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How to make firefighters work with you

EMS1.com News

January 21, 2013


The Art of EMS
by Steve Whitehead

How to make firefighters work with you

Knowing these communication tips can make calls go more smoothly

By Steve Whitehead

Some of the best advice I ever received as a young paramedic came from my first field instructor. We had just climbed back into the medic unit to leave the scene of a minor traffic accident. Our patient had refused our care and, as we buckled in and prepared to reenter traffic, the firefighter from the engine crew stopped traffic and waved us into the empty lane.

My preceptor and the firefighter exchanged a friendly wave and off we drove. Then he spun in his chair and made an observation that I've never forgotten. "You see those guys?" he asked, gesturing toward the fire engine. "When everything hits the fan, those guys will make or break your call for you."

I quickly figured out exactly what he meant. It wasn't long before I was a cleared paramedic out there in the 911 system running calls on my own. Soon, I was running those calls that my preceptor was talking about, the ones where things went sideways and there was too much to do and with too few hands.

What I found was that the single greatest factor in determining how smoothly those calls went was the fire crew that responded with me. (A helpful partner makes a considerable difference as well.) If the crew was engaged and motivated to work with me, I could sort out just about any challenge. If the crew was disengaged and unmotivated, even the simplest tasks could feel like pulling teeth.

So how do you foster that kind of working relationship that motivates firefighters to want to follow your lead and work with you on scene? Regardless of how strong or fractured your current relationship is with your local fire crew, here are a few tips that you can use to start strengthening that bond immediately.

Begin by learning about your local fire departments rank structure and refer to officers by their rank unless they request differently. Firefighters operate under a chain of command. Referring to an officer by rank is a sign of respect. The company officer should be riding in the front passenger seat of the fire apparatus.

If you aren't sure of the commanding officers rank, start with the bugles (those silver or gold bars on the collar.) One bugle is a Lieutenant, two bugles is a captain and any combination of crossed bugles can safely be referred to as chief.

It's OK to not know who the company officer is or what their rank is, but it isn't OK to ignore the command structure entirely. Make an effort to identify the company officer and speak to them with respect.

If you are first on scene, take the time to give the arriving fire crew a basic size-up when they arrive. I'm sure you've had the experience of showing up on scene and being ignored by the crew working the scene. We know this intuitively, but many providers insist on leaving the fire crew in the dark until they have a specific request.

Nobody likes being ignored and fire crews are no exception. As the crew enters the scene identify the company officer and give them a quick run-down of what has happened so far before you request their assistance.

Look up from your patient at the first appropriate moment and say something like, "Hi Lieutenant, thanks for coming. This is Amanda and she has asthma. It looks like she's having a pretty significant attack right now and I'd like to get her an Albuterol treatment first thing. Could we have one of the guys set up a nebulizer? Then I'd like to get her moving toward the ambulance."

When you provide the fire crew with a quick scene size up and let them know what you are thinking, you show them the same respect that they show you when you arrive as the transporting crew. You also send the message that you see them as a vital part of your team.

Be polite and say thank you, especially when fire service members carry your patient.  This simple habit takes no time and it goes a long way to express appreciation. Get in the habit of saying thank you every time a firefighter lifts one of your patients or your things.

Ultimately your patient and your equipment is your responsibility. Don't fall into the mistaken assumption that firefighters are well paid bellhops who are obligated to be your Sherpa. Any time someone on scene carries a patient or a piece of equipment, you should consider that moment the same way you might consider a friend who carries your suitcase in an airport.

You are the primary caregiver. That patient is your responsibility. Those things are your things. Everyone else is just helping. You should thank them for their help.

Provide follow up on patients to your fire crews when possible. Often, the fire service personnel who assist on scene never get the benefit of consulting with hospital staff on the patient's differential diagnosis. When you receive follow up on a patient's diagnosis, course of treatment and outcome, make a point to drop by the firehouse and let the crew know what transpired after the initial call.

Those discussions also create great opportunities to talk about what went well on the call and what could have gone better. Having those types of discussions is infinitely more useful than complaining about poorly trained firefighters. And while we're talking about it…

Get involved in mutual training. Offer to train fire service crews on medical subjects and request to participate in fire service trainings that have an EMS component (such as hazmat, extrication and technical rescue).

Having an interest in training your local fire crews and using their training to expand your own knowledge is a good way to send the message that you see yourself as part of a single team. Doing this kind of training before the big call can make some of your most challenging EMS moments a lot less stressful.

