BY MICHAEL J. BARAKEY
What are the benefits of running emergency medical service (EMS) calls off the engine or ladder company? The U.S. Fire Administration’s National Fire Incident Reporting System (NFIRS) topical run profile demonstrates that fewer than 10 percent of runs made by fire departments involve fire. More than half (55 percent) of the incidents to which fire departments respond are categorized as EMS or rescue.1 Many times, firefighters do not value EMS calls; they lack the adrenaline-producing results, which most firefighters enjoy experiencing, of the fire or nonmedical emergency response.
EMS incidents are routine, bread and butter. They are predictable; are often scripted; and, for the most part, are uneventful. The challenge for the company officer and the members of the fire company is to take the opportunity to refocus their thoughts and identify the advantages of responding to and providing EMS services off the fire apparatus—what can the fire service gain from these incidents? Take the time to use these responses as a tool to market, train, and grow as a company while providing the citizens with a quality service.
Don’t overlook that responding fire apparatus on EMS incidents provide a beneficial and valued service to the community. Many departments provide advanced life support (ALS) off the engine company; this first response is necessary to provide time-sensitive basic life support (BLS) and ALS to the community. Although the primary focus of the EMS response is to care for the injured and sick, take the time to maximize your time away from the firehouse. Use the incident, from the time of alarm to the time you return to the station, to learn, see, and train.
Use EMS calls to develop new apparatus drivers. Give new operators the opportunity to drive and learn how to operate during emergency conditions. Develop their skills during rush hour and in wet and dark conditions. If young firefighters are not operating the vehicle yet, take the time to show them why you approached the scene the way you did, why you parked where you did, and what considerations you took to place the truck for that incident. Every incident allows the operator to learn how the truck will behave during emergency conditions, in tight spaces, and with limited access.
Spot hydrants after the call has been completed, and run scenarios with the crew to simulate fires in various structures that are on the scene. Back up the apparatus as if you were going to lay out from the attack engine. There is no better way to develop an operator’s confidence in backing up large apparatus than to have him practice doing it in the field. Develop your crew and their confidence prior to a building fire.
Apparatus Placement and Parking
Each medical-related incident will have at least a medic responding with the fire apparatus. Simulate leaving room for the aerial when spotting the building. Have the operator park as if the building were burning, and critique the placement after you clear the incident. Have the driver discuss hydrant locations and distances from the hydrant to the incident scene. Discuss forward and reverse lays. Pull the map page or complex map to see if all the hydrants are properly marked and located.
Handline Selection, Placement, and the Roof
If you are stretching handlines, what obstacles are present? When walking to the door or area, discuss the distance and whether your department’s preconnected handlines would reach the room or area of the medical emergency. Once the incident has been completed, talk hoseline size and line placement. Look at the fire load and live and dead loads. Can you see the roofline? Are there large heating, ventilation, or air-conditioning units on the roof? Can you access the roof from the interior of the building? Can ground or aerial ladders reach?
Arguably, the most beneficial reward of responding to EMS calls is learning your district or run area. If the company waits for a fire-related response into a subdivision, apartment complex, or business district, you may not respond to that area for a while. Use the EMS response to preplan for a fire: Look at hydrant locations, fire department connections, utility and electrical cabinets, stairwell locations, and access points for apparatus. After you clear, walk the building and ask questions of the employees or staff.
Pre- and Post-Planning Buildings and Districts
During a response to single-family residence, take the time to learn the layout of the home. Where are the bedrooms? Are the stairs to the left or right of the front door? How many people are living or staying in the residence? Are bars or burglar security devices on the windows or doors? While you are inside, check the smoke detectors, and look for the attic access and unique features of the building. Walk around the exterior of the home. Look for hydrants and access to the structure for the first-arriving units. Identify trilevel homes and homes with a basement. Identify concerns that may be present in case you have to return for a fire.
For responses to multifamily and apartment complexes, look at the location’s utilities, power lines, and service drops. Check access to the building. Locate the fire walls; indicate how fire travel will be accelerated or delayed based on the construction of the building. Are exits or fire lanes blocked? Is the standpipe or sprinkler system accessible? Is it full of trash or debris? How many sides can the aerial ladders reach based on parking and curbs?
Update key holder information and responsible party contacts when at commercial buildings or apartment complexes. Ask for responsible party and key holder information and phone numbers. If the EMS incident is at a major target hazard, pull the prefire plan at the completion of the incident. Send updated information to the Emergency Communications Center or fire administration as well as updated key holder and responsible party information. This builds relationships with the building managers and security department.
