During the Firefighter Life Safety Summit in May 2004, sponsored by the National Fallen Firefighters Foundation, 16 initiatives were established to help reduce the number of firefighter deaths by 25 percent within five years and 50 percent within 10 years. The Anne Arundel County Fire Department, Millersville, Md., has attempted to identify programs it can implement to help achieve many of these objectives.
In fact, on April 6, 2006, Fire Chief Ronald D. Blackwell accepted the “Seal of Excellence Award” from the National Fallen Firefighters Foundation for those efforts. One of the 16 initiatives recommended a national protocol for emergency response, part of which would specifically determine when an emergency response is and is not appropriate.
This article describes the Anne Arundel County Fire Department’s non-emergency response policy entitled “Hot, Warm, Cold” developed to help specifically address this initiative.
An increasing number of firefighters in the United States are being killed while responding to or returning from emergencies. According to the National Fire Protection Association (NFPA), more firefighters were killed during 2003 and 2004 while responding to or returning from emergencies than any other type of duty.
In 2003, vehicle collisions claimed the lives of 53 civilians and fire service members. Of those, 37 (70 percent) occurred during an emergency response, according to National Highway Traffic Safety Administration (NHTSA) statistics.
In 2002, more than 50 percent of civilian and firefighter fatalities in vehicle collisions occurred while en route to or return from emergency scenes.
On April 9, 1970, the Anne Arundel County Fire Department (AACFD) experienced its first line of duty death of a career employee during an emergency response.
Since 1977, the fire department has been involved in 3,875 collisions. The total direct costs of those collisions have exceeded $1,648,719. A total of seven civilians have died as a result of collisions with fire and emergency medical vehicles during an emergency response.
Clearly, the experiences of AACFD, as well as national statistics, suggested that additional efforts were needed to help reduce the risk of vehicle collisions.
Anne Arundel County, Maryland has a population that exceeds 500,000 and covers 534 miles of shoreline along the Chesapeake Bay. AACFD’s 31 fire stations and support facilities are staffed by more than 1,400 career and volunteer personnel who provide emergency medical services, fire suppression, inspections, investigations, hazmat responses, special operations, communications, training and related functions with an annual budget of $81 million. The number of annual dispatched calls exceeds 73,000.
Over the years, AACFD has taken steps to enhance safety and reduce the overall number and severity of vehicle collisions. Drivers meet NFPA standards, take part in annual driver’s training that includes a classroom and a practical component; drivers are automatically included in a “red flag” program which allows Anne Arundel County to receive notice anytime an entry is made to their Maryland Driver’s License record.
Those with more than six points are not allowed to drive and face disciplinary action. A vehicle collision review board reviews all collisions and recommends action to prevent a recurrence. A discipline process is administered to those involved in preventable collisions and safe drivers are recognized for their years of not being involved in a preventable collision.
Traffic preemption devices have been installed at numerous intersections that allow emergency vehicles to preempt a red signal. Several types of calls have already been designated for a non-emergency response including: controlled burnings, odors of smoke outside, and assisting the police with evacuations. Most recently, emergency medical personnel began making an on-scene determination if an emergency or non-emergency transport to the hospital was warranted.
In 1998, the department completed its first self-assessment of the NFPA Standard 1500, Standard on Fire Department Occupational Safety and Health. The initial assessment found the department was only 41 percent compliant – and there was work to be done, including improvements as recommended in the Vehicle Safety Section of NFPA 1500 to reduce vehicle collisions included the establishment of policies regarding vehicle speed, actions at intersections, and so forth.
The procedures used to implement a non-emergency response policy within Anne Arundel County Fire Department consisted of several steps. The first step was to solicit information from fire/EMS departments from across the United States regarding their non-emergency response policies.
The results indicated that 65 percent of the respondents had a departmental policy that prohibits an emergency response or requires a split (emergency/non-emergency) response on certain types of calls.
All of the respondents indicated that the reason for implementing such a policy was to reduce the risk of vehicle collisions. This was followed by a desire to reduce wear and tear on apparatus, excessive busy times, fuel use, false alarm reductions, and increased seasonal populations.
Another item on the survey asked respondents to identify the issues that were considered when implementing their non-emergency response policy.
