This is our second story in a series about Fire Department staffing. See the first installment at this link.
Staffing at Marshfield Fire and Rescue has been a continual concern for members of the department. As call volumes continue to rise due to what national experts are calling the “silver tsunami” of an aging population, and the budget challenges presented by Medicare and Medicaid, staffing levels at Marshfield Fire and Rescue remain stagnant as staff continues to assume more responsibilities.
Chief Scott Owen’s primary goal is to find a solution and ensure the department has the proper staffing numbers before something tragic happens.
Budget Challenges & Rising Call Volumes
A special meeting of the Police and Fire Commission originally scheduled for Thursday was cancelled. The main goal of the meeting was to discuss adding additional staffing, something that has now been put on hold until next budget cycle.
Originally, Owen hoped to be able to increase staffing during the 2019 budget process, but this effort has been pushed to 2020, primarily at the request of the Police & Fire Commission – the governing body of Marshfield’s public safety departments.
(Unlike other City departments that report directly to the City’s elected Common Council, Marshfield Fire and Rescue and Marshfield Police Department, respectively, report to a Police & Fire Commission that is appointed by the Mayor. Marshfield’s government consists of a “weak” mayor and strong Council, with the Police & Fire Commission operating with optional powers.)
“In the current budget process that we’re starting, additional staff has been put on hold pending further data collecting and another look at the feasibility study,” said Owen.
Currently the department is in a new four-year contract with Marshfield Clinic Health Systems to provide interfacility and intercept ambulance services, and with the return of helicopter service through LifeLink III, there are several variables that will be part of the review before making a decision to increase staffing.
“The initial push was to get at least six months of data. Now we have a year’s worth of data with the Clinic,” explained Owen. “However, one of the items that was discussed with commissioners was making sure that we have the funds available to add staff, and to show that it’s a community need and we are not subsidizing the Marshfield Clinic by bringing on additional staff solely for that. We’re assisting the Clinic, but we’re doing it more for the patients in Central Wisconsin.”
“The direction of PFC is they’d like more information,” said Owen. “With LifeLink here, I understand to a point that they want to make sure that we are self-sufficient, that we aren’t asking for more taxpayer money, that we shouldn’t be supporting another business. But, this isn’t just about another business. This is for all requests for services the department responds to in the city (e.g., fire, ambulance, hazardous materials, etc.). No matter what the request is the fire department is an all-hazard response agency and we will assist as we can.”
“The commission is made up of business individuals,” he added. “They want to make sure we are not putting ourselves in the red or subsidizing the Clinic. They look at it from a business perspective.”
Additionally, the department is still waiting on the final results of the annual ambulance audit, which was delayed due to staffing struggles in the City of Marshfield Finance Department.
Nationally, call volumes are rising due to an aging population. Though providing intercept and interfacility transfers through the Clinic is a factor, the department has seen a steady rise in 911 calls for service.
“Ambulance services and health care in general across the nation are going to be dealing with the Baby Boomers as they retire,” said Owen. “As everybody gets older, it’s going to have an impact.”
Also creating a burden on staffing efforts is the financial limitations of the current setup. Though Marshfield Fire & Rescue is funded through City taxes, the city ambulance service is operated as an Enterprise fund, meaning it is run similar to a business and not through tax dollars.
“The amount that we made last year was not as much as what was anticipated,” said Owen. “People don’t always pay their bills. One of the things that we didn’t take into account was, as our billing increases, the amount of Medicare automatic adjustments increases as well. Medicare, as well as state Medicaid, have an impact on what we’re able to do. Because of these programs, it is hard to collect on ambulance services.”
Rising maintenance costs are also a practical concern that impacts the budget.
“One of the other things that we took into account, but not as full as we should have, is ambulance maintenance,” he said. “We didn’t know how many interfacility transports we would be doing because we weren’t privy to that info from the previous operator. We have been doing neonatal interfacility transfers for the hospital for years, but we were backup to the Spirit who conducted majority of the transfers. We haven’t had a helicopter for a year. Now, we have a helicopter again. How much is LifeLink III going to play into our long distance transports? We don’t know.”
