The Davis firefighters’ union, in a recent video, touts the fact that they get 4500 calls for service in a given year. What they fail to differentiate is how many of those calls for service are fire versus medical. The reality is that, from almost all municipalities, firefighters these days primarily deliver paramedic rather than firefighting services.
Amid the calls for reform in the wake of the city’s ongoing budget crisis has been a call to re-examine whether bringing a fire engine, fully loaded with firefighting equipment with four firefighters, is the most efficient, the most cost-effective, or the best practice for public safety.
While former Interim Chief Scott Kenley’s report does not tackle this question head on, implicit in the staffing changes is the move to a two-person rescue apparatus that can act as a stand-alone unit and deliver paramedic services in a more efficient and mobile manner.
There have been additional calls to look into ways to better utilize the fact that more than 90 percent of all calls are for medical coverage. There have also been calls to re-examine the city’s utilization of AMR (American Medical Response) in the wake of a new county contract.
In this context, it is often worthwhile to see what other communities are doing – as many are facing the same challenges of providing good service to the community, given dwindling resources and out-of-control employee compensation costs.
This week, Los Angeles’ fire chief, Brian Cummings, rocked the world with the announcement that he is planning to “reassign dozens of firefighters from engines to rescue ambulances beginning next month to handle an increase in medical emergencies,” according to a report in the Los Angeles Times.
The controversial plan, Chief Cummings said, was needed in order to change the fire department to match the agency’s workload which, like Davis and other communities, “has shifted from fighting fires to primarily responding to calls for emergency medical help. Those calls now account for more than 80% of 911 responses, according to department officials and an independent data analysis by The Times.”
“Fire officials say the proportion of medical emergency calls continues to increase,” the LA Times reported. “In the first two months of this year, emergency medical service calls grew 6.2%, compared with the same time period last year.”
In Los Angeles, “Emergency medical incidents accounted for 84% of the 1127 daily calls for service within the first two months of 2013,” the report read.
The plan calls for deploying 11 new ambulances that will take EMS (Emergency Medical Services) calls, leaving the fire companies available to handle other non-EMS incidents. The ambulances would be “assigned to Light Force only stations.”
There would be a two-person minimum staffing on the ambulance with “One Firefighter from the designated Task Force company and one Firefighter from the fire station where the new BLS [Basic Life Support] ambulance is housed.”
The chief hopes this will increase availability of ambulances and light force availability for non-EMS incidents. At the same time it would improve emergency response times while incurring no additional cost for staffing, “as positions are redeployed from current staffing.”
“This is an EMS provider agency,” the chief told the fire commission. “That is our core business.”
Not surprisingly, the proposal which appeared to be suddenly and hastily planned, coming after months of criticism over the agency’s response times, according to the LA Times, “drew immediate opposition from labor groups representing firefighters and department commanders, who warned the change would put firefighters at greater risk.”
The firefighters’ union and the chief officers’ association immediately condemned the move.
“The Fire Chief is unilaterally moving forward a proposal for a 6 month trial program that will remove the inside firefighter from 22 truck companies in order to open 11 Basic Life Support (BLS) ambulances,” a position paper read. “United Firefighters of Los Angeles City (UFLAC) and the Chief Officer’s Association (COA) embrace the idea of expanding the number of BLS ambulances but are opposed to doing so at the expense of further weakening our existing firefighting resources”
“The basis of this opposition is grounded in a clear understanding of NFPA [National Fire Protection Association] standards and the harmful impact that our organization’s reduced service levels will have on firefighter safety,” the opposition paper continued.
The union called the chief’s data “flawed,” arguing that the six percent increase was based on specifics in the year’s flu epidemic, rather than an overall shift to medical calls.
The union also argued that there are no provisions to determine which neighborhood would receive these resources, along with no defined expectations on how to add new ambulances to the aging fleet.
“The Fire Chief is demonstrating a willingness to further weaken the remaining group of 22 truck companies by removing one of the three firefighters who are currently assigned to these resources,” they continue. “Public safety and firefighter safety in Los Angeles, has never been placed in a more compromising position than the one we find ourselves in now. The Fire Chief entertains this proposal knowing that it reduces firefighter safety and violates NFPA standards for recommended staffing of fire companies in large metropolitan areas.”
“Los Angeles is the 2nd largest city in the United States and our Fire Chief needs to understand what we already know. Our Fire Department has hit rock-bottom and needs to start moving forward – not backward,” the union argued, before calling on the public and elected leaders to stand in opposition to the plan.
The firefighters’ union leader, Captain Frank Lima, told the LA Times, “The chief’s proposal will put fire engine crews in danger by cutting back personnel needed to safely attack structure fires. Taking a firefighter away from a light force could affect search-and-rescue operations, the ability to hoist heavy ladders onto buildings and cut holes in roofs to release dangerous buildups of heat and toxic smoke,” Lima said.
“It sounds good on paper,” Captain Lima said of the plan. “But to have one less firefighter, it absolutely puts our firefighters at risk.”
The bellyaching by the union is both predictable and understandable. Councilmember Mitchell Englander, who chairs the city’s Public Safety Committee, challenged the findings.
“We know that the data has been flawed and has been wrong,” Councilmember Englander told the Times. “I’d like to see the numbers to back it up.”
