In previous columns (see part 1 here and part 2 here), I looked at the comparative cost of fire and emergency medical services (EMS) in neighboring cities and the funding model for regional fire authorities. In this column, I want to look at the metrics that South County Fire presented to the City of Edmonds and the level of service that we receive from South County Fire Regional Fire Authority (RFA) under our current contract.
RFA Service Levels
In their most recent report to the Edmonds City Council, the RFA reported that there were 6,334 calls in Edmonds in 2023. This represents approximately 16.4% of the total calls received by South County Fire in 2024. This is a little higher than Edmonds’ share of the population which is about 14% of the RFA total. Also, while the RFA chart shows a 27.3% increase from 2020, they acknowledged that the numbers for 2020 and 2021 were somewhat lower due to COVID. The numbers for 2019 were comparable to 2021. The growth in call volume from 2021 was 16% and from 2023 to 2024 just 3%.
More than 84% of calls dispatched in Edmonds were for emergency medical aid, with 28.6% of the total being for advanced life support, which includes things like cardiac arrest. These numbers are slightly lower than 2023 but generally consistent year to year and across the RFA and other fire districts locally.
Response time is a key metric that is used to gauge the effectiveness of a fire/EMS service. The goal is an 8-minute response time for 90% of calls but the RFA is meeting this goal less than 80% of the time — and the response times for the 90th percentile of calls hovers in the 9- to 10-minute range. South County Fire is not unique in missing these metrics. From what I have seen, most fire departments struggle to achieve the common response time metrics.
A factor that affects the response times is the backlog for delivering patients to hospital. With a reduction in the number of hospital beds and no new hospital facilities coming online to accommodate a growing population, many hospitals cannot cope with the rate of arrival of patients at certain times, and this can lead to ambulances waiting in a queue to drop off their patients. This means that those vehicles are not available to respond to the next call that comes in and units need to be dispatched from further away, contributing to an increase in response times.
The Everett Fire Department has created a public/private partnership that uses a private ambulance service to transport some basic life support patients to the hospital to minimize this hospital waiting time issue and keep fire service vehicles and crews available for emergency responses. I have not been able to find data on the cost of this agreement or on whether the private ambulance company is authorized to pursue patients for additional charges over and above what their insurance pays. These would be important considerations if South County Fire were to pursue a similar approach.
Fire Chief Bob Eastman had an interesting take on this metric. He said that the 8-minute goal was established when most 911 calls came from landline phones, which meant that the dispatchers knew exactly where the call was coming from. With most 911 calls now coming from mobile phones, the dispatchers need additional time to ascertain the precise location of an incident.
The response time metric discussed above combines all call types into a single measure. Looking at a breakdown of response times by incident type, we see that advanced life support calls achieve the targeted response time, which is 6 minutes and 45 seconds. Turnout times that measure the time between calls being dispatched and the fire truck or ambulance leaving the station are generally in line with an adopted standard that is slightly more lenient than what is in the contract. But response times that include travel to the site of the incident are missing the mark. Note, however, that the number of incidents in some of these categories is quite low. The detailed compliance report for 2024 is not yet posted to the RFA site but, for example, the 2023 Compliance Report shows that there were eight first-alarm residential fire incidents in Edmonds, which require a total of 15 firefighters on scene to meet the criteria for the metric. Of those eight incidents, five met or exceeded the goal of 7 minutes and 45 seconds, while three did not. The three that did not missed by between 2 and almost 5 minutes. There were five first-alarm commercial incidents, which require 18 firefighters to arrive on scene, and four of these met the goal while just one did not. But again, the one that failed to meet the goal missed by a long way — 15:25 vs a goal of just 9 minutes. In these incidents, which require multiple units to arrive on scene, emergency response can begin even before all units are on scene.
Although not included in the graph that was presented to council, the annual compliance report also contains metrics for other categories, including response times for hazardous material, technical rescue and marine rescue incidents. The 2023 compliance report shows that there were five hazardous material incidents in Edmonds, all of which met the response time goals. There were seven technical rescue responses, five of which met the goal and one missing just narrowly, and the other one missing by more than 3 minutes. The other categories had zero incidents in 2023. The RFA technical rescue unit is located at Martha Lake and the hazardous materials unit is located at Hilton Lake, both of which are far outside the Edmonds city limits.
