Mergers and Acquisitions

Aug 22, 2014

Every day, I try to put aside some time for combing the internet and reading a variety of industry related articles.  This week an older article from FireRescue1.com from July of 2012 that former Washington DC fire chief Dennis Rubin reposted called “5 reasons not to merge fire and police” caught my eye.  The article presents arguments against combining police and fire departments.  I read through the article and was able to draw a parallel between this topic and the argument against merging fire and EMS.  Keep in mind that this is in no way a reflection of every single fire-based system on the map.  Some do it very well but for each of those effective, progressive fire based EMS systems, I feel like I have found two who do it very poorly or worse, do not understand or care what they are getting into when they take over ambulance response.   I invite you to read the full article by clicking here  but here are some of the chief’s observations and my thoughts on them.

“There are a multitude of examples where communities have fused the police and fire departments into one public safety agency.  The motivating logic seems to be that neither department is busy enough to command the tax share needed t operate separate agency.

The initial belief is that merging two costly departments into one will create a more efficient department, thereby saving big public bucks.”

EMS and fire are often combined for the exact same reason.  The fire departments are not busy enough so in theory, combining fire and EMS gives them the ability to handle an additional piece of the public safety workload.  The workload that EMS brings in, however, is often ignored or it is not realized to be as involved and time consuming as it is.

However, the transition of police duties into the fire and rescue department comes at a steep price that you will not find on a budget line-item spreadsheet.  Intangibles such as organizational stress, personnel, resistance, and demoralization of the rank-and-file members of both departments are the major factors that will ensure this type of plan’s failure.”

Take a close look at any fire and EMS merger and you will see many of the same problems.  When a fire department is made to take over an EMS service, there will be a group of firefighters who have absolutely no desire to have any part of running on an ambulance.  In some departments, it is said that being put “on the box” is looked at as being punishment.  Staff and candidates are sometimes even “forced” to become EMTs or paramedics in order to maintain or obtain employment.  Also, from the EMS side, you have the same issue in that not all EMTs and paramedics want to be firefighters.  Furthermore, their positions are the ones that are eliminated contributing to the thought that making a career out of EMS is a very difficult thing to do.  The low morale that has been noted in departments like the Fire Department of New York’s EMS branch for example shows absorbed EMS personnel being treated as second class citizens.  Other unions either refuse to represent their EMS brothers and sisters or try to have them held to a different standard all in the name of lower wages and different hours for EMTs and paramedics.  For some reason though, it is all tolerated.

“The duties and responsibilities of a modern day firefighter are many and diverse.  The public expects firefighters to provide pre-hospital emergency medical care in a way that positive results are possible.

When not responding to emergency medical alarms, firefighters are expected to be the first line of defense to protect communities against hazardous material releases of all types.

Add to these two critical fields of service, technical rescue technicians to remove people trapped in automobiles or similar predicaments.  That leaves the requirement to properly and quickly extinguish unwanted fires in the community.”

This passage speaks to the important role that firefighters serve in the fire and rescue spectrum.  I currently am stationed in a firehouse and the men and women who work in the house are constantly training and trying to better themselves.  For example, one day when we came back to the station we found them experimenting with a technique that one of them had read about that involved using a ladder and a pivot to help lift a car off of a patient.  From that and a couple of other fire departments that I have been around in my county, I am seeing more than I ever have in my career the amount of training and preparation that goes into firefighting.  They work hard, and it shows.  Chief Rubin continues this passage with:

“So, the question that begs answering is, can an employee learn and maintain the necessary skills for one complicated discipline and learn to function within another equally complicated community-safety discipline?”

Well?  Can they?  Take all of the training that goes into fire/rescue and add to that the amount that the amount of time and training it takes to obtain an EMT certification, obtain a paramedic certification and then stay current and proficient in paramedicine.  As Chris Montera says, “how can you expect someone to serve two masters?”  Chief Rubin apparently does not think that it is possible.  And, in my experiences, initial paramedic training takes longer than initial police or fire academy training.

