EMS soon may be the core responsibility of U.S. firefighters. In fact, traditional fire calls have dropped significantly in the last decade, from 1.8 million fires in 1999 to 1.4 million in 2008, according to the U.S. Fire Administration. With fire-call volumes down, fire departments plan to expand existing medical-response services to seal the perfect marriage between fire and EMS. But the challenge is to fund it and convince communities it’s a worthwhile, value-added service.
Firefighters began providing first-response EMS in the 1960s, said Dennis Compton, a 40-year fire veteran and co-chair of the Fire Service–based EMS Advocates. In those days, many pre-hospital EMS providers were firefighters who had additional medical-services training, he said. Today, nearly every U.S. firefighter receives at least some medical training. In fact, out of the 200 largest cities in the U.S., 97% have fire service–based pre-hospital 911 EMS with advanced life support.
“There are a lot of fire departments who have fully integrated EMS into their system—that is not unique,” Compton said. “Now almost all fire departments do at least first response.”
Having firefighters cross-trained in EMS makes sense based on how fire departments are positioned throughout communities, Compton said. Fire stations already are built and strategically located, and response-time modeling for EMS is similar to fire suppression — location is crucial. In addition, firefighters are trained for high-stress, life-threatening situations, making them well-suited to learn additional life-saving skills, he said.
“There’s a natural fit there,” Compton said. “You’re simply using existing resources in a much more cost-effective way.”
Fire departments in cities such as Miami already have integrated EMS, Compton said. In those markets, firefighters are expected to be trained as paramedics as a prerequisite for employment. Most fire departments don’t want to pay for training or commit to the administrative process to keep paramedics certified. It applies whether it is a city or community department, he said.
“So most community and city fire departments don’t have everybody as a paramedic,” Compton said. “But a lot of them do have at least an EMT and one or two paramedics on their response units.”
To pay for medical services, Compton suggests departments seek approval through federal, state and local channels and charge a fee for transport services.
“You charge a fee unless the community itself was willing to subsidize service — which is not common,” he said. “They may subsidize part of it but [officials] would expect, in most cases, a fee to offset costs.”
Volunteer departments have a separate challenge, said Steve Austin, who co-chairs the Fire Service–Based EMS Advocates alongside Compton. Austin acknowledged fire calls have declined while EMS calls have increased. As a result, volunteer departments need to think about deploying a fire-based EMS system, he said. Having a robust medical component built into a fire department, whether first responder or paramedic, is what the community needs. It also lets fire departments offer an all-risk response, including EMS.
Austin said many of the nation’s volunteer firefighters have at least been trained as first responders. But departments already struggle with tight budgets, so to add on the expense of paramedic certification is cruel and unusual punishment.
“It’s unfortunate because fire departments deployed to the area often are located closer to a victim compared to a private EMS service provider,” Austin said. “If someone has a heart attack, fire departments can get their quicker and stabilize the patient.”
First-responder training is a good place to start leaning toward a full EMS service, Austin said. Volunteer departments can start small and build up to providing services. But providing services also means building a salary funding model, such as a fee-for-service billing process. He said many volunteer departments already support a quasi-paid status, where EMTs and paramedics are hired and compensated when on duty.
“That becomes a combination fire department,” he said. “But there are successful models where departments are doing that because there is a demand for having the station fully staffed 24/7.”
Volunteer departments need to consider the minimum EMS-service fee to bill for services and recoup equipment and personnel costs, Austin said. Transport charges can range from $100 to $300, and fees are most often paid through insurance providers, such as Medicare and private insurances.
“The fee can get the department started on procuring the right equipment, training and salary budget to have people on duty all the time,” he said.
Austin said volunteers must involve community members and discuss what implementing a fire-based EMS service would entail: the costs and the benefits.
“There’s no doubt about it,” Austin said. “Good fire protection and good emergency services are a quality-of-life issue. If fire departments step up to provide medical services, it is going to improve the quality-of-life in that community.”
Read the May 2010 print edition to learn more about fire and EMS trends and how departments are attempting to pay for services.