Include the firefighters in patient care decisions that involve them. This is a simple habit that we often neglect, especially after a few years in the field when we become confident in our decision making.

When the time comes to move a patient from a vehicle, carry them out of their homes or find a good place to initiate a resuscitation effort, communicate your plan to the team and then end with a phrase like, "Does that sound good?" or "Does anyone have a better way to do it?"

Asking those types of questions communicates that you know that your plan isn't always the best way to get from point A to point B. By the way, if you are under the impression that your plan is always the best idea I'm sorry to burst your bubble. Experiment with asking these questions and you will be amazed at the creative ideas that occasionally get offered up.

You'll never get to hear any of those ideas if you always bark orders like an EMS general commanding your troops. Let the fire service personnel know that you respect their ideas and opinions and they will be more enthusiastic about following your plans when you do need them to make something happen in a hurry.

I hope you have spent the time to develop a good working relationship with your local fire crews. I've always enjoyed a great working relationship with my local engine and truck companies and it begins with my genuine respect for their role in the EMS continuum of care. It has made my job immeasurably easier throughout my career. 

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at steve@theemtspot.com or at Steve.Whitehead@EMS1.com.
Comments
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Martin Emanuel Martin Emanuel Tuesday, January 22, 2013 11:36:36 PM Excellent article Google NLP medical Metaprograming.
Steve Jacobi Steve Jacobi Wednesday, January 23, 2013 2:18:25 PM Around here the FF/Paramedic is in charge of the patient whether he or she is on the engine or ambulance. The FF/Paramedic will remain in charge until the patient is at the hospital or the patient can be released for BLS transport by the private ambulance even if it has Paramedics on the truck. If ALS is required, only a FF/Paramedic is in charge of the patient. Consistency is key.
Skip Kirkwood Skip Kirkwood Wednesday, January 23, 2013 4:24:52 PM Strong work, Steve. And oh so right on target!
Skip Kirkwood Skip Kirkwood Wednesday, January 23, 2013 4:49:31 PM One thought. You don't have to "make" firefighters work with you. They showed up to do that, and they will do their jobs well unless you "work" to make them NOT work with you. If you were the kind of kid who couldn't be friends with the kids from the next block, this might be an issue for you. Show disrespect, or take for granted, and your road will be long and difficult. Those guys are EXPERTS at behavior modification.
Jon Politis Jon Politis Wednesday, January 23, 2013 5:10:14 PM Great piece Steve! Respect is the foundation of good teamwork...
J Dale Johnson J Dale Johnson Wednesday, January 23, 2013 5:13:48 PM Be nice, be respectful, and be appreciative. And practicing sausage biscuit, doughnut, or home-made lasagna diplomacy works really well, too.
Mike Grill Mike Grill Wednesday, January 23, 2013 6:56:00 PM Spot on Buble.
Dan Greenhaus Dan Greenhaus Wednesday, January 23, 2013 7:03:46 PM You know what I get from this article? that EMS should always ask for approval from the FD to do ANYTHING! "When the time comes to move a patient from a vehicle, carry them out of their homes or find a good place to initiate a resuscitation effort, communicate your plan to the team and then end with a phrase like, "Does that sound good?" or "Does anyone have a better way to do it?"" When you phrase this, you are ASKING PERMISSION to do YOUR JOB. That's BS. "You are the primary caregiver. That patient is your responsibility. Those things are your things." I agree, the patient is your responsibility. It's YOUR call as the EMS professional, and as the EMS professional that you are, you should be in charge of the scene. The Fire Chief, Captain, or Lt might be on scene, but it's a medical call, which means the EMT or Paramedic runs the call. In the FD world, the EMT running the call should be the equal to a FD Lt, since they are running the call and responsible for their crew. I am not saying you should be rude or disrespectful to fire officers (or police officers for that matter), but you don't need their permission to do something. Do the Fire Officers ask you how you to extricate the patient from an overturned car? on a fire scene, does he ask you how to put the fire out? Of course not, they are fire professionals, and they are there to do their job, and you are assisting them in what they need done. And they won't thank you for coming to a scene; that's your job, and you do it because it's your job. Would you expect a cop to do the same thing? no, they do their job, and you theirs, and you both respect each other knowing you have jobs to do (and always wave when you pass each other), and want to do everything you can to ensure both of you make it home at the end of the shift. If the FD beats you to the scene, and starts patient care, great, that's what first responders are there for. Once you, as EMS arrive, it becomes your patient; they should be giving you a report on what is going on, what they have done, etc, and then letting you do your work. If you need help with something, feel