On the other hand, we know that, increasingly, firefighters are not battling fires but rather medical emergencies, and the use of equipment and the clunky response of bringing a four-person fire engine to every call for services seems wasteful and inefficient.
Can a plan like this work in Davis? Could the Davis firefighters have six people transferred to ambulances and deployed in the city of Davis to respond to emergency calls, leaving small fire units in a better position to respond to non-EMS calls?
It is something that seems worthwhile to at least study, even if the union will holler, and it might ultimately not work.
—David M. Greenwald reporting
[quote]On the other hand, we know that, increasingly, firefighters are not battling fires but rather medical emergencies, and the use of equipment and the clunky response of bringing a four-person fire engine to every call for services seems wasteful and inefficient.
[/quote]
David,
Do you have the actual breakdown of emergency calls for both the City of Davis and the university in terms of fire vs medical emergency calls ? Also, do you have a breakdown of the types of fire calls ( auto, structure, brush) and location ? It would seem that evaluating all of these factors could provide a basis for consideration of a pilot to see if a more nimble force would improve response times, but more importantly outcomes.
It seems that dedication to the maintenance of a historically successful, but perhaps outdated model ,may be keeping us from innovating in ways that might provide equal or perhaps even improved public safety at less
expense.
Here’s an article ([url]http://davisvanguard.org/index.php?option=com_content&view=article&id=5440:across-the-state-most-fire-calls-are-for-medical&Itemid=79[/url])from last year that shows most calls across the state were medial
I was witness to four firefighters showing up in a huge fire engine and all standing over a mild injury that could’ve easily been handled by just two and I and some of the other bystanders thought it was such a waste.
David
I would really be interested in local data. Do you know where it might exist in a concise form ?
medwoman wrote:
> It seems that dedication to the maintenance of a
> historically successful, but perhaps outdated model
> ,may be keeping us from innovating in ways that
> might provide equal or perhaps even improved public
> safety at less expense.
My firefighter friends will go months on end without leaving the station to “work” (and most of the “work” they need to do in the station is done by young fire science “hang arounds” that want to show how hard they can work and get a job.
When you are making more than 90% of the households in America, work very little and have a multi-million dollar pension that kicks in at 50 (even earlier if you get bored and say your back hurts) this “outdated model” is working just fine for you.
It is scary how the Internet works that when I go to SFGate.com an ad from the Davis Firefighters pops up. It is sad that there are not any ads telling people that we would be even safer with more public safety employees if we just paid them less.
The 2011 CityGate report has it around 2/3rds of all calls as medical. That seems a little low. I’ll see what I can get.
“I would really be interested in local data. Do you know where it might exist in a concise form ?”
The CityGate reports really don’t have that data in any sort of usable form. It doesn’t look like Kenley delved into that.
If anyone sees a webad for the Davis Firefighters, screen shot and email it here. Thanks.
SOD
[quote]outdated model [/quote]
I want to make a clarification about my use of these words. I was referring to the overall model of number of firefighters assigned to a type of vehicle, and the numbers and types of vehicles used for response overall.
I was in no way impugning the work, or work ethic of individual firefighters. Nor do I consider anecdotal stories of “firefighter friends” sitting around for most of their time any more convincing evidence of financial waste than I do anecdotal, if poignant stories, of how the firefighters saved my life or that of my family.
These are stories meant to shore up an emotionally driven point of view. As such they do not represent data.
Data is what is needed to make rational decisions and that would appear to be sorely lacking so far in this discussion.
Further, I do not see statements regarding the pensions or lifetime benefits as particularly relevant to this discussion. These issues are dependent upon one’s overall view of whether or not personal risk, on the job injury, late occurring work related conditions such as pulmonary and cardiac conditions which may manifest many years post last exposure should be taken into account. This issues are well beyond the scope of a post
regarding immediate vehicle type and staffing issues although I certainly feel that they are worth separate consideration.
David posted a link to a past Vanguard where he wrote:
> The Mercury News reports, “A report by the watchdog
> panel found that 70 percent of fire department calls
> are medical emergencies, and just 4 percent are
> fire-related.
Medwoman wrote:
> I was in no way impugning the work, or work ethic of
> individual firefighters. Nor do I consider anecdotal
> stories of “firefighter friends” sitting around for
> most of their time any more convincing evidence of
> financial waste than I do anecdotal, if poignant
> stories, of how the firefighters saved my life or
> that of my family. These are stories meant to shore
> up an emotionally driven point of view. As such they
> do not represent data.
I’m not “impugning the work, or work ethic” of firefighters either. I’m just pointing out the fact that “firefighters” who are not “firefighter/paramedics” don’t go on medical only calls at most departments (and as David posts above medical are 70% of the calls). Non-medical calls are an even lower percentage in the upscale bedroom community where my friends work.
I have a strong work ethic but when I worked for a “Big 8” CPA firm I often spent a lot of time sitting around doing nothing. I’m sure kids today still fly to audit a company and sit for days waiting for the company to get them the files they need to do their work.
My problem is when as taxpayers we are forced to pay (a lot of money) for people to sit around and do nothing. One of my ideas would be to separate the medical calls from the firefighting department and have a private ambulance firm take all the medical calls. We could then re-train all the firefighters so they could spend their days working for the city doing building inspections ready to fight the (rare) fire.
