The Art of Gripe: A Policy for Intra-Organizational Complaining

There’s a lot of complaining happening in my fire department. If you asked most of management why that is, you’d probably hear something about malcontents or ungratefulness. And that’s half true. But only half true. The thing is that complaining is a perfectly valid form of discussion. My only concern is that you might be doing it wrong. And I should know. When it comes to lamenting the world’s injustices, I happen to be one of the best.

So yes. I’ve decided to start my article on complaining by bragging about how good I am at complaining and then bitching at you for having bad technique. And I might be right if:

  • You tell people to be appreciative and that there’s something wrong with them if they complain.
  • And instead of voicing your own complaints to the people that matter, you spread negativity to people who are in no position to offer a solution because it’s less risky.

This should all stop.

The fact of the matter is, a big part of taking ownership in an organization is pointing out how things could be better. And a big part of leadership is hearing out the complaints of the members. Organizations that have a lot of problems don’t need to spend their efforts silencing the complainers.

Instead, they need to channel that negative energy into positive changes. So instead of shaming members who piss and moan (which might be a sign that they care), let’s just set some ground rules. Once the department members know they can respectfully voice a concern (and actually have their opinions considered), there will be no reason for them to hide their grumbling – a behavior that inevitably leads to festering and division.

What follows is a sort of unofficial policy that can serve as protection for everyone. On the one hand, a member should be safe to voice criticism so long as he/she has followed the rules. On the other hand, following these rules should protect the organization from rampant negativity, echo chambers, malcontentedness, and other toxic culture.

Complainer, follow these rules when airing a grievance.

  1. Have and use a pressure relief valve (PRV). Some thoughts sound justified inside your head. But then once you say it out loud you realize, “Nah. I have no right to be pissed about this.” It’s nice to know that the only person you said that to was a close friend that you can gripe to in confidence, your PRV. Have a really close friend to bitch to and let him/her bitch back with the understanding that some of the time what each of you has to say is nonsense and that’s okay. When complaining to the PRV, none of the other rules in this policy apply.
  2. Only complain in the right place, at the right time, and to the right audience. Complaining about your fire department to a public audience is so obviously wrong it has a cliché name, “airing out dirty laundry.” It is embarrassing for the entire fire service when fire fighters do this.
  3. Speak only the truth. Fact check first. It’s important to admit your biases and keep complaints to what you know to be true. I know most fire fighters are not liars. But I also know that most fire fighters gossip worse than the old people they run on in the nursing homes (complaining about something you don’t actually know to be true is wasted energy for you and the people who have to hear it).
  4. No echo chambers. An echo chamber is a group, team, crew, house, or office made up of individuals who are like-minded on a particular topic and spend significant amounts of time repeating well-known complaints back and forth at each other. There is rarely any disagreement. They build figurative straw men and then sadistically destroy them. These groups give each of the participating members the false impression that their ideas are flawless and that only a fool (or an enemy) would oppose them. It’s a divisive phenomenon that builds isolation.
  5. Be willing to help. I’m not saying it’s your job to fix everything but make sure you consider this option.
  6. Be willing to voice your complaint to the person that is actually able to do something about the problem. Too often, in a department of 500 people, exactly 499 people are aware of the fact that a member screwed up. The 1 person that doesn’t know is the person that did it. Don’t let this be your department.
  7. Don’t complain about opportunities to help people in need (no complaining about calls). It’s important to execute this rule as exhaustively as possible. People who need help (or think they need help) and call the fire department are the reason you have a job. Sometimes people call and it seems unnecessary to you. It’s okay to think that. It’s okay to look for underlying reasons for the call or alternative resources to assist next time. It’s not okay to bitch about the run. Not even at 03:00, not even for a non-emergent reason, and not even for a frequent caller.
  8. Be open to the possibility that you’re just missing something. Steve Jobs said “Everything around you that you call life was made up by people that were no smarter than you.” And maybe in that moment, people needed to hear that. But what also needs to be said is that those people were no stupider than you either. Before you charge into some situation and start barking about how much better it could be, try to understand the history and the rationale behind why it is the way it is. You might be missing something major.
  9. Show appreciation for sacrificial leadership. Sometimes a leader is challenged with a question for which there is no good answer. In such a moment, a good leader stands firm in a principled position knowing and accepting that harsh criticism is inbound. Recognize when your leadership has chosen to do this and (whether you agree with the decision or not) respect that he/she was willing to accept that fate. Appreciate the fact that your leader has taken a principled stand even if you don’t like the outcome. And learn from that leader. Be willing to learn so that one day, when it is your turn, you can do the same. If you cannot recognize such a circumstance when it occurs, your perspective on the department is too narrow. (Btw, this is strictly a prescriptive instruction — not a restrictive one. Show appreciation for this particular type of leadership wherever you see it because it is uncommon. This should not be taken to mean that you cannot also voice a dissenting opinion.)
  10. It is what it is. Consider the possibility that you are the unjustified victim of an unnecessary and crappy circumstance. That might be the case and the people that care don’t have the power to change it. If there’s nothing you can do and you’ve exhausted all of your options, either exercise your power of exit or get over it. Every job just has certain crappy parts. Are you willing to leave the department because the situation is that bad? Yes? Don’t forget your exit interview. No? Then look inside yourself for some toughness, contentment, (not a common skill), and joy. Come to peace with the parts of the job that suck so they don’t make you bitter.
  11. Don’t let complaining define your relationships. You spend a lot of time with your crew. After a while, even close crews start to run out of original things to talk about. To fill the time, some crews complain. Driving the rig, over coffee in the morning, sitting in the office, on the way to calls, and shopping for meals some crews in response to the innate need to bond through commonalities discover that the only perspective they agree on is that they are powerless victims in an uncaring world (all while doing the greatest job in the world). These are your brothers and sisters. Be creative and find encouraging things to talk about.
  12. First, count your blessings. You are your only accountability on this. And you are the only person this is designed to protect. For the sake of your own mental health, spend time recognizing just how bad ass it is that you work for the fire department. And if you don’t think that’s bad ass, it’s time to go elsewhere. If you can honestly tell yourself you’ve done this enough, gripe away!
  13. Either go nuclear or take your finger off the button. Don’t just threaten to officially grieve a circumstance via the union, human resources, media, or the law. Usurping the chain of command and using legal representation to demand answers and action is not to be taken lightly. So if you’re willing to claim that what has been done to you, the department, or your community is hostile or illegal, do something about it. Either believe your own hype and take action or reconsider whether your problem is truly as big as you say.

