As a social scientist, one is trained always to view the world of data analysis through skeptical and critical eyes. In the real world, that makes you skeptical of conclusions based on limited studies that have not weathered competing hypotheses and alternative conclusions. It is with those eyes that I read Rich Rifkin’s column in the Davis Enterprise.
Without a lot of the work of Mr. Rifkin, the issue of employee compensation would be something just a few people on the council would know anything about. So, I do not want to go too far in criticizing Mr. Rifkin. But what Mr. Rifkin is guilty of is going too far to show that he has an open mind and that he is willing to change his views based on new data and information. That’s an admirable trait, but one must always be cognizant of drawing too broad a conclusion from a limited inquiry and small sets of data.
The question Mr. Rifkin asks is if it is necessary for the fire department to show up with two engines followed by the EMR ambulance every time someone calls for a medical emergency.
Writes Mr. Rifkin, “In February of 2008, I wrote a column critical of the city’s emergency medical response policy. ‘What confounds me,’ I wrote, ‘is why it’s necessary to always have so much overkill? Why does a person suffering chest pains need one ambulance and its crew plus an entire company of firefighters and all of the fire trucks and gear? Couldn’t an ambulance do that job by itself?'”
“Then a month ago, I learned that the city keeps records which show exactly when an ambulance is dispatched, when a fire truck is dispatched and when each arrives. That, I was sure, would prove that we didn’t need to send out the fire trucks so often,” he continues. “But I was wrong.”
“The records sample I requested were from July 2010. There were 283 medical calls that month. For the first 15 days of July, I noted the call time, the DFD company which was dispatched, the arrival of AMR, the arrival of DFD, who was on scene first and the neighborhood of each call,” he writes. “I stopped making notes at half a month because I was exhausted and the pattern was obvious: 72 percent of the time, the Davis Fire Department arrives first; the other 28 percent it’s AMR.”
He goes further to say, “The fire trucks not only arrive first, they arrive three or more minutes before the ambulance on 28 percent of all calls. Three extra minutes is huge if someone has had a heart attack or a stroke. The ambulance never beat the fire trucks on scene by a significant amount of time,” he summarizes.
He then issues his conclusion from half a month of data he randomly selected: “The July numbers disprove the notion that the fire trucks are chasing ambulances. We need firefighters on scene to care for patients at least until the ambulance arrives,” he writes and then concludes, “Unless we have more ambulances stationed in Davis – there are supposed to be two, but a single ambulance responds almost every time – we have no choice but to keep sending out the fire trucks. Lives depend on the DFD’s speedy response time.”
The problem here is that he has not done much of an analysis. He simply notes an observation and draws a very broad conclusion from a very limited set of data.
Several people wrote to me yesterday about their surprise with Mr. Rifkin’s column and what they saw as an overly-broad conclusion.
In my view there are several steps that Mr. Rifkin never took in this inquiry.
The first question is really about the data he is looking at. He finds that ambulances 72% of the time arrive after the firefighters. And 28% of the time they arrive three or more minutes after the fire trucks. But he never bothers to try to find out if that is not in fact by design. He simply assumes from limited data that the ambulance arrives late by some systemic factor without exploring what that factor might be.
One alternative hypothesis for that is that the ambulance arrives after the fire truck because they are not, in fact, first responders to the accident or injury scene. They do need to show up first because the paramedics in the fire station are trained to be the ones that respond and treat the individuals on the scene, and that the role of the ambulance personnel is not to treat injuries, it is to transport the victims/patienst to the hospital after their condition is stabilized by the firefighters.
That is a big unexplored question in Mr. Rifkin’s column. He assumes that the fire trucks arrive first because somehow they are inherently faster or better located than ambulances. And in part, that may be due to the different functions each perform.
A second point that Mr. Rifkin uncharacteristically leaves unexplored is the core assumption of his test, that we necessarily need three units to respond to each emergency. His test only looks at time of arrival, i.e. speed of the response. It does not look at the weight of the response and the need for four individuals in two vehicles to show up to each scene, along with an ambulance.
