Fire / Medic Roulette

 A Game No One Should Play

Firehouse roulette, the practice of closing fire companies on a rotating basis instead of paying overtime or adding new employees to fill vacancies, was a practice started in the 1970’s. It has reappeared during budget shortfalls or hiring freezes every decade since then.

Baltimore firefighters are suffering from the latest, and more troubling, version I am calling Fire/medic Roulette. Fire/medic roulette occurs when on-duty fire companies are closed so crews can staff additional ambulances. Up to ten of the 55 suppression units may be unavailable to respond to fires because members are staffing four red alert and six ready reserve ambulances. This is another example of not walking the fire-based ems talk.

This is especially aggravating for Baltimore after they lost staffing for four engine companies, two truck companies and a battalion chief in 2001 in order add ambulances, reduce overtime and stop Baltimore’s old-school firehouse roulette. Three mayors have reduced on-duty firefighter staffing since 1984. The closing of three fire stations in 1991 by Mayor Schmoke is one of the few fire department case studies used by the Kennedy School of Government at Harvard.

Baltimore City Paper reporters Michael Anft and Van Smith wrote “Burning Questions: Understaffed and Overworked, the Baltimore City Fire Department – Once Hailed as the Nation’s Best – Faces a Crisis Point” in April 29, 1998 that described the impact of this process.

Incoming Mayor Michael O’Malley assembled a ten-person committee from the Greater Baltimore Committee and President’s Roundtable to look at fire department operations in 1999. They noted four trends. The number of structure fires dropped by more than 50% in five years (two bar chart). The majority of fire department responses were for ems. (pie chart)

[photopress:demand.jpg,full,centered][photopress:pie.jpg,full,centered] 

 The paramedic ambulances were averaging 14 hours and 25 minutes responding to, treating and transporting patients in a 24-hour day while the engines and trucks spent about an hour and forty minutes on emergency activity in a 24-hour day. About half of the fire company responses were as ems as either first responder or to assist on scene medics. (three bar chart). It took twice as long for an ambulance to get to the scene as it took a fire company. At that time, Baltimore showed an 8 minute 44 second average. Philadelphia showed a much better 6 minute 12 second ambulance response average. (two bar chart)

[photopress:timeis.jpg,full,centered][photopress:resptime.jpg,full,centered]

Their recommendation was to close seven fire companies. Reassign 100 firefighters to cover existing vacancies. Transfer 40 positions to staff four to six additional paramedic ambulances. They claimed that they would improve ems delivery and reduce overtime by $4 to $5 million dollars. By time the dust settled, there were four more paramedic ambulances in service, four fewer engine companies, two less truck companies and one less battalion chief.

While that may have addressed the ems workload from a 1999 analysis, Baltimore experienced the same skyrocketing demand for ambulance service that other cities encountered. Using the LAFD workload maximum, Baltimore needed 30 paramedic ambulances instead of the 22 that they staff.

There were four “red alert” ambulances that would go in service when the number of available transport units fell from 22 to three. Medics 41, 42, 43 and 44 would be staffed by placing fire suppression companies out of service. By 2005, the red medics were in service for 20 consecutive days or longer. In 2006, these four units apparently morphed into 12-hour peak demand units, in service from 0900 to 2100. Unfortunately, staffing remained from the existing pool of on-duty firefighters and paramedics. These units averaged 2736 runs in 2006, about 7.5 responses a day.

[photopress:medic_15_wrecked.jpg,full,centered]

There are six “ready reserve” paramedic ambulances, one in every battalion. Medics 61, 62, 63, 64, 65 and 66 apparently serve the original mission of the red alert medic units. They averaged 309 responses per unit in 2006.

This is not the first time what was promised is very different from what was finally delivered. In 1989, the department merged five engines and five truck companies to establish aerial tower (quint) companies. The creation of the aerial towers dropped fire station staffing from 8 to 6, eliminating a company officer and apparatus operator. Over the years, minimum staffing continued to decline until the crew was down to four. When the department replaced the 1989 quints, they purchased traditional aerials. Engine 28 and Truck 2 were merged to create Aerial Tower 102. Thirteen years later, Truck 2 returns to service and Engine 28 remains a memory. This link provides more detail: http://www.bcfdtruck2.org/steadman.htm

[photopress:truck_2baltimore03.jpg,full,centered]

Update, Aug. 13:  According to Division Chief/EMS Lloyd Carter, when the original red alert medic units morphed into 12 hour units last year, they were staffed with available staff or overtime and did not require the closing of a fire company. Four 12 hour units Monday-Friday, two 12 hour units on weekends.
…….FossilMedic