EMS: Making a Difference in the Moments that Matter

By Richard Marinucci

Emergency medical services are such a vital part of many fire departments’ responsibilities that the performance of personnel on every call has become a measure of fire departments’ capabilities in the eyes of many in the public. Of course, as with fire calls, the public has little real knowledge and establishes its opinion based on its perceptions, not necessarily reality. This doesn’t matter. The fire service must be professional in its approach and provide the best possible service it can based on its knowledge, not necessarily public perceptions.

Responders should consider two parts to every call: the customer service that is provided and the technical aspect of the skills needed to adequately resolve the emergency. This approach accomplishes addressing potential perception issues from the public and ensuring that the best possible care is given. Another way to put this is that “bedside manner” is just as important as the actual care, and they should not be considered mutually exclusive. With this philosophy comes the responsibility to make sure that personnel are prepared for both.

EMS Competence

Competence in EMS can be measured in various ways; there is a subjective component regarding how well the service is being provided. Those in the EMS business can tell those that have the greatest skill regardless of what the measurement tools say. If you were to survey your medics as to whom they would want treating their loved ones, you would probably find that a majority identify the same medics. Those in the profession know who the high performers are because they see them performing every day. There is nothing scientific about this, just professional perspective.

Competence is attained through study, training, and practice. There are varying skill levels among EMS personnel even within the same licensure. Some are more capable of starting IVs while others read EKGs better. It could be a combination of natural abilities and practice. Regardless, all EMS personnel must be able to perform at a particular level. That level should be high, and the goal of every organization should be to greatly exceed the minimum standards established for the profession.

Avoiding the Routine

Many EMS calls could be considered “routine” by those that respond. That is because they happen frequently and fit into the category of normal or “textbook” incidents. For these calls, there is great success delivering the expected service. It is a combination of frequency, which gives responders confidence and experience to handle the calls, and the fact that the incidents fit into the established protocols and diagnoses. Medics are trained a certain way, and if the incident fits the training, it makes the treatment almost automatic. Further, repetition increases competence and confidence.

Less frequent are the calls that require more skill, knowledge, and ability. These are the calls where responders can truly make a difference. They are the calls that don’t happen frequently and don’t fit into the normal expectations. The performance on these calls really determines an individual’s and organization’s overall competence. Every organization can handle the routine-only those that really pursue their professionalism can perform consistently at a high level regardless of the type of call, its frequency, or when it occurs. Organizations aspiring to be truly outstanding must commit the energy, effort, and resources to make differences in the moments that matter.

The Right Time; the Right Tools

One component of great service is response time. The sooner definitive treatment begins, the better the outcomes. There are some that will say that this may not be true statistically. If you look at all the routine calls, you might be able to make a case. But if you are talking about the less frequent but more serious incidents, it would be difficult to make a case that response time doesn’t make a significant difference. As such it is very important for departments to always be prepared to respond as quickly as possible while maintaining safety. This means having a little hustle in your step, knowing your response district, and making sure all the equipment is ready. When the call comes in, it is not always possible to know if that call will be the one that will require nonroutine response. So, treat every call as if it will be the one.

Having the right tools at your disposal will result in better outcomes. There have been many developments in medical equipment, not only improving usability but providing more options. With more options comes the need to train on the equipment. The fact that you have access to the latest and greatest does not mean much if you fail to become competent with the equipment. This is not to say that organizations are not challenged to find the time to become really good with the equipment provided, but you must address this if you wish to make a difference.


Be nice! What could be simpler? It continues to amaze me how much of an impact those in EMS can have by just being nice-not only to the patient but to those in the area of the emergency. I don’t know if there is any scientific basis, but it seems that a good bedside manner helps to relax the patient and allow for better technical treatment. Even with my limited skills I have found that most situations improve with the simple act of kindness. Unfortunately, we rely on individuals to develop their own manner and rarely offer additional training in this area. But there are a few simple things to remember to help the situation.

Try using names to personalize the situation. Take note of the tone of your voice. You should not get excited because taking care of emergencies is your business. Say please and thank you. Ask permission when needed. Communicate your actions before you take them. This is not earth-shattering advice. It probably helps to have a reminder from time to time. Just pretend your mom is watching!

The implication here is that a large majority of calls are easily handled, as they should be. There is a percentage that requires great competence, and the responding crew’s skills make a difference, either positively or negatively. It should be every organization’s goal to be outstanding and capable of handling less frequent events that offer the opportunity for the best possible outcome in the least amount of time. Through great training and repetition to solidify skills, the right equipment, and a desire to be as good as possible, you can be prepared to make a difference in the moments that matter. And of course, even in these situations, remember your bedside manner and be nice.

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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