Thursday, June 21, 2012

Emergency response vehicles

I had a public speaking engagement at a civic organization Monday, and opened the floor for questions after my presentation. One of the questions concerned why both a fire engine and ambulance respond to so many medical emergencies in Lincoln. I explained that our goal is to put an adequate number of trained personnel at the patient's side without regard to what type of vehicle they arrived in. We have 18 fire companies in Lincoln, but only 6 medic units, and those medic units are often tied up. The engine or truck is staffed by EMTs, and usually includes a paramedic, and is typically in a better position to get to the scene more quickly. We are currently experimenting with a smaller alternate response vehicle, but right now, the only ride Station 12 has to pick from is Engine 12. Fire engines have become more like general purpose emergency response vehicles, as the medical emergency workload has eclipsed the number of fire responses.

I get questions of this nature fairly often. These are sometimes mildly critical, and merit an explanation. A typical story starts like this: "Smoke was filling our house, and we called 911. In the meantime, we realized that the smoke was from burning popcorn downstairs, and we doused it in the sink just before three fire trucks, a couple of red SUVs, and about a dozen fire fighters showed up.  It caused quite the uproar in the neighborhood, and we felt really bad about causing such a scene.  I just can't understand why so many people and so much equipment had to come to something so minor.

Another version I have heard several times sounds like this: "My husband has a medical condition, and was feeling ill.  I couldn't get him out to the car, so I called for an ambulance.  Instead, a fire truck roared up the street with its lights and sirens on, follwed by the ambulance a few minutes later. There must have been seven firefighters in our living room. When they finally took him to the ambulance, all the neighbors were outside watching to show.  We were terribly embarrassed." Let me explain:

Virtually all fire and rescue departments nationwide (for that matter, worldwide) establish response protocols: plans and rules about which personnel and apparatus to send to a particular type of emergency. Lincoln's is pretty typical. These protocols often result in a lot of stuff being sent, but they are grounded in experience and research. The goal is to get an effective working force en route, based on the nature of the emergency. When the first arriving units find something different, like a false alarm or a situation that requires fewer resources, the response may be downgraded. This is an excellent video that provides a description of the role of various apparatus and responders at the scene of a working fire:


Anonymous said...

How could anyone be 'critical' or 'embarrassed' regarding the health or safety of themselves or a loved one?

I bet these people are also 'embarrassed' taking their clothes off in front of their doctor who has seen it all as well!

While it might not be any fun for either of you, I say - better safe than sorry!

Mike Burda said...

The challenge is that no one ever seems to want to say, "We smelled smoke and thought it something minor. We called the emergency number. Boy were we happy when everyone had arrived as the fire had taken off and it was starting to become serious. Fortunately, the response crew resolved the issue and our neighbors were able to watch Lincoln's finest in action."

Steve said...

I'm pretty sure those in charge are doing their best to keep costs low without jeopardizing safety of their personnel or the public.

That being said, I found the video about traffic calming devices quite interesting. I'm sure speed bumps do slow the majority of traffic. However, in my humble opinion, the "bump" effect is far less at higher speeds. The suspension of the car will take the shock out of it. It might be harder on the car than going extremely slow, but that's why suspension systems are there. If all roads were smooth, we wouldn't need them. I'm really surprised that a large fire truck would even consider slowing down for a speed bump, especially since time is so important. The average driver may not be in a hurry, and might choose to slow down becasue time is not important.

My gut feeling is that speed bumps only slow those who would probably be going slow anyway. So often I see them in parking lots 10 feet in front of a stop sign. It seems ridiculous to me. If a person planned on stopping for the sign, they'd already be going slow. If they don't plan on stopping for the sign, they're probably not going to slow down for the bump either. I've seen some that are high enough as to be a real hazard, especially to motorcycles who may not even realize they are there until it's too late (in traffic or at night).

Anonymous said...

What are the regulations concerning the location and number of fire hydrants around the city? If a fire hydrant was located every (?) feet maybe the number of the ultra expensive pumping units could be reduced. I would think that a fifteen passenger sized van could carry four EMT/firefighters plus all of the equipment needed. Retrofitting all of the city's water lines and having more fire hydrants in place is probably too expensive but maybe it isn't?

Gun Nut

Anonymous said...

