Emergency Services and Electricity (Part One) - Saving Lives and Light
In the first edition of this blog, I noted that “the electric sector underpins every other essential industry sector, and it also relies on many of them. I…think of the overlaps like the Olympic rings – all interlinked, with some overlapping more than others.”
For the next few editions (we’re really close!), I’ll continue to focus on each critical infrastructure sector in relation to the electric sector because electricity – which began to be deployed as a service close to 150 years ago – has enabled the progress, convenience and abundance that are hallmarks of modern life. Thereafter, I’ll get into the overlapping policy issues in more detail.
For this edition, we’ll compare the Emergency Services Sector and the Electric Sector. Before we get started, I have to admit to an extreme bias. I believe, at least in emergencies, that the electric utility should be considered an emergency service and should coordinate with representatives of that sector accordingly. I’ll explain why later, but I wanted to be transparent going into the discussion. Going back to our trusty Department of Homeland Security’s (DHS) Cybersecurity and Infrastructure Security Agency for our overview of the sector, it includes:
The mission of the Emergency Services Sector is to save lives, protect property and the environment, assist communities impacted by disasters, and aid recovery during emergencies.
Five distinct disciplines compose the ESS, encompassing a wide range of emergency response functions and roles:
Law Enforcement
Fire and Rescue Services
Emergency Medical Services
Emergency Management
Public Works
The ESS also provides specialized emergency services through individual personnel and teams. These specialized capabilities may be found in one or more various disciplines, depending on the jurisdiction:
Tactical Teams (i.e., SWAT)
Hazardous Devices Teams/Public Safety Bomb Disposal
Public Safety Dive Teams/Maritime Units
Canine Units
Aviation Units (i.e., police and medevac helicopters)
Hazardous Materials (i.e., HAZMAT)
Search and Rescue Teams
Public Safety Answering Points (i.e., 9-1-1 call centers)
Fusion Centers
Private Security Guard Forces
National Guard Civil Support
If I tried to tackle the history of each of these areas individually, it would be too much ground to cover, even for a longer-form newsletter like mine. So, I will focus on the history of medical emergency response, fire emergency response, policing, and disaster response. Even with that narrowing, however, I’ve decided to tackle this sector in two parts. The history of each of these elements is deep and individualized. Therefore, doing them justice required such an approach. In this first part, I’ll focus on emergency medical response and firefighting.
Emergency Medical Response
As has been the case in this newsletter so far, the history is deeper and more interesting than I expected. According to Wikipedia, references in ancient texts exist that describe both strangers and non-strangers alike helping people going through medical challenges – the biblical story of the Good Samaritan being one example. As noted in the seventh edition of this newsletter, the evolution of healthcare also began in ancient times, but it progressed much more significantly than did the concept of emergency medicine.
Battlefield aid to soldiers was performed during the Middle Ages by the Knights Hospitalier, but, according to several sources, including the Emergency Medicine Residents’ Association (EMRA), the term “emergency,” was only first coined in the 1630s. The EMRA notes that it “is derived from the Latin word emergere, meaning unforeseen events that require immediate attention. The term “emergency medicine” can be traced to the French Revolution (1789–1799).” Dominique Jean Larrey, a military medical surgeon, is known as the father of emergency medicine because he developed a system of battlefield ambulances (usually horse-drawn), known as ambulances volantes, to remove wounded soldiers during the battle rather than waiting until after the fighting had ceased.
As with other critical infrastructure sectors or subsectors, emergency medical response developed rapidly starting in the 1800s. A system of ambulance services emerged for civilians as well as soldiers, from voluntary to private sector to government provision of such services. In many cases, the town’s undertaker had the only viable form of emergency transportation available, so his hearse was often used for a dual purpose – with the same client in some cases, depending on what happened en route to the hospital.
With the advent of automobiles in the early 1900s, ambulance use quickly evolved and the concepts of on-site and en route triage were fully fleshed out thereafter. The entities involved from the beginning – volunteer groups, private sector companies, hospitals, and local and state governments – continue to be involved to this day. It wasn’t until 1970, however, that the “Star of Life” was initiated by the American Medical Association. Having been born in 1971, this signage is so much a part of my existence that I have taken for granted the fact that someone had to create it. According to Wikipedia, “Emergency medical services exist to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery. This common theme in medicine is demonstrated by the Start of Life.” The Star of Life is a graphic depiction of what comprises optimal pre-hospital care for someone suffering a medical emergency. Again, according to Wikipedia, “Each of the “arms” of the star represent the six stages of high quality pre-hospital care, which are:
Early detection – members of the public, or another agency, find the incident and understand the problem
Early reporting – the first persons on scene make a call to the emergency medical services (911) and provide details to enable a response to be mounted
Early response – the first professional (EMS) rescuers are dispatched and arrive on scene as quickly as possible, enabling care to begin
Good on-scene/field care – the emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident without doing further harm.
Care in transit -– the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey
Transfer to definitive care – the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, into the care of physicians.”
I find it interesting that this conceptual framework came after the practical application of the concepts by first responders for many decades.
Similar to the variation in owners and operators of ambulances continuing to this day – although the use of hearses has, thankfully, gone by the wayside – there continues to be variation in how the people serving as first responders are trained and where they are embedded. For example, while minimum standards have evolved for emergency medical technicians, local jurisdictions and countries apply different lenses through which they view these functions. In France and Germany, for example, the governments require physicians to be in ambulances, while in the U.S. and elsewhere, EMTs, paramedics, and even volunteers can perform certain levels of care en route to getting to a doctor/hospital. I also love that many in the U.S. are trained in CPR and first aid, including my 15-year-old daughter, who had her first job as a lifeguard last summer.
