Reality Check

While relaxing at home a man begins to feel discomfort in his chest. He cannot catch his breath, and he breaks out in a cold sweat. He yells to his wife, "Call 911, I think I am having a heart attack." After calling 911, she checks on her husband and finds him unresponsive; he has gone into sudden cardiac arrest. Each minute he is in cardiac arrest his chance of survival diminishes greatly. His cells are being starved of the oxygen they need to live. "According to the American Heart Association C.P.R. Manual, if Cardio Pulmonary Resuscitation is not initiated within 4 minutes and Advanced Cardiac Life Support by paramedics is not initiated within 8 minutes, the man has little probability of survival." The timer starts at the onset of his cardiac arrest: not when his wife calls 911, not when the paramedic crew receives the dispatch, and not when the paramedics pull out of their station. Will EMTs and paramedics get to the man in time?

When deciding where to live, a person utilizes many different criteria to help in making their decision: neighborhood condition, proximity of shopping, school system ranking, prevalence of crime, and the opportunity to engage in their specific interests. The list can be quite extensive, and differs with a person's interests and lifestyle. Invariably, the questions most often omitted from a person's list pertain to the services provided by their local emergency departments. I have been a firefighter paramedic for fifteen years, and it has been my experience that an overwhelming majority of the population does not have an understanding of the true capabilities of their fire and emergency medical services. 

A common misunderstanding is that if there is a fire station in close proximity to a person's house then the ambulance or fire engine will arrive rapidly when the person calls 911. That is not always the case in many communities. For instance, volunteers staff Kettering Stations in the evening and on the weekends, which inherently leads to increased response times and out of service time. In an example from the dispatch logs, the amount of time a crew is available from Station 37 to respond to an emergency averages 60.42 percent of the time; the remaining 39.58 percent of the time, the station is out of service and will not respond to your emergency. The response time, for firefighters and paramedics to arrive at your home, increases because responding apparatus are coming from the next closest available station. Even when volunteer stations are in service, no one is actually at the station. When the dispatcher receives a 911 call, they alert the volunteers via pager. The volunteers then respond from their homes to the station, and then, they respond to the caller's home. According to K.F.D. statistics, this response configuration lengthens the average time it takes the fire department to arrive at the caller's home by three and a half minutes or more, versus a response from a crew that is at the station at the time of the 911 call. Kettering dispatch logs show there are times when as many as four of the seven stations in Kettering are out of service (unable to respond to an emergency) at the same time. When the 911 call of Kettering's most recent fatal fire came in, the fire investigation report reveals that three of the four closest fire engines were out of service. It took 12 minutes for the first fire engine to arrive on scene. Station 37 (0.4 miles from the address), Station 31 (1.9 miles from the address), and Engine 32 (2.4 miles from the address) were all out of service. If a person has an emergency at their home, the amount of time it will take the fire department to arrive may be appreciably longer than the expected amount of time. According to statistics from the National Fire Administration, Kettering fails to meet national response time standards nearly 40 percent of the time.

Another misconception found prevalent among the people I discuss emergency services with, is that all fire departments train their personnel to the same level, and provide identical services. Unfortunately, that is not an accurate statement. The level of services provided by different departments can vary greatly. These disparities not only exist between departments, but may also exist within a single department. The Kettering Fire Department is an example of service levels varying within a department; the level of service provided is dependant upon the time of day an emergency takes place. Comparing the Wayne Township Fire Department, which covers Waynesville and the surrounding township, and the Dayton Fire Department, illustrates the inconsistency between two departments. The D.F.D staffs a paramedic on every fire engine and every ambulance. W.T.F.D does not have any paramedic capabilities at all. This greatly reduces the amount of emergency medical treatment available in that community. Even if the ambulance arrives quickly, with the absence of a paramedic to provide advanced life support, a fast response may not be enough to save a patients life. If you call 911, for a medical emergency, the emergency workers may not have the training to administer the care needed to facilitate a positive outcome.

No two fire departments are identical; they provide services in different ways. Factors that effect fire service delivery are either inherent or controllable. The geography and weather of the community is inherent, and can be a significant factor in the way a department provides service. An example of a controllable factor is the type of staffing configuration the department chooses to employ. Even though some of the factors that affect the level of service a department provides to the community are uncontrollable, the factors of configuration, staffing, and deployment are controlled by the decisions of public officials. Regrettably, it is has been my experience that many elected officials have the same misconceptions about their fire department that their constituents have and therefore do not mandate necessary measures to guarantee the best service.

Fortunately, anyone can become an expert about their current or potential emergency department. All of the information required to assess the department is public record. When attempting to gain knowledge about the services obtain information from several sources: Fire Department Administration, City Manager or Mayor, department employees, and local labor organization (International Association of Fire Fighters). Avoid asking subjective questions. Ask questions that can only be answered by facts such as; what is the average response time to my neighborhood, does your department staff paramedics on all vehicles, and what is the insurance service rating (a study that enables the comparison of different departments) of your department. According to Ohio law, these statistics must be kept by every department.

I am never surprised but continually amazed that most citizens know where the community park is located, can tell you where to find the best cup of coffee in town, and can talk for hours about the school system but few can answer questions about their fire department. If people educate themselves and decide they are not comfortable with the emergency services provided in a community, they can make a difference. The decision makers work for the public, and the citizens of their community have the power to influence their decisions. You may live in a community with excellent emergency services, or you may live in a place where the services are an afterthought of the local officials. The only way to know which type of community you live in is to ask.