The Fire-EMS Challenge in High-Poverty Neighborhoods

The most frequent users of emergency medical services (EMS) are more likely to come from a lower socioeconomic group, be non-white, be older, live alone, be uninsured or on Medicare, have chronic medical conditions, and may have an addiction or behavioral health issue.

Los Angeles Skid Row

Skid Row covers about 50 city blocks (0.4 square miles) in Los Angeles and has 12,000 to 14,000 residents. Approximately one-third are persons experiencing homelessness (PEH). The rest live in single-room occupancy (SRO) hotels, residential hotels, or apartments. 68.9% of Skid Row residents live below the poverty line (Ward et al., 2024). This may be the most extreme example of Fire-EMS challenges in high-poverty neighborhoods.

Graphic from: Collins, B., & Loukaitou-Sideris, A. (2016, July-August). Skid row, gallery row and the space in between: cultural revitalisation and its impacts on two Los Angeles neighbourhoods. Town Planning Review, 87(4)

A 1971 UCLA study of the Los Angeles City emergency ambulance system found that 13 of the 632 census tracts, small permanently established geographic areas, generated 10% of the total public emergency ambulance demand. (Aldrich et al. 1971). John Hisserich’s public health dissertation used the same 1964 to 1967 data to analyze the determinants of service in detail.

“Sick Calls” were highly correlated with variables describing census tracts with socioeconomically depressed populations. The 13 busiest census tracts included the city’s three Skid Row areas. Census tracts within the minority ghetto area south of the central city were the next highest-demand areas (1970).

In 1976, Los Angeles city planners created a ‘Containment Plan’, which relocated affordable housing and social services from elsewhere in the region to Skid Row, effectively concentrating the homeless population in one limited downtown area (Haas and Heskin, 1981; Goetz, 1992).

These socioeconomically depressed census tracts are persistent, defined as tracts with 20% or more of residents living below the poverty line for about 30 years (Benzow et al., 2023). The 13 Skid Row census tracts identified by Hisserich show that 79% of residents have lived below the poverty line for 38 years (Benzow & Fikri, 2020).

These tracts have experienced a major change in ethnicity while continuing to have high poverty. Benzow and Fikri (2020) describe what changed:

Hispanics now make up 73 percent of the population of Los Angeles’ high-poverty neighborhoods, even though they represent a little less than half of the city’s total population. Blacks saw their share of the city’s high-poverty neighborhood population fall from 43 percent in 1980 to just 12 percent in 2018, largely driven by their exodus from the city over that time. Los Angeles’ Black population declined by one-third from 1980 to 2018, while its Hispanic population increased by 139 percent. (p 20).

Fires in High-Poverty Neighborhoods

High-poverty census tracts face nearly six times the odds of experiencing multiple serious residential fires compared to the least deprived quartile (Wibbermeyer, 2025; Pae et al., 2025). Family poverty, unemployment, low education, and low household income are all independently associated with higher frequencies of residential fires (Wibbermeyer, 2025; Shai, 2026). In Philadelphia, low income and older housing interact to produce fire injury rates exceeding the combined effects of either factor alone (Shai, 2026).

Outside Fires

The Los Angeles Fire Department responded to 24 homeless encampment fires daily in 2020 (Smith et al., 2020). Most of these fires were within the same 13 census tracts that were the busiest for emergency ambulance calls between 1964 – 1967.

From 2018 to 2024, the unhoused population in Los Angeles grew by 44.6%, from 31,285 to 45,252 individuals, according to the Los Angeles Homeless Services Authority. Rubbish fires increased 475% from 5,541 to 31,964 between 2014 and 2024. “While not all of those have been documented as directly associated with a person experiencing homelessness (PEH), many have,“ the report states.

In 2024, rubbish fires involving PEH totaled nearly half of LAFD’s Rubbish Fire call volume at 46.84%. Meanwhile, fire calls involving homeless persons during that same period accounted for 32.91%, or nearly one-third, of all LAFD fire activity, the report states (Kurzwell, 2025).

