Will Fire-based EMS become a nationwide practice?

[gotbeerz001]

When you say 5%, you are likely speaking strictly about dispatched calls.

If you compare apples to apples and look at total man-hours required to accomplish each discipline, you will find that fire response, in a busy system, is far more than the 5% that you speak of.

 

[Tigger]

When you say 5%, you are likely speaking strictly about dispatched calls.

If you compare apples to apples and look at total man-hours required to accomplish each discipline, you will find that fire response, in a busy system, is far more than the 5% that you speak of.

No doubt. But I still doubt you'll find that funding priorities match up.

 

[Burritomedic1127]

I agreed fire equipment costs more but I highly doubt you're buying new pumps and ladders every year. More even budgeting/spending I'm sure would go a long way

 

[Christopher]

When you say 5%, you are likely speaking strictly about dispatched calls.

If you compare apples to apples and look at total man-hours required to accomplish each discipline, you will find that fire response, in a busy system, is far more than the 5% that you speak of.

You're correct, except I actually overestimated fire suppression by percentage. Most of the dispatched "working structure fires" do not require fire attack with engines, towers, and tankers. Pot burned on a stove, etc. The number is lower. Good catch!

Anyways, fire suppression is obviously not the only thing we do on the Big Red Trucks (white trucks here). Removing medical first response (60% of call volume on the Fire side), we've got ~10% chasing false alarms, ~15% "good intent", 10% are cancelled prior to arrival, and the remaining split between fire suppression and rescue (2.1% involve physical property on fire; e.g. structure or vehicle).

Yes, capital expenditures are large on the fire side. Yes, manpower requirements are similarly large. And yes, training/preplanning/readiness takes up a large number of manhours too. However, UHU's are nothing like EMS, and the risks to the populace are nothing like EMS (more taxpayers die due to medical conditions than fire conditions). My point is the funding split for most areas is not based on current risk assessments / integrated safety analyses, but rather historical norms often dictated by the legislation which creates/allows the various public safety agencies.

 

[46Young]

Sure, most box alarms turn out to be either something mundane like food on the stove w/o extension or appliance/chimney fires, but there are also many EMS calls that are equally routine and non-acute. Your typical food on the stove or odor in a building are the fire equivalent of a medical call for a drunk or a 25 y/o with a headache and general malaise for three days. Fire alarm bells are the equivalent of an MVC with paint transfer or a dented bumper with All-State-itis neck pain. Once in a while that drunk could be a diabetic, and the headache/weakness could be a CVA. The same goes with fire - nine times out of ten it's food on the stove, the tenth it's a structure fire. A fire alarm or odor in a building could. once in a while, be fire hidden behind a wall due to an electrical anomaly.

Fire needs to maintain adequate staffing and deployment to achieve the goal of availability to every call as if it's the real deal. Same for EMS - 90% of patients would have no change in outcome if they were driven to the hospital vs. calling an ambulance. That does not mean that we can cut EMS services 90% and give taxi vouchers instead. That would be silly. We run mostly non-acute, routine taxi runs, but once in a while we get to change a sick patient's outcome. Last month I ran three cardiac arrests, treated two diff breathers, gave pain management to three people, and the other 90% were just vomit (Vitals, Monitor, Oxygen, IV (sometimes), txp). Out of that 90% I give a pass to the elderly that need to be carried, but the rest are mostly needless transports that would be better served by an urgent care or PMD visit.

To prepare for the 10% of "real" calls on both the fire side, and the EMS side, fire needs much more (expensive) apparatus, and many more people to achieve deployment goals. Two on an ambulance, 3-5 on engines/trucks/heavy rescues, then you have Hazmat units, tankers, things like that.

What do you think is acceptable for response time/distance to fire calls, and what is acceptable for ambulance runs? Should they be equal? Should EMS be quicker? Should fire be more timely? Should ambulances outnumber fire engines? Should they outnumber the total number of fire apparatus? Should there be more engines than ambulances due to the need for several to be on a box alarm? As an example, my department has 42 ALS ambulances, 38 engines, 14 trucks, eight heavy rescues, and two Hazmat units. Eight of the fourteen trucks run with four, the rest have three. All other apparatus run with four, except for the Hazmat support unit, which runs two. Our ISO rating is strong, and our response times are low. We have 391 square miles of land, and a population of 1.1 million.

Our people are all dual role, but the fire specific budget dwarfs the EMS side, if you were to count fire equipment vs. EMS equipment, and payroll for suppression spots vs. ambulance spots. Even with that "disparity," EMS here is well funded. It's just that fire needs more equipment and people to achieve deployment goals vs. EMS, which is a fleet of ambulances staffed by two people. Fire is always going to have the lion's share of the budget, even with a well funded EMS side.

 

[gotbeerz001]

You're correct, except I actually overestimated fire suppression by percentage. Most of the dispatched "working structure fires" do not require fire attack with engines, towers, and tankers. Pot burned on a stove, etc. The number is lower. Good catch!

Anyways, fire suppression is obviously not the only thing we do on the Big Red Trucks (white trucks here). Removing medical first response (60% of call volume on the Fire side), we've got ~10% chasing false alarms, ~15% "good intent", 10% are cancelled prior to arrival, and the remaining split between fire suppression and rescue (2.1% involve physical property on fire; e.g. structure or vehicle).

Yes, capital expenditures are large on the fire side. Yes, manpower requirements are similarly large. And yes, training/preplanning/readiness takes up a large number of manhours too. However, UHU's are nothing like EMS, and the risks to the populace are nothing like EMS (more taxpayers die due to medical conditions than fire conditions). My point is the funding split for most areas is not based on current risk assessments / integrated safety analyses, but rather historical norms often dictated by the legislation which creates/allows the various public safety agencies.

My bad. I work in an area that burns.