Emergency medical services (EMS) have been a significant part of most fire departments for as long as most current members have been in the service. Although relatively new considering the origins of the fire service, EMS has been part of the responsibilities of many firefighters since they signed on. Yet EMS and its role in the fire service continue to be questioned on some fronts—mostly from external agencies but occasionally from within.
I hear various answers to the question, “Why are fire departments involved in EMS?” Some point to the old television show Emergency!, with Johnny and Roy, as the reason many departments include EMS as a critical function. A long time ago, when I first started responding as an emergency medical technician (EMT), many referred to us as paramedics or medics, even though we had not yet attained that level of licensure. The people who watched the television show must have assumed we were all like Johnny and Roy, even though they were not particularly well versed in the levels of service they could provide.
Another reason cited for the fire service’s foray into EMS is productivity. Communities experienced a decrease in fire calls, and some people thought it would be a good use of personnel to treat the sick and injured. You can still hear people say that fire departments engage in EMS to justify their full-time positions because they don’t have enough fire activity. I am not convinced that this is the real reason. If it were just about keeping people busy, there are many other options.
Why would fire departments need to take on the extra responsibility of EMS if it was being adequately handled by others? Many saw the opportunity to add value. Communities viewed improvements in EMS as a way of improving the quality of life by providing a level of service that probably could not be done without using fire service resources. This is because the basic premise of successful EMS is the same as it is for successful fire suppression—quick response with enough properly trained personnel who have the right equipment.
When someone calls 911, whatever the reason, they are not having a good day. They want someone to come and fix the problem. They don’t get a choice as to who will respond as they cannot shop for the best possible service. There are a variety of EMS response models, and they must be acceptable to the community in which they are used. But, just because they are acceptable does not mean they are the most capable. The fire department model, in almost all cases, offers distinct advantages that lead to better service and better outcomes.
First and foremost, fire departments offer a response time that generally cannot be matched by any other agency or service because of fire station locations. Municipalities choose locations that help provide rapid response to fires. Quick responses provide the best chance to minimize damage. Response time is also critical to positive outcomes when providing EMS.
Specifically with paramedic or advanced life support, the quicker treatment begins, the better the end result. This results in potentially saved lives, shorter hospital stays, less time in rehab, and faster return to preinjury condition.
Staffing on EMS responses also can distinguish levels of service. On paramedic calls, there are many procedures employed, depending on the severity of the illness or injury. An incident that requires patient assessment, IV therapy, administering drugs, monitoring the heart, treating trauma, and keeping records at the same time needs the right number of people to have the best chance to achieve the most desired outcome. Even something as basic as moving or extricating a patient requires more than two people. Ask anyone who has tried to get a 300-pound patient from an upstairs bedroom to an ambulance!
Another question asked is whether or not fire-based EMS is cost-effective. In cases where full-time, staffed fire stations are already in place, it is. This does not mean income that can be generated will solve all your problems. The community must decide the value of EMS to its residents and the level it wishes to provide. Communities that can get paramedic service to patients the fastest will usually produce the best outcomes. When you evaluate the cost to the fire department, look at the marginal costs to provide the service. This means you see what additional costs you need above what is already in place. Firefighters are already working and vehicles are mostly available to respond. Consider the cost of upgrades needed to get to the level of service you wish to provide. This is the real cost of providing EMS in communities with full-time staffing.
There is a misconception that third services, whether hospital-based, a separate division of the fire department, or a private service, do not cost the community or the fire department. With rare exceptions, fire departments or communities subsidize these services in some manner, many times through personnel and short response times. Most third services cannot meet established response time criteria, so fire departments are dispatched and arrive first a vast majority of the time. Also, third services that are trying to pay their bills from calls cannot staff adequately and rely on the extra sets of hands that fire departments provide.
When considering fire-based EMS with cross-trained personnel, remember there are adjustments to be made. Apparatus is one. Generally fire department rescue/ambulances can be a bit more complicated and therefore cost more. They will require more fire and rescue equipment, such as self-contained breathing apparatus and rescue tools, because of the multiple job functions firefighters are asked to perform. Obviously more compartment space is needed, and some of this equipment can add significant weight to the vehicle. You must consider this when developing specifications.
Fire-based EMS has definite advantages. This doesn’t mean that other systems do not provide service to the areas in which they respond. It is also not my intention to debate the capabilities of individual licensed medical personnel, regardless of their affiliation. The purpose is to point out that there are some distinct advantages to using personnel who are strategically located for emergency response, with some of their cost already included because of their jobs as firefighters. EMS is most successful when a sufficient number of properly trained personnel arrive quickly enough with the right equipment to make a difference. Lives saved, shorter time in the hospital, and less rehabilitation contribute to the quality of life of individuals and their communities. Fire departments, fire chiefs, and all fire personnel must know what their service contributes to their communities. They need to be able to explain why they are a valuable commodity.
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 three bachelor’s degrees in fire science and administration and has taught extensively.