This episode is sponsored by Transcend, a veteran owned and operated performance optimization company that I introduced recently as a sponsor on this show.
Well, since then, I have actually been using my products and I've had incredible success.
There was initial blood work that was extremely detailed, and based on that, they offered supplementation.
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dihexer to help cognition after multiple punches to the head and shift work and peptides.
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So I cannot speak highly enough of the immense range of supplementation that they offer, whether it's male health, female health, peptides to boost your own testosterone, which I would argue is needed by a lot of the fire service,
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which is putting veterans and first responders through some of their protocols free of charge.
Now, Transcend are also offering you the audience 10% off their protocols, and you can find that on jamesgearing.com under the products tab.
And if you want to hear more about Transcend and their story, listen to episode 808 with the founder Ernie Colling, or go to transcendcompany.com.
Welcome to the Behind the Shield podcast. As always, my name is James Gearing, and this week it is my absolute honor to welcome on the show,
Division Chief over EMS for Vancouver, Washington, and 34 year veteran of the fire service, Rob Milano.
Now, as you will hear in this conversation, addiction fractured Rob's family.
And it was that same perspective on the mental health crisis that pushed him to be part of the solution in his own department.
So we discussed a host of topics from some of the progressive wellness solutions they have,
the amazing telehealth embedded in their 911 system to reduce the non emergent calls they respond to, leadership, sleep deprivation, and so much more.
Now, before we get to this incredible conversation, as I say every week, please just take a moment.
Go to whichever app you listen to this on, subscribe to the show, leave feedback and leave a rating.
Every single five star rating truly does elevate this podcast, therefore making it easier for others to find.
And this is a free library of almost 1000 episodes now.
So all I ask in return is that you help share these incredible men and women stories,
so I can get them to every single person on planet earth who needs to hear them.
So that being said, I introduce to you Rob Milano. Enjoy.
Well, Rob, I want to start by saying truly thank you so much for reaching out as people are going to hear in this conversation.
Your department has so many proactive solutions to some of the things that really do plague our profession.
But I want to start by simply welcoming you onto the Behind the Shield podcast today.
Yeah, thanks, James. I've been a longtime listener.
I think that you've added an amazing thing to our profession and to law enforcement and our military troops.
It's it's I there's been many of your guests that I've had huge takeaways from.
So I'm happy to be here today and hopefully I can I can share some of the things that have worked well for us in our system.
Absolutely. So where on planet earth are we finding you?
My morning, excuse me, your morning, my afternoon.
Yeah, of course. So I'm at home today.
I live in a small suburb south of Portland, Oregon, by the name of Camby.
I've been here for the last 20 years.
We live on a small farm.
We have some acreage and yeah, so we actually have a lot of sunshine today.
So that's that's a good thing for us.
Beautiful.
Now, are you with the farmer, you actually grow in your own food and do you have livestock or poultry?
We have some poultry and we do have a horse.
We're down to one, thankfully.
They eat and go to the bathroom a lot.
And I swear that their waste is twenty dollar bills most of the time.
So they're not a cheap animal to maintain.
We do have a large garden and we do garden like a lot of our own vegetables and stuff.
So, yeah, so that's pretty much, you know, the main use that we use our place for.
But we have a very large family that we'll kind of get into and how we got there as well at some point.
So we have a lot of kids that needed a lot of room to run.
Beautiful. Well, we'll get to that.
But just just with that one singular focus of being self-sufficient, how did that look?
How did that serve you through the pandemic?
And if you were king for a day, what would you advise people as far as
leaning into that self-sufficiency for their own health and obviously,
you know, the ability to grow your own food when the food supply is dwindling?
Yeah, the king for the day thing.
I think the biggest thing is cost, right?
Processed food is cheap and especially a single income family like ourselves
with a lot of mouths to feed.
You know, we kind of get trapped sometimes in that in the processed food bank as well.
But, you know, I think that if I was king for a day, I would hopefully be able to find a way
to reduce the cost of whole foods.
And, you know, and make that apparent, you know, both back in the school system,
as well as like in our home life.
So during like during the pandemic, you know, I was fortunate to work from home a lot.
You know, so we were able and again, coming back to like a large family with a lot of kids,
like our kids really weren't isolated because we had room for run and they all had people,
you know, to be with, you know.
And it was amazing during that time how our calendars just like went blank,
which was probably like the most healthy thing for our family at that time.
Because we were just running from sports field to sports field and theater to theater
and concert to concert with all of our kids that it was just never a minute of downtime.
So it was a really nice reset for our family.
Unfortunately, that creep has kind of come back in post-COVID that we're pretty busy again.
But I think like being able to be home, being able to, you know,
live off our land a little bit better was definitely helpful, you know,
for our families like mental health during that time.
So let's jump ahead because I'm curious.
I'm sure you're listening.
So what's the backstory and the dynamic of this large family?
That you have now?
Yeah, of course.
So we're a blended family.
Both my wife and I came into our relationship 13 years ago, both with two kids each.
And products of addiction was really the demise of both of our relationships.
So that was a uniqueness that, you know, I think really tied my wife, Jessica and I together.
Was that piece.
And so, and our kids being affected by that.
So we both had sole custody of our kids.
And so we were able to blend our family pretty seamlessly, which was amazing.
Like it was like from the first day our kids met each other, they were like just instant,
you know, friends and engaged and continued to be.
That is one problem we don't have in our house.
Like we don't have a lot of friends.
We don't have a lot of infighting.
Our kids are kind of like their own little tribe and they really do stick together.
So a few years after we'd been married and things were moving along,
we got involved in the Oregon foster care system.
And we were successful in fostering a seven-year-old boy that was the same age as our son.
And he, after two years of some port battles and DHS integrations, we were able to adopt him.
And so he's been with us for the last eight years and, you know, is just one of our tribe.
And then, and he was again a product of addiction and mental health.
His mom really struggled with that and ultimately, you know, lost custody of him.
Then about three years ago now, my wife's first cousin went through some tough times
and struggles with addiction.
And DHS showed up at her doorstep and was going to take her kids.
And so she called my wife and we still had our foster care licensing.
So we were able to work out a deal that the kids came to us and not into the system.
So they've been with us for the last three years.
Pretty tough time over the last three years with that.
Of both parents, there's three parents involved with those three kids and two separate dads.
And one dad's completely out of the picture and one dad struggles heavily,
and all of them struggle heavily with addiction.
But one dad really wasn't able to take on the kids.
So we entered in, as we tried to navigate everything, even like the simpleness of trying to get
the kids healthcare insurance and to start trying to meet their needs,
led down a pretty tough path for us.
And since we didn't have custody and the state kind of backed out of any assessment,
as far as the foster side of things go.
So we were kind of just left on our own with it.
So we started down the guardianship and custody route.
And that took almost a solid year to get through, but we do have custody of them now.
I am happy to say, and hopefully we'll kind of get into this a little bit more in the future,
about some of the innovations that Vancouver Fire has done as far as the opiate issues in our area.
Both parents are clean and sober.
And mom is well engaged and back in their lives and participating right alongside of us as co-parenting.
This month, they actually moved to some overnights with both parents.
So there is success stories out there.
Yeah, so that's kind of our tribe.
That's how we kind of came to be.
That's amazing.
And this is the conversation I've had so many times on the show.
And it's so beautiful, especially when law enforcement says, look, this war on drugs isn't
working. Arresting people because of addictions is just simply creating more trauma in households.
And you're obviously seeing the next generation of addiction.
It can go one of two ways.
The mother and or father find that the healing that they need, get back on their feet, and then
are able to start rebuilding that family dynamic.
And in the meantime, you and your family have stepped in and been that family for them.
Or they get discarded and the kids end up in a different place.
The parents are in prison or even worse, crippled addiction or overdose.
And it's just the solution is so painfully simple, which is just putting compassion and kindness
back into the addiction conversation and encircling those people in the therapies and the help that
they need to get them back on their feet.
Yeah, no, I couldn't agree more with you, Jim.
You know, and Oregon's been pretty progressive with the decriminalization laws, as has Washington
State. And the unfortunate piece of both of those programs was there was not the support system built
to bring those people into care and to assist them.
And that still is a problem.
And I think that's a very important point.
And we're getting ready to roll out medication-assisted treatment in our field.
And one of the big hurdles that we're having right now is being able to build a network of social
workers and clinicians that can help support these people as their brain fog kind of lifts from their
addictions. And so it's, you know, so that's the problem.
And so it's, you know, so that's been it's almost kind of backfired in our states.
And I believe almost made the problems worse with the decriminalization, because again, just all
those pieces weren't in place.
It's kind of the cart before the horse approach.
I was literally having the same conversation with someone the other day, you know, and what happens
now is you get the, you know, the people who still are set in their ways because they don't have the
capacity to think like a kind, compassionate human being.
So they want to keep arresting addicts and they point to, you know, the Northwest and go, see,
it didn't work there.
But we didn't do it properly.
It's like pointing to Obamacare and saying that national health doesn't work.
That wasn't national health.
Wasn't even close to it.
If you look at the Portuguese model, they took that money from the war on drugs.
And obviously then, let me just be very clear, they freed up a huge amount of money and resources
for chasing the traffickers and chasing the dealers.
That's those people are behind bars.
But all the other money they referred and they opened addiction counseling, you know,
mental health counseling, job creation, housing.
So they had all those pieces in place.
What we've done wrong in America is like you said, there's been decriminalization or, you know,
safe injection sites, but we haven't proactively done, you know, put everything in place so that
addict can go from that criminal route to that medical route that they actually need.
And now you've got the opposition, you know, wringing their hands going, see, it didn't work.
