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How to make firefighters work with you

Knowing these communication tips can make calls go more smoothly

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. 

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