Where Do We Belong?


Before I get to the meat and potatoes of this blog I feel I should firs clarify a few things. The fire departments in this country are staffed by some of the hardest working most highly skilled professionals I’ve had the pleasure of working with.They risk their lives everyday, and put others before themselves without a second thought.If I could shake each of their hands and thank each of them personally for that I would. Their job is a very important one, and they are an essential piece of the Public Safety model in this country.

Over the past 30 years, Fire Suppression and more importantly Fire Prevention has greatly improved nation wide.Fires are down almost everywhere you go.Fire inspection regulations and building codes have become more strict.Fire Fighters are better trained and better prepared to do their jobs than they ever have been.They have achieved their desired result: less fires.Now, with less fires, the question that comes up is “what do we do with all of these fire fighters?”You now have all of these municipal employees doing so much less work at higher wages than they’ve been paid in the past.The result: find more work for them or lay them off.

None of this should be viewed as the Fire Departments’ fault.The blame should be placed (dare I say) on our local and state Politicians who stare at spread sheets all day and worry about the all mighty dollar.Lets face it, if Fire Prevention wasn’t what it is, and Crime was instead exponentially down, Ambulances would be driving around with the words “Police Department” on the side of them.The Cash Cow that is the ambulance business would be moved to which ever department was in the bigger budget crisis.

Getting back to the problem at hand though, the answer to budget shortfalls has been simple for many departments: Respond to Medical Calls, either in a first response capacity or take over the ambulance.Lets face it, Ambulance runs mean volume and money.Money means jobs.Its a no brainer, right? Wrong.The result in some of our largest cities has been to put a band aid on a sucking chest wound.Take a look at these examples of two of the largestEMSsystems in the country that are, in my opinion failing in some major way:

Philadelphia Fire Department had some major accomplishments in 2009.Their fire fatalities were down 23%, and were the lowest that the department had seen in the past 10 years.Since 2005, the department’s overall volumehas increased from 253,946 calls to 268,996 calls.They have seen their medical responses increase from 209,472 to 221,133, a 5% increase.All other calls (Fire, public safety activations etc) have actually decreased from 54,474 to 47,863.To them, I say “Job well done!”Aggressive fire prevention has saved lives, and made a difference in their department’s numbers.For me though, that is where it ends.

Over the years, Philadelphia Fire has been plagued with high volumes, and long response times.They’ve had people wait in excess of 30 minutes for an ambulance and die.If they’ve had that happen, I’m sure they’ve had plenty of instances where people have waited that long and been fine.In 2006, the busiest 24 hour Ambulance responded to 9,368 calls.That’s 25 calls a day.Their busiest 12 hour truck responded to almost 5,200 calls.That’s 14 calls in a 12 hour shift, on average!Can we say burnout?

According to their official department website, the Philadelphia Fire Department currently employs 2,400 uniformed Fire Fighters.There are 83 Fire Suppression units (Ladder Trucks and Engines) in the city.Unofficial numbers that I was able to find elsewhere cited that the Department employs approximately 220 Paramedics who staff approximately 45 ambulances (28 Full Time, 17 Part Time).Now, those numbers might have changed a bit because the data I found was from 2006, but that means that in 2006, 10% of the Department’s staff was trained to handle 80% of the Department’s workload!How is that fair and efficient?With units that busy, Patient Care could potentially suffer.It almost creates a “war zone” mentality of get in, get out and get them to the hospital.The city is almost in a constant state of system overload.

Even in the largest EMS system in the world,New York City, almost half of all the ambulances you see running emergencies don’t say “FDNY” on the side of them.There are around 1.2 million medical emergencies a year inNew York City, yet the department employs approximately 3,200 uniformed EMTs and Paramedics as compared to over 11,000 Fire Fighters.

These large US Cities are taking two totally different businesses and trying to run them with the same mentality.Fire is staffed on a “just in case” basis.That is to say, we know that if we get a fire, we could potentially need “X” number of fire fighters to fight it.We can determine that need from historical numbers, but lets face it: A fire can break out anywhere, and anytime, so our Fire Departments must always be at the ready.

EMSis staffed on a “When and Where” basis.We look at historical data that can be better broken down by area, and units have the potential to be strategically deployed based on the times when call volumes are higher, and in areas where calls are more frequent.

Simply put, it takes the same number of fire fighters to fight a fire at 3am as it does to fight one at 3pm.You might not need as many ambulances to cover your volume at 3am as you do at 3pm.

So what do I think the answer is?Well, for me, its quite simple: EMS basedEMS.Nationally, medical calls consistently increasing every year.Fire calls, on the other hand, are on the decline.In these higher EMS Volume settings, the majority of the funding for the Ambulances could potentially be obtained from Patient Transport revenue and subscription programs.While that might not cover all of the budgetary needs of an EMS Department, depending on the socioeconomic situation of the area being serviced, Departments could work in a “non-profit” capacity with all excess revenue going back into the Department to improve it.Funding from Fire Departments should come largely from the tax payers, and be publicly funded.

Additionally, with the potential for the change and evolution of Pre Hospital Care (read: EMS 2.0) with EMS basedEMS, the full focus could be put where it belongs: on Patient Care.In my almost ten years as a Paramedic, in a system that is not the most progressive, I’ve seen many changes in the care I am able to provide: 12-Lead EKGs, RSI, CPAP, Adult I/O’s, and there is more to come.We work in a very young field as compared to Fire, PD, and the medical field as a whole.When it comes to the care we could potentially provide in the future, the sky is the limit.Look at what EMS Services are doing in other parts of the world.

So lets start the move away from the “All Mighty Dollar” and take back our field, which has become in some places a Cash Cow and a way to justify jobs.Let’s moveEMSto the setting it needs to be in and create one unified mission for everyone with an EMT or Paramedic Patch on their sleeve:

Provide the best possible Patient Care for every Man, Woman and Child that we encounter.