EMS and the Medical Profession

Richard Marinucci   Richard Marinucci


The most significant change in the fire service in the past 40 to 50 years would have to be the addition of emergency medical service (EMS) to fire department responsibilities.


Some estimates are that 97 percent of the 200 largest cities in America use the fire service to provide EMS. One would be hard-pressed to find many organizations that don’t have some role in the delivery of medical care. The result of this has been the fire service’s significant transformation in many different ways. Obviously, responses have increased, and the public’s expectations have changed. Customer service and bedside manner are very important, and dealing directly with other people is something that all fire-based EMS personnel must do. Think about it. When responding to a fire, most firefighters don’t ever have to deal with the public. Yet for an EMS call, there is personal contact every time. Personalities and relationships with the citizens have become more important.

The Fire Service and Other Industries

Prior to EMS, the fire service really had no connection to other professions in the way that EMS aligns itself with others in the medical profession. Obviously there is a direct tie-in to emergency rooms, but there is much more to it than that. Depending on the level of service, whether as a medical first responder or paramedics who transport patients, there is a certain level of performance expected. Further, licensure, not just certification, along with continuing education is required. Alignment with the medical profession mandates the types of requirements to continue involvement not previously seen in the fire service.

There is much the fire service can learn from others in the health care industry. It behooves organizations to look at the broad picture and view various perspectives and options for improving the service. There are clear examples of how this can work by enhancing services. For example, paramedics have always used three-lead EKG technology. Hospital and office settings used much more sophisticated 12-lead devices. Eventually many EMS providers transitioned to the EKG that offers more diagnostic information.


Organizations and individuals need to pay attention to medical advances that may someday reach the fire service for field use. One way to do this is to establish relationships with medical professionals and facilities. Build these relationships through regular contacts and by demonstrating a sincere interest in quality care. They can be with professionals in emergency rooms, operating rooms, critical care units, and perhaps outpatient clinics. Fire service organizations can press the issue by extending an invite to other health care professionals to ride along to see how they deliver medicine outside controlled environments. Mutual understanding and respect goes a long way and only improves through interaction.


Another area to consider when looking for trends and ideas is marketing. There is so much to learn from others in the profession regarding service delivery. You can listen to advertisements on the radio or television and get a good idea of what professional marketers deem important, relevant, and the real selling points. If you listen, you will hear them tout their professional staff, their commitment to quality service, their use of the latest technology, and the speed with which you will likely receive service. They will use cases, without revealing names or compromising identities, to demonstrate positive outcomes. Occasionally, a patient will act as a spokesperson. These particulars must be effective because all of the hospitals that advertise for “customers” use some or all of these.

Remember that the hospitals have a bigger budget than you do and can afford to hire people with significant marketing backgrounds. They don’t try to figure this out on their own. Since you don’t have the same resources, you cannot do the same. But, you can pay attention to what is being said and how it is being said. They have likely done some study to determine what messages are likely to resonate with the public. Evaluate your services and see if there are any similarities-there are-and develop your message based on the information you glean from various commercials. Don’t forget to consider those in print. They may help you identify items and issues to include when you are in a position to hand out materials to the public-taxpayers, too.

Rarely do you hear any negative campaigning about the competition because it focuses on the positive attributes of their service. This includes highly trained doctors and outstanding facilities. Consider your personnel and the training they receive. If you have training programs that continually enhance the minimal requirements of medics, they are a point to highlight. How would the medical facility sound if it advertised that its doctors get the minimal training offered and is still operating as it did when it first received its license?


Often your equipment is top notch. It is important to keep it that way. The vehicles you are driving down the road are advertising the quality of your service to everyone who notices. Maintenance and cleanliness are very important, as are the graphics that send a message. You should also let people know when you make improvements to better technology or newer versions of the tools you use. I hear advertisements talking about “cyber knives” and “robotics.” I guess the marketers have figured out that these things get the attention of the public. The members of your organization should be able to explain the wonderful tools at their disposal when in a position to offer information.


Now think about customer service and professionalism. Do you get a first impression of medical professionals based on their appearance? I think most people do. It is important to always put your best foot forward. I realize that sometimes this is not possible because of other job responsibilities-if you are returning from a fire when the next medical call comes in you may be a bit dirty. But, make every effort. I have heard firefighters and medics comment that no one ever had an issue with their appearance during a true emergency. That may be the case, but you should be looking for an edge. You also should remember that there are others observing your actions and appearance who you are not treating. They are assessing your capabilities too.

Always be conscious of your bedside manner. This often is the most important thing you can do and the action most likely to be remembered from the emergency. Again, look to others in the medical profession and think how you view their performance. Better yet, consider how your family and friends view the situation. Most do not have the medical training that you have, so they do not know the quality of the treatment. But, they do know if they were treated nicely. I remember talking to my Mom about her doctor. She went to him because he was nice to her. She never said it was because he was a great doctor! He may have been, but to Mom it was irrelevant!

Medical Regulations

The last thing to mention is for you to consider what you can learn from others regarding medical regulations. For example when the Health Insurance Portability and Accountability Act (HIPPA) became law, it affected others in the medical field much more than EMS. They needed to get a good understanding of the impact of the legislation and were a good resource to the fire service looking to comply. Today, the Affordable Care Act is changing health care, and others are committing resources to figure out exactly what it means to the future of the industry. I doubt the fire service has the same amount of resources, so it seems logical to pay attention and learn from those who have a lot to gain or lose.

Benchmarking is always a good way to look at the quality of your service. Sometimes you need to look outside the fire service to compare to others in related professions. There is a lot to learn. Sometimes it may be from a negative experience, but most often it comes from watching and learning from those who are successful. Take the time to observe and find some behaviors that improve service and quality. Remember, you are the only option that people have during an emergency. They don’t have time to shop around. You must strive to do your best every time out.

RICHARD MARINUCCI is chief of the Northville Township (MI) Fire Department. 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 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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