Q&A: Leveling up fire-based EMS

Kerri Hatt

Fire department mission statements across the United States vary, but have similar basic tenets:

  • To provide professional, courteous and effective emergency response
  • To protect the lives and property of citizens and visitors
  • To reduce the risk to citizens through fire prevention, public education fire investigation

EMS systems share a similar mission: to provide professional service when called upon; to provide an effective response model to provide the best customer service; and to conduct preventative measures for the public (e.g., blood pressure checks, blood glucose checks).

EMS is part of the core fire service mission, which is to protect the lives and property of our citizens and visitors to our communities,” noted Chad Deardorff, a 33-year veteran of the fire service. “The fire service is in an ideal position to deliver EMS as, unlike third service providers, fire departments are full service organizations, capable of entry into hazardous environments, complex extrications and technical rescues. Their ability to deliver EMS in austere environments is part and parcel of the fire service mission.”

Deardorff, deputy chief of the City of York Department of Fire/Rescue Services (Pennsylvania), and secretary/treasurer of the IAFC EMS Section, says, “The ultimate mission of both fire and EMS agencies is to ensure that our customers (Mr. & Mrs. Smith) receive the best possible service that each discipline provides.”

Deardorff sat down with Fire Chief to share his vision for providing the best fire-based EMS service for departments of all shapes and sizes.

FIRE CHIEF: How is the fire service positioned to provide EMS services?

Chief Deardorff: The fire service is positioned to provide EMS service by cross-training firefighters into the role of firefighter/EMT of firefighter/paramedic. Many fire departments across the country are providing an all encompassed service providing EMS protection by ensuring that all of their personnel are cross-trained in order to provide a quality level of EMS to their respective jurisdiction as they are staffed 24/7/365.

No other public safety entity has the full-service capabilities found in fire departments. Additionally, the regular interaction of fire departments with their communities through building inspections and fire prevention activities helps develop a closer familiarity with citizens, their work and home environments, and their special needs.

How should fire departments approach integrating EMS training with firefighting training?

EMS training is provided during many fire training academies across the country for a rookie firefighter. As the fire service continues to see an increase in EMS responses per year, EMS training needs to remain a vital part of a department’s training schedule.

Building on the basics is a method that many fire departments utilize for their firefighters. Firefighters are often required to complete a “rookie book” to ensure they are proficient on the basics of the fire service. From there, you start the process of training personnel to promote to driver/operators, lieutenants, captains, up through chief officers.

Use a similar process for EMS providers. During the academy, a firefighter may be trained to the first responder or EMT basic level. EMS training should be conducted to build on those basic skills. If your department’s overall goal is to have all your firefighters certified to a paramedic level or a basic first responder level, proficiency in the basic skills is critical to the care that your personnel will provide.

If a firefighter is not proficient with hose line management, suppression efforts may be delayed, which could potentially result in serious injury or death. An EMS provider that is unable to differentiate between hypotension and hypertension increases the risks for the patient.

What are the biggest EMS budgeting challenges fire chiefs face?

The cost of providing EMS services continues to rise, including:

  • Personnel
  • Employee benefits
  • Equipment
  • Disposable supplies
  • Medications
  • Ambulances

As expenses rise, reimbursement remains stagnant or, in many cases, has declined. Many departments have not seen an increase in Medicaid/Medicare reimbursements in years. Imagine in your personal budget if you continued to buy more expensive items without receiving a raise from your employer. Continued rising expenses and stagnant revenue are a combination of a failed system.

How can the fire service impact public health challenges?

Obtaining firsthand knowledge is the start of impacting public health challenges. Conducting the appropriate research to determine what opportunities exist in your jurisdiction could make a significant impact. We, the fire service, are unable to do this sitting behind a desk. Fire/EMS leaders will only know what challenges are affecting their communities if they get out and understand those challenges.

Additionally, the importance of working with our public health colleagues cannot be overstated. Often, public health agencies are unfamiliar with the services available from fire and EMS. Communication and collaboration often serve to improve services.

How should fire chiefs evaluate their EMS deployment model for success?

Evaluating an EMS deployment model is not an easy task and needs to carefully consider the resources, needs and expectations of the community. A few things a fire chief should do to ensure that their deployment model is successful include analyzing the data to determine if they are meeting the demands for service.

A chief has to understand when the peak times are for incidents. If an organization is not able to meet the needs of the community during their peak times, then the deployment model is failing.

A fire chief has to be able to prove the productivity of their agency as well as show an effective use of their resources. How does a chief do this and show some type of return on the investment of taxpayer money? One way for fire chiefs to evaluate their deployment model for success is through patient-focused data, such as:

  • Number of cardiac arrest patients that had return of spontaneous circulation
  • Average time of dispatch to initial patient contact
  • Average time of initial stroke patient contact to first CT scan
  • Percentage of restoring blood flow for STEMI patients
  • Overall customer satisfaction

Numerous other metrics have been published by the NHTSA EMS Compass project, the Prehospital Guidelines Consortium and, in the future, by the National EMS Quality Alliance. These metrics, many of which use NEMSIS data elements, help a fire chief benchmark his or her department against others.

What advice would you give to the chief looking to enter into fire-based EMS or enhance their current system?

The biggest piece of advice I would give a fire chief looking to start a fire-based EMS system is to do their research. Prior to committing to starting a fire-based EMS system, the fire chief should ensure that they have a complete understanding of what a fire-based EMS system is and how they operate. Speak to other fire chiefs who have gone through the same process and learn from their successes and mistakes. Like many other areas in the fire service, there is no need to reinvent the wheel.

Know that there are numerous resources out there that would be willing to assist. The International Association of Fire Chiefs and the International Association of Fire Fighters are both excellent resources for fire chiefs interested in starting a fire-based EMS system.

Similarly, before a fire chief can enhance their current fire-based EMS system, they first need to have a thorough understanding of what services they currently offer as well as a thorough understanding of the enhancement they wish to implement. Networking is critical and this can be achieved through membership in the EMS Section of the International Association of Fire Chiefs, which offers internal access to listserves and publications that assist fire service leaders with the EMS programs.

What will fire-based EMS face in the coming year?

Each year there are numerous issues that are always of concern for fire-based EMS systems. I feel that one of the biggest/most important issues we are facing in the fire service is the increase in first responder suicide. In 2017, there were more first responders who died as a result of suicide than were killed in the line of duty.

In 2017, there were 97 line of duty deaths in the fire service. The Ruderman White Paper on Mental Health and Suicide of First Responders notes “In 2017, at least 103 firefighters and/or EMS workers across the United States committed suicide. Data for firefighters and EMS workers is combined, since many professionals play both roles.” These are staggering statistics that are of a growing concern amongst the fire service.

One hot-button item for fire service leaders this year is a push by EMS educators to require a college degree to graduate from a paramedic program. While the fire service has always been a proponent of higher education as a tool for advancement, this recommendation would severely impact the EMS workforce not only in the fire service, but in several large commercial EMS services and the military as well.

More than 20 percent of existing paramedic programs would be forced to close, leaving some areas with no paramedic training programs. The IAFC has published a position paper opposing this change and will be providing fire service leaders with tools and talking points to ensure the continued continuity of our valuable EMS workforce.

Fire-based EMS has seen significant changes over the last 5-10 years, from clinical care protocols and medications, to technology. EMS providers have access to more complex equipment than ever before and are being tasked with performing more complex clinical care in the street. The level of care being provided by fire-based EMS systems has seen improved outcomes for the patients that we are tasked to treat.

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