Though I’d like to write a glass-half-full article, the 2010s were a tough decade for public safety, and more, many of the problems and challenges facing police, EMTs, paramedics and firefighters are likely sticking around in 2020 and beyond. Here is my list of the challenges, disappointments and transformations that significantly impacted public safety professionals in the last 10 years.
#1 Mass Murder in Our Schools
Though the Columbine school shooting happened in the last year of the last century, school shootings began to have an indelible impact on every child’s education in the 2010s. The 2012 killing of 20 children and six adults in the Sandy Hook elementary school forever changed how children, parents, educators and public safety personnel respond to active shooters.
Unfortunately, mass murder in our schools, as well as churches, businesses and public gathering spaces, persisted throughout the decade. The 17 deaths at Marjory Stoneman Douglas High School in 2018 is one of the many incidents that bookends a decade of tragedy from active shooters.
Most post-incident school shooting investigations reveal inadequate training, jumbled communications, poor leadership and turf battles with accompanying acts of incredible courage and heroism. Sadly, little significant change has resulted from this repetitive set of lessons learned.
At the dawn of a new decade, every public safety agency needs to have an active shooter response plan, including adoption of the rescue task force, that is regularly practiced, supported by policy and SOPs, and communicated to school officials.
Prediction: By 2029, nearly every school will be fortified against attack, have at least one-full time police officer in the building every day, multiple teachers and staff will be carrying firearms, and bleeding control instruction will be as common as a fire drill.
#2 Expanding Scope of Care for the Lay Responder
The Hartford Consensus, a result of the Sandy Hook investigation, identified the importance of rapid layperson care to assess and stop severe bleeding with direct pressure and tourniquets. This evolved into the Stop the Bleed campaign, which has spread nationwide through public service announcements, in-person and online training, and the growing availability of tourniquets to teachers, cops and civilians. Increasingly, a Stop the Bleed kit is inside or adjacent to an AED cabinet in many public locations.
In the 2010s, civilians were also given increased access to:
- Epinephrine to treat anaphylaxis
- Naloxone to treat opioid overdose
- Notification through the PulsePoint app of out-of-hospital cardiac arrest
- Instructions from a dispatcher to begin CPR
Prediction: By 2029, through the increase in 5G (followed by 6G and 7G), there will be an increasing array of clinical instructions delivered through AI-powered telemedicine applications. Numerous medical conditions will be recognized, as well as prevented, by wearable or implanted devices, which will contribute to the continuing decline of transports from peak EMS.
#3 War on Drugs Is the Endless War
Public safety personnel have always been on the frontline of the war on drugs. The multiple-front war has achieved occasional successes, but the population of addicted persons and what they are willing to inhale, inject or ingest seems to have no limits.
In the early part of the decade, crystal meth was a top concern, especially the immediately dangerous to life and health (IDLH) environments of homes and vehicles used to cook meth. Responders trained on how to recognize IEDs protecting meth labs and decontaminate children exposed to the byproducts of meth cooking. At the end of the decade, meth is making a raging comeback, especially in rural America, challenging public safety and public health officials.
Throughout the decade, the opioid epidemic worsened to incomprehensible levels. Most of us were aware of the increasing number of overdoses and deaths well before the mass media, elected officials and policymakers took note in the middle of the decade. The epidemic, which has persisted despite important local efforts, like the Safe Station, and President Donald Trump’s public health emergency declaration, shows no signs of lessening in the years ahead.
In between the rise, fall and rise again of meth and the opioid epidemic, first responders have had to deal with mass overdoses from synthetic marijuana, the impact of marijuana legalization and the bizarre behaviors caused by flakka. Patients with excited delirium, often precipitated by drug use, continue to be a threat to the safety of first responders and bystanders.
Prediction: By 2029, public safety personnel will still be on the frontline of the endless war on drugs, while also dealing with the consequences of addiction to virtual and augmented reality applications.
#4 Mission Creep, Creep, Creep
The expectations of police, firefighters and EMS personnel expanded throughout the last decade. Either by stated expectation or default, police officers have become mental health case workers, paramedics have become social workers and firefighters have become drug addiction program referrers. Police officers consult with principals and pastors on hardening their facility from lone-wolf attackers. Firefighters remove vegetation surrounding homes and businesses to reduce the risk of catastrophic damage from wildfires, exacerbated by climate change. Paramedics, through community paramedicine training, monitor patient medication compliance and try to prevent hospital readmission.
You are expected to do more and are indeed doing more for your community than you’ve ever done. Despite the mission creep, it’s unlikely your department’s budget for personnel, equipment and training has grown in step with the expanding mission.”
Prediction: Law enforcement officers will become the predominant all-hazard responder. A declining number of fires, unwillingness of insurers to cover entry into IDLH environments, success of residential sprinkler legislation, and changing building practices will supplant fire suppression with fire containment. Peak EMS, reached in the late 2010s, will continue so that most emergency care is provided by early arriving and basic life support-trained law enforcement officers. A highly skilled, but small cadre of paramedics, with college degrees, will perform ambulance transports when necessary.
#5 Is Any of This Working?
This decade, leaders, agencies and field personnel have heavily invested time, money and personnel into:
- Mental health/PTSD recognition and treatment
- Physical fitness programs
- Roadside safety training
- Cancer prevention PPE and SOPs
- Driver training, assessments and policy
Are these efforts important? Absolutely, but there seems to be a gulf between what we want to happen (less injury and death) and what is happening (continuing injury and death).”
