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I love being a paramedic and providing medical care to those in need. There is an overwhelming sense of satisfaction and joy that comes from watching someone walk out of the hospital who might have died if not for our intervention. There are the great moments also of delivering babies.
But this is what firefighter/paramedics do. In fact, that is the majority of what we do. You might say that most fire departments are really EMS agencies that sometimes go to fires. Do a breakdown of how many fires your fire department goes on and how many EMS calls your fire department goes on and you will find it is usually somewhere more than 60% EMS calls. In many fire departments, that number is probably around 90%. According to the U.S. Fire Administration (USFA), 69% of all U.S. fire departments offer EMS. And as I noted in my January column (“What If the Fire Service Gets Out of EMS?”), the fire service provides EMS transports in 16 of the 20 most populous U.S. cities and provides first response to all the EMS transport providers in the other four cities.
In 2011, the United States government conducted a study called the “National EMS Assessment.” That study showed that 40% of all EMS transport agencies in the country were fire-based EMS. This study did not include all the fire departments that provide first responder service to non-fire-based EMS agencies such as third services, private ambulance companies or hospital-based EMS providers. The fire service has clearly established itself as the leading provider of EMS in the United States (see my February 2012 column, “Study Proves Fire Service Is Top EMS Provider in U.S.”).
Along with establishing yourself as the leading EMS provider, also comes the responsibility to advance the profession and shape what the future of EMS will look like. The fire service has certainly stepped up to that challenge. The International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Volunteer Fire Council (NVFC) and National Fire Protection Association (NFPA) all have offices or sections dedicated to EMS.
All four national fire organizations have teamed up with the Congressional Fire Service Institute (CSFI) to form the Fire Service-based EMS Advocates to ensure that Congress and the Administration more thoroughly understand the role of fire service-based EMS. Its mission is to add clarity to national policy discussions regarding EMS issues.
Many issues face the fire service with respect to EMS currently and in the future.
One current issue is to convince the EMS profession to accept NFPA 1917, Standard for Automotive Ambulances (see “NFPA 1917 Released,” November 2012). The NFPA established this technical committee after being petitioned by the IAFC. The main goal was to establish ambulance standards ensuring the safety for those who work or ride in ambulances. The current standard that many states adopted is nothing but a buying specification that the federal government issues for the purchase of ambulances. Nothing within that buying specification deals with safety.
The NFPA process of building a consensus standard is inclusive of end-users and manufacturers. In fact, only seven of the 43 principals on the NFPA 1917 technical committee came from the fire service. Unfortunately, there is resistance to NFPA 1917 from some non-fire service EMS individuals.
Another issue that the fire service will have to tackle head on is how the Patient Protection and Affordable Care Act (ACA), commonly known as “Obamacare,” will impact fire service EMS in the future. The U.S. Supreme Court upheld the law in June 2011 and a Democratic president and a Democratic majority in the Senate were re-elected in November 2012, so the law is bound to go into effect. Changes to the healthcare system are going to happen. Either the fire service can sit on the bus or drive the bus when it comes to how the healthcare law will impact EMS.