Turning Paramedics Into Firefighters

As fire departments continue to handle an increasing number of medical calls, more and more departments are recruiting paramedics and EMTs and training them to be firefighters.

The math is simple: Turning a firefighter into a paramedic means taking the firefighter out of service for nine months or more, which means additional expense to the fire department to pay for training and overtime to cover lost shifts, plus a temporary loss of unit cohesion. However, turning a paramedic into a firefighter costs the fire department less, takes no one off the line and takes less time.

The solution does not come without challenges. What hurdles—physical, mental, emotional or otherwise—will a medical professional experience when crossing over to the world of the firefighter? What can paramedics do to improve their chance of success? What can fire departments do to decrease the rate of training attrition and help paramedics through the program?

The North Metro Fire Rescue District, located just north of Denver, CO, has trained both paramedics and civilians to become firefighters for over 50 years. The district covers 115 square miles with a population of 90,000+. It encompasses parts of five counties, two cities and the state’s fourth-busiest airport. There are 67 full-time firefighters, along with special hazardous-material and wildland teams. Of the 6,700 calls last year, 71% were for emergency medical services. That’s a very good argument for hiring paramedics.

Recently, the district graduated its first all-paramedic class. And not all of them made it. EMS Magazine went along for the ride with the fall 2003 all-paramedic fire academy class.

Starting Out

It’s the first week of training, and they’re already in trouble. Five trainees, all paramedics, sit in silence in the training room as punishment for their infractions. What did they do wrong? Their lead instructor, firefighter Larry Williams, says this group already committed the most common trainee crime—they have an attitude problem.

“We can teach anyone to throw a ladder,” explains Williams, “what is harder to teach is attitude.”

The trainees are not a bunch of wet-behind-the-ears boot camp recruits. They are all seasoned paramedics, with anywhere from five to 10 years in the emergency medical response industry. However, respect within the fire department is a finely drawn line. Failing to stand up when a lieutenant, a captain or worse—the chief—enters the room is seen as an egregious error by the cadre. Williams stresses that the paramedic must fit into the fire department, not the fire department into the paramedic. This is one of the hardest lessons to learn.

Among the class is Clint Fraley, a five-year EMS veteran with experience at Denver Health Medical Center; Charles Gross, a former ski patrol member at Keystone ski resort in Colorado, who also worked for eight years for the Summit County (CO) Ambulance Service; Jeff Tipton, previously a firefighter and paramedic with the Pullman (WA) Fire Department; and Randy Nelson, who is being trained by North Metro, but will return to the Mountain View Fire Protection District in Longmont, CO.

As training begins, they are all excited, with some nervous anticipation. Not only do they have to learn many new procedures, they must also learn how to fit into this new culture. Going from a two-man ambulance crew to a five-man fire crew, and part of a much larger department with multiple fire crews on-scene, is a considerable challenge. Firefighters have to rely on each other for their own safety and protection. This attitude of mutual support must also be instilled in the trainees.

The first few weeks of the academy are spent primarily in the classroom. Paramedics learn about everything from union representation to public relations. Paramedics are rarely on scene long enough to be cornered by the media, but firefighters definitely are, and the public information officer wants to make sure they know how to handle media relations. The trainees must also learn how to handle emergency situations. In the field, paramedics will discuss each patient’s situation and decide the best course of action; firefighters must execute the orders of their superiors, quickly and decisively. Williams says this is one of the biggest challenges paramedics experience when becoming firefighters. To be successful, they must learn that they don’t need to know everything to do the job. Things happen too fast during a fire-rescue operation to allow unnecessary discussion or debate. Supervisors must still be made aware of unsafe situations or critical information, but the art of firefighting often demands more action than conversation.

“Paramedics have to understand that things just need to be done,” Williams says. “The instructors will teach you what you need to know, and in the end it will make sense—just have faith in the instruction and pay attention to everything that’s going on, but don’t overanalyze it too much.”

Training

Throughout the academy, the paramedic trainees learn about breathing apparatus and air tanks, conduct forcible entry and ventilation drills, undergo physical fitness training, train in vehicle extrication, learn the hazards of methamphetamine labs and other hazardous-material responses, prepare for ice rescue and understand how to integrate with other fire crews on-scene. The training eventually leads to the burn house, where trainees face live fire, superheated air and smoke-filled rooms.

To prepare trainees for the burn house and, eventually, life on the line, they endure numerous exercises including crawling through a smoke-filled maze and navigating narrow passages and obstacles, with full equipment, including air tanks, strapped to their backs. It is at this point that the fall 2003 academy class experiences its first real setback. One of the recruits fails to complete the maze exercise. He is given a few more chances to complete the exercise, but still cannot get through the maze without his air running out. He leaves the academy shortly thereafter.

Williams says it can happen to any trainee, regardless of his or her background.

“It just wasn’t his time and he mentally couldn’t get past a couple of things.”

The trainee was given the opportunity to come back to a future academy.

Into the Burn House

By the time the trainees reach the burn house, they are so prepared it is almost anti-climactic. Not only does the class look comfortable sitting inside one of the rooms with a raging inferno just a few feet away, they also look comfortable working alongside their future peers. When training started, hardly anyone would even acknowledge the trainees’ existence, but during the burn-house exercises, trainees and seasoned veterans exchange casual banter and even joke around. In fact, they are so well-prepared, Williams can find few faults. Williams and the instructor cadre are happy that there are no real surprises.

“Our main goal for the academy is when we get down to the burn day, that there’s no instruction done, we just go,” explains Williams. “And that’s exactly what happened.”

Trainees ran through numerous other exercises before the burn day, including blackout drills, some live fire and hose drills, and low visibility with fake smoke exercises. The burn day involves learning how a fire behaves and about different smoke conditions.

The trainees pass the burn house with flying colors, and also pass the attitude test.

“I didn’t see a problem with them whatsoever,” says Williams. “I would say ‘do this’ and there wasn’t any hesitation, they just did it, and that’s a big thing on the fireground.”

Even the trainees said that everything came together at the burn house, just like their instructors said it would.

A New Identity

The fall 2003 North Metro academy class graduated on Christmas Eve. Their gifts were assignments to their new station houses. They trained for a few more weeks, learning more about hazardous materials, but soon took their place alongside their new firefighter brethren.

So did it work? Will North Metro and other agencies continue to hire paramedics?

“As with any position, you have to look closely at each individual applicant,” said North Metro Fire Chief John O’Hayre. “It’s too complex to say that every paramedic will succeed with this type of career transition and cross-training, and as with any new hiring strategy or program, there is always a period of evaluation that follows.”

Over the next few months and years, O’Hayre and his staff will watch as these paramedics incorporate and strengthen both their understanding and performance in firefighting, while also maintaining their paramedic skills.

“This ongoing review helps us determine what are the best future hiring practices to implement that fulfill the expectations of the department and sustain the high service-quality levels provided to the citizens of our fire district,” he says.

It has long been characteristic of the North Metro District to try new strategies to resolve problems. While the hiring of paramedics will probably continue due to the high level of EMS calls and the cost savings to the departments, agencies and districts, there is no compromise on quality. All paramedic trainees have to accomplish each objective and pass the knowledge and skills testing expected of any new firefighter before being allowed to join North Metro’s ranks.

North Metro currently has 22 paramedics on-board and numerous EMT-Intermediate personnel.