A total of 31 concerns relating to issues were provided. The results indicated that 82 percent addressed an issue relating to response time and how the difference in travel time between an emergency response and a non-emergency response might impact their delivery of service.
This was followed by legal concerns, citizen concerns, dispatcher training, Insurance Services Office (ISO), local government officials, medical director approval, mutual aid, and other medical services.
When asked if there was a single issue that was more difficult than any other, the responses included getting firefighter-drivers to slow down, insurance (ISO) ratings, the legal duty to respond, and the unknown.
Concerns About ISO Ratings
Their concerns about ISO ratings prompted additional research in this area. On September 27, 2005, I spoke with a representative of ISO. The purpose of the call was to clarify whether ISO had any requirements that would mandate an emergency response to any call types.
The representative advised that the ISO is only concerned with a unit proceeding to an incident. Policies regarding the emergency or non-emergency response of that unit are left to the discretion of local authorities.
The survey also asked how other departments selected non-emergency call types. The greatest number of respondents (82 percent) said they used common knowledge to select calls such as alarms and Dumpster fires.
This was followed by the use of a commercially available Medical Priority Dispatch, common knowledge of the results of alarm soundings and Dumpster fires, an in-house protocol system for medical calls, use of a commercially available Fire Priority Dispatch program, review of patient care needs, and ISO requirements.
In an additional section of the survey, the respondents gave examples of fire calls that they have decided warrant a non-emergency or split (emergency/non-emergency response). They included: automatic alarms, residential alarms, vehicle accidents with no injury/fire, reduced responses during severe weather, leaves/debris, check detectors, small fuel spills, carbon monoxide alarms, continuous false alarms, contractors working on alarm system, service calls, coverage to another station, second-due truck company to commercial structures, second-due truck company to multi-family occupancies, and wires down.
Respondents also provided examples of medical calls that they have decided warrant a non-emergency response. They included check welfare, units requiring staging, when police are on scene, non-threatening calls to hospital, facility to facility, pick up someone who has fallen, man down, “A” calls in EMD, “A-C” calls in EMD, “regular customers,” and EMS screening (non-response/no code) life assists.
Only 40 percent of the respondents had a method of monitoring, feedback and control mechanisms to measure the effectiveness of their program. Techniques included monitor responses, use quality control reviews, feedback from personnel and analyze response data.
Our next step was to solicit input from citizens of Anne Arundel County regarding a non-emergency response policy. This was addressed through the use of a telephone survey. Its purpose was to gain a sense of the public’s perception of a non-emergency response policy.
The first question asked was as follows, “Some fire departments are providing their dispatchers with specialized medical training to screen 911 calls more thoroughly.”
As a result, ambulances sometimes respond to an incident without red lights and siren. This decreases the risk of vehicle collisions and enhances the safety to everyone on the highway.
The next question asked if the residents would you be opposed to such a policy. The results indicated that 85 percent of our citizens would not be opposed to such a policy.
Next, they were asked “Upon arrival and evaluation by our medical personnel, they may decide it is in your best interest to proceed to the hospital without red lights and siren. Would you be opposed to this?” Again, 85 percent responded that they would not be opposed to this.
Surveying The Public
Lastly, they were asked “Certain fire calls could receive the same non-emergency response such as isolated Dumpster fires, reports of an outside odor. Would you be opposed to selected fire responses being handled without lights and siren?” This time, 96 percent reported that they would not be opposed.
Next, we analyzed emergency and non-emergency response times. Travel times were compared for several types of calls over a 12-month period from the department’s computer aided dispatch system.
First, the travel times to structure fires and cardiac arrests were obtained. These two types of calls were selected because both required an emergency response per department policy. Next, travel times to fire and EMS service calls were summarized. These two types of calls were selected because both required a non-emergency response per department policy.
Within the 12-month period, there were 10,701 structure fires and cardiac arrest responses and 2,466 fire service calls and medical service calls. Research indicated that the travel time for the structure fires and cardiac arrest responses averaged 5 minutes and 54 seconds. The travel time to fire and medical service calls averaged 5 minutes and 35 seconds.
In addition to this technique, a more detailed procedure was established whereby response and travel times were measured with a stop watch. Three different medical units were selected to participate – one in an urban area where response times are normally short, another in a suburban area where there is a mixture of responses, and a third in a more rural area of the county. During this procedure, drivers on the three medical units used a stop watch to measure their actual response time to the scene and to the hospital.
