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Proposed Budget: Reduce Engine Service, Increase EMS, Trim OT

Original post made by Fred Balin on Jun 6, 2012

Fire engine service from one of the Palo Alto Fire Department's six round-the-clock stations would be reduced, possibly dramatically, under a budget plan to shift personnel to expanded emergency medical services (EMS), while also reducing overtime costs.

Under the plan, when fire engine staffing was low, one 3-person engine company would be shut down.

The specific engine company chosen would be the same for the entire year in order to simplify logistics as well as the tracking and measurement of impacts, the city's fire administration stated. After the period of evaluation, the city would consider making the reductions permanent.

Wording in the proposed budget implied that Engine Company 2, situated at Hanover Street's Fire Station 2, would be the fire engine impacted. After residents' comments at the May 15th Finance Committee hearing, the fire administration confirmed it. However, at the follow-up May 29th committee hearing, the city's fire administration said that it might utilize another, unspecified station.

The extent of the engine company brownout has also not been detailed. Understated wording in the budget merely says that "up to one fire response vehicle may be taken out service when staffing falls below a preset number due to absences …." [See Page 201, Note 4 within the proposed budget at Web Link ]

However, based on the $1.1 million dollar line-item budget savings associated with this plan (Page 200), I calculated a shutdown of 360 full days. In response, the city manager's office stated its plan was not to permanently shut down an engine company, but it also did not define the extent of the brownout.

Working from a different and more conservative vantage point, a very likely period of impact would be during the 120 days from July through October when the city staffs an additional engine during the daytime at Foothills Fire Station 8. In addition, the budget's plan to shift six fighters to expanded emergency medical services (EMS), with no increase in firefighter staffing, raises the likelihood that the engine company brownouts will extend to other periods of the year as well.

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The Crux of the Matter
When an engine company is out of service, response times will increase. This could impact the first-response engine to a potential fire situation (fire alarm, smell of smoke) or the full 3-engine complement to a confirmed fire (1st alarm); but also EMS, rescue, hazmat, and other responses in which engines play an integral part.

The city manager's office stated that response times would still be adequate and referred to data from the city-contracted Fire Utilization and Resources Study of January 2011. Web Link

The goal of the study was was to provide an independent review of of the Fire Department operations so that city officials could understand how well the system is working and whether the fire department can provide services more efficiently.

A second, follow-on study, on Emergency Medical Services was presented early this year. Web Link

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Why This Article?
Concern over the impacts of reductions in engine service combined with the proposed budget's opacity, and the city's decision not to mention the engine service reduction in its presentation at the May 15th Finance Committee meeting, are the motivators for this article.

Nonetheless, this piece is intended to be as objective as possible, and provide you and your circle with information related to what is an important public policy matter moving rapidly through the budget process.

The Finance Committee has recommended approval of the plan, although it appears that committee members' familiarity with the full proposal and its impacts was limited. The budget approval process concludes with back-to-back Monday evening council meetings on June 11th and 18th .

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Update on Fire Services Study
On June 12, interspersed between the final two council meetings on the budget, the Policy and Services Committee will hear an update on the two studies related to Fire Department services.

Some of the elements in those studies will be noted further below, but Tuesday's meeting remains an excellent opportunity for you to ask questions based on this matter and further help you form and/or refine judgments. The update on the fire studies is the first item listed on the tentative agenda for the meeting, which begins at 6 pm at City Hall.

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Article Content
The material in this piece is informed by a review of the two studies, video of the related council hearings from early last year and this, a thorough dissection of this year's fire department budget, attendance at the Finance Committee meetings on the topic, a review of last year's fire department budget and hearings, communications with the city's fire administration, discussions with firefighters, and review of other relevant history.

Kindly send any corrections to me at fbalin@gmail.com .

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Expanded EMS Proposed
According to the studies, Emergency Medical Service (EMS) calls comprise 60% of all fire department response requests. In the years from 2000 to 2009, EMS calls increased by 48%, while total calls for the fire department increased by only 19%.

Proposed increases in paramedic services and associated new positions in fire administration mirror recommendations within the fire studies.

The budget proposes to increase EMS from its current two, up to a total of three, concurrent, two-person paramedic staffed ambulances. EMS services are part of the Palo Alto Fire Department (PAFD) with firefighters also trained as paramedics.