Systemic Impact on Fire and EMS Operations

Citygate Associates LLC performed a Standards of Cover analysis for the Los Angeles Fire Department. In this Battalion 1/Battalion 11 cluster image, stations 4, 9, and 11 are among the 10 busiest, while stations 3, 10, 13, and 6 are among the 28 busiest in a department with 106 fire stations.

The top ten busiest engine, truck, and rescue ambulance companies are adjacent to each other, predominantly in two clusters. The individual unit-hour utilization (UHU) measures for these units significantly exceed 30 percent for long, consecutive hours at a time.

Based on this measure alone, the busiest unit crews are overworked and in need of relief units and/or strategies to decrease the quantity of non-urgent EMS incidents. The volume and simultaneous demand on the top 10 to top 28 LAFD stations is the highest Citygate has ever measured in a metro client. (Citygate, 2023, pp. 6-7)

The Battalion 1/Battalion 11 cluster falls within the same census tracts that were the busiest for emergency ambulance calls between 1964 – 1967.

“Skid Road” Fire Station 9 has the smallest first due area in the city, about 1.5 square miles. The station staffs two paramedic engine companies (Engine 9 & Engine 209), the city’s only stand-alone paramedic truck company (Truck 9)¹, two paramedic rescue ambulances (Rescue 9 & Rescue 209), one 24-hour and one variable-hour EMT rescue ambulance (Rescue 809 & Rescue 900), and a paramedic/firefighter fast response vehicle (FR 9).

In the Citygate study, Rescue 809 (EMT) was the busiest LAFD ambulance, with 6,522 annual responses. Paramedic Rescue 9 and Rescue 209 responded to 5,221 and 5,090 calls, respectively. In the National Fallen Firefighters Foundation 2022 video about the Boyd Street Fire, the 19 on-duty members working a 24-hour shift at Station 9 averaged 100 responses every day; 90 percent were EMS calls.

SoCal Connected (2020) Fire Station 9. [Video] Season 10, Episode 1107. Public Broadcasting Service

Fast Response 9

The firefighter/paramedics assigned to the four Fast Response Vehicles (FRV) [deployed throughout the city] have a unique authorization from the Los Angeles County Department of Health Services to medically clear certain patients experiencing acute behavioral crises or chronic public inebriation for transport to either a Mental Health Urgent Care Center or Sobering Center, rather than to a traditional hospital emergency room. In addition, all LAFD FRV personnel certified Tactical EMS (TEMS) units and are available to support LAPD SWAT Team efforts. (LAFD, 2020)

This 2:19 minute video shows Fast Response 9 handling a homeless encampment fire in 2025. https://youtu.be/kLgR2QPGFH0

The 2020 Boyd Street Fire – Narrative from the LAFD “Green Sheet”

On Saturday, May 16, 2020, at approximately 18:27:00 hours, the Los Angeles City Fire Department (LAFD) responded to a structure fire at 327 East Boyd Street in the Skid Row [Toy District] area of downtown Los Angeles. The first arriving resources found a one-­story commercial occupancy with light, intermittent brown smoke showing from the top of two closed rolling steel doors. The subject occupancy was doing business as a wholesale distributor to dispensaries and smoke shops, and it had closed for the day prior to the time of alarm.

Conditions noticeably worsened over the next several minutes. Initially, members described a notable change in smoke emitting from the front of the occupancy, and then a rapidly increasing “freight train” or “jet-­like” sound, accompanied by rapid and escalating “popping-­like” noises. Subsequently, companies initiated a rapid retreat – both off the roof and out of the building. As firefighters began initiating their escape, a large volume of smoke ignited, and then immediately following, fire “blowtorched” out of the front of the occupancy, across the street, and out of the rear portion of the roof.

As a result of the catastrophic fire event, just eleven (11) minutes into the incident, twelve (12) firefighters were injured. The injuries were sustained when the firefighters were engulfed by a large volume of fire, some while retreating from interior firefighting positions, and others as they were descending the aerial ladder. All told, eleven (11) firefighters sustained minor to critical burns, and one (1) additional firefighter suffered a lower extremity injury.

