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Let's say you think you're having a stroke, and you call 911 for an ambulance. In many cities, there's a good chance that a fire truck will arrive instead with a full fire crew including a paramedic. But as Monica Eng of member station WBEZ reports, that does not mean they can deliver the care you might need.
MONICA ENG, BYLINE: In Chicago like a lot of cities, the fire department oversees both firefighters and paramedics who work on ambulances. That means when a medical call comes in, dispatchers have choices to make.
While they usually prefer to send ambulances, there are only half as many of those as there are fire trucks. And fire department spokesman Larry Langford says those ambulances can be super busy.
LARRY LANGFORD: They'll hit the street at 7 o'clock in the morning and may not come back to the firehouse at all until 7 o'clock the next morning.
ENG: Meanwhile, those fire trucks are often much less busy and parked in firehouses just minutes away from any given emergency. So 911 dispatchers make a choice.
LANGFORD: They save valuable time by sending the closest vehicle which is usually a fire truck that has at least one paramedic, a lot of equipment on it.
ENG: That sounds logical until you ask why Chicago's fire department still has twice as many fire trucks as ambulances, especially when the department gets 20 times more medical calls than fire calls. Getting answers can be difficult, and that has a lot to do with the political power of fire departments and their unions and the challenge of trying to change that.
But Chicago's not alone in facing these challenges. Most cities are seeing big drops in fire calls and big jumps in medical calls, but few are really reforming their departments to meet this changing emergency landscape. Researcher Phil Keisling thinks that's a mistake. He looked at why fire departments don't just admit that they're mostly medical services these days.
PHIL KEISLING: And I keep getting answers that are really not a whole lot more than, well, that's the way we've always done it. And that's the way we've always done it - I don't think is a very strong answer in a world that has limited resources, and you want to try to optimize the resources you've got.
ENG: Indeed, as more cities see the drawbacks of using giant fire trucks for medical issues, they're facing calls for reform. That's what Misty Bruckner found when she researched the problem at the Public Policy Center of Wichita State. While she didn't find agreement on everything, she said there was some consensus.
MISTY BRUCKNER: I think everybody, you know, can agree that the ladder truck responding to someone who may have a sprained ankle is not the best use of our public resources.
ENG: Chicago Fire Department's Larry Langford disagrees. He thinks people shouldn't get so hung up on what kind of vehicle arrives. He's even got a catch phrase for it.
LANGFORD: Don't look at the conveyance. Look at the care.
ENG: Catchy or not, the conveyance can matter and here's why. Fire trucks aren't equipped to take you to the hospital, only ambulances are. And this transport part can be crucial for some patients, according to veteran Chicago paramedic Rich Raney.
RICH RANEY: You get a stroke patient or a trauma patient, the most important thing is that he be transported to the hospital as quickly as possible. As they say with stroke patients, time is brain basically.
ENG: But each city runs its emergency services differently. In Chicago, for example, paramedics want more ambulances and staffing. New York and Wichita recently started deploying medics and SUVs for less urgent calls. And Washington, D.C., is trying something called nurse triage lines. They let callers talk through their problems with the nurse on the phone. But Keisling says some proposals should also look at moving resources from large firefighting staffs.
KEISLING: And I'm not anti-firefighter, it's not anti-union, it's not anti-government. It's just why aren't we taking limited resources and deploying them in a smarter way?
ENG: While there's no agreement on exactly what that smarter way is going to be, most agree it does not involve sending a fire truck to treat someone with heartburn. For NPR News in Chicago, I'm Monica Eng.
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