———————————–
Question for Universal Health Care supporters:
Suppose i am a homeless guy who lives at the Pine Street Inn. Suppose I am standing on the corner next to a person who currently has health insurance.
Now suppose a car goes out of control and hits us both. And then suppose we each get the exact same injuries. Broken leg, broken pelvis, whatever.
Now, here is my question. Where do we part company in the medical treatment we each receive for our injuries? Because I have no insurance and no money or assets, what will not be done for me which will be done for the insured guy?
Why do I see a shell game which will cost me more money?
—————————————–
Sen. Jamie (chick’s name if you are not under 12) Eldridge recent self-congratulatory post has me scratching my head. Jamie thinks the new ethics reform laws will really prevent the elected whores from selling their souls to non-elected whores.
In it Jamie stated
We also saw, with the indictment of former Speaker Sal DiMasi, the way greater transparency could have prevented some of the (alleged) crimes that were committed.
Huh? In a comment I asked Jamie if he could explain how, if the charges against DiMasi are true, the new ethics reform laws, if in place at the time, would have “prevented some of the crimes”? Which particular changes and/or editions in the new ethics reform would have prevented which specific crimes Speaker DiMasi is currently charged with?
No answer from Eldridge. Why? Because he made that up. That’s why.
I didn’t take it personally though. If you read Master Jamie’s post you see a number of questions asked by readers. Yet, not one response from our courageous, straight shooting senator.
———————————————-
How stupid were the baseball owners and the players union in allowing anonymous drug tasting even though they would not be anonymous? The current fiasco was a matter of when, not if.
———————————————
Mayor Menino does shit for the kids of this city. He should be embarrassed to have to go to the universities and sports teams to raise some dough for high school sports.
What a joke.
———————————–
Does Michelle McPhee have any self-respect? She calls herself a journalist but all she is a cop sniff. The cops can’t respect her. They just use her. Doesn’t she get that?
BTW, where was she raised. I know she was born in Savin Hill, but that means crap. I understand her family moved to Tewksbury or someplace like that when she was very young. Where did she spend her formative years? Where did she go to grade school and high School. I could be wrong. She could have lived in Dorchester growing up. And if she did? She still sucks.
Being a ball washer for the police does not make you a street smart Dorchester girl or Eastie girl or whatever it is you wannabe Michelle.
P.S. How often do you google yourself Michelle. Ever time I check the key word analysis for BMG I see a Michelle McPhee search. Poor thing.
—————————————–
Let’s start closing some fire stations. We have too many. Times are different and the fire department has to evolve.
And I am so tired of seeing huge portable water pumping machine (fire trucks) and the manpower that goes with it respond to medical emergencies and other bulshit where a few cop and the emts are fine. Of course this is union stuff so the firemen can look busy and look like they are needed more than they actually are.
on EMS calls are less union than emergency service. I can’t find my copy of the MMA’s MUNICIPAL ADVOCATE Vol. 24, No. 3, where the article is located, but I recall one municipality purchasing a car or something to use instead of a fire truck, which wastes a lot of gas.
<
p>I wonk!
how sobering.
Here’s the list of stations:
<
p>http://www.cityofboston.gov/fi…
<
p>So let’s talk response time. Mutual aid. EMS/First responders. Haz mat. Port safety. Transport Safety (hazardous materials being transported by rail; a lot of sick Boston jakes when one of those babies derail). Natural disaster response. Effect on safety and security plans in Greater Boston.
<
p>So how many stations and what’s your acceptable loss rate?
<
p>Massachusetts has one of the lowest FF deaths per capita in the country; only New Hampshire and Rhode Island come in ahead.
<
p>http://www.usfa.dhs.gov/statis…
<
p>
You have not supported your implied connection between station closings and loss rate.
<
p>What Ernie is complaining about, I think, is the current practice of requiring a fully-equipped and manned fire truck for each of these calls. That, in turn, requires a fire station so that all those fire trucks are nearby and at the ready.
<
p>How many of the current scrambles require that fire truck? What if initial responses were with smaller vehicles that do not require an entire bay in a fire station when not in service?
<
p>If it’s people that are needed on-scene, those people don’t require fire engines and fire stations to get there. Most runs are made for routine calls — sprinkler alarms, medical emergencies, lockouts, etc. — for which the current approach is massive overkill.
<
p>I need to be convinced that we can’t adopt a significantly more agile and less expensive response strategy while maintaining current loss rates.
for anything is the bottom line. All too often – these men and women do not know what they’re faced with. The callers, some with limited English, may not be able to articulate their needs. The fire department come prepared to deal with anything. So, you want to reduce capabilities…so what’s your acceptable loss rate?
<
p>So- let’s hear how you plan to address the issues I’ve outlined above. You and EBIII advocate for closing fire stations – so let’s hear your big plan.
<
p>I had this same conversation with Chippie from the Citizens for Limited Taxation. I never thought I’d see the day that I’d be having it on BMG.
We’re talking about risk management. It doesn’t have to be a slugfest unless you insist on making it one. “Reducing capabilities” is meaningless without knowing how often those capabilities are needed. The best way to predict whether a capability will be needed tomorrow is to examine how often it has been needed historically.
