Posted by: medicblog999 | August 12, 2009

Fire Based EMS. My thoughts…..

Lego ems

The picture will make sense by the end of the post….honest!

Ive been listening for quite some time, gathering information as best as I can, and participating in more than a couple of discussions about one topic in general. One which doesn’t affect me in my role over here (yet!), but one which seems to be a bit of a hot potato in the states.

That of Firefighter Paramedics…

If you have been reading my blog for more than a month you will know all about ‘The Project’. If not, then click here to read about what is going to be a great learning experience and hopefully a chance to share ideas and maybe even change some practices when I go over to work with The Happy Medic, and when he returns to the UK to work with me.

(just a quick side note, we are still awaiting final approval from my employers for this to go ahead, but with my Chief Executive and Director of Ops backing the exchange, I can only hope that it will get the green light soon)

I was reading Happy Medics blog the other day when I came across this post. HM is going to be losing the ambulance that he usually works on, so will loose the opportunity to complete a full patient episode from call to the ER. From now on he will remain an ALS paramedic, but will only respond as an initial response before a standard ambulance crew arrives and takes over care of the patient. If you read his blog, you will know how passionate he is at being a paramedic as well as a firefighter (which apparently isn’t that common amongst firefighters).

Which brings me to my point and question.

Should EMS and the Fire Service be joined? Should there be a joint qualification of a Fire Fighter and a Paramedic, or should the two professions remain separate?

I am straight away going to set my stall out and say that I am writing this now so that I can have my opinions down to reflect on after I have been out and worked with HM (whenever that may be). I have just finished listening to last weeks episode of the EMS Garage, where they have a brilliant discussion on the merits (or not) of having a fire based EMS system. I would advise everyone to go and have a listen, It really is a very interesting discussion.

So, what are my thoughts?

There has been a long standing discussion and some trials in the UK for Fire Services to ‘co-respond’ for the Ambulance service. In these instances, they would attend certain categories of medical or traumatic emergencies and act as ‘first responders’ to deliver immediate Basic Life Support and basic interventions until a Paramedic arrives on scene. Even though this has been tried, it has apparently failed due to the Fire Brigade unions fighting against the change in their practices.

Personally, I would love to have my colleagues in the Fire and Rescue Service help us out, as ultimately it is my patients that will benefit. The ambulance service is a very busy service. Certainly, on my station, all of the crews tend to be out for the majority of the shift, with many occasions out of our primary area. The residents of my community then have to rely on crews from farther afield to provide cover which of course brings about longer response times. Wouldn’t it be great if the two Fire appliances at my station were then available to plug the gap for cover for life threatening emergencies in my own area?

My stations Fire Fighters are very quiet. they tend to get a full nights sleep most nights and rarely go out during the day much. It appears that this would be the same in America if you took away the medical calls, with Fire Departments having a split of 80% medical calls compared with only 20% for Fire/rescue stuff. As Fire Prevention continues to improve, then the Fire Service in this country will continue to be relatively quiet and could be a great resource for assisting the very stretched UK ambulance service.

So, to clarify – Yes to Fire Brigade First Responders!

But, what about Fire Fighter Paramedics?

I have had a number of conversations with two close blogger friends from the states. One has very strong views about splitting the two and making them independent of the other, the other can see the benefit in being duel qualified, but maybe that is because he is one of the few(?) who work as hard to be an exceptional paramedic as well as an exceptional Fire Fighter.

I cannot see that ever happening over here, and I can honestly say that I don’t think that I would want to see that in the UK. It takes all my time and energy to ensure that my medical skills, background knowledge and current and future practical knowledge are up to date, without having to think of learning another completely different career. One which has its own problems and training needs to deal with.

The other questions is, do the two different careers attract the same type of people anyway?  If not, is it possible to have a good firefighter be a good paramedic and vice versa? Im sure it is in some cases, but is this the minority or the majority?

I am intrigued to see how it all works over in the States. I cant wait to get the go ahead and just get over there and see if my preconcieved ideas are right or completely wrong.

What do you think?

Should it be a Fire Service and an Ambulance Service or should it be the Fire&Ambulance Service?

Whoops, almost forgot….The picture…..