The annual compliance reports state that “SHB 1756 requires an explanation when Council-adopted standards are not met, the predictable consequences of failing to meet the adopted standards, and the steps necessary to correct deficiencies in order to achieve compliance.” However, no such explanations or corrective actions are included within the documents posted to the RFA website and the Q&A at this week’s council meeting did not elicit any explanations for the incidents that missed the goals. Since those incidents were clearly outliers, it would be important to understand what special circumstances led to those misses and what steps are being taken to address those circumstances in the future.
Whatever the reasons for these metrics not meeting their goals, they represent the essence of what a fire/EMS service is, and there is room for improvement. Even 6 minutes and 45 seconds to respond to an ALS call must seem like an eternity to a family whose loved one is suffering from a stroke or a cardiac arrest. Reducing the response times will not be easy but business models, staffing levels, station locations and other factors all contribute to an agency’s ability to reduce response times.
There are relatively few metrics on outcomes but one that is available shows that the RFA achieves a 60% cardiac arrest survival rate. This is among the highest in the nation, and the RFA attributes this success to its use of high-performance CPR, which the RFA states can triple a person’s chance of surviving a heart attack. It is this high-performance CPR approach that is used to justify the high number of responders that are dispatched to an advanced life support call. Note that other fire agencies in our region use a similar model and have similarly high cardiac survival rates.
In remarks to the council on Feb. 25, Chief Eastman noted that the RFA was interested in moving to more outcome-based measures, which would certainly be a very welcome development. But it would also be helpful to see comparative numbers on cost-based metrics such as cost per resident or household and cost per call, especially if the cost per call could be provided for different categories of incident. The cost of putting out a two-alarm fire, the cost of an advanced life support call and the cost of a basic life support call are very different from each other.
In addition to providing emergency response, South County Fire also provides a range of services that are funded through a combination of grants and tax revenues. These include:
An ACT Program, which trains residents to act in emergency situations. This includes training for responding to overdose situations, performing CPR and applying a tourniquet to stop bleeding. The RFA reports that 2,775 Edmonds residents have taken this training.
A Community Paramedic Program, which works with people who frequently call 911 to find alternative and more appropriate resources to help them with whatever situation they are dealing with. This program is credited with achieving a 50% reduction in 911 calls from clients of the program, resulting in significant savings to the RFA. The report does not make clear what period those savings cover so it is difficult to put the number into perspective, and I have chosen not to quote the actual number. Edmonds residents make up 22% of the population served by this program.
Various community outreach programs for home safety, aging in place and safe kids resources.
To the extent that these programs are funded by grant money, there is always a risk that they may be withdrawn if the grant money disappears, or the cost of maintaining them will be transferred to the taxpayer.
In summary:
– The level of service that Edmonds receives from South County Fire is very high. Cardiac arrest survival rates are best in class.
– Response times, while comparable to what I see in other agencies, are missing their established goals and there is room for improvement.
– The metrics that are available provide some visibility into the operations of the RFA but there is a need for additional metrics that look at outcomes and costs.
– There are numerous additional programs offered by South County Fire. These are funded in part by grant money, which may affect their long-term viability.
In the next part of this series, I will look at staffing levels under the existing Edmonds contract and the question of whether Edmonds is, or is not, paying its fair share.
Niall McShane is an Edmonds resident, occasional contributor to Scene in Edmonds and a retired IBM executive with experience in managing software development and customer service organizations.
I have read the compliance reports for Edmonds, and also the reports for the whole RFA for all the years that are published on their website. The standards were set by the State legislature when the legislature created the ability to set up regional fire agencies. The State wants the residents to know if standards are being met, and if not- the fire agency has the duty to develop a program to improve their business operations and meet the standards. The description of the fix-it program should be in the compliance report. But this South County Fire RFA doesn’t seem to take the responsibility to develop corrective programs very seriously. Their description of a fix is missing from their reports. In addition, the current contract the City has with the RFA states that when performance goals are not met, the fire agency will provide corrective action plans to the City. That isn’t happening. Why didn’t any City Council members call that out when the Chief presented the annual metrics? To comment on the use of cell phones as an excuse for missing standards isn’t acceptable to me. A cell phone user who sees a traffic incident and calls 911 from the road is significantly reducing the amount of time it will take to get an EMS technician on-site.
As is usual, the answers about 911 calls and response time for these calls aren’t as simple as they appear on the surface. Most cell phone users now have Apple or Android phones. When dialing 911 from these phones, the call is routed through a system called Device Based Hybrid (DBH) that allows auto location of the 911 caller to within 30 feet of the location of the cell phone. A first responder will have fairly accurate information about the location of the caller—about the same as a caller who calls from a land line.
