As first-responders, we understand the importance of short response times and their effect on saving lives and property. But getting to an emergency quickly is only effective if the resource arriving is well-equipped and properly staffed.
True medical emergencies require up to six people – including ambulance transport – to effectively address. Have you ever seen how many medical professionals are needed in an emergency room when a patient needs CPR? That is the same procedure we follow in your living room.
The City Council-commissioned Citygate report evaluated the San Diego Fire-Rescue Department’s coverage and response capability. It recommended adding resources. As firefighters, we have known for years that we are understaffed and under-equipped. We haven’t added resources downtown since the 1970s. We are stretched thin.
Unfortunately, the author of the report chose San Diego to conduct an experiment with low staff and resources. He even acknowledged that no other metropolitan city has tried the concept of using a two-person squad as a standalone unit.
The report asserts that San Diego has geographic areas that aren’t the same size as the districts most standard engine companies serve. It also states these areas are difficult to serve in acceptable response times. So, the report concluded, half-districts could be served by half-engines. The problem is that these districts don’t have half-emergencies.
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Maybe Richard Rider should pick up a fire hose, go to paramedic school & show us all how easy it really is! BTW, do it for free so you can help out America's Finest City.
Having been the subject of nasty retorts whenever I comment about fire department staffing, work schedules or yearly incomes, I hesitate to subject myself to further grief, but I can’t resist Let me just say three things, and please “fact check” me on these assertions:
1. About 90% of the calls to SDFD are medical emergencies.
2. A fire engine is routinely scrambled together with the paramedic van on many of these calls, and the result often as Ken Platt describes. A fire engine, unlike a van, justifies the employment of a “Fire Captain”, who is in charge of the larger vehicle and is paid more highly.
3. Although the normal work schedule for firefighters is 7-8 shifts a month of 24 hours each, firefighters have almost unlimited opportunities for overtime because the department purposely runs below authorized staffing, year after year. This results in uniformed firefighters, not counting SDFD management, routinely being over 50% of the 100 most highly compensated city employees year after year.
@Bill Bradshaw Okay, I'll take a swing:
1) I believe this number is closer to 60-70%, but it might be different in the City of San Diego than it is in other areas.
2) Yes, there are generally more fire houses than ambulances that serve the same districts, and yes, an ambulance is always dispatched with the first responding fire crew. This is because the locations of fire stations were initially laid out to get a fire crew to the scene of a fire in 4-6 minutes--the time frame in which anyone who might still be trapped inside a burning building has the best chance of being rescued. With the new emergency medical procedures that firefighters and paramedics are trained in, we now bring the most critical emergency services of an Emergency Room to your bedside in that same 4-6 minute time frame. If your heart has stopped beating or your are unable to breathe, you've got about 4-6 minutes before permanent brain damage occurs. This is also why almost all fire departments now have at least one licensed paramedic on every piece of responding apparatus (most have more than one, but all the other crew members are trained to at least the Emergency Medical Technician [EMT] level). The ambulance can come later (and cover a few more fire engine districts) since the initial emergency response work done by the responding crew still takes a certain amount of time before the patient is ready for transport anyway. The first responding paramedic(s) and their team of EMT's are assessing the patient for severity and beginning life saving interventions as needed.
In Ken Platt's case below, had his family member been unconscious, or had his heart stopped, he would have witnessed a completely different scene: one person doing chest compressions, one person securing the patient's airway, one ventilating (breathing for) the patient, one gaining intravenous access (starting an I.V.) to administer medications, one applying the EKG/defibrillator to find the cause of the heart stoppage and prepare for cardioversion (i.e. "shocking" the patient's heart from a lethal rhythm back into to a non-lethal one), one gathering pertinent patient medical history (including the medications taken, recent surgeries, allergies, etc.), and one or two more to work on extricating the patient from the house to the waiting ambulance (is the patient upstairs, behind the bed, does furniture need to be moved, is the patient big/tall, are they on a backboard from a fall injury, etc.), and to help carry all the equipment (oxygen tank/regulator, EKG/defibrillator, drug box with medications, any needed splints, backboards, portable suction devices [dying people frequently vomit and can choke on it and this also needs to be addressed]).
