A major debate seems to be brewing within the Fire Service. It is one that has been developing for several years. It appears to be a controversy borne of misunderstanding and human nature. However, it is a reality to be faced within this decade. Should the Fire Department be the primary provider of Emergency Medical Services (EMS) in your community ??
Some traditional fire service professionals have said for years; "We don't need that %#@%&*^$ (expletive deleted) ambulance work!". "We have more than enough to do...just fighting fires". "Get rid of that *&^%$#@#$% (deleted again) ambulance and we won't be bothered all night!". "Besides, we didn't get hired to "play doctor", we FIGHT FIRES for a living". In some fire departments, it was "unoffical" punishment to be detailed to the ambulance.
For years, the City/Village Manager or Mayor was willing to listen to these type of comments and accept them as truthful, necessary, and forthright. He/she maybe even commensurated with the firefighters as having a tremendously dangerous and demanding job. In some towns and cities, the Chief Executive Officer (CEO) may even have been persuaded to turn the task of EMS over to a private provider by contract, or into developing a "third emergency service" within the community. The fire service moved further and further away from non- fire-related duties and providing emergency medical care.
Then came the late 1970's and early 1980's..... budget cuts, rising taxes, and "Proposition 13" type legislation which manadated "reductions in force" of municipal and state employees. Financial responsibility became the "watchword" for elected officials. "Productivity" was the name of the game, and those departments and functions that were "Non- Productive" came under closer and closer scrutiny.
Management experts came to government. Analysis of time and motion began to happen. Chief Executives began to examine what their employees actually did. Concurrent with this self-examination, came a television show called "Emergency". "Roy and Johnny" made Paramedics and emergency medical services a household word. People began to expect the same type of service that they saw being provided on T.V. and wanted it to be provided with the same tax dollars that they were already paying. The "dual-role" firefighter/paramedic was thrust in the public imagination. Soon....every firefighter was a paramedic and every paramedic was a firefighter...in the view of the public.
Several fire departments saw the advantage of this response model and "jumped on the band-wagon". Soon... there actually were firefighter/paramedics all over the country. Particularly in the Western part of the United States, the idea seemed to be accepted as "THE" way to go. However, in the Mid-Western and Eastern part of the country, this concept seemed to be often rejected in favor of maintaining the "status-quo" within the fire service.
As previously mentioned, many "old-line" departments clung to the concept that "all" they had to do was fight fires. Some completely refused to participate in EMS, and rejected additional emergency medical care training. They maintained that "what they were doing was enough" and they persuaded union and fraternal organizations to "bargain away" the ambulance work.
As the "efficiency experts" continued their inevitable "march" through the various city departments in search of unused or mismanaged tax dollars, they often missed emergency response agencies. The city Police and Fire departments avoided the inquisition for a long period of time, largely due to official and public perception of the danger and necessity of the jobs.
However, "all good things" eventually come to an end. The analysts soon began to investigate the seemingly "untouchable departments" (e.g. Fire & Police). Once there, it was often discovered that.....YES.....there was waste and mismanagement of resources within the "emergency" departments. All too frequently, statistical analysis showed that fire prevention efforts, sprinkler systems, and stricter fire codes had paid off. Fire departments were doing fewer and fewer fire suppression related responses. The ambulances did more responses and the fire trucks fewer.
Additional dissection showed that as fire suppression forces did less and less work, emergency medical service crews did more and more! This was particularly evident in departments that had abandoned EMS. In departments that had maintained EMS as a fire department activity, or as a division or bureau of the department; administrators and analysts found that EMS was comprising from 50-70% of the department's emergency work load.
Then, "push came to shove".....the budget "axe" fell and the various city managers and mayors were forced to take action. In the towns where EMS had been forced out of the fire service, employment "lay-offs" began to occur. The positions of retired firefighters weren't filled. Fire stations were being closed. And yet, the formulation of many "third service" or private ambulance organizations was even encouraged and supported by some fire service organizations.
In certain parts of the fire service, traditional attitudes and behaviors prevailed. In some towns, it was "cheaper" and "politically easier" to hire paramedics and form a new department than to try to convince the firefighters that EMS was their job. However, the budget to support this function, had to come from somewhere. Where would it come from?
Well, in several civic locations, the previously closed firehouses were turned over to the "fledgling" EMS departments. The monies saved from firefighter's salaries were quickly given to EMTs or Paramedics. The public recognition and perception of paramedics demanded that their services be provided. After all....statistics don't lie; Give the resources to the people doing the work, many Chief Executives reasoned.
Other fire departments soon found that additional duties were being "handed" to the EMTs or Paramedics. Soon, the young and aggressive EMS personnel had assumed extrication, dive rescue, hazardous materials, and other traditional ancillary duties of the fire department. In some cities, all the fire department did...was go to fires. And.. while this seemed to be the best possible alternative for some firefighters, it only aggravated the decline of those same departments.
Suddenly, at the end of the 1980's, and into the 1990's, various fire departments found themselves experiencing the results of their own folly. The preverbal saying; "Be careful what you ask for...you might get it...came true". Those departments that had resisted EMS and won the battle...lost the war. They were now fighting a desperate fight to maintain manning levels and to avoid the closing of additional fire stations. By the 1990's, EMS had come into it's own and those that had not embraced it were suffering from the purposeful "alienation of affection" between EMS and Fire.
The fire service can (collectively) be "down-sized" to meet the demand for solely, fire-suppression-related duties and suffer the inevitable lay-offs, cut-backs, and reductions-in- force or it can become productive and truely meet the needs of the mission for which it was originally intended.... the SAVING OF LIVES.
Few will disagree that the very most productive use of any firefighter's time is the saving of LIVES! However, some will cling to the notion that their real job is simply rescue and then to turn to the protection of property. They will continue to brag about that "nice stop" of a fire, or "how much smoke they ate" as they watch the injuried taken away by another agency. They will refuse to admit that their involvement should be more extensive, or that a life could have been saved....if.... they had known what to do.
The most heroic rescue will only prove as effective as the medical care that is then provided. Only through the prompt and proper provision of both... RESCUE & EMERGENCY MEDICAL CARE, will the citizen derive the greatest benefit. To suggest that these necessarily concurrent duties should be performed by different agencies is both an ineffective and costly use of valuable personnel and an unacceptable compromise of the public trust.
Therefore, it is the hypothesis of this author that the fire service must enthusiastically foster and support the inclusion of emergency medical care training and practice within it's ranks.......or the service as a whole....and the citizens we serve, will undoubtedly suffer the consequences.
(C) Copyright by Clark L. Staten, 1991
All rights reserved, except otherwise assigned.
Reprinted with prior permission from Firefighter's News
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