Improving Public Support for the Fire Service Through EMS
RESCUE/EMS
Should EMS be a responsibility of the fire service? With increasing demands for good EMS systems, it may be beneficial for fire service personnel to at least explore the benefits of getting involved in EMS.
The fire service has been involved in performing EMS in the United States for many years. In the past 10 to 12 years, that involvement has progressed to include the ability to provide advanced pre-hospital patient care for coronary and trauma victims. The issue of EMS as a fire service responsibility is still controversial, even though 65 to 70 percent of all fire departments are performing some level of EMS. A substantial number of successful advanced mobile intensive care systems in medium to large cities are performed by fire departments.
The decision of whether the local fire department should provide EMS services is dependent on a number of factors: the desire of the community; local resource capability; the political impact of the decision; funding sources; and the attitude of the fire department to undertake the additional responsibility.
In the past three years, the city of Plano, Texas, has improved EMS response through fire department involvement, as have so many other cities in the past 10 years. Developing a state-of-the-art EMS system is one means of coping with rapid urban development in the city.
In an effort to improve the level of EMS and cope with growth and expansion, the city and fire department moved to provide mobile intensive care service through fire department paramedics in late 1981, with the delivery of services beginning in August 1982. Early in 1983, an EMS action plan was developed to establish specific objectives and set time lines for accomplishing those objectives. The primary goals for the EMS action plan were simple:
—photon by Karen, Plano Star Courier,
plishing those objectives. The primary goals for the EMS action plan were simple:
- To develop a progressive EMS service by looking at and learning from the problems experienced by other fire departments across the country.
- To select favorable elements from other EMS systems and implement them to the existing system.
- The specific objectives included in the finalized EMS action plan consists of:
- Train all fire department members to
- the level of EMT. *
- Select and train a total of 36 paramedics.
- Train all paramedics as CPR instructors and develop an aggressive city-wide citizen CPR training program.
- Train fire department dispatch personnel to the level of EMT, and then implement an emergency medical dispatch system.
- Provide ongoing continuing education of EM T and paramedic personnel in the fire stations.
- Equip all fire department vehicles to provide basic life support capability.
- Initiate paramedic capability on engine and truck companies.
- Provide EMS critique sessions on all severe trauma incidents for review by all personnel.
- Provide hospital review of all EMS incidents and feedback to personnel.
- Recruit a volunteer physician with an EMS background to serve the department in the capacity of an EMS advisor.
- Provide a patient follow-up system for paramedics.
- Require mandatory paramedic certification for all fire fighters hired after Sept. 1, 1983, and mandatory EMT certification for all personnel as a condition of continued employment.
- Initiate a user fee per individual treated to minimize system abuse, and limit transport to closest medical facility.
Progress on the EMS plan has met or exceeded all its target dates as of Sept. 1, 1983. Periodic review on a quarterly basis is conducted to monitor progress and identify present or potential hurdles in order to keep the plan moving on schedule.
The final implementation of the plan will provide a top level of EMS capability in the community, from preemergency, pro-active elements (such as the aggressive CPR program) through receipt of emergency calls and dispatch of an appropriate response level, to the reactive services in the field and delivery of the patient to an emergency medical hospital facility.
Problems that will be avoided or at least minimized include the often-seen split in fire only vs fire/EMS personnel through regular assignment of engine and truck companies to EMS incidents. The paramedic burnout phenomena will be minimized through rotation of all personnel to engine-truck/ambulance assignments. The inception of paramedic engine and truck companies will provide full upward mobility to EMS personnel, which is not possible in many systems.
Planned flexibility in the system will provide a skills match for the situation at hand through departmental operating procedures that will handle basic life support calls with basic life support personnel and advanced life support calls with advanced life support personnel. This procedure will maximize the availability of highly trained paramedic personnel for incidents requiring these skills. Through development of paramedic engine and truck companies, a minimum of four crew members will be maintained to not only handle advanced life support task demands but will also provide necessary manpower for fire suppression assignments.
Other problems to be addressed include the added costs to upgrade all vehicles to basic life support capability initially, and advanced life support capability in the years to come. System data will be gathered and analyzed, and continuous interaction with the community will be maintained to monitor the pulse of the system and its acceptance and reactions of the community. Growth of the community should provide adequate field experience for EMS personnel, and simulation drills will be conducted to fine tune any identified deficiencies.
The professional development of any service organization depends on the ability of the organization to identify what the community wants. The fact that in most communities people hold paramedics and EMS services as a more important role than fire protection may be hard for fire suppression personnel to accept. But who in the community will admit they are going to have a fire? And how many in the community have had a family member or close friend use the service of the EMS system?
Citizens demands for good EMS systems has opened a whole new realm for the fire service. Wise fire service and municipal administrators who have seen the benefits of such programs have recognized the great amount of public relations and community support developed through EMS. EMS holds benefits not only for the public but also the fire service in that it increases our ability to justify agency funding and existence on a more comprehensive basis. The time has come for the fire service to deliver to the public what they want, not what we think they want or would like to give them; otherwise, the fire service soon may discover firsthand the experience of the American auto industry.
Plano, TX, is approximately 20 miles north of downtown Dallas in an area of the Metroplex that has experienced explosive growth. Twenty years ago an agricultural town of 3000, Plano’s population is expected to pass 100,000 in 1984 and could top 300,000 by 2003.
The “planned” community is made up of single-family homes with a $100,000 to $300,000 price range and a mix of multi-family, commercial strip shopping centers and two large regional malls. In addition, several headquarters of major corporations have moved into the area.
EMS and fire services in the city are currently provided by 130 emergency personnel operating out of five fire stations. Projected growth in the next five years may necessitate the addition of as many as three additional fire stations.