SOD
[quote]I have a strong work ethic but when I worked for a “Big 8” CPA firm I often spent a lot of time sitting around doing nothing. I’m sure kids today still fly to audit a company and sit for days waiting for the company to get them the files they need to do their work.
[/quote]
Wow. Now I am really curious. A couple of questions for you.
1) Did you really, as a member of a private firm, get paid a lot of money for “sitting around doing nothing” ?
This would seem to be in direct contradiction to the claims of a previous poster here who frequently
made the argument that private firms were invariably more efficient than government workers. Your thoughts
about this ?
2) Since the use of computers and on line resources, I would be at a loss as to why any auditors would have to
wait days for a company to compile any records for their review. Would they not just electronically send the
request for records and then, depending upon the degree of modernization of the firm, await the electronic
transfer of records for review, or await electronic notification that all of the files were available prior to
sending out a reviewer ?
And on another note, I had no intent to imply that you were criticizing individual firefighters either. My intent was only to clarify the narrow range of my comment. I apologize if it seemed otherwise to you.
SOD
[quote]My problem is when as taxpayers we are forced to pay (a lot of money) for people to sit around and do nothing. One of my ideas would be to separate the medical calls from the firefighting department and have a private ambulance firm take all the medical calls. We could then re-train all the firefighters so they could spend their days working for the city doing building inspections ready to fight the (rare) fire. [/quote]
I agree with this sentiment. I am not sure however that these people are “sitting around doing nothing”.
Just as I would like evidence of specific call numbers, response times and outcomes, I would appreciate it if the firefighters would do an honest an complete accounting of their time spent including training, equipement maintenance and whatever else it is they do with the time spent per task. This would enable those who pay their salaries to truly assess the relative worth of the services provided and make a data driven assessment of the value of this time that is not spent directly on calls, but which is equally vital to the performance of their duties.
That way taxpayers, city staff and elected officials would be working from data driven knowledge rather than speculation or gratitude for a specific but rare intervention.
[quote]Nor do I consider anecdotal stories of “firefighter friends” sitting around for most of their time any more convincing evidence of financial waste than I do anecdotal, if poignant stories, of how the firefighters saved my life or that of my family. [/quote]
Remember that when you tell one of your many anecdotal stories that you often share with the message board here.
GI
Not understanding your comment. Can you clarify ?
I wrote this last week in another thread in response to some questions posed that I think deserves a vetting here. I will address the misguided idea that firefighter lay about waiting for a call in my next post.
My agency’s setup for each station is one paramedic ambulance staffed with two firefighters and a fire engine staffed with a fire captain and a firefighter. At least one person on each unit is a paramedic and both units are fully equipped with paramedic level equipment and drugs. Obviously the ambulance transports patients and has more medical stuff but the idea is that both units can provide the same level of care in the field prior to transport.
My county’s dispatch center used ‘Priority based dispatching’ to determine what to send. Basically the dispatcher asks a series of questions and based on the answers to the questions the CAD computer aided dispatching software determines both whether the call merits an ambulance, engine, or greater and whether all some or none of the units respond lights and sirens.
As an example, a chest pain or shortness of breath call generally calls for both the engine and ambulance to respond lights and sirens while a ground level fall where the person is fully conscious and has a sprained ankle will likely only have an ambulance respond no lights or sirens.
The idea is to sent the most appropriate type and number of units to each call at the right time. It also serves to reduce liability through reduced lights and sirens use.
http://www.emergencydispatch.o…hatis.html
This system is not used in Yolo county and as far as I know all EMS calls are dispatched as lights and sirens runs for both AMR and Fire.
As to the public/private setup as it exists in Yolo, I firmly believe that fire departments are the superior means for providing paramedic level EMS service and transport. The duality you see exists IMO for two reasons. The first is an old school mentality among most yolo county fire departments that EMS is a sideshow. The fact is fires are not anywhere near as common as they once were and EMS is easily 80% of our job. This mentality is changing but slowly. The second reason is that the contract EMS provider, AMR has successfully lobbied to prevent fire departments in yolo county with the exception of cache creek from providing a higher level of care than EMT basic. This in combination with a monopoly of EMS transports in Yolo County means AMR calls the shots and takes the money from transports. I know the county was looking to change providers but who knows…
Anyway in my perfect world for Davis each fire station would be staffed with a 3 person engine company. At least one person would be a paramedic and equipped as such. station 32 and 33 each also would have a 2 person ambulance staffed with at least one firefighter paramedic. Station 31 would have rescue 31 cross staff anther ambulance at the paramedic level for third out calls. UC Davis would also staff a EMT basic ambulance during weekends and special events or special call outs with student FF/EMTs while the engine and ladder truck would have full time paramedics aboard. Both the City and UCD would bill patients transported by ambulance for treatment rendered and mileage to the hospital. Costs recovered should largely be able to fund the ambulances in a well off city such as Davis where most all are insured.
Again, this is my pie in the sky dream but I think it could happen.
