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)

_______________________________

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

At that moment, no formal mobilization orders had been issued. Every metropolitan Washington, D.C., fire department had plans in place to respond to a major emergency. The second plane crash mobilized hundreds of responders before orders were issued. Members of Fairfax County’s Urban Search and Rescue (USAR) Team began mobilizing in anticipation of deployment to New York City.

I was about a mile away from the airport when I heard WTOP News Radio reporting smoke coming from the Pentagon. I have posted a link to Dave Statter’s (STATter911) description of reporting on the Pentagon attack. https://statter911.com/2025/09/11/september-11-2001-7/

Setting Up The Fire and Rescue Academy for a USAR Deployment

For an 80-person Heavy USAR team deployment, Virginia Task Force 1 needed to head to Andrews Air Force Base in Prince George’s County, Maryland, within four hours of a State Department notification. That required an equal number of folks to support USAR team deployments for both international and national missions. In 2001, the Fire and Rescue Academy served as the team’s staging area and assembly point.

This picture shows a recent USAR deployment from the facility that replaced the academy as a staging and assembly point.

When I was assigned to the academy as a uniformed officer, my “… and related duties” included setting the facility up for USAR deployments on evenings, holidays, or weekends. That meant driving the academy rigs out of the high-bay building, converting the four multi-purpose classrooms into a single room, and opening the USAR communications cache. I retired 14 months before 9/11 and, for the only time, regretted that decision.

I still worked at the academy as a part-time civilian instructor. I listened to the chaos on news radio while driving to the academy. Responding to a major USAR event in our front yard disrupted normal protocols, as some of the on-duty USAR team leaders were heading to the Pentagon or into Arlington County as first responders.

When I got to the academy, the uniformed staff was deployed. The recently hired civilian specialist who remained at the academy had not been trained to set up the facility for USAR staging. While explaining what I was going to do, we watched the first tower collapse on live television. I set the academy up for USAR staging and assembly. It was neither heroic nor lifesaving, but it left me with a small feeling of accomplishment on a terrible day.

Telling The First Responder’s Story

Picture of Fort Myers Fire and Rescue Foam 161 at the heliport fire station.

Northern Virginia uses a multiple-jurisdiction automatic aid system using a single radio system. The initial response to the Pentagon included Fort Myers Fire and Rescue, the Metropolitan Washington Airports Authority at Reagan National Airport, and the Arlington County Fire Department. Technically, Fort Myers Foam 161 was the first unit on the scene, but the rig, the heliport fire station, and the three civilian firefighters were impacted by the crash.

For the tenth anniversary of the attack, Journal of Emergency Medical Services editor A. J. Heightman interviewed the fire-rescue leaders who responded to the Pentagon and described the planning Arlington County Fire Chief Ed Plaugher did before the attack. Part III of Out Of Darkness covers the Pentagon. https://www.jems.com/wp-content/uploads/2023/09/911-0911.pdf

A Six-Part Video Record of Pentagon Operations

A three-person team from the Fire Emergency Training Network (FETN)¹ was filming at the Baltimore Fire Department. They got to the Pentagon around noon. This 25th anniversary remembrance includes their recordings.

https://youtu.be/1JiJg06Yh6k

The Family Left Behind

Sally Jenkins wrote a moving feature article about Rescue 4 Lieutenant Kevin Dowdell, what happened on 9/11, and what has happened to his wife and two sons since 2001. It is worth your time to read the Atlantic article. https://www.theatlantic.com/magazine/2026/09/fallen-september-11-firefighter-family/687964/

James holds his father’s Halligan bar. Haruka Sakaguchi for The Atlantic.

John Feal (2026) I Will Follow You Anywhere: The True Story of the 9/11 Responders Who Took On Congress

Published this month, it describes the 15-year effort by 9/11 responders to fully fund the James Zadroga 9/11 Health and Compensation Act of 2010, a federal 9/11 victim compensation fund. It provides a rogue approach to the ground game of representative government, empowering readers in all walks of life to take on the system and win.

I hope this book gives the reader some insight and nuance into the man who has taken me on an invaluable fifteen-year odyssey of frustration, tenacity, resilience, camaraderie, and into the lessons in selflessness and compassion he has graciously bestowed. I would follow him anywhere … although as I mentioned earlier, it is sometimes not easy given how short he is. (Forward by Jon Stewart, 2025.)

__________________

¹Fire Emergency Training Network (FETN) closed in 2008.

Feal, J., & Daly, C. (2026). I Will Follow You Anywhere. BenBella Books, Inc. ISBN 9781637748756. https://benbellabooks.com/shop/i-will-follow-you-anywhere/

Heightman, A. J. (2011, September). Out of Darkness, Volume III: Strike on the Pentagon. Journal of Emergency Medical Services. https://www.jems.com/wp-content/uploads/2023/09/911-0911.pdf

Jenkins, S. (2026, September). The Man Who Refused To Sit On The Sidelines: Kevin Dowdell, a lieutenant in an elite FDNY rescue unit, taught his sons to take action. When he disappeared on 9/11, they went to Ground Zero to search for him. The Atlantic. https://www.theatlantic.com/magazine/2026/09/fallen-september-11-firefighter-family/687964/

Statter, D. (2025, September 11). September 11, 2001: The Attack at the Pentagon, STATer911. https://statter911.com/2025/09/11/september-11-2001-7/

The 9/11 Legacy Foundation (2001/2026) The Pentagon Response: A Series of Rememberance [YouTube] https://youtu.be/1JiJg06Yh6k

Ward. M. J. (2002, April). Attack on the Pentagon: the initial fire & EMS response. Journal of Emergency Medical Services 27(4). 22-30,

Featured Image: Gralund, D. (2016, September 7). 9/11 Fading. Portsmouth Herald. https://www.seacoastonline.com/story/opinion/cartoons/2016/09/07/granlund-cartoon-9-11-fading/25498344007/

For this article, we will divide United States Emergency Medical Services into three universes.

• Private services include national commercial agencies like Falck and American Medical Response, regional agencies like Acadian, hospital-based services, local “Mom and Pop” services, and community volunteer rescue squads
• Non-fire municipal services like Boston, Cleveland, Wake County (North Carolina), Indianapolis, Pittsburgh, as well as the High-Performance Public Utility Models
• Fire-based EMS represents the largest universe and employs both firefighters and single-role employees as EMS caregivers.

Updating a Legacy EHS Master’s Degree

I submitted a proposal to the Emergency Health Services (EHS) department chair at the University of Maryland Baltimore County (UMBC) in 2019 to increase industry awareness of UMBC EHS’s role in EMS leadership development. The legacy master’s degree in Emergency Health Services needed an update for the 2020s. This was part of my public policy doctoral adventure as an adjunct EHS faculty member – following a tradition of adjunct faculty updating the EHS curriculum while working on their Ph.D.

Creating and maintaining EHS 640: High Performance EMS

EHS 640: High-Performance EMS was a core course in the brand-new 1999 EHS master’s degree. Stephen Dean developed and delivered the original course while working on his Ph.D. at UMBC. In 2010, Kurt Kruperman, while a visiting EHS professor and Ph.D. student, significantly updated 640, adding a digital version of the American Ambulance Association’s EMS Structured for Quality: Best Practices in Designing, Managing and Contracting for Emergency Ambulance Service reference. Jon Washko assisted with providing deployment and revenue exercises. In 2022, I revised and updated 640, covering the same knowledge areas but in a format more accessible to the international, preventative medicine/epidemiology, physician, and cybersecurity students enrolling in the program.

“Who Will Pay For It?”

One question was, “Who would pay for it?” in terms of employers. Would they preferentially hire a candidate with this EHS degree over another candidate? Would they send their rising leaders to get this degree or credential?

Most EMS employers surveyed in 2019 that responded to the survey wanted leadership candidates with a pre-existing master’s in Health Administration, Quality Management, or Business Administration. Private and non-fire employers would not send their rising leaders to get a master’s degree on the agency’s time or dime. Some fire-based employers used undergraduate formal education as part of a career-development promotional path, but not at the graduate-school level. In some fire departments, a master’s degree would be a preferred requirement for a fire chief candidate.

This was one factor that led UMBC to replace the EHS master’s degree with an Emergency and Disaster Health Systems master’s degree in 2026. There was a disconnect between who EHS thought would enroll and who actually enrolled. Most of the students enrolling in the EHS master’s program in the 2020s were not paramedics seeking upward mobility.

Graduate programs are subsidized by funded research. Pre-DOGE, there was scant research or grants for non-clinical EMS research. Available research grant money goes to disaster research and emergency management. Other universities with similar graduate disaster/emergency management programs had higher enrollments than UMBC EHS.

Let’s see what is available for the upwardly bound EMS caregiver.

Portfolio-based Professional Development

There are two portfolio-based assessments. Candidates provide information on formal education, clinical credentials, work experience, community involvement, and professional development.

