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It's Operational
by Louis N. Molino, Sr.

Why Are Operations the “Forgotten” Part of EMS?

The operations side of EMS is something that needs to be discussed in the light of day as opposed to the din of the night — and that's something I hope to do in my new column.

So why do I think operations are the forgotten part of EMS? Well, maybe forgotten is too strong of a word for the title of this article, but in my opinion it helps put an important issue in the spotlight.

For me, the only two people who count in EMS is the Patient and the Provider — note the capital letters are intentional as I feel that in this case the words are proper nouns and not just nouns. Everything that we do in EMS centers and focuses on these two people and everything that is operational supports them — or at least that’s how it should be. But all too often this does not happen in the real world.

As well as my 27 years in EMS working in every conceivable environment both as a career and as a volunteer Provider, I've also had the good fortune to literally travel across the United States and the world. It gave me the opportunity to observe not only EMS but fire and at times even police operations. All of these experiences have led me to the conclusion that the operations side of the equation is the missing link of sorts.

Take away those things directly carried out in caring for the Patient, and operations in EMS relates to everything else.

Now don’t get me wrong, the Patient is in most cases our top priority; the only time they're not is where matters of the Providers' safety are at stake. But all too often in many EMS responses, the operational side of the response is wrongly assumed to be secondary. In fact, the operational side is in many ways vital to the ability of the Provider to do his/her job, which in the majority of cases is care for the Patient. When the operations side of the response breaks down, all too often the Patient-care aspect suffers. The end result is the Patient suffers.

Now some of you who know me know that I have always cast myself as an “Operations Guy.” Whenever I'm sat with others at a conference or around a kitchen table discussing EMS, I'll always somehow try to turn the conversation to the operational aspect of the response whereas many folks are concentrating on the medicine side of the incident.

There is no doubt that the medicine is a huge part of the business we call EMS. But every single response has multiple operational aspects. Of course, these normally go well and no problems are encountered. These likely represent 98 percent of the calls and situations that are daily occurrences in EMS and all the other areas of emergency services. However, in those 2 percent of the cases were some operational aspect of the response goes awry then we see degradation of Patient care and it can even result in the wellbeing of both Provider and Patient being put at risk.

In the coming months, I'll be focusing on various operational aspects of EMS. I'l try to dissect these operations so that you can all find ways to make your EMS operations better EMS operations. I will likely say things at times that some of you disagree with, maybe even at times vehemently so. But that’s OK as long as we all keep an open mind and realize that different is not necessarily wrong and that everyone as a professional has a right to their opinion and to express it professionally in a forum such as this.

The bottom line is that there needs to be open and forthright information exchange, which will help create better working environments for those two ever so important people in EMS — the Patient and the Provider.

I look forward to your EMS operational-related comments and questions via the member comment function on this site and I can also be reached at

About the author

Louis N. Molino, Sr. is a 27-year veteran emergency services provider. He has served in suburban, rural and urban environments in varied capacities from field provider to chief officer. He has been published in a number of national trade magazines and has been a contributor, reviewer and editor for a number of texts. In 2006 his textbook Emergency Incident Management Systems: Fundamentals and Applications was published by John Wiley and Son’s. He is currently a fire protection, homeland security and EMS consultant and an emergency services instructor based in Bryan, Texas where he resides with his four adult children and a very special lady that puts up with him. He can be reached at and welcomes your input.

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