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Palo Alto plans major revamp of Fire Department

Original post made on Jun 7, 2012

Firefighters are typically associated in the popular imagination with burning buildings, wildfires and disaster response. These images, while valid, are increasingly becoming anachronistic in the Palo Alto Fire Department, where requests for medical service are now taking up more than half of all calls.

Read the full story here Web Link posted Thursday, June 7, 2012, 3:05 PM

Comments (30)

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Posted by Wayne Martin
a resident of Fairmeadow
on Jun 7, 2012 at 3:30 pm

> "Shutting down one of the city's and Stanford's six 24/7
> engine companies is a major policy decision requiring clear
> and detailed explanation, public outreach and adequate
> discussion," Balin said. "Rather, it has been slipped into the
> proposed budget with almost none of that.

Why is shutting down one engine company a 'major policy decision'? Would anyone suggest that starting up a new engine company also a 'major policy decision'? It's important that the basic goals of response time be met, which sits on the Fire Chief/City Manager/City Council to insure. But if they have done this homework, and there is sufficient evidence to allow the change, then shutting down a company should be no different than shutting down a branch library, or service that is no longer used.

If it turns out to be a mistake, then the engine company can be restarted.

It's important for the City to monitor all of the calls-for-service for every department, with the goal of becoming more nimble in the future than they have been in the past. The rising cost of labor, and the linked pensions, demand this more responsive form of management.


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Posted by Firefighter
a resident of another community
on Jun 7, 2012 at 4:30 pm

Companies are often life long and careers for many in the fire/ems services. Shutting down an engine company in a traditional fire department is not something you do on a whim. Until recently with increasing costs, poor city management and planning, and a failed economy, the thought of an engine company or ambulance squad being downsized was thought to be impossible, especially in a growing city, much like palo alto.


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Posted by Peter Carpenter
a resident of Atherton
on Jun 7, 2012 at 4:36 pm

Peter Carpenter is a registered user.

"Shutting down an engine company in a traditional fire department is not something you do on a whim."

The logically fallacy in this statement is that communities can no longer afford 'traditional fire departments' - at least ones that have no longer have traditional pay, benefits and pensions.


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Posted by Alphonso
a resident of Los Altos Hills
on Jun 7, 2012 at 4:48 pm

The real exposure is not College Terrace - it up in the hills along Page Mill.

The general idea is sound - the medical response activity helps subsidize the rest of the department - might as well provide the service that is most needed. It is a wonder that other communities (except Woodside) have caught on to the concept.


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Posted by Alphonso
a resident of Los Altos Hills
on Jun 7, 2012 at 4:50 pm

OPPS

It is a wonder that other communities (except Woodside) have NOT caught onto the concept.


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Posted by Walter_E_Wallis
a resident of Midtown
on Jun 7, 2012 at 6:47 pm

Walter_E_Wallis is a registered user.

I have no exposure to the fire fighting expertise of Palo Alto Fire Fighters. On the other hand I have had several exposures to their medical expertise. I am O.K. with this as long as it is not related to an increase in clerical staffing.


 +   1 person likes this
Posted by Read and learn
a resident of College Terrace
on Jun 7, 2012 at 7:19 pm

Basically, it works like this. It is a "calculated risk". If the firefighters try to talk the public out of "browning out" a fire engine, then they appear to be using scare tactics. So, the firefighters have chosen to remain silent on this issue. They are well aware of what happens on fire calls AND medical calls when response times are delayed.

One can google "delayed response times" and see a myriad of examples where delayed response times had significant effects on the outcome of life, property, and the environment. Once again, if the firefighters were to discuss this, they would appear to be using scare tactics.

This time, the City Officials are willing to take the risk, and the liability, and roll the dice.

If that is their choice, then so be it. Most resonable people would think twice about reducing their home or auto insurance coverage. Sure, you can save money, but only until the next incident happens.

Cheers.


