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EMS and the Fire Service: The Impact on the PGFD
I first posted this on another topic but felt it would be selfstanding and worth a discussion of its own.
The impact on the fire service, especially the volunteer fire service has been drastically impacted in the negative from transport EMS services. I use my past experiences in the Prince George's County, MD Fire Department as the example. The backgound, impact and a feasible solution are below:
To begin with - the PG County VOLUNTEER Fire Department is a goldmine for all firefighters. Where else can someone, as I did, volunteer in a metropolitan area that matches some of the biggest cities in the country in call volume, population and other comparable aspects? No where! I would not be where I am right now if it were not for the experiences gained as a live-in member of Company 29, Silver Hill VFD.
Diverse opinions have been posted here in the past couple of days on the subjects of impact to the PGFD. Please bare with the length of my email as I explain the background of the department, the problems it faces and the solutions anyone would arrive at looking from the outside in.
First of all, the bare bones background on the PGFD.
PG County surrounds DC on the south/southeast comprising approximately 1/2 to 2/3 of the Maryland/DC border. It is a county with a 60 + percent minority population of over 850,000. It runs over 160,000 incidents per year. It is made up of urban, suburban and rural areas with the majority of population and urban areas surrounding the district. This includes dense business/industrial and residential areas that are indiscriminatable to corresponding areas in the district.
Staffing is comprised of a combination career/volunteer base of over 47 stations spread throughout the county, with the most being located within the Capital Beltway (I-495) and the busiest from the central portion of the county south. The busiest companies run about 6,000 engine calls, 1,200 truck, 4000 ambulance and 3000 squad calls per year.
As with suppression services, EMS is provided through both combination staffing, as well as strictly volunteer / strictly career personnel. All ALS is provided by county staffing in the form of about 8 (correct me if I'm wrong) medic units. All but 4 stations have ambulances, some having "Rescue" units which are 100% career staffed ambulances. The remaining stations either staff ambulances by all volunteers or a combination career / volunteer makeup.
Although the PGFD is a combination department, by numbers, it is a VOLUNTEER DEPARTMENT, SUPPLIMENTED BY CAREER STAFFING. This is true in the fact that career staffing, with the exception of about 15-20 stations is between the hours of 0700 and 1500. This staffing though isn't required to meet minimum manning requirements until 0900 technically (before the company is placed out of service if no one can be detailed to fill the vacancy). Therefore, the county FD is only required to maintain staffing between 0900 and 1500 M-F. This includes chief officers (Battalion Chiefs) as well. (As a side note, volunteers and career personnel are held to the same standards for training and certification, establishing the basis for a seamless command structure where a Lt = Lt and a Capt = Capt, and so forth).
From 1500 to 0700 the county is probably staffed with greater than 75% volunteers. This is when the majority of fires occur incidentally as well. It is true that units are routinely understaffed from many stations but I must go back to spbrooks' post to expand on why it is this way and the impact.
THE STAFFING ISSUE (and EMS ISSUE – one and the same)
First of all spbrooks hit the nail on the head. The PG County fire department has made a couple of drastic miscalculations, which to anyone looking in from the outside would agree, has created the current problem of understaffing, as well as future issues which will arise. These miscalculations surround EMS and where career staffing is dedicated.
EMS in PG County
The county maintained a HUGE volunteer base for up until the mid to late 1990s. This was capable for a number of reasons, the largest relating to EMS, and specifically transport services. The county has, especially in the last few years, put undue pressure on the volunteers and their respective companies to provide EMS transport services. The problem regarding this push is that as I have explained, the county is made up of a dense, comparatively (to other US counties) depressed socio-economic population. As anyone who is familiar with other EMS systems in similar areas of the country could attest – EMS transport services are a glorified taxi service to the highest degree. I would wager to say that approximately 70% or more of EMS incidents, including ALS dispatched incidents are not life-threatening emergencies requiring EMS care. The citizens use, and abuse this public service. And therefore, use and abuse the providers of the service.
The citizens do pay taxes for these services and therefore should be provided them (I am leaving my own thoughts here unwritten). The firefighters though, those who VOLUNTEER their time, DONATING it to the county ***do not live in the stations, or spend time in the stations to be abused, nor for the majority of them, provide EMS/Taxicab service in general. They VOLUNTEER to provide fire suppression, rescue and their inherent first response to *serious* emergency medical services!***
This has over the years reduced the volunteer base significantly. The main reason: Why would you, as a firefighter who wants to volunteer performing fire suppression, rescue and as I differentiated, *serious* EMS care want to be stuck on a big taxi cab filling out hours of paperwork per BS run? Not me, and I would wager, not you. So the volunteers left because they got BURNED OUT.
