The delivery of emergency services to a 21^st Century American City requires planners to think outside the current norm.  We must take into account the drastic changes that have taken place in the 20^th Century relative to our life style, the impact of building codes, traffic congestion, and the advances in communication and medical science.

The challenge is to optimize the delivery of emergency services considering cost efficiency, demographics and traffic congestion.  Consider that many of the public safety challenges we face today did not even exist near the beginning of the 20^th Century when many of the patterns for these services were established.

Try this exercise:  Take out a blank sheet of paper and imagine you are a consultant hired

                        by a new community to plan for the delivery of emergency services.  Nothing exists today except a thirty-five (35) square mile city with roads, subdivisions and commercial space that will be inhabited in the next few years with 50,000 people. Your research tells you  that a city of this size will generate an estimated 5000 calls for service.

                      Of the 5000 calls 4000  will be medical emergencies ; 80% of which will require transport  to the hospital. 800 calls will be general assistance calls for automobile accidents, hazards material spills, water related emergencies and other.  200 calls will be fire or fire related.

Now go to work and see what you can come up with.  Remember, you have no services in place at this time so do not spend any time trying to adapt existing personnel or equipment to fit your model.   One group did such an exercise in a brainstorming session sponsored by CommonSenseGovernment.us  they came up with the following thoughts.

EMERGENCY MEDICAL RESPONSE:

We would purchase and equip five ambulances to respond to all medical emergencies. We would staff each ambulance with a paramedic and an emergency medical tech.  Each unit would carry all the necessary first aide and advanced life support equipment.  Each unit would have advanced communications equipment tied to the dispatch center, with each other and a computer display screen that could transmit and receive information from the hospital emergency room. A GPS tracking devices would show the location of all units in real time for backup and support.  Each unit would be equipped to control traffic signals as they approach in emergency mode.

The units would be mobile, strategically located throughout the city with the capability of shifting locations frequently to cover when other units are actively servicing patients or transporting to the hospital. We would encourage units to shift to different configurations responding to the needs of different times of the day and night, traffic congestion, road construction, special events,etc.

 Units would be manned 24 hours a day on 8 hour shifts to avoid fatigue.  Staffing requirements would be flexible to accommodate peak and slack demand time day or night.

These mobile emergency response units would patrol their assigned areas and/or park in the pre-designated parking spots. Designated parking locations should include electric hook up and the availability of rest room facilities for the public safety personnel. For example, shopping centers, churches or private community service area.  Mobil Emergency Response units could be flexible enough to locate near a known high risk patent or high risk accident corner during rush hour.

 On board television units would feature interactive on the job training programs as well as entertainment to keep officers alert in the long hours between calls.  Fully trained personnel known as “Public Safety Officers” should be trained as paramedics and firefighters to encompass all the skills necessary to meet every type of emergency.

 Additionally, public safety officers could serve as the eyes and ears of the police department as they sit on station or patrol neighborhoods.  They would have direct communication with the police dispatcher, both audio and video so they could photograph and report any unusual situation or potential bad behavior they observe.

FIRE SERVICE

We would purchase four fire trucks and place these at three statically located public safety stations throughout the city.  Three trucks would be general purpose units; pumpers with ladders; and one unit for brush fires.  Each general purpose unit would be staffed with one firefighter; the brush fire unit would be staffed on demand.  Any additional specialty equipment would be on demand from the County or shared with neighboring departments.

While the staffing on fire apparatus may seem quite lean, we would also note that each public safety officer is a trained firefighter and will respond to any fire related calls in their area.  Additionally we would make extensive use of volunteer firefighters. Fire trucks could carry extra personal equipment for the public safety officers located in the neighborhood and the volunteers who would meet the fire engine at the fire location. Chances are the public safety officers and perhaps even some volunteers would arrive at the fire scene before the fire engine arrives, so they are able to evaluate the situation, locate the fire, locate the hydrants and organize the scene prior to the Fire equipments arrival.

Chances are your local Public Safety officer in just down the street.

PUBLIC SAFETY STATIONS

 Public safety stations would serve as storage for fire apparatus and equipment storage of off duty ambulances and medical equipment.  Please note we have not made provisions for sleeping quarters or office space. Public safety officers working an 8hr shift would not need to sleep on the job. Supervisory personnel should be housed in mobile units, perhaps an SUV or van out in the field on the job. Computers and cell phones have eliminated the need for a fixed office. For example, if a supervisor is making a fire inspection, attending a Rotary meeting or giving a first aid demonstration at the grade school, their office is right there with them.  Supervisors in the field would be available to respond to calls and assist in fire, rescue and EMS operations.

