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3. EMS Operations1 92o6 T4: Mayor Pamela B. Kennedy and Kalispell City Council FROM: Randy rodeh , Fire Chief James H. Patrick, City Manager SUBJECT: EMS and Fire Response Staffing from Two Stations WORKSHOP E: 2 o6 BACKGROUND: The Kalispell City Council met on April 17, 2006. During the council member discussion, questions were raised regarding medical response by the Kalispell Fire Department to the areas served by Fire Station Now 61 The following information addresses those questions: x Who is responsible for assigning which apparatus and personnel respond to what location? The Flathead County Sheriffs Office Dispatch Center receives initial requests for emergency response in Flathead County. If it is a request for fire or EMS response, the Dispatch Center contacts the appropriate agency through a set of radio tones and transmits a description of the call. Like for all fire and EMS agencies in the county, Dispatch does not assign or track resources. Therefore, in the City of Kalispell, the Kalispell Fire Department duty officer rust assign personnel and apparatus as calls core in to meet the reed. The Dispatch Center only dispatches the station, without assigning resources. Dispatch does not track when a station is empty of all or part of its resources} so Dispatch continues to dispatch that station, regardless of whether there are any resources available from there or not. Since the Dispatch Center does not track resources, the duty officer is responsible for monitoring which apparatus and personnel are available at any given time, both in the City and apparatus that are assigned to responses outside of the City. The danger exists in Dispatching over committing the resources of a station, and a call being dropped. Tracking these resources is no small task for the duty officer, because, as often happens, the department is working multiple events at multiple locations. It should also be noted that the duty officer is often actively 'Involved in one of these responses while managing resources for additional responses in other locations. Management of resources Is commonly the responsibility of the Dispatch Center using CAD technologies that have been available for over thirty years* In 2002, the Flathead County fire and EMS responders formally requested that Dispatch track resources. These agencies have continued to request that this be corrected, but this issue continues to be unresolved, even though it is frequently discussed by the 9-1-1 Board and the County Commissioner's. issioner . Regardless of these discussions, resolution is not assured in the near future. a What resources are assigned to what stations in Kalispell? For the most effective response of personnel and apparatus, personnel numbers are stacked at one station more than at another station. This stacking of personnel also allows the most decision flexibility for the duty officer. Since a majority of our in City EMS responses either begin or end within a few blocks of Kalispell Regional Medical Facility, it is logical that the station with the most personnel and medical transport vehicles will be the station nearest the hospital. (Station No. 62 is less than a mile from the oftax) This stacking of personnel at one station also means that the duty officer can shift teams of personnel back and forth between apparatus. Since an ambulance has a two person tear, and a fire engine has a 3-4 person team, having a majority of personnel at one station and a single company at another, helps the duty officer define response possibilities, To help explain how this works, there is a chart attached that shows 24 of the most likely combinations that can be put together with the resources of the Kalispell Fire Department. In yellow are the configurations we use depending on the number of firefighters on duty on that tray. In orange are configurations that we are considering, and that we are testing. The duty officers are monitoring this and will be providing feedback that will solidify our permanent assignment plan. a How many firefighters are needed to respond from Fire Stations No. 61 and 2 The number of personnel needed to completely staff two firefighter1paramedic stations is 10 personnel on duty. This allows a twelve person shift, and staffing down to ten to account for up to two firefighters on leave. The department is currently staffed with 10 firefighter/paramedics per shift a minimum of 8 firefighters on duty, with two firefighters on scheduled leave). This number of staff allows the station to function each shift, but means that it does not allow the flexibility needed to staff both a fire engine and an ambulance at Fire Station No. 61 wftot reducing the overall response capabilities* All Kalispell firefighters are also paramedics, providing a greater flexibility in how the department responds to the Comm unity"s needs. Additional staff has been requested 'in the coming budget year. These addftional personnel will allow the department to futfill the current response demands of the community. 0 'what is the medical response in Fire Station No. 's response area? Station Now 61 has a minimum of three firefighter/paramedics on Fluty each shift, providing advanced life support from a fire engine. When there are more than eight firefighters on duty In the city, Station 61 will be staffed with four firefighters, and will provide either an engine or an ambulance response. When an ambulance responds from this station, it means that there are only two personnel left to staff a fire engine. While this is not optimal, the staffing to do this differently does not exist without compromising the ability to be flexible for the greater response needs of the community. Attached to this document is the response matrix used y the Kalispell Fire Department when coming to this conclusion. on. s mentioned earlier, the duty officer is responsible for knowing which apparatus are in service, how many firefighters on that apparatus, and anticipating when assigned apparatus will become aaale. Again, a