Given the fact that the vast majority of calls for service for the fire department are medical, not fires, why do we need to send all personnel on every call? The fire department will tell you that the reason they need it is for simultaneous calls and to make sure that they have all equipment on the scene, in case of the need to respond to a fire after an injury. However, that is a high degree of waste for a minority of responses, and it seems possible that they could produce some alternative to be able to deploy and rendezvous a four-person team to a fire, even if both vehicles do not start out at the same location or if they have to mix and match to deploy from one event to another.
But Mr. Rifkin, in his column, never explores the possibility that, even given the speed of response, we could create a different system for deployment that keeps the element of speed, but eliminates the use of too much personnel and equipment.
Firefighters will tell you there are times, even in an injury situation, that they need more than two individuals. I do not dispute or dismiss that possibility. That means there are two possible alternatives. One is that they deploy a two-person team to a basic accident scene, but can have an alternative under certain circumstances to deploy a four-person team, if needed. The other alternative is to train police officers, who also end up on the scene and often beat the firefighters to an incident, to assist in medical attention.
That is also a possible fix for the four-person entry team. We justify having four-person firefighter teams largely because of the OSHA regulations that require two persons in – two persons out when there needs to be an entry into a burning building. The problem is that the department in Davis may only have three or four such entries a year, and the rest of the time they may be overstaffed. One solution might be, in a pinch, before the next unit arrives, to have a trained police officer serve as the fourth person.
Many cities are now going to multi-use emergency services where police and fire services are actually interchangeable, and the individuals shift between law enforcement and firefighting duties.
The bottom line with all of this is that Mr. Rifkin seems willing to discard his hypothesis far too soon, based on a very small amount of data and a very broad reading of that data.
A more thorough analysis may show there are alternatives that are cheaper and more efficient that still deliver a good, speedy, and quality emergency medical response to Davis residents.
—David M. Greenwald reporting
I may be wrong but AMR is a private contractor and I believe they are contracted through the county. The fact that they arrive before or after the Fire Department arrives is therefore dependent upon where they are located when the call is dispatched. You will usually find them parked at the University mall parking lot.
“One alternative hypothesis here is that the ambulance arrives after the fire truck because they are not in fact first responders to the accident or injury scene. That they do need to show up first because the paramedics in the fire station are trained to be the ones that respond and treat the individuals on the scene and that their role is not to treat injuries it is to transport the victim/ patient to the hospital after their condition is stabilized by the firefighters.”
I think that statement is flawed. Davis Fire hires/trains EMT’s, not Paramedics. So when Davis Fire shows up at a medical emergency they are capable of EMT services which are more limited than what the AMR Paramedics can offer. Sure an EMT can save people in some situations but a Paramedic can save people in a broader range of situations. A Paramedic can open airways in ways an EMT can not and can inject life saving drugs – an EMT is not allowed to “break skin”. Getting a Paramedic to any life threatening scene first should always be the goal!
Of course Davis Fire could hire Paramedics and have at least one per truck – then there would be no issue except the cost would be greater. However, in a world where 90% of the calls are medical it makes more sense (risk/reward) to have a Paramedic on each truck (of 3 people) rather than the current EMT crews (of 4 people).
If the vast majority of calls are medical it would seem to me that if there is a problem we should invest in more paramedics and fewer firemen. The big issue here is are we getting the most bang for our buck giving so many public safety dollars to firefighters, who have a proven penchant for driving up costs (labor, pensions, # firetrucks, # people per crew, pension spiking, etc.).
The pension spiking bothers me more and more as I think about out failing state pension system–it is essentially institutionalized fraud.
Has anyone done a benefit/cost analysis looking at lives/property saved compared to what we pay?
I’ll weigh in on this conversation later today when I get some free time.
