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Comment by sema4hacker | Hacker News Reader

Our community has three large fire trucks, and one is sent out for every 911 call, even though the vast majority of calls are for medical emergencies, not something requiring a fire truck (which always arrives quickly, but a subsequent ambulance on call is what inevitably hauls a patient to the hospital). I've never understood why the fire department doesn't acquire and dispatch small vehicles for all those medical calls instead of a giant fire truck. Seems like that would help hold down costs.

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> I've never understood why the fire department doesn't acquire and dispatch small vehicles for all those medical calls instead of a giant fire truck.

Staffing.

Almost every call requires more than two people and ambulances are typically only staffed with two people.

If there is a second call (fire, rescue, or anything that requires the larger apparatus) while the fire engine is out assisting the EMS crew and the crew has taken a smaller vehicle, they have to drive back to the station, get on the engine, and then respond to the second call. This is not uncommon-- for my department I'd say it's routine.

In smaller volunteer departments like mine, there aren't enough people to go around.

In larger paid career departments, the cost of the extra personnel needed to staff smaller vehicles very quickly exceeds the cost of the wear and tear on the larger apparatus. You have to account for more than just their salaries, but also insurance, training costs, any equipment issued, and retirement contributions.

There's also the matter of equipment. Larger apparatus carry tools and equipment that smaller vehicles can't or don't.

Many jurisdictions do have a mix of resources where EMS crews can get the additional resources they need on a call without an engine or truck responding, and it does work for the most part. Most jurisdictions can't afford that.

It seems common in Europe to not send fire apparatus, but I'm willing to bet they deal with many fewer bariatric patients so most calls don't need six guys.

Valid question, and I hear it all the time. Most of the time it's due to preparedness and staffing. By having those 4 people on a fully equipped engine, if something big (structure fire, vehicle extrication, rescue) happens, they can jump in and go with a vehicle full of tools. (provided the ambulance crew can take over).

Otherwise if they're in a car, they'd have to drive back through traffic to the station, move their gear to the new vehicle, and drive back to the scene. It can cost valuable time. Fire engines carry a surprisingly large amount of tools and equipment for a variety of purposes.

That being said, many larger departments are trying out "cars" (usually an SUV) with two people and a med bag to go to medical calls. While the engine/truck and crew stay at the station. This is fairly expensive with the new vehicle, equipment and extra staffing. However it is being done now with success in urban areas.

but the ambulance crew already has a paramedic, so why do they also need one from the fire department?

Because the fire department can usually get there faster. The goal is to get medical help there as quickly as possible.

What do you optimize for?

Person on scene?

Time to hospital for patient?

Time to arrival of a fully equipped ambulance to deal with emergencies?

Risk and time from dealing with a complex handover of the patient from fire truck crew care to ambulance care?

For me it seems like in the vast majority of cases optimizing for getting a fire truck on scene fast is the wrong solution. Waiting a few extra minutes for the ambulance would improve outcomes.

And it is of course possible to differentiate on calls.

A life or death situation like a cardiac arrest or someone bleeding out would select from all available units. Including the fire department, ambulances and police. But those are a tiny sliver of 911 calls.

Vote up from me, but even this isn't optimal. As opposed to fire trucks, ambulance vans can be parked almost anywhere in the city waiting for calls. They don't need to wait at their base station. They get faster to a call location than a fire truck.

In 99% of US jurisdictions, you cannot even develop land in a way that prevents an enormous firetruck from driving all around the property. Which means less density, more wasted space for road, further cementing a car-centric life.

Yes, in some places there may be more fire stations than ambulance locations. But that's not always the case. In the modern age you would think that either the ambulance or the fire truck could be routed to the destination based on the their GPS locations depending on which is closest.

But also, I don't understand why first responder ambulances don't co-locate with the fire stations (in places where there are more of the latter). If there's an emergency that is not a fire, the ambulance goes.

I think this video from the Not Just Bikes channel shows quite well the major difference in approach between fire departments in the USA vs the Netherlands (which is quite similar to many other European countries): https://www.youtube.com/watch?v=j2dHFC31VtQ

Fire engines in Europe are as well equipped as the American/Canadian ones while not depending on these massive and expensive bespoke rigs.

