Reform 3.5.1: Ambulance and Fire Truck and Deployment

[Consider alternative] Ambulances vs. Fire Trucks and Deployment Models (Fighting Fires vs. Medical Emergencies).

Other Information:

Between FY 1980 and FY 2005, the number of emergency medical incidents reported to the City exhibited a four-fold increase. During the same period, the number of fires reported to the City actually decreased1. Between FY 2006 and FY 2009, the City Fire-Rescue Department responded to an average of 3,802 calls for fire per year, compared to 89,896 for EMS2. This means during this period, the Fire-Rescue Department handled 23.64 EMS calls for every fire. In FY 2010, 85.64% of calls handled by the City's Fire-Rescue Department were for EMS, while the remaining 14.36% consisted of fires and other types of calls3. Basic Life Support (BLS) care, provided by Emergency Medical Technicians (EMT's), is basic medical care and transport of non-critical medical patients. Advanced Life Support (ALS) care, provided by Paramedics, is the level of medical care and transport necessary for more critical patients. Both Fire-Rescue fire engines and SDMSE ambulances provide BLS and ALS care, however only SDMSE ambulances can provide for medical transport. County of San Diego Emergency Medical Services Treatment Protocols/Policies, Section P-801, requires that the City respond to all ALS incidents with a minimum of two paramedics. However, because the city has adopted a policy that all City Fire-Rescue engines are staffed with three EMT's and one paramedic, while SDMSE ambulances are staffed with one EMT and one paramedic,4 the City dispatches both a fire engine and ambulance to all ALS incidents. As a result of this service-delivery model and staffing structure, the city sends four EMS personnel to all incidents, thus making those resources unavailable for all other calls. In contrast, a system primarily dependent upon ambulances (rather than fire trucks and ambulances), could send two or four EMS personnel to a call depending on severity, thus providing the potential for two EMS personnel to remain available for other, perhaps more critical, incidents. The need for a thoughtful review of current fire engine staffing is not a trivial issue. Under the City's current Memorandum of Understanding (MOU) with its firefighters, the cost of maintaining a level of staffing above that which is legally required by the County is significant. To maintain the minimum legally required staffing (under the current cost structure), the City would need to pay only the sum of the four firefighters’ base salaries plus a premium of 8.5% of base pay to one EMT (omitting overtime and other considerations). To maintain its current staffing levels, the City must pay the sum of the four firefighters’ base salaries plus an 8.5% premium to three EMT's and a 13.5% premium to one paramedic (again omitting overtime and other considerations). Thus, approximately speaking5, the current EMS delivery method increases engine-staffing costs by 7.5%.

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