Medical calls dominate fire run stats

When the dispatch call goes to a typical Michigan fire station, chances are it has nothing to do with fire. In fact, odds are about four in five it's some kind of medical emergency.

And even then, it may well turn out to be a false alarm.

Not exactly the kind of sirens-blaring drama many associate with their local fire station.

In St. Joseph in Southwest Michigan, officials from the International City/County Management Association studied daily logs for that city's firefighters. In that department, which does not respond to medical calls, it found firefighters in active service just 33 minutes in a given 24-hour period.

Thanks in large part to the advent of smoke detectors and commercial and industrial sprinkler systems, fire departments battle far fewer fires today than they did decades ago.

In Michigan, the number of fires fell to 33,421 in 2010; in 1977, the total was 82,297, reports the National Fire Protection Association.

But while fire calls dropped, EMS responses reached new heights as fire departments have transformed into medical first responders. According to the NFPA, fire responses accounted for about 4 percent of calls in cities of more than 50,000 in 2008, compared to more than 70 percent for EMS and false alarms.

Two of Michigan's largest cities --Grand Rapids and Lansing-- illustrate the trend.

The Grand Rapids Fire Department reported 19,634 calls in its 2010 annual report, including 12,601 emergency medical service calls and 689 fires extinguished. Lansing reported 16,769 calls, with 14,507 being EMS calls and only 398 fire calls.

"Most fire departments now are largely EMS departments that, as a sideline, do firefighting," said Leonard Matarese, a public safety consultant for the International City/County Managers Association. He has advised departments across the country on ways to share services and cut costs.

Bridge graphic: Per capita fire protection costs for Michigan's 51 largest communities

Matarese and other consultants believe the decline in structure fires and growing role of firefighters as medics should prompt rethinking of how departments do business.

In the aftermath of 9/11, firefighters were celebrated as national heroes. And they are rightly acknowledged for courage. After all, 87 Michigan firefigthers lost their lives fighting fires from 1975 through 2011, an average of more than two per year.

But as police and fire departments eat up half or more of a typical municipal budget, cash-strapped cities across the state are beginning to ask: Is there is a smarter, cheaper, better way to protect communities from fire and provide front-line emergency medical care?

Answers in Michigan come in many forms, with wildly uneven results, and no clear consensus on what system affords the best bang for the buck. And in much of Michigan, EMS dispatch can be a hodgepodge of potentially missed rescues because it is not centralized and coordinated. That means the closest ambulance to an emergency might never get the call.

Lansing relies on a comprehensive fire-based EMS system, dispatching medically trained firefighters to medical emergencies and providing hospital transport, as well. Cities such as Grand Rapids send firefighters as medical first responders, but rely on private ambulances for advanced on-scene treatment and to get patients to the hospital.

Detroit's EMS system -- budgeted as part of the state's second-most expensive large-city fire department at $236 per capita in 2010 -- has struggled with broken rigs, mismanagement and reported response times of twice the national standard. A grandmother waited 25 minutes for an ambulance earlier this year after her granddaughter stopped breathing. The infant died.

In 2010, neighbors of a man injured while cutting grass reported calling EMS for 35 minutes and being told there was no ambulance available. A TV news crew followed a Detroit EMS ambulance crew for a night and found an average response time of 20 minutes.

The NFPA benchmarks emergency response time at 9 minutes for urban areas, 10 minutes for suburban areas and 14 minutes for rural areas.

State Fire Marshal Richard Miller thinks a fire-based EMS system, when done right, is hard to beat for prompt medical response. With stations typically spread throughout a municipality, EMS units get to a victim more quickly than a typical private ambulance service, he said.

"Fire-based EMS is the Cadillac," said Miller, a former fire chief for Dearborn who assumed his state post earlier this year. "Those rigs are coming from a designated spot and normally, fire-based EMS is the only one that can provide that model.

"Mrs. Smith has a better chance of survival with fire-based EMS than not."

Rich Szczepanek, EMS systems administrator for the Ottawa County Medical Control Board Authority, concedes that "in a perfect world" the closest resource would always be sent. The county relies on a combination of firefighter and sheriff's department medical first responders and several private ambulance firms for advanced on-scene treatment and transport to the hospital.

The private firms are dispatched by jurisdiction in fixed portions of the county, a system Szczepanek  contends "works well" even though it does not assure the closest ambulance always gets the call.

"Is it a perfect system? I don't think there is a perfect system," he said.

Ted Roelofs worked for the Grand Rapids Press for 30 years, where he covered everything from politics to social services to military affairs. He has earned numerous awards, including for work in Albania during the 1999 Kosovo refugee crisis.