Here is just one of many examples of what can be accomplished with 21^st Century thinking.  The City of Troy in Oakland County Michigan is a city of thirty four [34] square miles and population of 81,000 people and has an assessed value of 13 billion dollars.  This city contains numerous high rise buildings that house headquarters to several NYSE listed companies.  Interstate I-75 runs through the middle of the city.

Fire service in the city includes fourteen (14) full time firefighters and one hundred eighty (180) authorized volunteers.  They responded to 1500 calls last year which included fires, hazardous material spills, drowning and auto accident extractions. The city has an I0S class three rating with an operating budget of $3.9 million and a $500,000 capitol budget.  Paramedic First Responder is Alliance Mobile Health Service which responded with an ambulance to four thousand (4000) incidents last year; ninety percent (90%) within five minutes.  Total cost to the taxpayers was $500,000 dollars.

This is a level of service beyond excellent and with a total budget of under $5million annually divided by the City of Troy’s estimated 32,000 households the cost per household is under $160.

A more local example is Weston Florida a city of 61,000 people located in Brevard County.  Weston has 3 fire stations and 4 fire engines to service its 61,000 residents.   They respond to all medical calls with two paramedics in an ambulance ready to transport to the hospital.

Unfortunately Emergency Service response in Bonita Springs is much different than the plan we have conceived above or the example we see in other cities.  Bonita Springs with a population of 40,000 people has 13 fire trucks and 29 other vehicles with 112 personnel located in 5 fire stations. Bonita does not own an ambulance or an EMS vehicle.

Bonita Springs Fire and Rescue responded to 5,142 calls last year less than 200 were fire related.  Bonita responds to all calls with one or more fire trucks. Ambulance service is provided separately by Lee County.  Bonita Fire and Rescues budget which does not include ambulance service was in excess of  $20 million last year.  Divide the $20 million by an estimated 26,000 households and the cost was over $769 per household.    Now add to that the cost of ambulance service that is included in your Lee County taxes.

Do you sometimes wonder why your property taxes are so high?  Bonita Springs Fire District was the third largest item on your tax bill right after Lee County and the School District.

Since 90% of the calls for service are medical perhaps a few more words about Emergency Medical response.  People are less concerned with who provides EMS than with how it is provided.  Our customers want a quality EMS system that assures prompt, reliable, courteous and most importantly clinically competent service. 

EMS providers should respond to each call for assistance safely and efficiently. Every  responder to any emergency scene must have a positive impact on the patient care equation.  They must add value to the care being provided to the patients.  If they detract or add no value to this equation, they should not appear at the scene.  It should go without saying that the  right equipment should be sent to the scene and not waste resources by assigning  unproductive personnel or equipment.

  The most capable clinicians on scene should perform a thorough (high index of suspension) and rapid clinical assessment.  The entire clinical team present should determine the proper care required and implement essential life support measures as soon as possible.  Each finding and intervention should be recorded on the patient care report and all related information must be transferred to the receiving hospital staff (nurse or physician) upon transfer of care at the hospital. 

 Every intervention (life support measure) should be considered as another step closer to the hospital. The only delays in this progression to definitive care should be reserved for the preservation of life, prevention of further injury / disability and for the reduction of suffering.

The final goal of each EMS interaction is to effect the timely transportation of patients to area hospitals for definitive care.  Nothing should inhibit that prime directive. 

The taxpayers of Bonita Springs are paying an exhorbanent price for Fire and Rescue Service and not receiving the quality of service they deserve.

 In 1999 Bonita Fire and Rescue was given the responsibility as First Responder for emergency medical calls.   It is inexcusable that after 8 years Bonita Springs Fire and Rescue has less than ---% of their personnel qualified as Emergency Medical Technicians and of the departments 112 personnel only ----are Paramedics.  More shocking is the fact that the department does not own one Ambulance and must rely on Lee County to provide transport to the hospital that is required on 80% of the calls.  Further they have resisted the idea that they should provide transport to the hospital, they respond to all calls with a Fire Truck and insist on preserving the archaic practice of working 24 hr shifts that requires them to eat and sleep in the fire hall.

The Board of Commissioners for Bonita Springs Fire and Rescue should relinquish their monopoly on Emergency Medical First Responder and put the contract out for bids.  This would allow a private contractor (such as the case in the example above)  or Lee County EMS, either of which are better positioned to bring the level of service up to par for the citizens of Bonita Springs immediately.   

If you or a loved one had a medical emergency in the middle of the night which would you prefer to see at your front door, a fire truck or an ambulance?