How do Firefighters Feel About Work Dominated by EMS Calls?
By Charles Bausman
Last week, we asked for the input of our fire/rescue athletes regarding the prominence and implications of EMS requirements within fire departments nationwide. We received some great feedback, and wanted to share with you below.
Summary of Responses
Most firefighters do not seem to resent EMS requirements as part of the job, and some responded that they enjoyed a different aspect in serving the community. One issue which causes resentment is frequent abuse of EMS (commonly referred to as “frequent fliers”) to provide basic level care for calls who don’t want or can’t afford to go to urgent care or the hospital.
There was a split between respondents regarding training time allocation for fire fighting specific skills, and EMS specific skills. Several complained about the majority of training going towards EMS, despite the most dangerous situation a firefighter will experience is suppressing a structure fire.
A predictable effect of the rise of EMS responsibilities is the change in personnel hired as firefighters, and the requisite certifications they must have prior to being hired.
Most respondents stated their department requires a Paramedic certification (a 1-2 year program dependent on prior education). This clearly provides a higher level EMS capability, but seems to attract a less mechanically inclined individual. Those mechanical skills, particularly those with skills in housing construction (and therefore a better understanding of how a home ablaze will burn), would appear to be decreasing in the firefighter ranks.
In terms of where the firefighter profession is going, several interesting ideas were suggested to better enable the fire and EMS capabilities of departments. These included; (1) creating “medic only” and “fire only” departments under a Emergency Services hierarchy, and; (2) preventative medical care with patrolling paramedics and traveling prescription drug distribution provide a possible method better serve the community and reduce costs.
The challenges are signifiant as fire departments nationwide move forward and the EMS responsibilities grow. We appreciate the discussion you have provided and hope it will generate new ideas to make fire departments as efficient and safe for those in the profession.
Thank you to all those who responded to the survey! Below are the respondentss answers to our survey. Click here for the original article
Question 1: Do you resent EMS responsibilities within your department?
I do not resent my duties as an EMS provider. In fact, I relish the opportunity to help someone in legitimate need, whether that need stems from a fire, automobile accident, HAZMAT spill, or a medical emergency. We all joined the fire service to help others. However, I (and many I work with) do resent how certain segments of society take advantage of our EMS system, using us to fulfill their need for attention, to support their continuously poor life/lifestyle decisions, and as their personal free taxi service to the hospital, to name a few examples.
No. As a career FF/Paramedic, as well as a “righty”, I believe it’s the government’s job to protect the people. EMS would be covered under that umbrella, and combining it with Fire is logical.
Overall? No. Our job was, is, and always will be “saving lives, and protecting property”. That said, myself, and every other fireman tasked with EMS duties, as well as single cert EMT and Medics resent the system abusers, the liars, and the attention seekers that drain the system, and lead to provider burnout.
EMS has been a significant part of our departments responsibilities for decades. I started as a firefighter-EMT, became a firefighter-paramedic, tech rescue, and have since moved on to become a suppression officer. amy experience has been that the people that resent EMS are lazy. They want the glory,without the work. The “salty fire dogs” aren’t all that salty, don’t have the experience they want you to think they have, and just talk a big game. The guys who are there because they want to help other people, They do the job asked of them, EMS or fire. I’ve saved far more lives through EMS, than people I’ve pulled out of fires.
No. I resent the firefighters who get hired thinking they won’t have to do EMS or think that it is beneath them and offer inferior care as a result.
Not at all. It’s job security.
I do not resent having to function as a paramedic the majority of the time rather than a firefighter. We all like to get buried up in a good structure fire from time to time but the reality is that it rarely happens anymore. That is definitely the fun part of the job, but I feel that the EMS aspect is the more rewarding aspect. There is no other feeling like being in the back of the ambulance with a critical patient (medical or trauma) when shit is going to $9 a pound, having to utilize all your skills as well as critical thinking to save their life. Then to have them show up at the fire station three months later after you have completely forgotten about the incident and thank you for saving their life. Those calls are not incredibly frequent either though. The only thing I resent in EMS are the people that take advantage of the system. Those that do not take responsibility for their own health and rely on EMS as their primary care rather than utilizing community resources in place for them.
I definitely don’t resent, but I know some who do. I do love EMS, but it is a secondary love to technical rescue and firefighting.
No, I enjoy both aspects
Yes, way too many non-sense EMS calls and not enough actual-need EMS calls.
No, its part of the job, however it is not as dangerous as fighting fires.
Question 2: Do you feel that firefighting training time has been reduced due to EMS training requirements?
