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Welcome to my site and thank you for reading. After many times thinking, if only I had a blog, well-- here we are. This blog will feature writings on a variety of topics from roadside food, to leadership in the fire service; politics; culture- gay, straight, and indifferent, my experiences in Ohio, New York and beyond; and much much more. It's my hope that you will find it interesting and that it stirs at least some thought and discussion. I am certain you wont always agree, but that is what its all about right? Oh and one more thing: The views expressed on this site are entirely my own. They do not reflect in anyway the views or positions of my employer.



Friday, June 23, 2017

Wake Up and Smell the Reality

Congratulations to the Columbus Dispatch on their editorial highlighting the increased overtime costs that continue to plague the Division of Fire Budget, despite recent changes to the EMS delivery model.  This was as expected as it is frustrating, especially for those who learn early in life that you can only get so much blood from a turnip or hours in a week from a paramedic. 

On paper it would seem to make sense. Reduce the number of required paramedics per shift-- and viola!-- reduced costs.  But it really is not that simple to realize cost reductions OR improved quality of care as long as several important realities remain unaddressed, even though they long ago crawled out from behind the curtain with the enthusiasm of an understudy dancer on the one night she has to make a really good impression. 

To review, those realities are this: 

1) The City of Columbus is now a City.  In every way.  What worked before for 35,000 EMS runs a year, or even 80,000 will not work for a system that is approaching 200,000 runs per year. Resource Management is essential for organizational success.  Sending fire apparatus on every ALS EMS run "just because"-- is a waste of that apparatus and contributes both to increased response times and increased reliance on mutual-aid partners. Here is an example to explain that concept.  For EMS runs near Rickenbacker, the nearest Engine is sent (which is BLS), the nearest Medic (normally Medic-172 with a crew of three) and an additional engine (normally 181) because the policy says an ALS engine should respond.  But is it really needed if you already have two or three medics on the responding ambulance AND a first-responder Engine?  Why waste that additional resource? 

2) When the majority of EMS runs you respond to are BLS or at a minimum could be handled with one paramedic, at most only one paramedic should respond.  EMS is not free.  You may accuse me of being a bean counter, but we must be smarter about how we spend the limited-sized pie of money that is public safety dollars.  Unjustified spending in one area (too many ALS vehicles) means we do not have the $$ to hire extra personnel or build the new stations that are the single most important factor in improving response times. Or, to put it bluntly, a fire engine with an EMT and a defibrillator that arrives to you in five minutes is WAY more effective at saving your life in a critical emergency than a $250,000 paramedic truck that arrives in 12 minutes.  

Just one potential strategy: Reducing the number of CFD medics to around 400, translating to around 70 medics on the street each day, would save CFD enough money to fund forty new positions!  That's enough to staff two new firehouses! 

3) Perhaps most shocking of all, as I have previously shared, is that this is not a new problem.  In the late 1800s and in the 1950s, CFD Fire Chiefs cried out for additional resources to meet the demands of a growing city.  In both cases, they did not have mutual aid to help in the outer areas of the city.  Today, calls for service continue to increase in both the City and the Suburbs.  Creating an over-reliance on Mutual-Aid partners creates the assumption that those resources will be available for Columbus runs when they are needed and the reality that Columbus taxpayers are not getting what they pay for. 

4) The Firefighters Union, Local-67 and the Leadership of Columbus Fire and the Division of Public Safety must come together to solve this problem.  Today.  It means that the Union may have to give up paramedic positions and some other job rules in the name of saving money so that the city can build stations and hire more personnel.  The City must understand that this expenditure its required. Eight new additional firehouses will need to be built in the next ten years, and a number remodeled and relocated. Both sides must get creative and find new ways to pay for this. For example, large developments must be required to contribute to the public safety resources they will require, whether by donating land for a firehouse or paying for apparatus.  Either way, a Fire/EMS Impact fee MUST be strongly considered by the Columbus City Council and the CFD must come up with standard firehouse designs that can be constructed with a minimum of local variance to help save time and costs.  

5) The city needs to improve its personnel management and distribution process.  This will require work, but with adjustments to work rules and some common sense, the amount of available staffing can be increased with no overall increase in firefighter headcount.  One example: the 50 Firefighters assigned to Dispatching Duties should be utilized for the jobs which they were hired for.  They can and should be replaced by trained, professional, dedicated dispatchers. (This action alone would not only provide more staffing, but improve resource management and effectiveness-- since every successful 9-1-1 response begins with a successful call answering and dispatch process.)  In today's  busy environment, Columbus needs a  fire/ems dispatch operation that is dedicated to meeting that challenge. 

6) Columbus must move away from an entirely AVL based dispatching solution.  This means that instead of recommending the closest unit, without regard to ownership, preference must be given in most cases to the "most appropriate" unit. Generally from the agency that is responsible for the area in which the incident occurs.  This can be far more nuanced and complex than is currently the case.  This step alone would go a long way towards reducing the burdens on Columbus's mutual-aid partners.  

7) Many of the busier outlying medic units should be given a 2nd Paramedic to ensure (3) person staffing.  (Medics 5, 26, 27, 28, 29, 31, 32, 33).  The dispatching program used by Columbus can recognize these heavily staffed medics and send them alone on critical calls, thereby saving the associated Engine Company for the NEXT EMS run in that area.  This will help response times in outlying areas.  

8) CFD needs good data on where and when their busy periods are.  Additional 24 hour medic units at fixed locations may not be the best solution.  Additional medic units should be placed in service where and when they will do the most good.  The deployment software that Columbus already has can assist with that effort and help lower response times.  CFD leadership just needs to use it more effectively! 

9) The same software can help  Columbus's with move-ups.  These remain an issue and something CFD no longer does effectively. No doing move-ups effectively means much longer response times in areas where major incidents are underway.  Simply redeploying resources from where there are many to where there are few will improve outcomes IF it is done in a coordinated, consistent, and productive manner.  

10) Finally, the CFD needs to fully grasp the challenges that they face, admit they have a problem, and get people behind a solution that works for everyone.  Time and again, the citizens of Columbus have demonstrated they are willing to pay for good public safety.  Division and Union Leadership. along with the City Administration must come together and create that workable solution. One that does not burn out CFD's firefighter/paramedics, the mutual aid partners or the budget.  This issue is not going away on it's own. The growth in Columbus is expected to continue, which translates to ever more calls for service and a Division of Fire that will be stretched ever more thin.  

Im summary, the problem is solvable.  It will take give and take, cooperation, and collaboration to overcome.  But the  safety of the citizen's of Columbus demands it. Let's make it happen.