Center for Public Safety Excellence

The Commission on Professional Credentialing recognizes 4,542 professional designations held by fire and emergency service leaders committed to continuous improvement, professional development, and excellence in service. This includes 310 Chief EMS Officers as of July 2026.

Candidates must have at least 10 years of EMS experience as an EMT, Paramedic, RN, Advanced Registered Nurse Practitioner, or Physician. The evaluation process is based on a points system:

• Education points range from 25 to 150 points and can include an academic certificate
• Experience points range from 5 to 60 and may be influenced by the length of time in the position

Once submitted, there is a peer review process that evaluates the candidate’s resume, professional development, employment information, professional contributions/recognition, community involvement, and professional memberships/affiliations. The credential needs to be renewed every three years.

The American College of Paramedic Executives

The American College of Paramedic Executives was developed by the National EMS Management Association (NEMSMA) and follows the process used to credential health care executives. Candidates present a portfolio of education, letters of recommendation, and a description of professional and community service.

There is a written exam based on the NEMSMA National EMS Officer Competencies. For the managing and executive (fellow) levels, an interview. The fellow level (FACPE) requires a presentation, publication, or research paper. The credential must be renewed every five years. I was in the first cohort to be credentialed as Fellows, and I renewed the credential in 2023.

As of August 2026, there are 309 credentialed officers:

• 113 Fellows of the American College of Paramedic Executives (FACPE)
• 100 Managing Paramedic Officers (MPO)
• 96 Supervising Paramedic Officers (SPO)

Potential ProBoard or State Credential: NPFA 1020 EMS Officer I, II, III

After 15 years of requests to the committee, the 2025 edition of NFPA 1020 Standard for Fire and Emergency Instructor, Fire Officer, and Emergency Medical Services Officer Professional Qualifications includes Job Performance Requirements (JPR) for EMS Officer I, EMS Officer II, and EMS Officer III. Most of the JPRs are similar or identical to the Fire Officer JPRs.

What is different includes:

EMS Officer I

• Deliver an educational topic that specifically covers EMS continuing education clinical and skill training
• Evaluate unmet requirements in a member’s continuing education training, given a training record, so that education gaps are identified and a plan is created to fufill the unmet requirements
• Deliver clinical or procedural training, given data from a quality review or direct observation, so that identified deficiencies are addressed
• Manage unit staffing assignments, given scheduled deployment, special conditions, and emerging situations, so that operational needs are met
• Respond to a public inquiry, given policies and procedures, so that the inquiry is answered accurately, courteously, and in accordance with applicable policies and procedures
• Collect patient care data, given the goals and mission of the organization, so that patient care data is complete, accurate, protected, and available for interpretation.
• Verify patient triage categories, given multiple triaged patients, an agency triage system and protocols, so that the patient priority is correctly determined.

EMS Officer II

• Conduct a climate survey, given a climate survey instrument, so that the survey reaches the intended audience and the privacy of the respondents is maintained.
• Evaluate clinical or procedural training needs, given data from a quality review report or direct observation that indicates a need for training, so that a training plan is developed and delivered, and the training need is addressed.
• Manage staffing assignments across multiple units or areas, given the need to adjust staffing and a list of personnel and their capabilities, so that the staffing needs of the organization are met
• Evaluate the community demographics, given community demographic data, so that the ability of the organization to provide EMS outreach programs to at-risk populations is determined and recommendations are made.
• Design an evaluation instrument, given EMS risk reduction program goals and objectives and an evaluation strategy, so that the evaluation instrument measures the program outcomes and program goals and objectives are demonstrated
• Recommend a change to a records management program, given EMS run reports, patient care records, report storage and retrieval methods, access to records, and a need for change, so that the change is assessed for compliance with all federal, tribal, territorial, state, provincial, or local laws
• Recommend changes to a risk management plan, given a specific risk to the organization, an EMS related risk, and a risk management plan, so that the risk is evaluated, risk management options are identified, and the recommended changes are presented to a supervisor.
• Recommend changes to an accident investigation program, given federal, tribal, territorial, state, provincial, or local laws and regulations, an accident investigation program, and a work-related accident, so that the recommended changes are presented to a supervisor
• Recommend changes to an injury prevention program, given relevant local and national data, an injury prevention program, and an EMS related injury, so that the recommendations are evaluated and the recommended changes are presented to a supervisor
• Recommend a change to a post-incident analysis policy, given a multi-unit EMS incident and the need for a change, so that all required critical elements for the change are identified, the change is communicated

EMS Officer III is a combination of Fire Officer III and IV and may be discussed in a later article.

Fire service credentialing is a state, professional group, or industry process. The National Board on Fire Service Professional Qualifications (“Pro Board“) has been the original fire service system for the accreditation of agencies that certify candidates to the various disciplines and levels identified in the NFPA Professional Qualification series of standards. The Pro Board did not include the NFPA 1020 (2025) chapters covering EMS Officer I, II, III in the January 7. 2025 “Agency Compliance Dates to NFPA Standards.” The Fire Instructor and Fire Officer chapters have an agency completion date of December 31, 2026.

EMS Officer Responsibilities Pushed Down the Fire Service Career Ladder

Some of the NFPA Job Performance Requirements (JPRs) for EMS Officers show significant differences in roles. The Fire Officer I is supervising a single fire company; the EMS Officer I is expected to “Manage unit staffing assignments, given scheduled deployment, special conditions, and emerging situations, so that operational needs are met.” That is a task performed by a manager (Captain or Battalion Chief) on the fire suppression side.

The EMS Officer II is expected to “Manage staffing assignments across multiple units or areas, given the need to adjust staffing and a list of personnel and their capabilities, so that the staffing needs of the organization are met.” That implies an agency-wide resource allocation, usually done by a manager/administrator (Battalion Chief or higher) on the suppression side.

Will Interest in NFPA 1020 EMS Officer Translate to State or Pro Board Credentialing?

At this date, no states have a stand-alone NFPA 1020 EMS Officer I or EMS Officer II credential. Maine, Alabama, Maryland, Virginia, Connecticut, Montana, Kentucky, Wisconsin, and North Carolina provide EMS leadership training, some based on the Fire Officer I and II professional qualifications, but there is no ProBoard-accredited or state NFPA 1020 credentialing exam.

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References

American College of Paramedic Executives (2020, August). Paramedic Certification Officer Handbook and Policy Manual. https://cdn.ymaws.com/www.nemsma.org/resource/resmgr/acpe/certification_manual_-_v4_fi.pdf

NEMSMA (2014). Seven Pillars of National EMS Officer Competencies. National EMS Management Association. https://cdn.ymaws.com/www.nemsma.org/resource/resmgr/pdfs/credentialing/nemsma_seven_pillars_of_nati.pdf

NFPA (2025). NFPA 1020 Standard for Fire and Emergency Instructor, Fire Officer, and Emergency Medical Services Officer Professional Qualifications. https://www.nfpa.org/codes-and-standards/nfpa-1020-standard-development/1020

Ward, M. J. (2019, April 8). Are you really a “pro”? A look at the growth of professions and what it means for firefighters and paramedics today. CompanyCommander.com. https://companycommander.com/2019/04/08/are-you-really-a-pro-a-historical-look-at-the-growth-of-professions-and-what-it-means-for-firefighters-and-paramedics-today/

Consultants are used to provide experienced analysis using specialized skills. We are also hired to do the unpleasant and difficult tasks when implementing change. The ambulance agency covered a portion of a county and had 9-1-1 ambulance contracts with seven towns. Another private ambulance service covered the rest of the county. Our client’s ambulance agency was in a financial crisis.

Unsustainable Town “Exclusive Ambulance” Contracts

In this state, the towns function as EMS gatekeepers. They can designate the town’s permitted EMT-level ambulance provider. The previous owner signed “exclusive ambulance” contracts with seven towns in the county that were covered by the other ambulance service. These contracts were restrictive. The exclusive ambulance could respond only to emergencies within town borders. The exclusive ambulance had to respond to every fire department call within the town.

The process to pull town ambulances for a mass casualty incident, or to help with the Friday afternoon surge of interfacility transports from the hospital, was difficult – we would not get a timely response from the town. The rent we paid to house the town’s exclusive ambulance in some volunteer fire department buildings was above the fair market rate I could get for space in an industrial park.

About half of the exclusive-town ambulances had a transport Unit Hour Utilization of 0.08, responding to 1 or 2 calls a day.¹ The combined UHU for the town ambulances was 0.125. The only revenue was from billing for transports. Servicing the seven exclusive town 9-1-1 contracts was creating a multi-million-dollar loss for the ambulance agency. Towns refused to amend the contracts, so the client authorized us to give notice that the contracts would be terminated in 120 days.