I feel that in my department we receive an appropriate volume of EMS training, which corresponds with our high call volume and high acuity of EMS calls. This is classified as a high risk/high frequency type of call and requires a high level of training. I do feel that our firefighting training is not adequate in volume nor depth. While we, like most fire departments, do not see as much fire as we used to see, it still demands a high level of training due to the catastrophic consequences of poor performance resulting from poor/inadequate training. While fires are now a high risk/low frequency type of call, this should force us to focus more on the types of calls (fires) that we do not perform with the same regularity as acute EMS calls.
Yes…but. The people who aren’t training the fire side aren’t doing so because EMS is usurping their time. They just aren’t training….period.
In fact, I think it’s actually backwards. Firefighting has become the low frequency, high risk event that we spend all our time training for. EMS on the other and, which makes up the majority of our call volume gets a fraction of the budget, and an ounce of thought at training.
Reduced to more of a 50/50 split.
Absolutely! My department has weekly EMS training (online and hands on); we have fire training monthly.
I feel that training across the board is poor, and not performed often enough, instead being assigned other duties so cities and even districts can feel that they’re getting something out of the firefighters, who instead should be regarded as an insurance policy, not employees they’re not getting anything out of.
No, our training division ensures that we have significant fire training in addition to our monthly EMS. In my firehouse we also focus upon our technical rescue skills often.
Definitely, once you are on the road all of my training time is taken up by my paramedic requirements, no time for firefighting courses. The initial academy training is the exception, that is usually mostly firefighting.
Not in our city. Its up to each company to train on what they need. If they don’t train thats ultimately on them
Question 3: Any change in the kind of person your department hires now with EMT/Paramedic requirements?
No. we have been a paramedic department since 1994. We hire firefighters that have been trained as paramedics.
All new hires must be a paramedic at time of hire.
Yes, they are smarter and more educated.
I cannot speak to the difference (if any) in the type of person we hire, if we are comparing pre-EMT/PM requirements to post-EMT/PM requirements. I have only been in systems that require EMT/PM certifications. However, my department has a strong desire for diversity within the workforce. They use PM certification as a trump card to help they fill diversity quotas with otherwise unqualified or less-qualified applicants.
No, but there should be. There are still too many people who want to “fight fire” and have no interest in the 80%+ of calls they’re going to be dispatched on.
No, we require EMT, no medic requirement until you promote to Lt or above.
We hire both firefighter-EMT and firefighter-paramedics. The firefighter-paramedic can do the job of the firefighter-EMT, but not vice versa. Additionally, the medics tend to perform better administratively and in promotional exams. The caveat to this, is that recruitment has to hire the right medics for suppression jobs. Some medics are great with the Medical knowledge, but they have no mechanical aptitude and baulk at the idea of manual labor.
I think there needs to be (as some cities have done), an option to be a firefighter, paramedic/emt, or both. You shouldn’t have to be a firefighter if you only want to work in EMS. Our department likes to put unfit medics above fit EMTs who want to be firefighter to have enough ALS ambulances, but there are fat/unfit people all around the department.
Approximately 12 yrs ago my workplace made having a paramedics license along with the fire academy a pre-requisite.
No at my department. We are one of the few departments left in the Dallas/Ft. Worth area that doesn’t require applicants to have any prior certifications. We will send everyone to fire academy, EMT school, then after a couple years out in the field he/she will be sent to paramedic school. However, if you fail out of paramedic school, you will be terminated.
Yes, preference to higher medical but we can’t operate at higher protocols anyways.
Entitlement and individual expectations ate a bigger problem as a whole with our developing society, and that is causing more issues than EMTS and paramedics. I feel that largely, personnel who get there medic license have more invested in their career, and act appropriately, seeking training and developing themselves.
No, EMT-basic has been our minimum standard for at least twenty years. Like myself, a third of our line personnel are firefighter/paramedics.
Yes, almost exclusively paramedics and we train them to be firefighters.
Not as mechanically inclined as previous
Question 4: Where do you see the profession going in regards to this topic?
More and more medical and car wrecks. less fires
Large changes, being driven by the Affordable Health Care Act, are underway and EMS may or may not end up staying in the hands of Fire. Ultimately many things may end up looking very different from today
Most likely staying on the same pace. Fires will always burn, and people will always be sick and need help. Communities are asking firefighters to be able to be do it all and provide more for the districts they serve.
I don’t see EMT/PM requirements decreasing anytime. EMS system are increasingly taxed by a failing healthcare system. We are becoming many citizens’ primary care providers. Fire departments nationwide are trying to justify their existence in a world of continually decreasing fires. FDs, which are often the largest part of a city’s expenditures, do not generate any revenue, unlike the police department. We use EMS to help justify our existence. Politicians and taxpayers can see the service that they are being provided (EMS), even if we do arrive in a FIRE engine.
