Fire-Based EMS

By Michael Morse

Prior to entering the fire service, I never gave much thought as to who showed up at emergency scenes. People showed up, did their jobs admirably, and moved on. I did not realize that there are vastly different ways to provide emergency services. We have full-time paid fire departments, volunteer fire departments, fire departments that use an on-call system where responders are paid for calls they respond to, private ambulance companies, taxpayer funded ambulance services, and combinations of the above.

Ask the average person on the street where help comes from during an emergency and he will tell you the Fire Department. That is all he needs to know and, more importantly, all he wants to know. Outside of our little world of responders exists an active, productive, at times heroic populace that depends on us to show up and is not at all interested in our structure.

In my opinion, a fire department-based EMS system is the most effective way to deliver quality patient care to the community. When the people assigned to those fire companies are trained and motivated, which they are in my town of Providence, Rhode Island, nothing beats it. But that is my opinion, based on my experience.

I have learned that outside my little bubble, things sometimes are not so rosy between firefighters and EMTs, and that is a shame.  Battles between the two distinctly different agencies, often under the umbrella of one organization, mostly the fire department, exist. 

It just makes no sense to me when people whose primary function is public safety cannot work together. It speaks poorly of both our vocations when ego gets in the way of delivery of services. I’ve heard some pretty disturbing stories about firefighters offering the bare minimum help at EMS scenes and EMS crews reticent to enlist the help of their local fire department to the detriment of patient care.

This week’s examples of how it could be:

  • A diabetic, unconscious in Mount Pleasant. All Providence rescues out; Engine 15 arrives three minutes after initial call. Rescue 1 clears Rhode Island hospital, ETA 11 minutes. We arrive, patient is alert and conscious, BG 145 from a 22, IV established, D-50 administered, wondering what all the fuss is about.
  • Overdose in the West End. Rescue 1 is fifth due, ETA eight minutes. Engine 8 arrives on scene in two. 2.0 mg narcan adm. IM, the patient who was seconds from death prior to their arrival now alert and conscious, denying drug use.
  • Seizure in Washington Park. Seventeen-year-old kid, first seizure. Family going berserk. Firefighter from E-13 speaks fluent Spanish, calms the scene; two firefighters lift the 200-pound kid from his bed, postictal at the time, secure him to stair chair while the patient gets combative, figure a way to get him out of the bedroom and down the stairs while the rescue officer gets pertinent information from family. Once in rescue, IV established, meds administered, vitals assessed, and a report radioed to the ER. Impossible to do with two hands; six worked just fine, thank you.
  • Two intoxicated males, on the street in South Providence. On arrival, Rescue 1 is attacked by intoxicated males. Police called. Engine company dispatched. Two minutes later, Engine 10 arrives on scene, order is restored, the intoxicated males subdued and restrained in the back of the rescue with assistance from firefighters. Police arrive on scene as we depart, engine company following.
  • Chest pain in the North End, Rescue 1 ETA 12 minutes. Engine 2 on scene in three. Nitro, aspirin, and oxygen delivered in four, vitals and an IV to boot. Rescue 1 arrives on scene, the engine crew carries the elderly gent down two flights of stairs and into the rescue. I do the paperwork and say thanks.
  • MVA on Rt. 95. Engine 11 arrives on scene five minutes prior to Rescue 1 and seven minutes prior to police. We arrive, the lights and presence of the engine providing some safety from passing motorists, bleeding from vehicle occupant controlled, c-traction applied, leaking fluids contained, and patient history assessed and documented. The firefighters retrieve the spine board from the rescue’s compartment, extricate the patient, and deliver her to the rescue, then stay on scene until we depart.

I have dozens more from the past four days alone. I am fortunate to work in a department with great people beside me. I cannot do this alone or with just my partner.

In addition, during the tour, three building fires and countless other fire department responses were handled, and four firefighters transported by Providence Fire Department rescues to area hospitals for injuries during operations.

Thanks to each and every Providence firefighter for doing the job the way it should be done. Great work, as always. We all do the best we can with the resources available to us. I am fortunate to work in an environment where help is readily available, willing, and able.


Michael Morse, a Providence (RI) Fire Department member for 22 years, writes about his experiences as a firefighter on Engine Co. 2, 7, and 9 and Ladder  Co. 7 and 4, as well as his time on Rescue Co. 1 as a lieutenant and Rescue Co. 5, where he is currently captain. He lives with his wife Cheryl seven minutes from his station, which, fortunately for him, is “worlds away.”



Fire-Based EMS Opportunities


By Mike McEvoy
EMS Editor

The combination of hard financial times and health care reform have intensified efforts to outsource EMS, overlooking the unique ability of the fire service to deliver timely, safe, competent, cost-effective and compassionate prehospital care. The Fire Service-Based EMS Advocates are working to advance the understanding of the unique contributions Fire-Based EMS delivers. Formed by the Congressional Fire Services Institute (CFSI), the International Association of Fire Chiefs (IAFC), the International Association of Fire Fighters (IAFF), the National Fire Protection Association (NFPA), and the National Volunteer Fire Council (NVFC), the Advocates are developing a “Best Practices” section on their Web site to highlight and share fire service based EMS success stories. Submissions should be sent to Chief Dennis Compton, Co-Chairman of the Fire Service-Based EMS Advocates Steering Committee at, not exceeding 1,000 words, including a brief bio introducing the author.