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DEVELOPING 21st-CENTURY TIME ON TASK AND OUTCOMES DATA

There is a multiple organization effort starting next month to identify the current “time-on-task” for fire suppression and ems activities from 400 fire departments. In addition, there will be 50 fire and 30 ems experiments to identify the time required to obtain measurable outcomes. The results of this effort may have the same effect on staffing, deployment and evaluation as the Ontario Pre-hospital Advanced Life Support (OPALS) project had on paramedics in 2005. http://www.chsrf.ca/final_research/ogc/stiell_e.php

LAST CENTURY’S RESEARCH

When California voters passed Proposition 13 in 1978, local government revenues were significantly reduced due to restrictions on the property tax rate. This required immediate and serious reductions in local government staffing and services. The Los Angeles Fire Department (LAFD) was faced with the possibility of a reduction in staffing of their single-unit engine companies. At that time about half of the 103 LAFD fire stations operated a single-unit engine company.

The LAFD developed a task analysis of typical initial fireground scenarios that included a list of required on-scene performance objectives for an engine company. They broke each objective into fundamental and discreet tasks and performed extensive time and motion studies using different staffing levels to accomplish the tasks. The Measure of Effectiveness System (MES) identified the tasks performed by each fire fighter in chronological order. The analysis was performed with variations in crew size from three to six members and documented significant increases in the time that was required to accomplish the standard fireground objectives as the size of the crews decreased. The results justified retaining five fire fighters on single-unit engine companies.

There were three subsequent studies that followed the LAFD success. They formed the core of fire suppression staffing and deployment research in the 1980s. Seattle, Houston and Phoenix used research to support the maintenance or expansion of fire company staffing and deployment.

There is a problem with the 1980s research. While the results were valuable for decision makers in Los Angeles, Seattle, Houston and Phoenix, the process cannot establish a validated set of best practices for use by others. They did not use the structure and academic vigor needed for professional-grade research. To be fair, none of the studies were constructed with that goal, but for two decades we have tried to extrapolate their results to make the connection.

THE START OF 21st-CENTURY RESEARCH

During the 2003 IAFF EMS conference, 17 focus group meeting were held to identify indicators of EMS system quality. The IAFF EMS committee was charged with generating an agreed-upon set of performance indicators. http://www.iaff.org/tech/ops/performance.htm

The resulting IAFF/IAFC EMS System Performance Measurement instrument consists of 15 EMS quality indicators, their definitions and performance measures. The instrument also provides background information relating the indicator to quality in an EMS system, explains any existing standards, notes the absence of standards, proposes a system goal and provides for data collection of information related to each main measure. The indicators include: call processing time, turnout time, defibrillation time to first shock, employee turnover, patient outcome, protocol compliance, deployment of mobile resources, staffing and employee illness and injury. The measurement instrument will provide system leaders the best way to collect relevant data and to report on that data in the future.

This project is the latest example of labor-management initiatives that benefit the fire service. Part of this effort includes the 2007 Fire-Based EMS white paper and DVD that was profiled in my July 24th column.
http://firegeezer.com/2007/07/24/walking-the-fire-based-ems-talk/

FIREFIGHTER SAFETY AND DEPLOYMENT STUDY

Building upon the work started by the IAFF/IAFC EMS Systems Performance Measurement program, a Department of Homeland Security funded research effort is starting to gather data and conduct time-on-task experiments to develop a prospective deployment model. http://www.firereporting.org/

Joining the IAFF and IAFC in this effort, are three national groups and one technical sponsor: the Center for Public Safety Excellence http://www.publicsafetyexcellence.org/ , the Worcester Polytechnic Institute Department of Fire Protection Engineering http://www.wpi.edu/Academics/Depts/Fire/What/index.html , National Institute of Standards and Testing http://www.fire.nist.gov/ , and Firehouse Software http://www.firehousesoftware.com/ .

From May through the end of 2008 FireReporting.org will be obtaining data from 400 fire departments, including the 53 largest fire departments. The letters of invitation will be going out next month. The data obtained will be used to document experience with time-on-task skills and outcomes.

While the data is obtained, crews from Montgomery County, Maryland, and Fairfax County, Virginia, will be participating in experiments to determine time-on-task requirements and comparing different staffing schemes with outcomes. There are 50 fire suppression and 30 ems time-on-task experiments. We are coming a full circle, as these experiments are similar to the LAFD fireground task studies using three to six firefighter engine companies in 1979.

May even address the issue of two paramedic versus one paramedic and one emt ambulance staffing. This will end thousands of hours of passionate but statistically devoid firehouse kitchen debates.

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