Comparison of BCAS and Vancouver Fire call types.

Image Source: http://www.gettyimages.ca/detail/illustration/icon-set-emergency-services-royalty-free-illustration/165723541

In my previous post, which can be found here. I evaluated the cost structure differences between Vancouver Fire and BC Ambulance (division of BCEHS) operations in Vancouver.

Here I am following up with a comparison of the breakdown of the types of calls Ambulance and Fire responds to. In my previous post, I mentioned that Vancouver Fire responds to nearly 50% of all Ambulances' calls and commented that given the much higher cost per call for Vancouver Fire that this may be a miss appropriation of public funds, as BCAS may be able to provide the same service for cheaper if they beefed up their resources.

Of course, the issue becomes. What if, the majority of calls which Vancouver Fire responds to are types of calls in which their special skills and training come into play adding a benefit over an additional ambulance crew. For example, if most of these calls are HAZMAT, Rescue, MVA (Motor vehicle Accident), or Fire (Burns). Then perhaps this high rate of call out is justified!

As promised, here is the breakdown of the calls received by BCAS in 2014 in Vancouver and corresponding Fire response based off of call category.

In the above bar chart (organized by highest to lowest frequencies of BCAS calls) we witness that the top five calls which BCAS responds to are for

1.  Sick (12,393 calls)
2. Unconcious (6107 calls)
3. Psychiatric (4890 calls)
4. Breathing Problems (3975 calls)
5. Chest pain. (3672 calls)

At the same time the top give calls which Vancouver Fire responds to most are: 

1. Sick (4157 calls)
2. Unconcious (4015 calls)
3. Breathing problems (3975 calls)
4. Chest pain (3508 calls)
5. Falls (2233 calls)

The part that I find most interesting about this, is that (as far as I know as an observer!) there is no added benefit of special skills from Fire in the response of these calls over having an additional paramedic crew respond.

Next, let's look at how many of BC Ambulances calls Vancouver responds to as a percent by call category. 

Right off the start - Fire responds to 100% of BC Ambulances HAZMAT calls. Just as I would have expected, the use of their specialized skill set to assist and aid in this situation. 

Next down, Fire also responds to 100% of breathing problems, 99% of Cardiac arrests, and 96% of chest pain. For these calls, I am struggling to understand what extra benefit Fire would provide over an extra ambulance crew (Any insight would be appreciated! as hopefully there is a rational)

What I find interesting is the other side where Fire only responds to 6% of the MVA's which Ambulance responds to (I am assuming that Ambulance only responds to the MVA's which are serious enough to justify). This I find interesting because if the accident is serious enough for Ambulance, might there be a need for Fire in this case as well?

This last graph is Ambulance and Fire response by call severity. from Alpha to Omega, which I understand is most serious to least serious. 

My (updated) understanding is that these call severities, in order from most severe to least, go Echo, Delta, Charlie Bravo, Alpha, Omega. Given this call ordering, our fire response perfectly lines up with the frequency of Fire response, with Fire responding to nearly all Echo and Delta calls and showing up with decreasing frequency as we move down the call severity. 

What are your thoughts on all of this? Feel free to comment below.

EDIT: A previous version had the order of call severities reversed, Thank you for bringing this to my attention in order to correct.

Costs of Emergency Response: Comparing Ambulance in Vancouver with the Vancouver Fire Department.

Image Source: http://www.bcehs.ca/PublishingImages/BCAS_VAN_033012_113.jpg

A while ago I stumbled across this dataset which outlined the call volumes and types of calls which BCAS (BC Ambulance Service) responded to in the lower-mainland. Although I have plans to use this dataset for some future analysis. At an initial glance, what popped out at me was that the fire department responds on average to about 5% of BC Ambulances calls in the entire lower mainland but, close to 50% of calls in Vancouver itself. (in 2014)

This piqued my interest and got me wondering. What is the cost structure of the fire department? what is the cost structure of BCAS?

