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EMS Delivery and Leadership: Officer Down!

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On Waiting 

The DC press was all over a recent incident where a Metropolitan police motor officer was struck and injured by an auto while stopped in far southeast DC, close to the border with Prince George’s (PG) County, Maryland.  No DC ambulances were available and the officer was eventually transported by a PG unit after one was requested.

You would think that no one ever had to wait for an EMS transport unit before.

While this appears to be about “wait times” it is also about how DC works with neighboring jurisdictions.  For example, PG, Montgomery, Arlington, Fairfax, Alexandria, etc. have essentially integrated their dispatching protocols at the 911 level so that the closest unit is often dispatched based on their availability.  It matters not where they are from.

 Automatic Aid

The fact that a PG ambulance treated and transported the officer should not be an issue, the wait should be.  DC Fire and EMS (DCFEMS) or DCFD, whatever you want to call it, should be working to integrate as fully as possible with the other Washington area Council of Government fire departments.  (The fact that they are not is amusing, in at least one aspect, since so many DC firefighters volunteer in PG and neighboring Montgomery County, Maryland.  They integrated in their own special way.)

The “wait time” issue is thorny, complex and longstanding.  This is just one example.  DCFEMS Chief Ellerbe seems to want to run the department as if it were a business:  staff to meet the demand.  If you ran a clothing store and 90% of the customers came in from 5PM to 9PM, you wouldn’t have 90% of your employees working in the morning.  They would show up at 5PM.  This is hardly rocket science but it is a big change for the department.  And, there will be times when an ambulance is not readily available, that’s why we have fire companies with EMS (including Advanced Life Support) capability.  That’s also why automatic mutual aid is essential.

 Leadership

And another major issue is leadership:  Ellerbe as fire chief and IAFF local 36, the union that represents the members.  Has Ellerbe really tried to get labor buy-in for this and other changes?  Is labor basically “thumbing their nose” at any healthy and effective change?  (It’s easy for labor to be mired in the status quo as leaders are likely to be tenured and not especially fond of rocking the boat.)

Who can argue against a rational model that deploys the resources in such a way that they are likely to be available when most needed? If Ellerbe’s ideas fall within the parameters of a professionally acceptable approach to deployment of fire and EMS resources, the council (and the Mayor) should give them a chance to work.

Agendas

At the end of the day, the Department (and the union) is made up of a variety of folks with their competing agendas.  It would be nice if it were a sure thing that Local 36 was interested in the welfare of the citizens but I am not sure that is the case.  As an example, this past New Year’s Eve, 100 folks called in sick resulting in 12 ambulances being placed out-of-service.  According to a local media outlet, “one man died from cardiac arrest while waiting for an ambulance on New Year’s Eve.”  Some ascribe this to firefighters being pissed off about not receiving holiday pay on Christmas Eve.

Finally, regarding  unfilled paramedic positions, it is a widespread problem across the US.  Paramedics do a large majority of the work and are often treated like third-class citizens by firefighter co-workers.  No wonder people won’t take the jobs or become burned out.  Returning to the business aspect for a moment, would Microsoft treat their most productive employees the same way?  (We know the answer to that question.)

 

Posted by on March 16, 2013 • Filed under: Administration & Leadership, Command & Leadership, EMS Dispatch, EMS Topics, Funding & Staffing, Safety and Health, Vehicle Operation & Ambulances

FF Pensions: Over the Cliff in Illinois

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The Big Squeeze 

Gov. Quinn

The current unfunded pension liability of five of Illinois’s state run pension systems is $96 billion.  The amount is so large that Standard and Poor, the credit rating agency, downgraded the state to A minus, making it more difficult for the them to borrow money in the form of bonds.

Governor Pat Quinn used this week’s State of the State address to once again make a plea for reform but to also point out the effects of the huge unfunded amount.  In 2014, just about 20 cents of every state dollar will be spent on servicing the funds.  Quinn likens this requirement to costing local government services such as public safety, “$17 million dollars a day.”

In Illinois, as in other places, it pays to pay attention to unfunded pension balances.  Your’s may be fine but if enough others are not, the negative effects are pervasive, as Quinn suggests.  And, fixing the problems in not easy or painless as it often involves labor contracts, state constitutions and current and former employees.  Those in the know cannot even agree on how to value current plan assets.

