‘24 years behind the curve’
Ashland City Council will decide in the coming year whether to continue the Ashland Fire & Rescue ambulance service, which carries implications for the department’s staffing and highlights an ongoing tension between cost and quality in public services.
“Our staffing model has become so intertwined with the operation of the ambulance that there is truly no difference from our firefighters and our ambulance service,” said Ashland fire Chief Ralph Sartain, addressing the City Council Monday.
“Like all the fire departments in Southern Oregon, we respond to medical emergencies, we treat patients with medically qualified firefighting personnel, but then instead of having someone else take the patient to the hospital, we take them ourselves,” he said. “We’re simply finishing the job that we started.”
The fire department’s organizational structure includes a fire chief, administrative assistant, deputy chief of operations (vacant, pending an offer), division chief of fire and life safety, which covers fire marshal duties (vacant), and wildfire division chief.
A proposed reorganization of the executive structure would bring two divisions under one senior administrator and eliminate the position of division chief of fire and life safety.
The wildfire division chief would become “deputy chief of wildfire and community risk,” overseeing the fire marshal, fire adapted communities coordinator, community engagement coordinator and emergency manager, with a small pay raise commensurate with the responsibilities of the executive post, pending specific training and certification, Sartain said. The fire and life safety division chief title would change to “fire marshal” with lesser pay.
“For the time being, the fire marshal will remain unfunded, as I can maintain the executive portions of this position as the fire chief, as long as there is a deputy fire marshal to assist in the day-to-day inspections, plan reviews and complaints we receive,” Sartain said. “The fire marshal position will be funded once the community comes out of the financial burdens, or more dedicated funding is available.”
The vacant part-time CERT coordinator and weed abatement coordinator positions would be combined into one specialist, to be filled by a candidate who is both a firefighter and certified basic fire inspector, Sartain said.
In 2006, Ashland City Council mandated all commercial structures be inspected every two years — an unachievable goal in the fire service staffing environment, Sartain said — and the department was authorized to collect fees upon completion of inspections.
Under pandemic-induced budget tightening, the fire inspector position dissolved to preserve firefighter positions and the council authorized an overtime budget to complete inspections, Sartain said. Three firefighters were trained as basic fire inspectors, with a limited range of small buildings they can inspect.
“Unfortunately, our call volume, mandatory overtime and departure of employees have removed this availability,” Sartain said.
Sartain said efforts to establish a deputy fire marshal position were “sidelined” due to budget constraints and turnover, including the city’s finance director and city manager.
“We keep having to start the discussions over again,” Sartain said. “The work has to be reorganized to meet the demands of increased staffing issues.”
Sartain said he implemented a third-party, real-time tracking inspection program at no cost to the city, which shows whether a building’s fire system is “functional or deficient” and keeps records.
As a result, qualified firefighters shifted focus to inspecting residences, care facilities, apartments and dorms — aligning AFR’s work with national data showing the latter structures present the highest risk for loss of life and firefighter injury during a fire, Sartain said.
“The deputy fire marshal is needed to complete all of the inspections to continue to move the construction and development aspects of this community forward, complete higher level commercial inspections and handle day-to-day operational needs of fire and life safety for this community,” he said, adding that intergovernmental agreements could cover parts of Ashland’s fire inspection needs.
Councilor Paula Hyatt, supported by Councilor Shaun Moran, said she is in favor of revisiting the inspection interval and potential IGAs to determine “how we might work those aspects together such that Chief Sartain’s department’s needs are met, the community needs are met and that we keep our budgeting scenario in view.”
Under an 8/10 staffing model, 10 firefighters start each shift and up to two people can be off duty without hiring back personnel on overtime to meet mandatory staffing minimums. The last week of September, seven people on one shift were unable to work, causing a drastic force-hire, Sartain said.
In 1995, AFR fielded 1,011 calls for service with 21 firefighters. The following year, after one year providing city-owned ambulance services, calls increased by more than 800 with the same number of staff, representing the beginning of a burdensome trend, Sartain said.
By 1997, with firefighters working five to six days in a row to handle more than 2,000 calls and additional ambulance duties, spouses began calling the fire chief, “voicing their frustration about not allowing their loved ones to come home,” Sartain recounted.
As a result, the council authorized the department to hire three more firefighters.
“In 1997, having taken over the ambulance service and increased our call volume by 112.27%, we should have gone from 21 to 30 firefighters,” Sartain said. “For the last 24 years, we have always been behind the curve.”
Staffing numbers remained constant between 2002 and 2014. In 2015, with the addition of three personnel, 30 firefighters received nearly 4,000 calls for service, including 1,453 overlapping calls.
In 2018, the staffing model temporarily increased by one per shift, but with up to two people off duty at once, family medical leave vacancies, retirements, illness and injury causing regular overtime assignments, the system regressed to financially unsustainable, Sartain said.
In early 2020, the model reverted to 8/10 and AFR received 4,510 calls, including 1,687 overlapping calls, with 30 firefighters on staff.
While call volume since 1995 increased by more than 345%, staffing increased by less than 43% in the same time frame, with fewer executive officers, Sartain said.
