By 2010, Tysons Corner had 46 million square feet of office and retail space, including two regional shopping malls. Weekday population was 105,000 office and retail workers, 55,000 shoppers, and about 17,000 residents (Fairfax County, 2014). The Emerald City uses 1% of the county land and generates 7% of tax revenue. In 2024 that resulted in a net tax surplus of $154M to the county (Woolsey, 2024). The Tysons business district houses 25% of available county office space and 12.5% of county retail space.

Protecting the Emerald City

These war stories look at Tysons Corner Fire Station 29, which anchors the west end of the Emerald City. Prior to late 2021, Dunn Lorning 13 covered the east end, Vienna 2 covered the south end, and McLean 1 covered the north end. Four engine companies, a truck company, a tower company, and a heavy rescue company. As a teenaged McLean volunteer firefighter, I was hanging on to the backstep of Engine 1’s 1970 Pirsch as we raced down Chain Bridge Road to an overnight alarm activation at Tysons Corner Mall.

Scotts Run 44 opened in September 2021, staffing a paramedic engine company, paramedic ambulance, and the reassigned heavy rescue company from the McLean fire station. McLean Rescue Squad 1 eventually became Rescue Company 2 and operates out of 44 as part of the reorganized special operations division.

Modified from 2024 map of the Tysons Corner planning district. The author added the fire stations.

Fire Station 29 opened in December 1978 as one of seven new county fire stations built to support the county’s rapid growth from a rural and agricultural community to an urban one. Back-to-back recruit schools trained firefighters to staff the new fire stations. Tysons Corner 29 opened with an engine company, 100′ tiller ladder truck, EMT ambulance, and a battalion chief’s office.

When the station opened, I was working on Vienna Medic 2 as an EMS Firefighter II (paramedic). About 40% of Medic 2’s responses were in Tysons Corner. McLean Medic 1 covered the other side of the Emerald City. Dunn Loring Ambulance 13, one of the county’s busiest EMT ambulances, and Tysons Ambulance 29 completed primary EMS transport coverage in Tysons.

Picture from Tysons Reporter (2020) https://www.tysonsreporter.com/2020/12/02/fairfax-county-moves-forward-with-planned-tysons-fire-station-upgrade/

New Tysons Fire Station Runs 14 to 20 Activated Fire Alarm Calls Every Day

The original dispatch for an activated fire alarm in a commercial or multi-family occupancy with no report of smoke or fire was two engines and a truck company. Some new commercial occupancies in Tysons Corner announced themselves by having two to three activated fire alarms every 24 hours during their first weeks of operation. At some point, the department reduced alarm-activation response to one fire company.

Looking From The Code Enforcement Office

It took years for the county to pass a faulty fire alarm ordinance. This ordinance reduced, but did not eliminate, the Emerald City’s faulty fire alarm activations. If the fire official determines that faulty equipment caused the alarm activation and it was the third faulty activation in 90 days:

• The owner or occupant is required to run a witnessed test of the faulty fire alarm system
• Follow-up inspections from non compliance or reinspection:
  • $216 per hour per inspector
  • $432 per hour per inspector for after hours or overtime inspections (Fairfax County, 2026)

Risk Management Near Miss and an “Adaptive” Rescue Squad 1 Response.

Within 29’s response area is a high-rise retirement home for residents aged 62 and older, with 274 apartments. It opened in 1976 and generates one or more activated alarm calls a day for shower steam, burnt toast, and other cooking misadventures. Under the single-company dispatch protocol to an activated fire alarm with no report of smoke or fire, Engine 29 arrived solo and reported smoke showing and a resident needing an aerial rescue from a balcony … during a heavy snowstorm.

The after-action analysis of this multiple-alarm incident reclassified this high-rise retirement home as a high life-safety hazard. This required a commercial box alarm assignment for every activated alarm report: 3 engines, 1 truck, 1 heavy rescue, and a battalion chief. In the mid-1980s, I was a career Fire Sergeant with HazMat Rescue Squad 1 in McLean.

Photo from the McLean Volunteer Fire Department. 1980 GMC Brigadier/Salisbury 250/200.

I was troubled by the leisurely response when Squad 1 was dispatched to the high-rise retirement home for alarm bells. The chauffeur explained that he would not start hauling ass until Engine 29 marked on scene or there was a report of a working incident. When Engine 29 marked on scene, the officer would immediately cancel the rest of the box alarm response, “… holding Engine and Truck 29.”

The chauffeur pointed out that if Squad 1 hauled ass immediately, Engine 29 would cancel the response after the squad passed the McLean business district and went into the suburbs. That would require a long drive back to the station. By driving slower, the squad could turn right at the end of the shopping center and return to quarters easily. With the Squad getting immediately canceled on almost every run to the high-rise retirement home, the station commander was fine with this adaptive response.

Commanding Engine 29: The Alarm Activations Never Stop

After three great years as the boss of Engine 9 on “The Highway,” I was encouraged to accept a transfer to Tysons to prepare for my next promotional exam. It worked, but that’s another story. When I arrived in the 1990s, Tysons 29 had a paramedic engine, a 135′ rear-mount aerial, a paramedic ambulance, and Battalion 2’s office.

