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Home My WebLink AboutExpense Increase Staffing ALSStaffing and Service Increase Proposal Nantucket Fire has a minimum staffing of 3 in the winter and 4 in the summer. All interior hazard/fire calls require a minimum of 4 firefighters and medical calls require 3 firefighter/EMTS. This staffing dictates that we can only handle one call at a time. Nantucket Fire currently does not cover the station with off duty personnel when the duty crew is committed on a call. This means that the station is empty if a second emergency occurs on the island. This occurs approximately 837 times a year, or 27% of our yearly call volume. When this occurs our dispatch center calls off duty personnel via pager to respond to the station for the response. This all takes time and ultimately results in the arrival of aid being up to and over 10 minutes. The National standard for response to fire and medicals is under five minutes for 90% of the requests for aid. Nantucket Fire is only able to provide a 5 minute response time for 40% to 45% of our calls. Part of the reason for the extended response times is the long road miles to either end of the island and the other part is the 27% of the calls being concurrent, two, three or more calls received with the same time period. 0 1000 2000 3000 4000 5000 6000 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FY 15 Emergency Calls Non-Emergency Calls Total Another way to analyze staffing is comparison with other fire departments of similar size. Nantucket Fire is unique in that its summer call volume is much larger than its winter call volume. Nantucket does about 400 emergency calls per month during June, July and August and about 200 emergency calls per month in the winter. A survey of comparable Massachusetts fire departments illustrates that 0 50 100 150 200 250 300 350 400 450 July Aug Sept Oct Nov Dec Jan Feb Mar April May June FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FY 15 departments with emergency call volume of 400/month staff with an average of 11, and departments with emergency call volume of 200/month staff with an average of 5. These levels are the minimum number of firefighters to start a shift. Most departments hire to an increased level to allow for sick time and vacations and reduce overtime. Population Seasonal Area (sq.Miles) Full Shift Min Shift Calls/Staff Emergency calls Gloucester 28000 50000 26.5 24 18 66 4772 N. Attleboro 28000 14 71 4000 Wellesley 28000 13 77 4000 Weston 11500 7 89 2500 w. Springfield 28000 16 92 5900 COMM 23000 26 12 10 97 3885 Barnstable 5000 6.5 4 3 100 1200 Clinton 15000 5 5 5 100 2000 Concord 17000 8 100 3200 Sharon 18000 25 6 6 104 2500 Easton 23,200 29.2 9 8 7 Night 109 3500 Shrewsbury 36000 21 9 8 109 3500 Westwood 14500 7 111 3100 Bourne 20000 41 11 9 111 4000 Duxbury 15400 25 5 5 120 2400 Orleans 6500 13.9 5 5 125 2500 Sandwich 20500 35000 42 9 7 125 3500 N. Hampton 28000 14 125 7000 Chatham 7000 15.9 6 5 6 Summer 135 2700 Kingston 12700 19 5 4 144 2300 Gardner 21000 7 6 146 3500 Dennis 18000 65000 22 10 8 146 4684 Whitman 15000 6.1 5 5 150 3000 Somerset 18250 7 7 5 160 3200 Ipswich 1300 33 4 3 169 2028 Hyannis 9 11 9 194 7000 Nantucket 15000 60000 47.5 5 3 4 Summer 258 3100 Nantucket Sumer 400 calls/month 300 calls/staff Average 118 not including ACK Nantucket Winter 200 calls/month 200 calls/staff Every other fire department in Massachusetts depends on Mutual aid. They staff for the normally expected routine calls and borrow resources from neighboring departments when their call volume exceeds the normal volume, and for larger calls which exceed their resources, this typically includes all structure fires. Nantucket does not have this option. Any mutual aid is deployed from the Cape and would take a minimum of 2 hour for personnel and 4+ hours for equipment. As a result Nantucket should have the highest staffing level as a function of emergency call volume. Currently Nantucket has the lowest staffing as a function of emergency call volume. A survey of comparable fire departments illustrates that the level of calls per staff ranges from 66 to 194 with an average of 118 calls/minimum