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Posted by Firefighter
a resident of another community
on Jun 7, 2012 at 9:05 pm

"The general idea is sound - the medical response activity helps subsidize the rest of the department - might as well provide the service that is most needed. It is a wonder that other communities (except Woodside) have caught on to the concept."

Cost and set up, ambulances are not cheap! Billing department, IT department (for digital medical records), medical QI/QA review boards, ETC.

Companies like AMR and Rural Metro can offer these services far cheaper to the county and offer more, due to purchasing in volume. An ambulance cost a lot less for AMR/Rural Metro, who buy hundreds a year (across the country). They also have lower operating costs, as they don't have their own billing departments in alot of regions, but use a centralized service that they pay a percentage of based on volume. They still are not making huge profits, much to the public's disbelief. They may charge more then public services, but that is just due to cost shifting, as you have medicare/medicaid patients that have payment at a fixed rate, and those who do not pay. Public services may seem more effective, but just like Palo Alto has shown, it is not. Public services don't have the volume, they also cannot cost shift, and any unpaid bills get eaten by tax payers dollars.

To be completely honest, whether you like it or not, privatized EMS service just like privatized medicine, is at least on paper "better".


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Posted by Martin
a resident of Downtown North
on Jun 7, 2012 at 9:28 pm

Excellent!! Also, moving the ambulance from Station 1 at 301 Alma St. to PAMF, would greatly reduce the number of calls to that station. I live near the station, and most calls are simply to transport patents from PAMF to Stanford Hospital. Moving the ambulance to the main source of calls, would improve service, and reduce needless noise int he North of University neighborhood.

Good job Mr Keene!


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Posted by Henry
a resident of College Terrace
on Jun 7, 2012 at 11:07 pm

Station 2 and station 6 are so close ( less than 2 miles apart) that it makes sense to shut down the engine at station 2. Also, there will be still a rescue truck and a ambulance at station 2 too. Wise choice.


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Posted by Scott
a resident of Professorville
on Jun 7, 2012 at 11:32 pm

Not a wise choice Mr. Keene. Even your own surveys that you kept starting and stopping until you got the right answer informed you that browning out an engine company would be a reduction in service. They even were against it but it is what you wanted. Having a rescue and an ambulance at the Hanover station does not provide protection for the residences in that district. The Stanford station covers all the way to Sand Hill and Alpine as well as the whole campus and Stanford Dish area. Secondary coverage is not going to be what you think it is, but I guess we will have to wait and see. If you look back in history and pay attention to how laws, rules and change come about, you will see that it is usually after something bad happens. I fear that we have just placed ourselves in this predicament.


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Posted by Alphonso
a resident of Los Altos Hills
on Jun 8, 2012 at 6:45 am

Responding to comment made above
"Cost and set up, ambulances are not cheap! Billing department, IT department (for digital medical records), medical QI/QA review boards, ETC."

The simple fact is that PA generates income from it's ambulance service and that is one of the reasons they are adding another ambulance. Companies like AMR are great for counties (they are paid a franchise fee) and great for people living in remote areas of the county (they get better service), but it is not free - the more populated areas end up subsidizing the county and the rural areas. Some communities like MP put a paramedic on every fire truck (to their credit) so they can respond to medical emergencies but they do not benefit from the revenue of ambulance (money patient's insurance pay for care and trips to the hospital). As medical calls increase relative to fire calls it makes sense to change the Fire model to a Medical/Fire model - providing better service and reducing the overall net cost of the program.


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Posted by Wayne Martin
a resident of Fairmeadow
on Jun 8, 2012 at 11:26 am

> To be completely honest, whether you like it or not, privatized EMS
> service just like privatized medicine, is at least on paper "better".

Huh?? Are you saying that as a "fireman" you are qualified to characterize, rate and comment upon the health care provided by, primarily, the private sector here in the US, and all of the government-provided health care around the world?


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Posted by firefighter
a resident of another community
on Jun 8, 2012 at 11:52 am

I work as a part time non union firefighter-Paramedic but also have an educational background in healthcare policy, management, and strategic planning.