Alphonso: “I think that statement is flawed. Davis Fire hires/trains EMT’s, not Paramedics. So when Davis Fire shows up at a medical emergency they are capable of EMT services which are more limited than what the AMR Paramedics can offer. Sure an EMT can save people in some situations but a Paramedic can save people in a broader range of situations. A Paramedic can open airways in ways an EMT can not and can inject life saving drugs – an EMT is not allowed to “break skin”. Getting a Paramedic to any life threatening scene first should always be the goal!”
That is my understanding as well. Firemen are EMTs only, not Paramedics. Paramedics from AMR can perform more lifesaving tasks than EMTs from Fire Dept.
Above average journalism is not the norm for this day and age .
What Rich Rifkin did correctly, was to not listen to hearsay , he actually went and did the research where the correct information would be found .
It’s not easy to do the right thing and be truthful for previous half truths and just using hearsay as your journalistic research .
This blogs journalistic reporting is below average , heres why .
#1. Uses hearsay as facts
#2. Unwilling or unable to do the research needed to get the facts
#3. Not having the ability to write articles objectively , only the blogs version
#4. He is a social scientist , who lacks respect .
Dr. Wu ,
“””Has anyone done a benefit/cost analysis looking at lives/property saved compared to what we pay? “”””
What is the cost of a life , a mom or dad , a son or daughter , grandparents , your best friend .
When your time of need is happening , calling 911 , will you be concerned about the cost to save a life , or a house ?
Think about it before you answer .
David Greenwald wrote about Mr. Rifkin’s Davis Enterprise column: “He assumes that the fire trucks arrive first because somehow they are inherently faster or better located than ambulances.”
My question: how did Mr. Greenwald arrive at this assumption of his about what he apparently assumes was Mr. Rifkin’s assumption–which is nowhere explicitly stated in Mr. Rifkin’s column?
I would suggest Mr. Greenwald interview the fire chief, or appropriate public relations personnel with the Davis Fire Department, to get the facts.
For it’s a good question: are fire stations better positioned than the ambulances to enable their speedy response to emergencies?
But, as is, this question cannot be the basis for the assumption Mr. Greenwald makes. It’s just speculation without facts to back it up. That’s because, to reiterate, if Mr. Rifkin’s column is carefully read, he never made the assumption Mr. Greenwald assumed he made.
“What is the cost of a life , a mom or dad , a son or daughter , grandparents , your best friend . “
Avatar is trying to argue by emotion rather than reason. Either that or he/she doesn’t understand the principle of benefit/cost analysis.
When the city spends excessively on the fire department, it shortchanges alternative expenditures such as traffic safety, police, public health, sanitation etc. If your mom or dad, son or daughter, grandparents or best friend gets hit by a car that skidded due to poor road maintenance, will you be concerned Avatar that it happened because the city starved these agencies for funds?
The way to tell what the most effective place to spend money in order to save lives is called benefit/cost analysis.
“What is the cost of a life , a mom or dad , a son or daughter , grandparents , your best friend .
When your time of need is happening , calling 911 , will you be concerned about the cost to save a life , or a house ?”
If cost shouldn’t be an issue as you put it then we should have a fire and police dept. on every block. Cost is an issue unless of course you’re an overpaid fireman.
Rusty49 ,
Did you pay your house insurance for the year , did you pay your auto insurance for the year , did you pay your life insurance ?
If you paid your taxes for the year , then you insured yourself in case you need cops , firefighters , tree trimming , street work , sewer work , and so on .
Property taxes for all these services isn’t that high .
Avatar:
We make public policy decisions on life and death every day. I never said you had to use $$ (though there are many publications on how to do this and courts accept such estimates all the time).
You could look at lives saved. If by shifting resources to EMT and away from fire, if we could save more lives would you be in favor? I’m just asking. It seems to me a lot of City decisions are made with little or no data.
And yes although Rich’s data is limited it is far better than no data at all. He is doing what our well-paid staff should have done.