Working The Change Process

The first step was to meet with leadership in each town, explain the situation, and propose a solution. For the town described in the opening paragraph, we offered to continue using the town fire station as a post for the rudimentary system status management we were implementing for ambulance deployment.

For all seven towns, there would be no exclusive town ambulance contract. If they stayed with us, they could not select which crew would respond to their town. The towns have three choices: they could continue to allow our ambulance agency to respond to 9-1-1 calls; they could select the ambulance service covering their side of the county; or they could do something else.

Ambulances would no longer respond to every fire company dispatch, including activated fire alarms with no report of smoke or fire. An ambulance would respond to:

• Possible working fires with trapped occupants
• Confirmed working structure fires
• Transportation accidents with injuries
• Greater alarm events
• Any situation where the on-scene fire or police incident commander requested an ambulance.

The ambulance agency will track all EMS calls into the town and provide town leadership with a monthly report on ambulance response times. The ambulance agency will identify responses that exceeded the agreed-upon response time requirement and notify town leadership the next business day. We offered to provide town hall meetings to explain the changes.

A Very Angry Fire Chief

The chief who responded to that activated fire alarm at the start of this article was the angriest. He used reverse 9-1-1 to gather a town hall meeting in the high school basketball court. That town has a few assisted living and over-55 facilities. Those residents were in the front row. Behind them were the volunteer firefighters. John Smith and Mary Doe, senior ambulance agency employees who worked the day shift on the town’s dedicated ambulance, sat behind the firefighters.

I could not understand why the fire chief was so angry. The fire department is not the town’s EMS first responder. The fire company does not have an AED. The town police respond with lights and siren to every EMS 9-1-1 call. Patrol vehicles have an AED. They arrive within two to three minutes. In the past five years, all but one of the cardiac arrest resuscitations in the seven towns included a police-operated AED.

Diving Deeper

I later learned that the angry volunteer fire chief documented fire company/fire chief response to fire incidents using the town ambulance response time. The two- to 10-minute fire company/fire chief response times reported to the mayor and town council were based on ambulance response times; the actual fire company/fire chief response time was much longer. This had been going on for a while.

The most senior ambulance agency employee, Joe Smith, retired when the exclusive ambulance contract ended. Smith started a dozen years ago with the ambulance agency assigned to this town. He did not work at any other ambulance assignment. A few years into this assignment, Smith joined the volunteer fire department. The fire chief justified using the ambulance response time to the mayor because Smith was a VFD member.

Mary Doe, his partner, started on the town ambulance seven years ago. She moved to a weekday surge unit but left the agency within three months. The surge ambulance did 4 to 8 transports in 12 hours, while the town ambulance averaged 0.7 transports in 24 hours.

Six towns stayed with our ambulance agency. Moving from many slow, exclusive town ambulances to regional coverage for the towns with a basic system status management deployment raised Unit Hour Utilization from 0.125 to 0.30. The ambulance response times to the towns increased by an average of 2.2 minutes. The previous owner was “planting his flag” with these ambulance contracts in towns on the other side of the county, hoping to push out the other ambulance service. The town contract with the angry fire chief was losing almost half a million dollars a year.

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¹ Unit Hour Utilization is a High-Performance EMS metric calculating the time-on-task workload of a staffed ambulance per hour.

Elements, identifiers, and sequence of events may be altered in “war stories” to protect the innocent or work better as an example.

Featured picture: Action Ambulance. (2026, February 10). Our Ossipee Valley crew has been busy at work. Thank you to everyone who has helped out! [Instagram] https://www.instagram.com/p/DUmw9cFjqUt/

P.S.: Here is a different view on the issue of EMS-only staff doing firefighting tasks

Davis, J. (2026, August 21). Somerset EMS, fire chiefs revive plan to cooperate on fire calls: ‘We don’t want to start nothing else,’ commission president says. The Baltimore Sun. https://www.baltimoresun.com/2026/08/21/somerset-county-ems-volunteer-fire-calls-policy/

Fire officials say the county’s volunteer firefighters are aging, and new members have been harder to find. County EMS crews are often first to fire scenes, yet current policy can leave them standing by while shorthanded fire companies get to work.

Somerset took over county EMS late last year, while volunteer fire companies remained independent. Some fear the county eventually wants to absorb them, despite repeated denials by commissioners.

County officials said no one is asking an ambulance crew to put on a mask and charge into a burning building. The request is simpler: If a hose needs pulling, a hydrant needs connecting or tools need carrying, don’t make trained hands stand by and watch.

With that, Somerset County officials and volunteer fire chiefs are developing a policy allowing county EMS crews to provide that kind of assistance, reviving a plan that collapsed amid fears of a county-run fire department.

While working as an Assistant Professor at The George Washington University, I followed the efforts of Los Angeles and Baltimore fire departments as they addressed the challenge of adding ambulances to their overworked systems (2000 – 2007). One element was the impact of authorized but unfilled full-time positions.

In looking at other fire departments, we observed that when the percentage of authorized career positions that are unstaffed exceeds 12%, the number of firefighters or single-role paramedics willing to work the overtime to fill those vacancies plummets. Anecdotal evidence suggests that some fire departments are wrestling with this issue today.

The Impact of Excessive Overtime

John Hicks, writing in The Firemen’s Grapevine, articulated the reality for LAFD employees:

You’re working another 72-hour shift. It’s okay, you’re young. You have a girlfriend/boyfriend, but it is just the beginning of the relationship. You recently bought your first condo, but the payment is low, and your health is good. A little time passes. You are still doing those 72-hour shifts, with an occasional 96-hour now thrown in. Your significant other is now wearing a wedding ring, and your first born is asking you if he or she is going to have a brother or sister soon. The condo was traded for a three-bedroom home in suburbia USA along with the cheaper mortgage. Overtime is now more of a necessity than a luxury.

Due to the abundance of overtime, the days of having a “C” shift job have all but disappeared for LAFD members. Not only has this hurt the department by limiting the talents learned by the experience gained by working other types of job, such as construction, electrical, and plumbing related careers, it means that overtime seems to be the sole means for most to earn a little extra money. (2022)

The Challenge of Fire Department Position Management

There has been a long dance over what staffing a fire department needs to meet its operational requirements. Jurisdiction leadership is resistant to creating new full-time positions, as they require 137% funding to cover salary, workers’ compensation, annual/sick leave, training, personal protective gear, and other human resource expenditures.

The jurisdictional administrators and elected leaders struggle with the concept of having a workforce where there are more full-time equivalents (FTEs) on duty than the minimum required seats to fill. As Fitch and Associates LLC partner Steven Knight, Ph.D., points out:

Using my old department as an example, the staffing was determined on a legacy basis and that legacy pre-dated most, if not all, of the institutional knowledge. For example, the department staffed five personnel for every seat on an engine, four for every seat on a truck company, and two for every seat on a rescue. While the daily minimum staffing was consistently applied, it had to overcome the inconsistency in staffing for each position. In fairness, these legacy-staffing strategies may have been compromises over the years and budget cycles, but to clearly articulate the strategy at a future moment in time proves difficult. (2019)

Looking At LAFD

A 2015 Evergreen Data Library audit of overtime led the Los Angeles City Council to approve hiring 48 additional firefighters. At that time, “420 LAFD employees earned more than $100,000 in overtime, and 19 earned more than $200,000. One Fire Captain made $311,316 in overtime on top of a $120,829 salary, for a staggering total of $448,594 in overtime pay. … a Commander at the LAFD informed the Controller’s office that the employee with $311,316 in overtime did obey all policies and procedures regarding overtime.” Evergreen noted that “Los Angeles uses what is called a ‘constant staffing’ model, which intentionally keeps firefighter positions open and uses overtime to make up for the missing employees. … LAFD is understaffed to the brink of collapse.”

Those 48 additional firefighter positions in 2015 did not end the overtime issue.

An audit of the Fiscal Year 2019 expenditures (July 2018 – June 2019) showed that “Eighteen employees of the Los Angeles Fire Department earned more than $200,000 in overtime pay last fiscal year, with one firefighter making $360,010 in overtime.” The 2019 audit also observed that “More than 90% of sworn police and fire employees last fiscal year received overtime, earning an average of $27,737, while 40% of the city’s general employees, defined as other sworn and civilian workers, received such pay. That group earned an average of $7,528” (Smith, 2019)

In 2022, The Center Square reported, “A captain in the department made $434,394 in overtime in 2021, pushing their gross pay to $598,532 to become the highest-paid employee in the city that year. Another fire captain made $420,055 in overtime, pushing that person’s gross pay to $593,314 in 2021. That person was the second-highest paid employee in the city, according to city payroll records. A firefighter with a base salary of $129,638 made $411,606 in overtime, making that firefighter’s total compensation $554,056. There were 86 employees in the fire department who made $400,000 or more in 2021. However, the highest ranking employee was not among those. The fire chief made $338,624, or nearly $250,000 less than the fire captain.” (Gantert et al., 2022)

The 2021 overtime increases in Los Angeles are linked to multiple-day wildfire campaign operations and the interrupted hiring cycle during the COVID pandemic. Emergency workers are dealing with the lingering effects of a massive increase in disease exposure (opioid overdoses and COVID) and a physically challenging workload. The 2023 Standards of Cover Analysis performed by CityGate Associates LLC made this observation: “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, p. 6).

