With demand for emergency medical services on the rise, the Palo Alto Fire Department is preparing to add a fourth ambulance to its fleet and rebrand itself to reflect its changing role.

The city's paramedics operation, which has been in place for nearly four decades, was most recently expanded in 2013, when the department added a third ambulance. The additions reflect the growing number of ambulance transports and medical-service requests in recent years, as the city's population has both increased and aged.

According to the city's 2013 Performance Report, a compendium of data about various departments, the number of ambulance transports from the city (which includes both Fire Department facilities and ambulances from outside agencies) has increased from 3,005 in 2011 to 3,220 in 2012 and up to 3,523 in 2013. At the same time, the number of medical/rescue incidents has steadily grown from 4,521 in 2011 to 4,584 in 2012 and to 4,712 in 2013.

The growing role of paramedics services is also reflected in the Fire Department's recently completed Strategic Plan, a big-picture document that evaluates the department's strengths and weaknesses; surveys community and personnel attitudes about department priorities; and proposes ways to improve.

The document, which was completed in late May, suggests that the community is well aware of the the Fire Department's evolving role. When the department asked a broad group of external stakeholders (which included neighborhood leaders, business owners, civic groups and several reporters, including one from the Weekly) to rank eight department services in order of importance, "emergency medical services" ranked first, just above "fire suppression."

Following these two services, in order of preference, were technical rescue, fire prevention, hazardous-materials mitigation, domestic preparedness planning and response, public fire/EMS safety education and fire investigation.

Fire Chief Eric Nickel told the Weekly that he wasn't surprised to see medical response take precedence over fire suppression. He noted that emergency medical services are "about 70 percent of what we do" and that the department's paramedic program has enjoyed a high profile over the past four decades. Palo Alto's changing demographics have made this function particularly important, as more seniors prompt more calls for medical response. Nickel noted that residents 65 and older make up about 17 percent of the city's population but use close to 50 percent of its ambulance services.

Nickel said that while the department remains as committed as ever to training for firefighting, the Strategic Plan further underscored the need to devote more resources to medical response.

To that end, the department will in January add a fourth ambulance to its fleet. Much like the third ambulance that was recently added, the new vehicle will be staffed by existing firefighters, many of whom are trained paramedics. Nickel said he's been working with labor groups in recent months to work out the details of how the employees' roles will change.

"We have some incredibly talented paramedics who are probably some of the best in the field because of our affiliation with Stanford Hospital and because we've been a paramedic department for so many years," he said.

One of the goals is to reduce the number of responses from outside agencies, mainly Rural/Metro Ambulance, which handles medical-transport services when all of the Fire Department's ambulances are in use. Before the third ambulance was added in Palo Alto, Metro would come into town between 60 to 70 times per month, Nickel said, a number that dropped to about 22 times a month with the addition. The goal is to bring the number to fewer than 10 trips a month, he said.

The city is also rebranding itself to reflect its broad range of functions and the growth of the medical-response operation, Nickel said. Department officials are considering, among other ideas, a new name for the department to reflect its more expansive role.

The new Strategic Plan, which covers the period of 2014 to 2018, also notes areas in which firefighters believe the department can be improved, with "communications," "succession planning" and "retention challenges" all on the list. These findings reflect the recent period of turnover in the department, a result of both demographics and the city's efforts to cut benefits in the aftermath of the 2008 economic downturn.

Nickel said when he arrived in 2012, most of the middle- and upper-level managers in the department were "brand new" and many didn't have the benefit of executive training or further education to be prepared for leadership positions. He added that the department is implementing a "pretty aggressive and robust succession preparedness program" for leadership training, with high-level officials taking graduate-level courses to prepare them for executive roles.

Turnover is also expected to be an issue in the coming years, with 42 firefighters eligible to retire in the next five years. There are 110 sworn firefighters currently in the force.