Running head: THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 1. The Future Staffing of the Sterling Heights Fire Department. Christopher T.

Running head: THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 1 The Future Staffing of the Sterling Heights Fire Department Christopher T. Martin

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 2 Certification Statement I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotations so indicate, and that appropriate credit is given where I have used the language, ideas, expressions, or writings of another. Signed:

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 3 Abstract The problem was that the Sterling Heights Fire Department will face future budget cuts that will cause either the reduction in manpower or the redistribution of manpower to provide Advanced Life Support (ALS) transportation. These changes will result in either financial savings or revenue generation. The purpose of the research is to analyze the effects that either of these changes would have on our service delivery. Evaluative research was used to answer the following questions: (1) what financial impact would the transition to the reduction model have; (2) what financial impact would the transition to the transport model have; (3) what impact would the reduction model have on our response to fire incidents; (4) what impact would the transport model have on our response to fire incidents? The research indicated that the transport model would be better financially, as well as provide less of a negative impact on our service delivery. The recommendations suggested that, if changes to staffing had to be made, the department should take on the duties of ALS transport.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 4 Table of Contents Certificate Statement 2 Abstract.3 Table of Contents...4 Introduction 5 Background and Significance 6 Literature Review.15 Procedures.23 Results...29 Discussions/Implications...36 Recommendations..41 References..43 Appendix I.46 Appendix II 47 Appendix III..54

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 5 The Future Staffing of the Sterling Heights Fire Department Introduction The Sterling Heights Fire Department (SHFD) provides an all hazards response to various emergencies throughout the city. As with many fire departments nationwide, the majority of the incidents handled by SHFD are medical emergencies. The current staffing model uses a four person Paramedic Engine Company (PEC) to handle most emergencies. Despite good financial planning, Sterling Heights is in no way immune to the current economic problems that are challenging many municipalities. Over the past few budget years, the city has used concessions from all of its bargaining units, the elimination of many positions throughout the city, and an increase in the mileage rate to balance the budget. These changes have affected the fire department in many ways except in the daily manning of apparatus. However, as every other area within the fire department has been cut to the maximum, the only area left to seek any budget reductions would be in the area of manpower in the extinguishment division. The problem was that the Sterling Heights Fire Department will face future budget cuts that will cause either the reduction in manpower or the redistribution of manpower to provide Advanced Life Support (ALS) Transportation. It is widely believed by many of the stakeholders within the fire department that we will be forced to reduce our Engine Company manning to three, or implement patient transport by manning the Engines with two and adding an ambulance with two personnel. The purpose of the research was to analyze the effects that either of these changes would have on our service delivery. Evaluative research was be used in an attempt to determine which change, the reduction in manpower (reduction model), or the transition to ALS transport

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 6 (transport model), would be better for the department and city. To determine the impact of these two changes, the following questions will be answered. What financial impact would the transition to the reduction model have? What financial impact would the transition to the transport model have? What impact would the reduction model have on our response to fire incidents? What impact would the transport model have on our response to fire incidents? Background and Significance The City of Sterling Heights, Michigan is located six miles north of the City of Detroit. Geographically, the city covers 36.8 square miles, making it the third largest city in Michigan. The 2010 population of 129,699 makes Sterling Heights the fourth largest city in Michigan in regards to population. The city has 52,190 housing units with a median age of 40.4, and 44,076 residents over the age of 62(American Factfinder website of the U.S. Census Bureau, table 1). The city also has a large industrial corridor running through its center, serviced by a rail system. This industrial corridor contains four large automotive plants, two Chrysler, and two Ford, as well as General Dynamics, the maker of many types of weaponized vehicles for the military. Many other smaller industrial facilities exist within the corridor, servicing the automotive industry. The Sterling Heights Fire Department (SHFD) currently has 96 budgeted positions, 90 in Fire Suppression, and six in staff positions in the Prevention, Training, and Administration Divisions, not including the Fire Chief. The Fire Department operates five fire stations, each with a Paramedic Engine Company staffed with a minimum of four personnel daily. Fire Station 1, in the center of the city, also houses a Heavy Rescue (Rescue 1) and Ladder Truck (Truck 1), each minimally staffed with two

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 7 persons. A Battalion Chief is housed at Fire Station 5, which is also attached to Fire Headquarters. This staffing deployment requires a 25 person daily minimum, with the use of overtime any time the shift falls below that minimum. The department operates a three platoon system, with 30 people assigned to each platoon. The 96 members are organized under the International Fire Fighters Association Local 1557 (L1557). The department has seen many changes since its founding in 1962. It was not until 1971 that SHFD became involved in Emergency Medical Service (EMS) when it began responding to calls for medical emergencies, responding at the Medical First Responder level. At this level, the main purpose was to be able render the first line of medical care in hopes of stabilizing a patient until better trained personnel from a private ambulance company arrived to take over care and provide the transportation of the patient to the hospital. The transportation of patients to the hospital has been handled by Universal Macomb Ambulance Service (UMAS) since that time. In 1982, the department became trained to the level of Basic Life Support (BLS) and began responding with the equipment and training at that level. Soon after, SHFD became the first department in Macomb County to implement the use of Automatic External Defibrillators (AED), which soon became the standard of care. In 1990, SHFD again upgraded their EMS delivery by establishing the Advanced Life Support (ALS) program. ALS is the highest level of pre-hospital care that can be delivered. The delivery of pre-hospital ALS brings many of the life saving treatments found in the emergency room directly to the scene, allowing paramedics to save more lives. Originally, ALS was only provided by two non-transporting ambulance style vehicles that responded throughout the city with the closest BLS Engine. As the city population continued to grow, so did the number of

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 8 incidents, which quickly overwhelmed the two ALS units. In 1994, a third ALS unit was placed in service. In 1995, the department transitioned to the Paramedic Engine system that is still in place today. This increased the number of ALS units in the city to five, thus decreasing the response times of ALS throughout the city. During each of these changes, no revenue was generated by the fire department for the rendering of service. UMAS billed for the transportation services, despite most of the treatment being rendered by the fire department. Since the inception of the ALS program within the SHFD, FD Medics would ride in the private ambulance and continue patient care when it was deemed necessary by the Company Officer. The ambulance would then return the FD Medic to the station after clearing the hospital. While there are no strict guidelines to when the FD Medics would ride along with the ambulance and continue care, the following are examples of when it would happen; All Priority 1 patients Priority 2 patients who were administered medications, or whose condition may deteriorate during transport Any pediatric patient Certain unique runs that may require an extra set of hands, such as combative or obese patients, or other special circumstances at the discretion of the Company Officer or Medic. In some cases, two FD Medics would ride along with the patient to the hospital to continue patient care. The frequency in which the FD Medics ride along to the hospital, and how often that would continue under either of the proposed changes was a large part of the research.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 9 The SHFD operates under protocols established by the Macomb County Medical Control Authority (MCMCA). Under MCMCA protocols, the guidelines for establishing patient priorities are as follows; Priority 1: Critically ill or injured patients with an immediate life-threatening condition Priority 2: Seriously ill or injured patients without immediate life threatening condition Priority 3: Ill or injured patients not fitting the above categories who require medical attention and do not have a life-threatening problem. Priority 4: Dead on scene (Macomb County Medical Control Authority website, n.d., p. 1) Since the transition to ALS in 1990, Fire Administration and L1557 have made several attempts to convince the city administrators to allow the fire department to take over the ALS transport service, which is known to generate revenue. The two original vehicles purchased to respond to ALS incidents were fully capable of transporting patients to the hospital, as that seemed to be the direction the department was heading. Yet, in the five years those vehicles were in service, they did not transport a single patient to the hospital. Today, the fire department does not have one vehicle that can transport patients. In 2004, the city attempted to use the bid process to seek a private ambulance company who would reimburse the city for services rendered by the fire department on medical emergencies. The city planned to approve the bid from the company who offered the highest amount of reimbursement, provided that they were capable of providing at least the same level of service the city was receiving from UMAS. This caused UMAS and another local ambulance