There’s seems to be a misperception that I am criticizing Mr. Rifkin for using data. I’m not. In fact, I applaud it as I have often used data and studies to back my conclusions and analyses.
However, Mr. Rifkin errs because he begins asking one question and then answers a question that appears to be a completely different question.
The error is saying the data answer the first answer when it does not.
Time of arrival does not answer the question of do we need all those people and equipment out at every call.
Indeed, it might well be that a stripped down Fire Dept medical response would be even faster than the current huge launching.
And this is not typical of Mr. Rifkin to miss an analysis by that much. I respect his work a lot, but to me he did not finish the story and the analysis and yet jumped in with a conclusion.
To address Avatar’s point, I would just say that we have to make choices in how we spend money. If we spent too much in one place, we end up putting our lives in danger driving on unsafe streets. So the question is not how much is a life worth but rather whether we can provide similar levels of safety for less and don’t tell me we can’t because we just now have started trying.
Hey Avatar, if it should be all about the saving of lives and not about the money then why won’t the firemen step up and work for less salary then the City could afford much more in emergency services and save more lives?
Sorry if the following is verbose. I am going to respond to most of what David wrote in his essay. This will take me a number of posts:
[i]“But what Mr. Rifkin is guilty of is going too far to show that he has an open mind and that he is willing to change his views based on new data and information. That’s an admirable trait, but one must always be cognizant of drawing too broad a conclusion from a limited inquiry and small sets of data.”[/i]
”I am an open-minded person. I think that is the opposite of being an ideologue. That’s not to say I don’t have certain values which bias my views. However, I always try to let the evidence lead me and not the other way around.”
[i]” The problem here is that he has not done much of an analysis. He simply notes an observation and draws a very broad conclusion from a very limited set of data.”[/i]
To be clear, I looked at the full month of data for July. I looked over every page of it. However, I stopped taking detailed notes after half of a month, because 1) I was tired and 2) I could see in the second half data that the same pattern was there.
As such, I drew my conclusions based on roughly 250 some odd 911 calls. (I excluded those in which one or the other responder recorded no “on scene” time and those in which one or the other was dispatched earlier or later.) You might think that 250 calls is insufficient. I don’t think it is. I’m willing to bet that if you compare the July 2010 data with that of August 2010, you would find the same trends.
[i]” He finds that ambulances 72% of the time arrive after the firefighters. And 28% of the time they arrive three or more minutes after the fire trucks. But he never bothers to try to find out if that is not in fact by design.”[/i]
This is a vacuous criticism, because I understand from the outset the essential design of our system. That is, I realize we have 3 fire houses in Davis, roughly dividing the city in thirds—west, central and south; and I realize we have (or are supposed to have) 2 ambulance crews, each taking half of the city*. That is the systemic design. I also was sure to not count any calls in which one party was dispatched earlier or later.
*I did not track carefully the actual ambulance which took the call: Ambulance 1 or Ambulance 2. However, I mentally noted that it was almost always Ambulance 1 and never 2. That makes me think we don’t always (or even often) have 2 ambulances in town. My understanding of the county system is that AMR repositions our ambulances toward Woodland or toward West Sacto when those cities have a heavy volume of calls.
[i]” He simply assumes from limited data that the ambulance arrives late by some systemic factor without exploring what that factor might be.”[/i]
I never explicitly explained what that factor is. However, I think (now) it is pretty clear: we have (most of the time) one ambulance running all over Davis and we have 3 firehouses each taking its third or so of town. As such, if the ambulance is not far out of position, it can make it to a call roughly the same time as a fire crew can. But in about one-fourth of all cases, the ambulance is either busy or starts from very far away. I tried to show that with my Village Homes call example in my column.
