The fact is if you attempted to extract any one of these specialties from the rest something would be lost from the other. They build off each other and support one another. The firefighter throughout history always claimed to be a “jack of all trades” and it never claimed to be a “master” of any. The firefighter is not arrogant enough to think he or she could be a “master” at any one of the rescuer disciplines because he or she is smart enough to know that emergency management is fluid, always changing, and the firefighter is always in transition along with it. The firefighter does not attempt to be a “master” because he or she knows that no two fires are the same, no two heart attacks are the same, no two auto accidents are the same, and no two positive or negative outcomes of any kind are the same. The firefighter doesn’t know it but he or she is really only a master of their own perception of themselves because they realize their own individual limitations and rely on team members to problem solve. That is the true foundation of our business and why the tax payers always win with the firefighter acting as the paramedic acting as the rescue specialist acting in the best interest for their neighbor.

If you truly want to rob from the public go and tell them that they now have to fund an EMS department through tax dollars. Don’t think for a second that you wouldn’t still have to support a fire suppression service as well. Fires are down across the country in commercial structures due to better construction and fire protection features. But the fire service continues to fight aggressively in residential homes because we still find our highest causalities in one and two family dwellings. The fact that today there were no fire fatalities is not a point that can be argued. Tomorrow there may be one or an entire family or 3000 Americans. So until a sprinkler system is built into every newly constructed home or retrofitted into the existing ones across the country at the expense of the home buyer, I don’t think anyone is getting away from funding and properly staffing a fire department. Because no one wants to step outside and watch their neighbors home go up in flames. Or imagine yourself standing on the front lawn seeing one of your own loved ones trapped in the upstairs bedroom waiting for the down sized and under staffed fire trucks to arrive. And therein lays the greatest benefit to the taxpaying citizen that called for help. When they call for today’s crossed trained firefighter/paramedic they are truly getting the greatest bang for their buck. Firefighter/Paramedics respond in a constant state of readiness 24 hours a day, 365 days a year to small and large emergencies. It is of no matter if today the firefighter/paramedic responds to three fire related calls, 9 medical related calls, one auto accident, and one shooting during their 24 hour tour of duty. It is a matter that in every one of these cases the firefighter/paramedics are responding with the hidden potential that the very call they are going to may be exactly as it was describe upon dispatch, or something of a completely different nature. However, rest assured that the cross trained firefighter/paramedic does not care if the call is a fire, an auto accident, a heart attack, or a cut finger. He or she will mitigate and treat any situation found upon their arrival. That is what they are trained to do and that is what the public taxpaying citizen expects from them.

Furthermore, local firefighter unions, state firefighter associations, and the International Association of Firefighters are not out there in USA land making the argument that the fire service needs EMS to stay alive. They make the argument that the public receives far superior fire protection, medical care, and emergency response from rescuers that are supported by tax dollars. This is because the tax paid firefighter/paramedic knows where their paycheck comes from and is loyal to the citizens that make those funds available. Private services and hospital based EMS cannot offer that level of blanket loyalty to any community. In fact these two entities would not even be interested in offering pre-hospital medical treatment to the public if the potential to make money was not there. This is not a reflection that the people who work for private ambulance companies or hospital based EMS services are greedy. There are certainly people who are simply passionate about providing pre-hospital medical care and only want to perform to that level. Agencies that only offer medical care and transport do a great job but their limitation to the public is in their job description. And because private forms of EMS are not tax based driven, they halve to charge in order to operate their budget to cover overhead cost, pay wages and benefits to the employee, and simply make a profit. If private agencies could find the nest egg that would allow them to fund an Emergency Medical Service along with related emergency response mitigation they would be selling themselves as a multipurpose agency for hire.

The charge has been that the fire service uses EMS as job justification. This suggests that fire departments have shifted their responsibilities to overcome a deficit. Not true what so ever. Public demand shifted because we are growing in human numbers and the fire service was already in place to answer the call. A true crime would have been to overlook that fact and attempt to build a completely new infrastructure that only addresses one public need. In many cases it is a city by city model that depicted where EMS responsibilities would be placed. Some very large cities, such as Boston and New York City (which in 1996 shifted EMS under FDNY making it the largest Fire-based EMS department in the country), started out by building two separate infrastructures; one that supported fire suppression and one that supported medical treatment. But in most cases the fire department was already in place and it made sense to use this group to meet the needs of the public. Is there room for improvement? Of course there is, but it is by no means broken.

