The only reason we get away with giving such large doses of epinephrine to these patients is that they are already dead.

- Rogue Medic

IAFF’s Jack Reall faces discipline for delaying a 911 call in order to protest research he does not like


 

One of the advantages of fire department-based EMS is that there is a clear chain of command and that discipline is not a problem. The exceptions to this may be rare enough that they make headlines. Here is one.
 

A Columbus Fire battalion chief could face discipline for insubordination after an internal investigation found that he disrupted a pilot program intended to more efficiently respond to emergencies.[1]

 

The first oddity is that the Battalion Chief (Jack Reall) is also the president of Local 67 of the International Association of Fire Fighters. A management position and a union position – and not just any union position, but president. Jack Reall apparently cannot keep his priorities in order.

The fire department is studying whether 911 calls should receive an initial response from one paramedic with a basic EMT or from a pair of paramedics. There is no evidence that sending one paramedic and one EMT causes any kind of harm, or that two paramedics provide better care, so there is no basis to claim that anyone is being in any way endangered by this pilot program.

If there were a legitimate concern, then the time to address that was when the pilot program was being considered. It appears that Jack Reall is not happy with that and his union boss persona delayed a 911 response in violation of fire department rules.
 

The Fire Division launched a pilot program that morning to reduce the number of paramedics who respond to routine calls, allowing the division to disperse medics elsewhere. Instead of two paramedics on a truck, there would be one medic and a basic emergency-medical technician, or EMT.[1]

 

Is it possible that this was a complete surprise to Battalion Chief/Union President Jack Reall?

I don’t know what kind of preparations were made by the fire department, but I suspect that they began well in advance of BC/Pres. Jack Reall’s attempt at sabotage.

It is appropriate to study things when there is a state of equipoise about which is best.

Equipoise is just a fancy word for We do not know which is best.

When we do not know what is best, we should find out, rather than arrogantly assume that we know all that we need to know to force an uninformed opinion on others. That is the alternative – I don’t know, but I am going to force my opinion on everyone else because I am certain my opinion is more important than learning the truth.

Research means we learn more, even if we never learn the whole truth. Opposing research is opposing learning more – especially if the truth disagrees with opinion.

Equipoise means that we cannot be certain, because we do not know enough to be certain.
 

Reall was against the plan from the start and said fewer paramedics meant lower-quality service.[1]

 

The fire department and the union probably have worked out procedures for resolving these differences of opinion. They probably do not include delaying 911 responses to make a point.

If Jack Reall were behaving responsibly, he would have raised these concerns at an appropriate time and place.
 

Reall said the plan was not presented well to firefighters and paramedics and was “not well thought out.”[1]

 

He did raise them at the appropriate time, but he did not get what he wanted.

When I don’t get what I want, as a responsible adult, I should throw a tantrum.

True or False?

A Battalion Chief is supposed to be a person to turn to to resolve confusion, not to create confusion. One part of the job is to make a clear decision (such as to protect the interests of a patient) and to take responsibility for that decision.

It appears that Reall was doing the opposite.

Footnotes:

[1] Firefighters-union chief faces discipline from Fire Division
By Lucas Sullivan
The Columbus Dispatch
Wednesday July 9, 2014 5:51 AM
Article

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Comments

  1. I would hope that Batt Chief Reall is afforded due process in this matter. You certainly seem to have no problems making assumptions and jumping to conclusions regarding this matter. It certainly wouldn’t be the first time a union officer was targeted for frivolous discipline by his employer. The story in the press seems the give only the management side of the story. Perhaps when the matter is deposed, then ( if it is warranted) you can feel free to comment on the matter. Until then I think BC Reall has earned the right to having judgement reserved until the situation is resolved.

    • Steven Schnaudt,

      If you read the article, it clearly states that there has already been an investigation. The question is what to do with Battalion Chief/IAFF Local 67 President Jack Reall.

      A Columbus Fire battalion chief could face discipline for insubordination after an internal investigation found that he disrupted a pilot program intended to more efficiently respond to emergencies.[1]

      Are you claiming that there was no investigation?

      Are you claiming that the investigation was inadequate?

      Are you claiming that the article was inaccurate?

      Are you claiming that the investigation was unfair?

      Please provide some evidence to support whatever you are claiming.

      I would have preferred if the newspaper article included full quotes, but I did not write the article and I am not on the editorial board. Feel free to contact The Columbus Dispatch with your concerns.

