01-19-2001, 05:05 PM #1bostonffFirehouse.com Guest
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 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.
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.
01-19-2001, 06:01 PM #2Rescue 21Firehouse.com Guest
Thanks for the insight into the PG County problem. Why not set-up a seperate PG County EMS division? It could be funded by third party reimbursement by insurance companies. This would allow the career members to remain doing what they want to just like their volunteer counterparts.
01-19-2001, 06:31 PM #3TXFIRE6Firehouse.com Guest
I'm not so convinced that would solve all your problems. The paid FIREFIGHTERS i'm sure alos would like to respond on engines, and trucks, and should have every right to. After all they are firefighters. They are there because volunteers can't handle the staffing levels needed by that large of a population. Perahps there should be more of them, many more. I'm sure they don't want career burn-out you described, if they get burned out and quit, it affect their family, and life. That's not fair to them either.If Prince George's County Fire Dept. runs an EMS service, and the volunteers are part of that fire department, then they should be held to do the smae job as the paid guys. I'm sorry, but that sounds liek some guys don't want to do the "not so fun stuff" will they be there to roll hose after a fire? That's not all that fun either.... Not every part of this job is fun, or what we want to do... but you have to take the good with the bad, or maybe don't take it at all...As for improving services..Hire more people..Supression ans EMS
Any Opinion expressed, are my own, and do not reflect my Department...RB
01-20-2001, 01:13 PM #4ffnbsFirehouse.com Guest
Ditto TXFIRE6, I know this is a real problem, but believe me this is not only going on in PG county! Welcome to the world. If I had a penny for every BS call I had to respond and transport I could leave this business. Bostonff- I'm not saying I know what all is going on down there but it sounds to me like if it ran as you think it should you would be creating an animosity problem(if there isn't already) between the fulltime staff and volunteers. [volunteers want the full timers to bake the cake and frost it and serve it to the volunteers to eat and then the full timers have to wash the dishes when the volunteers are done with their treat] If I was down there and enjoyed being a ff then I would get my high paying engineering job or whatever some of the volunteers do for a living and in my off-time respond on a fire truck to all kinds of exciting stuff while the full time staff takes care of all of the 'garbage' for me. I don't wish for this to turn into an ugly debate but just remember that this is going on all over the country, not just in PG county.
01-20-2001, 03:04 PM #5SBrooksFirehouse.com Guest
There's a theory in management circles that no one is uncompensated for what they do...i believe this. A volunteer may not recieve a paycheck, but he recieves intangible benefits such as cameraderie, satisfaction, etc. Given these inducements, he will put up with a certain amount of detractions, such as rolling hose, mopping floors, riding the ambulance. If you increase the detractions to the point they outweigh the benefits for that individual, he will cease to volunteer his services.
PGFD Career FFs are very expensive. They are well paid (3 years on, $40k+, 10 years on, captain $70+) and they only work 42h a week. Their union has obtained this for them almost entirely by the fact that there are relatively few of them. There are relatively few of them because historically, there has been a strong volunteer system in the county. And I've never once been thanked by a Local 1619 member
A county the size of PG county, if it were entirely career, would need something on the order of 1500+ firefighters & EMS personnel. This would cost the county 1000 ff x $55000 (salary and benefits) = $55 Million more dollars a year, roughly double, i believe. More as they get step increases. I'm sure the taxpayers wouldn't mind that.
Or the alternative is to pay someone to take out the trash, or rather run the EMS transport calls, and exploit the fact that well trained, well equipped volunteers will do (a portion of) the job well for free.
There is a movement afoot accross the country to subvert the importance of fire suppression forces in favor of EMS. These people make the argument that fire runs are down and ems runs are up. Those of us in know realize that fire runs ARE down, but they still exist; EMS runs ARE up, but not as much as the numbers say...in fact true EMERGENCY MS calls are not up much...calls for service are.
The fire department is a public safety entity. It responds to emergent calls for service, mitigates a problem, and goes home. This rightly includes responding to life-threatening medical conditions & injuries.