Audience, when receiving a complaint follow these rules.

There’s a few rules for officers and supervisors to consider here as well. Remember that complaining has a bad reputation because it often gets out of control but it can (should) be a good thing.

  1. Be willing to listen to and consider the gripes of others. Be willing to either do something to help or explain why you won’t.
  2. A solution is not prerequisite for voicing a concern.
  3. Be willing to admit your mistakes.
  4. Be willing to explain why things are the way they are. Be willing to explain why things are unlikely to change.
  5. Understand that just because you don’t see the solution, it doesn’t mean there isn’t one. Don’t be too quick to shut down a complaint just because you think it’ll go no where.

I don’t intend to excuse any particular type of complaining. Whether someone is being toxic or helpful often comes down to individual judgement. Just know that it has its place and that when it’s out of control, you need some good tools to reign it in. Above all else, remember that your fire brothers and sisters are like a type of family. And just like any other family, it’s more important to encourage them than to point out their flaws.

Fix your Memo: Business Writing in Fire Service Promotion Exams

Drawing of a psychadelic skeleton fire fighter sitting at a laptop computer and typing chaoticly.

Weak written language skills cost people promotions.

You’re already aware that in your upcoming promotional exam, nothing is likely to cause more movement in the ranking than reading (multiple choice exam) and writing. Other activities (tactical exercise, interview, role play, etc.) don’t seem to have as much scoring variance. In other words, one of the best things you can do to dramatically improve your outcome is get better at writing.

Keep in mind that promotional exams are a surrogate for personal development. During the promotional process, the intent is that members will become more valuable (whether they successfully promote or not). And writing is one of the most important areas for improvement. When all members of the fire service begin to treat the art of communication in written word with the same respect as the glamorous disciplines in the operations sector, the fire service will be better, more adaptive, and more effective.

But that’s not really what this article is about. In this article, I want to lay out a specific algorithm that you can apply to a writing exercises in an assessment center. The goal here is to help you improve in just a few days. (But promise me you’ll keep improving your writing even after the assessment center.)

The overall process is simple and you need to memorize it. There’s three steps that are designed to keep you from getting stressed, distracted, or aimless. Let’s get started!

Make quick fixes by using a consistent method.

Step One: Find the hidden theme.

Every department has a stated mission and list of values. Invariably, the values are things like accountability, courage, honor, professionalism, and service (this list is from Colorado Springs Fire Department).

So if the assignment is something like:

A citizen has complained to you about an ambulance crew in a near by station being rude while on scene; write a memorandum to your captain explaining how you handled the event.

don’t just start writing. Start by addressing which of the values are in question. I would say professionalism is the theme here. At some point, explicitly state:

One of our fire department’s values is professionalism.

