a backboard, the patient and equipment were carried out of the construction site to a waiting stretcher approximately 40 ft (12 m) away.

Tasks
The on-scene tasks focused on the activities firefighters regularly perform after they arrive on the scene of a patient with a traumatic injury. The experiments compared time-to-task performance based on varying crew sizes and ALS configurations.

Forty-five trauma experiments were conducted to assess the time it took various crew sizes and ALS configurations to complete the assigned tasks. Time between arrival of the first responding unit and ambulance transport unit was held constant at three minutes.

The following narrative describes the general sequence of activities in Part 2 of the experiments.

The first responding unit arrived, conducted a size-up and initial life safety assessment of the area, and gathered the appropriate equipment. The crew, with equipment, then proceeded into the construction site and located the patient. The patient was lying supine on the ground. The responders introduced themselves, obtained patient consent to examine and treat, and immediately initiated cervical spinal immobilization precautions and the patient interview. Other crew members then followed Airway, Breathing, and Circulation (A, B, C’s) protocols. During the patient assessment, it was revealed the patient had a head laceration and an angulated fracture of the tibia/fibula (closed) on the right leg. Patient information was recorded on a standardized form created for the experiments and can be seen in Appendix B.

During the scenario, when the backboard straps were secure, the patient went into respiratory arrest. Crews then rechecked vital signs which revealed the patient had stopped breathing. The crew immediately began respiratory arrest protocol including administering a patent patient airway using an endotracheal tube.

Intubation was performed using strict spinal immobilization restriction. With the airway established, the patient was then ventilated using a bag-valve-mask and patient packaging was completed. Crews then carried the patient and all equipment out of the construction site to the waiting stretcher.

Table 4: Time-to-Task Measures for Trauma Scenerio
Movement causes labored breathing = Agonal Respiration
>> Patient Vomits >> Patient Unconscious
25 ITEM 2.2 - ATTACHMENT 7

451
26 Fourteen tasks were completed in the trauma experiments.

Meticulous procedures gathered data to measure key areas of focus, such as individual task start times, task completion times, and overall scenario performance times. Each task was assigned a standardized start and end marker, such as accessing oxygen equipment (start) until the mask was on the patient and oxygen was flowing (stop). The 14 tasks can be seen in Table 4.

ITEM 2.2 - ATTACHMENT 7

452
27 Part 3: Cardiac Patient
The cardiac scenario involved time-to-task experiments
focusing on a labor-intensive medical event, i.e., a patient that experiences a myocardial infarction leading to cardiac arrest. This part of the experiment quantified the time intervals for different crew sizes and ALS configurations responding to the event.

Incident Scene
The cardiac experiments were conducted in a laboratory at the Fairfax County Fire and Rescue Department EMS Simulation Center. The Simulation Center houses classrooms, laboratories, and offices for training of EMT’s and paramedics. Assorted furniture was staged in the laboratory to duplicate a “home” setting. When cued, crews entered the room and proceeded approximately 10 ft (3 m) to the patient. The patient was represented by SimMan® by Laerdal. SimMan® is an adult-sized manikin that can produce vital signs including, a pulse, heartbeat, lung sounds, blood pressure and other signs noted in real humans. SimMan® also had vocal capabilities such as speaking or crying (Laerdal, 2010). SimMan® was operated remotely from a control booth adjacent to the laboratory.

Prior to the start of the experiments, participants were provided with the scenario background. Specifically, the call originated from a private residence and the caller complained of chest pain.

Responders entered the room carrying an airway bag, oxygen, drug bag, and defibrillator. The defibrillator was either an AED and/or a 12-Lead ECG model defibrillator dependent upon the arrival of ALS trained personnel. During the scenario, the patient went into cardiac arrest on cue and crews reacted by changing their path of patient care for chest pain to a more time-critical path of treatment for a pulseless, apneic patient. When crews had completed on-scene patient care tasks, the patient was packaged onto a backboard and stretcher. The patient and all equipment were removed from the room to conclude the experiment.

Tasks
As noted previously, the on-scene tasks focused on the activities firefighters perform after they arrive on the scene of a patient with a cardiac emergency. The experiments compared crew
performance for a typical cardiac scenario using a combination of varying crew sizes and configurations.

Forty-five cardiac experiments were conducted to assess the time it took various crew sizes and configurations to complete the assigned tasks. Time between arrival of the first responding unit and ambulance transport unit was held constant at three minutes.

The following narrative describes the general sequence of activities in Part 3 of the experiments.

The first responding unit arrived, conducted a size-up and initial life safety assessment of the building and gathered the appropriate equipment. The crew, with equipment, then
proceeded to the front door of the patient residence, knocked, and entered. After confirming the scene was safe, patient assessment was begun.

The responders introduced themselves, obtained the
patient’s consent to examine and treat and then proceeded to conduct the patient interview. The patient interview was standardized to include SAMPLE and OPQRST protocols.

Patient information was recorded on a standardized form created for the experiments and can be seen in Appendix C.

During the scenario, on cue, the patient went into cardiac arrest. Upon patient arrest, the crew rechecked the patient’s vital signs which revealed the patient had stopped breathing and had no pulse.

The crew then followed protocol and moved the patient to the floor where they could immediately begin CPR and
prepare to administer defibrillation. Study protocol then followed Advanced Cardiac Life Support guidelines for
patient care (AHA, 2005).

Twenty-two tasks were completed in the cardiac experiments.

Meticulous procedures gathered data to measure key areas of focus, such as individual task start times, task completion times, and overall scenario performance times. Each task was assigned a standardized start and end marker, such as accessing oxygen tank equipment (start) until the mask was on patient and oxygen was flowing (stop). The 22 tasks can be seen in Table 5.

ITEM 2.2 - ATTACHMENT 7

453
28 Table 5: Time-to-Task
Measures for Cardiac
Scenerio
PATIENT ARREST START - Timer cued when task complete
STOP - Witnessed arrest
ITEM 2.2 - ATTACHMENT 7

454
29 This section describes the analytic approaches used to address the research objectives of the study. The statistical methods used to analyze the EMS time-to-task
observations are presented. Then the time-to-task results are reported for EMS responses in three scenarios:
 access and removal of patient;
 a trauma event; and
 a cardiac event.

Time-to-Task Analysis
Time-to-task data were compiled into a database and assessed for outliers and missing entries. As is common in a repeated experiment with many pieces of data to be entered, occasionally data elements were not collected. Missing data occurred in less than 1 % of timing observations. Such instances were reviewed via video and/or radio tapes. Missing data attributable to timer error were replaced by the time observed in the video. Where video and/or radio documentation proved inadequate, missing data were imputed with the mean of the observed corresponding task times from the other two experiments. The extremely low occurrence of missing data and associated imputation should have a negligible impact on the statistical findings in the analyses.

Data Queries
The statistical methods used to analyze the time-to-task data were driven by the principal goals of this research project —- to assess the effect of crew size, ALS placement on the responding crews, and the number of ALS trained personnel in the crew configuration on time-to-task for critical steps in each EMS scenario. The research goal motivated the development of four specific research questions (see Figure 14) that in turn pointed to specific statistical analyses to generate inference and insight.

Statistical Methods
The analysis of the time-to-task data involved a sequence of ordinary least squares regression models. The models relate the experimental outcomes (i.e., various measures of time — start time, completion time, or duration of the task) to key dimensions for each scenario as follows:

For Access and Removal:
 first responder crew size (regardless of ALS placement), and  ambulance-only versus ambulance with first responder engine with varying crew sizes.

For Trauma and Cardiac scenarios:
 presence of an engine at the scene,
 crew size on the first responder engine, and
 placement and number of ALS personnel (on the engine, on the ambulance, or both).

To account for these dimensions in the analyses, indicator variables representing each key dimension were employed. For example, for the trauma and cardiac scenarios there were indicators for the number of first responders on the engine, three indicators of the assignment of ALS personnel to the ambulance or engine, and indicators for the “no engine” scenarios.

Using these indicators, sets of regression equations were developed for the analysis of each scenario. Indicators corresponding to the three scenarios and multiple dimensions listed above were included. For example, when an engine was sent, the number of first responders (two, three, or four) assigned to the engine were varied, as well as the placement of ALS personnel (one ALS on the engine only; one on the ambulance only; two on the ambulance; and one ALS each on the ambulance and engine). When no engine was sent, zero, one, or two ALS personnel were placed on the ambulance.

The regression equations took the form:

Where the xk represented the test conditions such as presence of an engine or placement of ALS personnel, and the dependent variable y represents the observed outcome (e.g., task duration).

The model coefficients from the completed regressions provided direct estimates of the change in time associated with the number of first responders (e.g., four versus two, three versus two), as well as the change in time associated with alternative assignments of ALS personnel. These estimates are generally the same as those obtained by comparing the difference in means across groups.

However, for a small number of outcomes, the estimates differ from those obtained using difference in means by appropriately accounting for data that are missing in particular scenarios.

Table 6 to Table 8 present the list of time-related outcomes that were used to explore effects on outcomes for patient
access/removal, as well as for cardiac and trauma scenarios, respectively. Not all tasks were subjected to testing for this report.