We never know what we will find when we are called to your home for a "chest pains" call or a " (elderly) fall", or a "difficulty breathing" call. Is this "chest pains" call someone having a potentially fatal heart attack who collapses into complete unconsciousness as we walk in the door? Was this "fall" caused by the patient's heart stopping? Will this "difficulty breathing" progress to complete respiratory compromise and require more intensive interventions by the entire team? Precisely BECAUSE WE DO NOT KNOW what we will find on arrival, we always "send the world" knowing that if it turns out to be a minor call we can always cancel the other responding units. However, the reverse is almost never justifiable. Imagine you are the police/fire chief being grilled by the media and irate family members: "Why didn't you do more to help my loved one?!?!?" "Well, we didn't think it was that big a deal. The call for service came in as what sounded like a 'routine' ____ call, and we just sent our (fiscally responsible) normal response of two guys. By the time we realized it was a serious call, the other responding units were delayed, and . . . . I'm truly sorry for your loss, but it was the most (fiscally efficient) that I have been authorized to do."
3) Most municipal Fire Departments run a three platoon schedule. That means, since someone has to be on duty 24 hours a day, 365 days a year, you can take that 365 and divide it by three, making 121+ days a year or a bit over ten 24-hour shifts a month, or about 56 hours a week. Let me remind you that includes nights, weekends, holidays, and sometimes being up all night, requiring your entire following day off to fully recover to be able to report for duty well rested the following day, etc.. Since you rightly mentioned that it is cheaper for cities to work their existing crews overtime, vs. hiring new employees, it is a "win-win" for both the taxpayer and the firefighters--except when certain curmudgeons like to continually point out merely how much they make in annual gross salary without taking into account that they worked 60-90+ hours a week for that pay. A firefighter starts out at about $39,000 a year and can progress to about $70,000 a year (not including overtime), but if you look at the hours worked for that salary (again not including evening, weekend, holiday bonus pay, etc.) that pencils out to about $26.00-$48.00 per hour. http://www.sandiego.gov/fire/careers/faq.shtml These are very highly trained professionals who are called upon any hour of day or night to come and fix your really bad day. Have you noticed what your auto mechanic is charging by the hour to work on your car or what you pay your masseuse? Have you considered the amount of hours and the breadth and depth of training the average firefighter/paramedic has to have to be able to efficiently handle mitigating your emergency in an efficient and safe manner? True, they are not all extreme emergencies, but can we really justify NOT treating each call for service as the "worst case scenario" until proven otherwise? Do the people in Encanto, or any of the many other under-served areas in the City of San Diego not deserve the same response and treatment as you would demand for YOUR emergency?
Lastly, this reminds me of going back to the bad old days I had heard about from the "old guys" before I got hired, when we used to just send the two-person ambulance crew on "medical aids". The fire crew was too valuable to be bothered: "Call us if you need us" was the refrain. Well if that two-person crew is just putting on an oxygen mask and carrying the patient down stairs, they couldn't do much more for them anyway. Who cares that they all retired out early on back injuries. No one is going to actually do any digging to look at the data to see how much more it's costing taxpayers to continue to use up and discard these firefighters. There are plenty more young, hungry guys and gals willing to take their places--and we'll use them up and spit them out, too. "Oh, you're retiring out on a work-related back injury? That's a bummer. Good thing the Republicans gutted that recent Workers' Compensation legislation, or you'd be costing me even MORE money to replace. NEXT!!!!" :-P
@Jamie Edmonds @Bill Bradshaw
Thanks for not calling me a “stupid civilian”, I like “curmudgeon” better. Your description of the safeguards built into the system is fascinating. It seems to be designed to provide almost foolproof backup capabilities in case a person in distress needs more help than normal. Human life is precious, and it’s tough to argue against the safest possible situation, regardless of costs.
A police officer on every corner would dramatically reduce the crime rate in every city (New York comes pretty close), but few people suggest anything like this for the obvious reason, unaffordable cost. Rescuing sick or injured people seems immune from this sort of argument.