      I do not see any reason to modify anything I have written.

      Of course, you are entitled to your opinion. You are entitled to treasure your unique and beautiful snowflake opinion. Flaunt your entitlements.

      Maybe I should write about whether the IAFF (International Association of Fire Fighters) is spreading misinformation in order to protect fire fighter jobs at the expense of patient care.

      This would not be the first time that someone representing the IAFF has behaved badly, on behalf of the IAFF, and been caught.

      The IAFF is a union that has been established to protect the jobs of fire fighters. The IAFF does not represent patients.

      I am only interested in what is best for patients.

      Provide valid evidence and you will have my attention. Provide only an opinion and you provide nothing of value.

      .

  2. Mr. Rogue Medic,

    I find it ironic that I am somehow writing to a blog called rogue medic defending my alleged “rogue” actions. Although my contact information is readily available on the web, you chose not to contact me prior to basing your opinion on the opinions of others.
    Let me help you out:
    The investigation is not complete.
    The AC in question has a history of anti-union antics.
    The medic unit was not delayed due to my actions, in fact, I was not at the station when the call was taken, however the AC and a DC were.
    I am given the authority to make deployment decisions every day in the 15th largest FD in the country. I am a paramedic and know the appropriate response to a seizure. I chose on that day to send the 1 Paramedic vehicle to the seizure and leave the 2 Paramedic vehicle in service for another call that may be an ALS call. If you disagree with these actions, I would like to know why. That is the gist of the event. Unfortunately, it has gotten blown out of proportion by an AC who does not like the Union and a newspaper who opposed collective bargaining.
    Have a great day and good luck in your future endeavors.

    • I am the AC Jack Reall calls “anti-union”. I was a vice president of Local 67 for 4 years and while I do not support some issues that the national labor organizations support, our local union has operated fairly effectively for a number of years and provides a sound place for disagreements to be discussed and mediated. So far as being anti-union – produce the evidence. I have worked very hard with our union leadership on many cases to come to equitable solutions and get firefighters help through problems affecting their performance. Ask other officers of this same union if I am anti-union. Am I in the union? No. Jack Real, when faced with possible huge cutbacks in the city budget a few years ago that would have resulted in layoffs of possibly 185 firefighters, negotiated a deal with the city to extend our contract wherein the city called for the removal of the Assistant Chiefs from the union. Jack personally came to each AC and discussed this with us. While I didn’t like it, it was a linchpin in getting the deal done, five of us giving up being in the union for the security and betterment of 1500. I seek no award for this or even a “Thank You” – it was simply the best thing to do at the time. And, it’s pretty hard to argue that AC’s are not “management.”

      The investigation is complete. After one year of no action on the charges, a few people involved in the incident were re-interviewed as there were reportedly some discrepancies in the timeline of the event. The event occurred on September 17, 2013 and an adjudication has not been issued by Fire Chief Paxton as yet. Regardless of the memories of what the chronology of events was, and that will naturally fade over the years, the testimony concerning the actions of BC Reall stand.

      Concerning the delayed run that day, it is indisputable from sworn testimony of firefighters and officers who were assigned to station 10 that day that BC Reall directed them to operate differently from the experimental plan that was to be used for the Medic vehicle that was to be staffed with one paramedic and one EMT-B – we called it the PB Medic. Captain P, FF L, FF S and FF B – all testified under oath to this effect.

      It is also a fact that Local 67 IAFF Union president Reall objected to the plan and voiced some concerns to myself and to the Fire Chief concerning this planed, experimental deployment. Let’s back up a bit… Former Safety Director Mitchell Brown directed Chief Paxton to review the EMS delivery system the Division had employed since 1996 to see if we could be more efficient in how we operate. Like it or not, that is within the realm of responsibilities of the Director, who routinely cited Seattle, viewed as the premiere EMS systems in the country, that operates with one-eighth the number of paramedics used in our delivery model. Our delivery system is to have one paramedic on each Engine company and two paramedics on each transport vehicle – we call them “Medics”. So we have 34 Engines and 32 Medics staffed this way every day. It may be the best possible system and it may be what the citizens demand. That’s ok with me if the public wants this, it is the best we can offer and the city is willing to pay the bill.

