The American fire service certainly is used to conflict, and one hotly debated issue is whether the fire service should provide emergency medical services (EMS) to the citizens it serves. This conflict arises between nonfire service and fire service agencies and within the fire service itself. Unfortunately. the fire service may fail to see that it is potentially “shooting itself in the foot” with such internal bickering, as EMS could mean everything to the fire service.

On a national level, there is no question that the fire service is a primary provider of EMS across the country Some national organizations question whether EMS belongs in the fire service, but few question its prevalence there today. Most professional and trade organizations agree that any national effort or voice on EMS issues must include the fire service, as it is a powerful force when it comes to political influence at any level of government. but not all groups are happy about this.

The few “turf battles” that still exist throughout the emergency service community are actually questioning whether EMS is a public safety or a public health function. When you take the ownership and emotion away from the argument, it becomes obvious that EMS is a public safety entity charged with delivering public health services. The “emergency” aspect of EMS makes it public safety; the “medical” aspect makes it public health. The two aspects of EMS cannot be separated, and neither one plays a more dominant role than the other. Successful fire service EMS systems depend on a positive relationship linking the public safety and public health aspects of EMS as well as quality within both aspects. Successful nonfire service EMS depends on the same thing.


It is hard to understand why some local fire departments don’t want to provide this essential public safety/ public health service. One department in the Northeast even opted to wash city vehicles rather than begin providing EMS! Such departments don’t know the opportunities they are missing; they also don’t realize that they are slapping today’s fire service in the face.

In addition to providing patient care to the citizens, EMS can benefit the fire department and the community in many ways. Community support of the fire department can lead to support from elected officials, which can lead to increased resources for the department. This in itself is important, since resources are dwindling in many communities, especially for the fire department that does not provide EMS. These increased resources can lead to increased services for a community if they are used correctly. Thus, fire service EMS at any level can become a win-win situation for every -one involved.

Mow does EMS make this work? For one thing, EMS is visible. Typically, 60 to 80 percent of all emergency responses by fire departments that provide EMS are for medical emergencies. In these cases, citizens see the fire department in action three or four times more often. This “action” they witness is, by nature, positive—EMS is helping people — and it can be personified for those who see it. Thus, the fire department is viewed more as a customer service department (as it should be) rather than as a crisis management department (as it traditionally has been).

At least one recent study, conducted in New Jersey, shows that fire departments that deliver EMS increase their utilization and productivity in their communities, thus becoming more cost efficient for the consumer/taxpayer. If a fire department promotes this efficiency properly, citizens respond with support. These citizens are the same ones who elect local government officials. VC hat candidate or potential candidate won’t stand behind an important, visible, cost-effective public service that the citizens support so much?

On the other hand, however, any fire department (or fire service organization) that advocates EMS solely because it will increase its budget, staff, or job security has missed the boat. These benefits certainly can come with providing EMS, but using these points as a main argument for providing EMS is very shortsighted. Any department using them as their EMS goals won t win any battles (or friends) and probably won’t be providing EMS for very long. In fact, part of the reason some of the national nonfire service EMS organizations question whether EMS belongs in the fire service is because they keep hearing the argument about how EMS will benefit fire service jobs and budgets, with no mention of patient care.

If there is one lesson the fire service in general still needs to learn, it is that the main goal of EMS is and always will be to provide quality patient care. Any fire department that provides EMS without this as the main goal should think about either changing its goal or getting out of the EMS business. The same can be said of private ambulance services that use profit as the main EMS goal. It doesn’t matter what the patch on the uniform says; EMS is EMS—it still boils down to quality patient care.

Similarly, it really doesn’t matter what agency is charged with providing EMS (or any part thereof); hi is is a local decision. However, if the fire department can provide better patient care, or if it can improve the level or quality of care being provided (such as by implementing a first responder program to reduce response times), it should do so. The department should make it known that it is doing so for the customers, and it should work as part of the EMS system, stressing teamwork with other players (such as other agencies, hospitals, etc.). The fire department must show that it is that critical link between the public safety and public health aspects of EMS—all in the name of patient care.

Fire departments can be involved in providing EMS in many different ways. In many jurisdictions, the fire department is the sole EMS agency, providing both first response and transport services (emergency and nonemergency). Another common, very successful type of EMS system uses fire department first response (with firefighters trained as EMTs or paramedics, responding on engines) and ambulances (with EMTs or paramedics) I from a private EMS provider. As long as both agencies work as a team and have patient care as the top priority, this becomes a win-win situation — especially for the patient (the customer).


So why is there still a question of what EMS means to the fire service? Perhaps because some fire chiefs still feel that the job of the fire service is to “put the wet stuff on the red stuff,” and that it is someone else’s responsibility to provide patient care. (Because of this attitude, fire departments in more than one city now are relegated to doing just that —nothing more.) Or perhaps it is because the firefighters themselves feel that providing patient care is “too dangerous” because of today’s violent society and the threat of infectious disease exposure (again, a truism from the point of view of a major fire department in the Northeast). Or maybe it is because some fire chiefs and firefighters know all they need to know about firefighting but don’t really understand EMS; they simply don’t want to delve into something they don’t understand. Whatever the reason, it often doesn’t reflect the needs of the department or the community’, only the wants of those who are making the decisions. But if a department isn’t willing to make patient care a top priority, perhaps not providing EMS is the best decision that department can make.

When a fire department does provide EMS, there is often a problem of the priority of EMS within the department. Even if the street-level EMS providers in the department look at patient care as the priority, they face a stressful, uphill battle if management looks at EMS as either an inconvenience or a budgetary bonus. Many departments don’t recognize the benefits that EMS can provide for them and their communities if it is a priority in the department. Ignorance and apathy about EMS by fire department management has cost many career and volunteer fire departments the opportunity’ to provide EMS and thus the benefits it can bring.

The fact that many departments aren’t looking at EMS/patient care/ customer service as their primary mission is tarnishing the image of these departments within their own communities, lowering the effectiveness of the services they provide, and minimizing the positive political power that EMS can provide. This results in a losing proposition for the department and the community. It also perpetuates the fire service stereotype “200 years of tradition, unimpeded by progress.” That is not something the fire service should be proud of— locally or nationally.

With decreasing budgets and a declining workload for fire departments that don’t provide EMS, job security is in question. Some departments are “going out of business”; other departments are being privatized or scaled back to the point where they resemble fire brigades rather than fire departments.

Fire departments that do provide EMS, on the other hand, find that they are actually “EMS departments that respond on a fire call once in a while,” according to Chief Alan Brunacini of the Phoenix (AZ) Fire Department. More and more departments are changing their names to “fire and EMS department,” “EMS and fire department,” “fire and paramedic services,” or “emergency services.” These departments and others are leaving tradition and turf protection behind and providing the “protection of life and property,” as today’s “fire” department should.

With this in mind, I ask again: What does EMS mean to the fire service? It should be clear that it means everything. Because if a fire department isn’t going to provide adequate, quality EMS, someone else is. That “someone,” someday, just might have the resources and support to offer a more efficient, effective way to provide productive fire services to a community. And if that catches on ….

The views expressed in this column are strictly those of the author and do not necessarily reflect those of the US. Fire Administration or the Fairfield Community Fire Company.

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