[i]”One alternative hypothesis for that is that the ambulance arrives after the fire truck because they are not in fact first responders to the accident or injury scene, that they do need to show up first because the paramedics in the fire station are trained to be the ones that respond and treat the individuals on the scene and that their role is not to treat injuries it is to transport the victim/ patient to the hospital after their condition is stabilized by the firefighters.”[/i]
There are a couple of mistakes in this “hypothesis.” First, you ignore the fact that the dispatch times for each are the same. So the question of how long it takes each to get there is a matter of positioning in Davis—that is, distance from where each starts and where the emergency is. And second, the paramedics are not in the fire station. Unless I have been misled in this regard, my understanding is that all of our firefighters are EMTs, not paramedics. (Maybe one or two also have paramedic training, but it is not a requirement of the job.)
Third, the conclusion to this “hypothesis” (which you use to try to say I did not consider it) is in fact my conclusion. I say in my piece, the firefighters need to be on scene until the ambulance arrives. That would not be the case (in most instances) if the ambulance got there first. But, as the evidence shows, the fire trucks get their first most of the time, and often times much, much sooner.
[i]”That is a big unexplored question in Mr. Rifkin’s column.”[/i]
Let me state one kind of obvious point this critique ignores: I write a column. Most columns are 750 words. I usually push that up to 800 or 850. In this one I was close to 900. Thus, as a columnist (and not an on-line writer who has no space limitations) my goal is to get in as many facts as possible and still be brief and interesting. I think I succeeded in that in this column.
[i]”He assumes that the fire trucks arrive first because somehow they are inherently faster or better located than ambulances. And in part that may be due to the different functions each performs.”[/i]
Take a step back: before I searched the data, I assumed just the opposite: that ambulances arrived first. I was told that by an AMR driver; and he further told me that they arrive first “90 percent of the time” because when a call comes in, they take off immediately, while the fire crews have to put on their gear and that takes them a few minutes before they can leave. So discovering that the fire trucks arrive first (more often) was in fact news to me.
Now the question is why the fire crews arrive first (more often): I suspect it is because of where they are positioned and the fact that we (likely) have one ambulance in Davis (most of the time) in contrast with three fire houses.
As to their functions, that is a (partly) byproduct of their arrival. That is, fire helps the patient until the ambulance arrives. Because the ambulance contains a paramedic, if advanced medical training is required, the paramedic can do everything and more the EMTs can do.
A question I did not explore – keep in mind, I am writing a column, not a treatise – is what value the fire trucks have in those cases where they essentially arrive at the same time as the ambulances. In those cases, they are not adding value, unless the patient requires more than two people to move him or there are many people requiring medical assistance at the same time.
I continue to believe that is a question worth exploring for policy purposes: that is, should we have a dispatch system in which the dispatcher knows exactly where the ambulance is – the police dispatchers don’t know this now – and based on that knowledge determines 1) that the ambulance alone can handle the call and 2) that the ambulance is as close as the nearest fire house and therefore will arrive no later than the fire crew. In those cases, I continue to favour just sending the ambulance. However, I didn’t have time to get into this issue; and until the ambulances are directly controlled by the police dispatchers we cannot have this kind of a change. (Note that AMR has its own dispatchers who relay the police dispatch, though that is done instantaneously.)
[i]”A second point that Mr. Rifkin uncharacteristically leaves unexplored is the core assumption of his test, that we necessarily need three units to respond to each emergency. His test only looks at time of arrival, i.e. speed of the response. It does not look at the weight of the response and the need for four individuals in two vehicles to show up to each scene along with an ambulance.
Given the fact that the vast majority of calls for service for the fire department are medical, not fires, why do we need to send all personnel every call?”[/i]
I think you answered your question—it is speed of arrival. That is the crucial factor in medical emergencies.
[i]”The fire department will tell you that the reason they need it is for simultaneous calls and to make sure that they have all equipment on the scene in case of the need to respond to a fire after an injury.”[/i]
That is what Chief Conroy told me. However, what she did not say was that they tend to get their first. She might not have known. However, that is the crucial difference in the system in Davis.