ICMA and Center for Public Safety Excellence: 21st Century Fire & Emergency Services

The ICMA and Center for Public Safety Excellence white paper on 21st Century Fire and Emergency Services identified two themes:

• The past strategies of deferring conclusive action on critical issues with short-term solutions and leaving them for the next set of leadership are not a sustainable strategy for the future. To continue to do so will worsen the eventual correction(s) that will have to be made.
• We must begin recruiting talent with the mindset, skill sets, and resolve to help build a core organizational culture that can adapt and respond to rapid changes and that is not vested in a 20th-century fire service paradigm or antiquated local government bureaucracy. (2020)

This white paper may serve as a starting point to change the conversation with jurisdictional leaders and elected officials. We need to develop a new narrative that promotes appropriate organizational staffing to meet the expanded and complex roles that a fire department performs today.

The Impact of Overcommitting Existing Staff

Robert Peterson’s Executive Fire Officer capstone research paper examined employee perceptions of hours worked within the Corona (California) Fire Department (CFD). A ten-year retrospective analysis found overtime was only slightly cheaper than hiring, while daily vacancy levels were high enough to justify additional positions outright and identified fatigue-driven injury risk as the hidden cost. Corona Fire Department documented a 93% increase in injury-related time off alongside a 119% increase in forced hire/mandatory overtime over ten years (2024, p. 6). The vacancy is not eliminated; it is converted into overtime liability, workers’ compensation exposure, and attrition.

The National Highway Traffic Safety Administration (NHTSA) awarded a five-year contract to the National Association of State EMS Officials (NASEMSO) to understand the science of sleep health and apply these principles to develop fatigue risk management guidelines. One of the products is the Implementation Guidebook: 2018 Fatigue Management Guidelines for Emergency Medical Services that recommends EMS personnel work shifts shorter than 24 hours (Patterson & Robinson, 2018, p. 7).

Just before 5:20 a.m. Sunday, April 2, 2023, as BLS 16 responded to a call, it slammed into a power pole, a crosswalk sign, and a wall.  The crew, in the 69th hour of a 72 hour shift, suffered minor injuries.

“Right now, we still have employees who are still dealing with sleep deprivation and knowing that this has been going on for over a year and didn’t come up with concrete solutions to solve it,” said Pritchard.

President Rex Pritchard, Long Beach Firefighters Association Local 372, said he and leaders of the International Association of Machinists Local 1930 have been urging the department to address what they say are extreme call volume and fatigue issues for over a year but haven’t seen any changes.

“What is very common in this department is to work 72-hour shifts,” said Pritchard. “You’re lucky if you get, in that 72 hours, four to six hours of rest.” (CBS LA Staff, 2023)

Changing The Conversation

The fire service has argued about staffing in the same terms for decades: seats, minimums, and the price of one more position. Los Angeles added 48 firefighters in 2015 and, by 2021, had 86 fire department employees earning more than $400,000, with a captain out-earning the fire chief by nearly $250,000. Incremental hiring against a structurally under-authorized workforce does not close the gap; it only changes who is exhausted.

The ICMA and Center for Public Safety Excellence white paper offers a more useful frame, calling for recruitment of talent with “the mindset, skill sets, and resolve to help build a core organizational culture that can adapt and respond to rapid changes” rather than one “vested in a 20th-century fire service paradigm or antiquated local government bureaucracy.” That reframing matters because the fire department is no longer staffed for the mission it actually performs. It is an all-hazards, high-acuity, medically dominant enterprise being resourced by a formula built for structural firefighting.

The new narrative should describe risk exposure, service reliability, and total labor cost rather than in seats and minimums. It should treat fatigue management as a standard of care. And it should be honest that the choice was never between spending and not spending. The choice was between spending deliberately on positions and spending involuntarily on the consequences of leaving them empty. The departments that make that case successfully will be the ones able to staff without force hires in the future.

References

CBS LA staff. (4 April 2023). Long Beach unions say ambulance crash highlights staffing shortage. KCAL CBS. https://www.cbsnews.com/losangeles/news/long-beach-unions-say-ambulance-crash-highlights-staffing-shortage/

CityGate. (2023). Los Angeles Fire Department Standards of Cover Analysis. Volume 1 of 3: Technical Report. CityGate Associates LLC.

Evergreen Data Library (2015) Los Angeles – Payroll & Overtime Analysis. https://evergreen.data.socrata.com/stories/s/Los-Angeles-Payroll-Overtime-Analysis/ijhv-thke/

Fox, S. (1999 Dec 26). Proposal Targets Paramedic Shortage. Los Angeles Times. https://www.latimes.com/archives/la-xpm-1999-dec-26-me-47674-story.html

Gantert, T., Apel, E., & Rowland, B. (2022, July 18). Los Angeles’ $600,000 fire captain and 86 firefighters made more than $400,000 in 2021. The Center Square. https://www.thecentersquare.com/california/los-angeles-600-000-fire-captain-and-86-firefighters-made-more-than-400-000-in/article_ca6b4cbc-06a8-11ed-9919-679807fe6e61.html

Hicks, J. (2022, April 1) Overtime – Too much of a good thing? The Fireman’s Grapevine. Los Angeles Firemen’s Relief Association. https://www.lafra.org/overtime-too-much-of-a-good-thing/

ICMA & CPSA (2020) 21st Century Fire and Emergency Services. https://www.cpse.org/wp-content/uploads/2020/07/21st-Century-Fire-and-Emergency-Services-White-Paper-Final-07.15.20.pdf

Knight, S. (2019, March 12). Full time, part time, overtime: How to fill fire department vacancies. FireRescue1.com. https://www.firerescue1.com/fire-chief/articles/full-time-part-time-overtime-how-to-fill-fire-department-vacancies-uRC8dscpvRkfgRhN/

Patterson, P. D., & Robinson, K. (2018, October). Implementation Guidebook: 2018 Fatigue Management Guidelines for Emergency Medical Services. National Association of State EMS Officials. https://s3.amazonaws.com/ClubExpressClubFiles/157064/documents/Fatigue_in_EMS_Implementation_Guidebook_1551393887.pdf

Peterson, R. (2024, April). Employee Perceptions of Hours Worked in the Corona Fire Department. [Capstone research project, National Fire Academy]. U.S. Fire Administration. https://apps.usfa.fema.gov/pdf/efop/Robert-Peterson-Employee-Perceptions-of-Hours-Worked-in-the-Corona.pdf

Smith, D. (2019, Nov 6) L.A. firefighter banked $360,010 in overtime pay in one year, city audit finds. Los Angeles Times. https://www.latimes.com/california/story/2019-11-06/lapd-lafd-audit-overtime-city-controller

Williams, E. (2007 Aug 29). Paramedic Coded Assign Hire to End Sept 9. Battalion 14 News & Information (dormant rss feed).

What Do Retired Firefighters Dream About?

A recently retired firefighter posted that question on a private social media account comprised of other retired members from the same department. Those who responded mentioned dreaming of being back in the fire station, interacting with the crew, and recalling the mundane non-emergency aspects of the job.

In my back-on-the-job dreams, a feeling returned that I was an integral part of something bigger, something important in a group that makes a difference in the community. I felt calm, competent, and connected. A feeling that has not shown up in any of my endeavors after retiring from the fire department.

Robert McCarl spent 18 months embedded with the Washington, District of Columbia, Fire Department (1978-1979) to conduct an ethnographic study of urban firefighters. An ethnographic study is an immersive, qualitative research method where a researcher embeds themselves into a specific community or social group to understand their culture, behaviors, and everyday practices from the participants’ own perspectives. McCarl explained his presence to firefighters this way, “I was hired by the union to document how information is passed from one guy to the next, say from an experienced man to a rookie” (McCarl, 1985, p. 21).

McCarl’s interviews with firefighters reinforce the concept of the fire department as a second family:

It’s hard to describe the closeness you felt with the guys in the fire house. I don’t think my wife has ever really understood it. I just used to love coming to work – especially on those long Saturdays when we’d have a big roast or ham or something and sit around and talk or play cards. … It’s a group of men with unique brotherhood feeling – they’ll never let you down (McCarl, 1985, p. 97)

A theme that will be repeated in the EMS section, “After the first few months in the house and on the fireground, however, this formal education (recruit school) has been shaped by the informal culture of the company and the officer, and the rookie has begun to reflect the attitude and techniques of those he has chosen as a model” (McCarl, 1985, p. 39).

