Chief Concerns: Challenges of EMS

BY RICHARD MARINUCCI

Richard Marinucci
There is no doubt that emergency medical services (EMS) have become a critical component of almost all fire departments.

EMS has improved the quality of life in the communities where it is delivered and added value to fire departments. There have been more lives saved with EMS than any other aspect of the fire service, and it could be argued that EMS has increased the professionalism of the service. It is hard to find too many negatives associated with fire-based EMS, but there are some challenges that need to be addressed, and some changes need to be made. Some of the areas affected are recruitment (hiring), training, run volume, and mental health.

RECRUITMENT

Many, if not most, fire departments, are having difficulty getting enough applicants. This is true in career and on-call departments. The impact of EMS on this is not the only reason but could be a contributing factor. In on-call departments, the added responsibility may place too much of a burden on those wishing to give back to their community. To respond to EMS calls, minimum training is required. Depending on the level of service provided, the number of hours just to get started can be hundreds. Then, there is the need for continuing education. Just this added commitment can act as a deterrent to apply. Once approved to respond after initial training, individuals who have other jobs, families, and interests may find the number of calls in some departments can be overwhelming. It would be naïve to think that this has not become a factor regarding declining numbers in on-call agencies. Again, there are other factors, but this one needs to be rigorously evaluated to measure its impact.

In career organizations, many are experiencing a significant decline in the number of applicants, especially those requiring paramedic level licensing to apply. People who have been in the service for any length of time can recall the large number of candidates who tested for these positions. That number in many communities has declined. It is not always prudent to assign one cause, as there can be other reasons for declining interest in a great job, but discussions with many in the profession find that there is a strong belief that added criteria restrict the number of applicants. There are logical reasons to require credentials, mostly because of the time and cost to provide this training. Departments can take individuals with paramedic licenses and have them responding months, if not years, before someone who enters the service with no training. Yet, some thought needs to be given to other options. Another impact is the ability to recruit minorities. In many areas of the country, minorities are not obtaining licenses prior to hire and, therefore, are at a disadvantage of getting selected for the job.

TRAINING

Training in this industry is essential. With many organizations experiencing a reduction in the number of significant fires, training to obtain and maintain skills is critical. Sets and reps, from basic skills to incident command, are necessary to keep the expected competence and level of safety. But, EMS has many training requirements. This would include cases where new equipment and techniques are added and require continuing education necessary to maintain licensure. This is a challenge for both career and on-call departments. In full-time organizations, it may be the issue of finding time or replacing other aspects of the job. In volunteer departments, the time commitment may act as a disincentive to some who want to help but just cannot commit to the training that may be required. This needs to be properly evaluated in every organization to determine the impact.

RUN VOLUME

Run volume places extra strain on the entire department. This will vary depending on the run volume of the organization and of the individual units. Some are responding to calls that don’t allow for rest and recovery, training, and normal maintenance activities. There is a point where productivity and individual safety suffer. In those cases, departments must look at the situation to determine the best course of action for both the individual firefighters and the department. Excessive response can affect responder health and impact service levels. In on-call departments, responders may find that the “part-time” work is too much, or it may keep them from responding to other types of calls requiring more staffing such as structure fires. Regardless of whether it is a career or volunteer department, there is an impact. There may be a need to increase staffing, rotate assignments, or implement other ideas that are suggested locally.

MENTAL HEALTH

One aspect of the fire service that has received some much-warranted attention lately is that of the mental health and well-being of firefighters. Response to EMS calls certainly has a part in this. It is the added run volume and the individual calls that may have special significance because of the severity and individual involved. I do not like to use the term “burnout,” but it applies here. There is the chance that firefighters will reach the point where they need a break from the regular routine.

Every person is an individual and handles difficulties in his own way. There are things that organizations and supervisors need to do to support their personnel. First, and foremost, they need to pay attention to everyone. This is important for heavy volume responders and in cases where there are unusual calls that can have a negative effect. Provide resources, which may involve experts outside the fire service. Departments and individuals need to pay attention to developments in mental health research and learn what they can so there is a support system available if needed.

Arguably, the most significant change in the fire service in the past 50 years has been the addition of EMS to the responsibilities of the vast majority of fire departments. Fire departments that existed to save lives and fight fires are now saving many more lives responding to EMS calls. The value to communities cannot be denied, and departments are not going to go backward. EMS continues to have a tremendous effect on the direction and evolution of the fire service. With the large percentage of emergency calls greatly exceeding responses to fires along with training and licensure requirements, the impact is creating new challenges. The leadership of the fire service must continue to develop an organization that addresses the challenges.


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.

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