.

Why Fire Trucks Go Out On Rescue Calls

Fire Chief Henrikson and Deputy Chief McGillivray explain.


Many times, over my career, I have been asked, “Why it is necessary to send a fire truck on an ambulance or rescue call?” This is the Most Frequently Asked Question of the fire service. As the answer is not readily apparent to our taxpayers, I would like to explain why we send the fire truck on rescue calls.

All of the firefighters of the East Greenwich Fire District are cross trained to respond to both fire and emergency medical incidents. Every firefighter is an Emergency Medical Technician–Cardiac (EMT-C) licensed by the state. They are required to maintain their licensure throughout their careers. The EMT-Cardiac performs all measures of Advanced Life Support (ALS) Care as approved in the Rhode Island Pre-Hospital Protocol and Standing Orders.

When responding to a medical emergency, the Fire Engine (two people) responds along with the Rescue (two people) to assist with carrying all the necessary equipment, assisting with the treatment of the patient and possible transport of the patient to the rescue. In the more life-threatening cases, such as a CPR in progress, engine personnel may accompany the rescue during transport to the hospital. The engine may then also go to the hospital to retrieve people to become available for future incidents.

Some of this begs the question; is it really necessary for a rescue and a fire truck to respond to many of the minor injuries? It seems wasteful to drive a very fuel-inefficient fire engine to an incident where the additional personnel may not be needed. While there are some calls for emergency medical assistance that can easily be handled with just the two personnel on the rescue, there are many more that require additional help.

The practice of sending both a rescue and a fire engine, equipped with defibrillators, oxygen, and other first-aid essentials, to a medical call is widespread nationwide. And the reason, as most fire chiefs would say, is simple: With fire stations located strategically throughout a city or town and EMT’s often tied up for an hour or more on a single call, firefighters, even firefighters driving a bulky ladder truck, can often get to an emergency faster than a rescue and provide life-saving treatment as soon as possible.

Nearly every Emergency Medical Service (EMS) system sends a unit to “assist” the ambulance for a number of reasons. Many times there is not always enough reliable information on the patient’s condition to determine if additional help is needed. Valuable time may be lost if additional personnel are not dispatched until the rescue arrives and makes an assessment. Also, even so-called “routine” medical calls require the patient to be removed from their home and lifted into the back of the rescue. Even if the patient is not obese, it is safer for the patient and for the backs of the EMT’s to have additional help to assist with moving and lifting.

Another example is when a fire engine and a rescue respond to auto accidents. The engine has many duties at this type of call including blocking traffic to ensure the safety of all first responders, stabilizing and making the vehicle safe to work in and around, perform heavy rescue tasks utilizing tools such as the Jaws-of-Life, and assisting with the treatment and removal of any injured occupants.

Another taxpayer concern is cost. The Fire District, as the provider of the town’s fire protection and emergency medical services, has already invested in the fire truck, the advanced medical equipment and medicines they carry, the salaries for the firefighters, and the fuel in the trucks, therefore, it would be imprudent to NOT send the fire engine and its personnel on what would even seem to be a minor medical call. When the fire truck is not needed on an incident, it is released to go back into service as soon as possible, or even respond to another emergency – whether a fire or rescue call. The cost of the fuel, to have the extra help immediately available when it is needed, is a small cost when compared to the loss of precious minutes when a life is on the line.

Chief Peter F. Henrikson
Deputy Chief Russell McGillivray, Jr.

