When, where, and how much are the common questions asked by administrators, city or county council, and citizens when it comes to determining the resources for Fire Departments. Determining the proper level of resources to deploy for a fire department involves asking the same questions as well as balancing the safety concerns of citizens and the financial situation of the local government.
Of the ‘when, where, and how’ questions “where” is the biggest question and has the most impact on other decisions. Some of the areas it can impact include: how many units are needed, how big should they be, and when should the units be deployed. All of this impacts overall cost.
Poorly-placed fire stations, apparatus and personnel often results in more resources being placed in the community than are needed to provide the desired level of service. The availability of land to build on impacts the cost and the size of a new station, which can also impact the types of apparatus that can be located at that station. Deciding how many emergency response resources to deploy, and where, is not an exact science. There are no perfect deployment models, but there are a lot of resources, studies and data that support devolving these standards.
The available sources, include the Insurance Services Office (ISO), the National Fire Protection Agency (NFPA), the Commission on Fire Accreditation International (CFAI), the Occupational Safety and Health Administration (OSHA), American Heart Association (AHA), and comparable departments across the nation.
The ultimate decision is based on a combination of risk analysis, professional judgment, and the city’s willingness to accept more or less risk. Accepting more risk generally means that fewer resources are deployed, though deploying more resources is no guarantee that loss will be less, especially in the short term. Obviously, there are many pieces to consider, but there are some good sources to draw on to help make the decisions.
Response Time Standards: Emergency Medical Services—One method of measuring and evaluating response times is to count the number of patients who survive to the point of being released from a hospital. Although survival is not solely a function of the timeliness of care, time is crucial to a critically injured or seriously ill patient. Guidelines published by Basic Trauma Life Support International (a widely known training institute) suggest that a trauma patient’s odds of survival are directly linked to the amount of time that elapses between the injury and definitive surgical treatment.
Prevention of death and disability secondary to acute coronary syndromes is also an issue of time. The American Heart Association 2005 guidelines for CPR and Emergency Cardiac Care emphasize the importance of shortening response time to suspected cardiac arrest patients. If brain tissues are deprived of oxygen, they will begin to die within four to six minutes. For that reason, it is imperative to begin resuscitation measures as soon as possible.
Highlights of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, found that defibrillation was most effective if it was provided within six minutes of the patient’s initial collapse. The study also found the following: Effectiveness decreased significantly as the interval between cardiac arrest and defibrillation increased between 6 and 11 minutes. And after 11 minutes, the odds of patient survival were extremely poor. The odds of patient survival were doubled if ALS (paramedic) care was provided alongside BLS (layperson/police officer/EMT) defibrillation at all points prior to 11 minutes.
The American College of Emergency Physicians noted that for every minute of cardiac arrest, the chance of survival decreases up to 10 percent. Fire Departments and EMS systems should attempt to achieve travel times of 3-4 minutes for medical first response and 4-6 minutes for advanced life support. Our Fire Departments average response time from 911 activation to units on scene is 4 minutes for (ALS / BLS) care within City limits of Jacksonville 24 hours a day 365 days a year. This is something that everyone in the community of Jacksonville should be proud of.
Insurance Services Office (ISO)—The ISO is a national insurance engineering service organization that assigns a public protection classification (PPC) to jurisdictions based on fire department services. Insurance companies typically establish insurance rates for individual occupancies or groups of occupancies based on the PPC.
PPCs are established using the ISO’s Fire Suppression Rating Schedule (FSRS). Once widely used by fire departments to evaluate system performance, the FSRS’s use is somewhat limited in that it only evaluates fire protection (not EMS, which most fire departments now provide to some degree). Also, the FSRS does not consider efficiency (e.g., how many resources are deployed in comparison to the number of actual calls). Though not as widely used now, ISO ratings are still appropriate to consider as part of a more comprehensive system performance review.
Combined with other assessments, ISO standards are useful, but not by themselves. Our Fire Department was issued an ISO Rating Class 2 at that time was the lowest rating in Jackson County. This is something that everyone in the community of Jacksonville benefits from.
When It comes to service delivery I serve as the Fire Chief of Jacksonville Fire Department, I am always asking myself the following questions:
- Are we doing the very best we can do with the tools we have?
- Are there opportunities for more effective and/or more efficient use of Department’s resources?
- Are there options for mergers and/or expanded cooperation with neighboring jurisdictions beyond mutual aid agreements?
- How do the services provided by the Fire Department correspond to those provided by similar jurisdictions?
- Are there opportunities that would enhance city services and/or result in long term cost savings?