The nature of public safety is in flux and has always been. Few people, with the exception of a baby with a wet diaper, like or embrace change.
Agencies have to respond appropriately to a constantly changing operational environment, matching resources and supply to the demands of the workplace. Perhaps EMS organizations are the best example of this dynamic.
The argument between city leaders and fire union officials in Sacramento on how to staff their EMS units is emblematic. How do organizations faced with multiple pressures of budget, staffing and call volume respond in a way that is ethically most appropriate?
The nature of the fire service has been changing for decades. Since the 1973 publication of “America Burning,” the landmark position paper on the importance of fire prevention, the occurrence of fatal fires in the United States has declined significantly. Much of the success comes from the efforts of the fire service through increased building regulations, better code enforcement, sprinkler system installation and innovations in fire suppression technology.
Simultaneously, as the population grows older and arguably less healthy, the calls for EMS service have steadily climbed. Many fire agencies have responded appropriately by placing greater emphasis on EMS duties while maintaining fire protection services. But the costs of both can be high to taxpayers, with little evidence supporting better patient outcomes. In other instances, poor implementation of EMS services has led to expensive models which may not significantly improve community health overall.
The fire service is not the only segment of the health care industry trying to respond or adapt to change. EMS agencies, both public and private, struggle to maintain funding in a dwindling reimbursement market. While community paramedicine projects are proving their effectiveness in improving community health while reducing the cost of service, some EMS organizations and providers believe that emergency response should be their only function.
I don’t advocate for one type of system or another. I’ve seen plenty of great fire-based, third service and private EMS providers perform tremendous work in protecting and serving their communities.
I’ve also seen numerous agencies of all types fail to accomplish their mission because they lose sight of it. The only constant in life is change. EMS agencies must embrace that and work diligently to provide appropriate services in a responsible and ethical manner.