THE MISCALCULATION
The county fire department though continues to insists upon requiring those individuals to provide this transport service although they hire compensated staffing. This paid staffing should be directed to positions which would reduce the negative impact on volunteer FIREFIGHTERs, allowing them to do what they are willing to do for free. If the county was to take on what spbrooks recommended, SYSTEM STATUS MANAGEMENT, many of the current issues would be mitigated or resolved. For those of you who are unfamiliar with the term system status management, it is basically a dynamic demand based EMS system placing dedicated (paid) staffed units where they are most needed. This could be both from firehouses as well as key locations throughout the county.
By doing so, the HUGE, unrealistic and devastating burden of EMS transport would be lifted from the volunteer base bringing back many of the volunteer who left from EMS BURN OUT and keeping others who would have left given the current practice.
SOLUTION:
Take the paid fire department staffing and place them on ambulances to allow the volunteers, those who are not compensated, and do not want to be unduly stuck on an ambulance, the ability to ride firetrucks. By taking two paid firefighters per unit and placing dedicated ambulances on the street, the suppression positions they would normally be placed in would be more than made up by keeping, bringing back and basically shoring the volunteer base for fire suppression. In addition, when a fire incident occurs, have the ambulance respond with the fire trucks to supplement fire ground staffing (great for 2-in, 2-out – train them to be the RIC team then those firefighters on the responding units can concentrate on suppression directed activities).
In doing so you will experience a significantly improved EMS system (more units and faster response), improved suppression staffing (fewer to no understaffed fire trucks) and better moral overall (compensated individuals do the work the volunteers don’t want to, but get a pay check in return and the volunteers get to spend their DONATED time doing what they came to do). This would SAVE COUNTY TAXPAYERs money because their would be higher volunteer staffing and improved services.
Does it make sense? Why won’t the county leadership listen – or the fire department decide they should do what is in the best interest of the county and not Local 1619 of the IAFF?
I left PG, and have gone on to other things but my heart is still there and I wish young firefighters in 10 years will still get the opportunity I had.
: 1) EMS incidents were still realitively low - the Taxi attitude hadn't taken own a life of its own quite yet. This insured that the firefighters who lived in, or volunteered at the stations could spend their DONATED time doing what they came to do - ride firetrucks, not transport sick people to the hospital that could have driven themselves or called a cab and; 2) Non-profit casino gaming was still in existence.
The impact on the fire service, especially the volunteer fire service has been drastically impacted in the negative from transport EMS services. I use my past experiences in the Prince George's County, MD Fire Department as the example. The backgound, impact and a feasible solution are below:
To begin with - the PG County VOLUNTEER Fire Department is a goldmine for all firefighters. Where else can someone, as I did, volunteer in a metropolitan area that matches some of the biggest cities in the country in call volume, population and other comparable aspects? No where! I would not be where I am right now if it were not for the experiences gained as a live-in member of Company 29, Silver Hill VFD.
Diverse opinions have been posted here in the past couple of days on the subjects of impact to the PGFD. Please bare with the length of my email as I explain the background of the department, the problems it faces and the solutions anyone would arrive at looking from the outside in.
First of all, the bare bones background on the PGFD.
PG County surrounds DC on the south/southeast comprising approximately 1/2 to 2/3 of the Maryland/DC border. It is a county with a 60 + percent minority population of over 850,000. It runs over 160,000 incidents per year. It is made up of urban, suburban and rural areas with the majority of population and urban areas surrounding the district. This includes dense business/industrial and residential areas that are indiscriminatable to corresponding areas in the district.
Staffing is comprised of a combination career/volunteer base of over 47 stations spread throughout the county, with the most being located within the Capital Beltway (I-495) and the busiest from the central portion of the county south. The busiest companies run about 6,000 engine calls, 1,200 truck, 4000 ambulance and 3000 squad calls per year.
As with suppression services, EMS is provided through both combination staffing, as well as strictly volunteer / strictly career personnel. All ALS is provided by county staffing in the form of about 8 (correct me if I'm wrong) medic units. All but 4 stations have ambulances, some having "Rescue" units which are 100% career staffed ambulances. The remaining stations either staff ambulances by all volunteers or a combination career / volunteer makeup.
Although the PGFD is a combination department, by numbers, it is a VOLUNTEER DEPARTMENT, SUPPLIMENTED BY CAREER STAFFING. This is true in the fact that career staffing, with the exception of about 15-20 stations is between the hours of 0700 and 1500. This staffing though isn't required to meet minimum manning requirements until 0900 technically (before the company is placed out of service if no one can be detailed to fill the vacancy). Therefore, the county FD is only required to maintain staffing between 0900 and 1500 M-F. This includes chief officers (Battalion Chiefs) as well. (As a side note, volunteers and career personnel are held to the same standards for training and certification, establishing the basis for a seamless command structure where a Lt = Lt and a Capt = Capt, and so forth).
