Rx4EMS: Where We Make a Difference

Where We Make a Difference

By Alan Perry

March 6, 2014

There are times when riding in the back seat is desirable, such as being a jump seat firefighter. But it really chaps my parts when I continually see the Fire Service, Major Fire service publications and Fire training divisions focus nearly exclusively on Fire related items while placing EMS training and discussion in the backseat. EMS has been acknowledged as being at least 80% of our job. Are we in denial? Are we uncomfortable with the subject? Do we find it Boring? Is it less important, or is the Fire service culture still resisting the change that has already occurred?

While the data appears somewhat subdued and hard to find, most large fire departments that provide EMS services report an average of only 3% actual fire calls. Yet their persona and training programs remain largely centered around the fire service. Certainly not all present themselves in this way, but it has been my experience that EMS is still viewed as a necessary evil by most. According to the IAFC[i] career firefighters provide EMS services to 85% of the population overall, and 97% in the 200 most populated communities. So why the resistance? Even among a minority it makes no sense.

Fire and EMS represent two distinct personality types in my view which may largely explain these circumstances. Firefighting represents bravery in the face of danger, care of the sick and injured represents compassion. Ideally both of these should exist in the Fire-based EMS system; the reality is that we seem to attract one or the other. It is apparent in older departments that the entrenched old-guard firefighter mentality is enshrined in the administrations and leadership, this alone could explain some of the resistance, but most of these veterans are retiring now, so why does it persist? They left us a gift in the form of training their replacements, all the while instilling their old outdated views of firefighting and EMS. Dinosaur Eggs. Some have gone as far as to suggest that the value of EMS calls to the fire service is that these calls can be used as fire training[ii], as if that somehow makes them more worthwhile.

According to the IAFF [iii] “No other organization, public or private, is capable of providing pre-hospital emergency response as efficiently and effectively as fire departments”. For this to be true every Fire-based EMS system must also provide effective EMS training and quality control measures to assure that they are actually “capable” of providing this service better than any other organization. Also, merely being “capable” does not necessarily equate to actual performance. It appears to me that in many cases the administration and training components appear to have misread the data and believe 80% of their calls are fires and 3% EMS. The result being a lopsided training and public information based on that model.

The IAFC asserts that “ ⁱIf EMS is the intersection of public safety, public health, and medical care…. The U.S. Fire Service is uniquely qualified to be at that intersection” If this is a serious statement then why do the majority of fire departments still qualify promotions by assessments that evaluate fire tasks that are only performed 3% of the time? I realize that the duties of an officer include much more than the wrote skills involved in firefighting and/or EMS, and that the management and command components apply equally regardless of the service, but these same officers, chiefs & administrators must understand equally well what is going on at the street level in both Fire and EMS before we can make statements like this. So why don’t we make EMS management skills a greater part of that assessment to insure we kill the “dinosaur eggs” and promote EMS competence throughout the chain-of-command?

I am not an enemy of Fire-Based EMS, it is my career, a career I love and want to see be the best it can be. What I cannot tolerate is apathy, failure and hypocrisy. A white paper promoted by the IAFF states “[iv] The fire service has become the first-line medical responder for critical illness and injury in virtually every community in America”. This is an awesome responsibility, one we must take seriously; we have the opportunity to save lives. Lives cannot be rebuilt once lost; damage usually cannot be fully repaired. If we are to live up to our billing we will meet this obligation by responsibly representing the value of EMS services, conduct serious and frequent EMS training, and promote those that take the EMS mission seriously and display a continuous desire to improve our services in all areas relative to their public impact.

Be Safe,

Alan