Washington Fire Dept. Shifts Medical Call Protocol

March 03--The Spokane Fire Department has quietly made a dramatic shift in how it responds to medical emergencies.

After years of insisting that it was best to respond to medical calls with fire engines and ladder trucks so firefighters are ready for the next call immediately after they finish work at a scene, this year the department began responding to some medical calls with ambulances or pickups.

The change has started at three stations and is expected to be implemented at a majority of the department's 15 stations by the end of the year.

Critics, including the Spokane Firefighters Association, say the policy puts people at risk because when firefighters are driving back to a station from a medical call, they can't go directly to a fire because they have to switch vehicles. Or, more likely, a company from a station farther away would have to go to the fire call.

Fire Chief Bobby Williams said he implemented the change, in part, because the city's trucks likely have more miles on them than at any time in the department's history. With the increase in medical calls and rising costs of buying new engines, it was time to explore options to slow deterioration of the fleet, he said.

"We're hoping that we can extend the life of those apparatus," Williams said.

Department statistics show that fire calls and nonmedical calls have remained steady in recent years. Since 1998, the annual number of nonmedical calls has ranged between 4,000 and 4,800.

Medical calls, however, have significantly increased. In the past decade medical responses increased in all but one year. In 2002, the department dealt with 17,590 medical calls. Last year, the department responded to 27,733.

The Spokane Fire Department is the first to respond to medical emergencies. It contracts with American Medical Response to transport patients to a hospital via ambulance.

Williams acknowledged that the switch could affect response times to specific incidents, but he said that since the department only responded to about 400 fires deemed significant enough to require a full response (about 16 firefighters) last year, it would be relatively rare for a company to be driving back to a station while a fire call is received in that area.

Williams said response times might be helped by the change because of the maneuverability of smaller vehicles.

"I don't have any expectation that it's going to hurt our response times," he said.

The new strategy contrasts with the way most fire departments operate and with the position of the city's fire leaders until recently.

In March 2010, Williams and Assistant Chief Brian Schaeffer said in interviews that they would be open to using smaller vehicles for certain medical responses but that doing so could negatively impact response times.

"We're so busy that they go call to call to call to call," Schaeffer said then. "The safest thing for people at this point is to have them drive around in their Swiss Army Knife because they can go to a car fire to a heart attack to a child that has a broken arm."

Williams, responding to a 2010 consultant report that recommended using smaller vehicles for medical response at stations with four-person ladder companies, had said he didn't expect big savings by making such a switch. Although the city would save in gas, switching systems would also mean maintaining more vehicles.

The report from the Abaris Group of California recommended that Spokane consider a system in which only two members of a four-person ladder company would go a basic medical call in a smaller vehicle. Doing so would have kept two firefighters at the station to drive the ladder truck to other incidents where a ladder truck was needed, the report said.

Williams said last week that the department considered the Abaris recommendation, but breaking up a four-person crew would require negotiations with the fire union.

One of the three companies that made the switch is a four-person company that usually uses a ladder truck. Williams said that once other ladder truck companies make the change, the system will be designed to prevent too many companies from being away from their ladder trucks.