It's like, no, that was never ever a true trial of what it should look like.
It was the same piecemeal attempt as Obamacare was.
So if we're going to do it, we need to do it properly.
Yeah.
And I think that that's, I mean, that's one of those things, right?
That, you know, you get so much governance that comes into play in those arenas and those spaces
in, you know, that it's a really good idea as it enters the ballot, right?
And people vote on it.
And obviously in Oregon and Washington, those things passed.
But then now it's planning time, right?
So government has to get involved.
And I, you know, having been in government work for 30 years,
I see that over and over again, that these really good ideas come to the forefront.
But by time it goes through the machine of the politics, the labor groups, the,
you know, management and it gets spit out the other end and it looks completely different.
And, you know, I mean, you bring up the Affordable Care Act.
I mean, that was identical to what happened there.
You know, Obama, I think, had a great idea and it looked really good during the polls.
And then when it got spit through the political machine,
it was something completely different that actually, I believe,
made healthcare worse in the United States.
So, yeah, I think we need to have more purpose, like, in those conversations.
100%.
All right.
Well, let's go to your timeline and then we'll obviously talk about some of the proactive things
that you're doing in Vancouver.
So tell me where you were born and tell me a little bit about your family dynamic,
what your parents did, how many siblings?
Yeah. So I was born in Whittier, California, down in Los Angeles County, and that's where my parents
were raised. And they were kind of post high school sweethearts. And I grew up in Southern
Orange County. My dad has always been in finance of some sort, whether financing cars or financing
homes. And he did some real estate brokerage for a long time down there. And he was in army intelligence
in Vietnam and spent some time over there. And so pretty great stuff there. He was also adopted
through his church. Just another family had two boys about the same time and couldn't afford both
of them. And my adoptive grandparents couldn't have kids. So they worked out a deal and all of
a sudden my dad had new parents at a really young age. And it was just not really talked about.
And I don't know if that's what kind of led me to having some passion towards adoption. But I think
that his story definitely kind of tells true of later in life he was able to reconnect with his
biological brother and then that he has an amazing relationship with. And probably one of the reasons
that it pulled them from Southern California up to Oregon because my uncle is here in Oregon. So
they've rekindled a pretty solid bond and relationship after 30 years of being separated.
And he was able to reconnect with his biological father before he passed and his biological mother.
So pretty good story there. My parents have been married I believe over 40 years now.
And so I came from a really solid foundational home. My mom was a hairdresser for a long time
and then she kind of entered the corporate world in like a safety industry. And so I think that
you know in helping with like safety systems and did that for a really long time. She's also
retired now. My parents live pretty close to us. They're about 15 minutes away so we see them quite
frequently and a big part of our tribe and our family. And then I have an older sister that's
still down in Southern California. She lives in Fountain Valley and her and her husband are both
school teachers down there. And I have two nieces through that as well. So that's kind of my family
dynamic. With you being a 30 year first responder yourself, have you had conversations with your
father about the impact of his service in Vietnam? Because that generation especially with the home
coming element had such a different experience than I mean the Korean War sadly a lot of people
don't even discuss but obviously the World War II vets and then more recently the Gulf War vets.
What was the ripple effect if any that you've discussed with him about the Vietnam experience?
Yeah that has come more to light in the last few years with him more so than ever. It really
wasn't discussed very much and he didn't really talk about it very often. But more and more
over time he has become more open about it. Post retirement they downsized their house a little
bit and moved more into kind of a planned community. And he made some new friends in
the neighborhood and they started a poker club and they were all part of like a veteran group.
And my dad just really didn't he never had the need to access military services or VA services.
So he just never did. And so in that group one night they're all playing poker and they start
saying like he was complaining about his hearing aids or his eyeglasses are like well why don't
you go up to the VA and get some stuff and he's like oh no I don't need to do that and they're
like oh you should sign up it's great you know. So now my dad's all in like he kind of got a taste
of that and he is all in and utilizing those services. My dad's a three-time cancer survivor
and also was just recently diagnosed with Parkinson's and is in that early onset and all
of those things tied back to the chemicals that they were using in Vietnam. So now he actually
has a disability through the VA as utilizing those services and I think a lot of that has opened up
more pride in his service and his ability to talk more freely about his time. He was fortunate.
He was able to like stay in the United States for the majority of his service time and only had to
spend a little bit of time over in Vietnam and most of that time was spent like in an office
building because he was doing Army intelligence and kind of like a little bit of a little bit
kind of directing the crews on the ground. So thankfully he wasn't necessarily out in the
front lines of that but I do know that he did spend some time out in the field and saw the
the effects of war and so yeah we've talked through some of those things.
My father-in-law had the same thing he was exposed to Agent Orange when he was in the Navy in Vietnam
and these multiple cancers and all kinds of things. So this is the thing about taking care
of our veterans specifically. I mean our first responders too but our veterans whether it's the
burn pits of modern day or whether it was the Agent Orange back then. I mean if they were
inadvertently poisoned when they were supposed to just be worrying about the enemy then
it's up to this country to take care of them. Yeah I fully agree. All right well then what about
athletics? What were you playing and doing as far as sports when you were in the school age?
Yeah so you know growing up in Southern California I know you spent some time down there. I mean it
was that you were an hour from the beach, an hour from the mountains. So I've always been a big
board sports guy so whether it was skateboarding or surfboarding or wakeboarding or up in the
mountains you know snowboarding that has been a big passion of mine my entire life and still is today.
So and then like as far as like high school sports I was a runner so I ran track and cross country.
I grew up playing soccer and but when I got to the high school level I just
it was way too competitive in Southern California for that you know that's kind of the people ship
their kids there to play soccer. So yeah so I toyed around a little bit with that but you
know my big thing was you know running more long distance you know so long distance stuff in track
and then cross country. And what about career aspirations? What were you dreaming of becoming
when you were in the school age? Yeah so fire service was a big thing for me. I like at a really
young age. I grew up on a small cul-de-sac with five houses. On one side was a Newport Beach captain,
on the other side was a battalion chief with Wayna Park. And so you know so I was just immersed
in that and in California like conflagrations happened all the time and we lived in Southern
Orange County and so they would come I remember distinctly both of them coming into the cul-de-sac
with their task force you know to like grab some food because their wives had made food and all
the kids in the neighborhood come up you know run out and you know participate you know with
with that fire apparatus in the cul-de-sac. And so that was kind of that start of it all.
I also like really thought about being a teacher and so when I hit college you know I was actually
taking some early childhood education classes and the fire program at the same time because I was
kind of trying to weigh which way I really wanted to go. But yeah the fire service just really stuck
with me. In high school we had Orange County Fire Authority come in with their Explorer program into
the high school and the guy that was running the program, the coordinator of the program, was a big
skateboarder as well and had a big half pipe in his backyard and he lured us all over there.
And then before I knew it I was signing up and being a part of Orange County Fire Authority and
doing that for all through high school and then my first year of college as a pay call.
What was the environment that you were trying to get hired in? Because we
modern day and we'll get to this of course you know we have this horrendous recruitment crisis
now and I think that what people don't realize is how far we are from the 90s and early 2000s
when thousands of people were testing for a handful of jobs. Oh yeah I mean it was it was amazing James.
I remember sleeping on street corners just for an application. It was like a homeless
encampment around City Hall of just a bunch of firemen that are trying to get a job.
And I remember you know you'd make relationships with people in the line so you could go use the
bathroom or go grab food or do something. So and that was just to get an application.
You know and I remember testing at LA County and having to go to the old Lakers arena with like
20,000 people and it was just this constant noise and they gave you like a little piece of plywood
and your your test and you're sitting there in the bleachers you know trying to take a test.
You know so that environment has just completely shifted and very hard you know to get into the
program. You know thankfully through Rancho Santiago College which is now Santa Ana College down
there my affiliation with Orange County Fire as an explorer and as a pay call like assisted in
getting into that program and the mentors that I had through that. But then you took all the
classes and then you just waited for your name to be drawn to go into the academy. And so it you
know it was very prolonged. And then paramedic school was the same thing. They literally used to
have this it was like the old lottery ball like bingo like old folks home bingo thing with all
the balls in the cage and they'd roll it around and they'd pull names out of who the next paramedic
class was going to be. So I sat through that for a few times and wasn't one of my balls wasn't
picked. So I headed up to Oregon to go to paramedic school there. Yeah it was such a different you
know environment and I wasn't there. I went to school in let me see 03 04 I got hired in 04.
But the environment I went it was still very very challenging. It just happened that Hialeah at the
time was so poorly paid that not as many people were applying because Miami-Dade was actually
making double. So when I put it in and there was so many Cuban people there like I was a minority
you know a random English person in a very very Cuban city was I was almost the affirmative action
hire I think. But I mean but that was a real thing as well you know and this is the thing people are
scared to talk about diversity and affirmative action. But you were part of the explorer program
and I think that is the how you truly forge diversity these mentorship programs especially if
you go into underserved communities that aren't being represented and that has to be you know
rectified. But you find the best candidates within you don't just scoop a bunch of people that fill
that criteria and say you know you're all welcome because you haven't you know selected the ones
that are actually worthy to do the job. So talk to me about that as a white male in the 90s.
What was the resistance to getting hired because I mean it is a conversation needs to be had because
I don't think it was done in the correct way back then. Yeah so it was tough and most of the hires
were and even down to the college level into programs there was very much high levels of
incentive for minorities to come in and women as well. Because again the fire service was poorly
represented with those with those groups. So I understand why they needed to do what they needed
to do there. But like as a white male that made it more difficult. Like it forced me to figure out
my individuality of being a different candidate and how to express that in interviews and what
I could bring to that table. Which took time you know I tested a lot of fire departments. I sat
through a lot of interviews. I went through a lot of you know captain so and so's interview for
success classes you know over the years. And I think the biggest takeaway was just trying to
divide myself from the cookie cutter other candidates and bring something else to that table.
