The Default Solution is Always More

My wife announced that there wasn’t enough money in the checking account again. áThe obvious solution to her was that I simply needed to add more money to it each month and that the problem would then go away. áAny attempts on my part to question where the money is being spent is considered completely offensive simply on face value. áThere are so many details that I would just not understand. áAfter all, I simply need to know that we are talking about meeting the needs of our family. áHow could I even consider not addressing those needs? áDo I want a child to go without an education? áWithout shoes or food? áIt could happen she warns, if the funds are not provided. áOh, and I can’t reduce the family size either by letting any of the kids (or even my wife) go. áAlright, maybe I took that analogy to an extreme there at the end, but replace my wife with the fire chief or union leaders, my kids with union firefighters, and make me a politician or simply the public and the story is replayed all over the country and even across the world. á”If we don’t have more money, someone could die!”

I was thinking about this economic routine when I read the articleáCity asked to boost fire resources in wake of slowing response times. áI was prepared to blast it as another of the “how can you put a price on a life” stories. áBut to my surprise, “city administrators” in this case started discussing “restructuring” – they even got to specific issues by pointing out that it was “chute time” that was slowing down even though the actual travel times were improving. áHowever, the familiar refrain still finally appeared, the Alderwoman in this particular story “plans to bring forward a notice of motion asking the city to look at what she calls a general lack of resources within the department.”

While I cannot diagnose why the response time compliance in this specific situation went steadily down from 64.7 percent in 2007 to just 54.7 percent last year, I also cannot concur automatically that it is by default a lack of money. áEven the Deputy Fire Chief “expects a number of factors have played into the slowed turnout times since 2007,” before admitting “but he welcomes additional resources into the department, including more firefighters.”

Again, I admit that I don’t know all of the details surrounding the specific question in this next case askingáShould City Merge Emergency Operations?á But the first thing that struck me was that the city was looking to take over a nonprofit ambulance service in order to save money. áI understand that the city is a major contributor to this service and that the fire department attends one third of their calls yet the city is the one complaining of the duplication of effort. áThe assumption is that the entire amount of support currently being given to the volunteers would be considered savings and could mean a new fully equipped ambulance after a merger. áIt seems to me that the money that was being used for operations would still be needed even after the fact.

A final article I read on the topic wasáNew Toronto Fire Chief Says Merger with EMS Eyed. áIn this story, the City Fire Chief acknowledged that the existing fire model was broken saying “The status quo … is not an option. It just isn’t.” áPart of his initial attack of the problem was reducing the number of firefighters to save money while an official service review is conducted. áOnce that review is completed,á”every single truck in every single location” will be examined to determine the most “efficient” route forward. áIt was exciting to hear an administrator keeping the options (outside of the status quo) open. áBut the next line in the story asked about the recommendation of an accounting firm to merge with the more profitable EMS agency. áThen I began to hear that common refrain begin again when the chief respondedá”I’m not opposed to anything that improves service for citizens.” áHowever, he changed the melody a little by sayingá”You’ve got to build a model that fits this city. We need a ‘Made in Toronto’ solution.” áthere was no talk of “quantitativeáeasing” or government agencies “too big to fail.” áIt was, I hope, straight talk about finding real solutions in a bad economy. áIt may still be the money in the end, but let’s keep those options open until then. áAnd I hope more agencies look at “locally grown” solutions before defaulting to money or taking over EMS.

Oh, and just for the record, I would never really compare my wife to a union boss. áIt was just an analogy, Sweetheart.

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High Performance EMS

High Performance Emergency Medical Services (HP-EMS) systems provide effective clinical care promoting positive patient outcomes and community wellness while maintaining a focus on improving economic efficiency of the system.  This site is dedicated as a community seeking to increase agency performance by promoting useful information regarding the developing trends and improvements in the efficiency of delivering basic and advanced medical care in the field.

Roger Thayne
Static v. Dynamic: A Continuum of Cost
Totally agree. I would add that response and transport need to be understood. Within busy urban areas an ambulance can be both the response and transport vehicle. In rural areas response can be achieved efficiently by a Community Paramedic in a car within 8 minutes supported by an ambulance within 20 to 30 minutes i.e.…
2014-08-10 10:28:37
Jodi, it took a while, but we have begun putting this sort of information together in book form. Our first attempt is "Dynamic Deployment: A Primer for EMS" ( We are already in the process of building its sequel that we hope to be a broader compendium of cases, authors, and opinions regarding the measurement…
2014-08-08 07:44:52
Could Busier be Better?
Since medical calls are now the focus of fire service. Maybe it's time for a rebranding if you will to new terms like "EMS Based Fire Service". Paramedics are constantly upgrading thier knowledge and skills and get thier butts kicked daily but don't enjoy the same pay or benifits that firefighters do. Something is wrong…
2014-08-05 03:55:31
Could Busier be Better?
This article is more about understanding evidence based research then applying it rather then replying on personal experience and tradition. Even if you don't like what research says.
2014-07-19 20:30:03
Could Busier be Better?
High quality comes from seeing multiples of truley sick patients with strong training and support from an experienced partner, not just from being a busy transport vehicle.
2014-07-19 08:26:57

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