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 10 provider to claim that this was against the law, and amounted to kick backs being given to the city. The city requested a legal opinion from the Department of Health & Human Services, Office of Inspector General (OIG). In August 2004, the OIG ruled in favor of the City of Sterling Heights and its plan to seek bids from private ambulance companies willing to provide reimbursement. Despite the ruling in their favor, the city did not pursue this revenue generation, and continued with the approval of the contract with UMAS, that is still in effect today (OIG, 2004) In 2008, Fire Administration and City Management, with the help of L1557, contracted the services of the Ludwig Group LLC to do a feasibility study of the fire department taking over ALS transport services within the City of Sterling Heights. An important part of this study was to examine the financial affects to the city by taking over the service after hiring nine additional firefighters, and purchasing the needed vehicles and equipment. This would allow for the four man PEC to transition to a three man PEC while at the same time adding five ALS transport vehicles, one at each station. The Ludwig Group concluded that the SHFD could generate over one million dollars per year, after the capital outlay of the first year and the increase in manpower (Ludwig Group, 2009). While the research performed by the Ludwig Group was sound and substantial, it did not take into consideration how the downtime of the ambulance crews may affect the response to fire emergencies. This research included those variables. Despite the findings of the Ludwig Group, the concept of taking over ALS transport gained no traction and was dropped once again. This was most likely due to the hesitance on behalf of the city to hire additional firefighters in such a poor economy, as well as other political factors.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 11 The Fire Chief was directed in 2009 to seek areas of revenue generation that could be used to offset the reduction in the Fire Department Budget and stop the loss of personnel in the Fire Prevention division, as well as other large budget cuts. The Fire Chief pursued cost recovery for the response to certain incidents such as personal injury accidents (PI s) and fire inspection fees, but mainly in the area of the department s response to medical emergencies. Again, an attempt was made to seek reimbursement from the private transporting contractor for medical services rendered by the fire department. The Chief was suggesting a reimbursement amount similar to the difference between a BLS transport and an ALS transport. The Chief anticipated that the city would realize an estimated $564,000 in revenue under this proposal (City of Sterling Heights, 2009 pg. 7,9). The Fire Chief and Financial Director presented this plan at the June 2, 2009 City Council Meeting. When the floor was opened for remarks from citizens, several citizens complained about the plan and asserted that it was just another way to get money out of the residents. No doubt due to political pressure, a motion was made to table this proposal indefinitely. The motion passed unanimously (Sterling Heights, 2009, p. 6). During the budget process for the 2010/11 fiscal year, the cost recovery issue was not even considered. In order to approve the Fire Department Budget, the city received concessions from L1557 and cut one more Fire Inspector position, as well as cuts in the clerical staff. The 2010/11 Fire Department Budget, which is currently in effect at the time of this research, is $18.3 million (City of Sterling Heights website, p. 169). When it came time for the budget process to begin in early 2011, L1557 took an aggressive approach in an attempt to convince the City Council and City Management to allow the fire department to take over transport services for the city. This time, the Union and Fire

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 12 Administration conceded that they would allow this to be done with existing manpower, negating the need to hire nine additional firefighters. Using the data from the Ludwig Group study, and the savings from the lack of need for additional manpower, it was believed that the city would realize over two million dollars each year in revenue. This caused political mayhem and each council meeting for three months was packed with citizens speaking both for and against the proposal. In the end, the budget was passed by further concessions from L1557 and the elimination of yet another Fire Inspector. The issue of ALS transport was tabled for 120 days to allow for more studies and negotiations between L1557 and the city. The next budget year coincides with the end of the existing contract between L1557 and the city. Due to anticipated further reductions in property values resulting in less tax collection, the city will either need to bring in new revenues or cut more positions. This time, these positions will have to come from manpower in the Extinguishment Division. This led to the need for this research. Many within the organization wonder if we would be better off reducing our staffing on the Engines to three, or splitting the four man Engines to a two man Engine and two man Ambulance model in each station. Both models would have specific financial implications as well as implications to our response to fires and other emergencies. No matter which change is made, it will take strong leadership to handle these adaptive challenges, which has a direct link to the Executive Fire Officer Program, Executive Development class content in Unit 5- Change Management, Unit 7- Organizational Culture and Change, and Unit 11- Service Quality.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 13 Furthermore, this research was directly linked to more than one of the five United States Fire Authority Goals and Initiatives, however, specifically Goal 3 to Improve the Fire Services Capability to Respond to and Recovery from All Hazards (United States Fire Administration [USFA], 2010, p. 42). For the purpose of this research, actual expenses and incidents for calendar year 2010 were analyzed. The research assumed the affects that would have resulted if each of these models were in place for the entire year of 2010. SHFD uses the National Fire Incident Reporting System (NFIRS) to report all incidents. Patient Care Reporting (PCR) is used to record and report all aspects of EMS incidents; the PCR is part of the National Emergency Medical Service Incident System (NEMSIS). The following three tables show data retrieved by the researcher from the 2010 NFIRS data pertaining to all incidents. Table 1 shows a breakdown of all Incidents during 2010. Table II shows a breakdown of all EMS incidents during 2010. Table I Total Incidents 10681 Total EMS Incidents 8227 Total Transports 6762 Fire Incidents 351 Vehicle Accidents 705 Table II Station Pri 1 Pri 2 Pri 3 Total Transports per station 1 83 724 735 1542 2 80 616 840 1536 3 75 540 615 1230 4 89 607 554 1250 5 79 628 497 1204 Total per priority 406 3115 3241 Total Transports 6762

