Why Are We Leaving EMS Out Of the Fire Officer Testing Process?

A friend recently asked me to write a letter of reference for him, as a captain's position had opened in his fire department. I have known him for a few years and did not have a problem writing the letter for him.

During the course of the conversation, I asked him what process would be used to test individuals so that a promotional list could be established. He said he was not sure, but the applicants were told to study several books dealing with strategy and tactics on the fireground, as well as hazardous materials operations.

Knowing that he works for a small rural department, I asked him, "When was the last time you had a working house fire?" He had to think long and hard, then guessed that the department's last working house fire had occurred about five months earlier. My next question was, "How many EMS runs have you gone on in the last five months?" He said, "I go on those every day." At which I point, I said, "Well, why are they testing you on a working-fire scenario or a hazmat scene when that is not the majority of what you do?" Obviously, my friend had no answer, since he was not the one making up the test, but he could see my point.

To me, there is nothing wrong with assessing future officers with how they would handle a fire or hazmat incident, but why leave EMS out of the testing process? After all, don't many fire departments pump more oxygen than water?

This conversation caused me to wonder why, in many cases, does 80% of a fire department budget go to suppression when that's only 20% of the workload? Most fire departments that provide EMS commit just 20% of their budget to 80% of the workload. Of course, this can be somewhat justified by the fact that it costs more to buy and maintain an engine or a truck than an ambulance, and typically you will have more staffing on an engine or truck than an ambulance. But, why do engines and trucks far outnumber ambulances in most fire departments?

I went to the National Fire Data Center (NFDC) website to see and compare statistics nationally regarding the number of fire and EMS incidents. Although I could not find any EMS statistics on the website, the NFDC noted that 1.6 million fires were reported in the United States in 2005. Compare that to the FDNY, which ran nearly that many EMS calls alone in 2005!

Now, before I get any hate mail, I am not advocating cutting back on engines, trucks and personnel doing suppression activities. I enjoy a challenging fire as much as the next firefighter. With that said, I am also well aware that fighting a fire can be far more labor intensive than even working a full cardiac arrest. However, the prevailing attitude in some fire departments is "we do fire, hazmat and, by the way, EMS is something we do in our spare time." The reality is that many fire departments are EMS agencies that sometimes go to fire calls.

Some fire departments have adapted to their expanded role in EMS and have even changed their names. Instead of being the XYZ Fire Department, they now are the XYZ Fire and Rescue Department or the XYZ Fire and EMS Department.

EMS has become an important part of the service we provide. Even many fire departments that do not transport provide first-responder services. If they are providing first-responders services, they are typically doing more EMS runs than fire runs.

Several years ago, an International Association of Fire Chiefs (IAFC) survey found that about 90% of their members reported that their fire departments provided some level of EMS. The 2006 annual city survey in the Journal of Emergency Medical Services reflects that most EMS delivery to the 200 most populous cities in the United States is provided by the fire service, either through EMS transport or first-responder services.

Add up all the facts and the number of fires in the United States is nowhere near the numbers we saw 30 or 40 years ago. Through better water delivery systems, public education, smoke detectors, sprinklers and tighter building codes, the fire problem - although of concern - is not of the magnitude it once was. Add the fact that a large segment of the U.S. population commonly known as the baby boomers is now entering their latter years. Those born in 1946 turn 60 this year. As they grow older, they will have more medical needs, adding to the drain on some existing EMS systems.

So, as the number of fires continues to decrease and the baby boomers continue to grow older, there is no doubt that fire departments will pump more oxygen than water now and well into the future.