Q&A: Evaluating the state of fire-based EMS in America

EMS Chief Dr. Mike McEvoy reminds, “There is no other component of the fire service that saves more lives than EMS”


Dr. Mike McEvoy serves as the EMS coordinator in Saratoga County, NY, as well as IAFC EMS Section chair. He is also the chief medical officer for the West Crescent Fire Department in New York, the professional development coordinator for the Clifton Park & Halfmoon EMS and a cardiovascular ICU nurse clinician at Albany Medical Center in New York.
Dr. Mike McEvoy serves as the EMS coordinator in Saratoga County, NY, as well as IAFC EMS Section chair. He is also the chief medical officer for the West Crescent Fire Department in New York, the professional development coordinator for the Clifton Park & Halfmoon EMS and a cardiovascular ICU nurse clinician at Albany Medical Center in New York.

Although there has long been a debate about the role of EMS in fire departments, no one can debate the fact that far more fire department runs are for medical emergencies than actual fires.

FEMA reports that data submitted to the National Fire Incident Reporting System (2017) shows only 4% of runs made by fire departments involve fire, whereas 64% of all fire department runs were categorized as EMS and rescue.

FEMA reports that data submitted to the National Fire Incident Reporting System (2017) shows only 4% of runs made by fire departments involve fire, whereas 64% of all fire department runs were categorized as EMS and rescue. (AP Photo/Mark Lennihan)
FEMA reports that data submitted to the National Fire Incident Reporting System (2017) shows only 4% of runs made by fire departments involve fire, whereas 64% of all fire department runs were categorized as EMS and rescue. (AP Photo/Mark Lennihan)

Of course, this doesn’t diminish the hard work of firefighters responding to fires, nor the myriad other “all-hazards” calls now falling under fire departments’ umbrella of responsibilities – but it does underscore the reality that fire and EMS work are inextricably linked. And some departments are still struggling to integrate these essential services.

I connected with Dr. Mike McEvoy, who serves as EMS coordinator in Saratoga County, NY, as well as IAFC EMS Section chair, to address the state of fire-based EMS in America – why the integration is vital to fire department relevance, how these systems benefit the community, and advice for deploying this model. Dr. McEvoy is also the chief medical officer for the West Crescent Fire Department in New York, the professional development coordinator for the Clifton Park & Halfmoon EMS and a cardiovascular ICU nurse clinician at Albany Medical Center in New York.

FireRescue1: How would you describe the current state of fire-based EMS in the United States?

Dr. McEvoy: I think the coronavirus pandemic has dealt a serious blow to all EMS, especially fire-based EMS, as the majority of fire-based EMS is municipally funded. There are no local governments that will escape significant losses of revenue moving forward. The IAFC Economic Impact dashboard is already showing huge impacts on fire departments across the U.S. 

Do you see more fire departments shifting to a fire-based EMS model? 

In this day and age, fire departments that do not offer EMS service to their communities will find it increasingly difficult to maintain the workforce and budgets necessary to provide fire and hazardous situation response. So, in that regard, I think all fire departments will incorporate some sort of EMS response into their services delivered. This looks differently from community to community, depending on need and how the fire service can best support the EMS needs of their community.

Why do you believe some fire departments are still resistant to the concept of fire-based EMS and more significant integration of services? 

In many cases, it comes down to budgets. Reimbursement for EMS by insurers does not cover the costs of delivering care and transportation. Localities have been forced to subsidize EMS for many years, often using EMS providers that are less costly than firefighters. Finding ways to integrate services or deliver EMS at lower costs than local governments are currently paying can be very challenging for a fire chief.

What do you say to fire service personnel who argue that EMS is a “distraction” from the fire mission? 

I believe EMS is a part of the fire mission, just as much as is fire suppression, hazardous materials response, extrication, building inspections and fire safety education. The mission of the fire service is to save lives and property. There is no other component of the fire service that saves more lives than EMS. To call EMS a distraction from the fire service mission is to ignore this major component of the mission itself.

How do fire-based EMS systems best serve the community in terms of patient care and response times? 

The optimal way to deliver outstanding patient care and response times is to collect data, analyze those data, and make adjustments based on what the community tells you they expect (response times) and what outcomes you see in patient care. It is not enough to incorporate new EMS bells and whistles unless you connect those patient care interventions with measurable outcomes in the community. Every fire chief should know what the cardiac arrest survival rate for their department is, how neurologically intact those leaving the hospital are, what the specific interventions that affect those outcomes are and how well they are being delivered. The same is true for stroke, sepsis, airway interventions, and every other type of call the department responds to.

Is a fire-based EMS system an advantage during mass-casualty-incidents (MCIs)? 

Some would argue that a fire-based EMS system may perform better in an MCI than a non-fire EMS service. Certainly, dual-role, cross-trained firefighters are all-hazard responders who can safely and effectively mitigate virtually any situation. They come equipped with the tools and protective equipment needed for complex rescues, such as structural collapses and hazardous material releases. However, not all fire-based EMS systems have these capabilities and some private and third-party service-based EMS have capabilities equivalent to fire-based EMS.

How much cross-training is realistically needed for personnel? 

Cross-training is a local decision, based on budgets, workflow and a variety of functional variables. At minimum, every firefighter should have Emergency Medical Responder (EMR) training, and some would argue that EMT training be the minimum standard. Cross-training all personnel as paramedics may be foolhardy in some systems, unless members work enough EMS shifts to utilize their paramedic skills frequently enough to remain fully proficient at providing medical care.

What advice would you give a chief looking to adjust their deployment model to one of fire-based EMS? 

I would suggest having a discussion with local government leaders about unmet EMS needs in the community and how the fire department could potentially fill those voids. No community has all their EMS needs completely met. Once the chief has a sense of where there are opportunities for the department, he or she should discuss these with their union and/or members to formulate a plan as to how they could best collaborate to better serve their community.

What resources does the IAFC offer related to fire-based EMS?

The IAFC EMS Section has a huge network of fire-based EMS leaders who regularly collaborate on a closed list server called KnowledgeNet. This resource shares policies, procedures and ideas, and allows for exchanges of problems and solutions among all of the 1,700 members of the EMS Section. The EMS Section also provides frequent webcasts, publications and hot topic resources, such as Medicare Cost Reporting, COVID-19 dashboards and legislative updates pertinent to EMS.

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