This step is more important than it might seem. Don’t get baited into writing firefighter level content. Consider this assignment:

You notice that one of your firefighters skipped several important safety steps while raising a ladder during training. Write a memorandum informing your battalion chief how you plan to correct the issue.

The theme is not ladders (or even training). Don’t go on and on about how much you know about ladders. The theme here is accountability. So write what you know about that and why it matters to the department.

Step Two: Write the major parts of [every] memo.

Admittedly, this step is pretty common sense. But if you can break the memo into 3 parts, you will find it easier to keep focused.

Imho, these are:

  1. Problem and Context
  2. Solution (Methods)
  3. Follow up & CTA

If you can remember this, long provocative questions will be less likely to throw you off. I won’t describe in detail what each of these things should be; if you want more detail, lmk.

CTA stands for call to action, btw. Start with a generic one and develop it as necessary. It might be something as simple as:

Please contact me at if you have any questions or comments.

Step Three: Proof read at least twice.

The process of scanning your work for errors should involve one repetition with major edits and one repetition with only minor edits. Here are some key tips that will clean up the most common grammar problems.

Cut every sentence into its simplest parts.

Look at this sentence:

Although these members begin their careers with good intentions, after five to ten years, the stress of the job leads not just to avoidance issues, but even integrity problems.

It sounded great inside the writers head. But this type of complex structure causes unnecessary confusion for the reader who cannot hear the tempo and tone that the writer intended. So anything that can be made its own sentence should be. As with all fire service communication, clarity is everything. Instead:

These members begin their careers with good intentions. But after five to ten years, stress from the job leads to avoidance issues and integrity problems.

Btw, apply similar principles to every other component of your writing:

  • If you can use a simpler word (or less words), do.
  • If you can use simpler punctuation, do.

Properly format bulleted and numbered lists.

Inevitably, every memo has a bulleted (or numbered list). I recommend them. Assuming that your memo does, let’s do some quick checks to make sure it won’t cost you grammar points.

Is the list ordered or unordered?

If you could change the sorting of the list and it would still make sense, the correct list type is bulleted. If the list needs to stay in order (such as chronological), use a numbered list.

Are the list items complete sentences?

They don’t necessarily have to be. If they are, use punctuation. If they aren’t, don’t. Whichever route you take, be consistent. Every item in a list should be formatted the same. A list with periods terminating some of the items but not others is likely a syntactical flaw.

What is the tense?

Be consistent in how each list item is tensed. This is best explained with an example. See if you notice anything awkward in this list:

The fire department has been successful in these risk reduction efforts:
• Full-time certified fire inspectors and fire fighters conduct thousands of fire-safety inspections annually.
• Our highly-trained professional fire fighters spend much of their time in the local schools as well. They help to conduct fire drills to help make certain that students evacuate safely and efficiently.
• Increased the number of Advanced Life Support units available during peak times by 40%.

Unlike the first two items, the final item in the above list is past-tense. Additionally, it is not a complete sentence. Both problems make this distracting to read.

Alternative punctuation choices might signal doubt in your writing.

Be careful with anything that isn’t a period or a comma. Inserting hyphens, quotes, underlines, colons and semicolons where they don’t belong is a mistake.

If you’re not quoting someone, don’t use quotes. Quotes are not a way to excuse the fact that you are using the wrong term, slang, or inappropriate jargon. The following sentence is an attempt to use quotation marks to lazily convert slang into formal text, I consider this bad writing:

The Commander has attempted to be more collaborative by regularly requesting feedback from “the boots on the ground.”

Exercise: Clearly, there must be a better term than “the boots on the ground”. How would you fix this sentence? Answer in the comments.

Grammar is a journey. Learning the rules of writing shouldn’t end in grade school. This is for a few different reasons. Namely: the rules change, which rules you should follow will change as you mature as a writer, and there are a whole lot of rules in the English language.

Step 4: Breathe and read. The mistakes are hiding.

After you think you are done, read your work. Come to this step with the expectation that it is perfect and no more changes are necessary. If you find problems and need to fix them, that’s fine. But that means you are on step three, not step four. The reason I say this is because many mistakes are resultant of last-minute edits. Fixing one part of a sentence might render another part of a sentence ungrammatical.

Your final read-through should involve no editing.

Great writing solves problems.

Once you have memorized and practiced this process, you are one moment closer to taking on a leadership role in the fire service. Therefore, it is now even more important that you constantly improving yourself for the sake of your department and community.

