The overwhelming number of fire departments provide some level of emergency medical services (EMS) and have been doing so for quite some time. The increase in job responsibilities has changed many aspects of emergency service delivery including the core mission of fire suppression.
There is no doubt that EMS has increased the status of fire departments, improved education levels, and ultimately saved countless lives in the process. It is hard to imagine what the service would look like if EMS was not such a huge part of it. But, like any significant portion of any service, the changes have created and continue to create challenges with respect to service delivery in all aspects of the fire department.
One aspect of the added responsibilities that doesn’t get enough attention is the added strain on the workforce. We all know that most firefighters cannot say no when asked to help. Yet, one must start to wonder what the impact is on the continual increase in EMS responses and the need to maintain current as the profession changes. Additional runs, added training, new equipment, and maintenance responsibilities greatly change the work day and increase demands. Regardless of your views on this, there are points where the job growth exceeds the capabilities of the individuals. At some point, there needs to be the realization that without adequate resources, there cannot be proper delivery of service, and quality in some areas will suffer.
The issue of work overload is a tricky one. It is probably as much about the political realities in your organization and community as it is about any concrete reason. Certainly, there are places where the workforce can take on additional responsibilities, but there are others that have reached a saturation point. It may be difficult to quantify this. You will need to evaluate the entire package of services provided, the quality desired, and the ancillary activities needed to maintain the goals. You will also need to look at your personnel. Regardless of your views on “burnout,” more and more studies are indicating that there are workload factors that affect the mental and physical health of firefighters. Pay attention to the details so that the most important part of service delivery is not on overload.
Fatigue can also be a factor to consider. Employees who are not adequately rested or properly rehabbed are not going to make the best possible decisions. In the moments that matter, you should want medics to make good choices and minimize mistakes. This is especially important for the low-frequency/high-risk events (thank you, Gordon Graham). We should all know that people who are overly tired will not make good decisions as a rule. While there are occasions where circumstances do not allow for ideal rest periods, those who experience regular and routine times of excessive fatigue must consider options to change this situation.
Apparatus have evolved as departments look for the best model from which to deliver quality EMS. There is the base vehicle, the ambulance, and an assortment of rescue vehicles along with paramedic engines. For those delivering only EMS from a vehicle, the options are much simpler. But for those also using the vehicle for fire and the other ancillary services and special rescue situations, the challenge to find the right vehicle for the particular department and possibly individual stations has led to many “hybrid” trucks. Departments are continuing to “tweak” their vehicles to find the best mixture of essential and “nice-to-have” equipment that will allow for the right tools to be available when needed.
Finding compartment space for the increasing equipment needs can tax any department. As the entire service evolves, not only in the area of EMS, there are more products that offer great promise to improve capabilities and meet protocols. Generally, when a product is deemed worthy of use, it needs to go on a truck. Rarely, if ever, does it replace something, so there is more added and none subtracted. So, the options are to build a better truck or become more efficient in storage. The efficiency can be tricky, as equipment often needs to be accessed quickly in times of emergency. Burying certain pieces can slow an operation, especially at those low-frequency events that require high skill and use of specialized tools. Besides finding space, departments need to be cognizant of added weight to the vehicle. This may not necessarily apply to smaller EMS items, but tools that contribute to better rescue operations can be more of a challenge.
Any time new equipment is added, there is a learning curve, and additional training time is needed. As anyone in the business who has busy companies knows, there is very little “downtime” available to add more training. Yet, there needs to be an orientation and remedial work to maintain competence. Too often, other training falls off the table, and another aspect of the service suffers. There is no magical solution to this, but having a plan is essential. Training programs must start with the high-risk/low-frequency events in all areas of service delivery including fire response and special rescue, not only EMS. Within EMS, there needs to be a system that gets personnel to a high level of competence and maintains it for the rarer calls where a difference can be made. This will include an evaluation of new techniques and equipment that are either mandated or part of an improvement program for a department.
Training in itself is a challenge for many, if not most, departments beyond finding the time to add new topics and skill development. Finding an appropriate trainer can be difficult for even the most progressive departments. For those with dedicated training officers, there is tremendous pressure to learn all aspects of the job to the point of being able to deliver quality training. The instructor must not only know the subject very well but must also be able to create a training program that engages firefighters and medics. Being a “jack of all trades” but not being a “master of all” fits most trainers in the modern fire service. One approach to counter this is to continually seek out help. This can come from within the department, mutual aid, outside instructors, and even manufacturers and suppliers. Also, focus training on the previously mentioned high-risk/low-frequency events.
As EMS has become a larger part of most fire department workloads, there has been more asked with respect to service delivery. EMS continues to evolve with new protocols and equipment. This includes training, apparatus, and equipment and affects all operations—not just EMS. Finding the right balance with other job responsibilities while providing the quality service citizens demand is a challenge. Continual evaluation and adjustment are necessary to find the right mixture. Finally, remember to pay attention to your personnel. While we all like to think we are “superhuman” and can handle just about anything, adding more work, especially the type of work EMS entails, will impact personnel. If you want to have the best possible service, you must take care of your firefighters.
RICHARD MARINUCCI is the executive director of the Fire Department Safety Officers Association (FDSOA). He retired as chief of the Farmington Hills (MI) Fire Department in 2008, a position he had held since 1984. He is a Fire Apparatus & Emergency Equipment and Fire Engineering Editorial Advisory Board member, a past president of the International Association of Fire Chiefs (IAFC), and past chairman of the Commission on Chief Fire Officer Designation. In 1999, he served as acting chief operating officer of the U.S. Fire Administration for seven months. He has a master’s degree and three bachelor’s degrees in fire science and administration and has taught extensively.