You are right in saying communities like PA can operate an EMS system while still staying above the red-line. This does come at a price though, and while I don't have the numbers in front of me PAs fire service (obviously the fire department has been a hot topic in PA) is not cheap. Not to say PA should pack up its EMS system and invite in a privatized service, I was just making comment to the poster who asked why Menlo Park and other services do not introduce their own ambulance services.

Also, the "franchise" fee for service depends on the county, city, regional location. Not all private ambulance services require an up front fee, its a cost/benefit analysis on their part and contract negotiating on the part of the county.

I cannot speak for Menlo Park, as that is San Mateo county, but at least back in the day in Santa Clara county, fire departments did not have a choice when it came to staffing a Paramedic on an engine. It was part of the EMS contract, and I believe AMR covered the cost (in at least San Jose) instead of having more ambulances up and running.


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Posted by Firefighter
a resident of another community
on Jun 8, 2012 at 11:56 am

Also, on another note! If you are asking about those involved in EMS being qualified enough to discuss healthcare topics, you are obviously misinformed. EMS, is the new primary care in this country. (think baby boomers) As health systems work on continuity of care, EMS is more important then it has ever been before. Hey wait! Isn't that why PAFD is dumping an engine to start up another medic unit?


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Posted by Wayne Martin
a resident of Fairmeadow
on Jun 8, 2012 at 12:16 pm

> If you are asking about those involved in EMS
> being qualified enough to discuss healthcare topics,
> you are obviously misinformed.

Healthcare is incredibly complicated—granted. But isn't it true that most EMS workers are not degreed (4+years)? So, to what extent would you endorse seeking medical care based on comments/discussion with an EMS worker? Or choice of hospitals? Or choice of doctors at a given hospital? Or selecting the funding of a nation's health care, based on EMS input?

> EMS, is the new primary care in this country

Interesting. Hospitals have been saying that so of thing about services delivered through their Emergency Rooms for a long time. Wonder how many Hospitals/actual primary care provides would agree?

It's probably true that EMS has never been better. Moreover, it's a safe bet that through the emergence of metropolitan/regional data networks, and more on-board diagnostic capabilities, care will be even better in the future. However, the increase care will come from computer-based, or realtime/remote resources, rather than the paramedics.


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Posted by Firefighter
a resident of another community
on Jun 8, 2012 at 1:21 pm

While PAFD has top notch emergency service workers, I will agree with you, EMS workers in general are not 4 year degree academic type. Oh wait, I must add, in California. Yes, California might be the best at everything else but EMS is not one of them. So I will agree with you in that respect. Just look up north, Oregon has a 4 year program, Seattle has a 4 year program, and out east they have masters degree programs involved in Emergency Medical Service (George Washington). I no longer work in California, and left very early in my career/training/education. All of the Paramedics in my rural service have at minimum a 4 year degree in either biology or the "pre-med" type Bachelors in Science, if not more.

I will also add that most Californian Paramedic schools are private, "puppy mills" that pump out medics in 6 months with the minimum 500 hours of field internship, 200 hours of clinicals (if that) and the 700 some hours of classroom time. This is absurd, and its why many states will not accept Californian Paramedics. Many states require double, if not triple the training and education.

As far as primary care is concerned, it depends region to region. In rural regions EMS has more autonomy, as well as more respect and cooperation with others in the medical field. In bigger cities out east, there are PAs and Paramedics that perform house calls, physicals, ect.

On the national level California (and a few others) is still in the 1970s when it comes to the perception, education, and duty/roles of EMS. Ambulance drivers are a thing of the past.


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Posted by Firefighter
a resident of another community
on Jun 8, 2012 at 1:24 pm

Technologies being the answer to better patient care and not Paramedics? Sorry to burst your silicon valley bubble, but that is false.

Nothing can replace a strong education, a firm understanding of disease processes and their treatment in the acute setting, and a good physical hands on assessment.