To Anon 8:40: I am one of those people who would feel embarrassed by the response to a 911 call. I just would never call no matter what. I actually had someone break into my house once but thought they had left, so I called the police non-emergency number as I wasn't sure if it was a real emergency worth 911. The police came basically to check things out, and they ended up wrestling the intruder (a stoned teen-aged girl) to the floor in my living room. This was in Hastings, so perhaps things are different here.

Tom Casady said...

Gun nut,

Wish you would have asked a question about the ballistics of .45 ACP vs. 9mm, I'd be more comfortable with, but here goes: having plenty of hydrants on large mains that weren't laid in the 19th century is certainly a nice thing, but it doesn't eliminate the need to amp up the pressure at the nozzle with a powerful pump. How far can you squirt your garden hose? Without a pump, you're pressure-at-the nozzle is dictated by gravity. Don't confuse flow rate with pounds-per-square-inch. You need both to fight a fire: good supply from the water source, good pressure to get it to where it needs to go.

I think we can do the job and cover the fire risk with the number of engines we have, if we space things a little better. Our big growth area is in medical emergencies, and that's why it makes sense to be experimenting with a smaller, lighter, alternate response vehicle.

Anonymous said...

Your point on water pressure and volume is valid. However the size of the pump in a fire engine is fairly small. The holding tank is what takes up the volume. A booster pump and the connections plus a few hundred feet of fire hose could PROBABLY be enclosed in a van sized unit and still have plenty of room for the crew and other equipment.. Power take off driven pumps have bee used in irrigation for decades. I am just throwing out a few possibilities.

I don't remember what the City of Lincoln paid for the last new pumping unit but I remember I thought it was a staggering amount. If that expensive piece of equipment could be replaced with less expensive equipment that could do the job cheaper and better with the same manpower it would be a win win for all involved.
Gun Nut

Steve said...

So, Tom, do you think the extra weight of a S&W 500 is worth the extra stopping power compared to a .45 ACP? It makes my bike lean to one side if I only carry one of them. :)

Tom Casady said...

Gun Nut,

Google mini pumper, click "images."

I'm unqualified to unilaterally decide what the best apparatus for Lincoln is, but I'm good about asking such questions, and my track record is to make decisions based on information and analysis, and to be willing to try things that fly in the face of the status quo.

I also understand that men tend to prefer the big pickup truck and the Harley, even if a minivan and a Vespa would be more practical and just as effective (for example, see Steve's choice of weapons, in his comment above). Every guy I know has at least one cordless power drill, and they all want to replace the current model with the Binford 5000 18V Lithium model, which they will use twice this year to install a curtain rod and a tighten a hinge plate.

An observation, though: our fire engines are general purpose vehicles that can be used in a number of roles: structure fires, car fires, rescue calls, medical emergencies, you name it. The more specialized a piece of equipment becomes, the more its use is limited to a smaller number of roles.

If we stuffed four firefighters in an ambulance, they'd be able to respond to 75% of what we do pretty effectively. But they don't carry water, pumps, bunker gear, hydraulic tools, hand tools, hoses, ladders, and so forth. We can put a couple of EMTs and a paramedic at your side with an engine during a medical emergency and save your life. We cannot, however, do much of anything at a structure fire with the same four people arriving in a medic unit with a fire extinguisher.

I think there's a place for various kinds of vehicles and apparatus in the overall mix, but your bread-and-butter front-line apparatus needs to be able to handle a pretty wide variety of the kinds of incidents you typically respond to.

I think the smaller, lighter, alternate response vehicle is gaining a lot of momentum in this business, but here in Lincoln, I suspect that it's role is in addition to, rather than instead of. Ideally, I'd like the company officer to be able to pick the best equipment for the task based on the nature of the call: man down nature unknown: ARV, foot trapped in storm sewer grate: engine, help needed to move obese patient: ARV, and so forth.

Anonymous said...

While we are discussing LFR response vehicles, what is the justification for LFR Captains being chauffered to calls in supersized pickup trucks? I find it hard to believe that they don't have room in one of their ambulances or engine trucks for any equipment or personnel brought by the Captain and his driver.

I knew LFR operated in this manner many years ago. I was under the impression it had been stopped when more rational minds took charge. That is until I just recently saw a Captain being driven to a traffic accident scene.

(I might add that the Captain's pickup was just one of the eight LFR vehicles on the scene for this two car accident...)