During my initial Advanced Technician training, one of my Instructors gave an analogy of what was happening to the UK paramedic back then. At the time, we were changing dramatically, new skills were coming on line every year, greater responsibility for referring onwards, respond not convey training, autonomous thrombolysis for MI etc etc etc. He said that we were becoming like lego paramedics, and every year we get more ‘bricks’ added on. One day the lego paramedic will fall over with the pressure and instability of all the bricks!

If thats the case with paramedics, how many more bricks would be added if you turned us all into firefighters as well???


  1. Hi

    I work for a mainly rural Ambulance service I the UK by the sunny sea. We currently have two rural retained fire rescue stations which deploy co-responders. It’s still relatively new but seems to work ok. They do the standard CFR course, plus their normal fire rescue trauma/bls. Only problem is their response times are generally poor- they run from the station with 2 or 3 on board which means a lengthy mobile time, and the fact we hve to allocate via fire control rather than directly. I think with a few changes it could work great, but I don’t think many fire fighters could/would want to be paramedics- different ball game!

  2. As a Firefighter/Paramedic for a department here in the states I have not had the opportunity to work for a separate service. For the most part it works, having said that a lot of people who I work with hate the medical side and vice-versa. I personally enjoy the fire side but it was being a paramedic as the reason for pursueing this career. In my opinion they should be separate as you are creating a “jack of all trades, master of nothing” scenario as the knowledge base for both sides is vast. Keep firefighters as first responders mainly for manpower issues and have them respond for certian calls. Codes, car wrecks and the like.

  3. I was reading the HM blog about this too and brought the topic up with a senior Paramedic that I’ve been training with. His opinion is that the Fire service unions are too strong and not interested in co-responding let alone providing Paramedic cover for the Ambulance service.

    My own opinion is that fire crews and ambulance crews are made up of almost opposite personality types. I’m not going to go into that here but that’s just what I think.

    I don’t think that the two roles can be combined successfully either. As you say, just minimalising the skill fade as a medic is difficult enough without worrying about a whole new set of skills. I do believe that we as the ambulance service can learn a thing or two about organisation and rank structure from the fire service though.

    The lego man is a superb analogy.

  4. Please, no merger. It’s great when the two services work closely together, but let’s not forget that they are TWO services. People join one or another for diferent reasons.

    Like Diesel says, there are two different personality types. Each demands their own respect, but they are specialists in their own jobs.

  5. Wow, Mark. No pressure on me huh?
    I’m formulating a post specific to responding to your comments and observations, give me 12 hours to formulate it. But the gist of it is that cross training only works from the ground up. You can not successfully move firefighters onto an ambulance or paramedics onto a fire engine unless they have always been that way. It sounds odd, but unless a person is BOTH personality types (it is possible) to survive the “macho” fire service and the more “science based” EMS (I’ll catch crap for that) the merger will never work. My service is a perfect example of this, but in an urban setting the resources can be split without a major impact on service. In rural and suburban areas cross training is almost a necessity both for patient care and cost savings.
    I’ll go into more detail soon. Can’t wait to get you over here, bunked up and doing both jobs!

  6. The Seattle Fire Department handles ALS transport for the city of Seattle. ALS for the South end of King County is provided by the public health department in cooperation with around 20 different fire departments that provide BLS first response. One nice thing about the fire departments that do provide ALS is that their paramedics have a minimum of three years as firefighter/EMT-Bs in the department regardless of previous training/experience. In those departments once a firefighter becomes a paramedic he or she can no longer be involved with firefighting. The county public health ALS provider does have an open hiring pool. However like the large departments in the North end of the county candidates must have a minimum of 3 years of 9-1-1 EMT-B experience in first response and/or transport.

    The Seattle Fire Department has a good record with medical calls. Unlike cities such as DC their response time to medical calls is faster than fire calls. Also firefighters are graded by paramedics on every trauma call.

    Overall I like the current system in my area and hopes it stays that way.