“There is a lot of preparation work required every single duty shift in order to provide a reliable and quick response to alarms.  All apparatus and associated equipment must have surveillance checks performed each day and after every use.

The day that these comprehensive checks are not performed is the day that something like the water tank was left partially filled.  This can be embarrassing and potentially deadly for both the members and the customers, with the organization’s liability rising sharply (wasting more taxpayer dollars).

Couple that with the need for time for physical fitness and it is apparent that there will not be enough time left in a workday to take on many other tasks.”

Again, with a change in perception of fire-based EMS over the last year and a half, it is clear how much time, preparation and upkeep the fire service requires.  Other things that can be embarrassing include running out of oxygen at a scene because the O2 tank was not filled, or not having equipment that you are supposed to have immediately available to you.  Preparation for an EMS day can take quite a bit of time as well and needs to be just as high of a priority.

“What happens when all hell breaks loose and there are not enough police officers and firefighters to go around?”

What happens when all hell breaks loose there are not enough firefighters and EMTs to go around?  In reviews of two major incidents spanning last twenty years’ time the Boston bombing in 2013 and the first World Trade Center attack in 1993, both reports stated that one key to success was having separate fire and EMS branches of service because there was more work than one branch could handle.  That is no reflection of the abilities of the Boston Fire Department or the Fire Department of New York’s fire suppression abilities.  It is, however, a harsh reality of these major events.  As casualties mount up and suppression and rescue procedures are ongoing, the need to have separate leadership and personnel for both becomes apparent.

“The last job elements that must be considered are mission-critical programs such as public education, fire and event planning, fire hydrant flush testing and fire inspection duties.  The best fire or medical call that a department can respond to is the one that the fire department was able to prevent – no call, no hazard, no harm to anyone.”

Fire prevention is one of the greatest things that has happened to the fire service.  Couple that with improved building codes and you can see the marked reduction of fires in this country.  DCFD’s smoke detector program under Chief Rubin’s watch was an incredibly successful one, until it was cut by city government.  From the EMS side, prevention is the future.  With the introduction of community paramedicine in a number of systems, EMS is adjusting its sights to not only include responding after an emergency has happened, but we are learning from our fire department counterparts and getting there before the emergency happens, or helping people understand that not everything that they experience is an actual emergency.  While still within a paramedic’s scope of practice, community paramedicine taps into a completely different skill set.  Training and preparation for that role takes time and dedication.  Finally. . .

“It is time for the fire and rescue service leadership to ensure that the required critical tasks are being performed properly and completely.  If the leaders do their job correctly, there cannot be a lot of discretionary time leftover to carry a gun or a ticket book.

The fire department bosses must take the responsibility to alert the political and economic leaders of the community as to what the firefighters should be doing to protect their community.”

To our single role EMS leadership, this is a call to action for you.  Establish a PIO.  Share what your department does now, and what they are capable of in the future.  Make sure taxpayers and public officials understand what receiving high quality care means to them and the people that they represent.  Failure to do so is not their fault for being ignorant, it is your fault for not educating them.  The “why don’t they understand?” excuse just does not fly anymore.

This is not a post that will cry for the downsizing of fire departments in favor of EMS.  The fact is, taxpayers and community leadership needs to realize the value in both departments and fund them appropriately.  If you opt for a cheap system, and a consolidated system then you will not get the quality of service that the two standalone services could provide.  When someone that I love is having chest pains, I want the best trained paramedic available to take care of them, not someone who is biding their time until they can get off the ambulance and into the jump seat of a fire truck..  And when my house is on fire, or I or someone that I care for is trapped in a car after a motor vehicle collision, I want the best trained firefighter who wants to be a firefighter to be the one handling the emergency and not someone who is putting on some turnout gear because they have to in order to maintain their career as a paramedic.

I know, that might be a pipe dream, and many will say that it is probably impossible in many communities.  We should do everything in our power though to try and make a public safety model that provides for police, fire, and EMS from separate agencies to be a possibility.  Believe it or not, it works.  And believe it or not, it works extremely well.