DOT Deals EMS Joker In 3rd Service Game
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The threat of the United States Department of Transportation to alter the provision of emergency medical service by the fire service remains a viable challenge despite the published conclusions of a DOT study.
Three hearings were conducted last February in Atlanta, Omaha and Sacramento with the expressed purpose of hearing discussions by organizations and individuals that were aimed at exploring “the feasibility of establishing” a third uniformed service to provide EMS throughout the country. The hearings were held by a study group consisting of 10 members of the 35-member National Highway Safety Advisory Committee, whose members are appointed by the President and who advise the secretary of transportation. The study group’s findings were reviewed and included in a report the committee made to the secretary of transportation.
Committee conclusions
The paragraph in the advisory committee’s report that reduced some fears in the fire service stated:
“Members concluded it is not important that the title ‘third service’ be used, but that quality emergency medical services be available. Whether this service is provided by way of an independent private provider; a hospitalbased provider; or a fire departmentbased provider is unimportant. Therefore, the Committee makes no recommendations as to whether a separate emergency medical service system is preferrable to a system provided by hospitals, police or fire departments. The Committee does feel that what will improve the care is for citizens in every location to demand the best they can afford whether it be volunteer or paid; for the Federal level to provide technology and training; and for the States to provide coordination and leadership.”
Joker In the deck
Although the conclusions in this paragraph may mollify some of the fears that the DOT intends to divorce EMS from the fire service, another section of the report raises warning flags that the fire service still faces threats of change in the manner in which it provides
EMS.
The cards dealt to the fire service by the advisory committee contain a joker in the deck that could have a disruptive effect on fire service provision of EMS. The joker is in the committee’s recommendation that the “legal validity of strength and endurance tests for EMTs” be studied by the secretary of transportation. The committee report states:
“The Committee recommends that the Secretary of Transportation should develop a model career ladder for EMTs. This criteria could include qualifying standards which would insure equal employment opportunity for men and women who are interested only in EMS as a career. Further, the Secretary should study the legal validity of strength and endurance tests for EMTs and if found invalid, work toward their removal.”
While on the surface equal employment opportunity cannot be challenged as a goal, the concept isn’t that simple when it is applied to fire service EMS. The majority of EMTs in the paid fire service are hired first as fire fighters and therefore must meet the physical requirements for fire duty.
The advisory committee noted this and reported, “Fire departments generally require dual training and work in both fire and EMS duties. They also have certain standards (strength and endurance) which individuals must meet. These standards are based usually on what is required for fire-related duties, not for EMS duties.”
Change demanded
The “low percentage of women employed as EMTs” in fire service EMS systems was deplored by the advisory committee, which added that many men and women are prevented from working in the emergency medical service field because they cannot pass the physical tests for fire fighters.
“Unrealistic barriers that prevent the employment of people capable of providing emergency medical care must be eliminated,” the advisory committee declared.
What the committee report does not mention is how all but the largest fire departments can provide cost-effective EMS and fire service without having its members work as fire fighters as well as EMTs. In many city fire departments, the first responder to an emergency medical call is frequently an engine company simply because there are more engine companies than rescue companies or ambulance squads and therefore the engine company first-due areas are smaller. When the rescue company or ambulance arrives, the engine company may continue to assist if needed.
The committee report does not say what changes would have to be made if a fire department retained the responsibility for EMS but had to hire individuals who would be limited to emergency medical duty because they were not physically able to do fire duty.
Career ladder
The report also viewed a separate EMS system—even under supervision of a fire department—as a means of creating a career ladder for EMTs. The committee pointed out that at some point in his professional development, a fire fighter EMT has to switch back to the fire suppression division to gain further promotions.
According to the United States Fire Administration, the fire service provides about 80 percent of the EMS in the nation. The fire service is doing this at minimum cost to the taxpayers by using its members in the dual role of fire fighters and EMTs.
The volunteer fire service, of course, does not face a payroll problem and therefore traditionally has had members who are active in emergency or ambulance squads but do little or no fire fighting. Many years ago, volunteer fire departments opened their ranks to registered nurses who rode their ambulances and in later years, women have become EMTs with volunteer fire department rescue and emergency squads or ambulances.
Other recommendations
In addition to urging the establishment of a career ladder for EMTs, the advisory committee recommended that each state have a “senior level” agency that would be responsible for EMT training standards and certification. Such an agency, the report stated, should coordinate EMS programs throughout the state and promote legislation that would improve EMS quality.
The report conceded that “each community will have to decide the level of sophistication it demands in its EMS system,” and it urged the secretary of transportation to “continue to improve the quality of training for EMTs and to promote basic first-responder training for all people.
In the communications area, the advisory committee called for the use of “911 as a nationwide system for public access to EMS.” It also urged the establishment of minimum standards for communications systems that allow hospital emergency room personnel to talk with EMTs on the emergency scene.
