Engine Company EMS: The Cavalry

Ambulance

By Michael Morse

Firefighters and medics do not always play well together. Even when EMS is part of a fire-based system, things at the station are not as cohesive as we would like. There is more than a little good-natured rivalry that exists behind those walls. The EMS crews tend to run ragged, leaving the fire crews to pick up after them. Firehouse life is at its best when all participants contribute equally, but that’s not possible when the ambulance personnel are seldom in the building. Resentment builds and things can get ugly. Private EMS agencies deal with hostility from fellow responders far too often, and volunteer medics who respond with paid firefighters are sometimes not treated with the respect they have earned and deserve. Somehow though, despite our differences, patient care remains excellent. By putting our egos aside during calls and behaving like adults, we are able to hold on to the excellent reputation that we have built.

If I had a nickel for every time I keyed the mic and said, “I need an engine company for assistance,” I would have a lot of nickels. Sometimes all that was needed was a lift assist and sometimes it was only for a few strategically placed lights on a dangerous roadway. Every now and then, I needed help with a combative patient or I needed a driver when both of our hands were tied up with patient care. When a routine call that my two-person crew responds to goes badly, and everything we do is not nearly enough. Knowing that a call for assistance is being answered by an EMS engine (or ladder) company lessens the stress of whatever emergency is in progress and allows our ambulance crew to continue doing our job while on scene. At those moments, nobody cares very much about who is coming, as long as they are on the way.

And they always are. Every time.

It could be anything: a response to a person down in an area known for its homeless population that turns out to be a gunshot victim; a person who called 911 because they felt weak but is actually having a CVA; or a baby with a fever that is seizing uncontrollably upon arrival. Knowing that trained, reliable help is on the way creates calm where it matters most, inside the heart and mind of the responder. There is little more sweet noise than the sound of sirens in the distance when you are growing fatigued after 10 minutes of CPR, or when the family is growing restless as you try to revive their loved one. It is difficult to stay focused on a highway when tractor-trailers are screaming past your rig. The overwhelming need to forgo good patient care to preserve your own safety takes over, and you have to scoop and run. A crowd that is turning against you becomes far less threatening when BIG RED arrives on scene.

A good, well-trained, and motivated EMS engine company offers far more than a few extra hands on scene during a medical call. In many circumstances they literally becomes the difference between life and death. Treating life-threatening injuries on scene has been proven far more effective than rapid transport. On-scene time for cardiac arrests of more than 30 minutes has become EMS standard of care in many jurisdictions, and rightly so. We can, and do, revive patients far more frequently when we have the resources to do everything it takes to properly run a code. Without help from the fire department, EMS is far less effective. That goes for volunteers, private, and fire-based responders equally.

When the tones go off, and the call is for an EMS crew requesting assistance, know this: the folks who called for help are listening for your sirens, and are breathing a little easier knowing that the cavalry is on the way.

Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.