10 Critical Questions Every Fire Chief Should Be Prepared to Answer In today’s fiscal environment, cash-strapped city managers are examining every expenditure, and nothing is immune. And as the largest category in many municipalities, public safety is increasingly coming under scrutiny, often with the expectation that there’s always something more to cut. The aim is no longer doing more with less; the new goal is doing less with (even) less. For fire chiefs, that means tough questions and tougher choices than ever before. To help you prepare for conversations with your city manager, this report focuses on some of the most pressing issues, with information that can help you develop thoughtful answers to the most difficult questions.
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Smart chiefs know that the keys to meeting any challenge are preparation, solid information and clear leadership. For the past 30 years, Fitch & Associates has helped hundreds of communities across the United States and around the world deliver better and more efficient emergency services, accountably and sustainably. To learn how we can help you prepare for—or meet—the challenges your department faces, call us at 816-4312600 today for a free, no-obligation consultation.
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“Should we be involved in community paramedicine?” What the question really means: When city managers ask about community paramedicine or mobile integrated healthcare, their concerns could be related to fear of a new distraction, possible new hires or workforce expansion, or losing the ability to implement workforce reductions. They may also be thinking in the opposite direction—that is, seeing a potential source of revenue. And, of course, they may simply be interested in providing better care to the community. How to formulate your answer: “We already are” is the short answer. Every fire first-response program is a part of the community health network. Whether it’s offering free blood-pressure checks or a full scale mobile integrated healthcare program (MIHP) to complement first response or transport services, fire agencies need to make decisions based upon community needs and their own capabilities to provide superior service. There may be economic benefits to the department, but offering this type program involves different skill levels, enhanced data and technology capabilities, and an expanded commitment to being more tightly integrated with medical control, disease prevention and chronic disease management. A responsible analysis of this question will also consider that changes in healthcare reimbursement are driving hospitals to seek ways to keep patients from being readmitted, along with a general move toward prevention and patient-centered care. Make no mistake: These trends will affect your city, if they haven’t already. Accordingly, community paramedicine may be a way that your department adapts to meet evolving community needs. Useful resources: For in-depth articles and additional information about this evolving area, visit http://www.fitchassoc.com/ mobile-integrated-healthcare-practice-resources/
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“Are our stations in the right locations?” What the question really means: City managers who ask about the locations of fire stations may be looking to justify keeping a station open. Or they could be searching for support for flexible deployment, brownouts or closing one or more stations outright. At the very least, they’re giving you an opportunity to defend station location and staffing based on a stronger rationale than “that’s the way we’ve always done it.” At best, they’re giving you an opening to propose ways to optimize your department’s resources and capabilities. How to formulate your answer: Note that fire station locations are often based on history, politics, and economics, and to meet Insurance Service Office (ISO) criteria. Having a favorable ISO rating benefits a community by having lower insurance rates for homeowners and businesses. However, under the International Association of Fire Chiefs’ (IAFC) “all hazards” concept, the best location for a community resource to handle medical calls, hazardous condition investigations, traffic collisions, outside/trash fires and structure fires may not be the same locations needed to meet an ISO measurement. Fire departments may need to adopt flexible deployment. Do you need to staff three ladder trucks to protect a central business district when it is 80% closed from 11 pm to 7 am?
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“Standards of Cover” is a tool used by the Commission on Fire Accreditation International (CFAI) to evaluate fire departments for the Center for Public Safety Excellence (CPSE). The process starts with assessing the community’s outcome expectation, followed by a community risk assessment. With the risk assessment, the process looks at distribution of fire stations, followed by evaluation of concentration of resources. Would it be better to staff a “super station” with two pumpers, an aerial and a heavy rescue, or spread them out in four different locations? Oregon State Fire Marshal’s office provides an overview of the process, with examples: ht tp://w w w.oregon.gov/osp/SFM/pages /data _ standardsofcover.aspx A solid example of a Standards of Cover strategic plan is from the Novato Fire Protection District: http://www.novatofire.org/Modules/ShowDocument. aspx?documentid=34 Fitch & Associates conducts a detailed risk assessment that incorporates these traditional approaches with a proprietary risk-based assessment for fire and EMS demand. For further information, contact Guillermo Fuentes, partner, at 816-431-2600 or gfuentes@fitchassoc.com
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“Why do you need so many firefighters responding to medical calls or minor fires?” What the question really means: Citizens, the media, elected officials and city managers often wonder whether it’s really necessary to have so many vehicles and responders on what seems like a run-of-themill call. The assumption is that the more vehicles and responders on a call, the more expensive—and unnecessary expenses mean waste. How to formulate your answer: Unfortunately, there’s no one-sizefits-all answer. A comprehensive assessment—encompassing risk, demand, current internal capacity and mutual aid resources—is required. The first version of NFPA 1710 Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments was approved in 2001. Local government managers opposed its passage, calling it an expensive, one-size-fits-all standard that requires a crew of four on every fire suppression unit.
