Rethinking the costly role of fire departments
About 11,500 calls poured into the Medford Fire Department last year, but only 217 were for actual fires, just 35 of which involved buildings (twice as many were for “cooking”). Medford Fire responded to nearly as many calls for lockouts as it did to fires of all sorts.
Medford, where I live, reflects a national trend: In 2021, only 3 percent of calls to fire departments involved fires while 66 percent were medical, according to Susan McKelvey, communications manager of the National Fire Protection Association. Fire departments today thus face a whiplash of trends: Even as improved building codes, materials, and construction standards minimize fires, a failing health care system makes 911 the default house call for an aging and uninsured or underinsured population that often doesn’t seek medical care until it becomes a crisis. In 1981, fire departments responded to just over 5 million medical aid or rescue calls; by 2021, that number had exploded to 26.3 million, according to data from the National Fire Protection Association.
Yet while the reasons for being dispatched have radically changed, how fire departments across Massachusetts respond mostly has not: 911 calls often still trigger a flashing light show of police cars, ambulances, and, often, big red fire trucks. People in distress don’t care about how help arrives, and no matter their vehicle, firefighters and other emergency responders continue to perform life-saving work, often under challenging conditions. But in a time of dwindling resources, both financial and in the fresh supply of emergency responders, is a 40-foot ladder truck that weighs up to 30 tons, gets less than 5 miles per gallon, and requires a crew of up to five really necessary for a broken leg?
“It’s arguably the best known, least acknowledged and most inconvenient truth in local government: ‘Fire departments’ … no longer exist anywhere in America,”
Phil Keisling, former director of Portland State University’s Center for Public Service, wrote in Governing back in 2015. “Thousands of official entities bear this or a similar moniker. But given what they and their employees actually do, ‘Emergency Medical, Incident Response and Every-Once-in-a-While-an-Actual-Fire Department’ would be far more accurate.”
The need to rethink fire departments may not be a hot topic in Massachusetts, but it has taken hold elsewhere long ago, including in California, where civil grand juries convene annually to independently examine the operations of local government, with the 20102011 Santa Clara County Civil Grand Jury reviewing local fire and other emergency operations. “Logic would dictate that [county] fire departments’ continued insistence on clinging to a 100-year-old response model designed to fight structure fires makes no sense given the modern reality that structure fires are the exception and medical emergencies are the norm,” it reported.
Adaptation to this reality is happening in some jurisdictions, with fire departments turning to rapid response vehicles, which are smaller, more agile, and fuel-efficient for medical calls.
In Massachusetts, Amesbury Fire Chief James Nolan agrees with that approach — in theory. “Would I love to be able to respond to more medical calls with an RRV [rapid response vehicle]? Absolutely,” he said in an interview. “But that works only if I have the budget and the people to make it run.” Amesbury this year took delivery on a new 100-foot ladder truck to replace an aging one (a decision that predated his tenure as chief, Nolan said). Fires and other disasters may be increasingly rare, but they still happen — ask Maui — and departments still need ladder trucks to handle them, he and other fire officials explained.
They cite other reasons for continuing to dispatch big red trucks, such as the fact that they can carry tools and personnel to handle unexpected situations. “Suppose we get a call for a minor accident,” Nolan said. “If there’s a gas spill, (the truck) has the equipment to respond. Or I may need a big vehicle to block the highway to protect my people” working the scene. By dispatching them together, a ladder truck and its crew are positioned to respond immediately to another call, rather than having to return to the station.
That’s all true, but it begs the underlying truth of a fundamental mismatch between fire department apparatus and personnel and the demands they face today. With better coordination, budgeting, and staffing, fire departments should be able to effectively respond to lowerpriority calls without jeopardizing their capacity to handle major incidents. “No one suggests we eliminate the fire department, and if my house was on fire, I want them there fast,” said Pioneer Institute senior fellow Eileen McAnneny, whose father was a firefighter. “But in Massachusetts, local rule makes for a ton of inefficiency and inconsistency.”
While most fire departments coordinate with neighboring towns through mutual aid, the delivery of emergency services in Massachusetts — and of transportation, education, and other public functions — is controlled by cities and towns, each with its own rules, priorities, and politics. Some localities combine emergency services with the fire department; others contract out ambulance services or run their own. Some have turned to shared regional dispatch.
Rich MacKinnon Jr., president of the Professional Fire Fighters of Massachusetts, said he agrees that the job of the 12,000 members he represents “has changed into an allincident response. And we’d be willing to take part in any conversation about changes to better serve the public we took an oath to protect. But I don’t know what change would look like or how it would happen in Massachusetts, where we are very siloed, with each town having its own 911 system.”
MacKinnon is all for thinking about long-term reform, especially as the ranks of firefighters and other emergency responders continue to thin. “Any system, especially how we respond to emergencies, has to be looked at and updated. But we still have to maintain priorities of safety, adequate staffing, and equipment,” MacKinnon said.
So for now, the mismatch — in both apparatus and personnel — between established ways and growing demand continues. Medford contracts out its ambulance service, but its fire department also answers thousands of medical calls, often with big rigs that burn 2 gallons of fuel every half hour they idle. All 102 Medford firefighters are trained to the first responder level (trained in CPR, defibrillator use, and Narcan administration) but only 16 are certified EMTs. Medford officials would not make city fire officials available, instead issuing a statement that the city “routinely evaluates its emergency response strategy and … will continue to assess the needs of our fire department as we move forward with our facility improvement projects.”
Those firefighters and other first responders do their best with the limited resources they have. Their daily challenges are emblematic of the need for Massachusetts to cut through the inefficiency and waste that goes with hundreds of uncoordinated local systems, not only in emergency services but across the public policy board.
Though more than a decade old, that California grand jury report captured the challenge facing Massachusetts today: “Interviewees … emphasized that a confluence of public awareness, political will and agency leadership, all pushing for reform, would be the only way to effect change,” it found.
The alarms for change are already going off.
In a time of dwindling resources, both financial and in the fresh supply of emergency responders, is a 40-foot ladder truck that weighs up to 30 tons, gets less than 5 miles per gallon, and requires a crew of up to five really necessary for a broken leg?