very difficult task without a Dispatch Center that is capable of tracking resources. a Is there a medical need for an ambulance with paramedics to be on scene before or instead of a fire engine with paramedics? Kalispell Fire Department is fully paramedic staffed, That means that every firefighter or officer on a fire engine is a Nationally Registered Paramedic. Every ambulance and every fire engine carry the necessary equipment o triage and treat every patient, and therefore are recognized by the NF A as Advanced It Support Units. According to the rationally recognized NFPA Standard 1710, standard for the an * o and o Fire S rassior era ions EmeMenczse r a O pera for s, andSpecial rations to the Public bx Careen Fire ,D artments, the recommended arrival tunes of trained personnel are as follows: The lire department organizational statement shall provide service delivery objectives, including specific response time objectives for each ma or service component (i. o., fire suppression, EMS, special operations, aircrar rescue are d fire fighting, rarin rescue and fire fighting, andlor wildland fire fighting) and objectives for the percentage or responses that meet the response time objectives* M 1,2. 1 The fire dep a rtm e n t sh a # establish the fo 110 wing time o biect s: (1) One minute (60 seconds) for tumout time (This is the time It takes between receiving the dispatch information atio via radio and tomes over the station intercom, and the apparatus actually going n route.) Four minutes 20 seconds) or less for the arrival of the first am'ving engine company at a fire suppression incident andlor 8 minutes es o seconds) or less for the deployment of a full first alarm assignment at a fire suppression incident (This is the time :men the apparatus going in route, and arrival on scene, for a total response time of 5 mints 3 o seconds.) (3) Four minutes 2 0 seconds) or less for the aiTival of a unit with first responder or higher level capability at an emergency medical incident (4) Eight minutes seconds) or less for the anival of an advanced life support unit a an emergency medical incident, whore this service is provided by the fire department 4.1.2.2 The fire department shall establish a Perfonnance objective of not less than 90 percentfor the achievement or each response time objective specified in 4.1.2. 1. The response time objectives of the Kalispell Fire Department were set in 2003 as five minutes or less, 90 percent of the time, inside the city limits. This is an excerpt from the dear r ent "s goals and objectives that was presented to the council In Zoo w Goal #2 Mitigate all FirelEMSIRescue, and Hazardous Matetials events in the City of Kalispell. Objectives Respond to all emergency calls within 60 seconds or receiving the alarm. Complete 2. Arrive a % of all fire calls within 5 minutes or receiving the alarm by April 2: 3,, Arfive at 90% or a EMS calls inside the City Limits within 5 minutes by April 2006. . Prevent the emergency from deteriorating after our artval. In placelongoing The goal was to be completed by Aprf ; 2006. Under our current response matrix, with Station No. 61 staffed to a minimum of three firefighters, and Station No. 62 staffed to a minimum of five firefighters, we meet or exceed this goal. Outside of the city limits, basic life support is provided in all of our response areas, by local fire or Quick Response Units (Volunteer EMS responders also known as I Us). These istrircts are not subject to NF PA 1710, but are subject to the less restrictive NF PA 172 which is the standard for volunteer and combination departments. Depending on the availability of volunteer responders, and the location of the need, medical first responders arrive as soon as they can. Patient care 's initiated by these responders, and the patient i often ready for transportation when we arrive wfth an ambulance. Medical training for these responders vases from the First Responder level to Paramedic in some cases. Advanced Life Support is not guaranteed In any of these areas until the Kalispell Fire Department or the ALERT Helicopter arrives. Kalispell Fire Department covers such areas as Creston,, F ys Lake, and Smith valley. Response times may be 20 minutes r more t these areas so advanced life support may be delayed until our arrival. Why doesn't South Kalispell Rural Fire District got the same service as other areas that we respond There Is an exception to local fire or QRU response outside of the City. This is the South Kalispell Volunteer Fire District. This district has chosen to not respond to any type of EMS call. Because of this,, the Kalispell Fire Department may use one of two options to assure adequate emergency medical response occurs. The first is t send an ALS engine on this call. The second, if that engine is already on another response, may be to send additional personnel In the ambulance. Neither of these is a great option because both consume more City resources than in the other rural districts, leaving the City wfth less ability when responding to other requests for response. However, the department regularly uses both of these options, depending on the type of call and the available resources. N The Medical Director for the Kalispell Fire Department is Dr. Richard Briles. He is providing a leftr In support of the rational used for determining where personnel and apparatus are located. (To be distributed) ■ The decisions for placing personnel and apparatus are made with much consideration of the possibilffies and the impacts to the residents served. Comments made by council members at the council meeting of April 17, 20061 indicated that an ambulance should be placed at Station 61 . An ambulance needs to arriveinstead of a fire engine because of the need for immediate transportation to the hospitaL This can be the case, although It is rare that immediate treatment by paramedics is not preferred. (See letter from Dr. riles,) When there is a need for immediate transportation it is almost always due to a severe traumatic injury such as night occur in a high speed motor vehicle crash. The typical process for this patient would be a the patient, if trapped, is extricated from the vehicle by firefighters. Paramedics (whether they rode to the scene on a fire engine or ambulanceis immaterial) evaluate the medical condition and treatment needs of the patient and begin treatment. The patient is put on a backboard and packaged to be moved to the ambulance. The process can not change for this patient. The difference is whether the patient travels to the hospital in an ambulance traveling with lights and sfr n. Whether transported rapidly or at the same speed as normal traffic, does not effect the initial actions of firefighters and paramedics on the scene. The arrival of the ambulance eight minutes after the fire engine with paramedics saes not change the medical outcome of the patient. 