In the UK the NHS/local health trusts actually have a few fast response cars which contain at least a paramedic but more often someone who is trained higher. Even the fire service will have a small car as part of an incident response team.

I've also seen more ambulances that are based on a transit/mini bus platform for call outs that aren't major, think old person falling over. They save the big boxy ones for more serious issues.

In my country, no fire truck is called unless there's a fire. Extracting people from a mangled car isn't the job for a fire truck. All the needed tools fit in an ordinary van.

Also, going back to get the tools or change the vehicle is incredibly stupid because: 1) crews already know what they're going to be dealing with before they leave, 2) just suppose they forgot to pack the tools - we have mobile phones, you know...

>Also, going back to get the tools or change the vehicle is incredibly stupid because: 1) crews already know what they're going to be dealing with before they leave

They have precognition and can see into the future and know that a house fire is going to start while they're out at a non-fire call in your country? That's amazing! And by "amazing" I mean "bullshit". Now it's perfectly possible in your specific region of your specific country that they have sufficient resources, or face a some what different problem space given local details like types of construction etc, which lets them allocate things differently. But you shouldn't be so quick to lob around accusations of "stupid" at proven emergency response forged through hard lessons and ruthless practical local realities from your limited perspective and thinking.

>2) just suppose they forgot to pack the tools - we have mobile phones, you know...

Did you really just suggest that an extra 20-45min wait is no problem in a life/safety critical situation, or that there will necessarily be someone who can go bring it from a volunteer fire department? Or do think that there is nowhere further then a few minutes from a fire dept? Either way you are in a serious, serious bubble.

> They have precognition and can see into the future and know that a house fire is going to start while they're out at a non-fire call in your country?

Do heart attacks and car accidents usually include fires in your country? I could only find statistics for Finland [1]. It seems that fires are so rare they're put in the "rescue and other authorities" category which has a total of 5% of calls requiring intervention.

In my country I know of only 2 or 3 cases of cars that caught fire in an accident in the last 10 years and they all caught fire immediately, not after ambulance arrived. They're so rare, it's a major news story every time. And I know of no heart attacks that were followed by a fire. /s

Let's assume that somehow a fire starts after the initial crew gets there. I'm sure everyone is trained to: 1) call for the fire truck (that's separate crew, nobody has to go back and fetch it), 2) use the fire extinguisher from the van and 3) as most emergencies are in cities, use the building's fire hoses and extinguishers until 1) arrives.

> extra 20-45min wait is no problem in a life/safety critical situation

That's not what the statistics show. [2]

> Either way you are in a serious, serious bubble.

No, I don't belive I'm in a bubble. I still belive it's a very very big waste of money and resources to call a fire truck if there's no fire.

[1] https://112.fi/en/-/statistics-on-the-emergency-number-112 [2] https://wifitalents.com/emergency-response-time-statistics/

I think the idea is that fire trucks dispatch for a heart attack, get there, and then get called in to fight a fire in another location.

It still doesn't make sense.

Fire/emergency stations are placed so they can get quickly anywhere in their assigned area. If they're at another call when a real fire starts, it's not statiscally probable to be closer than if they were at the base station. They could be delayed even more by the traffic jam caused by the car accident they're responding to.

So better send one of the vans to heart attacks and car accidents and keep the fire truck at the base stations for fires only.

You definitely seem to have a lot more background in the details and nuances of these systems than I do, sounds like you've got it figured out!

Most rigs in Europe (I'm in France) are Sprinter type van like an ambulance, which is the one which gets mostly called. The other Sprinter are with tools, and or two big ladder trucks for the real fires which rarely happen.

To me they seems to have tuned their rigs to what they need most In rural area prone to forest fire, they have big all terrain trucks with water tank (useless in cities)

The fire truck goes because it has a paramedic.

It needs a paramedic because fire fighters often need paramedics.

So if the small vehicle has a paramedic, you still need one for the big truck.

And if you have another vehicle, you need a bigger apparatus bay at the station and more beds and more staff times three shifts.

Finally, when the 911 call comes in there is not time to triage. The system is optimized for response time because people might die.

I assumed it's so it gets used, otherwise it would just sit there and might not work when needed

> Seems like that would help hold down costs.

That's not a goal.

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