Firefighters almost never fight fires nowadays, turning fire departments into emergency medical services agencies. Is there a better way?

By DAVE DALEY for the Badger Institute

At the Greenfield Fire Rescue Department in 2016, 87 percent of total calls were for EMS/rescue. Photo by Allen FredricksonThe ever-blaring sirens in Cudahy suggest the small city of 18,000 is perpetually ablaze. Fire Department vehicles rolled out of the city’s two fire stations on almost 2,400 calls in 2016.

But just 3 percent of those calls involved fires of any sort.

A whopping 86 percent were for medical calls and most of the rest for traffic accidents, falls in homes, hazardous material spills, false alarms and the like.

Still, at a city meeting last December, Cudahy Fire Chief Daniel Mayer set off a minor squabble when he would not acknowledge the changing landscape.

“We’re staffing for fires, but we’re still staying busy with EMS (emergency medical services),” Mayer argued to an alderman asking if medical calls were not the department’s main business these days. “We run the ambulance on the side,” Mayer insisted. “It’s what we do in our spare time.”

Not really.

Cudahy’s own data for 2016 show the reality: 2,058 calls for emergency medical services, 270 calls for other services and a mere 70 calls to fight fires in dumpsters, buildings, vehicles, fields and the like.

The department’s annual report listed only $428,306 in total fire losses for 2016 — the two most notable being a condo fire on Creekside Drive that caused $65,000 in damage and a garage fire on College Ave. with an estimated loss of $30,000.

It’s the same story all over Wisconsin. Less than 3 percent of calls to fire departments in Appleton, La Crosse and Sheboygan were for fires, most of which were hardly infernos. Less than 2 percent of calls to fire departments in Madison, Greenfield and West Allis involved smoke or fire. In Eau Claire? Just 1.2 percent.

And even those percentages are a little misleading because most “fires” included in “fire call” statistics in most cities are not a threat to life or valuable property. In Milwaukee, where 3.4 percent of Fire Department calls in 2016 were classified as “fire calls,” for example, only 1 in every 164 actually involved fire or smoke in structures other than garages. Even in the category of “fire calls,” rubbish fires were more prevalent than structure fires. And for every one fire of any sort, the department responded to 24 emergency medical calls.

The fact is that fire departments nowadays don’t deal much with fire.

Throughout the Badger State and much of the rest of America over the past two decades, fire departments have morphed right before our eyes into EMS agencies. And this raises sometimes uncomfortable questions about whether our most cherished of public servants are really serving the public as efficiently and effectively as taxpayers and policy wonks would hope.

The questions are obvious: Have fire departments downsized to the extent possible? Are they really the best and most logical way of providing medical services and transportation? Separating emotion from fact is particularly difficult given America’s debt to firefighters of the past.

In an increasingly volatile world, public safety professions have taken on “sainthood,” former Beaver Dam Mayor Jack Hankes says. Too many cities view fire and police positions as a “sacred cow.”

“They’re untouchable since 9-11,” he adds. “No elected official I know will whack public safety without a lot of thought, as it is tantamount to political suicide — that is, ‘How dare you put my children at risk?’ ”

Risks and rewards

The risks, any actuary would conclude, are nowhere near what they used to be.

While the nation’s population grew over 40 percent since 1977, structure fires plunged 57 percent over the same period, according to the National Fire Protection Association.

Big improvements in fire safety — more fire-resistant building materials, tougher building codes, quicker fire detection through increased use of smoke alarms and automatic sprinkler systems — are behind the sharp drop in fires, the experts say.

Fire deaths across the United States match that downward trend: Home-structure fire deaths fell 56 percent since 1977, NFPA data show. You’re now about seven times more likely to be murdered in America than you are to die in a fire or from smoke.

Fire chiefs and the often unionized firefighters they manage saw this coming decades ago. Fire departments across the country and in Wisconsin started providing ambulance and emergency medical services in the mid-1970s. Levels of acknowledgment of the extent of the transformation vary widely, however.

Mayer, the Cudahy chief, says his remarks at the December meeting need to be put in context.

“My complete comments relate to a longstanding understanding of the Fire Service that may not have been found or made clear in … one specific meeting,” he says. “No question, we perform more EMS responses than fire responses. But even if we eliminated the EMS calls from our responsibility, we would still need to maintain our staffing for effective and safe firefighting operations.”

