# EMS is the most dangerous job in the US



## Fish (Nov 26, 2012)

I personally know two people killed in the line of duty, so I found this interesting

http://www.jems.com/article/health-and-safety/studies-show-dangers-working-ems


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## EpiEMS (Nov 26, 2012)

One would think that there'd be some sort of compensating differential for pay, but I've yet to see it in my reading.


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## usalsfyre (Nov 26, 2012)

Including 2007/2008s air medical data in this is going to MASSIVELY skew the numbers . Ground EMS is dangerous for stress injuries, but not fatalities. HEMS is a whole different kettle of fish.


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## Fish (Nov 26, 2012)

usalsfyre said:


> Including 2007/2008s air medical data in this is going to MASSIVELY skew the numbers . Ground EMS is dangerous for stress injuries, but not fatalities. HEMS is a whole different kettle of fish.



HEMS accounted for 31%


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## Flight-LP (Nov 26, 2012)

EMS is still significantly lower than construction when it comes to the annual BLS fatality rate. 

2011's rate per FTE was 8.9. 2010 was even higher. 

This data demomstrates a higher than average fatality rate, but no where near the highest in FTE or total quantity.


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## mycrofft (Nov 26, 2012)

We've run this before and come up with almost no deaths due to patients and bystanders, more likely to die in a work related vehicle death or maybe even assault at the hands of a coworker (haha).

I'm sure underground miners, loggers, active firefighters, commercial fishermen and inner city seventh grade teachers wold be amused to read this.


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## Fish (Nov 26, 2012)

mycrofft said:


> We've run this before and come up with almost no deaths due to patients and bystanders, more likely to die in a work related vehicle death or maybe even assault at the hands of a coworker (haha).
> 
> I'm sure underground miners, loggers, active firefighters, commercial fishermen and inner city seventh grade teachers wold be amused to read this.



It is a 4 year accumulation of data, I am not sure why it claimed EMS is the "MOST DANGEROUS" job, but it certainly is dangerous. Which we all knew all along, just now there is data to prove it. The study never said anything about being attacked by a patient causing death(not that I saw) It showed that being struck by a vechicle, or in an Ambulance crash were the most option causes. And that HEMS accounted for a large amount.

This data shows that within this 4 year margin, FF's deaths were lower than EMS within the same 4 year margin. 

"Finally a formal study confirms what we knew in our heavy hearts: EMS has far too many line-of-duty deaths and work-related injuries. The data examined from 2003–2007 comes from a series of credible national sources: The Bureau of Labor Statistics, Census of Fatal Occupational Injuries, the National Institute for Occupational Safety and Health and the occupational supplement to the National Electronic Injury Surveillance System. 

The researchers discovered a total of 65 EMS fatalities (13 per year). *The EMS fatality rate was 7.0* per 100,000 full-time equivalents (FTE) EMS workers with a 95% confidence interval (CI) of 4.7–9.3. 

*By comparison, the average for all workers is 4.0 and 6.1 for firefighters in the same four-year period*......."


One thing that is also important is that Police & Fire have actual formal reporting and tracking of their line of duty deaths, EMS does not. And like this article states, there most likely are deaths related to EMS that were not reported or included in this data.


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## Fish (Nov 26, 2012)

Flight-LP said:


> EMS is still significantly lower than construction when it comes to the annual BLS fatality rate.
> 
> 2011's rate per FTE was 8.9. 2010 was even higher.
> 
> This data demomstrates a higher than average fatality rate, but no where near the highest in FTE or total quantity.



I wouldn't dispute that, I just posted that in the title because the article stated it.

But also remember, 2011 and 2010 were not years that were used in this study.


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## Flight-LP (Nov 26, 2012)

2011 marked a 5th year decline in FTE fatality averages. The years included in this study were higher. 

EMS has the same formal reporting requirements as fire and police. The OSHA 300 log must be submitted yearly for any occupational injury or illness beyond the first aid level. This is a requirement for all employers in the US. 

I like the study and the emphasis on a cultural need for safety improvements. The problem lies in the fact that the numbers can be seen through quite easily.


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## Summit (Nov 26, 2012)

The rate is not good, but it is not that high.


