HomeMy Public PortalAboutStaffing for Basic Life Support Ambulance - Fire DepartmentCity of Watertown, MA
ARPA Project Proposal
Submitted by: Ryan Nicholson
Submitted on: May 23, 2023
Request Number: ARPA-8
Project Name: Staffing for Basic Life Support Ambulance
Proposal Type: City Department
Watertown Fire Department
Recommended Project Manager: Provisional Chief Ryan Nicholson
Project Summary:
The Watertown Fire Department is requesting American Rescue Plan Act funds to staff a Basic Life Support Ambulance to supplement our
existing Advanced Life Support Ambulance. The proposed funds would be used to cover the overtime costs associated with the minimum
staffing increase to operate the BLS ambulance 24/7.
Amount of ARPA Funds Requested: $3,569,052
Minimum Funds Needed: $
Matching funds available? No
Other funds available? No
Project Narrative: I have a detailed narrative to upload
pg. 1
WATERTOWN FIRE DEPARTMENT
OFFICE OF CHIEF OF DEPARTMENT
Fire Department Headquarters, 99 Main Street
Watertown, Massachusetts 02472-4410
Tel. (617) 972-6512 Fax (617) 972-6575
www.fire.watertown-ma.gov
RYAN A. NICHOLSON
Provisional Chief of Department
To: Committee of the Budget & Fiscal Oversight
From: Provisional Fire Chief Ryan A. Nicholson
Date: May 23, 2023
Subject: American Rescue Plan Act Proposal
Applicant Name
Watertown Fire Department
Contact Person
Ryan A. Nicholson, Provisional Fire Chief
Contact Email Address
rnicholson@fire.watertown-ma.gov
Contact Phone Number
(617)972-6511
Project Name
Staffing for Basic Life Support Ambulance
ARPA Funds Requested
$3,569,052
Matching Funds
There are no matching funds available for this project.
Other Funding Sources
The project could be funded by the City’s general operating budget, but it is unlikely due to the
financial constraints the City faces due to increased borrowing and an unclear picture of future
growth.
pg. 2
Minimum Funds Needed
Given the nature of this project’s implementation, it is possible to scale the length of the project to
the amount of funding available. This proposal estimates a start date of January 1, 2024 with an
end date of December 31, 2026 (three years) for budgeting purposes.
Recommended Project Manager
Watertown Fire Department, Chief of Department
Narrative
The Watertown Fire Department is requesting $3,569,052 in American Rescue Plan Act funds to
staff a Basic Life Support Ambulance to supplement our existing Advanced Life Support
Ambulance. The proposed funds would be used to cover the overtime costs associated with the
minimum staffing increase to operate the BLS ambulance 24/7. For budgeting purposes, we are
proposing the project run for a three-year period from January 1, 2024 through December 31,
2026. Please see the following budget:
Date Range Fiscal Year Overtime Hours Needed* Overtime Rate** Overtime Needed
1/1/24‐6/30/24 FY24 8,736 hours $65.3774/hr $571,136.96
7/1/24‐6/30/25 FY25 17,520 hours $66.9951/hr $1,173,754.10
7/1/25‐6/30/26 FY26 17,520 hours $68.6532/hr $1,202,804.00
7/1/26‐12/31/26 FY27 8,832 hours $70.3529/hr $621,356.81
$3,569,051.87
*24 hours X days in period X 2 personnel
**Rate represents the OT rate for a 15‐19 year firefighter (middle step)
**OT rate estimates a 2.5% annual increase in the event a collective bargaining agreement is reached
A start date was selected to determine the budget, but this project could begin sooner. In addition,
it would strengthen our service to the community to continue this project indefinitely beyond
ARPA funding for a number of reasons outlined herewith.
By way of history, the Watertown Fire Department has been providing emergency medical services
with transportation since 1975. Since that time, it has been a requirement for all uniformed
personnel of the Watertown Fire Department to be certified to the level of EMT-Basic by the
Commonwealth of Massachusetts. In 2017, we upgraded our level of service to Advanced Life
Support. With the upgrade, Watertown began to employ paramedics. The department currently has
15 paramedics who staff the ALS ambulance 24/7, providing a high level of care to the citizens
and visitors of Watertown. Over the last ten years we have seen an increase of approximately 70%
in ambulance call volume from 2,073 runs in 2012 to 3,543 runs in 2022.
At an average of nearly ten transports per day, it is simply not feasible to serve each transport with
one Watertown ambulance. If Medic 1, Watertown’s ALS ambulance, is on scene elsewhere in the
city (transporting to an area hospital, transferring care at an area hospital, providing mutual aid to
surrounding communities or otherwise unable to respond) we rely on Professional Ambulance, our
backup provider, to deliver an ambulance to the scene. When this happens, our residents and
pg. 3
visitors in need of an ambulance experience longer wait times and have non-WFD personnel
providing transportation care. It is important to recognize that Watertown Fire will always respond
with an Engine or Ladder company staffed with EMT-Basics to begin patient care within minutes,
however an ambulance may be delayed. In 2022, 857 Watertown patients were transported by an
outside ambulance.