1984 E-One Hurricane 135′ rearmount. Picture from Sanders Apparatus Photography. https://sandersap.smugmug.com/

While Engine 9 and Engine 29 had a similar number of runs each day, the work differed significantly. Engine 9, C-shift, operated at a room-and-contents or larger structure fire about every three weeks, including a couple of fires a year that escalated to greater alarms. I was four months into my assignment at Engine 29 when we handled a well-involved auto fire in a parking lot. It was the first fire we used a 1.75″ attack line since my arrival.

Engine 29 did go to a couple of structure fires in a year. It was the only time I was first arriving and laid dual supply lines into a well-involved two-story vacant commercial building that required an elevated master stream. Another shift caught a greater alarm fire in the service bay of a luxury car dealership.

Engine 29 (1986 E-One Hurricane 1250/500) at a Battalion 2 multiple-company drill. The officer’s west coast style door mirror is different because the original one was pulverized while responding through a Dulles Toll Road toll booth. The officer’s window was down. It took a while to get the mirror shards out of the cab, gear, and my hair.

Checking the Mobile Data Terminal At 2:30 AM

Before the department decided to send a fire company to every EMS call, few suppression rigs were on the air in the middle of the night. It was the second week at Engine 29 when I checked who else was up as we cleared another faulty commercial fire alarm. It was my buddy JC, commanding Engine 11, “The Pride of the Highway.” JC was responding as an EMS first responder because the three normally nearest EMT or paramedic ambulances were on other calls.

Engine 29 was still handling 6 to 10 activated fire alarms every 24 hours. Most were from faulty systems, a few were accidental, and rare cases involved a sprinkler head ripped out by a mechanical mishap. In the winter, Fire Prevention mobilized the Tysons “frozen pipes” task force. They handled hundreds of frozen/broken fire protection system incidents every winter. An older, sprawling 1988-era garden apartment community experienced broken pipes in almost every building every winter. Cheap construction with inadequate insulation. The rental apartments were converted to condominiums in the 2000s.

A Thanksgiving Surprise

Hilton Hotels gifted us a fantastic Thanksgiving Day buffet. In the months before, they struggled with a malfunctioning fire alarm system at their flagship hotel next to their headquarters building. We responded to the hotel about a dozen times while the system was being repaired. Then the hotel had a major middle-of-the-night water leak, which I may have documented as 30 minutes of salvage (squeegee) skill training on the monthly report.

Evacuating the original America Online (AOL) headquarters

America Online’s original headquarters and operational center was at the end of Westwood Center Drive, 0.7 miles from the fire station. One Sunday morning, we stood by as a locomotive-sized back-up electric generator was helicoptered behind the building. A few months later, we started responding almost every week for an activated fire alarm in the middle of the night. The building was staffed 24 hours a day, and the overnight security staff wouldn’t let us in to locate the alarm. They waited for us to arrive, reported they found nothing, then reset the alarm panel, and told us to scram.

I spent two years as a supervising assistant fire marshal in code enforcement. Under the statewide fire prevention code, the fire marshal can order an emergency evacuation or fire watch when buildings face severe hazards, active fires, or compromised fire protection systems. Each shift had a duty assistant fire marshal to perform initial fire investigations and handle significant life safety code problems on evenings and weekends.

The AOL alarms were irritating but hadn’t become a significant problem. The building was sprinklered and the faulty alarm pattern pointed to dirty detectors. We submitted the faulty alarm paperwork to Code Enforcement. A couple of weeks later, the duty assistant fire marshal showed up at the fire station Saturday with the signed paperwork. The fire marshal was to hand-deliver it on Monday. Later that night, when we got an activated fire alarm call to AOL, the duty fire marshal added to the response.

It was epic. The security force tried to tell us to scram. The assistant fire marshal pointed out that the building clearly had a compromised fire protection system and ordered a complete evacuation. There was pushback until the fire marshal pointed out that he would arrest them if they obstructed the evacuation or interfered with the firefighters.

We located the defective detector – it was filthy. The workspace smelled like a guy’s college dorm room. The AOL manager on duty received the fire marshal’s order to correct the faulty alarm and perform a witnessed system test. Within a couple of weeks, the faulty alarm calls stopped.

Months later, Engine 29 responded to a 1 am EMS call at AOL. I noticed that a different security force was working in the building.

Scotts Run Fire Station 44

The county’s comprehensive plan for the Tysons Corner urban center creates eight neighborhoods. Four of the neighborhoods center on the Silver Line Metro Transit stations, creating intense, mixed-use (about 65% office and 20% residential), walkable downtowns. The Tysons Tracker reports 59.8 million square feet of developed space within 328 buildings in 2024. Almost all the spaces have central station monitored smoke detectors, and about 85% have automatic fire sprinklers.

Scotts Run, opened in September 2021, is in the neighborhood around the McLean Metro station, Tysons East. The current Tysons Corner fire station is within the neighborhood around the Spring Hill Metro station, the Tysons West neighborhood.

