Born of Necessity, EMS Is Viewed As Child With Problems to Be Solved
Battalion Chief Warwick, R.I., Fire Department
In spite of efforts seldom seen before in the fire service, emergency medical service still remains an illegitimate child.
Its mother was necessity and its father political expedience, specializing doctors or some other ill-defined entity. The mother wanted a child, the father was obliging, for the most part, out of purely selfish interests. With such a heritage, the child is confused at best and retarded at its worst.
The legal basis for legitimacy is open to serious question. Can a fire department get into emergency medical service just because it wishes to? The authority granted by the various states to municipalities and volunteer fire departments may not provide for legal protection that becomes necessary with the expansion of service to include EMS. If the charter incorporation paper, or special act states that the fire department is organized “to provide fire protection to the community,” can that be loosely interpreted to include the sophisticated emergency medical service that is not directly related to fire protection? Are fire fighters assigned to the EMS acting within the scope of their employment or authority and are they legally protected while doing non-fire-related emergency work?
Good Samaritan laws
Many consider the point academic, citing so-called Good Samaritan laws as legal protection. But do such laws really protect or would the reasonableness doctrine apply? What would a reasonable, prudent individual with the same amount of training have done under the same circumstances? The judgment of a lay person’s actions, for whom the Good Samaritan laws were written, would be less harsh than for a trained emergency medical technician.
When this question has been raised to those in the legal profession, a vague and shallow reply has been given.
In the case of a municipality, one might ask, “Why isn’t the charter changed to include EMS within its provisions?” The answer most probably is that during the time necessary to effect a charter change—drafting, publicity and placing it on a referendum—a deluge of lawsuits would be filed against the municipality by those sensing the opportunity for monetary gain.
If the legality of EMS is solved, the next question is, “Do we really want to provide such service?” The answer to this is not quite as simple as it sounds. Too often, EMS has been either added to or assumed by the local fire service without adequate consideration of the budgetary ramifications. The number of EMS calls handled by the fire service in most areas increases steadily each year. In many areas, even now, it represents in excess of 50 percent of all calls handled by the fire department.
However, even in departments with a good management structure, rarely do you find a division of rescue to complement the divisions of fire fighting, fire prevention, fire alarms, repair, etc.
Specific funding needed
Even more rare are those cases where a specific portion of the budget is earmarked for EMS. For example, a fire department with an overall budget of over $3.8 million budgets $3,500 specifically for rescue service. If you divide the 4500 runs handled by the rescue into the budgeted sum for such service, the cost per run comes out at $.78 per run. If you divide the total number of runs handled for fire-related incidents into the remainder of the budget the cost per run is $844. While such a comparison is simplistic, it illustrates the point. For EMS to achieve legitimacy, it must receive its proportionate share of the finances.
The personnel structure of many EMS systems is indicative of illegitimacy. While most divisions of the local fire service have a ranking individual to head them, such is not true of EMS in all cases. We have superintendents of fire alarm, chief inspectors and chief mechanics, but how many chiefs of rescue service are there?
Without a command structure that provides an incentive to those who choose EMS, personnel with extensive EMS training and invaluable experience must compete for promotion as line fire officers. They find themselves at a severe disadvantage competing for promotion in a system geared to fire prevention and suppression. The disadvantages usually lock an individual into EMS and its dead-end promotional system. The result is an attitude that becomes more negative with the passage of time and with being passed by contemporaries.
Public relations evaluated
Many fire organizations take on EMS for its public relations value. Public relations cannot be minimized but it should not be maximized. Too frequently, the notes and letters lionizing EMS activities are received by the chief executive of the municipality or the president of the volunteer fire company. The phone calls of complaints are received by the fire chief. Unless the two are equated, a false view of the public relations value presents itself. A person who feels victimized by the lack of opportunity for advancement is hardly the one to be handling public relations for a fire department.
Internal relations in a fire department are often strained when an EMS worker finds that the command structure makes him answerable to a fire officer who does not understand EMS work and just maybe is antagonistic toward it. Historically, there has always been a rift between the experience-oriented officer complement and education-oriented subordinates in the fire service. EMS, being education-oriented for the most part, finds itself suppressed and often ridiculed by experience-oriented fire officers. This may manifest itself by an indifference or hostility in quarters that sometimes results in the assignment of the least desirable tasks to the EMS personnel.
At incidents where EMS personnel are in charge, a fire officer who feels that his authority, gained after many years of service, is unduly minimized may fail to cooperate to the fullest extent possible. Reporting such action to that officer’s superiors, themselves products of outdated, traditional promotional systems, often strains the relations even further. EMS personnel come away from such an experience feeling more victimized than before.
Solutions to problems
The solutions to these problems posed are not going to be easy, nor are they the only problems. Certainly the Banderlog technique (something great, wonderful and new, done by only wishing it true) will not suffice. Change has always been slow and traumatic in the fire service, but an excellent start would be made if all, or even some, of the following were accomplished:
- The legal establishment of EMS to end questions of liability and authority.
- The creation of an EMS division in fire departments that provide such service.
- Adequate funding for EMS to provide for its special needs.
- A promotional system that provides incentives to stay in EMS, including monetary and prestige considerations.
The problem of conflict between experience and education will be solved only by attrition—if at all. When the problem of human relations is the stumbling block, one can look to the volumes written on the subject and the lack of success that has been achieved. The person who comes up with the answer to this will acquire fame and fortune as well as success in many fields, for it is a problem wherever age and experience encounter youth and education.