Homeland Security Watch

News and analysis of critical issues in homeland security

May 23, 2012

Standards of Cover(-up)

Filed under: State and Local HLS,Technology for HLS — by Mark Chubb on May 23, 2012

For weeks now, the Los Angeles Fire Department has been under intense scrutiny for errors in its reporting of response time data. Previously reported figures suggested the department was doing pretty well meeting its response-time targets despite budget cutbacks that affected service levels. However, it later came to light that the methodology for calculating response-time data presented to elected officials was flawed. These flaws included a failure to present the results of models as predictions rather than actual response data and errors in the way response times were measured and performance against targets reported.

When it became clear that the fire department’s responses had been affected by changes in staffing and service levels, the media and elected officials began asking some difficult questions. Unfortunately, most of these questions were precisely the wrong ones.

It’s one thing to ask whether the department is meeting response time targets. It’s another thing entirely to ask whether these targets are meaningful indicators of service performance. Errors in reporting could affect the answer in either case, but the effects would be very different.

In Los Angeles, it’s now clear that the fire department does not meet its stated targets. It should be equally clear that these targets are arbitrary and all but meaningless in the vast majority of cases. (In other words, the Los Angeles Fire Department remains a world-class outfit despite the cuts.) Unfortunately, the latter fact has dawned on very few people despite abundant evidence that the unwelcome answer to the first question is due in large measure to the growing dependence of the community on fire department responses to many low-priority and even non-emergency events where time matters very little if at all.

The expectation that fire departments are there to deal with anything unwelcome or untoward that people encounter when no one else is there to help them has not come about by accident. Firefighters love to be loved (and needed) and have been all too willing to answer these calls without regard to the costs. The controversy in Los Angeles suggests these costs are not just fiscal. The opportunity cost of attending so many low-priority and non-emergency calls is clear: The system cannot meet the performance expected when genuine emergencies arise.

For firefighters the answer is simple: expand capacity. For administrators, that’s simply not an option in these austere times. Sadly, elected officials too rarely take responsibility for the fact that you cannot please all of the people all of the time.

Nearly everybody these days accepts the adage that when it comes to performance, speed, quality and cost matter, but you can only have two of these. This is especially true when it comes to emergency services. The problem is that our expectation of which two we are willing to accept varies a lot depending upon the circumstances.

When it comes to situations that clearly are not time critical, time should not matter. But it does when you confuse it with an indicator of quality. And almost every fire department does just that because they have no idea how to measure quality but they can measure time.

Fire departments are inherently inefficient operations. They operate on two basic premises: 1) no one should ever have to wait for a response and 2) every response should be treated as an emergency until proven otherwise. These two assumptions combine with pernicious effect when it comes to the way we handle 911 calls. And let’s be clear about this 911 is no longer shorthand for “emergency.” These days, about 40 percent of all calls coming into public safety answering points are misdials and many more involve queries that have nothing whatsoever to do with police, fire or emergency medical services.

Rather than take a few seconds to find out what’s really going on, most agencies insist that dispatching decisions get made within 60 seconds of call receipt regardless of circumstances. This was once a relatively simple affair because it relied on the intuition and judgment of experienced call-takers and dispatchers who made the call based on relatively simple heuristics. When they were equipped with little more than a telephone and a radio console, the required action took little time or effort. Not so today. These days we have two, three or even more layers of technology between call-takers and dispatching decisions. Even after a dispatch is initiated, we have even more layers of technology through which signals alerting stations and conveying information about the call must pass before responders get the message.

These interventions have made it possible to track the most minute details about each and every incident. But they have not made the process of delivering emergency service faster or more efficient. In fact, it’s just the opposite. In many instances we have become unwitting slaves to the planned¬†obsolescence¬†of the technologies themselves and helpless victims of the technological hurdles involved in marrying up diverse platforms supplied by competing vendors procured by different agencies.

When fire departments talk about standards of cover – the five dollar phrase for these response targets – they rarely acknowledge the fatal flaws in the logic (or lack thereof) they apply to deciding what matters. These standards, often derived from flawed analogies to fire growth curves and the onset of brain death following cardiac arrest, were easy to meet using legacy technologies that were far simpler and more efficient. But now we must contend with the expanded and often unrealistic performance expectations arising from our inability or unwillingness to make the simplest distinctions about the services we provide.