  7. I’m a firefighter/paramedic (AP in Blighty !) and I have to say I think I enjoy the best of both worlds.

    I ride a NON-transporting Squad and we are the “first due” for all EMS calls in our district. We get on scene before the ambulance (usually) and can begin ALS treatment prior to the ambulance arriving (not totally unlike a RR car). We will ride into the hospital with the ambulance if it’s a bad case….so I get to avoid transporting the BS runs and get to play on the traumas, cardiac arrests etc..

    We also respond on all fires in an expanded district, and if we have no patients on arrival
    we assist the first truck with search.

    I’d die of boredom if we only went on fire runs (and we get quite a bit of fire where I work) but I like the mix.

  8. My Aunt is a “volunteer firefighter/emt” in a VERY rural area. 45 minutes from town. That’s from the highway, not necessarily deep in the backwoods where some of these people live. During winter time they are the only response team.
    So I guess it would have to depend on location, timing, and all around need.

  9. There is a marked difference between the USA and UK – distance. There are very few places in mainland UK that are 45 minutes from the nearest ambulance.

    For the benefit of non-UK readers, in England (can’t speak for Scotland, Wales & NI) there is a target to hit all Category A calls within 8 minutes. This is not always possible due to distance, narrow roads, traffic or some combination thereof, but it’s still the target.

    I’m a Community First Responder, a volunteer, who can get O2 and a defib to people in my locality often quicker than the ambulance can. I don’t do trauma as I’m in my own car and don’t carry all the kit. My time on scene counts for the 8 minutes.

    I can very much see the point of combining sevices in rural USA. In a more densely populated area like the UK, each specialism can reach the scene reasonably promptly. Some fire services do co-respond, but not all.

    Just to frustrate things even further, the brass at our local ambulance service and our local fire & rescue service do not get on at all. Obviously things are different at the sharp end!

  10. I work in one of the “big city” EMS systems in the US that has not mergeged into a combined Fire-EMS service. I’m very happy with that for many of the same reasons you mention.

    Unlike the UK, the fire unions in the US want to take over EMS, but it has nothing to do with patient care.

    As our VP Joe Biden would say, it’s all about a three letter word J-O-B-S!

    If you look at the studies that show poor intubation skills and the biggest screw ups in EMS, they are in areas where the two services are combined.

    If the UK doesn’t merge the services, both the medics and patients will be better off.

    I’ll be adding you and Happy Medic to my blog roll. Feel free to come over and take a look. If you like what you see, please reciprocate.

  11. […] follow up to Fire Based EMS The post I published last week on Fire Based EMS  started a bit of a discussion between two  of my blogger […]

  12. I am a Fire Lieutenant in Seattle. As others have stated, ours is a Fire-based EMS system. BLS units (Aid Cars, Fire Engines, and lastly Ladder Trucks) respond to BLS calls alone, based upon county protocol and Criteria Based Dispatching interviews performed by the dispatchers. Medic Units (staffed by FF/Medics) only respond to ALS calls, in conjunction with the closest BLS unit.

    Seattle/King County continues to have the highest survival rate in the nation for in-the-field, witnessed cardiac arrests. Some of that credit goes to the Fire Fighter/EMTs and their rapid response to EMS incidents. Some of that credit goes to our high ‘citizen CPR’ percentage (the Medic II training program). More of the credit goes to the Medics who, via the Harborview Medical Center Paramedic Training Program, undergo 2000 hours of training. Let’s not forget the support of the community in general.

    We have fewer Medic Units per population than most of the other large U.S. cities. However, we have higher survival rates for cardiac arrest (I like to think that carries over into trauma outcomes as well). The Medics tend to go on a higher percentage of “serious” responses and on a lower number of BLS responses due to the Criteria Based Dispatching. They remain ‘In Service’, available to respond more of the time due to that.

    BLS response times average around four minutes, ALS (Medic Unit) response times average around 8 minutes. Our system works very well, but different communities & population densities might benefit from other deployment models.

  13. Paramedic/firefighters who take both aspects of their jobs seriously are fantastic. It’s those people that become medics so they can land firefighter jobs and who are secretly wishing they were ventilation a roof every time they are intubating, do a huge disservice to our profession. It’s all about attitude. Cops and firefighters are just different people, same thing with firefighters and paramedics. Some people do a very good job at both, and others are incapable of mixing the two.

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