There is a saying in medicine and EMS especially...

"treat the patient, not the monitor"


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Posted by Wayne Martin
a resident of Fairmeadow
on Jun 8, 2012 at 2:24 pm

> burst your Silicon Valley bubble ..

You are not likely to burst any of our SV bubbles, at least with a couple of words.

You might not be aware of some developments in the Computer-assisted Healthcare industry that are rather recent involving IMB's Watson AI engine--

IBM Forms Watson Healthcare Advisory Board:
Web Link

IBM/Watson:
Web Link

WellPoint and IBM Announce Agreement to Put Watson to Work in Health Care:
Web Link

It's a little too soon to point to any specific "wins", but the NIH has been experimenting with Knowledge-based medical diagnostic systems since the mid-1970s (at least). Even that far back, it was clear that Knowledge-based systems would outperform human diagnosticians. It's not clear why these systems have never been integrated into the current healthcare delivery model, but it's clear that they will be integrated, in some way, in the near future.


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Posted by Wayne Martin
a resident of Fairmeadow
on Jun 8, 2012 at 2:36 pm

There is every reason to believe that a lot of "primary care" will be delivered in the home, in the not-too-distant future. The following videos make that case—

Eric Topol: The Wireless Future Of Medicine:
Web Link

Daniel Kraft: Medicine's Future? There's An App For That:
Web Link

George Whitesides: A lab the size of a postage stamp:
Web Link

The link between these three presenter's vision is that Cell Phones are now a reliable, and ubiquitous communications link from anywhere in the world, to anywhere else in the world—via the Internet. It doesn't take too much imagination to come to see that people who have previously not been properly diagnosed, or who might not have been seeing a primary care physician enough to detect disabling conditions, such as strokes and heart attacks, could be diagnosed with technology that is either worn, implanted, or operating in the home.

How this technology, EMS, ER, Primary Care and Hospital Care will play out in terms of who "owns" what part of the terrain is an open question. But there is every chance that the number of emergencies that occur in older people might well be diagnosed within a 48-hour window that will allow them to get to the hospital by means other than an emergency transport.


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Posted by Wayne Martin
a resident of Fairmeadow
on Jun 8, 2012 at 2:57 pm

A final point about rural health care delivery. It's not exactly new news that rural healthcare is an issue, based on the high cost of building/running hospitals, the lack of interest of doctors to live in "the boonies" and the general disinterest of people living in the outback to pay for first rate medical facilities.

The US Military has developed a scalable health care facility that can provide care for soldiers needing immediate care. These facilities are not designed to provide long-term, critical care, but will provide enough care to stabilize patients before their being moved to more appropriate facilities--

Combat Support Hospital
Web Link

Life and Death in the War Zone:
Web Link

There is no reason that these units could not be deployed in very rural areas, at least for situations where there is not sufficient regional health care available within a reasonable driving range.


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Posted by Firefighter
a resident of another community
on Jun 8, 2012 at 2:58 pm

Wayne, I mistakenly misunderstood your prior post. I just wanted to clarify and then leave this issue to rest, as it is irrelevant to the PAFD changes this article discusses.

My post in regards to healthcare systems was in response to a previous poster who asked why other departments do not transport. While EMS is a specialty of medicine as a whole, the strategic planning is no different then other types of healthcare specialties or public services, both private and governmental. On paper its about resource allocation, supply and demand.

I also wanted to clarify that my understanding of your previous post was very elementary in the fact that I assumed you were talking about nifty difty machines, such as 12 lead monitors that tell the practitioner what the computer reads. (often times it is wrong).

In terms of knowledge based medicine, I want to agree with you and disagree. Firstly I will agree that knowledge based medicine is the thing of the future, but it isn't so "new". This all happened with the managed care phenomena (think Kaiser) and the gatekeeper to specialized care. Why are we doing X procedure when its not proven to make a difference? Why do they do X procedure in part Y of the country and not part Z? I agree wholeheartedly. Kind of reminds me, is this not what healthcare reform and nationalized healthcare hopes to cover? (in addition to many other topics). Then again, I probably don't need to teach you in this matter, as I am sure from your citations and links you know what your talking about.