<
p>The fire department is tasked to address a certain range of situations. Always has been, always will be. Each of type those situations happens with a certain frequency. While nobody can say for certain where and when the next hazmat situation is going to be, people can say (if the department has kept its records in order) where and when prior hazmat situations have been for the last few decades.
<
p>History therefore provides a very good baseline from which to predict the immediate future (within a range of uncertainty). I suggest that the department perform an analysis of what has actually happened in the past two decades. What has been rolled on each call, and what has been used. Based on that history, adjust the deployments and standard operating procedures accordingly.
<
p>My “acceptable loss rate” is whatever it is now. You still haven’t demonstrated the connection between making the adjustments I propose and the alleged increase in loss rates that you trumpet.
Yet we have EBIII advocating for closing down fire stations before any analysis begins! You better believe I have a chip on my shoulder, every time I see half-assed advocacy masquerading as being informed. It always looks great on paper…but I would want to hear (from the people who would put this sort of thing into action) whether it could work in practice. If this had been a thoughtful, sophisticated and coherent discussion of issues facing FD planning in this century – then we might have a reasonable place to begin the discussion….but to insist of closing stations before any thoughtful analysis begins speaks to me of another agenda that has no place at the planning table. Only look at EBIII’s response to me, and you’ll see what I mean.
<
p>The “adjustments” you mention need to be vetted by professionals in the fire science/city planning/risk management function who can determine whether it’s a wise course of action. I always leave this kind of stuff in the hands of the professionals. But as a former city councilor, I’ve seen various knuckleheads through the years presume they know more than the professionals, with predictable and disastrous results.
<
p>This is exactly why I raised the various risk management challenges in my initial comment – none of which have been addressed by the initial poster.
that risk assessment and management has to be done by competent professionals.
<
p>My concern is that for every “knucklehead” who “insist[s on] closing stations before any thoughtful analysis begins”, there is an equally unhelpful counterpart who insists more firefighters are always needed, more stations always need to be built, more firetrucks need to be purchased, all premised on the assumption that more means “lower risk”.
<
p>I suggest that this is a situation where we will do better to listen and pay attention to all sides of the question. Yes, we need to manage risk. Yes, we need to ensure that our loss rate does not increase. Yes, we need to examine whether there are more affordable ways to do that. Yes, we should look at staffing and training, with an eye towards finding a mix that maintains the current level of service at significantly reduced labor costs.
<
p>One thing that I think we must not do is automatically and blindly strive to maintain or increase public service payrolls. The primary function of public agencies — police, fire, transportation — is to provide a needed service. Whatever jobs are created by the performance of the function generates is a happy accident — NOT a reason for the agency’s existence.
words are “thoughtful and coherent analysis.” I was merely responding to a very off-the-cuff, unthoughtful commentary about public policy that deserved far more than the biased diatribe it received. What I can’t abide is the hand-wringing that ultimately goes along with the body bags,when one doesn’t need a crystal ball to see the forseeable. In 2005, a mere four years ago, the Globe wrote an article about the terrible death of a Lancaster volunteer firefighter. The report revealed the lack of manpower and resources in many locations.
<
p>http://www.boston.com/news/spe…
<
p>Unfortunately, people forget very quickly.
<
p>
If there is a medical call (ranging from chest pains to an auto accident), the fire dept usually arrives before an ambulance. Policemen have a small amount of medical training; firemen have much more. Their ability to
* provide relevant information to EMTs before EMT arrival
* stabilize patients
* provide four extra sets of medically trained hands to the EMTs when they arrive
* administer CPR or a number of other medical procedures
are all really important. This system is far cheaper than increasing the number of EMTs (and ambulances) by a factor of five or more in urban areas.
<
p>I agree that it seems strange that when I had a bike accident (equipment failure) and someone called 911, the fire truck came. But, they were there in about 90 seconds, and quickly determined that an EMT wasn’t needed. Were the accident worse, they’d have been the ones to stabilize my neck and deal with other injuries while the cops diverted traffic around my body sprawled in the middle of the road. How much did it cost the Town to deal with my 911 call? Well, they gave me two ice packs ($2 in bulk?) and they might have used a collective one gallon in gas ($2?). Our town has one EMT on contract, precisely because the firemen can deal with medical emergencies.
<
p>
<
p>Firemen are sitting around on call most of the time anyway. Given that it makes sense for them to know a long list of medical procedures, and given that there’s insignificant labor and capital cost to their responding to medical emergency calls, it seems to me that for their level of risk and harm mitigation, using firemen to respond to medical calls is far cheaper than using many more EMTs. Could they come in a car instead of a truck? Sure, but that would (a) require a car, and (b) require that they drive back to the station if a more urgent emergency broke out when they were already dealing with a now-stable medical emergency.
I agree with the need to provide the immediate response of appropriately-qualified personnel. I wonder if the choice between “EMT” and “Firefighter” is a false dichotomy, though.
