By John Woolfolk
jwoolfolk@mercurynews.com
Posted: 06/15/2011 08:17:36 PM PDT
Updated: 06/15/2011 10:38:46 PM PDT
A Santa Clara County civil grand jury on Wednesday called for a wholesale rethinking of fire departments and emergency responses, arguing that sending firefighters to what are now mostly medical calls is outdated and wasteful.
A report by the watchdog panel found that 70 percent of fire department calls are medical emergencies, and just 4 percent are fire-related. But even so, firefighters respond as if they are heading to a fire, sending a crew of three or more on a truck or engine costing an average of $500,000 -- five times the cost of an ambulance.
Typically only one of the three arriving firefighters has medical training, the report said. That creates a "mismatch between service needed and service provided," with fire departments deploying "personnel who are overtrained to meet the need" -- that is, paramedics also trained as firefighters.
"Taxpayers can no longer afford to fund the status quo," the report said. "Using firefighter-paramedics in firefighting equipment as first responders to all non-police emergencies is unnecessarily costly when less expensive paramedics on ambulances possess the skills needed to address the 96 percent of calls that are not fire-related."
The report comes as firefighters face growing scrutiny for six-figure salaries and pensions. City officials say mounting costs are driving them to insolvency, forcing layoffs and cuts to popular programs such as libraries.
Santa Clara County and city officials have 90 days to formally respond to the report.
County spokeswoman Gwen Mitchell said the county, whose Emergency Medical Services Agency governs response protocols for most of the county, would not comment before issuing a formal response.
But San Jose fire Chief Willie McDonald questioned whether private ambulance services can do the job faster and cheaper than firefighters. He argued that because they already are heavily staffed and widely deployed to tamp down fires, firefighters can respond more quickly, and it's more cost-effective to give them paramedic training. An ambulance company would have to hire more medics to meet the firefighters' response time targets, he said, and those costs would be passed on to patients and their insurers.
"We have the personnel, and the service is compatible with advanced life support," McDonald said.
The report sharply criticized politically influential firefighter unions, accusing them of stymieing efforts to "think outside the box" to protect jobs. It argues that schedules allowing firefighters to live far outside the communities they serve "may unintentionally foster a culture of insensitivity to residents' sentiments" and a perception of being "entitlement-minded."
"Unions are more interested in job preservation than in providing the right mix of capabilities at a reasonable cost, using scare tactics to influence the public," the report said. "The result is a clear impression of firefighters as self-serving rather than community serving."
The jury report also suggested ambulances could respond faster. And it assailed minimum-staffing requirements in firefighter union contracts as hindering flexibility for departments to operate more efficiently.
San Jose Battalion Chief Robert Sapien, the new president of the San Jose firefighters union -- which a 2009 civil grand jury accused of being needlessly hostile toward city leaders -- said the jurors never talked to him before they issued the report.
He noted that the union's new contract calls for 10 percent pay cuts and for further negotiations on pension reforms, in addition to allowing more staffing flexibility to reduce costs.
"The union and Fire Department have been trying to come up with alternative ways to respond so that we can come up with the best ways to respond to both emergency medical and fire protection," Sapien said. "The assertion that we're immovable and not innovative, I don't know where that comes from."
McDonald said that "our union is interested in talking about all this stuff and willing to look at all kinds of options."
The grand jury interviewed all the city managers and fire chiefs in the county and examined data gathered in a December report by the county's Local Agency Formation Commission, which oversees the boundaries of cities and special districts.
In 2003, the report noted, Sunnyvale -- which operates an unusual public safety department in which police serve dual roles as firefighters -- explored using roaming light-response vehicles, similar to ambulances, for medical calls and found it would improve response times.
"In spite of this data," the report said, the "Sunnyvale Public Safety Department could not generate the institutional and political support necessary to implement change."
http://www.mercurynews.com/politics-government/ci_18283358
2 comments:
Perhaps if the Grand Jury had considered patient outcomes, based upon input from EMS system Medical Directors (doctors), rather than politics and questionable economics of service delivery models, the editorial (not "report") would have some validity.
I was quite surprised to read what is a "C" or "B" grade, high school level paper coming from the Grand Jury. There are no citations backing up most of the stated assertions.
Patient outcome data is the only valid way to evaluate & report on an EMS system's service delivery model. Unless, of course, the purpose of your report is political or financial, rather than medical efficacy.
After reading the grand jury's report, I failed to find one fact that was even close to being accurate. Where did you come up with $500,000 for a fire engine to respond to a medical call? How do you know how many firefighters are required to handle a medical emergency? I suggest you folks take advantage of the fire department's ride-along program and educate yourselves before you publish a report that does nothing but makes you look as bad as this one does. One last question. Are any members of the grand jury in the emergency medical field or have and fire department experience? My guess is no! I got my education by spending 30 years as a fire fighter/fire engineer in San Jose.
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