MEDS: [i]”I would really be interested in local data. Do you know where it might exist in a concise form?”[/i]
The 2011 fire department call statistics are on the city’s website:
FIRE 154 (3.74%)
MEDICAL 2,453 (59.52%)
HAZARDOUS CONDITION 396
SERVICE CALL 387
STEAM/OVERPRESSSURE 2
GOOD INTENT*** 238
CANCELLED ENROUTE 187
FALSE ALARM/FALSE CALL 301
[u]OTHER CALLS FOR THE DFD 3[/u]
TOTAL RESPONSES 4,121
***I have no idea what a ‘good intent’ call means.
Here are the breakdown of some of the categories which have various subtypes:
[b]FIRE 154 [/b]
Structure Fire 62
Vehicle Fire 28
Natural Vegetation 33
Outside Rubbish 22
Special Outside Fire 9
[b]HAZARDOUS CONDITION 396 [/b]
Vehicle Accident 304
Other 92
[b]SERVICE CALL 387 [/b]
Assist Invalid 182
Water Problem 18
Smoke, Odor Problem 16
Unauthorized Burning 5
Public Service Assistance, Other 166
Meds: [i]” I would appreciate it if the firefighters would do an honest an complete accounting of their time spent including training, equipement maintenance and whatever else it is they do with the time spent per task.”[/i]
Multiple retired Davis ff’s have told me that on a typical busy day, they work 8 hours out of 24; on a typical slow day, they work 4 hours; but on some rare days, where there are many calls and a structure fire, they will work as much as 16 hours out of 24. One ex-ff told me he “almost never” got to sleep 8 straight hours at the fire house. But the same guy told me, he got “some sleep” every day, even the busiest days.
On a related note… I agree with you that it would be much more helpful to have an actual time-log, as opposed to anecdote, of how each crew spends all 24 of its hours every day. I would be most interested in the actual work time of many others on the public payroll who are paid as if they are working full time, but it is unclear to me that anyone would dock their pay if they were not. Prime candidates in this latter category are all of our countywide elected officials. It’s very interesting to me that some of them have full time jobs–very serious, 50+ hours per week jobs–and they have 3 full-time staffers doing a lot of their supervisorial work, and yet they are still paid a full time salary with full benefits (the medical, of which, they fully cash out).
Medwoman wrote:
> Now I am really curious. A couple of questions for you.
> 1) Did you really, as a member of a private firm, get paid
> a lot of money for “sitting around doing nothing” ?
Yes I did
> This would seem to be in direct contradiction to the
> claims of a previous poster here who frequently
> made the argument that private firms were invariably
> more efficient than government workers.
> Your thoughts about this ?
It is not a contradiction… Private firms are (almost always) more efficient than the public sector. In my example the (“Big 8”) firm was making a profit every hour I “sat around” since the client paid when we were on site even if they were not ready for us ( aka the last minute cash flow manipulations were taking longer than they thought they would).
> 2) Since the use of computers and on line resources,
> I would be at a loss as to why any auditors would have
> to wait days for a company to compile any records for
> their review. Would they not just electronically send
> the request for records and then, depending upon the
> degree of modernization of the firm, await the electronic
> transfer of records for review, or await electronic
> notification that all of the files were available
> prior to sending out a reviewer ?
The “Big 8” became the “Big 6” about 25 years ago, back then there was no “on line” (and no “on line resources”) there was also no “electronic transfer of records” (sure you could ship giant data tapes or floppy disks but unless you had an identical computer accounting system with the exact software version you could probably not read them). We waited until the reports were printed (on a dot matrix tractor feed printer) and given to us.
> And on another note, I had no intent to
> imply that you were criticizing individual
> firefighters either. My intent was only to
> clarify the narrow range of my comment.
> I apologize if it seemed otherwise to you.
Thanks for the apology and I want to make it clear that I don’t want to bash firefighters (just like I would not bash individual doctors if they had a strong union got them paid them more than twice what other doctors would work for working half as many hours). I don’t have all the data that Rich does on the current “444” system vs. the proposed “3332” system, but I’ve read a lot of stuff that leads me to believe that in addition to saving money it will make the people of Davis safer. The firefighters that want to keep things the same have not put out anything objective to defend their position (that I have seen or heard of)…
Let me give you a typical 24 hours in my station. Again, I don’t work in or near Davis but i work for a district serving a Davis size population as a paramedic/firefighter that divides 5500 annual calls among 4 stations each staffed with a 2 ff paramedic engine and 2 ff paramedic ambulance working 48 hours on and 96 hours off.
All times are approximate and may be interrupted (and usually are) at any point for calls.
My shift starts at 0730 each morning. I arrive around 0700 to relieve the offgoing crew. A late call transporting a patient is an hour minimum and three for a long transport. My being there not only means the ff getting off work goes home on time but it also saves the department overtime. I’m not on the clock for any calls before 0730.
By 730 my firefighting gear is on and the ambulance and I’ve put the flag up the flagpole. After checking in with my captain I’m checking out the ambulance and its equipment until about 0830. Around then the captain usually holds a morning briefing outlining the plan for the day, the weather, special hazards, and any special memos handed down from above. Around 0900 we exercise as a crew using equipment we have at the station or bring from home. District policy says we should be showered and in uniform by 1030.
Depending on the day and call volume we train as a crew 2 hours either in the morning after workout or in the afternoon after lunch. Training may be physical or classroom. There is a monthly minimum of about 20 hours of topics handed down from the main office and the captain may include other training as needed.
Either the fire engine or ambulance crew shops in the morning of the first day for lunch & dinner for day 1 and brunch & dinner for day 2. We each pay out of our own picket $20 or $5 a meal for our food and do our best to budget within that limit. The department does not pay for meals.
