IAFF: Effective Strategies for Tomorrow’s EMS Systems
By Brie Mathews
Sometime around mid-May, I received a phone call from John Hanley asking me if I would like to go to Minnesota for an IAFF EMS Conference to represent Local 798. I was told that I was chosen due to my experience as a paramedic/firefighter and my hard work on the H-3 Advisory Committee. At first I was honored to be chosen and even though Minnesota was hardly a place I was dying to see, I accepted the invitation proud to represent our Union. Then John told me that I would be attending the conference with James Vannucchi and suddenly it all made sense why I was picked….no one else was willing to hang with “Vannucch” that long! Just kidding Jim! Actually, the 5-day conference (June 6th through 9th) was very interesting and I was pleased to be in the company of such a professional, yet entertaining fellow!

So, about the conference. In between opening and closing ceremonies, Brother Vanucchi and I were each assigned 6 workshops to attend. For the most part, we attended different lectures so that we could cover as much as possible of what was presented and report back to all of you. With that said, I will do my best to summarize each of the workshops I attended.

I. GIS: Geographic Information Systems
This workshop featured 3 speakers whose departments have already implemented the GIS. These speakers came from Contra Costa County, Local 1230; Omaha Nebraska, Local 385; and Surrey Canada, Local 1271. The theme of their lectures were on how the use of the Graphic Information System has helped improve their Fire Department functions thus allowing them to better serve the general public.

So what is GIS? Well, first of all, they made it very clear that it is NOT a GPS (Global Positioning System). Basically, the system is a computer generated information system that can, among other things, map response zones in order to ensure that the closest and most accessible units respond first followed by the next available units (2nd alarm, 3rd alarm, etc.). Other benefits of the GIS include: indicating the type and locations of hydrants closest to fire incidents, hydrants out-of-service in the vicinity of fire incidents, street closures and best route for response, information specific to buildings involved in the incident (wet vs. dry standpipe, location of hand lines, access codes….) etc. The system can even plot toxic plumes in HazMat incidents!

Each speaker also emphasized how the GIS has been useful in the political arena. This has been accomplished by using the system to show to public officials why certain stations targeted for closure should remain open. It has even been used to justify the need to open new stations, push for funding for more apparatus (both medical and fire) and to show the need for increased personnel.

Anyone interested in further information on this topic can contact Director Jonathan Moore, IAFF Department of Fire & EMS Operations/GIS at 1750 New York Ave., NW, Washington DC 20006.

II. Programs Ready to Use: NFPA’s “Risk Watch” & NHTSA’s “Buckle Up America”
This workshop was primarily an information session focusing on the many outreach, public information, and injury prevention programs available to Fire Departments in order to better serve their communities. Most of the programs function through local school systems to provide safety related public education. The speakers in this session spoke in depth of their various programs & provided information how to get a program started in your area. Examples of the various programs include:

  1. “RISK WATCH”- An injury prevention curriculum for children in pre-school through grade eight. The program is taught by teachers and endorsed and assisted by local fire departments.
  2. “First There First Care”
  3. SAFE: Safety Advice from EMS - A guide to injury prevention.
  4. “Make the Right Call”

For more information visit: www.nhtsa.dot.gov or www.riskwatch.org

III. HCFA: Revised Rules and Regulations / Alternative Funding Resources
This was a 2-part lecture, the first being about ambulance fee charges and how billing through Medicare may change in the future. Currently billing varies greatly from state to state & county to county. The proposed changes are an attempt to equalize costs & reimbursements. To facilitate this, a Fee Schedule National Rule Committee was assembled bringing together federal government, municipal, & private corporation stakeholders. For California, the new fee schedule would most likely reduce greatly the funds reimbursed to EMS providers whose services were rendered to patients that have Medicare. Although, the fee schedule pertains only to Medicare patients, the speakers cautioned that more than likely, other Health Insurance Providers such as AETNA and HealthNet will follow suit. Fortunately, the new fee schedule which was scheduled for implementation on Jan 01, 2001, has been delayed pending a final rule from the Committee. At the time of the conference, the fee schedule had yet to be finalized.

The second part of this workshop was a very important discussion on how to obtain grants and alternative funding for Fire Departments and EMS Services. The lecture was presented by FEMA representative and USFA member William Troup. Given the current budget crisis in San Francisco and the SFFD, this seems like a logical alternative for supplemental funding. I urge anyone with experience in grant writing to notify our administration and/or Union to tap these resources.

For more information on grants available and help on how to obtain them, go to www.hcfa.gov.

IV. EMS System Performance Measures and NFPA 1710

A. System Performance Measures:
Apparently, the IAFF is working on a project to develop performance measures for EMS systems in the United States and Canada, so that local and regional governments will have an accurate and unbiased tool to assess the quality of the EMS systems in their communities. These performance measures will also provide a mechanism for which to assess compliance with the EMS-related standards in the proposed NFPA 1710 (described later in this article). They will enable local fire chiefs to report tangible information to municipal budget officials to justify what the fire department does with its budget dollars. Further, it will allow chiefs to communicate knowledge about the system, not just numbers in annual reports.

