A Fire/EMS merger might make sense, but there's lingering internal strife over the decision

A Pissing Match Long Overdue 

A Fire/EMS merger might make sense, but there's lingering internal strife over the decision

The plight of urban emergency medical service is a study in dire, vague statistics, but it is best illustrated in absolutes: There are never enough medics; there are never enough ambulances; there is never enough time.

That's not 100­­-percent accurate, but across the nation, city EMS divisions have been stretched so thin that it's beginning to look like an epidemic. Philadelphia, for instance, employs 248 paramedics compared to 1,912 firefighters, even though 84 percent of 911 calls are medical in nature. In Washington D.C., there has been a mass exodus of emergency medical personnel because of overwork and stress, leaving the already understaffed department with an even more critical shortage.

In Cleveland, the situation is similar. Mayor Jackson and the ever-elusive fire chief Daryl McGinnis cooked up a Fire/EMS integration plan in large part to address the changing landscape of emergency response.

Scene published a story two weeks ago castigating Jackson for fast-tracking the integration's first phase without proper vetting by city council and the support of the firefighters union.

What's clear now is this: Though Jackson was still imprudent to orchestrate this substantial restructuring of public safety with what appeared to be a lack of transparency – city council, firefighters and some EMS workers all maintain that they first learned about the integration's schedule (to the extent that there was one) in the pages of the Plain Dealer – the plan is actually necessary for a more balanced approach to public safety.

In real-world terms, the Fire/EMS integration means citizens will get a better, more efficient response to emergencies. After the final phase, (whenever that is), all emergency employees will be dual-role providers – in effect, firefighters/paramedics – so they'll be a more versatile, flexible corps.

That's theoretically a great deal for citizens, but Fire and EMS personnel are apprehensive about what it means for them individually as the integration continues to move forward. Both divisions acknowledge that the integration makes a certain amount of macro-level sense, but there are still many unanswered questions on the micro level.

"The uncertainty is stressful for the field people of both fire and EMS, most of whom have families to support," said one EMS employee. "You have an already thankless job at a very busy department, where employees routinely become injured, are bled and vomited upon, and are cussed at and and sometimes even assaulted. And yet you go to work every day not knowing if your job, healthcare, and pension, as you know it, will still be there tomorrow."

IMBALANCE, STRIFE

Cleveland's personnel dilemma isn't as lopsided as Philadelphia's, but the roughly 260 EMS workers the city employs compared to the roughly 800 firefighters makes one seriously question the department's current makeup, especially when 70 percent of emergency calls are medical in nature, according to the city.

Make no mistake: EMS employees are generally very laudatory toward the fire department. Assistant Public Safety Director Ed Eckart said that though the relationship between Fire and EMS has been bumpy over the past 20 years, it's "gotten much better" recently. He added, in good faith, "I wouldn't do [a firefighter's] job for a million dollars."

But despite firefighters' crucial service to the city in the areas of suppression – literally putting out fires – and rescue, Eckart said what's most needed today in Cleveland's poor, aging communities is simple medical help – a faster response for older folks who go into cardiac arrest, for gun-shot victims, for the perennial terror of heat stroke, etc.

Therein lies the integration's practical hinge: The city has firefighters sitting around in stations more or less twiddling their thumbs. The stations may be decrepit and outdated – as Fire Union President Frank Szabo is fair to point out – but they're certainly outfitted with beds and TVs and computers.

Meanwhile, EMS squads routinely spend the entirety of their 12-hour-shifts in an ambulance, on emergency calls. They don't even have stations, per se. They're relegated to the basements and closets of nursing homes and police stations. They technically aren't even allowed to sleep on overnight shifts or during overtime hours.

JUST TO MAKE THINGS CRYSTAL CLEAR

Frank Szabo said that last year, with 38 companies, the fire department responded to 65,000 calls. On average, that's 178 calls per day. Divided among the division, that's an average of just fewer than 4.7 calls per company.

And bear in mind that that doesn't mean 4.7 fires. That's 4.7 calls. And that's through a full 24-hour day (emergency response obviously isn't just a 9-5 job), so that's a call every five hours or so, on average.

EMS responds to about 90,000 calls per year – city officials hate nothing more than exactitude – and from 2009-2012, there were only 15 active ambulances. Simple math here: (90,000 / 365) / 15 = 16.4.

Paramedics estimate that an average call can take anywhere from 40 minutes to an hour – 10 minutes to arrive, 20 minutes to stabilize the patient, 10-15 to transport to the hospital – so it's not like there's much downtime.

In fact, there were days during the 15-ambulance period when there was no downtime at all. Both Eckart, who was EMS commissioner at the time, and EMS Union President Orlando Wheeler confirm that on many occasions, every single ambulance was actively on a call and people with medical emergencies were forced to wait.

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