Inundated with emergency calls and facing hard budgetary choices, North Shore Fire and Rescue needs help, department says
More people are calling North Shore Fire and Rescue than they were a few years ago, especially for social service support, NSFR officials said.
To help the department keep up with the steady rise in emergency calls, NSFR is looking to hire a case manager to respond to non-life-threatening emergencies and to handle calls seeking support navigating social services.
NSFR estimates it will respond to over 12,000 total calls by the end of 2023, a figure that’s been steadily creeping upward for years, according to an analysis of call data obtained from NSFR. In 2015, the department fielded 7,828 calls. By 2022, the number was up to 11,323, an increase of 45%.
“Year over year, we're seeing a 5 to 7% increase in our call volume,” Daniel Tyk, assistant chief at NSFR, said.
Earlier this year, NSFR had hoped to add another ambulance and team of six responders to ease the strain the call volume has placed on the department but couldn’t find the funding for it, NSFR Fire Chief Robert Whitaker said.
Instead, the department is seeking approval to hire a case manager who could help handle the call volume. Whitaker said the case manager will be able to assist and become acquainted with frequent users of the 911 system who often need transportation or support navigating social services.
How has the rising call volume impacted NSFR?
Keeping up with the inundation of calls has placed immeasurable stress on NSFR’s personnel and resources, Whitaker said.
“It creates wear and tear on vehicles and equipment, but also wear and tear on people,” he said. “And when we’re busier, it takes us longer to get to other emergencies.”
The department is frequently forced to place people on mandatory overtime on days they normally wouldn’t be scheduled to work, Assistant Chief Daniel Tyk said.
“It takes a mental and physical toll,” Tyk said. “Imagine being on calls, asked to make life or death decisions and think critically and on your toes after 72 hours. We want to be successful and have good outcomes, but that mental and physical strain is why we’re seeing a nationwide increase in police and fire suicides because of the mental health toll of constantly seeing people at their worst with little recovery.”
A University of Arizona analysis of state death registry data in the state between 2009 and 2015 revealed that the odds of dying by suicide were 1.39 times greater for first responders than the general adult population during the same period.
Increasing call volume is taking its toll on department vehicles, too
Keeping up with the call volume is also causing faster exhaustion of NSFR’s resources and quicker wear and tear build-up on vehicles.
“We're not driving the most fuel efficient vehicles,” Tyk said. “Fire trucks don't get great gas mileage. And constantly bumping a million dollar piece of equipment down the road, especially during Wisconsin winter weather which can beat the snot out of the bottom of your car, takes a toll on our vehicles.”
The cost of fixing and replacing the wear and tear creates budgetary strains for NSFR because the vehicles keep rising in cost. Last year, for example, it cost $600,000 to purchase a fire engine. This year, it will cost the department $900,000, Tyk said. Fire trucks, which have the large ladders attached, now cost just under $2 million when four years ago, they cost $900,000.
The turnaround time is longer, too.
Previously, it would take between 18 and 24 months to order these vehicles. Now it takes between 40 and 48 months, meaning the department has to budget and secure funding for new vehicles four years before they will need them.
“We’re certainly facing challenges that, five or six years ago, weren’t even on our radar,” said Tyk.
Why are 911 call volumes rising at North Shore Fire and Rescue?
The main category driving the volume increase in total calls for service is medical calls. The EMS calls category includes responses to life threatening emergencies like car accidents and overdoses but also responses to requests for social service support, mental health crisis support or even transportation to urgent care, Whitaker said.
“What people call for an ambulance now in 2023 is vastly different from when I started in 1993,” Whitaker said. A larger population of older people living in their homes alone with ambulances a call away will often call for headaches or ear pain," he said. “More and more frequently, people are using 911 as a social support service to basically be their health care."
In 2015, NSFR responded to around 5,000 EMS calls. In 2022, the department responded to almost 8,000.
A recent survey conducted by the University of Wisconsin-Oshkosh Whitburn Center for Governance and Policy Research found that that over 10% of Wisconsin fire agencies had at least one instance over the past year where a service call in their jurisdiction yielded no response.
Tyk said, “The confusion and difficulties that come with navigating the healthcare system leads people to call an ambulance for things that they wouldn’t have previously.”
Fifteen percent of the calls from 2022 were from patients who appeared in the database five or more times, according to an audit of NSFR’s patient database last year.
“Health care and social service systems are so complicated,” Whitaker said. “And if you’re already facing some kind of challenge in life, it just adds on a whole new burden."
Weaknesses in the mental health system create a lot of ambulance requests too, Whitaker said. Many people with mental health issues as well as concerned or fearful family members call 911 during crises.
NSFR covers the North Shore, but also responds to calls in Milwaukee and surrounding areas
NSFR covers the City of Glendale and the Villages of Bayside, Brown Deer, Fox Point, River Hills, Shorewood and Whitefish Bay.
But it also frequently responds to ‘mutual aid calls,’ as Whitaker put it, from neighboring communities. In 2022, NSFR responded to 1,237 calls in the City of Milwaukee. The Milwaukee Fire Department, in turn, responded to 1,167 calls on the North Shore.
“There’s this pretty intense agreement in the mutual aid world that the municipality doesn’t matter when there’s a major call," Whitaker said. "When there’s a minor call, jurisdiction matters. But when your house is on fire or someone’s not breathing, the fire departments on the North Shore have taken the attitude that we’re going to respond with the closest unit.”