Only substantively critical milestones in the task sequence were considered. For instance, the assembly of equipment and conduct Analysis of Experimental Results
For Response Access & Removal:

1. What are the effects of first responder crew size regardless of ALS placement with respect to:
a. reaching a patient?
b. removing a patient after packaging?
For Cardiac and Trauma Scenarios (task timings measured between arrival at patient to the completion of patient packaging):

1. What is the effect of crew size on EMS task times?

2. What is the effect of ALS personnel placement on EMS task times?

3. What is the effect of the number of ALS trained personnel on EMS task times?

TIME-TO-TASK RESEARCH QUESTIONS
Figure 14: Research Questions for Time-to-Task Experiments ITEM 2.2 - ATTACHMENT 7

455
30 of size-up were not assessed for the Access and Removal scenario.

Instead, the elapsed time from arrival on scene to reaching the patient (as denoted by completing the ascent of stairs) was determined to be of primary importance. Similarly, the elapsed time between packaging patient and the completion of loading the ambulance was assessed rather than individual timings of any task in the sequence between these two major milestones. Similar judicious choices of critical milestones were made in the assessments of trauma and cardiac, and these are depicted in the outcome measures tables.

Although several of the analytic questions of interest can be obtained directly from the model, others require a linear combination of the coefficients. The statistical software (Stata) calculates both the desired combination of coefficients and the measure of statistical significance via t-test.

Table 6:

Outcome
Measures for
Access and
Removal
Scenario by Task
ITEM 2.2 - ATTACHMENT 7

456
31 Table 8:

Outcome
Measures for
Cardiac Scenario
by Task
Table 7:

Outcome
Measures for
Trauma Scenario
by Task
ITEM 2.2 - ATTACHMENT 7

457
32 The objective of the experiments was to determine the relative effects of first responder crew size, ALS provider placement and the number of ALS providers on the effectiveness of the EMS crews relative to key milestones among the task intervention times for each of the three scenarios. The experimental results are discussed below.

Of the various EMS tasks measured during the experiments, those described in the remainder of this section were determined to have significant differences based on the crew configurations studied. Their differential outcomes based on variation of first responder crew size, ALS crew configuration, and the number of ALS level providers on scene, are statistically significant at the 95 % confidence level or better. Times reported in seconds are rounded to the nearest five seconds. As a final technical note, we did not adjust significance levels to take into account the large number of tests being conducted. The observed number of significant results far exceeds what would be expected simply by chance.

Measurement Uncertainty
The measurement of tasks using stopwatch timing has unique components of uncertainly that must be evaluated in order to determine the fidelity of the data. All timers were equipped with the same model of digital stopwatch with a resolution of 0.01s and an uncertainty of + 3s per 24 hr. The uncertainty of the timing mechanism in the stopwatches is small enough over the duration of an experiment that it can be neglected.

There are three components of uncertainty when using people to time the EMS tasks. First, timers may have a bias depending on whether they record the time in anticipation of, or in reaction to an event. Second, multiple timers were used to record all tasks.

Third, the mode of the stimulus to which the timer is
reacting—audible or visual.

Milestone events in the EMS experiments were recorded both audibly and visually. A test series described in the NIST Recommended Practice Guide for Stopwatch and Timer Calibrations noted that reaction times for the two modes of stimulus to be approximately the same, so this component can be neglected.

Based on the assumptions made in the Residential Fireground Experiments (Averill et al., 2010), bias estimated for timer reaction time was determined to be 230 ms as a worst case scenario.

Considering the above, the total estimated combined standard uncertainty is + 3.23 s. The magnitude of uncertainty associated with these measurements has no impact on the statistical inferences presented in this report.

How to Interpret the Time-to-Task Graphs
Figure 15 presents a sample of a time-to-task results graph.

Each crew size/configuration has a bar graphic showing the start time and completion time for the task. Visually, bars start from the left and extend horizontally across the graph based on time expended by various EMS crew configurations. The length of the bar graphic is a visualization of the duration of the task. Longer bars indicate longer duration times. Actual time data are also shown on each bar.

Figure 15: Sample Time-to-Task Graph
ITEM 2.2 - ATTACHMENT 7

458
33 Time-to-Task Graphs
Part 1- Patient Access and Removal
Overall Scene Time (Time to complete all
EMS tasks for Patient Access and Removal)
Access
The crews can differ in the time required to reach the patient (access) and in the time needed for patient removal. To address these tasks, sets of simulations were conducted by varying crew size on the first responding engine. Ambulance crews were held constant at two persons. As noted previously, the arrival times were staggered between the engine and the ambulance. When an ambulance was sent without a first responder engine, for measurement consistency, it was assumed to arrive at the scene at the same time as would an engine (i.e., there is no systematic, built-in delay).

The results for patient access show that two-person first responder crews take longer to reach a patient than configurations with larger crew sizes. Two-person crews finished the patient access tasks approximately half a minute later than larger first responder crews. Moreover, the ambulance crew alone finished with a time between that of the two-person and the larger first responder crews. The ambulance alone result is likely attributed to the removal of the staggered arrival time when first responder crews were not sent. (See Appendix E for the timings by staffing configuration, difference of means and associated t-tests.) Patient Removal
The patient removal results show substantial differences associated with crew size. Crews with two-person first responder crews completed patient removal between (1.2 – 1.5) minutes slower than larger crews, depending on crew size. This is largely the result of work load in carrying equipment, supplies and the patient with fewer crew members. All crews with first
responders completed removal substantially faster (by 2.6 min. -

4.1 min.) relative to the ambulance-only crew. Again, this is largely the result of the difficulty of carrying and loading the patient, as well as the equipment and supplies with only a two-person crew, given that one person must remain with the patient at all times. (See Appendix E)
Figure 16: Patient Removal Time
ITEM 2.2 - ATTACHMENT 7

459
34 Part 2- Multi-System Trauma
Overall Scene Time (Time to complete all
EMS tasks for Trauma Patient)
As previously noted, for the trauma scenario part of the experiments, there was an assumed three minute stagger in arrival between the first responder crew and the ambulance crew.

Crews responding with one ALS provider on the engine and on the ambulance completed all trauma tasks 2.3 minutes (2 minutes and 16 seconds) faster than crews with a BLS engine and an ALS ambulance with two ALS level providers.

Crews responding with four-person first responder crews, regardless of ALS configuration, completed all trauma tasks 1.7 minutes (1 minute and 50 seconds) faster than first responder crews with three persons, and 3.4 minutes (3 minutes and 25 seconds) faster than first responder crews with two persons. This suggests that for trauma scenarios, the more hands available, the easier it is to implement the full portfolio of tasks to be completed.

The statistical tests that correspond to these findings appear in Appendix F. Appendix H shows the original regression coefficient estimates upon which the tests in Appendix F were constructed.

Figure 17: Overall Trauma Scene Time
ITEM 2.2 - ATTACHMENT 7

460
35 Individual Task Times
Oxygen Administration
First responders with four-person crews were able to begin oxygen administration to the patient nearly a full minute (55 seconds) sooner than the three-person crew.

Vital Sign Assessment
First responders with four-person crews were able to begin checking the patient’s vital signs nearly one minute (55 seconds) sooner than a two-person crew. They also completed the check about 80 seconds faster than the two-person crew. First responders with four-person crews were able to begin checking the patient’s vital signs 30 seconds sooner than a three-person crew. To the extent that checking vitals is a critical task in a trauma response sequence, the reduction of half a minute to a minute of time could be seen as an important improvement.

Figure 18: Oxygen Administration Start Time
Figure 19: Vital Sign Assessment Start and Duration
ITEM 2.2 - ATTACHMENT 7

461
36 Wound Bandaging
First responders with three-person crews were able to begin bandaging the patient’s wounds a minute and 40 seconds sooner than first responders with two-person crews. The value of a four-person crew witnessed in the earlier tasks (e.g., checking vitals) did not manifest for this task.

Splint Leg
First responders with four-person crews were able to begin splinting the patient’s leg approximately a minute faster than either the two- or three-person crews. A small advantage of a four-person crew re-emerges at this next step (i.e., following bandaging) in the response task sequence.

Crew configurations with one ALS provider on the first
responding engine and one on the ambulance were able to begin splinting the patient’s leg 40 seconds sooner than crews with two ALS providers on the ambulance.

Figure 20: Wound Bandaging Start Time
Figure 21: Splint Leg Start Time
ITEM 2.2 - ATTACHMENT 7

462
37 Figure 22: Spinal Immobilization Time Airway – Endotracheal Intubation Figure 23: Airway – Intubation Start Time
Spinal Immobilization/ Back board
First responders with four-person crews were able to conduct spinal immobilization/back-boarding of the patient two minutes faster than either two- or three-person crews. No differences were observed based on placement or number of the ALS personnel.

Airway — Endotracheal Intubation
First responders with four-person crews were able to begin securing the patient’s airway using endotracheal intubation two and one-half minutes (2 minutes and 35 seconds) sooner than the two-person crews and two minutes sooner than the three-person crews.

