The All-Hazards Myth


Yesterday the D.C. Fire and EMS Department announced that it will hire a group of single-role paramedics instead, reversing its policy of only hiring cross-trained firefighter/paramedics.  This comes five years after the department moved its separate-but-equal EMT’s and paramedics into a “fully integrated, all hazards agency,”  amid daily headlines of long response times, staffing shortages, mass-sick call-outs,  paramedics leaving in droves, ambulances catching fire, and running out of gas during presidential motorcades.

Still, the DC firefighter’s union does not like the idea.  This, according to EMS 1:

Dabney Hudson, vice president of the D.C. Firefighters Union says. “I think ultimately this is going to do a disservice to our ability to respond to calls.”

Hudson fails to mention that there is a well funded effort by the IAFF and IAFC to take over single-role EMS services. With a declining number of fires and EMS calls accounting for 70% or more of fire responses, cross training everyone protects firefighter jobs.  The IAFF and IAFC tout the benefits of training everyone to handle everything, promise faster response times, and cost savings from consolidation.  This happened in Kansas City a few years ago, and is being proposed in Austin right now:

“We would save an enormous amount of money,” said Levy, who also pointed to signs of declining morale and service at Austin-Travis EMS. “It has fallen far, far, down from the standard.”

I suppose you never know when someone with a medical problem’s house could be on fire, but you never know when there’s a bad guy there either.  According to TheFreeDictionary.com, hazard is defined as:

1. exposure or vulnerability to injury, loss, evil, etc.

2. a thing likely to cause injury, etc.

3. chance; accident

That covers threats from bad guys too, which means that a truly all-hazards department would also provide law enforcement.  While the IAFF and IAFC believe that the fire service is best equipped to handle EMS with cross-trained firefighter/paramedics, they have a whole brochure describing why  police and fire department mergers are a bad idea, complete with a template to submit to legislatures in protest proposed mergers.  Here are some of the reasons they provide:

1. Neglect of the total fire safety program

2. Increased costs

3. Low Morale

4. Inadequate Training

5. Insufficient on-the-job experience

6. Loss of firefighting team concept

7. Roll conflicts

8. Lack of departmental planning and goal setting

9. Failure to meet the demand for fire and police services

So let me get this straight.  Fire department takeovers of EMS save money and improve morale.  Fire/police mergers cost more and and worsen morale.  There is no role conflict between firefighting and medicine, but there is between firefighting and law enforcement, even though paramedic training is longer than the police academy.

The issue of insufficient on-the-job experience deserves extra attention.  The paper sites concern about skill retention with firefighter/cops, but not with firefighter/paramedics.  This is good for for job retention, but apparently not for cardiac arrest survival.  A 2005 USA Today series found higher survival rates in communities with lower paramedic to population ratios:

Seattle, Boston and Tulsa represent cities with fewer paramedics. They believe that a paramedic who rides a fire engine to every call doesn’t get enough practice providing skilled care because so few calls are real medical emergencies.

 

Mickey Eisenberg further explains the problem with cross/trained firefighter paramedics in his book Rususcitate!

 “Dual training an individual to be both a firefighter and a paramedic, then expecting stellar performance in both jobs, reflects a hope based on what is probably a flawed concept…The point is that paramedics must be allowed to learn the skills they need and then to hone them as professionals. This is not to say that they can not work within fire departments, but only that, except in emergencies, they should not be asked to perform the duties of firefighters.”

My experience with all-hazard departments is that most of the firefighters really don’t want to be paramedics, and a lot  of the paramedics don’t want to be firefighters.  They are different jobs that attract different personality types.  The reality is that when EMS merges with fire, EMS loses.  When fire merges with police, fire loses.   And these arguments are based on protecting jobs and politics, not clinical outcomes or what is in the best interest of the community.

 

Comments

  1. Dominick Walenczak says:

    Hit the nail right on the head.

    It seems to be a universal truth that the SOLE reason fire departments respond to EMS calls is to justify budgets. The sole reason that the IAFF is in favor of assuming EMS roles is to add more dues paying members. It’s sad that organizations that are supposed to advocate for the benefit of the people their agencies serve tend to play self-serving politics instead.

    I think maybe we should just consolidate everything into one city-wide department. Call it “Emergency Services”. Every branch, Fire, Police, and EMS, would have employees that are cleared to perform only that role (ie, firefighting). It would seem to make it easier to coordinate in times of disaster as the department would be headed by an overall emergency manager.

  2. Next issue, please discuss the “EMS isn’t just mostly a transportation problem” myth.

    Who best to handle the bulk of EMS call volume – the 84% of callers who require no intervention? All-ALS SSM Medics? Minimum-wage private BLS crews? People with their NREMT-P who haven’t been promoted to ALS in their “few Paramedics” system?

    How accurate is MPDS? How are you going to ever meet a clinically-beneficial 4 minute response time without rapid dispatch of the closest emergency response unit as soon as EMS is selected? How are you going to do it if you give up 60-90s to the calltaker?

    Quite frankly, BLS EMS and entry-level firefighting are high-school level jobs. They can be combined to make one half-decent profession. Community policing / law enforcement stands on it’s own in a way the other two do not. ALS could stand on it’s own, and often does in some systems, particularly where ALS covers multiple BLS jurisdictions. However, in DC and in many other places, there’d be no reason to have ALS in a separate agency from BLS.

  3. Hi. I work for a FD that is now trying to move away from sole service providers to a cross-trained model. Does anyone know of any research/documentation that has been done rebutting the advantages of the cross-trained system? We can use all the help we can get to slow down and hopefully reverse this juggernaut being forced upon us. Thanks in advance for any leads you might have.

    • emspatientperspective says:

      Unfortunately there is very little research on anything in this area. Seattle Fire Department Medical Director Mickey Eisenberg’s book Resuscitate! states that if paramedics are in a fire department, that they should only do medicine. You could site that.

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