At present, one ambulance with dedicated 24-hour, 7-day regular-time staffing is on call at Fire Station 1 (at Alma and Everett).

A second medic unit is at the Hanover Street Station 2. It has dedicated 12-hour daytime staffing, via an overtime shift, and is "cross-staffed" with Engine Company 2 at night. Cross-staffing means that firefighter shift crew members go out on either a fire call via the engine or a medic call with the ambulance -- whichever call comes in first -- but obviously they can not handle both at the same time. Palo Alto fire engines crews are staffed with up to two paramedics within its crew of three.

The budget proposes to ramp up the Station 2 ambulance ("Medic 2") to dedicated 24-hour regular staffing as is the current practice at Station 1.

The budget also mentions a third, concurrent medic ambulance unit, but does not state how it would be staffed or where it would be stationed. However, to avoid overtime costs, it would probably require a normal 24-hour firefighter shift. The city's follow-up study specifically devoted to EMS services recommended including a cross-staffed ambulance at Station 3 (on Embarcadero at Newell).

So a reasonable assumption is that engine and paramedic service would be shared between a 24-hour 3-person firefighter shift at Station 3, if the city intends to have the potential of 3 concurrent ambulances available at all times.

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Reasoning for the increase in EMS as per the studies are as follows:
- Increasing EMS services responds to the high rate of increase of emergency medical calls to the department
- Increasing capacity reduces dependance on 400 to 600 annual mutual aid calls to private ambulance services from the county, which generally have a longer response time, and are not viewed as comparable to PAFD paramedic service
- A large percentage of the city's EMS operating costs are returned to the general fund via fees for the services.
- While Palo Alto receives mutual from the county EMS, it does not provide it in return. Should it be required to, it would increase demand up to 11%.

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EMS and Fire Engines
The Palo Alto Fire Department sends both an ambulance and a fire engine on an EMS call, a total of 2 vehicles with up to 4 paramedics. Some view this as overkill, while others see this as excellent and needed service.

Here is some of the reasoning in favor of this policy:
- Engines are at every fire station, ambulances are not. Therefore, fire engines are first on the scene for many EMS calls.
- As engines also carry paramedics, emergency service can start right away if the engine arrives first.
- In case of a very serious or complex situation, additional paramedic staff is available.
- Once the EMS situation is stabilized, the engine leaves the scene.

On the other hand, the fire services study recommended development of a dispatch system methodology for EMS calls such that fire units are only dispatched to high priority medical calls, not every routine medical situation. The study also stated that 96% of EMS calls are for "possible life-threatening" situations, but believes the true number to be much lower. It is not clear if the city plans or is ready to implement new dispatch protocols at this time.

Combining additional EMS capabilities together with the brownout of an engine company adds strain to the overall system. The fire administration mentioned the possibility of using the city's single Rescue vehicle (Rescue 2 at Station 2) to pair with an ambulance on EMS calls. As per the study, Rescue 2 is primarily responsible for extrication at accidents and to augments staffing at structure fires. The 3-person crew and vehicle is are also equipped to provide other types of rescue and hazmat services. The study views Rescue 2 as underutilized and recommends it be cross-staffed.

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How Many Fires?
When most people think of fire engines, they think of fighting fires. So let's go directly to an often asked topic.

How many fires are there in Palo Alto? Or to phrase it differently, as Palo Alto also provides fire services for Stanford under contract and reimbursement with the university, how many actual many fires does the PAFD handle?

[Note: Fire Station 4 is on the Stanford campus on Serra Street. The former Fire Station 7 on the grounds of SLAC, closed last Fall and is now supported off-site by the Menlo Park Fire Protection District.]

The 2011 fire study shows that from 2000 to 2009, fires ranged from an annual low of 181 to a high of 242; or, in other terms, between 2.0 and 3.8% of calls during those years.

These numbers include vehicle fires, building fires, fires in portable and mobile homes, fires confined to a structure like a cooking pot, outside fires, and others.

There were five fatalities and five injuries over that time. The numbers comprise fewer fires and deaths per capita than averages for the US, the west coast, and communities of similar size. Fire injuries are significantly lower than national, regional, and community size averages.

