The Next Five Years: Forecasting the Future for EMS, Emerging Technology and Hazmat Response

To get a picture of the future of the fire and emergency service, we asked members in several disciplines to describe where we’ll be five years from now compared to where the fire service is today. Specifically, we asked them:

  • Where are we now?
  • Where will we be in 5 years?
  • Where should we be in 5 years?
  • How do we get there?
  • What are the challenges to reaching this vision?
  • What should IAFC members do now to help get their departments there?

Chief Gary Ludwig, chair of the EMS section, provided a perspective on EMS’s future; the IAFC Technology Council developed answers during a recent Council meeting. The look into the future for hazmat comes from Rick Edinger, a member of the IAFC's Hazmat Committee from Chesterfield County (Va.) Fire Department. Here are their views of our future:

Take time today to consider these perspectives and learn how to prepare for what’s coming in each field. The investment of today will pay off significantly in the future.

The Future of EMS

Where are we now?
The fire service is the predominant provider of emergency medical services in the United States. This was clearly spelled out in the recent release of a government document titled “National EMS Assessment.”

That report, which excluded four states that have many fire-based EMS departments, showed that 40% of all transporting ambulance services were fire-based; fire service-based EMS was the largest category of service provider in the report.

This doesn’t include all those fire departments that provide EMS through first response to non-fire-based EMS transporting agencies. Thus, the fire service is the leading provider of EMS in the United States

Where will we be in 5 years?
Sometimes the future is tough to predict, but I believe the fire service will continue to be a major provider of EMS in the United States. The fire service is truly the public safety net of any community.

Where should we be in 5 years?
We need to get away from the 45+ year model of transporting all patients to the emergency room regardless of their condition or chief complaint. Ambulance services only do this to ensure reimbursement from Medicare, Medicaid and private insurance companies who only reimburse ambulance service if the patient is transported.

I also believe fire departments should be reimbursed by health care insurance providers for providing first response.

How do we get there?
The fire service and other non-fire service EMS providers need to work with the federal government and private insurance companies to demonstrate that the above isn’t a cost-effective model if patients can be treated and released, transported to clinics or other medical facilities while the responders still receive reimbursement for these services.

What are the challenges to reaching this vision?
The biggest challenge is to manage the logistics of working with huge bureaucratic agencies and private insurance companies entrenched in the model of reimbursing ambulance services only if the patient is transported to an emergency room. Other EMS providers, such as private ambulance companies and third-service ambulance services, would also have to agree to changing the current model. I envision a long and tedious process to effect any change in the current reimbursement models, including reimbursing fire departments for first response services.

What should IAFC members do now to help the fire service and their own departments get there?

  • Get involved in the EMS Section! If you’re not a member, become a member! 
  • Stay informed on the issues and join together in one unified voice on these issues; the EMS Section can help push the agenda forward to change the current reimbursement models.

The Future of Technology

Where are we now?
We are well into the information age, but many departments are overwhelmed with too much information and the ease of obtaining it (or receiving it). So they choose not to use any of the modern tools that are available to them or just resist the changes altogether. They prefer the “Keep it simple, Stupid” (KISS) principle.

Technology is on the move and doesn’t wait for any department. Chief officers need simplified tools to get them great answers and direction.

Where will we be in 5 years?
Our equipment, facilities and personnel will be more computerized than ever before. It will be a huge challenge to satisfy the appetite our younger generation will have to leverage the newest technology, keep from busting our budgets and become more efficient in the fire business.

Where should we be in 5 years?
We should have the ability to grasp technology by understanding what it looks like and how it feels and quickly evaluate it. We should then make good, intelligent, informed decisions on using it without exhausting our personnel resources during the information-gathering phase.

How do we get there?
Collaboration is the answer. Working together and leveraging our power in numbers with carefully considered processes for evaluating new technology will give fire service leaders a powerful jump on what continues to come their way.

What are the challenges to reaching this vision?
Communication, communication, communication. We need to get the word out to all IAFC members and fire service vendors that the IAFC Technology Council exists and can help cut through a lot of the red tape of sorting out information on new technologies without departments spending a lot of their own resources to gather the information. 

What should IAFC members do now to help the fire service and their own departments get there?

  • Let the IAFC Technology Council know what technologies you’re interested in.
  • Encourage fire service vendors to utilize the processes of the Technology Council to help inform IAFC members about new technologies or enhancements to old ones.

