This story first appeared in Voice of San Diego Quarterly.

As the city of Escondido’s population exploded over the 1990s and early 2000s, city leaders noticed they had a problem. Emergency teams weren’t getting to people as fast as they should and the problem was only going to get worse.

They had one natural answer: Build more fire stations. And in 2004, voters passed Proposition P, which by 2006 gave the city the money up front to build two new stations and relocate another one.  It also raised property taxes so residents could pay down the debt.

Then the economy collapsed. The city could build all the fire stations it wanted. It couldn’t, however, pay for firefighters to work in them.

The brand new Fire Station 6 was unstaffed.

And things were getting worse.

“We were calling on our neighboring cities for support in emergencies,” said Mike Lowry, Escondido’s fire chief.

But Escondido was also seeing what most cities see: The vast majority of emergency calls are not for fires. They are for medical emergencies.

Rather than add emergency services capacity the way it always had, Escondido leaders had to figure something else out. The buildings they had finished could not themselves respond to medical emergencies. How they addressed this may provide other cities a model. The city of San Diego is not responding to medical emergencies in some of its poorest neighborhoods quickly enough.

Voice of San Diego’s Liam Dillon has explained this well. The city is trying to find $1 million per year, for instance, to spend on a “fast response squad” for the Encanto area of San Diego. These are two-person teams that use an SUV and operate out of storefront. But they are trained in fire suppression as well as medical emergencies.

Escondido made an investment of $1 million a year to respond to a similar crisis, as response times were growing too long and they were relying on other agencies too much. Escondido officials decided to address the medical need directly.

“We decided we needed to add ambulances,” Lowry said.

And add them he did, along with a fire engine. Last year, the city had six fire engines, one truck, three 24-hour ambulances and one 12-hour ambulance.

Now, Escondido has seven engines, one truck, six ambulances during the day and four at night. It’s more than doubled its capacity. It increased the budget by $1 million — that’s $1.4 million less than had the city grown the traditional way, adding both firefighting and medical response capability.

The route Escondido took is cheaper because they were not as many firefighters as they would with a traditional investment. Firefighters require more training, and they work 24-hour shifts, which cause scheduling challenges and high costs.

Escondido officials decided that they did not need much more in fire equipment and firefighters. What they really needed were more ambulances. So they focused on that. A $1 million investment went far.

To the south, in San Diego, 85 percent of the city’s emergency calls are for medical needs, according to a 2012 audit report.

I asked the city of San Diego’s fire department why we so many people trained in fire suppression to respond to medical calls?

The answer is that while most calls are medical, you still need a minimum amount of fire suppression personnel and equipment.

All municipalities deal with this issue. Here’s how Russ Knowles, Escondido ‘s fire operations manager, put it: “That 20 percent of non-medical calls we’re getting about fire or disasters isn’t a huge percentage, but you have to have that support when you need it.”

In other words, you may not need fire fighters every day, but when you do, you better have them.

“The deployment plan used by the city of San Diego is both efficient and effective because the same number of first-responder units would be required for all-hazards protection of our community even if the medical response mission were to be removed and replaced by adding additional, single-purpose ambulances at considerable expense,” wrote Maurice Luque, San Diego Fire Department’s chief information officer.

And so this is why, when you’re having trouble breathing, or when you don’t leave the house soon enough when your wife is in labor (I know a little something about this), it’s the firefighters who often arrive before the ambulance. They’re closer, we have decided we have to have them and so we’ve made some of them capable of responding to medical emergencies.

But when medical emergency response hits a crisis situation, choosing to hire firefighters to solve it may not be the best decision.

Escondido decided to add ambulances and medical personnel and fewer firefighting equipment and workers than they might have in the past. So, for $1 million, San Diego would get a two-person fast response squad.

For $1 million Escondido got a fire truck, and three additional ambulances during the day and night.

“As hard as it has been, some good has come from it,” Lowry said about the financial crisis.

Until this summer, Escondido was asking neighboring agencies to help with calls 30 to 50 times a month.

In July, they had to do that just four times.

Scott Lewis oversees Voice of San Diego’s operations, website and daily functions as Editor in Chief. He also writes about local politics, where he frequently...

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