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## mycrofft (Nov 27, 2012)

Fish said:


> It is a 4 year accumulation of data, I am not sure why it claimed EMS is the "MOST DANGEROUS" job, but it certainly is dangerous. Which we all knew all along, just now there is data to prove it. The study never said anything about being attacked by a patient causing death(not that I saw) It showed that being struck by a vechicle, or in an Ambulance crash were the most option causes. And that HEMS accounted for a large amount.
> 
> This data shows that within this 4 year margin, FF's deaths were lower than EMS within the same 4 year margin.
> 
> ...



Nothing there to argue with. The "Most Dangerous Profession" headline is like "Teen Suicides Increase", it appears periodically.

Digging into it for my old thread, one thing which struck me (and has stricken me repeatedly here reading the back and forth) is the absence of an official, or even generally agreed-upon, definition for "EMS" or "EMS worker". Is it prehospital, or include the ED?  Does it include only dedicated medical personnel, or firefighter/security guard/law enforcement-slash-medical responders? Volunteers? 
Without that, it will continue to be poorly recorded and subject to influence by the reporter's agenda, such as keeping their insurance rates low and refusing hazard pay.

And the blue letters above? Whenever you read those in a "study", start suspecting the content. That was once lesson from Statistics I did remember. Doesn't mean it is incorrect, but it does tend to reveal bias and appeal to mass sentiment rather than sheer logic. WIll sell more magazines though.

PS: I totally spaced off being stricken by passing motorists! Never heard of a coal miner being whacked by a car full of drunken lookie-lous, or a kid texting while driving.


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## Amberlamps916 (Nov 27, 2012)

Hmmmmmm........this study looks a bit skewed in my opinion. I can think of a few professions that are more dangerous than ems.


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## ffemt8978 (Nov 27, 2012)

How much of this is brought about by our own actions, such as Code 3 driving?


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## Amberlamps916 (Nov 27, 2012)

Excellent point. A good breakdown of specific causes/incidents would be great to look at.


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## Chris07 (Nov 27, 2012)

Considering we go code to EVERY 911 call and go code to the ED on 95% of ALS transports, I can see traffic collisions being the top contributor.


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## mycrofft (Nov 27, 2012)

#1 for firefighters on the job is cardiac failure. I think wildland firefighters have MVA's as their #1 cause, cardiac #2, and falls as #3.

Need bigger trucks!


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## Fish (Nov 27, 2012)

ffemt8978 said:


> How much of this is brought about by our own actions, such as Code 3 driving?



A lot


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## the_negro_puppy (Nov 27, 2012)

Chris07 said:


> Considering we go code to EVERY 911 call and go code to the ED on 95% of ALS transports, I can see traffic collisions being the top contributor.









lol wut? Code to EVERY 911 call?

We go code to about half our calls. I can count on one hand how many times i've driven code to hospital this year


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## Smash (Nov 27, 2012)

usalsfyre said:


> Including 2007/2008s air medical data in this is going to MASSIVELY skew the numbers . Ground EMS is dangerous for stress injuries, but not fatalities. HEMS is a whole different kettle of fish.



HEMS in the states seems to be very, very broken for some reason.


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## RocketMedic (Nov 27, 2012)

the_negro_puppy said:


> lol wut? Code to EVERY 911 call?
> 
> We go code to about half our calls. I can count on one hand how many times i've driven code to hospital this year



My agency runs code to everything. Even transfers.


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## AtlasFlyer (Nov 27, 2012)

Including helo accidents in that count is like saying being a "commercial pilot" is dangerous, and they're including jobs like Alaskan bush pilots in the count along with airline pilots. Being a bush pilot is WHOLE different world than being an airline pilot. 

Statistics can be made to say pretty much whatever you want... 83.4% of all statistics are made up.


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## shfd739 (Nov 27, 2012)

Rocketmedic40 said:


> My agency runs code to everything. Even transfers.



Like BLS hospital discharge transfers?


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## 46Young (Nov 27, 2012)

It's true that 50% of firefighter fatalities can be linked to cardiac causes. Dying during or after a working fire is not the main cause. The real contributing factors are lack of exercise, diseases caused by hyperinsulinism/Western diet (obesity, high cholesterol, HTN, hypothyroid, ASHD, insulin resistance/diabetes), as well adrenaline dumps from being abruptly woken from sleep to run calls, and adrenaline dumps from running code 3.

These causes are also experienced by EMS, where we certainly are not in the land of fit people. The other significant cause of first responder death is due to traffic incidents, being struck while operating at the scene.

When I worked in NYC EMS, we rarely had any vehicles blocking the MVA scene. I've been nearly run over several times.