free to ask them, but you shouldn't be asking permission to do your job. They know their job, and they should be offering to help you with what they can because it's their job. I know the author is a firefighter/paramedic, who works for a fire department, so the entire post is biased towards the FD doing everything and the ambulance playing second fiddle to the FD. and that might be how it is where he works. But it also ensures that the EMS will never be treated as an equal to the FD. If you want to be considered a professional, than you need to ask like one, and asking someone else for permission to do YOUR job isn't a sign that you are a true professional. I work for an EMS system, that isn't dependent on the fire department. I've worked in cities that the FD goes on calls, and they know their job. If they beat us to the scene, they assess the patient. then they give us a report, and step back, letting us do our job. If we beat them to the scene, they will come in and ask them if we need anything. Maybe they will ask if anything needs to be carried out, and if I need them to do something (like help with carrying the patient), I will. and if they think of a better idea, that's ok, but in the end, it's my call. As the author said, "That patient is your responsibility", and in the end, as the medical professional, it will be done my way, because patient care is MY responsibility.
Dan Greenhaus Dan Greenhaus Wednesday, January 23, 2013 7:47:09 PM Respectfully disagree. All the article says is how EMS needs FD's permission to do their job, and if you do what the author says, it will foster a culture where EMS will never be seen as an equal to the FD. After all, when was the last time the fire department asked the EMS crew for their permission or opinion on how to fight a fire? or a cop asked EMS what was the best way to stop an armed robbery? If you are a professional, other agencies will treat you with respect. having to ask for permission on how to do the job you are the expert in is a sign you aren't respected by the FD, and will never be treated as a fellow professional.
Frank McLaurin Frank McLaurin Thursday, January 24, 2013 2:30:12 AM Trying to make firefighter work with you is like trying to push a cow uphill with a rope. Just step back, they will take care of the situation with you.
Dave Leclair Dave Leclair Thursday, January 24, 2013 4:16:09 AM Good article, we are all there for the same thing "PATIENT CARE". The more the cooperation the better the care.
Skip Kirkwood Skip Kirkwood Friday, January 25, 2013 4:52:10 PM Dan, I didn't read that at all in the article. This article could be entitled "How to develop great teamwork with your local firefighters" (or whomever else might provide medical first response). I didn't hear "permission" anywhere. Your police and fire comparisons don't work for me either - EMS folks are not trained and experienced in doing police work or suppressing fire. Firefighters whose job includes running medical calls are co-equals, and when you can work together with them, it is great! One of the many really great things about the environment in the Wake County EMS system is that our FDs are full partners in the EMS system, work with us, and the citizens really benefit from that partnership!
Brendan Bourne Brendan Bourne Friday, January 25, 2013 6:46:17 PM I'm sorry but I couldn't disagree with you more, nowhere in the article was anyone asking a FF for permission to do a job. What was discussed was a colaborative, team effort in solving a problem. Do you not discuss your plan with your partner from the ambulance - how is it different to discussing the plan with other attending services? If someone is to be extricated from a building and FF will be assisting, surely you would include them in the decision making process? Often people become very patient orientated and forget to see the bigger picture, perhaps one of the firefighters can see another way of extricating the patient - possibly more safely for the patient and attending crews. There is certainly more than one way to skin a cat - or get a bariatric patient down a flight of stairs or remove someone from the wreckage of collision. Arrogance and lack of consultation with others involved in a scene/call will not develop a positive working relationship - only perpetuate the "Us and Them" mentality. Rest assured you're not the only person with experience, knowledge and scene management skills.
Rommie Duckworth Rommie Duckworth Friday, January 25, 2013 7:25:32 PM Dan, it seems the point of disagreement is in the style of "in charge of the call" that you describe. As a both a fire officer and paramedic I very often as my crews "Does that sound good?" or "Does anyone have a better way to do it?". I'm not asking them permission to go ahead with my plan. I am incorporating crew resource management to ensure that the best ideas to manage the (patient, fire, hazardous material, rabid dog, angry cat) are rapidly identified and efficiently implemented. To say "I'm in charge and this is the way you're gonna do it." generally shows shows short sightedness and will not get your crew working together according to your plan, even if you're in the rare situation where you have clear and direct authority over all of the responders involved.