Here is where I disagree, EMS and Emergency Medicine (both pre-hospital and hospital) differs in the fact that the primary goal is and always will be life saving techniques and maneuvers. This is of course on paper, as we all know actual life threatening emergencies are the minority. That being said, the concept of acute care does not change, be it a life saving emergency or the mental aspect of an emergency in the perspective of the patient, you treat the acute issue.

Evidence and knowledge based medicine is applicable to all avenues, its just not as applicable in terms of computer software, coding, and diagnostics in the acute setting. The goal is not to diagnose (although this is counter intuitive, since to treat the symptoms a well educated practitioner should have a good idea when it comes to what is going on) the goal is to treat the symptoms.

The new networks and computer systems are great when deciding treatment plans for a 68 year old female patient with UTI like symptoms, elevated white blood cells, signs and symptoms of kidney failure, and history of congestive heart failure. Wouldn't it be great if that physician treated the patient with the best evidence based medicine? Treated them just like the hospital across the street? I think so!

In the field though, evidence based medicine is taught, updated, and retrained into the minds of providers who provide quick decisions/procedures based on hands on assessment. (hence why education and clinical training are so important) I can't get a full (CBC- Complete Blood Count) in the field, but a 68 year old female with a fever, swelling in her ankles and a history of foul odored low urine output, is going to be treated in a manner that stabilizes her. I will treat her like I treat all my patients, make sure the blood goes round and round, her blood pressure for perfusion of the brain is adequate, and her breathing is not effected.

Sounds simple enough, but providing advanced life support in the field should not be discounted, it takes education, training, updating, retraining, and hands on experience to become proficient. As evidence based medicine leaks its why into peer reviewed journals, gets reviewed by services, and presented to their medical program directors, changes can be made to existing treatment plans and programs.

Nice debate, nice talking to you, and thanks for the links.


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Posted by David
a resident of Duveneck/St. Francis
on Jun 8, 2012 at 3:58 pm

Thank you firefighter and Mr. Martin for some good, basic education on the problems and possible solutions to care prior to transport to a hospital.

My granddaughter is an LPN in the boonies and is overworked and underpaid because the area won't support a first class medical facility. I will send her the links Mr. Martin supplied. Maybe she can send them to the county supervisors who might appreciate a lower cost alternative to a PAMF.


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Posted by Jake
a resident of another community
on Jun 8, 2012 at 6:16 pm

Read the second to the last paragraph, I'll conceed that it's up for debate as to how much impact taking E2 out of service will effect emergency response and risk of people and property. BUT for City Officials to "dispute any suggestion that it would put neighborhood in danger"?
It sounds to me that City Officials are not living in reality, I'm sorry but nobody is ever going to convince me that eliminating any type of emergency response unit from an area will not have an impact on public safety. The City should come up with an answer to that neighborhood as to what if E5 or E6 are on another call already. Thus even longer delay.
E2 also takes many backup calls on Stanford University when E6 is busy on calls (happens a lot) so the Assistant City Manger might want to have a response for Stanford as to how eliminating E2 will impact the Stanford Communities saftey and property as well. Being Stanford pays a third of the PAFD budget most people would say Stanford has a stake in the issue.