      Back to the experiment. It is president Reall’s right to speak differently from the management of the Division. On this issue, he made it very clear the position of the union was this was a “reduction in services” to the public. I’m ok with that, his difference of opinion. But, when the Chief made a decision to move forward with the experiment, which was debated for months before implementation, it was my duty to implement the program to see if we could operate in a different staffing mode that would allow better use of our paramedics.

      As implemented, the plan still called for three paramedics being dispatched on all ALS-2 call types – one on the PB Medic, one on the Engine and one EMS Supervisor. The plan had specific dispatch matrices based upon call-type that were vetted by our EMS Medical Director.

      This plan was different from what we had been previously running as a Peak Demand Medic (PDM) which were staffed twelve hours per day, five days a week, in that the PB Medic had one paramedic and one EMT-B, whereas the previous PDM was staffed two paramedics, making the PDM the equal of the permanently assigned Medic unit in that station, and for all practical purposes interchangeable.

      But on the day in question, BC Reall knew they were not equal, had opposed the implementation of the experimental plan, and had even e-mailed the Fire Chief and myself on Friday evening, September 13, 2013 stating, again, his opposition to the plan, a plan he acknowledges under oath as having read.
      I get it. He didn’t like the plan. But I don’t have the option of disagreeing with the plan. In fact, at the back of the Medic that day as the firefighters were checking their equipment, BC Reall stated to me “Apparently you didn’t get my e-mail Friday night”. I did, indeed get it, and I asked the Fire Chief if I was to modify the plan or implement it as designed, a design that was crafted over many months and with much input and foresight. Jack simply didn’t agree with it. And I told him the Chief and I got his e-mail, but I have not been directed to alter the plan.

      As I stated before, the evidence is incontrovertible that BC Reall directed personnel at Station 10 to operate differently from the plan. One of the designs of the plan was to compare the two staffing models side-by-side and compare the results. When BC Reall directed the staff to operate differently – specifically, he directed that the PB Medic would take only BLS runs and the regular Medic, staffed with two paramedics – would take only ALS runs – it defeated the purpose of the study, and in effect, set aside the directive of the Chief by converting the PB Medic to a “BLS Squad”. I would say, given his repeated disagreement with the experiment and his opposition voiced even the Friday night before the Tuesday implementation, that this was not a BC making a tactical decision on how resources are used on the fly, but an obvious attempt to set aside or modify the orders of the Chief to his liking, or the desires of the local union. He could not persuade the Chief to change the program, so he unilaterally attempted to change it.

      As for the seizure run that was delayed: Engine and Medic 10 were dispatched on a seizure. After some lapse in time, and after seeing a paramedic I knew was assigned to Medic 10 that day still in quarters, I asked why he hadn’t responded. He answered that BC Reall had directed them that the PB Medic would take BLS runs and they would only take ALS runs. Sworn testimony of Captain P, FF L, FF S and FF B affirms there was confusion as to who was to take the run due to the directives of BC Reall and contrary to the plan being implemented that day. This is not simply conjecture on my part, it is the sworn testimony of the individuals, one of whom in fact stated specifically he was confused due to BC Reall’s directives. Note to anyone reading this: If your unit is dispatched on a run; take it. Take the run and ask questions later.

      Lest I seem I am bashing BC Reall, I will add that I believe he is a good incident commander and has many skill sets that are above average. I sent him an e-mail two days ago asking him to attend an FBI sponsored event in Cincinnati concerning pre-deployment of resources for the All Star Baseball game in July when I noticed there was no invite sent to any members of Ohio Task Force-1, one of the 28 FEMA sponsored urban search and rescue teams. I think it is important that if there is to be an all-hazards approach to this event, OHFT-1 should be involved in the pre-panning. I elected to send Jack in my place to this event because I am confident he will represent OHTF-1’s assets and capabilities very well.
      To those who want to label me as anti-union or that I picked on BC Reall the day of this incident, I remind you I was the one following orders, and we do not get to choose which orders we obey and which ones we do not in a para-military organization such as a fire department where obedience to orders can be critical.

      I didn’t bait BC Reall into anything, I didn’t threaten him; in fact, when I was ordered to write a synopsis of the events of the day by the Fire Chief, I offered that we find a way to mediate the issue rather than filing charges, which I have no authority in our department to do. (Only the Chief or Admin AC can file charges).

      This is what I have to say.

      Karry L. Ellis, Assistant Chief
      Columbus Division of Fire

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