By Kevin Meyer
An article in today's Wall Street Journal made me think a bit about organizational scope creep.
It takes twice as many firefighters to put out half as many fires as it did 30 years ago. Fewer fires because of better fire safety is one reason, but another is the dispatch of overqualified firefighters and their vehicles to things that aren't fires.
In Orange County, Calif., only 2% of responses involve fires. In Massachusetts the figure is 5%—only because Massachusetts doesn't count emergencies that don't result in injury or property damage.
The Orange County Grand Jury, an official watchdog agency, is the latest to plumb this phenomenon: "This transition from fire emergencies to medical emergencies has not generated major changes in the operation model. . . . Each emergency call generally results in both fire trucks and ambulances being dispatched to the site of the emergency regardless of the type of emergency."
What would really make sense, of course, is properly manned fire trucks responding only to fires, leaving other emergencies to one- or two-person police or ambulance crews.
The article describes several similar situations, and provides a lot of fodder for those that believe government has become too large or that there's an alternative to raising taxes. But that's not my point and I won't go there.
It's not just big cities. Here in my small central coast beach town, I regularly see ambulances go up the street to check on my plethora of retired elderly neighbors… followed by a couple of large fire engines. Of course the police blotter in this town is filled with such nepharious activities as "Mildred heard a noise but it ended up being her gate swinging in the wind." Or something mischievious happening at the local "medical" marijuana dispensary.
The scope of the fire department has changed over the years, and now includes responding to medical emergencies. Perhaps that's entirely appropriate as firefighters have EMT training. But as noted above the operational model hasn't changed, so unnecessary equipment and personnel also respond, therefore the response cost has increased.
We could identify innumerable other examples of this in government – safety nets that have become entitlements provided to 100 million citizens, intelligence strategies that have become "proactive" offensive missions (see! I covered both sides!), etc. All requiring more money – more taxes – to provide a skewed but now expected level of service.
But my point is that the same happens in business. How many bandaids upon bandaids of "quality checks" or "signature approvals" get added because managers don't have the guts (ok, "no time") to attack the root cause of a problem or issue? How many non-value added admin groups expand and expand thanks to managers focusing on power instead of what's best for the organization? How many times does a senior manager have to get involved to make very small decisions because the folks that actually own and run the process aren't empowered – or trained – to make the decision.
When do you use a fire truck when an ambulance would do just fine?
Bill says
I live in a small town with a volunteer fire department. Many years ago my father took what we thought was a stroke. My mother phoned for an ambulance and while we were waiting for it to arrive we could no longer detect a pulse on my father. While my brother and I commenced CPR we had my mother call the fire department to get more bodies on the scene to help. They came with all the trucks. Yes it would have been more cost effective / efficient to just come with the emergency vehicle but in these situations how do you get enough information to make the proper decision?
My father passed away that day from an aneurism of the aeorta which I blame as the result of a lifetime of being a heavy smoker.
Robert Drescher says
Hi Kevin
It points to thebig problem that we have created systems where people have to little time to slowdown and think things through clearly instead we jump to apply another bandaid and never stop to actually fix the real problem.
Mike T. says
Going a step further, what is often the biggest reason for fire trucks to be mobilized in those 95%-98%? Perhaps a small, ‘utility’ truck with jaws-of-life and basic EMT equipment would be a better, quick-response unit to supplement an ambulance – in case there is greater need? I wonder what some observations of the process would reveal? Perhaps a new emergency response protocol.
James says
I think you’re stumbling towards a really important point, that the whole government bad private sector good / more efficient dynamic, or the reverse, is really not helpful, or true. In my work I’ve found both sectors and the charity sector for that matter full of inefficiencies, band aid solutions, poor management etc. The causes and manifestations are different as are the incentives but there is plenty of waste in both.
Which is probably my prime attraction to lean, it try to avoid this kind of simplistic labelling and instead see organisations from a systems perspective.
Frank Billington says
Mr. Meyer, did you actually ask anyone in the fire or EMS services to explain this before writing about it?
It is a complex issue that requires more education than can be provided in a few readable short paragraphs, but I’ll give you some leads to follow.
(1) CPR calls require at least three EMT/medics, not including the ambulance driver. How do you provide four personnel using two-man ambulances and not leave a vehicle behind?
(2) Trauma calls requiring spinal immobilization (any car wreck, fall, etc) also require more than two EMT/medics to get the person stabilized for transport.
(3) Due to cheap/advanced engineering and materials, structure fires grow more quickly, generate more toxic fumes that kill faster, and cause structural failure exponentially earlier than 30 years ago.
Fire engines are more geographically diverse and ready compared to a few ambulances. A typical EMS call generates a fire engine (first response) followed by an ambulance, resulting in at least five personnel on scene. This means there is enough help to handle the big calls and still have a fire engine driver to go pick the crew up. And for less serious calls, the firefighters have their big toolbox right there with them and can quickly respond fully equipped to any other calls that come up.
This is not to say that every EMS call should get the works, and they don’t. Today’s evolved 911 EMS triage can assign just the resources needed based on the info provided by the caller, so you don’t get two or three units at a broken toe or sideways nasal hair that can in fact be handled by just two medics.
It is better to show up with more than you need and not need it than not enough and needing more. You can always turn unneeded resources back. Seconds literally count for critical EMS calls and for fires, and if you go down in cardiac arrest and understand how much help is needed for you to have a chance at surviving, you would not so easily characterize a two-man ambulance as “just fine” for your emergency.
Chuck Waddell says
Well said Frank Billington. Readers should also be aware of the extent to which most Fire/EMS personnel are trained in skills beyong fire extinguishment and emergency medicine. Here in Chicago, there are long waiting lines to participate in training classes in hazardous materials mitigation, confined space, trench and vertical rope rescue, SCUBA diving, vehicle and machinery victim extrication, and others. The men and women of the fire service are prepared to provide these services to complete strangers at a moment’s notice, at all hours, in all weather and in dangerous situations. The fire service is not and will never be a “lean enterprise.”
Kevin Meyer says
“The fire service is not and will never be a lean enterprise.”
Why not? Frank and Chuck have explained how there’s additional value provided by Fire/EMS beyond the simple paramedic calls. If that value is appropriate – and valuable from the customer’s perspective – then if it is being delivered as efficiently as possible it can be a lean enterprise. “Lean” does not mean “lacking.”