In December 2012, a bipartisan pension reform bill, HB6258, was introduced in an attempt to make progress.  It would effect virtually anyone receiving or expecting to receive a state pension by limiting  annual increases, phasing in an increased retirement age and a pensionable salary cap.

A 2012 Harvard/Kennedy School report estimated the total US unfunded pension liability to be several trillion dollars, a not insignificant portion of annual GDP.

The states with the largest unfunded pension liabilities in percent:

California 32%

Illinois 57%

Ohio 39%

New Jersey 51%

Texas 30%

The cities with the largest unfunded pension liabilities in percent:

Chicago 53%

New York 41%

San Francisco 27%

Boston 51%

Detroit 43%

Predictably, The Kennedy School report listed pension padding and DROP programs as being among the biggest sources of ruinous expenditure.  The current situation also emphasizes the point that giving municipalities a pass on making “required” pension system payments is never a good idea.

Finally, just about everyone seems to agree that allowing pension systems to claim an 8% return when forecasting worth is an absurd idea.

 

Credits:  NYT, Kennedy School, the Civic Federation

 

 

 

 

Posted by on February 8, 2013 • Filed under: Administration & Leadership, Command & Leadership, Firefighter Pensions, Funding & Staffing, Values and Ethics

London Fire Brigade: Boris Knows Best

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Mayor Overrules Brigade Leaders

Boris at the Wheel?

London’s Mayor Boris Johnson is pressing ahead with cuts to the London Fire Brigade (LFB) which would result in a decrease of 520 firefighters.  A dozen stations and some 18 engines would be closed or placed out-of-service.

The LFB is one of the world’s largest fire services, deploying about 5,800 firefighters at 122 stations across the 600 square mile city.

A few days ago the  London Fire and Emergency Planning Authority declined to press ahead with the measures citing a threat to public safety.  The Mayor was apparently unconvinced.

American born and conservative politician Boris Johnson is gaffe prone, absurd and re-electable.  A bit of Johnsonian political philosophy: “if you vote for the Conservatives, your wife will get bigger breasts, and your chances of driving a BMW M3 will increase.”

The Fire Brigade’s Union (FBU) regional secretary for London, Paul Embery, said, in part: “These cuts are reckless and wrong, and it is an outrage that the mayor is going against the democratic decision of his own fire authority and the wishes of most Londoners. The mayor makes the absurd claim that these cuts would somehow improve public safety. But the London Fire Brigade’s own figures reveal that the cuts would result in increased response times for nearly five million Londoners, with only a fifth of the capital’s population seeing an improvement.”

One wonders if the FBU would have a stronger hand if they engaged in the integrated delivery of both basic and advanced medical care?

 

Posted by on February 3, 2013 • Filed under: Administration & Leadership, Command & Leadership, EMS Topics, Firefighter Politics, Funding & Staffing

When Monopolies Fail

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Postal Service Fails to Gain Federal Contracts

 

Let’s face it–monopolies are not supposed to fail.  By their very nature they have captured a market to the extent that they control the vast majority of business and are often, by hook or by crook, able to set prices and the terms and conditions of business.

The description sounds a bit like municipal fire and EMS departments who are interwoven into the community fabric to the extent that any alternative seems impossible, even outlandish.

Few institutions are more interwoven than the US Postal Service, the hidebound invention of the legendary Benjamin Franklin who served as Postmaster General.  Despite their history and longevity, they are in serious trouble, and have been for years.  According to the NYT the USPS had a net loss of just about $16B last year.

The USPS Office of Inspector General recently published a report detailing that 98% of federal government long-term shipping contracts were going to United Parcel Service and FedEx.  The Postal Service is failing to capture the business of its own federal partners.  Of the $337M in 2012 federal shipping contracts, the USPS had just $4.8M, or less than 2%.

Mail volume is down and some say that fire volume is down too.  Both UPS and FedEx gained a solid hold by providing services that USPS would not provide or could not provide by congressional action.  In fact, congress, the USPS equivalent of a city council has dithered while the USPS has been bled white by poor decision-making and outmoded business practices like Saturday delivery.

The USPS faces a perfect storm or confluence of business factors that was slow in forming but which now represents a pack of hungry jackals nipping at their prey.  Who knows where the USPS would be today if they had rapidly dropped outmoded business practices and if Labor had reacted quickly and effectively to looming competition and the Internet?

