Firehouse: Las Vegas Fire & Rescue recently went through the accreditation process for the second time, and has been reaccredited by the Commission on Fire Accreditation International (CFAI). What does that mean for the department?
Myers: It’s a learning process every time. Going through the accreditation process, if taken seriously, will help your organization drive better performance and ultimately become more efficient. We were placed on deferred status at the close of 2010 and had a great deal of work to do if we wanted the accreditation back. Accreditation is about demonstrating your organization’s efficiencies and performance. It’s about demonstrating that your organization is serious about excellence and has programs in place to assure excellence and keep you there.
Firehouse: You are only one of a select few departments rated Class 1 by ISO. How do you keep up that rating?
Myers: This hasn’t been easy. First, maintaining an ISO Class 1 rating has to be a priority with the city and it is here in Las Vegas. The executive staff must be educated on the process and it helps to have a planning team in place year-round. Our executive staff, along with an analyst, our CFO (chief financial officer) and several fire officer-level personnel, serves as the team for Las Vegas Fire & Rescue. We know how many points we receive for every item we stock and for every location we have a resource housed. Data and records management must be very organized. I would argue that every department needs a good analyst directly assigned to the executive team to manage both ISO and accreditation programs.
Firehouse: What specific goals have you set for the department and how do you stay on top of them?
Myers: We just finished updating our strategic plan for next fiscal year, which lists about 100 goals for us to meet next year. Some of the more significant goals we forwarded to the city manager are:
• Operationally – Decrease call processing times; decrease out-of-barn times; 80% of residential fires confined to the room of origin; 30% of all witnessed cardiac arrest victims to walk out of the hospital neurologically intact; and reduce fire deaths (we had one fire death in 2011).
• Administratively – Decrease on-the-job injury rates; decrease preventable vehicle accidents; decrease employee sick-leave use; decrease overtime costs; and increase the revenue recovery for EMS transports.
Las Vegas Fire & Rescue utilizes a performance-based management process focused on high performance in the critical areas of our business. Every area of our business is broken down and key performance measures are developed to help managers monitor the efficiency and output of the operation. Dispatchers, firefighters, company officers, inspectors, protection engineers, mechanics and inventory control staff are all included in managing the performance goals for their area. We report these monthly in a general staff meeting and quarterly to the city management team.
Firehouse: How do you get feedback from the members assigned to the various units in the field, communications and shops and keep the lines of communication open?
Myers: Organizational-wide communication is always difficult and is one of the more difficult tasks facing any executive staff. Obviously, it starts with a well-thought-out organizational command structure that balances supervisor span of control. Next, the organization, from the top down, must build an environment of creativity and innovation that is department wide and involves every team member from every pay grade.
Our philosophy is simple: No matter who you are or where you work within the organization, we believe the idea that will help us change how we do business in out there and someone will be able to present it in a manner that we understand. We need everyone thinking on how we can improve and it is more likely that a communications specialist who answers 911 calls every day for a living is more likely to have an idea on how we can improve their area of business then the executive who supervises the area.
We sit with our staff regularly. I personally visit the fire stations and sit at the table to hear what the main issues are; many times I address them with a phone call while I’m there. Communication is an active mannerism, not reactive. We seek input, ask for ideas, talk openly and passionately about topics and create the environment of communication. Successful organizations have communicators as managers and leaders who seek out input continuously.
Firehouse: Your dispatch operation ANNUALLY? sends out 350,000 calls in an 8,000-square-mile area. How do you provide such service and how does technology play into it? Has automatic aid, the computer sending the closest unit despite jurisdiction, worked well?
Myers: Technology has had an enormous impact on how we operate our communications center; however, I believe we also have the very best communications specialists as well. Together, technology and talent put us at the top of our game. Dispatch centers are hard places to manage. The specialists who work in these units work a tremendous amount of hours and handle thousands of calls and get very little feedback in return. Performance measures for call taking, dispatching and overall call processing are stringent and each specialist is responsible for their own personal performance goal. We use real-time dashboards to support this and provide state of the art communication equipment to augment our service. We even track how fast data runs along the fiber optic lines to each firehouse.
We service all of the Clark County and North Las Vegas fire departments as well as our own City of Las Vegas, which means we need a global approach to dispatching closest unit. We all work within an automatic-aid agreement with our neighbors and we have been successful with unit standardization, strategy and tactic standardization and incident command standardization. Using a computer-aided dispatch system and global positioning on our units, we are able to send the closest resource to any call regardless of jurisdictional responsibility. It is seamless and has been working well here in Las Vegas for many years.
Firehouse: What innovations has the department made to keep up with the growing demand of providing the best in EMS?