In my county alone, we've had several instances where the blocking engine was struck by a motorist on the highway. There's a good reason why the apparatus position in a certain way so that the rig rocks away from the scene to protect responders. This is also why we take 1-2 lanes more than are involved in the MVC.

Do your part by getting off the MVC scene ASAP and not doing everything in the back before you leave for the hospital. Do your part by doing strength training so that your partner doesn't get injured by compensating for your weakness when handling a pt. Do your part by not being significantly overweight.  

Speaking of that, on page 25 of the Manual of Emergency Airway Management 2nd Edition, time to desaturation after Succinylcholine is measured with four patients: the normal 70kg adult, the moderately ill 70kg adult, the normal 10kg child, and the obese 127kg adult. The mean time to SpO2 desaturation for each was

-70 kg normal adult: nearly 10 mins

-Moderately ill 70kg adult: just over 6 mins 

-Normal 10kg child: just over 4 mins

-Obese 127kg adult: just under 4 mins

I found it interesting that the obese pt sees a de-sat quicker than the other three populations. All that adipose actually compromises your physiological reserve to a significant degree. Just because you think you feel fine while overweight, just know that you could function much better overall, and experience much less chronic disease if you get your hyperinsulinism under control.

Ever notice how many patients have obesity, high chol, HTN, and hypothyroid, and sometimes DM? It's due to hyperinsuinism from the Western diet, which is easy to do in EMS. Instead of grabbing fast food and subs from the gas station or Subway, how about chop up a turkey kielbasa, mix it with a 12 oz. package of broccoli cole slaw, add Italian dressing, and either have an apple on the side, or add some cashews to the salad? That's two meals on the road right there, and it keeps well in the cooler even if it doesn't stay that cold. How about cold cuts, nuts, and apples? Snack on some fruit and nut mix and steak strips, both found at Costco. It's all about smart choices. 

Really, google hyperinsulinism and diabetes, HI and cancer, HI and type III diabetes (Alzheimer's), HI and infertility, HI and thyroid malfunction (T3-T4 in particular IIRC), HI and obesity, HI and dyslipidemia. It'll blow your mind.


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## triemal04 (Nov 27, 2012)

Smash said:


> HEMS in the states seems to be very, very broken for some reason.


A for profit business model with large amounts of competition and misuse that uses an unstable and inherently dangerous transport mode with little to no regulation aside from the FAA...naw...there's nothing wrong with HEMS here...


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## mycrofft (Nov 27, 2012)

*2010 BLS fatality comparisons*

EMS: Not listed in top 10, nor was firefighting.
Others, in deaths per 100,000:

#1: Commercial fishing (116)
#2: Logging (91.9)
#3: Aircraft pilots and flight engineers (70.6)
#4: Farmers and ranchers: 41.4
#5: Mining (19.9)
#10: Law enforcement: 18
(source: http://finance.yahoo.com/news/the-10-most-dangerous-jobs.html)

Three years of statistics for EMS: 7
(source:  http://www.jems.com/article/health-and-safety/studies-show-dangers-working-ems  )


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## bigbaldguy (Nov 27, 2012)

I wouldn't be too concerned flight attendant made the top 10 two years in a row as I recall 

Here is the actual breakdown by events and industries. Check out melon farming! Those are soe dangerous melons. Year 2011

http://www.bls.gov/iif/oshwc/cfoi/cftb0259.pdf


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## mycrofft (Nov 28, 2012)

bigbaldguy said:


> I wouldn't be too concerned flight attendant made the top 10 two years in a row as I recall
> 
> Here is the actual breakdown by events and industries. Check out melon farming! Those are soe dangerous melons. Year 2011
> 
> http://www.bls.gov/iif/oshwc/cfoi/cftb0259.pdf



Totals not per capita fatality.


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## silver (Nov 28, 2012)

Lets just think and look who this is being published by and in whose journal?

If anything, we should take from it that we need to overhaul the idea of occupational safety in EMS. EMS is vastly far behind in reporting data, analyzing it, and implementing measures to make it safe for providers and patients. We need to take some of the methodology from aviation safety and now rise in patient safety to reduce some of these human factors and system failures.

Sadly, just another part of EMS that needs an overhaul. Again, I think the start is education.