Continuing on the same path due to a population that’s been trained to rely on the government whenever they have any problem, and due to better building practices/codes/enforcement.
More shift away from Medics, which will strain each medic, as they have to be on each Ambulance. Instead of being able to split duties, now one medic is solely responsible.
The future is increased EMS demands in our fire departments. You’ll never be able to eliminate fires, so there will always be a need for firefighters. With that said, you have to justify the budget and capital expenditures. EMS is a need the community has, and coincidentally, the fire department already has the infrastructure to handle emergency response.
I see a lot of departments using EMS to justify the amount of firefighters and EMS really getting pushed aside. This is unfortunate, as the amount of EMS calls is constantly (it seems) increasing.
Mobile clinics. Prescription drug distribution. Preventative care.
EMS will continue to 80-85% of our call volume. Its a result of the way health care is delivered in the U.S. EMS is primary care provider for many people.
I don’t see it changing too much. The person being hired is going to have to be more well rounded to fit the changing aspects of the job
I believe this profession will move more heavily into a community care model where Public Safety services will be integrated into a preventive medicine system to avoid overloading Emergency Rooms. The alternative is to lose full-time fire department staff and move back to a “volunteer” part-time model for fire response.
Community paramedics are a hot topic right now. Their basic function would be to do weekly/monthly visits to “frequent fliers” who abuse the system, make sure they are taking their meds, help schedule doctors appointments for them, etc. However, not many cities have had much luck with such programs because the benefit is to local hospitals reducing re-admissions for chronic illnesses. The hospitals want the cities to fund the program, and the cities are typically strapped for cash, so they invite the hospitals to pay for the program – typically they graciously decline.
It really depends on the department and current medical protocols and county/municipal EMS (ambulance) services. In general, I think the fire service will continue in skills and knowledge.
Difficult to say, things are always changing, but it its recognized in EMS that high risk skills not performed often need more training. And while people talk about wanting to fight fire, barely anyone wants to go sweat in their bunker hear in a burn building. We definitely need to focus more on training, or just give up trying to bring our fatalities down. (A significant portion of which, are training related)
I believe this will continue to be the expected norm and communities are becoming more versed in their knowledge of fire-based EMS.
I see a major shift in responses and equipment. Trends towards Fast-Response trucks and away from Fire Engine/Ladder trucks to support an EMS dominated job. I could also see a regionalized Fire service with local EMS work.
Statistics can be deceiving. Half the calls are ems, however about 10 percent of those are real emergencies where people really do need ems help. There should be another statistic that states false alarm ems calls. That would make a more true comparison
Question 5: How would you change things (if at all) within your department to better meet the Fire/EMS training requirements and recruitment?
I am satisfied with my department’s EMS training. I wish we focused more on fire training.
Hire more recruits with Paramedic certification.
More simulation based training, less online. We can read all day long about something, but without putting hands on equipment, it is useless. Spend the money for instructors who have the experience, and knowledge. Flesh out the bad medics who are incapable of critical thinking.
It all starts at recruitment, as with anything else. You have to put the right people in the right position. Not everyone is mechanically inclined and suited for firefighting. Departments red to find the right medics to fill the spots. There are also great medics who make horrible firefighters, and don’t want to be firefighters. I think many departments, including my own, that miss out on these gem employees because they won’t pursue the creation of jobs that would fit these people. There is a need for these “medically oriented” people that often get left out and end up working more menial tasks. It’s incumbent on departments to grow their culture so that EMS is embraced. Recruitment can start by communicating that the job of firefighter-EMT/paramedic includes as much, if not more emergency medicine than fire. Set the expectations for both parties, so both the employee and the department aren’t caught unaware.
Two divisions: EMS and Fire. This would put more pressure on private EMS and increase the level of care provided.
Hire EMT’s with the stipulation that the get their paramedic licence after hire. Broadens the hiring pool and allows you to pick up good younger people.
in the 20 yrs I’ve been involved in Fire/EMS , the tables have turned, EMS is now 80% of what we do but its usually only 25% carrying that load. EMS should become its own division.
I would make EMT a requirement to be hired and cut the 5 weeks of EMT training in the academy and add more specialized training
My department is BLS only, and we do not operate any ambulances. I believe it would be beneficial for our personnel to do a ride-along on the county ambulance on a yearly basis.
Where I work, they seem to understand the majority of calls are EMS related. I feel it’s up to the individual to keep up his fire skills.
My city is pretty squared away regarding training and recruitment. The only area to be improved upon is once these young men/ladies get out in the field. They have learned how things are supposed to work from being in school. It is important to mold them and teach them how it works in real life. We try to keep them away from the jaded and burned out medics, and/or the older sometimes lazy guys who’s inherent nature is to arrive at the station in the morning and expend every bit of ATP they can generate in order to sit on their ass.