Where’s My Gear?

I was surprised to find I was not the only retiree searching for my gear (fire coat, bunker pants/boots, helmet, portable radio) while dreaming of firehouse life. Probably something hard-wired from the recruit school/rookie year.

Emergency Medical Services (EMS) Is Different

Ethnographic studies of U.S. 9-1-1 ambulance service focused on private providers (Prener, 2022; Seim, 2020; Mannon, 1992; Metz, 1982). In these organizations, EMS caregivers arrive already credentialed as EMTs or paramedics. New employees receive orientation and, usually, a skills checkoff. Then they are sent out to work as part of a two-caregiver team.

Supervision may be remote and infrequent. They may spend a lot of their time between responses parked at an intersection or parking lot. This is a very different team environment from that of a fire station, with a larger fire suppression crew that includes a supervisor and a home base with a kitchen, bathrooms, bunkrooms, and dayroom to relax and recover. Caregiver annual turnover for United States EMS staff in 2022 is 25-30% (Zarei et al., 2026).

In The Ordinary Hours, James Weber uses the business fable storytelling technique to illustrate the EMS caregiver retention problem at a fictional four-station EMS 9-1-1 agency. The descriptions are vivid and valid. Following the retention improvement journey from Station 4 to the challenging Station 7 – with a 71% turnover in one year – is engaging.

Weber shows that EMS has 90 days to develop a new hire. It is a three-phase process.

• Month 1 is stabilization: provide psychological safety and agency orientation, using one consistent person as a mentor.
• Month 2 is to deepen agency integration and skill building,
• Month 3 is caregiver autonomy and organizational commitment, where the new hire’s mentor evolves into one of many resources the new hire has within the agency.

If the new hire is not anchored to the EMS agency by the 90th day, they will decide to leave.

References

Country Callbacks. (2026, June) Country Roads Went Viral at the FIFA World Cup – Here’s Why Soccer Fans are Obsessed! [YouTube] https://youtu.be/1-vSER43-GY

Mannon, J. M. (1992). Emergency encounters: EMTs and their work. Jones and Bartlett Publishers.

Metz, D. L. (1982). Running Hot: Structure and Stress in Ambulance Work. Cambridge, MA: Abt Books. https://doi.org/10.1525/maq.1983.14.3.02a00210

McCarl, R. (1985) The District of Columbia Fire Fighters’ Project: A Case Study in Occupational Folklife: Smithsonian Folklife Studies, Number 4. Smithsonian Institution Press. https://repository.si.edu/server/api/core/bitstreams/10e84cae-cc7f-4b6b-aea8-f02c2ad9208a/content

Prener, C. (2022). Medicine at the margins: EMS workers in urban America. Fordham University Press. https://doi.org/10.5422/fordham/9781531501075.001.0001

Reliable Source (2013, October 4) Bill Danoff on how ‘Country Roads’ became a German Oktoberfest hit. The Washington Post. https://www.washingtonpost.com/news/reliable-source/wp/2013/10/04/bill-danoff-on-how-country-roads-became-a-german-oktoberfest-hit/

Seim, J. (2020). Bandage, Sort, and Hustle: Ambulance Crews on the Front Lines of Human Suffering. Oakland, CA: University of California Press.

Weber, J. (2026) The Ordinary Hours: Why Your Best People Leave – And The Small Things That Make Them Stay. Oak Street Press. https://www.amazon.com/Ordinary-Hours-People-Leave-Things-ebook/dp/B0FQTNKY2Y/ref=sr_1_2

Zarei, E., Safari, M., Zamani, Z., & Kakemam, E. (2026). Turnover intention and its predictors among Emergency Medical Services (EMS) professionals: a systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 34. https://doi.org/10.1186/s13049-026-01567-8

Since the COVID-19 pandemic, more fire departments have added 9-1-1 emergency ambulance services. Some have been successful bidders on ambulance service contracts, replacing commercial ambulance providers like AMR and Falck. Others have resulted from a political decision by the authority having jurisdiction. Finally, some are functioning as the municipal safety net after a private or community volunteer ambulance service ceases to provide service.

Many of these transitions promise lower costs to the municipality. Once the ambulance service starts, the reality is that the fire department or municipality used unrealistic or naive financial analysis. This article provides a background and recommendations for chief fire executives.

A $3.65B Bolus of Federal and Robert Wood Johnson Funding to Start EMS

The current United States EMS system started in 1966, with Congress reacting to the National Academy of Sciences white paper on Accidental Death and Disability: The Neglected Disease of Modern Society. Congress included Emergency Medical Services (EMS) as a component of the National Highway Safety Act of 1966. The Federal Department of Health Education and Welfare’s (DHEW) five demonstration projects, the 1973 EMS Systems Act, and the Robert Wood Johnson Foundation poured $3.65 billion (in 2026 dollars) into 349 EMS systems (Shah, 2006; Bass, 2015; Sadler & Sadler, 2022).

DHEW funded demonstration projects in Arkansas, California, Florida, Illinois, and Ohio. The University of Oklahoma’s Center for Economic and Management Research (CEMR – economists and behavioral scientists) got the assignment in 1975 to study the performance of the DHEW EMS demonstration projects. 

The Jacksonville (Florida) Fire Department got the highest assessment. They took over the emergency ambulance service from funeral homes in 1967 and used DHEW money to train and equip firefighters to better handle cardiac-related calls. Jack Stout, director for the Arkansas EMS demonstration project, recalled:

AIl five of the demonstration project directors were to speak, and I was scheduled (set up) to follow Jacksonville, Florida’s Captain John Waters. When Captain Waters finished, the audience of about 800 folks was rolling in the aisles from his truly professional comic delivery. Waters’ famous dual slide show presentation had convinced even me that death was a thing of the past in ]acksonville. Watching Captain Waters, I felt sorry for other department heads who had to compete with him for a share of the ]acksonville city budget (Stout, 1985, p. 55).

Birth of High-Performance EMS and the Public Utility Model

Jack Stout moved from the Arkansas EMS project to be a researcher at CEMR. An economist, Stout believed that under the right conditions private sector ambulance services could provide better services than the Jacksonville Fire Department’s “socialized medicine” (Stout, 1985, p. 55).  This evolved into the High-Performance EMS (HPEMS) concept where the ambulance service was self-sustaining based on revenues and effective use of resources. There were nine “Public Utility Model” (PUM) high-performance EMS agencies in the 1980s. Many of the metrics we use today, like Unit Hour Utilization, came from HPEMS.

A key aspect of HPEMS is that every ambulance transport – 9-1-1, critical care, interfacility, and facility-to-home is provided by the HPEMS ambulance service (Overton & Stout, 2002). When I attended meetings of the Virginia State EMS Advisory Board, I heard complaints from volunteer rescue squads outside the City of Richmond that were not allowed to transport patients from city hospitals to their homes. The ordinance that established the Richmond Ambulance Authority (RAA), a public utility model, required that all patients transported on an ambulance stretcher in the city be moved by RAA.

When the Kansas City Fire Department took over ambulance duties from the Municipal Ambulance Services Trust (MAST) in 2010 (Mansur et al., 2009), and the Fort Worth, Texas, Fire Department replaced MedStar Mobile Health in 2025 (Wolf, 2024), the fire departments did not continue to provide interfacility transports. This dismantling of the Public Utility Model range of services affects the fire department EMS budget, as revenues from interfacility transports subsidized the cost of 9-1-1 responses in the PUM system.

A Look At Billing Revenues

The FY 2027 EMSA Strategy & Budget Book from the Emergency Medical Services Authority – a public utility model serving Tulsa and Oklahoma City – includes an EMSA Reimbursement Reality section. “The chart below underscores the vast difference between projected FY2027 billed charges and net revenue expected to be collected from the federal government Centers for Medicare & Medicaid Services (CMS) – two payors that account for nearly 70% of EMSA’s payor mix.” (EMSA, 2026, p. 4)

Breaking The Reimbursement Information Silo

While working as an assistant professor at The George Washington University, I did a deep dive into non-fire EMS. I remained active as an IAFC EMS Section member and engaged in committee work. Our tribal roots were clear, as it seemed that if the American Ambulance Association (AAA) advocated for a federal policy change, the fire service organizations would oppose it. I felt a bit like a stranger in a strange land when attending the AAA conference as an academic. Information was rarely shared between these tribes.

The first Fitch & Associates Pinnacle Conference in 2005 was an eye-opener. Dr. Jay Fitch exclaimed, “It reminds me of the Fourth Party!” The Fourth Party was an organization created by Jack Stout to provide training and advocacy for HPEMS. As with the AAA conference, some of the keynote speakers and many of the topics found at Pinnacle were not covered in fire conferences, including IAFC’s Fire-Rescue Med (FRM).

