As this chart from marginalrevolution.com shows, structure fires in America have declined dramatically over the decades, but the number of firefighters has continued to rise, even during the recent recession. This has left local governments with an excess of idle fire personnel. What to do? Communities could look to reduce personnel, but there are limits on how low firefighter complements can go, and not only because of pressure from firefighters unions. After a certain point, shutting down firehouses pushes up response times. And though, even in the case of medical emergencies, researchers have cast doubt on the low-response-time imperative, certainly minutes matter to the public.
So then how to make the best use out of idle firefighters? Two solutions have been proposed. Jonathan Cohn, writing in the print edition of the new New Republic, advocates "turn[ing] firehouses into walk-in medical clinics":
With the country growing older and 30 million more people getting health insurance from Obamacare, we're facing a serve shortfall of primary care providers. At the same time, fire incidence in the United States has been at historic lows, thanks for improved prevention. Firefighters-most of whom have basic medical training-already respond to more calls for health emergencies, anyway.
An alternative approach is to cross-train fire and police personnel. Examples may be found in Michigan and California. Naturally, the International Association of Fire Fighters loathes the idea, but the savings can be substantial. Sunnyvale, CA, which has cross-trained its personnel since 1950, manages to provide public safety services on a per capita basis of $100s less than neighboring communities.
Cross-training is a better idea because turning firefighters into doctors constitutes mission creep. Cohn is an expert in health care policy, not city government. Cohn cites a few examples of local governments tasking their firefighters with providing immunizations and other forms of basic care, but these are exceptions. City governments are generally not in the health care delivery business, but they are in the public safety business and always will be. In light of this, and their strained budgets, cities should focus more on improving the delivery of services to which they are already committed, not expanding into new services.