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.  

What is a “Wicked Problem”?

The term “Wicked Problem” was introduced in 1973 by Horst Ritter and Melvin Webber in describing the challenge of addressing planning and social policy problems. Wicked problems of planning lack clarity in both their aims and solutions. Unlike the “clean sheet of paper” approach, wicked problems are subject to real-world constraints that prevent multiple risk-free attempts at solving them.

Rittel, H. W., & Webber, M. M. (1973). “Dilemmas in a General Theory of Planning.” Policy Sciences, 4(2), 155-169.

A Tale of Two Fire Department Ambulance Services

While an Assistant Professor of Emergency Medicine, I did a deep dive into Baltimore and Los Angeles City as they took different approaches to resolve the problems of staffing, ambulance workload and response time in 1999. Both departments use the same time-on-task measurements, and I had access to their data.

Baltimore: Underutilized Fire Companies and Overworked Ambulances

In 1999 Baltimore Mayor O’Malley asked the Greater Baltimore Committee and The President’s Roundtable to examine fire department operations. Using time-on-task analysis:

Baltimore engine companies averaged 1 hour 47 minutes in 24 hours working on incidents, while paramedic ambulances averaged 14 hours and 25 minutes in 24 hours on incidents. Over the past five years, structural fires declined 58% to 2,367 working fires in 1999. Half of the engine company responses (49,000) were to EMS calls. (1)

Baltimore staffed 40 engine companies, 21 truck companies, one rescue company, and 18 paramedic ambulances. Engine company average response time was 4:16 minutes, and paramedic ambulance response time was 8:44 minutes.

On May 10, 2000, the city started the process to close seven fire companies. Of the 140 firefighter positions affected, 100 will be moved to other fire companies to save $4 to $5 million in overtime, and 40 will staff 4 to 6 additional ambulances. After lengthy labor and legal negotiations – interrupted by a July 2001 chemical train fire in a tunnel that closed downtown for three days – the 2005 Baltimore Fire Department was comprised of:

• 32 Engine Companies – closed 4 companies and upgraded 4 companies
• 4 Squad Companies – engine companies upgraded to “rescue engines”
• 19 Truck Companies – closed 2 companies
• 22 Paramedic Ambulances – added 4 ambulances
• 1 Rescue Company
• 6 Battalion Chiefs – lost 1 battalion

The average time-on-task for all 22 Baltimore paramedic ambulances in 2005 was 14:40 hours:minutes in 24 hours, a system-wide Unit Hour Utilization of 0.61.

2021: Operational & Management Assessment by FACETS Consulting

Baltimore City engaged FACETS Consulting to perform a detailed fire department operations and management analysis. Their assessment showed an average ambulance response time of 8 minutes 31 seconds, with a 90th percentile of 13 minutes 56 seconds using 21 paramedic ambulances staffed 24/7. Paramedic ambulances are spending 14 hours and 54 minutes every 24 hours responding to, on-scene, transporting, and awaiting patient transfer to the emergency department. Engine company workload has increased to 3 hours and 36 minutes every 24 hours. Truck company workload has slightly decreased.

The workload among BCFD unit types is highest for the ALS and BLS ambulances (ranging from 39.27 percent to 71.07 percent). These numbers are exceptionally high, especially for caregivers working a 24-hour shift. 

Even the least busy ambulance exceeds the workload percentage recognized by many agencies for 24-hour shift durations by almost 10 percent. 

This level of workload can result in substantial employee wellness issues, does not provide on-duty time for essential training, and also leads to extended response times at the current level of resource deployment. Moreover, fatigue can negatively affect patient care and decision-making at incidents. (2)

Time-on-task for individual Baltimore paramedic and EMT ambulances in 2018-2019 ranged from 9:26 hours: a UHU of 0.39 to 17:03 hours:minutes – a UHU of 0.71. The caregiver on Ambulance 24 provided an over-the-radio perspective last September.

Los Angeles: Losing Paramedics Faster Than They Could Train New Ones

There needed to be more single-role Los Angeles Fire Department paramedics in 1999. Fourteen percent of the 435 authorized positions were vacant. A single-role paramedic made significantly more money than the fire chief, working five or more consecutive 24-hour shifts weekly. At that time, Los Angeles City lost paramedics quicker than they could hire replacements. (3)

One reason was the “force hire” that ordered paramedics back to work during their scheduled time off. In 1999 there were 60 unfilled LAFD single-role paramedic positions. If you wanted to make sure that you could get off to take a vacation, celebrate a holiday, or attend a family event, you needed to work 96 hours of voluntary “assigned hire” overtime in the previous month. (4)

Bad-outcome EMS calls highlighted in San Fernando Valley Secession Effort

LAFD established six rescue ambulances in the San Fernando Valley in 1957 to replace a private ambulance service in the 210-square-mile district. By 1968 eight LAFD rescue ambulances were handling 14,000 responses a year. (5 and 5a)

One of the 1957 GMC Suburban rescue ambulances assigned by LAFD to the San Fernando Valley. Restored by Lou Farah.

San Fernando Valley homeowners and businesses tried to secede from Los Angeles in the late 1990s. This effort by Valley VOTE was driven, in part, by a perception that San Fernando Valley tax payments were not used to provide city services in the valley. (6) Rescue ambulance average response time had increased to ten minutes, with over one-third of the rescue ambulances exceeding the department guideline of 350 responses a month. (7)  

The Valley VOTE campaign used high-profile, bad-outcome EMS incidents as examples of inadequate city services. While the secession vote was defeated, it was a driver of a significant five-year expansion of the Los Angeles Fire Department rescue ambulance and paramedic services.

EMS Resource Deployment Plan 2001-2006

By 2005 LAFD added 210 single-role paramedic positions, placed a paramedic in every fire station (on a rescue ambulance or a suppression company), and put a rescue ambulance in every fire station. The rescue ambulance fleet increased by 39% – 88 paramedic and 40 EMT ambulances.

Rescue ambulance workload is under 6 hours (responding to, at the scene, transporting, and delivering a patient to the hospital) in 24 hours. Paramedic Rescue Ambulance average response time is reduced to 6.5 minutes. The average Unit Hour Utilization for all 128 LAFD rescue ambulances in 2006 was 0.25.

2023: 15-Minute Wait for LAFD Rescue Ambulance to Arrive at a Cardiac Arrest

Michael Davis’s wife called 9-1-1 after he collapsed. It took about 15 minutes for an LAFD rescue ambulance to arrive. It is unclear in the Fox 11 news article if there was a fire company first responder. The three-month Fox 11 investigation uses anonymous paramedic sources that paint a picture of 10 to 20-minute rescue ambulance response times. (9)

The Ten Characteristics of a Wicked Problem

Rittel and Webber describe 10 important characteristics of a wicked problem:

1. They do not have a definitive formulation
2. They do not have a “stopping rule.” In other words, these problems lack an inherent logic that signals when they are solved.
3. Their solutions are not true or false, only good or bad
4. There is no way to test the solution to a wicked problem
5. The cannot be studied through trial and error. The solutions are irreversible so, “every trial counts.”
6. There is no end to the number of solutions or approaches to a wicked problem
7. All wicked problems are essentially unique
8. Wicked problems can always be described as a symptom of other problems
9. The way a wicked problem is described determines its possible solutions
10. Planners, that is those who present solutions to these problems, have no right to be wrong. Unlike mathematicians, “planners are liable for the consequences of the solutions they generate; the effects can matter a great deal to the people who are touched by those actions.”(10)

Fire-based EMS issues are challenging to solve because they involve complex, interconnected situations involving healthcare organizations and community populations. The environment of out-of-hospital unscheduled emergency medicine is constantly changing:

• New clinical best practices – including transport of 9-1-1 patients to specialty care centers (trauma, stroke, STEMI)
• Revenue or compensation opportunities
• Documentation requirements
• Emerging health issues
• Deteriorating hospital capabilities – increased “wall time” at emergency departments when delivering a patient
• Shrinking healthcare staff at nursing homes and assisted living facilities that generate more 9-1-1 calls
• Community population demographics

These problems often require creative solutions involving multiple stakeholders. Identifying the root causes and developing effective strategies to address them is difficult. Local government often lacks the resources or capacity to address these issues quickly or adequately.

Baltimore and Los Angeles invested financial and political capital in resolving the 1999 EMS crisis based on their resources, history, communities, and traditions. By 2005, they felt they had resolved the problems identified in 1999. Eighteen years later both cities are back in the news with staffing, workload, and response time issues.