Your analysis of the working hours of the typical firefighter is enlightening. What you are saying is there’s a 40% overtime factor built into the normal work schedule, at 56 hours per week, but most firefighters work additional shifts, bringing the average up from 56 hours weekly to 60-90. Wow! Now I understand why fire department turnover is so low compared to police.
My wife thought even "curmudgeon" was too strong, but I find it sort of endearing. ;-)
Part of our jobs (like it or not) is to help educate the public who will otherwise NEVER know what happens behind the scenes. It takes us years just to get the elected representatives up to speed (and then they're termed out), but the only thing the average citizen knows is that when THEY pick up the phone to dial 911 they want they whole world showing up if it turns out to be a truly serious emergency.
Re: the overtime question, because firefighters have historically worked much longer shifts than the average M-F 9-5 job, we have been exempted from the overtime rules that apply to most other jobs. In most cases, with most departments, our 56 hour work week is all straight time. We only get overtime (time and a half) when we sign up to work additional shifts over and above the minimum 56 hours a week. One shift being 24 hours and your 72-hour work week just went to 96. Most of us work a rotating 24-hour schedule (24 on, 24 off) for three or four shifts, then get a block of days off in a row before the pattern repeats. If you are stationed at a busy house running a lot of wake up calls when most working folks are fast asleep, you can frequently spend most of your days off recovering. So some weeks are only 24 hours, while others are 120 or even more. If we have sent out strike teams of firefighters to protect structures in the back country areas that have far less coverage, those firefighters on the strike team or those backfilling the stations to run the normal calls may not see their families for a week or more. And even then, only the "extra" shifts are overtime, the rest of the time we are just on the clock for our normal shift.
Remember, when you watch the morning news while you sip your coffee and see all the footage of the horrific DUI crashes, house fires, shootings, etc., remember, there were dozens of firefighters, paramedics, EMT's, police officers up all night putting things right again.
It's a young person's job. The traumas, the assaults, the shootings and especially the suicides and pediatric calls wear on you. The toxins we're exposed to daily take their toll (I contracted cancer at 37 after only ten years on the job), and the constant political battles grind you down. The reason the turnover is fairly low is that it's one of the last careers with any hope of a pension to support you after you've given your all to serving the public--or at least it used to. Did you know we don't get Social Security either?
It would be helpful to have a comparison of the full personnel and non-personnel expense of each option (squad v. engine company). I don't think it's appropriate to compare the full cost of one option to only the personnel cost of the other.
There really isn't any confusion between the concepts. I was the Emergency Operations Assistant Fire Chief at the time the report was delivered to the City. The report stated clearly that the City of San Diego was so severely under-resourced in several areas, that the public was at risk. The report called for several fire stations to be completed and staffed fully, additional Truck Companies to be established, and for the creation of two additional Battalions for command and control BEFORE any "squads" should be implemented and tested to serve the gap areas.
In fact, my concern then, which is now coming true, is that the political forces would come in to play and the "cheaper" solutions would be implemented instead of developing a solid plan to implement the entire findings of the report. Very simply, the City of San Diego has fewer fire fighters and fire fighting resources, and protects more people than most major cities in the western United States. While I fully believe that the squad concept is a good one, it is not the solution for all of the coverage issues within the City.
There seems to be a confusion between two concepts. One is the "perfect solution," which a part-time, two person crew is not.
The other is a practical solution. After years of discussions, consultants, and analysis, here's a step forward that actually got implemented.
As a taxpayer, I'm happy to see the city experimenting with relatively low cost solutions to see if they will actually work.
3 weeks ago my 81yr old 130lb father law passed out in our living room from complications from an earlier angioplasty. After calling 911 a 4 man fire engine and 2 man ambulance showed up and we had 6 guys standing in our living room. 2 guys were providing aid to my father-in-law. 2 guys were standing around watching them. And 2 guys were admiring and commenting about our family photos on the wall.
I am a huge supporter of our Fire Dept and I gladly support them along with our police dept with my taxes. However, what I witnessed in my living room that day was a HUGE waste of manpower to deal with our situation. There was no need to have 6 guys show up to handle this call despite what the union leaders harp about.