Keep this in mind: our ambulance system in Davis is part of a multi-county JPA ([url] http://www.ssvems.com/%5B/url%5D). The state of California has by law put counties in charge of ambulance service (so all rural areas end up with coverage); and Yolo County has agreed to a contract with AMR along with nine other counties in northern California. As such, we in Davis cannot change how the ambulance service works here. What we must do is devise a fire-medical response system to fit in with that ambulance service.
When I believed that ambulances got to calls first and fire crews were merely onlookers, I thought it made sense to stop sending them to most calls. But now that I know my assumption was wrong, I cannot see a different system (in the main) for augmenting what ambulance coverage we get from AMR.
[i]”The problem is that the department in Davis may only have three or four such entries a year and the rest of the time they may be overstaffed. One solution might be in a pinch before the next unit arrives, to have a trained police officer serve as the fourth person.”[/i]
I think you are getting far afield with this. I don’t see how having 3-man fire crews (which I have advocated longer than anyone else in Davis has, by the way) is a criticism of my piece or challenges the notion that, due to their faster arrival times, changes the conclusion that we need to dispatch fire crews to medical calls.
I do note at the end of my piece that if we had more ambulances here we could change the system. But we don’t have more ambulances.
[i]”Many cities are now going to multi-use emergency services where police and fire services are actually interchangeable and the individuals shift between law enforcement and firefighting duties.”[/i]
I’m open to learning more about that. I know in the city of Marina, CA (next to Fort Ord/CSU Monterey Bay) the cops are also the firefighters and vice versa. But once again, this is not the question at hand in my column.
[i]”The bottom line with all of this is that Mr. Rifkin seems willing to discard his hypothesis far too soon based on a very small amount of data and a very broad reading of that data.”[/i]
It’s funny that you started out explaining that you are a “social scientist” and therefore you have some sort of authority to criticize my sampling of the numbers. Yet in this very long essay you never did that. Maybe I did use too small of a sample size. You should explain (based on your authority) what the right size of my data base should have been. You should further hypothesize that you think the sample I picked was likely not random enough—if that is what you believe—and thus if you chose a much larger data set you would have found that the fire crews don’t arrive first in the approximate percentages I found they do.
That is, if you believe that about my sampling. If on the other hand you think my sampling was sufficient, then say that and drop the business about your expertise as a social scientist, albeit one who never finished his degree.
[i]”A more thorough analysis may show there are alternatives that are cheaper and more efficient that still deliver a good, speedy, and quality emergency medical response to Davis residents.”[/i]
That goes beyond what my quest was. I wanted to see if the ambulances or fire crews arrived first on scene a disproportionate amount of the time and by a significant amount of minutes. What I found was the opposite of my presumption going in.
Given the state laws which govern county control of ambulance service and given the actual ambulance service we have in Davis, my conclusion that we need to keep sending out the fire trucks (most of the time) is a rational conclusion.
DON SHOR: I would be grateful if you can fix my mistakes above with my URL and later the mistake with making all of my text italicized after the paragraph which begins “The bottom line …” Thanks.
P.S. Once you do that, just erase this post.
I don’t know. Maybe the solution is to have enough firemen to put out the fires we have in Davis (very few) and enough ambulances on duty to take care of medical emergencies (perhaps a few more than we have at present.) All things considered, I suspect it would save the city a lot of money and provide appropriate emergency services in a more timely manner. Just a thought.
Before reading the comments, I’d like to say that it isn’t Rich’s logic that’s flawed it’s yours.
First, Davis and UCD firefighters are not paramedics they are EMT Basics. essentially that means that they are limited to simple interventions such as applying oxygen, splints, and bandages while a paramedic can start an IV, insert a breathing tube, and administer a myriad of medications in the field among other things. Therefore the role of the FD on a medical scene is to ‘hold the fort’ until the paramedic arrives and assist the paramedic as needed once they do.
