A Fire Department Ridealong

After my recent string of editorials in EMS Magazine regarding fire departments and combination fire/EMS systems, the outcry ranged from "Right on!" and "Amen!" to "Shut up!" and "You stupid &*%$#@!"

For readers who didn't see those columns, I'm not a hater of the fire service or someone who wants to bash fire departments; I just have strong opinions on the division of fire and EMS. The gist of the articles was that firefighters have a job to do, but that job shouldn't include EMS.

Among the many comments I received, I was sent a few invitations to ride with fire departments and see how things work, to see firsthand that firefighters aren't all bad. In the spirit of reconciliation, I worked a shift with the Greenville City Fire Department (GCFD) of Greenville, SC. The GCFD runs fire operations for the city and provides first-responder medical services, but does not transport patients. Countywide EMS response is provided by Greenville County EMS.

During my eight hours with the crew of Engine 2 at West End Station 2, I not only reaffirmed my belief that, on the whole, firefighters are a great bunch, but I also discovered they can teach EMS a few things that could help us become more professional and advance our own careers.

Once I explained the purpose of my ride-along to GCFD Assistant Chief Delma Lord, he set me up with the crew that ran the most medical calls. I wanted to run a few calls where the crew worked with EMS, to see how they interacted with the ambulance folks. I'd already run numerous shifts with the Greenville County EMS during a school internship a few years back and knew them to be an extremely professional group. On my rides with them, I never experienced any problem with a fire crew from the EMS point of view.

Arriving on Scene

Upon arriving at the fire station, firefighter George Jones gave me the grand tour of the trucks and the station. He showed me where all the medical equipment was stored on both the engine and the "quint" (five-function) unit.

After the tour, I began my interviews. I asked each of the crew about their experiences with EMS. I asked if they ever experienced any problems or arguments. Being a paramedic myself and understanding the medic frame of mind, I even asked the crew members if they'd ever experienced any personality problems with paramedics who believe they can walk on water. (Don't deny it, true believers. I know there's at least one medic like that in every agency.) The answer to all the above was "no."

The only hint of a problem between fire and EMS in Greenville occurred in the past. One of the older firefighters, nearing his 30th anniversary with the GCFD, said that at one time relations weren't the best, but that all the differences were ironed out by establishing joint training between the agencies. He told me that some of the past disagreements were from a time when EMS and fire didn't fully understand each other or where each job began and ended.

I had a great time with the crew. The fire-versus-EMS war that takes place in some areas is not happening in Greenville. Firefighters are mostly a great bunch of guys who do a difficult job for little pay. It seems to be a select few with large soapboxes who proclaim EMS to be of little use without the leadership of the fire departments.

On calls where the fire units interacted with EMS, the scenes ran smoothly. It was great to see two separate and distinct agencies work so well together. When one crew ran into an unfamiliar area, they asked the other for guidance. For instance, the fire crews understood that primary medical care was to be delivered by the EMS crew. They asked how they could help and then assisted with care or helped ferry patients and equipment. On the EMS side, the responders understood that fire was in control of rescue efforts, such as vehicle extrications, and of the scene as a whole. They didn't question the fire officers regarding traffic control or how to cut a car apart. Likewise, the fire crews didn't question whether the medics chose the correct IV catheter gauge or put the ET tube in right. I have seen both happen on scenes.

I did, however, learn something important. Although EMS needs to be a separate and distinct public safety agency, there are several lessons EMS personnel can take from the fire side:

1) Work ethic
For the most part, EMS crews are lazy. I have never been in a dirty fire station. On the other hand, I have been in many EMS stations where I wanted to suit up in full hazmat gear before entering. Not only are firefighters meticulous about cleaning, they don't waste as much downtime as EMS crews do. Much of their downtime is spent checking and double-checking the trucks and equipment or training.

2) Preplanning
Go into virtually any fire station and you'll find booklets full of plans, maps, drawings and notes on special situations that might occur in their coverage area. One of the calls I responded to with Engine 2 was to inspect a construction area where new water lines were being installed. Not only did the crew inspect maps to establish detour routes around the construction, but they were also careful to check all fire hydrants that might be affected by the work.

I have worked with EMS agencies that seemed to consider it a mortal sin to engage in what I call area familiarization. If a crew wanted to work on getting to know the area, it was with a paper map at the station. We usually discovered road construction and detours as we approached them at Code 3 speed with a patient in the back. Many EMS departments don't provide the sophisticated map books many FDs possess. If we want good maps, we have to buy them at the store.

3) Military atmosphere
Fire departments thrive in a paramilitary culture. Chain of command, rank, seniority and policies are clear. Many EMS agencies lack this. We often have field crews, headquarters staff and the chief. There is often no clear line of advancement: Either you work on a truck or you don't. Rank is often nonexistent as well, unless you include the three-level hierarchy of medic, supervisor and chief found in many places.

Conclusion

I'm glad I had the opportunity to work with Engine 2 and its crew. It was a rewarding experience. I not only learned a little more about firefighters, but deepened my respect for them as well. While I still believe EMS should be a separate entity, I discovered there's a lot we can learn from our brothers in emergency service.

I also think many fire and EMS agencies could take a cue from their counterparts in Greenville. It's a town where both agencies know their jobs and the jobs of the other. Its providers also realized a long time ago that since they work the same scenes together, they need to train together. It's a simple idea, but one that's seldom implemented.

David W. Powers, NREMT-P, BCETS, BCECR, is CEO of the Emergency Response Corps in Surfside Beach, SC. He is board-certified by the American Academy of Experts in Traumatic Stress as an Expert in Traumatic Stress and in Emergency Crisis Response. He can be reached at docbeaker@aol.com.