“This is an EMS department that occasionally goes to fires” is a pejorative statement thrown out when heated discussions erupt at the fire station kitchen about the respect that fire-based paramedics believe they are not getting from their suppression-oriented colleagues and bosses. The first time I heard the phrase it was applied to a department where 35% of the engine company responses were for medical calls.
Last week, Las Vegas Fire and Rescue’s PIO Timothy Szymanski was responding to a rumor that American Medical Response employees who staff ambulances that respond to 9-1-1 incidents in the city may go on strike. He told a newspaper reporter that the fire department was staffing 4-5 additional ambulances, reminded the community that every one of the 28-some engine and truck companies in the ISO Class 1 fire department is staffed with a paramedic. He also pointed out that 97% of the fire department responses are to medical calls. A 2012 ICMA study of the department showed that 91% of the responses were to EMS runs.
A Continuing Increase in Fire Company EMS Activity
The 2019 ESO Fire Trends Report looked at 638,979 run reports from January 1, 2019, to June 30, 2019, from 244 fire departments. EMS-based calls represented 72% of the runs, while fire-based calls represented 2%.
NFPA’s annual description of fire company activity recorded that 64% of the responses in the calendar year 2016 were for medical assistance with 4% for fire calls.
New York City added Certified First Responder-Defibrillator (CFR-D) role to FDNY engine companies in the late 1990s. In 2017, CFR-D responses represented:
- More than 50% of the workload for 9 engines
- Between 40% to 50% of the workload for 75 engines
- Between 30% to 40% for 88 engines
Engaging The Workforce in Medical Response
Firefighters who are not engaged in the medical response aspect of the mission endanger patient outcomes, department effectiveness and public trust of the agency.
The success of the “Be Nice” campaign during the Alan Brunacini era in Phoenix was not because the quality of firefighter was different than other jurisdictions but on the consistent effort by both labor and management to promote the concept with reinforcing internal communications, individual and fire company level recognition.
Phoenix was working to change the engagement to “snivel calls” – fire company ems first responder runs that did not require much caregiver intervention. The company officers I spoke with at Phoenix during that era joked that there was a “Deputy Chief of Nice” that oversaw all of the firefighter engagement efforts.
Robert Lavigne’s research on the use of employee surveys in improving engagement at the Institute for Public Sector Employee Engagement validates the Phoenix approach (Lavigne 2018):
- Make improving firefighter engagement a strategic priority
- Emphasize the business case
- Commit from the top
- Communicate, communicate, communicate
- Involve unions
- Keep surveys confidential … but share survey results
- Drill the results down to the fire company level
- Take action
Lavigne recommends setting priorities based on the issues that come out of employee surveys and the drivers of employee engagement. This may require changes in dispatch, deployment, and tasks. The results of the engagement surveys may change the department’s relationships with hospitals and medical facilities.
Fire departments are still extinguishing fires, rescuing civilians from harm, imposing order on chaos, mitigating dangerous situations and saving lives. These are all high-priority community expectations that require training, dedication, and high-quality delivery.
Getting our folks and bosses more engaged in the most frequent fire department activity can make a clinical outcome and organizational difference. A Google search can reveal how a trend of slow responses, perceived indifferent EMS care and a couple of bad outcome events can destroy the community’s trust in the fire department’s ability to be a valuable asset. As Dr. Cassi Fields points out “A lack of trust is the kryptonite to any fire-rescue organization.”
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Hynes, Mary (2019 October 31) Las Vegas fire crews ready in case of ambulance worker strike. Las Vegas Review-Journal. https://www.reviewjournal.com/local/local-las-vegas/las-vegas-fire-crews-ready-in-case-of-ambulance-worker-strike-1882926/
International City/County Management Association (2012 November) Final Report: Fire and Emergency Medical Services. Las Vegas, Nevada. Washington DC: ICMA Center for Public Safety Management.
Gardner, Bill & Remle Crowe (2019 October) 2019 ESO Fire Trends Report: Insights and Best Practices For Fire Departments. Austin, TX: ESO.
NFPA (2018 May) Fire Department Calls.
CBC (2018 November 25) Reviving EMS: Restructuring Emergency Medical Services in New York City. New York, NY: Citizens Budget Commission.
Kellar, Elizabeth & Gerald Young (2018 October) Workforce of the Future: Strategies for Making Change. Washington DC: Center for State and Local Government Excellence.
Lavigna, Robert (2013) Engaging Government Employees: Motivate and Inspire Your People to Achieve Superior Performance. New York NY: AMACOM.
Lavigna, Robert (2018, July 06) The Roadmap to Engaging Government’s Employees: Surveying them is the first step. It’s important to do it right — and then act on the results. Governing.com. Washington DC: e.republic.
Fields, Cassi Dr. (2018 February 2) Enhancing Fire-Rescue Human Capital: Trust in the Fire Service. ICHIEFS. Chantilly, VA: International Association of Fire Chiefs
Featured image: Las Vegas Fire and Rescue