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In 2005, a research partnership of the Commission on Fire Accreditation International (CFAI), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Institute of Standards and Technology (NIST), and Worcester Polytechnic Institute (WPI) was formed to conduct a multiphase study of the deployment of resources as it affects firefighter and occupant safety. NIST’s Report on Residential Fireground Field Experiments: Technical Note 1661 was issued in 2010, describing the outcome of staffing experiments in handling 22 fire ground tasks while operating in a low-hazard residential fire as described by NFPA 1710.
than three-person crews. The fourperson crews also were able to complete laddering and ventilation 25 percent faster than three-person crews. The consortium also looked at EMS tasks in a 2010 NIST publication, Report on EMS Field Experiments. The analysis examined various response configurations, including operating with a paramedic-staffed fire company and a paramedic + EMT transport unit; results were mixed.
In those experiments, four-person crews were able to deliver water to a similar-sized fire 15 percent faster than two-person crews and 6 percent faster than three-person crews, steps that help to lower property damage and reduce danger to the firefighters. Four-person crews were able to complete search and rescue 30 percent faster than twoperson crews and 5 percent faster
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“With the cost of vehicle operations so high, do we need to send heavy fire apparatus to all calls, including all medical requests from 911?” What the question really means: As with questions about the number of firefighters who respond to calls, questions about the wisdom of sending heavy fire apparatus to calls are often based on a desire to eliminate unnecessary expense. How to formulate your answer: Ideally, your answer would note that your department is already considering the potential for lighter, more cost effective apparatus for EMS response, an approach that is becoming increasingly common in other cities. The savings can be considerable: In one recent study conducted by Fitch & Associates for a major city, consultants found that an EMS response with an SUV vs. a Quint would be $29.63 less expensive per mile. Responding to even one-half of that fire department’s EMS responses in SUVs would result in almost $1.7 million savings per year. Your analysis should also look at fire company workload, which, at least on a national basis, has changed. Jennifer Flynn, writing in the 2009 “Fire Service Performance Measures” for the National Fire Protection Association, categorized fire department responses as follows:
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EMS accounts for 50% to 72% of fire company responses. Activated fire protection system alarms are the second most common reason for a fire company response. Investigating an odor, hazardous condition, or other service call is the third most common fire company response. Encountering any type of fire condition – from incipient fire or inferno – accounts for fewer than 5 out of 100 responses in departments serving communities of 25,000 or larger. Access that report here: http://www.nfpa.org/~/media/Files/Research/ NFPA%20reports/Fire%20service%20statistics/ osfsperformancemeasures.pdf Also note that some fire departments have extensive experience using smaller vehicles to handle non-structure fire events, like Ladder Tenders in metro Phoenix and Minis in Syracuse, NY. Under such a model, fire company staffing typically is split between the heavy apparatus and the quick response unit, with the expectation the crew re-combines when arriving at a structure fire. Some programs were designed to reduce firefighter staffing by replacing a four-fire-fighter fire company with a twofirefighter quick response unit.
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“What is an acceptable productivity level to expect from the department’s EMS personnel?” What the question really means: City managers or staff who ask about productivity levels want to know that they’re getting what they’re paying for. Even for someone who understands the concepts of readiness and risk reduction, the idea of highly trained personnel “getting paid to sit around” can be uncomfortable and difficult to defend. How to formulate your answer: The traditional fire station based model of deployment (24-hour shifts) does not always work well for EMS transport units, as some metrosized fire departments discovered when they took over or merged with their ambulance agency. High demand and longer shifts become problematic. Longer shifts and high utilization without adequate rest increase risks associated with performing complex tasks.
staffed and available for response. A 24-hour unit consumes 8,760 unit hours per year. When compared to transports, the UHU measures the percentage of on-duty time engaged in call activities. Not included in calculation of UHU are time for training, maintenance, and other preparedness-related functions, along with standby services and public education efforts. Part of the determination about appropriate UHU analysis must include length of shifts, whether personnel are “single or duel role” (e.g. duel role means cross trained as firefighters and actively participate in firefighting activities), and departmental policies regarding outside employment and ensuring adequate rest prior to shifts. Another important factor to consider is the relationship between utilization and response times.