So, it doesn’t seem justified to point to 911 calls coming from modern cell phones as justification for missing medical response metrics.
Dave, I assumed that cell phone calls would have some location information available but I wasn’t sure how accurate that would be. Thank you for clarifying.
Thank you Mr McShane for the comprehensive and informative piece. At a time when things are often way too contentious, I hope we can all take a breath, do our homework and vote responsibly for our community.
It seems to me that this “cardiac survival rate” metric needs an absolute definition of what that is and that definition would have to absolutely apply exactly as stated at every department there is in the United States to have any real meaning for this claimed statistic. For example one department might view “survival” as we got a pulse while another might view survival as the patient is able to breath and make movements on his/her own. (Like blink twice when I hold up my finger). Unless the definition is absolutely the same absolutely everywhere, that comparison is virtually meaningless. Other factors effecting this metric would be the distances people live apart and how well ordinary citizens are trained to start and use CPR before help gets there. Comparing Furnas Co. Neb. (Pop. 4500) survival rate to Sno. Co. WA. (Pop 1,000,000) survival rate is a meaningless statistic in the great scheme of things. I’d think long and hard before I used that claim as a reason to vote yes.
Clinton, you raise a good point. I searched for the definition of the metric with limited results. There is a substantial body of research on the subject which would require a commonly accepted metric definition for academics to study survival rates across different populations. I cannot say whether this metric defines survival as regaining a pulse, admission to hospital, discharge from hospital or five year survival post incident.
You are also correct that population density, the number of trained citizens etc are important in improving this metric but the RFA provides classes on how to respond in an emergency and their data says that they have trained 2775 residents of Edmonds. Also, while it may not be fair to compare the counties that you mention, I think we can compare the South County Fire region to neighboring communities like Shoreline, Everett, Seattle etc.
Finally, no single metric is a reason to vote yes or no but this metric is important when thinking about alternatives. Those who want to start our own fire service should look to the EMS costs that are hampering Everett and Mukilteo and ask if a city department constrained by the 1% property tax rule can maintain this rate. Those who want to privatize our EMS service should ask whether a for-profit company will deliver the same outcomes.
“ask if a city department constrained by the 1% property tax rule can maintain this rate. “
Taxes are becoming one of my favorite topics. Here’s more advice: The reader of this article and all the comments should remember that the RFA is constrained to the same 1% increase that a City is constrained to on their regular levy.
Not strictly true. The property tax portion of the RFA revenue stream is constrained by the 1% rule but the RFA can raise additional funds by increasing the percentage of their budget that is raised through the fire benefit charge. In part 2 I made the case for increasing the fire benefit charge in order to reduce the levy rates but raising the benefit charge to achieve higher overall revenue is also possible.
Niall- We need to understand a lot more about the cardiac survival rate. King County/MedicOne (Seattle’s contract EMS provider) claims a 60% survival rate also. Do they deploy 9-12 firefighters ad paramedics for every cardiac arrest? At the Town Hall meeting last night, an Edmonds resident described an RFA cardiac arrest call for her husband. The paramedics arrived several minutes after she had administered CPR (she is retired ER nurse) and her husband was stable. Several minutes after that a fire truck arrived with 3 firefighters. The RFA personnel basically stood around and did nothing. She drove him to the hospital and he ‘survived’ and is doing fine. Even though the RFA did nothing – did they count him among the 300 or so cardiac victims who survived? Be careful of statistics. Other nurses have questioned how the RFA can have such great stats when their response time is 8-9 minutes, as that would mean an almost certain stroke. Is that patient brain dead with a beating heart? And other nurses have questioned why you need 9-12 firefighters to do CPR. The NIH recommends 2-4, and the nurses concur. What’s really going on here? Just great PR from the RFA? btw- South County/RFA has a Level 3 rating – putting them in top 15% of WA fire/ems providers. Shoreline is Level 2 – top 1%.
Thanks Bill. I find it much more difficult to get information on Shoreline – many searches for Shoreline information yield only documents related to Northshore Fire District which is the entity that served Kenmore and Lake Forest Park before being subsumed into the Shoreline department. I did find a news article about Shoreline achieving level 2 status as you state – This apparently happened in 2023 (https://www.shorelineareanews.com/2023/08/chief-matt-cowan-shoreline-fire.html) – kudos to them.