Edit: with that being said, I believe the NAEMT, National Association of EMS Educators, the National Association of State EMS officials, and the National Association of EMS Physicians are failing their EMTs/paramedics by letting the final statement in the conversation be by NIOSH in the paper:
"Emergency medical technicians and paramedics have higher fatal injury rates when compared with all workers. To reduce fatalities, targeted efforts should be made to prevent ground and air transportation incidents. Reducing nonfatal injuries may be accomplished by developing and evaluating interventions to prevent bodily stress and overexertion injuries."

There needs to be a white paper.


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## RocketMedic (Nov 28, 2012)

shfd739 said:


> Like BLS hospital discharge transfers?



If it's unscheduled, yes, because it's then an "emergency". Luckily, there's a few private companies here that do the vast, vast majority of those. However, EMSA is responsible for all ER-to-ER calls, levels permitting, and those get emergent responses unless scheduled. 

Hand pain x3 weeks 2* punching a wall, going to ortho surgery in the morning? L/S response.

Yeah. I know.


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## ExpatMedic0 (Nov 28, 2012)

does anyone know where HEMS alone stands? I would be even more curious to compare U.S. HEMS stats with say UK, HEMS stats or another comparable modern western country.


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## mycrofft (Nov 28, 2012)

*You think EMS is bad? Try goose control!*

"Man Killed By Geese. Film At Eleven".
(With condolences to friends and family).


http://articles.latimes.com/2012/apr/16/health/la-na-nn-killer-swan-attacks-chicago-man-until-he-drowns-20120416


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## Smash (Nov 28, 2012)

triemal04 said:


> A for profit business model with large amounts of competition and misuse that uses an unstable and inherently dangerous transport mode with little to no regulation aside from the FAA...naw...there's nothing wrong with HEMS here...



Nothing to see here.... move along, move along.....



schulz said:


> does anyone know where HEMS alone stands? I would be even more curious to compare U.S. HEMS stats with say UK, HEMS stats or another comparable modern western country.



I don't know about other places, but in Victoria, Australia which runs 5 rotary and several fixed wing 24 hours a day, there has never been a fatality.  I'm fairly sure that there has never been a bird down at all.  

I suspect that it may be due to the fact that it is run as almost the polar opposite of what triemal describes above.  Part of my current role is as Officer in Charge of Denying Requests for HEMS.  Crews have to have a clear rationale as to why they want HEMS.  If they cannot provide a reason why HEMS will be of benefit to the patient, they do not get one.  And even if I say yes, the Flight Paramedic and ultimately the pilot can say no.  And no means no, regardless of how sick the patient may be.


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## triemal04 (Nov 28, 2012)

Smash said:


> Nothing to see here.... move along, move along.....
> 
> 
> 
> ...


Can you explain that a bit more?  How does it work, and how well is it working?  I've read about a couple of Canadian services that will refuse transports if they don't meet their criteria, so just curious.

As an aside, I've worked alongside (not for) 3 different flight services.  None asked for the resosn for a field responce, just the weight of the patient.


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## Shishkabob (Nov 28, 2012)

mycrofft said:


> I'm sure underground miners, loggers, active firefighters, commercial fishermen and inner city seventh grade teachers wold be amused to read this.



Let's get something straight:  The vast majority of "heroic" FF deaths are preventable and caused by idiotic policies.


No interior attacks = MUCH lower numbers.


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## mycrofft (Nov 29, 2012)

We lost an animal control officer today to gunfire through the front door of a repossessed house which was supposed to contain only some pets. He and a bank officer with keys for the new locks arrived, either knocked or went to unlock the door, and it was over. Shooter is barricaded in, presumably the former owner who had said when evicted yesterday that he had no place for his pets to go.
Stand aside when you knock, take five to stay alive.


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## Smash (Nov 29, 2012)

triemal04 said:


> Can you explain that a bit more?  How does it work, and how well is it working?  I've read about a couple of Canadian services that will refuse transports if they don't meet their criteria, so just curious.
> 
> As an aside, I've worked alongside (not for) 3 different flight services.  None asked for the resosn for a field responce, just the weight of the patient.



We have basically 2 tiers of triage between the event and the helicopter.  I sit in the dispatch centre, screening jobs (not just flight jobs) after they have gone through ProQA and liasing with the medical, pediatric and neonatal retrieval teams and hospitals, as well as providing medical advice to the crews in the field.

We then also have a flight coordinator.  Their normal day to day business is primarily based around scheduling of routine flights (we have fixed wing who essentially do flying non-emergency transport due to the distances that have to be covered) and flights that the medical retrieval teams need to do (mostly fixed wing, some rotary).  They also talk to me when I want a helicopter, or when they need a crew to pick up a patient and take them to the airfield.