So talk to me about the move to Oregon. You're trying in Southern California it's just not
happening there. You know what was the the difference when you got to that state?
Yeah so my right after high school we my family my parents we did a short stint
of a move from Southern California up to Eugene Oregon when I was about five years old.
And we were there for five years and my parents loved it and my sister and I loved it. But my
grandparents who were still back in Southern California you know their health was deteriorating.
And so we moved back. And then it was always talked about we're moving back to Oregon we're
moving back to Oregon. And then my sister got into high school and then I got into high school and
so my parents just didn't want to uproot us during that time. But the minute I graduated high school
my parents were there was a for sale sign in front of the house and they were gone.
So they moved back to Oregon. Yeah so I forged ahead on my own down there like at that point
you know being an 18 year old kid that was surfing every morning and very much involved in the
Southern California lifestyle. Like I wasn't going to Oregon. I'm not are you kidding. I'm not doing
it. So but after after the first year stand down there it was apparent that I was not going to get
into medical school down there at that time. And that was kind of that next thing that was going
to separate me. And that was what my mentors were telling me. You got to get your paramedic. That's
you know you're going to go from testing against thousands to testing against hundreds if you can
get that medic done. So you know my parents actually like moved into a rural community
just outside of Eugene. And there was a small volunteer fire department right across the street.
So my dad calls me one day and was like hey I walked across the street the other day and talked
to the chief and they need volunteers so bad like they'll put you on a fire truck tomorrow.
You know come on up here. You know and so I went and visited over Christmas and
ended up like going back home packing up and moving to Oregon. There was nearly zero competition.
They were almost begging for people to come into the paramedic program. And they I was fortunate
enough to meet some great people that brought me in as a resident volunteer within a fire station.
I was awarded a scholarship that I drove their fire based ambulance form and they paid for all
of my medics school gave me a place to live. Introduced me to my lifelong friends that I still
have to this day. And so I lived there for two years. Finished off my paramedic degree there.
And got a ton of experience. You know a great small rural fire department that ran ambulance
and kind of like you know did the rig shuffle. If it was a fire you got on the fire truck.
If it's a medical call you got on the medic unit. So did that for three years and I think it really
qualified me and made me ready for you know the next year. And so I was able to get a
degree for you know my next step you know when I got my first career job.
So where did you find yourself then? Yeah so was testing like crazy right. And I even had a point
in paramedic school that was like I don't want to do this. Like I just want to be a firefighter.
And you know really wanted to drop out. But pushed forward. I had a chief officer kind of get a hold
of me one day. And back when it was a little bit more aggressive in the fire stations. You know he
grabbed me by the shirt and pushed me up against the wall. And told me that it will never be easier
in your life than now to get that done. And he was a gentleman that had gone he'd gone back to get his
paramedic about 10 years into his career as a firefighter. And he's like I was married. I had
kids. And here I'm back in medic school. You know and he's like so don't do that. You know you're
almost there. Finish it out. And it will make things better for you. And I'm glad that I took
that advice. I'm glad he got my attention. You know. And so finished up medic school and had a
bunch of job offers. Right as I was finishing up medic school. So I went to work in southern Oregon
for the city of Grants Pass. And I was Grants Pass was kind of a training ground department
for a larger department south of there Medford. And Medford had just hired like eight
Grants Pass firefighters. So they had to do a big grab. And so I came in and they had actually
I was I was far enough down on the list that I didn't get the first grouping offers. So the first
group of candidates were just finishing up their academy. And I came in right as they were finishing
and they said well there's only two weeks to the academy left. But if you can catch up with them
you can take the final and then we'll put you on the line. So I was successful with that. So within
so within two weeks I'm in a station and working on a rig. So so that happened you know pretty fast
and at the time they were running two person engine companies. You know so you were just
you were right in the middle of it. And that was like the first real hit you know because that was
in 98 and black tar heroin was a big thing. And down in southern Oregon they the county there
they would vote out the police department quite frequently. And then they had a privatized fire
department a few of them that covered the county areas. So the city was really the only like
professional fire department in the county. And so we you know it was weird. You would go out into
the county on a fire and if they didn't have a contract with the private provider you would wait
for the Oregon Department of Forestry and they'd come in and make sure that like the forest lands
didn't burn down and they let the house burn to the ground. And so just an interesting environment
down there and then a huge at the time before legalization a huge marijuana grow operations.
I mean thousands and thousands of acres just west of there kind of in the mountain range
towards the coast. And just like no man's land and cartels were in there. And just so a ton of drugs
were running through that community. And so seeing that firsthand was a big eye opener.
Really seeing like my first real like pandemic that you know that we're giving Narcan all the time and
getting people back breathing and having them walk out of the hospital. And so yeah so that
that was my first adventure. I met my first wife there. We got married and she was from there and
wanted to move away because she'd been there her whole life. And so we so I started taking
fire department tests up in the Portland area. And then made that transition moved up the I-5 corridor
to the town that I actually live in now. And went to work for that fire department. And
was there for 16 years and promoted through the ranks. Left there as the division chief of EMS
and training. I mean fire and EMS training and safety. And I was also the volunteer coordinator.
So a lot of hats. And really I guess I approached the grass is greener approach. I think I had a
really good gig at that department. And a really good group of people to work with. And a neighboring
department that was a little bit larger was going to the outside for shift battalion chiefs. And
saw an opportunity to go back to shift. And so I took that job. And great department.
Really different demographic of Canby. Canby is kind of a country club. We have you know
good schools, good economic backgrounds, large farming community, right on a gorgeous river,
a lot of things going for it. And a lot of care homes. So run a lot of car wrecks. A lot of
rural roads. Really low fire response. So you're just kind of running fall patients and chest pain.
And just kind of not really having a really more rugged
response. But moving down to Marion County, larger department, four staff stations,
three additional volunteer stations. So Marion County is where Salem is, which is the state
capital. So just tons of penitentiaries, being a state capital seat. Just the demographic was
different. And all of a sudden I'm running stabbings and shootings and a fire every shift.
They worked the 4896. But we did all in class overtime. And so we had to do a lot of
work. So you're pretty much on a 72 as a BC and then a 72 off just constantly.
And really busy system. Fire base transport as well. And you were just going and those crews
were just getting wrecked and dealing with mandatories and budget constraints constantly.
So it was just here I'd come from this, again, this country club of a fire department for the
majority of my career. And then I'm just in the thick of it now. And then not being, not promoting
up through the ranks there was an interesting gap of just trying to integrate with the shift and
just kind of get the buy-in of the crews. And I feel I was successful with that. But there was
some strain there. And it was interesting, the fire chief at the time said, I'm hiring you
to be our change agent. We got to do something different here. And so I was just trying to
get that change there. And that was a tough feat to get that change there.
And so I mentioned budget cuts. So the budget cuts were coming. Oregon has some weird tax laws,
not weird, but some tax limiting tax laws that don't allow government agencies to keep up with
inflation. So what that causes is that the majority of public agencies within the state of Oregon have
levies and bonds. And those are three to five year terms that you have to revote in every time.
And so very quickly, a levy was probably not going to pass. And the idea was to just get rid of the
battalion chief program. And since I didn't promote through that system, I didn't have any
bump back rights to go back on the fire engine. So I started looking for a job really quick.
Because I saw that I probably wasn't going to have a job pretty soon. So the city of Vancouver,
just across the river here in Oregon, was hiring. And so I put in my name. And it was a really long
process. It took a year. So it was from the time I interviewed to the time I started my job was
11 months later. And they actually had had a deputy chief resign in the middle of the
division chief hirings. So they had to kind of pause the division chiefs and get a deputy
hired first. So it just kind of prolonged things. But in 2017, I moved to Vancouver fire
and as the EMS chief. And it's been great. I mean, I can't say enough about the department
and about the humans that work there. It's been amazing.
When you talked about the Black Tar heroin, I had Sam Quinones on the show who wrote Dreamland. And
from what we've seen, and obviously, Dope Sick is another great story on the prescription side that
led to Black Tar. Was the Oregon crisis created by the prescription by the Ocicontin, that kind
of thing that so many other parts of the country saw? Assumably. I don't know the statistics on it.
Assumably. And just from my own personal story, my ex-wife transitioned from prescription
painkillers to more illicit street drugs. And that was because the doctors were finally cutting her
off. And it just led down a darker and darker road. And unfortunately, I don't think she's found
that sobriety fully yet. We don't really have any contact with her anymore.
But and just seeing that firsthand, I think sometimes we want to sensationalize that the
opiate crisis, whether it was in the 90s with the Black Tar all the way up through the Oxycodones
and Norcos up to Fentanyl and Parafentanil now, it's not just on the street. It's in the million
dollar home. It's the businessman. We actually in Clark County, our Sheriff's Office just had one
of their commanders found at his desk overdosed and died. And there was Fentanyl crushed up on
his desk. So he was snorting Fentanyl from his desk. So I don't think that it's just on the street.
And sometimes it gets sensationalized that way. I think it's in our neighborhoods. It's in these
houses. It's in our schools. I think it's much bigger than just the streets.
Yeah. Yeah. I know Johann Hari did a great job of showing. And this is just a sad truth.
When it was the crack epidemic in LA and New York and some of these other places were real hot spots,
it was obviously viewed as a poor person's disease and arguably even certain races.