With the request for increase in staffing being pushed back, there is now more time to review the impact of LifeLink III, which is a welcome addition to the emergency response community, and to study the impact of Medicaid and Medicare on the department.
Along with more time to review also comes more strain on current department staff and leadership.
From Three to Two
Since the beginning of Owen’s career at Marshfield Fire and Rescue 22 years ago, there have always been three personnel dispatched on the first responding ambulance.
Starting July 1, changes will be made to how the department staffs the first ambulance. Traditionally the first ambulance has been staffed with three paramedics, and the subsequent ambulances staffed with just two. Starting next week, all ambulances, including the first one dispatched, will be staffed with two paramedics.
According to Owen, majority of calls by the first ambulance are capable of being handled by two paramedics.
“That third person is nice to have on the scene, however with our concurrent calls, and with the sheer volume of calls, we have to call in off duty people more and more,” he said. “By reducing that first ambulance staffing to two paramedics it’s going to keep another paramedic here for an ambulance call or fire response. We’re just making it uniform. It’s allowing one more paramedic at the station for additional calls.”
In the event there is a need for additional staff in the City for an ambulance response, Owen said an engine will be dispatched and procedures are being put in place that the engine will respond as needed. The engine already responds to assist the ambulance crew within the City as requested by the on-scene crew or nature of call. This is not a new concept; it is one that is done by departments across the country.
“There are some that are upset that we are dropping to two on the first ambulance,” said Owen. “It’s a big change. All they’ve known is having three. I’ve had some crew members talk to me about it. Some are not excited about the way we are going, but I have to look at what’s best for the department and the city. I have to watch out for the firefighters. They are our #1 resource, but I also have to watch out for what’s best for everyone else.”
Owen assures the community that there will be no decline in care due to the switch.
“The patients will not see a difference. There is no reduction in the level of care to the citizens. Period. They are still getting a critical care paramedic – just two instead of three on the first ambulance,” he said. “The only thing that we’re looking at is reducing the need to have to call in off-duty people for multiple ambulance calls. By having that extra person here, it will help in the grand scheme of the budget, especially in overtime costs.”
According to Owen, Marshfield is actually one of just a few ambulances in the area that run three paramedics on the first ambulance. In Wisconsin Rapids, for example, a chase vehicle is dispatched if extra staffing is required. However, comparing Marshfield to other municipalities is far from an apples to apple comparison. Every community is different and has different geographic responsibilities and resources. For example, Marshfield’s ambulance serves not just the City of Marshfield, but outlying County areas under annual contracts.
“My goal has been and will continue to be to try to get firefighter/paramedics hired here not solely for the ambulance calls, but primarily for that cross staffing of apparatus making sure the appropriate number of rescuers are available whatever the circumstances,” said Owen. “As well as making sure that we have enough firefighters on the scene of a house fire to be able to do an effective attack without having to wait for off duty personnel or mutual aid departments.”
Morale Takes a Hit
Though the change itself may not affect patient care, a majority of staff at Marshfield Fire & Rescue are disheartened by the decision, largely because they were hoping additional staff could be hired to assist with workload. More importantly, department staff feels the decision shows a trend moving in the wrong direction.
“They were looking forward to getting more staffing to spread the work out, and the decision very much took a hit to morale,” said Deputy Chief of EMS Steve Bakos. “It’s very obvious around here. I understand the reasons – it always comes back to budgets, but with the amount of calls we’re running, and the size of our community…we can project where we are going to be at in the future and we really need to start looking at staffing.”
“For our job, it takes a lot of time to bring someone on board,” added Owen. “Trying to plan ahead is really what we’re looking at.”
Having a fire-based EMS service has multiple benefits to the community, including increased availability, higher rate of paramedic retention, and the availability of a wide array of services to the community. Firefighters that are cross trained offer flexibility in staffing various types of apparatus. They also are able to handle issues right away as they happen instead of having to call a different agency for assistance. Personnel assigned to the ambulance respond not only to EMS calls, but fire and other calls as well. Because they are cross trained, they can be assigned any task that needs to be completed on an incident. Staff are versatile and can help in the event of pretty much any emergency situation – be it fire or EMS related. Having fourteen people on staff is the national standard for a residential structure fire, but to implement that in Marshfield would cost approximately $1 million.