Crew configurations with one ALS provider on the first
responding engine and one on the ambulance were able to begin securing the airway using endotracheal intubation one minute and 25 seconds sooner than crews with two ALS providers on the ambulance.

Additional personnel marginally speed up the intubation procedure. A second ALS person and having more than two persons on the engine each reduce the time of the intubation by half a minute.

ITEM 2.2 - ATTACHMENT 7

463
38 Figure 24: Bag Valve Mask Start Time
Figure 25: Patient Packaging Start and End Times
Bag Valve Mask
First responders with four-person crews were able to begin bag valve mask ventilation after intubation two minutes and 35 seconds sooner than the two–person crews and nearly two minutes (110 seconds) sooner than the three-person crews.

Crew configurations with one ALS provider on the first
responding engine and one on the ambulance were able to begin bag valve mask ventilation after intubation one and one-half minutes (one minute and 29 seconds) sooner than crews with two ALS providers on the ambulance.

Patient Packaging
Additional first responders reduce the times until the start and completion of packaging. First responders with four-person crews were able to begin patient packaging 3.1 minutes (three minutes and 5 seconds) sooner and complete all packaging activities moving toward transport nearly 3.4 minutes (three minutes and 25 seconds) sooner than the two-person crews. In addition, the four-person crews were able to begin patient packaging 1.6 minutes (one minute 35 seconds) sooner and complete all packaging activities moving toward transport 1.7 minutes (one minute 40 seconds) sooner than the three–person crews.

Crew configurations with one ALS provider on the first
responding engine and one on the ambulance were able to begin patient packaging 2.1 minutes (two minutes and 5 seconds) sooner and complete all packaging activities moving toward transport 2.3 minutes (two minutes and 15 seconds) sooner than crews with both ALS personnel arriving on the ambulance. No differences were associated with placement of a single ALS ITEM 2.2 - ATTACHMENT 7

464
39 Table 9: Trauma Scenario Coefficient Direction and Significant Differences provider or with the availability of a second ALS provider.

Patterns in the Trauma Scenario
The preceding presentation focuses on the specific tasks that comprise the overall trauma response sequence. Examination of the collection of findings across tasks, reveals patterns that provide insight into how crew configurations affect trauma response. To examine this, the occurrences of significant differences of elapsed time to start by task were tabulated. Table 9 presents the task sequence and statistically significant differences when comparing ALS placement (Columns A and B) and
contrasting crew sizes (Columns C – E) for the outcome “elapsed time to the start of a task.” Column A shows a clear advantage to placing one ALS on the engine (with one on an ambulance that arrives three minutes later) versus two ALS on a later arriving ambulance. The time advantage manifests in the last third of the task sequence, beginning with splinting the leg. One explanation for this would be that that having an ALS on the engine creates small increments of time that cumulate and finally manifest (at a statistically significant level) beginning with splinting the leg and carrying forward to all subsequent tasks. Another factor may be that certain tasks may be performed concurrently rather than sequentially when enough hands are available at the scene and this leads to overall time reductions relative to smaller crews that are forced to complete some set of tasks sequentially.

No clear pattern emerges for starting time significant differences when contrasting the addition of a second ALS person (Column B). The same appears to be true for comparing the crew sizes of three versus two (see Column C).

On the other hand, distinct patterns are seen in Columns D and E of Table 9 which depict the comparison of four versus two and four versus three crew sizes, respectively. Although there is some evidence of real time savings (as far as elapsed time to start a task) for the middle third of tasks in the sequence (for example between O2 administration and splint leg), a consistent pattern favoring a crew size of four is seen beginning with airway intubation and continuing through patient packaging.

Taken as a whole, Table 9 suggests that while a crew size of four may not consistently produce time savings in the start of tasks initially in the trauma task sequence, there are clear advantages as work progresses, beginning with airway intubation through patient packaging. The same can be seen (beginning earlier with leg splinting) when comparing the start times for one ALS on the engine and one on the ambulance versus two ALS on the
ambulance. No such pattern emerges for the single ALS provider regardless of placement on the engine versus the ambulance.

ITEM 2.2 - ATTACHMENT 7

465
40 Figure 27: Total Cardiac Completion Time
Part 3- Chest Pain and Witnessed
Cardiac Arrest
Overall Scene Time
Crews responding with four first responders, regardless of ALS configuration, completed all cardiac tasks from the “at patient time” 70 seconds faster than first responder crews with three persons, and two minutes and 40 seconds faster than first responder crews with two persons.

Additionally, crews responding with one ALS provider on both the engine and ambulance completed all scene tasks from the “at patient time” 45 seconds sooner than crews with two ALS providers on the ambulance and a BLS engine.

Crews responding with an ALS Engine and a BLS Ambulance completed tasks from “at patient time” two minutes 36 second sooner than crews with a BLS Engine and one ALS provider on the Ambulance.

These results echo the trauma findings.

Due to the nature of the cardiac scenario, where crews began the experiment with a chest pain patient who then went into cardiac arrest (no pulse and no respirations), it was necessary to assess some tasks relative to the time the patient arrested. The arrest was cued from the end time for the 12-Lead ECG task.

Crews responding with four first responders, regardless of ALS configuration, completed cardiac tasks following the patient going into cardiac arrest 85 seconds faster than first responder crews with two persons.

Crews responding with a BLS engine and an ambulance with two ALS level providers completed all cardiac tasks following the patient arrest 50 seconds sooner than crews with an ALS provider on both the engine and ambulance. This counter-intuitive difference in the results may be attributable to the delay of the patient arrest time based on the arrival of the 12-Lead ECG monitor with the two-person ALS Ambulance crew. The 12-Lead ECG task end time was the arrest start time. In this scenario, there were instantaneously two ALS providers present at the arrest rather than the one ALS provider placing the 12-Lead ECG device in the ALS engine /ALS Ambulance crew.

The statistical tests that correspond to these findings appear in Appendix G. Appendix H shows the original regression coefficient estimates upon which the tests in Appendix G were constructed.

ITEM 2.2 - ATTACHMENT 7

466
41 Figure 28: 12-Lead ECG Start Time
Figure 29: IV Access Start Time
Individual Task Times
12-Lead ECG Monitor
Crew configurations with one ALS provider on the first
responding engine and one ALS level provider on the ambulance were able to apply the 12-lead ECG device two minutes and 20 seconds sooner than crews with both ALS providers on the ambulance.

Similarly, crew configurations with one ALS provider on the first responding engine and no medic on the ambulance also were able to apply the 12-lead ECG device two minutes and 20 seconds sooner than crews with no ALS on the first responding engine and a single ALS level provider on the ambulance.

These results may be influenced by the fact that this task can only be administered by ALS level providers. When ALS
personnel are only on the ambulance, the task cannot begin until three minutes after the start of the experiment – the ambulance arrival time built into the experiments. Nonetheless, this finding is noteworthy given that national data show that ambulances typically arrive later than first responder crews.

Only a small difference in the time to begin applying the ECG device was associated with having a second ALS provider on the scene. This is not surprising, as ECG application typically requires a single ALS trained provider. Other ALS tasks later in the sequence show greater significance for having two ALS personnel on scene.

IV Access
Crew configurations with one ALS provider on the first
responding engine and no medic on the ambulance were able to start the procedure for IV access two minutes and 30 seconds sooner than crews with no ALS on the first responding engine and a single ALS level provider on the ambulance. No reductions in the time to IV access were associated with a second ALS on scene.

Although likely a by-product of the three-minute ambulance stagger, this finding is noteworthy because of the typical lag (behind first responders) in the arrival of an ambulance.

ITEM 2.2 - ATTACHMENT 7

467
42 Figure 30: Airway- Intubation After Patient Arrest
Airway- Endotracheal Intubation
Crew configurations with two ALS level providers were able to begin to secure the patient’s airway using endotracheal intubation over a minute (65 seconds) sooner than crew configurations with one ALS provider.

Patient Packaging
Measured from the time of arrest, first responders with four-person crews were able to begin patient packaging one minute sooner and complete all packaging activities moving toward transport one minute and 25 seconds sooner than the two-person crews.

First responders with three-person crews were able to complete all patient packaging activities moving toward transport 50 seconds sooner than the two-person crews, while four-person crews were able to complete all patient packaging activities moving toward transport 85 seconds sooner than the two-person crews.

Crew configurations with two ALS personnel arriving on the ambulance were able to complete all packaging activities, post arrest and move toward transport 50 seconds sooner than crews with one ALS provider on the first responding engine and one on the ambulance.

Figure 31: Patient Packaging Completion After Patient Arrest ITEM 2.2 - ATTACHMENT 7

468
43 Table 10: Cardiac Scenario Coefficient Direction and Significant Differences Patterns in the Cardiac Scenario
As with the trauma analysis, the preceding presentation of findings focused on specific tasks that comprise an EMS cardiac response.

