DON’T OVERLOOK THE OBVIOUS
FIRE SERVICE EMS
An excellent article that appeared in the August 1993 issue of Fire Engineering. “In Response to the Demand for Fire Department Cutbacks,” by Denis G. Onieal, provided a thorough account of the reasons municipalities should not reduce staff on fire apparatus. The step-by-step description of the various functions and evolutions that must be performed simultaneously or in rapid succession at a typical residential fire were clear and very well delineated.
The convincing part of Dr. Onieal’s argument was the description of these evolutions in terms of weight—the weight of personal protective equipment, hoses (with and without water), and tools firefighters must carry regardless of crew size.
This was a simple, straightforward, and easy-to-understand argument to which nearly everyone can relate.
Dr. Onieal’s article came on the heels of a very heated controversy in the fire service about minimum foreground staffing as it relates to firefighter safety. Some people have likened the controversy to a “fire service civil war” in which sides are chosen on the basis of one’s stance on the minimum staffing issue.
It has become very obvious that national organizations and others who were proponents of a minimum staffing requirement in national standards did not emphasize in their arguments the important, yet obvious, aspect of the issues presented by Dr. Onieal. His simple, but detailed, de-scription shows objectively how staffing can have a direct impact on firefighter fsafety.
THE IMPACT OF EMS ON THE FIRE DEPARTMENT
So what does this have to do with emergency medical services (EMS)? No, I certainly am not advocating a minimum staffing requirement for EMS units, nor do I think we need to evaluate EMS evolutions in terms of the weight carried by EMS personnel. But I do think it is time to look at the obvious—the simple, direct facts that often are overlooked when a fire department is trying to determine if, when, and how to provide some level of EMS.
The priority of patient care notwithstanding, it is a simple fact that providing EMS makes a fire department more productive. When municipal officials, “bean counters,” and taxpayers (or financial donors) see this, they are more likely to provide the necessary resources to maintain a quality level of service. In this day of economic hardship, it is important for all fire departments to show how productive they are and how they are saving their municipality—and their customers— money.
How does the fire department show that it is saving money (without turning in unused funds at the end of its budget year)? Actually, this can be done in many ways, some of which are very in-depth and complicated and others that are simple, obvious examples that probably have been overlooked. It is time for us to overlook the politics and look at the obvious.
A STUDY
Robert Sudol, a lieutenant with the Bloomfield (NJ) Fire Department, wrote a college thesis entitled “Fire Service Delivery of Emergency Medical Service: A Comparative Study.” The premise behind Lt. Sudol’s research is that fire departments become more cost-efficient agencies when they offer EMS to their communities. Three New Jersey townships—Belleville, Bloomfield, and Union—were examined to provide comparisons and contrasts in an attempt to prove his hypothesis.
The three townships are similar in terms of area, population, and firefighters per 1,000 population. The Belleville Fire Department delivers EMS response and transport services to its community using cross-trained/dual-role firefighters trained as emergency medical technicians (EMTs). The Union Township Fire Department started providing EMS first-response services to its community in October 1991, using cross-trained/dual-role firefighters trained at the first responder and EMT levels. The Bloomfield Fire Department does not provide any type of EMS to its community.
Lt. Sudol’s study evaluated fire and EMS service response volume data collected from each department over a five-year period from January 1988 through October 1992. Department operational budgets for the same five-year period then were obtained from the townships’ financial directors. The yearly total operational budget was divided by the total number of service responses each department recorded for the coinciding fiscal year. A dollar cost per service response was obtained using this method. These yearly figures then were averaged to determine a cost per response for the five-year study period.
Analysis of the financial and operational data revealed that it cost the Belleville Fire Department an average of $767.88 dollars per service response over the study period. The Union Township Fire Department’s cost per response was $1,940.35, while the Bloomfield Fire Department’s cost per service response was $2.430.28. Clearly, the fire department that delivers full EMS services provides a better bargain for Its customers.
When the Union Township Fire Department’s cost per service response is examined on a yearly basis, statistics show another example of greater cost efficiency when EMS is delivered. A $106 decrease was realized in 1991 when EMS activity was added into the response total for the last three months of the year. A $275.58 decrease in the cost per service response is seen in the 1992 portion of the study. When factored into the entire study period. adding EMS for the last 12 months of the study reduced the cost per response over the entire five-year period by $76.15.
While other components certainly could factor into these equations, Lt. Sudol’s statistics reinforce the idea that fire departments that deliver EMS increase their utilization in their communities, becoming more cost-effective for the customer. The fire service may take this for granted because it is so “obvious,” but it may not be so obvious outside our “ivory hose towers.” This is a critical, yet relatively simple, thing for fire departments to show to their municipal officials and their customers.
