Strategic Plan: Chapter 2 Literature Review

TRANSITIONING FOURTEEN VOLUNTEER FIRE STATIONS INTO A COMBINATION DEPARTMENT WITH CAREER ALS QUICK RESPONSE VEHICLE

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WORKING TABLE OF CONTENTS

CHAPTER

1. INTRODUCTION

Background ……………………………………………………………..4

Statement of the Problem……………………………………………….5

Operational Definitions…………………………………………….…...7

Significance of the Study..…………….………………………………..9

Summary………………………………………………………………..10

2. LITERATURE REVIEW

Pertinent Studies……………………………………………………….. 12

Reflection …………….………………………………………………... 15

Summary……………………………………………………………….. 15

REFERENCES …………………………………………………………………16

CHAPTER ONE

INTRODUCTION

Background

Fire and Emergency Medical Services (EMS) protection in Carroll County is provided by fourteen private, non profit fire stations, which maintain service for the entire county. The Carroll County Volunteer Emergency Services Association (CCVESA) is a group that oversees the fourteen stations. The group consists of a President, two Vice Presidents, Treasurer, Secretary, and then five representatives from each of the fourteen stations. The “Officers” are voted on each year at an annual convention by the members of the CCVESA. The CCVESA meets monthly and works toward unifying the fourteen stations on many issues dealing with the fire service.

The county volunteer system evolved in a time when people lived and worked within their community and most employers would allow employees to leave work to fight fires and handle medical emergencies. In recent years, more people have started working in communities other than where they reside. People also generally live very busy lives making their availability to volunteer diminish. Many of the volunteer stations are seeing a reduction in the number of people responding to emergencies resulting in their units not being able to respond to the calls. As the number of volunteers continues to drop, the county still has a need to provide a service and has started looking into combination stations. The CCVESA is looking into the current need to fill the gaps due to the loss of volunteers. It is necessary to form a strategic plan on how to handle the diminishing support of the volunteers and their ability to respond to emergencies within the community. The plan will allow the CCVESA a framework for replacing the volunteers and improving the quality of patient care.

Carroll County covers 449.13 square miles, with an approximate population of 169,353 based on the quick facts from the U.S. Census Bureau for 2008 (U.S. Census Bureau, 2010). Each year, the county responds to approximately 17,848 calls for assistance (Safety, 2008). Currently 66% of the calls within the county are medical in nature and 12% of our calls from mutual aid contracts outside the county are medical in nature (Safety, 2008).

Statement of the Problem

The volunteer system has recently come under criticism with the recent budget crisis. It has been recommended that a committee be established to compile a plan to hire full time Advanced Life Support (ALS) staff as well as a paid Engineer for each station. This task would be overseen by the CCVESA and the personnel would also be overseen by the CCVESA to ensure consistency among the fourteen companies. By having one group responsible as opposed to each of the fourteen companies, the CCVESA feel it will allow employees to be moved from station to station if the need arises to fill vacancies or cover an extra busy area. The discussion and recommendation came about due to each of the fourteen companies purchasing their own equipment. This resulted in a need for expensive fire apparatus and transport vehicles for fourteen different stations creating a duplication of services. Many of the stations house two engines as well as a special service piece, several utility vehicles, and an ambulance. At this time only one of the fourteen companies does not house an ambulance. In fact we have three stations that house two ambulances and two stations house three ambulances. This has created an enormous duplication of services.

Several companies are seeing the need for additional help when responding to emergencies and have started to hire their own paid EMS providers to cover the times of day when they found their response times were in jeopardy. As a result, a committee is being formed to start compiling statistics on late and no responses for each of the fourteen stations in an attempt to determine where help is needed the most. Statistics can be retrieved from the Carroll County Office of Public Safety who oversees the 911 system. It will be necessary to conduct a study to determine where levels of service are inconsistent. The strategic planning committee will also need to take into account the minimum recommendations for initial manpower as set forth by the National Fire Protection Association. All fourteen fire stations agree that they can no longer effectively run the EMS service for the county without implementing a combination department to assist in handling medical emergencies. However, all fourteen stations do not agree on what the best method to covert from a volunteer system to a combination system. By establishing a combination department, EMS would be provided by paid staff and that staff would report directly to a supervisor who is hired by the CCVESA. This would help to take down any barriers that exist due to district boundaries bringing EMS into a single entity with one set of standards and operating guidelines. Allowing for unified training programs and the ability to pull from a large group of employees to cover shifts as opposed to the current situations of having no one to cover if some one cannot make it to the station on any particular day. This would keep providers from working for multiple stations and accidently scheduling themselves at multiple stations for the same shift. At this point each station is working independently to hire their own staff and establish their own work schedules and rules in an attempt to fill the gaps. As a result, we are getting duplication of services among the fourteen stations and a tug of war between the stations. Those stations that have more money are able to offer a higher salary and essentially “stealing” medics from each other in attempt to cover shifts.

