Transitioning to Fire-Based EMS Systems

July 30, 2010
Reports continue to stream in from all over the United States and Canada of metropolitan areas and smaller communities that have transitioned or are beginning to change over to fire-based EMS systems.

Reports continue to stream in from all over the United States and Canada of metropolitan areas and smaller communities that have transitioned or are beginning to change over to fire-based EMS systems.

More communities are recognizing the values that a fire-based EMS system can provide. Among many values, one of the most notable is eliminating duplication. Instead of two chiefs, two communication centers and two training centers, everything is combined into one operation to save money and improve efficiency, since a fire department providing first response and a non-fire department EMS transport system have the same mission — to deliver emergency medical care to a patient. On April 25, 2010, in another death-blow to yet another public utility model (PUM) EMS system, the Metropolitan Ambulance Service Trust (MAST) in Kansas City, MO, was disbanded and EMS transport was taken over by the Kansas City Fire Department. Kansas City Fire Chief Smokey Dyer said he anticipates improved response times and a possible savings of $1.6 million.

The idea of a PUM was devised by an economist in the 1980s with an emphasis on finances, not clinical performance. Under the PUM system, a quasi-government agency with a board of directors oversees the EMS system, including all capital assets and accounts receivable for EMS billing. The PUM then contracts with a private ambulance company to handle day-to-day operations, including personnel matters. The contracted private ambulance company usually projects staffing levels based on time of day and dynamically moves ambulances around from street corner to street corner where EMS calls are projected to occur under a process called "system status management." EMS personnel then sit in their ambulances waiting for calls to occur. Under the Kansas City Fire Department EMS system, EMS crews will be able to take breaks at fire stations between calls.

Also moving to a fire-based EMS system is the Orlando, FL, Fire Department. As reported in the Orlando Sentinel, the traditional method in the city of the fire department providing first response and a private ambulance company doing transport will soon come to an end with a plan proposed by the fire chief and supported by the mayor. The plan calls for the Orlando Fire Department to transport about two-thirds of the most serious patients while the private ambulance company, Rural/Metro, will transport the remaining one-third of patients. All Orlando firefighters are already EMTs or paramedics.

Another major city beginning to transition EMS into the fire service is Cleveland, OH. A six-member committee of fire and EMS personnel has begun the process of designing what the new system will look like. On May 10, the mayor announced an integration of both EMS and fire, not a merger. The integration, according to the mayor, is designed to save money during tough economic times.

Other large cities that have explored in recent years or are considering merging fire and EMS include Pittsburgh, PA; Atlanta, GA; Charlotte, NC; and Honolulu, HI. Cities in the last 15 years that have merged EMS into the fire department include New York City; St. Louis, MO; San Diego and San Francisco, CA; and Tallahassee, FL.

Lots of smaller communities have merged or are also looking at merging fire and EMS. In Garner, NC, on June 22, the Town Council voted to notify Garner EMS and Rescue that its contract to provide EMS services will be terminated by next July. The town has formed a work group that will meet with the Garner Volunteer Fire-Rescue Department, Garner EMS and Wake County to flush out details of the transition. After several meetings, the merger is expected to occur by year's end.

In Pearland, TX, near Houston, the mayor believes the time is right to merge the two departments, considering the tremendous growth the community has seen and the opportunity for a better organization and more control for the city. And on June 28, in a 5-0 vote, the Board of Selectmen for the Town of Belchertown, MA, voted to hire its first four full-time firefighters and merge the ambulance service into the fire department.

The recent plethora of communities, large and small, examining the benefits of fire-based EMS is noteworthy. The key to the success is that the EMS mission is valued and supported by those at the top.

GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 32 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

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