Rather than starting this article with the heading “Weak written language skills cost people promotions,” I should have started it with “Weak written language skills cost people their lives.” Obviously, that would be unnecessarily forceful for an article about writing. But it’s true. Because the quality of the service we provide is reliant upon the ability of our leadership to strengthen and adapt the complex public safety systems within which we operate. And our business is saving lives. The point is that I’m offering a mandate to every fire fighter: get good at writing.

Which is well outside the scope of this article. Because great writing requires vision. And the development of vision is a wholistic process. Writing is more than just a way to convey a message. It is a way to develop a thought. So good writing suggests sound thinking.

I hope this helps. Please feel free to let me know in the comments or on social what you think of this article. And good luck in your assessment center!

Respiratory Distress + Altered Mental Status = _____

Have you ever had a Coke?

How about a flat Coke? What was the difference? It was still good, right? But it was not as good. Why are the bubbles so important to the flavor? The Coke was missing something. Kind of like fries without ketchup, fish and chips without vinegar, lemonade without lemon, or a reuben without sauerkraut. What’s missing from each of these is quite often the final important thing that makes food tasty: acid.

Acid is so important to cooking good food: think pickles, lemon zest, vinaigrette, coffee. This article is about medicine, I swear.

But what’s with the Coke example? There’s no acid taken out of Coke to make it flat. Just bubbles. Right?

Let’s do some firefighter level science for just a second here: the bubbles are carbon dioxide. Under pressure, dum dum dum dada dum dum, the carbon dioxide liquifies and mixes with the water. And liquid carbon dioxide is acidic. Hence the name carbonic acid, which is the name of the molecule created by combining water and carbon dioxide. (If this simplified version of chemistry is offensive to you, you are too smart for this article, so please feel free to correct me in the comments or just go to doctor school or whatever.)

So as the carbon dioxide (CO2) breaks free from the water, the carbonic acid is destroyed. The acid disappears from the Coke.

In a roundabout way, what I’m trying to explain here is that as an EMS worker, when you think CO2, think acid. Acid in cooking is good. Acid in the blood? The body would rather not. But we know that acid occurs in the blood due to certain processes.

Respiratory rate? What’s that?

Exactly. This is the most overlooked vital sign in EMS. Get in the habit of checking respiratory rate (RR) as one of the vital signs you evaluate on every patient. And if it’s elevated, think acid. (There might be other reasons, of course. But until you have ruled out acidosis, they’re not really worth considering.)

If the blood becomes acidic for any reason, the respiratory rate will increase because more respirations means more CO2 out and more oxygen (O2) in. Counterintuitively, increased RR is not the result of decreased oxygen. It’s the result of acidosis. Which means that it is entirely possible for a patient in profound respiratory distress to have a peripheral capillary oxygen saturation (SpO2) over 90%.

Failure is between distress and arrest.

Most respiratory distress (not all) in the elderly in Colorado is caused by chronic obstructive pulmonary disorder (COPD). The distress is the result of poor gas-exchange–carbon dioxide is not efficiently escaping the body’s circulating blood. Oxygenation is also diminished but the key factor is trapped CO2. As carbon dioxide continues to be spilled into the blood by cells as a byproduct of energy production, the body responds to ineffective gas exchange with increased respiratory rate.

The RR can only increase so much. It’s ability to compensate is finite.

I’ve wondered whether patients in respiratory failure are completely incapable of following directions or if they are just so focused on breathing that they consciously shutout all stimuli (including the directions of the attending paramedic). At one point in the process, the one turns into the other. Either way, it is an archetypal death-stare presentation. Short choppy breaths. Suddenly the patient that has been leaning forward trying to move as much air as possible will lean back and start to list to one side.

As a paramedic working in the field (I can’t speak for anyone else), a diminishing mentation is the key finding that distinguishes respiratory distress from respiratory failure. Inside of the failure patient, the feedback loop has been overwhelmed. The RR can only increase so much, it’s ability to compensate is finite.The respiratory distress patient compensates and the respiratory failure patient cannot. Once you observe this sign, cardiac arrest is near.

Oh dear! What do I do?

This isn’t a JEMS article. It’s not an excerpt in a paramedic textbook. And it’s not your protocol. So while it might feel like I’ve reached the point in the article where I tell you what treatment plan is most appropriate in what setting, that just isn’t what this is blog about. I only mean to help explain some things that used to mystify me. I hope there is something useful to be found in my particular method of explaining this subject.

The bottom line is that medicine is not about intervention. Treatment is simple. Your patient has x problem, you provide x treatment. Assessment is hard. The real question is not what is the treatment? It’s what is the pathology? And answering that question takes experience, understanding, and (most of all) compassion.

And if this little explanation helps you help your patients, I’d love to know it. Put it in the comments.