The indicators include: call processing time, turnout time (the time from dispatch to load into apparatus), defibrillation time to first shock, employee turnover, patient outcome, protocol compliance, deployment of mobile resources, staffing, employee illness and injury, and more. In total, there will be 15 performance indicators. Initially, the more than 250 departments that are participating will answer questionnaire’s relating to these indicators. Later, a smaller sample of fire departments will be chosen to participate in a more in-depth field study. The IAFF intends to start implementation on July 1, 2001. I am not aware of whether or not SFFD will be participating in this study.

B. NFPA 1710
The much talked about NFPA 1710 was recently passed by the IAFF and is intended to be the minimum standard against which to measure career public fire department performance. NFPA 1710 demonstrates that deployment capability, staffing levels, and fire department resources are a public safety and firefighter safety issue.

The standard specifies as follows:

  1. Minimum criteria for effectiveness and efficiency of structural fire suppression, EMS, wildland, aircraft, marine, and special operations to adequately protect the safety of the public and fire department employees.
  2. Fire engine and truck staffing at a minimum of 4 firefighters (5 or 6 in jurisdictions with tactical hazards and high-hazard occupancies).
  3. BLS and ALS staffing at level required by state/provincial law.
  4. Fire departments must be capable of establishing RIT teams at all incidents.
  5. Fire departments must staff chief’s aide positions.
  6. Response time of 4 minutes for the first arriving fire unit and/or the arrival of the full alarm assignment in 8 minutes.
  7. Response time of 4 minutes for the arrival of a unit with a First Responder or higher level capability at emergency medical incidents and if provided, 8 minutes for the arrival of ALS.
  8. Fire departments must be capable of establishing the following functions at each structural fire: incident command, water supply, attack line(s), back-up line(s), search and rescue team(s), ventilation team(s), and rapid intervention team(s). Benchmark requirements are based upon a 2000 sq. foot detached single-family occupancy. Urban fire departments will have to increase requirements according to the occupancies and hazards in their jurisdiction.
  9. Minimum requirements for health & safety, incident management, training, communications, and pre-incident planning.
  10. Fire department must inform the public about its response capabilities and consequences of not meeting the specified deployment criteria.

V. Cross-Trained/Dual-Role: Fire Suppression or EMS?
This workshop focused on the integration of EMS into the fire service of Local 964 & Local 734, a joint Union association in Baltimore, Maryland. Their story was an eye opener and their message was important because what happened to them is happening everywhere. Read on…

Their problems started with a Chief who wanted to privatize EMS, thereby losing any possible revenue that EMS generated. Together, the 2 unions fought not only to save EMS but to include the paramedics in the fire & police pension which they were successful in attaining. They also fought for “procedural guarantees” which protect their members from accusations of misconduct. To further show their commitment to EMS, the department began an internal firefighter/paramedic apprentice program with the intention to cross-train ALL members of their department.

Not long after overcoming their first EMS roadblock, the department was faced with a brand new mayor who threatened cutbacks and closures. First, the mayor refused to negotiate for parity & promotions. Then he revealed his intention to close 7 fire companies and disband 2 Battalion Chiefs in order to give the police a 33% raise and add additional EMS units to the street (without hiring more medics to staff the units).

At this point the Unions took to the streets to defend and justify the need to keep these units open. After a long crusade involving reaching out to the public, soliciting the help of the media, and launching a full counter-attack on the mayor, the only agreement the mayor would succumb to was allowing the fire department to choose which units were to close down.

Further noteworthy information about Baltimore Maryland fire department include:

  • Since 96’ every new firefighter is trained as a paramedic & required to keep their license as a condition of employment throughout their career
  • 4 “red alert” units were created and staffed with suppression members to assist with medical calls when available ALS units drop below 5
  • Due to current lack of medics, engines are only BLS and will be staffed with medics as firefighters are cross-trained

I guess we could learn from this department and their struggles. If we don’t get on board and set our own criteria for EMS we could very easily face a future administrator or political figure that is not so “fire-friendly” that will set it for us.

VI. Medical Priority Dispatch: Call Dispatch Innovations
This workshop basically addressed the crisis in EMS in which “non-emergent” transport patients overwhelm the dispatch and EMS system. The system known as MPDS (Medical Priority Dispatch System) is basically the “Clawson” system which SFFD plans to switch to later this year. According to the speaker, William Finch, a consultant for Medical Priority Consultants, this MPD System focuses on alternative means for transport &/or care of non-emergent patients. An example he gave was of the non-emergent overdose call in which patients who fall under specified criteria are referred to poison control instead of having an ambulance dispatched. Once poison control agrees to assume responsibility they become responsible for patient outcome.

Another thing that is accomplished by this dispatching method is that calls are “stacked” meaning that if they are non-emergent, they are put on hold until all pending ALS calls are handled. In some jurisdictions suppression units respond to low-priority calls and if transport is necessary, a private ambulance is called for transport. Further, frequent callers of 911 are tracked and provided with social service to offer alternatives, i.e.: elder care, rape crisis, etc..

Mr. Kinch did say that the extent of alternatives implemented will depend on each individual department, but this system seemed like a step in the right direction. We all are aware that working at dispatch is difficult. The calls most often come from people who are hysterical and distraught, or the caller has little information to give. So unless we return to the days where paramedics triage calls, then at least this system might offer some improvement, even if only slightly. I guess we’ll have to wait and see!

So that was the conference. Overall the theme of the conference seemed to be about staying on top of the trends toward EMS within the Fire Service while maintaining the exemplary skills of fire suppression. And as for you Brother Vannucchi….I’ll catch you at the next conference!


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