Lunch is usually sometime between 12 and 1330. After lunch we either train if we didn’t in the morning or work on our individual projects. Each firefighter is assigned a office work type duty. Mine is keeping the EMS supply closet stocked of bandages, drugs, and such and maintaining the records for the supplies.
Each day there is also a list of cleaning chores to be completed such as mowing the lawn, washing windows, deep cleaning the kitchen and other such tasks. Each day of the week has 2 or 3 tasks assigned to it.
After 1700 we are allowed to dress down ie put on shorts if desired and the “work day.” is over. Generally cooking, eating and cleaning of dinner runs from 1700 to 1900. After that the night is ours to either catch up on reports and projects, read, watch tv, or whatever. The TV is not allowed to be on and we are not allowed to use the recliners in the dayroom between 0800 and 1700. I generally go to bed around 10. In a perfect world I sleep all night but I almost never do.
The next day we are required to be up at 0645 and the station tones go off at that time to ensure this. The second day is similar to the first except for the evening of the second day we clean the day and living areas of the fire station and wash the apparatus to ensure they’re clean for the next crew.
Questions?
[url]http://www.emergencydispatch.org/articles/whatis.html[/url] the working link to my first post explaining priority dispatch.
Growth Issue wrote (addressed to medwoman):
> Remember that when you tell one of your many anecdotal
> stories that you often share with the message board here.
Then medwoman wrote:
> GI Not understanding your comment. Can you clarify ?
I think there is a big difference between posting an “anecdotal story” like Jimmy’s Daughter posted about the good work the fire department did in her neighborhood when no one (that I have read) has ever posted that the firefighters don’t do a good job when they show up to fight a fire. Today when I posted that a friend who is not a “paramedic” does not go on medical calls it was not responding to someone who said that “non paramedics go out in the ambulance all the time”…
Not to give medwoman a hard time but off the top of my head I pointed out that most (but not all) woman working today are doing it because they “need” the money and she mentioned that she knows some doctor that works full time, but does not “need” the money.
When someone pointed out (in the debate about the alleged gay basher raised by a single mom while his MD Dad was flying around the world) that most (but not all) kids raised by a single parent have more issues than kids raised by both parents we heard about her great kids (and the kids of other MD single Moms) that turned out OK.
I think that we all know that some people just love working (especially super smart super skilled people like MDs) but that does not change that most (and just about all) woman would quit working if they got a check for $10 million. I also think that it is great that madwoman’s kids turned out well (and can’t imagine how hard it would be to raise kids on my own, but that does not change that most (but not all) people in prison were not raised by both parents…
My thanks to both Rich and nvn8v for providing exactly what I asked for. That is a lot of information for a not very numerically agile gynecologist to absorb. My hope would be that our city staff and city council members, whose opinion actually matters, would be taking all of this data into account.
Which brings me to GI since I now understand and would like to respond to your comment.
[quote]Remember that when you tell one of your many anecdotal stories that you often share with the message board here.[/quote]
I do remember exactly that whenever posting.
I think that there are a number of different reasons why one might post, whether anecdotally or factually. My area of expertise is very narrow, and not a usual topic for the Vanguard. So it is an unusual circumstance that I will be the most knowledgeable person posting on most topics not directly medically related. In the rare circumstances when I am the most informed on a topic, I try to explain why I feel that is the case, and then lay out my rational for my beliefs. In these rare cases, my purpose is to persuade.
In most of my posts, I try to be clear that what I am posting is either a question for clarification, or an anecdote in order to present a different point of view. In these cases, I am not attempting to prove, or persuade anyone that my point of view is correct. I am merely attempting to present a point of view for consideration that someone else may not have thought of in the same way because of different life experiences.
I doubt this will lessen the irritation of those who do not like my style, my politics, or my posts in general.
I do hope that it sheds a little light on why I present my ideas as I do.
One of the beauties of a blog such as this is that it allows those who post to lay out their beliefs in whatever format they choose. It also allows those who respond to critique those thoughts without necessarily attacking the poster on a personal level.
SOD
[quote]Private firms are (almost always) more efficient than the public sector. In my example the (“Big 8”) firm was making a profit every hour I “sat around” since the client paid when we were on site even if they were not ready for us ( aka the last minute cash flow manipulations were taking longer than they thought they would). [/quote]
What an interesting point of view. I think we are perhaps using the word “efficient” to mean very different things. For me efficiency is a reflection of real world value created per unit of time, not necessarily the amount of money earned.
You seem to be defining “efficiency” in terms of amount of money gained regardless of whether anything of value was being generated. Do I have you right, or am I misunderstanding ?
nvn8v wrote:
> Questions?
Do you have any volunteers/hang arounds (fire science kids from the local JC or kids that have completed a JC fire science program) that help you out with the lawn mowing/cleaning and other tasks around the fire station at your department?
Any idea what the average Total Cost of Employment/TCOE per firefighter is at your department (I have never found Yolo county on line, but you might be able to see your name and TCOE on the link below)? One of the things that blows my mind is that there are fire departments in California that have an average TCOE of about 50% of what Davis pays and other departments in California that have an average TCOE of 50% HIGHER than Davis.
http://www.contracostatimes.com/salaries/
P.S. Thanks for the detailed post on “a day in the life of a firefighter”
My fire district has a component of volunteer firefighters who supplement the staff for fires and other critical calls. Both they and the general public are allowed to do ride alongs with us if scheduled beforehand. A normal ride along is daytime 8-5 Monday-Saturday. During the ride alongs the volunteer FFs are expected to participate fully in our routine including cleaning and though some take advantage of that and make the ride along do all the work I do not. It’s a team sport after all. There’s usually one ride along like this every week otherwise we just see them at calls and training.