Alicarn July 31, 2012 at 08:23 PM
This is good info, I always wondered and, Chief, you've explained it well. Keep up the good work for our town!
Paul Alexander July 31, 2012 at 09:10 PM
Smart, well-written and informative. Thank you, gentlemen.
Jack Baillargeron July 31, 2012 at 11:47 PM
exactly, should be posted in every town hall and sent to taxpayers once a year in their bill. truer words were never spoken as they say. Good write up.
Barbara Smith August 01, 2012 at 12:32 AM
This article is great! Is it possible to get a copy emailed to me? bsmith@the-dawson-group.com
Jack Baillargeron August 01, 2012 at 12:52 AM
Just highlight it and past to word, you can then correct anything you that you want to remove.
Jack Baillargeron August 01, 2012 at 12:55 AM
I put it in word and sent it to you Barbara
Elizabeth McNamara (Editor) August 01, 2012 at 01:54 AM
Thanks Jack!
Scott K. August 01, 2012 at 11:54 AM
I wonder if anyone out there has seen the study done in San Mateo California? http://www.scscourt.org/court_divisions/civil/cgj/2011/FDResponse.pdf The study talks about the wastes that result from responding too many units to medical emergencies. Have a read, its interesting. Also, a tool such as the Medical Priority Dispatch System is effective in triaging and determining the appropriate responses to send for each call. Quite often, the response of multiple units by a fire department is used to increase call volume and justify positions. While those positions might be vital, leadership should be honest with those they represent. Finally, it is statistically proven that the majority of emergency medical calls are not "seconds count" emergencies. When those calls come in (As determined by Medical Priority Dispatch) then the appropriate number of units should be sent, but the majority of the time, this is just not the case. It is the same thing as sending out the same number of units for a trash fire the same way one would a warehouse fire. I am sorry if I offend anyone with this post. I am a twelve year paramedic, and I care about my job and the people that I encounter every day, but having fast care does not mean that you are getting better care. I am sure that I will get blasted, but the evidence is there. Don't believe everything you read, folks.
David Bibeault August 01, 2012 at 12:21 PM
I didn't see anything in the article that justifies sending a firetruck to the many "fender bender" accidents. It's all to inflate numbers to justify unnecessary staffing and budgets. Can you explain to me why a person that works on an EMT truck has to be a Union Fireman? An emergency room trauma Doctor can't work on an EMT truck in RI thanks to the RI General Assembly's members bought and paid for by the pubic employee unions.
Dale Loberger August 01, 2012 at 12:48 PM
Very well written, but I am concerned over some points. I'm not familiar with the details in CT, however most municipal FDs represent about 25-30% of a city budget so cost accountability should not simply be waived away as sunk expenses in this economy. For instance, the typical burdened cost to run a single mile with an engine is $28.22 (several times more than a quick response vehicle or ambulance) an expense and wear that is difficult to justify by carrying "defibrillators, oxygen, and other first-aid essentials" that are on every ambulance elsewhere. Similarly an engine cannot even transport a patient when required. The extra hands are sometimes helpful, but not necessary at every call and sometimes space is not even available in the home which means these firefighters have to wait outside. Nationally, about 70-80% of non-law enforcement related 911 calls for service are medical in nature. The automatic "all hazards" response you recommend causes a direct additional expense beyond salary to be incurred compared to staging those same resources back at the station where they are available for other responses as necessary. Most PSAPs can distinguish between a chest pain call and an MVC to allow an appropriate response. I am not familiar with the EMT-C designation but find it interesting that it "performs all measures of Advanced Life Support (ALS) Care" which includes administration of IVs and drugs that is restricted to Paramedics in other states.
kathi August 01, 2012 at 01:17 PM
If you have ever needed the rescue you would appreciate what they do. Good work EGFD
Scott K. August 01, 2012 at 02:40 PM
Nobody is debating the quality of response EGFD provides to the community. That is not the issue here. I am an EMS professional as well, and I know exactly what goes on in an ambulance, and I am aware of what resources that I, as a paramedic, need on the calls that I respond to. The two questions that I would have would be: what evidence supports "all hazards" response and what is the motivation for these responses?
Rich August 01, 2012 at 04:33 PM
Well written article, Chief! I've seen the comment about fire unions demanding additional trucks to respond in an effort to pad runs and justify positions. To the layperson it seems reasonably possible. However, as a professional firefighter/EMT-C, I can assure you it's entirely false. The justification for these positions lies in NFPA staffing standards which dictates the number of firefighters, trucks, stations and equipment required to respond to emergencies within 4 mins. Every single FD in RI already operates well below these standards as is. The total number of runs is irrelevant and there is no need to pad runs. It's a complete non-concern for us both on the street and in the union hall.
Petar_1 S August 01, 2012 at 05:46 PM