The fire service is an all-hazards response and mitigation service. EMS is part of today’s fire service; therefore, the community should be informed on each incident that its firefighters are skilled in providing critical EMS skills that save lives. Let the citizens know that their firefighters are active and don’t sit around waiting for the next fire or alarm activation. Once in the home or business, and the EMS incident has been turned over to the ambulance, the remaining firefighters on the scene can shift gears and offer educational information regarding the services the fire department offers. Offer to check citizens’ smoke detectors, educate them on the importance of carbon monoxide detectors, and replace detector batteries or remind the citizens to change them. Offer to perform an in-home fire safety inspection, including the use of electrical cords and the storage of chemicals and items in the garage or shed. Teach elderly residents tips for cooking safely. These teaching points may not be appropriate to cover immediately after a medical incident, but make the contact and offer to return at a later date to perform these inspections.
The interaction between the first-arriving fire apparatus and the ambulance crew is important to public relations. Whether your department uses a third-party service or provides EMS services itself, maintain a professional attitude and demeanor during patient contact and turnover. The entire EMS scene is being watched not only by the patient’s family members but also by neighbors and other interested parties who migrate toward the scene. Most cell phones have cameras, and the citizens are evaluating your performance. Remember to always employ the Golden Rule toward the patient, the citizens, and the ambulance crews.
Following up with a family or patient is excellent for public relations. Instead of checking up on your next visit to the hospital to pick up your medic or returning to the home or business on your next cycle, take the opportunity to show that you care and are interested in the citizens that you protect. These relationships will pay dividends at your next fund-raiser, council workshop, or budget hearing. A survey or response letter sent directly to the patient is a tool your department could use to continue the education and relationship built at the emergency scene. Ask for feedback regarding the fire department’s response. This information can help you gauge customers’ satisfaction and the quality of service provided. This feedback is needed to demonstrate how first-response EMS off the fire apparatus is a critical link of assessment, vitals, initial BLS and ALS interventions, and turnover to the ambulance crew for transport.
Any response is an opportunity to market the fire service and your department. EMS calls place our apparatus and firefighters in the community. In many cases, the firefighters remain on scene once the medic leaves for the hospital. Take that time to communicate, answer questions, and let the citizens know that the fire department is committed to the community.
1. The Fire Department Overall Run Profile. Federal Emergency Management Agency/U.S. Fire Administration National Data Center. Vol. 7(4), Dec. 2007. www.usfa.dhs.gov/statistics/reports/index.shtm/.
Checklist: Fire Apparatus to EMS Incidents
Responding and Size-Up
- Discuss primary and secondary routes of travel.
- Identify and view primary and secondary hydrants.
- Note the size and type of the building.
- Are there unique building construction features?
- Are there fire department systems or connections?
- Provide three sides of the building to the officer.
- Leave room for incoming units.
- What length of hose is needed to reach the room or area of the medical incident?
- What are the locations of the stairs, elevators, and entry and egress doors/windows?
- Where is the alarm panel located?
While Approaching the Patient or Area
- Size up the scene to include the safety of firefighters.
- Note fire loads in the structure, hoarding, and other concerns.
- Are exits blocked or obstructed?
- Are standpipes accessible?
- Is the area to the patient clear and unobstructed?
- Is the hoseline deployed, and does it reach the patient’s room/area?
- Are burglar or security bars present?
After the Medical Incident Is Completed
- Are smoke detectors present and working?
- Do standpipe caps turn easily, and are they free of debris?
- Are site maps up to date?
- Is the responsible party information up to date?
- Are the locations of hydrants and firedepartment systems accurate?
- Review and discuss access limitations: vehicles, curbs, traffic flow, and so forth.
- Identify fire walls.
- Market the department.
● MICHAEL J. BARAKEY is a battalion chief with the Virginia Beach (VA) Fire Department, where he is assigned to operations. Previously, he was chief of training. Barakey is a graduate of the National Fire Academy’s Executive Fire Officer Program. He is a hazmat specialist, an instructor III, a nationally registered paramedic, and a neonatal/pediatric critical care paramedic for the Children’s Hospital of the King’s Daughters in Norfolk, Virginia. Barakey is a plans team manager for the VA-TF2 US&R team and has a master of public administration degree from Old Dominion University in Norfolk, Virginia. He is a classroom instructor at FDIC.