Baltimore: Four Decades of Incremental Fire Suppression Reductions

Baltimore mayors have incrementally reduced fire suppression resources since 1984. Five quints were established in 1986 by combining an engine company crew and truck company crew of eight firefighters into a six-firefighter Aerial Tower company. Quint staffing was reduced until the unit was a 4-person truck company or eliminated. Fire stations have closed, and fire companies disbanded. (11)

Mayor Schmoke’s 1991 closing of three fire stations is a Harvard case study at the Kennedy School of Government. Case #1130.0 How to Bite the Bullet: Baltimore Mayor Kurt L. Schmoke and Fire Station Closings.

The 2005 final product from the Greater Baltimore Committee/The President’s Roundtable recommendations reduced fire suppression overtime costs. The four additional paramedic ambulances did not reduce the systemwide transport workload or improve ambulance response times as the EMS workload continued to increase yearly.

In 2012 Truck 15, Squad 11, and Truck 10 were shut down. In 2020 an effort was made to close Engine 4 (northeast Baltimore) and Engine 55 (Pigtown) to reduce the fire department Fiscal Year 2021 budget by $3.6M. Organized community effort delayed the closures pending the result of the FACETS report.

Los Angeles: Well-Funded EMS Expansion until the 2008 Recession

Los Angeles enjoyed political support and budget resources to expand the city’s emergency ambulance and paramedic services. A second five-year plan was issued covering activities through 2012. (12) The 2008 Recession halted the second five-year plan.

After three years of rotating closures of 15 engine companies and six ambulances, the 2012 Fiscal Year budget permanently closed 11 engine companies, seven light forces (a truck company with a pumper), and four EMT ambulances. Thirty command staff positions were eliminated. The 17 variably-staffed ambulances were closed.

Between Fiscal Year 2006 and Fiscal Year 2012, there was a net reduction of 228 firefighters and paramedics on duty each day. This is about a 17% reduction in the LAFD workforce.

A $15.4M Staffing for Adequate Fire and Emergency Response (SAFER) grant in 2018 allowed the reopening of four engine companies.

March 9, 2023: Los Angeles Fire Chief asks for 300 additional positions (13)

On April 21, 2023, Engine 8, with a paramedic/firefighter, responded to a drowning call where they encountered twin 4-year olds in cardiac arrest. They arrived within four minutes of the 9-1-1 call. Fire Station 8 is one of the eight LAFD fire stations without a staffed ambulance. Rescue Ambulance 107 is the closest ambulance with a six minute response time, but it was handling another emergency. The firefighters were doing CPR for 14-15 minutes before the nearest available ambulances arrived. (13a)

Evaluating Issues Impacting the Wicked Problem of Fire-Based EMS Staffing, Ambulance Workload and Response Times

Dover Professional Firefighters Local 1312 (2023 Feb 12) “Ambulances 1, 2, and 3 stacked up at Wentworth-Douglass Hospital. Just another Sunday evening.” New Hampshire. Ambulance 3 was added on September 18, 2022.

In considering this wicked problem, lets look at three areas impacting any solution today: best clinical outcome for patient, best situation for the EMS caregivers, and best result for the fire department.

What Provides the Best Clinical Outcome for the Patient?

This question is more focused and nuanced than the old-school “What is Best For the Patient?” In the first 18 months of the Seattle Medic One program (March 1970 – August 1971) firefighter/paramedics resuscitated 111 clinically dead patients. (14) Today, success is measured by the number of resuscitated out-of-hospital cardiac arrests (OOHCA) discharged from the hospital without neurological deficiencies.

Establishing an 7 minute, 59 second response time for paramedic ambulances

Preliminary results from “Project Restart,” a three-year Robert Wood Johnson funded study looking at community cardiac mortality identified two OOHCA survival metrics and established the 7:59 minute paramedic response time.

Mickey Eisenberg’s group analyzed 604 CPR incidents in Seattle and King County from April 1976 to August 1977. At that time, there were four paramedic ambulances in the community. Two Seattle Fire Department ambulances at Harborview Medical Center, one at Bellview Fire Headquarters, and one at Evergreen Fire Department. In 1976 only paramedics could use defibrillators, administer IV medications, record a heart rhythm, and use an advanced airway.

Eisenberg’s group identified two OOHCA survival metrics: If CPR was initiated within four minutes and if definitive care was provided within ten minutes, 43% of patients survived. If either time was exceeded, the changes of survival fell dramatically. (15)

Refining the Clinical Outcome Question

As research continued into out-of-hospital cardiac arrest survival, a subset of patients were identified as most impacted by these efforts. Focus was on patients who suffered a cardiac arrest that was witnessed by someone else and showed ventricular fibrillation as the cardiac rhythm. Adoption of the 1991 Utstein Style guidelines on uniform reporting of cardiac arrest, updated in 2004, 2015, and 2019 are an effort to provide “apples to apples” comparison for out-of-hospital and in-hospital cardiac arrest final outcomes.

The Resuscitation Outcomes Consortium is a massive research effort started in 2004 that conducted experimental and observational studies of out-of-hospital cardiac arrest and trauma treatments at eleven regional centers. (16) The most significant clinical change is the impact of two minutes of continuous closed chest compression (CCCC) applied at 100-120 compressions a minute to a witnessed cardiac arrest patient in ventricular fibrillation. The number of patients experiencing a restoration of spontaneous circulation (ROSC) almost doubled when first responders provided CCCC as the first treatment, followed by defibrillation as the second treatment. (17 & 18)

In 2007 the U.S. Metropolitan Municipalities EMS Medical Directors, known as the “Eagles,” developed evidence-based performance measures to benchmark urban EMS systems. They used the Number Needed to Treat (NNT) metric. NNT is the number of patients you must treat to prevent another bad outcome (death, stroke, etc.).

The clinical situations benchmarked included:

• ST-elevation myocardial infarction (STEMI)
• Pulmonary edema
• Asthma
• Seizure
• Trauma
• Cardiac arrest

Four of the situations required out-of-hospital paramedic-level medical intervention. Trauma situations focused on minimal on-scene time with transport to a trauma center. Cardiac arrest focused on the arrival of CPR-trained providers and a defibrillator within five minutes. (19)

For cardiac arrest the Eagles proposed that EMS systems not focus response time measurement on ALS ambulances, but rather pay greater attention to first response/BLS response time to measure what it called the “… most important predictive elements for optimal outcome: time elapsed until initiation of basic chest compressions and time elapsed until defibrillation attempts.”

At the same time, I analyzed the out-of-hospital clinical tasks delivered by firefighter/paramedics in a large urban county. Using a year of patient care reports, I counted the number of times caregivers documented:

• Inserting an advanced airway, like an endotracheal tube or King LT
• Performing a chest decompression
• Administering a medication though an intravenous line, intermuscular injection, nebulized breathing treatment, or by mouth
• Infusing 500 or more milliliters of Lactated Ringer’s (the protocol for fluid resuscitation)
• Delivering a defibrillation or cardioversion

Six percent of the patients transported to an emergency department received one of those treatments. Within this group, one-fourth of the patients received two to more treatments, representing 1.5 percent of the patients transported. (20)

The majority of the patients transported did not receive paramedic-level care to improve clinical outcomes of serious medical conditions.

An updated survey of delivered out-of-hospital tasks will probably show a higher percentage of patients receiving paramedic-level care due to COVID complications, opioid overdoses, an aging population, and increased focus on stroke/ST-segment elevation myocardial infarction (STEMI) care. Using the percentage of transported patients getting paramedic-level care is a difficult metric to use when considering paramedic staffing, dispatch, and deployment.

Many fire departments identify critical EMS calls based on how the telecommunicator coded the incoming 9-1-1 call. Critical EMS calls are the “Echo” and “Delta” responses under the Medical Priority Dispatch System (MPDS). (21) This Pitt County video provides a reenactment of a “Delta” call,

The number of EMS calls coded as Echo or Delta is significantly higher than that of transported patients receiving paramedic-level care. The MPDS dispatches documents the fire department resource commitment to the incident before the first patient contact.

What care does the other 94% of transported patients receive?

Within the reports I reviewed, almost all patients had documented vital signs; some were splinted, some received wound care, some received a 12-lead EKG, and others had an intravenous line started without medication or fluid resuscitation. Many of the 94% transported needed to go to an emergency department, clinic, or physician’s office for further treatment.

What is the Best Situation for the EMS Caregivers?

Let’s look at three factors impacting EMS caregivers.

Excessive and exhausting work hours

Just before 5:20 a.m. Sunday, April 2, as BLS 16 responded to a call, it slammed into a power pole, a crosswalk sign, and a wall. The crew 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. (22)

Phoenix firefighters interviewed by AZ Family discussed working “Stand Up 24’s” – a 24 hour shift with no rest periods. An increase in mandatory overtime means many firefighters and firefighter/paramedics are working “Stand Up 48’s”. (23)

Single-role paramedics treated like second-class fire department members

There is not much peer-review research on how fire service leaders influence the attitudes of firefighters as motivational predeterminate of performance and organizational outcomes. Perceived Organizational Support (POS) is a social exchange variable in which justice perceptions affect organizational commitment and job satisfaction. Huntsman’s group surveyed two metro-sized Western fire departments. The fire department members perceive justice in both procedures – such as promotions – and outcomes – such as pay rates. (24) I often hear EMS single-role caregivers complain that they are treated as second-class members within their fire department.

