It really is not hard. In fact, it comes down to match and data. I realize that for many public safety leaders their biggest fear is to be labeled a "bean counter." Chastised as no longer one of the boys, but rather a faceless bureaucrat who cares only about dollar signs and spreadsheets.
Avoiding for now the debate about the egos and self-esteem issues of those who serve in leadership roles in Public Safety, the reality remains that we must get smarter about how we deliver EMS services. This is especially true for those agencies who run fire based ALS EMS. Many of them, across the country, are experiencing rising workloads, lowering employee morale, and the reality that what they are doing is simply not sustainable.
A "bean counter" who concerns himself or herself with the paychecks, time off requests, and pension paperwork is actually a friend of all in the organization, no matter what bathroom stall walls or their modern equivalent of social media posts may say. That is also true of Leaders who take the time to actually crunch the numbers to determine how best to serve the needs of their community. The foundation of that action is the same, no matter what sized community we are talking about:
1) Plan for the call volume you have and will have over the next five years. Is it growing? Then you need to start figuring out where to find additional resources YESTERDAY. The budget process is slow, the $$ can be hard to find, and politicians love to get credit for reigning in the free-spending ways of public safety chiefs. (But hell fire on the department if you are late responding to the City Council President's heart attack... but I digress). Having good data about your run volume is essential to move to the next step.
2) Plan for the resources you really need. What is your percentage of ALS calls versus BLS? What is your average response time? What density of ALS coverage do you need to ensure an (8) minute response time most of the time? Do you need to explore ALS service on Fire Suppression Apparatus to meet response time goals? Thankfully, there are any number of ways to get this data. Starting with the IAFF that runs a data shop to help fire departments make better decisions. You can also buy software or even get a consultant. This really is not rocket science. One very important tool to consider are peak time ambulances, especially in areas where demand fluctuates over time. If you do half the calls at 2am as you do at 2pm, then having the exact same number of ambulances on the street during both times is not a very effective way to do things. Keep in mind, that is DIFFERENT than fire suppression apparatus. A fire needs the same number of people 24/7/365, and the standard for arrival time and activities is also the same. For EMS however, nighttime buys you reduced driving times (less traffic); less demand; and the ability to mix up or rotate staffing.
3) Practice resource management. Look for anyway to SAFELY reduce assignments. Especially if you are already stretched thin, using what you have more effectively may just be the way to go. It may also buy you just enough time until you can convince the city to staff another ambulance or build some needed stations. And remember, just because a unit is responding to one call does not mean it cannot be diverted to another. If your one ambulance is going to an ill person and is about to drive by a heart attack and you do not have a system in place that gets that ambulance diverted to the higher priority call, then just like Lucy, You have some explaining to do! Likewise, during periods of extreme demand, such as storms, your department MUST have a resource management plan to put in place automatically, or you will have extremely bad outcomes in a very rapid amount of time.
4) Finally, use the 9-1-1 system to get data on the calls as they are happening. The use of EMD allows you to prioritize what you are responding to. This is an essential part of meeting the demands of the public more effectively and managing your resources.
Together, we can all play a role in meeting the challenge of EMS delivery and not bankrupting our departments and communities. This is the challenge of the leader and the bean counter and it is one we must meet.
Observations, essays, ramblings, thoughts and more from a slightly reformed New Yorker who has returned home to Ohio. A spiritual person having a human experience, writer, photographer, and public safety professional.
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