To: City Council
From: Board of Directors, Friends of Sunset Park
RE: 1/27/15 Council agenda item 8-B: FY 2014-15 Midyear Budget — Fire Department
The January 27th City Council agenda will include the midyear budget review.
There has been some discussion as to whether to add:
a) 6 paramedics to staff one rescue ambulance 24/7, or
b) 12 personnel to staff one reserve fire engine 24/7 with 2 paramedics
and 2 EMT’s.
The FOSP Board of Directors urges the City Council to maintain the current
response model by funding an additional 12.0 FTE firefighters to allow for
the full-time 24/7 staffing of one of the Santa Monica Fire Department (SMFD)
reserve fire engines with 2 paramedics and 2 EMTs.
We think that the staff recommendation for 6.0 FTE firefighters to allow for
the full-time staffing of one rescue ambulance (RA) with 2 paramedics 24/7
is insufficient, in addition to being an unwise and unnecessary change in the
city’s current model of responding to calls for both fire suppression and
emergency medical assistance with a fire engine staffed by 2 paramedics and
The Santa Monica Fire Department received a Class I rating in 2012 (one of
seven cities in California with that rating currently — http://www.isomiti-
gaion.com/ppc/1000/graphs/CA.html) with the current model of sending a fire
engine with 2 paramedics and 2 EMT’s in response to calls for both fire sup-
pression and emergency medical assistance.
The FOSP Board does not understand the rationale for the Santa Monica Fire De-
partment to start switching to a different, and seemingly less effective, res-
We understand that affordable housing is a funding priority for the City Coun-
cil. However, it seems puzzling that the Council would fund housing for resi-
dents less likely to be able to afford health insurance, less likely to visit
a primary care physician for regular check-ups, more likely to use the ER for
primary care, and therefore more likely to need Emergency Medical Assistance,
at a time when we apparently can’t afford to maintain the city’s current high-
ly effective model for Emergency Medical Assistance.
Growing demand for service:
Calls for Service to the Santa Monica Fire Department (SMFD) have increased dramatically over the years, from 1,800 calls in 1972, when the department
had 5 engines and 1 ladder truck, to 13,000 calls in 2013, when the department
had 6 engines and 1 ladder truck. http://www.santamonicafire.org/dailyreports.
Insufficient staff for fire suppression:
Due to the increase in calls, SMFD apparently has to call on the Los Angeles,
Culver City, and Beverly Hills Fire Departments for “mutual aid” more and more
At the time of the November 18, 2014 attic fire in a 7,000 sq ft home in the
2300 block of La Mesa Drive, due to the size of the structure and the type of
roof construction, the incident commander had to call a “2nd alarm,” i.e., add-
itional equipment and staff. However, SMFD does not have enough firefighters
for a 2nd alarm, so the dispatcher contacted other cities for “mutual aid.”
Unfortunately, none was available, although the LA Fire Department eventually
sent an engine and an ambulance. According to the Daily Press, “A total of 35 firefighters were on the scene.”
Fire Department responds to structure fire” — Santa Monica Daily Press –
11/20/14 – p.12 — http://smdp_backissues.s3.amazonaws.com/112014.pdf
Santa Monica only has 31 firefighters on duty at any given time, so this one
fire apparently required nearly the entire Fire Department. What if another
emergency had occurred in Santa Monica at the same time, and the nearby fire departments couldn’t provide mutual aid?
When the Expo Light Rail starts bringing even more people into the city on a
daily basis in 2016 and tying up north-south traffic, there will apparently be
only two engine companies to serve the neighborhoods south of the light rail,
i.e., the Pico neighborhood, Sunset Park, and Ocean Park.
Fire Station 2 is on Hollister in the Ocean Park neighborhood.
Fire Station 5 is on 25th and Ashland, next to Santa Monica Airport.
An additional concern is that when Engine Company 5 is out on a call, there is
no one to man the Aircraft Crash Rig at Station 5, which is specifically de-
signed to suppress flammable liquid fires in the event of an aircraft accident.
Approximately 78% of emergency responses in Santa Monica are medical in nature.
