White Paper States Case for Fire-Based EMS

     Who's ready for another round of "Does EMS belong in the fire service?"?

     That long-running and always-passionate debate began a new chapter this summer with the release of a white paper from top fire organizations that argues that the fire service is best-equipped and suited to deliver prehospital EMS in the United States.

     What's notable about this paper-entitled Prehospital 9-1-1 Emergency Medical Response: The Role of the United States Fire Service in Delivery and Coordination-is that the case is made by three EMS physicians. The authors are Paul Pepe, MD, medical director for Dallas EMS and the metro Dallas BioTel systems; Franklin Pratt, MD, medical director for the Los Angeles County Fire Department; and Steven Katz, MD, EMT-P, associate medical director for Palm Beach County (FL) Fire Rescue.

     They wrote on behalf of Advocates for Fire Service-Based EMS, a coalition of major fire organizations dedicated to promoting fire-based EMS as the best model for prehospital emergency care. The coalition includes the IAFF, IAFC, National Volunteer Fire Council, Congressional Fire Services Institute and National Fire Protection Association.

     "We feel that EMS is at a crossroads, as the Institute of Medicine report pointed out, and that fire-based EMS is in the perfect position to help get past that crossroads in delivering first response," says Katz. "The fire service is strategically positioned to deploy to all kinds of hazards in 9-1-1 emergencies."

     That's one of the paper's key arguments: That victims of things like auto accidents, building collapses, hazmat incidents, etc., may need physical rescue in addition to urgent medical care. Often, nonfire EMS can't provide such rescue.

     "Early in my career, I was a volunteer paramedic on an ambulance squad in New York," recalls Katz. "We were dispatched to a car accident, which was typical back then-there was no fire service dispatch; the ambulance got dispatched to motor vehicle accidents. And there was a guy who was awake and talking and entrapped in his vehicle. It caught on fire, and I watched this guy burn to death when he was clearly not critically injured. Had we been a fire department responding, he likely would have survived."

     For the paper's other main points, see the sidebar. Meanwhile, the first major response came in an essay by EMS journalist John Becknell, publisher of Best Practices in Emergency Services.

     While not specifically opposing fire-service involvement in EMS, Becknell, in An Open Letter to the Fire Service, challenged it to stop talking about its commitment to EMS, and start demonstrating it. "While the fire service readily agrees that a majority of its calls and activities are EMS-related," Becknell says, "we find that EMS is only a small part of what it talks about. You can see that in the fire journals, you can see it in their conferences, you can see it in the membership of the IAFC EMS Section. So the question really is, how important is EMS to the fire service? Only its actions will demonstrate that. If it wants to champion EMS, it can."

     All sides generally agree that what's really going on here, from the fire side, is a cultural evolution. As fire-suppression calls drop and emergency medical calls rise, the identity of the fire service is shifting. It's coming to terms with EMS being a-perhaps the-primary component of what it is and does.

     "I believe the fire service has evolved to accept EMS as a primary mission," Katz says. "Here in south Florida, if you told a firefighter that he wasn't going to provide EMS, he wouldn't understand what you were talking about."

     Yet as Becknell notes, the proportional underrepresentation remains, and there hasn't been a lot of direct fire advocacy for emergency medical systems and funding. Addressing that, he says, will do more to convince street providers that fire is serious about EMS than any number of white papers.

ARGUMENTS FOR...
     Other arguments made in Prehospital 9-1-1 Emergency Medical Response: The Role of the United States Fire Service in Delivery and Coordination:

• Whomever eventually provides transport, the fire service is typically first to deliver on-scene care. Its resources are strategically positioned to do this in a timely way.
• Virtually all firefighters today receive emergency medical training.
• Hasty transfers of care, such as from first-responding fire to nonfire EMS, are occasions ripe for errors that can harm patients.
• Due to its experience with incident management and command, the fire service is best suited to coordinate large and difficult incidents.
• Ambulances are often delayed at hospitals. Fire apparatus, with trained responders, can respond more promptly to time-sensitive emergencies.

     Advocates for Fire Service-Based EMS has also produced a DVD to accompany the white paper; for more, see www.cfsi.org. For Becknell's response, see www.emergencybestpractices.com/issues/10_6/columns/614-1.html.