On March 18, 2002, newly appointed Fire Chief Alex Cohilas issued a directive abolishing the Clayton County (Ga.) Fire Department's almost 20-year history of operating two separate chains of command for fire suppression and emergency medical services shift operations. The chief's intention was to “accomplish the department's goal of a unified chain of command” for all line operations.
The department had been an early adopter of the 1970s national trend of fire departments offering emergency medical services. Firefighters assigned to the EMS division were cross-trained as both paramedics and firefighters. Furthermore, they were eligible to take promotional examinations for both fire suppression and EMS positions. But after numerous administrative and operational issues over many years, the EMS division eventually became separate from the fire suppression division.
Support for the department's integration is offered by Gordon Sachs, who discusses the importance of changing the traditionally accepted but operationally vague and inadequate term of “fire department” in his Officer's Guide to Fire Service EMS:
“Departments that have embraced EMS … find that they are actually EMS providers that occasionally respond to fires. More and more are changing the way they describe themselves: ‘fire and EMS department,’ ‘EMS and fire department,’ ‘fire and paramedic services,’ or ‘emergency services.’ Such organizations are leaving tradition and turf protection behind, and are instead providing the protection of life and property as today's ‘fire’ department should.”
The decision to merge the chains of command needed to include an assessment of the views of EMS personnel. The ensuing challenges and solutions should be useful to other fire departments considering the integration of fire and EMS operations.
The primary method for assessing how the EMS personnel viewed the unified chain of command directive was a questionnaire that revealed the paramedics strongly supported the department's unification efforts. They found the previous divided operational model to be ineffective for accomplishing the department's EMS mission.
Additionally, in the eight months since implementing the policy, the unification was viewed by EMS personnel as being successful. There was consensus that promotional opportunities for EMS personnel had been improved in the unified fire/EMS department. From a community perspective, there was strong consensus by the paramedics that the department's ability to serve and protect the county's citizens in the unified department had been improved significantly.
The paramedics' questionnaire responses identified several areas of improvement needed during the integration process: Training for implementing the increased demands of unified EMS and fire suppression operations was rated as less than average. Additionally, despite the department's increased emphasis on improving internal communication, paramedics rated departmental communication regarding unifying EMS and fire suppression operations as being less than adequate.
Another area of concern noted by the paramedics' responses is that they generally view their supervising fire suppression lieutenants as lacking the expertise and interest to properly evaluate paramedics' performance and complete their annual evaluations. Paramedics rated fire suppression lieutenants' ability as supervisors of EMS personnel as approaching inadequate. However, Cohilas had implemented several programs to improve officers' leadership skills and EMS abilities before the questionnaire was distributed. These programs include an 80-hour officer candidate school, hiring additional EMS instructors and lobbying the county commission to approve EMS certification incentive pay. Consequently, many of the areas of improvement identified by the 54 paramedics are works in progress.
Officers not on board
The study found that EMS personnel view lieutenants, captains and battalion chiefs as possessing only marginal acceptance of the integration efforts. After reviewing the research results, Dr. Barry Barnes said, “It's apparent the middle of the lake is frozen.” Barnes, a professor of organizational behavior, explained upper management understands the critical need for integrating the divisions, and rank-and-file employees support the change based on their personal experiences and frustrations with two divisions, but middle managers are concerned they lack the skills for the new operational model.
As first-level supervisors, lieutenants possess enormous power to either support, passively resist or aggressively fight the department's unification efforts. EMS personnel perceive many lieutenants have a preference for remaining fire service officers but not fire/EMS leaders. As the chain-of-command integration progresses, it will become more challenging to change resistant fire officers' willingness to expand their EMS career skills and abilities.
The findings and comments offered by Sachs, an emergency services educator, writer, and consultant with over 20 years of fire service — based EMS experience is relevant to this study's findings:
“The biggest challenge that EMS in the fire service has faced is that of acceptance. Almost a moot point now, there was a time when many firefighters and chief officers wanted nothing to do with EMS, since it was unfamiliar territory and they joined the department to fight fires. Often their negativity arose out of a lack of understanding about EMS, insecurity about learning the necessary skills, and other such attitudes.”