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 14 Table III Percentage of 6762 transports 1531 FD Medics to the hospital of 6762 Transports 22.6 1414 1 FD Medic to the hospital of 1531 FD Medics to the hospital 20.9 117 2 FD Medics to the hospital of 1531 FD Medics to the hospital 1.7 103 Priority 1 patients of 117 2 FD Medics to the hospital 1.5 14 Priority 2 patients of 117 2 FD Medics to the hospital 0.2 915 Incidents when medications given and patient transported 13.5 734 Incidents when medications given, patient transported and FD Medic rode along 10.8 A first alarm assignment within the City of Sterling Heights calls for 2 Engines, Rescue 1, Truck 1, and the Battalion Chief. At minimum staffing levels, this represents 13 personnel. If the incident is reported in a high life hazard building, such as one of our high rises or senior living facilities, a third Engine is dispatched on first alarm, making the first alarm assignment 17 personnel. Also, if the information received leads the dispatcher to believe that there is a working fire, the third Engine is dispatched. SHFD strives to be fully compliant with Occupational Safety & Health Administrations (OSHA) 29 CFR 1910.134(g)(4), more commonly referred to as the two in - two out rule. SHFD takes that rule a step further and does not consider the Fire Engine Operator (FEO) of the first arriving Engine as part of the four needed to comply with two in two out, as it is believed that the duties of the FEO in securing a water supply are such that the position can not be vacated to assist in rescuing a firefighter. The arrival timing of the first alarm companies in most sections of the city are conducive to this system as other companies are usually arriving prior to the first line being advanced into a fire. SHFD also strives to comply with National Fire Protection Agency (NFPA) 1710, as well as industry standards for establishing an initial rapid intervention crew (IRIC), followed by an

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 15 entire Engine Company (four personnel) dedicated to rapid intervention (RIC) when the incident calls for it. SHFD is part of the Macomb County Fire Chiefs Association (MCFCA), which uses a box alarm assignment style system for mutual aid. In recent years, all departments within the MCFCA mutual aid were trained and similarly equipped to handle RIC duties for one another upon request, and in some cases, automatically. The response to Special Operations and Hazardous Materials incidents is done both with local resources, which allow for technician level responses in all disciplines, as well as county and regional agreements prearranged if the incident overwhelms local resources. Literature Review The literature review for this research began with EMS in the fire service, and specifically, using funding from EMS in the fire service. The trend over the last fifty years has been for fire departments to get involved, and in some cases, completely take over EMS services. Roberts (2010) points out that EMS and the fire service is a perfect marriage. The geographic positioning of fire apparatus and manpower make it an obvious asset for the response to medical emergencies in which response times can mean the difference between life and death. Furthermore, to pay for it, fire departments should pursue billing for the delivery of EMS. Ludwig (2010) points out that seventeen of the twenty most populated cities in the United States run fire based EMS systems. Furthermore, EMS transport is a very lucrative venture, which now has private equity firms investing large sums of money into takeovers of some of the largest private ambulance services in the country, obviously because they see further potential for profits to be made.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 16 The Journal of Emergency Medical Service (JEMS) conducted an in depth survey of 200 cities in 2006. The survey found that over 91% of these cities had fire-based EMS systems. Of those providing transportation of the patients, the average fees collected per transport ranged from $375.91 for and BLS non-emergency transport, to $639.58 for an ALS 2 emergency transport (2007, p. 4). JEMS (2007) further pointed out that the public has high expectations for the performance of their EMS system. They demand quick, reliable and quality service, and entrust EMS leaders with doing everything possible to meet that objective" (p. 6). In their study on the role of the fire service in the delivery of EMS Katz, Pepe, Persse and Paratt (2007) concluded: In terms of the rapid delivery of emergency medical care in the out-of-hospital environment, fire departments have the advantage of having a free-standing army ready to respond anytime and anywhere. Pre-hospital, 9-1-1 emergency response in support of community prosperity and security is one of the essential public safety functions provided by the United States fire service. Fire service-based EMS systems are strategically positioned to deliver time critical response and effective patient care and scene safety. Fire service-based EMS accomplishes this while emphasizing responder and patient safety, providing competent and compassionate workers, and delivering cost-effective operations (2007 pg, 16-17). That conclusion sums up the advantage that the fire service has in the delivery of prehospital EMS. Any community that chooses to provide an adequate response to fires by geographically positioning apparatus and personnel to respond to fires in a timely manner, can also take advantage of the same response network for EMS calls. It would simply need to train

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 17 and equip the highly motivated personnel that they have retained for the response to fires, and have them also respond to EMS incidents. That was the reasoning behind the fire service getting involved in EMS sixty years ago, and also why the fire service has become the leaders and innovators of today s EMS delivery. Many fire departments across the nation have studied using funding from the delivery of ALS transport to allow them to hire or retain firefighters. Garber (2008) concluded that the City of Staunton, Virginia could use revenues generated from ALS transport to hire nine additional firefighters and open another station. This would not only increase their capability to more effectively respond to medical emergencies, but it would also allow for a better response to fires in the city. The City of Westerville, Ohio is protected by the Westerville Fire District (WFD). WFD shares many similarities to SHFD, including relying heavily on property taxes to fund fire operations. Much like SHFD, as the property values decreased, so did the tax levies. Ross (2009) suggested that Westerville political leaders look into charging a fee for ALS transport in order to secure revenue to allow fire department operations to continue. The National Fire Protection Association (NFPA) developed NFPA 1710: Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments. While this standard is not law, it sets strong suggestions to municipalities as to how a fire department should be run. Several points in this standard were important to this research, such as; The standard was developed to address the response to fires in 2000 square foot structures, without basements. While most structures in the City of Sterling

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 18 Heights have basements, many are below the 2000 square foot size. The city also has several residential structures that exceed the 2000 square foot size (pg. 1). The geographic location of the fire stations in Sterling Heights is such that allows for the response to meet the standard of having the first Engine arrive within four minutes (travel time), and the rest of the first alarm response to arrive within eight minutes (travel time) on 90% of the runs. SHFD has set this as a performance objective to meet this standard (4.1.2.1 (3) pg. 7). The standard calls for the arrival of first responders equipped with an automatic external defibrillator (AED) within four minutes travel time, as well as the arrival of ALS within eight minutes travel time. SHFD has set this as a performance objective (4.1.2.1 (4) (5) pg 7). The standard defines the two person Engine two person Ambulance response as one company, provided that they respond together and work together as one company, under the direction of a single company officer (3.3.13 pg. 5). The standard calls for the ability of the first arriving company to have the capability to implement an initial rapid intervention crew (IRIC) (5.2.4.1.2 pg. 9). The standard calls for the implementation of a four person rapid intervention crew (RIC) when the incident presents significant risk to responders. A four person RIC is standard for SHFD on working incidents (5.2.4.3.2 pg. 9) The standard calls for a first alarm assignment to provide fifteen personnel. While, under the current system, a first alarm for SHFD provides thirteen personnel, it is quickly upgraded to seventeen upon any report of an actual fire (5.2.4.2.2 pg 9).