A good example of this is a full on heart attack. The FD usually arrives with a crew of 3-5 first and begins basic life support measures – CPR, Oxygen, and AED. On the ambulance’s arrival, the paramedic begins advanced procedures such as IV, breathing tube, and cardiac medications as well as applying a cardiac monitor. on a real code it takes at least 4 people to do a good job. An ambulance has two people. Therefore the FD responds.
I can say from experience that the fire department does beat AMR the majority of the time. As rich said, once in a while that is the difference between a positive outcome and one that’s not so good.
Could a majority of Davis medical calls be handled by only an ambulance? Probably but if it was your child seizing on the floor would you really want to wait an extra minute or two for help?
The dual role fire-police idea is not a new one Sunnyvale, CA has had it for nearly 30 years now. The problem with it (and why so few municipalities use it) is the old phrase ‘jack of all trades and master of none.” The FD and PD both respond to emergency but their roles at a scene are so very different that maintaining competency in all aspects is very difficult.
What would be a good idea for a new system? Fire based EMS. Get rid of AMR, and create tow or three Davis Fire Department paramedic ambulances staffed with two firefighter/paramedics. This isn’t a new idea either. Sacramento, Palo Alto, Vacaville, Los Angeles City, and a great many other areas of California have used this system for years. It has the advantages of being not for profit (unlike AMR), eliminating the whole overhead of a private ambulance, responding a Paramedic from the fire station (therefore advanced care arrives sooner), placing the paramedics under the control of the city, and utilizing the city’s firefighters better as both firefighters and paramedics.
[quote]First, Davis and UCD firefighters are not paramedics they are EMT Basics. essentially that means that they are limited to simple interventions such as applying oxygen, splints, and bandages while a paramedic can start an IV, insert a breathing tube, and administer a myriad of medications in the field among other things. Therefore the role of the FD on a medical scene is to ‘hold the fort’ until the paramedic arrives and assist the paramedic as needed once they do. [/quote]
This being the case, the current system makes even less sense than it did before. Why is 90% of our fire service being used for basics in an intervention system? Why not hire full time paramedics who are mobile and able to respond quicker and leave the firefighters to fight fires?
And as an added benefit, with ambulances in the fire stations, it would be logical to reduce an engine crew from 4 to 3 because with the ambulance crew of two the total becomes 5. Now the reason you wouldn’t want to reduce the engine crew to 2 or 1 is… What happens if the ambulance is busy transporting someone? A 3 person crew is the absolute minimum for effective fireground operations.
to David – you’re right it doesn’t make sense. That’s why most full time departments in CA are going to the paramedic level. The main group trying to stop this is AMR. Why? the contract to provide ambulance service is BIG $$$. Paramedics in Davis, particularly on ambulances, would cut significantly into their profit margin. As evidence of the fight AMR puts up, google ‘Stockton fire paramedic’ and read what you find. AMR just managed to shut down Stockton fire’s paramedic service. They had been employing firefighter paramedics since 1978 – a pioneer.
[i]”Why not hire full time paramedics who are mobile and able to respond quicker and leave the firefighters to fight fires?”[/i]
This logic fits with my conclusion: [quote] “Unless we have more ambulances stationed in Davis – there are supposed to be two, but a single ambulance responds almost every time – we have no choice but to keep sending out the fire trucks.”[/quote] But if we in Davis* “add ambulances,” we won’t see any savings elsewhere ceteris paribus.
I realize that you favor (as I do) going back to 3-man fire crews. And you might say, “We could pay for the extra ambulances with the savings we make on the reduced fire crews.”
But that is likely** not a “holding all else equal” argument. Further, it does not change the fact that adding ambulances is likely** a dead-weight cost. In other words, adding ambulances to replace the firefighters does not change the number of firefighters we need to have on hand to provide fire and hazmat protection.
*I suspect that the county contract with AMR (by way of the JPA) prohibits us from doing this unilaterally. That is, the county probably would have to agree to this and then get it into the next JPA contract.
**I qualify my statement with likely because I can see one argument which results in a different sort of change with regard to the cost of the fire department. If we ended the role of the firefighters as primary emergency medical responders, then we might be able to say: “The firefighters don’t do very much; therefore the firefighters only should get half the current total compensation they are gettng per man.”