The significant differences of elapsed task start times were tabulated by task and appear as Table 10. The table presents the task sequence and statistically significant differences when comparing ALS placement (Columns A – C) and contrasting crew sizes (Columns D – F) for the outcome “elapsed time to the start of a task.” The results appear mixed. Column A shows that an ALS
provider on an engine has advantages over an ALS provider on an ambulance for start times in earlier tasks – ALS Vitals 12-Lead through IV access. No other ALS provider placement advantages appear for the remainder of the response sequence.

Columns B and C show sporadic task-specific advantages for start times in a few tasks. For example, when comparing crews with one ALS provider on the engine and one ALS provider on the ambulance versus two ALS providers on ambulance, and when comparing crew configurations with two ALS providers
(regardless of placement) to crews with one ALS provider. A Similar sporadic advantage appears when comparing first responder crew sizes of three versus a crew size two.

A pattern similar to that observed with trauma appears when comparing the start times for a first responder crew of four versus a first responder crew of two. The advantage of the four-person crew appears in a few early tasks with at least two tasks being completed sequentially, including the initial ABC’s being completed with the vital sign check, and the 12-Lead ECG being completed with exposing the patient’s chest task. However, comparing these first responder crew sizes, a greater sequential time advantage is revealed for the last three tasks (analyze shock #2 through package patient), as shown in the last three rows of Column E.

ITEM 2.2 - ATTACHMENT 7

469
44 The objective of the experiments was to determine how first responder crew size, ALS provider placement, and the
number of ALS providers is associated with the
effectiveness of EMS providers. EMS crew effectiveness was measured by task intervention times in three scenarios including patient access and removal, trauma, and cardiac arrest. The results were evaluated from the perspective of firefighter and paramedic safety and scene efficiency rather than as a series of distinct tasks. More than 100 full-scale EMS experiments were conducted for this study.

As noted in the literature review, hundreds of firefighters and paramedics are injured annually on EMS responses. Most injuries occur during tasks that require lifting or abnormal movement by rescuers. Such tasks include lifting heavy objects (including human bodies both conscious and unconscious), manipulating injured body parts and carrying heavy equipment. Several tasks included in the experiments fall into this category, including splinting extremities, spinal immobilization (back boarding) and patient packaging. During the experiments larger crews completed these tasks more efficiently by distributing the workload among more people thereby reducing the likelihood of injury.

A number of tasks are also labor intensive. These tasks can be completed more efficiently when handled by multiple responders.

Several tasks in the experiments are in this category. These include checking vital signs, splinting extremities, intubation with spinal restriction, establishing IV access spinal immobilization, and patient packaging. Similar to the lifting or heavy work load task, larger crews were able to complete labor intensive tasks using multiple crew members on a single task to assure safe procedures were used reducing the likelihood of injury or exposure.

Finally, there are opportunities on an EMS scene to reduce scene time by completing tasks simultaneously rather than concurrently thus increasing operational efficiency. Since crews were required to complete all tasks in each scenario regardless of their crew size or configuration, overall scene times reveal operational efficiencies.

Each of these perspectives is discussed below for the patient access/removal scenario, as well as both the trauma and the cardiac scenarios.

Patient Access and Removal
With regard to accessing the patient, crews with three or four first responders reached the patient around half a minute faster than smaller crews with two first responders. With regard to completing patient removal, larger first responder crews in conjunction with a two-person ambulance were more time
efficient. The removal tasks require heavy lifting and are labor intensive. The tasks also involve descending stairs while carrying a patient, carrying all equipment down stairs, and getting patient and equipment out multiple doors, onto a stretcher and into an ambulance.

The patient removal results show substantial differences associated with crew size. Crews with three- or four-person first responders complete removal between (1.2 – 1.5) minutes faster than smaller crews with two first responders. All crews with first responders complete removal substantially faster (by 2.6 min. -

4.1 min.) than the ambulance-only crew.

These results suggest that time efficiency in access and removal can be achieved by deploying three-or four-person crews on the first responding engine (relative to a first responder crew of two).

To the extent that each second counts in an EMS response, these staffing features deserve consideration. Though these results establish a technical basis for the effectiveness of first responder crews and specific ALS crew configurations, other factors contributing to policy decisions are not addressed.

Trauma
Overall, field experiments reveal that four-person first responder crews completed a trauma response faster than smaller crews.

Towards the latter part of the task response sequence, four-person crews start tasks significantly sooner than smaller crews.

Additionally, crews with one ALS provider on the engine and one on the ambulance completed all tasks faster and started later tasks sooner than crews with two ALS providers on the
ambulance. This suggests that getting ALS personnel to the site sooner matters.

A review of the patterns of significant results for task start times reinforced these findings and suggests that (in general) small non-significant reductions in task timings accrue through the task sequence to produce significantly shorter start times for the last third of the trauma tasks.

Finally, when assessing crews for their ability to increase on-scene operational efficiency by completing tasks
simultaneously, crews with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks

2.3 minutes (2 minutes 15 seconds) faster than crews with a BLS engine and two ALS providers on the ambulance. Additionally, first responders with four-person first responder crews completed all required tasks 1.7 minutes (1 minute 45 seconds) faster than three-person crews and 3.4 minutes (3 minutes and 25 seconds) faster than two-person crews.

Cardiac
The overall results for cardiac echo those of trauma. Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks (from at-patient to packaging) more quickly than smaller first responder crew sizes. Moreover, in the critical period following cardiac arrest, crews responding with four first responders also completed all tasks more quickly than smaller crew sizes. As noted in the trauma scenario, crew size matters in the cardiac response.

Considering ALS placement, crews responding with one ALS provider on both the engine and ambulance completed all scene tasks (from at-patient to packaging) more quickly than a crew with a BLS engine and two ALS providers on the ambulance. This suggests that ALS placement can make a difference in response efficiency. One curious finding was that crews responding with a BLS engine and an ambulance with two ALS providers completed the tasks that follow cardiac arrest 50 seconds sooner than crews with an ALS provider on both the engine and ambulance. As noted, this counter-intuitive difference in the results may be attributable to the delay of the patient arrest time based on the arrival of the 12-Lead ECG monitor with the two-person ALS Ambulance crew. The 12 -Lead ECG task end time was the arrest start time. In this scenario, there were instantaneously two ALS providers present at the arrest rather than the one ALS provider Conclusions
ITEM 2.2 - ATTACHMENT 7

470
45 placing the 12-Lead ECG device in the ALS engine /ALS Ambulance crew.

A review of the patterns of significant results across task start times showed mixed results. An ALS on an engine showed an advantage (sooner task starting times) over an ALS on an ambulance for a few tasks located earlier in the cardiac response sequence (specifically, ALS Vitals 12-Lead through IV access). A crew size of four also showed shorter start times for a few early tasks in the cardiac response sequence (initial ABC’s, and the ALS Vitals 12-Lead and expose chest sequence). More importantly, a sequential time advantage appears for the last three tasks of the sequence (analyze shock #2 through package patient).

Finally, when assessing crews for their ability to increase on-scene operational efficiency by completing tasks
simultaneously, crews with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks 45 seconds faster than crews with a BLS engine and two ALS providers on the ambulance. Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks from the “at patient time” to completion of packaging 70 seconds faster than first responder crews with three persons, and two minutes and 40 seconds faster than first responder crews with two persons. Additionally, after the patient arrested, an assessment of time to complete remaining tasks revealed that first responders with four-person crews completed all required tasks 50 seconds faster than three-person crews and 1.4 minutes (1 minute 25 seconds) faster than two-person crews.

ITEM 2.2 - ATTACHMENT 7

471
46 While resource deployment is addressed in the context of three basic scenarios, it is recognized that public policy decisions regarding the cost-benefit of specific
deployment decisions are a function of many factors including geography, resource availability, community expectations as well as population demographics that drive EMS call volume. While this report contributes significant knowledge to community and fire service leaders in regard to effective resource deployment for local EMS systems, other factors contributing to policy decisions are not addressed. The results however do establish a technical basis for the effectiveness of first responder crews and ALS configuration with at least one ALS level provider on first responder crews. The results also provide valid measures of total crew size efficiency in completing on-scene tasks some of which involve heavy lifting and tasks that require multiple responders to complete.

These experimental findings suggest that ALS provider
placement and crew size can have an impact on some task start times in trauma and cardiac scenarios, especially in the latter tasks leading to patient packaging. To the extent that creating time efficiency is important for patient outcomes, including an ALS trained provider on an engine and using engine crew sizes of four are worth considering. The same holds for responder safety – for access and removal and other tasks in the response sequence, the availability of additional hands can serve to reduce the risks of lifting injuries or injuries that result from fatigue (e.g., avoid having small crews repeatedly having to ascend and descend stairs). Cost considerations for EMS response and crew
configurations were not considered in this study.

Summary
ITEM 2.2 - ATTACHMENT 7

472
47 Study Limitations
The scope of this study is limited to understanding the relative influence of deployment variables on laborintensive emergency medical incidents, specifically multi-system trauma and cardiac arrest events. It should be noted that the applicability of the conclusions from this report to a large scale hazardous or multiple-casualty event have not been assessed and should not be extrapolated from this report.