The cab of the first-arriving Truck 9, with its deployed aerial ladder, sustained significant damage because both were in the immediate path of the flames. (LAFD, 2020)

This link takes you to the Green Sheet, an Informational Summary Report that is issued by LAFD as a safety/training tool: https://lafd.org/sites/default/files/Boyd_Green_Sheet.pdf

Captain II Victor Aguirre (Truck 9), the last remaining LAFD member to be hospitalized from the Boyd Street Fire, was released following 65 days of care in the burn unit of the Los Angeles County + USC Medical Center.

The National Fallen Firefighters Foundation produced a video about the Boyd Street incident. It includes a description of Station 9’s first due district. https://www.firehero.org/2022/11/18/boyd-street/

24 Hours at LAFD Station 9 (2019)

In December 2019, SoCal Connected, from the local Public Broadcasting System station, spent 24 hours responding to calls from Fire Station 9.

One of my students called the SoCal Connected video “apocalyptic.” https://www.pbssocal.org/shows/socal-connected/episodes/fire-station-9

The Invisible U.S. Fire Problem

A 2025 white paper from Kindling, Inc., sponsored by the National Fire Protection Association (NFPA), examined how human and shelter vulnerabilities intersect to shape fire risk in U.S. communities.

This scoping paper has shown that the US fire problem is not solved. Certain groups of people suffer disproportionately from fire and evidence indicates people experiencing homeless are particularly vulnerable to fire, as are those living in insecure and vulnerable shelter more generally.

These fire problems seem ‘invisible’ at the national level, but they are plaguing American cities, undermining the lives and livelihoods of affected populations, and having negative impacts beyond those directly affected (such as the fire services and neighbouring communities). (Antonellis et al., 2025, p. 44)

The paper identifies the gaps and challenges when looking at the fire safety of insecurely and vulnerably sheltered populations in the US.

(Antonellis et al., 2025, p. 39)

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¹Los Angeles Fire Department “Light Force”

All but Truck 9 are “Light Forces” – a 100′ tiller aerial truck married to a 200 series engine (pumper) as a single six-person crew. Some of the 42 light forces are paramedic-staffed.

Light Force 73 operating in the San Fernando Valley (2015). Photo by Mike Peters. https://www.lafra.org/swift-water-rescue-results-in-medals-of-valor/

90210FireBuff (2025, June 1) catches Light Force 61 arriving at a recreational vehicle fire. 9:42 minute video. https://youtu.be/opMG_PUVZZo

References

Aldrich, C. A., Hisserich, J. C., & Lave, L. B. (1971). An Analysis of the Demand for Emergency Ambulance Service in an Urban Area. American Journal of Public Health, 61(11), 1156-2160.

Antonellis, D., Vaiciulyte, S., Meacham, B., & Jennings, C. (2025, November). The Invisible US Fire Problem. Kindling, Inc. https://kindlingsafety.org/wp-content/uploads/2025/11/The-Invisible-US-Fire-Problem.pdf

Benzow, A., and Fikri, K. (2020). The Persistence of Neighborhood Poverty: Examining the power of inertia and the rarity of neighborhood turnaround across U.S. cities. Economic Development Group. https://eig.org/wp-content/uploads/2020/04/Persistence-of-Neighborhood-Poverty.pdf

Benzow, A., Fikri, K., Kim, J. & Newman, Daniel. (2023). Advancing Economic Development in Persistent-Poverty Communities. Economic Development Group. https://eig.org/wp-content/uploads/2023/06/EIG-Persistent-Poverty-Report.pdf

Cali Fire Photo. (2025, December 16) (Small Explosion) LAFD FR9 Handles Rubbish Fire. [YouTube Video]: https://youtu.be/kLgR2QPGFH0

Citygate Associates LLC. (2023) Los Angeles Fire Department Standards of Cover Analysis. Volume 1 of 3: Technical Report. Citygate Associates LLC. https://ens.lacity.org/lafd/lafdreportarchv/lafdlafdreport1864172030_06012023.pdf

Collins, B., & Loukaitou-Sideris, A. (2016, July-August). Skid row, gallery row and the space in between: cultural revitalisation and its impacts on two Los Angeles neighbourhoods. Town Planning Review, 87(4), 401+. http://dx.doi.org.proxy-bc.researchport.umd.edu/10.3828/tpr.2016.27

Goetz, E. G. (1992), Land use and homeless policy in Los Angeles. International Journal of Urban and Regional Research, 16, 540-54. DOI: 10.1111/j.1468-2427.1992.tb00195.x

Haas, G. & Heskin, A. (1981), Community struggles in Los Angeles. International Journal of Urban and Regional Research, 5, 546-64.

