Chief Concerns Richard Marinucci
Fire department involvement in emergency medical services (EMS) has overtaken all other responses, except in rare occasions, by a long shot.
EMS is the dominant service in the vast majority of organizations because of its sheer volume and reduced significant fire incidents. While the benefits to the service are great, there are many challenges to maintaining competencies in all aspects of the job along with other emerging issues sure to put more stress on administrators, managers, officers, and firefighters.
While there have always been challenges with fire departments providing EMS while maintaining the necessary functions for other aspects of the job, the problems are more acute. As such, departments and their leadership need to take steps to address emerging issues to ensure that EMS remains viable and not neglect other critical job components like fire response. Many of the issues can be traced to understaffing, increased run volumes, and additional regulations.
Obviously, you cannot deliver EMS without human resources. Organizations must look at all aspects of the job and the effect EMS has on their workforces. Some significant issues are hiring, retaining, training, and firefighters’ mental wellness. Though understaffed departments face greater challenges, those with higher authorized staffing numbers may have difficulty finding qualified personnel to fill the vacancies. This is a lament of many fire departments throughout the country. Solutions must be investigated.
Not too long ago, positions on fire departments were sought after to the point that hundreds or even thousands of applicants would be interested in even a few openings. Discussions with fire chiefs around the country are revealing that many times there are not even enough applications for the vacancies, let alone qualified candidates to fill the spots. In some areas, firefighters are leaving one department for another, chasing better pay, benefits, hours, or opportunities. Maybe the days of staying with one place for an entire career are over. If this trend continues, it will exacerbate problems.
Departments should assess the prerequisites they establish regarding new hires. To control costs, those that provide advanced life support (ALS) frequently require paramedic licensure along with firefighter training as a necessity to apply—paramedic training is costly and time consuming. But, the adverse effect is limiting applicants. With a smaller pool to select from, getting the most qualified for the long term may not always occur. Another point to consider is the premium put on paramedic licensure that lessens the value of firefighting potential somewhat. Not all paramedics make great firefighters and vice versa. Though response to fires may be declining, the importance of personnel to do the work cannot be neglected.
Some departments are “biting the bullet,” so to speak, and reducing the requirements for prelicensure in the EMS field to increase the number of applicants. They then mandate the training upon hire. There are pros and cons to this. The obvious additional cost could challenge many fire department budgets. The time to go to training may also keep new hires from being assigned to apparatus for months. But, expanding the selection pool may prove beneficial in the long run and could become the norm and the cost of doing business. Each department should analyze its practices and adjust if different means are necessary for the overall goals and objectives.
Once hired (and trained to the paramedic level), departments must maintain their staffing. As stated above, some firefighters are shopping for the best employment package and are not bound to any specific organization. Departments need to remain competitive in their areas. There will be some communities that have an advantage because of a sufficient tax base to support the cost. Others will continue to struggle. Some of the longer-term solutions are not necessarily palatable to individual departments. One option would be consolidating departments into single organizations on a county or district basis. This would merge pay and benefits and eliminate the desire to pursue better options. Additionally, larger organizations would better absorb the costs of training recruits. This option is off the table in too many areas for a variety of illogical reasons, mostly political. But, perhaps it is time to discuss this in more detail to help address many of the challenges facing organizations.
Firefighter “burnout” seems to be increasing. By this, I mean more firefighters are exhausted by the increase in responses to EMS calls. One hardly hears of firefighters getting “burned out” because they had too many fires. The sheer volume and types of medical responses are taking their toll. I was recently told of a firefighter who decided to retire even though he really didn’t want to and was too young. He liked the department and the people he worked with. But, he grew tired of going to the “mundane” EMS calls. It seems that those greatly outweighed the more “exciting” calls for fires and even serious EMS calls. Going to “regulars” and nonemergencies in numbers greater than tolerable led to at least one firefighter hanging it up. This is not to imply that those calling 911 don’t need to. Instead, it is meant to identify an issue that needs to be addressed.
Understaffing is a contributing factor. There is a limit to the number of calls individuals can reasonably handle in a given shift. When this occurs daily, you should recognize this and work toward improving the situation. Funding remains the driving force. Some communities don’t have the resources, and others that do are not willing to spend more for the fire department. The fire service, in general, needs to improve its ability to obtain resources for the desired services or reduce levels of protection. This is not easy to do, but if you don’t have enough players for the game, you cannot compete.
Another consideration is operating practices. Some departments have practices that assign personnel to EMS calls based strictly on seniority. Once promoted or enough new hires are made, individuals can opt out of initial EMS response. This places more burden on those going on every call. Rotating personnel can help alleviate this but not totally eliminate it. Taking a break from the daily routine can be something to look forward to and help keep individuals focused on the overall job.
Another emerging issue is acquiring ambulances. At this time, vehicle delivery times can exceed two years. This requires better planning and may also require deviances from normal purchasing practices. Departments with high run volumes can put tremendous mileage on the vehicles. This necessitates strong preventive maintenance programs to go along with a long-range replacement policy that may not be too long. If you have not investigated this issue recently, it would behoove you to do so. You don’t want to be left without critical apparatus.
There are many challenges for fire departments to continue providing quality EMS service to their communities including hiring, retaining, training requirements, protocols, and continual advances in the profession. This brief article cannot address all the issues. As a critical component of most departments, continual monitoring and ongoing improvement are essential. Resist the temptation to continue on the same path as always. Preparation starts long before the real emergency occurs.
RICHARD MARINUCCI is the executive director of the Fire Department Safety Officers Association (FDSOA) and chief (ret.) of the White Lake Township (MI) Fire Department. He retired as chief of the Farmington Hills (MI) Fire Department in 2008, a position he had held since 1984. He is a Fire Apparatus & Emergency Equipment and Fire Engineering Editorial Advisory Board member, a past president of the International Association of Fire Chiefs (IAFC), and past chairman of the Commission on Chief Fire Officer Designation. In 1999, he served as acting chief operating officer of the U.S. Fire Administration for seven months. He has a master’s degree and three bachelor’s degrees in fire science and administration and has taught extensively.