The crews involved in this study typically operate using three- to four-person engine crews, and two-person ambulance crews.

However, other departments across the United States vary in crew sizes, some using two- to five-person first responder engine crews and three-person ambulance crews.

Every attempt was made to ensure the highest possible degree of realism in the experiments including the use of multiple crews from multiple shifts in the participant departments. However, as the trauma and cardiac experiments were repeated a minimum of 45 times, for crews involved in more than one experiment, a learning curve on the part of the participants may have been established.

All experiments were conducted indoors, during daylight hours.

Treating patients outside among varying weather conditions or at night, when visibility is lower, could pose additional obstacles.

Additionally, the actual effect of ALS interventions on patient outcome is beyond the scope of this study. Patient outcomes were not quantified or estimated.

The design of the experiments limited the patient care scenarios to a systemic trauma event and a medical cardiac event. Other patient illnesses and injuries including diabetes, seizures, gunshot wounds, stabbings, and motor vehicle accidents were not considered.

EMS protocols pertaining to the treatment and transport of patients vary by departments. For the purpose of this study, tasks were standardized by technical experts and individual times were recorded for each task. In real-world situations, as in this study, many of these can be performed simultaneously based on the number and training level of responding personnel. Attempts to generalize the results from these experiments to individual departments must take into account protocols and equipment that vary from those used in the experiments.

Finally, data from U.S. fire departments were used to set response and arrival time assumptions. For departments with different deployment capability for both first responder crews and ambulances, the results may vary.

ITEM 2.2 - ATTACHMENT 7

473
48 Future Research
I
n order to realize a significant reduction in firefighter and paramedic line-of-duty injury, fire service leaders must focus directly on resource allocation and the deployment of
resources, a known contributing factor to LOD injury. Future research should use similar methods to evaluate
firefighter/paramedic deployment to other medical emergencies as well as combination scenes where both fire suppression and EMS resources are needed. Additionally, resource deployment to multiple-casualty disasters or terrorism events should be studied to provide insight into levels of risks specific to individual communities and to recommend resource deployment
proportionate to such risk. Future studies should continue to investigate the effects of resource deployment on the safety of firefighters, paramedics and the civilian population to better inform public policy. Finally, the ability to relate response and task timing to patient outcomes and survival rates should be quantified.

ITEM 2.2 - ATTACHMENT 7

474
49 Acknowledgements
Aproject of this magnitude extends well beyond the
capabilities and expertise of the authors of this report.

The following individuals were instrumental to the success of the EMS experiments.
 Technical Experts – Phil Pommerening, Captain II, Station 34A from Fairfax County Fire and Rescue Department,
Michael McAdams, EMS Chief, Montgomery County Fire and
Rescue Department, Dr. Greg Mears, Medical Director,
University of North Carolina, Paul Neal, Safety Officer for Montgomery County Fire and Rescue Department, Lt. Tom
Papoutsis, EMS Training, Fairfax County Fire and Rescue Department, and Adam Barowy, National Institute of
Standard and Technology.
 Project Support — Montgomery County Fire and Rescue
Department – Chief Richard Bowers AND Fairfax County
Fire and Rescue Department – Chief Ronald Mastin for
supporting this study over a period of years to an
unprecedented degree.
 IAFF Staff/Data Entry/ Timer supervision – Nicole Taylor, Randy Goldstein, and Ron Benedict
 Timers – Cliff Berner, Lead, DeWayne Dutrow, Alyssa Vance, Nicole Taylor, Ron Benedict, Randy Goldstein, and Adam
Barowy.
 The dedicated Fire and EMS Officers and
Firefighters/Paramedics from Montgomery County Fire and Rescue and Fairfax County Fire and Rescue, who performed the difficult work of EMS response and patient care safely and effectively.

ITEM 2.2 - ATTACHMENT 7

475
50 References
 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care (2005). Circulation, Vol. 112, No. 24 (Suppl), Pg 1-88.
 Averill, J.D., et al.; Moore-Merrell, L. ;Barowy, A.; Santos, R.; Peacock, R.; Notariann, K.; Wisooker, D. (2010), NIST Report on Residential Fireground Field Experiments. Natl. Inst. Stand.

Technol, NIST Technical Note 1661.
 Becker, L.B.; Ostrander, M.P.; Barrett, J.; Kondon, G.T. (1991).

Outcome of CPR in a Large Metropolitan Area- Where are the Survivors? Ann Emerg Med, Vol. 20, No. 4, Pg. 355.
 Boyd, C.R.; Tolson, M.A.; and Copes, W.S. (1987). Evaluating Trauma Care: The TRISS Method. J. Trauma, Vol. 27, No. 4, 370-378.
 Braun, O.; McCallion, R.; Fazackerley, J. (1990). Characteristics of Midsized Urban EMS Systems. Ann Emerg Med, Vol. 19, No. 5, Pg. 536.
 Brown, L. H.; Owens Jr., C. F.; March, J. A.; Archino, E. A. (1996).

Does Ambulance Crew Size Affect On-Scene Time or Number of Prehospital Interventions? Prehosp Disast Med, Vol. 11, No. 3, Pg. 214.
 Commission on Fire Accreditation International (CFAI) Standards of Cover, Fifth Edition (2008) Chantilly, VA
 Chu, K.;Swor, R.; Jackson, R.; Domeier, R.; Sadler, E.; Basse, E.; Zaleznak, H.; Gitlin, J. (1998). Race and Survival after Out-of-Hospital Cardiac Arrest in a Suburban Community. Ann Emerg Med, Vol. 31, No. 4, Pg. 478.
 Cummins, R. O.; Ornato, J. P.; Thies, W. H.; Pepe, P. E. (1991).

Improving Survival from Sudden Cardiac Arrest: The “Chain of Survival Concept.” Circulation, Vol. 83, No. 5, Pg. 18-32.  DeMaio, V.J.; Stiell, I.G.; Nesbitt, L.; Wells, G.A. (2005). Faster Advanced Life Support Response Intervals May Improve Cardiac Arrest Survival. Acad Emerg Med, Vol. 12, No. 5, Pg. 16.  Eisenberg, M.S.; Horwood, B.T.; Cummins, R.O.; Reynolds-Haertle, R.; Hearne, T.R. (1990). Cardiac Arrest and Resuscitation: A Tale of 29 Cities. Ann Emerg Med,Vol. 19, No. 2, Pg. 179-186.
 Hallstrom, A.P.; Ornato, J.P.; Weisfeldt, M.; Travers, A.; Christenson, J.; McBurnie, M.A.; Zalenski, R.; Becker, L.B.; Schron, E.B.; Proschan, M. (2004). Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest. N Engl J Med, Vol. 21, No. 7, Pg. 637.
 Heick, R.; Young, T.;Peek-Asa, C. (2009). Occupational Injuries Among Emergency Medical Service Providers in the United States. J Occup Med, Vol. 51, No. 8, Pg. 963-968.
 IAFC/IAFF Fire and EMS Operation Database: Analysis of Response Times (2005).
 Karter, M.J. Jr.; Molis, J.L. (2009). U.S. Firefighter Injuries-2008.

NFPA Journal, November/December 2009.
 Kellerman, A.L.; Hackman, B.B.; Somes, G.; Kreth, T.K.; Nail, L.; Dobyns, P. (1992). Impact of First Responder Defibrillation in an Urban EMS System. Ann Emerg Med, Vol. 21, No. 14, Pg. 1708.  Laerdal Medical Corporation. (n.d.) Retrieved from
http://www.laerdal.com/doc/7320252/SimMan.html.
 Litwin, P. E.; Eisenberg, M. S.; Hallstrom, A. P.; Cummins, R. O. (1987). The Location of Collapse and its Effect on Survival from Cardiac Arrest. Ann Emerg Med, Vol. 16, No. 7, Pg. 787.  Maguire, B.J.; Hunting, K.L., Guidotti, T.L.; Smith, G.S. (2005).

Occupational Injuries Among Emergency Medical Services
Personnel. Prehop Emerg Care, No. 4, Pg. 405-411.
 Moore, L.L. Quality Performance Measures for Fire
Department-Based EMS Systems. UMI, Ann Arbor, Michigan
(2002).
 Morrison, L.J.; Angelini, M.P.; Vermeulen, M.J.; Schwartz, B. (2005). Measuring the EMS Patient Access Time Interval and the Impact of Responding to High-rise Buildings. Prehosp Emerg Care, Vol. 9, No. 1, Pg. 14-18.
 National Fire Academy (1981). Fire Engines are Becoming Expensive Taxi Cabs: Inadequate Manning. United States Fire Administration, Emmitsburg, MD.
 NFPA (2009). 450: Standard for Emergency Medical Services and Systems. National Fire Protection Association, Quincy, MA.  NFPA (2007). 1500: Standard on Fire Department Occupational Safety and Health Program. National Fire Protection Association, Quincy, MA.
 NFPA (2010). NFPA 1710: Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments. National Fire Protection Association, Quincy, MA.  NFPA (2010). NFPA 1720: Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Volunteer Fire Departments. National Fire Protection Association, Quincy, MA.
 NFPA (2008) 1999: Standard on Protective Clothing for Emergency Medical Operations. National Fire Protection
Association, Quincy, MA.
 Olson, D.W.; LaRochelle, J.; Fark, D.; et al. (1989). EMTDefibrillation: The Wisconsin Experience. Ann Emerg Med, Vol. 18, No. 8, Pg. 806.