The first replacement of the “USPS styled fire department” is already here.  It is, of course, the fully integrated Fire/EMS department able to provide high-quality ALS treatment and transport using multiple platforms.  If your’s is a fire department uninvolved in EMS treatment and transport or dabbling at the edges, you are pedaling the equivalent of a 10-cent first class stamp.

The psychology of monopoly is ugly and failure-ridden.  Providers talk and act like they are the only game in town, trashing customers they perceive as being unworthy of their service or compassion.  Social media, especially Facebook, have opened an ugly eye onto “professionals” who take to the Internet to speak disdainfully of those they are paid to serve.  Such talk is  sure evidence that the talker sees no connection between their salary and their sarcasm.  Vent if you must, but do it at the coffee table.

The USPS is done for in its current configuration in part because of tradition, bureaucracy, and the inertia of management and labor leaders.  Whether it survives at all will depend on the success of radical and painful surgery.

Ben Franklin started the first post office and the first fire department.  Let’s learn from the letter carriers and make him proud.

 

 

 

Posted by on January 23, 2013 • Filed under: Administration & Leadership, Command & Leadership, Firefighter Pensions, Firefighter Politics, Funding & Staffing, History, Values and Ethics

Fire Politics- US Senate: (Con) Fusion Centers a (Bad) Joke

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DHS/FEMA Implicated in Tomfoolery

You know, those centers–sleek, state-of-the-art facilities bristling with technology where trained professionals quickly and deftly analyze incoming local and state intelligence data to find crucial information on developing terror schemes.  Then, key reports are quickly written and disseminated across the intelligence community, the FBI moves, arrests are made.

Not.

A United States Senate Committee with a name too long to type here issued a relentlessly scathing two-year, bi-partisan report yesterday on the Three Stooges/Chaplinesque nationwide Fusion Center effort.  When Senators Tom Coburn and Carl Levin agree on anything, it’s NEWS.

The report cites fusion center products, those few that weren’t shot-down outright, as “often shoddy, rarely timely, and unrelated to terrorism.”

Perhaps the only thing worse than a useless product is not knowing how much it cost, sort of.  To their credit, FEMA managed to narrow the cost down to somewhere between $289M and $1B.  That’s a $700M spread, but it’s only taxpayer money.  The report indicates that there is a certain fondness out there for flat-screened TVs as well as Chevy SUVs and button cameras.  Button cameras?

The fusion center concept roughly emanates from the 9/11 report which suggested that the existing intelligence framework failed to “connect the dots”  where the (mostly) Saudi hijackers were concerned.  This new system, created under “W”, was supposed to be the crucial linchpin in forming a coherent, upwardly focused, highly responsive intelligence apparatus.  It was also said, by senior DHS officials, to be a “force multiplier.”  (I have no idea what that means but I have always wanted to use it in a sentence.)

Instead, it takes months for the often publicly sourced (sometimes from press releases), anemic and shoddy intel reports to be reviewed, re-reviewed and re-re-reviewed by four offices before they are finally published, months later.  Luckily, most were shot down in the review stage.

They must be yukking it up over at 10th and Pennsylvania.  The FBI looks fabulous.  The Senate report makes it clear that FBI is out front  when it comes to pushing relevant domestic intelligence up the Federal food chain.  They often transmit data same day that it takes DHS months to vet–and then shred.

FEMA comes across as looking like the “Price is Right” on a  windy day.  Cash swirls lazily about as the slightly dazed winner hears about that new SUV and, oh yes, the all expenses paid vacation to the upcoming “National Fusion Centers Conference.”  FEMA has no program to ensure effective compliance or that the stated mission is being accomplished for the millions spent.  They are quoted in the report as saying that they don’t micromanage and they need flexibility.  Uh-oh.

Franklin Delano Roosevelt once said during the Great Depression, “Try something. If it works, do more of it.  If it doesn’t try something else.”

I think we know where we are on that score.

 

 

 

 

 

Posted by on October 4, 2012 • Filed under: Administration & Leadership, Firefighter Politics, Funding & Staffing

EMS Fees Redux: Quacks Like a Duck

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The Insurance Scheme

Duck

A recent post here detailed the upcoming plan for Montgomery County, Maryland, to join other Fire/EMS departments in charging those in need of EMS care.  All-in-all it was a bit of a love fest as management, labor and the volunteers are all on board with the plan.  Money does have a tendency to smooth the way.