I did also find an FAQ on the Shoreline website (https://shorelinefire.com/information/faq/) that states “a cardiac arrest call requires at least seven, and ideally even more personnel. Our goal is to have firefighters arrive in five minutes or less. The first arriving vehicle may be an engine, an aid car, a rescue truck, or a command staff vehicle. The first arriving crew will set up a plan of action and communicate this plan to other responding units—which could include more engines, a medic unit, and perhaps another Command Unit or MSO (medical services officer) rig”. So it does seem there is some room for discussion on this topic although in reality I wonder what “ideally even more” means?
I forgot to mention; I did find the following in an academic paper on cardiac arrest survival rates: “The numerator in calculating a survival rate should include only those patients who survived an event but who otherwise would have died except for the application of some facet of emergency medical care”. Still clear as mud of course and we don’t know for sure if the metrics reported by any local fire department actually adhere to this but at least this indicates some acknowledgement of the issues you raise.
Also, thinking about this a little more, due to HIPAA regulations about patient privacy etc, the EMS department definition of survival almost certainly cannot include anything beyond hospital admission. To understand full lifecycle survival rates would require access to hospital records as well as post release medical records for those who get discharged. Having said that, getting admitted to hospital alive is a critical first step in longer term survival rates and anything that improves a person’s odds of making that transition is worth while.
Point well taken about doing local comparisons of survival rates perhaps, but RFA is making this bold claim cf being almost 30% more successful than the country as whole with a nifty little heart chart for visual impact to impress the voters with a highly questionable figure as to having any real validity or meaning. If you look at the fine print they are even using different years and tracking agencies for their numbers. My point is that this looks more like a contrived PR type statistic than a rigorous academics type statistic. Fine print is generally used to be sure not to be accused of false advertising or statements.
They use Utstein out of Hospital survival. Aka you are neurologically intact and get discharged from the hospital. These statistics are staggering, and just recently has more of the country started to have better resuscitation outcomes like our area has had for quite awhile. https://www.resuscitationjournal.com/article/S0300-9572(24)00182-5/fulltext
Thank you Peter. That link makes it clear that there are very detailed descriptions of these metrics. Presumably the department gets some sort of a data dump of statistical information on the outcomes for patients who have been admitted from a fire department crew rather than detailed, per patient, information which would violate HIPAA regulations.
Niall, sometimes in questions there are hidden answers. Everett and Mukilteo are hurting for funding just like Edmonds, but they are well established and have been basically well run departments over the years. An ILA/RFA with them would seem like the possible better answer right now, especially with the RFA ask appearing to be at least somewhat out of line with what is really appropriate for Edmonds as well as being unfair to Edmonds. We have buildings that I assume are paid for and the right to buy back the equipment RFA doesn’t need after we bail out. Mukilteo and Everett have the equipment they could share for awhile and the expertise to get us up to speed fairly quickly. I would call it the Salish Sea Co-Op Fire Dept. (keeping city names on the trucks) which has kind of a nice proper regional vibe to it and it would make good use of our centrally located fire boat and include the resources of two nice sea ports. If we had more real management ideas and less PR in our town we would get better answers to problems we have. I think RFA really needs us more than we need them; but the powers that be have chosen the no push back route. NO NOW could change the dynamic and actually save some money.
Niall, Thank you for all the research, analysis and reporting you are doing on this very complicated topic. It is a great service to our community.
If we do luck out and get a no vote on this the first time around, it will be crucial that some sort of citizens’ volunteer commission form and do a real honest and accurate study of an alternative plan for Edmonds with a projection for cost. This would involve consulting with Everett and Mukilteo I would think. It looks like the basic foundation for such a commission already exists and the rudiments of such a study already exist. Our Mayor and Council are not likely to do this as they have already agreed to just resubmit the annexation levy in the Fall as Niall has pointed out and neither the RFA or the City want any other alternative outcome. A NO vote would just be winning the first battle, but far from winning the war. It would be nice to think Mayor Rosen would use his executive authority to officially sanction such a commission, similar to his Blue Ribbon Budget Commission, to appease his constituents but from what I’ve seen so far, I would not count on that happening without a second no vote in the Fall.
Blue-Ribbon follow-on committee was recommended by BR and presented to council. They have not acted.
I like the idea of a Salish Sea Co-Op Fire Dept. It makes a lot of sense, but that doesn’t always bode well. However, Edmonds is fortunate to have so many well-informed and smart constituents who are willing to participate, not simply to favor or to oppose something, but to ask questions and to gather facts, to explain why they’re thinking a certain way(s), etc., which are of benefit to all residents and any reader for that matter. Frankly, that’s why I read MEN, it’s not only for the articles, but for the value of your thoughts. Keep up the great work.