DC "fire" department continued

I didn't attend yesterday's hearing on the performance of Chief of the Department Kenneth Ellerbe, but the Post reported on it, "DC fire chief, council member spar over response times, department's readiness."

Just because DC's population is increasing doesn't mean we need more fire fighters

It's interesting that the fire fighters union, just like the Police Department, is arguing that because of the city's population increase, they need more staff and more equipment.  From the article:

The union, which voted no confidence in Ellerbe this week, opposes the changes, saying the department needs to hire more people and buy more equipment. The fight comes at a time when the nation’s capital attracts 1 .5 million tourists a year, takes in a half-million commuters a day and has a population that grew by about 13,000 people last year.

Note that there is an error as the city gets 15 million tourists per year, not 1.5 million. But be that as it may, neither the number of tourists nor commuters has significantly increased in the past decade.  I think the same is true for the 80%/20% split between medical versus fire and rescue calls.

It would be useful to know how DC's personnel and service footprint for fire and emergency medical services compares to other cities.  And if calls have increased as the population increases.

After all, the service structure of fire stations (like the schools) was set up to serve the city at its maximum population, which hit almost 900,000 during World War II but declined to the Census enumerated peak of 802,500 in 1950.

"Frequent flyers" consume a disproportionate amount of emergency services, how is DC working to better manage this reality?

If anything, as the city's population of the extremely impoverished and significantly distressed homeless decreases, emergency calls could drop.  See "Seattle may extend alcohol-sale limits to much larger area" from the Seattle Times, the series "Health Care 911" and "A Costly Cycle of Care" from the San Diego Union Tribune, and "Million Dollar Murray" from New Yorker Magazine.

These stories discuss what emergency services personnel call "frequent flyers," the people who are the most frequent consumers of emergency medical services. These clients go in and out of the system, and consume a disproportionate share of the resources. In San Diego, 1,136 frequent users, less than 1% of the city's population, generate 17% of the emergency calls, which cost about $20 million annually. According to the 2004 Seattle Times article:

An estimated 2,000 chronic street alcoholics live in King County, nearly all in the three downtown Seattle zip codes. The 20 worst offenders among them cost an estimated $2 million a year for police, medical, ambulance and transportation, according to the King County Department of Community and Human Services.

Note that DC has been shifting the chronic homeless to housing (the general concept is described in the New Yorker article), which addresses this somewhat.

One reason for splitting fire services from emergency medical care services

Brookland activist Dan Wolkoff has made the argument that because most of the emergency calls fire fighters go out on are for alcoholics, they become inured and tend to think that most of the people they come across are alcoholics.

Wolkoff believes that's why New York Times reporter David Rosenbaum was misdiagnosed when he was found on the ground--it turned out he was unconscious because he was mugged/beaten--and went unchecked for head injuries.  This diagnostic failure led to his death.  See the AP story, "Panel recommends reforms for D.C. EMS following reporter's death."

Separating the services might be better in terms of outcomes.  It just might be outside the fire department's skill set to run emergency medical services operations. And emergency care personnel might be better represented by a different union too.

More on changing the service footprint of emergency medical services to better serve specific demographics within the city

I mentioned yesterday about how some emergency services programs have changed their service footprint, for example to better serve areas with a high frequency of tourist visits--the National Mall and Downtown in particular--with smaller, more mobile--on bike or motorbike--units. He writes:

Miami-Dade and Austin have 2-wheeled first responders. Hong Kong, Singapore, London, and Sydney also use cycle responders in the urban context. Other cities do, too. Why not here?

-- "Motorcycle Medics Reach the Injured Faster in Austin," Government Technology Magazine
-- "Miami-Dade Fire Rescue Introduces Motorcycle Medic Team," EMS World
-- "Motorcycle responder," London Ambulance Service, NHS Trust
-- TV news feature, New South Wales, Australia Intensive Care Responder

Are there other innovations in the way that either or both fire and rescue services and emergency medical care services can be provided within the city?

Conclusion

We need an evaluation of the department, and a plan for how it ought to be serving the city.  With such a plan and evaluation, it would be a lot easier to "get to the bottom" of problems with the department.

It's very rare without either an evaluation or a plan that a Council hearing can delve deeply enough into these issues and come to substantive conclusions.

A lot of the time hearings are more like "brainstorms."  They open up the discussion, lines of inquiry, and even the issuespace that allows for the consideration of innovation, but aren't likely to achieve the necessary  depth that is required to bring about substantive change.