But when the Oxycontin crisis, when the opioid crisis came in, all of a sudden it wasn't rich
or poor. It wasn't poor. Excuse me. It was rich and middle class and it was black and white and gay
and straight and Christian and Muslim. It was everyone, which is the reality of addiction.
But up until that point, I think people have been allowed to be duped into the fact that
addiction is a poor person's issue. But it's not. And there's as many wealthy
alcoholics as there are poor alcoholics. Addiction is a mental health crisis that
goes beyond any sort of borders whatsoever. Of course. And our family is a living testament
to that. Every all 10 of us in our household are a product of addiction. And so it is truly everywhere.
Well, let's start with that topic then as far as Vancouver. So you've had such a story career up
to this point from volunteer, paid on call, the EMS side, the fire side. Now you're in Vancouver.
What are some of the proactive things that you're putting into place when it comes to the addiction
side? Yeah. So the addiction side, we have a high rate of opiate problem. Again, not just on the
streets. And we're responding to two or three overdoses a day in our system. We're 11 stations.
We have 19 companies in those 11 stations. We have about 220 humans. And we run about 40,000
calls a year. So we're a busy system. We're fire-based. And so everything's ALS from our
squads to our truck companies. And so we have a minimum staff of at least one medic on all those
rigs. And then we have a public-private partnership that we own the contract for the ambulance
transport and our current provider is American Medical Response, who I believe we have an amazing
relationship with. And comparatively to what you see throughout the nation, some of the street wars
that will happen between private and public. So as far as the opiate response, again, two to three
times a day, our crews are responding to that. And there's just, I think, there's a lack of
coordination between all the resources. So the crisis teams aren't talking to the homeless
response teams that aren't talking to the police department, that aren't talking to the fire
department that aren't talking to the ambulance. So there's zero coordination. And then the
hospitals are doing their own thing. So the big piece was really bringing together
all those players into one space. So we implemented, about 10 years ago, we implemented
a crisis response team coordination meeting that brings together all of those players.
Because we're all going on the same people, but how do we coordinate better to provide them,
the patient, the best access? Or when somebody new hits the streets. Everybody has a loyal customer
or a frequent flyer that they go on consistently. And so it's just a matter of time before we all
start seeing that same person. So that has been a great group. That was kind of a starting point,
was having some of that crisis integration. And then the next piece that we implemented
at the beginning of the year was a leave at home Narcan program. So anytime our crews
deliver Narcan in the field and get a response back from the patient, they're offered a leave
at home Narcan nasal spray kit that's left with them. The hope there is that they have that
available to them in the case of overdosing again. Because again, the addict, especially with opiates,
has a total brain fog. Their receptors are completely different rewired when they're
addicted to the opiate. So when we give them Narcan in the field, we send them into withdrawal.
So they're dope sick. They're hating life. So the only thing they're thinking about at that point
is getting high again. So a lot of times we'll revive somebody and before we can even get a
refusal, they're walking off down the street and they're going to find their next high because they
feel like crap. So we wanted to provide that piece. It wasn't as well accepted by the field
as initially thought. Some of our crews actually had some pretty strong political views on it that
were just enabling the addict. So we're in a partnership with the Oregon Department of Health,
I apologize, the Washington Department of Health, and they're providing through grant funding,
they're providing the Narcan kits and we had to apply to get into that program. And during that
interview, you had to do an intake interview, and the gentleman on the other side of the screen,
you could tell probably had a harder life. And so I asked him, hey, obviously there's other programs
like this throughout the state of Washington. What are some hurdles that you're hearing from
the agencies that are utilizing it? And he said exactly what we faced. He said, yeah,
some people have some political stance on it that we're just enabling the addicts. And he goes,
but I'm a walking testament. He goes, it was the fifth time that I had had Narcan that I finally
got clean. I've been clean for 10 years. So utilizing that story is just so powerful,
I think, with the crews. And ultimately at the end of the day, our crews signed up for a job
to protect lives. And sometimes I think we can forget that. And I think there's a lot of different
reasons why, but at the end of the day, we're there to protect lives, whether it's pulling them out of
a house, whether it's Narcanning them for the 15th time, maybe that's the time that it happens for
them. I'll pretty much guarantee you that even if we pulled the same person out of a burning house
five different times, nobody'd have a problem doing that, especially with our crews. But
for some reason, these other kinds of things, I think they struggle a little bit more with.
So our next phase of that, like we talked about, we recognize that that would drive
symptom is a real problem. And so our next phase is here this next month, our county cares team,
so our community paramedics will be rolling out buprenorphine, which is medication assisted treatment.
So what that is, is it's a withdrawal medication that will stay in their system and help kind of
clear that brain fog. And we're still establishing currently like our social work system and our
care, like our crisis center systems and our drug rehabilitation system so we can reconnect with
those individuals post-treatment. And there have been a lot of different systems throughout the
United States that have done this program. San Francisco was kind of the forefront of that.
And Contra Costa County area of California, they kind of started that through their public health
system years ago. But it has stayed in the hands of those community paramedics. What we're going
to attempt to do in Clark County is put it on every fire apparatus so every paramedic in the county
can give that treatment. So we're going to do that quick trial with our community paramedics.
First and then we'll be rolling it out the first of the year countywide, which is different.
Hopefully we have a better response from that, that we can get people
clear enough to be able to accept the help. Their addictions at that point are so harsh
that they're not thinking clearly. And obviously for somebody to get help, they need to have a
clear mind to be able to want that help and accept that help and have a higher level of success
of receiving the help. So that's what we're doing as far as the opiate crisis in our community.
When you talk about the resistance, this is one thing I struggle with. And I know we talked about
this before. Firstly, it's a waste of Narcan. I literally had someone I used to coach with in
a gym say this about one of her family members. And you hear these stories, like you said,
the person you spoke to, Christina Dent, who I had on recently talking about addiction,
it was amazing because she's a conservative Christian, brought up through that kind of
philosophy doctrine. And she had very opposing views. And it was actually a foster situation
for her too, where she saw how much this mother who was struggling with addiction truly loved her
child. And she ended up overcoming that. But if you just said, oh, she's a waste of Narcan,
that mother never would have survived and that baby would have been motherless. So you have the
compassion fatigue element. And obviously our crews are burnt out. And we're not going to be
talking about that in a minute, how we can mitigate that through work weeks and proactive
telehealth solutions. But the other side, I think, is cultural. And this is what I struggle with.
And I talked about this a lot. I have a faith, a kind of multi spiritual faith, if you like.
And the tenets of what I believe in are kindness and compassion and community and
gratitude and forgiveness that most of them share. What I believe in is that we can all
share. What I don't understand as a nation is how you can leave a synagogue or a church
after listening to the teachings of, for example, Jesus, who was out there amongst the people,
giving everyone as many chances as they needed. And then you can say, we're wasting Narcan on
addicts. So culturally, within the fire service and then within the nation, I think a lot of us
need to take a step back, look in the mirror and ask this question. If it was your family member,
would you give up after five Narcans? If it was one of your brother or sister firefighters,
would you say five is enough? Of course you wouldn't. So why won't you have that same mentality
to the people that you're actually paid to respond to? Yeah. And I think compassion fatigue is there,
right? And I think that that when that is hitting those crews, I think that that is definitely on
that forefront of the reasoning of why they were feeling those ways. But yeah, I can't agree with
you more as far as like, I have a strong faith myself, James, and Jesus was not out there helping
the rich, right? Like he was in the trenches helping the murderers and the rapists and the
adulterous and the prostitutes, right? And if we're going to really make a dent from a faith base,
I really believe that that's where our approach needs to really be. So yeah, I think moving
forward with like our opiate problems, I think like sharing this information with our crews,
sharing like some of these stories of the people getting help, like as this program develops more,
especially the medication assisted side of it, like that, oh, wow, like this person really did
get the care that they needed and they're a thriving member of society now. I really think
that those are going to be part of that storyline to really, I guess, change that narrative.
Well, I love that idea of is it buprenorphine? Have I got that right?
Yeah, because I hadn't heard of that. That wasn't in the discussion when I was working. I actually
just saw today is my six-year anniversary of transitioning out of a paid fire department. But
I, you know, the number of overdoses I used Narcan on, I mean, I'd say that in the fire service,
you truly save lives when you use Narcan. I mean, I'm okay. And at Dunkin Donuts once having to
any do an EJ is before the, you know, the mad device. And, you know, the woman was so pissed off
because I'd ruined her high. She had like two breaths per minute. You know, she was literally
moments from death, but, and another one that filled my rescue with everything from every orifice
possible after she came around, you know, so it's, it is a violent snatch back to reality. So then to
be able to temper that with a transition drug. I mean, that's, that's genius.
Yeah. Yeah. And it's not new, right? Like, you know, Suboxone is, is, you know, the trade name.
It has been around forever, you know, you know, for a really long time and they've used that,
but it's been more in a clinical setting, you know, and now we can take it to the field. So,
and getting like medical oversight, you know, through like our medical program directors.
