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The nation's fire service is at war, as it relates to emergency medical services. Not a police action or a conflict but a war. The combatants are The Fire Service vs. The Fire Service, The Fire Service vs. The Public Sector, The Fire Service vs. The Private Sector, and The Fire Service vs. Managed Care.
Five thousand years ago, the Chinese general Sun Tsu wrote The Art of War. His work has been translated and rewritten throughout the years because his basic principles are timeless. Sun Tsu defined war as "the ability to impose our will on the enemy." The weapons of war, he wrote, are intelligence, speed, deception and tactics. If you will accept for a moment that we are at war, do you have the tools within your organization to wage war effectively?
The Fire Service vs. The Fire Service. The fire service is a collection of special-interest groups and we are suffering an identity crisis. We divide ourselves along multiple lines; full-career vs. combination vs. all-volunteer, major metropolitan vs. small city, urban vs. suburban vs. rural.
We also divide relative to who provides EMS vs. the puritans that provide no EMS. Even those departments that provide EMS are divided on how much service is delivered - basic life support (BLS) first response only, advanced life support (ALS) first response, BLS transport, ALS transport and billing vs. non-billing.
What is our role? Since the 1960s, we have effectively reduced the threat of "the red dragon" (fire) by our fire codes, detection systems, suppression systems, fire prevention education and fire-resistive structures. Many of our newer cities have a very low fire problem. Even our older cities are retrofitting their infrastructure and seeing a reduction in their overall fire problem. Is it time for a professional metamorphosis?
Now, before you fire up the tar bucket and get out the bag of feathers, we're not saying we need to reduce the number of traditional fire service resources. The United States continues to lead the industrialized world in deaths by fire. Also, with the advent of plastics, the time-temperature curve has shifted dramatically to the left. Our fires rapidly advance to flashover. We continue to have high life and property hazards that need timely response. However, we do need to look at new ways to serve our communities while we continue to reduce the fire problem. Within the fire service, EMS has become a foster child. We are a part of the family but not a full part.
The Fire Service vs. The Public Sector. Three major cities New York, San Francisco and St. Louis have amalgamated the provision of EMS under the aegis of their fire departments. Reasons include less duplication of existing command, control and communication; efficiency; effectiveness; and, for the policy makers, eventually less costly. All good reasons. However, many within the existing workforce, both fire service and the third service EMS, feel threatened and fearful. Many will become casualties and some will become walking wounded.
It is incumbent upon the fire service to fully recognize the importance of the role EMS plays and minimize the shell-shock effect in the transition for all involved. Embracing EMS as a full fire service partner will go a long way in terms of retooling the organization for future survival and success. Clearly, both organizational structures and cultures can learn from each other with the end result being the emergence of a highly effective and community receptive organization.
The Fire Service vs. The Private Sector. The consolidation of the ambulance industry has created all kinds of chaos. The Chinese definition of chaos is danger and opportunity. There are now only two of the big invested-funded companies left standing (although by the time this goes to print, that may change) Laidlaw/AMR (American Medical Response) and Rural Metro.