2. w,.for political reasons* If Council gives the direction to change the current configuration of personnel and apparatus, the department will put that change into effect immediately. However, unless directed differently by the City Manager, the fire chief will continue to make decisions bad on the best use of resources to meet the mission statement of the fire department. Mission: Respond to ag Fire, Rescue, and Hazardous M n'als emergency requests within the City of Kalispell, and immediately begin to mitigate the emergency; respond to all requests for emergency medical i l services i ire the ambulance response area; and assist our community in reducing and preventing emergencies. Rr y roe, Fire Chief H. Patrick, City Manager KALISPELL FIRE DEPARTMENT STAFFING OPTIONS Staffing Personnel Personnel Indicates that this is an either ambulance or engine or truck option. Can not be all. To: Randy Brodehl Fire Chief, Kalispell Fire Department From: Tim Soule President, Kalispell City Firefighters Local 4547 Re.- Operational. Response and Staffing Date: April 2, 20 Chief, l am writing this letter representing Kalispell City Firefighters Local #547 in response to the recent questions and co ccr. s expressed by City Council regarding the Departments" operational response now that we have two stations. As you are aware, I wear many hats within this Department; Lieutenant, Training Officer and Union President. These roles, at times, have priorities which are different, however, the one priority which is constant throughout these roles 's firefighter safety. Under all tree "hats" I wear, firefighter safety is the number one concern; the most effective and efficient operational response for the citizens of Kalispell and then, the surrounding communities, would follow closely behind. I have sat in many meetings with the officer corps and Chief Diehl attempting to balance these Priorities as we moved to a two station response. Although not ideal, the current staffing and response guidelines are the only way to maintain a response for three EMS units and keep a fire response with a dedicated three person engine company for the City with our current staffing. For firefighter safety and operating most efficiently for the citizens of Kalispell, this current operational guideline is the best. We have a dedicated three person engine company for fire response and first response for EMS in the downtown and southem parts of the City* This engine carries all of the advanced life support equipment found on our ambulances along with three paramedics. There is not a conceivable medical emergency 'in the first response area of the downtown engine that citizen care would he compromised while waiting for an EMS transport unit. Firefighter safety is markedly improved by adding a fob person to the engine response. Per N' A, OSHA and NOSH, a fog person engine company is recognized as the most efficient and safest method of staffing a engine, It should he recognized, however, that having a four person engine company with eight persons on duty unduly interferes with our ability to staff three EMS units* Chief Diehl. has also agreed, With the Union's prompting and the Officers agreement, to staff a four person engine company and bring the third EMS unit downtown when we have nine or ten persons on duty. This will, still, not allow us to meet all three goals to their fullest. The only way to do this wood he to have a ten person minimum staffing allowing us to staff each station with five, send an EMS unit into the county from each station and still maintain an engine company for fire response. This would take, at a minimum, an additional six personnel. Kalispell City Firefighters Local 4547 appreciates the efforts of the Fire Department . Administration and the City of Kalispell in providing additional personnel and a new station. This shows an obvious commitment to firefighter safety and meeting the needs of the City and surrounding communities_ We support your continued efforts to provide additional full time staffing as it should be recognized that this is the only way to improve the response to both the citizens of Kalispell and surrounding communities without sacrificing firefighter safety, Please feel free to share this letter with the City Manager and City Council. R t , 4im 0ue,, President ' pell City Firefighters Local #547 'lease note that our current dispatch situation is the most dangerous issue for firefighter and citizen safety and operational efficiency. Dispatch consistently gives us poor or incorrect inforn atior4 dispatches us to another city or dispatches another city to us, fails to dispatch the correct station and is unable to dispatch .per type of apparatus needed. Dispatch may also send a rural fire response to a City address and not send a City resource due to how they receive their information and the politics of the fire districts. This could result in a structure fire in the border of the City limits not receiving a fire response from. the City as the call was received from a rural fire district address. Every dispatch from our current. Dispatch. center is not poor or incorrect; but there are mistakes made daily* Emergency Dispatch is not an area where mistakes should he tolerated at all.