CERT — Bureaucratic teaching

CERT-LogoYesterday I completed the first half of my Community Emergency Response Team (“CERT”) training. CERT is a FEMA program that’s intended to give ordinary people some basic crisis management skills in the event of a natural or terrorist disaster. I ended up learning a fair amount, but it wasn’t thanks to the way the program was created or — with all due respect to the firefighters who taught it — the pedagogy.

Regarding the last, let me just say that it’s a reminder, as if I needed one, that most people aren’t very good teachers. A good teacher is an informed, logical thinker who is able to communicate his knowledge in an understandable and, if the students are lucky, interesting manner. The firefighters who taught our course clearly knew their stuff, and it was obvious that they were prepared for this teaching gig, but they simply weren’t born teachers. That’s okay. I don’t hold it against them. They were good people making their best efforts and for that I was grateful.

What I found distressing was the course’s structure and for this I blame the bureaucratic brains at FEMA. The class got wrong-footed instantly because it didn’t start with a course overview, explaining to the diverse group of citizens assembled in the room precisely what they would and would not learn.

A slight digression here: By diverse, I don’t mean that we had a carefully calibrated ratio of different skin colors, sexes, and sexual orientations, as if we were a class in any university in America. Instead, I mean that we were a self-selected group of people with different ages, backgrounds, socio-economic status, education, experience, and intelligence. That in itself was a good thing for me, because my neighborhood has a little bit of Lake Woebegone about it, insofar as all of the families are “above average” — people who don’t have an edge can’t afford to live in our community. It’s too easy living in my neighborhood to remember that not everyone communicates as well as we do or grasps concepts as quickly as we do. And now back to my main point.

If I had created this CERT program, I would have started with an introduction making the following points:

In most communities, professional responders are easily able to handle every day crises, ranging from heart attacks to freeway pileups. Occasionally, however, a community is hit by a mass disaster. These disasters can range from hurricanes to earthquakes to terrorist strikes. By definition, a mass disaster is one in which there are more injured than there are professional first responders and time is of the essence for locating and treating the injured and for neutralizing potential future injuries from downed power-lines, fires, more bombs, etc.

Human nature being what it is, when a mass disaster strikes, volunteers inevitably come forward to help within their own community. Studies of mass disasters have shown, however, that when these volunteers are untrained, they’re not as useful as they could be and, worse, they are often killed or injured themselves.

The purpose of this course is to teach you — people who plan to step forward to help yourself, your family, and others in your community in the event of a mass disaster — how to organize volunteers after a disaster; how to identify ongoing danger spots, put out fires, and isolate downed power lines and other ongoing hazards until emergency services can show up; how to locate and provide basic care for injured people; and how to perform triage (i.e., classify victims by the severity of their injuries) so that, when professional first responders are able to appear, they are immediately able to treat the injured and clear the community of further hazards.

That’s what you’ll learn during this 18 hour class. What you will not learn is first aid, including CPR. Additionally, this class will not organize your neighborhood for you. We encourage you to take a first aid class and to connect with others in your neighborhood so that you can get an emergency infrastructure in place, but that’s not what will happen here.

Instead of this overview, the class started by talking about CERT’s history.  This lesson was completely irrelevant, because it wasn’t framed so as to explain the scope of the class. The curriculum then muddled its way through various vague subjects that I can’t even remember now.  What was clear from the questions people asked throughout the class was that, without an introduction, the assembled students were often confused. Because none of the attendees knew the class’s boundaries, they wasted an enormous amount of time asking questions outside the scope of the class.  Meanwhile the firefighters teaching the class had a hard time answering these questions, because they didn’t know how to address the fact that the questions exceeded the seminar’s limitations.

This “overview” failure continued throughout the class. Later in the day,, the instructors plunged into a lesson about the all important Incident Command System without first explaining to people what it was and how it worked. Again, before teaching the module, I would have taken a couple of minutes to give an intro and, by doing so, no doubt would have saved at least a half-hour dealing with subsequent student confusion.  My intro would have gone along these lines:

In a crisis, being organized can sometimes be the difference between life and death. Over the years, first responders and the military have created and refined an organizational system called the “Incident Command System” or ICS. It’s basically a pyramid system with one leader at the top of the heap. Beneath him are teams that have responsibility for specific tasks. These teams, in turn, can be broken down into more specific sub-teams.

