How do you integrate EMS into the fire department culture? Set goals and develop personnel who can help you meet those goals, said Mike Metro, deputy chief of the Los Angeles County Fire Department. Metro oversees the department’s operational mission, which includes 170 fire stations serving 58 cities — protecting about 4.5 million citizens. He also is on the executive board of the International Association of Fire Chiefs' EMS Section.

A certified paramedic and 37-year veteran of the fire service, Metro also speaks at industry conferences, including a 2012 Fire-Rescue International session on changing the fire-service culture to embrace EMS. He discusses some of the tips touched upon at the session, including how to develop members for an EMS mission.

Step 1: Decide where the department wants to be in five years. That’s a critical decision point. Decide how the department will be shifting into a more public healthcare model in five years. I envision the fire service as an integral part of the healthcare delivery system, including choosing methods of care. That’s the critical piece.

Step 2: Develop the behaviors needed for an EMS culture. Develop the knowledge and attitudes needed and then go back to your hiring process. Develop the written exam based on the knowledge and attitude needed for the person who is going to help meet the mission in five years, such as the Health Occupations Basic Entrance Test (HOBET V).  Identify the attitude and skills needed to develop that person. Going back to 1980, when I came on the job, my written test should have accessed my ability to become a firefighter/paramedic. It didn’t. What happen after that? We continued to force firefighters to go to paramedic training, rather than them volunteering.

Step 3: Stock the department’s library with educational resources. Let’s take customer service as part of the initiative the fire chief wants to do. You get textbooks, put them in the department’s library, and then you tell your folks preparing for the promotional exams that questions will be coming from a customer service–related textbook. What’s that going to do? It is going to force them to study the book. It is going to force them to be more proficient in customer service.

Step 4: Change performance evaluations. Begin to measure the behaviors you need in the department to meet that five-year goal. As part of that, you must change your promotional process based on those standards as well as re-develop written exams for entry-level firefighters. It is important to change performance evaluations to measure behaviors you’re looking for and feed that into the promotional process.

Step 5: Focus on the “why” of EMS and fire service. We need to focus on why we do our jobs. Our why is that we save people’s lives and the lives most precious to them and their property. We need to hire people and develop people that understand that why. We can’t only be focused on the what. That’s important as we try to change the perspective of how we interact with the people who entrust their lives to us every day.