Anonymous said...

Here is an example of a med call that turns out to be more than originally thought. Once in a while, LFR is dispatched to a medical call, and finds that when they arrive, the individual is, oh, 400-500 lbs - or even more - which isn't as easy to move as a compact .quarter ton box with nice grippy handles. Such a load might well be judged as being beyond the reasonable capability of just the ambulance crew to life and handle with care.

Anonymous said...

Director-Here are my thoughts. If I have a fire at my place, I want all units within 12 miles sent quickly. If it's somebody else's house, send a rookie on a Vespa first to figure out the cheapest way to cover the fire.

If I have a heart attack, send as many paramedics as you can in the world's largest ambulance. If my neighbor has a heart attack, send a cab (preferably a hybrid)and save city funds.

Steve-2 saddle bags=2 guns

Hope you enjoy the protocol:


Anonymous said...

I understand that change is difficult, however just because this is the way it has always been done and this is the way most other departments do it does not mean its the best way. If you applied this logic to the police department you would send the assigned officer, a k-9 officer, the SWAT team, and several detectives to every call just in case they may be needed. As you know from your time with LPD this would be an expensive misuse of resources. I understand sending an engine and an ambulance to a traffic accident because they could boh have a high likelihood of being needed. On the otherhand when someone calls because they have a stomach ache and want to go the hospital I can think of no reason to send 2 people in an ambulance and 4 in an engine. I have seen the quick response SUV respond to medical calls and even when that is sent they are still sending an engine even before that paramedic has a chance to evaluate the situation. Essentially all that is being done in practice is now an extra vehicle is responding. I have faith in you in this job and realize that change takes time and can not happen overnight. Good luck.

Tom Casady said...


We are working on right-sizing our responses to avoid wasting resources. We've revised our response protocols this year (including more single unit responses and code 1 responses), we are testing an alternate response vehicle, I have reduced the use of fire apparatus for what were essentially errands, and when the time comes, I think you can expect us to be downsizing some of our fleet (as with LPD in the recent past.)


That pickup is Battalion 1--the fire command unit. It is staffed by the Officer in Charge (battalion chief), and a firefighter who serves as the Incident Command Technician. The ICT assists the OIC with such things as communications and computer work, is a second set of eyes and often serves as the safety/accountability officer on a fireground. In the past, these roles were often filled by Battalion 2--a second battalion chief. We eliminated Bat 2 this year, in a series of organizational changes that save $150,00 per year. In the process, we also reduced the number and type of incidents to which Bat 1 typically responds. I could have the ICT drive a separate vehicle, but that wouldn't make much sense.

As for 8 LFR vehicles at the scene of a two-vehicle traffic crash, I agree, that sounds like a lot. I'd have to know the details, though, to determine if there was a legitimate need for these resources. If you provide the location and date, I will look into it.

Anonymous said...

NFPA "standards" are overly complex, combursome and specifically written to perpetuate the Fire Departments importance while ensuring job security for all of the national union members. Anytime a politician or intelligent person questions Fire practices the automatic response is "NFPA Standards." Take a look nationally at the strongest most active gov't unions and you'll consistently see the IAFF at the top of the list.

How many of these NFPA standards are adhered to in LFR?

Herb said...

I am wondering what would be more embarrassing, to have a fire truck and ambulance show up vs. having the coroner and a black bag hauled across the lawn...

Anonymous said...

Liability has gotten us to the point of overkill. Money is tight and people want to see their tax dollars used wisely but you never know exactly what you will have when you get there.

In a perfect world, you could send a smaller vehicle to handle things and then call out bigger trucks if more help is needed. If the small vehicle arrives in 5 minutes and they need more help, they call for the big truck which is 5 or more minutes away. That lapse in time is what will eventually cost the City way more money in a lawsuit than all of the wear and tear and fuel used by sending out the big truck in the first place.

I think the Director is more on track with relocating some of the apparatus so there are better response times which means less wear and tear and fuel use plus less liability.

Anonymous said...

11:48 you are right. There are a lot of things that go in to making decisions. Sadly liability issues are a huge factor in the decision process.
Gun Nut

jelly andrews said...

I think there is nothing wrong with those situations. You should not be embarrassed when it concerns your safety. And it is a good thing that there are people who respond to your needs.