A lot has happened since 2005 …

Inadequate Ambulance Service Reimbursement

Until the Bipartisan Budget Act of 2018 directed CMS to build the Ground Ambulance Data Collection System (GADCS), the 2002 Medicare national ambulance fee schedule was established without actual cost data. Since 2004, Congress has added temporary add-ons to the fee schedule that have to be repeatedly reauthorized.

The Finance Committee of the National EMS Advisory Council, a nationally recognized council of EMS representatives and consumers to provide advice and recommendations regarding EMS to the federal government, issued a report on EMS Funding and Reimbursement in 2016. Their first conclusion:

The systematic cost of providing emergency ambulance services in the US exceeds currently available revenue. This mismatch can be resolved with one of two actions: 1) increase reimbursement or subsidies or 2) decrease costs. With fixed costs required to provide a clinically acceptable level of service, decreasing dollars spent on will result in a direct negative impact on the quality of care provided. The NEMSAC has previously recommended to FICEMS that it increase reimbursement for ambulance services utilizing the existing payment structure (NEMSAC Finance Committee Final Report, 2009). In the current economic climate, that recommendation is unlikely to be realized. (NEMSAC, 2016, p. 15)

Analyzing the Ground Ambulance Data Collection System (GADCS) Results

The first results of the GADCS surveys were published last year. Matt Zavadsky and the team from Page Wolfberg & Wirth LLC Advisory Group (PWW|AG) have been analyzing the data and interacting with the RAND Health Care’s lead author. The 2025 article Quantifying the gap between expenses and revenue for EMS services, posted on ems1.com, is the start of a continuing series analyzing the data, how the RAND author interprets it, and the implications for EMS operations. In PWW|AG’s January 21, 2025 webinar, “What We Learned From the First CMS Ambulance Cost Report,” they used CMS data to create Table X, which shows the stunning average revenue shortfall for all ambulance suppliers.

You can view this webinar and additional information on EMS reimbursement by enrolling in the PWW|AG Resource Hub, which includes a monthly EMS Financial Index. For policy issues, they have PWW|AG Industry Updates.

The post-pandemic 21% Solution that Unraveled Public Utility Models

Private-sector ambulance services poorly paid EMS caregivers before the pandemic. California is the only state to create an industry profile of the EMS caregiver workforce. The UCLA Labor Center identified “Private-sector EMTs and paramedics earned 39 percent less than their public-sector counterparts. Even when controlling for age, gender, geography, education, and race and ethnicity, public-sector wages were still much higher than private-sector wages” (Jacobs et al., 2017, p. 4). California public sector EMS employers are fire departments.

Non-fire municipal and commercial 9-1-1 paramedic ambulance services significantly raised salaries to fill EMS caregiver positions left vacant after the COVID-19 pandemic. Wake County EMS in North Carolina, a non-fire municipality, increased caregiver pay by 21% for existing and future caregivers to fill open paramedic positions and slow attrition. The 70-some open paramedic positions represent an 18% vacancy rate (Melmed, 2022). The Richmond Ambulance Authority increased caregiver salaries by 23%, raising the hourly rate by $4. Its employee turnover rate decreased from 43% to 17% (RAA, 2025, p. 13).

Similar pay raises were implemented at MedStar Mobile Health in Fort Worth, Texas; the Emergency Medical Services Authority in Tulsa and Oklahoma City; and the Three Rivers Ambulance Authority in Fort Wayne, Indiana. The increased salaries and the post-pandemic exponential jump in ambulance, medical equipment, and supplies costs placed all of these systems into financial peril. Stout’s High-Performance EMS process is financially unsustainable in the current healthcare environment.

Recommendations for the Chief Fire Executive

1) Identify and utilize a EMS reimbursement expert on your state’s regulations and practice

Medicine is a state-regulated activity. CMS regulations for reimbursement are complex. Especially now, with the dramatic DOGE initiatives and a chaotic federal government change process, you could benefit from having access to an insurance reimbursement expert in ambulance billing for your state.

2) Establish an effective audit process for submitting reimbursement claims

Some metro-sized fire departments have encountered significant potential federal fraud penalties for inaccurate or improper claim submissions. The municipal liability does not go away if you employ a vendor or subcontractor to process the claims.

3) Clearly show the expenses in adding an ambulance service

Some fire departments lump all of the operational expenses into a single budget category – if it has a siren and emergency lights, it goes in this bucket. Either internally or publicly, the municipality should be able to identify the direct expenses and the increase in existing services (911 center, apparatus shop, warehouse, training, etc.) associated with implementing a new ambulance service.

4) Consider EMS Services Going Beyond a Lights-and-Siren Rush to a Critical Patient

We will explore this in a later article, but only about six to seven percent of the patients treated and transported are clinically improved through paramedic street medicine. For those in cardiac arrest, stroke, sepsis, cardiovascular failure, allergic reaction, multi-system trauma, asthma attack, or acute metabolic crisis, we are lifesavers.

A recent study using 9.5 million EMS encounters in the 2024 ESO data revealed that:

Three percent of patients accounted for 16% of all encounters. Patients with very-high utilization were disproportionately covered by Medicaid, resided in socioeconomically vulnerable communities, and more commonly presented with chronic conditions. Despite higher transport rates, they were 40% less likely to be admitted than single encounter patients. The median time between encounters was 10 days for very-high utilizers (Fernandez et al., 2026).

Many of our 9-1-1 EMS calls are for situations never imagined in 1966. An ESO Solutions review of a little over ten million fire company responses (pumpers, ladder trucks, and heavy rescues) in 2025 shows that 66% are to EMS calls. Is this the best use of this resource?

References

Bass, R. (2015). History of EMS. In D. C. Cone (Ed.), Emergency Medical Services: Clinical Practice and System Oversight (2nd ed., Vol. 1, pp. 1-16). John Wiley and Sons, Ltd. 

Crowe, R. P., Fernandez, A. R., Treichel, A., Gardner, B., & Myers, B. (2026). Fire Service Index: Insights and Best Practices for Fire Departments (8^th edition) [White Paper]. ESO Solutions. https://www.eso.com/fire-service-index/

EMSA (2026) FY 2027 EMSA Strategy & Budget Book. Emergency Medical Services Authority. https://emsaok.gov/fiscal-strategy-and-budget/

Espinoza, M. (2026, July 26). Sonoma County Fire District, the regions largest ambulance service provider, seeks 16.36% rate increase. The Press Democrat. https://www.pressdemocrat.com/2026/07/18/sonoma-county-fire-district-regions-largest-ambulance-service-provider-seeks-16-36-rate-increase/

Finance Committee. (2016 ). EMS Funding and Reimbursement: FINAL. National EMS Advisory Council. Washington, DC: U.S. Department of Transportation.

Fernandez, A. R., Myers, J., Bourn, S. S., Crowe, R. P., Preusser, E. C., Muisyo, J., Treichel, A., Green, A. M., Onaeko, K., & Beck, E. (2026). A national description of emergency medical services patient utilization patterns. Health Affairs Scholar, 4. https://doi.org/10.1093/haschl/qxag144

Jacobs, K., Heller, N., Waheed, S., & Appel, S. (2017, February 7). Emergency Medical Services in California: Wages, Working Conditions, and Industry Profile. UC Berkeley Labor Center. http://laborcenter.berkeley.edu/emergency-medical-services-in-california-wages-working-conditions-and-industry-profile/

Mansur, M., Horsley, L., & Ochsner, C. (2009 Sep 28). MAST Takeover Won’t Change Service, Officials Say. The Kansas City Star.

Melmed, G. (2022, Mar 23). Wake County increases pay for EMS employees in effort to fill jobs and retain workers. CBS 17 https://www.cbs17.com/news/local-news/wake-county-news/wake-county-increases-pay-for-ems-employees-in-effort-to-fill-jobs-and-retain-workers/

Overton, J., & Stout, J. (2002). System Design. In Kuehi, A. E. (Ed.) Prehospital Systems and Medical Oversight. (3rd ed. pp. 114-131) Kendall Hunt Publishing.

