IAFC 150 anniversary logo

Company Officer Leadership: Advancing Fire-based EMS

John and Roy riding Los Angeles County Fire Department Squad 51 on the television show Emergency introduced many of us to the concept of fire-based EMS. When the show aired in the 1970s, cities such as Miami, Jacksonville, Columbus and Seattle, in addition to Los Angeles County, were already proving that the fire service was ideally equipped to deliver EMS with firefighter/paramedics.

It was quickly recognized and documented that rapid fire-department response could save lives and reduce disability.

Since that time, EMS has become an integral part of the services fire departments provide to the communities they serve. EMS fits well into our mission of saving lives.

In most cities and counties, fire department leadership has recognized that providing EMS is important to the survival of the fire department in its current form. It provides an avenue for showing value to the community, increasing the productivity of the personnel delivering fire and EMS services and in many cases, providing an additional revenue stream to support the agency’s budget. Both the IAFC and the International Association of Fire Fighters have endorsed fire-based EMS and the NFPA has developed standards for EMS response.

In 2009, the IAFC reported that in 97% of the 200 most populated communities the fire service is delivering prehospital EMS, and in 90% of the 30 most populated U.S. cities and counties advanced life support response is provided by the fire service. Overall, 60% of the EMS delivered in the U.S. is provided by the fire service.

While 60% of EMS is provided by the fire service, it isn’t delivered consistently. There is a variety of delivery models that provide basic life support, advanced life support or both. Some agencies transport, while others partner with a private or third service.

State and federal agencies have attempted to increase the consistency of the EMS delivery by standardizing the knowledge and skills of EMS providers and establishing rules and guidelines for agencies providing EMS response.

However, the ultimate responsibility to improve and advance fire-based EMS lies with us, the members of the fire service. As the providers of EMS service to our citizens, we’re in the best position to enhance the current service we provide and continually seek ways to advance fire-based EMS.

As company officers, we have the primary responsibility for the quality of EMS provided by our crews and to encourage fire-department leadership to measure and benchmark the service provided. These measurements help to ensure the high quality of the current service and to identify opportunities to further improve and advance EMS in the community.

Two basic measures include response time and cardiac survival rate. However, many other measurements and benchmarks should also be considered, depending on the model and level of service provided.

Fire departments delivering EMS should also participate in the following activities:

  • Periodic review of the EMS delivery model
  • Participation in research and studies
  • Development of data-driven care protocols or guidelines
  • Assurance of high skill retention for EMS providers

Each of these is a topic in itself, and there are many resources available on these subjects on the internet, from the IAFC and IAFF and in the research literature.

The single most important factor that affects the delivery of EMS and so likely to have the greatest impact on advancing fire-based EMS is our own membership. I frequently hear members state that their department provides EMS, but the leadership doesn’t support it. This is short sighted; company officers should encourage their leadership to embrace and support EMS whenever possible.

However, a more disturbing trend I’ve identified is the attitude I see developing in many of our newest members that “I’m here to fight fire, not take care of sick people.”

I’m not sure where this ideology comes from, but I do know it’s our responsibility as company officers to reset the attitudes and expectations of the crews we supervise. We must ensure that the highest quality of care is provided, that care is provided consistently and equally to all patients and that our crews maintain a high level of competency in their EMS skills.

I recently heard Randolph Mantooth (Johnny Gage on Emergency) speak in Baltimore. He spoke passionately about his respect for firefighters, the role we play as EMS providers and the unique opportunity we have to make a positive impact on people’s lives, as some did for his own sister, by delivering emergency medical care when they’re sick or injured.

As company officers, we should be reminded by Randy’s words of the power we have to influence perspectives about EMS with simple actions inside our departments and in our communities. It’s likely that these simple actions will have the greatest effect in advancing fire-based EMS in the future.

Craig Aman is a company officer and a paramedic for the Seattle Fire Department. He's a member of the EMS Section and has been a member of the IAFC since 2010.

Related News
You are not logged in.