Fire Service-Based EMS: Re-Informing Policy-Makers

The Congressional Fire Services Institute (CFSI) recently hosted a seminar in Washington, DC addressing fire service-based EMS issues. It was one of several excellent seminars held in conjunction with the CFSI Dinner event in April 2009. The seminar panel consisted of Lori Moore-Merrell representing the International Association of Fire Fighters (IAFF), Chief John Sinclair representing the International Association of Fire Chiefs (IAFC), Steve Austin representing the Fire Service-Based EMS Advocates coalition and Randy Mantooth, the actor who played Paramedic John Gage on the TV series "Emergency!"

Lori and John each outlined benefits of fire service-based EMS systems and how they integrate with the all-hazards approach to delivering emergency services through a fire department. Steve talked about the Fire Service-Based EMS Advocates, the work the group has done and its goals for the immediate future. Randy discussed the impact that playing the role of Paramedic Gage had on his career and his life. He also said how much he came to respect the men and women who are the real firefighters and paramedics and how honored he was to represent what they mean to the safety of our nation. It's a shame that every member of every fire department in America wasn't there to hear this panel and realize the importance of what they had to say. Fire service-based EMS is a long-standing tradition with a rich history in career, volunteer and combination departments…and the fire service should be very proud of that.

In the late 1960s and into the mid-1980s, fire chiefs, labor officials and other fire service leaders devoted significant time and effort to ensuring that elected officials and other policy makers at the federal, state, county and local levels understood the importance of implementing and nurturing fire service-based EMS systems. However, many of those who were in decision-making positions within all levels of government during that time have moved on, and it's obvious that the fire service has some re-informing to do for the people in those positions today. Some Congressional offices, state legislatures, city councils, fire district boards, and leaders of federal and state agencies are either misinformed or uninformed of the role the fire service plays in pre-hospital 911 emergency medical care and the advantages of basing EMS services in fire departments — and that lack of understanding needs to change. They must realize that contrary to what many believe, EMS is not just an ambulance ride. It is a complex public safety system with many components, the ambulance transportation component being just one of them.

It has been reported that more than 90% of the nation's 31,000-plus fire departments deliver EMS to the public. More than 60% provide full ALS services delivered by firefighters or other fire department members arriving at emergency scenes on engines, trucks, squads, rescues or ambulances. It is also estimated that about 45% of fire departments provide ambulance transportation services as part of their EMS system. In the United States, the fire service-based EMS model is far more common than any other EMS models. An important goal for the fire service is to further enhance the understanding of the critical role that fire departments play in EMS, and to continually improve the integration of fire service-based EMS within fire department service-delivery systems. Major fire service membership organizations have done this on an individual basis, but now, in addition to each organization's independent efforts, they are working collectively within the Fire Service-Based EMS Advocates coalition.

Established in September 2006, the Fire Service-Based EMS Advocates Steering Committee consists of the CFSI, IAFF, IAFC, National Fire Protection Association (NFPA) and the National Volunteer Fire Council (NVFC). A few of the major accomplishments of the steering committee include:

  • Developed a "Statement of Principle" for coalition membership
  • Distributed a white paper prepared by prominent members of the medical community titled Pre-Hospital 911 Emergency Medical Response: The Role of the United States Fire Service in Delivery and Coordination
  • Developed a DVD titled Fire Service-Based EMS: The Right Response
  • Developed a website:
  • Made presentations to members of Congress and their staffs
  • Made many presentations at major national conferences
  • Wrote several articles for various fire service magazines
  • Developed a strategy for growing the coalition membership

The "Statement of Principle," white paper, DVD and instructions for joining the coalition are available on the website. Many fire service-related associations, fire departments, and even individuals in leadership positions in the fire service, medical community and related disciplines have joined the coalition, and membership continues to grow.

Many of the final decisions that affect systems used to deliver EMS are made by elected officials and agency heads. To make an informed decision about EMS delivery systems, they must understand the value of fire service-based EMS, and it's up to the fire service to make sure that is happening at the federal, state, county and local levels. EMS is one of the most critical and popular services fire departments provide, and the quality of care delivered by fire departments through their EMS systems is outstanding. Many lives are saved, and many others positively impacted, through EMS services delivered every day, throughout the nation, by dedicated firefighters and other fire department members.

The fire service should not assume that policy-makers understand this. The story must be told, and then told again and again. Every new and existing decision-maker who has authority over EMS decisions is a our student. The panel of presenters at the CFSI seminar in April told the story very well, and the Fire Service-Based EMS Advocates are also telling the story, as well as trying to ensure that fire chiefs and firefighters have tools that will help them do the same.

DENNIS COMPTON, a Firehouse® contributing editor, is a well-known speaker and the author of several books, including the When in Doubt, Lead series. He is also co-editor of the current edition of the ICMA textbook Managing Fire and Rescue Services. Compton was the fire chief in Mesa, AZ, for five years and assistant fire chief in Phoenix, AZ, where he served for 27 years. Compton is the past chair of the Executive Board of the International Fire Service Training Association (IFSTA) and past chair of the Congressional Fire Services Institute's National Advisory Committee. He is also chairman of the National Fallen Firefighters Foundation Board of Directors and the chairman of the Home Safety Council Board of Directors.