Richmond Ambulance Authority (RAA). (2025). Presentation to City Council’s Public Safety Standing Committee. https://www.rva.gov/sites/default/files/2025-02/Richmond%20Ambulance%20Authority.pdf

Sadler, A. & Sadler, B. (2022). (P)LUCK: Lessons We Learned for Improving Healthcare and the World. Silicon Valley Press. ISBN 9781735873183

Shah M. N. (2006). The formation of the emergency medical services system. American Journal of Public Health, 96(3), 414–423. https://doi.org/10.2105/AJPH.2004.048793

Stout, J. (1985). Public Utility Model Revisited: Part 1: Origins. Journal of Emergency Medical Services (February), 55-58, 62-63. http://emsmuseum.org/wp-content/uploads/2021/05/Public-Utility-Model-Revisited-Part-1-_-Origins-55-58-62-63-1985-02-JEMS.pdf

Wolf, E. (2024 May 21). Fort Worth council approves switch from MedStar to fire-based EMS system. Fort Worth Report. https://fortworthreport.org/2024/05/21/fort-worth-council-approves-switch-from-medstar-to-fire-based-ems-system/

Zavadsky, M., & Wolfberg, D. (2025, February 17). Quantifying the gap between expenses and revenue for EMS services, ems1.com. https://www.ems1.com/ems-trend-report/quantifying-the-gap-between-expenses-and-revenue-for-ems-services

This concept is used when discussing risk management, healthcare, and engineering. It is also a component in designing better systems under the Just Culture model. Reason points out that failure is an inevitable result of human systems—we are all fallible. Countermeasures are based on the idea that “we cannot change the human condition, but we can change the conditions under which humans work.” So, failure is seen as a system issue, not a person issue.

High-reliability organizations take this approach to failure awareness:

• Analyze every event, no matter how small, to implement system-wide changes
• Encourage and reward error reporting
• View near-misses as opportunities for improvement rather than proof of success
• Continuously learn from defects and develop failure-free processes

Two years before wildfires incineratedswaths of Los Angeles, the city’s fire chief, Kristin M. Crowley, identified “one significant area of weakness” in her department’s ability to contain wildfires. L.A. had no specialized wildland unit to respond to daily brush fires and scrape vegetation, dig ditches and do the other labor to ensure blazes did not spread or rekindle, she wrote on Jan. 5, 2023, asking for $7 million to assemble its own squad.

In a memo that has not been previously reported, she told city fire commissioners that L.A. relied almost entirely on overburdened “hand crews” from other jurisdictions to bring such muscle to its brush fire emergencies. Hand crews, the most elite of which are sometimes called “hotshots,” fight wildfires with chain saws, axes and shovels, setting containment lines and then sticking around to meticulously monitor smoldering fires, feeling by hand for heat and digging out live spots to make sure fires don’t relight.

High-reliability organizations resist oversimplification of explanations for successes and failures:

• Constantly question “why” and invite diverse opinions
• Avoid simplistic explanations for failures
• Recognize the complexity of their work and its potential to fail in unexpected ways

Forget “wildland-urban interface”

When catastrophic fires occur, experts often blame the so-called wildland-urban interface, the vulnerable region on the perimeter of cities and suburbs where an abundance of vegetation in rugged terrain is susceptible to burning.

Yet the fire disasters that we’re seeing today are less wildland fires than urban fires, wildfire expert Jack Cohen said. Shifting this understanding could lead to more effective prevention strategies.

“The assumption is continually made that it’s the big flames” that cause widespread community destruction, he said, “and yet the wildfire actually only initiates community ignitions largely with lofted burning embers.”

The belief was that urban fires no longer exist, but they’ve come back. “It’s like watching polio return,” he said. “It’s happening repeatedly.”

While the Bel-Air fire in 1961, which destroyed 484 homes, and the Mandeville Canyon fire in 1978, which destroyed 230 homes, are often cited for the scale of their destruction, the 1991 Tunnel fire in the Oakland and Berkeley Hills marked the start of the modern era of urban fires, destroying 2,843 homes.

More recently, fires devastated Gatlinburg, Tenn., in 2016, the towns of Superior and Louisville in Colorado in 2021 and Lahaina, Hawaii, two years ago.(Curwen)

High-reliability organizations maintain high awareness of the state of their systems and processes:

• Focus on preserving constant awareness by leaders and staff of factors affecting the mission
• Proactively identify and prevent defects and harm
• Use real-time data and insights to prompt action, learning, and outcomes

Officials said that the Santa Ynez Reservoir had been closed since about February for repairs to its cover, leaving a 117-million-gallon water storage complex empty in the heart of the Palisades for nearly a year. (Hamilton)

High-reliability organizations cultivate resilience by:

• Prioritizing safety over other performance pressures
• Developing the ability to assess and respond to unexpected situations quickly
• Continuously learning from both successes and failures
• Investing in emergency training for unlikely but possible system failures

Thirteen years ago, Los Angeles Fire Department officials were bracing for the kind of dangerous winds that could drive flames across hillsides and canyons and tear through neighborhoods from Malibu to the Pacific Palisades to the San Fernando Valley.

The National Weather Service had issued red flag warnings of doomsday gusts as fierce as 90 mph.  LAFD commanders ordered up at least 40 extra fire engines for stations closest to the areas where the fire hazards were greatest, including the Palisades, The Times has learned through interviews and internal department records.

Among the additional rigs were more than 20 that were pre-deployed to those stations and 18 “ready reserve” engines that supplement the regular firefighting force in such emergencies, the records and interviews show.

“We could not take any chances on this, because the risk was too great,” said former LAFD Assistant Chief Patrick Butler, now chief of the Redondo Beach Fire Department, who led the agency’s preparations in 2011. (Tchekemedyian & Pringle) (Image is from staging for a 2010 brush fire – Mike Meadows)

High-reliability organizations value insights from those with the most pertinent knowledge, regardless of hierarchy:

• Empower frontline staff to make critical decisions
• Recognize that those closest to the work often have the greatest situational knowledge
• Ensure leaders know who possesses specialized expertise within the organization

Davis, Aaron C.; Boburg, Shawn; Sacks, Brianna; Hennessey-Fiske, Molly: & Lee, Joyce Sohyun. (2025 January 18) A key ‘weakness’ in L.A.’s wildfire strategy went unaddressed for years, Post probe shows. The Washington Post. https://www.washingtonpost.com/weather/2025/01/18/2023-memo-la-fire-chief-warned-significant-gap-wildfire-defense/

Curwen, Thomas (2025 Jan 11) Inconvenient truths about the fires burning in Los Angeles from two fire experts. Los Angeles Times. https://www.latimes.com/california/story/2025-01-11/fire-experts-asses-los-angeles-blazes-amid-changing-times

Hamilton, Mark. (2025 January 10) State to probe why Pacific Palisades reservoir was offline, empty when firestorm exploded. Los Angeles Times. https://www.latimes.com/california/story/2025-01-10/as-flames-raged-in-palisades-a-key-reservoir-nearby-was-offline

Tchekemedyian, Alene & Pringle, Paul. (2025 January 18) Amid dangerous winds in 2011, LAFD engines stood ready. That didn’t happen this time. Los Angeles Times. https://www.latimes.com/california/story/2025-01-18/amid-dangerous-winds-in-2011-lafd-engines-stood-ready-in-the-palisades-that-didnt-happen-this-time

Catastrophic reform drive changes to the fire prevention code: public assembly exits and interior finishes after the 1942 Cocoanut Grove nightclub fire in Boston, smoke/heat control through compartmentalization/fire doors and automatic detection in schools after the 1958 Our Lady of the Angels school fire in Chicago, sprinklers required in highrise buildings after the 1980 MGM Grand fire in Las Vegas, and pyrotechnics restrictions, interior finishes and exit signage after the 2003 Station Nightclub fire in Providence, Rhode Island.

The window of opportunity for reform is influenced by:

• Discrediting existing institutions and elites
• Weakening opposition to change
• Creating urgent pressure for solutions
• Shifting public expectations and demands
• Making previously “impossible” options seem necessary

Los Angeles fire operations are no strangers to catastrophic reform. Fire Chief Keith Klinger went to the Los Angeles County Board of Supervisors to report during the 1961 Bel Air-Brentwood wildfire. When the supervisors asked what should be done in the future, Chief Klinger immediately provided a comprehensive plan. Most plan elements had been proposed before and rejected by the board. Approvals were made at the height of the Bel Air incident.

In the early 2000s, residents and business owners in the San Fernando Valley felt that their city taxes were going downtown and not providing service to the valley. ValleyVOTE was an effort to secede from Los Angeles City. Inadequate rescue ambulance service was one of the issues, and some high-profile bad outcomes occurred.

Mayor James Hahn directed Fire Chief William Bamattre to “fix it.” This multi-year response increased the rescue ambulance fleet by 40% and put a paramedic asset (single-role paramedic or paramedic/firefighter) in every fire station.

… MAY BE A FIRE EQUIVALENT TO A CATEGORY 5 HURRICANE

That’s Stephen Pyne’s assessment. In 2019, fire historian Stephen Pyne and wildfire expert Jack Cohen spent three days touring Pacific Palisades and participating in the NFPA’s “Assessing Structure Ignition Potential from Wildfire” training with LAFD’s Defensible Space Program members and homeowners.  

Cohen makes these observations of the 2025 fire:

When you study the destruction in Pacific Palisades and Altadena, note what didn’t burn — unconsumed tree canopies adjacent to totally destroyed homes. The sequence of destruction is commonly assumed to occur in some kind of organized spreading flame front — a tsunami of super-heated gases — but it doesn’t happen that way.