All firefighters must possess EMT certification at the minimum. Almost half of
the SMFD firefighters are licensed as paramedics. All the EMTs and paramedics
are also firefighters, which allows the SMFD to provide a full service response, whether it’s a medical emergency, fire traffic collision, or any other emergency. http://santamonicafire.org/Content.aspx?id=9428
According to the City of Santa Monica, “More than 1/3 of Santa Monica residents
are over the age of 50, and the percent of adults 65 and older will increase dramatically over the next 10 or 15 years.” This will inevitably result in an increase in the need for emergency medical services.
According to the Center for Disease Control’s “Leading Causes of Death” as of
2010, heart disease was the leading cause of death for males and females of all
races and ethnicities. http://www.cdc.gov/nchs/deaths.htm
From the American Heart Association: “We’ve all seen the movie scenes where a
man gasps, clutches his chest and falls to the ground. In reality, a heart
attack victim could easily be a woman, and the scene may not be that dramatic. Although men and women can experience chest pressure that feels like an ele-
phant sitting across the chest, women can experience a heart attack without
“Instead [women] may experience shortness of breath, pressure or pain in the
lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper
back pressure or extreme fatigue. Even when the signs are subtle, the conseq-
uences can be deadly, especially if the victim doesn’t get help right away…
Even though heart disease is the No. 1 killer of women, women often chalk up
the symptoms to less life-threatening conditions like acid reflux, the flu
or normal aging.”
2-person Rescue Ambulance squads vs. Fire Engines staffed with 2 paramedics
and 2 EMT’s:
With 4-person response, for example, if the call is to an apartment building
with a security door, one person secures the entry door and guides the cont-
ract ambulance crew to the apartment, while a second person documents the call, contacts the hospital(s) and gets a destination, talks to the family, gets the patient’s medical history, and finds out what medications the patient takes.
This leaves the third and fourth to perform Advanced Life Support (ALS) proce-
dures — check vital signs, start IVs, attach 12 leads for EKGs, perform capno-
graphy and intubation, or whatever is needed.
If the patient suffers a heart attack, all 4 stay with the patient:
1 – airway (intubation)
2 – chest compressions
3 – connect the patient’s 12 leads to the EKG monitor
4 – start an IV with cardiac drugs
According to Wikipedia, capnography is increasingly being used by EMS personnel
to aid in their assessment and treatment of patients in the pre-hospital envir-onment. These uses include verifying and monitoring the position of an endotra-
chael tube or a blind insertion airway device. A properly positioned tube in the trachea guards the patient’s airway and enables the paramedic to breathe for the patient. A misplaced tube in the esophagus will lead to the patient’s death if
it goes undetected.
If only a 2-man squad responds to a call, one does chest compressions while the second person does CPR with a bag valve mask (which can inadvertently push air
into the stomach, causing vomiting), and they wait for back-up to arrive. From
what we understand, a 2-man squad can’t start an IV, and they can’t intubate air directly into the lungs.
The advantage of starting an IV to administer cardiac drugs is that these drugs apparently strengthen the heart in case shock treatment is required (which para-
medics can do, but not with a 2-man crew).
Complications from using the bag valve mask, rather than intubation, are related
to over-inflating or over-pressurizing the patient, which can cause 1) air to
inflate the stomach, 2) lung injury from over-stretching, and/or 3) lung injury
When a face mask is used in conjunction with a manual resuscitator, the intent
is for the force-delivered air or oxygen to inflate the lungs. However air
entering the patient also has access to the stomach via the esophagus, which
can inflate if the resuscitator is squeezed too hard (causing air flow that is
too rapid for the lungs to absorb alone) or too much (causing excess air to
divert to the stomach).
Gastric inflation can lead to vomiting and subsequent aspiration of stomach con-
tents into the lungs, which has been cited as a major hazard of bag-valve-mask ventilation, with one study suggesting this effect is difficult to avoid even
for the most skilled and experienced users. Stomach inflation is a complex prob-
lem that may cause regurgitation, gastric acid aspiration and, possibly, death.
For these reasons, it seems that maintaining the current model of sending a Fire Engine with 2 paramedics and 2 EMT’s in response to calls for emergency medical assistance would be safer than sending only a Rescue Ambulance with 2 paramedics.