“We’re lucky if we have eleven on a scene,” said Owen. “We usually have eight or nine. Additional staff would definitely benefit the citizens. We’d be able to do more. We’ve run with the current number since 2008-9.”
Another benefit to more staffing would be more time to train; with the increase in call volume, there has been virtually no time for training.
“All deputies are doing administrative work all day. They don’t have time to train with their shift,” said Owen. “It’s been discussed for 20 years that we should have a training officer here. We’ve needed one forever.”
Owen’s worst fear is that someone gets hurt – be it civilian or firefighter/paramedic – because of staffing limitations.
“To me, the perfect storm would be: three concurrent (happening at the same time) emergency calls, leaving two or three people left in the station. We get a fire call, respond and confirm it is an actual fire. We make calls for off-duty personnel and we may or may not get anyone depending on time of day/year. If off-duty personnel do come in there is a time delay which has an impact on fire suppression/rescue efforts. If we activate mutual aid departments, by the time they get here, it’s usually too late,” he said. “We have told the crews ‘Above all, take care of one another.’ That’s getting harder. People are tired.”
The Need for Staff
With an old downtown and several large industrial workplaces such as Masonite and Weinbrenner, a dangerous fire in Marshfield is far from impossible.
“It’s only a matter of time. My number one goal is to make sure that these firefighters have the resources to do their jobs, that they have a long successful career and then a happy retirement,” said Owen. “I want to have the resources here, as any fire chief in the world does, to do our job and to do it safely and to do it the best that we can. If that means that we need to look at other options, we will. One of those is additional staffing.”
On one recent fire, he described how one firefighter had to run up and down stairs to feed a hose to an upper story where a mattress was on fire.
“He did that several times, and it’s not easy. It’s very taxing with the added weight of fire gear and their air pack,” said Owen. “It’s those little things that people don’t necessarily think about. It might seem like it’s just someone standing there feeding hose, but it’s not. Time is everything during a fire.”
With 315 square miles to cover for the ambulance service, Marshfield is somewhat isolated when it comes to providing service. The next closest paramedic service is Wisconsin Rapids or Stevens Point. While Rapids has sufficient mutual aid with Nekoosa Fire and Ambulance as well as a private ambulance service in Grand Rapids for ambulance responses, Marshfield has no other departments in the immediate vicinity that are at the paramedic level. The surrounding agencies are paid-on-call/volunteer departments and the two ambulance services are at the EMT (Basic) level.
“We are on an island with no water,” said Bakos. “If we call in people, we typically get a few. If we put in a call to mutual aid to Hewitt, Richfield, or others by the time they get the page, get to the station, get on their rig, it’s often too late.”
“If money were not object, I’d love to see each shift with 14-15 people,” said Owen. “The mayor is for it, and some commissioners are for it. The others need additional information. I totally get that, but sometimes you just have to take a chance. Unfortunately, it’s going to be that one fire where either a civilian or firefighter is seriously injured or dies and the after action review will include ‘what could have been done to have prevented this?’ – that’s something the Commission and the City will need to consider and be prepared to discuss. I hope it never comes to that.”
A complex issue, Owen plans to use the next several months to continue collecting data and examining budgets with the end goal being to increase staffing and lessen the current burden on department staff.
“My goal is, if we’re going to hire additional staff, it’s to have them funded by the EMS fund and not taxpayer dollars,” said Owen. “What I’m anticipating is taking the data that we’ve collected from July 1, 2017 through 2018 and starting to put together the request again in 2019 for the 2020 budget. If there’s a way that the revenue we’ve received in 2018 shows the EMS fund can support additional staff, then we’ll look at it even earlier. It’s all dependent on what the revenue is.”
In the meantime, he and his department will keep serving the City of Marshfield to the best of their ability, hoping that it’s time and not a tragedy that leads to much-needed change.
“We are reaching a breaking point soon,” said Owen. “We don’t want the breaking point to be at the expense of staff health and community health. My plan is to keep moving forward, to keep studying, and to hope that by the end of the year we have answers.”