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The first part of this series on automatic aid explained the concept and how it is set up. This part will look at those components of the system in need of reform: reimbursement and staffing levels.

Section 9.L. of the automatic aid agreement states, “Participants agree that automatic aid is reciprocal. While automatic aid does not ensure that a community will receive the exact same amount of assistance as it gives, it does mean that all participants will provide assistance outside its jurisdictional boundaries and that the level of service delivered within the Automatic Aid System will be comparable.”

Section 11 says, “Except as specifically agreed to by both parties for a particular incident, neither party shall be reimbursed by the other party for any costs incurred pursuant to this agreement. In the event of Declared Disasters, participants may apply for reimbursements from County, State and Federal agencies.”

This agreement acknowledges that some governmental agencies will send more aid than will be received and mandates that the level of service provided will be comparable. There is no acknowledgement of reimbursement in the amount of service provided by one agency to another. It goes on to specifically mandate that there will be no reimbursement from one agency to another.

Here is the problem with those concepts. In information provided by Glendale Fire Department’s Assistant Chief DeChant (now Acting Chief) in 2014 for Fiscal Year 2012-13 Glendale provided automatic aid outside of Glendale for 5,583 calls. It received automatic aid within Glendale from other jurisdictions for 3,361 calls. Glendale answered 2,222 more calls for service outside of its city limits in FY 2012-13 than it received from other jurisdictions. Glendale per the automatic aid agreement was not reimbursed for any of those 2,222 calls representing an imbalance in reciprocity. According to a recent Arizona Republic story that number rose in FY 2014-15 to a disparity of 3,800 calls, unreciprocated, made by Glendale outside of its boundaries.

It is impossible to accurately determine the cost of sending a large engine or ladder truck to an emergency call. Internet researched numbers vary from a low of $400 to a high of $1200 per call. For purposes of this discussion I chose a number in the middle – $800 per call. This number would reflect the salaries and benefits of personnel, the use of a ladder truck or engine answering calls 90% of which are medical, the fuel cost and the maintenance cost of the vehicle.  If you multiply the excess number of calls made outside of its boundaries in FY 2012-13 which is 2,222 by $800 per call the total is $1,777,600 dollars. $1.7M is a fair estimate of the expense to Glendale taxpayers in FY 2012-13 to answer more calls outside of Glendale than are received inside of Glendale due to automatic aid. Does that seem equitable to you?

Apparently in 2013 when the Sun City West Fire District was attempting land annexation within the City of Peoria, Peoria’s Fire Chief Bobby Ruiz raised the very issue of equitable automatic aid service. A Peoria Times story in June, 2013, reported, “Peoria Fire Chief Bobby Ruiz was on the ground floor in the 1980s, when the fire departments of Glendale, Phoenix and Tempe came together to form the automatic aid system with Phoenix being central dispatch. Under that system, whichever fire engine or paramedic truck was closest to an incident, it would automatically respond first.”

“Then, it would eliminate building duplicate fire stations across the street from each other,” Ruiz said. “It’s always been the intent of cities to provide fire, life safety, and medical services within their own jurisdiction. So, being comparable, it would be equitable.”

“In Sun City West Fire District, in the last calendar year, we responded 62 times, they responded 32 times” to parcels in the SCWFD covered district, Ruiz said. “It’s still understood one jurisdiction should not benefit from another district.” Sun City West Fire District Assistant Fire Chief Mary Dalton responded to Ruiz by pointing out, “In 2012 alone, Peoria residents were the beneficiaries of more than 4,500 calls for 9-1-1 service answered by neighboring fire departments. However, Peoria emergency units only assisted their neighboring jurisdictions roughly 2,700 times.”

Here’s something else to think about. Automatic aid may be putting pressure on the response times of all jurisdictions. Let’s imagine that you live down the street from a fire station. It’s very comforting to think that should you need emergency medical service the response would be very fast, maybe 2 or 3 minutes from time of dispatch to your home. Not so fast. What if that station is answering another call…in Peoria or Phoenix? The next closest unit would be dispatched and it is possible that it would take the unit more time to arrive at your home. It’s an issue to think about if you are the one with the medical emergency.

In Section 3 of the automatic aid agreement it states, “It is agreed that the scope of this agreement includes automatic assistance in responding to fires, medical emergencies, hazardous materials incidents, rescue and extrication situations and other types of emergency incidents that are within the standard scope of services provided by fire departments in the Automatic Aid System.” What type of vehicular equipment does the Glendale fire department utilize to answer medical emergencies? It uses large engine or ladder trucks with 4 personnel on board.