Apropos of these fees, there was a story in the news recently about a City of Los Angeles incident where good Samaritans, helping at a car accident, died of electrocution and suffered the apparent double miss fortune of catching a final ride to the hospital, for which, they will be charged.

According to Yahoo, “City fire officials say they do not have the power to circumvent municipal codes and waive the mandatory paramedic fees, even in cases during which a citizen is accidentally injured or killed.”

I said previously that it is those least equipped who wind up getting shafted by such fee schemes:  the frail, the elderly, the mentally incompetent. To that list we can now add grieving families.

Frankly, it is nothing more than a government run insurance monopoly.  The Fire/EMS department charges you a “premium” in the form of taxes in exactly the same manner as you pay a premium for auto or homeowners insurance, whether you use it or not.  Then, if you actually need the “coverage” you are subject to a deductible, in this case the fee.

Mr. Monopoly

If Fire/EMS departments are going to be in the business of selling “EMS Insurance” they should invite other providers to bid on the provision of the service to ensure that citizens are receiving the best care for the lowest cost.  This will be anathema to some but it is the price to be paid for selling your services.  You should be forced to compete for the market share.

A. Philip Randolph

Labor should be especially ashamed as they are historically the presumed protectors of the little guy.  A. Philip Randolph, the famed labor organizer, said, “The labor movement has been the haven for the dispossessed, the despised, the neglected, the downtrodden, the poor.”  Well, not anymore.  Labor is lined up to levy a charge on a service that has already been financed by public revenue.

The plain truth is that health care dollars are in short supply and if those dollars are used to pay for a service that has already been paid for under the guise of “cost recovery”, the “little guy” loses in the short term and everyone loses in the long one.  Critically, labor loses the most as they forfeit their commitment to fairness on the altar of faulty and dubious profit, the very thing they say they hate about management.

Sources: Yahoo, Hasbro

Posted by on September 6, 2012 • Filed under: Command & Leadership, EMS Topics, Firefighter Politics, Funding & Staffing, Values and Ethics

Your House Fire Comes to $41,655. Cash or Credit?

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Oh, your taxes?  That was just in case you needed us.

Montgomery County, Maryland, is one of the richest and most educated counties in the United States.  Their 2013 approved fire/rescue budget is $196.6 million, an increase of $16.6 million over FY 2012.  Just what does $197 million dollars get you?  Apparently not a ride to the hospital if you are sick or injured.  That, my friends, will cost you extra.

The Washington Post reports that County residents and others unfortunate enough to require medical transport will soon be paying $300 to 800 for the privilege.  Perhaps for the $300 fee you have to get into and out of the ambulance on your own.  In addition, you will only have a choice of the two closest hospitals and there will be an additional fee if you insist on a trauma center.

Ambulance

 

Now for $800, the cot will be wheeled to your bedside, you have a choice of any hospital, including MedStar, music of your choice will be played en route, and if your medical condition allows, light hor d’oeuvres will be served.

It turns out that the County’s volunteers have fought the fee in the past but reached an agreement with the bosses where they will receive a 15% cut of the $18 million annual take.  Now they are on board.

Residents are exhorted to remain calm as no one will actually have to pay. “County officials said that in nearly all cases, private insurance companies, Medicare and Medicaid would cover the cost of ambulance service…”  In a county where every other person has a post-graduate degree they are to ignore the fact that the costs of health care are skyrocketing and that Medicare and Medicaid are under attack.  Ignorance is bliss.

This brilliant economic model where taxpayers fund the emergency service to the tune of $196 million dollars but have to pay if they actually need it, should be extended to fire operations, as well.

If you call the fire department because you think you might have a fire, but you don’t, there will be a standard $2500 consulting fee as they have a look around and find nothing.

Fire Truck

If you actually have a fire, a matrix will be used to determine the cost based on the water used and the number of hoselines, and ground ladders deployed.  The use of master streams and aerial devices is not covered in the  matrix and are charged separately.  For example, the deployment of a standard rear-mount aerial for use under five floors will cost $1500.  Tillers and platforms are more.

County officials are exploring a “Diamond Plate Plus” program where any property owner, for an annual fee of $5,000 will be covered for one EMS call and one two-alarm fire per year.  This should not be confused with the annual tax bill because taxes are paid just in case.

(Source:  WP, Patch, Wiki, MC)

Posted by on August 14, 2012 • Filed under: Administration & Leadership, Command & Leadership, EMS Topics, Firefighter Politics, Funding & Staffing