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 19 There have been several studies on the effects of apparatus crew size on the outcome of fire incidents. The latest and arguably most comprehensive is the 2010 report from the National Institute of Standards and Technology (NIST). In this study, NIST performed more than 60 experiments to test the effectiveness of different crew sizes on the ability to perform time to task objectives. Using NFPA 1710 as a standard to work from, they tested the varying crew size and arrival of first due apparatus, as well as the arrival of a first alarm compliment. Some critical key points they revealed were: A three person engine had a 10% better time to water on fire than a two person engine. A four person engine outperformed the two person engine by 16% in the same criteria A primary search was performed by a three person crew 25% faster than a two person crew, and a four person crew performed the task 6% faster than a three person crew, and 30%, or three minutes faster that the two person crew The proper placing of ground ladders and ventilation was performed by a four person crew 30% faster than a two person crew, and 25% faster than a three person crew The stretching of hose was performed by a four person crew 87 seconds faster than a two person crew, and 57 seconds faster than a three person crew (NIST, 2010, p. 52) The NIST research further concluded that the two and three person crews were not able to meet the industry standard as defined by NFPA 1710. This industry standard calls for there to be fifteen firefighters on scene in eight minutes (NIST, p. 11).

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 20 While the study may be dated, Miller (1984) made some interesting conclusions in his study of the affects of crew size in the Dallas Fire Department. He concluded that an Engine Company should have no less than four personnel, and a Truck Company no less than five when responding to fires in apartment complexes. Furthermore, he concluded that crew sizes of five for a response to high rise fires is optimal, and that crews of three suffer from too great a loss of function and capacity (p 11-12). While considering crew size during responses to residential structure fires with trapped occupants, Miller (1984) concluded that the five person crew was optimal and the four person crew acceptable. However, the three person crew was able to control the fire, but unable to complete the search of the structure until the fire was knocked down. This would cause a delay in the rescue of trapped occupants, possibly causing death (p.12). Crowley (2004) concluded, in his study of the Colorado Springs Fire Department (CSFD), that CSFD could see increases in fire damage of 60%, firefighter disability of 45%, and a 452% increase in fire related deaths if the city chose to staff CSFD apparatus with three personnel instead of four. Crowley (2004) further concluded that the delivery of EMS would also suffer by the reduction in staffing from four to three in that the likelihood of surviving a cardiac arrest would decrease by 18-26% (p. 10). Injuries are another area that has a significant impact on the fire service. When fire fighters are injured, it causes a considerable financial liability to communities in both the cost of treatments as well as the cost to replace the personnel on shift. Several studies have been conducted on the affect of staffing levels on the frequency and degree of fire fighter injuries. Varone (2010) studied the affects on injuries in the Providence Fire Department of transitioning from three personnel to four on apparatus. He concluded that a decrease of 23.8%

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 21 was seen in reported injuries, as well as a 25% reduction in time-loss injuries. CSFD transitioned from three to four personnel per apparatus in 1998. During the period from 1998 to 2002, CSFD saw a reduction in firefighter lost-time injuries of 56.6 percent (Crowley p. 11). The ability for firefighters to be able to protect each other when engaged in firefighting operations has become a priority over the last decade. The availability of manpower on the scene of a fire to be assigned to rapid intervention duties is directly related to the amount of manpower available to that jurisdiction. While NFPA and other organizations call for there to be four personnel assigned to RIC duties, two specific studies have found that four is no where near enough, and many communities struggle to even assign four to that task. Both the Seattle Fire Department (SFD) and the Phoenix Fire Department (PFD) performed extensive studies to determine how many fire fighters were needed to rescue another fire fighter during mayday event. Morris (2004) pointed out that SFD and PFD concluded that 11 and 12 firefighters respectively would be needed to affect a rescue of a down fire fighter in a large structure (para. 5). The quality of EMS delivery is also very important. Many studies have shown that four personnel on scene is very important to the outcome of the patient in cardiac arrest. One might wonder how the SHFD has performed in the area of Out of Hospital Cardiac Arrest (OHCA) with its four person PEC. Sterling Heights takes part in Cardiac Arrest Registry to Enhance Survival (CARES). CARES keeps statistics on cardiac arrest outcomes from many locations throughout the nation. The statistics show that the chances of surviving a cardiac arrest are greater in Sterling Heights than throughout the nation. Averages on how SHFD compared to the nation during 2010 is shown in Table IV below.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 22 Table IV SHFD Average National Average Characteristic Return on spontaneous circulation in the field 38.60% 36.70% Dead in field 4.30% 25.60% Ongoing resuscitation in ED 91.40% 55.40% Pronounced in ED 4.30% 19.00% Overall Survival to Hospital Admission 40% 27.70% Overall Survival to Hospital Discharge 11.40% 10.40% With Good or Moderate Cerebral Performance 11.40% 7.80% The information from CARES can not be retrieved without membership to the CARES network, therefore the information used in Table IV as well as cumulative information from 2005-2010 has been attached in Appendix III. Change in any organization is difficult, but it seems that any change in the fire service is especially difficult. The researcher is certain that any of the changes researched would be met with a certain amount of resistance. Smollan R. & Sayers J. (2009) suggested that to limit resistance to change, an organization should ensure that the values of the organization be aligned with the values of the participants of the change (p. 435). Getting active participation in decision making from throughout the organization is also a good way to reduce resistance (Price, A.D.F & Chahal, K. 2006 p.250). (Alyn) 2011 suggests that people do not resist change in general, rather they resist change that they feel is not beneficial, is not worth the cost, or that they had no part in creating. Having the change created by multiple parties can alleviate the other forms of resistance. The literature review has enlightened the researcher to the importance of crew sizes in regards to the effectiveness and safe operations of fire fighting crews responding to fire and EMS

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 23 incidents. The researcher also gained valuable information regarding the use of ALS transport revenue as a way to fund fire operations, and the importance of managing change. Procedures The first aspect of the research, questions one and two, was to determine the financial implications of the transition to the reduced staffing model, and the transport model. While a reduction in manpower could take on many variations, the model used for this research calls for each of the five Engines to be reduced from four to three. The Rescue and Truck companies would increase from two to three, and there would be no change to the staffing of a Battalion Chief. This would call for a reduction in a daily minimum from 25 to 22. This represents a reduction in three firefighters per shift, and nine department wide. This model has been the one selected by senior staff as an alternative if a reduction of staffing was required. While it reduces each Engine, it increases the Rescue and Truck to allow for the same number of firefighters responding on a first alarm of fire. Under the transport model, the daily minimum of 25 would remain the same. The change would come in the moving of two personnel off of each Engine, and placing five transport vehicles in service. There would be no change in the staffing levels of the Rescue, Truck, and Battalion Chief. This would also increase the number of ALS units within the department to 10 from five, as the Engines would stay equipped for ALS. In order to determine the financial implications of the two models, the research would have to determine how much money would be saved in the reduction of nine personnel, as well as how much money would be made by providing ALS transport. To determine the amount of savings in a reduction of manpower, the assistance of the City of Sterling Heights Financial

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 24 Director and the Assistant Fire Chief were solicited. Figures gained from their experience with the budget were used to determine the savings of having nine less fire fighters. In order to determine the amount of revenue that would have been generated from the transportation model, the number of medical emergencies that resulted in the transportation of a patient to the hospital was archived from the NFIRS records recorded by the SHFD in 2010. The amount of revenue generated per transport was determined by the average amount received by 11 comparable fire departments surveyed by the city as directed by City Council at the March 15, 2011 meeting (Sterling Heights, 2011, March 15 pg.11). The comprehensive survey of 13 comparable communities was undertaken by City Administration and its results are attached in Appendix II. Below are the questions that were sent out by the City of Sterling Heights to the 13 communities. CITY OF STERLING HEIGHTS AMBULANCE TRANSPORT / EMS SURVEY CITY OR TOWNSHIP: 1. Does your Fire Department provide ambulance transport service for your community? 2. What is your total number of transports for the most recent completed fiscal year or calendar year? (Please specify the time period) 3. What is your total number of EMS runs for the same time period used in Question #2? 4. What is your total number of Sworn Extinguishment Staff? 5. How many Fire Stations do you have? 6. What is the current population of your City?