Medical Service is a *Public Health* Issue. Because most calls for EMS are not infact truly emergent, but are in fact usually the symptom of deep seated socioeconomic factors, namely lack of primary care public health, EMS would better be handle by the Healthcare Profession / Public Health Agencies.
Of course these opinions are my own and not those of any of my employers.
01-20-2001, 03:43 PM #6Dalmatian90Firehouse.com Guest
No one's time should be wasted.
However, what is a good use of time may very well vary. Volunteer or on-call personnel are using time at the margins of their life -- usually in addition to putting in a full week at work or school. Career personnel can do the job and then still do other activities in the off hours.
Emergency Medical Services as we know them today are only about 30 years old, and I will say 30 years from now you won't recognize them. As a "system" it is seriously out of whack. Most of the transports performed are not neccessary. Better systems *will* be developed that treat most acute medical problems in the field or the community. The Fire Service will continue to have a role, especially in the true emergencies, but I wouldn't hang one's department's future on providing ambulance service.
The staffing and deployment for police, emergency medicine, and fire are different and unique.
Police handle the most incidents, with the least help -- one or two officers can handle most events.
EMS handle a smaller number of incidents, but always needing at least 2 technicians, and 3 or 4 more on scene to help move patients can make the job much safer.
Few fire incidents can be handled safely with fewer than three; and a major incident like a MVA with entrapment or a structure fire can easily involve 16 or more firefighters. How many incidents do you ever see 16 police officers on scene or EMTs treating patients? Yet routinely 16 firefighters role for automated fire alarms.
A combination of a core of career staff supplemented by a call force (either paid or volunteer) is the most efficient way to provide safe, effective firefighting to the majority of the U.S., certainly geographically, and possibly even by population.
Government doesn't exist to be a jobs program, it exists to provide services for trade & commerce to take place safely and efficiently. If you can have well trained, well staffed volunteers and call forces in place, that's good government.
If preserving volunteer firefighting means hiring a small number of people to staff ambulances, that is much more efficient in the long term than driving out the volunteers and having to pay for a career force that is properly manned for both fire and medical duties. Add to that the uncertainty whether EMS will be as big of a crisis 20 or 30 years from now...will local governments be stuck with large paid forces now with neither a lot of fires, nor many medicals to respond to?
For most communities, good government means preserving a significant, active volunteer role -- providing the manpower needed on the few major fire service incidents. Preserving volunteers, however, in many communities can mean a significant role for a paid core of firefighters who can handle administrative duties, inspections, preplans, maintenance, and calls needing only a few people -- like ambulance runs.
01-20-2001, 05:41 PM #7NozzleHogFirehouse.com Guest
Up until now, I have made it a point not to respond to all the petty, divisive career vs. volunteer issues on this board. I will make this one exception.
As a full-time professional fire officer in a major metropolitan department and a small town volunteer, I respect both "sides" if it must come down to that. If anyone out there, like myself, has wondered why there exists the degree of friction and hostility within the Prince George's County Fire Service they need only look as far as "BostonFF". If his is the prevailing attitude displayed by volunteers in that county, it is no wonder they have have full blown brawls on the fireground!
In essence, what "Boston" (and I wonder if he really is a Jake) is suggesting is that despite the high volume of calls, the complexity of operating in an urban environment, and already inexcusably low staffing levels in PG County, that this could and should be remedied by removing career firefighters from the companies, relegating those individuals to an underclass status, and making fire response the exclusive domain of volunteers. Rubbish!
Volunteers may or may not be in the firehouse at any given time. I have heard from several independent, reliable sources that it is not unusual for volunteer companies to fail to respond to fire calls in PG County and that it is, in fact, a daily occurrence. For every Kentland there are three or four Brentwoods, companies we don't hear about, but who are nowhere near as viable. In many cases these companies fail because the career firefighters are staffing an EMS taxi.