The pandemic identified unequal pay and working conditions for the single role EMS providers employed by the Fire Department of New York when compared to firefighters. Mayor De Blasio’s response “… EMS work is different.” was not well received.

Twenty five single role EMS caregivers filed a federal class-action lawsuit against the city and FDNY. The Equal Employment Opportunity Commission determined that:

… any difference in duties between the EMS first responders and firefighters fails to explain the pronounced gap in wages and benefits, and [the city has] failed to adjust the pay scales of EMS first responders to keep pace with the changes to their duties since the City merged EMS with the Fire Department in 1996. (25) We may learn a lot about “occupational separation.”

Moral injury and compassion fatigue

Moral injury was first used in 2009 to describe soldiers’ response to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (26) Physicians adopted the concept when describing the frustration of being unable to provide high-quality care and healing in the context of front-line health care. (27)

Moral injury occurs for paramedics and firefighters when there is a gap between what they want to do and the conditions they are confronting. An example is the opioid epidemic, where caregivers resuscitate the same person a couple of times a year with no change in addictive behavior. Or the person with a behavioral health situation who will not benefit from transport to an emergency department but that is your only option.

In some communities, the number of on-duty firefighters has shrunk while the workload has increased. There are incidents where paramedics and firefighters face devastating human conditions that they cannot reverse or mitigate, creating a situation described by Litz as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”

Compassion fatigue (CF) is a secondary traumatic stress syndrome defined as a sudden or gradual loss of compassion from exposure to stress or stressful events. Colloquially, CF is referred to as the “cost of caring,” which describes the process by which compassion and empathy felt by a caregiver for their patient can devolve into a lack of compassion by the continuous exposure to traumatic situations that is both unhealthy for the caregiver and distorts reality, despite its protective notion. (28)

Examples of compassion fatigue include:

• Lack of compassion
• Frustration with the patient
• Rage response
• Gallows humor
• Somatization: “suppression of emotions and distancing strategies after exposure to intense emotional material, which can ultimately lower empathy and result in additional traumatization”

These are some factors that contribute to the suicide rate of caregivers (29) and the 26% voluntary turnover of active paramedics in 2022. (30)

What is Best Result For the Fire Department?

Fire departments have significant economies of scale when establishing a new emergency ambulance service. Existing fire stations, a two-way communication system that includes dispatch/deployment, vehicle maintenance capability, tiered command structure, and logistics. With all of those advantages, adding an emergency ambulance service is not revenue neutral. The insurance reimbursement system does not cover the actual cost of services. (31)

Changing community needs

Modern United States Emergency Medical Services started in 1966 with a combination of federal funding that was focused on reducing highway accident deaths and disabilities, medical research to improve the survival rate of out-of-hospital cardiac arrest, and President Johnson’s “Great Society” initiative that included the creation of the Freedom House Ambulance paramedics in Pittsburgh. (32 & 33)

Up to 80% of fire company responses are for EMS incidents. The opioid overdose crisis was overshadowed by the pandemic, but continues to outpace other accident-related morbidity and mortality situations, with more than 107,000 deaths in calendar year 2021. (34)

There has been a continuing increase in lift-assist calls from individuals and assisted living/nursing homes. It appears that some healthcare facilities are cost-shifting lift assistance from facility staff to EMS caregivers. They are calling 9-1-1 because the labor organizations representing security and maintenance workers removed patient handling as one of their job-related responsibilities. This was due to worker compensation claim denials and liability concerns. (35 & 36)

Advanced Practice Provider (APP)

The COVID 19 pandemic accelerated the expansion of emergency ambulance into other services. Los Angeles has added Advanced Provider Response Units (ARPU), staffed with a nurse practitioner or physician assistant teamed with a firefighter paramedic. The ARPU is capable of treating patients in place or navigating them to select alternate destinations, such as a mental health urgent care or a sobering center.

The initial APRU was deployed in South Los Angeles in 2016. It was able to safely treat or navigate 50% of patients away from the ED by performing on-scene, simple procedures that lie just beyond the traditional paramedic’s scope of practice, including applying clinical decision rules, performing uncomplicated laceration repair, providing culturally sensitive health teaching and promotion, connecting patients with social workers, and helping patients and their families navigate to ongoing in-network care. (37)

Street Crisis Response Team

An alternative to police or EMS response to behavioral health issues is the San Francisco Street Crisis Response Team (SCRT). SCRT is staffed with a fire department community paramedic, a behavioral health clinician from HealthRIGHT360, and a peer specialist with lived experience from RAMS, Inc. (Richmond Area Multi-Services) who have a range of specialist skills to engage on the scene with a person in crisis.

The first six months of the program showed that 9% of the SCRT encounters have ended in a 5150, an involuntary mental health hold for those who are a danger to themselves or others. 18% were transported to a hospital and 18% to a program such as residential care or drug treatment. (38)

With six teams launched, SCRT is now diverting over half (58%) of calls monthly for “mentally disturbed persons” from law enforcement. In the first year the SCRT responded to over 5,000 calls related to people suffering mental health and substance abuse issues on city streets. (39)

Los Angeles Skid Row – a Challenging Community of Addiction and Unsheltered Homeless

The out-of-hospital emergency medical services environment in 2023 is tremendously more complex than Baltimore and Los Angeles handled in 1999. A dramatic example is what LAFD encounters in the Skid Row community. Public Broadcasting Service (PBS) spent a day with the firefighters at Los Angeles Fire Station 9 in 2019. This 27-minute documentary was shown on SoCal Connected on February 18, 2020. https://www.pbs.org/video/fire-station-9-9syxup/

Footnotes

(1) staff (2000 May 24) The debate: city fire coverage. The Baltimore Sun. Accessed March 5, 2023 https://www.baltimoresun.com/news/bs-xpm-2000-05-24-0005240127-story.html

(2) Operational & Management Assessment: Baltimore City Fire Department – Final Report. (2021 November). FACETS Consulting LLP. https://fire.baltimorecity.gov/baltimore-city-fire-department-facets-report

(3) Fox, S. (1999 Dec 26). Proposal Targets Paramedic Shortage. Los Angeles Times. Los Angeles, CA. Accessed March 5, 2023 https://www.latimes.com/archives/la-xpm-1999-dec-26-me-47674-story.html

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

(5) Ditzel, P. (1965) Dial 0 for Rescue. The Firemen’s Grapevine.

(5a) Hisserich, J. C. (2020 July 1) How the Los Angeles Fire Department Became the City’s Ambulance Provider. Los Angeles Fire Department Historical Society

(6) Faught, J. (2006). “Breaking Up is Hard to Do: Explaining the 2002 San Fernando Secession Vote.” Journal of Urban Affairs 28(4): 375 – 398.

(7) Wells, W (2004 February 1) “Los Angeles Fire Department Implements EMS Resource Plan.” Firehouse.com Accessed Mar 5, 2023 https://www.firehouse.com/home/news/10526932/los-angeles-fire-department-implements-ems-resource-plan

(8) Bamattre, W. R. (2006 June 12). EMS Resource Deployment Plan Update, Los Angeles Fire Department.

(9) Silva, G. (2023 February 12) ” ‘It happens every day’: LAFD paramedics say 911 response times continue to rise. Fox 11 News, Accessed March 5, 2023 https://www.foxla.com/news/lafd-paramedics-say-911-response-times-continue-to-rise.

(10) “What’s a Wicked Problem?” Stony Brook University. accessed February 25, 2023 https://www.stonybrook.edu/commcms/wicked-problem/about/What-is-a-wicked-problem

(11) Baltimore Fire Officers IAFF Local 964 (2023 April 19) “On this date in 1986, Aerial Tower 111 was placed in service. Engine Co No 1 and Truck Co No 11 were disbanded and combined to place the tower in service, at their station at 401 W. North Avenue. The unit ran as both an engine and a truck company on fire boxes, and was staffed with 6 personnel. The tower lasted a little over 10 years, being disbanded on 4/9/1997, and the firehouse closed.” FaceBook https://www.facebook.com/BFO964/posts/693953376068826

(12) LAFD (2008). Five-Year Emergency Medical Services (EMS) Plan 2007-2012, Los Angeles Fire Department.

