When dozens of fire engines and ambulances show up it’s either a parade or a disaster. The March 3 meeting of the Jefferson County Commission was definitely not a parade, except for the steady stream of volunteer firefighters and EMTs standing up to address the Commissioners. Most of the speakers asked a version of the same question — how does it make sense to pay a consulting company from Missouri $35,000 to analyze how to restructure the county ambulance system without even talking to anyone in any of the seven fire companies around the county?
The EMS Consulting Project
Fitch & Associates is a consulting firm with many years of experience in assisting local governments in evaluating both fire and emergency medical services (EMS). The County Commission contracted with Fitch in May of 2021, requesting a very limited review of the county’s EMS system — a basic analysis of ambulance response data with no on-site (or telephone) interviews with any operational staff in the county’s Emergency Services Agency (ESA) or the seven volunteer fire companies located in the county.
The Report: 11 pages with 7 recommendations, including a recommendation to adopt response time standards that would allow for a 37 percent increase in response time compared to the county-wide ambulance response data for 2021.
What It Means: The County Commission is looking at operational models proposed by the consultants that would reduce the number of ambulances on call from the current 12 across the county to options that would house 4 and 6 ambulances in only a few stations. An 8 ambulance model included in the consultant’s presenation has been characterized as an unaffordable “Cadillac” model by one of the commisioners. With these models, the staffing would also change from a mix of ESA staff and fire company volunteers to just the ESA staff employed by the county.
Listening to county staff and the chiefs of several of the volunteer fire companies, The Observer heard several concerns (so far):
- Misinterpreted Data
The first page of the report states: “In 2020, there were 6,601 unique requests for service within Jefferson County. This totaled 23,336 distinctive vehicle responses, which averaged 3.5 responding units per unique EMS incident.” These response numbers appear to combine both EMS and fire responses. Table 6 of the report appendix breaks out the numbers for EMS and Fire response, indicating only 5,220 EMS requests and 17,764 EMS responses — an average of 3.4 responses per incident. Table 9 in the report appendix breaks out the responses by station, indicating 5,832 responses from Station 11 — the reporting code for ESA staff. The reality is that there are not 3.4 ambulances responding to the average call for medical services. Jefferson County has customized its emergency call tracking system to reflect the mix of staff and volunteers to be dispatched with an ambulance, with separate coding for each. Unfortunately, the data used throughout the report fails to take into account this unique data coding, counting personnel as vehicles — and throwing into doubt many of the conclusions drawn from the data. The consultants referred The Observer back to the County to address the question of why the information needed to interpret the non-standard data coding was not provided to its team.
- Increase in Response Time
The report from Fitch & Associates recommends the adoption of standards from CFAI (Commission on Fire Accreditation International). Following the “rural” standards, the report indicates that the “goal time” for EMS unit response (turnout + travel) would be 15 minutes (the “benchmark”) with an acceptable time of 19 minutes, 42 seconds (the “baseline” response time at the 90th percentile). Adding the county’s 2021 average dispatch time of 1 minute, 48 seconds to the travel and turnout times to calculate the potential Total Response Time pushes the clock to more than 20 minutes for the proposed acceptable standard.
- Staff Utilization & Safety
The report references recommended workload standards for the paid emergency services (ESA) staff. However, the EMS models presented in the report do not take into account the ambulance requirements for fire calls, so the workload of the various models is significantly understated. Volunteers provide additional staffing for many medical responses and ESA staff provide initial response to many fire calls, so the dispatch data do not provide a complete picture of the ESA staff workload.
Effect on Fire Safety Services
In the current system, both volunteers and staff are cross-trained for both emergency medical and fire services. Many of the volunteer EMTs are actually career paramedics in other jurisdictions, who use their volunteer time to enhance their skills and fulfill training requirements. The fire chiefs have voiced the concern that, if the opportunities for EMT volunteers are eliminated, the number of volunteers available for fire calls will be significantly reduced — which would force the County to take on that responsibility and cost as well.
Discussions between the County Commission, the volunteer fire companies, and the Emergency Services Agency are ongoing. The Observer will be updating coverage of this story in the coming weeks.
This page originally published April 3 2022. Update April 7 2022 to add additional report references references and clarification on personnel response.By Steve Pearson