ITEM 2.2 - ATTACHMENT 7

476
51  Pratt, F.D.; Katz, S.; Pepe, P.E.; Persse, D. (2007). Prehospital 9-1-1 Emergency Medical Response: The Role of the United States Fire Service in Delivery and Coordination. White paper.
 Studnek, J.R.; Ferketich, A.; Crawford, J.M. (2007) On the Job Illness and Injury Resulting in Lost Work Time Among a National Cohort of Emergency Medical Services Professionals. Am J Indus Med, Vol. 50, No.12, Pg. 921-931.
 Sweeney, T.A.; Runge, J.W.; Gibbs: et al. (1998). EMT Defibrillation Does Not Increase Survival from Sudden Cardiac Death in a Two-Tiered Urban-Suburban EMS System. Ann Emerg Med, Vol. 31, No. 2, Pg. 234.

ITEM 2.2 - ATTACHMENT 7

477
52 Glossary
12-Lead Electrocardiogram (ECG) — A representation of the heart’s electrical activity recorded from 10 electrodes placed in standard positions on the body’s surface.

Advanced Cardiac Life Support (ACLS) — A set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to use those interventions.

Advanced Life Support (ALS) — Emergency medical
treatment beyond basic life support that provides for advanced airway management including intubation, advanced cardiac monitoring, defibrillation, establishment and maintenance of intravenous access, and drug therapy.

Ambulance Transport Unit — Provides transport for patients from the incident scene to a health care facility.

Automated External Defibrillator (AED) — A portable
electronic device that automatically diagnoses potentially life-threatening cardiac arrhythmias of ventricular fibrillation, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmias, allowing the heart to reestablish an effective rhythm.

Basic Life Support (BLS) — A specific level of prehospital medical care provided by trained responders, focused on rapidly evaluating a patient’s condition; maintaining a patient’s airway, breathing, and circulation; controlling external bleeding; preventing shock; and preventing further injury or disability by immobilizing potential spinal or other bone fractures.

Cardiac Arrest — Sudden cessation of heartbeat and heart functions, resulting in the loss of effective circulation.

Cardiopulmonary Resuscitation (CPR) — Procedure
designed to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) or whose heart has stopped (cardiac arrest).

Chain of Survival — The four components of EMS response to out-of-hospital cardiac arrest that are thought to effect the most optimal patient outcome. The four components include early recognition and EMS access, early CPR, rapid defibrillation, and advanced life support.

Combination Fire Department — Fire department consisting of both paid (career) and volunteer personnel.

Crew configurations — Specific ways of staffing or organizing members of the work force.

Definitive Medical Care — Medical treatment or services beyond emergency medical care, initiated upon inpatient admission to a hospital or health care facility.

Emergency Medical Services (EMS) — The treatment of
patients using first aid, cardiopulmonary resuscitation, basic life support, advanced life support, and other medical procedures prior to arrival at a hospital or other health care facility.

EMS Protocols — Written medical instructions authorized by an EMS medical director to be used by personnel in the field without the necessity of on-line or real-time consultation with a physician or nurse.

Emergency Medical Technician (EMT) — A member of the
emergency medical services team who provides out-of-hospital emergency care, trained to any level of emergency medical services.

Emergency Medical Technician- Basic (EMT-B) — A
member of the emergency medical services team who provides out-of-hospital emergency care, trained in the delivery of Basic Life Support services.

Emergency Medical Technician- Defibrillator (EMT-D) —
A member of the emergency medical services team with special training in the use of cardiac defibrillating equipment. (Defibrillation training is now part of Basic Emergency Medical training.)
Emergency Medical Technician- Paramedic (EMT-P) —
A member of the emergency medical services team who provides out-of-hospital emergency care, trained in the delivery of Advanced Life Support services.

Endotrachael Tube (ET) — Flexible plastic catheter placed into the trachea to protect the airway and provide a means of mechanical ventilation.

First Responder — Functional provision of initial assessment (i.e., airway, breathing, and circulatory systems) and basic first-aid intervention, including CPR and automatic external defibrillator capability.

First Responder Unit — The first arriving unit at an
emergency medical incident, whether it be a fire suppression vehicle or ambulance.

Intervention — Act designed to alter or hinder an action or development.

Intravenous (IV) — An injection administered into a vein.

Intubation — Insertion of a tube through the mouth or nose and into a patient’s lungs to help them breathe.

Knox Box Rapid Entry System — Small, wall-mounted safe
that holds building keys for firefighters and EMTs to retrieve in emergencies.

Mayocardial Infarction — Heart attack.

Measurement uncertainty — Parameter, associated with the result of a measurement that characterizes the dispersion of the values that could reasonably be attributed to the measure.

ITEM 2.2 - ATTACHMENT 7

478
53 National Fire Protection Association (NFPA) — A
nonprofit organization, established in 1896, with the mission to reduce the worldwide burden of fire and other hazards on the quality of life by providing and advocating consensus codes and standards, research, training and education.

NFPA 450— Guide for emergency medical services and systems.

NFPA 1500 — Standard on fire department occupational safety and health program.

NFPA 1710 — Standard for the organization and deployment of fire suppression operations, emergency medical operations, and special operations to the public by career fire departments.

NFPA 1720 — Standard for the organization and deployment of fire suppression operations, emergency medical operations, and special operations to the public by volunteer fire departments.

NFPA 1999 — Standard on protective clothing for emergency medical operations.

One-Tier EMS System — EMS system in which all units are advanced life support.

Operational Effectiveness — Capable of producing a
particular desired effect in “real world” circumstances.

Operational Efficiency — The effect or results achieved in relation to the effort expended.

Ordinary Least Squares (OLS) — In statistics and
econometrics, OLS or linear least squares is a method for estimating the unknown parameters in a linear regression model.

Out-of-hospital — Care for the sick or injured in settings other than hospitals or hospital-affiliated outpatient medical or surgical facilities, typically beginning with a call to 9-1-1.

Patient Packaging — Securing a patient to a mobile
contrivance (e.g., stretcher or stair chair) for moving to the transport unit.

Pulse Oximeter — Medical device that measures the oxygen saturation of a patient’s blood.

Regression analysis — Includes any techniques for modeling and analyzing several variables, when the focus is on the relationship between a dependent variable and one or more independent variables. More specifically, regression analysis helps us understand how the typical value of the dependent variable changes when any one of the independent variables is varied, while the other independent variables are held.

Standard of Response Cover (SORC) — Policies and
procedures that determine distribution, concentration, and reliability of fixed and mobile resources for an emergency response system.

Standard t-test — Measures whether there is any statistical difference in the mean of two groups.

Statistical significance — A number that expresses the
probability that the result of a given experiment or study could have occurred purely by chance. This number can be a margin of error or it can be a confidence level.

System resources — Personnel, vehicles, and equipment used in providing EMS.

Systemic trauma — Injury or shock affecting the body
generally.

Transport — Conveyance of the sick or injured in an ambulance or emergency vehicle to a hospital setting.

Trauma and Injury Severity Scores (TRISS) — A system
developed in the 1980’s to improve the prediction of patient outcomes through the use of physiological and anatomical criteria.

Two-Tier EMS System — EMS system that uses first
responder or BLS units that typically arrive and begin treatment prior to the arrival of a transport unit.

ITEM 2.2 - ATTACHMENT 7

479
54 Acronyms
 A, B, C’s — Airway, Breathing, and Circulation
 ACLS — Advanced Cardiac Life Support
 AED — Automated External Defibrillator
 AHA — American Heart Association
 ALS — Advanced Life Support
 BLS — Basic Life Support
 CFAI — Commission on Fire Accreditation International  CPR — Cardiopulmonary resuscitation
 DHS — Department of Homeland Security
 DOL — Department of Labor
 ECG — Electrocardiogram
 EMS — Emergency Medical Services
 EMT — Emergency Medical Technician
 EMT-B — Emergency Medical Technician- Basic
 EMT-D — Emergency Medical Technician- Defibrillator
 EMT-P — Emergency Medical Technician- Paramedic
 FEMA — Federal Emergency Management Agency
 IAFC — International Association of Fire Chiefs
 IAFF — International Association of Fire Fighters
 LOD — Line-of-Duty
 NFPA — National Fire Protection Association
 NIST — National Institute of Standards and Technology  OHCA — Out-of-hospital cardiac arrest
 OPQRST — Onset, Provokes, Quality, Radiates, Severity, Time  SAMPLE — Signs and Symptoms, Allergies, Previous history, Medications, Last oral intake, Events leading up to
 SORC — Standard of Response Cover
 TBI — Traumatic brain injury
 TRISS — Trauma and Injury Severity Scores
 WPI — Worcester Polytechnic Institute
ITEM 2.2 - ATTACHMENT 7

