Information Charlottesville

Charlottesville Fire Chief Hezedean Smith has been on the job nearly ten months and he had the opportunity Monday to talk about the department as well as to explain changes to the way the fire department dispatches ambulances. Earlier this month, representatives from the Charlottesville Albemarle Rescue Squad critiqued the new “proximity dispatch” system. (Story from September 8, 2021)

“I’m appreciative of the many years of contributions from CARS for over 60 years and for our Fire Department for over 165 years and agree that working together collaboratively, we’ll be able to create a model system framework in this region based on 21st century concepts and strategies,” Smith said. 

In this community, emergency calls are routed through the Charlottesville-UVA-Albemarle Emergency Communications Center. Smith said there are initiatives underway to make the system more efficient.

“This medical priority dispatch system will replace an almost 25 or 30 year old system that’s being currently used to triage calls that are sometimes not necessarily 100 percent accurate because it requires on information from the 9-1-1 caller,” Smith said.

Smith said EMS services across the nation are working to implement something called EMS Agenda 2050 which seeks to position public safety calls as people-centered. 

“It talks about how EMS personnel must have immediate access to resources that they need for patients including health care providers, social services, and other community resources,” Smith said. 

In his tenure, Smith said he has realigned the command structure of the Fire Department to better meet those goals and others. One of those is the Neighborhood Risk Reduction program which seeks to inform residents about the specific hazards that face specific demographics and geographic areas.  A StoryMap on this program is available online:

“So for example if you want to look at 10th and Page, what’s going on in 10th and Page, you can see what the community profile looks like and this is a compilation of various data sources that are out there,” Smith said. “This neighborhood is first in cardiac arrests. Third for structure fires, diabetic emergencies, cardiac emergencies, falls.” 

Smith said knowing that information can help with preparations and community outreach. 

As it relates to the dispatch system, Smith said everyone wants a system that works but there are disagreements about whether the recent change to the proximity dispatch system has been beneficial. Chief Smith said he is in frequent conversations with Albemarle Fire and Rescue Chief Dan Eggleston. 

“Chief Eggleston and I have the same vision for this system delivery in this region so we have conversations about what the future should look like in this system,” Smith said. 

Smith said while he intends to collaborate with CARS but if they cannot meet a desired level of service, the city will provide the service instead with professional crews whose salaries are covered by tax dollars. 

At issue is how to get service calls to get to the scene more quickly with a travel time target of four minutes. Also at issue is the difference between Advanced Life Support (ALS) and Basic Life Support (BLS). Here’s Deputy Chief Mike Rogers with an explanation. 

“The basic life support level is emergency medical technician basic,” Rogers said. “That’s a requisite for the jobs that the firefighters here at the Charlottesville Fire Department have and that’s the basic level. Bleeding wound care, CPR to the basic life support level, basic anatomy and physiology of being able to take care of the patient.” 

Advanced Life Support requires more training to allow care at a trauma level. 

“And essentially that allows the EMT to begin to place IV’s, give some limited amounts of medication,” Rogers said. 

Chief Smith said the system that has been in place is due for a replacement to increase the chances of a patients’ survival by ensuring all calls have the chance of receiving ALS. 

“The triage protocols that are in place are greater than 20 years old so the move to a 21st century protocol and electronic framework is underway currently,” Smith said. “Oftentimes the basic life support if all you have is an EMT who cannot execute any advanced skills, that patient does not have getting anything done pre-hospital unless there’s a call for the Fire Department to come and provide ALC which oftentimes delays care even more.”

The proximity dispatch system uses algorithms to dispatch calls using automatic vehicle localities and the global positioning system. Chief Smith acknowledges that that the system has caused concerns, but also notes that Albemarle County initiated proximity dispatch in recent years. He also presented evidence that shows how the system is working to increase response times in some neighborhoods. In all, he gave an hour-long lecture that is a must-view for anyone interested in this topic. (watch on BoxCast)

During his hour-long presentation, Chief Smith said that “what can be measured can be improved.” 

“Seventy-one percent of the time in FY21, the first arriving CARS unit on the scene met the performance benchmark for turnout and time,” Smith said. “Not bad. Actually decent! But there’s opportunities for improvement.”

However, CARS’ performance on more advanced calls were much lower. Chief Smith said CARS met these calls on time ten percent in FY21. But here’s where the need for better metrics comes in.

“The system is designed in a way that the numbers for ALS versus BLS are not necessarily clearly defined because the protocols vary in how the system was set up but essentially there are opportunities for improvement,” Smith said. 

Smith said the Charlottesville Fire Department’s results on more advanced calls could also use improvement. 

“Here we have a 58 percent metric that we’re not doing well,” Smith said. “There’s opportunities for improvement here for CFD as well,” Smith said. 

During the public comment period, UVA trauma surgeon Forest Calland took the opportunity to ask Smith a series of questions and to question the idea of sending ALS units to as many calls as possible. 

“There’s just simply no evidence pointing to the benefit of having response teams under four minutes for BLS calls and there’s no evidence that sending paramedics to BLS calls is of any benefit,” Dr. Calland said. 

Last year, Charlottesville a federal grant from the Federal Emergency Management Agency to hire additional firefighters. Dr. Calland said he is concerned by prioritizing ALScalls, the city will lose the financial benefit of volunteer labor. 

“Your system is going to cost $2.5 million additional per year once your grant runs out,” Calland said. “Is the City Council prepared to take this money out of the taxpayers’ pockets when CARS has been providing this service for free for the last 50 years?”

Chief Smith said his presentation was to prepare for the future, and not debate the past. In addressing the questions, he said the SAFER grant was to ensure firefighting capacity and he acknowledged a need to address capacity issues. 

“I will not be satisfied having insufficient firefighters on the fireground and potentially risking losing a firefighter,” Smith said. “Ultimately the staffing limits will have to be addressed.”

Chief Smith said he would be willing to meet with CARS officials when the time is appropriate. 

“But the idea is to have a conversation because what we have done for the last 60 years or what we’ve done for the last 165, if we continue to do that I don’t think we will move forward with meeting the needs of this community,” Smith said. 

Charlottesville’s arrangement with CARS is in a memorandum of understanding that has both an operational and a budgetary component. City Attorney Lisa Robertson had suggested that Chief Smith not meet with CARS management while disputes were ironed out.

“I think the two issues were conflating and they need to be separate,” Robertson said. “The financial relates to the other but they’re two separate issues. In both issues, both the city manager and the fire chief will have to sit down with CARS and work through both sets of issues. It has absolutely not ever been by intention to tell anyone that you can’t sit down and talk to each other because of legal issues. These are almost purely operational and financial issues.”

If you want to know about how emergency services operates in the area do take a look or listen to the whole discussion. (watch on BoxCast)

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Before you go: The time to write and research of this article is covered by paid subscribers to Charlottesville Community Engagement. In fact, this particular installment comes from the September 22, 2021 edition of the program. To ensure this research can be sustained, please consider becoming a paid subscriber or contributing monthly through Patreon.