Unit Hour Utilization (UHU) is a calculation that measures the amount of time a unit is staffed, on duty, and prepared to respond to a call. This is measured as a percentage and it is the total amount of hours a unit is
UHU benchmarks in highperformance systems often range between 0.35 and 0.50. However, Pinellas County, Florida, fire chiefs opined in 2009 that EMS utilization
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for EMS personnel on 24-hour shifts should not exceed 0.30 UHU. Nevertheless, a survey of firebased medical transportation in 2007 showed larger cities with far heavier workloads. Philadelphia, for example, has medic ambulances responding to more than 8,000 incidents a year, a UHU of 0.73. Most of the Baltimore, Chicago, and Washington, D.C., fire department ambulance units handle 15 or more responses in 24 hours. At the time of the survey, Chicago ambulances were averaging 0.46 UHU, with a high of 0.71. Concerns about safety led to the IAFC compiling a report titled Effects of Sleep Deprivation on Fire Fighters and EMS Responders. This study provides additional references related to this topic.
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“Do our personnel have too much down-time while waiting for calls?” What the question really means: Questions about standby time or down-time may be posed directly by city managers or concerned taxpayers, or they may appear in local media. They’re often based on the premise that in difficult financial times especially, nobody should have a cushy job with little to do. How to formulate your answer: If you can’t honestly reply that your department uses a risk-based staffing solution, it’s time for you to get proactive. At a minimum, as chief, you should know what the current workload is at every station. In cities where workload has been measured and publically reported, fire suppression companies appear to have significant standby time. Before the recent recession, the busiest engine companies in the city of Los Angeles were spending up to 6 hours out of 24 responding to emergencies, operating at emergency scenes, cleaning up/restoring equipment and returning to quarters. As far back as 1999, engines in Baltimore were averaging 1 hour and 47 minutes of work in 24 hours and truck companies were averaging 1 hour and 40 minutes of work. (This compared to the department’s medic ambulances, which were averaging 14 hours and 25 minutes of work in 24 hours) Since the recession’s onset, staffing has been reduced at many departments. Brownouts and other non-risk based staffing reductions, however, are not necessarily the best answer. It may be time to consider variably-staffed fire companies to meet community need. Under such a model, resources are increased when the needs increase (e.g., Christmas crowds in shopping districts) and decreased when the needs decrease (e.g., high-rise district between midnight and 6 am). One additional factor to consider is that personnel who are not responding to calls are not necessarily sitting around with nothing to do. The mission of a fire department requires ongoing training, checking equipment, completing paperwork and other tasks. The city of Glendale, California, released an internal audit of fire department workload from Fiscal Year 2011 – 2012. It is a comprehensive workload analysis and a good example. Download the report here.
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“What should response times be for our community?” What the question really means: Questions about response times are often rooted in a desire to balance cost with public expectation for levels of service. Response times seem both easy to understand and simple to measure, although both of those are untrue. Nevertheless, the subject is practically guaranteed to come up in any discussion about performance and/or costs. How to formulate your answer: Any question about response times is an ideal opportunity to educate the questioner about the need for evidence-based, legally defensible response-time goals tracked according to an accepted standard for measuring them. Setting fire and EMS response times are often a mixture of what the evidence indicates and what the community desires (customer service), but there are more authoritative sources. Measuring response times on a fractile (90th percentile basis to a defined target rather than averages) and demonstrating concerted efforts to improve against that target is considered best practice. Fire suppression response time criteria come from two sources: NFPA 1710 Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments. (2010) Commission on Fire Accreditation International. Standards of Cover Manual, 5th edition.
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Fire suppression response times are influenced by the NIST/UL flow path research. Fire chiefs should review this article from Steve Kerber: Analysis of Changing Residential Fire Dynamics and Its Implications on Firefighter Operational Timeframes. For EMS, urban emergency medical services response criteria is influenced by this position paper by the National Association of EMS Physicians: J. Brent Myers, Corey M. Slovis, Marc Eckstein, Jeffrey M. Goodloe, S. Marshal Isaacs, James R. Loflin, C. Crawford Mechem, Neal J. Richmond, Paul E. Pepe. EvidenceBased Performance Measures for Emergency Medical Services Systems: A Model for Expanded EMS Benchmarking. Prehospital Emergency Care April/June 2008, Vol. 12, No. 2: 141–151. This position paper provides no response time criteria for ALS (paramedic) response, noting that: “much of the clinical research used to establish acceptable ALS response time intervals was conducted prior to the widespread dissemination of AEDs and at a time in which the compression component of CPR was not emphasized as it is now.” As a result, the consensus group proposed that EMS systems not focus response time measurement on ALS ambulances, but rather pay greater attention to first response/BLS response time to measure what it called the “most important predictive elements for optimal outcome: time elapsed until initiation of basic chest compressions and time elapsed until defibrillation attempts.”