Hisserich, J. C. (1970). Public Emergency Ambulance Service: Determinants of Demand. (Publication Number 7100637) [UCLA]. Public Health Doctoral Dissertation, Los Angeles. DOI: 10.1111/j.1468-2427.1981.tb00567.x

Kurzwell, T. (2025, April 16). Unhoused account for nearly one-third of fire calls: Los Angeles Fire Dept. KTLA5. https://ktla.com/news/unhoused-population-accounts-for-nearly-one-third-of-fire-calls-los-angeles-fire-dept/

LAFD. (2020) Informational Summary Report: Injuries/Commercial Structure Fire, May 16, 2020, Boyd Incident. CA-LFD-001073. https://lafd.org/sites/default/files/Boyd_Green_Sheet.pdf

LAFD. (2020, February 11) With the addition of FRV 82 in Hollywood, the LAFD now has FRVs assigned within all four of the department’s geographic bureaus. Los Angeles Fire Department. https://lafd.org/news/lafd-augments-fast-response-vehicle-deployment

NFFF. (2022, November 18) Boyd Street [Vimeo video: 1:08 hours] National Fallen Firefighters Foundation. https://www.firehero.org/2022/11/18/boyd-street/

Pae, G., Paulsen, A., Pothula, S., Galet, C., & Wibbenmeyer, L. (2025). Integrating spatial analysis with census data to unravel the complex interaction between socioeconomic variables, the built environment, and multiple house fires in a predominately rural state. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 31, 327 – 332. https://doi.org/10.1136/ip-2025-045691

Phillips, D. (2020, May 6). 11 Firefighters Escape Through Ball of Fire in Explosion at Downtown LA Building: Some of the LAFD firefighters injured in Saturday’s fire and explosion suffered critical injuries, but all are expected to survive. NBC4 Los Angeles. https://www.nbclosangeles.com/news/local/10-firefighters-injured-in-downtown-la-fire/2363892/

Shai, D. (2006). Income, Housing, and Fire Injuries: A Census Tract Analysis. Public Health Reports, 121, 149 – 154. https://doi.org/10.1177/003335490612100208

Smith, D., Queally, J., & Molina, G. (2021 May 12). 24 fires a day: Surge in flames at L.A. encampments a growing crisis. Los Angeles Times. https://www.latimes.com/california/story/2021-05-12/surge-in-fires-at-la-homeless-encampments-growing-crisis.

SoCal Connected (2020) Fire Station 9. Season 10, Episode 1107 [Video 27:57 minutes]. Public Broadcasting Service. https://www.pbssocal.org/shows/socal-connected/episodes/fire-station-9

Ward, J. M., Garvey, R., & Hunter, S. B. (2024) Annual Trends Among the Unsheltered in Three Los Angeles Neighborhoods: The Los Angeles Longitudinal Unumeration and Demographic Survey (LA LEADS) 2023 Annual Report. RAND. https://www.rand.org/content/dam/rand/pubs/research_reports/RRA1800/RRA1890-4/RAND_RRA1890-4.pdf?utm_source=perplexity

Wibbenmeyer, L., Paulsen, A., Pothula, S., Galet, C., & Pae, G. (2025). 608 Geomapping and Spatial Analysis to Examine Socioeconomics, the Built Environment, and House Fires. Journal of Burn Care & Research: Official Publication of the American Burn Association, 46, S183 – S183. https://doi.org/10.1093/jbcr/iraf019.237

Featured Image is from Lopez, S. (2021, April 21) Ending homelessness on skid row won’t happen just because a judge orders it. The Los Angeles Times. https://www.latimes.com/california/story/2021-04-21/column-a-federal-judge-ordered-a-skid-row-cleanup-but-is-this-progress-or-posturing