The bottom line for this part of the emergency services sector – formalized response is a more recent development historically, but the concept of aiding people suffering from medical emergencies is not a new one. This is a very “bottom-up” type activity. A bystander or family member could witness the medical emergency, call 911, help the suffering person by applying basic first aid and waiting for the ambulance and EMTs to arrive – unless a doctor happens to be on the scene as a bystander, the level of medical experience steps up from the time of the emergency until the person reaches the hospital. For very serious cases, emergency personnel may also be required to transport a person in serious condition from one type of hospital to another. My daughter just told me of one of her 15-year-old friends who served as her dad’s emergency first responder. While out on a short bike ride recently, her dad had a stroke. She checked on him and realized he was incoherent, then flagged down another biker to borrow their cell phone, then waited with her dad until the ambulance arrived. Her dad is recovering well thanks to this teenager’s calmness and the system of response we have in place. I remember what it was like before cell phones – it would have taken quite a bit longer. Thank you to the telecom sector for that improvement.
Firefighting
Now onward to firefighting. This activity has a deeper history than that of emergency medical services. While fires have occurred throughout the world during human history, whether from wildfires in rural areas to fires spread by people in denser urban environments, I could not find much explanation of the evolution of firefighting outside ancient Rome and then evolving in Europe and North America. Having lived in Japan, I know fire is a major concern there, so I am sure there was some attention paid to firefighting in Asia and elsewhere before modern times, but I don’t see it/have access to that history. So, this account will focus on the West.
According to Fire Rescue and other sources, while some evidence of firefighting devices has been found in Egypt, the first organized firefighting effort began – you guessed it – in Rome. About 2,000 years ago, Caesar Augustus formed a brigade of 500 slaves, known as the “Vigilant Corps” to “roam” the streets of Rome and watch out for fires and crimes (they had to wear special badges so Roman soldiers didn’t kill them as runaway slaves). By the time of Emperor Nero several decades later, firefighting had become a business. Property owners had the choice of paying firefighters to try to save their property or to sell it after a fire. These efforts didn’t stop a major fire in Rome during Nero’s tenure in 64 A.D., but the concept itself filtered to other parts of the Roman Empire throughout Europe. The informal, volunteer “watchers” for fire and criminal activity became embedded into society, but more formal efforts did not emerge until the late Middle Ages in France. The King had his own night watch, but also formed a citizens night watch separate from the crown. While the citizens' watch was eventually disbanded, it was an important step in the evolution of firefighting.
As we’ve seen countless times throughout history, great tragedy can spur innovation. Such was the case with the Great Fire of London in 1666 when two square miles of the city burned, thousands were left homeless, and many died. Subsequently, insurance companies took an interest in fires and paid fire brigades to fight insured properties. While this type of “winners and losers” approach was not sustainable, the concepts of insurance and more formalized ways to combat fires were established and laid the groundwork for more egalitarian approaches in later years.
According to Badge and Wallet, the first fire engine company was formed in Boston, six years after the first fire hose was created by Dutch artist Jan Van der Heyden, and the first fire brigade was formed in Paris in 1716. The term firefighter was coined by the French during that time, although the direct translation is “pumper.” Innovations in fire engines evolved quickly beginning in the early 1700s and continuing as automobiles were brought onto the scene 200 years later.
Also, according to Badge and Wallet, one of the first fire-fighting organizations in the U.S. was founded by Ben Franklin in Philadelphia as a volunteer fire department called the Union Fire Company. Another luminary, George Washington, contributed to firefighting by donating a new fire engine to the town of Alexandria, Virginia, in 1774, after volunteering as a firefighter at the Friendship Veterans Fire Engine Company earlier in his life.
Interestingly, the first official female firefighter was also the first known African American firefighter. A former slave, Molly Williams worked for Engine 11 of the Oceanus Engine Company in New York City after many of the men were taken down in a flu epidemic. Help was needed during a blizzard in 1818 and she came to the rescue.
While many positive steps were taken to combat fires, especially in urban areas, not all was rosy. Firefighting companies in New York City fought to be the first ones on the scene to get paid and the tie to insurance companies was not always on the up-and-up during this era. However, professionalizing the industry helped eventually, with Cincinnati, Ohio, being the site of the first full-time fire company and Scotland forming the first fire brigade tied to municipal government. This trend continued in the U.S. after the Civil War as municipal governments began to form their own fire departments.
Despite widespread use of telecommunications by the first half of the 20th century, the idea of a central emergency number system didn’t emerge until 1959, in Winnipeg, Manitoba, Canada. However, it only took about 20 years thereafter for the vast majority of North American cities to have adopted the 9-1-1 system.
Today, firefighting continues in the U.S. with a combination of volunteer, private and public firefighting, depending on the needs in particular localities. Firefighters also often perform the function of emergency medical professionals, being trained as paramedics or EMTs, or house those professionals and function as an arm of the firefighting units. Even when those emergency medical services are performed by other entities such as hospitals, there is much collaboration and coordination between the two.
The Nexus with Electricity
Electric utility personnel deployed in the field, often known as “line-workers” are highly trained in handling electrical equipment and, in many cases, operating in environments where live electricity could kill them if not managed properly. As such, they are trained in CPR and other basic first aid. They are trained to climb poles and rescue someone who is hurt from the top of a pole if needed. These skill sets dovetail with many of the same skills needed in firefighting and emergency medical services. In certain fire situations, these line-workers may be needed to ensure that electricity is not live in order to mitigate hazards before firefighters are deployed into a building to fight the fire.
In Part 2 of this newsletter, I’ll discuss policing and emergency response, where the nexus with the electric sector continues. At that point, I’ll discuss the overlapping policy issues for all three. Until then, keep your cell phone charged and don’t forget your emergency exits!