Civilian ride alongs obviously have a more restricted role in terms of training and participation and response but if they offer to help with the chores I won’t say no. These are rare unless we are engaged in a hiring process. Even then it’s not super common.
We also offer ride alongs for class credit for programs such as the community college fire academy, EMT course, and a full 10 week paramedic internship for paramedic students. These obviously are focused on training and job functions but they (especially the paramedic interns because they work the full 48 hour shift with us) are also expected to help us with the daily chores.
I have yet to experience a person walking in off the street offering to mow the lawn. That would be strange.
I do not have that information available but I would guess counting PERS and benefits an average of $100,000 to $150,000 per employee in total comp.
medwoman wrote:
> You seem to be defining “efficiency” in terms of
> amount of money gained regardless of whether
> anything of value was being generated. Do I
> have you right, or am I misunderstanding ?
You are misunderstanding me…
Efficiency is very different that Profitability (but efficient firms are usually more profitable).
An example of private sector vs. public sector is in the building of a small wall. If I as a private citizen want a small concrete wall built I’ll call a private company (specifically a guy I know that runs his successful concrete company out of his home) and he will come by to measure and be out the next week with a crew and build the wall.
If a government wants a wall built staff members will work on a request typically killing a half day of staff time then it will go to the board for the approval to get a bid (it will get voted on at another meeting). They will then either use an in house architect/engineer (or give the job to a campaign contributors firm) to design the wall and before the design and cost estimate even makes it to the board for final approval they will have spent twice as much as I spent to build my wall. If they go forward and use government labor to build the wall it will on average cost 5 to 10 times more than my private sector wall and not be any better…
[quote]“The second reason is that the contract EMS provider, AMR has successfully lobbied to prevent fire departments in yolo county with the exception of cache creek from providing a higher level of care than EMT basic. This in combination with a monopoly of EMS transports in Yolo County means AMR calls the shots and takes the money from transports.”[/quote]How locked-in is this monopoly? Who makes this decision? How does it impact Davis firefighters when they arrive on the scene and AMR isn’t there?
How many of our firefighters are EMT-trained/certified?
[i]”Private firms are (almost always) more efficient than the public sector.”[/i]
My own work experience, all in the private sector, including times as a general partner and others as a contract employee (where I was effectively self-employed), is that there is a wide spectrum of efficiency among private enterprises. All companies composed of fallible human beings, with quirks or flaws or just a need to chill at times, and so even the most efficient are never perfectly efficient.
I’ve worked for excellent companies which, while efficient in the main, still have areas which are inefficient or staffed by a few bad managers who fail to get the most out of the people who work below them.
I’ve also seen situations where ineffective employees who deserve to be fired are never let go. (Usually this happens because the company believes, rightly or wrongly, that firing “so and so” would result in a lawsuit and the cost of the lawsuit would be more than the benefit from the firing.)
What I have never seen in a private company of any size is where a highly effective and ambitious employee did not rise through the ranks. If there is a company out there where that happens on a regular basis, it won’t last in business very long. Good people who are not rewarded for being good will leave and find a better job at a different company and the company they left will be run out of business (unless it’s in a monopoly situation, I suppose).
By contrast, my sense is that a big problem in government (including public schools) is that the cream does not always rise to the top. Ambitious people usually do. But they are not necessarily good. And some public agencies have a real “holding down the Joneses” ethic, where a very good worker is viewed by others as someone who is trying to make the rest look bad. In that environment, quality gets pushed aside. This is even worse in public agencies where “managers” cannot fire bad employees, because the bad ones have civil service or union protections. That kills morale in any corpus.
Something problematic that almost all large companies have in common with government work is they are bureaucratic–where everyone is forced to fill out a lot of needless paperwork and forced to attend staff meetings and forced to take some sort of re-education classes*, none of which adds to the bottom line.
*In my own life, I am thinking of having to go, every year, to a “sexual harrassment prevention” seminar. Total waste of time for me and for everyone but the ladies who get paid to run them. I have been told by others their companies force them to do the same things to prevent race discrimination or in one case for “handicap awareness” and so on. Also, I know people in physical labor jobs at many large companies regularly have to get waste of time “safety training.” Ultimately, all of these things come down to IQ. If you are not stupid, you don’t need these things repearted to you. A one time lecture for a new employee can be helpful for topics an employee is unfamiliar with. The repetition is where the waste comes in.
[i]”How many of our firefighters are EMT-trained/certified?”[/i]
100%.
[i]”How locked-in is this monopoly? Who makes this decision?”[/i]
From the 12-5-12 Davis Enterprise: [quote]Yolo County will withdraw from the 10-county emergency medical services agency it has been a part of for 37 years and create its own local EMS agency within the next six months.
County supervisors voted unanimously Tuesday to make the change following the recommendation of Yolo County fire chiefs and city managers, several of whom testified that a local EMS agency will provide more efficient, effective and expedient services to county residents.