From a cost perspective, I have always wondered how cost effective it is to send 6 firefighters and the large fire truck to that many calls - both from a wage and capital cost perspective. Keep in mind, both BCAS and the Fire Department are paid for with public funds, just at different levels of government, provincial and municipal respectively.

Now, luckily the Vancouver fire department provides an extremely detailed breakdown of their previous years' activities in each municipal budget, these can be found here.  Unfortunately, BCAS provides a much less detailed public budget, as a result, I have had to do my best, scrounging together information from the above dataset, the BCAS 2014 annual report, which can be found here, and the BCAS 2014 Vancouver demand analysis which can be found here.

Compiling all this information I obtain the following table, which has also been augmented with wage data from workbc.ca

The big disclaimer here is that the BCAS expense data for Vancouver and the Lower mainland is entirely estimated at 25% and 50% based off of call volumes in relation to the provincial level. As such these are entirely arbitrary and may have no bearing on reality, but at least provide an insight into these areas.

While the expenses are estimated, the call volumes and labour information is accurate and obtained from the above-noted BCAS reports.

The second disclaimer is that Vancouver Fire provides their staffing information in terms of FTE, while BCAS provides it in terms of regular full-time, irregular full-time and part-time.

Through hear-say I understand that many of these "part-time" paramedics in Vancouver can, and often do, work more than a full-time schedule. But, at the risk of underestimating, I assign each part-time employee only 0.5 FTE while each full-time 1 FTE in calculating the FTE for BCAS in each region.

Finally, for the per crew information, BCAS generally operates in crews of 2 while I understand Vancouver Fire generally operates in crews of 4. (thank you, Brian, for this update! Also recognizing that Vancouver Fire will operate with as little as 2 for some medical calls. While this changes the number of FTE crew, this does not change the total expenses/call)

Now some discussion of the actual results of the above table.

My first surprise was that only 3% of the Vancouver fire departments calls are actually to deal with fires. Another 25% of their calls are fire inspections, to finish off with 72% of their calls being medical in nature, supporting BC ambulance. That means despite being a fire department (with their budget being about twice the estimated Vancouver BC ambulance budget) they primarily act in a capacity of being first responders to medical calls.

Now in a bit of preliminary research on this topic. I looked into the importance of first-responders, and empirically it appears that having a fast response time, all else equal, greatly increases the viability of the patient. My question then; does society benefit more when the first responder is from the fire department? or given the cost of fire response, would a modified response structure with BCAS be more cost effective and provide the same patient benefit?

Clearly, the Fire Department provides an extremely valuable service, especially in cases of vehicle accidents and hazardous materials. Unfortunately, I have not yet worked out from the above dataset, what percentage of Fire calls are due to hazmat or MVI (Motor Vehicle Incident), or just medical, with the request of a first-responder (Fire) crew. This will definitely, be the area of future follow ups! (followed-up here)

To finish off this post, as it has gotten a little long, If we evaluate the cost per call and the wage cost per call between calls in Vancouver for BCAS and the Fire Department we see that:

• Vancouver Fire has a wage cost per call almost 8 times larger than BC ambulance.
• Vancouver Fire has a total cost per call almost 3 times larger than BC ambulance. 

Although this data is already 3 years old and pre-fentanyl crisis, I find it fascinating that most of the news coverage on the crisis comes from the fire department, resulting in calls for more department funding when perhaps a more cost effective solution would be to increase ambulance funding and staffing.

But then again, these observations are just from a quick back of the envelope calculation. Perhaps there is much much more to the story. 

As I said my interest has been piqued and I now have a good chunk of data to pour over. 

Move over real-estate market, I have found a new topic for the next little while.

What are your thoughts? feel free to comment below.

EDIT: In retrospect, this article may seem like I have decided to pick a side in an emergency services battle for supremacy. This is not the case! Rather the above article is purely motivated by my curiosity and surprise based on the results and through this hopefully stir some thought on how these essential services may be provided in a more cost-effective manner!