Don't be too quick to assume that lower-income people have more risk than their well-off counterparts. However, the only way to determine if there's any difference is to recognize that the difference exists. An examination of the frequency, location and nature of calls will help determine that the social vulnerability in rich neighborhoods is not the same as it is in moderate- or low-income neighborhoods. Without labeling these as being good, bad or indifferent, demographic factors do play into the combination of fire department workload and call frequency.

Another interesting demographic element is the cluster effect, which occurs when you have a particular occupancy that requires a particular type of call on a fairly frequent basis. We all know these exist. As a matter of fact, many fire departments love to share anecdotes about their frequent-fliers program. It's common to find that nursing homes, mental institutions, homeless shelters, and other homeless-people magnets like bus depots and train stations frequently require a community's emergency services.

The social vulnerability question in this case would be to look at why these people are placing such a demand on the services. Frankly, there isn't a lot we can do to teach these people how to be a customer, and they can't be regulated out of existence. Understanding where they are and what they're doing there can open up a dialogue regarding funding and the deployment of resources to cope with the problem. Many politicians would like to think that problems of this nature will simply go away if they aren't discussed. But these problems won't go away for a modern fire department. They'll continue to fester until something is done to reconcile them with resource allocation.

Another social vulnerability factor is crime. Most fire departments do not pay enough attention to crime statistics as they relate to demand in the response system. Granted, firefighters called to the scene of a gang shooting or domestic assault can't ignore what's in front of them, but this factor of social vulnerability should be considered during the planning process. The lessons learned from these events might influence the training of our EMS personnel or enhance security by improving relationships with law enforcement.

Social vulnerability is behaviorally driven and every bit as important to the fire department planning process as the structural conditions in a response area. Preplanning of fires requires a look at building construction and fire behavior to establish a heads-up on what to expect with individual occupancies. In the same way, social vulnerability looks at the culture of a community in relationship to the contributing factors that cause people to place demands on the fire service. Social vulnerability should be part of EMS preplanning.

Preplanning with social vulnerability requires extrapolation: the use of information beyond its present state to identify future trends and patterns. This technique can be used to project patterns of distribution and concentration of risk for the emergency medical services. The danger is that attempting to examine social vulnerability can rub some people the wrong way, especially groups that are very sensitive to any implication of being singled out. While this unintended result is something to avoid, it shouldn't dissuade fire chiefs from looking at information that's a matter of public record.