Section 9. I. of the agreement states, “System participants recognize the importance of service delivery and personnel safety issues. The minimum daily staffing level for engines and ladders shall be four members. Henceforth this will be referred to as full staffing. Engine and ladder staffing may be reduced to three trained personnel for short periods of time as established by the Life Safety Council throughout a 24 hour shift. Departments that enter the system with a staffing level of three members on each engine and/or ladder shall have an active plan to accomplish full staffing within one year of entry.”

Section 9. P. says, “System participants agree that full staffing as described in NFPA 1710 on engines and ladders provides the most efficient and effective personnel safety and service delivery to the public. Staffing engines and ladders with less than full staffing has financial implications to neighboring jurisdictions, the system as a whole, and the public. Before June 30, 2016, participants that reduce staffing below full staffing shall be subject to financial considerations intended to make the system whole. After June 30, 2016, participants that reduce staffing below full staffing shall no longer be members of the automatic aid system.”

The issue is not the use of a large truck with 4 personnel when responding to a fire. Even as a non fire call expert one recognizes the need and necessity for large equipment to respond to fires. No, the issue with automatic aid is the tremendous number of emergency medical calls.

An estimated 90% of all calls to which Glendale fire responds are medical emergencies. The following information was provided by Acting Chief Chris DeChant in 2014 (then Assistant Chief) in my request for information after attending the first public session of the department’s Customer Based Strategic Planning exercise: “In FY 2012-13 the total number of medical calls in Glendale was 23,824 and the total fire calls were 2,222.” Why is it necessary to send a large engine or ladder truck with 4 personnel to over 23,000 medical calls?

Just think of the costs involved. If I remember correctly these large vehicles get about 4 or 5 miles to the gallon. Think of the wear and tear sending these vehicles to thousands of medical emergencies annually and the maintenance costs associated along with the salaries and benefits paid for 4 personnel. Typically one or two personnel on these vehicles have either Advanced Life Support (ALS) or Basic Life Support (BLS) certification and the other two personnel do not.

How much money could a municipality save in using smaller vehicles with just 2 ALS or BLS paramedic personnel on board? Mesa is attempting to find out despite the threat of a hammer in Section 9.P of the automatic aid agreement. At the 2013 California Fire Chiefs Association Annual Conference Mesa Fire Chief Harry Beck and Mesa Medical Director Doctor Gary Smith presented The Horizon of Fire-Based EMS. Here is the link to their presentation: Mesa EMS costs .  It is interesting and well worth reading. In it Mesa outlines the current pressures on traditional fire-based medical service call delivery. Mesa is using 4 Transitional Response Vehicles (TRV) staffed with an EMT Captain and an Advanced Life Support (ALS) firefighter. It is a concept whose time has come and makes a great deal of sense in terms of cost savings to the community as well as providing efficient medical service delivery. Mesa’s concept flies in the face of the currently mandated stipulations within the automatic aid agreement that acknowledges the use of fire engines and ladders to respond to all calls, including medical calls. If you reread sections 9.I. and 9.P. cited above it appears to be a preemptive strike to prevent Mesa from moving forward with the concept.

After the council’s vacation this July Glendale staff will make a presentation on public safety needs. It would be wise if this council requested to hear a presentation from the Mesa Fire Department and its use of Transitional Response Vehicles (TRV) in responding to medical emergencies. If it has proven itself in Mesa perhaps it is time for Glendale to adopt Mesa’s model. Perhaps the $3M+ the Glendale Fire Department is seeking would be better spent in the development of an alternative medical emergency response approach. After its initial investment it would create cost savings for Glendale’s taxpayers with more effective service.

Then there is the question of lack of a reimbursement scheme within the current automatic aid agreement. It is not equitable that some jurisdictions, such as Glendale, require their taxpayers to subsidize thousands of emergency medical responses to its neighboring jurisdictions. The imbalance has become far too great and far too costly in a time when dollars are so important to every governmental agency. Council should direct staff to begin this conversation of reimbursement with other participating automatic aid agencies. It is an issue whose time has come.

Automatic aid is an essential component of fire delivery service in the Valley. It should not be scrapped but it can be made better. Participating jurisdictions have got to look at the imbalances and inequities within the system and address a means of restoring equity between agencies. They also must recognize that using large trucks with 4 personnel for a majority of calls that are medical is not cost efficient or effective and develop a new model to respond to those types of calls. A system created 40 years ago can certainly use some reform.

In Part 3, automatic aid gives rise to the questions surrounding ambulance service and annexation issues – related issues for your consideration.

© Joyce Clark, 2015

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