DOT Threat to Fire Service EMS
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Senior Medical Service Officer Seattle Medic One Seattle Fire Department
Emergency medical service is at a crossroads in its development and management. A proposal for a nationwide third uniformed service that originated in the United States Department of Transportation has engendered a contentious issue that has the potential of hindering the progress of fire service EMS.
Hearings held by a special study group of the DOT’s National Highway Safety Advisory Committee and remarks made by one member of the study group before the full committtee indicate a desire to separate EMS from the fire service, although the study group’s report does not go so far as to recommend excluding the fire service as a provider of EMS. The report does make recommendations, however, that would seriously affect the ability of the fire service to provide EMS as it now does. (See article on the study group’s report on opposite page.)
The Federal Emergency Management Agency (FEMA), which includes the United States Fire Administration, opposes the formation of a third uniformed service with the exclusion of the fire service as an EMS provider.
Vickery opposes exclusion
Gordon Vickery, administrator of the United States Fire Administration, offered a different solution to critics of fire department EMS systems:
“Rather than build new EMS systems, it would be more cost-effective and beneficial to citizens if we improved existing private and fire service EMS systems. Identifying EMS needs or problem areas would be the first step toward providing efficient delivery and coordinated management of EMS.”
A white paper, entitled “Accidental Death and Disability: The Neglected Disease of Modern Society,” in 1966 sparked the conscience of America and the medical community. It presented a stark picture of the limited capabilities of the fire service in providing emergency medical care. As a direct result, the Miami Fire Department took a major step in providing cardiac training for fire fighter paramedics. However, organized emergency care operations were not immediately developed and systematized in the majority of fire departments.
A natural evolution was for EMS to be provided by the local fire department. In the past, the solution to EMS development and management problems was left to city and county managers. Currently, 80 percent of the EMS care in the United States is provided through fire departments.
Fire service involved
In cities where private ambulances were not able to provide optimum care, fire departments were mandated to provide EMS to some degree. Seattle is a city that currently provides EMS through its fire department.
In its early years, EMS developed without a text or management goal. A partnership between the local medical community and the fire department assured the success of the Seattle EMS program. This winning combination was adapted to other local programs throughout the country. Seattle’s experience has been repeatedly pointed to as a model EMS program for fire departments nationwide.
Seattle’s EMS program has been periodically questioned by politicians, the medical community and private EMS providers. Replacing the Seattle EMS program with a third uniformed service was considered in 1979, but it was rejected as too costly. Seattle has successfully deterred attempts to alter the system or replace it with a third uniformed service by pointing to the scientifically valid records it has kept since the program’s inception.
While local initiatives to establish a third uniformed service in Seattle have subsided, I have watched with interest national attempts to direct EMS. Recently, DOT’s special EMS study group was given the responsibility to “hold informal hearings and obtain views of the constituency” on EMS delivery by a third uniformed service. The DOT hearings were selectively advertised and held last Feb. 11 in Atlanta, Feb. 13 in Omaha, and Feb. 15 in Sacramento, Calif.
Intent revealed
National fire service organizations and their EMS representatives were noticeably absent from the hearings. When the study group urged its parent National Highway Safety Advisory Committee to adopt its EMS report, the study group’s desire to divorce the fire service from EMS was revealed in the following exchange of remarks between Mrs. Young, a citizen representative on the advisory committee, and Dr. William Mays, vice chairman of the study group:
Mrs. Young: When you talk about EMS as a third service, do you mean it would be separate from the ordinary fire department way of providing it?
Dr. Mays: In most circumstances,
that is exactly what we (the EMS study group) mean.
Mrs. Young: Would adoption of this report (as a result of the three previous hearings) imply that we also supported that?
Dr. Mays: It would imply that the committee supported the recommendations to the secretary (of DOT).
Mrs. Young: Of a complete separation?
Dr. Mays: Yes.
Opposition to third service
The cities of Los Angeles, Seattle, Alexandria, Phoenix and St. Paul voiced strong opposition to national third uniformed service initiatives in letters to DOT. While these EMS providers acknowledged that their programs would improve, they voiced the opinion that establishing another service for EMS was not the solution.
Citizens expect efficient management of EMS systems and progress is being made by fire departments. Fire departments are receiving assistance in identifying EMS needs and program development from the USFA. A national EMS authority, James O. Page of the ACT Foundation, recently commented on fire department EMS in the future:
“The evidence of lifesaving benefits is growing and it shows clearly that the fire service can build on and improve its reputation and tradition of service to humanity.”
Local decisions imperiled
In many fire departments, EMS is an integral part of the total service they provide. Other fire departments choose not to participate in EMS and EMS is provided by another agency. In each case, the decision has been made at the local level. DOT’s third service initiatives would take that decision away from city and county authorities.
In a letter to DOT Secretary Neil Goldschmidt, FEMA Director John W. Macy provided the following comments about a national third uniformed service plan:
“In the interest of better emergency planning and federal credibility, please consider that this singularly poor (DOT) National Highway Traffic Safety Administration study project be withdrawn and discontinued.”
Cause for concern
Human nature seems to dictate that people act on problems only when a threat is at hand. DOT proponents of national third uniformed service initiatives have caused considerable concern in fire department EMS circles. The threat to established fire department EMS programs, like Seattle’s, is real. If successful, DOT could do much to interrupt the orderly development of EMS. Fire departments that have invested in EMS development should not underestimate the move to establish a national third uniformed service.
The National EMS Coalition has been formed to offer a national platform for EMS goals. An organizational meeting was scheduled for October 21 at Baltimore-Washington International Airport to determine procedural affairs. Participation by fire departments in this new organization will allow input in initiatives as they develop—such as a national third uniformed service.
The evolution of a third uniformed service would have many unknown effects on fire department EMS programs. Only by communication with other EMS providers can we in the fire service determine the impact new issues would have on program control and management. I urge your participation at the next meeting of this new National EMS Coalition.