<
p>If most calls are of this nature (which is surely true because, as you point out, most firefighters are sitting around on call most of the time anyway), then perhaps we need a new role — “emergency responder” — who handles these things.
<
p>Suppose each “Emergency Responder” were, while “on call”, required to be 30 seconds away from a suitably-equipped vehicle — NOT a fire truck.
<
p>A car is far less expensive to acquire and operate than a truck. If firefighters sit around on call most of the time anyway, then perhaps we don’t need so many of them on call. If emergency responders were dispatched to medical emergencies (like your bike accident), then they could go directly to fire scenes — when needed and only when needed — in their more-agile car.
<
p>If firefighters didn’t need to handle medical emergencies (because of the availability of emergency responders) then we wouldn’t need so many firefighters and we might not have to pay them quite so handsomely.
Methinks you’re putting the cart before the horse.
<
p>1. Decide on the fire response time you’d like to reasonably assure town-wide.
2. Determine the sufficient number of fire stations, based on geographical spacing and (1).
3. Once you’ve done this, you’ve committed to both (a) a staffing number and (b) an equipment number. At this point, if you have a shortage of fire personal, stations, or trucks necessary to respond to medical emergencies, use the BrooklineTom Emergency Responder plan.
<
p>I suspect that (3) never happens. We choose (1) and (2) based on fire requirements, and in doing so don’t need to add additional emergency responders under (3). Instead, we recognize that (1) and (2) were chosen for the rare occasion that there is real urgency and extreme danger; the rest of the time we’ve got a surplus of (already being paid) firemen and (already paid for) fire trucks, just sitting idly. Why not send them to medical emergencies in the mean time, given that the only marginal cost is a little extra gas, and the savings are the avoidance of additional Emergency Responders and their necessary vehicles.
I think the aspect of your analysis that merits re-examination is the assumption that the scope-creep for the staffing of those fire stations determined in step 2 comes for free.
<
p>As Justice4All observed below, the resulting job description for those firefighters has blossomed. Their salaries have correspondingly increased (and rightly so, given their expanded duties), and that increased salary needs to be incorporated into our model somewhere — perhaps in the marginal cost.
<
p>I suggest that firefighters who are just firefighters could cost far less than the full-service variety we’ve now created. Those expanded labor costs are a significant portion of the overall emergency service budget.
<
p>I’m not sure that those “Emergency Responder” vehicles need to be anything more elaborate than a passenger car with an add-on light and siren.
or do you just take the word of self-entitled firefighters?
<
p>really Justice, dn’t you have any self-respect?
Can’t answer the questions? Why else indulge in an ad-hominem attack?
I raised legitimate points – risk management challenges facing the department. These are among the many issues that have to be addressed before “consolidating” the department.
why can’t so many thinbgs. Closing firestaions is my way of saying we have too many firefighters.
<
p>because fires are not anywhere near the frequency as they were 40 years ago it reasons that fire departments swould stay current with the times.
<
p>But nooo, we have ladder trucks responding to medical calls. Common sense tells us the fire departments are over staffed. if they were not, they would not be making needless calls to incidents where police and EMTs should eb able to handle.
<
p>Cops, especually suburban cops, should have me EMTs and have medical stuff in trunk. they are there the fastest.
<
p>BTW. The job description has not changed. We know they are protecting us and blah blah blah.
<
p>But you know what justice? That doesn’t mean we should let them pull their pants down and piss on us. But that is what we do.
<
p>Screw them!
<
p>Fire stations are over-staffed 100% of the time they aren’t responding to a fire or rescue. That is, in fact, the vast majority of the time.
<
p>Of course, when they are needed for response, staffing is essential. Fewer fire stations guarantees slower average response time. The question is: in the case of a fire or rescue, how much time do you want folks to wait until the fire department arrives?
has changed tremendously in the last 20 years. It has gone from being a fighter of fires to being a firefighter/EMT/Public Safety and Public Health officer. In the last 20 years, my husband has been exposed to TB (after the family swore up and down the patient didn’t have it), burned in a fire, nearly delivered a baby, jumped in a river to save kids from drowning, stabilized an HIV-infected cabbie after an accident, picked body parts off the railroad tracks numerous times….shall I keep going? This job has changed, and just because you might not see the changes, doesn’t mean it isn’t happening. Let’s face it – when you need the resources, you’re going to want them there. And they take everything they need with them…just in case. You might call it a waste, but ask the people who have been saved how they feel about it. If you need a defib…do you really want to wait?
<
p>As for the cops getting anywhere faster …well, put up the data on that one. When I’ve had to call for a medical, it’s always been the fire dept. to get there first.
<
p>And there are always a few bad apples. You shouldn’t judge the professionalism of the entire department by the actions of a few.
that the job description of firefighter has dramatically expanded. I wonder if this is an important part of the problem.
<
p>It seems to me that both you and Ernie are correct. The approach we’re taking now demands the kind of firefighter you describe. At the same time, Ernie’s observation that scrambling a fully-equipped ladder truck for every routine medical call seems excessive has the ring of truth about it.
<
p>It seems to me that there might be a better way, and the only way we’ll find out is by daring to actually consider it.