It would be interesting to see the make-up of the department's runs. What percentage are EMS versus fire calls? Compare that to the share of budget allocated to the EMS division. I bet the "share of wallet" allocated to EMS is small compared to the fire suppression division. This creates a "need" for fire apparatus to be busy; the full time staffing model of the EGFD has to justify their existence (manpower, salary, benefits, equipment, etc). Rich states: "the total number of runs is irrelevant" but as a "professional firefighter/EMT-C" he is obviously biased; reference to NFPA standard is dubious since we don't know whether it's teh right standard (there are plenty). Rich: it is a concern to us on the street, at the union hall and at home and we very well should be concerned. This information would allow the reader to ask: is this the best way? Not a critique of the Chief but an observation at the state and national level. A recent article in the ProJo estimated that about 50% of Providence's rescue calls were non-emergencies. What the percentage is in EG and how that could be better handled? This may result in less call volume & more questions by the taxpayer. Perhaps it's time to rethink the elimination of the volunteer/call force and return to a realistic combination department rather than this 100% career model that so conveniently happened. Don't tell me about the TV commercial and the recruitment and all that jazz. We all know how that process was "managed."
Rich August 01, 2012 at 05:55 PM
You mis-quoted me. I'll assume it was accidental. I said it is a non-concern of ours. To be clear, staffing is most certainly an issue of ours. However, padding runs is not. There is no need to. The engines come along because we need the help. What is lost in this discussion is how often Rescues "cancel" engine companies when rescues arrive first and determine the assistance isn't needed. I quoted the NFPA standard because it is the flagship organization for fire and EMS protection and the one that impacts the ISO rating. The selection wasn't dubious nor is the policy of including engines a conspiracy theory. They are needed. Sorry. I refuse to get into the volunteer/paid on call dept. conversation. It has a place in some communities, many of them in RI. In my opinion, EG is too busy for it.
Scott K. August 01, 2012 at 06:14 PM
Saying that the NFPA standard is the "Flagship" for Fire and EMS standards is a bit much. It might be for Fire, but for EMS there is plenty of evidence out there to refute the lights and sirens response, and the everything out of the house mentality. Most emergencies can be handled by two paramedics (or EMT-C's whatever you want to call them) and as a matter of fact, most can be handled by one paramedic.. or even two EMTs. The NFPA standards are antiquated.. there is plenty of evidence out there to IMPROVE them. We just choose to ignore it. Somehow, Europe seems to do fine (and much better than us) without the NFPA's oversight.
Jack Baillargeron August 01, 2012 at 06:32 PM
Actually Europe has bacicly the same standards and like the NFPA they are updated all the time, to include the EMS of the fire service. The Firefighting and Fire Protection Standards Committee (FNFW) has developed from the "Department for standardization of firefighting equipment in the Standards Committee of the German Industry" which was founded back in the year 1920. According to the structure of the International and the European Standardization,
Petar_1 S August 01, 2012 at 06:34 PM
Rich-Padding runs may not be a concern but changes in run volume should be: less runs makes it more difficult to justify a budget. The perception that all we do is "sleep & eat" is rampant and difficult to break (it's not the big red bed for nothing). ISO and NFPA are concerned, those are all good and well but let's be honest: few (if any) departments in the state are at NFPA staffing levels and the standard means nothing when the costs to maintain the standard aren't sustainable. You want to meet the standard, find a way to make it work financially or face a lot of uncomfortable situations. "Too busy", I find that hard to believe. Your annual report lists 2976 calls with 67% (~1993) being EMS and the balance (983) are "everything else." Rich, you're an EMS department that runs fire calls. In comparison, Lincoln Rescue ran about 3600 calls a year, Cumberland Rescue runs a similar number and both provide significant mutual aid to urban areas including Pawtucket, Woonsocket, Central Falls and even Providence. They are a full time service as a stand alone town based entity. But, they're embedded in fire districts which are combination departments. If we look at your non-EMS runs, I find it hard to believe you couldn't manage less than 1000 runs between two stations as a combination department. Your tax base allows you to be a career department for now but that may well change and you could easily find yourself in the same difficult spot as the rest of us.
Petar_1 S August 01, 2012 at 06:42 PM
Jack, in many (if not most) European countries the fire service does not service as an EMS provider or as the primary EMS provider. In the UK for example, the fire brigade does not get involved in EMS unless there is a technical rescue related issue. In most cases government standards are set centrally and dumped on local organizations or sent as an EU mandate. Scott, think of an EMT-C as a state level Paramedic-lite. We can do almost all the things a NREMTP can do but the education/training length (and cost) is significantly less. For a state with, typically, short transport times to a PCI capable hospital or trauma center the system works. Since the ambulance advisory is essentially stacked with out union's members (in part coded in law) there is little risk of change.
Scott K. August 01, 2012 at 07:04 PM
Jack - In England, for example, transport is a last resort. To calls determined as lower priority, occasionally single medics in fly cars are sent. They have more options regarding transporting non-priority patients (and in some cases not transporting them at all). EMS is regulated there from a medical stand point not a fire stand point. They might have Fire Standards that dictate fire response but as Petar stated, they are largely seperate.
Rich August 01, 2012 at 07:26 PM
Let me clarify. I'm not a EG firefighter. If I accept your 1993 numbers (run volumes have increased) I still maintain that a career/on call FD would represent a decrease in protection for the residents of EG and considering how poorly staffed the career EGFD dept is in the first place the savings wouldn't justify the increase in adequately staffed response times nor the general decrease in protection. It's a difference of opinion I suppose.
Scott K. August 01, 2012 at 07:29 PM
To clarrify, the 1993 number is not the year the statistic was taken from it is 67% of the 2,976 calls. So the department's volume is 1,993 EMS calls and 983 making up "everything else."

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