Many of the department's officers need to acknowledge that greater support for the integration process would be viewed quite favorably by EMS personnel. While officers nearing retirement will most likely dismiss their subordinates' comments, officers with longer tenures or promotional desires must acknowledge the department's mission has changed course. In Management in the Fire Service, Harry Carter and Erwin Rausch advocate that “fire officers need to be aware of those areas that are relevant to their departments now and in the foreseeable future.” Clearly, the department's integrated operations should place EMS at the top of officers' career development efforts.
The demands of being a leader in an integrated fire/EMS department will be enormous. The image of firefighters lounging around fire stations waiting for the occasional fire alarm has vanished in most departments. The frequency and complexity of contemporary fire officers' professional development will be immense.
Carter and Rausch predict, “An important challenge for the [fire] officer in charge of a company with EMS responsibilities is to maintain full competence in both fire suppression and EMT (or possibly even the higher paramedic) knowledge and skills.” Consequently, the following recommendations were developed as an outcome of the primary author's EFO research paper:
- Revise fire lieutenant's job description
The unification directive demonstrates a commitment to changing the department's mission and vision. While it's one thing for the fire chief to draft a policy, subordinate officers ultimately bear the professional responsibility to implement the spirit and intent of the chief's directive.
Engaging a focus group of lieutenants to revise their job description to reflect an increased EMS role and presence is a critical step for addressing issues identified in this study. While the administration could take the responsibility to revise the job description, empowering lieutenants to undertake the task will increase their acceptance and compliance with the revised job description. It also helps because, as Sachs says, “The collective minds of a group of dedicated firefighters are much stronger than that of any one chief fire officer.”
The study results support this recommendation. EMS personnel found many fire suppression supervisors possess only minimal acceptance for the integration of EMS and fire operations. Revising job descriptions to emphasize fire lieutenants' expanded EMS role reinforces the department's commitment to the change process.
- Fire lieutenants should ride EMS units
It is recommended that annual performance evaluations have specific and measurable goals for riding EMS units. Even non-EMT lieutenants can ride in an observer role when staffing levels permit. The paramedics' comments indicated a strong advocacy that fire lieutenants must have dual roles in the integrated fire/EMS department and more involvement with routine EMS duties. Paramedics expect their fire lieutenants to possess more interest and expertise with EMS assignments.
The study results support this recommendation. EMS personnel found many fire lieutenants were inadequate in their ability to properly evaluate EMS personnel and complete their annual performance evaluations. More interactions between fire lieutenants and paramedics in EMS environments are worth undertaking.
- Fire lieutenants should become EMT/paramedic-certified
It is recommended that the department revise the lieutenant promotional criteria be amended to mandate EMT certification by 2006. Additionally, it is recommended the lieutenant promotion criteria mandate paramedic certification by 2010.
This will be a long-term, gradual process, and the department is making progress toward implementing this recommendation. The department's EMS academy was dormant for more than 10 years but has been resurrected recently with the following actions: EMT and paramedic courses are now being taught internally by newly hired instructors, and there is now enforcement of a departmental policy that firefighters must become EMT-certified within two years of employment.
The department is communicating to its employees that EMS is a critical component for delivering quality emergency services to the community. While in the past this mission was implied, it is now quite explicit. In Managing Fire Services, James O. Page cautioned that “where the department's administrators fail to communicate the importance of the EMS component, disregard and contempt are likely to filter down through the ranks. In such instances, the EMS personnel tend to feel rejected by their department and an imbalance of loyalties is a common result.” Nevertheless, we're pleased with the progress for enhancing the delivery of fire/EMS operations.
The study results support this recommendation. As previously stated, EMS personnel found many fire lieutenants to be inadequate in their ability to properly evaluate paramedics and complete their annual performance evaluations. More officers with EMT/paramedic certifications will strengthen the quality and quantity of delivering EMS in an integrated department.