From 1500 to 0700 the county is probably staffed with greater than 75% volunteers. This is when the majority of fires occur incidentally as well. It is true that units are routinely understaffed from many stations but I must go back to spbrooks' post to expand on why it is this way and the impact.
THE STAFFING ISSUE (and EMS ISSUE – one and the same)
First of all spbrooks hit the nail on the head. The PG County fire department has made a couple of drastic miscalculations, which to anyone looking in from the outside would agree, has created the current problem of understaffing, as well as future issues which will arise. These miscalculations surround EMS and where career staffing is dedicated.
EMS in PG County
The county maintained a HUGE volunteer base for up until the mid to late 1990s. This was capable for a number of reasons, the largest relating to EMS, and specifically transport services. The county has, especially in the last few years, put undue pressure on the volunteers and their respective companies to provide EMS transport services. The problem regarding this push is that as I have explained, the county is made up of a dense, comparatively (to other US counties) depressed socio-economic population. As anyone who is familiar with other EMS systems in similar areas of the country could attest – EMS transport services are a glorified taxi service to the highest degree. I would wager to say that approximately 70% or more of EMS incidents, including ALS dispatched incidents are not life-threatening emergencies requiring EMS care. The citizens use, and abuse this public service. And therefore, use and abuse the providers of the service.
The citizens do pay taxes for these services and therefore should be provided them (I am leaving my own thoughts here unwritten). The firefighters though, those who VOLUNTEER their time, DONATING it to the county ***do not live in the stations, or spend time in the stations to be abused, nor for the majority of them, provide EMS/Taxicab service in general. They VOLUNTEER to provide fire suppression, rescue and their inherent first response to *serious* emergency medical services!***
This has over the years reduced the volunteer base significantly. The main reason: Why would you, as a firefighter who wants to volunteer performing fire suppression, rescue and as I differentiated, *serious* EMS care want to be stuck on a big taxi cab filling out hours of paperwork per BS run? Not me, and I would wager, not you. So the volunteers left because they got BURNED OUT.
THE MISCALCULATION
The county fire department though continues to insists upon requiring those individuals to provide this transport service although they hire compensated staffing. This paid staffing should be directed to positions which would reduce the negative impact on volunteer FIREFIGHTERs, allowing them to do what they are willing to do for free. If the county was to take on what spbrooks recommended, SYSTEM STATUS MANAGEMENT, many of the current issues would be mitigated or resolved. For those of you who are unfamiliar with the term system status management, it is basically a dynamic demand based EMS system placing dedicated (paid) staffed units where they are most needed. This could be both from firehouses as well as key locations throughout the county.
By doing so, the HUGE, unrealistic and devastating burden of EMS transport would be lifted from the volunteer base bringing back many of the volunteer who left from EMS BURN OUT and keeping others who would have left given the current practice.
SOLUTION:
Take the paid fire department staffing and place them on ambulances to allow the volunteers, those who are not compensated, and do not want to be unduly stuck on an ambulance, the ability to ride firetrucks. By taking two paid firefighters per unit and placing dedicated ambulances on the street, the suppression positions they would normally be placed in would be more than made up by keeping, bringing back and basically shoring the volunteer base for fire suppression. In addition, when a fire incident occurs, have the ambulance respond with the fire trucks to supplement fire ground staffing (great for 2-in, 2-out – train them to be the RIC team then those firefighters on the responding units can concentrate on suppression directed activities).
In doing so you will experience a significantly improved EMS system (more units and faster response), improved suppression staffing (fewer to no understaffed fire trucks) and better moral overall (compensated individuals do the work the volunteers don’t want to, but get a pay check in return and the volunteers get to spend their DONATED time doing what they came to do). This would SAVE COUNTY TAXPAYERs money because their would be higher volunteer staffing and improved services.
Does it make sense? Why won’t the county leadership listen – or the fire department decide they should do what is in the best interest of the county and not Local 1619 of the IAFF?
I left PG, and have gone on to other things but my heart is still there and I wish young firefighters in 10 years will still get the opportunity I had.
: 1) EMS incidents were still realitively low - the Taxi attitude hadn't taken own a life of its own quite yet. This insured that the firefighters who lived in, or volunteered at the stations could spend their DONATED time doing what they came to do - ride firetrucks, not transport sick people to the hospital that could have driven themselves or called a cab and; 2) Non-profit casino gaming was still in existence.
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