I wouldn’t change anything. Our medical protocols to allow us to do should being growing finally. Our county medical director has had a tight grip on what skills we are allowed to perform. We have to knowledge and skills; just being allowed to use them has been the issue.
More accountability, more time focused on hand on, skill based training, as we are likely to be staffed at a fire. Nothing that’s any new ideas, but ideas that are often talked about and not implemented
I am currently trying to figure out why internal recruitment for paramedic school candidates is so flawed. We hire 90% of our paramedics from outside our agency and put them through our 16 week academy.
I would separate the services, but keep them under one authority. So, it would be Needham Emergency Services Dept with a Fire section and EMS section, that way you get to hire for each, staff each separately, likely leaving the crews with time and OT to train their respective jobs.
State the importance of Fire fighting and remind people that half are ems calls, however the most dangerous situation will always be entering a structure with an uncontrolled act of nature, fire. It is the most dangerous thing we will face. Our training and preparations should be centered on this. The public expects it. Save my children, put the fire out.
Question 6: Any additional comments or feedback?
I enjoyed this survey and look forward to reading the results. For added context, I work for a full-time fire department in a city of 300+K people on the Front Range of Colorado. We are all certified as EMTs at a minimum, but we all sign a contract stating that we must become certified as Paramedics within 4 years of being hired.
In Ontario EMS is primarily provided by Primary-Care, Advanced-Care and Flight Paramedics. Fire responds in a tiered-response, primarily to difficulty breathing (SOB), choking, unconscious, VSA. Trauma calls are only dispatched to us when Fire is responding to a MVC autoX event. I don’t foresee this changing anytime soon, despite the efforts of the provincial fire union to create a ‘FireMedic’ certification and have one FireMedic on every Pump (Engine). Paramedics and Firefighters are represented by 2 separate unions at the provincial level. Thanks!
Divvy up the responsibility. Double medic boxes, and screen incoming 911 calls. Partner with hospitals to send a community paramedic, and PA, or ARNP to calls. Reduce pressure on the ED, and EMS units. For basic level calls, send a private ambulance with 2 EMTs. Reduce the stress, pressure, and bullshit placed on EMS crews.
My experience has been that the guys that just want to do the fire stuff are usually what I call PBFF’s, that’s pay and benefit firefighters. They’ve sought out the job for the schedule, paid leave, benefits, and pay. The people applying for the job has changed over the years,and I equate it to the fact that in a lot of jurisdictions you can now live off the salary and benefits. You really had to want to do the job decades ago, because you were going to have to have three other side jobs to pay the bills, and you fire department job was your passion. The guys with the passion, who understand what the job is about, also understand that it doesn’t matter if it’s a fire or an EMS call, it’s all a noble calling. Coincidentally, the guys with the passion, who get the job, also get the brotherhood. The PBFF doesn’t get the brotherhood, and has done more to hurt the brotherhood.
Indianapolis and Des Moine are two places with fire and EMS separated. I like this model and think it needs more evaluation and changes to work well, but could be important going forward as fires decrease and medical emergencies increase.
Thanks for taking interest in this topic and the profession in general.
Due to politics, the next 10 years should be real interesting in EMS, specifically the how and by whom its delivered to the public. No worries though, we’re the Fire Department, we improvise, adapt and overcome to provide help to the people that call us.
I appreciate the work you guys do! I really enjoyed the article on overweight firefighters and how effective (or ineffective) they are on scene. I like the “in your face” approach to delicate topics that MTN Tac takes. Enough of this politically correct bullshit….if someone is a POS they need to be told so they can fix it. Keep up the good work and I will stay tuned for more. Regards, Greg Ward Sgt, USMC, firefighter, paramedic, ER nurse
I enjoy the EMS side of the fire service. Being dominated by it or responding to patients that abuse the system is what bothers me.
The trend is in free-fall towards EMS, the task is to keep the crews interested in the job. Finding a way to stop the nonsense calls would help a ton, but that is another major undertaking.
All emergency services are important. Statistics can go sway an argument any way the statistician would like the argument to go. Fire departments can use the fact that todays fire environment is more dangerous than twenty years ago, therefore we need to be better trained and more fully staffed. There are stats to support this argument as well. A higher risk and lower frequency event. Higher temperatures in fires, lower frequency events (less experience), quicker arrival of fire crews (fire alarms, cell phone calls) puts todays urban firefighter in the most dangerous situation. Again, the public does not really care about this when it hits the fan. Put the fire out, get my kids out
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