Cheryl Daniel Cheryl Daniel Friday, January 25, 2013 11:32:55 PM I wish people would stop reading into everything. The article was a well written piece with good points about teamwork. It is not about asking permission, one service over the other, etc. I began my EMS career as a volunteer firefighter/basic EMT. As a paramedic on the ambulance and in the ER, I always had the utmost respect for the firefighter who responded with me, paid or volunteer. It did not matter to me whether they were highly trained as paramedics, first responders or without any medical training at all. They showed up. I always made it a point, even during a code, to say 'please' and 'thank you'. I benefited from their expertise in extrication and moving people. Why would any paramedic assume that just because it's 'their patient' that they know best about everything? How arrogant. If that were the case, I'd sure like to see them run that call alone and get the patient to the hospital by themselves. When we arrived on our scenes, many times I would hear one of the firefighters say, "Thank God 'the girls' are here!" THAT is the biggest compliment of all. I love me some firefighters.
Tom Bouthillet Tom Bouthillet Saturday, January 26, 2013 6:43:41 AM Bingo!
Steve Whitehead Steve Whitehead Saturday, January 26, 2013 3:08:47 PM This is a great discussion. I always appreciate additional insights after I've contributed my articles.As an author, I don't always hit it out of the park on the first run through. (Or the third.) Looking back, this contribution could have had a better title. I'm not in love with the idea of "making" other people do things. I could have found a better title for the piece. We learn as we go. I'm no exception. I do, however, stand by the advice. Every bit of it. It has served me well. I know that some folks get the idea that, because they walk on scene with the ultimate responsibility for appropriate patient care that they should project their authority and be dictatorial in their delegation and decision making. (This, after all, projects confidence and lets everyone know who's in charge.) This style may work for some, but it has never been my preference. I don't think it serves us in the long run. I prefer to see my ultimate decision making responsibility in a broader context. I'm responsible for bringing the team together and using my position of authority to make sure that we make use of all of the assets available to us. That includes our knowledge assets. That includes having the humility to recognize that, even after two decades of providing paramedic care, I don't always have the best idea. I don't strive to collaborate with my fire service partners because of some sense of condescending obligation or need for permission. I collaborate with them because, often, they are absolutely necessary assets for providing good patient care, and many of them are fantastic caregivers and knowledge resources. I never ask permission. I do ask for advice. The advice I've gotten has saved my bacon on more than one occasion, and I sincerely thank my firefighter partners for that.
Dan Greenhaus Dan Greenhaus Saturday, January 26, 2013 5:03:55 PM Ronnie, great point. Here is the problem: As the Lt, you can absolutely ask for opinions, because sometimes someone else will come up with a better plan. What happens when you, the EMS officer wants things done a certain way (because it's better for patient care), but the Fire Lt wants it done a certain way? Now what are you going to do? You are the EMS expert, and you are ultimately responsible for the patient. On a medical call, the ambulance professional should be "in charge." Receive a report, than the FD can help out, but the ambulance professional should be the expert, and should be running the call. MVAs, Rescues (including barriatric carry downs), HazMats, etc, are not simple medical calls, and as such, shouldn't be treated as such. In those cases, the EMS should work with the FD, and the FD should consult with EMS/the ambulance crew. But on a medical, the transporting crew should be the EMS experts, as they will be held responsible for patient care.
Walter Waganka Walter Waganka Saturday, January 26, 2013 5:08:36 PM Good article Steve. Mutual professional respect goes a long way at creating an atmosphere of positive teamwork resulting in a smoother running call rather than one which just gets more and more chaotic and loses focus of best patient care practices. It is a two way street and any negative behaviour on the part of any first responder, whether EMS, fire or law enforcement, if not properly addressed, will not self-correct on its own, and ulitmately good patient care suffers as does the public relations perception of those watching what is going on at the scene.
Brad Miller Brad Miller Monday, January 28, 2013 9:25:28 AM This is one sided. All of this advice is good and works well since it will put the fire department in a position of being in charge, they like that. This article could and should be written for firefighters with the title "How to Make EMS work with you".
Brad Miller Brad Miller Monday, January 28, 2013 9:26:17 AM Respect needs to go both ways.
Kyle Hoagland Kyle Hoagland Monday, January 28, 2013 11:54:06 AM just another plan on how to make sure we initiate adequate ego massage to the fire department and further propagate the belief that Fire > Ambulance drivers.
Robbie Pycior Robbie Pycior Monday, January 28, 2013 12:13:49 PM some of us know we are on the same team

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