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 25 7. What is the size of your City (square miles)? 8. Please list the vehicles you have at each station and the number of sworn staff assigned to each vehicle per shift. (i.e. Station #1: Engine 3FF, Ambulance 2FF, Chief s Vehicle 1FF; Station #2: etc.) 9. Does the total number of sworn staff in Question #8 equal your minimum staffing level requirement? If not, what is your minimum staffing level requirement? 10. What is your net revenue (revenue collected) from providing Transport Services (if provided in-house)? Are fees paid to a Billings/Collections Agency deducted from this amount? If Finance Department should be contacted, please provide name and number of contact (S, Whitehead, personal communications May 13, 2011). The study performed by the Ludwig Group in 2009 estimated that the City of Sterling Heights would realize a higher average revenue collection per transport than the current survey conducted by the city. This research used the lower of the two estimates so as not leave the impression that the numbers are inflated (Ludwig, 2009 pg.25). The second aspect of the research, questions three and four, was centered around the implications of a transition to either of the proposed models, mainly on the affects on the ability of SHFD to respond to fires. To do this, the research looked at the impact that the delivery of EMS service had on the availability of manpower to respond to a fire incident. Specifically, under the reduced manpower model, how often would the three man Engine be down to a two man Engine, or out of service, due to the sending of medics to the hospital with the patient? Also, how often would the Ambulances be unavailable while transporting patients to the hospital, leaving only a two man Engine in that district? Furthermore, how often would there be a need to take FD personnel off of the two man Engine to assist with patient care in the two man Ambulance, leaving no resources in that district? The results were represented in minutes and hours per day that these changes would occur, as well as total man hours available per day under each model.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 26 As previously stated, the decision to send an FD Medic to the hospital with the private ambulance is quite subjective. There are obvious times when it happens, such as all priority one patients, but after that, it is Officer discretion. The key to understanding how either model researched would affect available manpower lies in determining what the decision makers would do in such cases. For this, 31 people within the department were selected to take part in a survey geared to attempt to understand how often FD Medics would be sent to the hospital under these models. The 31 people selected were the following; 14 Paramedic Company Officers 8 Paramedic Sergeants 3 Battalion Chiefs Fire Chief Assistant Chief Training Chief EMS Coordinator Training Instructor The Union President The selection of the Paramedic Company Officers (Lieutenants and Captains) is obvious; they are the ones making the decisions each day. The Paramedic Sergeants frequently act as Company Officers, in their absence, and as such are also making these decisions very often. The three Battalion Chiefs are all previous Paramedic Company Officers whom have made those decisions for years, and now are charged with ensuring the right decisions are made. The Fire Chief, Assistant Chief, Training Chief, EMS Coordinator, and Training Instructor were also previous Paramedic Company Officers or Sergeants, and also are instrumental in ensuring the

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 27 right decisions are made. The Union President is a senior Firefighter/Paramedic who is tasked with negotiating any changes in our deployment. The researcher made the decision to exclude non Paramedic Company Officers and Sergeants as they may lack the training to completely understand when the need for an FD Medic to ride along exists. Many also ride on the BLS apparatus, and do not make those decisions often. The researcher also excluded the Paramedic Firefighters from the survey due to the fact that they are the ones who are actually sent to the hospital with the private ambulance, and that may have biased their opinion. The survey questions were as follows; 1. Do you think we should change the criteria used to decide when a Medic goes to the hospital if we transitioned to three man Engines? 2. Under what circumstances would you send a medic to the hospital under a three man Engine system? 3. Under what circumstances would you send more that one medic to the hospital under a three man Engine, taking your Engine out of service? 4. Consider that we are operating with a two/two Engine/Ambulance system, under what circumstances would you take one of the Engine personnel to ride with the FD Ambulance, taking both companies out or service? In order to determine how long the FD Ambulances would be unavailable during each transport, the researcher collected similar data from other comparable fire departments, as well as UMAS, the private contractor handling the ALS transport within Sterling Heights. This was done through personal communications with a point person from each organization. The goal was to determine the average time that their

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 28 ambulances were out of service from the time of the call, until clearing the hospital and available to respond to another incident. There are several limitations to this research that need to be noted. First off, it is not easy to determine exactly how much can be saved by the reduction in staffing of nine firefighters. This is due to the fact that firefighters with less than five years on the job are in the step process for pay rates. This means that every year they have a pay increase until they are at full pay. Also, it is unknown where the reduction of manpower would come from, senior people through attrition, or junior people through lay offs, which would affect savings. There are many other factors that can affect the cost of firefighters, such as injuries or sick leave. Either of these circumstances could lead to overtime expenses. Either of the changed models could have resulted in injuries which could have decreased the amount of money saved. Furthermore, the department or city does not track exactly how much overtime is spent on minimum manning of the stations, instead only all overtime expenses are tracked. The figure used was determined by the input and experience of the Budget Director and Assistant Chief. Also, as previously mentioned, it is hard to determine exactly how much money could be made from the transporting of patients to the hospital. Several factors were used by the Ludwig Group in determining the estimate of anticipated revenues. These factors included, but were not limited to, the median income of the residents, number of residents living below the poverty level, reimbursement rates from Medicare and private insurance companies, and number of transports. Despite this comprehensive approach to estimating the anticipated revenue, the researcher chose to use the average from the 11 surveyed fire

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 29 departments, as some members of City Council believed the 2009 figures represented by the Ludwig Group may be outdated due economic conditions. Since SHFD currently has no vehicles capable of transporting patients to the hospital, it would take a significant capital investment to be able to provide this service. In the process of preparing for such a transition, SHFD had received bids for six vehicles, fully equipped. There are also other associated expenses to the transition that have been detailed and presented to City Council. The cost of the vehicles and associated expenses must be considered in the analysis of revenue generation. Results The first research question was, what financial impact would the transition to the reduction model have? The researcher came to the conclusion that, with the reduction in nine firefighters, the city would realize a savings of $1,062,120. To come to this conclusion, the researcher used the amount of $113,000 per year, per firefighter, totaling $1,017,000. This amount was obtained directly from the Finance Director for the City of Sterling Heights, as the amount the city used in the budget for that year (B, Baker, personal communications May 25, 2011). Furthermore, in 2010, the Fire Department spent an estimated $376,000 in minimum manning overtime. This amount was obtained from communications with both the Finance Director, and Assistant Fire Chief. A reduction in nine Firefighters, three per shift, is equal to twelve percent of the minimum manning level. For this reason, the researcher concluded that the city could have realized $45,120 in overtime savings, twelve percent of the $376,000. The combination of wages and overtime savings totaled