“Thirty-seven percent of the time, we’re getting multiple calls at one time,” he said. “We’re depleting our entire resources within a matter of minutes on 37% of our calls during the day, so we have nothing left to protect our community.”
Other area emergency service entities dispatch to overlapping calls, but the industry as a whole faces staffing issues and rising call volume, Sartain said.
Two-thirds of AFR calls are medical. Public assists account for the next largest portion of calls (12.3%), followed by good intent calls (10.8%), false alarms (6.7%), hazardous conditions (2.4%) and fires (1.8%).
“We should not be having a private ambulance service billing our citizens for an ambulance transport or an ambulance pickup when the fire department is paid by the taxpayers,” Sartain said, addressing the idea of AFR no longer responding to low-acuity calls to balance the workload.
Moran said under this format, Medford Fire Department decreased their calls for service significantly in the past.
Regardless of AFR ambulance service area coverage, the department could not cease EMS training for staff unless the City Council, via the residents of Ashland, decided AFR should only respond to fires and no other emergency situations, Sartain said.
An analysis by Public Consulting Group presented to the City Council on June 14 found that the city would not financially or operationally benefit from eliminating the ambulance service.
PCG reviewed national firefighting and EMS standards, budget, volume of calls and five years of AFR expenditures and revenues in its audit. The city paid for the analysis with contingency dollars in the general fund, costing $48,720, according to council documents.
“The decision to discontinue the ambulance service will affect not only the residents in the city of Ashland, but also residents in areas surrounding Ashland,” according to the report. “[The analysis] clearly indicates that the ambulance transport is an enhancement, not a detriment, for the city.”
As of 2015, the city’s Insurance Service Office rating — indicating a fire department’s capability to defend its community — was Class 3, with Class 1 being the best possible rating. The city received a 50% deduction in points for inadequate staffing. The classification influences property insurance rates in the community.
AFR’s on-duty personnel structure falls short of standards established by the National Fire Protection Association, which requires at least 18 personnel respond to a low energy structure fire, based on response time and emergency management objectives.
“Just on our population alone, not taking into account any visitors, we should be at a minimum staffing of 10/12,” Sartain said. “If a major medical comes in, like a car accident, the ambulance and the fire truck leave, just leaving us with two people out of Fire Station 2. The next call depletes our entire staff.”
The side of town served by Fire Station No. 2 includes the Ashland Transit Triangle and the bulk of the city’s more affordable housing, said Councilor Tonya Graham, noting an equity consideration.
According to the PCG analysis, it costs nearly $2.3 million to operate the ambulance service. Factoring in revenues, the net cost to maintain the ambulance service is $840,900 annually. The figure represents the true amount of general fund dollars leveraged to maintain the ambulance service based on a five-year average.
By fiscal year 2031, the projected net cost approaches $2.4 million, after factoring in a projected $1.4 million in revenues, according to PCG.
Transports generated from 911 calls represent the fire department’s largest revenue stream — about 94% of total ambulance-related revenue — while interfacility transfers accounted for half of 1% of revenue in fiscal year 2019.
“When those calls are coming in — because we’re so short staffed and we’re required to respond to our 911 calls and not our transfers — we’re giving those all away to Mercy Flights,” Sartain said. “We have the availability to increase exponentially in funding, but it takes staff for us to get there.”
Ending ambulance services would cut the department’s ability to respond to concurrent calls in half, while requiring the same amount of staff to respond to medical emergencies and fires per NFPA engine staffing requirements, Sartain said.
Without the ambulance service, overall call volume would decrease by about 20%.
Sartain said eliminating ambulance service without replacing its financial benefit would lead to significant operational changes and vulnerabilities, including closure of Fire Station No. 2, six firefighter layoffs, a staffing model shift to 6/8, increased mileage on engines, a worse ISO score and demotions among chief, captain and engineer positions.
“[The staffing model] is inadequate right now, even with a million-dollar revenue stream that comes in from the ambulance,” Graham summarized. “We need to get ourselves to a 9/11 staffing to deal with the reality of what our world looks like, and we haven’t even started talking about the increase in fire risk because of climate change.”
“We can’t even fund a proper, super minimal fire department with what is left over if we don’t have the ambulance service,” Graham continued. “It seems very obvious to me that given the way that money moves in with revenues into the fire department through the general fund, removing the ambulance service from us just digs our hole significantly deeper.”
Graham asked city staff to prepare a cost estimate of a 9/11 staffing model that is “appropriately resourced” for fire inspections, which City Council could use as a springboard for exploring IGAs and other cost reduction methods, she said.
Councilor Gina DuQuenne pressed for consideration of bringing on volunteer firefighters.
During the PCG analysis review in June, project specialist Charley Hurley said across the U.S., volunteer firefighter programs have proven unable to overcome recruitment and retention challenges that impede success. Volunteer firefighters still incur costs for specialized equipment and thousands of hours of training required for certification, he said.
The latest studies show that seven volunteer firefighters are required for every one paid firefighter, Sartain said. Other formats, such as working with journeyman or student firefighters, have shown more promise, he said.