Why would a fire department ask the public to help it set performance goals, when saving lives and property are its obvious mission? Las Vegas Fire and Rescue (LVFR) convened community stakeholders to discuss how it could achieve its mission, while better meeting the needs of the community. LVFR worked with GovEx to develop a community engagement plan and to collect and share relevant data on which to base these conversations.
In partnership with the people of Las Vegas, LVFR adopted a goal to reduce fire and rescue calls per capita by five percent by 2021. According to LVFR Chief Willie McDonald, calls to the Department have risen year over year – from around 87,000 in 2010 to hundreds of thousands presently. Many of these calls are non-emergencies or requests for resources LVFR is not best positioned to provide. These cases were tying up equipment and often failing to meet the needs of callers.
Previously, like many other fire departments, LVFR was measuring its success based on quickest response time. However, this measure does not directly correlate to the number of lives saved. Rather, measuring performance according to response time may incentivize a fire department to send out equipment as soon as possible, not as sensibly as possible.
As a result of community conversations and the subsequent focus on reducing calls for service, Chief McDonald and his team implemented three critical strategies, which immediately freed up engines and equipment for the more serious calls:
- Prioritizing calls according to urgency
- Addressing unmet social needs
- Increasing education for the public on fire and life saving techniques
One easy way LVFR has seen immediate results in better serving its community and made progress on its call volume goal was by instituting a priority scheme for each call’s urgency. The most urgent, life threatening cases are categorized “Echo” and are addressed immediately with the City’s equipment and staff. The lowest priority case are “Alpha” and may be handled by sending a private ambulance rather than a Fire Department vehicle.
Vicky had developed an extreme phobia of going outside and could no longer leave the home where she lived. Eventually, her home became an unsafe environment to live in. When Vicky ran out of her prescription medicine and needed to see the doctor, she called 911 for help. Her call was prioritized “Alpha” by the dispatcher and she was sent a private ambulance to take her to a rehab hospital. Since then, her medical conditions have stabilized and, with the assistance of a local nonprofit, she was able to move to a new apartment and even adopt a dog.
By prioritizing calls based on urgency, those which are less pressing still receive services but in a way that is less resource intensive for LVFR and more responsive to the community’s true needs. Using its prioritization scheme, in February 2017 alone, Las Vegas Fire and Rescue was able to reduce the number of emergency vehicles deployed for mental health interventions, medical transfers, and other non-emergency requests by 300.
Addressing Unmet Social Needs
As part of its call reprioritization efforts, LVFR partnered with UNLV School of Social Work Masters students to start the Community Health Improvement Program (CHIPS) to address the unmet social needs of 911 callers.
Fire department dispatchers were trained to refer callers like Linda, a 60 year old woman struggling to care for her middle-aged son, who was paralyzed by a gunshot wound, to CHIPS for assistance. In trying to help her son from his wheelchair to his bed, he would sometimes fall on top of Linda, pinning her to the floor. To get him up and into bed, she would call 911.
Working with Linda, CHIPS saw she needed an off-the-ground hospital bed for her son, which would make it easier and less dangerous to move him. CHIPS students advocated for Linda to get the bed she needed and cut down her reliance on emergency services.
The Las Vegas Fire Department is also using education as a way to cut down on calls and keep more equipment available for emergency cases. When someone calls LVFR because a fire detector needs replacing, the department no longer sends an engine. Fire prevention officials are individually sent to neighborhoods to teach fire and other safety techniques, such as how to best convey information to 911 or check the functioning of smoke detectors.
Stories like those of Linda and Vicky are anecdotal proof that LVFR’s efforts are paying immediate dividends for Las Vegas residents. By implementing and measuring prioritization and education, Las Vegas Fire and Rescue estimates it will achieve its goal of a five percent reduction in call volume over the next four years.
In addition to the overall goal of reducing call volume, Las Vegas and GovEx developed supporting measures to determine the success of these strategies. Fire Department analysts segmented calls for service into five categories that they targeted for improved resource alignment, which included medical facility transfers, detox transfers, non-emergent requests for service and Legal 2000 transfers, which allows authorities to hold individuals who may do harm to themselves or others. Based on this analysis, the Department aims to increase by five percent the number of callers sent the appropriate equipment. To ensure this outcome, LVFR will monitor the percentage of emergency and non-emergency requests that are assigned to the appropriate response and resource.
Through education and engagement, including community risk assessments, LVFR also plans to reduce hazards by 20 percent by 2021, which will reduce future calls for emergency services. This is primarily targeted to residential properties, as analysis has revealed more deaths occur in residences rather than commercial buildings.
A third new LVFR goal is to increase the percentage of persons suffering from sudden cardiac arrest who are discharged from the hospital by 10 percent by 2021. This measure reflects increased survival rate as a result of prevention as well as public education, and pre- and post-hospital care. LVFR chose this supporting measure because it’s important to educate the public about sudden cardiac arrest, cultivate partnerships, and strengthen the skills of first responders.
Beyond setting these measures, GovEx supported the City in refreshing its performance management program, Results Vegas. Through routine meetings with the City Manager and other City leadership and staff, LVFR will hold itself accountable to measures the City values. For instance, LVFR will analyze trends in reducing hazards in targeted areas to determine whether there has been success in reducing hazards in residences.
Goals are not expected to be achieved overnight. Instead, GovEx encourages LVFR to use its goals galvanize the Department, residents, and other stakeholders around their initiatives. It is gradual but fulfilling work, which takes the concerted collaboration and dedication of Chief McDonald, fire fighters, emergency services crews, 911 operators, and even UNLV students. But, critically, more Las Vegans are getting the help they need from their Fire Department, in large part thanks to a shift in priority indicators.