It has been a long time since I have seen truck loads of hogs and cows lined up for slaughter at the Monfort Packing Plant in Des Moines, Iowa. It is a sickening process. There is another slaughter in progress today that is just as sickening. This time the trucks are lined up and loaded with fire-based EMS personnel. For years I have been telling fire departments to build their EMS programs to rival or exceed the private-ambulance industry. Those that haven't are finding their resources and way of conducting operations at risk — trimmed like a ham at Christmas dinner.

A recent proposal from a private ambulance service to take over the city of Dallas's EMS transport operations should be an alarming wake-up call to all fire-based EMS systems. Dallas has a solid EMS program — involved in the Return to Circulation (ROC) study; deploying variable staffing; strong medical directors monitoring the system; and a long history of providing EMS. The private-ambulance service has suggested that it will purchase and operate the Dallas Fire Department's ambulances, giving the city a one-time cash infusion to help them through these hard times.

The proposal comes with the usual rhetoric that the cost to the consumer will be lowered. It claims that the salaries for those doing solely EMS work would be less because the dangers of EMS are not as significant as those faced by firefighters, who are paid more given their exposure to the dangers of firefighting. However, as the NAEMT's safety committee will tell you, EMS is a close second to firefighting when it comes to disability. Back injuries, shoulder injuries and stress-related illnesses for EMS are epidemic. This highlights one of the major problems with a proposal like the one in Dallas — it has no respect for the worker.

An ongoing argument exists over whether government should be a provider or purchaser of EMS. The debate hinges on an essential philosophical question: Is EMS simply a transportation service that is not within the realm of government operations, or is it part of public safety? I believe it is a part of public safety. I also believe that fire-based EMS provides an invaluable service to the public — one that unfortunately is difficult to quantify.

A colleague who I consider to be one of the best minds in the fire-protection world called me the other day. He caught me as I was ending a visit to a city that was looking for answers to a budget shortfall that would not allow them to continue business as usual. (Incidentally, it was a department that is involved only superficially with EMS.) For 20 minutes he told me with great concern that the NFPA's annual report entitled "

• The Total Cost of Fire in the United States," released in March 2010, indicated that the total cost of fire for 2007 was $347 billion, which is about 2.5% of the U.S. gross domestic product (GDP), an increase of 86% from 1980.

  The total cost of fire is a combination of many factors that include the monetary losses caused by fire and the money that society spends on preventing and fighting fires. In 2007, the cost of fire included:

  • $18.6 billion property fire loss
  • $36.8 billion career fire departments
  • $128 billion donated time of volunteer firefighters
  • $17.2 billion insurance
  • $61.5 billion building fire protection
  • $42.4 billion monetary equivalent monetary costs for death and injuries
  • $42.3 billion other economic costs
  
  

  As you can see, America spends about $165 billion for fire-service labor. The fire property loss is $18.6 billion. Thus, in this age of economic recession, the private-ambulance industry and the public could argue that spending nearly nine times the value of the property loss on firefighters might not be beneficial, i.e., compared with what it costs to staff and operate the fire service, we could save billions of dollars by letting structures burn down and paying to replace them.

  But that argument would be specious because it does not take into account the economic value of the loss that is averted as a result of fire/EMS response. For example, a fire loss may come to $20,000, but we saved the rest of the house — which has a market value of $250,000 — resulting in a net save of $230,000. The public doesn't see that. The same goes for EMS. While it may cost $500 to dispatch a fire-based EMS unit to a child who has suffered a head injury, it is reasonable to think that the speedy and professional response of that unit will save years of disability and hundreds of thousands of dollars. There are other less tangible examples, such as a neurologically intact cardiac-arrest victim who received prompt hypothermia care and lives a quality life for another 20 years. Such examples rarely, if ever, are taken into account when the value of fire-based EMS is considered.

  Fire-based EMS needs to demonstrate to the public its economic value. It needs to show, as a result of its response, that it saved X lives, minimized Y injuries and thus saved Z dollars. If we had those numbers, we could justify our professional existence much better. And it is imperative that we do so. Today, fires account for about 7% of what a department does. Consequently, there is no way that the fire service can sustain itself or justify the spending levels outlined above without EMS. We have known this for years — EMS is needed for our very survival. I told a group of fire-service leaders last month that I expect to see a 30% loss in staffing and firefighters over the next five years, and it would not surprise me to see that number exceeded. Agencies that do not have accurate data on response times, cardiac-arrest save rates, cost per response and cost per capita will be vulnerable to another agency taking their EMS services, resulting in a reduction in staffing, equipment and/or stations.

  Like the pig named Wilbur in Charlotte's Web, you had better get going on your marketing. If you want to survive, something you are doing has to say that you are “some pig.” The public has to see the real value of your service. Will your fire-based EMS organization be winning first prize at the state fair, or will you be off to the slaughterhouse to become a ham on the table of a private-ambulance company's CEO?

  Bruce Evans is the EMS chief for the North Las Vegas (Nev.) Fire Department. He also is the fire science program coordinator at the Community College of Southern Nevada and an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. He has an associate's degree in fire management and a master's degree in public administration.