Fairfax County Fire and Rescue Department picture

Recessionary Budget Revision Eliminates 24 hour service in Tysons East, July 11, 2025

A reduction in tax revenues led the Fairfax County Board of Supervisors to require all agencies to reduce their Fiscal Year 2026 expenditures. The Fire and Rescue Department had to cut $2.9 million dollars. While there were no layoffs, two rescue companies were permanently closed, and an engine company, tower company, and rescue company shifted from 24/7 staffing to 14-hour staffing, Monday through Saturday, from 5 am to 7 pm.

Franconia Tower Ladder 5, Scotts Run Engine 44, and Scotts Run Rescue 2 are now called Peak Time units. In a Fiscal Year 2024 EMS reorganization, Scotts Run Medic 44 became EMT staffed Ambulance 44. Ambulance 44 remains staffed 24/7.

A New Tysons Corner Fire Station in 2029

The Tysons Corner fire station is three minute walk to the Spring Hill Silver Line Metro station, making this parcel highly desirable for developers. By Summer 2029, a new five-bay fire station will be co-located with a five-bay bus transit facility at the intersection of the Dulles Toll Road, Jones Branch Road, and Spring Hill Road. This moves the fire station into the North Central neighborhood.

Fairfax County. https://www.fairfaxcounty.gov/publicworks/capital-projects/tysons-fire-station-29-and-bus-transit-facility

Grimm + Parker Architects. https://www.grimmandparker.com/projects/tysons-fire-station-bus-transit

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

Fairfax County (2014, April 29) Fairfax County Comprehensive Plan, 2013 Edition: Tysons Corner Urban Center. https://www.fairfaxcounty.gov/planning-development/sites/planning-development/files/assets/documents/comprehensiveplan/planhistoric/2013/area2/tysons/4-29-2014%20areawide%20recommendations.pdf

Fairfax County (2024, October 22) Tysons Tracker: Monitoring Comprehensive Plan Implementation. https://www.fairfaxcounty.gov/tysons/sites/tysons/files/Assets/Documents/pdf/annual_reports/2024-Tysons-Tracker.pdf

Garreau, J. (1992). Edge City: Life on the New Frontier. Knopf Doubleday Publishing Group.

Office of the Fire Marshal. (2026). Billable Services & Fees. Fairfax County Fire and Rescue Department. https://www.fairfaxcounty.gov/fire-ems/fire-marshal/billable-services-fees

Woolsey, A. (2024, December 13). Tysons makes more tax revenue for Fairfax County than it receives, study finds. FFX Now. https://www.ffxnow.com/2024/12/13/tysons-makes-more-tax-revenue-for-fairfax-county-than-it-receives-study-finds/

Featured photo. The McLean Metro station and part of the Tysons East neighborhood. 2020, Duane Lempke Photography, CC BY-SA 4.0.

Plano, Texas, alternative response vehicle

What 10.2 Million 2025 Fire Company Run Reports Tell Us

This is the eight annual index report from ESO Solutions, sharing the information from their clients that use the electronic data entry from both the computer aided dispatch system and the last year of NFIRS incident run reports.

Call Volume

• 66% are EMS related
• 12% are Good Intent
• 8% are Service Calls
• 7% are False Alarm or False Call
• 3% are Hazardous Condition (No Fire)
• 3% are Fire (Series 100)

Breaking Down the 341,000 “Series 100” Fire calls

• 37% structure fires
• 23% natural vegetation fires
• 19% rubbish fires
• 13% mobile property (vehicle)

61% of the 34,381 structure fires were classified as Working Fires

Among residential structure fires, one- or two-family dwellings account for 77%, followed by multifamily dwellings at 16%. While two-family and multifamily dwellings make up a substantial percentage of residential fires, single-family homes remain the primary concern for community fire safety and prevention efforts (Crowe et al., 2026, p. 8).

Residential Fires and Civilian Rescues

Midwest City (OK) Training Chief Brian Brush repeated the 2021 research he did while working on a master’s degree at Oklahoma State University. His original study was profound, showing that, on average, firefighters in the United States rescued 9.8 civilians from fires every day. This placed Chief Brush as a “big room” keynote speaker at the Fire Department Instructors Conference. Chief Brush revisited this issue in 2026 and shared his results in this Fire Engineering article.

Residential structure fires are where the rescues occur. In 2026, only 10 of the 1,033 victims were rescued from commercial structures. The data for the single-family dwelling once again supports the idea that we need to prepare for rescues in the plural term as average number of victims per incident with a rescue is once again greater than one.

For the higher density multifamily dwellings, we see that the number of victims per incident with rescues was 2.6 in 2021 and 3.2 in 2026. While several incidents with more than a dozen rescues at a single apartment fire incident does influence this, there is still a significant strategic take away for incident commanders.

A working apartment fire with exposures has a significant resource demand on its own. If you are dispatched to one with reports of trapped occupants, ensure you are also starting the units and staff to also potentially establish a medical group ready for triage treatment and transport of multiple victims (Brush, 2026).