480
55 Appendix A: Time to Task Measures
Time-to-Task Data Collection Chart -EMS
(Overall Response- Patient Access and Removal)
Date ___________ Start Time____________ End Time (all tasks complete) ___________ Crew Used:  Montgomery County  Fairfax County
Timer Name___________________________________________
ITEM 2.2 - ATTACHMENT 7

481
56 Time-to-Task Data Collection Chart -EMS
(Trauma — BLS — ALS on scene)
Date ___________ Start Time____________ End Time (all tasks complete) ___________ Timer Name___________________________________________
ITEM 2.2 - ATTACHMENT 7

482
57 Time-to-Task Data Collection Chart -EMS
(Medical — Cardiac)
Date ___________ Start Time____________ End Time (all tasks complete) ___________ Timer Name___________________________________________
ITEM 2.2 - ATTACHMENT 7

483
58 Appendix B: Trauma Patient Assessment and Interview Form Name:____________________________________________ Age: ________ Male / Female Chief Complaint: __________________________________________________________________________________________ Mechanism of Injury: ______________________________________________________________________________________ Primary Survey:

Airway status: open / occluded
Breathing: normal / labored-abnormal / none
Circulation: normal / shocky / none
Mental Status: alert / voice / pain / unresponsive
Body Sweep Findings? _____________________
Secondary / Focused Survey Findings:

Head L Arm
Face R Arm
Neck Abdomen
Chest L Leg
Back R Leg
Vital Signs:

BP ______ Pulse: ______ Resp:______ PulseOx: ______
BP ______ Pulse: ______ Resp:______ PulseOx: ______
Treatment:
 oxygen  C-spine  Splinting  Bandaging
ITEM 2.2 - ATTACHMENT 7

484
59 Appendix C: Medical Patient Interview Form
Name:____________________________________________ Age: ________ Male / Female Chief Complaint: __________________________________________________________________________________________ Mechanism of Injury: ______________________________________________________________________________________ “SAMPLE” history
Signs & Symptoms
Allergies
Medications
Previous Medical History
Last Oral Intake
Events Leading Up to?
“OPQRST” pain survey
Onset? What were you doing?
Provokes? What makes it better or worse?
Quality? “What does it feel like?
Radiation? “Does it go anywhere?”
Severity? 1-10 scale
Time? When did it begin?
Vital Signs:

BP ______ Pulse: ______ Resp: _____ PulseOx: _____
Treatment:
 oxygen  ECG  12-lead  IV
 medications? __________________________________________________________________________________________ ITEM 2.2 - ATTACHMENT 7

485
60 Appendix D: Medical Patient Assessment/Interview Form Signs & Symptoms
“What is bothering you this morning? Pain under my breastbone.

Allergies
“Are you allergic to any medications?” None
Medications
“Do you take any medications?” Aspirin and Cardizem.

Previous History
“Do you have any medical problems? I was diagnosed with high blood pressure two years ago.

Has this ever happened to you before?” No, I have never felt pain like this before.

Last Oral Intake
“Have you been eating normally?” Yes. Had a full breakfast this morning.

Events Leading Up to?
“What happened prior to you developing this pain?” Nothing, I was feeling fine before this.

PAIN SURVEY Onset?
“What were you doing when pain began?” I was sitting on the couch watching television.

Provokes?
“Have you done anything that makes the pain better?” No, it is a steady pain and I can’t get in a comfortable position.

Radiates?
“Do you feel the pain anywhere besides your chest?” Yes, I feel it in my spine also.

Severity?
“On a scale of 1 to 10, with ten worst pain you can imagine, how severe is your pain now?” It is a 6.

Time?
“When did your chest pain begin?” About 30 minutes ago. “SAMPLE HISTORY” PAIN SURVEY
ITEM 2.2 - ATTACHMENT 7

486
61 Appendix E: Statistical Analysis of Time to Task Data Patient Access and Removal Time between Arrival and ascent
of stairs
Time between packaging patient
and completion of loading patient
ITEM 2.2 - ATTACHMENT 7

487
62 Appendix F: Statistical Analysis of Time to Task Data Patient Systemic Trauma Patient ITEM 2.2 - ATTACHMENT 7

488
63 Appendix G: Statistical Analysis of Time to Task Data Cardiac Arrest Patient ITEM 2.2 - ATTACHMENT 7

489
64 Appendix G: Statistical Analysis of Time to Task Data Cardiac Arrest Patient Continued
ITEM 2.2 - ATTACHMENT 7

490
65 Appendix H: All Regression Coefficients Continued
ITEM 2.2 - ATTACHMENT 7

491
66 Appendix H: All Regression Coefficients Continued
ITEM 2.2 - ATTACHMENT 7

492
67 Appendix H: All Regression Coefficients
ITEM 2.2 - ATTACHMENT 7

493
68 Appendix H: All Regression Coefficients Continued
ITEM 2.2 - ATTACHMENT 7

494
69 Appendix H: All Regression Coefficients Continued
ITEM 2.2 - ATTACHMENT 7

495
70 ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ NOTES:

ITEM 2.2 - ATTACHMENT 7

496
71 ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ITEM 2.2 - ATTACHMENT 7

497
ITEM 2.2 - ATTACHMENT 7

498
Item #: 2.3

STAFF REPORT
TOWN OF SAN ANSELMO Item #: 2.3
MEETING DATE: October 24, 2023
AGENDA TITLE: Resolution Adopting Required Findings Pursuant to Government Code Section 4217 Approving Sole
Source Energy Services Contract with EcoGreen
Solutions LLC for Energy Efficient Lighting
Improvements for Town Owned Facilities and
Authorizing Town Manager to Execute Associated
PG&E On-Bill Loan Financing
FROM: Sean Youra, Climate Action Coordinator
Sean Condry, Public Works and Building Director
RECOMMENDATION:

Conduct Public Hearing and adopt the proposed Resolution (Attachment 2).

BACKGROUND
Town staff have continuously sought to implement energy efficiency and electrification projects in Town-owned facilities to help reduce operating costs and greenhouse gas emissions. The Public Works Director has been trying to upgrade the lighting in Townowned facilities to LEDs for several years, but there has been insufficient funding to move forward with this project.

In May 2023, EcoGreen Solutions LLC, conducted an energy efficiency survey of Townowned facilities at no cost to the Town. EcoGreen identified several Town facility lighting improvements that would save energy and money for the Town. EcoGreen is an energy services company that specializes in energy efficiency upgrades and is an authorized agent for utility programs such as PG&E’s Energy Efficiency Retrofit Loan Program.

After the survey of the facilities was completed, EcoGreen finalized a scope of work for each facility to receive PG&E approval and funding in the form of no-interest loans for the project.

The California legislature has encouraged energy efficient improvements for public facilities by allowing flexible contracting and associated financing for certain energy499 Item #: 2.3
related projects without the need to follow formal procurement rules if the required findings are made.

Government Code sections 4217.10 – 4217.18 authorize the Town Council to enter into an energy services contract and financing if it finds that: 1) the energy efficient improvements are in the best interest to the Town; 2) and that the costs of the project will be less than the anticipated marginal cost to the Town of the energy that would have been consumed in absence of the improvement (i.e., the energy cost savings exceed the project costs). These findings must be made at a public hearing with two weeks’ notice (Attachment 1). This process saves costs and time for the Town because it eliminates the need to separately contract for the design and construction phases of a qualifying project. The Town may instead enter into a “sole-source” contract without formal bidding.

As explained below, staff suggests that the required findings can be made because the Town facility lighting improvements are in the best interests of the Town, and the energy cost savings will exceed project costs.

DISCUSSION/ANALYSIS
The project includes the removal and replacement of various lighting components at Town Hall, the Historical Museum, Library, Corporation Yard, Memorial Park, and Isabel Cook Community Center to upgrade them to higher efficiency LEDs.

As required under Government Code section 4217, the energy cost savings will exceed the project costs and the improvements are in the best interests of the Town. The total project cost is $147,331.28 and would be paid off over 120 monthly PG&E bill payments at a fixed payment amount of $1,207.43 per month. The estimated monthly energy cost savings resulting from the lighting upgrades is $1,219.62. Therefore, the estimated monthly cost savings would more than offset the monthly repayment of the loan, and the estimated cost savings to the Town over the life of the loan is estimated at $192,906.68.

The simple payback is estimated at 9.9 years for this project.

This work will be funded through On-Bill Financing (OBF) provided by PG&E. This program provides the opportunity for public agencies to pay back a no-interest loan based on projected energy savings, via installments on their monthly PG&E bill. The payments of this loan will be a flat monthly rate, irrespective of seasonal energy use/savings variations. After the loan is repaid, any energy savings that result from the new energy efficiency equipment will translate into lower utility costs. To attempt to meet bill neutrality, actual savings from the project are used to calculate the loan by PG&E.