After the data was collected, fire departmental personnel who were assigned to “light duty” timed the same route under non-emergency (routine) driving conditions. A total of 49 calls were measured. The median difference in travel time between an emergency and non-emergency response was 2 minutes, 11 seconds to the scene and 2 minutes, 21 seconds to the hospital.
The final step was to analyze response data from the Anne Arundel County Fire Department in an effort to determine what call types might be candidates for non-emergency responses.
For each fire call, the following data was provided: (a) nature code; (b) number of units dispatched; (c) number of units arriving on location; (d) total time on scene; (e) situation found.
The percentage of units not arriving on the scene was calculated, the types of situation codes that indicated a non-emergency were selected and totaled and the average time on the scene was calculated.
Using this method, for example, if a large percentage of an individual nature code had situation codes indicating no emergency, minimal on-scene time, and a large percentage of units canceled prior to arrival, this may suggest a non-emergency or split response would be appropriate.
A total of 12,030 calls were included over a 12-month period. The results indicated that an emergency did not exist 78 percent of the time; that the total on-scene time was 11 minutes, 26 seconds; and that an average of 38 percent of the apparatus dispatched was cancelled before its arrival.
Furthermore, the results showed that in detector activations (including water flow alarms) in high-life-hazard occupancies and smoke detector activations in residential occupancies, a non-emergency situation existed more than 70 percent of the time.
Calls where the average time on the scene was less than 15 minutes included controlled burnings, smoke detector soundings, brush near structures, alarm soundings, odor smoke/gas in area, Dumpster fires (standing alone), high-life-hazard detectors, appliance fires, and miscellaneous fires. We also identified numerous types of calls in which 50 percent of the units were cancelled prior to their arrival.
The analysis of this data was presented to the Anne Arundel County Fire Department’s Occupational Health/Safety Workgroup, the Volunteer Chiefs Council and the senior staff of the Fire Department.
These groups categorized each fire call type as a “Hot,” “Warm,” or “Cold” response. “Hot” responses were defined as those where all units respond under emergency conditions. “Warm” responses would be a split response, where the first-due unit(s) responds under emergency conditions and all other units respond under non-emergency conditions.
“Cold” responses require everyone to respond under non-emergency conditions. Of 38 fire call types, 17 were recommended to be “Hot” responses, 6 were recommended to be “Warm” responses, 12 were recommended to be “Cold” responses, and 3 were recommended to be left to the discretion of the dispatch supervisor.
The implementation of a well-researched, non-emergency response plan may have the potential to be a tremendous risk reduction strategy for any emergency service organization.
In their book, “Principles of Emergency Medical Dispatch,” 2004, authors Jeff Clawson and Kate Boyd Dernocoeur indicate that Salt Lake City, Utah, Fire Department experienced a 78 percent decrease in vehicle collisions after full implementation of their program.
St. Louis Deputy Chief Frank Schaper said in a 1998 article published in Fire Chief, that the St. Louis Fire Department experienced a 35 percent reduction in vehicle collisions. While our new response policy has not been in use long enough to fully measure its effectiveness, the Anne Arundel County Fire Department is hopeful it will experience similar positive results.
An analysis of your department’s response policies is part of a full and comprehensive safety and health self assessment/self audit.
For its self assessment, AACFD used NFPA 1500 as a guide. Since our initial audit in 1998, we have improved from 41 percent to nearly 85 percent compliance with that standard. It is critical that fire departments, large and small, undertake a similar serious approach to the 16 Firefighter Life Safety Initiatives and create a safer environment for all its members.
This article was intended to provide an overview of the process used by the Anne Arundel County Fire Department, Maryland, to establish their non-emergency response policy.
Questions or a request for a copy of the complete research analysis project may be directed to the editor of Fire Apparatus and Emergency Equipment Magazine at [email protected], or by postal service at Fire Apparatus, 234 Monarch Hill Road, Tunbridge, Vt. 05077.
Editor’s Note: Allen S. Williams, a 29-year veterans of the fire service, is a division chief with the Anne Arundel County (MD) Fire Department. He has an A.A. degree in fire service technology and a B.S. degree in fire service management from the University of Maryland and is an NFSQB-certified Fire Officer IV and Instructor III.