(13) ABC 7 (2023 March 7) Fire Chief Crowley and Mayor Bass Discuss State of the LAFD. https://youtu.be/NOvvSgigols

(13a) Silva, G. (2023 May 1) LA’s ambulance shortage impacting city’s public safety, paramedic says. Fox 11 News. Accessed May 6, 2023 https://www.foxla.com/news/las-ambulance-shortage-impacting-citys-public-safety-paramedic-says

(14) “50th Anniversary” in Seattle Fire Department 2020 Annual Report. City of Seattle. p. 26.

(15) Eisenberg, M., Bergner, L., & Hallstrom, A. (1979). Paramedic Programs and Out-of-Hospital Cardiac Arrest: I. Factors Associated with Successful Resuscitation. American Journal of Public Health, 69(1), 30 – 38. 

(16) Zive, D.M.; Schmicker, R.; et al. (2018) Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium, Resuscitation. 131:74-82

(17) Brown SP, Wang H, et al. (2015) A randomized trial of continuous versus interrupted chest compressions in out-of-hospital cardiac arrest: rationale for and design of the Resuscitation Outcomes Consortium Continuous Chest Compressions Trial. Am Heart J;169:334-341.e5

(18) Nichol, G., Leroux, B., et al. (2015) Trial of continuous or interrupted chest compressions during CPR N Engl J Med, 373 (23), pp. 2203-2214

(19) Myers, J. B., Eckstein, M. et al. (2008). “Evidence-Based Performance Measures for Emergency Medical Services Systems: A Model for Expanded EMS Benchmarking.” Prehospital Emergency Care 12(2): 141-151.

(20) Unpublished 2006 data from an internal study.

(21) Pennino, J. A., III. (2021). The expanded implementation of the medical priority dispatch system (MPDS) in Pinellas County: A public value perspective [Doctoral dissertation, Valdosta State University]. In Dissertation Abstracts International: Section B: The Sciences and Engineering (Vol. 82, Issue 1–B).

(22) staff (4 April 2023) Long Beach unions say ambulance crash highlights staffing shortage. KCAL CBS. Accessed April 6, 2023 https://www.cbsnews.com/losangeles/news/long-beach-unions-say-ambulance-crash-highlights-staffing-shortage/

(23) staff (31 January 2023) Phoenix Fire Department in Staffing Crisis. AZ Family. Accessed 8 April 2023 https://youtu.be/qulxrnOtNO8

(24) Huntsman, D., Greer, A., & Murphy, H. (2020) Leveraging Justice: How Leaders Influence Performance Determinants in the Fire Service. Risk, Hazards & Crisis in Public Policy. 11(3) 270 – 295. doi: 10.1002/rhc3.12188

(25) Freeman, D. (2023 January 10) EMS unions sue city, FDNY alleging pay discrimination: Suit concerns effects of ‘occupational separation’. The Chief Leader. Accessed January 22, 2023 https://www.thechiefleader.com/stories/ems-unions-sue-city-fdny-alleging-pay-discrimination,49591

(26) Litz, B. T., Stein, N. et. al (2009). “Moral injury and moral repair in war veterans: A preliminary model and intervention strategy.” Clinical Psychology Review 29(8): 695-706.

(27) Talbot, S. G. and Dean,W. (2018) “Physicians aren’t ‘burning out.’ They’re suffering from moral injury.” STAT.

(28) Renkiewicz, G. K., & Hubble, M. W. (2021). Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services Personnel. Prehospital Emergency Care. https://doi.org/10.1080/10903127.2021.1943578 

(29) Vigil, N. H., Grant, A. R., et. al (2018). Death by Suicide—The EMS Profession Compared to the General Public. PreHospital Emergency Care, 23(3), 340-345. https://doi.org/10.1080/10903127.2018.1514090 

(30) Doverspike, D. (2023) 2022 EMS Employee Turnover Study. American Ambulance Association and OnShift Inc-Avesta Systems Inc.

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

(32) Shah M. N. (2006). The formation of the emergency medical services system. American Journal of Public Health, 96(3), 414-23

(33) Edwards, M.L. (2019) Pittsburgh’s Freedom House Ambulance Service: The Origins of Emergency Medical Services and the Politics of Race and Health. Journal of the History of Medicine and Allied Sciences 74 (4) 440-466. dot: 10.1093/jhas/jrz041

(34) Advocacy Resource Center (2022 December 22) Issue Brief: Nation’s drug-related overdose and death epidemic continues to worsen. American Medical Association

(35) Thomas, L. & Biantoro, C. (2021 March) A Review of Fire First Responder Responses to Lift Assist and Traumatic Fall Incidents: Analysis on City of Surrey Medical Incident Response. Surrey, British Columbia: City of Surrey Fire Services

(36) Ward, M. (2020 January 20) Looking at Fire-EMS Lift-Assists: Aging Community, Troubling Health Trends and Healthcare Cost Shifting. Reston, VA: CompanyCommander.com Accessed April 11, 2023 https://companycommander.com/2020/01/20/looking-at-fire-ems-lift-assists-aging-community-troubling-health-trends-and-healthcare-cost-shifting/

(37) Sanko, S., & Eckstein, M. (2021). Mobile Integrated Health Care in Los Angeles: Upstream Solutions to Mitigate the Covid-19Pandemic. NEJM Catalyst: Innovations in Care Delivery 2021, 2(2). https://doi.org/https://doi.org/10.1056/CAT.20.0383 

(38) Thadani, T., & Cassidy, M (21 May 2022) S.F. finally has a new mental health team to respond to homeless people in distress. Is it helping? San Francisco Chronicle. Accessed 10 April 2023 https://www.sfchronicle.com/local/article/s-f-s-new-street-crisis-team-is-helping-people-16180437.php

(39) Office of the Mayor (2021 November 30) San Francisco Celebrates One-Year Anniversary of Street Crisis Response Team. Accessed April 10, 2023 https://sfmayor.org/article/san-francisco-celebrates-one-year-anniversary-street-crisis-response-team

“IT IS CHEAPER TO PAY OVERTIME THAN CREATE MORE POSITIONS”

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

From my professional experience, 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 Steven Knight 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.

Knight, S. (2019 March 12) Full time, part time, overtime: How to fill fire department vacancies. firerescue1.com

LOOKING AT LOS ANGELES

In 1987 a Los Angeles County firefighter/paramedic made more money than the fire chief. That firefighter/paramedic got $59,673 in overtime pay along with his $38,811 annual salary. Firefighter/paramedic Wilson worked five consecutive 24-hour shifts a week, every week. That made the Los Angeles Times.

In the late 1990s, a single-role Los Angeles City Fire Department paramedic made significantly more money than the fire chief, working five to seven consecutive 24-hour shifts a week. At that time, Los Angeles City was losing paramedics quicker than they could hire them.

One reason was the “force hire” that ordered paramedics back to work during their scheduled time off. In 1999 there were 60 unfilled LAFD single-role paramedic positions, representing a 14% vacancy rate in the paramedic workforce. If you wanted to make sure that you could get off to take a vacation, enjoy a holiday, or attend a family event, you needed to work 96 hours of voluntary “assigned hire” overtime the previous month.

When I was looking at other fire departments pre-pandemic, the number of firefighters and paramedics willing to work overtime decreases when the number of authorized but unfilled positions exceeds 12%. This is usually when forced, or mandatory, overtime starts in earnest. After a few months of forced overtime, some departments see an increase in injuries, sick leave, retirements/resignations, and a decrease in the number of employees voluntarily signing up for overtime.

A 2015 audit of overtime resulted in the Los Angeles City Council approving the hiring of 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.”

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.”

Last week Company Commander posted an article that 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.”

AN ANNUAL DANCE OF MEDIA FUELED OUTRAGE

In many jurisdictions, this dance of overtime outrage occurs every year. Most of the media articles blame or shame the individuals that worked overtime, ignoring the elected officials and public safety leadership that developed and implemented policies that generate overtime. 

Company Commander posts these articles not to pile on blame or shame, but to share examples of the staffing and budgeting issues that every jurisdiction faces. The ICMA and Center for Public Safety Excellence white paper on 21st Century Fire and Emergency Services identified two themes:

• First, the past strategies of deferring conclusive action on critical issues with short-term solutions and leaving them for the next set of leadership is not a sustainable strategy for the future. To continue to do so will worsen the eventual correction(s) that will have to be made.
• Second, 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 are not vested in a 20th century fire service paradigm or antiquated local government bureaucracy.

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 promoting appropriate organizational staffing to meet the expanded and complex role that a fire/rescue department performs in 2022.

AN OBSERVATION ABOUT THE FREQUENCY OF OVERTIME POSTS

Company Commander also posts articles that describe closed fire companies and reduced staffing that some jurisdictions are forced to do to stay within their authorized overtime budget. In terms of number of posts, there are about four times as many posts about closed fire companies, reduced staffing, or “browned-out” fire companies as there are about overtime earnings.

