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Friday, January 18, 2013

CFD Fire/EMS: Solving the crisis before it starts

Columbus Fire EMS Delivery Model


The Columbus Division of Fire is experiencing a rapid increase in the volume of EMS Calls that it handles.  In outlying areas; the burden of these additional calls is frequently falling on automatic aid partners; while in the center portions of the City, EMS units are responding to upwards of 5,000 or 6,000 calls per year.  This type of volume is not sustainable.  It leads to increased response times; burnout of EMS personnel; and potentially less successful outcomes for patients.  This is despite the mid-90’s reorganization that resulted in Columbus transitioning to an all ALS system.  As a result of the single tier system, Columbus has a high percentage of medics to population, and, for many Medic units, the majority of calls they respond to are BLS in nature. 


·         Match Service Delivery to Service Demand

·         Work to reduce excessive reliance on automatic-aid partners

·         Strive to maintain or improve response times—especially on critical EMS and Fire Incidents.


Potential Solutions:

The following efforts would help to achieve the above goals.  Although they will require a minimal investment in personnel, software, training, and equipment— they would result in significant improvements in response time and agency effectiveness.  Further, if CFD is able to handle more of its own EMS workload, an added benefit will be increased revenue.  If the CFD is able to bill for approximately 5,000 more EMS incidents per year, the increased funding will more than match the costs associated with these proposals.

1.       Third Firefighter (EMT) on outlying Medic Units at Stations: 5, 6, 26, 27, 28, 29, 31, 32, 33, 34 This will permit these Medic Units to respond to calls independently.  CAD can be programmed to support this functionality with ease. As a result, Engines will remain available for 2nd EMS runs in these areas, or Fires—preserving response time.


2.       When First-Due Engines are available, and are ALS equipped, preference should be given to dispatching Columbus Medic Units to Columbus incidents. (When there will not be a negative impact to arrival time for the first paramedic)  A potential time rule could be:  If CFD Paramedic Engine is responding and is the closest medic equipped unit a CFD Medic shall be assigned if it is within ten-minutes—no matter if an automatic-aid medic unit is available or not.  Exceptions shall be for Non-Breather; Cardiac Arrest, Unconscious.   This will help lessen the burden of City EMS incidents on Automatic Aid Partners.  [The new CAD will easily support this dispatch rule]


3.       Columbus Fire should deploy five (5) BLS units in the central portion of the city and the far north-side, staffed by two (2) Firefighter EMTs.  These units should be based at Stations 1, 6, 15, 17, and 18.  They will respond to BLS calls where they have an ETA of ten minutes or less or on special calls or to mass-casualty incidents.  Normally, they should not respond with an ALS unit or a first responder engine company.  The dispatch rule (easily accomplished in new CAD) should be:  For BLS calls, if a BLS unit is within ten minutes, it will be assigned… if not, then the nearest CFD Medic unit shall be assigned if it is within ten minutes, if none within ten minutes—then assign the nearest available medic unit regardless of department.


4.       CFD Should implement a medical-priority dispatch system as soon as possible- and enable the new CAD system to recommend the re-direction of medical units from calls of lower priority to higher priority.  This will ensure an adequate use of resources and reduce response times to higher priority calls.


5.       CFD should utilize Rescue and Ladder Companies to respond for Manpower requests, freeing up the ALS Engine Companies to respond to ALS incidents. 


6.       CFD Should consider redeploying Medic Units to match periods of peak activity, or consider staffing supplemental Medic units during period periods at key locations.  Hiring overtime personnel to staff additional medic units at key locations may be a beneficial cost to the department.  Analysis to determine peak periods and locations would need to be conducted to determine problem placement and benefit.


Faced with an ever increasing workload and limited resources; but with a New CAD and other potentially beneficial technologies, the Columbus Division of Fire should implement creative and multi-faceted solutions to ensure that it is able to maintain or improve its effectiveness.  These solutions should help the CFD avoid the problems that have plagued EMS systems in other large cities, improve resource management, and thereby safe lives and be more cost effective.


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