Is Four-Person Staffing Hurting Your Response Efforts?

In the late-1990s, Occupational Safety and Health Administration (OSHA) standard 29 CFR 1910.134 included new rules mandating fire departments must have two firefighters outside a fire when they send a crew of two or more firefighters into a fire beyond the incipient stage. It appears Congress paid little or no attention to the fact that 80 percent of our emergency calls were for EMS when these rules were written.

To many fire departments, this two-in/two-out rule convinced them to reconfigure their units so each unit has a minimum of four members. The OSHA rules do not mandate four members on each fire apparatus; it only provides rules for what you must do while fighting a fire beyond the incipient stage. Now that many departments have made these staffing changes, I have to wonder if this is the best use of their staffing.

Questions to consider

So, is four-person staffing hurting your ability to provide the best service level for your community? Before I can give you my answer to this question, I need to see if we agree on a few items, allowing us to view this from the same perspective.

Would you answer “Yes” to the following questions?

We will always save more lives in EMS than in firefighting.
The sooner we get to a fire or EMS incident, the better for everyone.
Half of the EMS incidents can be initially handled by two or three members.
The sooner we arrive at a fire and start application of water, the safer it will be for both firefighters and civilians.
We respond to far more EMS incidents than to fire incidents.
In a number of fires, the second-arriving unit is on scene prior to our entry into the building with a hoseline.
In situations requiring CPR, if we are late arriving, the patient suffers.
The costs to send an ambulance are less than responding with a fire apparatus.
There are times when a paramedic unit is unavailable or the next due unit is 30-plus minutes away.
On-duty training will mandate taking an engine out of their district for a few hours and sometimes all day.
There are times when you must leave your district to get needed items (fuel, supplies, staffing), leaving your area unprotected.
It takes seven members to most efficiently perform CPR.

Justification

I hope you agree with me on the above list. If you have doubts on any of these statements, I’ll try to answer them below.

In my 39 years of service, I have been on the scene of at least 200 EMS saves. I spent 20 years on an engine company, and I was only involved in one incident where I led a small group of people out of a burning structure. I am sure we saved at least one person per month in EMS and sometimes plenty more. So, my save rate is over 200 EMS to four fire.
Response time has always been an important issue for the fire service, and it doesn’t matter if it is for an EMS incident or a fire incident.
In many of the EMS situations we encountered, we could deal with it with two or three people as we handed the patient off to the ambulance.
The sooner we start application of water to a fire, the sooner we can gain control of it. The longer we wait for water application, the larger the fire gets and the more injury or death potential we must deal with.
We go to more EMS alarms than fires. In most fire departments, 80-plus percent of the calls are for EMS.
Our stations were located 1½ to 2 miles apart. So, unless we were going away from town and on the outskirts, the next-arriving unit was close behind. In many cases, the second unit arrived prior to our entry with the initial attack line.
In incidents requiring CPR, if you don’t arrive in less than 4 minutes, it makes no difference how proficient you are in CPR; the patient has virtually no chance to survive.
I recall these cost-related statistics from about 14 years ago: The cost per mile for an ambulance-type unit was about $1.56, compared to about $4.58 for an engine and about $8.75 for a ladder. The cost per mile for a quint was over $11. Today the amounts will have increased, but the differences will be similar.
If you have a BLS unit, there are times when you could transport the patient if the paramedic unit is delayed or unavailable. This may actually save their life, lessen their severity and allow you to become “available” sooner (referring to the unit being in service or available to take another call). There may also be a department policy where you can transport your own members or family to lessen the costs to the community. There are also times where there are just too many patients for the normal transport system, and the extra BLS unit can help fill that role.
If you have a second unit in some of the stations, then you can move one of those units to a station vacated for training to maintain the EMS and fire coverage.
When you only have one unit in each alarm district, you have no way to provide any EMS or fire coverage when you must travel out of your district. If there is a second unit in your station, this problem is somewhat resolved.
I saved the best for last: In my department, we always sent seven or more members on all CPR events—three-person engine, two-person BLS unit, two-person paramedic unit. I know many departments do this with fewer members and they feel they are doing a good job. I can only tell you that for the last 35-plus years, my department consistently had the highest CPR save rate in the world.¹ I believe that sending the appropriate number of members was an important part of that system.

