chief concerns richard marinucci
Ever since the fire service got into the ambulance/rescue business, it has been looking for the perfect vehicle to use.
As of now, there is no one such vehicle that will be applicable to all organizations and all situations. Some departments use paramedic engines while others use smaller response vehicles while still others have tried out sport utility vehicles. Some only worry about the transport portion, and some have some basic capabilities for firefighting as their personnel are needed for fire response. This might even include some hose and a little tank water. One will also find organizations with distinct delineations of responsibilities so fire trucks do fire work and ambulances take care of emergency medical services (EMS).
Fit the Mission
Fire departments need to look at their mission, goals, and objectives. They need to evaluate their resources and the services expected of them. While there is always value in considering what others are doing, you do not need to “keep up with the Joneses” regarding your vehicle. You need to get what is good for your system and service as you consider the finances available for your use. Besides the cost, contemplate specifics for your department and personnel such as training, drivability (your road system and congestion so you can negotiate traffic, streets, and parking lots), maintenance, weight, and safety.
EMS can be provided in a variety of ways and with variances in many methods. In a perfect world, there might be carbon copies, but like much of the fire service, there are differing opinions for what is the best system. Each community gets to make its choice. Hopefully, it is an informed decision so it selects the best method. We know that departments can choose not to be involved in EMS, but this is more the exception to the rule. Organizations have the option of medical first responder level, basic emergency medical technician, or paramedic service (though there are some intermediates scattered about). They can choose to transport or not or be backup for true emergencies. They can have a governmental third service or private support through a hospital-based system or a private ambulance company. Depending on your system, your vehicle should be commensurate with your delivery model.
Departments have enjoyed successes with many types of vehicles and are often committed to their approach. As such, they will “brag” about their approach. They may be believers in remounts or basic “van-type” vehicles that are relatively inexpensive and disposable. On the other side of the argument are more heavy-duty vehicles that cost more but offer the advantages of a larger, more durable vehicle. One could make the case that there are successes in each approach, and service delivery and quality are in line with the expectations of the community. Those decisions are made locally but should not be made in a vacuum. Those who ultimately make the decision need to know the advantages and disadvantages. While cost is certainly a factor, it needs to be weighed against the desired quality and likely outcomes.
One issue that seems to be reoccurring is when departments select a vehicle and then continue to add equipment needed for the various services the truck is expected to deliver. Each vehicle has limited space, and personnel tend to not only fill the space but overload it. This starts innocently enough as the ambulance/rescue is purchased to meet budgetary constraints. If the department was not successful in getting the funds needed to purchase the appropriate vehicle, it will still try to make the truck do as much as possible. This leads to issues and challenges that can affect service delivery and create long-term maintenance problems. Sometimes an inadequate investment up front will lead to more expenses downstream. Without getting into the political aspect of this, those in control of the resources don’t always look past the next election and are trying to save money in the short term. To use a common expression, they are kicking the can down the road for the next people. The best way to try to counteract this is through thorough research and knowledge of the subject. The more information you have that is based on logical views of the situation, the better chance you have of being successful.
Listen to Your People
The people who know the most about what a vehicle should be and how it should be outfitted are those who use it the most. They know what they need and what is most efficient and effective. With that said, they need direction. No one has a blank check, and there will always be financial considerations. You can use the knowledge of the end user, but you need to give specific direction upfront. This will include any restrictions because of budgets and any specific considerations that you may have. The vehicle must be designed based on what is needed for the overall goals of the organization and not any individual desire. There are many items that will improve service. Consider the cost and likelihood of use. When considering EMS, return on investment doesn’t always compute. But, communities establish their level of risk through their taxing and funding mechanisms and amount. Provide the best service possible within the parameters established.
Remember the Customer
Service industries should always consider the recipient of the service. As such, whatever vehicle an organization selects should provide for the comfort and safety of the patient. This can affect both smaller and heavy-duty vehicles. Cramped trucks make service delivery more challenging and uncomfortable during treatment and transport. Some of the heavier duty ambulances have stiff suspensions making the ride bumpier. Consider that the patient is already starting off in an uncomfortable situation—you don’t want to add to it with a rough ride to the hospital. Again, knowing your desired service levels and overall use of the vehicle assists in making the right choices.
Ambulances used by fire departments can vary based on the services provided by the vehicles. Some organizations only provide EMS with the vehicles while others are cross-trained and have firefighting responsibilities. This affects the space needed because of equipment considerations. Departments must evaluate their options and select the right vehicle. Occasionally, organizations will spend more time trying to determine paint schemes and colors and striping than they do truly evaluating their needs. While one can learn from others, not every model can be copied exactly. With EMS accounting for the majority of calls in most communities, obtaining a reliable, durable, and useful ambulance should be a top priority. The only interaction many taxpayers will have will be with the EMS system. Give them good service, which will include the best apparatus for the job.
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.