Staff. Nantucket is currently at 200 calls per staff in the winter and 300 calls per staff in the summer. ALS/BLS Advanced Life Support (ALS) has become the standard in pre hospital care. According to the Massachusetts Office of Emergency Medical Services, Nantucket is the only region of the state which has fulltime fire protection but does not have ALS services. There is a dramatic increase in level of care provided at the ALS level, and a moderate cost increase for these services. Service provided at the ALS level gets billed at approximately twice the rate of BLS service. Approximately 80% of medicals calls should be at the ALS level. This will increase ambulance billing by approximately $300,000. Skills comparison Emergency Medical Technician Basic(EMT-B) Additional Paramedic Skills Basic Vital Signs EKG Monitoring 12 lead interpretation Bleeding control Interosseous Fluid Administration Tourniquet Intravenous Fluid Administration CPR Chest Decompression Glucometer Manual Defibrillation Automatic Defibrillation Cardiac Pacing Basic Oral Airway (OPA) Advanced Airway (intubation) Breathing Treatment (albuterol) Breathing Treatment (albuterol & Atrovent) CPAP (continued positive airway pressure) Pain Management EMT Medications Additional Paramedic Medications Albuterol Adenosine Amiodarone Oxygen Atropine Calcium Chloride Naloxone (Narcan) Dextrose Diazepam (Valium) Asprin Diltiazem (Cardizem) Diphenhydramine (IV Benadryl) Nitroglycerin (assist pt. with their own) Dopamine Epinephrine (IV) Epinephrine (Epi Pen, Auto inject) Fentanyl Furosemide (Lasix) Oral Glucose Glucagon Haloperidol Hydrocortisone Ipratropium Bromide (Atrovent) Lidocaine Lorazepam Magnesium Sulfate Methylprednisolone Midazolam (Versed) Morphine Sulfate Nitroglycerin Ondansetron (Zofran) Pralidoxime Sodium Bicarbonate Thiamine Vasopressin Recommendations We recommend that Nantucket Fire gradually increase staffing to a level of 7 per shift with a minimum of 5 in the winter and a minimum of 9 per shift in the summer months. The seasonal increase in staff will be accomplished with a seasonal work force and overtime for fulltime staff. We also recommend that Nantucket Fire increase the level of service offered from Basic life Support (BLS) to Advanced Life Support (ALS). This will be accomplished by hiring trained paramedics and training current fulltime and call firefighters. Seasonal staffing of Madaket and Sconset Stations will also be required to reduce the excessive response times to these areas. We propose the following schedule for increasing staff and implementing ALS service; FY2017 July Hire 4 fulltime firefighter paramedics September -May Paramedic Classroom training for up to 10 Fulltime and Call firefighters May-August Paramedic practical training (250 hours ride time & 250 Hours Hospital time) FY2018 July Hire 4 Fulltime firefighters Renovate Sconset for 24 hour summer staffing FY2019 Hire 12 seasonal Firefighter EMTs (work from Mid June – Early September) Staff Sconset (Mid June – Early September) Renovate Madaket for 24 hour summer staffing FY2020 Hire 12 seasonal Firefighter EMTs (work from Mid June – Early September) Staff Sconset and Madaket (Mid June – Early September) Budget Budget FY2017 Recurring Cost Non Recurring Costs 4 Paramedic Firefighters (salary&benefits) $ 400,000.00 Overtime to Maintain 5 summer and 4 winter $ 76,000.00 Training 10 paramedics $ 250,000.00 ALS Equipment for 2 ambulances $ 100,000.00 Increase in Ambulance Billing at the ALS rate (80% at ALS) $ (300,000.00) Total $ 176,000.00 $ 350,000.00 FY2018 4 Firefighters (EMT or Paramedic)(salary&benefits) $ 400,000.00 Overtime to Maintain 6 summer and 5 winter $ 76,000.00 Training Budget Increase to train one paramedic per year $ 20,000.00 ALS Equipment for second 2 ambulances $ 100,000.00 Renovations to Sconset for 24 hour summer staff $ 500,000.00 Total $ 496,000.00 $ 600,000.00 FY2019 12 Seasonal Firefighters (Staff Sconset Summer) (salary&benefits) $ 196,560.00 Renovations to Madaket for 24 hour summer staff $ 500,000.00 Total $ 196,560.00 $ 500,000.00 FY2020 12 Seasonal Firefighters (Staff Sconset&Madaket Summer) Total $ - $ - Totals $ 868,560.00 $ 1,450,000.00