Marriage Counseling Part I: The Dysfunctional Fire-EMS Relationship

Washington, D.C. Fire and EMS, in its continuing efforts to put lipstick on a pig, is integrating civilian medics into their department to form a new “integrated, all-hazards agency.”

Predictably, the fire and non-fire factions of EMS debated the news on various internet EMS forums with a level of enthusiasm and lack of decorum usually reserved for monkey-poop fights at the zoo.

Except, of course, that monkeys are vastly more entertaining — and not to mention, more accurate — when they fling poo at each other.

Understandably, career firefighters bemoaned the fact that civilian medics would be allowed to enter their system with pay parity, rank and seniority intact, all without the benefit of promotional exams or additional training.

Career civilian paramedics rejoiced and cried “Hallelujah!” at the news that someone had finally had the sense to reward their skills and knowledge as being on par with their peers in the fire service — and they didn’t even have to drag hoses!

The debate prompted a forum moderator here at EMS1 to pose the question, “What will it take for medics to achieve equality in the firehouse?

Obviously, the relationship between fire suppression and EMS is dysfunctional. Everyone except the proponents of dual-role systems realizes it. The question is, can the relationship be mended?

In reply, one poster threw out this verbal grenade:

Sorry to say it, but companies like AMR are the main cause of inequality in the firehouse. There are plenty of great AMR medics, but AMR in general looks at profit before people.

Aside from the frightening naiveté of such a statement, the poster never even bothered to address the moderator’s original question of what it will take for EMS to achieve equality in the firehouse. Naturally, the statement chapped my behind like a pair of Brillo underwear, and put me in the interesting position of defending for-profit EMS, even though I believe that a taxpayer-funded, third service is the ideal EMS system model.

This attitude is an object lesson in why EMS receives no respect from other healthcare professions; not only do we have a propensity for impotent bellyaching, we also eat our own young. Paid crews look with disdain on volunteers. Third service municipal systems ridicule fire-based systems. Senior administrators worship graven images of Jack Stout, while their crews burn him in effigy. And all of them look down their noses at for-profit ambulance companies like AMR or Rural Metro.

Providers identify themselves as firefighter medics, or career medics, or vollie medics or hospital medics. Why can’t we just see ourselves as medics?

We can’t even agree among ourselves who we are, and trying to integrate firefighting and EMS into one agency simply deepens our identity crisis.

If you want to look at the economic reality of fire-based EMS, the EMS runs make up roughly 80 percent of the run volume for departments that do both fire suppression and EMS transport. Yet you will find that nowhere in this country exists a fire department that funds its training and operations that way. In fact, it's usually just the opposite; they spend 80 percent of their budget, 80 percent of their promotional pathways, and 80 percent of their training on preparing for that 20 percent portion of their calls.

The blunt truth is, for most fire departments in this country, EMS is a means to an end — nothing more. It makes for a handy way to pad run volumes when the time comes to ask the taxpayers for raises or shiny new ladder trucks. The cities that have merged fire and EMS in the name of efficiency and cost savings have discovered that the dual-role agency is actually less efficient. Costs have inflated, and the crews – both EMS and fire suppression – are more dissatisfied than ever.

If you want to consolidate municipal services and save a ton of money, I have a better, more workable idea: merge the Fire Department and Public Works Department. Have a ladder truck follow the garbage truck on its rounds. Make the probies toss the garbage cans around, and have the senior firefighters conduct safety inspections, smoke alarm checks, and read water meters. Trim the trees around the power lines as you go and leave the limbs for pick up the following week. Have the tree limb pick-up crews test water hydrants on a set rotation. That way, every single house in the district gets a safety inspection once a week, every fire hydrant gets tested multiple times a year, and every firefighter in the department gets to know their district in intimate detail.

Hey, it could work. If anybody wants to try it, remember that I thought of it first.

But that doesn’t answer the basic question: What steps need to be taken for paramedics to achieve equality in the firehouse? I have some suggestions in that regard that I’ll explore in the next few columns.

Until then, I invite your comments…

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