Everybody is familiar with the fairy-tale story of Cinderella and her wicked stepmother and stepsisters. The stepmother would have Cinderella do the dirtiest housework. Cinderella would scour the dishes, tables and floors and would be forced to clean her stepmother's and stepsisters' bedrooms. She slept in a loft, on a broken-down straw bed, while her sisters slept in fine rooms, with fine floors, on beds of the very newest fashion, and where they had mirrors so large that they could see themselves at full length from head to foot. Cinderella bore all this mistreatment patiently and did not dare tell her father, who would have scolded her, since his wife (stepmother) ruled him entirely also.
Unfortunately, 30 years after the EMS Act was passed by Congress and signed into law by President Nixon in 1973, in many fire departments and among many individuals, EMS is not accepted. Those who perform EMS duties are treated like a "stepchild" in the Cinderella story. Regrettably, the horror stories abound and I hear them frequently.
In one major city, the medics, who are civilians in the fire department, are not allowed or welcomed in the firehouses. I have heard many sordid stories, including when medics drop off backboards at the engine house, the board is grabbed and the door is slammed in their faces. Not even a "Hey, want a cup of coffee?" There have even been reports of fistfights on scenes between medics and firefighters in this major city.
In another major city, you might as well paint a yellow line down the middle of the engine house with the firefighters on one side and the medics on the other side. Heaven forbid if anybody crosses the line. In one major West Coast fire department, a fire department union official even published an article in the union newsletter advocating privatizing EMS in the department.
In still another example of the EMS stepchild mentality, I walked into a fire chief's office one day and he had a sign hanging on the wall behind him with the word "problEMS" in a mounted frame. It was not a far walk to guess the attitude toward EMS in that department when the chief sets that kind of tone.
Finally, one Midwest city fire chief who has EMS among his many prejudices has lost over 70% of his EMS personnel over the last 11/2 years due to his treatment of EMS personnel as second-class citizens and where harassment is the order of the day.
In another sad commentary, the malcontent talk usually reserved for the bunkhalls and kitchens of engine houses recently made its way into a trade journal. The article was written by a paramedic/firefighter who espoused that, "EMS is placing considerable stress on our organizations." He went on, "The time has come for us to evaluate where we stand with fire-based EMS and open a new dialogue regarding our vision for the future." The author contended that performing fire-based EMS resulted in "serious challenges and difficulties that we didn't bargain for" and "have diluted our attention away from the fire mission." The author further contended that we are financially draining resources and depriving firefighters of training, pre-planing, rehab and physical fitness because they are running EMS calls.
It is all bad? Absolutely not! Unfortunately, the "EMS stepchild" mentality is isolated to departments whose thinking has not come into the 21st century yet or individuals in the fire service who think unless a call has fire or smoke showing, they should not even be bothered. During lectures, I sometimes make the statement, "Most fire departments are really nothing but EMS agencies that sometimes go to a fire call." Without exception, somebody in the room gets mad. I then challenge those people to name one fire department that provides EMS and that does more fire than EMS calls. Obviously, they are hard-pressed to name one and they usually let their comments drop.
This mentality has not gone unnoticed by those outside the fire service. Jack Stout, an economist who is a strong advocate of privatizing EMS systems, made the following statement several years ago: "Why not cross-train firefighters to be ice cream vendors or computer operators since they will leave the patient's side if a fire call comes in." Opponents of EMS in the fire service continue to argue that fire departments only do EMS to save jobs since there are fewer fires.
Where does this stepchild mentality come from? Based upon my observations and discussions with others, the majority of those who are not proponents of EMS being performed by the fire service are those who joined the fire service only to fight fires. Somewhere during their career, the fire department that they belong to changed their mission and started doing first responder runs and/or starting doing EMS transports. Grudgingly and with their fingernails leaving marks on the brass pole, they were dragged away from their handlines and forced to wear latex gloves. Others simply do not like doing EMS since it increases their workload. Many of my fire service EMS colleagues refer to these individuals as dinosaurs and jokingly promote stepping on their eggs so that no more dinosaurs are hatched.
No one is suggesting that EMS is more important than fire suppression or prevention. To the contrary! Most fire departments have as their mission to preserve life, protect property, and the environment. Providing EMS, fire suppression and prevention, doing hazmat and technical rescue falls into that mission and are all equally important. While certainly there is no joy in getting up at 3 A.M. for someone who has been ill for a week, many in this profession accepted the job with the knowledge that service to the citizen is paramount and that it is not an 8-to-5 job.
But many feel the future looks bright. Those paramedics of the 1980s and '90s who were the subject of the jokes during fire classes are now moving up to the chief officer ranks. All over the country, firefighters are rising through the ranks to the fire chief position while still holding their paramedic licenses or were once paramedics. Others who may not have been paramedics but who are visionaries and forward-thinking individuals are becoming fire chiefs. They realize the value to the community of the fire service performing an EMS mission and welcome the opportunity.
How fitting is it that the new U.S. Fire Administrator, Dave Paulison, once was a street paramedic or how appropriate is it that several recent presidents of the International Association of Fire Chiefs (IAFC) were licensed paramedics or EMTs? The International Association of Fire Fighters (IAFF) recognized the value of EMS in the fire service about 10 years ago when it created an EMS Department to assist its locals with fire-based EMS issues.
So as we stand on the threshold of a new year and the 30-year anniversary of the signing of the EMS Act into law, the time has come to put aside any resistance and defiance to EMS in the fire service. Whether you do EMS transport or just first responder runs, performing EMS in the fire service is good for the patient, the community and the fire service.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief of Special Operations for Jefferson County, MO. He retired in 2001 as the chief paramedic for the St. Louis Fire Department after serving the City of St. Louis for 25 years. He is also vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC). He is a frequent speaker at EMS and fire conferences nationally and internationally, and is on the faculty of three colleges. Ludwig has a master's degree in management and business and a bachelor's degree in business administration, and is a licensed paramedic. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636-789-5660 or via www.garyludwig.com.