ADDITIONAL APPROACHES TO EFFICIENCY AND ECONOMY
Fire departments can use spinoffs to this approach to show the efficiency of all types of operations or to justify a positive change in service delivery. For example, fire departments all over the country are being criticized for responding to medical emergencies in large, heavy fire apparatus. Most reply by saying that they have to be ready for a fire emergency as soon as the medical emergency is over. What about looking at the obvious, just as you might do if you were paying the bills (which, in effect, we ail are)?
The Phoenix (AZ) Fire Department took this approach and studied apparatus usage per response, looking at total apparatus cost plus maintenance, fuel, mileage, and lifespan. The department was easily able to determine that it cost S1.87 per mile to operate a full-size pumper and S5.04 per mile to operate a ladder truck. For a fire department that provides EMS first-response service with pumpers and ladder trucks, this cost is significant, particularly when 75 percent of the total call load is EMS. The Phoenix Fire Department was able to use this information to justify the purchase of smaller units, known as “tenders,” to handle the EMS call load with the same crews assigned to the fullsize units. Even though more vehicles are purchased for the fleet, the cost savings are staggering—an estimated S20,500 per year for each of seven ladder companies and a projected S13,000 per year for each of 14 engine companies that respond on more than 3,000 calls per year. Many other benefits also have been realized by using the tenders.
Looking at simple cost-per-call or costper-mile statistics can help a department decide whether to provide EMS, whether to continue providing EMS. and the level of EMS to be provided. Other similar, obvious comparisons can be made to show how productive EMS can be for a department. Take training, for example. You can train firefighters and EMS personnel together or separately—which is more cost-efficient? Obviously, this is topicdependent; however, there are many subjects that both fire and EMS personnel must be taught.
In a cross-trained, dual-role department, training dollars are maximized because personnel are both firefighters and EMS providers and each training class covers the “two” audiences concurrently. When EMS providers are separate from firefighters but housed in the same station, training them together makes it possible to train more people on certain subjects using less time, money, and effort. It may take some extra coordination to have training courses that include firefighters and EMS providers from separate agencies and stations—particularly if they work on different shift schedules—but it can be done. This system also can build teamwork, partnerships, and a harmonious working relationship. ⅛
From a financial perspective, fewer classes are needed to teach the same quantity of information to all the right people when fire and EMS providers are taught together. But this is important for another obvious reason. Operationally, when everyone is trained the same way on’ the same subjects, things run smoother.
Consider, for example, emergency incident rehabilitation. EMS personnel must -know when, why, and how to set up a rehab area and how to operate in it. Firefighters need to know what rehab is, why it is important for them, and when/ how they need to go to it. Wouldn’t it make more sense to have one training session with both EMS providers and firefighters rather than two separate classes? If fire and EMS personnel learn about rehab together, they will have a common understanding about how it works and how it is to be done at an incident. If they are taught about rehab in separate classes, fire personnel may have one idea about how rehab is supposed to work and EMS personnel another. This can create confusion, inefficiency, and ultimately animosity between fire service and EMS personnel. (It also can result in physiological harm for firefighters who may be overlooked in the rehab process because of ensuing arguments at the scene.)
Emergency incident rehabilitation is only one example of a topic that should be taught to fire and EMS personnel together. Other training topics suitable for joint classes include hazardous-materials first response, extrication, responder safety, emergency vehicle operations, incident management system, infection control, EMS operations at routine and mass-casualty incidents, disaster operations, critical incident stress management, and technical rescue first response. Simply put, for any situation in which they will work together, fire and EMS personnel should be trained together—for cost-effectiveness and for efficiency in operations. Again, this is quite obvious if you look past the politics.
Much has been written about the cost savings realized when fire departments participate in joint purchasing agreements. One order for turnout gear for two departments typically will cost each department less than if each orders separately. The same is true of medical and infection-control equipment—if your community has a separate EMS transport service, you should have a joint purchasing agreement with it. This again is based on a simple, everyday premise: the larger the quantity of an item purchased, the lower the item’s unit price. This is true of everything from adhesive bandages to ambulance vehicles.
The fire service must look past its “200 years of tradition,” its turf-protection ideals, and the politics that have hindered the growth of EMS in the fire service. The fire service must look at itself as a business and must recognize EMS as an integral part of the business—inseparable, whether or not it is provided from within. And the fire service must begin to realize that to succeed it must look at things the way citizens and elected officials see them— usually as dollar signs, with little concern about who actually provides a given service (as long as it is provided). The sad thing, or perhaps the encouraging thing, is that the ways to do this should have been (and still should be) obvious to the fire service.
It is time for the fire service to stop overlooking the obvious. To move ahead in fire and life-safety protection overall, the fire service must start by kx>king at the simple, obvious things that have so often been thrown out. disregarded, or simply ignored in the past. The successful fire departments and most private EMS companies did this a long time ago—and it shows.
The views expressed in this column are strictly those of the author and do not necessarily reflect those of the U.S. Fire Administration or the Fairfield Community Fire Company.