The Greenfield Fire Rescue Department is one of the agencies acknowledging the shift. In 2016, it had 4,444 EMS/rescue calls — 87 percent of total calls — but only 64 fire calls, or just over 1 percent.

“We have to admit it; we’re an EMS department,” says Chief Jonathan Cohn. In fact, Cohn’s business card reads: “Fire Chief-Emergency Manager.”

Jonathan Cohn, Greenfield fire chief-emergency manager“We want to not just talk it but become a more EMS-centric fire department. We recognize the changing field and are doing something about it,” he adds.

“The role of the fire chief is not standing in front of a burning building ore. It is about evaluating best practices, focusing on vision and making that happen,” Cohn says.

Reshaping the department to fit that new model is a hard sell, Cohn admits. “A lot of the industry is still selling firefighting,” he says. “People get in to fight fires. We recognize that. Fighting fires is sexy. That’s what we’re up against — the romanticism of firefighting.”

Cohn shrugs, laughs and adds: “It’s not too sexy at two in the morning helping someone get off the toilet.”

Training requirements

Greenfield firefighter Melissa Janson, an eight-year veteran of the department, admits she was surprised when she first got into the profession to discover how little firefighting is done these days.

“Most people get in to fight fires,” she says. “That’s what they thought the job was.”

And why wouldn’t they?

Despite the fact that only one in 20 calls, if that, involve any sort of fire — let alone a structure fire — personnel hired in large career departments typically are trained to fight fires in addition to having EMS skills.

The minimum to get hired at most departments is Firefighter Level 1, requiring 96 hours of training. EMT-Basic is 150 hours of training, and paramedic level is 1,500 hours of training.

Responding to EMS calls, says Janson, “is an accepted part of the job now.”

Helping someone in a medical emergency, seeing that instant relief, is gratifying, she says, but admits that responding to a multi-alarm fire “is a different kind of a rush.”

The costs

Becoming a firefighter is not a path to riches.

The U.S. Bureau of Labor Statistics last year reported that the average firefighter earns $46,870 annually, or $22.53 an hour. The Milwaukee Fire Department last year advertised a firefighter position that paid $44,490 after academy training and had a top range of $74,045.

Costs to taxpayers, however, are much higher. In Wisconsin, where firefighters were exempted from Act 10 and still have substantial collective bargaining rights, benefit costs are considerable. In one Milwaukee suburb, for instance, the five highest-paid individuals one year were the city administrator, public works director and three firefighters, raking in big bucks through overtime.

Some departments are growing or shrinking in rough synchronicity with their populations.

In Madison, where the population jumped 47 percent from 170,000 people in 1980 to more than 250,000 in 2016, the Fire Department staff also increased dramatically, with 75 new positions in the past decade.

Milwaukee, a city that lost over 6 percent of its population since 1980 and where only 3.4 percent of calls are now for fires, has implemented cuts under Mayor Tom Barrett. The Fire Department staff dropped 13 percent from 2007 to 2016 — 1,152 employees to 1,007. And in a belt-tightening move last year, the city lost another 75 firefighter positions and closed six fire stations, though not without much doomsaying.

When Barrett proposed the changes as part of his budget last fall, the firefighters union blasted them as “destructive” and told residents to oppose them because “your life may depend on it.”

Such blowback seems inevitable.

But the big question in most cities, not just Milwaukee, is whether fire departments are restructuring as efficiently, quickly and logically as they could — especially at a time when there are a lot of options for providing medical assistance and when mutual aid agreements are increasingly prevalent.

Medical assistance

Part of the high cost of fire service is due to the way departments respond to a simple medical call, like a resident falling on ice. Typically, a department ambulance and a fully staffed fire engine are sent to the scene, complains the former mayor of a Milwaukee suburb, who called it “overkill.”

That kind of response occurs regularly in big-city departments across the U.S., critics say.

“While firefighters’ working realities have changed profoundly in recent decades, their government structures and operating protocols remain largely frozen in bureaucratic amber,” noted a 2015 article in Governing magazine.