The Future of Hazmat and Alternative Fuels

Where are we now?
We face a continued threat of terror that uses explosives, chemical weapons, etc. Emerging energy technologies using new fuels and materials, including ethanol, hydrogen, batteries (acids), are increasing. Problems with an aging infrastructure—especially pipelines—cause spills and leaks. We live and work in a highly technological world with a great deal of instrumentation. And of course, continued funding shortfalls often mean that specialty response areas, such as hazmat and technical rescue are underfunded.

Today’s responders are challenged more and more with new materials and alternative fuels that require firsthand knowledge, skills and abilities to deal with the hazards they pose. From special fuels for vehicles like ethanol and biodiesel to hybrid vehicles powered by hydrogen or batteries, responders must be familiar with these fuels to know how to respond appropriately. The appearance of these hazards is becoming an everyday occurrence in many communities. The learning curve for appropriate response is steep and the information comes to us from numerous sources.

Where will we be in 5 years?
More of the same, particularly with emerging fuels and infrastructure concerns. There will be more technology, but we must still take care of the basics of hazmat response.

Alternative fuels will be moving around our country and world in many forms. The rail industry is increasingly being used to deliver these fuels and is preparing for even more use in the future; rural communities with rail lines may see a significant change in commodity transfer operations.

The pipeline infrastructure will be under significant review, with new changes and updates to the pipelines in the United States.

Finally, we’re going to lose a lot of experience as older members retire, so new members need to step up.

Where should we be in 5 years in our ability to deal with these potential incidents and emergencies?
We must be better prepared for new response challenges and able to more quickly understand and manage emerging issues. We must also be more engaged in the legislative and regulatory process to ensure our concerns are heard.

The fire and emergency service must establish a better relationship with the energy industry—pipelines—to establish effective partnerships for prevention, response and mitigation.

Each response agency needs to evaluate the hazards they may have to respond to. Responder training must be available 24/7/365 and at a low cost, delivered directly to responders. Response systems throughout the country have to be provided with all the tools, training, material and personnel to respond.

The older members of response teams need to mentor newer members, and in turn, the new members need to listen and absorb the knowledge and wisdom of their predecessors.

What are the challenges to reaching this vision?
Time, money and resources, just as with everything else.

Beyond that, it seems that some younger members don’t have the mechanical skills that some of the older members brought to the fire service. Twenty-plus years ago, we looked at members to have other, transferable skills, such as welding, heavy equipment operations or teaching. But now we get many Computer-Age members who need to learn these and other skills to be able to continue to respond to these challenges in the future.

So how do we get there?
The overall fire service and particularly the hazmat-response community must be more proactive and engaged in these issues as they surface. We're far too reactive in some aspects. There needs to be more emphasis on awareness, training and funding to prepare for these challenges.
Emergency service leaders have to be engaged in every way possible, not only within their organizations but also in the communities they serve. Funding is the key component to providing these response services and recognizing this can make your service delivery more effective.

You have to be the sales person in your community—you as the emergency responder are the local expert to educate your community about the risks and what you need to respond to them. To reach your community, you must also work with industry leaders and ask for their help. Building consensus with community leaders and industry will help you work through potential hazard for the future today, which can only make your community better prepared tomorrow.

What should IAFC members do now to help the fire service and their own departments get there?

  • Raise the level of awareness of these challenges and address local threats and hazards as a priority.
  • Provide the required internal (fire department) resources to be properly prepared to safely respond to these challenges and protect our communities.
  • Develop subject-matter experts who can engage the legislative and regulatory processes on behalf of the hazmat-response community at the local, state and federal levels to prevent adverse outcomes
  • Engage local politicians and city and county administrators to address funding and resource shortfalls. 
  • Plan and prepare as well as you can within your means to properly mitigate these types of incidents. Take advantage of all currently available resources to minimize the community impact. 
  • We can’t lose sight of the basic core hazmat competencies and response necessary for a safe and effective operation.
  • Although our responsibility is expanding for chemical, biological, nuclear, radiation and explosive events, we need to balance high-probability/low-consequence and high-consequence/low-probability incidents.
  • To continue responding to rail and cargo tank car incidents (such as with ethanol and propane), the hazmat-response community needs to keep its knowledge and skills honed for these common events.
  • Yes, we do need to be prepared for incidents involving weapons of mass destruction, but our time and efforts should still be heavily focused on the everyday occurrences.
  • The 2012 Emergency Response Guidebook has just been released by the U.S. Department of Transportation's Pipeline and Hazardous Materials Safety Administration. The ERG contains an indexed list of dangerous goods and the associated ID number, the general hazards they pose and recommended safety precautions. Responders should review the updates and changes.
  • Take advantage of the great resources for pipeline education—a free training program—on the Pipeline Hazardous Materials Safety Administration website.
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