Myers: We are proud of how far Las Vegas Fire & Rescue has come with our delivery of EMS. We continue to innovate and create new ways to provide our service. One of our primary areas of focus has been on improving survival from sudden cardiac arrest. We believe strongly that combating the problem of poor cardiac arrest survival rates takes a community approach. Using the Cardiac Registry to Enhance Survival (CARES) registry as our measurement tool, we work continuously on measuring and strengthening each of the five links in the AHA (American Heart Association) Chain of Survival.
• 911 process – We took a bold step and tweaked the way we handle incoming life-threatening emergency calls. Utilizing a quick-launch call-processing procedure we were able to double the number of cardiac arrest calls in which we arrive on scene in less than four minutes. The idea and process on how we did this came directly from the 911 dispatchers themselves. They thought of the idea and were asked to create the solution and they did. It has helped us decrease total response times and save lives.
• Review of 911 calls – We took serious steps to measure, track and improve on dispatch-aided CPR rates and identify obstacles to starting dispatcher-assisted CPR.
• CPR – Using historical data from our computer-aided dispatch system and our electronic patient care reporting system we have been able to plot out where bystander CPR is being done (or not being done) and cross reference that with survival rates. Where bystander CPR is lacking we saturate the area with a community Save A Life Program that teaches compression-only CPR and AED (automated external defibrillator).
• AED – Everything starts at your home. Here in the City of Las Vegas we have been strengthening our city’s Public Access Defibrillation Program by teaching city employees compression only CPR and AED use. Additionally, all City of Las Vegas facilities have an AED on campus.
• Advanced care – We focus on high-quality, uninterrupted chest compressions; measure and feedback CPR fraction; avoidance of hyperventilation; aggressive first strike; safe transport with continuous chest compressions using the Auto-Pulse hands-off CPR device. Together with high-performance response times we are making a positive difference in people’s lives.
• Post-resuscitation care – We were the first agency in southern Nevada to provide therapeutic hypothermia; careful monitoring and care of ETCO2 (end tidal CO2, the level of carbon dioxide released at the end of expiration), temperature, blood pressure management and a healthy partnership with community hospitals.
Our cardiac arrest survival started at 5%, peaked at 48% and currently sits at 30%.
Firehouse: How have you designed new EMS units for safety and better operations?
Myers: We have an excellent medical services division and in my opinion of course, are the best in the business. Led by Deputy Chief Dr. David Slattery we put a technical specification team together to design an ambulance unit that was the safest available for both the crew and the patient. Our new rescues have numerous new safety features. These include: three strategically placed captain-style seats; every item is secured in case of an accident; eliminated head-strike areas; keeping our providers seated and restrained; placement of medical/airway equipment on both sides of the unit; controls are reachable from both sides of rescue; protected and redundant sharps containers accessible from both sides; increased visibility of our units; improved overhead lighting; yellow assist rails on the ceiling; increased emergency lighting for coverage and visibility; and Reflexite graphics on the rear of the unit.
Firehouse: How are you able to open and plan to build new fire stations with a reduced budget?
Myers: Building the fire stations are one thing; staffing and then opening is a whole other issue. We used capital money from a bond to fund the construction of three new fire stations that fill in coverage gaps within the city. Cost advantages were gained by the fact that land cost and construction service costs are currently less expensive due to the recovering economy. We capitalized on the market situation.
Staffing and opening the firehouse has been interesting. As a fire chief, you must balance strategic unit placement (operational interest), ISO and accreditation needs (administrative interest), what does the community you are serving expect to be in the fire station (community interest), what does the bargaining unit leadership expect (political interest), what was already promised years ago prior to the station construction (moral interest), current salary and benefit budget allowance (fiscal interest) and a whole host of other special considerations.
None of these interests seem to match or support one another. In the end the fire chief must do what is in the best interest to the community and financially sustainable. This may mean not giving the community exactly what they want, but making the best operational decision to support the performance goals and protect firefighter safety. After many community meetings, long talks with the labor union, evaluations from our fire suppression and EMS battalion chiefs, costing plan discussions with city leadership, we settled on a staffing plan that involved moving apparatus around to maximize their potential and start a new recruit class to help staff a new fire station with a rescue unit. We also had to change out two five-person tiller trucks with two four-person platforms to free up two additional personnel each day. This allowed us to staff another rescue for a future fire station.
Firehouse: What does adding solar panels to the fire stations do for your operation?
Myers: It is everyone’s responsibility to reduce the carbon footprint we make on our environment. The fire service is not exempt from this. Along with many other shifts in business and facility changes, the city greatly assisted us in constructing parking shade structures at each of firehouses roofed with solar panels to collect and convert energy that we use to offset the cost of our facilities. Solar energy, along with green building construction habits, central HVAC control, water usage monitors, and recycling programs, help us to do our part in helping secure a sustainable environment.