Operational Definitions

Ambulance – a vehicle used by emergency medical personnel to transport ill or injured persons

with medical needs (Glossary of Emergency Medical Technology, 2010).

Advanced Life Support (ALS) – a level of emergency care consisting of “invasive life-saving

procedures including the placement of advanced airway adjuncts, intravenous infusions, manual defibrillation, electrocardiogram interpretation, advanced airway management and administration of medication” (Glossary of Emergency Medical Terminology, 2010).

Basic Life Support (BLS) – “basic life support consists of essential non-invasive life-saving

procedures, such as CPR, bleeding control, splinting broken bones, artificial ventilation, and basic airway management. Basic life support level providers include emergency medical technicians and certified first responders” (Glossary of Emergency Medical Terminology, 2010)

Carroll County Volunteer Emergency Services Association (CCVESA) – organization comprised

of elected officers, full time staff members, and five delegates from each station. The CCVESA is a mechanism for the stations to govern their collective selves, establishing and enforcing standards on manning, training, apparatus construction and equipment. The CCVESA also creates a way for companies to interface with the fire station, county and state government (County, 2010).

Combination Department – “Fire departments where personnel consist of both paid and volunteer Members” (Barr & Eversole, 2003, p.926).

Consolidation – an act or instance of consolidating; the state of being consolidated; unification:

consolidation of companies (Dictionary.com).

Emergency Medical Services (EMS) – “The delivery of medical services to people experiencing

medical emergencies, specifically in a pre-hospital setting” (Barr & Eversole, 2003, p.923).

Emergency Medical Services Operations Division – a committee comprised of a representative

from each of the fourteen stations that is overseen by a chairperson appointed by the CCVESA. ‘This group is charged with maintaining the EMS system within the county in regards to compliance, training, protocols, and disciplinary measures for providers.” (Barr & Eversole, 2003, p.932).

Emergency Medical Service System – A complex, coordinated system of emergency medical

resources startegically located to respond in a timely manner to reduce physical and emotional impact related to medical emergencies regardless of patient’s ability to pay (Barr & Eversole, 2003).

Emergency Medical Technician (EMT) – a certified medical provider who is trained to provide

basic life support (BLS) treatment such as CPR, bleeding control, splinting broken bones, artificial ventilation, and basic airway management (Glossary of Emergency Medical Terminology, 2010).

Maryland Institute for Emergency Medical Services Systems (MIEMSS) – a statewide network

that includes volunteer and career EMS providers, medical and nursing personnel, communications, transport systems, trauma and specialty care centers, and emergency departments. Oversees and coordinates all components of the statewide EMS system in accordance with Maryland statute and regulation (Maryland Institute for Emergency Services Systems, 2010).

Mutual Aid Contract – a contract between two or more emergency medical service agencies to

help provide medical services in a jurisdiction when the regular resources are overwhelmed (Barr & Eversole, 2003).

National Fire Protection Association - The National Fire Protection Association (NFPA) is an

international nonprofit organization that was established in 1896.  The company’s

mission is to reduce the worldwide burden of fire and other hazards on the quality of life

by providing and advocating consensus codes and standards, research, training, and

education (National Fire Protection Association, 2009).

Paramedic – a licensed medical provider who is trained to provide advanced life support (ALS)

treatment, including invasive procedures such as intravenous infusions, manual defibrillation, electrocardiogram interpretation, advanced airway management and administration of medication (Paramedic, 2010).

Quick Response Vehicle (QVR) – designed to provide quicker response of advanced life support

personnel to the scene of a medical or traumatic emergency (River Falls Area Ambulance Service, 2006).