What this means for the city is that in addition to our residents and visitors waiting longer and not
having the comfort knowing Watertown Firefighters are treating and transporting them, the city is
losing revenue from ambulance fees to outside agencies. Based on data from July to December of
2022, our average net revenue per transport was $618. If we were able to capture all of the lost
transports that equates to $529,626. The reality is that we would not be able to capture all of the
lost transports, but ¾ is a reasonable estimate. Below please see a table of lost transport data:
2022 2021 2020 2019
Transports Lost 857 874 749 743
Revenue Lost* $529,626 $540,132 $462,174 $459,174
¾ Revenue $397,220 $405,099 $346,631 $344,381
*Based on $618/transport
There is an EMS provider shortage that reaches further than the state or even the region, however
we already have capable providers as well as the necessary vehicle and equipment to make an
immediate positive impact locally. Instead of relying on understaffed private companies, we can
have our Watertown Firefighter/EMTs directly serving our community members. As the EMS
shortage has grown so has the need for ambulances, especially in the area of mental health, a direct
impact of the Covid-19 pandemic. Currently it is not our policy to have our ALS ambulance
transport on mental health service calls, which necessitates that a private BLS ambulance be
summoned. This practice is designed to reserve our paramedics for more acute medical calls. If
this project is funded, the practice would allow our own BLS ambulance to field the growing
number of mental health related calls for service.
In addition to the improvement already noted for our community members and city, this project
will also have positive impacts internally to the fire department. With the growing number of calls,
and difficulty reaching our full complement of paramedics (16 by contract), the practicing
paramedics are overwhelmed and facing burnout. In fact, we recognize a retention problem that is
at least partially due to the workload and lack of relief. Since the practice of hiring paramedics
started in 2016, we have had over ten resignations or transfer requests to other departments.
Putting a second ambulance into service would help to balance the workload and provide much
needed relief for our paramedics. Secondly, having a BLS ambulance provides ample opportunity
for our EMT-Basics to practice their skills in a transporting capacity. Prior to upgrading to ALS in
2017, it was customary for newer employees to be assigned to the ambulance to hone their EMT
skills. It is during this time where new EMTs learn how to treat patients, communicate on the
radio, and become familiar with area hospitals. There are many great outcomes that came out of
upgrading to ALS, but the lack of experience for our EMT-Basics is one area that is a detriment to
the department. Again, a second BLS ambulance would help to revitalize those lost experiences. In
all, department morale would undoubtedly be positively impacted by the implementation of a
second ambulance. For six months in 2019, the department was able to staff a second ambulance
on a trial basis through the budget process. During that time, we realized many of these benefits.
pg. 4
Unfortunately, overtime estimates came up short of actual costs and the project trial ended. The
budget presented here is designed to account for every hour of overtime required, as opposed to the
2019 proposal which estimated staffing needs.
Ancillary to the numerous benefits previously outlined, having two additional firefighters on shift
will also have a profound impact on firefighting operations and will allow us to better comply with
NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations,
Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments.
On a fire scene, these extra firefighters from the second ambulance would be used to supplement
our ladder companies which are yet to fully recover staffing from the 2008 recession. At our
current minimum staffing of 17 per shift, each of our two ladder trucks only have two personnel
assigned, which is drastically understaffed compared to the NFPA recommended staffing level of
four. The additional staffing would bring us closer to compliance, while increasing firefighter
safety and efficiency.
In analyzing the merits of this program, we can confidently assert that providing a second
ambulance will greatly impact our community’s EMS service. The need for EMS service is
especially relevant for those who are most at risk and impacted by Covid-19, including the
exponentially growing number of mental health calls that continue to occur since the onset of the
pandemic. In the same ten-year period of 2012-2022, mental health calls have increased nearly
50%, from 77 private transports in 2012 to 111 private transports in 2022.
At end of the program, the City will need to determine whether or not to continue funding the
program, which is anticipated to cost between $1 and $1.5 million annually if subsidized with
overtime. Alternatively, the city could investigate the possibility of hiring 8 more firefighters to
bolster the staffing levels in order to continue staffing a second ambulance. Currently, the cost to
do so would be $780,000 annually including benefits, and subject to change depending on future
collective bargaining agreements. There is an opportunity for the city to create a revolving fund for
ambulance fees collected throughout the program and use that to offset the staffing costs created
by overtime, salaries, or a combination thereof.
Measuring the success of the program can be accomplished objectively by studying the data,
particularly surrounding the number of transports lost to outside ambulance companies and the
revenue increase from the additional ambulance. Subjectively, we can conduct interviews with
internal stakeholders to gather data about the impacts that are more difficult to measure, such as
department morale and job satisfaction.
This proposal falls directly in line with the City of Watertown’s Home Rule Charter guiding
principles, namely by “promoting the health, safety, and welfare of our community.” We also are
able to move towards meeting the capacity needs of the City’s Comprehensive plan by improving
fire department services. As the city responds to increased population and development, we have
identified a service gap, and this project would work to rectify it while providing our community
with a more complete level of emergency medical response for all.