Three Examples of First/Fast or 2-piece Companies

Let’s look at Syracuse, New York; Phoenix, Arizona; and Los Angeles City, California, which use non-traditional approaches to meet community needs. Firefighter staffing is different. Syracuse splits the four person engine company crew with two on the mini and two on the maxi, Phoenix has all four firefighters staff the ladder tender or the aerial truck, and Los Angeles adds additional firefighter/paramedics to staff the fast response vehicles.

Syracuse NY Mini-Maxi Deployment

Most of this section is from Chief David Reeves’ extensive history of the Syracuse mini-pumpers and Tom Shand’s pictures. In 1970, Mayor Lee Alexander approved a reorganization plan for the Syracuse Fire Department. This was driven, in part, by New York State legislation requiring career firefighters to work a 40-hour week by January 1, 1974. In Syracuse, this led to the closure of 3 engine companies and 2 truck companies. That meant the fire department had to hire 62 new firefighters instead of the 125 new firefighters to meet the 40 hour workweek requirement (Reeves, 2017).

This image shows the Syracuse (NY) crews along with Chief Thomas Hanlon on the ramp of former Station 17 on South Midler Avenue.

The reorganized fire department staffed 13 two-piece engine companies and 6 ladder companies. A full alarm assignment for a known or possible working fire was 2 engines, 1 ladder, and a 7-firefighter squad company. Four firefighters will staff a two-piece Mini-Maxi engine company (Loeb, 1974).

The engines were built by Ward Lafrance. Ambassador 4×4 models were equipped with a Hale single-stage 1500 GPM pump, 55′ HiStream boom, 500 gallon water tank, and 20 gallon Rapid Water system. The mini-pumpers were equipped with a 300 GPM pump, 200 gallon water tank. and a remote controlled deck gun.

Tom Shand photo: Engine Company 12 is seen here flowing three streams using the Hi Stream boom along with the Monex remote controlled monitor on each vehicle.

The original role of the minipumpers, beyond responding with the Maxi engine, was to respond alone to car fires, outdoor fires, lock-outs, downed power lines, and nuisance calls from the hundreds of street alarm boxes throughout the city. In the 1980s Syracuse expanded its role in Emergency Medical Services beyond the Rescue Company by training all firefighters as certified first responders and sending the mini-pumpers to EMS calls.

No Longer A Mini Pumper

By 2000, the minis had no pump or water and served as EMS first-responder vehicles, carrying a load of supply hose to complete a fireground layout.

In 2022 the Minis were SUVs

Phoenix Ladder Tenders

Former Phoenix Fire Chief Allen Brunacini compared a truck company responding to an EMS call to “Using a cement truck to deliver pizzas.” A Ladder Tender (LT) is a smaller, medium-duty second piece assigned to a Phoenix Fire Department (PFD) truck company. Per SOP 205.10, its purpose is “to provide a full level of truck capabilities, while extending the service life of the larger, more costly apparatus”. Tenders are bought “at a fraction of the cost of full-sized truck companies” and are used “wherever they are deemed adequate (i.e., EMS calls, special duties, extrications, etc.)”. The city’s impact-fee cost table reflects that difference: a Ladder is listed at $2,204,100 and a Ladder Tender at $732,100 — roughly one-third the price (Phoenix 2021).

Ladder Tender 26: 2024 Freightliner M2-106/Rosenbauer. tollesonfirebuff picture

Functionally, “each of our ladders is married with a ladder tender, a Freightliner chassis with a box on the back that carries extraction tools and other rescue equipment, a three-section 28-foot ladder, and the same set of saws and rescue tools as the aerials”. PFD’s own city legislative record notes the department “owns and utilizes [Holmatro extrication] equipment on every ladder truck and ladder tender in the City”.

Standard Operating Procedure (SOP) 205.10: Ladder Tender Response

Under SOP 205.10, a ladder company forms a “two-piece truck company” (Ladder + LT). Dispatch rules:

• Structural alarms of 3-1 or greater from quarters: the complete crew responds on the Ladder Truck; the officer may bring the Tender for flexibility.
• If the crew is already out of quarters in the LT when a structural is dispatched, they respond in the LT and Dispatch/TRO advises all units that a Ladder Tender is coming; hand ladders and equipment from engine companies may be needed on scene.
• BLS dispatches: the officer of a two-piece truck company may respond with a minimum four-member crew on the LT.
• Tenders may run as BLS (“LT”) or ALS (“LPT”) when paired with a paramedic team.
• Governing rule: “a pessimistic approach is required … when in doubt, request a Ladder company backup” (Phoenix, 2003).

In everyday practice PFD uses LTs to “chase” EMS calls, motor-vehicle accidents (962s), mountain rescues, and other non-truck calls to reduce wear on the aerial, keeping the aerial available for confirmed structural or elevated-rescue work. Practitioner accounts note that actual daily use varies by crew — “I only know of one crew around the city on all three shifts that actually uses theirs daily” — with many companies keeping the LT primarily for EMS/MVA runs while the aerial stays committed to structural response (Reddit, 2023).

Ladder Tender Specifications

Equipment loadout on each LT includes a full complement of extrication tools (Holmatro on every ladder and ladder tender citywide), a three-section 28-foot ground ladder, and the same set of saws/rescue tools carried on the paired aerial. All 14 Phoenix truck companies have a ladder tender.