With the exception of the team leader, which is usually a solo position, each team is made of between 3-7 people, with 5 being the perfect number. In order to keep confusing chatter down, and to prevent conflicting decisions and the spread of misinformation, communications go strictly up and down the pyramid. The ICS leader will talk to the team leaders immediately below him; those team leaders will talk to the leaders of the sub-teams and so on, all the way down. Ultimately, information flows up to the ICS leader, and assignments flow down from him.

We’ll show you how, in a mass emergency, CERT volunteers can immediately create an ICS that harnesses the knowledge of other CERT volunteers, as well as the abilities and efforts of other, untrained volunteers. The best thing that can happen after this class is for you to return to your neighborhood and begin creating an ICS structure now, so that it’s in place in the event of a mass emergency. However, as you’ll see, you can instantly create one of these systems at the scene of an emergency.

I’m writing this on the fly, and after first learning about the ICS system only yesterday, so forgive my mistakes. My point, though, is that you cannot intelligently teach volunteers about the ICS approach to crisis management without explaining its purpose or giving an overview of its function. Because the CERT program (foolishly, in my opinion), instantly plunges into details, half the room was very confused.

I use the word “half” with precision. A voluntary gathering such as a CERT training class is a reminder that an IQ of 100 is average, with half the people in a random crowd having, on average, only a two-digit IQ. I don’t say this to be arrogant. IQ is only one type of intelligence. I happen to function well in an environment that demands a high IQ, but I’d fail miserably in a setting that demands a high emotional intelligence, mechanical intelligence, artistic intelligence, athletic intelligence, or any other type of mental skill set other than dealing with abstract ideas. When you’re dealing with people whose strength isn’t abstract ideas, you must make a special effort to be clear and organized in your presentation.  Drifting into myriad incomprehensible details makes things unreasonably difficult.

The program bogged down again when it came to triage. It quickly turned out that the people assembled in the classroom thought that they were responsible for first aid as a subset of triage. Everyone was ready to dive in with CPR and goodness knows what else. That, too, should have had a quick overview:

One of the most important services CERT volunteers can perform during a mass emergency is to (a) try to stabilize people who are unable to breathe, are bleeding out, or are going into shock and (b) to classify the injured so that, when the professional first responders finally arrive, they can immediately treat the most seriously injured people first without having to do the sorting process themselves.

Triage is not the same as first aid. One of the most significant differences is that you will not learn here CPR and you are not expected to perform it at the scene of a disaster. When casualties are lining up, it’s much more important to sort people, and to treat for bleeding, shock, or airway blockage than it is to attempt to give one person CPR. Sadly, doing the greatest good for the greatest number of people sometimes means turning your back on a single heart attack victim so that you can said (and save) several more people.

In this segment of the class you will learn how to identify and provide basic care for the three most common causes of death in a mass disaster: airway blockage, excessive bleeding, and shock. You will also learn how to classify the injured as walking wounded (who are able to care for themselves or even care for others); those who need delayed care (while they cannot care for themselves or others, their lives are not at risk); and those who need immediate care (those whose injuries are so severe that they are at risk of death or permanent, grave injury if a medical professional cannot see them). You’ll also learn how to recognize when someone has died for triage purposes (which is different from the standard used in a hospital during ordinary care), and how to handle the fact of that person’s death.

And with that introduction, the teachers would have been able to cut at least 30 minutes off of confusing instruction time.

Ultimately, the triage lesson proved to be very interesting, as we learned out to deal with shock, airway obstruction, and bleeding, as well as practicing basic carries.  Next week we learn how to search a structure safely and how to put out fires, among other things.  I expect to enjoy myself and come away with a great deal of useful information.  But I also expect to come away frustrated at the inefficient way in which this information is conveyed.  And as the title of my post suggests, I can’t help but think that the problem with this muddled, vague teaching system is that it’s the product of a bureaucratic committee, rather than a gifted educator.