Adopting arbitrary standards of cover, like 60 second call processing times and five minute travel times, may allow us to direct the blame at others when we miss the mark overall, but it does almost nothing to solve the problem when performance falls short.

When time matters, it matters a lot and cost is not much of an issue. The good news is that getting these decisions right involves little more than giving people permission and encouragement to treat very different situations differently. The quality of the outcome always depends on how well the people perform, and when the way they use the technology becomes an impediment to what they are trying to accomplish we have the tail wagging the dog.

The single biggest factor affecting our success may well our willingness to recognize that what people experiencing or witnessing an event do before we arrive matters much more than how long it takes us to get there. Sure, response time and the quality of care help, but not if people wait too long to seek help or take no action to mitigate the consequences before we get there.

The best case in point may very well be right in my back yard: King County and Seattle, Washington have managed to achieve a 50 percent survival rate from witnessed cardiac arrest involving shockable arrhythmias (ventricular fibrillation and ventricular tachycardia). Sure, we were among the first communities to establish a fire-based advanced life support paramedic program. Yes, we send first-response EMTs on fire-based units to every call, and often as many as 10 responders to confirmed cardiac arrest calls. But the factor that has probably made the most difference has been the frequency and quality of bystander CPR.

Other programs send paramedics on the first due fire engines whenever possible. We do not. Some use dispatchers to give CPR instructions over the phone. We do too. But we do something even more important: We get out in the community and teach everyone willing to give us a few minutes of their time how to save a life.

Don’t get me wrong. People here still worry about response times. But they have a lot less reason to do so because we have nothing to hide: We rely on the public as much as they rely on us, and we’re proud of it.

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Comment by William R. Cumming

May 23, 2012 @ 9:03 am

The point is that statistics can lie?

Hoping LA Fire is world class because they may just get the big one all worry about! Assume since you state LA FIRE is world class how many linguists are available to that department given LA has over 50 relatively common languages, including the largest Korean American population in the USA? How many Korean Americans on the LA FIRE ranks?

And just who does comparative analysis of Fire departments? The insurance business?

Comment by William R. Cumming

May 23, 2012 @ 9:07 am

It has always been of interest to me that the top five lobbying groups for the FIRE SERVICE in Washington are roughly aligned by the ranks of their members in their respect fire departments.

With two prior battalion or special chiefs leading FEMA under DEMS and Republicans (neither actually headed major metro area fire departments is my understanding] perhaps we now see the final shootout over the future of EM between the FIRE SERVICE and the Health Preparedness and Response types. FEW HS background in the FIRE SERVICE, EM, or Public Health. Perhaps too technical.

Looks to me like the bulk of HS higher-ed is in the for profit sector. Wonder why?

Comment by Mark Chubb

May 23, 2012 @ 11:34 am

Bill, world-class is a relative ranking. LAFD does compare favorably with its peers. As you note, this may not say much when you consider the needs of the community it serves. My point is simply that the cuts and scandal are not or should not be Angelenos’ real cause for concern.

I have recently wondered why we don’t insist on independent civilian oversight of police and fire services on a day-to-day basis. I’ve heard the argument made that “civilians” don’t understand the core business and cannot adequately respond to the issues confronting these complex services. To that, I say, “Rubbish!”

What really concerns me is whether so-called civilian oversight would lead to agency capture the same way it has for our nation’s military services. It really comes down to the quality and consistency of political oversight in either case. And we both know what a sorry state of affairs now afflicts our political discourse.

Comment by William R. Cumming

May 23, 2012 @ 1:42 pm

Mark! While the President remains Commander In Chief [and Chief Executive] civilian control is a whispery thin line at this point in time. With over 1000 Flag Ranks all confirmed by Congress the civil military relationship is IMO at an all time low.
Why? So few civilians have the slightest notion of the culture of the US military and the military of US culture, politics, and economics. The huge investment in captive universities and colleges continues to insulate the career military from the civil sector. The Service Academies are largely indoctrination centers rather than training or educational institutions. Again IMO!

Having had many politicians announce a war on teacher’s unions, can police and fire be next up?

Comment by Mark Chubb

May 23, 2012 @ 2:25 pm

Bill, I am absolutely confident that police and firefighters unions are next. Indeed, that war has already started in several states. I can understand why too!

The median base pay of firefighters in my jurisdiction is north of $85,000, plus fully paid health care, pension and deferred compensation contributions. Not bad these days for a job that requires little more than a high school diploma, a reasonable degree of fitness, a clean driving record and some skill-based training, eh?