So, you know, that, that, I think that's where the difference is, because as I said, you know,
probably even back when you were, you know, out in the field, most of the time when you Narcan
these people, you would take them to the hospital, right? And right now, a very small majority
go to the hospital post Narcan. So, so like the hospital doesn't have the opportunity to get them
connected with social work and get them started on those treatment plans, right? Whereas us in the
field, we can do that. Like we can be out there and we can provide that. And can we make the
difference? Again, I'm worried that we don't have enough support for them. You know, there's not
enough facilities to take them to. There's not enough social workers to help them and navigate
those convoluted systems, depending on if they're on Medicaid or Medicare or, you know, a state
funded healthcare system or, or private insurance. You know, there's just some barriers there that I
think we need to find approaches to help break down those barriers and make it as easy as possible
for that person in crisis for that glimpse that that medication can provide of clarity, you know,
because that's our target time. We've got to get in there with the appropriate services to hopefully
help that person get that help. It's amazing how many issues that we struggle with, you know,
globally really stem from a philosophy as false economy. And, you know, some people are making a
lot of money and I always talk about the obesity epidemic that we have. That's extended to England
or to the UK. And to me, the NHS is the most beautiful altruistic healthcare system on the
planet, but at its core, it's relying on the fact that there's a push to make the nation as healthy
as possible. So you don't dip into the taxpayers money until you absolutely need it, you know,
expectant mothers and taking care of the elderly and God forbid, you know, car crash or cancers.
But the general population, you want to keep healthy. That's where the money is by not using
a system. There is the money. But if you, as the UK is seeing now, allow your, you know, your
nation to get fat and sick, now you become an absolute drain. And so what we've seen in,
you know, in the addiction world is the prison systems that are making a huge amount of money.
You know, you see the war on drugs, there's a shitload of money in the war of drugs itself.
These are all reactive. They are not solving the problem. So when people say, oh, we're going to,
you know, we're gonna need more taxpayers money like, no, we just need to take you from downstream
where it's not working and you know, it's not working and move it upstream. And it's the same
conversation with the firefighter work week, you're destroying your firefighters. We need to take that
money from downstream and give my opinion, an extra shift to 24 72. And there's going to be money
left over. And you talked about, you know, brand out stations and those kinds of things. All those
stations will be open. All those rigs will have three or four people on at that point. But if we
continue to allow, you know, something that is just clearly not working and the war on drugs,
I mean, the thirties is when it started. So we're talking, you know, 80 90 years by this point
of a longitudinal study by proactively. And that means courageously taking that money and putting
it at the front, investing in your fire department, in your nation. That is how you fix it. You don't
need more money. You just need to use your resources wisely.
Yeah, I agree. I agree. Yeah. And I, you said a lot of things there. So the, yeah,
obviously the funding, as we kind of talked about earlier, you know, as that money gets shuffled
through a system, right through whatever machine that money is getting shuffled through, right,
there's just everything that's going to be shuffled through. And so, you know,
every hand in the world, you know, grabbing ahold of it, you know, and, and then sometimes that
money, especially in a government level, gets so watered down, trying to appease as many people
as possible that there's not enough to get it right. You know, and again, like that coordination
of looking at that big picture, right? Like if we can do all of these things, we would have the
funding for whatever passion project was there to make things better, right? And sometimes we can
even be our own worst enemies, you know, with, you know, I fully support and agree with work week
reductions, both at the, you know, at the chief officer levels and in the 40 hour environments
and at the shift level environments. And, but sometimes, like, again, we can be our worst
enemies with that, but maybe, maybe we don't want to negotiate down our work week because we want
more pay. Or we, this time we want to go after work week reductions, but we don't want to go after pay,
you know, so it's all this big negotiated, you know, ship or not limiting our work hours, right?
You know, I, across my desk yesterday, an email came about we, our firefighters are allowed to work
96 hours in a row with a 12 hour break. And this individual had worked 218 overtime hours in a two
week period. He's choosing to do that, right? Like, we're not, he's not being mandatory. None of those
were mandatory shifts. But here is an individual, he is a paramedic, he is a driver that is literally
has had like three 12 hour breaks, you know, in a 14 day cycle, you know, which is just asinine to me.
And, you know, so at like, at what point do we help save each other from ourselves, you know, with
that, I'm sure he will have a very nice paycheck and his retirement will be boosted and all of
those things. And by him voluntarily taking those shifts, it didn't mandatory somebody into those
shifts. But I think that there are things that we can do to save us from ourselves.
I mean, this is that this is why I think this has been a sticking point is this conversation goes
from the new hire all the way through to the city and county managers and everyone in between chiefs
and you know, everyone below that, because the answer is yes, every single one of us needs to do
our part. And I've talked about this a lot. Firefighters need to stop going around telling
the world that we have the best shift schedule ever, because we don't. It's awful. Absolutely awful.
You know, the when it comes to the shifts, you know, the chiefs have got to stop saying, well,
if we give them more time off, they'll just work more. If there's all that overtime available,
that means that there's, you know, a huge issue when it comes to staffing that they have so much
overtime available in the first place, you know, those should be filled. If there's a need, an
ongoing need that should be with a paid person in that position. And I think the overtime absolutely
comes around when you have the wildfires and the hurricanes and the earthquakes and all the things
where we have to kiss our families goodbye and say, I need to be there. I need to do the extra
stuff today. But this is the problem is, you know, when when it comes to my rank, the firefighter,
if you're pushing against wellness and wellness initiatives, because you're living above your
means, you need that money, then you need to figure out another way of getting that money.
Because if you give if we fight for this rest and recovery that we need, that gives you a
beautiful opportunity to become an entrepreneur and do something else that you love on the side
that puts you in your home with your children and your wife or your husband or your partner,
getting a good night's sleep to get up the next day and go hang drywall sculpt logs with a chainsaw,
whatever your thing is, that, you know, you're not is not going to be detrimental to you.
So when people complain about the overtime, this is my thing. It's like that was never supposed to
be when you when you signed up, it said salary is this. And you've allowed yourself to devolve and
become part of the problem when it comes to the staffing. What we need to do is create an
environment that really draws people back to the profession, just like when you were testing when I
was testing so that they you know, we are fully staffed and occasional overtime, which is great
once in a while. Perfect. And then not only will that second entrepreneurial project, if you need
it, allow you to make money on the side, but it also gives you a new tribe. So when you transition
from the job, whether you're fired, whether you retire, whatever it is, you have that next thing
to go to, but to go all in, in the fire service at the detriment of you never being home. As a
firefighter, we have to look ourselves in the mirror and go, I can't do that anymore because
I'm screwing every single other man and woman in this department by my self-serving attitude.
Yeah, no, that's that's true. That is definitely true. And again, I think that comes back to being
purposeful with your system. Right. And it kind of like root causes back to recruitment. So we were
fortunate two years ago to float a ballot measure that added a third truck and added three paramedic
squads. And at the same time, some general fund money came in that we were able to add an 11th
engine. So that added all those positions. We're a four platoon system, you know, with like a 46 and
a half hour work week, you know, that keeps getting negotiated down. Obviously, hopefully the goal is
at some point to get to the 42 hour work week that that they wouldn't have any debit days that they
needed to pay back. So so we've been transitioning through that that four platoon system since 2017.
Or 2018, January 2018. So it's, you know, but when we hired all these positions, obviously, we also
were dealing with our attrition at the same time of retirements. So we were down all of these
positions, we had made promises to get those rigs into service as quickly as possible. So back in
January of this year, we actually staffed our third truck and our third squad. And we were able to
get it into service. And then we had to move on to the fourth squad without the people. So those
those two rigs across all, you know, four shifts are staffed with overtime. And so on top of we can
have 12 people off per shift and all of the other things that happen within the labor contract. So
we had to move on to the fourth squad. And because before the firefighters all rotated through the
driver position. So, so that, and at the same time, we went for class for class overtime. So now the
pool got smaller of people that could be available for those shifts. And because of promotions and
rank, not having all those positions is probably the one that has hit the hardest every day with
mandatories. So coming back to recruitment, so we recruit all these individuals, we get them into
our academy, one of the things that we've seen over multiple academies now are pre existing injuries
that come to the forefront. We have a very aggressive 18 week academy. We really hold a high
bar, our training cadre does an amazing job. And we are, people are breaking. And it's not because
it's not because we're doing something wrong, like on the training ground, or that we're not being
purposeful with warmups and stretching and functional fitness and all of those things.
It's that literally these people are broken coming in. And so we've worked with like our medical
provider that does our physicals and put more focus on looking at pre existing conditions.
But if the candidate doesn't advise of that during their medical physical,
then we don't know about it. And then they come in and all of a sudden we get a recruit that says,
I can't do burpees. I have like a torn rotator cuff. I can't do a burpee.
So like all, well, did you disclose that in your medical physical that you had a torn rotator cuff?
No, he never asked. So we've actually had these 30 person academies,
that like we were only graduating 20 to 25. And so that's been a real struggle. So then we're just
each academy, we think we're going to gain some ground, but then we're still down five and we're
still down five from the last one. And we're trying to catch up with that. And until that happens,
that we can get enough quality candidates in there, that we're going to be able to get
the right candidates. That we're going to continue to have the mandatories. We're going to continue
to have the reduction of that staff that aren't able to fill those positions. And I agree with
you, James. My worry is like looking upstream that we're just going to have compounding issues
with our mental health of our people, our burnout, our people just quitting and going
back to the profession. And I hate to see that, the investment that both the candidate and the
city put into these people to get them through their first year, is huge. And for them not to
make it, is hard. And we have no qualms our organization is aggressive. We have no qualms
not making it. We have a very thorough performance appraisal system during the academy and they
get put on a performance improvement plan pretty quick and if they don't remediate to
that plan, then we cut our ties. So we do our effort to try to help them, but at the
end of the day we can't help, then they're let go.
What is your physical entrance test? Is it the CPAT or?
It is. It is. And so we're concerned about it and we're bouncing everything off. Our
current fire chief came from CAL FIRE and so he's a big BIDL test guy. So we have been
evaluating the BIDL, we've been evaluating the CPAT and then we've also been evaluating
going back to our own in-house physical agility test. Or a mixture of all of them. It's like
the first pass, like a CPAT, that they come in with their CPAT and then as we get close
to job offer, we bring them back and we do an in-house physical. Like kind of maybe a
work hardening or work performance type test and just really kind of see where their functional
fitness is. Just to try to eliminate some of those that should have never hit the line
and should never have hit the academy. Because that just endangers everybody else out there
on that drill ground if they're not whole coming in.
