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.