Los Angeles City Fast Response Vehicles

LAFD repurposed two brush fire trucks into a paramedic/fire fast response (FRV) units in 2015. One was assigned to Fire Station 9 in Skid Row and the other in to Fire Station 20 in the north San Fernando Valley area. By 2020, four FRVs were staffed in the city. Their value today is is handing the increase in EMS and rubbish fires in the city.

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

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

The newest Fast Response Vehicles are 2023 Ram 3500s with a QTAC slip-in skid with a 100 gpm pump and 150 gallons of water. Full complement of paramedic equipment (monitor/defibrillator, medications, advanced airways, and trauma kit).

What Would Work In Your Community?

Based on the ESO Solutions data, it seems the first/fast vehicle will be your primary EMS first responder. Your community needs and local ambulance provider’s performance will determine if the unit will be an AED/Emergency Medical Responder, Emergency Medical Technician, or Paramedic. Syracuse’s mini-pumpers evolved into an EMT-level SUV. Some IAFF locals have balked at splitting a fire company crew to staff an EMS first responder rig.

“Good Intent” and “False Alarm or False Call” represent 19% of the responses. We cannot predict at dispatch whether a 9-1-1 call will be good intent or a false alarm. Phoenix allows the ladder company officer in charge to decide which rig to staff at dispatch. Under Phoenix’s labor-management plan, the four-firefighter crew remains intact.

Phoenix Medical Response Unit Assigned to City of Glendale Fire Station 154

Screenshot of Medical Response 70 (2023) by arizonafirebuff1

Phoenix placed Medical Response 154 at a Glendale fire station in 2018 because Engine 154 responded to more than 3,000 EMS first-responder calls in Phoenix annually. Phoenix staffed the medical response unit with a captain, engineer, and two firefighter/paramedics. Renumbered Medical Response 70 in 2023 to reflect a planned new Phoenix fire station, the unit continues to respond from Glendale Fire Station 154.

Los Angeles added employees to staff the Fast Response Vehicles. They are especially helpful with the increase in EMS calls and cooking/rubbish fires generated by “persons experiencing homelessness.” We did a deep dive into “Skid Row” in an earlier post https://companycommander.com/2026/09/13/the-fire-ems-challenge-in-high-poverty-neighborhoods-sept-13/

Do you think your department would benefit from a fast or two-piece fire company? Or is it best practice for a $2 million tiller truck to accrue most of its road miles and engine idle time running EMS first-responder calls?

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References

Brush, B. (2026, September 7) Counting Rescues: The Mission Metric, Five Years Later. Fire Engineering. https://www.fireengineering.com/firefighter-training/search-operations/counting-rescues-the-missing-metric-five-years-later

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

Crowe, R. P., Fernandez, A. R., Treichel, A., Gardner, B., & Myers, B. (2026) 2026 Fire Service Index: Incidents and Best Practices For Fire Departments. ESO Solutions.

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

Loeb, D. (1974, October). Syracuse Updated – a look at the Mini-Maxi Pumper Concept in Action. Fire Chief Magazine. https://www.gotbigwater.com/files/doc/288/Syracuse%20Updates%20-%20Leob%20-%20Fire%20Chief%20%20(1974).pdf

Phoenix. (2021, May 19) City Council Formal Meeting: Additional Expenditures for Equipment, Parts and Services – Requirements Contract – RFA 18-315A (Ordinance S-47582) [Minutes]. https://phoenix.legistar.com/LegislationDetail.aspx?From=RSS&ID=4954691&GUID=24B3D53F-21C8-48E9-9706-798E6C615B93&utm

Phoenix Regional Standard Operating Procedures. (2003, March) Ladder Tender Response (M.P. 205.10). Phoenix, Arizona, Fire Department. https://www.phoenix.gov/content/dam/phoenix/firesite/documents/074793.pdf

Reeves, D. (2017, February 12). Syracuse Mini-Pumper History. [Online forum post] FirePics Online Group, https://www.firepics.net/MyBB/printthread.php?tid=139

TakashumiHoldings. (2023) Why is Phoenix FD’s ladder tender concept not used out of Arizona? [Online forum post] Reddit. https://www.reddit.com/r/Firefighting/comments/138sksa/why_is_phoenix_fds_ladder_tender_concept_not_used/

Featured photo: Plano, Texas, alternative response vehicle. https://www.fireapparatusmagazine.com/fire-apparatus/departments-cite-effectiveness-of-alternative-response-vehicle-and-rapid-response-vehicle-programs/

Dan Munsey’s Executive Fire Officer applied research project on firefighter workload efficiency included an extensive literature review of how UHU is determined and which thresholds are used. The literature showed wide variation in definitions and in how UHU is calculated and applied (2018). Stout’s framing was managerial rather than mathematical. He defined the unit hour and argued that dispatchers must “utilize the available ‘unit hours’ in the best way…to squeeze the highest response time performance possible.” He did not publish a UHU percentage formula in the 1983 article; consulting firms and industry bodies later codified UHU ratio conventions and thresholds.

