Detroit’s Back!

With that headline, one might think this is an article about Calvin Johnson and the resurgence of the Detroit Lions.  I wish that were true!

Is anyone else tired of hearing about the Detroit Fire Department?

In a recent story reported by the Fox affiliate in Detroit who has been following the department’s struggles rather closely, it was reported that they had not even ordered the promised 20+ ambulances promised to be on the road by January of 2012.  Not even ordered yet?  Come on!

While it does not take long to get a truck on the road once it is licensed and put together, the steps leading up to that point can take some time.  Lettering needs to be decided on, equipment needs to be ordered, and the trucks need to be manufactured.  Once again, the Detroit Fire Department has dropped the ball.

This brings up the question: when is enough enough?  When is the City of Detroit going to step up, tell the Fire Department they are not cutting it, and start looking elsewhere for EMS coverage?  While that can be a difficult undertaking, especially in a city in the financial dire straits that Detroit is in, it may be a necessary step to provide a better service to the city.  In other settings around the country, cities would be calling for the heads of the administrators of a department that has failed as badly as Detroit Fire has, but it almost seems like their answers of “we’re doing the best that we can” and the promises of improvement are enough to keep the city pacified.

Providing EMS service in an urban setting is a difficult undertaking.  Providing quality service is exponentially more difficult, and yes, there is a difference.  Volumes tend to be higher, and acuity is lower.  Sometimes convincing municipalities that maybe an entire fleet of paramedic level ambulances is not the answer to the problem is difficult.  Detroit is in the perfect situation to bring someone in who can say “trust us, let us run the service.  The calls will be done, and people will be taken care of.”  Who knows, it could be the perfect blank canvas to find that balance of fast response, appropriate level transport, and high quality medical care.

Systems around the country have come rather close to achieving that level of EMS Zen, look at what systems like Boston, Fort Worth, and Wake County have done.  Sure, Fort Worth and Wake are 100% ALS systems, but they have expanded to include advanced practice paramedics as well.  Boston on the other hand has achieved a high level of success by using a true tiered system involving a first responding fire department, BLS transport ambulances, and ALS transport capable ambulances.

Ultimately though, I think it is time for the Detroit Fire Department to admit defeat.  Their model is not working.  It is not clinically sound, it is not meeting response times, and it is not providing what it should for the citizens of Detroit.

What Detroit needs to be careful of though is the one thing that is worse than an over confident department administrator: an uninformed politician.  It is people like Kenneth Stokes from Jackson, Mississippi or the city council in Kansas City, Missouri who know nothing about EMS who can do more damage than they could possibly imagine.

But really, whose fault is it for letting their ignorance continue?

  • I would be willing to bet that the contract is held up in city government beyond the fire department. It takes us almost a year to finalize anything, I can only imagine what it is like in Detroit.