If you truly want to address what is broken then look no further than the 911 system in this country. As a whole society we have become dependent on calling 911 for anything and everything. In the past, calling 911 truly meant your home was on fire, you were hurt in an auto accident, or you were having a heart attack. Today 911 is dialed if we can’t figure out how to relight the pilot on our furnaces or we lock ourselves out of our car. All while at the same time the 911 operators are answering the same serious “life or limb” type calls. Because there is no other system in place to answer the non-emergency calls, they fall to the fire service in many cases. The reason for this is because public trust has already been built between the people and their fire department. In the minds of many are saying as they dial 911, “the fire department has never let me down before and I’ll bet they won’t this time either”. If you truly want to fix something try developing a non-emergency agency that answers “no distress” calls and free up the Fire-based EMS departments to do what they do best, which is manage emergencies.

Because we live in a post 9/11 world and have all seen the true nature of what an emergency looks like, the public has demanded that we as First Responders become more versatile and adaptive to respond to anything thrown our way. It just happened to be the Firefighter that picked up this call to duty from the public. It is the public masses that demanded a better response to man-made and natural disasters after events such as 9/11 and “Katrina”. And because publicly funded Fire-based EMS departments are transparent to the taxpayers and by nature a “not for profit” organization, it allows the public to trust that the Fire-based EMS department will do the job well.

I don’t attempt to take anything away from someone who wants to dedicate themselves to a medical specialty. Just don’t suggest that this type of person can outperform a crossed trained firefighter/paramedic. That’s not really even the argument at all. No one is outperforming the other. It’s simply a fact that the crossed trained firefighter/paramedic can truly go into so many different environments where so many others can’t go. However, to suggest to the public that they would be better served by one specially trained “medically orientated” department is placing far too much confidence in that type of system. It would be impossible for a signal disciplined response group to know what to do in every situation requiring medical care. Because it is a fact and often very real that caring for patients is intertwined with some other emergency it makes perfect sense to train rescuers in the art of Basic and Advanced Emergency Medicine. If the idea is that the public would be better served by a stand-alone EMS service and a stand-alone fire department because of the specialized training involved then it only stands to reason that all types of emergencies should be separated and handled only by individuals and agencies specialized in a particular discipline. This model would appear as a metropolitan area being protected by a Fire Department, EMS Department, Police Department, Water Rescue Department, and Technical Rescue Department. But wait! The technical rescue arena is wide ranged involving Confined Space Rescue, Structural Collapse Rescue, Trench Collapse Rescue, Rope Rescue, and Vehicle/Machinery Extrication. Should there be a department for each of these specialties as well? Please realize that within each type of discipline listed we are talking about people (patients) who are all too often trapped and seriously injured requiring immediate medical care to sustain their life while the extraction from the incident is lengthy and on-going.

To broaden the picture further the Police Departments across this country are cross training themselves as we speak. Because of our heightened awareness to terrorism they are becoming more diverse in man-made attacks involving everything from active shooters on campuses to man-made devices that destroy buildings or even blocks of cities. Should police departments be cross training themselves? They too spend the majority of their time responding to lesser violations but they are always prepared for the worst as well. If you agree with the vision of a total EMS department or an EMS driven fire department then you should be wagging your finger at the SWAT teams that are training their police officers in Tactical SWAT Medicine. That is the epitome of crossed trained personnel performing high risk tactics while delivering advanced medical care to not only patients but to their partners under fire! Bravo to them for stepping up to these challenges! Time and time again fire departments and police departments are proving that they are modular and can grow to support multiple tasks that in the end serve the public well. Both groups respond to the public when called and realize that in many cases there is a patient submerged in a realm of chaos.

Certain individuals show their lack of experience when they suggest that Advanced Life Support care is rarely initiated in the “hot” danger zones. True, two firefighters dragging a victim out of a burning house do not stop midway and begin ALS care on the victim. They turn them over to firefighter/paramedics on the scene who start that type of care within seconds (by the way, while those two paramedics awaited the victim they helped to throw a ladder to the second floor window, flake out the hose in the front yard, and helped the engine hook to the hydrant because they were cross-trained in these tactics which helps to save time). This is the only scenario that I can think of where the conditions around are changing too rapidly for that type of care to begin in that type of environment. However, there are countless cases of firefighters trained as rescuers who are trained as paramedics administering ALS care to victims who are trapped in adverse conditions. This type of crossed trained firefighter/paramedic offers the best chance of survival to the victim because this rescuer has a three pronged approach to all emergency situations. First, as a recruit firefighter it is instilled that any environment can rapidly change and it is our heightened awareness to the risks that can save us and our victims. This is continually beaten into the firefighter over his or her career by the firefighters that have gone before them. Second, teamwork is what gets the job done. Having a Fire-Based EMS Department with crossed trained personnel means that everyone is working off the same game plan. Third, we will risk a lot to save a lot, and risk nothing to save nothing. If that means that a rescuer is going to enter into a trench, a confined space, a crumpled automobile, or a collapsed building and there is a viable victim trapped for hours, that rescuer will stay with that victim giving them as much basic and advance care possible for the duration of the incident. Neither private services nor Hospital based EMS can contend with that reality.