A typical 911 call in many big cities means the dispatch of both an ambulance and a fire truck. “The result is an increasingly familiar tableau,” the article continued. “Five or six gear-laden firefighters and/or ambulance personnel arriving on the scene, regardless of whether there’s a fire, stroke or a heart attack in progress — or a passed-out homeless person on the sidewalk, or a motorist slightly dazed in a fender bender.”

In West Allis, where last year there were 50 times as many EMS calls as fire calls, Assistant Fire Chief Jay Scharfenberg says criticisms that departments over-respond to simple falls is a fallacy. He defends the custom of training and equipping virtually all personnel to fight fires even though that is now a minuscule part of the job.

His department uses computer-aided dispatching to determine how to respond in more than 30 typical emergency calls, he says. That response can range from as little as two fire personnel in a single ambulance to more than 80 personnel in 29 response vehicles for a multiple-alarm fire in a high-rise.

“It takes a certain number of firefighters to put out a fire,” adds West Allis Chief Mason Pooler. “(But) there are less and less fires. By requiring everyone to be cross-trained, we can double-dip.”

There were only 156 fire calls last year in West Allis, many of which were not building or structure fires.

“West Allis needs at least 23 firefighters each day in case a fire breaks out. But when those 23 people are not responding to fires, they can all respond to EMS calls, which happen all day, every day. So rather than need 29 public safety employees per day — 23 firefighters and six or so EMTs or paramedics — we can get by with 23 who can do both and be prepared to respond to anything,” Pooler says.

Mason Pooler, West Allis fire chiefAnother way to look at it is that EMS requires fewer people to handle each incident but has many more calls, while firefighting has fewer incidents but requires far more personnel per call, he says.

Large city departments, of course, are quite different than largely volunteer departments in smaller towns and villages, but the overriding issues are the same. There aren’t enough fires to keep old staffing levels of firefighters busy. And while medical calls have grown, there are many alternative ways to provide that service:

• In some Wisconsin communities, the fire department provides emergency medical care but uses private ambulance services if transportation to a hospital is needed, as is the case with the Appleton and Neenah-Menasha departments.

• In Burlington, the Fire Department provides fire and EMS services but uses a separate service, Burlington Rescue, if patients require transportation to hospitals, says Fire Chief Alan Babe. Burlington Rescue, funded solely by the Burlington Rotary Club, is a private, non-paid, all-volunteer fire and rescue service that serves both the city and town of Burlington.

• In the Fitchburg-Verona area south of Madison, Fitch-Rona EMS provides emergency medical care using paramedics delivering what it calls “emergency pre-hospital care.”

The Fitchburg Fire Department, meanwhile, provides fire protection using paid on-call firefighters, while the Verona Fire Department uses a mix of five full-time command staff and three full-time firefighters along with paid on-premises and paid on-call firefighters to augment the full-time staff.

Back in Cudahy, the city relies on neighboring departments when medical calls require paramedic-level assistance, which its 25 full-time firefighters/EMTs cannot provide. Mayor John Hohenfeldt says that deficiency needs to be addressed — and like most city issues, the huge stumbling block is where to find the money to train, hire and pay those paramedics.

Money was also at the heart of the December squabble when a Cudahy alderman questioned why the Fire Department needed more firefighter overtime pay and asked for an audit of the department’s overtime budget. The Common Council reviewed and accepted the audit in mid-March, and the issue is now closed, Hohenfeldt says.

But challenges remain for the Cudahy Fire Department and departments across Wisconsin and the country. Firefighters seem to be slowly coming to the realization that tight city budgets do not bode well for them, that they are no longer sacred cows and untouchable. The profession is at a crossroads.

Fire departments are fair game, and big changes — including privatization of fire services — could be on the horizon if the firefighting community does not start serving up answers to the questions that the public and city hall number-crunchers are asking.

The picture is clear: With cash-strapped municipalities looking for efficiencies in a basic service like fire protection, forward-looking fire departments will themselves find more effective ways to deploy personnel before outside groups decide those better ways for them.

Dave Daley, a journalist for over 30 years, covered the Capitol for The Milwaukee Journal and legal affairs for the Milwaukee Journal Sentinel.

This first appeared in the Spring edition of Diggings Magazine, published by the Badger Institute.