BY DENNIS COMPTON
It was 1973 when I first witnessed a Phoenix (AZ) paramedic at an emergency scene delivering advanced life support (ALS) treatment in a fire department-based emergency medical services (EMS) system. I had watched Rescue 51’s Paramedics Johnny Gage and Roy DeSoto on TV in Los Angeles, but that was nothing like watching Rescue 1 in Phoenix doing the same kinds of spectacular work on real patients in need of ALS care. At the time, I had been a firefighter for less than three years and had been on many “first aid responses,” as they were called before the term “EMS” worked its way into our vocabulary.
Although Phoenix Fire Department Rescue 1 and later Rescues 3, 6, 7, and 24, and so on were new to the deployment system, fire department medical responses were not new. In fact, many fire departments in the country were providing medical services delivered by firefighters trained in first aid and riding on fire trucks or ambulances for 30 years (and more) before basic EMTs, paramedics, base hospitals, and medical directors came along. Fire department-based EMS is a long-standing tradition with a rich history in career, volunteer, and combination departments, and we should be very proud of that.
THE FIRE SERVICE IS THE NATION’S PRINCIPAL EMS PROVIDER
The role of the fire service as the nation’s principal provider of EMS can get lost as EMS issues emerge and work their way through various levels of government. At the state and federal levels, where decisions are made regularly regarding various aspects of public policy, funding, homeland security, and other subjects, there is sometimes a misunderstanding of the major role all fire departments (albeit to varying degrees) play in the prehospital emergency medical care system in the United States. The fact is that more than 90 percent of the nation’s 31,000 fire departments deliver EMS to the public. More than 60 percent provide ALS services delivered by firefighters or other fire department members arriving at emergency scenes on engines, ladder trucks, squads, rescues, or ambulances. The fire department-based EMS model is far more common than hospital, nonprofit, or private-sector EMS models.
The goals for the fire service are to further enhance the understanding of the critical role that fire departments play in EMS and to improve the integration of fire department-based EMS into fire department service delivery systems. This can be achieved by the following:
- Clarifying for decisionmakers at all levels of government and within the medical community the characteristics of fire department-based, nonprofit, and for-profit EMS systems.
- Clarifying at the federal level the myth that very little federal grant funding goes to EMS. In reality, significant amounts of the federal fire service/homeland security grant funds that go to fire departments directly or indirectly benefit EMS response, prevention, public education, equipment, and training programs.
- Ensuring that the fire service is represented whenever planning or policy development meetings are held concerning EMS issues at all levels of government and within the medical community.
- Using data to better validate and communicate the effectiveness of fire department-based EMS systems and working diligently to continue to improve those systems.
- Continuing the integration of EMS into the mission of the United States Fire Administration and within the curriculum at the National Fire Academy.
- Encouraging our fire service professional and membership organizations to clearly communicate to their members and others the importance of EMS as a critical component of fire department service delivery systems.
EMS has emerged as one of the most critical and popular services fire departments provide to the communities they serve. This is well established at the local level of government, and we must ensure that state and federal elected and government officials are educated and knowledgeable about fire department-based EMS as well. The quality of care delivered by fire departments through their EMS systems is outstanding and second to none. Many lives are saved, and many others are positively impacted through EMS services delivered throughout the nation by dedicated firefighters and other fire department members every day. We should take the opportunity to celebrate the progress made in fire department-based EMS over the years and remember to tell our story outside the fire service every chance we get.
DENNIS COMPTON is a well-known speaker and the author of several books, including the When in Doubt, Lead! series and Mental Aspects of Performance for Firefighters and Fire Officers, as well as other articles and publications. He is also the coeditor of the current edition of the ICMA textbook Managing Fire and Rescue Services. He serves as a national advocate and executive advisor for fire service and emergency management issues and organizations. He served as chief in Mesa, Arizona, for five years and as assistant chief in the Phoenix (AZ) Fire Department, where he served for 27 years. Compton is past chair of the International Fire Service Training Association (IFSTA) executive board and of the Congressional Fire Services Institute National Advisory Committee. He is vice chair of the Home Safety Council board of directors and a member of the National Fallen Firefighters Foundation Board of Directors.
