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.

What's changed since 2010, Williams said last week, is the continued deterioration of the fleet, the continued increase in medical calls and changes that will soon improve the computer system that dispatches crews. One of the city's pumper ladder trucks is approaching 200,000 miles. Many trucks are nearly 20 years or older and about half have been driven more than 100,000 miles.

Voters narrowly rejected a tax in 2009 to pay for new firetrucks and equipment. The bond measure had more than 59 percent support but needed 60 percent.

Williams said he's happy with early results. In the first two months of 2013, the ladder truck at Station 1 downtown drove about 400 miles. Under the old system, it likely would have been driven about 2,500 miles.

Medical calls in the 1970s accounted for about a third of the department's call volume. They now account for three-quarters or more.

"Today we're more of an EMS department that occasionally goes to a fire call," he said.

The three companies with small vehicles available for medical calls were dispatched 577 times in January, Williams said. They used the smaller vehicles in 417 of those calls. Statistics are not available on how many times using a smaller vehicle slowed the department's response to a scene, but Williams said he's not aware of any time that the new system slowed a company's response to a significant fire.

Mayor David Condon said the city will study data to see if response times change. Improving service is the ultimate goal, he said.

"At the end of the day, it's, 'How do we save more lives?'" he said.

But City Council President Ben Stuckart said the policy appears to be intended to decrease complaints from citizens angered that big firetrucks respond to medical calls, not to improve service.

The Spokane Firefighters Association filed a complaint with the state Public Employees Relations Commission, arguing that the change should have been negotiated with the union because it affects working conditions. Union officials say the change affects firefighters' safety because delays in responding to fires could result in more dangerous fires by the time crews arrive.

Williams suggested in 2010 that the issue would have to be negotiated with the union.

Ken Willette, public fire protection division manager for the National Fire Protection Association, said budget cuts are driving departments to consider ideas like the one implemented in Spokane. Few departments have made the decision to have companies use a smaller vehicle for medical calls, he said.

"The economy has caused everybody to carefully look at how they're operating and look at any cost savings," Willette said. "Departments are looking at how they can reorganize and still maintain high levels of service."

He said he's unaware of any studies that show whether response times would improve or what potential cost savings would be in a system like Spokane's.

Stuckart said the City Council was unaware of the change until after the decision was made to implement it.

Willette said the association doesn't necessarily hold that the policy is bad. But, he added, the community should understand the possible benefits and risks before the policy is changed.

"The most important thing is for the community to have the discussion," he said.

Copyright 2013 - The Spokesman-Review, Spokane, Wash.