Fuzzy UHU Conventions, Thresholds, and Two Examples

No national consensus standard or benchmark exists for unit hour utilization. The measurement started with the Public Utility Model, which featured high-volume, dynamically deployed paramedic ambulances in cities. Recent examples use unit time-on-task to expand the UHU analysis to include emergency responses without transport and the cost of readiness. Cost of readiness includes the on-duty training, call documentation, post-call recovery, and return-from-hospital time.

Baltimore

FACETS performed an operational and management assessment of the Baltimore City Fire Department. At that time, Baltimore had the second busiest fire-based ambulances in the United States.¹

The workload among BCFD unit types is highest for the ALS and BLS ambulances (ranging from 39.27% [9.4 hrs] to 71.07% [17.1 hrs]). These numbers are exceptionally high, especially for employees working a 24-hour shift.

Even the least busy ambulance exceeds the workload percentage recognized by many agencies for 24-hour shift durations (30% or 7.2 hrs UHU 0.3) 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. (FACETS, 2021, pp. 48-49)

Photo from amott919 (2025, October 1)

FACETS used workload data from 2018-2019. The busiest EMS unit was on task – that is, responding to, at scene, transporting to the hospital, and waiting to clear the hospital – for 17.1 hours in a 24-hour workday. That is a UHU of 0.71.

FACETS, Citygate, Fitch, and other consulting groups are using a UHU of 0.3 as the upper workload limit for 24 hour 9-1-1 units. That is 7.2 hours time-on-task in a 24 hour workday,

Los Angeles City

Citygate Associates 2023 Standards of Cover analysis of the Los Angeles Fire Department observed:

Citygate recommends the LAFD add at least 14 additional rescue ambulances (both ALS And BLS to relieve the busiest types), … Further, there are currently at least 25 rescue ambulances on 24-hour shift staffing that are overworked for excessively long periods of a 24-hour day. Citygate does not believe that critical patient care, much less safe firefighting, is always possible when a crew has gone from call to call for 12 or more hours. (Citygate Associates, 2023, p. 7)

In a 2020 hour-by-hour analysis, LAFD rescue ambulances peaked at 0.62 UHU and experienced up to 15 consecutive hours above 0.40. Citygate recommended changing staffing for the 25 busiest rescue ambulances from 24-hour to 12-hour shifts.

Screenshot from 90210firebuff (2025, January 24)

Here is a summary of their recommendations:

Battalions 1 and 11

• Station 3: 12 hour shifts for both rescue ambulances
• Station 4: Add fourth rescue ambulance
• Station 6: 12 hour shifts for both rescue ambulances
• Station 10: 12 hour shifts for both rescue ambulances
• Station 11: Add third rescue ambulance
• Station 13: 12 hour shifts Rescue Ambulance 13

Battalion 13

• Station 33: Add third ambulance
• Station 46: Add third ambulance
• Station 57: Add fourth ambulance and go to 12 hour shifts for the three existing rescue ambulances
• Station 64: Add fourth ambulance and go to 12 hour shifts for the three existing rescue ambulances
• Station 66: Add fourth rescue ambulance

Battalions 5 and 18

• Station 27: Add third ambulance and go to 12 hour shifts for the two existing rescue ambulances
• Station 58: Add fourth ambulance and go to 12 hour shifts for the three existing rescue ambulances
• Station 61: Add third ambulance and go to 12 hour shifts for the two existing rescue ambulances

Northern Areas

• Station 39: 12 hour shifts Rescue Ambulance 39
• Station 60: 12 hour shifts for both rescue ambulances
• Station 89: Add third ambulance and go to 12 hour shifts for the two existing rescue ambulances

Northern Area: Battalion 12

• Station 7: Add second rescue ambulance
• Station 98: 12 hour shifts for both rescue ambulances

UHU was invented to optimize a dynamically deployed, transport-focused, revenue-sensitive ambulance service and was later imported into fire-based EMS, where units are fixed-post, cross-staffed, and expected to carry a substantial non-emergency workload.

Better Defining Real Work in a UHU Calculation

Wendy Korotkin and Alex Stephenson point out that the UHU metric used to calculate ambulance economics was not designed to measure workload, but no better option exists. Their study identified four operational factors that contribute to cumulative fatigue:

• Night wake-up
• Burst
• Volume
• Call severity

Night Wake-up

Calls from 10pm to 6am trigger a coefficient that grows with each successive interruption: 1.25 for the first wake-up, 1.50 for the second, 1.75 for the third, plus 0.25 for every additional disturbance. Sleep debt is not a step function. Each interruption costs more than the last, and recovery within a single shift does not occur.

Burst

When a unit leaves one call and is dispatched to another within 15 minutes, the second call is flagged as a “burst.” Daytime bursts carry a coefficient of 1.25, and overnight bursts, 1.50. The factor accounts for rehydration, decontamination, report writing, and rest time lost due to back-to-back assignments.

Volume (per 24-hour shift):

Volume is binned by the cumulative call count: no adjustment up to five calls, 1.05 above five, 1.25 above ten, 1.50 above 15, and 1.75 above 20 calls. Volume also serves as a proxy for the volume of administrative work (report writing, equipment checks, restocking) that scales with call count and is invisible to UHU.

