All posts for the month January, 2013

I present a no-win scenario. No matter what you do the patient is going to get sicker. Spans the time from 911 call to the ICU. Guest spot from Chewbacca and music from an album I made in the 90’s. Thanks for listening. JY

I read an incredibly annoying article this weekend from Orange County, CA describing a commission that was investigating the Fire department budget there. They cited the fact that fire calls had dropped by 60% in the last decade and that EMS calls had increased by more than that amount as evidence that they should lower firefighter pay, close stations, and basically rely on private EMS companies and sprinkler systems. I basically was amazed at the ignorance of reality in the article. There are several absolute truths that need to be accepted, even by the most reality challenged:

1. Homes and businesses will still catch on fire

2. Fires will still need to be put out

3. Firefighters will need to put out fires.

4. We, as a society, agree that fires should be acted on quickly, and fires should be put out before they run out of fuel (meaning the structures are now burned to the ground)

5. People will occasionally be caught in fires and will need to be saved

Now if you accept those five truths, several more truths follow, if you have any ability to use logic:

1. You need firefighters who have the equipment and knowledge to put out fires and rescue citizens

2. You need firefighters and equipment in locations so that your homes and businesses can be reached within a reasonable period of time

3. Communities will need to pay for this protection

The problem with all these truths, is that other that stating they will occur, we don’t know the frequency. This lulls communities into believing fires will never occur, which is fantasy.

Next, we need to look at the amount of training and expertise firefighters should possess. Structure fires fall into the category of high stress, high complexity, and low frequency events. Planning and training for these events is very complex, and is where there is a great deal of disagreement. Do you train people for the most complex incident they may see? Or do you train them for the most common incident (which will leave them tremendously vulnerable if a complex incident occurs). Hospital can play a game with this, they can hold themselves out to the community as “complete” hospitals, but if someone too complex comes in they can ship them off to the academic or tertiary care hospital. By having that option, the community hospital does not have to have all the equipment and expertise necessary (which is very costly and may only be used very rarely) and can shift all those costs to the academic/tertiary care hospital. On the other hand, since the community hospital will not see enough of the complex cases, they would probably not be very good in dealing with them, so they should send them out for the sake of the patient.

Can fire departments do this? Probably not. There is not a “tertiary” fire department in every jurisdiction or region, and even if there was, you cant get a helicopter to fly more advanced fire trucks and firefighters to a scene if they are needed like we can do with patients.

So what do you do? Rational thought would dictate that you need to have a pretty high level of competency for firefighting personnel and equipment in EVERY jurisdiction if you want to offer reasonable protection to every home and business. This is very difficult to do when municipalities want to cut funding when the fire frequency drops. If you accept that the fire frequency will never be zero (which it never will be) and that you need a reasonable level of expertise to save people and property, you need to support the costs. Firefighting also has the problem that if they carry out their prevention and inspection jobs well, there will be less fires and less perceived need for fire departments. Same kind of thing happen in trauma surgery, as we improve airbags and cars, the less Level 1 Trauma Centers we will need. Thankfully for trauma surgeons, people are constantly coming up with new and innovative ways to hurt themselves, so I am pretty confident in my job security.

Next, it is very important that municipalities not to be lulled into a false sense of security by the lack of major fires. It is vital for Chiefs to demand a level of competency such that all but the most complex incidents can be controlled, and even in the largest incident, the circumstances can be stabilized. This is a very hard job for fire administrators and chiefs, and they need to educate their communities and legislators to these facts.