Overall the point is this. Obviously there is no metropolitan area that could support endless departments of emergency response groups from the city budget. The real reason that it makes good sense for EMS to fall under the Fire Department of any city is that it does save the tax payer money and uses tax funds in the most efficient manner. It is true that both fire trucks and ambulances are expensive pieces of equipment but necessary none the less. The crossed trained firefighter/paramedic cannot be blamed for the cost incurred of purchasing apparatus. But when a crossed trained responder rides out on the fire trucks or the ambulance they are ready to respond to anything saving taxpayer’s money. Let us try to focus on reducing the number of calls that every response unit must go out on by educating the public as to what a fire truck and an ambulance is really intended to be used for. Only then would we reduce fuel costs, reduce the wear and tear on our units, reduce the frequency of needing to replace apparatus, and overall reduce the health and safety risk to all first responders.

Across the country fire stations are situated in areas to deliver quick response. Apparatus is on hand and most importantly the servants of the community are already on-duty and ready to answer the call. The fire department represents dependability to the public and an overall attitude that “no problem is too large or too small.” The fire service is to be commended for stepping up and not only meeting the challenge of EMS delivery but doing it in a way so that other services offered do not suffer. Because of its personnel on-hand and the infrastructure in place, this makes the fire department modular, meaning that it can respond in a small way (one engine, one ambulance) to individual emergencies or respond in force when demand calls for it. People cannot always describe what has happened, but they always know when something is wrong. And when they call 911 they can be assured that when a Fire-based EMS department arrives that they will be able to ascertain and mitigate the emergency while administering basic and advanced medical care within that “first” hour without hesitation.

The argument against changing any fire department’s name to something in the realm of the “Rockford EMS / Fire-Rescue Department is a selfish one on the part of the person who doesn’t even perform the duties described above. The fire service is not attempting to hide from the public that it responds to more medical related calls then it does fire calls. Thank god that is the case because could you imagine the widespread panic if homes were bursting into flames every hour of each day. The fact that the funding of a fire department goes heavily towards fire suppression and other emergency responses is because we all have learned early on that you don’t bring a knife to a gun fight. The fire service operates off of the premise that it must be prepared that the odds will go against them at some point. These were the cases in Charleston, South Carolina in 2007 when nine firefighters were killed in a furniture store fire, in Worchester, Massachusetts in 1999 where six firefighters died in a warehouse fire, and was certainly the case when 343 firefighters died in the World Trade Centers in 2001. In each of these cases there were reports of people trapped inside, so they didn’t die for the cost of the building. The members that enter into burning structures to remove a trapped victim, cut someone out of a crashed vehicle, dig a person out of a collapsed trench, or perform CPR on a living room floor are the ones who should be allowed to call themselves what best suits them. Yes, the statistics don’t lie. Roughly 80% of all fire department responses are medical in nature. And this is what the Rockford tax payer gets based on that statistic… between my partner and me we hold sixteen years experience between us of serving on the ambulance as paramedics for the city. We hold twenty years experience between us as firefighters for the city. We have been put through the best training that can be found. We have treated thousands of patients in their homes, advanced hundreds of lengths of hose towards fires, extricated many out of vehicle wreckage, and fell into the game plan with our fellow cross trained co-workers in large disasters. This diversified experience is available to every citizen in this area that calls for help. That is the experience we as firefighter/paramedics present to the public every time we step off the fire truck no matter what the call is for.

It has become the cross trained firefighter/paramedic that wears many hats. Not because they are made too or because any union told them too, but because the public asked them too! And they are the experts in managing emergencies in the streets, in the factories, in the trenches, in the burning or fallen buildings, and in your living room.