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 30 $1,062,120 (B, Baker, personal communications, May 25, 2011) (M, Deprez, personal communications, May 22, 2011). The second research question was, what financial implications would a transition to the transport model have? In determining this answer, the researcher had to estimate how much revenue would be generated by providing the service, and at what expense. In their 2009 report generated for the City of Sterling Heights, the Ludwig Group estimated that the city would generate $354 per transport. This amount took into consideration a seventy percent collection rate, as well as the reimbursement fee structures of Medicare/Medicaid and Blue Cross/Blue Shield (Ludwig, 2009 pg.25). For this research however, the amount of $319 per transport was used. This amount is the average amount collected by 11 comparable departments surveyed. This amount was the average of the actual amounts collected (City of Sterling Heights, May 17, 2009, pg 287). In 2010, SHFD responded to 6,762 medical emergencies that resulted in the patient being transported to the hospital. Using the $319 per run, the City of Sterling Heights would have realized $2,157,078 in reimbursement for providing this service. The Finance Director for the City of Sterling Heights prepared a cost analysis for the expected capital expenditures required for SHFD to take on ALS transport. This analysis was presented in the agenda items for the May 17, 2011 City Council Meeting. In the analysis, the Finance Director estimated that the total cost for six fully equipped ambulances was $1,161,612. This also included expenses that the city would incur for needed items not part of the purchase of the ambulances. This would provide for one spare ambulance to allow for maintenance to take place while maintaining five in service

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 31 ambulances. It is important to note that the $1,056,000 vehicle portion of that expense could be paid for over a three year period (City of Sterling Heights, May 17, 2009, p. 284). Taking advantage of the three year payment option, the first years expenses would be $457,612. This would leave two more payments of $352,000 from the purchase of the vehicles. Considering that the expected revenues for that year would have been $2,157,078, the City would have realized a profit of $1,699,466. That amount would increase slightly over the next two years, while payments are still made for the vehicles. The city would then see a dramatic increase in revenues when the vehicles were paid in full. In considering the financial implications for both models, the city would stand to save $1,062,120 and have nine less firefighters, or profit $1.7 million by taking on ALS transport, and retaining firefighters. The next phase of the research centered on the impact of transitioning to either of these models, specifically, the departments ability to respond to fire incidents, as well as other emergencies, compliant with NFPA 1710. Available manpower was the key consideration for this phase. Under the reduced staffing model, each Engine would have three firefighters, instead of four. If the need arose to send a FD Medic to the hospital with a patient, the Engine would be down to two, or even one if two Medics had to assist. How often would this happen, and how long would the manpower be unavailable? SHFD does not track the average time that the FD Medics are unavailable when they are with UMAS. So for the research, the time used will be the same time used to determine the time frame for the unavailability of FD Ambulances under the transport

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 32 model. This time frame was the average time of comparable fire departments, as well as UMAS, representing the amount of time from the time of call until the Ambulance is available for another incident. Table V shows the results in minutes. Table V Livonia Fire Department 42 (S. Whitehead, personal communications, May 13, 2011) St Clair Shores Fire Department 46 (J. Thompson, personal communications, May 21, 2011) Roseville Fire Department 40 (M. Holland, personal communications, May 18, 2011) Shelby Twp Fire Department 55 (J. Swinkowski, personal communications, May 26, 2011 Universal Macomb Ambulance 47 (B. Walker, personal communications, May 18, 2011) Average time 46 Input from the decision makers, through the survey, helped the researcher calculate the amount of time a three man Engine would be down to two, as well as one. Table VI shows the result from question one of the survey sent to select members of SHFD. Of the 31 people who were sent the survey, 25 responded. However, the response from one person was too vague to use any results. Table VI Do you think we should change the criteria used to decide when a Medic goes to the hospital if we transitioned to three man Engines? Yes 11 No 13 The remaining three questions that were part of the survey sent to SHFD were geared towards allowing the researcher to evaluate how these decision makers would

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 33 handle these subjective decisions. The results to the questions were such that they could not be tallied, but the researcher was able to glean important information from the respondents. Of the 13 respondents citing that no changes were needed, the majority of them also cited that patient care was the most important component, despite the possibility of another incident or fire. They also felt that they currently only sent a Medic when it was necessary, and would continue to do so. Of the 11 respondents citing that changes would be warranted, most of them also cited that patient care was the primary concern. However, many of them felt that they would reduce the amount of times that they sent a Medic to the hospital due to the reduced manpower. Many felt that FD Medics should assist with transportation, under the three man Engine model, only when patient care required it, instead of the possible need arising. From the information received from the responses to the survey, as well as the experience of the researcher, being a Paramedic Company Officer for 13 years, the research will assume the following would have occurred in 2010 under the reduced staffing model. All Priority 1 patients would have continued to have a FD Medic assist to the hospital. This occurred 406 times, including 103 times where there were two FD Medics. The research will use 303 single Medic, and 103 double Medic assists to the hospital. Of the 1,125 Priority 2 patients whom had a FD Medic assist in transport to the hospital, that number would see a reduction of 10 percent due to the

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 34 decision making with reduced staffing, totaling 1,012 FD Medics to the hospital on Priority 2 transports. Using these statistics, the average time per day (24 hour shift) that each of the five three man Engines would have been down to only two people was 33.14 minutes. This was calculated by taking the number of FD Medics expected to have assisted to the hospital (1,315), divided by the five Engines, divided again by 365 (days per year), multiplied by the 46 minute average down time. Using the same method, the three man Engine would have been down to one person, and out of service, for 2.6 minutes per day in 2010. It is important to note that these numbers can be misleading due to the fact that when these circumstances take place, it is not for 33.14 or 2.6 minutes at a time. To clarify, one can assume that the three man Engine would be down to two for 46 minutes once every 1.3 days. Furthermore, the Engines would be out of service due to multiple Medics unavailable for 46 minutes once every 17 days. When evaluating the transport model, the research had to determine how often the FD Ambulance would have been unavailable, as well as how often manpower from the two man Engine would have been deployed to assist the FD Ambulance. Considering that there were 6,762 transports in 2010, each FD Ambulance would have been unavailable for an average of 170.43 minutes (2.84 hours) per day (24 hour shift). This was calculated by taking the number of transports (6,762), divided by the five Ambulances, divided again by 365 (days per year), multiplied by the 46 minute average. In considering the amount of time that Engine personnel would be reassigned to the Ambulance, the research assumed that all Priority 1 patients would have required this