Well, I'm assuming as well there's probably some that could be. They're just not and they
need the time or the direction. So I don't know if you've, have you heard of the functional
movement screen FMS?
Yes.
Yeah. So I mean, maybe even some of those somewhere along the way, because I mean, I, it's funny,
I just came across it a couple of days ago. I did the CPAT thinking I'm going to have
to go back to the fire service because I'm not going to have any pension money left after
I left because I cashed it out to do this. And so I went and did it. And at 45 years
old, I was, the time was 720. And this is again, this is not, every time I sound like
I'm bragging, it's not, it's just the 1020 should not be like everyone high-fiving yourself.
Like that's a very substandard performance in the CPAT. So the way that you really get
that time down to where it should be is that you have the strength, you have the fitness,
you have the mobility that allows you to breeze through that test. Because the CPAT is not
a hard test. So, you know, if you're getting people that are getting through the CPAT that
clearly are still deconditioned or hiding injuries, then it sounds like, yeah, another
layer of kind of a, rather than just a medical, you know, where someone's just, you know,
it's getting you to bend over and cough like an actual athletic trainer evaluating these
people to make sure they do have it. And if they don't, you know, just rolling them back
in and saying, well, you're not disqualified, but we need to get you to where, you know,
you overcome that injury. You'd be a good candidate, but you can't go through with these
deficits because yeah, as you said, then you're going to break in 18 weeks of throwing 24s
and dragging hoes.
Yeah, correct. Yep. So that's, I mean, that's where we're at right now. We're evaluating
those pieces and we're learning each academy. Our academies historically were like 10 or
12 people. And, you know, for the last two years, our training division has been pumping
out 30 person academies. So it's just, it's been just an adjustment logistically of like,
how do you get that many people through and get them solid skill sets? And I mean, even
down to the EMS level, as I said before, we minimum staff at one medic per rig. And so
a lot of these candidates that are coming in are medics. And in our county, we require
them to be like a lead medic, like within like their third, like pretty much the first
three months that they're on the line, they're working through a paramedic taskbook with
an FTO. And so that's a lot of pressure for especially a brand new medic fresh out of
school to get them to the point that they're a lead medic in our county is tough. We have
aggressive protocols, we have zero call ins, you know, our medical director allows us to
do a lot, you know, and so we do expect a ton from our paramedics, you know, so giving
them the tools, one of the EMS captains that works with me, that is her only job when they
come out of the academy is she is like 100% assigned to each one of those FTOs of anything
that they need of getting those people up to speed and getting them ready to go.
Speaking of the work week for a second, you're working towards the 42, you're kind of close
already. How does that compare to the agencies around you? Are they still 56?
No, no, our county, our state really, Washington State has been really on the forefront of
work week reductions, you know, and four platoon has been in the, like up in the Seattle area,
have been like 20 years they've been in a four platoon system, you know, so and I think
that that's been a big negotiating tool for the Washington State Firefighters Council
is work week reductions. So I believe there's only currently there's two departments that
are on a four platoon in our county, all working about the same amount of work week, and then
two that are getting ready to transition there, like through their negotiations. And I believe
one other one has it in their labor agreement that they will discuss it next time. But they
do have their Kelly days, right? So, you know, that's been that's been in our system for
20 plus years, were the Kelly days. So, so they were we're getting work reductions, it
just wasn't the four platoon. And the majority of our state is not doing the 2472s, the majority
of our state is doing 24 on 48 off 24 on 96 off. So that's just kind of a schedule that
they have chosen. And I don't I don't know any of the data that went into those decisions,
you know, at the time, but but yeah, so it and I think a lot of it was in regards to
we do have, we have individuals that live in California, Oregon, and Idaho, and Montana.
So I think that they were looking for those longer breaks of time for like travel back
to wherever their home is.
Brilliant. All right, well, then, so that was the work week side, obviously, we're trying
to reduce the amount of time that we literally have to be in the station. The other side
of the conversation is, as you mentioned, you know, 11 stations, 40,000 calls, the immense
workload that we're putting on our first responders. And, you know, the term bullshit call is there
for good reason, because we are called for a lot of things that we should never ever
be called to in the first place doesn't mean that we're not going to respond with compassion
and kindness. But the reality is, it did not need a fire engine with three or four people
to mitigate it, it might have needed an urgent care clinic, or a simple prescription, or,
you know, a talk with a counselor. So talk to me about how you guys have addressed the
less acute calls with the with AMR, because I think this is a solution that is, in my
opinion, should be nationwide.
Yeah, so our first our first jump at it was eliminating low acuity, like priority five
calls for fire response. So we entered into an agreement as part of our contract with
AMR that they would handle those priority five calls by themselves. And we would only
engage if they needed us. So if they got on scene and the acuity was higher, they would
dispatch one of our rigs and we would respond. So that was kind of our first jump. And that
was that was multiple 1000s of calls a year that just dropped off. And it is kind of a
balancing act. Because you constantly have to be tweaking the system, like looking at
your your dispatch protocols and how they're how they're dispatching the call and how they're
intaking the call, you know, and really watching from like a medical direction standpoint of
are we meeting the mark or how many of these call types are ending up getting back, like
getting upgraded or are are like code three returns to the hospital. So just constant
vision on that and like with a with a really strict lens. And, you know, all the way down
to you know, it was it was interesting, the fire chief at the time that like really pushed
for the reduction of priority five calls. Our city hall, like right across the street
from our city hall is a big community park. And on the other side is like some buildings
that have some coffee shops. So he was he was actually himself like that was the big
forefront of the priority five reduction program. He's walking across that park one day and
a guy and he's a past paramedic and and a citizen drops and starts seizing. And he picks
up a cell phone, he calls 911. And and we actually have a fire station at that time,
we had a fire station like a couple of blocks from there. And and he's on the phone with
a 911 dispatcher and and the guy was, you know, coming out of the seizure and talking
to him now. So it gets coded as a priority five call. So no fire response. So he the
chief is even asking like, is is engine one or truck one and station? And they're like,
yeah, they're both available, chief. And and he's like, where are they? And it's a priority
five call chief. You're getting a MR and they're coming from across town. Right. So so even
like, you know, so that just kind of says like, sometimes it's just like it does miss
the mark in that sense. But negative outcomes, we have showed no negative outcomes from that.
So that's been a positive program. The next program that we instilled, we call our red
dot facilities. So and they are like health care facilities, urgent cares, care homes
that have 24 hour like nursing or physician care. We don't respond to those calls. So
we keep a track of those buildings and those structures. You know, we have I think just
over 25 of those buildings and it's just constantly growing and that we just don't even respond
to calls in those. It would be an AMR only like just an ambulance response only to those
facilities because they already have medical care on site. There's no need for first response.
So that that was kind of the second tier of that. The next phase is we rolled out a BLS
pilot with AMR. And that was and all of those attempts were to keep the ALS ambulances available
for the critical calls. So we partnered again with AMR on that and they rolled out three
cars in our system. And then we worked through it in the sense that if the BLS ambulance
is on scene and it ends up being an ALS call, our paramedic would get on that rig and ride
in with them. And that's countywide. And each of those BLS ambulances, part of that negotiation
was them being completely outfitted ALS. So they're outfitted ALS and our crews have access
to all of that equipment. So that's been a favorable program and that has shoveled off
a ton of we call it level zero when there's not an available ambulance for more than three
minutes in our system. Our system goes into level zero. And so that allows like the AMR
to start freeing up ambulances or up staffing their ambulances with like their support staff
or however they're going to manage like the surge that the system could hit. So that took
a ton of that stress level off the system and helped integrate the system better. And
then the third phase of that was a product that AMR provides called nurse navigation.
So that actually occurs at our 911 center. So as they're going through our pro QA dispatching
system, our medical director has allowed certain call types to just be automatically funneled
to the nurse navigation center. And so that links you up with at a minimum a registered
nurse in the state of Washington and all the way up to a PA or a physician at some times
that would then so you would get transferred as that caller over to the nurse navigation
center and there are a couple of different things can happen there. Either the nurse
navigator kind of talks you through it gives you some self care tips and you hang up and
everybody's good to the nurse navigator recognizing oh there's a higher acuity here and they kick
it back to the 911 system and we would do a higher priority response to oh it sounds
like you probably need to go to an urgent care. So they've developed contracts with
all the urgent cares and immediate carriers in our community and they can do scheduling
right through their system. So they could say hey Mr. Gearing looks like you've got
a zoom care right down the street from your house. We can get you in at three thirty.