One thing I tend to believe about our local fire union is that they try to inflate their activities in order to sell to the council and to the community how valuable they are. The change you suggest here would help to alter that busyness claim.
Yet, perhaps I am too skeptical, but I doubt our city council would say, “Gee. These firefighters are now only responding to 20% as many 911 calls as they used to be; we need to cut their pay.” Rather, based on the track record of the city council, their conclusion would be, “We’d better get those boys some better quality TV sets in the firehouses, so they don’t get too bored.”
After they finish watching TV our City Council can promote our firefighters and give them huge pensions–then hire a consultant to state that they are actually saving us money.
Rich: As a follow up it would be interesting to know how a typical firefighter spends his/her week–how many hours responding; how many hours doing other things. In this type of job its inherent that some waiting is necessary, but I get the impression that the firefighters have milked their public safety role as far as they can.
[quote]“We could pay for the extra ambulances with the savings we make on the reduced fire crews.”
[/quote] Not only that but the money that WAS going to AMR now goes to the fire department. I know of cases where the ambulance more than pays for its self through transport billing. (Vacaville comes to mind)
Rusty49
“””” then why won’t the firemen step up and work for less salary then the City could afford much more in emergency services and save more lives? “””””
You probably missed the article in the Enterprise because you were looking for hearsay on this blog !
They were the first city group to take a pay cut , 6 % .
rich rifkin: “Keep this in mind: our ambulance system in Davis is part of [url= ]http://www.ssvems.com/] a multi-county JPA. The state of California has by law put counties in charge of ambulance service (so all rural areas end up with coverage); and Yolo County has agreed to a contract with AMR along with nine other counties in northern California. As such, we in Davis cannot change how the ambulance service works here. What we must do is devise a fire-medical response system to fit in with that ambulance service.
When I believed that ambulances got to calls first and fire crews were merely onlookers, I thought it made sense to stop sending them to most calls. But now that I know my assumption was wrong, I cannot see a different system (in the main) for augmenting what ambulance coverage we get from AMR.”
This explains why more ambulance service is probably impractical as a solution. My daughter was involved in a situation in which she saved someone’s life using CPR (and she was given an award for it) on one of the UCD athletic fields. My daughter told me she was never so glad as when she saw the Fire Dept arrive – they were the first on the scene (in this case UCD Fire Dept). The guy she was trying to save had gone into cardiac arrest after being hit in the chest with a soccer ball, and was having agonal breathing (was in his death throes) when the Fire Dept arrived, despite her desperate efforts to save him. Mere seconds made all the difference in his survival.
For some reason, part of Rich Rifkin’s quote was cut off, so let me try this again:
rich rifkin: “Keep this in mind: our ambulance system in Davis is part of …a multi-county JPA. The state of California has by law put counties in charge of ambulance service (so all rural areas end up with coverage); and Yolo County has agreed to a contract with AMR along with nine other counties in northern California. As such, we in Davis cannot change how the ambulance service works here. What we must do is devise a fire-medical response system to fit in with that ambulance service.
When I believed that ambulances got to calls first and fire crews were merely onlookers, I thought it made sense to stop sending them to most calls. But now that I know my assumption was wrong, I cannot see a different system (in the main) for augmenting what ambulance coverage we get from AMR.”
This explains why more ambulance service is probably impractical as a solution. My daughter was involved in a situation in which she saved someone’s life using CPR (and she was given an award for it) on one of the UCD athletic fields. My daughter told me she was never so glad as when she saw the Fire Dept arrive – they were the first on the scene (in this case UCD Fire Dept). The guy she was trying to save had gone into cardiac arrest after being hit in the chest with a soccer ball, and was having agonal breathing (was in his death throes) when the Fire Dept arrived, despite her desperate efforts to save him. Mere seconds made all the difference in his survival.