FISCAL IMPACT
The monthly cost of the loan (i.e., $1,207.43) will be added to the Town’s PG&E electric bill but should be offset by expected energy savings from the lighting upgrades. There is no upfront cost to the Town to enroll in the program and complete the project. 500
Item #: 2.3

GENERAL PLAN CONSISTENCY
The proposed Resolution is consistent with the Town’s General Plan including Conservation Element Policy Guideline 13 to “take measures to reduce existing and future inefficient or unnecessary energy or natural resources consumption.”

CEQA AND CLIMATE ACTION PLAN CONSISTENCY
The project and associated on-bill financing are exempt from the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15061 “common sense exemption” because it can be seen with certainty that they will not cause a significant effect on the environment; CEQA Guidelines section 15301 “Existing Facilities”, because the project consists of the minor alteration to existing lighting in Town owned facilities.

The project is consistent with the following measures in the Town’s Climate Action Plan including:
 E-7: Municipal Energy Efficiency Audit and Retrofits: Work with the Marin Energy Management Team to identify and implement energy efficiency projects in municipal buildings and facilities and electrification of existing building systems and equipment that use natural gas.

CONCLUSION
Staff respectfully requests the Council’s adoption of the proposed Resolution.

ATTACHMENTS
Attachment 1 – Copy of Public Notice
Attachment 2 – Proposed Resolution
501
Legal No.

Marin Independent Journal
4000 Civic Center Drive, Suite 301
San Rafael, CA 94903
415-382-7335
[email protected]
I am a citizen of the United States and a resident of the County aforesaid: I am over the age of eighteen years,
and not a party to or interested in the above matter. I am the principal clerk of the printer of the MARIN
INDEPENDENT JOURNAL, a newspaper of general
circulation, printed and published daily in the County of Marin, and which newspaper has been adjudged a
newspaper of general circulation by the Superior Court of the County of Marin, State of California, under date of FEBRUARY 7, 1955, CASE NUMBER 25566; that the
notice, of which the annexed is a printed copy (set in type not smaller than nonpareil), has been published in each regular and entire issue of said newspaper and not in
any supplement thereof on the following dates, to-wit:
10/06/2023
I certify (or declare) under the penalty of perjury that the foregoing is true and correct.

Dated this 9th day of October, 2023.

PROOF OF PUBLICATION
(2015.5 C.C.P.)

STATE OF CALIFORNIA
County of Marin
Signature

PROOF OF PUBLICATION
FILE NO. Approval of Resolution #4519
0006783588
2072661

TOWN OF SAN ANSELMO
525 SAN ANSELMO AVE
SAN ANSELMO, CA 94960-2613
r.BP7-11/10/16 1
Item 2.3 Attachment 1
Item 2.3 Attachment 1
502
Item 2.3 Attachment 2
Item 2.3 Attachment 2
RESOLUTION NO. XXXX

RESOLUTION OF THE TOWN COUNCIL OF THE TOWN OF SAN ANSELMO

ADOPTING REQUIRED FINDINGS PURSUANT TO GOVERNMENT CODE SECTION 4217 APPROVING SOLE SOURCE ENERGY SERVICES CONTRACT WITH

ECOGREEN SOLUTIONS LCC FOR ENERGY EFFICIENT LIGHTING

IMPROVEMENTS FOR TOWN OWNED FACILITIES AND AUTHORIZING

ASSOCIATED PG&E ON-BILL LOAN FINANCING
WHEREAS, Town staff have continuously pursued energy efficiency projects for Town-owned facilities to reduce operating costs and greenhouse gas emissions; and WHEREAS, Government Code section 4217 et seq. authorizes the Town to forgo the standard procurement process for qualifying energy services contracts and associated financing if the Town Council makes findings that it is in the best interest of the Town, and that the anticipated cost to the Town will be less than the anticipated marginal costs that are directly related to the project that would have been consumed by the Town in absence of implementation of the improvements; and
WHEREAS, EcoGreen Solutions LLC (“EcoGreen”) is an energy services company that specializes in energy efficiency upgrades and is an authorized agent for utility programs such as Pacific Gas and Electric’s (“PG&E”) Energy Efficiency Retrofit Loan Program; and
WHEREAS, in May 2023 at no cost to the Town, the Town received an energy efficiency survey of Town-owned facilities by EcoGreen identifying several Town facility lighting improvements and upgrades that would improve energy efficiency and result in cost savings; and
WHEREAS, the Town wishes to contract with EcoGreen as a “sole-source” vendor pursuant to Government Code section 4217 et seq. to undertake the recommended improvements as set forth in the “Statement of Work” attached hereto and incorporated herein as Exhibit “A” (the “Project”); and
WHEREAS, PG&E provides no-interest loans for the purpose of lighting upgrades to reduce energy usage for public agencies through their Energy Efficiency Retrofit Loan Program; and
WHEREAS, the Town wishes to utilize said on-bill financing at 0% interest for up to 10 years through PG&E for all eligible costs for the Project anticipated to be $147,331.28 as set forth in the On-Bill Loan Financing Agreement attached hereto and incorporated herein as Exhibit “B” (“Financing”); and
WHEREAS, the Town desires to use Government Code 4217 et seq. as a basis to for the Project and its Financing; and
WHEREAS, on October 24, 2023, the Town Council held a public hearing at a regularly scheduled Council meeting noticed at least two weeks in advance for the 503
Item 2.3 Attachment 2
Item 2.3 Attachment 2
purposes of considering the Project and Financing pursuant to Government Code section 4217 et seq.; and
WHEREAS, the findings of Government Code section 4217 et seq. are satisfied because the Project and Financing are in the best interests of the Town, and the costs of the Project will be less than the anticipated marginal cost to the Town of the energy that would have been consumed in absence of the Project as the estimated cost savings from the Project is $1,219.62 per month, and the monthly fixed payment is 1,207.43 to be paid over 120 monthly PG&E bill payments resulting in a total cost savings of approximately $192,906.68 over the life of the loan; and WHEREAS, the Project is consistent with the Town’s Climate Action Plan, Measure E-7, related to Municipal Energy Efficiency Audits and Retrofits, which provides that the Town will “identify and implement energy efficiency projects in municipal buildings and facilities;” and
WHEREAS, the Project and Financing are exempt from the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15061 “common sense exemption” because it can be seen with certainty that they will not cause a significant effect on the environment; CEQA Guidelines section 15301 “Existing Facilities”, because the Project consists of the minor alteration to existing lighting in Town owned facilities; and
NOW, THEREFORE BE IT RESOLVED that the Town Council of the Town of San Anselmo does hereby:

1. Find that the recitals stated above are true and correct and incorporated herein by reference.

2. Find that the Project and Financing are in the best interests of the Town because the Town facility lighting improvements will result in a reduction of greenhouse gas emissions and operating costs.

3. Find that the anticipated costs of the Project are less than the anticipated marginal cost to the Town of the energy that would have been consumed in absence of the Project because the estimated energy cost savings from the Project is $1,219.62 per month, and the monthly fixed payment is $1,207.43 to be paid over 120 monthly PG&E bill payments, with a total estimated cost savings of $192,906.68 over the life of the loan.

4. Authorize the Town Manager to execute the On-Bill Financing Loan Agreement and any other necessary documents for the Project.

5. Authorize the Town Manager to execute a “sole source” agreement with EcoGreen to implement the Project; and

6. The Project and Financing are exempt from the California Environmental Quality Act (“CEQA”) pursuant to CEQA Guidelines section 15061 “common sense exemption” because it can be seen with certainty that they will not cause a significant effect on the environment; CEQA Guidelines section 15301 “Existing Facilities”, because the Project consists of the minor alteration to existing lighting in Town owned facilities. 504
Item 2.3 Attachment 2
Item 2.3 Attachment 2
RESOLUTION PASSED AND ADOPTED, at the regular meeting of the San Anselmo Town Council on the 24th day of October, 2023, by the following vote:

AYES:

NOES:

ABSENT:

ABSTAIN:

____________________________
Steve Burdo, Mayor
ATTEST:
________________________
Serge Avila, Town Clerk

EXHIBITS
A. Statement of Work
B. On-Bill Loan Financing Agreement
EXHIBIT A: STATEMENT OF WORK
505
Item 2.3 Attachment 2
Item 2.3 Attachment 2
506
Item 2.3 Attachment 2
Item 2.3 Attachment 2
507
Item 2.3 Attachment 2
Item 2.3 Attachment 2
508
Item 2.3 Attachment 2
Item 2.3 Attachment 2
509
Item 2.3 Attachment 2
Item 2.3 Attachment 2
510
Item 2.3 Attachment 2
Item 2.3 Attachment 2
511
Item 2.3 Attachment 2
Item 2.3 Attachment 2
512
Item 2.3 Attachment 2
Item 2.3 Attachment 2
EXHIBIT B: ON-BILL LOAN FINANCING AGREEMENT
513
Item 2.3 Attachment 2
Item 2.3 Attachment 2
514
Item 2.3 Attachment 2
Item 2.3 Attachment 2
515
Item 2.3 Attachment 2
Item 2.3 Attachment 2
516
Item 2.3 Attachment 2
Item 2.3 Attachment 2
517