Here’s some more things to compare and contrast:

http://nasemso.org/documents/FINALEMSSept2006_PMS314.pdf

- This is the National Scope of Practice model for EMS as released in 9/06 by a number of stakeholders in EMS with heavy involvement from the fire service (look at the credits). It’s 26 pages of information, but the charts in the latter part of the document are the most interesting. It’s a great read for everyone who is interested in where EMS is going and is a publicly available document.

http://www.jems.com/news_and_articles/columns/Bledsoe/Bledsoes_EMS_Scope_of_Practice_Model.html

- This is the “Bledsoe Scope of Practice” model written by Dr. Bryan Bledsoe, a well-known, well-written Emergency Physician who advocates nationally for EMS. He has stirred up a lot of controversy with his recent series of articles in EMS magazine entitled “Making Hamburger out of Sacred Cows”. It shows his disagreement with the above “National Scope of Practice” model and offers an alternative viewpoint.

http://www.emsresponder.com/print/Emergency–Medical-Services/Making-Hamburger-of-Sacred-Cows–/1$2506

- This is an interview that Dr. Bledsoe had on the series of articles. There is a section stating his disagreements with both the “Public Utility Model” of EMS (Where a jurisdiction grants franchise rights to a private service for exclusive EMS service, like a cable company) and the Urban Fire Based model of EMS.

http://www.emsresponder.com/print/Emergency–Medical-Services/EMS-Mythology/1$2023

- This is his popular series on “EMS Mythology”

As you can see, I like Dr. Bledsoe’s writings, but there are other resources out there. The best research available for EMS can be found by taking the time to do your homework. EMS is something we all should strive to improve every way we can.

May I ask you all where you think we should be heading?

In the beginning, I asked, where is the professionalism? While reading through this blog I was truly sickened by the lack of brotherhood portrayed through the writings. If you read through it entirely you will notice that both Chris and GSW had a very good debate going on. Maybe one that needs to be had in your area. They are two of the three people who posted valuable, interesting contributions regarding the issue. I don’t believe Chris posted anything personally offending towards anyone as stated in his previous postings, he merely used his local Metro fire/based Service as an example. If you would look behind the bickering you may notice that he is speaking about the system and the lack of experience some people have not specific personnel. GSW offered some very good information too but it seems he took it personally, which led others to misinterpret the material and caused the anger of those who posted the other comments. As far as I am concerned, not that my opinion really matters, this debate is a well known, nationalized, public debate and both Chris and GSW have every right to speak on it without anyone discrediting their Professionalism and Love for what they do. It seems that Chris had some great ideas and a wide array of EMS experience, maybe instead of his colleagues teaming up, beating him up and supporting closed mindedness. They could help him pull the knife out of his back that they so deeply penetrated and listen. It is unfortunate that so many of you offered to give names and throw a fellow paramedic under the bus because his opinion differs from yours. For those of you who so readily came forward with his personal information, you didn’t offer anything of value to the discussion, nor did you state your opinions on the topic. That is not only unprofessional, but childish. Tattling is not going to help anyone get anywhere. On that note, my suggestion is this, let’s all get to know and understand the debate for it is important. That knowledge can help us all bring the EMS system to the advanced level it needs to be for our community, whether we are for Fire-based EMS or not. Improvement is necessary for top-level care. (not that we don’t offer a high level of care but we can learn more and provide at higher levels). Like Mike said, it’s not what is right for us; it’s what is right for the community.

Further, there was a USAToday series back in 2005 that debunked the myth that ALS engines were a good thing. They aren’t a good thing and can prove to be a detriment to the people they’re trying to serve. This just furthers the question of why fire is so demanding on running EMS.

I don’t think you’ll see anyone arguing to make FDs obsolete. (I’d go so far as to argue that in many areas FDs are making themselves obsolete through code development and enforcement, effective prevention programs and effective public outreach. That’s another discussion for another day.) However, the public safety function of the FD does not mesh with the public health function of EMS. They are two completely different mind sets and require a different approach to different problems. As such, the role of EMS as a function of the FD should be made obsolete as they are two different jobs with little in common aside from occasionally working on the same scene together.

I also don’t think you’ll see many people out there argue that there aren’t some good prehospital providers employed by FDs. What I do think you’ll see is ineffective and general mismanagement for a variety of reasons, some good some bad, by FDs with regards to their EMS programs. Unit deployment as discussed above is a big one.

This isn’t about us. This isn’t about medics and FFs. This isn’t about us versus them. This is about the public we’re supposed to be serving. It’s about the patients we’re supposed to be treating. The best services out there are not fire based and provide for their communities far better than any fire based service can. Model yourself on what the most successful programs do and you can’t fail. Insist on the status quo and the only people who lose are members of your community.

Last time i checked, doing things to better your service didnt include bitching either, come up with some new material, make some constructive suggestions and people may listen.

Dani has a point, blogging wont change anything, leading by example will, setting a high standard will, and acting with integrrity will. This will not only help people listen to you, but will also achieve your goal of improving your service.