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The struggle of EMS in the fire service


“Why can a firefighter choose to not do EMS if it is a main focus of an organization and the fire service itself?” asks Limmer.

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This article was originally posted in the Paramedic Chief Leadership Briefing. Subscribe today for more research insights, leadership tips and operational strategies delivered to your inbox.

A recent FireRescue1 article paints a picture of EMS in the fire service that I don’t necessarily agree with.

Before I continue, I respect the author for his contributions, even if I don’t entirely agree. He has an opinion and shares it in a public forum. It is essential that we can disagree as colleagues and avoid the animosity that seems to have overtaken society in other areas of our lives. My respect for those in the fire service is unwavering.

In, “Why so many firefighters don’t become paramedics,” Ben Thompson lists five reasons why firefighters don’t “make the move” to paramedic. Thompson presents these well and logically, but ultimately makes the case that EMS should be more closely aligned with healthcare than the fire service.

Following is my response to these 5 factors impacting firefighters’ decision to become paramedics.

Factor 5. The NREMT

Thompson posits the NREMT examination is one of these limiting factors because, as he writes, “Firefighters and written tests go together like oil and water.”

Firefighters line up for grueling lieutenant exams, knowing it is required for a career path (and often with a degree requirement, but I will save this for another day) but the NREMT is too much for the brave members in the fire service?

While the NREMT is challenging, it should be to grant entry into a vital role like paramedic. While boards for other health professions are also challenging (and longer and more involved), people don’t avoid becoming radiologic technologists, nurses or dental hygienists because they don’t want to take the exam at the end.

Factor 4. Time is money

While Thompson notes many firefighters are taking second jobs to stay afloat, paramedic school isn’t always a pay cut. Some firefighters are paid overtime by contract if they exceed a set number of hours in class, and most get a stipend once they become a paramedic.

Factor 3. Limited online options

Determining whether limited online course options are a limiting factor driving firefighters from becoming paramedics is a mixed bag. In my experience, many prefer in-person education over online education for the connection created in the classroom. In-person pass rates are often better. While some public safety professions pursue online degrees, these don’t have a skill and clinical focus like a paramedic course, and many of these schools aren’t regionally accredited, a gold standard in post-secondary education.

Factors 2 and 1. The ambulance and organizational culture

I’ve combined these because they are so closely related.

Thompson writes, “being assigned to an ambulance means longer hours away from the station and more territory to cover. It brings paperwork, liability and the constant battle to remain professional in the face of disgruntled nurses at overcrowded hospitals.” He further states, “many are choosing to ride backward rather than risk being assigned to an ambulance for the next 20 years.”

For the record, the nurses are disgruntled for many of the same reasons your paramedics are: they are overworked.

Why can a firefighter choose to not do EMS if it is a main focus of an organization and the fire service itself? While I understand the concepts of seniority and how unions work, at what point will being assigned to an ambulance become mainstream and not the penalty box – or the assignment that firefighters bid away from as soon as they can? And why do organizations who rely on EMS for job retention and financial survival ridicule an interest in EMS and subvert those who embrace it?

5 things that would help EMS thrive in the fire service

While I am not convinced the fire service is the ultimate place for EMS, there are ways to make it thrive there. I will spare you the lengthy details, but my list of 5 things that would help EMS thrive in the fire service:

  1. Valuing education
  2. Placing EMS culturally in a place of prominence within the fire service – and the firehouse itself
  3. Sharing the load and requiring everyone to work on the ambulance
  4. Making EMS a requirement in the promotion pathway
  5. If the EMS side of the house works a lot more (and documents more and is exposed to more liability per the article), pay them more – a lot more

Dan Limmer is a paramedic, educator and police officer who has been involved in public safety for more than 35 years. He has authored more than a dozen EMS textbooks including the Emergency Care textbook and is a frequent international conference speaker. He is the Chief Knowledge Officer at Limmer Education, a company he co-founded to publish high quality study and test prep programs. Limmer is a member of the EMS1 Editorial Advisory Board.