Emergency response

In the 27 years that Spokane has used a tiered response system for medical emergencies, there have always been those who scratched their heads whenever a firetruck pulled up to treat a broken bone. The puzzle arose again recently at City Hall, where council members Steve Corker and Bob Apple balked at buying $2 million worth of new rigs that will respond to medical emergencies much more often than to fires.

The council wound up approving the purchase, 6-0, but not until Corker and Apple had questioned whether it makes sense to wear out half-million-dollar firetrucks on calls that smaller vehicles could handle. The answer, under existing conditions, is yes.

“Existing conditions” is another way of saying budgetary constraints that limit firefighter ranks to minimal levels. The phrase also embraces a marked change in the mission of most fire departments over the past three decades.

“Fire” department, in fact, is a misnomer because medical emergencies today account for nearly five times as many responses as fires. Thanks to modern fire and building codes, fire calls have leveled off in spite of growth. Meanwhile, battlefield techniques learned in Korea and Vietnam have been applied in U.S, communities, saving lives by delivering skilled treatment at the scene of an emergency.

Spokane and other communities figured out that they could train firefighters as emergency medical technicians and paramedics. Neighborhood fire stations made convenient bases for responding quickly to most emergencies. In some cases, firefighters trained as EMTs could provide all the care needed, and in more serious cases they could stabilize a patient until an ambulance arrived.

Prior to this arrangement – which also included a 911 system and the aggressive training of citizens in cardiopulmonary resuscitation – survival rates for cardiac and respiratory attacks in Spokane were about 12 percent. A year later they had risen to 20 percent.

In those days, the Spokane Fire Department had four ambulance-like medical units, but even then the first vehicle to arrive on a call was a firetruck.

Since 1988, the number of firefighters on duty in Spokane at a given time has dropped from 75 to 58 even though the population has grown by some 40,000. In that period, the number of units available for response has declined from 26 to 17.

As a result, 13 of the city’s 14 fire stations have only one crew on duty at a time. If that crew is out on a medical call, an incoming fire alarm has to be diverted to the next closest available crew, adding critical minutes to the response time. But even if the first crew has finished its medical emergency, it’s available to take the fire call only if it’s in a fire rig. Otherwise, it’s back to the station to get one – and more delays.

For the cost of adding two firefighters around the clock at just one fire station, Fire Chief Bobby Williams calculates, the city could buy about five firetrucks.

The rationale for sending a firetruck on a medical run was valid in 1981. With fewer crews and vehicles to spare, it’s even more so today .