Some people really get upset when I say this: “Most fire departments are nothing but EMS agencies that sometimes go to a fire call.” Why? Well, it certainly breaks the glass in the traditional sense of what a fire department does. After all, the word “fire” is usually in the department’s name. Some fire agencies have changed their name to include “EMS” in the official title. I know of one department that even put “EMS” before “fire” in its official title because EMS is the majority of what it does.
Perhaps it is time that the fire service examines itself and comes to the realization that we follow the 70-20-10 rule. Seventy percent of what we do is EMS, 20% is non-emergency activities such as inspections, hydrant flushing, training, community education and outreach activities and the remaining 10% is firefighting. Of course, these percentages vary from department to department, but if your department does any form of EMS, these numbers will be close.
Now before I get a flurry of emails calling me every name in the book and questioning my ancestry, I get just as much job satisfaction from a fire response as I do an EMS response. I feel fire suppression is a vital and necessary component of any fire department and should not be diminished or take a backseat to the EMS mission. Performing fire suppression and EMS are equal and fundamental missions of any fire department. But at the same time, EMS should not be a secondary mission of any fire department; i.e., something we do when we are not fighting fires. Unfortunately, I have heard of incidents where engine companies abandoned patients before an ambulance arrived because an unconfirmed report of a fire was dispatched in their territory. I repeat, the reports were unconfirmed. No one was on the scene yet. One incident involved a patient who was completely immobilized with a cervical collar and backboard, and the engine company left the patient lying on the side of the road before an ambulance got there because there was a report of a house fire in the next company’s territory. What would have happened if the patient started vomiting or some other complication arose after the engine company left?
The true test of where your fire department is with respect to the EMS mission can be answered with four simple questions:
- • Does your fire department “not tolerate” the EMS mission?
- • Does your fire department “tolerate” the EMS mission?
- • Does your fire department “accept” the EMS mission?
- • Does your fire department “embrace” the EMS mission?
Apply those same questions to the fire suppression side of the house and I would venture to say that almost all fire departments “embrace” the fire suppression mission. So why not “embrace” the EMS mission of the department?
My experience tells me that the acceptance of EMS in a fire department varies from place to place. I have noticed some geographic tendencies where EMS is fully accepted or not accepted as part of the mission. Fire departments throughout a geographic region that have a large contingency of paramedics within their departments seem to embrace the EMS mission more. But the bottom line regarding recognition of the EMS mission begins at the top of the organizational chart, with the fire chief. If the fire chief does not embrace the EMS mission, this usually trickles down throughout the entire organization and is reflected in the attitudes of the officers and firefighters. The good news is that more and more paramedics are rising to the rank of fire chief and I am happy to report that the trend is toward fire departments embracing the EMS mission.
The situation is much better than it was years ago. In the 1970s and ’80s, we still had firefighters who had started their careers in the late 1940s and early ’50s, when EMS was not even a part of their vernacular. But they have moved on and now the paramedics of the 1970s, ’80s and ’90s are moving into the management ranks.
It is time to move forward. It is time for fire departments that do not “embrace” the EMS mission to do so. Describing the fire service as “200 years of tradition unimpeded by progress” is not good when it comes to embracing the EMS mission. Two hundred years ago, EMS did not exist except for horse-drawn ambulances with no medical equipment and no training until the patient reached the hospital. It is time to put the horses away and embrace the 70-20-10 rule.