Transitioning from a Fire-based Service to an EMS-based One

In the weeks leading up to EMS World Expo—the world’s largest EMS-dedicated event—EMS World is spotlighting select pre-conference sessions to learn more from the featured speaker on what makes their presentation timely, informative, and worthwhile. In this installment, we speak with Todd Besancenez, assistant chief of EMS at Mehlville Fire Protection District, and Brian Hendricks, fire chief of Mehlville Fire Protection District, in St. Louis, Missouri, who will co-present “The Mindset Of Progress: How MFPD Has Made The Change From A Fire-Based EMS System To An EMS-Based Fire District” on Tuesday, Oct. 11, 2022, in Orlando. Learn more and register at www.EMSworldexpo.com

Making changes within a system interlaced with tradition and varying degrees of permanency from the past is a task that many established services will not undertake. But for Fire Chief Brian Hendricks and Assistant Chief of EMS Todd Besancenez of Mehlville Fire Protection District in St. Louis, the journey started with a desire to serve the community better, which began with listening and evaluating what the public was saying through glaring internal statistics.

Hendricks explains, “Over 95% of what we do is EMS related. We shifted our focus to that statistic. To deliver a better service to the taxpaying citizens, to increase better patient outcomes and patient satisfaction in what we do over 95% of the time. It’s the easiest and simplest way to explain what we did. It’s a mindset and a focus—that's what we decided to do and we’ve seen the benefits to our organizations and have been able to measure better outcomes.”

Roadmap to Success

Despite the bumps and lessons learned through the process of growth and change, both Hendricks and Besancenez can look back and see how much value this has brought to not only the service and its employees but also the community. This is the duo's first time hosting a workshop and they are excited to share, with transparency, their journey in converting from a fire-based EMS service to an EMS-based one.

“We are wanting to offer a roadmap to success for any agencies interested in switching what has historically been the fire department model. We’ve shown in our fire district that change can be done, that you can effect change, and it's not easy—it can be difficult,” says Hendricks. “What I’m hoping to provide is a roadmap of how agencies, if interested, could transition a fire-based EMS service to EMS-based fire service.”

This presentation includes how the Mehlville Fire District got to where they are, how they analyzed their data, pitched it to their board of directors for buy-in, and most importantly, how they worked to meet their community's needs.

“All of our successes and failures, how we’ve learned, adapted and overcome, and successfully been able to deliver a premier service in South St Louis county,” says Hendricks.

Ever-Evolving Conversion

They started their journey by looking at trends when the insurance industry began to change, resulting in the service seeing patients being discharged that would historically be in the hospital for a week or two longer. They began to see sick people being cared for by home health or at-home nursing.

“We made a choice to switch our focus based on that,” explains Hendricks. “We contracted with top-notch medical direction to expand the scope of practice to do more in the patient’s home.”

The conversion was expansive and ever-evolving because each time they discovered a solution to one problem, more questions arose.

“You have to do a lot of internal data analysis to see all the different areas of patient care where you can do better and perform at a higher level,” states Besancenez. “If a service isn’t willing to look at those types of things, you would be left wondering why you would want to do this. Until you look at every level of data, you won’t know that. While we are not pioneers, we are pushing against the grain—this is not the normal path but it's been beneficial. One of the things you have to do is analyze your own department's performance.”

One of the stages included Besancenez and Hendricks analyzing the data on first-pass intubation success. It's a high-risk, low frequency event. But when you take the fire medic that is running on a pumper Monday and Wednesday, and you throw them on an ambulance on Friday, are you putting that individual in a position to fail?

Besancenez explains, “Are we surprised that our first pass intubation numbers are low? We can train on a manikin all day long, but they aren’t doing it all that often in the field. When we shifted our focus to airway management, we made it so that our critical care paramedics are ultimately responsible for intubation. We credentialled them. We put them in a higher-stress environment to make those intubation attempts. It’s more focused care.”

“One of the most controversial things we've done is tiered our protocols and credential process,” says Besancenez. “People who were used to having ETT no longer do. We have seen positive results from all of our prehospital protocols that we changed.”

Hendricks sees both mindset and money as a challenge. “We do pay our critical care paramedics a premium and that is part of the model to make it work. The mindset in how you overcome that is there is a time for discussion, time for a decision, and time to move on. In the discussion phase, you listen to all parties involved, and you have to get to a point where you say you’re not wanting to set them up for failure. We are creating an environment that is better for everybody. We want to approach this from a team standpoint. Everyone has a role.”

Why Now?

“We know healthcare is going to get more complicated and expensive. We know we will see more sick people in a prehospital environment,” remarked Hendricks. “We see ourselves as a vital community resource to be there for everybody in their time of need and really focus on that EMS care aspect. We need to be equipped to handle these more serious calls in the home environment.”

The duo wants attendees to walk away knowing it’s possible to make the conversion and that they are ready and more than willing to offer a roadmap of how they did it.

“There are three different roads that lead to the same destination,” Besancenez says. “More than anything, I want attendees to know it's possible. It's a mindset, a big decision. If you are a combo department, where you have fire and EMS divisions, there is a lot that goes into bringing those together. It takes a long time to do it—but in the end, it's for services to decide if it's better for their community.”

St. Louis has impressive data compared to the national average—measurable data that proves how this change works and that the outcomes for the citizens and satisfaction are better.

“If you measure your data, you will find you could do better. At least have the desire to analyze your own department,” encourages Besancenez. “A lot of departments will see the very same data that we see. They just have to make a decision to see if it's worth the effort and reward. I really hope we can generate those conversations with people who are willing to look at their own districts.”

Leah Sobon is a freelance writer and paramedic at the Region of Peel, Ontario, Canada.