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 35 manpower. Using the 406 Priority 1 patients in 2010, one could assume that, in addition to the 170.43 minutes per day that the Ambulance was out of service, each Engine would also be out of service 10.2 minutes per day, or once every 4.5 days for 46 minutes. The researcher then proceeded to evaluate the two models against the current system of a four man Engine, which is also the industry standard as spelled out by NFPA 1710 (2010, 5.2.3.1, and 5.2.3.1.1, pg. 9). Furthermore, NFPA 1710 considers the 2 man Engine, 2 man Ambulance to be equivalent to a four man Engine (2010, A.3.3.13 (4) pg. 14). The different elements of the two models made them difficult to compare against each other, due to the fact that they were rarely at the same level. For instance, the transport model is a four man company for an average 21 hours per day (24 hour shift), and the reduced staffing model is never at the four man level. Furthermore, the reduced staffing model is a three man company for 23.4 hours per day, and the transport model is never at that level. For this reason, the researcher evaluated the two models in terms of average man hours available in a day (24 hour shift). This was calculated by representing the 24 hour shift as 1,440 minutes, then subtracting the amount of time previously calculated that each model would be below what is considered fully staffed for that model. Man hours were then calculated at each anticipated man power phase. Table VII represents those results.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 36 Table VII Transport Model Total Man Hours 4 personnel for 1259.37 minutes per day (20.989 hours) 83.958 2 personnel for 170.43 minutes per day (2.84 hours) 5.681 Out of Service 10.2 minutes per day 0 Total Man Hours 89.639 Reduced Staffing Model 3 personnel for 1404.26 minutes per day (23.414 hours) 70.213 2 personnel for 33.14 minutes per day (0.552 hours) 1.104 Out of Service 2.6 minutes per day 0 Total Man Hours 71.317 Total difference in favor of the Transport Model 18.322 This data represents that under the transport model, there would be an extra person available, over what the reduced staffing model would offer, for 18.32 hours per day. Also, the transport model is the only one of the two models that allows for the response of four personnel as one company for any portion of the day. The implications of the two models clearly is that the transport model is the model that allows SHFD to best be able to respond to structure fires as close to compliance with NFPA 1710 as possible for our organization. Discussion/Implications The City of Sterling Heights is not unique when it comes to financial problems brought on by the economic conditions over the past several years. Fire departments nation wide are facing budget cuts as cities look to balance their budgets by cutting public safety, but at what cost? These are hard decisions for politicians to make, but it is up to the fire service leaders to make sure they are educated decisions.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 37 Politicians and residents alike are largely uneducated when it comes to what the fire service offers, and what it needs to properly operate. This leads to a lack of understanding how cuts will affect the service we provide. It should go without saying that each resident wants nothing but the best service possible during their emergency, but may balk at the cost of providing that same service to everyone else. From the literature it should be clear that the fire service should be delivering EMS. Furthermore, each jurisdiction should strive to offer the best ALS service to their residents. In 2010, EMS incidents accounted for 77% of the responses for SHFD. The researcher agrees with Roberts (2010), Ludwig (2011) and Katz et al. (2007) that EMS in the fire service is an obvious match. The statistics gathered by CARES indicates that the SHFD is performing well in the area of OHCA. There are also many nonscientific ways to see that SHFD is making a difference in our EMS delivery. These come in the form of communications from residents as to the satisfaction of patient care and outcomes, as well as communications from local hospitals on issues such as how fast our treatment allowed a patient suffering a myocardial infarction to receive angioplasty. Personal observations on behalf of the researcher as a Paramedic since the inception of the ALS program can also bear witness to the quality of our service. Many have questioned the use of Engines in the delivery of ALS, and wonder if it is a waste of money. The PEC, properly staffed, is an awesome tool for many emergencies that fire departments face. It can allow for quick placement of the initial hose line at fires, as shown by the NIST (2010) study, as well as highly trained professionals at the scene of a cardiac arrest or trauma.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 38 While some may argue that the collection of fees by fire departments for patient transportation is a form of double dipping the tax payer, many departments have been successful in using this revenue to either maintain or increase staffing. It would seem a logical approach for municipalities to use such fees, in lieu of increasing taxes, to keep adequate staffing for their fire department. Garber (2008) and Ross (2009) showed how successful revenues from transport were for their departments. Every fire department has restrictions to some extent on what they can do in the face of emergencies, mainly fires. These restrictions can come in the form of equipment and training, but especially in available manpower on scene. There are also laws, such as OSHA 29 CFR 1910, and standards, such as NFPA 1710, that provide both restrictions and guidance to fire department operations. The main issue behind both OSHA laws and NFPA standards is also related to manpower. The researcher agrees completely with the need to maintain appropriate crew sizes to increase effectiveness of fire crews as shown by NIST (2010), Miller (1984) and Crowley (2004) as well as reduce fire fighter injuries and possibly deaths. It stands to reason that, should the City of Sterling Heights choose to make changes to the staffing levels for the SHFD, the city would be negatively impacted in the areas of property damage from fire, firefighter injuries, and even patient care. Should the transition to the ALS transport model take place, the city would see significant revenue generation as well as beneficial changes in patient care. The anticipated benefit to patient care comes in the fact that the care will be provided by professional firefighters during the entire incident, instead of the current tiered system that has the fire department transferring care of the patient to another entity. This will

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 39 allow for better continuity of patient care, which is sometimes lacking under the current system. The transport model would also increase the number of ALS units in the city from five to 10. This would be beneficial in reducing response times, especially when there are multiple incidents in the same response district at the same time. Under the current system, response times for the second due ALS unit routinely exceed seven minutes, when the first due ALS unit is unavailable. In cases of cardiac arrest and trauma, this can severely impact the outcome of the patient. The downside to the ALS transport model is that all vehicles will be manned with only two personnel. Despite the transport model staffing of a two man Engine/Ambulance deployment being considered a four person company by NFPA, there are times that those vehicles will be responding separate, leaving a two person company. While every attempt will be made to keep those companies married, it is inevitable that they will respond separate at times. For medical emergencies, taking advantage of the ability to split the companies will prove advantageous. However, the response of a two person crew to a fire incident is inefficient and dangerous (NFPA 2010 3.3.13 pg. 5). The largest negative impact of the transport model is that fire personnel will frequently be tied up bringing patients to the hospital. While the data for this research, using 2010 incident data, suggested that this amount would average only 2.84 hours out of a 24 hour shift, the aging population will continue to cause an increase in incidents, which will further increase the frequency of the FD Ambulances being out of service. Should the transition to the reduced staffing model take place, the city would see a savings in wages, overtime, and benefits, but will also face a loss of capability from the