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“Do units need to respond with lights and sirens to 911 calls, despite the nature of the complaint?” What the question really means: Questions of this nature often stem from concerns about liability—from, paradoxically, either failing to respond quickly enough or using lights and sirens unnecessarily and increasing the risk of a crash. How to formulate your answer: Your reply should demonstrate your evidence- and best practice-based policy of matching response mode to risk (i.e., risk to potential patients, crew members and the public in general). Given wider acceptance of protocol-based dispatch processes such as those developed by the International Academies of Emergency Dispatch (IAED) for EMS and fire agencies, it is no longer prudent to respond “hot” to all 911 calls. The time saved by responding lights and sirens for the vast majority of 911 calls does not warrant the risk to all involved. The International Association of Fire Chiefs’ Guide to Model Policies & Procedures for Emergency Vehicle Safety identifies what situations would warrant an emergency response:
• Smoke or fire in a building • Outside fire with exposures • Gas leak inside a building • Hazardous materials release with persons in distress • Critical medical incident
Access the model policy here: https://www.iafc.org/files/1SAFEhealthSHS/VehclSafety_ IAFCpolAndProceds.pdf
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“How does our department use NFPA and ISO standards?” What the question really means: Are you treating standards published by the National Fire Protection Association and the Insurance Services Office as requirements or mere guidelines? How to formulate your answer: Neither NFPA Standards nor ISO Grading are requirements. To illustrate the difference, consider how the “2-in, 2-out” requirement came about. When the first edition of NFPA 1500 Standard on Fire Department Occupational Safety and Health Program was approved in 1987 an effort was made to have the standard adopted as an OSHA regulation, including the requirement of a minimum crew of four on each fire suppression rig. Some NFPA standards have been adopted by federal, state or local “authorities having jurisdiction” (AHJ), such as the Professional Qualification standards for firefighter certification. The effort to adopt NFPA 1500 as an OSHA regulation was unsuccessful. The Department of Labor was asked about applying an existing respiratory regulation, OSHA’s Respiratory Protection Standard 29 CFR 1910.134, to structure firefighting. OSHA determined that structural firefighting was performed in conditions that are Immediately Dangerous to Life and Health (IDLH) and applied the two-in-two-
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out rule that was already in place to protect workers in Shipyards, Marine Terminals, Longshoring and Construction. Fire chiefs should enroll in ISO’s Fire Chiefs Online — a special secured website with information and features that can help improve your ISO Public Protection Classification (PPC™). The system involves:
• A Community Outreach Questionnaire to track the latest improvements in your fire department, water supply, and alarm system • Accessing an interactive map of your fire-protection area • Accessing valuable reports on commercial buildings in your jurisdiction • Information on building construction, occupancies, and hazards • Information on sprinkler systems • Estimating the Needed Fire Flow for buildings
Start here: http://www.isogov.com/ This link describes the NFPA standards development process: http://www.nfpa.org/codes-and-standards/ standards-development-process
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“Some communities are using rolling brownouts to reduce costs. What are the benefits and risks of this strategy?” What the question really means: Can your department reduce overtime or personnel costs by closing stations and “get away with it”?
Getting in Front of a Controversial Issue
How to formulate your answer: Acknowledge that temporary rotation closure of fire companies can reduce overtime or general personnel costs. Memphis; Philadelphia; Los Angeles City; Washington, DC; Cincinnati; Sacramento; Houston and others have employed brown outs. But also note that this game of roulette often ends after a citizen dies or is severely injured in a fire where the nearest fire company was closed.
As municipalities struggle with financial challen-
Philadelphia provided a brochure for the community: http://www.phila.gov/fire/pdfs/Brown-Out_FAQ.pdf San Jose provided a more comprehensive description: http://www.sanjoseca.gov/DocumentCenter/ View/2810 Milwaukee and Los Angeles City eventually stopped rotating brown outs and permanently closed fire companies. A much better strategy is to conduct a comprehensive risk assessment and reduce staffing and change deployment plans based on the results of that analysis.
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ges, fire departments are particularly susceptible to scandals—true or untrue—over budgetrelated concerns. Typically, these concerns involve things like claims of excessive overtime, sick leave and shift swapping. There have been clear patterns in how such stories have evolved in multiple jurisdictions across the country. Often, they’ve hurt the image of firefighters even when there has been no wrongdoing. Dave Statter, a retired TV reporter who runs STATter911 Communications, and has warned about trends in news stories that end up becoming issues for fire departments across the country, provides this advice:
• Get your house in order now
before a political leader makes it an issue
and/or a reporter starts asking questions
• Take corrective action on abuses
you uncover
• If you believe any problems you
discovered are likely to becme
news, consider breaking the news yourself
• Be able to defend your policies publicly
• Change the policy if you are
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