The Fire Service Was Supposed To Take Over EMS

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I’ve never met Michael Morse, but his blog Rescuing Providence is must read for anyone in EMS. He worked for many years as an EMT and Firefighter in an agency that is not known as being all that good at EMS. That is not a reflection on Michael, his co workers, or their dedication to EMS. It says more about the approach to EMS that the state and his department take. In other words, he’s a guy that did the right thing for patients in a system that didn’t make that easy.
About a week ago, he wrote a very short post about medics who work for fire departments, but don’t much like fire fighting. Medics fighting fire? It shouldn’t take more than a minute to read this, so go ahead.
>Now that you’ve done that, I’ll delve into a bit of ancient history. Back in 1989 or so, the late James O. Page wrote an article in JEMS in which he predicted that the future of EMS was in the fire service. A good number of fire departments, big and small, at the urging of the International Association of Fire Fighters, started to take on EMS.
Keep in mind that the goal was not to improve patient care, reduce response times, or even to save taxpayers money. Those were the stories told to the public and gullible politicians, but the real reason was jobs. The people who ran the fire service could see that smoke detectors, better building codes, and other improvements had reduced the number of fires and more importantly the number of fatal fires. City managers, mayors, and other politicians were starting to wonder why they had expensive fire apparatus and for the most part well paid firefighters sitting around all day doing nothing. There was talk of layoffs, budget cuts, and closing fire stations.

To counter this, the fire service leadership came up with the idea of getting involved in EMS. Many rank and file firefighters hated the idea as it cut into their down time, but they bit the bullet and started going to medical or “inhalator” calls as they were called.
In St. Louis, Louisville, Los Angeles, San Francisco, El Paso, and New York City, to name a few, the independent EMS services were merged with the fire department. It was not a happy marriage on either side in most cases. EMS was consistently considered a second class service. In a few systems, the EMS personnel were cross trained as fire fighters. In a couple some firefighters (mostly with low seniority) went to paramedic school. I won’t bore you with the various configurations, but suffice it to say that very few of them worked well.
Then something that not many people had foreseen started to happen. The old guard of both services started to retire. The new hires were expected from day one to perform EMS duties. Departments started to require new hires to be EMTs or paramedics. Paramedics who had never before shown an interest in the fire service were now being recruited. In areas without artificial age limits, long time EMS providers were suddenly being hired as fire fighters. They went through the fire academy, they worked on ambulances AND fire apparatus, they became part of the fire service.
Still, some of them saw themselves are paramedics first and firefighters second.
One reason was the much superior schedule most fire departments (at least in my area) have. There are a number of advantages to the 24 hours schedules that many fire departments work. School, outside work, family events, to name a few. I worked with a few medics who had 20+ years with my agency who left to take lower paying jobs with fire departments for the schedule alone.
Money. If you work for a private ambulance service, it’s very unlikely that going to the fire service is going to reduce your pay. Not to mention benefits like sick time, vacation, incentive pay.
The work load is generally much lighter. Not always, and in some cases (Michael’s former department comes to mind), they are busier than anyone should be.
Some of the new hires might actually want to fight the occasional fire as well, but many of them probably aren’t all that eager for that part of the job.
Which brings me at long last back to Michael’s post and my conclusion.

More than the fire service has changed EMS, EMS has changed the fire service. That’s not true in most big cities, but it’s true in a lot of smaller cities and in some towns where the departments would be half the size if not for EMS calls.
I don’t think that the people who propelled the fire service into EMS foresaw the changes that EMS would bring to the fire service.

One of those is that in many of the departments I work with, it’s the paramedics who are advancing to supervisory and command positions. I think this is becoming more common and at some point in the foreseeable future, being a paramedic is going to be a prerequisite to promotion.

It’s a much different EMS and fire service than either Michael or I saw 20 years back.

It remains to be seen if it’s a future that is better for our patients.

2 COMMENTS

  1. Thank you for the nice words, always appreciated, must admit I am pleasantly surprised that you still read my ramblings! It is difficult to stay relevant in EMS having left it, as much as things change the patients stay the same, and that is what it is all about.

    • It is hard to stay current not actually working on a truck. I still work with a lot of active medics reviewing calls. Which requires me to follow the trends in EMS. As a result, I spend a lot of time in classrooms, either taking or teaching classes. I see a lot of the new breed of paramedic/fire fighters. It’s about 50-50, between the guys who really wanted to be fire fighters and became medics as a means towards that end, and the other way around. Oddly enough, I don’t see much, if any, difference in quality of care.

      The dinosaurs of both EMS and the fire service are retiring so the change will continue. More and more fire departments, especially in smaller cities and towns, are becoming “EMS services that occasionally put out fires.”

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