What's the level of commitment to ems in your department? Does your department fully embrace ems with a dedicated ems chief - maybe even an ems command structure - and cross-trained personnel who have dual roles? This is a good level of commitment to one of the fire service's critical missions, but is it truly the best measure of the integration of ems within the fire service?

No, it's not. While having a separate ems command appears to be placing proper focus on ems, it may actually place tension on the fire-ems bond. A fire department, even one with cross-trained/dual-role personnel, won't achieve full integration of ems until all personnel and their leaders maintain daily ems responsibilities that are equivalent to their other duties.

Having a dedicated leader to concentrate on some of the unique challenges of effectively delivering ems is great, but it's no better than having other experts focusing on a particular specialty, such as hazmat, training, or search and rescue.

It's true that evaluating the delivery of some advanced patient care requires some technical expertise, but too many departments use the perceived need for technical expertise as an excuse not to incorporate ems into the key responsibilities of all supervisors. Intensive ems calls require the same personnel management, resource allocation, communications and organizational expertise as all other department responses.

If you do have designated ems officers, how many are there? Compare that number to how many other supervisors are available and positioned to respond to calls without an ems focus. Are there more ems officers? After all, the majority of your department's calls likely involve ems. More service interactions are conducted with customers/taxpayers/voters/donors through ems than any other type of incident.

What message about ems does your department and its leaders convey through actions and not just words? Are all the "ems" issues delegated to the ems chief, or does the same leadership team that addresses all key operational areas tackle ems challenges? On a complicated single-patient incident or one involving multiple patients, does the responding battalion chief wait for the arrival of the ems chief before initiating the ems sector? Are your leaders reluctant or unprepared to command the ems sector?

A large number of departments have required their firefighters to be trained and prepared for a variety of incidents. This, of course, is the concept of cross-trained/dual-role personnel. But wouldn't it be better to consider the use of multi-capable/multi-role personnel? For a growing number of departments, the roles can't be separated easily, but their chiefs often don't recognize this. Fire service leaders need to have the same multiple capabilities and multiple roles as their personnel.

One way to determine how a leader values an issue is by looking at how many of the best and the brightest are chosen when a focused team is needed to work on a problem. Based on your actions, do your personnel know that tackling a complicated ems policy matter, like all tough problems, is an opportunity for advancement? When viewing customer service opportunities and quality improvement concerns, what's the ratio of those prepared to observe ems calls compared with other responses?

How aware are you of the ems issues facing the fire service today? How are you personally involved? The ems Section of the International Association of Fire Chiefs, with the support of the board of directors, has been on the forefront as a key representative of the fire service's role in ems. For over a year, the iafc has also had a full-time staff member dedicated to these topics.

Congressional legislation now under consideration could potentially reduce fire service overtime costs by hundreds of millions of dollars, while maintaining staffing and service delivery at current levels. The H.R. 1693 bill, supported by fire service labor and management, defines the tasks of today's firefighter in the existing Fair Labor Standards Act fire service exemption.

The definition covers all of the tasks of today's fire service, including ems. The measure defines "firefighter" as one who responds to any emergency where life, property or the environment is at risk. If the fire service asks the bravest men and women to meet all these challenges, its leadership needs to have the same vision and commitment.

Another topic at the forefront of ems discussion is the National Highway Traffic Safety Administration's "ems Agenda for the Future" and its companion implementation guide, which provide a vision that arguably rivals the perspective and impact of "America Burning."

The "ems Agenda for the Future," ems practice blueprint, continuing education guidelines, and the new curriculum for emt-Intermediates and emt-Paramedics stand to have a radical effect on the fire service. iafc representatives provided essential input and review at every stage of these documents, which will affect the recruitment and retention of personnel, as well as their compensation.

Did you make sure your views on the issues were known to the organization representing you by exercising your right as a member to provide input? Did you rely on others for your information, or have you made it a high personal priority to closely follow ems developments at the local, state and national levels?

Recent pronouncements from the Health Care Financing Administration's Office of the Inspector General have caused a detrimental shift for many who need to obtain ems supplies, affecting readiness and the pricing of services. The changes to some departments have meant millions of dollars in increased service delivery costs. Is this topic on your agenda, or has it been delegated away or dismissed as "another ems problem?"

You're a fire service leader. Along with leadership comes responsibility. With few exceptions, you can't ignore or give less dedication to what's often the largest source of calls. You simply can't, anymore than the fire service can choose when to respond.