The new EMS agency will operate as a division of the county Health Department. County health director Jill Cook said American Medical Response will continue as the county’s ambulance provider for at least the next six months and possibly afterward, pending a competitive bidding process. The county will contract with Solano County to provide oversight and administration of the Yolo agency.
Since 1975, Yolo County has been a member of the Sierra-Sacramento Valley Emergency Medical Services Agency, which started out as a five-county agency but later grew to 10 counties stretching to the Oregon border.
The sheer size of the agency has hampered efforts to improve the delivery of emergency medical services in Yolo County, said UC Davis Fire Chief Nathan Trauernicht.[/quote]
[i]”How does it impact Davis firefighters when they arrive on the scene and AMR isn’t there?”[/i]
I am not sure if the JPA contract is what decided this, but the DFD does not transport patients. So if DFD arrives first, they will give medical aid until the AMR crew shows up. At that point, the AMR crew is in charge and decides if the DFD personnel is still needed. If not, the firefighters are sent back to their station. If the patient needs to go to the hospital, the AMR will take them.
Note that in Davis we have 2 ambulances stationed here (and, of course, 3 fire houses). So if a medical call comes in when no one is busy, chances are that one of the fire engines is closer, just because they divide Davis in thirds, while the ambulances divide Davis in half.
Yet there is another factor: Woodland and W. Sac get a lot more calls for ambulance service than we get in Davis. When Woodland gets a call, the AMR director will move one of the Davis ambulances half way between Davis and Woodland; or if W. Sac has a call, he could reposition a Davis ambulance half way to West Sac.
The result of these regular repositionings is that while Davis, in theory, has 2 ambulances, it very often will just have 1 in town. At the same time, we have very few fires. So our firefighters still divided Davis 3 ways, but the single ambulance takes all of Davis. As a result, if there is a very big difference (5 minutes or more) between the time a fire truck arrives at a medical call and the time an ambulance arrives, the ff’ers will always be there first. (I wrote a column on that.)
Also, DFD, UCDFD, and all Yolo Co FDs except Yoche Dehe Fire (Cache Creek indian casino) are not paramedics and thus limitied to providing basic life support snd first aid.
AMR provides Advanced life support with paramedics ie IV fluid, cardiac care, narcotics for pain, etc… Many fire departments including LAFD, the subject of the above article, not only provide ALS care but transport patients too.
In light of some posters interest in how many hours a group of public servants ff works, consider your current prez schedule…
[quote]President’s Schedule – April 19, 2013
Daily Guidance for 2013-04-19
Fri, 2013-04-19 09:27 — csponn
In the morning, the President and the Vice President will receive the Presidential Daily Briefing in the Oval Office. This meeting is closed press.
Later in the morning, the President will meet with senior advisors. This meeting in the Oval Office is closed press.
At 3:00 PM, the Vice President will meet with Deputy Prime Minister Taro Aso of Japan at the White House. This meeting is closed press.[/quote]
“Also, DFD, UCDFD, and all Yolo Co FDs except Yoche Dehe Fire (Cache Creek indian casino) are not paramedics and thus limitied to providing basic life support snd first aid.”
What does it take to qualify EMT firefighters as paramedics? Does the chief’s proposed plan include any paramedic capability?
JustSaying wrote:
> What does it take to qualify EMT firefighters
> as paramedics? Does the chief’s proposed plan
> include any paramedic capability?
There is a HUGE difference between an EMT and a Paramedic (I became an EMT years ago and it was just a little work beyond CPR/Advanced lifesaving and not nearly as hard as Wilderness Medicine).
I don’t know about Davis but many Fire Departments (that spend ~70% of their time doing medical calls) still do not require everyone to be a paramedic.
My best friend’s department has required new hires to be paramedics for years, but the union made sure that the older guys never had to become paramedics.
Paramedic training takes about one year. The first six months is a 1200 hour classroom based course where students typically must maintain a average score of 80% or greater. After that about 480 hours of hospital clinical rotations working in the ER and various other units. The final portion is another 480 hours of field internship on a transporting ambulance overseen by a paramedic preceptor where the student is assessed for general competence and ability to apply the training in the real world on real patients. The final step is a national practical and written examination.
Compare the EMT basic standard used by DFD of around 500 hours total of classroom and field time.
The other half of converting to a paramedic level of care is the up front cost of equipment. The normal price of a portable heart monitor/manual defibrillator is around $50,000 and there are several other pricey pieces of equipment to be bought including ambulances. It should be remembered though that providing a paramedic ambulance service would also mean the department could bill for services rendered like AMR does now thus offsetting most all of the up front and annual costs and with a good collection rate (this shouldn’t be a problem in Davis since most people are insured) may turn a small profit.
[i]” It should be remembered though that providing a paramedic ambulance service would also mean the department could bill for services rendered like AMR does now …”[/i]
My understanding is that the City could now bill for services rendered for a medical call. I was in on a conversation involving 2 members of this city council and a department head–we were actually discussing a slightly different matter–and one of the council members brought this idea up and the department head, who seemed to know the law on this topic, agreed that billing for such services was doable.
Just to be clear, I took the idea to mean billing medical insurers for these services, not uninsured individuals. But the idea was, if someone calls 9-1-1 and needs medical aid and the DFD shows up at the person’s house and renders any medical aid, the City would send out a bill for its costs.