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Posted by Jake
a resident of another community
on Jun 8, 2012 at 6:42 pm

In the second paragraph the reporter writes more than half the calls responded to were for emergency medical calls, my question is what are the types of other calls the PAFD was needed to respond for?
The article says later that EMS calls account for about 4,000 of the incidents (half) that means there are another 3,000 plus calls per year where the PAFD is needed other than EMS.
It seems to me those 3,000 plus emergency calls are also important and can't simply be brushed to the side, is the city planning on sending ambulances to natural gas leaks, brush fires, auto fires, fire alarms, smoke inside buildings, wires down on houses, gasoline spills, people stuck in elevators, oven fires, etc. ??
Just asking, if you watched that Finance Comm meeting that night the members spent much much more time working the Animal Shelter issue and when FD subject came up it was breezed right over. I guess outsourcing animal services outside the city has a HUGE impact on people and animals lives but taking E2 out of service has none?
I simply don't understand how assistant city manager and city manager can tell the people of Palo Alto there is no danger if their plan is put into place. Again i'll say it's a degree of risk and a roll of the dice and to what extent is open for debate but when I see words like "none" "never" etc I question the details.


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Posted by David
a resident of Duveneck/St. Francis
on Jun 8, 2012 at 10:44 pm

Another thought about coverage and safety. Fire Station 4 has more linear miles to cover than other stations (maybe except FS 5 to the hills). Cutting back on FS 2 won't hinder or help their response times. Drawing circles with one 1/2 mile (or one minute?) radii would give a clearer picture of who covers how much and which parts of the City are affected by browning out of any FS.


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Posted by Resident
a resident of Community Center
on Jun 9, 2012 at 3:34 pm

I am glad to see the city management take steps to improve the efficiency of the PA safety services. For too long the union bosses and politicians they funded worked together to ensure PA had a bloated, inefficient safety dept. The damage done (including unsustainable pensions) is going to be a burden for years. We will have to do with out many services while union retirees spend 30+ years living off the taxpayers. Currently the tide is moving in the other direction with the passage of Measure R in PA, Measure B in SJ, reform in San Diego and other places including Wisconsin. We should continue to work on reforms and strategic organizational changes to stop the excessive cost the government unions are placing on taxpayers.

Some of the reforms needed include:
1. not allowing government employees to bargain collectively
2.) converting all government employees to 401K style plans
2.) no pension payouts until the employee turns 67 (which means safety employees may have to work after they stop working their government job)

The biggest continuing threat to citizens from this problem is the relationship between unions and the politicians the union's payoff thru political campaign contributions. Currently they are lying low while reforms are being discussed. As soon as we citizens go back to their jobs and focus on our families etc, the union backed politicians (Price & Shepherd in particular) will try to roll back the reforms and bankrupt the government budgets again.


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Posted by Alphonso
a resident of Los Altos Hills
on Jun 10, 2012 at 8:31 am

"The biggest continuing threat to citizens from this problem is the relationship between unions and the politicians the union's payoff thru political campaign contributions."

Your blame is misdirected. If you really think about it, the local unions up and down the Peninsula are quite small - less than 100 members. I agree the unions in SF and SJ are bigger and may have some clout, but not the little unions in most communties. The real problem has been the rather inept labor negotiation process - a bunch of unskilled city council people (with short-term perspectives) falling victim to the idea that the good times will last forever and the concept that we need to pay the same amount as all other towns. Frankly, the City Managers benefited personally as the wages of their employees rose since they could command larger wages themselves - according they did nothing to hold the line on wage creep. Then there was us the voters - we had an opportunity to reform the state worker (filtering down to local) wages and benefits when Arnold S set forth his series of propositions - we turned him down. The problem is everywhere, not just PA, and there is plenty of blame to spread around.


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Posted by Joannie
a resident of Fairmeadow
on Jun 10, 2012 at 11:09 am

The idea of shutting down Station 2 is not a new idea. Palo Alto was talking about shutting down both Station 1 and Station 2 ten to fifteen years ago. This subject has been studied ad infinitum, Keene only has to look up the old records to get the information he wants.


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Posted by Peter Carpenter
a resident of Atherton
on Jun 10, 2012 at 11:37 am

Peter Carpenter is a registered user.

Don't underestimate the power of small unions. In the last two Menlo Park Fire Protection District elections the firefighters' union spent more than did all of the candidates combined - and they were not doing it for entertainment purposes.

While public employee unions have an important place in representing the needs of their members they, in my opinion, should not be the dominate force in our local elections.


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