By Blanca Cantu
The Dallas Morning News
Copyright 2008 The Dallas Morning News
DALLAS — Firefighters and paramedics throughout Dallas say they are being spread too thin by 911 calls and are in desperate need of relief.
On Monday, Dallas Fire-Rescue Chief Eddie Burns plans to release a draft proposal to reallocate department resources to address the rising demand.
“The call volume has increased, [and] it has outpaced our current resources,” Chief Burns said.
The proposal, known as the EMS Vision plan, focuses in particular on the rising number of emergency medical calls, which make up more than 60 percent of the department’s total calls, officials said.
For firefighters and paramedics, one issue stands out above all others: the need for more personnel and equipment.
Officials said the vision plan will call for adding more resources, although they declined to give specifics.
Over a period of eight fiscal years — from 1997-98 to 2004-05 (the most recent year for which data was available) — Dallas Fire-Rescue’s total calls rose 19.5 percent, department figures show. In the same period, staffing levels rose only 3.5 percent.
The number of personnel available per 1,000 calls actually fell during that stretch — 13.4 percent, according to the figures.
There’s one important piece of good news, said First Assistant City Manager Ryan Evans, who oversees public safety for the city: The department’s response times are better than the national average.
“Our citizens are fortunate,” he said. “But our responders are working very hard — perhaps too hard.”
Joe Kay, who recently retired as deputy chief for the department’s EMS operations, agreed.
“Our response times are good,” Mr. Kay said. “That’s not the issue. The real issue is we’re running our paramedics to death. The paramedics are exhausted.”
EMS calls have been rising each fiscal year — some years 6 percent or more — but staffing levels have not kept pace.
Adding to the department’s challenge is what first responders and officials say is a troubling level of 911 calls that turn out to be noncritical. Employees have cited examples ranging from minor injuries that required only Band-Aids to a young, inexperienced mother who didn’t know what to do about her baby’s diaper rash.
“We’ve become more of a mobile social service,” Chief Burns said.
“911 is a safety net for the U.S. health care system,” said Dr. Marshal Isaacs, the department’s EMS medical director. "[People] know that if they call 911, the fire department and paramedics will come and do their best for them.”
The vision plan will include a recommendation to start a multilingual effort to better educate the public on when it is appropriate to call 911, officials said. Dr. Isaacs said the department and the city need to help residents find access to agencies that can assist them with nonemergency needs and ease the burden on the 911 system.
Long days, nights
Firefighters and paramedics work 24 hours on duty, followed by 48 hours off. Most crew members sleep in their uniforms with their boots next to their beds.
“If you ride [an ambulance], you will not be sleeping until the next day,” Dr. Isaacs said.
To get a feel for what working one shift is like, Capt. Reynaldo Padilla of Station No. 18 suggested trying to jump out of bed at the sound of an alarm clock 10 to 15 times a night. That would be considered a slow night. On weekends, the number of calls can hit 25 — a workload that Dr. Isaacs called unreasonable.
More than half of the department’s ambulances are responding to an excessive amount of calls, Mr. Kay said. On average, each of the city’s 44 ambulances answers about 4,600 calls annually, he said.
“Anything over 4,200 runs per year is a busy ambulance,” he said.
In fact, several of the city’s ambulances answer more than 5,000 calls a year, said Mike Buehler, the most recent former president of the Dallas Fire Fighters Association.
Mr. Buehler noted the standard spelled out by the National Fire Protection Association, which states that cities with ambulances making more than 3,500 runs each per year should consider adding resources.
“In other words, more ambulances,” he said.
Mortality rates and response times could increase if Dallas Fire-Rescue isn’t given more resources, he said.
Mr. Buehler said there have been numerous recent instances in which an ambulance wasn’t available to respond to a medical call. When those situations arise, the department sends a firetruck or an engine as a first responder until an ambulance can get to the scene. Sometimes out-of-district ambulances from across the city respond, resulting in longer waits.
“We are the busiest in the county because [the city] hasn’t added the resources that we need,” Mr. Kay said.
Staffing or equipment?
Officials said the vision plan will call for more ambulances — but not necessarily more paramedics. During the last several years, nearly 100 firefighters and paramedics have been added to the department’s ranks, bringing staffing to 1,687 by early January.
“We may have enough to do different types of staffing,” said Dr. Isaacs, who is among a short list of officials who have seen the vision plan. He said the plan may call for staffing fire engines with a paramedic and equipping them with advanced-level supplies, providing care similar to what is available in an ambulance, short of the ability to transport.
Officials declined to say how many more ambulances have been recommended or when they might be added to the fleet.
“We would need six more front-line ambulances today” to handle the increasing call load, Mr. Buehler said, referring to ambulances that are on call 24 hours a day.
With ambulances costing more than $1 million each, it’s highly unlikely that six will be added to the fleet at once, he said.
Mr. Buehler said that Dallas Fire-Rescue must decide which two of three possible traits — cheap, fast and good — it wants to strive for.
“It can be cheap and fast, but it wouldn’t be good. It can be good and fast, but it’s not going to be cheap,” he said. “By all appearances, the city has decided it wants cheap and fast, which means they’re going to sacrifice quality of service.”
Dr. Isaacs said the department can provide fast and good service but also can be fiscally responsible.
Of the recommendations suggested in the plan, “throwing a lot of money at the problem was not a viable solution,” Dr. Isaacs said. “The answer to the [call] volume is not simply adding paramedics and adding ambulances.
“There are things the department can do.”