That positive news, however, may be of limited comfort for those waiting for help when an engine is out of service.

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Too Many Engines and Too Many Stations?
The Fire Services study contained recommendations for the merger of two stations and a subsequent shutdown of an engine company.

It recommended that Fire Stations 2 (Hanover Street) and 5 (Arastradero near El Camino) could be merged as they had low call volumes and workloads and significant overlap not justified by current or projected demand.

It recommended creating a new station in the vicinity of Miranda and Hillview Avenues.

The recommendation also stated ".. because planning for a new station would take several years, the city would be able to make small changes such as cross-staffing the engine/rescue and staffing the second medic while it evaluates the large questions of station consolidation."

There is no recommendation to shut down an engine company for significant periods of time prior to the merger.

Merging of stations is not on the table in this budget, but the fire administration stated that "we're trying to find other ways to maybe accommodate what the spirit of that recommendation would be with as little impact to service as possible."

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Current Response Times
According to the study, The National Fire Protection Association (NFPA) response time guideline is no more than 6 minutes from the initial call to the first fire responder at the scene, 90% of the time. The six-minute time frame is based on research showing that a structure fire begins to grow exponentially after six minutes, and individuals in cardiac arrest need defibrillation within six minutes.

The study estimates that Palo Alto is about a minute over this level even when the percentage is lowered to 80%.

However, the fire study is not overly concerned about this. It states that "most fire departments use the NFPA 1710 standard as a goal, not as a prescriptive requirement. Few departments are currently meeting or exceeding NFPA 1710, especially with respect to travel time (which is the hardest to improve)."

The study also states that "… there is no single set of nationally accepted response time standards. Many communities choose to develop their own response time goals in light of what is currently achieved versus what it would take to improve them. There have been a few attempts to measure the incremental value of a minute faster response time for fires and EMS calls, but there is no definitive study of the incremental benefit. Faster is better, but it is unclear how much better in terms of dollars or lived saved."

The NFPA 6-minute guideline is divided into three parts:
1 minute for call processing (i.e., initial call to entry in dispatch system),
1 minute for turnout (i.e., alert a station to crew ready on apparatus), and
4 minutes for travel.

The study states that under Palo Alto's "road network," it would be very difficult to achieve a 4:00 travel time and is comfortable with using 5 minutes as the goal at the lower 80% level. It does, however, see turnout times as an area for possible improvement.

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Increased Response Times Under Brown Out
The city manager's office stated that "when you look at the numbers [in the fire study] even with the elimination of Engine 2 … the response times would still be adequate."

But the study does not really validate that because it doesn't just pluck an engine out of a station. Rather it comes up with a new station location that takes into account existing coverage areas.

As the fire administration candidly states, the response time increases and impacts will not be known ahead of time. "We would have to collect that data and figure out what the response time difference is for that particular district, for that particular engine company ... We can look at historical data and take our best guess at it, but I think that wouldn't really benefit us in this case."

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Final Word
Major changes to engine company deployment really should come down to what the community feels comfortable with. As one of fire services study authors said at the council in January of last year, "ultimately the decision to merge a facility is a policy decision, certainly based on residents' expectations."

A similar statement can be made about the proposal to brownout an engine company, possibly for long periods of time.

But resident have not been given much time nor clear information to develop these expectations.

-Fred Balin
6/5/12

Comments (1)

Posted by Fred Balin, a resident of College Terrace
on Jun 9, 2012 at 7:21 pm

Fred Balin is a registered user.

A quick update to my June 6 Town Square article above.

After stating my concern over the city’s lack of transparency regarding the plans to cut fire-engine service (“Why This Article” section), I went on to say that on Tuesday, June 12, an update to two city-contracted fire services studies would be presented at the Policy & Services Committee, and that it would be an excellent opportunity for you to ask questions and develop and/or refine views on this matter.

This scheduled update was announced by the assistant city manager at the May 15 Finance Committee meeting and appeared in the next three tentative agendas released by the city clerk on Wednesday afternoons.

Last past Wednesday’s tentative agenda, no longer lists the fire service update.

Reasonable explanation, fear of the public asking questions, or something else?

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Correction: I mistakenly identified the Serra Street fire station as Station 4; it is Station 6. oon


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