Does that work for you. And you accept or deny. And then and then we would ask do you
have a ride. And so there's a contract with Lyft so they can come pick you up and take
you directly to your appointment bring you home. And then nurse navigation navigates
that with whatever health insurance or uninsured. They have to that was part of our contract
with them. They have to accept uninsured. So they provide all of that and then all the
way to well you know as you talked about earlier with an obesity crisis you know I'm four hundred
fifty pounds and I can't get in an Uber. Then Amar would send a BLS ambulance to pick them
up take them and bring them back. They also have the ability there to to transition to
a telehealth doctor. So so then they would just enter integrate right into that. So that's
been a really successful program for us. We're still just tinkering with those call types
because some of the call types that we brought in initially almost all of them were getting
pushed back into the 9 1 1 system. And then there was some call types that weren't in
the nurse navigation like criteria that we've just recently put in that had a really low
transport rating that we weren't transporting those patients. So it's just kind of tweaking
those dials all the time to try to find that fine tuning. That product is also available
to our field crews. So our paramedics on the fire trucks or on the ambulances can directly
call into that line on behalf of a patient maybe that they're on that maybe got triaged
really high acuity wise. But when they got there they they do an assessment and they're
like oh hey do you just want to go to an urgent care. And then they put them in touch with
nurse navigation. And so they have a direct line right into that. And so our crews can
access that very easily. So that's how we've been utilizing nurse navigation. It's been
a great product. Right south of us is like the Portland metro area and all of those counties
are also moving to nurse navigation. We were kind of the first ones in our geographical
area to do it. And so it's been a successful program for us so far of reducing again reducing
those calls. I've had a couple of guests on in the past that have talked about a similar
concept but not like I said at a national level there were small kind of startups. But
when I think about what I did for 14 years the number of calls where the medical director
was some places were very aggressive like if they called you just take them to hospital
you know DFO kind of thing. And you think about it now you've got let's say a five
year old with a fever and now that child is going to an ER where the lights are on all
night you might have a drunk and a psych patient either side or whatever it is. The parents
are now getting a huge medical bill for that ER visit and that little girl or little boy
is now taking up a bed that might be needed for a stroke or some true emergency. So there
is no downside. The family gets to stay in their own home assuming again it's appropriate
for that call. They're not getting a massive medical bill they're getting a far smaller
bill. The crew is not being woken up for that call and the ER retains another bed for a
true emergency. So every way you look at this model it makes perfect sense as long as as
you said you're looking at it and adjusting it you know and giving it the attention that
it needs so you're not missing things that are glaring.
Yeah yeah and the other piece of nurse navigation that GMR which is the parent company of AMR
has done really well with it is they do a hundred percent reconnect with that nurse
navigation patient. So they you know a couple days later they have a team that calls and
checks in and sees like you know does quality assurance and their ratings are super high
that the citizen is very much willing and able for that. I mean I think if we look back
historically right like as fires declined you know we had we needed a purpose in the
fire service right. So let's hey let's start running EMS calls you know and that's kind
of been this double edged sword that we were trying to increase our call volume but now
we've just come to this threshold that we're overwhelmed so that now we're looking at okay
how do we reduce our call volume you know and how do we reduce out of some of these
calls. But like you think about it you call your chiropractor you call your your therapist
you call your medical doctor if you get a voicemail that says if this is a life threatening
emergency call 911 like we have to change that narrative and helping people to understand
to make the right call right and providing them the resources of who that right call
could be whether it's a nurse navigation pretty much every private insurance now has
some sort of incentive to use telehealth you know helping people navigate their own health
care system you know. So I think all of those options to help re market you know like like
I look at like fire prevention efforts have been so successful historically you know where
are EMS prevention you know and where are we doing what are we doing to help people
to make that right call know when to call 911 and 911 is not the quick answer because
you can't get into your doctor for two weeks you know that you call 911 because you got
to go back to work right. So trying to eliminate some of that and I think that that therefore
reduces those stressors on our crews because they're not going on that stuff over and over
again and that they really are available for that more critical call.
Absolutely now what about the cost to the fire department some of the models that I've
heard there was no cost it was completely integrated and the billing was taken care
for that particular service was taken care of by that company what is the kind of overall
cost to the fire department in the ones that you're using.
Yeah so with our partnership with AMR we are receiving zero cost to that product so AMR
is absorbing that somewhere and I don't know where I have heard in systems to the south
of us getting quotes in the 10 to 20 thousand dollar range per year for that service you
know because nurse navigation like through DMR will actually even provide that service
if AMR ambulance is not in that geographical area so even if you had your own fire based
transport they would still provide that service to your dispatch center and to your medical
director so I think it all kind of depends on what your system is right. Obviously AMR
is a for-profit company you know so they're making money somewhere on it but for us at
the local level in Clark County we are paying zero for through any of the fire departments.
Yeah now from what I heard again from this other organization that you know that of course
is going to be billing but it's going to be a fraction of the cost for you know ALS transport
from a fire department so you got that bill now you walk through the front doors of ER
so you're talking about thousands for that you know and then god forbid you stay overnight
and get two Tylenol now it's another ten thousand dollars so avoiding you know that hyper inflated
healthcare system that we're all fully aware of which is absolutely pertinent when they're
trying to save your life but not for something that could be addressed in a centric care
or you know some sort of erosion setting. Yeah it's broken James I mean it really it's
broken you know we my wife and I really enjoy to get away to Baja California and so we go
down there a ton you know a couple times a year and we were unfortunately down there
one time and my wife had a kidney stone episode and so we end up in the urgent care in Toto
Santos and you know like the southern tip of Baja and I'm just curious like the whole
time like as she has a private room and a private nurse and they're taking her blood
and doing imaging and they're doing all this stuff right and I'm thinking at the end I'm
like oh man what's this and we had actually it was it was it was kind of a joke between
her and I as she's like in pain with a kidney stone but we're joking because we were supposed
to go to this nice dinner that night and I'm like hey do you think this ER bill is going
to be more or less than our dinner was going to be you know and after all of that imaging
medications and IV an assessment by a physician blood tests it was like $200 US you know so
as you say you know the $10,000 for two Tylenol in our health care system I mean that really
does shine a light on our system is broken and I wish I had an answer of how to get that
fixed but it really is completely broken.
Yeah well again I mean this is the the opposition to create in a healthy society when those
are the prices there's a lot of companies making a lot of money from insurance companies
to you know the hospitals themselves you know I mean all these different you know the prescription
drugs I mean so much money is going in the pockets at the detriment of the American people
so we owe it to you know not only ourselves but our children and grandchildren to turn
the ship to turn it around back to good health where you know your health care will be inexpensive
if it wasn't hyperinflated because there are so many consumers when 70% of the country
is overweight or obese you know then do you just have this endless customer so it's supply
and demand there's so much demand they basically can get away with charging what they want.
Yeah yeah no I fully agree.
So before we go to some closing questions are there any other proactive elements that
you've got going on aside from the ones we've discussed?
Yeah so I try to approach my division that I manage we have two amazing EMS captains
our captains come off the line for up to two years and they can renew if they want if the
daytime shift time stuff works for them and I am also blessed with a great EMS analyst
that kind of helps us compile the data and helps us manage our ambulance contract and
through that team our focus is what can we do to reduce the stress on the street.
So utilizing the captains is kind of the face of the EMS division like out in the field
they're responding on calls with the crews they're doing ride outs with new paramedics
they're you know they're sitting at the kitchen table the sacred place in the fire station
just filtering for information right and how can we make the job easier and less.
So some of the things that have come from that are we've instituted hand tevy you know
for pediatric protocols that's taken the 3 a.m. guesswork out of a pediatric dose we made
sure that any integrations that we bring in integrate with our RMS system so we can lose
all of the redundancy so our reporting system that we use is ESO which has been good and
hand tevy integrates right in there so as the captain is doing all the work through
the hand tevy app it just syncs right up with ESO so that paramedic doesn't have to write
it down twice so we're just taking those steps out you know so we want to be really purposeful
with any of that we don't want these one-off programs that you know somebody has to log
into some other thing and do a bunch of other stuff our whole county like it's been a passion
project of mine since I got there seven years ago to integrate the whole county to ESO so
we're all on one platform because we were all actually using something different so
as of today we all have ESO we can sync our tablets together completely reducing all of
that redundancy we bring together a team about every year of field providers and we bring
them in and we get in the backside of ESO and we try to figure out how can we reduce
clicks how can we orchestrate the drop-down menus for the most popular things to be at
the top so we can expedite that person completing that chart as quickly as possible and doing
it with the fewest amount of clicks some of our crews are running 15 to 20 calls in a
24-hour period and those three or four saved clicks you know that's just a false multiplier
that just adds up over time right so can we take that stress one of my EMS captains he
was on one of the busiest engines before he came in and he was a paramedic captain so
he here he was the captain of the rig and he was having to write 15 to 20 charts every
shift and so you know he's been a great like sounding board of like how can we make his
job easier when he was out there in the field we've we've also like instituted like Washington
State has a pretty strenuous EMT research program that's actually directed like through
our county medical director and like that gets approved by this at the state level that
is a good recertification program it's called our paramedic continuing education program
and and so that we have to have a hundred percent compliance on that and so as you know
like with work reductions guys aren't always there to take the training so we have to go
out and get that training for them and so we want to be really purposeful that like
if we have to get them off duty that we're not creating a mandatory hire behind that
right so we're doing our little part in the organization of like hey that training can
wait we don't need to mandatory somebody back to come cover for that person you know to
get that that training done so we really want to be purposeful with that the other piece
that we've done is we've integrated with the hospitals to have access to their epic like
their hospital data system so we can actually get instant hospital feedback on patient outcomes
and that has proved time and time again especially in the peer support space that you know being
being a you know first response ALS fire agency we don't go to the hospital very often right
so so our crews just kind of shut the back doors of the ambulance and then they're left
guessing like hey did that kid make it or you know did that mom live or whatever it
might be right so we can have our peer support members like reach out to our EMS team and