- Adopt incentive pay for EMT and paramedic certifications and college degrees
The department owes a responsibility to provide its employees with incentives and resources for acquiring the necessary professional development. Offering incentive pay for EMT, paramedic and college degrees is one aspect of a comprehensive performance and reward package. The 21st century is going to place enormous challenges and opportunities for fire service officers. Creating incentives for increased professional and educational development is one of many strategies for developing professional officers.
The study results support this recommendation. The paramedics' Personal Demographic Questionnaire found that 52% have college credits or associate degrees. Consequently, it's likely that employees with some college experience would be receptive to returning to school if incentives were available. An educated work force is an important prerequisite for achieving the department's mission. The fire chief has made numerous efforts to promote portions of this recommendation to the county commission, but the current economic climate remains a serious impediment.
- Expand EMS captains' fire suppression duties
The present departmental shift staffing is as follows. Fire captains are the primary relief for the shift's two battalion chiefs, and EMS shift captains are the alternative relief. It is proposed that fire shift captains be the primary relief for Battalion 2, and EMS shift captains be the primary relief for Battalion 1. This demonstrates the equivalency of the department's two shift captain (EMS and fire) positions.
By unintentionally offering fire captains higher status for serving as the primary relief for both battalion chiefs, we reinforce the traditional labeling of personnel as “suppression” or “EMS.” At the same time the department is asking fire personnel to be better EMS providers, EMS personnel should be asked to be better firefighters. It's important to note that most EMS captains have served as fire suppression lieutenants assigned to engine and truck companies.
While positions above lieutenant were not the focus of the applied research project, inferences can be made from the paramedics' overall responses. The authors advocate that committing to increase the perceived fire suppression leadership practices of EMS shift supervisors strengthens the quality and quantity of delivering emergency services in the integrated department.
- Expand EMS training for fire captains/battalion chiefs
Concurrent with the department's commitment that EMS captains can be relief for fire battalion chiefs, efforts should be devoted to enhancing the EMS commitment, compassion and competencies of fire captains and fire battalion chiefs. One method is having them attend the National Fire Academy's Management of Emergency Medical Services' course. The NFA's course description establishes the relevance to the expanded EMS demands on fire captains and battalion chiefs:
“This course focuses on current and newly emerging management practices as they relate to Emergency Medical Services (EMS) in the fire service. This interactive and fast-moving course will enable participants to deal more effectively with day-to-day management issues that supervisory-level managers are likely to encounter. Personnel, resource management, and quality improvements are some of the major components of this course. Upon completion of this course, the students will be able to enhance the quality and overall effectiveness of their EMS operations through the use of management techniques.”
The study results support this recommendation. While positions above lieutenant were not the focus of the applied research project, inferences can be made from the respondents' overall responses. Committing to increase the perceived EMS leadership practices of fire captains and battalion chiefs strengthens the quality and quantity of delivering emergency services in an integrated fire department.
It is expected that more challenges and concerns will face the department as the integration process moves forward. Each shift that passes increases the familiarity of the integrated model into the department's culture. As older employees who prefer the old system eventually retire, and as newer employees are hired into the integrated system, the integrated model becomes the norm.
The fire chief and his senior staff are committed to soliciting employee feedback and suggestions regarding the pace and complexity of the integration changes. Being patient and understanding as employees resolve their own personal skill assessments in an integrated fire department, promoting the successful resolutions of emergency alarms by integrated responses, and providing fire/EMS role models are positive steps for long-term success. It's clearly a work in progress and will be for quite some time, but the outcome is a more capable fire department for protecting and serving the public safety needs of citizens.
Bill Lowe, EMT-P, is an EMS captain with the Clayton County (Ga.) Fire Department, where he has worked for 24 years. Lowe has a doctorate in human resource management and a post-doctorate in marketing management. He is a university professor of public administration and is pursuing the National Fire Academy's Executive Fire Officer program.
Alex Cohilas is the chief of the Clayton County (Ga.) Fire Department, where he has worked for 28 years. Cohilas has extensive experience with company- and battalion-level line operations, and he served as the president of the department's largest employee organization for more than 10 years. Additionally, he possesses extensive experience as an investigator with one of the Southeast's most prominent law firms, specializing in public administration law.