Four Categories Of Fire-Based EMS

At a recent meeting with a fire department, a fire chief proudly announced to me, "We do EMS." The fire chief left the room and the meeting progressed with his command staff.

As the meeting proceeded, it was sadly apparent that this department "did EMS," but at what level? I did not say anything — I just listened! Finally, about two hours into the meeting, a deputy chief said, "We need to tell him the truth." The room went silent as though some death announcement was coming. Finally, the truth came out when another deputy chief, was almost embarrassed to say, "We do EMS, but what we do is terrible."

The deputy chief went on to admit that even though the department went on EMS calls, that was the extent of it. No EMS training occurred. There was no quality improvement program to look at how EMS was delivered and where it could improve. Supervision of EMS consisted of one captain in an SUV on each shift refilling drug orders and trading out broken EMS equipment — nothing else.

Hearing how this fire department operated its EMS system led me to conclude that there are four categories by which fire departments go about delivering EMS: They do not tolerate the EMS mission; they tolerate the EMS mission; they accept the EMS mission; or they embrace the EMS mission.

Fire departments that do not tolerate the EMS mission are those that want nothing to do with EMS. Most of these fire departments do not run EMS calls and EMS is not even thought of in the department's mission. EMT or paramedic qualifications are not even considered when the hiring process occurs. If one of these departments was treating a critical patient, it would abandon that person if a house fire came in. Most such fire departments do not run first-responder calls. Unfortunately, I know of at least one major metropolitan fire department that falls into this category. The people of that city truly receive a degraded level of service.

The next category concerns fire departments that tolerate the EMS mission. These fire departments perform EMS as a part of their mission, but grudgingly. These fire departments respond on EMS calls, but usually do not have advanced life support (ALS) companies or paramedics. The tone from the top of the organization is, "Well, we perform EMS, but if I had my way, we wouldn't." This trickles down through the rest of the fire department. One time, I walked into the office of a fire chief and saw a sign taped up behind his desk that he obviously created on his personal computer. The sign read, "problEMS." The sign clearly implied that "E-M-S" were the last three letters in the word "problems."

Usually in fire departments that tolerate the EMS mission, EMS training, EMS supervision and EMS quality improvement are minimal at best. Firefighters are usually left to fend for themselves to obtain CEUs for relicensing. EMS administration is more about fulfilling paperwork requirements than providing support and supervision during field operations.

The third category involves fire departments that accept the EMS mission. When a fire department accepts the EMS mission, the attitude toward providing EMS is more positive than in the first two examples. Usually, these fire departments dedicate enough budget resources to carry out the mission of delivering EMS. That means that adequate administrative personnel are devoted to EMS, a sufficient amount of EMS training occurs for personnel, and a quality-improvement program is in place that is designed to identify personnel who need help or otherwise find weaknesses in the system.

The fourth category includes fire departments that embrace the EMS mission. In many cases, the name of the department has been changed to include EMS. You may have seen some of this already. The "Resume Speed Fire Department" becomes the "Resume Speed Fire and EMS Department." I know of one department that changed its name to put EMS in front of fire in its name. But even changing the name to say EMS does not mean the department embraces the EMS mission. When a fire department embraces the EMS mission, it accepts it with approval and there is generally acceptance by most firefighters in the department of the EMS mission.

Fire departments that embrace the EMS mission dedicate more than sufficient resources to the mission. The attitude from the administration is that EMS is a vital and necessary part of what the department does. In these departments, it is a requirement you are, or you will become, an EMT or a paramedic and maintain that status throughout your career. As a result, most if not all firefighters in these departments are EMTs or paramedics. These departments also provide EMS transport. If a department does not provide EMS transport, it is always looking for opportunities to do so.

The bottom line when it comes to determining what category your fire department falls into is to look at the administration. The administration of your department will set the tone. It will not tolerate, tolerate, accept or embrace the EMS mission.

Into what category does your department fall?

GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 30 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at