Seperate Fire and EMS Organizations and Rescue Operations

[capt105]

I'm a Captain in a rural Northeast Vol. Fire Co. My Dept. is responsible for fire and rescue operations while EMS is handled by a seperate organization. Now I know that Rescue and EMS need to work "hand in hand" but we seem to be butting heads alot. I was wondering if there was any other organizations out there with similiar problems and if there were any sugeestions for bridging the Fire Dept/EMS gap?

[FSRIZZIO]

I feel your pain. I'm Asst. Chief of a rural Fire dept. that has an ambulance service/dept. we're funded through a common municipal budget, use the same facilities and provide services to the same community. The ambulance dept. used to be under the Fire Chief' management until several years ago a fallout occurred that separated the departments. The ambulance service was reorganized, and the Fire dept. pretty much left it be. Over time this became a real problem operationally because most of the EMT's with EMS didn't know the firefighters
and some of them developed a real animosity towards each others org. Fortunately a few of us are EMT/FF's and work with both dept's. Now that we run the place we've worked on patching up the old feud's. Turns out that there was a few people that kept things out of order. I started out by meeting with the EMS dept. head and reasoning that we had to work together for the common good. He agreed and things started from there. We've had common training sessions and social events that have really smoothed things over, we're in better shape during common operations and we know what to expect from each other.
Other Fire dept.s in our area have had the same problems with neighboring EMS groups.
An open minded management has really worked for them too. If you try to understand what each other need to do, and here's the key... have a solid ICS protocol...you'll probably see some improvement.
Good Luck, Frank

[This message has been edited by FSRIZZIO (edited 02-03-99).]

[firemanhank]

I think we have all been there. Im also from a small midwest town with separate ems and fire. Ive seen it go both ways over the years and to be honest the biggest thing that made the change was attitude. If you have guys with a chip, until they get rid of it you are going to have problems. Im glad to say right now we are in a good time. The biggest reason for the good attitude right now is we are short of emt's so firemen are driving the ambulance. Working together a lot seems to bring everyone closer. Have you thought of having more training together? Wish you luck.

[lutan1]

Looking through the archives and found this topic- anyone else still having problems?

We too have similar problems but after a fair bit of talking and communicating, I think the common denominator is that we don't REALLY know what each is capable of, what we do and why.

We need to break down a lot of these "Them and Us" attitudes with extrication and remember who we're there for...

Any other thoughts?

[Bones42]

Lutan - yes, I deal with EMS and FD as two different organizations in one small town. There are, at this time, very few of us who belong to both groups. Our FD runs about 180 calls a year, the EMS runs about 1300. The call load has taken it's toll on EMS and they are having trouble getting a rig out about 40% of the time. FD has offered to assist as drivers only multiple times, and do not always get the "friendliest" response from EMS. Being part of each organization, I have taken the few FD guys who really wanted to help and showed them the rigs, did some familiarization with them, and told them, just show up...you are not there to help the EMS you are there to help the patient. In the last 3 months, the members with the highest percentages have been FD drivers, so they continue to go and help. At fire scenes, we have no problems working together and have good relationship that way. Our biggest problem spot, coming up soon, is extrication. EMS performs this function, not the FD. Unfortunately EMS has started to lose interest in it and has not kept their training up to date at all. I am their instructor and have setup 3 training classes in the last few months, all of which have been cancelled by EMS captain for various reasons. Due to their lack of manpower and training, I have begun instructing the FD members on it. I have explained that extrication is still the EMS function, but to stay close as they may need help at the scene and be ready to offer it. EMS knows which members have been trained and the last 3 or 4 calls have been done by FD members. Really not a problem except the FD wants to take it over completely from EMS and some members are not too "politically correct" when they talk about doing that. EMS purchases their own equipment with monies raised by fundraisers, FD gets budget from town. EMS will not simply turn over the equipment to FD so monies would be involved, but EMS equipment is so old it would be better to purchase new anyway. Our (FD) current plans are to be replacing a pumper in next 5? years with a rescue pumper including full rescue tools and will takeover extrication then, but hearing that makes the EMS a little less friendly. Oh well, these are the battles we have.

[MalahatTwo7]

Being in from a small rural area, and separate EMS/Fire units is the norm here also. And we often run into problems with a "conflict of interest" when it comes to patient care protocols vs doing proper extrication techniques.

Our most common problem is that the EMS guys often arrive just ahead of our first out and as a result will have literally pulled the occupants bodily out of the vehicle, with little or no regard for stabalization or apparently their own safety. This is our biggest problem.

