As seen in the August 2004 issue of Fire Chief magazine
Budget planners are increasingly tightening belts and making tough decisions. It's certainly not uncommon to read about cities considering staff and service reductions to balance budgets, and unfortunately fire departments aren't immune from the budget ax. With cities throughout Texas facing a slower-moving economy with future unfunded mandates, it's a challenge to maintain service levels.
As Sugar Land approached the fiscal year 2003-04 budget process, department heads were challenged to reduce base budgets by 2% while maintaining service levels. The Sugar Land Fire Department viewed this directive as an opportunity to reexamine business practices, and managers discovered an opportunity to expand services within current resource levels to meet critical needs in a way that achieves long-term savings.
Resource reallocation
Sugar Land is a fast-growing city of about 68,000 southwest of Houston. As of the last census, the city had grown 158%, ranking it first in growth among the state's 45 largest cities. With a diverse population of mostly college-educated professionals, expectations for quality services are high.
The fire department has succeeded in meeting the community's expectations, as evidenced by the city's 2002 Citizen Survey. The fire department received some of the highest ratings, with 96.2% of respondents rating fire services as excellent or good. To build on this high level of customer satisfaction, the department recently identified several key areas for improvement, mostly relating to the ability to provide elevated levels of EMS and hazmat response.
In 2001, the department put into service a 1.5-ton emergency response vehicle designed to respond to non-fire-related calls, as medical emergencies and car accidents account for more than 60% of all calls in the coverage area. The plan was to use the smaller apparatus for emergency medical response, motor vehicle accidents, non-emergency service calls and hazmat spills, prolonging the life of the department's heavy-duty fleet and reducing maintenance costs. This was an excellent strategy at the time, but response statistics for the squad gave cause to take a hard look at the unit's role in the department.
In 2002, the squad responded to 1,017 EMS calls and 450 fire calls. Those EMS calls occurred within four of the city's six fire response districts, which represents 250 calls per station annually, or fewer than one additional call per station per day. But because the squad responded to every structure fire in the city, fire calls represented a duplication of services.
With engines running one to four calls per day, the squad was not accomplishing its original mission. Moreover, a new fire station is expected to open in the near future that will provide relief for the district where the squad makes the majority of its calls. Clearly the dynamics of the department have changed since the squad was placed in service.
Specifically, the department plans to reassign the squad to respond solely to hazmat incidents, one of its original missions. The number of hazmat response calls in Sugar Land doesn't merit 24-hour staffing of a hazmat vehicle; therefore, the squad will be assigned to a station staffed on all shifts with hazmat technicians. If there is an incident, the unit will be available for immediate response.
The firefighters who were previously needed to operate the squad will accommodate the department's current need for two additional firefighters per day to cover unscheduled absences related to personal issues or family illness, allowing an increase in opportunities to use benefit time. The reallocation of squad personnel also provides two additional personnel for overall operations.
Specialty services
In looking at alternatives to better use the squad, managers felt the department's role as an EMS responder could be leveraged and expanded. In April 2002, the department implemented an EMT-Intermediate pilot program for firefighters assigned to the squad. Under the guidance of Sugar Land's medical director, firefighters in the program have received advanced training recognized by the Texas Department of Health to the EMT-Intermediate and EMT-Paramedic level. All other firefighters are certified as EMT-Basic, allowing them to administer oxygen, apply bandages and splinters, and conduct emergency defibrillation.
Reassignment of the squad provides an opportunity to expand the EMT-I program to every apparatus. There are currently 24 firefighters trained to the advanced level, 18 of whom are needed to staff the six stations with one EMT-I firefighter per shift. The remaining six firefighters will be used to cover vacations, holidays and unscheduled absences. This plan uses existing resources, but more importantly, it makes ALS services more accessible to the community with no increase in the department's base budget.
According to the American Heart Association, more people can survive sudden cardiac arrest if the following sequence of events is carried out in a very rapid manner: early access, early CPR, early defibrillation and advanced care. Brain cells deprived of oxygen after four minutes start to die, a process that is often irreversible. Seconds can make the difference between whether someone lives or dies, a central factor in the decision to expand the EMT-I program.
Rapid results
Sugar Land has historically relied on Fort Bend County Emergency Medical Services to provide ALS services. According to the county, local responders most likely will arrive on a scene before a county ambulance, which could take more than 10 minutes to arrive. Because fire department vehicles are more numerous and more dispersed throughout the city than the county ambulances, they averaged a response time of five minutes for EMS calls in 2002. Expansion of the EMT-I program is expected to further improve the delivery of ALS services.
The department also has 30 firefighters trained as hazmat technicians. Like many suburban departments, Sugar Land has limited capabilities, such as identifying materials, containing spills, stopping leaks and, to some extent, rescuing trapped victims. Building on the plan to reassign the squad to hazmat duties, the department has been involved in a countywide effort to purchase $60,000 in hazmat equipment. Fire chiefs in the county have been working together to facilitate an improved regional response, with the focus being to combine resources and create a regional hazmat team that would be available for major incidents 24 hours a day, 365 days per year. Sugar Land is spearheading the creation of this team. Additional grant funding has been secured from a Texas Domestic Preparedness Assessment.
It's important to see a department embrace EMS and hazmat training in the way the young men and women of SLFD have. EMS makes up 80% of what most departments do today. This enhancement of services to the community not only provides an elevated level of service but also has improved morale in terms of professional development and additional compensation for use of special skills.
In financial terms, the directive from city management to identify a 2% reduction in the department budget equates to $122,000. Reassigning the squad represents an overall savings of about $225,000. This resource reallocation prevents the squad from being taken out of service and elevates the level of service provided by the department.
The reallocation of resources accomplishes many important purposes. It's a way to work smarter and achieve financial savings, but most significantly, it addresses the department's primary goal, which is to save lives. Sugar Land firefighters typically are the first responders to emergency calls. Because time is of the essence when delivering life-saving services, what they're providing is an opportunity to survive.
Dannie C. Smith assumed the position of fire chief for the City of Sugar Land in February 2003. His first task was to review levels of service within the department and identify existing opportunities for improvement.