So, a job may come in via the call-taker that is an automatic notification for HEMS, such as entrapment or major burns.  This does not necessarily mean that HEMS will launch, merely that they are made aware so they can let me know what helicopters they have available.  Depending on the details I have on the screen (or what I can get when I call the scene back) and the availability of road resources, I may ask for the helo to be launched (eg if the calls coming in sound terrible, or if there are access issues like needing a winch or if road is a long way away)
During my normal role of screening calls I may also identify other jobs that are not automatic notifications and ask for them to be sent to HEMS as well.

Normally however the crew will arrive first and then request a helicopter.  In order for me to send that request to HEMS they have to essentially convince me that there is a genuine clinical need for the advanced skills the flight medic brings (our flight medics carry blood and other exciting stuff) or that transport by road would be detrimental to the patient.

If they don't give me a good story, or I decide that they are best served going direct to the closest hospital and arranging secondary retrieval or whatever, they don't get the helicopter.  They don't like it, but that is just too bad.

If I think that the reason they want a bird is sound, I pass it on to the flight coordinator and they task whichever resource is most appropriate.  It used to be (and still is to some extent) that the flight medic can still say no at this stage.  They generally trust our judgement though.  However, the pilot can say no at any stage, even after the helicopter has launched, if they deem it to not be safe.  The pilot's word is law.

It can be very frustrating as we rely heavily on the word of the crew on the ground.  Most are very good, some like to see the whirlybird land so they make the job sound a whole lot worse than it is, and others just can't even get around to giving a sitrep, but then get all angry when I say no to them.

We do want to support the staff on the ground with whatever resources they need, but helicopters, and the highly experienced and highly trained people that staff them, are just too precious a resource to be squandering on trivial jobs.

For the most part it works well.  It is always a juggling act: sometimes a bird goes to a job where they aren't really required, and some jobs that could benefit don't get one.  Mostly though we match up the need with the resources pretty well, so the sickest patients get the highest level of care in the shortest time possible.  And most importantly there are no heroics and no helicopters crashing.


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## ATFDFF (Nov 29, 2012)

Linuss said:


> Let's get something straight:  The vast majority of "heroic" FF deaths are preventable and caused by idiotic policies.
> 
> 
> No interior attacks = MUCH lower numbers.



Erm...not really.  Approximately 60% of FD deaths (~45-50/year) are cardiac related, another 15-20% are MVA related.  

Annually, only about 10-15 deaths occur during active interior firefighting.  

(little thread hijack here, sorry!)


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## 46Young (Nov 29, 2012)

Linuss said:


> Let's get something straight:  The vast majority of "heroic" FF deaths are preventable and caused by idiotic policies.
> 
> 
> No interior attacks = MUCH lower numbers.



I beg to differ. Read this link:

http://www.nfpa.org/itemDetail.asp?...tatistics/The U.S. fire service&cookie_test=1

Edit: Also check this page:

http://www.nfpa.org/itemDetail.asp?...esearch/Fire statistics/The U.S. fire service

It seems like a lot more volunteers than professional firefighters have LODD's. From my experience, it's hit or miss is a VFD has strict SOP's in place for fireground operations that adhere to NFPA standards, or if they get killed by "freelancing." Also, physical fitness and general health seems to be a more significant factor. If you're otherwise sedentary, and exert yourself greatly on the fireground, even in a surround and drown situation, you can certainly go down, as your body is not used to it. It's like the 40-50 something y/o guy that drops dead while shoveling snow every year.


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## rescue1 (Nov 29, 2012)

46Young said:


> It seems like a lot more volunteers than professional firefighters have LODD's. From my experience, it's hit or miss is a VFD has strict SOP's in place for fireground operations that adhere to NFPA standards, or if they get killed by "freelancing." Also, physical fitness and general health seems to be a more significant factor. If you're otherwise sedentary, and exert yourself greatly on the fireground, even in a surround and drown situation, you can certainly go down, as your body is not used to it. It's like the 40-50 something y/o guy that drops dead while shoveling snow every year.



I was reading an article in Urban Firefighter (the Fire Engineering extra magazine) about LODDs in urban fire deparments, and they are significantly less per capita then the fire service as a whole. The vast majority of these, as I recall, took place during firefighting operations.

That being said, the debate on the cost/benefit of aggressive interior operations in firefighting probably is best discussed elsewhere.


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