Featured picture: “Firefighters Defend Neighborhood Structures as Hollywood Theater Goes Up in Flames.” LAFD.org. 7/13/2022

These situations provide opportunities and challenges for the front-line emergency service officer.

FIRE DEPARTMENT AS A SOCIAL SERVICES PARTNER

The San Francisco Fire Department Street Crisis Response Team (SCRT) is staffed with a community paramedic from SFFD, a behavioral health clinician from HealthRIGHT360, and a peer specialist with lived experience from RAMS, Inc. (Richmond Area Multi-Services) who together have a range of specialty skills to engage on the scene with a person in crisis.

In the first year of operation, November 2020 – November 2021, SCRT took more than 5,000 calls and engaged with nearly 3,000 people in crisis. In early 2022, the seventh team with six additional staff will launch.

The first six months of the program showed that 9% of the SCRT encounters have ended in a 5150, an involuntary mental health hold for those who are a danger to themselves or others. 18% were transported to a hospital and 18% to a program such as residential care or drug treatment. (source)

Demonstrating the program’s success as an alternative to law enforcement, SCRT diverted more than one-third of all 911 calls (38%) for “mentally disturbed persons” from law enforcement cumulatively during its first year of operation. With six teams launched, SCRT is now diverting over half (58%) of calls monthly for “mentally disturbed persons” from law enforcement. Once fully operational, SCRT seeks to divert 100% of calls.

City of San Francisco (2021 November 30) San Francisco Celebrates One-Year Anniversary of Street Crisis Response Team Press Release

RISING PROBLEM OF HOMELESS ENCAMPMENTS: FIRES, INFECTIOUS DISEASE, VIOLENCE AGAINST CAREGIVERS, AND EMS WORKLOAD

Lexipol provided a 2019 webinar on “Crisis in the Streets: Fire Department Response to Homeless Individuals” that was eye-opening. Click on this link to see the on-demand webinar.

Homeless encampments experienced a 1,000% increase from 2007 to 2017 and are occurring throughout the United States. Half of the encampments have 11-50 residents, 17% of the encampments have more than 100 residences. (NLCHP 2017) Fire departments are responding to calls for violence, fires and infectious diseases like typhus and tuberculosis (Gorman 2018)

Due to violence against first responders, some fire departments are sending two crews to any EMS event at an encampment, to have one company commander function as the scene safety officer while the others work at the task-level. (Goldfeder, Long & Schaeffer 2019)

Seattle Fire Chief Harold Scoggins reports that from Jan. 1 to April 10 of 2022 the department responded to 478 encampment fires – three to five encampment fires a day. In 2021 during the same time period, it was 327. The year before that, they responded to 168 encampment fires. They are also responding to 30 to 35 medical calls to homeless encampments every day. (source)

Los Angeles Fire Department, a city 6 times larger than Seattle, responded to 24 encampment fires a day in May 2021, many spreading to adjacent businesses and residences creating millions of dollars of property damage. (source) In downtown Los Angeles, fires from homeless encampments account for 80% of the blazes in the summer of 2021. (source)

WE ARE NOT TELLING OUR STORY: FIREFIGHTERS RESCUE A LOT OF CIVILIANS

Stunning results from the Firefighter Rescue Survey. They have been collecting information on rescues made by firefighters as reported in the media or by fire departments. In 2021 they found that 2,173 civilians were rescued by firefighters. They received 757 completed rescue surveys. 

As of April 5, 2022, Firefighter Rescue Survey has received reports of 300 incidents where civilians have been rescued by firefighters in 2022. Statistically, that equates to nearly 3.3 incidents per day where firefighters are making grabs. (source) You can get Chief Brian Brush’s “2021 Rescue Survey & The Culture Shift for 2022: People Before Water“ through this (source).

The goal of the Firefighter Rescue Survey initiative is to reduce civilian home fire deaths to under 2,000 per year. U.S. news media reported 2,264 civilian home fire fatalities for the calendar year 2021. Please visit their website http://www.firefighterrescuesurvey.com/

REFERENCES

Thadani, T. & Cassidy, M. (2021 May 17) S.F. finally has a new mental health team to respond to homeless people in distress. Is it helping. San Francisco Chronicle. accessed April 14, 2022. https://www.sfchronicle.com/local/article/S-F-s-new-street-crisis-team-is-helping-people-16180437.php

NLCHP (2017). Tent City, USA: The Growth of America’s Homeless Encampments and How Communities are Responding. Washington, DC, National Law Center on Homelessness and Poverty. http://nlchp.org/wp-content/uploads/2018/10/Tent_City_USA_2017.pdf

Gorman, A. and Kaiser Health News (2019 March 8). Medieval Diseases Are Infecting California’s Homeless: Typhus, tuberculosis, and other illnesses are spreading quickly through camps and shelters. The Atlantic. New York, Atlantic Media, Inc.  https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/

Goldfeder, B., A. Long and B. Schaeffer (2019 July 9). Crisis In The Streets: Fire Department Response to Homeless Individuals. Webinar. Irvine, CA, Lexipol.  https://info.lexipol.com/webinar-fire-department-response-to-homeless

Markovich, M. (2020 April 15) Seattle Fire Chief: Responses to daily encampment fires taxing already short staffed fire dept. Fox 13 Seattle. Accessed April 15, 2022. https://www.q13fox.com/news/seattle-fire-chief-reponses-to-daily-encampment-fires-taxing-already-short-staffed-fire-dept

Smith, D., Queally, J., & Molina, G. (2021 May 12) 24 fires a day: Surge in flames at L.A. homeless encampments a growing crisis. Los Angeles Times Accessed April 17, 2022. https://www.latimes.com/california/story/2021-05-12/surge-in-fires-at-la-homeless-encampments-growing-crisis

(2021 June 14) Homeless Encampment Fires Account For 80% Of Blazes Plaguing DTLA In Recent Weeks: ‘It’s So Sad.’ CBS Los Angeles. Accessed April 17, 2022. https://www.cbsnews.com/losangeles/news/rash-of-homeless-encampment-fires-continues-across-southland/

Feature image: Winthrop, C. (05 March 2021) One Dead Following Palms Homeless Encampment Fire in Possible Homicide. westsidetoday.com Accessed April 17, 2022 https://westsidetoday.com/2021/03/05/one-dead-after-palms-homeless-encampment-fire/

(2022 April 6) Year of the Rescue, FIREFIGHTER GRAB VIDEO, Reducing Civilian Fatalities Below 2000. County Fire Tactics. Accessed April 17, 2022. https://countyfiretactics.com/2022/04/06/year-of-the-rescue-firefighter-grab-video-reducing-civilian-fatalities-below-2000/

Brush, B. (2022 February) “2021 Rescue Survey & The Cultural Shift for 2022: People Before Water.” CountyFireTactics.com. Accessed April 17, 2022. https://countyfiretactics.com/2022/02/06/2021-rescue-survey-chief-brush-the-cultural-shift-for-2022-chief-isakson/

Like many, my plans and expectations continue to be rocked by the pandemic and the associated economic disruption. So, what will 2021 bring?

Research: Pandemic Impact on EMS Caregivers and Firefighters

One of the reasons to get a Ph.D. is to think about the “big questions.” That starts while honing skills and performing research as a student. I am part of a group looking at the pandemic’s impact on EMS caregivers in terms of PPE and worker compensation.

The first wave of the pandemic was an unscheduled major event that overwhelmed first responders. Like the 9/11 attack in New York City, there were assumptions and promises that crumbled months later as the magnitude of the World Trade Center illnesses were determined by state and federal authorities.

Worker compensation for COVID-19 is inconsistent. We are seeing the same pushback for COVID-19 infected EMS caregivers similar to last year’s Company Commander documentation of the Texas approach to firefighter occupational cancer claims.

There is a tremendous disparity in the protection of EMS caregivers based on their job classification and type of employer. Within the Fire Department of New York, firefighters get unlimited sick leave while single role EMS providers get 12 days a year.

Paul Cary, a retired Aurora, Colorado firefighter/paramedic, was working on a FEMA-deployed commercial ambulance in New York City. He gets infected on-the-job and dies of the coronavirus. Since he is not an employee of a jurisdictional emergency service organization when he was infected, his family will not get the same line-of-duty death benefits that a family of a volunteer rescue squad caregiver receives after a LODD coronavirus death.

Follow: Delivering Emergency Service During Austere Times

Last May the International Association of Fire Chiefs warned that the impact of the pandemic shutdown and quarantines could result in the loss of 30,000 fire department jobs because lost tax revenues will significantly reduce local government budgets.

