EMS Equipment
By Will Chapleau

Fire-Based EMS: A Foreign Approach
Fire-based emergency medical services (EMS) faces challenges daily. Challenges like maintaining staffing levels and the availability of ambulances to ensure response times leading to good patient outcomes.

Other challenges are fiscal and political. Communities wrestle with the cost of equipping and providing for personnel, and we are forced to address increasing call volumes with diminished resources. Further, we have to respond to non fire-based EMS calls with questions about focus and cost effectiveness.

Fire-based EMS can be aggressive in its approach to its work through imaginative operations and involvement in education for professionals and the citizens they serve.

In exploring ways to manage our response, it’s always good to take a look around at how other people are doing it. By other people I don’t mean just your neighbors or even elsewhere in the United States – I mean, other countries.

Like the U.S.,  the fire service all over the world is a combination of career and volunteer response. On every continent, people are facing the same and sometimes very different issues than we face in our own services.

Let’s take a look at a few places I’ve had the opportunity to work and examine what fire-based EMS is doing around the world.

Portugal uses full-time career staff, volunteers and combinations of both to provide fire protection and EMS services. Like the U.S., big cities can provide large career staffs supplemented by volunteer support.

In Lisbon, 1,200 full-time career firefighters staff over a dozen stations providing fire and EMS response for the city.

Portugal has a significant brush fire season so most of its departments have four-wheel drive engines. (Fire Apparatus Photo by Will Chapleau)

The interior of an advanced life support (ALS) unit in service with the DeQueluz Volunteer Fire Department has some significant differences from ambulances in the United States. ALS units in Portugal typically respond with a paid driver and volunteer basic or advanced life support technicians.  (Fire Apparatus Photo by Will Chapleau)

They average around 2,000 ambulance responses with one advanced life support ambulance and six basic life support ambulances. These numbers are lower than they might be for a city this size elsewhere as the fire department response is in support of a national ambulance response system called National Institute of Emergency Medicine (INEM). The career Lisbon Fire Department is backed up by seven privately-operated volunteer companies that operate 40 fire and rescue rigs with 500 volunteers.

Volunteer fire departments in Lisbon are the largest ambulance responding group with dozens of ambulances about half of which are advanced life support equipped. Typically, these units respond with a paid driver and volunteer basic or advanced life support technicians.

Requests for ambulances are handled by INEM, the Ministry of Health, which handles the 112 dispatch centers and operates basic and advanced life support ambulances along with Medical Emergency and Resuscitation Vehicle (VMER) units.

These are medical emergency and resuscitation vehicles staffed by a physician and a driver/nurse technician. These cars are based at stations and hospitals and are dispatched according to triage protocols. The INEM vehicles are primary response units, and the fire service responds when the call volume or proximity to the call warrants it.

Recently, I was invited by the Prehospital Trauma Life Support (PHTLS) faculty of Portugal to participate in a course conducted at the DeQueluz Fire Department in suburban Lisbon. It’s a combination department that has had to augment its volunteer staff with career personnel increasingly over the years, much as volunteer services in the U.S. have had to do. Twenty-four hour shifts and daytime personnel ensure that staffing is adequate to provide fire suppression, rescue and ambulance response.

This department has also added patient transfer calls to its response capability, and it is a growing part of its response. This is rare, but not unheard of in the U.S. I visited with a department in New Hampshire a few years ago that runs full-service ambulances covering emergency and non-emergent transfers.

The DeQueluz department has partnered with the PHTLS faculty in Portugal providing a facility and faculty for their courses. The fire department facility includes a full-service kitchen, which allows meals to be served to course participants on site.

While INEM still handles EMS dispatch and response, the department handles frequent emergency ambulance response according to proximity and volume. Along with their transfer work, the ambulances spend a great deal of time on the road.

Denmark Is One Example
We’ve heard of privately held fire and EMS services and most people probably think it started with Rural Metro in the western U.S. The truth is, private Fire/EMS has been around for a long time in Europe. Denmark is one example.

Falck is a huge, diverse, Nordic-based company that provides services as diverse as fire protection, EMS, insurance and tow truck services. Not only is this not a recent development, but it has been around for 100 years. They have been providing fire protection to more than half of Denmark and EMS services to all but Fredricksburg in the center of Copenhagen. In Fredricksburg, the fire department provides ambulance response. Falck is also international with services being provided in countries like Belgium and Slovakia.

In France, the fire service is active in EMS with fire-based physicians working at the fire departments. The fire departments respond with technicians in ambulances and the physicians respond in specialized cars to the scene according to triage protocols.

Bomberos
In visiting some of these stations, I’ve found the physicians also provided health services to the firefighters in clinic like settings at the stations. One example is the Milhouse Fire Department. It provides technician-based response with physician response as needed. The department is also actively involved in trauma training for the physicians, nurses and technicians that work with trauma patients.

While the Red Cross provides the bulk of ambulance response in Costa Rica, the fire service is increasingly providing ambulances to supplement the response in high volume areas and is training its firefighters, or “Bomberos,” to first responder and EMT level response capabilities. Here, as in many countries, the firefighters have worked with medical directors in providing trauma training for technicians, nurses and doctors.

In much of South America the Red Cross, as well as private- and hospital-based municipal ambulances, provide the bulk of the EMS transport response. However, the South American fire service is going after EMS in a big way. Currently, most of the municipal, Red Cross or private ambulances respond with nurse/driver technicians and a physician.

The fire chiefs associations there have committed to standardized first responder training for all personnel and are working on basic life support programs to provide response and transport services. Partnering with training companies and universities, they have embarked on a plan to have standardized training and consistent response capabilities across the continent.

In sharing some of the things fire-based EMS organizations are doing overseas, you can see, first, the brotherhood and passion we share, and second, you can see how they are working to be taken more seriously concerning EMS and applying their response capabilities to the needs of their communities.

Editor’s Note: Will Chapleau, who has 30 years of EMS experience, is the Advanced Trauma Life Support (ATLS) program manager for the American College of Surgeons. He is the former chief of the Chicago Heights (Ill.) Fire Department, has served since 1996 as the chairperson for the Prehospital Trauma Life Support (PHTLS) program of the National Association of Emergency Medical Technicians and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.