I get that fire dept funding is directly tied to the amount of calls that they respond to each year. And I get that the amount of true fire calls (fires, accidents, rescues, etc) is way down. But to waste manpower on medical calls just to keep the number of calls up just isn't right....I
I tried posting earlier but then it got erased when I "signed up". First off, I'm glad it sounds like your father is OK.
The reason you had 6 people in your living room is because during the "911" call something was said that determined this had the potential to be an acute emergency. The dispatcher can only go off the information given by the 911 caller. An 81 year old who passes out could have been a very acute call or something relatively minor. There is no way of knowing until we arrive and do a paramedic level assessment.
Not all calls in the city of San Diego get a fire engine and ambulance. If the dispatcher finds no true life threatening issue, they may dispatch an ambulance by itself or even an ambulance that has two EMT's not driving lights and sirens instead of an EMT and a paramedic. (Paramedic is a higher level of training)
Had your father been having a stroke, diabetic emergency or worse, you would have seen all 6 of those members working, giving oxygen or ventilating, doing an EKG, starting an IV, giving medications, doing chest compressions, talking to you for information, talking to the hospital, carrying him down the stairs, etc. The pace of the call would have been fast, no time to look at pictures. I'm sure you would want all 6 people in a true emergency. I know I would.
Before the crews arrive, they only have what little information that was relayed to them from the dispatcher who answered the 911 call. If they arrive, and find the call to be non-emergent, typically they stay to help the ambulance crew. While helping though, they always monitor the radio in case there is another 911 call in their district and will clear if they are not needed by the ambulance crew.
I hope this helps a little bit, and once again I hope your father is doing well. Thank you for your support if the Police and Fire department.
@Ken Platt When your father in law passed out, you should have asked for just a "little help"? Remember, when access 911, you are saying this is a LIFE & DEATH EMERGENCY. The Fire Dept. takes 911 calls seriously, that's why you recieve the people, equipment, & services. Maybe you should be "grateful" that you live in a country where they send "more" than you need. When a person calls 911, the dispatcher can't "measure" each & every emergency to determine what is EXACTLY needed, remember time is of the essence. It seems people want to complain about how much firefighters make or earn in overtime. If a firefighter is working overtime, sometimes by a direct order, that means they aren't at home, this means they miss things like birthdays holidays, kids ball games, etc. I can see how you think this is a great waste of money, I don't fault you. Maybe we should go to a strictly volunteer fire department, then we could save alot of money!........ BTW, I hope your father in law is doing well. Peace
@Ken Platt Mr. Platt,
I totally understand your concerns and see how you feel it was to much to send 6 people to your house. Lets look at it from another position. What if only an ambulance showed up with two people on the crew and your father n law was not breathing and his heart had stopped? How would you feel if you knew that having had 4 more people in your home could have saved his life but they weren't there because we followed the suggestions of you and others.
The facts are that sometimes 6 people show up, and only 2 are actually hands on while the other 4 do other things and yes sometimes make small talk in an effort to calm your nerves, make the situation a little less tense etc. Sure we could just stand there and be heartless drones but I don't think you want that either.
And I am willing to bet that when it was time to load up your father n law and get into the ambulance and go to the E.R. that everyone was carrying something or pushing the stretcher or what have you .
What if only 2 people showed up and asked you to carry all the equipment and push the stretcher or even drive the ambulance? That would be like going to a restaurant and being asked to wash dishes before they could serve you because they were low on clean dishes. You would not accept that as good service and we would never ask you to. In fact we will always provide you with the best service, the best response, the best trained people in the world.
"no other metropolitan city has tried the concept of using a two-person squad as a standalone unit."
Washington, D.C. has had them since 1996: http://www.washingtonian.com/articles/people/what-happens-when-you-call-911-in-washington-dc/indexp9.php
@Derek Hofmann --DC fire dept has over 800 more employees than San Diego FD, serving a population of less than half of San Diego. They have 33 stations vs 47 in San Diego. Are they overstaffed, or are we that understaffed?