These job losses come at a time when emergency service workload has increased, from both the pandemic as well as the increased number of residential cooking fires and fires in unoccupied businesses and office buildings.

EMS workload has skyrocketed, with many systems recording their “busiest days ever” that includes day-to-day workloads 50% higher than normal. This is driven by more patients and the fallout of overwhelmed hospitals during a COVID surge generating more interfaculty transports.

Some emergency service agencies have stepped up to help overloaded health care and public health colleagues by assuming additional roles and responsibilities.

Develop: Company Commander Supervision and Management During Times of High-Stress, Hyper-Partisanship, and Poor Quality Information

We are working in extraordinary times where we often encounter tsunamis of conflicting or confusing information that call for a response by a supervisor or manager. Beyond the arena of national politics, this affects our ability to command, supervise and train our team as these controversies can “… suck all of the oxygen (and energy) out of a room” and skew our decision-making process.

How can you maintain a non-hostile work environment when television, print and social media work every day to increase readership by promoting conflict, anger and angst?

Share: New and Recurring Voices

Opinion leaders, innovators and recognized experts drive emergency service practices. I continue to seek out the next opinion leader or subject matter expert that is working to make us better, safer and righteous. If there is someone or a team I need to know about, please send me an email.

This Week’s Take Home: Vincent Dunn’s Fire Battlespace Trilogy

On January 7, Chief Dunn posted an essay on his FaceBook page “Why I Wrote 7 Books.” https://www.facebook.com/VincentDunnFireBattlespace

I recall being a rookie engine company commander and reading the first edition of Collapse of Burning Buildings. It remains one of the most impactful experiences in my professional development.

The paramedic trained to the 2009 National EMS Educational Standard received a more intense medical education, especially pathophysiology. They have received training to respond to situations as a safe and effective critical thinker.

That same evidence and science based background will serve them well as they move into roles as evaluators, coaches and supervisors. Let’s see why.

History of EMS Credential Training

We have progressed through four versions of the federal EMS educational standards. Here is a summary of the timeline:

• 1977 National Standard Curriculum (NSC) for EMT-Paramedic. Published by the National Highway Transportation Safety Administration (NHTSA). 15 modules based in part on the University of Pittsburgh’s Freedom House training program.
• 1985 National Standard Curriculum revised. At the state’s request, lowered the requirements to obtain EMT-Ambulance credential, EMT-Paramedic curricula is reformatted into 6 divisions.
• 1994 National Standard Curriculum revised. EMT-Basic (1985) replaced with more comprehensive EMT-Ambulance. Other levels of caregiver training revised later in the 1990s.
• 2009 National EMS Educational Standards is a major revision. Stakeholder Task force established to implement standards by Fall 2014

2009: Expanded Depth and Breadth of Knowledge

The Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation.

National Emergency Medical Services Education Standards, Page 10

Pathophysiology was added to the EMT curricula to provide a basis for clinical critical thinking. An EMT who is a thinking clinician is able toidentify patients who are stable or unstable and require prompt transport. (Limmer)

This was such a significant change in the curricula that it took hundreds of leaders, educators, physicians, subject matter experts, regulators, publishers, medical writers and caregivers five years to get the 2009 National EMS Standards ready for implementation.

2014 Delivery Of The New Standard

The results of this massive multi-year effort is:

• 375 community/technical college paramedic certification programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP).
• 171 jurisdictional/private accredited paramedic certification programs that are CAAHEP accredited and have an academic partner in a consortium.
• The National Registry of EMTs initial paramedic credentialing procedure and knowledge exam adopted by 46 states

The Associate Degree Requirement

Much heat and angst were released when a position paper advocating a degree requirement for paramedics was published in Prehospital Emergency Care in 2018 (Caffrey, et. al.) The issue may not be as disruptive as feared.

A rumor started that said, if approved, every single paramedic would be required to obtain an associate degree. This was false, but created anger and anxiety for the hundreds of regulators, administrators and leaders that were credentialed long-before the 2009 standards went into effect.

In a study by Rivard, et. al (2020) that looked at the educational background of  nationally certified EMS professionals in the U.S. that re-certified through the National Registry between October 1, 2017 and March 31, 2018 and October 1, 2018 and March 31, 2019 showed that 28.5% of the paramedics rectifying had an associate degree.

The caregivers surveyed reported 3-7 years experience with 72% of the respondents working full-time. I anticipate that we will continue to see a rise in associate degreed paramedic caregivers taking recertification exams as those who were initially credentialed before Fall semester 2014 age out or let their EMS credentials expire.

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Limmer, D., et al. (2008) Beyond the basics, the art of critical thinking, Part 1. EMS Magazine 37(4) p. 87.

Caffrey, S. M., Barnes, L. C. & Olvera, D. J. (2018): Joint
Position Statement on Degree Requirements for Paramedics, Prehospital Emergency Care, DOI:10.1080/10903127.2018.1519006

Rivard, M.K., Cash, R.E., Mercer, C. B., Chrzan, K. & Panchal, A. R. (2020): Demography of the National Emergency Medical Services Workforce: A Description of Those Providing Patient Care in the Prehospital Setting. Prehospital Emergency Care. DOI: 10.1080/10903127.2020.1737282

CAAHEP (2019) Emergency Medical Services – Paramedic. Clearwater, FL: Commission on Accreditation of Allied Health Education Programs https://www.caahep.org/Students/Program-Info/Emergency-Medical-Technician-Paramedic.aspx Accessed November 15, 2019.

Featured Image: Wake County EMS, North Carolina. Mike Legeros

RE-IDENTIFICATION

The action items include:

• Activities to support risk reduction as well as medical and injury prevention efforts.
• Messaging strategies for clarifying and supporting the role of first responders in addressing risk reduction, medical and injury prevention and social services support.
• Strategies to reduce the number of 911 calls.

“Overcome By Events” is a military term used when a situation changes so rapidly that previously proposed courses of action are no longer relevant. It also shows up in long-term federal projects when the situation has changed the environment or requirements of a contracted service.

The coronavirus experience will accelerate the need to address Re-Identification as fire and emergency services continue to respond to the impact of the pandemic while in an economic collapse with a reduction of state and local funding along with mis-matched Medicare EMS reimbursement.

CULTURE

The action items include:

• Create a process that allows for goal setting, strategic planning, and periodic feedback by all stakeholders of the community and the members
  of the organization.
•  Adopt a philosophy that promotes seeking out the best industry practices of other professional organizations and establish a process by which organization can evaluate those practices and implement those that are relevant in their own organization to improve performance.
• Establish a process to continually assess the skills, knowledge, and abilities needed by the organizational workforce to meet the changing community demands for service, to meet the external challenges placing pressures on the organization, and to help address the changes and innovation that are occurring or will need to occur in the agency.

The experience of an international health crisis compounded by social justice issues – where emergency service workers have pinged-ponged from hero to enemy – presents an opportunity to evolve our culture that meets both the community and the emergency responder’s needs and expectations.

ROBUST USE OF DATA

The action items include:

• Champion a substantial update to NFIRS to become a more relevant and technologically robust system or replace it with another system capable of integrating with new innovative data systems to provide advance analytics, and support evidence-based decision making, built upon the receipt of quality data for local agencies.
• Employ advanced analytics to assist in making predictive and prescriptive decisions that are focused on the outcomes the agency is trying to achieve.
• Champion legislative changes to allow for sharing of patient data between hospitals and responding agencies and encourage interagency cooperation to promote the evaluation of patient outcomes based upon the entirety of the response to that patient.

An existing weakness in many emergency services agencies is the ability to use data to make smart decisions, define what is “good,” and explain it to our bosses and the public. Data analytics provides powerful decision-making tools.

HEALTH AND WELLNESS

The action items include:

• Conduct research on the impacts of current work cycles on the health of the workforce and the impacts of sleep deprivation and sleep hygiene on the longterm health of the individual and their cognitive abilities while on duty.
• Develop on-going mental health assessments for emergency responders to promote early recognition of developing mental health issues aligned with a mental health assistance process if issues are detected.
• Adopt physical performance and annual fitness testing requirements for fire and emergency services employees to ensure the responder can safely do the job without injury or risk to their health.
• Conduct continued research to develop a comprehensive approach to reducing exposures, the best method(s) for decontamination, and periodic testing to help ensure a safer environment for the workforce.

Occupational cancer and suicide are joining sudden cardiac arrest as the leading causes of death for emergency responders. The IAFC If You Don’t Feel Well, Don’t Make It Your Farewell initiative is one way to address this critical issue.

PARTNERSHIPS

The action items include:

• Inventory and leverage the allied services (law enforcement, health, social services, nongovernmental organizations) in the community to provide more effective and efficient services.
• Promote individual and neighborhood self-sufficiency though existing programs (e.g. community emergency response teams, the radio amateur civil emergency service, volunteers in patrol, and senior Medicare patrol volunteers) to create greater resiliency in the community.