The trainings, videos, articles and conference presentations available on these topics have increased by orders of magnitude this decade. Peer support teams have been stood up, wallet cards of suicide warning signs distributed, research on the poor efficacy of red lights and sirens has been published and physical fitness assessments conducted. Despite these well-intentioned and important efforts, public safety personnel are still dying by suicide, going home from work “not feeling well” and dying a few hours later, leaving the profession with undiagnosed traumatic stress, and being killed in collisions while not wearing a seatbelt and running red lights and sirens.
Working or volunteering as a police officer, firefighter, paramedic or EMT will never be 100% safe, but I am concerned that it hasn’t become remarkably safer in the last 10 years.
Prediction: By 2029, there will be evidence-based guidelines for mental health treatment and physical fitness programs. Pre-employment screening will be fine-tuned to remove bias and steer the most at-risk applicants to less-dangerous professions. Driver assistance technology, autonomous vehicles and vehicle-to-vehicle communication will eliminate almost all uses of red lights and sirens.
#6 More Money, Yeah Right
Public safety, in most places, has never recovered from the recession of the mid-2000s. Except for a few, most agencies are lucky if their personnel numbers, training funds, and vehicle/apparatus replacement schedules have returned to pre-2008 levels. Every agency is under-funded and the services that are reimbursed, such as Medicare, are usually well below the actual cost of delivering the service.
A constant state of being underfunded and overwhelmed is a top driver of the increasing challenge of recruiting applicants and the poor retention of existing staff in nearly every agency. Changing culture, improving morale and accepting the inevitability of mission creep is helping some agencies, but underpinning nearly every recruitment or retention effort is increasing budget for innovative recruitment efforts, modernizing equipment, software and facilities to attract applicants, and increasing pay and benefits to retain existing personnel.
Prediction: There will be an economic recession early in the 2020s. This decade’s decline in union representation and vilification of public sector employees, from cops to teachers, will result in dramatic budget cuts for public safety at every level. Instead of doing more with less, as many departments did in the 2010s, they will provide less service with less funding.
#7 It’s Autumn for Volunteers
I admire and appreciate the hundreds of thousands of fire department, EMS and police auxiliary volunteers. Your dedication to your community, neighbors and colleagues is amazing.
Throughout the 2010s, countless agencies launched PR campaigns to recruit new volunteers, lobbied for tax incentives or reduced training requirements, and changed state laws and administrative rules for ambulance crew configuration. Despite these efforts, many volunteer agencies and departments closed or merged into neighboring departments. Many more are in peril with a grim outlook for the 2020s.
For volunteer EMS, the problem is further exacerbated by the closing of hundreds of rural hospitals. Many volunteer EMS leaders, instead of recruiting and training new members, are busy running long-distant transports. At the start of the decade, a rural patient transport might have been 10 to 20 miles. Now, it could be a 50- to 100-mile ride to reach the nearest hospital.
Prediction: By 2029, we will look back on EMS volunteerism with same nostalgia we now direct to “Emergency!.” A few high-performing, all-volunteer led and operated agencies will still exist, primarily fire-based EMS departments. Elected officials and taxpayers will be confounded at the disappearance of a public good they relied on and the shockingly high cost of replacing EMS and firefighter volunteers.
#8 No Data Then, Too Much Data Now
Ten years ago, hand-written patient care reports, fire incident reports and police investigation reports were still common. Sorting those reports for quality assurance, billing or research was time consuming with high-risk of error. Now, nearly every report is entered into public-safety-specific software running on a smartphone, tablet or mobile computer. Those reports generate millions of data points.
In addition to report data; body worn cameras, dash cameras, fixed surveillance cameras and other sensors are generating terabytes of additional data for investigation, analysis and storage. Nearly every vehicle and device transmit data to a fixed server or the cloud. Plus, we want these applications to sync with the CAD, scheduling software and HR software. Making sense of this data has become a significant part of every supervisor’s and chief’s daily schedule.
Meanwhile, every one of these software applications and devices has a doorway that needs to be protected against ransomware attacks from outside intruders, as well as inadvertent mistakes of employees who install malware or fall prey to a phishing attack.
Prediction: In the next decade, public safety agencies will have positions for data analysts and IT security specialists that would have been unimaginable in 2010. Software developers will continue to integrate machine learning and artificial intelligence into their applications, and will leverage their aggregated data analysis into new service lines of operational consulting and agency management.
Will the 2020s Be Better for Public Safety?
The 2010s were challenging for public safety, and my lookback didn’t even include the threats from the gig economy (Uber vs. ambulance), confrontations between police and community activists, or the worsening impact of climate change on natural disaster and chronic disease.
There are no easy solutions to the challenges facing public safety agencies, personnel and leaders. But these attributes in public safety personnel will always matter:
- Caring for strangers and neighbors as you would your own family
- Knowing and upholding local, state and federal laws
- Understanding that risk and danger always exists
- Receiving training, purchasing equipment and adhering to policies to reduce risk
- Having interests outside of public safety that nurture your spirit, grow your mind and build your fitness
Thanks for all you do, and we look forward to continuing to support you and your departments in the next decade.
About the Author
Greg Friese, MS, NRP, is Editor-in-Chief of EMS1.com. Greg has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg is a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and 2018 Eddie Award winner for best Column/Blog. Ask questions or submit article ideas to Greg by emailing him at greg.friese@ems1.com and connect with him on LinkedIn.