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 40 fire department. The reduction in manning from four to three on each Engine will affect the tactics that are deployed on the scene of fire incidents as well as other incidents. As NIST (2010), Crowley (2004) and Miller (1984) have shown, this will cause a decrease in the effectiveness which should result in an increase in property loss, firefighter injuries (Varone 2010) and possibly even fire casualties. Patient care will also suffer. There will be less manpower on the scene of cardiac arrests and other serious medical emergencies, as well as a reduction in the frequency of Firefighter/Medics assisting with the transportation of patients and the continuity of care. Much like the transport model, the aging population of the city will mean an increase in medical responses, and will also increase the need for Firefighter/Medic assists with transports. While leaving a two person Engine in a district will occur less often under the reduced staffing model than under the transport model, the benefit of the increased manning overall that comes with the transport model outweighs that fact. The reduced staffing model will never allow for four people on the first arriving company to a fire. The assigning of an adequate RIC team at the scene of a working fire will also be problematic under the reduced staffing model. In order to get four personnel to make up the RIC, an Engine Company would need to be assigned another person, from another company. This could lead to accountability issues between companies which has been a cause of firefighter fatalities. Under the transport model, the RIC duties would fall on one of the two person Engine, two person Ambulances responding to the scene as a merged company.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 41 While a four person RIC is a standard, a department needs to be able to provide even more manpower to the rescue of a downed Firefighter, as Morris (2004) has shown that four simply is not enough. If the scene is already low on manpower, the ability to put more personnel in the rescue group would be delayed while awaiting mutual aid. Over the past several years, the moral of the department has been suffering. There is no doubt that this is related to the threat of layoffs and the concessions given back to the city. The future threat of seeing more reductions or the transition to ALS transport does not sit well with many. This has caused an overall lack in motivation, as perceived by the researcher, in the personnel at many levels. While most are still highly dedicated to do what it takes on a daily basis, any changes will be met with resistance. This resistance, as Alyn (2011) pointed out, can be minimized by getting buy-in from the membership. L1557 has done an excellent job being straight forward with the situation at hand and the stakes involved, however, it will take strong leadership from many different stakeholders to ensure a successful future. Recommendations The first recommendation that the researcher would provide to decision makers in the City of Sterling Heights would be to leave the current staffing levels alone. It would be nice to suggest a possible increase to the staffing of the Truck and Rescue, but in the current economic times, this would be an unreasonable request. Furthermore, the researcher would suggest revisiting the possibility of cost recovery for response to medical emergencies as deemed legal by the OIG in the 2004 opinion. If changes must be made, the researcher suggests that the transport model be adopted rather than the reduction model. While the reduction model would result in over

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 42 one million dollars in savings, the transport model would generate revenue that exceeds the savings that would be realized by the reduction model, while maintaining manning allowing for the fire department to offer adequate responses to the residents. In conclusion, the researcher would recommend that Fire Administration solicit help from throughout the ranks of the fire department in order to address the policy changes that will be required with the transition to either model. Furthermore, the department should focus on motivating the Officer cadre to provide the needed leadership to manage any change.

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 43 References 2006 JEMS 200-city survey, EMS from all angles. (2007). Journal of Emergency Medical Services, 1-12. Retrieved from http://www.jems.com/sites/default/files/2006jems200citysurvey-full_tcm16-13547.pdf Alyn, K. (January 24, 2011) The change-resistance myth. Firehouse Magazine. Retrieved from http://www.firehouse.com/magazine/leadership-lessons/change-resistance-myth American Factfinder website of the U.S. Census Bureau. (n.d.). http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=dec_ 10_DP_DPDP1&prodType=table City of Sterling Heights website. (n.d.). http://sterling- heights.net/bins/site/content/pages/gov/citybudget/2010-11_annual_budget.pdf?_resolutionfile=ftppath pages/gov/citybudget/2010-11_annual_budget.pdf City of Sterling Heights. (2009, June 2). City Council Meeting Minutes.. Retrieved from http://www.sterling-heights.net/bins/site/content/documents/council%20minutes%20- %2006-02-09.pdf?_resolutionfile=ftppath%7Cdocuments/Council%20Minutes%20- %2006-02-09.pdf City of Sterling Heights. (2011, March 15). City Council Meeting Minutes.. Retrieved from http://sterling-heights.net/bins/site/content/documents/council%20minutes%20-%2003-15-11.pdf?_resolutionfile=ftppath documents/council%20minutes%20-%2003-15-11.pdf

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 44 Katz, S., Pepe, P. E., Persse, D., & Pratt, F. D. (2007). Prehospital emergency medical response: the role of the United States fire service in delivery and coordination (White Paper). Retrieved from International Association of Fire Fighters: http://www.iaff.org/tech/pdf/fb%20ems%20whitepaper%20final%20july%205%2 02007%20.pdf Ludwig, G. (May 2, 2011). Show me the money. Firehouse Magazine. Retrieved from http://www.firehouse.com/magazine/ems/show-me-money Macomb County Medical Control Authority website. (n.d.). http://mcemsmca.org/wpcontent/uploads/2011/04/6-system-portfolio.pdf Miller, D. (1984, June). Dallas Fire Department staffing level study. Retrieved from the National Fire Academy: http://www.lrc.fema.gov/downloads/coll_dallasfire.pdf Morris, G. (2004). Can rapid intervention save fire fighters?. Retrieved from http://www.iafc.org/operations/legacyarticledetail.cfm?itemnumber=2250 National Institute of Standards and Technology. (2010). Report on residential fireground field experiments (1661). Washington, D.C.: United States Department of Comerce. Pratt, F. D., Pepe, P. E., Katz, S., & Persse, D. (2007). Prehospital 9-1-1 emergency medical response: the role of the United States fire service in delivery and coordination (White Paper). Retrieved from International Association of Fire Fighters: http://www.iaff.org/tech/pdf/fb%20ems%20whitepaper%20final%20july%205%2 02007%20.pdf Price, A.D.F., & Chahal, K. (2006). A framework for change management. Construction Management and Economics, 24(3), 237-251 Retrieved June 23, 2011 from ABI/INFORM Global (Document ID: 1007637731)

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 45 Smollan, R,. & Sayers, J. (2009). Organizational culture, change and emotions: a qualitative study. Journal of Change Management, 9(4), 435. Retrieved June 11, 2011, from ABI/INFORM Global (Document ID: 1919976521) The Ludwig Group, LLC. (2009). Sterling Heights Fire Department; A financial feasibility assessment for a fire-based EMS transport model. Hillsboro, MO: Document property of The City of Sterling Heights, Mi. U.S. Census Bureau Delivers Michigan s 2010 Census Population Totals, Including First Look at Race and Hispanic Origin Data for Legislative Redistricting. (2011). Retrieved from http://2010.census.gov/news/releases/operations/cb11-cn106.html United States Fire Administration. (2101). America s Fire andemergency Services LeaderStrategic PlanFiscal Years 2010 2014. [Adobe ]. Retrieved from http://www.usfa.dhs.gov/downloads/pdf/strategic_plan.pdf

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 46 Appendix I

THE FUTURE STAFFING OF THE STERLING HEIGHTS FIRE 47 Appendix II

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