Emergency services are the community’s focal point for neighborhood resiliency.

SUSTAINABILITY

The action items include:

• Develop a better understanding of community needs and their changing demands for services so as to modify the service delivery model(s) to meet them.
• Promote collaboration between labor groups, local government, and state government to ensure existing pension financial commitments are met ensuring adequate service levels within the communities being served.
• Adopt the concepts outlined in “Vision 20/20 – National Strategies for Fire Loss Prevention,” and incorporate these recommendations into the daily agency operation to minimize the impacts to the community and emergency responders.

States just have 71% of the assets needed to fund promised retirement benefits, as documented in the latest Pew Charitable Trust analysis.

Because growing pension debt leads to higher costs, states with poorly funded plans have had to increase their pension contributions. And the higher cost of paying for benefits may affect the states’ ability to fund other core government services and crowd out other important public investments.

Many fire departments are dealing with a crisis of underfunded pension liabilities. An October 1, 2018 commentary by Daniel DiSalvo from the Manhattan Institute described the issue:

In 2015, the Federal Reserve estimated that states’ and localities’ pension funds had accumulated $5.52 trillion in liabilities but had set aside only $3.7 trillion in assets.  To ensure that public employees receive the benefits promised by their plans, state and local governments are spending more every year on their pension systems. According to census data, those governments contributed $40.1 billion to their pension systems in 2000; by 2016, that number had skyrocketed to $140.5 billion. In addition, pension funds are making riskier investments in an effort to catch up.

That means more of the annual budget is committed to meeting the pension liability. In some fire departments, this represents up to 17% of a fire department annual budget in states that are mandating full funding of pensions by 2033 (or 2040 or 2050). Today’s pensions (and budgets) are suffering from earlier administrations that “skipped” a payment or raided the pension fund to meet a budget shortfall.

TECHNOLOGY

The action items include:

• Anticipate that artificial intelligence, smart technology, and robotics will shape future service delivery dramatically in the next 30 years and will change response methods requiring a new skill set and strategic processes for fire and emergency services agencies.
• Champion the United States Fire Administration, in concert with other national organizations, to develop a fire advanced research challenge to promote application of technology developments for use in the emergency services through proof of concept and competitive challenges, similar to the Defense Advanced Research Projects Agency (DARPA) challenge utilized by the Department of Defense.

INCLUSIVENESS

The action items include:

• Create pathways to attract, prepare, and hire underrepresented personnel into the fire and emergency services.
• Promote cultural understanding and humility within the workforce to increase the quality of interactions and the services provided to the community.

The late Honorable John Lewis, U.S. Representative from Georgia, addresses the 2010 IAFF Human Relations Conference (about 20 minutes)

Next Steps

If you have been working in local government during the last decade, you have experienced some of the most dramatic shifts in how it operates. Whether it’s the political dynamic, the elevated threshold for transparency, the lack of civility, or the demands placed on local government to provide more services, it has been a time of real change.

As we look to the future, those dynamics may continue, but other forces of change will emerge, making the leading and managing of tomorrow’s governmental system very exciting, very challenging, and very fast.

This white paper provides an excellent foundation to build the 2050 version of the Fire and Emergency Services leader. We face amazing opportunities and difficult challenges. We also have the talent and ability to build OUR future.

Please download the white paper and plan your path. https://cpse.org/projects/21st-century/

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Center for Public Safety Excellence website to view and download white paper: https://cpse.org/projects/21st-century/

IAFC Cardiac Arrest Toolkit. https://www.iafc.org/topics-and-tools/safety-health/cardiac-awareness-toolkit

Vision 20/20 – National Strategies for Fire Loss Prevention. https://strategicfire.org/crr

(2020 June) The State Pension Funding Gap: 2018. Overall debt at historic high after recovery, underscoring need to prepare for a downturn. The Pew Charitable Trusts. https://www.pewtrusts.org/-/media/assets/2020/06/statepensionfundinggap2018.pdf

DiSalvo, D. (2018 October 1) How Public Pension Boards Are Making a Crisis Worse. Because of the way they’re structured, they have incentives to ignore the retirement plans’ going term health. Governing.com

Petrella, D. (2014 June 2014) Rising police, fire pension costs squeezing city budgets. The State Journal-Register. https://www.sj-r.com/article/20140628/News/140619232

Feature Image: Screen shot from this animation of a gyroscopic firefighting vehicle.

A culture war is a cultural conflict between social groups and the struggle for dominance of their values, beliefs, and practices. It commonly refers to hot-button topics on which there is general societal disagreement and polarization in societal values is seen. Our current situation is summed up this way:

You’re either a liberal snowflake controlled by big government or a greedy conservative willing to sacrifice Grandma for the economy. It took less than two months for Americans to get here.

Lerer, L. (2020 May 7) The New Culture War (On Politics With Lisa Lerer) The New York Times.

1 – Keep Your Job By Guarding Opinions And Observations

A stunning number of emergency service executives, managers, and supervisors are losing their jobs because of what they post on social media. David Brooks talks about the actions by Social Justice activists:

The Social Justice activists focus on the cultural levers of power. Their most talked about action is canceling people. Some person, usually mildly progressive, will say something politically “problematic” and his or her job will be terminated. In this way new boundaries are established for what has to be said and what cannot be said.

Brooks, D. (2020 June 25) America Is Facing 5 Epic Crises at Once. (Opinion) The New York Times

Emergency responders getting fired over inappropriate or troubling posts on social media is not new. Former volunteer firefighter/medic and radio/TV Reporter Dave Statter coined the term “Social Media Assisted Career Suicide Syndrome (SMACSS)” in 2012.

Here are two take-aways from Statter’s recent coverage:

There are no “private” social media sites. Eventually someone will provide access or send screenshots or print-outs to an outsider. An example of a SMACSS MCI occurred last year in Philadelphia where 13 police officers were fired and 56 received formal discipline for making racist or offensive Facebook posts.

You cannot separate your emergency service affiliation with your social media activity. In the past some folks have gotten in trouble for posting while on duty or using images that can identify them as an emergency responder. Recent activities imply that you are always linked to your emergency service affiliation. A Harris County, Texas, firefighter lost 3 firefighter/EMS jobs over a Facebook post on his personal account about hunting immigrants.

Attorney and retired Deputy Assistant Fire Chief Curt Varone provide an analysis of what the First Amendment rights mean for firefighters in Fire Law Blog: NC Facebook Post Results in Two Cybercasualties.

The impact of the current cultural conflict has resulted in more than 30 chiefs and company-level officers losing their jobs because of social media posts.

2 – Follow The Coronavirus Science

This one is difficult to accomplish because of two situations.

Politicization of Science

The politicization of science is the manipulation of science for political gain. It occurs when government, business, or advocacy groups use legal or economic pressure to influence the findings of scientific research or the way it is disseminated, reported or interpreted.

An example of this is the research linking lung disease to cigarette smoking. The debate between opening up businesses before the COVID-19 infections are under control is another.

Yale Senior Research Scientist Anthony Leiserowitz discusses the “Liberate America” protests:

… we’re seeing some of the same actors that have been denying that climate change is a serious problem. … much of this resistance is driven by the political ideology of radical individualism. These people are deeply suspicious of climate change because it’s the ultimate collective action problem. We can’t solve climate change by our own virtuous individual behavior alone … And that’s the same worldview that’s driving these protesters, who are basically saying, “You’re infringing on my individual freedom by telling me to shelter at home.”

Dennehy, K. (2020 April 21) Will Politicization of COVID-19 Crisis Erode National Consensus On Response? Yale School of the Environment.

A Tsunami Of 23,000 Unvetted Scientific Articles

Scientific publishers made life-or-death research available as quickly as possible by dropping paywalls and encouraging researchers to post their submissions on pre-print servers, where anyone can access them before they undergo a peer-review process.

This means that an article submitted to Science was available in days instead of months. Posting initial research findings on pre-print servers allows researchers to quickly share preliminary work and may help the scientific community to collaborate more effectively and efficiently.

The Atlantic science writer Ed Yong describes how peer-review and scientific knowledge works:

It’s less the parade of decisive blockbuster discoveries that the press often portrays, and more a slow, erratic stumble toward ever less uncertainty. “Our understanding oscillates at first, but converges on an answer,” says Natalie Dean, a statistician at the University of Florida. “That’s the normal scientific process, but it looks jarring to people who aren’t used to it.”

With over 23,000 non-peer reviewed scientific papers about the disease flooding the scientific community (Brainard), factoids and tidbits are grasped as “the solution” by news media. This creates contradictory comments and erodes the public’s confidence in scientific information.

