Many mid-sized fire departments are experiencing a rising demand for EMS in expanding coverage areas. For example, the Mesa (Ariz.) Fire Department must serve a 128-square-mile coverage area and at the same time keep EMS response times down, said Harry Beck, the city’s fire chief. The 471-person department protects more than 453,000 residents with 18 fire stations and 24 advanced life support and firefighting units. The department added the ALS units to address the rising medical call volume, which grew to more than 75% of fire calls, he said.

As a result, the department is struggling to serve rising call volumes and is seeing an in increase in response times, Beck said. So during peak times of the year, the department hires seasonal employees, including a physician’s assistant for units in areas that run more than 5,000 calls annually. Such personnel increase the availability time of an engine or a ladder company by almost 10% and reduce response times by 4 to 6 seconds, Beck said.

“These units have picked up the slack, improved the availability time of advanced life support and firefighting units, and improved response times,” Beck said.

The department also now has transitional response vehicles (TRV) that can serve both fire- and medical-based calls. The department pays for the firefighters’ TRV training, Beck said. Once certified, firefighters deliver service from a Chevy Silverado with an ambulance box attached on back. The vehicle is equipped for basic life support services and is frontloaded with two firefighters, one a paramedic and the other an EMT. In addition, the TRV team also can serve as an engine company, having turnout gear on board. If a fire load is heavy in a particular area of Mesa, the unit can respond as part of firefighting efforts, he said.

However, a rising medical call volume didn’t result in more funding resources to help the Mesa Fire Department deliver services. In addition, there currently isn’t a fee-for-service billing plan in place to pay for EMS, so the department does not charge for its services. Beck explained that in Arizona, departments need a license from the state to provide emergency transports to be able to charge insurance companies.

“So we really are not in a position to charge for transports,” he said. “We see having the ability to do some cost recovery [in the future], depending on legislation. … Maybe we can charge for some services.”

The department is looking for ways to offset costs by improving services and efficiency. Beck said although they do not offer emergency transports, they do transport BLS patients to non-emergency urgent-care centers — rather than hospitals. By diverting patient traffic based on medical need, the ambulance bottleneck at hospitals during peak times dissipates. Re-directing medical attention to the urgent-care centers, which are often less crowded, also increases the response times of ambulances to other life-threatening emergencies, he said.

Even if departments can’t figure out a way to fund it, Beck warned chiefs about refusing to provide medical services. He said public-safety agencies have to consider legal consequences if they refuse to render service. In addition, chiefs need to push for state and federal funding to move the fire service into a one-stop emergency services agency because medical calls are rising nationwide.

“Rising medical calls will continue to be a growing trend throughout the nation’s fire service,” Beck said.