The real money is in transporting patients and providing ALS level care. My department charges anywhere from $900 to $2000+ per transport based on mileage and the level of care. ALS ads about 1/3 to the bill. My department bills everyone insured or not. and the remainder of the bill if any not covered by insurance for insured is billed to the individual. It might sound cold hearted but it’s how we keep the ambulance service cost neutral.
Here’s how Vacaville Fire bills for EMS and other incidents: [url]http://www.cityofvacaville.com/modules/showdocument.aspx?documentid=947[/url] They charge a resident and non resident rate.
Many agencies including mine offer an ambulance subscription service for around $50 to $75 a year where if a member of the subscribing household is transported the patient is not billed directly. Only the insurance (if any) is and the remainder is written off.
Here is an example from Carson City, Nevada [url]http://www.carson.org/index.aspx?page=1448[/url]
opps here’s the Vacaville link: [url]http://www.cityofvacaville.com/modules/showdocument.aspx?documentid=947[/url]
[url]http://www.cityofvacaville.com/index.aspx?page=88[/url] click on Fire Service fees. Sorry for the double posting!
SOD
[quote]Not to give medwoman a hard time but off the top of my head I pointed out that most (but not all) woman working today are doing it because they “need” the money and she mentioned that she knows some doctor that works full time, but does not “need” the money. [/quote]
Actually, what I mentioned is that I know many women physicians who do not “need” the money. Many of my colleagues are in two physician families. It would be hard to make the case that either partner would “need” to work in the sense of providing a secure living for their family. Most who are married work because we love what we do. I also know many nurses, CNMs and nurse anesthetists who do not “need” to work. Many are married to physicians so they certainly do not “need” to work. People work for many reasons, money is only one.
Also I would take exception to your comment that almost all women would stop working if given a check for
10 million dollars. Many, many women have more than 10 million dollars ( just Google women millionaires and billionaires) and many of the millionaires and billionaires continue to work. As a matter of fact, a large number acquired their fortunes through their own work, not through inheritance or marriage.
medwoman wrote:
> Actually, what I mentioned is that I know many
> women physicians who do not “need” the money.
People that work because they don’t “need” the money don’t spend any of the money they make. Do you really know “many” physicians that either invest or give away 100% of what they make? One of my wife’s best friends is married to a physician and she works (part time) because they “need” the money…
> People work for many reasons, money is only one.
> Also I would take exception to your comment that
> almost all women would stop working if given a
> check for 10 million dollars. Many, many women
> have more than 10 million dollars
Do you want to go out on a limb and say that most (more than half) of the single woman in America worth over $10 million are working full time. I am certain that the percentage working full time is well under 10% (a lot of men would also stop working but the number would be less than the woman). I’m not trying to pick on woman, I’m just looking at the real world…
> As a matter of fact, a large number acquired
> their fortunes through their own work, not
> through inheritance or marriage.
Sure there are some females worth over $10 million that earned it but it is a very very small percentage. The number of female billionaires in the history of the world that acquired her fortune on her own is one (just a single woman in the past 2,000 years even if we adjust for inflation)…
[quote]Just to be clear, I took the idea to mean billing medical insurers for these services, not uninsured individuals. But the idea was, if someone calls 9-1-1 and needs medical aid and the DFD shows up at the person’s house and renders any medical aid, the City would send out a bill for its costs. [/quote]Wow! The private sector will bill the patient, and accept 40 cents on the dollar if they are covered by insurance. They will bill and harass the uninsured, an invoice for 100%. Can you get that down to 40%? NO. Why shouldn’t the City bill 100%, and accept 40% from the insured or the uninsured? Should the uninsured get a “freebie”?
[i]” Why shouldn’t the City bill 100%, and accept 40% from the insured or the uninsured? Should the uninsured get a “freebie”?[/i]
I don’t know what the member of the city council who was discussing this idea would say to your question. However, my own take is that you really don’t want a policy which causes people who need emergency aid in a timely manner to eschew it because they fear an unaffordable medical bill. For example, say someone is pregnant and has medical insurance which covers her regular medical expenses and includes coverage of an ambulance taking her to the hospital, but does not cover the cost of a fire crew responding and delivering supportive medical aid. And say the city figures the cost for this delivery of service to her is $750. So, in need of immediate medical attention due to a complication in her pregnancy, she won’t call 9-1-1, for fear of that $750 bill. Instead, she drives herself to the ER and by doing so potentially risks her own health and that of her unborn child. It is that sort of thing that, from a public policy perspective, you don’t want to give people perverse incentives, if they result in unwise decisions as to emergency medical care.
I should add that, along these lines, I have been told stories by readers of my column about folks who refuse to call 9-1-1 for emergency medical aid for a different reason: Noise.
As I understand the various stories, they tell me that the problem is the massive presence of a fire engine, the fire rescue truck and the ambulance, all coming into their quiet neighborhood with the sirens blaring. In these cases, the patient has a chronic condition–such a heart disease–and will need emergency medical treatment every few months on an irregular, unpredictable basis. But they don’t want to call 9-1-1, because they know it means waking up everyone on their street.
I have also been told that at the URC, this noise situation was so bad that the DFD and AMR made a policy change to kill their sirens a block or more away from the URC, because they get calls their every single week, some weeks more than once.