The second problem is when there are "too many EMS" on scene and then there is no real command and control between them. This has resulted in a conflict of orders between the I/C, Sector I/C and the rescue/extrication team and EMS team. The last time this happened, the pt was placed in extreme danger regarding spinal considerations, and at one point, the hard collar was removed to "allow" his head to touch his chest so that EMS could bodily remove him; his head also bounced off the drivers door handle once or twice too. This caused the pt great pain, and airway complications. (This was a case of 6 foot male jammed into a Ford Festiva - not much room even when the car was "normal")

On this case, I was designated as the head responder, but never got the chance to even lay hands on, because there was a "Dr", several "nurses" (all off duty) and 3 EMS cars. We had good rapport with one of the nurses and all was going well, and then some EMS guy jumped in and started hauling on the pt. The conversation was short and sweet, at the cost of pt care&comfort. :(

Don't get me wrong here. We have also had some very good EMS crews. Both teams talked to each other, and great things were accomplished safely and timely. When that happens its a great day for everyone, including the patient(s). :)

[jimthefireman]

In NZ the Fire and EMS (or Ambulance) Services have always been two totally seperate organisations. I have watched relationships wax and wane over the three decades I have been a firefighter and today it is (although not problem free)a better relationship than it has ever been. Here are what I belive to be some bottom lines:
1) You can't work well together if you are not speaking.
2)You have to control your own loudmouths and loose cannons if you want them to control theirs.
3)Anyone who puts their own "political" position above good patient care should not be in an emergency service.
4)Bad publicity hurts everyone in the emergency services.

Of these four, number one is the most important. Here as professional fire crews, we are on station much more often than our busier colleagues in the Ambulance Service. When we started having regular organised cooked meals in the evening and inviting Ambulance staff over to be part of them we found things worked better at an incident. People knew each other on first name terms and the troublemakers (every Service has them) found it harder to stir up "them and us" animosities. I suggest you try to get together with your opposite number in the EMS and together sort out some protocols. Try to programme regular meetings with just the two of you so you can get to know each other and then look for opportunities to get staff to know each other better. Let your own crew know that bellyaching to others seldom improves things and if there is a problem, you want solutions not just complaints. Try to arrange for effective feedback from Trauma centres on the actual injuries found on the patients you handle so that everyone is encouraged to see how their actions affect those you care for. Finally remember bad things happen quickly but good changes take time, keep plugging away because the results are well worth it. Good luck

[nutty17]

In my experience any headbutting comes from ignorance. Either ignorance of extrication or ignorance of medical protocols.

So, we ensure the our squad members have at least a FR 3 level first aid and actually probably 7 or 8 (out of thirty) members are paramedics with the BC Ambulance Service. We also invite the BCAS in to a special training day where we have them observe extrication procedures and explain the hazards of extrication. It is an eye opener. Everybody gets a little apprciation for the other guy and people get to know each other in a less stressful enviroment.

Shane

[lutan1]

Couldn't agree more, Shane.

We've invited the local ambo's to so many lectures and sessions, ranging from Airbags/SRS, Hybrids, Extrication Familiarization, etc and they're not interested!

Can't win if people are not interested. There's so much "Them and Us" and I believe it will be here for a very long time- unfortunately!:mad:

[FireAdvocate]

I was Rescue Chief for a rural fire/rescue service and the major difference was who was in command. The domain was that Rescue covered EMS (ambulance operations), Above & Below Grade Rescue, High-Angle Rescue, Confined Space, and speciality recovery. On the later, if I was still with the department I would have also had responsibility for RIT.

In any case, the resources for any one of the following calls came from both EMS and from the Fire Service. Initially there was a conflict of power but after the Fire Chief understood that at a fire scene he was in command, all was okay. In fact, at a fire scene my role was for EMS sub-command.

The biggest problem is when you have a full-time or a combined department making routine calls (for both fire & ems). Routine calls including such things as on ems-difficulty breating calls, or fire-dumpster call. The operating command now is lowered to the person who responds. Often this is simply a person plus one (or two) other. We then have to deal with the volume question and how this all shakes out.

It's a new world out there and few communities can not afford two separate functions. Combining is appropriate but must be done in a very deliberate fashion.

[Rescue101]

Well our EMS is totally seperate from Fire/Rescue but it's like one big family.A fair percentage of people are cross trained and work for both depts.We've worked the system into a I'll do this,you do that using a unified command with both agencies represented and it works well for us.T.C.

[MtnRsq]

Seems odd that EMS folks are yanking people around w/no consideration re: immobilization. Isn't that part of the deal if you're an EMT?

Several people have hit on at least part of the answer. Multi-agency issues are less of a concern when there is familiarity and there has been communication PRIOR to the "big one" and the confusion that comes with surging adrenaline, etc. A clear incident command structure and the establishment of a unified command sure helps avoid confusion. Establishing mutually agreed upon protocols re: various incident types/roles are also useful - as long as everyone plays by the rules. Freelancing that is not checked will lead to a breakdown in your protocols.

Organizations that cannot function together are likely to have the matter sorted out in court by the plaintiff's attorney when the bickering leads to some negligent act.