Private ambulance companies play a role in the response
Since 1978, the City of Milwaukee’s emergency response system has been supported by several private ambulance companies that respond to non life threatening calls, said Chris Anderson, director of operations for Bell Ambulance.
Prior to 2020, Bell Ambulance was one of four private ambulance companies contracting with the City of Milwaukee. Over the years, the costs these companies faced increased while reimbursement rates stayed the same. Between 2020 and 2021, the other two private ambulance companies serving Milwaukee, Meda-Care and Paratech, were acquired by Midwest Medical Transport, a multi-state transport service that doesn’t typically respond to 911 calls.
The city and the private ambulance services had to reimagine their partnership, which continues to this day. Now, Bell Ambulance assigns an ambulance and crew to the Milwaukee Fire Department firehouse.
“At the time, it was groundbreaking for us,” Anderson said. “But it’s become the new normal. Everyone envisioned it being a temporary solution. It really works and there was no reason to stop it.”
Reimbursement rates have improved since the pandemic, and Anderson said Bell is doing better than it had been financially, while still responding to all requests. But there’s still a long way to go, he said.
Many of the calls those private ambulance services responded to were transporting people, especially those in nursing homes and assisted living centers, to urgent or emergency care. “When those companies went away, they all started calling 911, because we’re the only player left," Whitaker said.
Fewer people are applying for fire and rescue positions
Not only are private ambulance services dwindling, but fewer people are applying for fire and rescue jobs than they were a few years ago. “There isn’t a large pool of applicants lining up to do this work right now,” Tyk said.
Around the time when Tyk was hired to work at NSFR in 2005, openings would see between 300 and 400 applicants. “Now we’re carrying open positions for long periods of time,” he said.
What they're doing about it: 'The 911 side of things is only half of the picture'
As NSFR continues to pursue other funding sources for a new ambulance and team, in the meantime Whitaker said they will also seek to hire a case manager in partnership with the North Shore Health Department and the Bayside Communications Center.
When compared to the 1% budget increase it would cost in 2022 to start hiring half of a new six-member ambulance team, the case manager position would only increase the budget by a quarter of a percent, according to the budget proposal.
In Milwaukee County, a handful of other fire departments employ some iteration of a case manager, including Wauwatosa and West Allis. Officials from fire departments in both areas said they’ve also seen a rise in calls.
The Wauwatosa Fire Department shares a social worker with the police and health departments who helps respond to emergency calls, Chief of Emergency Medical Services for the department Chris Sandoval said.
The West Allis Fire Department has used both a mobile integrated health team, or group of specialized community paramedics, and a case manager, which work with the hospital system to provide and connect people to the resources, knowledge or support they need before the issues rise to the level of an emergency, West Allis Assistant Fire Chief Jason Schaak said.
“The 911 side of things is only half of the picture,” Schaak said. “We wanted to make sure that we were formally partnered with the hospital systems so that we can see the other side of things and basically understand somebody's care plan from start to finish — from the community, to the hospital, back to the community.
A number of community paramedic programs the West Allis department has run have been successful Schaak said. In particular, a 2015 program targeting a sample group of frequent callers saw an 86% reduction in emergency room utilization within the group.
“Those people don’t just disappear and stop accessing health care. They just stop accessing the emergency room because they were connected with more appropriate levels of care,” Schaak said.
A case manager could follow up with people who overdose
Whitaker especially envisions the case manager role as someone who would be able to follow up with people who overdose.
“It’s very common that we see people who overdose multiple times,” he said. “Once they’re given Narcan or are sent home from the hospital, the case manager would actually be able to follow up with the person after, give them Narcan and help connect them to recovery and mental health support.”
Over the last four years, the City of West Allis saw its overdose rates drop 8% after a case manager program was implemented, according to the department’s 2022 annual report. During that same time period, Milwaukee County overdose rates went up 22%.
West Allis’s community paramedic model is costlier, since it involves hiring more people, Schaak said, but “each farm is going to come up with their own formula, their own recipe, and I haven't seen one not work yet.”
The most frequent medical call category NSFR responds to is from people who fall — another focus area NSFR’s case manager would be tasked with.
“A lot of falls are preventable, but end up costing many elderly people and the healthcare system a whole a lot of money,” Whitaker said.
NSFR currently does not have a priority system for answering calls
Another potential solution lies in possibly implementing a priority system for answering calls based on emergency medical dispatch, a universal standard for emergency dispatchers taking calls for a broad range of field and triage response. Currently, NSFR does not prioritize certain calls over others.
However, in 2022, NSFR dispatchers started asking a few more questions to callers to help them assess the problem, essentially building a trove of data that could inform how NSFR might implement a system of call priority.
That kind of system would take years to build, Whitaker said. “And we’re trying to tie all the data together to see at what point we might have to actually handle calls differently if we can’t get more resources to respond to them,” he said. “And then, on the back end, we’re trying to assess whether the public would be OK with that.”
The NSFR governing board recommended the case manager position as part of its 2024 budget request, which must be approved by at least five of the seven municipalities NSFR covers in the coming weeks. If it passes, Whitaker said he expects the job posting to go up by the end of 2023.
Contact Claudia Levens at clevens@gannett.com. Follow her on Twitter at @levensc13.
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This article originally appeared on Milwaukee Journal Sentinel: North Shore Fire confronts surging calls and increased response times
