The Pepsi Challenge, New Coke, and Fire Department Tiered Response to EMS Calls

(I began thinking about writing this post a long time ago while reading Malcolm Gladwell’s book blink. Being from the South, I am intimately familiar with the Pepsi Challenge, and ‘New Coke’ and the ensuing disaster for Coca-Cola. I got tired of thinking about writing this post, and decided to do something about it.)


First, a little bit about the system in which I work: My county sends the closest fire engine to virtually every EMS-related call received in the 911 system (92% of EMS responses included an engine in 2012). That engine may be ALS or BLS, but it is always the closest engine no matter what, so ALS engines are frequently sent to BLS-level requests. The county also requires that an ALS ambulance is sent to every response, with response time requirements that don’t really matter for this discussion. For those of you familiar with ProQA, an additional ALS component is sent to every Charlie response and above, regardless of the level of care of the initial engine response.

So a 4 year old with croup in the middle of the night very well may receive three different pieces of apparatus, and between 8 and 12 responders, all because the patient is “under 15 years old” and is having “difficulty breathing” and is “making noises when he breathes.”

The citizens absolutely love this. They are just the most important thing in the world, and it only takes 3 pushes of buttons on a phone, 30 seconds with someone on the other end, and a dozen people will drop everything and rush as fast as they can to the citizen’s house.

But is it necessary?

Of course not.

I have my own issues with ProQA, or MPDS, or whatever it may be called in your area, but the bigger issue is with the tiered response.

One paramedic will do just fine, yet we find it necessary to send 3, 4, 5, and sometimes more to virtually every call.

So what does this have to do with the Pepsi Challenge? I’ll get there. But first, a little background.

In the 1970s, Coca-Cola had an almost 5-1 market share over Pepsi, and Pepsi wanted more. Like any business would. In the early 80s, the two products were virtually tied, with Coke having a 12 percent market share, and Pepsi having 11 percent. This is in spite of Coke’s wider availability and advertising spending.

Pepsi decides (brilliantly, I might add) to introduce the Pepsi Challenge, in which self-described dedicated Coke drinkers were asked to take a sip of two different beverages, in two different, unmarked cups, one containing Pepsi and the other Coke. The majority of the tasters preferred Pepsi, and the results were confirmed by Coke executives doing their own market research. Coke executives blindly ignored the inherent problem of the blind taste test, much to their later chagrin.

But why did Pepsi continue to win the Pepsi Challenge?

Because Pepsi is much, much sweeter. And the test was a sip test, or a central location test (CLT). Tasters didn’t drink and entire can, and they certainly didn’t take home an entire case to enjoy in front of the television.

So Coke decided to change. They changed their formula, after continued alterations and their own taste tests, and finally came up with a product that rivaled Pepsi. They marketed their product as New Coke.

And it was horrible. An absolute disaster.

I remember New Coke vividly. I remember people who refused to buy another Coke product until Coca-Cola Classic was brought back. People wrote letters, and executives got fired. People literally picketed in front of Coke’s headquarters. Coke was forced to tuck their tails between their legs, apologize profusely, and reinstate Coca-Cola Classic.

Only 79 days elapsed between the introduction of New Coke and the return of Coca-Cola Classic, but it was quite the time.

So what does this have to do with tiered response?

When I first started in this business, we only saw the fire department on fire-related calls. Occasionally, they were requested for extrication of victims from a motor vehicle crash, but that was not often. People called 911, asked for an ambulance, and they got an ambulance.

But now it is different. Fire departments are no longer “Fire Departments,” they are “Fire-Rescue” departments, or “Fire and EMS” departments. EMS has been taken over, and now ambulance standards are being written by NFPA.

The citizens seem to love the tiered response. As mentioned earlier, three button pushes and thirty seconds on the phone, and a dozen people will stop whatever they are doing and drive as fast as they can to get to you. All in an effort to mitigate liability, but that’s another post.

The citizens, the taxpayers, are the taste testers. They are taking a sip of this drink that is tiered response, but they aren’t being offered the alternative. This is just the way it is.

Somehow, this is going to have to change. The response that I outlined above is not just common, it is the norm. And it is a waste of money.

But money is the answer, isn’t it?

If the fire department doesn’t send their vehicles and their people to these calls, then the fire department runs a lot fewer calls. When the fire department all of a sudden runs 80 percent fewer calls, then local government wants to know why there are so many firefighters and so many pieces of apparatus for so few calls.

This tired response may not have begun to justify a larger budget, but that is certainly where it is now.

Everyone deserves better.


  1. I started to comment, but the comment became so long that it grew into a blog post.
    I remember the Pepsi Challenge, but I was one of those people that preferred, and prefer still, Coke. Coke’s retreat on “New Coke” was a classic in back pedaling.

    The original book on this was “The Other Guy Blinked” by Ron Enrico. Interestingly, I think that Coke eventually regained their market share or at least a large portion of it.

    A good post my friend. I just don’t know that it will ever change. Oh, the fire service is now becoming interested in “community paramedicine” which they see as a natural extension of what they do now. It will be interesting to see what happens when nursing realizes that EMS is encroaching on their territory. Two powerful lobbying groups at odds over jobs.

    • I question the sanity of people who prefer Pepsi over Coke. I mean, it just doesn’t seem right.

      I’ll have to look that book up. Coke has certainly regained their market share. I have another story about Coke vs. Pepsi that I will have to share some time, but that probably won’t fit on an EMS blog.

  2. Interesting thought: We run a tiered system in my county as well much differently though. We respond BLS ambulances backed up by ALS chase cars (QRVs, fly cars) to CHARLIE and above calls, so not EVERY call gets a medic. I wrote a post about my feelings on it which is going up this week, and I invite you to take a gander at it!

    The only place where this system is different is in one of the cities in our counties where the fire department sends an engine to all DELTA level calls. So you get a BLS engine with 4 people, a BLS ambulance with two EMTs, and a medic unit with two paramedics. Things get cramped quickly.

    The guys and girls on the engines do a GREAT job. They really are fantastic, but its almost too many hands. The only time this does NOT occur is when there is a structure fire in the city, or when their fire units are tied up. When that happens, DELTA calls get the standard BLS ambulance and ALS intercept response. My question for the masses would be simply: what is the difference in mortality for those DELTA level calls? If more people are living when the fire engine responds keep doing it. Otherwise, what’s the point? I have a feeling the difference won’t be that significant. . .

  3. Suburban and rural fire districts in California are finding and have known that the cost of being a first responder in a fire engine has created the cost of doing business to be unsustainable. The fire engine arrives determines the condition of the person needing emergency procedures. If the person requires medication to relieve pain from a broken bone, the fire fighters (EMP) have to wait for an ambulance to arrive, which in our area is about 2-4 minutes behind or sometimes ahead of the fire service unit, the fire unit remains until the patent is loaded in the ambulance, such a waste of resources. The state has passed laws that are tying the hands of local small districts, it is just a matter of time until CAL FIRE takes over all the districts, they have already taken over many area stations.

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