Severity

Two incident types were used: structure fires with more than 90 minutes of on-scene time and cardiac arrests with documented compressions. The severity of structure fires increases with time on scene, from 1.50 at 90 minutes to 2.50 after 3 hours. For cardiac arrests, severity is set at 1.50 for adults and 3.00 for children. These values account for both bodily stress and the mental impact of resuscitation, which is significant with pediatric patients. When none of these four conditions are met, the coefficient defaults to 1.0, making the weighted measure standard. Differences between the two occur only when the operating environment includes conditions UHU was never built to register.

The compounding effect of the work becomes clearer through an example. Consider Engine 23, dispatched to a structure fire at 2:30 am for an incident lasting 140 minutes. Three factors influence the timing: it’s the twelfth call of the shift, the crew’s second wake-up, and eight minutes after the last call.

Standard UHU says the crew spent 140 minutes on the call. The weighted measure tells a different story: the call was equivalent to 689 minutes. In this example, the multiplier is 4.92, the product of severity (1.75 for a structure fire above the two-hour threshold), burst (1.50 for an overnight burst), volume (1.25 for the 10-call threshold), and night wake-up (1.50 for the second wake-up). No single factor drives the gap. The compounding does.

What Does This Mean For You?

The weighted measure does not replace UHU. Ambulance economics still needs a denominator built from staffed unit hours, and the budget office still needs a productivity ratio it can defend. The Korotkin and Stephenson framework asks a different question. It asks what the shift cost the crew.

Engine 23’s 140 minutes on scene will show up on the run sheet, in the CAD extract, and in next quarter’s utilization report as 140 minutes. The crew that cleared at 4:50 am, restocked the rig, decontaminated turnout gear, finished the report, and tried to sleep before the 6 am tones will tell you something closer to 689. Both numbers are true. Only one of them predicts whether that paramedic is still riding the seat in five years.

Three Points To Explore

Run the numbers on your own houses. Pull ninety days of National Emergency Response Information System (NERIS) and electronic Patient Care (ePCR) data, apply the four coefficients, and rank your companies by weighted load rather than raw call count. Those are the crews to watch for sick-leave clustering, off-duty injury, disciplinary spikes, and voluntary transfer requests.

Identify the compounding shifts before they happen. Night wake-up and burst are knowable in near real time. A Computer Aided Dispatch (CAD) rule that flags any unit hitting a second overnight run within fifteen minutes, or a tenth call before 4 am, gives the on-duty chief a decision point: hold the unit down for the next low-acuity call, cross-staff from a slower house, or bring in an off-duty crew on overtime. You will need to add the trigger logic within the CAD system.

Build recovery into the deployment plan. After a structure fire past the two-hour mark or a worked pediatric arrest, the crew comes out of service for a defined interval. Not at the officer’s discretion, not contingent on call volume, not subject to backfill availability. Peak-demand units, jump companies, and mutual-aid agreements are the mechanisms. The weighted measure is the justification.

UHU was built to price an ambulance. It was never built to measure what the work does to the people doing it. Until something better arrives, a measure that accounts for when the call happened, what came before it, how many preceded it, and what it demanded is the closest the fire service has to an honest number.

Try this for a month. Pick one battalion, one pay period, and the four coefficients above. Run standard UHU and weighted UHU side by side. If the two numbers agree, your deployment model is absorbing the load. If they diverge, you have found a more informed way to describe the emergency response workload.

__________________________________

¹Philadelphia, Los Angeles City, Baltimore, and Chicago are the four busiest fire-based ambulance services in 2026.

References

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

FACETS (2021) Operational & Management Assessment: Baltimore City Fire Department – Final Report. FACETS Consulting LLC. 

Korotkin, W., & Stephenson, A. (2026). Not All Time Is Created Equal: In Firefighting, Time-Based Metrics Can Miss the Real Work. ORMS Today. https://doi.org/10.1287/orms.2026.03.03. https://pubsonline.informs.org/do/10.1287/orms.2026.03.03/full/

Munsey, D. (2018). Determining Workload Efficiency for San Bernardino County Fire Protection District Suppression Crews. [Executive Fire Officer Program applied research project, National Fire Academy]. U.S. Fire Administration. https://apps.usfa.fema.gov/pdf/efop/efo247258.pdf

Patterson, P., Martin, S., MacAllister, S., Weaver, M., & Patterson, C. (2025). Variations in Sleep, Fatigue, and Difficulty with Concentration Among Emergency Medical Services Clinicians During Shifts of Different Durations. International Journal of Environmental Research and Public Health, 22. https://doi.org/10.3390/ijerph22040573.