Firehouse: Have you streamlined the inspection process?
Myers: We have. This has been a very arduous process. Working with our city partners; we began by centralizing all the building and safety functions into a single building. This allows a contractor or developer to make only one stop to get all the permitting and regulation work done. We also instituted an express service for plan review. Currently, 38% of plans submitted are worked through the express service for which we charge a higher premium. We also have some of our inspectors working out of fire stations in their inspection districts. Instead of driving to headquarters each work day as in the past, they report to a fire station. This has reduced drive time expenses and allows the inspector to be in the field conducting inspections. Fire inspectors are issued computer tablets in which they receive their assignments, collect data during inspections and can upload their data real-time to the city’s computer network. That information is shared with several other city departments including Building & Safety, Business Licensing and Zoning to ensure that all properties are up to code.
Firehouse: Can you explain the advantage of the mobile shop?
Myers: The mobile shop (mechanic) has created a great deal of versatility for our apparatus maintenance program. The large majority of issues that arise with our fleet are minor in nature, but need attention. For these minor fixes we use a mobile shop housed inside a large walk-in two-ton truck. The truck looks like the support mechanic trucks used for high-end auto racing crews and is perfect for handling daily repairs. Having the mobile truck operating all day allows our crews to stay in service in their area rather than having to go out of service and travel across town to the fixed main shop site.
Firehouse: You meet every morning with your top staff. What do you cover?
Myers: We meet every morning about an hour into our day. The meeting includes our four deputies (operations, support, prevention/administration and medical services), our business analyst, the CFO, the PIO (public information officer) and our executive assistant. We go over the calendar for the week and make sure all of our schedules align and all the events are covered. We will discuss current pressing issues, make sure any approvals that need to made that day are discussed and we close out with each person covering any special circumstances they need the groups help on. This is the opportunity for the whole team to help any division leader with an issue they may be handling. Oftentimes, we come out of the meeting with small working groups having been assigned to meet that day to help brainstorm solutions to a problem we are dealing with. These daily meetings are my opportunity to keep momentum high, infuse the appropriate level of energy and set the tone of creativity and innovation that is so important for our success.
Firehouse: What does the installation of computer terminals in fire stations and the issuance of iPads do for the department?
Myers: We have had desktop computers in our fire stations for many years. We also have two Toughbook tablets on each unit (one used as the MDT and one used for patient-care reporting). The future, however, is changing and today’s firefighter is very savvy with communications devices and can multi-task much faster than past generations. We are trying to embrace this trend.
Our thought is to issue a tablet to each firefighter as their personal tablet. The tablet would be used for them to log into their department email, handle their personal electronic timecard, virtually attend all their fire and EMS training which we are pushing the bulk of the didactic to online, input all their patient-care reports and handle other department-related business. The idea is to mobilize our firefighters and create a business solution that allows them to maximize their time and energy. Of course, we would need to lock the tablet down to business use only.
The shift to mobilizing the firefighter will allow us to reduce out of service time spent going to and from the training centers for didactic presentations (this should lower fuel costs also). As fire service leaders, fewer and fewer of us can afford apparatus to be out of service at any time during the day for non-emergency-related activities. We must continually search for ways to become more efficient and utilize the growing talents of this new generation of fire fighter.
Firehouse: How important are physical fitness and wellness for the members?
Myers: There is nothing more important than the health and welfare of our members. We have invested heavily in health and safety within Las Vegas Fire & Rescue. Every fire station has its own gym with state-of-the-art equipment. We have two full-time physicians on staff (one of them is our deputy chief over medical services) and we operate a full-time medical clinic for our firefighters.
The annual physical our firefighters receive every year is a serious evaluation of their physical fitness and wellness. It is a confidential exam that includes a VO2 Max test and a physical fitness prescription. Every firefighter sits with our physician privately for a half-hour consultation after their physical is completed. This consultation is provided specifically to make sure the firefighter has access to a clinical professional that can help them with whatever it is they are going through.
Firefighters face unique problems; they see things in their line of work most humans don’t, it’s accumulative and it’s real. Drug and alcohol abuse, domestic issues, depression and confidence issues are all very real and should not be ignored by any fire service department. Any fire leader who suggests their department doesn’t have these types of issues with their firefighters isn’t looking for them; they are there.
We take wellness seriously. We allow our firefighters, if they wish, to go to a local gym in their response area on duty. The gyms in Las Vegas are amazing and offer a workout opportunity that is unparalleled. We take a bit of heat for this every year when a member of the public complains about our firefighters working out on duty, but it’s easily defended. We want our firefighters to be out in their neighborhood with the community. But most importantly, we want our firefighters healthy, fit and ready to go do their jobs. I am proud of our firefighters because I know that whatever they are asked to do, they are willing, fit and able to do it.