Scenarios

Let’s look at a city that has six fire stations and currently six four-person engine companies. For each EMS alarm, they send an engine company and a paramedic unit (a fire department paramedic unit, a private paramedic unit or a third-party service paramedic unit). While on this EMS alarm, they are unavailable for any other alarms. If Ms. Smith has a heart attack while they are unavailable, her chances of survival are greatly diminished. The same is true if Ms. Smith happens to have a kitchen fire while the engine is unavailable. If you believe in the theory that free-burning fires double every minute, you can easily see Ms. Smith’s kitchen fire is most likely a house fire when the first engine arrives.

So, let’s compare the above situation to another city where they also have six fire stations. Currently all six engines are staffed by three members, and in three stations, there is also a two-person BLS unit staffed by EMTs. Now the BLS unit is dispatched to the EMS alarm along with a paramedic unit as was done in the situation above. If they find a serious situation needing more staffing, they call for it and the engine responds. If it is a typical BLS alarm, they can handle it by themselves or with the aid of the paramedic unit. When Ms. Smith has either a heart attack or a kitchen fire, the engine responds in a timely manner to deal with the situation.

I know you are saying to yourselves, “But the law doesn’t allow us to enter the fire unless Ms. Smith is trapped inside.” Correct, but we must look at what else we can do with a three-person engine, and we must keep in mind that the second unit will likely be there prior to our entry. We can still lay our attack lines, we can establish a water supply, we can call for the correct amount of assistance we need, and we can apply water via windows and doors until the second unit arrives. If the fire is still in its incipient stage, we can legally enter the building and extinguish it. If Ms. Smith needs rescuing, then you are actually there to rescue her.

It would be good if you had four members aboard, but isn’t it better for Ms. Smith to have you there with only three members instead of having to wait for the second unit? Maybe we should ask Ms. Smith what she thinks about the need for the fourth person? It would be even better if you arrived with six members, but that would be a waste of resources. Maybe you only need to put up a ladder and help Ms. Smith down the ladder, or simply tell her to stay in place while you put water on the fire to control it.

You need to ask yourself what would happen to her if she has to wait for the second engine to arrive to get any help? There is always something you can do to make these situations better. Maybe not perfect, but always better.

This is where I should give credit where credit is due. Volunteer firefighters for years have responded with very few members and still put out many fires by attacking them from the exterior until additional help arrived. They had it right. The sooner you apply water to the seat of the fire, the sooner it is adequately dealt with. Small fires that can be dealt with quickly will prevent them from threatening other structures. This will also return your other units to “available” sooner so they can deal with other emergencies. The faster the fire is extinguished the safer we all are.

Best use of resources

As mentioned in #1 above, in my 39 years, I was at very few incidents where we had victims that could be rescued. So, with those statistics, doesn’t it make sense to best utilize your resources to provide the best services you can with the number of firefighters provided?

Ask yourself if you would be able to provide better service to your community with:

Six four-person engines (24 members)
Six three-person engines and three two-person BLS units (24 members)
Eight three-person engines (24 members)?

Do you have areas of town that are underserved because you insist on the four-person engines?

Staffing is a very touchy subject for most firefighters. You feel that having four or more firefighters on your engine is the only safe way to respond to fires. I get that, but I know from personal experience that you can safely deal with most emergencies with a three-person crew. As the company officer on three-person engines for over 17 years, I never saw a member injured due to staffing.

This issue comes down to a couple simple facts. First, Ms. Smith can’t deal with her situation alone. This is probably the worst day of her life. That’s why she called 9-1-1. Second, we have the best equipment and the best training, so we can decide what to do with each situation based upon the needs of the situation and on our abilities to deal with it. We should worry about the health and safety of our members, but is it appropriate to do so at the expense of Ms. Smith?

Final thoughts

The citizens can’t decide when to have an emergency, but each fire department can decide how they will respond to those emergencies. Citizens may be overcome by alcohol, drugs, old age, illness or fear. We are trained to deal with each of these emergencies, and we should do everything we can to deal with their situation. Simply saying that it isn’t “as safe” for our members to be on a three-person crew may make sense, but I doubt any of those people having the worst day of their life will agree.

Like I asked before, is four-person staffing hurting your community?