Perhaps someone can help me with this whole "live-in" issue? College students notwithstanding, is not someone who "lives-in" the firehouse being compensated in the form of room and board? Is that in the true spirit of volunteering or just very cheap labor? In my view, if it weren't for the firehouse that person would be just plain homeless. What percentage of these members "live-in" the lower socio-economically deprived communities they serve? Are they neighbors helping neighbors or something closer to children in a playground? When the siren blows in my town, I leave my family and the comfort of my home and respond to my neighbor's call for help. That is what a volunteer does and I could not do that 3000 or more times per year. In other words, the difference is that I have a home, a family and a life.
I would argue that any company that runs the amount of calls described would be far better served by full career staffing, both fire and EMS. The career firefighters, and those legitimate volunteers of PG County have my full sympathy and support .
01-21-2001, 02:06 PM #8SBrooksFirehouse.com Guest
So unless i'm helping My neighbors i'm not a legitimate volunteer?
If I join an organization, to be a part of a well run department, to gain training and experience, and generally enjoy myself, i'm not a legitimate volunteer?
Off hand estimate:
Option A: Require volunteers to provide EMS transport and 1 company in 5 fails weekly.
Option B: Reduce the requirement of volunteers (and cross staffed career ffs) to provide EMS transport and one company in 15 fails weekly.
Requiring dedicated staffing to provide the EMS transport does not make them "Second Class Citizens"...it seems that you are saying a firefighter is a better class of person than an EMS provider.
01-21-2001, 06:59 PM #9haliganbrFirehouse.com Guest
Nozzlehog, you couldn't have said things any better. Like you said for every one kentland there are five or more Brentwoods. I ask this question, if kentland has so many volunteers because they don't have an ambulance, then why doesn't Brentwood since they don't have a ambulance either. I have been to a few working fires just blocks away or even a couple of houses down from their fire station and they failed to respond.
SBrooks i ask this question of you. How many pg county volunteers live or even grew up in their "first due". I would venture to say not very many. How many volunteers would Hyattsville, College Park or even yourself have if it wasn't for the U of M?. Didn't you say in a few posts ago, the PGFD couldn't find its *** with a map, but aren't you a part of it being a volunteer. Your earlier post about how many ALS units there was wrong. There are 12 career ALS units and 1 volunteer medic unit. There is 24 staff ALS units 24/7. I might not understand how you broke your numbers down earlier. I do agree that some of the ems calls are b/s and it is used as a taxi. I know every one has their war stories about the bls unit being used as a taxi, and i don't think that alot of people would argue that point. The ambulance isn't the only reason why volunteers are going away. Nozzlehog said it perfectly, jobs and family. People just don't have the time to give like they used to. Just look at the average age of a volunteer in this county, and the average age of a line officer. Pretty young if you ask me.
You also stated that you have never been thanked by a career firefighter. Sorry to hear that, but i know i have thanked many a volunteer for the job that they have done. You have got to realize in this line of work you don't get many pats on the back. Also why should i thank a volunteer when i come to work in the morning and have to pick up the mess they left from the night before. I'm not their maid or their mother. How many times has a volunteer thanked a career firefighter, more than likely they put them down for one reason or another.
Just my thoughts, are some people going to like what i have to say, no, sorry you can't please everyone all the time
01-21-2001, 10:16 PM #10mark440Firehouse.com Guest
First of all RESPECT BRINGS RESPECT! Second, haliganbr, do you work the night shift? Do you want to work nights? Personally I hate working nights, being up all night, not sleeping in the daytime. I would love to have a fire job Monday through Friday 9:00 am to 5:00 pm that I can be home with my family at night time. I would be grateful to someone willing to give up thier nights so I can get a good night's sleep to be to work in the morning. What kind of a mess do they leave? Have they run 50 calls that night or just 1? If they are running all night, I really don't care if they leave a reasonable mess. After a long, hard day I tend to become messy too. But I have pride and clean up whether it is my mess or not. I want to act, and look as professional as I possibly can. A clean uniform, firehouse, person and truck are of the utmost importance in appearance!
*Just my opinion, if you don't like it... don't read it.
If in doubt - Call us out
[This message has been edited by mark440 (edited 01-21-2001).]
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