3 – Be A Trustworthy Information Source

For weeks “Left Behind USA” was on social media promoting a flag-burning event at the Gettysburg National Military Park in Pennsylvania.

Dozens showed up, some heavily armed, to prevent the flag burning. There was no flag-burning event.

Officials at Facebook and Twitter shut down the Left Behind USA pages last week after The Post inquired about the accounts, saying the person behind them had manipulated the platform by creating multiple accounts with overlapping content in an effort to amplify their messaging. The officials declined to identify the other accounts.

Boburg, S. and Bennett, D. (2020 July 4) Militias flocked to Gettysburg to foil a supposed antifa flag burning, an apparent hoax created on social media. The Washington Post.

There is a constant drip-drip-drip of conspiracies, catastrophes and calamities that are right around the corner. Some of this is driven by the dozens of talking heads, “experts,” and writers filling-up a 24 hour, seven-day-a-week information beast. They are competing for “time spent watching” their items. More time on their items, more market share and ad revenue.

Others are purposefully creating chaos to meet a political or tactical need. Finally, some just want to have the equivalent excitement of pulling a fire alarm box in the South Bronx to watch the rigs respond.

SIFT Your Information

Mike Caulfield is a digital information literacy expert at Washington State University. His “four moves” SIFT methodology to information sources provide a valuable tool.

• Stop
• Investigate the Source
• Find Better Coverage
• Trace Claims, Quotes and Media to the Original Context

The infodemic.blog webpage will walk you through the procedures.

Why do we like conspiracies?

While some conspiracies are true – President Reagan selling weapons to Iran during an arms embargo and sending that cash to support rebels overthrowing the existing Nicaragua government – Graham Lawton looks at why we gravitate to conspiracy theories:

The human brain did not evolve to process complex information about global politics, economics or science. It evolved to survive on the African savannah where threats and hostile intentions were a daily reality.

Our brains have other cognitive biases that make us susceptible to conspiracy theories. One is proportionality bias, a belief that major events have major causes. Intentionality bias makes us assume that events are planned by somebody or something. Confirmation bias means we seek out evidence that supports our beliefs. And the illusion-of-understanding bias makes us overestimate our knowledge of how things work.

Lawton, G. (2020) Conspiracy theories: Belief in conspiracy theories is the product of normal human psychology, but can be extremely dangerous. New Scientist

Company commanders are trained to impose order on chaos over a wide variety of life-threatening, potentially catastrophic events with inadequate information during a dynamically changing environment. We have the experience, discipline and tools to be trustworthy sources of information to our crews and community. I recommend we start approaching these issues as we would a 55 gallon drum leaking a purple fluid and issuing a light haze.

4 – Be An Active Voter

The vote you cast in a local or national election has more power than a million words on social media or a $10,000 donation to a Political Action Committee. Generally, less than 2/3rds of eligible voters in a community are registered to vote. In the 2016 Presidential election, 58.4% of the registered voters cast a ballot. That mean each person that voted had the power of 2.5 voter-eligible citizens in that community.

The polarization of political discourse – with a widening gap between liberals and conservatives – has become personal and emotionally negative. A review of academic research by journalist Thomas Edsall highlighted the degree to which the political polarization has increasingly taken on an
emotionally negative tone:

“Hostility to the opposition party and its candidates has now reached a level where loathing motivates voters more than loyalty,” and “The building strength of partisan antipathy — ‘negative partisanship’ — has radically altered politics. Anger has become the primary tool for motivating voters.”

Anger and outrage motivates voters on the extremes and have left moderate voters politically homeless, with 40% of voters surveyed in a May 28-June 4 Gallop survey identifying as Independent, 31% as Democrat and 25% Republican.

That same anger fueled the social media posts that lead to the loss of jobs for dozens of our colleagues. Be the knowledgeable and trustworthy commander and participate in our purposefully messy and raucous election process to allow us to continue to serve our communities and country.

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Ayesh, R. (2020 July 4) Trump casts himself as chief defender of American history in divisive speech at Rushmore. Axios. https://www.axios.com/trump-casts-himself-as-chief-defender-of-american-history-rushmore-65d3d482-9eba-4b0c-9798-f99feeddef20.html

Liasson, M. (2020 June 20) As The Culture Wars Shift, President Trump Struggles To Adapt. National Public Radio https://www.npr.org/2020/06/20/881096897/as-the-culture-wars-shift-president-trump-struggles-to-adapt

Lerer, L. (2020 May 7) The New Culture War (On Politics With Lisa Lerer) The New York Times. https://www.nytimes.com/2020/05/07/us/politics/liberal-conservative-coronavirus.html

Dennehy, K. (2020 April 21) Will Politicization of COVID-19 Crisis Erode National Consensus On Response? Yale School of the Environment. https://environment.yale.edu/news/article/will-politicization-of-covid19-crisis-erode-national-consensus-on-protecting-public-health/

Tingley, K. (2020 April 21) Coronavirus Is Forcing Medical Research to Speed Up. The New Your Times Magazine. Accessed April 24, 2020: https://www.nytimes.com/2020/04/21/magazine/coronavirus-scientific-journals-research.html 

Yong, Ed (2020 April 29) Why the Coronavirus Is So Confusing: A guide to making sense of a problem that is now too big for any one person to fully comprehend. The Atlantic. Accessed April 29, 2020: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/  

Brainard, J. (2020 May 13) Scientists are drowning in COVID-19 papers. Can new tools keep them afloat? Science. doi:10.1126/science.abc7839 Accessed June 21, 2020 https://www.sciencemag.org/news/2020/05/scientists-are-drowning-covid-19-papers-can-new-tools-keep-them-afloat

Boburg, S. and Bennett, D. (2020 July 4) Militias flocked to Gettysburg to foil a supposed antifa flag burning, an apparent hoax created on social media. The Washington Post. https://www.washingtonpost.com/investigations/hundreds-of-armed-men-went-to-gettysburg-to-defend-it-from-a-phantom-antifa-flag-burner-created-on-social-media/2020/07/04/206ee4da-bb05-11ea-86d5-3b9b3863273b_story.html

Brooks, D (2020 June 25) America Is Facing 5 Epic Crises at Once. (Opinion) The New York Times. https://www.nytimes.com/2020/06/25/opinion/us-coronavirus-protests.html

Wise, Jenna (2020 July 5) Dozens, some armed, come to Gettysburg to guard against rumors of Antifa violence. Pennsylvania Real-Time News. https://www.pennlive.com/news/2020/07/dozens-some-armed-come-to-gettysburg-to-guard-against-rumors-of-antifa-violence.html

Caulfield, M. (2020) Sifting Through The Pandemic: Information Hygiene for the Covid-19 infodemic. infodemic.blog https://infodemic.blog/

Lawton, G. (2020) Conspiracy theories: Belief in conspiracy theories is the product of normal human psychology, but can be extremely dangerous. New Scientist. https://www.newscientist.com/term/conspiracy-theories/#ixzz6RMShYuWK

Statter, D (2020) Social Media Assisted Career Suicide Syndrome. STATter911. https://www.statter911.com/tag/social-media-assisted-career-suicide-syndrome/

Palmer, (2019 July 18) Philadelphia Police Department to fire 13 officers over offensive Facebook posts. The Philadelphia Inquirer. https://www.inquirer.com/news/philadelphia-police-officer-firings-facebook-posts-database-20190718.html

Varone, C (2019 July 4) NC Facebook Post Results in Two Cybercasualties. Fire Law Blog. http://www.firelawblog.com/2019/07/04/nc-facebook-post-results-in-two-cybercasualties/

Woodwell, WH (2019 November) Voting Rights Under Fire. New York, NY: Carnegie Corporation of New York. https://production-carnegie.s3.amazonaws.com/filer_public/bc/46/bc469634-87fd-4233-bc93-d9a89bfc9c00/voting-rights-fin.pdf

Smith, H (2016 Nov 16) Turnout in the 2016 Presidential Election. FairVote. https://www.fairvote.org/turnout_in_the_2016_presidential_election

Newport, F (2019 December 5) The Impact of Increased Political Polarization. Gallup https://news.gallup.com/opinion/polling-matters/268982/impact-increased-political-polarization.aspx

(2020) Party Affiliation (trend since 2004) Gallup. https://news.gallup.com/poll/15370/party-affiliation.aspx

Featured image: Jedd Meddaugh, Dallas Morning News (2018 December 4) “Meet the new culture war (not the same as the old culture war): The anti-culture armies realized it was smarter to buy in to pop culture than to howl against its encroachment on everyday life.” https://www.dallasnews.com/arts-entertainment/books/2016/12/05/meet-the-new-culture-war-not-the-same-as-the-old-culture-war/