Volunteer Fire Station – a fire station with a roster comprised of all volunteer personnel

(Barr & Eversole, 2003).

Significance of the Study

By looking at several other jurisdictions that have consolidated, there is a major benefit to taxpayers with increased service levels and a removal of the duplication of services by function and geographic region. However, one major drawback is the possibility of a takeover by a government agency as a result of elected officials or officers of the CCVESA. Many fear that once we get this system in place, the county government will step in and take control away from the CCVESA pushing the volunteers out all together.

It is necessary to bring together the stakeholders from Carroll County Government, officers and delegates of the CCVESA, and a handful of residents from the community. This group would prepare an outreach initiative for the community to look at consolidating EMS services, providing paid staff, and quick response ALS vehicles. The community should be engaged via the internet, intranet, mail and media campaigns, as well as community forums to offer their suggestions and insight on the project. A web page for the project should be provided to allow members of the community to watch the progress of the project as well as participate in the process. Finally, the stakeholders should arrange to speak to local community groups and give presentations on how the community would benefit by consolidating the stations.

Summary

There is a need to improve the fire and EMS service within Carroll County due to a lack of volunteers. With the diminishment of volunteers, it is necessary for the county to begin looking at alternative ways to continue to protect and preserve the community as it has in the past. The strategic planning process will allow the county to look at several alternatives and determine the risks as well as the benefits that they have to offer. Currently, the protection for the county is being handled by fourteen independent stations. It is necessary to find a means to help save tax payers money without jeopardizing their service. It is also important to attempt to reduce the duplications in service that are currently happening as a result of the fourteen independent organizations. While the transition could be hard to implement and may not gain full support along the way, a strong strategic plan will help ease the adjustment. The consolidation will help create a more efficient EMS system by reducing response times and increasing the quality of patient care.

CHAPTER TWO

Literature Review

Faced with increased response times, increased service demands, and a lack of volunteers, Carroll County is looking at an alternative method to provide Fire/EMS service efficiently and productively. The purpose of this literature review is to look at pertinent information from a variety of sources to identify consolidations from around the United States. The research question used for the purpose of this literature review will be, “What were the experiences of other companies that have gone through a fire department consolidation?” We will focus on benefits, operational and functional issues, factors prompting consolidation, as well as other influencing factors. There has been a long history of medical services provided by fire stations however; it was not until the late 1960’s when fire based EMS systems were formally established (Pratt, Pepe, Katz, & Persse, 2007).

We will start with the factors that prompted consolidation. In the Blue Ribbon Report, the authors discuss the tremendous contribution that volunteers give to our community (Scott & Buckman III, March 2004). This report prepared by the International Association of Fire Chief’s (IAFC) discusses how to preserve and improve the future of the volunteer service. The authors point out that many stations are often under-funded and ill-equipped and have a difficult time retaining volunteers (Scott & Buckman III, March 2004). The blame has been placed on poor leadership and the lack of programs to help one acquire the knowledge and skills necessary for effective management (Scott & Buckman III, March 2004). In the book, Managing Fire Services, the author sites the following reasons to be the most influential catalysts for change by cities and counties considering changing the way they provide fire service. The factors are as follows:

1. “Growth in demand for service, especially ambulance and rescue services.

2. Municipal budget constraints and/or contractual labor demands.

3. Not enough volunteers during daylight hours.

4. Pressure to improve the productive use of paid firefighter “downtime.”

5. The complexity of modern firefighting and the length of training

volunteers required to meet community fire-safety standards.

6. Economics of scale” (Managing Fire Services, 1988, p. 439).

Although the CCVESA and local government officials are looking towards a consolidation for different reasons, Jan Thomas stresses that it is critical that the ultimate goal of consolidation is to enhance fire protection services for our citizens (Thomas, 1994). The goal must be recognized by everyone involved in the process no matter what their reasons for consolidation may be. Point Montara and Half Moon Bay Fire Districts began looking at consolidation efforts and initially found it not possible due to salary differences (Rice, August 1992). Salaries were adjusted and other areas of service integrated which led to the question, “why do we need two stations within seven miles of each other? Point Bay fire district covers six square miles, has eight paid personnel with a budget of $940,000. The Half Moon Bay Fire District covers 40 square miles, has 23 full time employees and a budget of $3.5 million” (Rice, August 1992, p. 2).