Stout, J. (1983, May) System Status Management: The Strategy of Ambulance Placement. Journal of Emergency Medical Services. https://emsmuseum.org/wp-content/uploads/2021/05/System-Status-Mangement-The-Strategy-of-Ambulance-Placement-22-32-1983-05-JEMS.pdf

Feature picture from Emergency Monologues. https://x.com/emergemonos

Los Angeles Skid Row

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

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

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

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

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

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

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

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

Fires in High-Poverty Neighborhoods

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

Outside Fires

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

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

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

Systemic Impact on Fire and EMS Operations

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

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

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

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

LAFD Fire Station 9

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

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

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

Fast Response 9

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

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

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

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

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

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

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

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

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

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

24 Hours at LAFD Station 9 (2019)

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

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

The Invisible U.S. Fire Problem

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

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

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

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

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

_______________________________

¹Los Angeles Fire Department “Light Force”

All but Truck 9 are “Light Forces” – a 100′ tiller aerial truck married to a 200 or 300 series engine (pumper) as a single six-person crew. 27 of the 42 light forces are “Paramedic Assessment”; the crew includes one paramedic/firefighter.

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Impact of Excessive Overtime

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

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

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

The Challenge of Fire Department Position Management

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

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

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

Looking At LAFD

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

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

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

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

The 2021 overtime increases in Los Angeles are linked to multiple-day wildfire campaign operations and the interrupted hiring cycle during the COVID pandemic. Emergency workers are dealing with the lingering effects of a massive increase in disease exposure (opioid overdoses and COVID) and a physically challenging workload. The 2023 Standards of Cover Analysis performed by CityGate Associates LLC made this observation: “The volume and simultaneous demand on the top 10 to top 28 LAFD stations is the highest CityGate has ever measured in a metro client”(Citygate, 2023, p. 6).

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

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

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

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

The Impact of Overcommitting Existing Staff

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

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

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

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

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

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

Changing The Conversation

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

What Do Retired Firefighters Dream About?

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

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

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

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

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

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

Where’s My Gear?

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

Emergency Medical Services (EMS) Is Different

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Birth of High-Performance EMS and the Public Utility Model

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

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

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

A Look At Billing Revenues

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

Breaking The Reimbursement Information Silo

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

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

A lot has happened since 2005 …

Inadequate Ambulance Service Reimbursement

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

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

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

Analyzing the Ground Ambulance Data Collection System (GADCS) Results

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

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

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

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

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

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

Recommendations for the Chief Fire Executive

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

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

2) Establish an effective audit process for submitting reimbursement claims

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

3) Clearly show the expenses in adding an ambulance service

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I collect items that may show up in the sixth edition of Fire Officer: Principles and Practice, which comes out after NFPA Standard 1020 is updated around 2030. The St. Lucie County Fire District in Florida has provided a climate survey example. The fire district employs 523 firefighters operating out of 19 fire stations. Three Battalion Chiefs and a Deputy Chief on duty for each shift. 2025 Annual Report.

Fire Station 1 at Fort Pierce is the busiest station, with the 8 employees responding to 11,044 incidents in 2025 while staffing an engine and two rescue (ALS ambulance) trucks. The department responded to 71,203 incidents.

Severe Hazing Results in 3 Terminated and 2 Suspended

Senior firefighters, including acting supervisors, severely hazed rookie firefighter/paramedics at Station 1A, including using a modified bug zapper to administer shocks in 2024. The fire district obtained the videos in March 2026. The 17-page media advisory released by the fire district on July 18th provides extensive details and can be accessed through this link.

In-Station Behavior

The law firm that conducted the investigation included the July 2025 Susan Gainey Workplace Culture Analysis. Those findings include:

• Overly aggressive banter, mockery, sarcasm, and personal questioning unrelated to job performance, including 1A firefighters asking recruits in front of a group about drug usage.
• Mocking or public correction of apprentices, which some described as humiliating or going “overboard.”
• “Light hazing,” “playing jokes,” or “horseplay” that blurs the line between camaraderie and misconduct. One employee noted that such behavior would not be accepted at other stations.
• A sentiment among multiple firefighters that certain individuals were “not welcome” unless conforming to unspoken social norms.
• An environment that is “cliquish” such that new employees or employees on short-term assignments do not feel part of the team and may feel isolated.
• More than one employee stated that 1A is composed of “cowboys” who “do their own thing.” One employee stated that he was told by someone from 1A that they “did things their way, not the department way,” suggesting that they do not follow District policies and procedures.
• Multiple employees stated that the workplace culture at 1A was not inclusive.
• Firefighters had requested transfers or expressed discomfort due to the 1A environment.
• One firefighter stated that the environment at 1A “made it tough to come to work.”
• Loyalty among existing crew members can result in the informal exclusion of newcomers.
• One firefighter reported there appeared to be favoritism or bias in advancement at 1A.

My experience on the job and as a consultant is that while the formal fire department may have a specific way or philosophy of doing things, each fire station creates its own version of “the fire department way.” Station 1A behaving like cowboys is an observation I have heard in earlier bad-outcome investigations at other jurisdictions.

The decentralized nature of fire departments makes effective emergency response, but diffuses fire headquarters directives. I spent a year as a relief Fire Lieutenant, filling C-shift vacancies in all six battalions in a department with 36 fire stations. Every station was different. The fire company commander and the battalion chief have a profound impact on crew behaviors and task competencies.

If you are a supervisor, manager, or administrator, you should read the St. Lucie County Fire District media advisory. The culture described in this report is troubling, but not unique. How would you handle it in your department?

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?

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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