The argument that the long hours and dangerous working conditions justify this situation doesn’t wash with me. Not when I look at what so many others must do just to earn minimum wage with no benefits.

Comment by William R. Cumming

May 23, 2012 @ 3:51 pm

With EMTs and HAZMATS personnel requiring a great deal of expertise they are almost but not quite separate professions from the FIRE SERVICE.

Comment by William R. Cumming

May 24, 2012 @ 6:36 am

By the way does anyone measure successful response vis a vis response time?

Comment by Mark Chubb

May 24, 2012 @ 5:28 pm

Bill, that’s the question: What do you consider “successful.” Is getting there enough? If so, then, yes, we do measure successful responses by time measures. (We reoutinely exclude calls where we don’t arrive.)

If you mean something more, like how well low response times correlate with better outcomes, then no, no one routinely measures that. Indeed, the few careful analyses of that question have suggested very little correlation between outcomes and response times unless the times are significantly less than three minutes or greater than 10 minutes. In other words, it makes very little difference in the vast majority of cases, and certainly not enough to justify adding a new fire station and full-time staff at +/1 $.2 million to shave 10-20 seconds of average response times across a jurisdiction.

Comment by Bruce Martin

May 24, 2012 @ 7:01 pm

Underlying the search for stats are some good policy questions. Does a program chase stats (in this case making times on more ems calls in denser parts of a jurisdiction would do so) or does a program look for service provision equity (equal protection across the jurisdiction). SOCs are the latest iteration of fire service attempts to apply management tools to explain its program gaps and value. As has been noted elsewhere, citizens dislike complex explanations, and governments seem to dislike tough policy choices. Attempting to apply production organization tools seems to make the analysis harder not easier as you observe. We wind up chasing seconds without articulating larger issues.

Not too different from TSAs problem of how much screening, and how much prevention truly results.

Despite very similar statistical experience here, our citizens recently reconfirmed that public safety services are the most important services provided by their local government. But when asked what we should spend public money on, the answers are economic development, and street repair services. Yet another layer of policy choice affected by how one asks the question.

Comment by Mark Chubb

May 24, 2012 @ 11:07 pm

Bruce, you are spot on with your analysis of the efficiency versus equity tradeoff. This distinction is often overlooked by officials. Policy-makers often incorrectly assume the two are mutually exclusive objectives — if they acknowledge the differences at all.

Even when these criteria get the credit they deserve in an analysis, we often lose sight of the imprecision of the analysis much less the way the tradeoffs operate in the real world. Our communities change much faster than the fire agencies realize, and people are usually far more pragmatic than we give them credit for being.

I love your local example! People respect firefighters and police, and always rate their services as being of high in importance. But heaven help the mayor or city manager who funds them at the expense of roads, parks and rubbish collection.

In the end, it really is all about the questions!

Comment by Brent Jones

December 5, 2012 @ 11:38 pm

@ Mark: I guess I would like to know what it is that you do for a career. It is always interesting to listen to someone that lives their life behind a desk. Typically the people that talk down about firefighters and police officers and how just a HS diploma seems to be good for making the wage that we do, are those who have never been in the military or ever had their life in someone elses hands, like with fire and police as well. The fire service is about more than the occasional fire. How often are you in a situation that firefighters and police officers are in? How often are you exposed to chemicals, hepatitis, hiv, aids, fire, people that are sick or the bad end of a 9mm?? People like yourself watch the news and say”thats sad” when a cop or firefighter are killed while doing their job to help people such as yourself, and then go about you day like nothing happened. Police, Fire and Military people do that job because we want to help people. We dont need your sympathy, your thanks, or anything else from you. We chose this life. But we do expect a little respect for risking our lives to help people like yourself when you want/need it.
Now, I dont know where you live that wages are $85,000 a year. But, as a twice promoted person within the fire service, I dont make that kind of wage. And I’m with a fairly large department in a city of 600,000 people.
The next time you, your family or friends are caught in a fire, have a heart attack, are pinned in a vehicle, or have been robbed or beaten, take the time to think of what your life is worth before you bastardize those trying to help you.
As a Marine, a fire Lieutenant, son of a Marine father and Marine mother and son to a law enforcement officer, I take offense to being looked down upon by someone like you who hasnt a clue to what its like to do our job or risk their own life to help another.

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