When evaluating the benefits of a consolidation you must first look at the benefits found in other stations throughout the United States. According to Charles Rule, former fire chief, in an article in American City and County magazine some of the benefits of consolidation are “enhanced career opportunities, joint training facilities, specialization in various functions” (Thompson, 1992). You also have the ability to “have more efficient personnel allocation, faster response times, increased service levels for dollars spent, and better use of resources and reorganization” (Thompson, 1992, p. 25). It is important to remember that a consolidated system that allows your agency to offer better service for the same money is, in effect, a cost savings (Hagstrom, 1999).

We now begin to look at the operational and functional issues involved with a consolidation. In the magazine American City and County, Stephanie Thompson suggested that labor groups such as unions should be involved from the beginning of the process or it will be doomed to fail (Thompson, 1992). She also stated that the consolidation effort can not be a disguise for an attempt to reduce personnel (Thompson, 1992). Reorganizing peronnel will need to occur during the consolidation to remove duplication of services. The important thing is that personnel need to be assured that they will have a place in the organization and that their future is secure (Tualatin Valley Fire and Rescue : Case Study and Outline Implementation, January 1996). William Hewitt describes how your current fire officers need to evaluate the operational and functional issues within the station. In Recreating the Fire Service, he states, “A major problem being experienced by many fire service leaders is that are having an ongoing love affair with the here and now” (Hewitt, April 1995, p. 153). They tend to be action oriented people and fail to look at the long range plans for the station. Instead, “they focus on what is happening today and let tomorrow worry about tomorrow” (Hewitt, April 1995, p. 153). Hewitt said that by creating a 5-10 year plan the station will survive with a here and now officer because the future will mapped out for them (Hewitt, April 1995, p.153).

Finally, we come to the other factors that effect consolidation efforts. Mary Jo Wagner quotes Chief Jeff Johnson of Tualatin Valley Fire and Rescue saying, “The four main obstacles to a merger or consolidation are turf, power, politics, and control” (Wagner, 1996, p. 23). In the same article Mary Jo speaks with Retired Chief Jack Snook who added that the biggest issue with consolidations is a loss of control (Wagner, 1996). Opposition to consolidation comes in many forms and by many types of people as change is never easy. John Kotter, professor of leadership at Harvard offers eight major factors why change may fail:

1. Not establishing a great enough sense of urgency.

2. Not creating a powerful enough guiding coalition.

3. Lacking a vision.

4. Under communicating the vision.

5. Not removing obstacles to the new vision.

6. Not sytematically planning for and creating short-term wins.

7. Declaring victory too soon.

8. Not anchoring changes in the organization’s culture (Kotter, 1995, p.

59).

Information flow will be key to a successful consolidation. Chief Johnson of Tualatin Valley Fire and Rescue suggests that you keep your elected officals and staff well informed is the key to “rumor control” (Wagner, 1996, p. 24).

Reflection

By evaluating the research listed above, it was hoped to gain a better understanding of other stations who have consolidated. This understanding will help us proceed in evaluating our consolidation needs and efforts in our own community. The objective of this review was to explore if consolidation of fire protection agencies could improve the delivery and efficiency of our EMS service to Carroll County. With the information obtained, it has been proven that consolidations can offer many benefits to both the fire departments and the community.

Summary

The literature review proved very helpful to this project. There are several communities in the United States that have taken on the project of consolidation. Many of those communities were very successful by utilizing organized and comprehensive plans. For those who were not successful there were mitigating factors that needed to be addressed before a successful consolidation could occur. The literature review gave credence to this research. The public is in need of better Emergency Services with regards to EMS response times and effective personnel. The county must look toward innovative solutions such as consolidating the stations and utilizing ALS quick response vehicles. The consolidation of the fourteen stations will provide both financial and operational benefits, which will result in greater efficiency and service to the citizens of Carroll County. With regularly scheduled 24 hour on duty personnel in strategically located stations, the fire station has the “potential for the most rapid delivery of advanced pre-hospital 9-1-1 emergency response and care (Pratt, Pepe, Katz, & Persse, 2007).

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