we can like get that information immediately right because the old days of us being able
to call call the charge nurse in the ER and say hey how's so-and-so doing on that transport
you know most the time we get blocked by the HIPAA talk right like oh we can't give you
that information you know who is this again right so so that was kind of a hurdle that
we overcame by like working with our legal departments to actually get access into those
systems and there's actually some federal stuff coming along about information share
as far as health care equity so so that would be really good to see too because I think
that will reduce those barriers even more to be able to get that feedback from the hospital
and that outcome so but from a peer support level just allowing again that instant feedback
to maybe that provider that was struggling with that call like hey they lived or hey
they didn't make it but the it's even right here in the ER physicians notes that EMS did
everything they could and like perfectly and that you know the aorta was completely torn
away from the heart and there was no way that person was going to live anyways right so
I think it helps bring that closure or that like that breath of fresh air to the to the
provider so so we've been really purposeful with with that and then let's see what else
have we done so obviously being two separate agencies from our fire department and AMR
obviously there can be crew conflicts right we have crew conflicts between our engine
companies sometimes right so but we wanted to establish a group so we we piloted and
and now we're doing a liaison group so we have a AMR supervisor and a field paramedic
and then we have a captain and a field paramedic from fire they have access to each other and
they can take in input like low-hanging fruit like certain ambulances don't bring in their
kits or fire I saw fire drive around the block again so they didn't have to come in and write
the chart or you know any of these little like petty low-hanging fruit items that group
gets funneled those things and they handle the outside of management like that this isn't
a discipline thing this isn't a you know we're going to try to do the I gotcha type thing
but it has proven to be a really good product like within our system of just having an avenue
to like funnel those like little concerns and so they don't get too big and then and
then we were a big hot wash so we do like a post-incident review right after all fires
and after all critical medical calls like that it's it's not to talk about what went
wrong it's just a real quick give a down and dirty of what happened anything that we can
improve upon next time those are all non-disciplinary and that has worked really really well in our
system that we can get kind of that more instant feedback and then doing joint training and
being a county that it's county driven EMS training really does allow us to have a better
interaction you know all the time with our mutual aid partners and our ambulance transport
agency that we're all on the same page and treating the patients the same way so that
that has been really helpful and kind of reduces that stress level I believe of our crews so
we just continue to look for those innovations of how do we take that stress out of those
calls we have I believe we have an amazing peer support team within in-house it's been
very purposeful it's policy driven it has a budget our members do an amazing job and
we call it bumps that like anybody can like call one of the peer support members and say
hey seem like James had a really hard time on that call can you give him a bump so then
somebody will reach out to him and do that and then and we have some decompression breaks
like so if a crew has a tough call they can they can call the battalion chief and they
can go out of service and we can do a defusing or a debriefing or if they just need to go
work out for 30 40 minutes they can do that so the the BCs just kind of handle that and
manage that so that's been like a helpful tool and I actually heard an awesome story
the other day one of our captains getting mandatory is a new thing for us because it
used to be when we didn't have position for position over time that the captain has just
never got touched right because it always had a firefighter before it ever get to a
captain so now our captains are getting mandatory and a crew recognized that the captain is
getting mandatory had just ran a pretty bad pediatric call and was kind of a ghost and
he was actually he was going to be mandatory into a 72 hour shift and the crew took it
upon themselves to find cover for him so he didn't get mandatory and called and negotiated
with another captain to take it right so I think that we really are watching out for
each other and I think that story is a testament to our guys buying in on our peer support
and taking care of each other and so I just hope that continues.
That's so good to hear I got a couple things I want to pull from you firstly when it comes
to patient outcomes I think the group that we forget about that really need to hear that
are our dispatchers are you able to get that information to them?
Yeah so it's great we have a great relationship with our county dispatch system our liaison
is actually a fire wife and she gets it and she was actually the wife of my first EMS
captain when I came to Vancouver it's his wife and she's so passionate about everything
so we have a county medical directors teams page that we do all of our QAQI through and
she is a member of that page so she sees all those outcomes she can even bring forward
like if they catch something on their QAQI internally like hey we want a patient outcome
because we just we think our dispatcher was off or our dispatcher coded it wrong so we
really want to know what the outcome is so she is a part of that and she's infusing that
information right back into our dispatch center and then our peer support team is engaged
with theirs and we invite them in whether it's virtually or in person for all of our
debriefings or diffusings as well.
Brilliant and the other thing when it came to the peer support what about access to counseling
itself that sounds like the best model that I've heard so far is either having a contract
with local counselors or even hiring one for your department.
Yeah so just a few months ago we finally brought on an in-house clinician we share that with
the police department he's still kind of getting his feet wet and figuring out our system you
know but he's already integrated heavily with both fire and police's peer support teams
our healthcare insurance is actually managed by our union so we have a healthcare trust
so that puts us in the driver's seat to provide services that are unique to firefighters and
not just to like a normal city employee so like stem cell replacement counseling with
culturally competent clinicians you know a naturopath you know 20 visits to a naturopath
or massage or chiropractic you know we really have a Cadillac program and our healthcare
trust is built of firefighters and retirees that are managing that system so it's I believe
it's next to none it's probably one of the reasons I have not promoted out of the union
because our healthcare is really good so hats off to our healthcare trust but one of the
things that we noticed was sometimes you know obviously clinicians are really having a hard
time like you know having available time so what do we do in the stop gap so our healthcare
trust recognized the city's employee assistant program was not meeting our mark so we established
our own EAP within our healthcare trust and that that is it actually links you to the
product better help which is a national system of virtual counselors that are licensed in
your area and their guarantee is that they will see you within 24 hours that they will
match you with a counselor so it's almost like a dating app that you kind of go through
and build your profile and then it matches you with a clinician that's going to meet
your need and we utilize that as a stop gap right like so hey we can't get you into an
in-person clinician for like a week or like four or five days but hey we can get you in
for better help to at least kind of stop the bleed we can get you in like within 24 hours
let's get that going so that's been really innovative I think it's been super helpful
and and been pretty progressive for our crews.
Brilliant.
All right well I'm going to shift to some closing questions so I can be mindful of your
time the first one I love to ask is there a book or other books that you love to recommend
it can be related to our discussion today or completely unrelated?
Yeah I have to say Tribe you know and I know you've had Sebastian on a few times and I've
I've listened to those that was so insightful to me just that the the move from an engine
as a captain to that chief car was like probably the most one of the most like depressing times
like in my career right because like now I'm just out there by myself and it didn't matter
that you'd worked with these guys for 20-30 years all of a sudden now you're you know
you've got a gold badge and you're not one of them anymore right so you're kind of this
Tribe of one now you know just kind of floating out there and you know and and so Tribe really
like brought it to my forefront of like how much community means and how I needed to be
purposeful like as a battalion chief to like engage with crews and and find those opportunities
to be a part of that Tribe still and how important that was so so I actually still give that
book to newly promoted battalion chiefs and and I think that I just yeah I think a lot
about that book the the other one right now that I'm just finishing up is Anxious Generation
by Jonathan Haidt and it is all about the effects that smartphones have had on us and
on our youth and raising you know two adult children and four teenagers and and two little
ones coming up it is amazing like just even though in our own house like seeing the effects
that screens have on their levels of anxiety and their levels of depression and and how
taking that away and getting back to playing and doing stuff is so important and it's funny
like you know I look at our acreage and we have a little motorcycle track and we've got
motorcycles and we've got a pool and we've got a trampoline and we've got all this stuff
that like and a horse and you know like I would have just been like and like it would
be like I was at camp every day but there's been times that our kids like we can't even
get them out there to do any of that stuff like they would rather sit and snapchat their
friend so so really being you know that book really like really shines a light on that
and so so that's that's been pretty insightful like for us and for our family.
What about movies and documentaries any of those that you love?
Oh man I do I do like documentaries I just finished the the Netflix one on Epstein and
trafficking and and how like big money how that gets hidden and it's not you know it's
kind of like what we were talking about earlier with opiates right it's not just it's not
just on the streets trafficking's not just on the streets you know it's in the million
dollar homes so so that was that was probably the latest one I watched and had a ton of
takeaways from that one.
Brilliant all right well then the next question is there a person that you recommend to come
on this podcast as a guest to speak to the first responders military and associated professions
of the world?
Yeah I'd really like to connect you with a woman Erin Johnson and she is a firefighter
up in the central part of our state and she's a clinician turned firefighter and she's also
the union president of that organization and she is the chair of our state council behavioral
health committee and I've gotten to know her through that and I think that she provides
an aspect of all of those worlds coming together right and I think that she has navigated that
well in her community and so yeah I would love to connect you with her.
Okay I'd love to as well thank you the name sounds familiar so I don't know if we're connected
on LinkedIn or somewhere I recognize the name but um but yeah that would be phenomenal thank
you all right well in the very last question before we make sure everyone knows where to
find you what do you do to decompress?
Yeah so um camping we do we try to get away and camp um we're fortunate our in-laws have
a really nice beach house up on the Washington coast we try to sneak away there um ride a
lot of motorcycles and still doing a lot of water sports and as I kind of mentioned earlier
like my wife and I love to get away to Baja as much as we possibly can and kind of spend
a little bit of time on the sea of Cortez side each trip and a little bit of time on
the Pacific coast side every time we go it's an awesome opportunity for us to connect.
Right well then the very last question I'm sure people have been blown away by so many
the you know progressive elements that we've discussed today where are the best places
to find you on on the internet and or social media?
Yeah LinkedIn's probably um a good good spot for that um and then um you know I I can share
you know emails with you um you know feel free to share that um uh with them I think
those are probably the best ways.
Thank you and then as far as the AMR I'll put the website on the uh web page for this
episode as well so people can access that.
Well Rob I want to thank you so much I mean like I said we've gone all over the place
from you know the powerful kind of addiction slash foster adoption story that you have
this beautiful large family now through to the progressive elements that have been infused
into your fire department but it's been a phenomenal conversation so I want to thank
you so so much for being so generous with your time and coming on the Behind the Shield
podcast today.
Yeah thanks James for the opportunity.