In high-density development, scattered burning homes spread to their neighbors and so on. Ignitions downwind and across streets are typically from showers of burning embers from burning structures.

This fundamental misunderstanding has likewise led to a misunderstanding of prevention. No longer is it a matter of preventing wildfires but instead preventing points of ignition within communities by employing “home-hardening” strategies — proper landscaping, fire-resistant siding — and enjoining neighbors in collective efforts such as brush clearing. (Curwen 2025)

Will the replacement homes look like this house that used wildfire home hardening techniques and survived the Palisades fire?

HOW LARGE OF A FIREFIGHTER STANDING ARMY CAN THE COMMUNITY AFFORD?

When the National Weather Service issued its “Life-Threatening & Destructive Windstorm” alert on Monday, LAFD called in 90 additional firefighters to staff units and predeployed nine fire companies to vulnerable areas. Los Angeles County moved 30 extra engine companies into the area with 100 overtime firefighters. The U.S. Forest Service moved resources closer. It is the pre-planned response for a “Red Flag” alert. (Fuller, et al. 2025)

The Tuesday Santa Ana wind gusts of 85 to 100 miles an hour grounded firefighting airplanes and helicopters. The Palisades fire started at 10:35 am. Strike teams from Ventura and Orange Counties were mobilized. The high winds accelerated the fire spread in the high-density community described by Cohen as “… scattered burning homes spread to their neighbors and so on. Ignitions downwind and across streets are typically from showers of burning embers from burning structures.”

Many residents were forced to flee their homes. The fire was spreading faster than the traffic, resulting in cars abandoned on gridlocked roads – most without keys. The fire department used a dozer to clear the road for responding fire companies.

While all hands were engaged at the Palisades fire, a second major fire started in Eaton Canyon in the Altadena community at 6:18 pm.

Around 9 pm Los Angeles County Fire Chief Anthony Marrone called the California Office of Emergency Services and requested 50 strike teams: 250 engine companies staffed with 1,000 firefighters

At 9:26 pm. LAFD was calling back all available staff to fire stations and the maintenance shop.

By midnight, crews were losing water pressure from the hydrants. The water system was not designed to deliver 400% of its rated capacity. The power shutdown also affected the water pumps supplying Altadena.

By Sunday night, there were over 15,000 personnel, 2.500 California National Guard troops, 1,390 fire engines, 80 aircraft, 160 water tenders, and 170 dozers.

THE COST OF PREPARATiON

Redondo Beach Fire Chief Patrick Butler, a retired LAFD assistant chief, explained the issue of red-flag alert predeployments. It is expensive to call back staff and put additional units in service. Chief Butler points out that he was in 30 large-scale predeployments, with just three of those deployments handling significant work. From Chief Butler’s perspective, it is worth the cost.

What levels of firefighter staffing does the community want to pay for?

In July 2023, the National Institute of Standards and Technology released a case study of the 2018 Camp Fire in Butte County. At that time, the Camp Fire was the most deadly and destructive California wildland fire, killing 85, destroying 18,00 structures, and triggering the evacuation of 40,000 people.

As Los Angeles rebuilds, what type of community engineering (roads, building codes, landscaping, and fire breaks) and brush fire abatement will they implement to reduce the fire spread risk and the cost of fire department preparation?

_____________________________________________________

Curwen, Thomas (2025 January 11) Inconvenient truths about the fires burning in Los Angeles from two fire experts. Los Angeles Times. Accessed Jan 12, 2025 https://www.latimes.com/california/story/2025-01-11/fire-experts-asses-los-angeles-blazes-amid-changing-times

Fuller, Thomas; Berzon, Alexandra; Browning, Kellen; and Hubler, Shawn (2025 Jan 11) L.A. Was Prepared for Serious Fires. But It Wasn’t Ready for Four. The New York Times. Accessed Jan 12, 2025. https://www.nytimes.com/2025/01/11/us/los-angeles-calfire-firefighters.html

Maranghides, Alexander; Link, Eric D.; Mell. William “Ruddy,”; Hawks, Steven, Brown, Chrisopher; and Walton, William D, (2023 July) NIST Technical Note 2252: A Case Study of the Camp Fire: Notification, Evacuation, Traffic, and Temporary Refuge Areas. Gaithersburg, MD: National Institutes of Standards and Technology. https://doi.org/10.6028/NIST.TN.2252

Rodney Dyche noted that the EMS Media Log documented 26 ambulance thefts in 18 states in 2024. Six of those thefts resulted in significant crashes. Matt Zavadsky observed that: “For patient safety, community safety, this is something that is a zero-failure option, and if you fail to secure your vehicle, you can go work somewhere else. Period.” Rob Lawrence said: “We need to work hard to ensure that we don’t have that statistic in 2025, an ambulance stolen every 2 weeks.”

I reviewed the stolen ambulance articles posted on Company Commander.com and the Company Commander Facebook page since 2018.

Crimes of opportunity

The most frequent theft comes from an unattended ambulance parked at the emergency department or medical clinic. Some were idling, and all were unlocked. Nashville Fire had two idling ambulances stolen on the same day in October 2023.

Less frequent is the ambulance stolen from an incident scene, either by the patient or a third party. Sometimes, the caregivers and patient are still in the ambulance. That happened in Charlotte, NC, in April 2019, Phoenix in November 2023, New Orleans in October 2023, and in Atlanta in April 2024.

In a rare event, an ambulance is stolen from a station. In April 2022, Chicago Ambulance 66 was stolen from the Chinatown fire station and chased nearly 80 miles. In October 2022 Chicago Ambulance 71 was stolen from the fire station. In June 13, 2021, an ambulance was stolen from the Kunkel Ambulance garage in Utica, New York, and driven into Irondequoit Bay

Our featured image is the aftermath of a person entering the Detroit Fire Department’s Medic 8-HazMat 1-Chief 1/Fleet Maintenance facility in November 2019. The interloper drove Medic 8 through a bay door and later crashed exiting Interstate 75, during a police pursuit.

Here is a two-step approach to thwarting crimes of opportunity:

1. Establish and enforce a policy of taking the keys and locking up the ambulance when it is unattended. The Commission on Accreditation of Ambulance Services (CAAS) mandates a standard for accredited agencies to have a written policy/procedure to prevent vehicle theft. These agencies must provide copies of the policy/procedure detailing how vehicles are secured when unattended.

• Install an anti-theft device that auto-locks the transmission when the vehicle is placed in park. Tremco (https://tremcoemergencyproducts.com/ ) and Intermotive (https://intermotive.net/autogard/) offer CAAS-compliant anti-theft devices.

Violence Against Caregivers

EMS caregivers are attacked, and the assailant steals the ambulance. The most tragic example is the murder of FDNY EMT Yadira Arryo on March 16, 2017, when Jose Gonzalez drove over Arryo with the ambulance.

It happened in Prince George’s County, Maryland in January 2014 (killing a bystander when the ambulance crashed in a restaurant parking lot), Kanawha County, West Virginia, in November 2017, Detroit in April 2019, Washington County, Georgia, in January 2022; Houston, Texas in July 2021, Bronx, New York in August 2021, Montgomery County, Maryland in February 2022, Greer, South Carolina, in May 2022, Macon, Georgia in January, 2024, and Schenectady, New York in September 2024.

Since the pandemic, the number of reported attacks on EMS caregivers has increased. This will require a more comprehensive and expensive effort to prevent, react, and obtain justice when our caregivers are attacked and vehicles stolen.

Preventing the attack involves caregiver training and practice in:

• Situation Awareness
• De-escalation
• Operational and tactical protocols when encountering high-hazard situations

React to an attack using:

• Self-defense training
• Wearing appropriate personal protective gear
• Effective emergency communication (panic button)
• Use an automatic vehicle locator or global positioning service to track ambulances
• Robust public safety response when an attack is announced

Provide consequences for attacks to obtain justice

• Complete reporting of incidents
• Caregiver body cameras
• Effective legal prosecution of assailants
• Employee assistance services for attacked caregivers

Since 2016 the Seattle Fire Department has experienced increased attacks on caregivers when responding to medical calls, especially in the homeless encampments. Because of the high frequency of these calls, police are not always available. In June 2018 the department added a fire company to respond with an aid car (EMT ambulance) to every EMS call in Pioneer Square (1,200 EMS runs a year) and homeless encampments. The frequency of attacks against fire department members continued to increase. Between January and April 2023, there were more than 50 attacks.

There was a need to close a legal loophole to protect Seattle firefighters from interference the same way police officers are covered when performing their work activities. Under the legislation passed in May 2023, people can be arrested and charged if they intentionally physically interfere with firefighters, EMTs, and other fire responders who are actively responding to an emergency. It would also prevent people from intentionally refusing to leave the scene of an investigation of a crime while an investigation is in progress after being requested to do so.