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Several years ago, I walked into a deputy fire chief's office and saw a sign hanging behind his desk. The sign read "problEMS." In essence, the last three letters of the word "problems" was capitalized and it read EMS. He thought it was cute and funny at the same time. But it confirmed what I thought was his mindset when it came to fire service EMS and firefighter/paramedics. Ironically, I was there to talk him about a problem related to a suppression issue.
The deputy fire chief turned his chair and pointed to the sign, "Did you see my new sign?" I answered, "Yeah, I saw it. What does it mean?" His reply did not make any sense as he stumbled through an explanation that included some situation concerning a firefighter/paramedic the previous year. Obviously, he was reaching and tried to come up with some type of logic, but he sounded like a kindergartner trying to explain calculus.
Unfortunately, his attitude was microcosm of the more global picture. That more global picture is that some in the fire service begrudgingly accept EMS as a part of one of its main delivery functions, except when it's time to ask for more money in the budget because of all the EMS run numbers. There are still some in the fire service who believe that unless smoke and fire are showing, the word "fire department" is not attached to it.
It is not, however, an "us-versus-them" situation. I fit both disciplines; I like firefighting and I like EMS. You do not have to find yourself in one camp either. Whether you are a firefighter doing suppression, EMS, prevention, hazardous material mitigation, inspections or public education, you are still a member of a fire department.
Now, the alarm bells are ringing and not for fires, which, I might add, are not as plentiful as they use to be. That alarm comes in the form of a report titled, "Back to the Future: An Agenda for Federal Leadership of Emergency Medical Services," released by the George Washington University Homeland Security Policy Institute. The report proposes moving EMS leadership from where it currently resides, with the Department of Transportation's National Highway Traffic and Safety Administration, to the Department of Homeland Security, where it would be of equal status with the U.S. Fire Administration (USFA) under the Federal Emergency Management Agency (FEMA). The report calls for the formation of a U.S. Emergency Medical Service Administration. This report has become a rallying cry for those who are non-fire service EMS providers and want federal dollars.
Bottom line, unless the fire service wakes up and truly embraces EMS, it stands the possibility that a federal agency that does not have fire service interest as a first priority will be dictating future policy that impacts training, collection of data, finances, grants, and a host of other items.
EMS delivery is a system. It is just not an ambulance showing up at a scene and transporting someone to a hospital. It starts in the communications center, where trained dispatchers evaluate calls and provide pre-arrival instructions. An EMS system also includes first responders, usually firefighters, responding to a scene and providing basic or advanced life support. Finally, an EMS system includes a transport vehicle showing up on a scene and transporting someone to a hospital.
The George Washington University report is obviously slanted and does not provide a clear picture of emergency medical service delivery in the United States. In fact, some who were listed on the George Washington University report from the fire service have withdrawn their names.
If you look at the latest Journal of Emergency Medical Services survey of the 200 most populous U.S. cities, the fire service delivers over 90% of emergency medical response, and these are not the smallest cities, these are the most populous cities.